中国儿童虐待流行病学研究的文献系统评价研究

目的 初步掌握中国0~17岁儿童虐待问题的流行现状,为制定和实施预防儿童虐待策略提供建议。方法 通过对近20年(1992-2012年)的国内外文献进行检索,获取较全面的、有代表性的中国儿童虐待流行病学研究资料,参考证据质量分级和推荐强度系统(GRADE)方法编制了文献质量评价体系,对文献质量和内容进行系统分析。结果 筛选出84篇文献综合分析中国儿童虐待的流行现状的文献,其中仅研究躯体虐待的文献有11篇,仅研究情感虐待的有3篇,仅研究性虐待的15篇,仅研究忽视的12篇,其余均为多种虐待同时研究。1)躯体虐待:城市地区儿童遭受躯体虐待的发生率为41.2%~67.3%,农村地区为32.4%~39.4%。不同研究对躯体虐待的测量方法不一致。2)情感虐待:目前尚没有统一的情感虐待测量方法,不同研究显示的儿童情感虐待发生率存在较大差异,发生率在10.6%~67.1%之间。3)性虐待:现有研究比较多的是调查16岁前发生的性虐待,多采用成年人回顾的方式进行调查。男性遭受性虐待的发生率为10.2%~23.0%,女性遭受性虐待的发生率为14.2%~25.5%。4)忽视:国内研究者从1999年开始进行忽视评价工具和标准的研究,形成了适用于城乡人群、针对不同年龄阶段儿童的中国忽视评价量表。城市3~17岁儿童的被忽视发生率为22.4%~32.8%,农村0~6岁儿童的被忽视发生率为53.7%~54.9%,暂无农村6岁以上儿童被忽视发生率的数据。结论 中国儿童虐待问题不容忽视,需要在儿童虐待定义、调查工具编制、全国流行现状等方面开展深入研究。     

Associations between childhood maltreatment and sex work in a cohort of drug-using youth

Although research has examined the impacts of childhood maltreatment among various marginalized populations, few studies have explored the relationship between child abuse and subsequent involvement in sex work among drug-using street-involved youth. In the present study, the relationships between the level of childhood maltreatment and involvement in sex work were examined using the Childhood Trauma Questionnaire (CTQ) as part of an extensive interview protocol in an ongoing prospective cohort study of street-involved youth in Vancouver, Canada. Between September 2005 and June 2006, 361 youth were recruited using extensive outreach methods and snowball sampling. The prevalence rates for abuse in the sample were 73% for physical abuse; 32.4% for sexual abuse; 86.8% for emotional abuse; 84.5% for physical neglect; and 93% for emotional neglect. Univariate and logistic regression analyses demonstrated that not only was sexual abuse independently associated with sex work, but emotional abuse was as well. These findings have implications for early intervention efforts aimed at vulnerable, high-risk youth populations as well as intervention strategies for active sex trade workers.     

The Relationship Between Child Abuse and Handicapping Conditions

ABSTRACT: This article discusses the relationship of child abuse, including neglect and sexual abuse, to the presence of handicapping conditions, both physical and psychological. Child abuse can cause physical and psychological disabilities in children who otherwise would have been normal. Studies show that children who are handicapped, or otherwise perceived as different by potentially abusive parents, are at high risk for abuse. Evidence also indicates that the handicaps of some children who were diagnosed originally as disabled are exacerbated by abuse. While cause and effect are not easily determined in specific cases, researchers agree that a pervasive relationship exists between handicapping conditions and abuse. Abused children are overrepresented in special education classes and handicapped children are overrepresented in the abused population. Many abused children become abusers as adults. Several suggestions concerning the problem are offered for school personnel.     

Exploring assumptions about child neglect in relation to the broader field of child maltreatment

Research on child neglect is reviewed as it relates to common assumptions in the field, the broader context of research on child maltreatment and trends within the larger society. Overall, while child Research on child neglect is reviewed as it relates to common assumptions in the field, the broader context of research on child maltreatment and trends within the larger society. Overall, while child neglect is the type of maltreatment most frequently reported to and acted on by official agencies, its proportion of all maltreatment in the general population is comparatively smaller. The issue.of "neglect of neglect" is placed within the larger framework of the low priority of research on child maltreatment in general. While research shows that all forms of child maltreatment are associated with devastating consequences for children, child physical neglect has the most profound effects on cognitive functioning and academic achievement, while child physical abuse has the most serious effects on aggression and subsequent violent behavior. Child emotional neglect, sexual and physical abuse have similarly grave effects on psychopathology, in contrast to child physical neglect which is associated with the least adverse consequences. These findings are discussed within the framework of research on the neurodevelopmental effects of child abuse and neglect. Research on the causes of child neglect, in particular as they relate to the perpetrators, points to a distressing "cycle of neglect." Finally, suggestions for breaking this cycle and keeping our children safe are discussed.     

Childhood abuse and neglect and the risk of STDs in early adulthood

CONTEXT: Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear. METHODS: Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self‐reported recent and test‐identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators. RESULTS: Among females, even after adjustment for socioeconomic and demographic characteristics, self‐report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test‐identified STD remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test‐identified STD (1.6). CONCLUSIONS: Young women who experienced physical neglect as children are at increased risk of test‐identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self‐reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations.     

Caractéristiques associées à la dépression et aux symptômes de stress post-traumatique chez les femmes victimes d’agression sexuelle durant l’enfance

BackgroundA significant proportion of childhood sexual abuse victims suffer from psychological sequelae in adulthood. Factors that provide a better understanding for the reasons why some victims develop these sequelae remain under-explored. In this context, the main objective is to examine the specific contribution of the contextual characteristics of childhood sexual abuse, multitype childhood maltreatment and adolescent suicide attempts on the development of depression and post-traumatic stress disorder in adulthood among sexually abused women as children. A secondary objective aimed to establish the prevalence of various forms of childhood maltreatment, adult onset post-traumatic stress disorder and depression among those women.MethodsThe sample included 479 women victims of childhood sexual abuse who participated in two separate surveys taken by women in the province of Quebec.ResultsMore than half of these women reported at least one other form of childhood maltreatment, 30% of them presented post-traumatic disorder and 40% suffered from depression in adulthood. Regression analysis indicates that post-traumatic stress disorder was associated with early onset childhood sexual abuse and intergenerational continuity of sexual victimization, as well as childhood physical maltreatment and negligence. Depression was associated with childhood psychological maltreatment and negligence, a non-supportive response following child sexual abuse related disclosure and suicide attempt in adolescence.ConclusionThese results confirm the need to consider the cumulative effects of various childhood adversity factors in the psychosocial assessment of sexually abused women in early life, thus helping to better understand and treat their psychological sequelae.     

A cross-national exploration of societal-level factors associated with child physical abuse and neglect

Children around the world experience violence at the hands of their caregivers at alarming rates. A recent review estimates that a minimum of 50% of children in Asia, Africa, and North America experienced severe physical violence by caregivers in the past year, with large variations between countries. Identifying modifiable country-level factors driving these geographic variations has great potential for achieving population-level reductions in rates of child maltreatment. This study builds on previous research by focusing on caregiver-reported physical abuse and neglect victimisation, examining 22 societal factors representing 11 different constructs among 42 countries from 5 continents at different stages of development. Our findings suggest that gender inequity may be important for both child physical abuse and neglect. Indicators of literacy and development may also be important for child neglect. Given the limitations of the correlational findings and measurement issues, it is critical to continue to investigate societal-level factors of child maltreatment so that interventions and prevention efforts can incorporate strategies that have the greatest potential for population-level impact.     

An exploration of child maltreatment among homeless families: implications for family policy

This research explores the incidence of child maltreatment among homeless families. The maltreatment explored in the study includes physical, emotional and sexual abuse. The data reported a high incidence of child maltreatment in the lives of the homeless. The policy implications for these findings are discussed.     

The burden of child maltreatment in China: a systematic review

Objective

To estimate the health and economic burdens of child maltreatment in China.

Methods

We did a systematic review for studies on child maltreatment in China using PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure databases. We did meta-analyses of studies that met inclusion criteria to estimate the prevalence of child neglect and child physical, emotional and sexual abuse. We used data from the 2010 global burden of disease estimates to calculate disability-adjusted life-years (DALYs) lost as a result of child maltreatment.

Findings

From 68 studies we estimated that 26.6% of children under 18 years of age have suffered physical abuse, 19.6% emotional abuse, 8.7% sexual abuse and 26.0% neglect. We estimate that emotional abuse in childhood accounts for 26.3% of the DALYs lost because of mental disorders and 18.0% of those lost because of self-harm. Physical abuse in childhood accounts for 12.2% of DALYs lost because of depression, 17.0% of those lost to anxiety, 20.7% of those lost to problem drinking, 18.8% of those lost to illicit drug use and 18.3% of those lost to self-harm. The consequences of physical abuse of children costs China an estimated 0.84% of its gross domestic product – i.e. 50 billion United States dollars – in 2010. The corresponding losses attributable to emotional and sexual abuse in childhood were 0.47% and 0.39% of the gross domestic product, respectively.

Conclusion

In China, child maltreatment is common and associated with large economic losses because many maltreated children suffer substantial psychological distress and might adopt behaviours that increase their risk of chronic disease.     

Risk of Fatal Injury in Young Children Following Abuse Allegations: Evidence From a Prospective,Population-Based Study

Objectives. We examined variations in children’s risk of an unintentional or intentional fatal injury following an allegation of physical abuse, neglect, or other maltreatment.Methods. We linked records of 514 232 children born in California from 1999 to 2006 and referred to child protective services for maltreatment to vital birth and death data. We used multivariable Cox regression models to estimate variations in risk of fatal injury before age 5 years and modeled maltreatment allegations as time-varying covariates.Results. Children with a previous allegation of physical abuse sustained fatal injuries at 1.7 times the rate of children referred for neglect. Stratification by manner of injury showed that children with an allegation of physical abuse died from intentional injuries at a rate 5 times as high as that for children with an allegation of neglect, yet faced a significantly lower risk of unintentional fatal injury.Conclusions. These data suggest conceptual differences between physical abuse and neglect. Findings indicate that interventions consistent with the form of alleged maltreatment may be appropriate, and heightened monitoring of young children referred for physical abuse may advance child protection.In the United States in 2011, 6.2 million children were referred to child protective services (CPS) for abuse or neglect.1 When the demographic profile of referred children is compared with that of the general population, it becomes clear these children face multiple individual,2–4 family,5–7 and community8,9 risk factors. Among children referred to CPS, however, the accurate identification of those for whom the threat is most immediate and consequential has proven difficult.10 High rates of maltreatment rereferrals among children with initially unfounded allegations,11–13 and child maltreatment deaths despite CPS involvement,1 point to the challenge of accurately assessing children’s current and future risk of abuse and neglect.One possible indicator of the nature and severity of the physical threat faced by a child is the type of alleged maltreatment. Nationally, more than three quarters of children are referred to CPS for neglect (78.5%); far fewer are referred as possible victims of physical abuse (17.6%).1 Despite high rates of concurrence between maltreatment types,14–17 it is notable that physical abuse is alleged for only a minority of children. Because of the ambiguity surrounding what constitutes child neglect (broadly defined as acts of parental omission that endanger children),17 an allegation of physical abuse for a child younger than 5 years may be a more reliable marker of safety concerns that necessitate CPS intervention. In other words, although many children referred for neglect may also experience varying degrees of physical abuse, if the physical abuse is so severe or chronic that it is explicitly alleged, this may be an important signal of risk.Public health researchers use variations in rates of death as population-based indicators reflective of broader group disparities in health, safety, and well-being.18,19 Similarly, variable rates of fatalities among children previously referred for maltreatment may provide a means of differentiating among high-risk subsets of children. Although death is a relatively rare event, group differences in fatality rates suggest variable exposures to antecedent risk factors. Previous research indicates that children with a history of CPS referrals have an increased risk of death by injury and other causes.20–24 We examined whether children previously referred for physical abuse had an increased risk of both unintentional and intentional fatal injury compared with children referred for neglect and children referred for other forms of maltreatment.     

Multiple types of child maltreatment and adolescent mental health in Viet Nam

Objective

To examine the prevalence of multiple types of maltreatment (MTM), potentially confounding factors and associations with depression, anxiety and self-esteem among adolescents in Viet Nam.

Methods

In 2006 we conducted a cross-sectional survey of 2591 students (aged 12–18 years; 52.1% female) from randomly-selected classes in eight secondary schools in urban (Hanoi) and rural (Hai Duong) areas of northern Viet Nam (response rate, 94.7%). Sequential multiple regression analyses were performed to estimate the relative influence of individual, family and social characteristics and of eight types of maltreatment, including physical, emotional and sexual abuse and physical or emotional neglect, on adolescent mental health.

Findings

Females reported more neglect and emotional abuse, whereas males reported more physical abuse, but no statistically significant difference was found between genders in the prevalence of sexual abuse. Adolescents were classified as having nil (32.6%), one (25.9%), two (20.7%), three (14.5%) or all four (6.3%) maltreatment types. Linear bivariate associations between MTM and depression, anxiety and low self-esteem were observed. After controlling for demographic and family factors, MTM showed significant independent effects. The proportions of the variance explained by the models ranged from 21% to 28%.

Conclusion

The combined influence of adverse individual and family background factors and of child maltreatment upon mental health in adolescents in Viet Nam is consistent with research in non-Asian countries. Emotional abuse was strongly associated with each health indicator. In Asian communities where child abuse is often construed as severe physical violence, it is important to emphasize the equally pernicious effects of emotional maltreatment.     

Treatment of Sexually Abused Children Who Are Deaf

This article will address the vulnerability of children who are deaf to sexual abuse and treatment techniques specifically for this population. The experience of the author was at a large city outpatient program in a department of psychiatry. This clinic served families where someone in the family was deaf or hard of hearing. The pioneering efforts in the 1980s were some of the first treatment for this population and this is the basis for this article.     

High school incompletion and childhood maltreatment among street‐involved young people in Vancouver,Canada

While the link between educational attainment and future health and wellness is well understood, little investigation has considered the potential impacts of distinct forms of childhood maltreatment on high school completion. In the present study, the relationship between five categories of childhood maltreatment (physical, emotional, and sexual abuse, and physical and emotional neglect) and completion of high school education were examined using the Childhood Trauma Questionnaire (CTQ). From September 2005 to May 2013, data were collected for the At‐Risk Youth Study (ARYS), a cohort of street‐involved young people who use illicit drugs in Vancouver, Canada. We used logistic regression to examine the relationship between childhood maltreatment and high school completion, while controlling for a range of potential confounding variables. Specifically, five separate models for each category of maltreatment and two combined models were employed to examine the relative associations between, and cumulative impact of, different forms of childhood maltreatment and educational attainment. Among 974 young people, 737 (76%) reported not completing high school. In separate multivariable analyses physical abuse, emotional abuse, physical neglect, and emotional neglect remained positively and independently associated with an incomplete high school education. In a combined multivariable model with all forms of childhood maltreatment considered together, emotional abuse (adjusted odds ratio = 2.08; 95% confidence interval: 1.51–2.86) was the only form of maltreatment that remained significantly associated with an incomplete high school education. The cumulative impact assessment indicated a moderate dose‐dependent trend where the greater the number of different forms of childhood maltreatment the greater the risk of not completing a high school education. These findings point to the need for trauma‐informed interventions to improve educational attainment among vulnerable young people, as well as evidence‐based prevention programmes, such as the Nurse–Family Partnership, aimed at supporting at‐risk families before maltreatment occurs.     

Sensory processing in children with a history of maltreatment: an occupational therapy perspective

ABSTRACT

Children with a history of maltreatment exhibit differences in a variety of domains, including sensory processing. However, little is known about how domain-specific sensory processing deficits differ by the type of maltreatment experienced. The focus of the current study was to investigate the relationship between abuse, neglect, or no maltreatment on seven sensory domains in a sample of adopted children. Caregivers of 408 adopted children (M= 7.89, SD= 2.03) reported their child’s history of maltreatment (abuse, neglect, or no maltreatment) and sensory processing abilities (Short Sensory Profile). Seventy-nine percent of the sample had sensory processing dysfunction (definite difference = 41%; probable difference = 38%). Children with a history of abuse (n = 147) had impairments in tactile sensitivity (84.4%) and taste/smell sensitivity (47.6%). Children with a history of neglect (n = 125) scored differently in underresponsive/seeks sensation (Neglect = 83.2%; Abuse = 57.8%). Both groups had significant differences in underresponsive/seeks sensation and auditory filtering. In summary, children with a history of adversity had domain-specific sensory processing differences that varied by the type of maltreatment experienced. These findings suggest that children may benefit from evaluation by an occupational therapist taking their specific history of maltreatment into account. Implications for allied health and mental health providers are discussed.     

The impact of childhood abuse history, domestic violence and mental health symptoms on parenting behaviour among mothers in Japan

Background To assess the impact of childhood abuse history, domestic violence experiences and mental health symptoms on the parenting behaviour of mothers in Japan who have separated from violent husbands or partners. Methods A self‐administered questionnaire survey was conducted on a sample of mothers (n= 304) and their children (n= 498) residing in 83 mother–child homes in Japan. The survey assessed the mothers' childhood abuse history (physical, psychological and sexual abuse and neglect history), domestic violence experiences, current mental health symptoms (dissociative, depressive and traumatic symptoms) and parenting behaviours after moving into the homes to separate from a violent husband or partner. Results The mothers' childhood abuse history and experience of domestic violence were not associated with their not playing with their children. In contrast, the mothers' dissociative and depressive symptoms were significantly associated with not playing with their children. Although there was no association between the mothers' total childhood abuse history and not praising their children, their childhood physical abuse history was significantly associated with their not praising their children. The dissociative and depressive symptoms were also associated with no praise. Interestingly, the experience of domestic violence showed an inverse association with no praise. Conclusions Mental health symptoms, more specifically dissociative and depressive symptoms, are associated with a decrease in parenting quality. Mothers who were physically abused as children are less likely to praise their own children, independent of maternal mental health symptoms. In contrast, mothers who experienced domestic violence but subsequently separated from their violent husbands or partners are more likely to praise their children. The treatment of mental health symptoms, particularly dissociative and depressive symptoms, therapy for childhood abuse history and separation from violent husbands or partners might be effective ways to enhance the quality of parenting in Japan.     

Preventing Child Maltreatment: Multiple Windows of Opportunity in the Health Care System

In this article I describe representative programs that have been developed to prevent the physical and sexual abuse and neglect of children. Prevention efforts germane to the prenatal, perinatal, and postnatal periods, as well as to preschoolers, school-age children, and adolescents are reviewed. Health care providers' contact with individuals across the life span provides unique opportunities to reduce the risk of child maltreatment. Their role in such efforts are explored and suggestions are offered to clarify how health care professionals may assume a broader role in preventing child maltreatment.     

儿童期受虐待经历与大学生自杀意念的关联

目的研究儿童期受虐待经历与大学生自杀意念之间的关联,为保障大学生的身心健康提供依据。方法2018年5-7月,运用多阶段随机整群抽样的方法,选取山西省6所大学的大学生(儿童期虐待有效调查人数3 854名,自杀意念有效调查3 882名),进行儿童期虐待问卷中文版和自杀意念自评量表调查。结果儿童期至少有过1种虐待经历的占42.4%,近1周内有过自杀意念的占3.9%。经χ~2检验,儿童期遭受过躯体虐待、情感虐待、性虐待、躯体忽视、情感忽视大学生自杀意念检出率均高于未遭受相应虐待大学生(χ2值分别为13.78,12.97,17.10,56.56,66.58,P值均<0.01);Spearman相关性分析结果显示,儿童期各型受虐待经历均和大学生自杀意念存在正相关(r值分别为0.06,0.06,0.07,0.12,0.13,P值均<0.01);多因素Logistic回归模型发现,在控制其他影响因素后,儿童期遭受躯体忽视以及情感忽视与大学生自杀意念发生呈正相关(OR值分别为2.18,2.07,P值均<0.05)。结论儿童期遭受躯体忽视和情感忽视可增加大学生自杀意念的风险。在儿童少年早期给予足够的关注和爱护可能有助于防止成年期自杀意念的产生。     

Psychological abuse between parents: associations with child maltreatment from a population‐based sample

Psychological abuse between parents: associations with child maltreatment from a population‐based sample
Chang, J. J. , Theodore, A. D. , Martin, S. L. & Runyan, D. K. ( 2008 ) Child Abuse & Neglect , 32 , 819 – 829 . Objective This study examined the association between partner psychological abuse and child maltreatment perpetration. Methods This cross‐sectional study examined a population‐based sample of mothers with children aged 0–17 years in North and South Carolina (n = 1149). Mothers were asked about the occurrence of potentially neglectful or abusive behaviours towards their children by either themselves or their husband/partner in the past year. Partner psychological abuse was categorized as no psychological abuse (reference), husband perpetrates, wife perpetrates or both perpetrates. Outcome measures for psychological and physical abuse of the child had four categories: no abuse (reference), mother perpetrates, father/father‐figure perpetrates or both parents perpetrates, whereas child neglect was binary. Adjusted relative risk ratios (aRRRs), adjusted odds ratios and 95% confidence intervals (CIs) were estimated with regression models. A relative risk ratio was the ratio of odds ratios derived from multinomial logistic regression. Results Children were at the greatest risk of maltreatment when parents psychologically abused each other versus no abuse: the aRRR for child psychological abuse by the mother only was 16.13 (95% CI 5.11, 50.92) compared with no abuse, controlling for child age, gender, Medicaid welfare and mother's level of education. Both parents psychologically abuse each other versus no abuse also results in an aRRR of 14.57 (95% CI 3.85, 55.16) for child physical abuse by both parents compared with no abuse. When only the husband perpetrates towards the wife, the odds of child neglect was 5.29 times as much as families with no psychological abuse (95% CI 1.36, 20.62). Conclusions Partner psychological abuse was strongly related to child maltreatment. Children experienced a substantially increased risk of maltreatment when partner psychological abuse was present in the homes. Practice implications This study observed that intimate partner psychological abuse significantly increased risk of child maltreatment. Increased public awareness of partner psychological abuse is warranted. Primary prevention should include education about the seriousness of partner psychological abuse in families. Domestic violence and child welfare agencies must recognize the link between partner psychological abuse and child maltreatment and work together to develop effective screening for each of these problems.     

Prevalence of childhood sexual abuse among Mexican adolescents

Background   To determine the characteristics and prevalence of previous child sexual abuse among a group of Mexican junior high school students.
Methods   A total of 1067 adolescents of both genders were selected to fill out a survey about child sexual abuse.
Results   The prevalence of child sexual abuse was 18.7% ( n  = 200). It was more frequent in girls (58%) than in boys (42%). Sexual abuse involved physical contact in 75% of those cases reporting abuse. The aggressors were neighbours (50.3%), relatives (36.8%) and strangers (13.9%). Abuse was committed through deception in 90% of the cases and involved physical mistreatment in 10% of the cases. Of the victims, 14.4% had spoken about the problem and 3.7% had taken legal action. And 9.6% of those surveyed stated that they required psychological counselling.
Conclusions   In the population studied, the prevalency of child sexual abuse was greater than that reported in Mexico City (4.3–8.4%), although it was similar to that found in the Spanish child population (15–23%). The risk of sexual abuse is greater for girls and the principal aggressors are male neighbours, family friends and relatives; the abuse is committed in the home of the aggressor or the victim and very few cases are reported to the authorities.     

Does Type of Harm Matter? A Factorial Survey Examining the Influence of Child Neglect on Child Protection Decision-making

Child maltreatment remains a serious social problem, with neglect arguably the most pernicious manifestation. Neglect is characterised by a chronic failure to provide for a child's basic needs and often co-exists with other forms of maltreatment. It usually occurs in a complex social environment where socio-economic disadvantage is rife and the family experiences numerous concurrent risk factors. The consequences of child neglect are pervasive and profound. However, there is little research on child protection decision-making as it relates to child neglect. The aim of this study was to explore social workers’ decision-making and intervention levels according to type of maltreatment with a particular focus on neglect. The study involved secondary analysis of factorial survey data. Fictitious vignettes (n = 327) with randomly assigned variables were rated by social workers. Multiple regression was used to examine the effect that the type of harm had on decision-making about risk, service provision, home visits and family contact. Social workers responded differently when the harm was child neglect. The respondents attributed a lower level of risk, a less intense service provision and fewer contact hours compared with when the harm was physical abuse or sexual abuse. In conclusion, neglect is the most common form of substantiated maltreatment. Child protection workers responding to vignettes respond to the maltreatment of neglect less intensively despite the preponderance of knowledge about the harmful effects of child neglect. This research indicates that further examination of decision-making in cases of child neglect is warranted.