Child Maltreatment as a Risk Factor for Rejection Sensitivity: A Three-Level Meta-Analytic Review

Theoretical and empirical evidence has suggested that child maltreatment victimization is associated with rejection sensitivity. However, empirical evidence on this association is inconsistent. Therefore, this meta-analysis aimed to examine the overall association between child maltreatment and rejection sensitivity, and to investigate variables that may affect the strength of this association. Studies eligible for inclusion were searched in the databases: Web of Science, Science Direct, PubMed, MEDLINE, and China National Knowledge Infrastructure after which relevant studies were coded. Studies were synthesized in advanced three-level meta-analytic models in R. A total of 16 studies (N = 5,335 participants) yielding 41 effect sizes were included. Results showed that child maltreatment is significantly and positively related to rejection sensitivity (mean r = 0.230; p < .001), and to a small extent. Furthermore, this association is stronger for emotional abuse (r = 0.275) than for physical abuse (r = 0.157). It is not affected by the mean age and gender distribution of primary study samples nor by sample type (community sample versus clinical sample). It is concluded that child maltreatment is a risk factor for developing rejection sensitivity later in life. Therefore, interventions for rejection sensitivity should consider potential trauma resulting from prior child maltreatment experiences.

Changing the mindsets? Education and the intergenerational spread of tolerance for physical violence against women in Zimbabwe

We investigate the relationship between childhood exposure to interparental violence and adult tolerance for violent beliefs against women. For individuals who have witnessed parental violence in childhood, our analysis suggests a 14.3-15.2 percentage point (pp) increase in tolerance, highlighting the transmission of violent beliefs across generations. Leveraging Zimbabwe's 1980 education reform as a natural experiment through a regression discontinuity design, we explore the potential of increased education to disrupt this intergenerational transmission. The reform led to an approximately two-year increase in female education, with a more pronounced impact in rural areas. This educational boost is associated with an estimated 4.1-7.9 pp reduction in tolerance for violence, especially among those who witnessed parental violence in childhood. We identify four primary mechanisms contributing to this reduction in tolerance: enhanced access to information, increased help-seeking behaviours, improved labour market outcomes, and higher educational levels among partners. Our findings underscore the effectiveness of educational policies in reducing tolerance for violence against women within low-income contexts such as Zimbabwe, thereby disrupting its intergenerational transmission. Moreover, these results emphasise the potential of education-based interventions in addressing the broader issue of violence against women in low-income countries.

Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review

Health professionals play a significant role in identifying and reporting child physical abuse (CPA). However, several studies have pointed out non-reporting behavior among these professionals, evidencing difficulties identifying and reporting suspected cases. This review aimed to explore the frequency and possible barriers in identifying and reporting CPA by health professionals worldwide and to identify associated factors. This scoping review was conducted in the Pubmed, Web Of Science, Scopus, and SciELO databases between July 2019 and December 2020. Analytical and qualitative observational epidemiological studies were selected and published in English, Portuguese, and Spanish, with data on the identification and/or reporting of CPA by health professionals. Twenty studies fulfilled the criteria of this review. The studies were conducted with dentists, nurses, pediatricians, and general practitioners. The frequency of identification of CPA ranged from 50% to 89%, while the frequency of reporting ranged from 8% to 47%. This review revealed that health professionals had a low frequency of reporting of CPA, especially for dentists. In addition, several associated factors and barriers in the identification and reporting of CPA were identified in the studies. These were discussed in five main themes: training and continuing education in CPA, impact on professional practice, experiences and perceptions about child protection services, the threshold for suspicion of the professional, and the professional category.

Associations Between Verbal and Physical Abuse in the Home and Mental Health Indicators Among Heterosexual and Lesbian, Gay, Bisexual, and Questioning High School Students in the US-Adolescent Behaviors and Experiences Survey, 2021

PURPOSE

A number of factors may contribute to disparities in mental health and suicidality for lesbian, gay, bisexual, and questioning (LGBQ) students, including parental abuse.

METHODS

The Centers for Disease Control and Prevention's (CDC) Adolescent Behaviors and Experiences Survey included a nationally representative sample of US high school students during the COVID-19 pandemic. The current analyses examined experiences of verbal and physical abuse in the home with mental health and suicidality among LGBQ students compared to heterosexual students.

RESULTS

The relationship between abuse and mental health and suicidality was significant for all students; however, LGBQ students experienced substantially more abuse and had significantly poorer mental health and greater suicidality than heterosexual students.

DISCUSSION

Experiencing verbal or physical abuse in the home is strongly associated with poor mental health and suicidality among youth, regardless of sexual identity; however, among LGBQ students who experienced abuse, the prevalence of poor mental health and suicidality reached crisis levels.

Association between longitudinal patterns of child maltreatment experiences and adolescent substance use

BACKGROUND

Although there is a well-established link between child maltreatment and adolescent substance use, it remains unclear if and how longitudinal patterns of maltreatment experiences are associated with substance use in adolescence.

OBJECTIVE

The purpose of the study was to examine how distinct patterns of longitudinal maltreatment experiences are associated with adolescent substance use.

PARTICIPANTS AND SETTING

The participants were 899 adolescents from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN).

METHODS

We conducted repeated measures latent class analysis (RMLCA) to identify patterns of physical abuse, sexual abuse, and neglect from birth to age 17 and their relations to tobacco, alcohol, and marijuana use at age 18.

RESULTS

RMLCA identified three physical abuse classes (Stable low physical abuse; School age peak physical abuse; Physical abuse primarily in infancy/toddlerhood), two sexual abuse classes (Stable no/low sexual abuse; School age peak sexual abuse), and three neglect classes (High neglect in childhood; Neglect primarily in infancy/toddlerhood; Neglect primarily at school age). Adolescents in the school age peak physical abuse class showed greater alcohol, cigarette, and marijuana use, compared to other physical abuse classes. Similarly, adolescents in the school age peak sexual abuse class showed greater substance use than those in the stable no/low sexual abuse class. Lastly, adolescents in the neglect primarily in infancy/toddlerhood class showed significantly less substance use than those in the other two neglect classes.

CONCLUSIONS

Findings highlight the importance of early intervention and ongoing maltreatment prevention.

Verbal, physical and sexual dating violence among a population-based sample of teens: Does exposure to intimate partner violence in the home account for the association between dating violence and mental health?

BACKGROUND

Teen dating violence (TDV) and exposure to intimate partner violence (eIPV) are associated with poorer mental health; however, few studies investigate verbal TDV or the independent contributions that TDV and eIPV have on mental health.

OBJECTIVE

Examine the prevalence of TDV (verbal, physical, sexual, multiple forms) among youth, associations between TDV and mental health, and how eIPV affects these associations.

PARTICIPANTS AND SETTING

A school-based sample of 71,635 9th and 11th grade students (51.5% assigned female, 71.9% White) completed the anonymous 2019 Minnesota Student Survey, providing data on mental/emotional/behavioral (MEB) problems and treatment, depression and anxiety symptoms, non-suicidal self-injury, suicidal ideation/attempts, TDV, and eIPV.

METHODS

Chi-square tests were used to compare the prevalence of mental health concerns by TDV form; logistic regression models controlled for demographic characteristics and eIPV. Interaction tests identified the multiplicative effects of eIPV and TDV on mental health.

RESULTS

TDV was reported by 36.4% of those with vs 13.6% of those without eIPV. Each type of TDV was significantly associated with adverse mental health (p's<0.001), even after adjusting for demographic variables and eIPV. The prevalence of each mental health outcome was significantly increased by eIPV for youth with no TDV (p's<0.001), verbal only (p's<0.001), sexual only (p's<0.05), and multiple forms of TDV (p's<0.001); findings for physical TDV varied.

CONCLUSIONS

Education on healthy, consensual dating relationships is critical, alongside regular screening for eIPV and TDV, referring affected youth for treatment. Further research on factors that attenuate the association between TDV and mental health is warranted.

Does Child Maltreatment Reduce or Increase Empathy? A Systematic Review and Meta-analysis

Arguments about the associations between child maltreatment and empathy remain controversial. This systematic review and meta-analysis aim to estimate the direction and magnitude of the relationships between child abuse and neglect and empathy. Four English databases (Web of Science, PsycInfo, PubMed, and Cochrane Library), three Chinese databases (China National Knowledge Infrastructure, Wanfang, and Weipu), and grey literature were systematically searched. We extracted data related to the associations between child maltreatment and empathy and pooled them using random effects models. A total of 24 eligible studies involving 22,580 participants and 176 estimates were included in the analyses. Overall, child maltreatment was significantly related to reduced empathy (r _  = -0.15, 95% CI [-0.17, -0.13]). Specifically, the rank-order mean effect size of subtypes of maltreatment on empathy is: emotional neglect (r _  = -0.18, 95% CI [-0.25, -0.12]) > physical neglect (r _  = -0.16, 95% CI [-0.23, -0.09]) > emotional abuse (r _  = -0.15, 95% CI [-0.21, -0.10]) > physical abuse (r _  = -0.12, 95% CI [-0.17, -0.07]) > sexual abuse (r _  = -0.07, 95% CI [-0.14, -0.01]). Furthermore, the meta-regression results suggested that the aggregated associations between child maltreatment and empathy were not inflated by publication bias, but they were moderated by the age of respondents, sample size, publication language, empathy measurement, and maltreatment type. The results indicate that general maltreatment and its subtypes are associated with reduced empathy. Parent training and empathy enhancement programs should be designed to help children with a history of childhood maltreatment, respectively, from an early stage.

Multi-level analysis of the determinants of physical domestic violence against children using longitudinal data from MINIMat mother-child cohort in Bangladesh

Objectives

Despite high levels of physical violence against children (VAC) globally (40-50%), the literature on the determinants of VAC remains inconclusive. Most of the literature on this topic is based on cross-sectional data, and the multi-level nature of the drivers of VAC is widely ignored. This leads to model specification problems and an inability to draw causal inferences. Moreover, despite the higher prevalence of VAC in low-and middle-income countries, studies from high income countries dominate the field. We examined the determinants of physical domestic VAC to address these gaps in the literature.

Methods

Data were collected between 2001 and 2020 from 762 mother-child dyads recruited in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study in Bangladesh. We conducted multi-level logistic regression analyses to identify the determinants of physical domestic VAC.

Results

Prevalence of physical domestic violence against girls (69%) and boys (62%) was extremely high. Community-level prevalence of physical domestic VAC increased the likelihood of physical domestic VAC at the individual level across gender (girls - OR-5.66; 95% CI- 3.11-10.32; boys - OR-7.67; CI- 3.95-14.91). While physical domestic violence against mothers was not associated with physical domestic violence against girls, it reduced the likelihood of such violence against boys by 47%. Having 3 or more siblings predicted physical domestic violence against girls (OR-1.97; 95% CI- 1.01-3.81 for 3 siblings; OR-4.58; 95% CI- 2.12-9.90 for 4 or more siblings), but not against boys. While girls in Hindu families were more likely to experience this violence, the boys were not. Mother's education, employment non-governmental organization (NGO) participation and, household wealth did not predict this violence against any gender.

Conclusion

We contend that physical domestic violence against mothers reflects an emphasized patriarchal culture in a family where a boy is less likely to experience physical domestic violence. Social norms and social learning theories explain the greater likelihood of a child experiencing physical domestic violence in a village with a higher level of such violence. We conclude that social norms around physical domestic VAC and patriarchal culture need to be changed to effectively address this violence.

Child Maltreatment Types by Age: Implications for Prevention

Child maltreatment is a global public health issue known to affect an average of 600,000 U.S. children of all ages (0-18 years old) annually. However, a preponderance of preventive programs target children on the younger end of the spectrum, specifically those aged 0-5. Annual reports of the prevalence of maltreatment provide opportunities to analyze trends, but in 2009, these reports stopped reporting the ages of victims for each type of maltreatment (i.e., neglect, physical abuse, emotional abuse, and sexual abuse). This omission limits the ability to match (or design) prevention programs responsive to the ages of those at greatest risk. Using data from the National Child Abuse and Neglect Data System (NCANDS) from 2011-2020, this secondary data analysis describes trends for four types of maltreatment by age from an epidemiological perspective. Implications for practice (i.e., prevention) and policy are presented. The findings of this study offer the first step in what is hoped to be a line of research that seeks to identify, match, and/or develop evidence-based programs to prevent child maltreatment among the populations at highest risk.

Defensive medicine practices as a result of malpractice claims and workplace physical violence: a cross-sectional study from Egypt

Defensive medicine refers to practices motivated mainly by legal rather than medical purposes. Increased healthcare costs, overutilization of medical services, and potential harm to patients from unnecessary procedures are among its drawbacks. We performed this study to assess the prevalence of defensive medicine practices in Egypt and their associations with experiencing malpractice claims and workplace physical violence. We investigated 1797 physicians (68.1% male), with an average age of 36.8 ± 9.1 years, practicing in Egypt between January 14th and February 23rd, 2023. SPSS was used for statistical analysis. The majority reported engaging in defensive medicine practices. Specifically, 89.6% acknowledged avoiding high-risk procedures, 87.8% refrained from treating high-risk patients, 86.8% admitted to making unnecessary referrals, 84.9% acknowledged ordering unnecessary tests, 61.4% reported performing unnecessary procedures, and 56.4% disclosed prescribing unnecessary medications. Obstetricians and surgeons exhibited the highest rates of defensive medicine. Using linear regression analysis adjusted for age and sex, malpractice claims and workplace physical violence were associated with defensive medicine score (zero-100): βs (95% CIs) = 5.05 (3.10, 6.99) and 5.60 (3.50, 7.71), respectively, (p values < 0.001). In conclusion, defensive medicine is deeply ingrained in the clinical routines of Egyptian physicians. Establishing a comprehensive national medical liability framework is required.

The neighborhood deprivation gradient and child physical abuse and neglect: A Bayesian spatial model

BACKGROUND

Child abuse and neglect is a public health priority due to its long-term maladaptive consequences. No study in the USA has assessed the nature and magnitude of the social deprivation effect on substantiated child maltreatment risk.

OBJECTIVES

To examine linear and non-linear relationships between area level deprivation and the log-risk of both substantiated physical abuse and neglect while accounting for spatial and heterogeneous random effects.

METHODS

Substantiated child maltreatment and population data (2008-2015) were aggregated to neighborhoods in Bernalillo County, New Mexico. The contribution of area level deprivation to the geographical variation in the log-risks of substantiated child physical abuse and neglect was modeled using Bayesian spatial regression.

RESULTS

Forty-three percent and 46.4 % of the 153 neighborhoods recorded greater risk for either substantiated physical abuse or neglect compared to the county average. The most deprived 20 % of neighborhoods had 71 % and 72 % more cases of substantiated physical abuse and neglect, respectively, than would be expected if the substantiations were randomly distributed throughout the county. Area level deprivation explained 47 % of the variation in substantiated physical abuse and 51 % of the variation in substantiated neglect after controlling for both spatial autocorrelation and heterogeneity.

CONCLUSIONS

Implications from this study can be used to quantify disparities in substantiated child maltreatment attributed to regional differences in social deprivation and to identify priority areas for intervention.

Hospitalization for physical child abuse: Associated medical factors and medical history since birth

BACKGROUND

Physical abuse often begins at a very young age and sometimes results in serious or fatal injuries. It is crucial to diagnose physical abuse as early as possible to protect this vulnerable population.

OBJECTIVE

To study the factors associated with the first hospitalization for physical abuse from birth to the infant's first birthday in France.

PARTICIPANTS AND SETTING

We included all singleton children born in a hospital setting in France between 2009 and 2013, who were identified from the French national information system database (SNDS).

METHODS

To study factors associated with the first hospitalization for physical abuse during the first year after birth, we used the Fine and Gray regression model. Factors included in the multivariate model were the infant's sex, prematurity, neonatal conditions, the number of hospitalizations (at least two), medical consultations and complementary universal health insurance (proxy for family precariousness and socio-economic vulnerability).

RESULTS

Over the 2009-2013 period, among 3,432,921 newborn singletons, 903 (0.026 %) were hospitalized for physical abuse in the year following birth. Among the factors associated with physical abuse, such as prematurity (aHR = 2.2[1.8-2.7]), male sex (aHR = 1.3[1.2-1.5]), or having had at least two hospitalizations (aHR = 1.7[1.4-2.1]), we found that complementary universal health insurance coverage was the factor most associated (aHR = 4.1[3.5-4.7]) with being hospitalized for physical abuse.

CONCLUSION

These findings could help introduce preventative measures for infant protection in certain groups, such as parents of infants born prematurely, especially if they are in a precarious situation. This study also suggests that particular attention should be paid to infants who have been hospitalized at least two times in the first year of life, whatever the reason.

Profiles of adverse childhood experiences (ACEs) and psychosocial adjustment in South Korea: Comparison between probation and non-probation youth

BACKGROUND

Adverse Childhood Experiences (ACEs) are risk factors affecting adolescent psychosocial adjustment. Youth involved in the juvenile justice system are more likely to have ACEs, but few studies have investigated this topic outside the western context.

OBJECTIVE

This study aims to (1) compare latent profiles of ACEs among probation and non-probation youth in South Korea and (2) examine which profiles pose the greatest risk of maladaptive psychosocial adjustment (offline risk-taking, online risk-taking, school adjustment, and happiness).

PARTICIPANTS AND SETTING

South Korean data adopting survey questions from the Fourth International Self-Report Delinquency Study was analyzed. Adolescents with complete information on regression covariates were included (non-probation: 1846/probation: 368).

METHODS

Latent profile analysis was utilized to identify distinctive patterns of ACEs. Multiple linear regression and logistic regression were performed to predict the maladjustment experiences of each latent subgroup.

RESULTS

Four ACE profiles emerged for probation and non-probation samples. Three profiles were common (i.e., emotional/physical abuse, emotional neglect, high maltreatment/domestic violence) and one profile was unique (high maltreatment with family dysfunction for the probation sample; moderate maltreatment for the non-probation sample). In the probation sample, compared to the emotional neglect group, the other three profiles showed poorer adjustment in at least one domain. In the non-probation sample, profiles with high emotional/physical abuse and high maltreatment/family dysfunction had poorer outcomes than the emotional neglect group.

CONCLUSIONS

These findings indicate the need for a comprehensive approach toward adolescents and their family environments for preventing delinquency and promoting positive youth adjustment.

Overlooked impact of less severe physical violence on antenatal care visits: Findings from South Asia

Background

In South Asia, women often experience intimate partner violence (IPV) and have limited access to maternal health services (MHS). However, the effects of IPV on antenatal care (ANC) visits remain unclear. This study aimed to examine the impact of IPV of different forms and severities on ANC visits in South Asia.

Methods

This cross-sectional study used the latest available data from demographic and health surveys conducted in Bangladesh, India, Afghanistan, Nepal, Maldives, and Pakistan. The study sampled 4467 women who had given birth within the past 12 months and were interviewed for IPV. IPV was measured by binary variables indicating the presence of physical violence (PV), categorised into less severe (LSPV) and severe physical violence (SPV), emotional violence (EV), and sexual violence (SV). ANC utilization was measured using binary variables indicating whether respondents had any, at least four, or at least eight ANC visits, as recommended by World Health Organization (WHO). Logistic regressions adjusted for survey weights were used to assess associations between ANC utilization and exposure to IPV during pregnancy and lifetime.

Results

The prevalence of LSPV, SPV, EV, and SV during pregnancy were 14.5%, 4.4%, 11.6%, and 4.1%. LSPV experience during pregnancy was associated with decreased likelihoods of at least four ANC visits (odds ratio (OR) = 0.55; 95% confidence interval (CI) = 0.40-0.76) and eight ANC visits (OR = 0.53; 95% CI = 0.31-0.90). Results of lifetime exposure to IPV followed similar patterns. Lifetime exposure to LSPV was associated with decreased likelihoods of at least four ANC visits (OR = 0.55; 95% CI = 0.41-0.74) and eight ANC visits (OR = 0.47; 95% CI = 0.29-0.77).

Conclusion

This study highlights the negativities of LSPV on the frequency of women seeking ANC visits. Policies are necessary to identify women at risk of the often-overlooked LSPV early and provide protective interventions to promote maternal health in South Asia.

Caregivers' Perceptions of Child Trauma Symptomatology, Stress, and Child Abuse Disclosures

Caregivers consider child abuse disclosures stressful life events, but research has not investigated whether this stress affects caregiver ratings of child trauma symptomatology. Secondary data from a Child Advocacy Center in the Midwestern United States between the period of January 1, 2018, and April 31, 2019, stepwise logistic regression models, and change in estimate calculations were used to assess (1) the relationship between child abuse disclosure(s) and caregiver stress and (2) the association between caregiver stress disclosure and clinically significant ratings on the Trauma Symptom Checklist for Young Children (TSCYC). While a child's physical abuse disclosure was associated with caregiver stress and caregiver stress was significantly associated with clinically significant ratings for child depression and anger/aggression TSCYC scales, abuse disclosure did not affect the relationship between caregiver stress and TSCYC scale ratings. Moving forward, caregiver-reported stress should be considered when utilizing caregiver-completed child trauma symptom screens.

"Many bad things had been happening to me": Children's perceptions and experiences of polyvictimization in the context of child physical abuse

BACKGROUND

The association between child maltreatment and polyvictimization has received growing attention since being identified by Finkelhor and colleagues in 2005.

OBJECTIVE

The current study was designed to explore the experiences and perceptions of children who reported polyvictimization during forensic interviews.

METHODS

This mixed-methods study sample comprised 117 children aged 5-14, referred for the first time to forensic interviews following suspected physical abuse by a parent. More than one-third of the children reported polyvictimization. A thematic analysis was carried out to spotlight these children's experiences.

RESULTS

The analysis identified three main themes: the way children comprehend the polyvictimization, the consequences of the polyvictimization regarding the children's negative self-attribution, and the way the polyvictimization was constructed through the dynamic with the forensic interviewers.

CONCLUSIONS

The findings pointed to the importance of the forensic interview platform in assessing children's maltreatment burden. The current study also provided a glance into the possible involvement of the mechanics of self-blame among maltreated children. These findings have the potential to enhance our understanding of the excessive psychological toll taken on polyvictimized children.

Longitudinal trajectories of sleep quality in correlation with maltreatment in early childhood: A cohort of Chinese early adolescents

BACKGROUND

Child maltreatment may lead to sleep disturbance during the critical period of child development. Our study examined the effect of maltreatment in early childhood on trajectories of sleep quality among early adolescents.

METHODS

The study included 1611 participants (mean ± standard deviation age at baseline: 12.5 ± 0.5 years) from a middle school in southeastern China. Of these participants, 60.5 % were males. Information on early childhood maltreatment during pre-seventh grade was obtained through a self-report questionnaire at baseline, and sleep quality was collected at baseline and during follow-up. We used a group-based trajectory model to characterize trajectories of sleep quality.

RESULTS

The study identified four trajectories of sleep quality, namely the low sleep score group (25.0 %), the moderate-low sleep score group (51.0 %), the moderate-increasing sleep score (17.0 %), and the high-decreasing sleep score (7.0 %) group. After adjusting for covariates, the findings revealed that emotional abuse and physical abuse were associated with an increased risk of developing new-onset sleep disturbances in early adolescents. Particularly, emotional abuse (incidence rate ratio = 1.71, 95 % confidence interval: 1.08-2.71) significantly increased the risk of belonging to the high-decreasing sleep score group. Moreover, there existed a dose-response relationship between early childhood maltreatment and sleep quality trajectories, with a higher number of maltreatment types in early childhood correlating with a greater risk of belonging to the high-decreasing sleep score group.

CONCLUSIONS

The findings of our study provide compelling evidence indicating that specific types and cumulative maltreatment during early childhood contribute to sleep disturbances among early adolescents. The study findings highlight the significance of preventing and reducing early childhood maltreatment to enhance sleep quality during early adolescence.

Examining Cases of Child Physical Abuse Evaluations to Identify Opportunities to Improve Intimate Partner Violence Screening in Pediatric Emergency Departments

The association between child maltreatment and intimate partner violence (IPV) is well supported. Universal IPV screening has been recommended by the American Academy of Pediatrics and the United States Preventative Task Force, and many children's hospitals have established screening protocols. However, the yield and best screening method in families undergoing a child physical abuse (PA) evaluation have not been fully explored. To determine if there is a discrepancy in IPV disclosures between universal IPV screening completed during pediatric emergency department (PED) triage ("triage screening") and IPV screening by a social worker ("social work screening") in families of children who were evaluated for PA. Caregivers of children who presented to an urban tertiary PED and underwent an evaluation for PA via a child abuse pediatrics consult. A retrospective chart review was completed. Data collection included: caregiver responses to both triage screening and social work screening, interview setting details and participants, the child's injuries, and details of the family's reported IPV experiences. Our study (N = 329) revealed that social work screening produced significantly more positive IPV disclosures than triage screening (14.0% vs. 4.3%, p < .001). Additionally, non-IPV violence concerns were identified in 35.7% (n = 5) of the positive triage screens, whereas social work screens had none. These results highlight the benefits of IPV screening by social work in high-risk scenarios, such as child PA evaluations, regardless of universal IPV screening results. Exploring differences between the two screening methods can inform decisions about screening protocols to improve IPV identification in high-risk populations.

Systematic review and meta-analysis of verbal and physical violence against healthcare workers in the Eastern Mediterranean Region

Background

Workplace violence is a serious threat to healthcare workers worldwide.

Aim

We aimed to determine the prevalence of physical and verbal violence against healthcare workers in the WHO Eastern Mediterranean Region and Türkiye.

Methods

We searched the Medline (via PubMed), Cochrane Library, Scopus, Science Direct, Web of Science and ProQuest databases along with reference lists from selected articles. Studies of health workers exposed to verbal and/or physical violence by patients or their relatives conducted in the WHO Eastern Mediterranean Region and Türkiye among staff working in hospitals and primary health care services were included. Seventy-five of the 3513 articles identified of studies conducted during 1999-2021 were eligible. The data were analysed using MetaXL version 5.3 and STATA version 16.

Results

This study covered 69 024 healthcare workers from 22 countries. Meta-analysis showed that 63.0% (95% CI: 46.7- 79.2) of them had experienced verbal violence and 17.0% (95.0% CI: 14.0-21.0) experienced physical violence. There was no significant difference for sample size, professional group, quality score, or response rate. The frequency of physical and verbal violence in the subgroup analysis was statistically significantly different for countries and years.

Conclusion

Findings from this study provide useful information for policymaking regarding interventions to prevent or minimize violence against healthcare workers in the Eastern Mediterranean Region and Türkiye.

Physical abuse re-reporting during the COVID-19 pandemic: The kids are not okay

BACKGROUND

Child physical abuse (PA) is a significant societal concern with limited research into predictors of re-reports.

OBJECTIVE

Our research explores correlations between sociodemographic variables and re-reported PA. Our aim was to characterize populations at higher risk and identify changes in presentation during the COVID-19 pandemic.

PARTICIPANTS AND SETTING

This retrospective descriptive study focused on 238 patients with re-reports of PA made by a pediatric hospital from January 2019 through April 2021.

METHODS

We analyzed sociodemographic information and details of reports made to child protective services (CPS) obtained from the electronic health record.

RESULTS

Females were 2.5 years older than males (mean 11.0 and 8.5 years, respectively) (p < .001, 95%CI 1.21-3.76). Males were more likely to have observable injuries (OR 2.61, p < .001) and a CPS response (OR = 2.70, p = .003). Patients categorized as "Other" races were less likely to have observable injuries (OR = 0.32, p = .006). Presentation changed during the pandemic: a quadrupling of re-reports by behavioral health clinicians caused the percentage of reports made by them to increase significantly (OR = 3.46, p < .001) and the mean age increased by 2.0 years (8.2 years before, 10.2 years during) (p = .009, 95%CI 0.5-3.5), though females remained approximately 2.2 years older than males (p = .003, 95%CI 0.8-3.7).

CONCLUSIONS

Males experienced higher rates of re-reported PA and were younger at the time of re-report. Changes to presentation during the pandemic suggest an increase in PA among older children. Future research should further explore differences in sex/race, while current prevention efforts should focus on children receiving behavioral health care.

Prevalence of and factors associated with peer emotional and physical violence among youth ages 13-17 in Cote d'Ivoire

BACKGROUND

Peer violence during childhood is associated with negative outcomes. Data are limited on its associated factors in sub-Saharan Africa.

OBJECTIVE

This study assesses the prevalence and factors associated with peer emotional and physical violence among children and adolescents aged 13-17years in Côte d'Ivoire.

PARTICIPANTS AND SETTING

Data from the 2018 Côte d'Ivoire Violence Against Children and Youth Survey (VACS) were used to examine peer emotional and physical violence victimization. VACS is a national cross-sectional household survey of females and males aged 13-24years.

METHODS

Data included physical, emotional, and sexual violence and socioeconomic, demographic, and relationship factors. We computed the adjusted odds ratios (AOR) and confidence interval (CI) for associated factors adjusted for food insecurity and rural or urban setting.

RESULTS

Thirty-one percent of females and 46.7 % of males experienced lifetime peer physical violence and 36.8 % of females and 40.2 % of males experienced peer emotional violence in the past 12 months. Witnessing violence in the home towards the mother (female AOR 1.2, CI 1.0-1.3); male AOR 1.4, CI 1.2-1.6) and witnessing violence in the home towards a sibling (female AOR 1.2, CI 1.1-1.3; male AOR 1.3, CI 1.12-1.4) increased the odds of ever experiencing peer physical violence. In males, not living with their biological mother (AOR 1.2, CI 1.0, 1.4) or biological father (AOR 1.2, CI 1.1-1.3) was associated with ever experiencing peer physical violence.

CONCLUSION

Interventions for children and adolescents living without parents and programming focused on education and skills-building may help to reduce peer violence against children in Côte d'Ivoire.

Comparison of the quality of clinical forensic examination of victims of physical violence conducted by clinicians and forensic examiners

INTRODUCTION

The Istanbul Convention calls for comprehensive care for victims of violence while maintaining forensic standards. After violent crimes, court usable documentation of injuries and securing of evidence is essential to avoid disadvantages for those affected in criminal prosecution.

MATERIAL AND METHODS

This retrospective study compares forensic relevant aspects in clinical forensic examination of victims of physical and sexual violence conducted by clinicians and forensic examiners. Forensic medical reports based on clinical documentation of individuals of all ages in the period from 2015 to 2018 (n = 132) were evaluated in comparison to a control group of examinations conducted by forensic specialists. A comparative statistical evaluation was performed.

RESULTS

The study revealed statistically significant differences in forensically relevant aspects. In the clinical examinations, full-body examination was performed in only 37.9%, and concealed body sites were examined in 9.8%. Photo documentation was often incomplete (62.4%), without scale (59.1%), blurred (39.7%), or poorly exposed (31.2%). Information on size, color, shape, and texture of injuries was often missing. In about every third examination, the findings were not described purely objective. A body scheme was used only in 8.3% of the clinical cases.

DISCUSSION

In order to establish nationwide care structures and the forensic standard required in criminal proceedings, intensive involvement of forensic medicine is essential. Standardized examination materials, regular training of medical staff, and telemedical approaches can improve the care for victims of violence regarding criminal prosecution.

Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study

BACKGROUND

The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors.

METHODS

The study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994-2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035).

RESULTS

During the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM.

CONCLUSION

The findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.

A comparative study of machine learning algorithms for predicting domestic violence vulnerability in Liberian women

Domestic violence against women is a prevalent in Liberia, with nearly half of women reporting physical violence. However, research on the biosocial factors contributing to this issue remains limited. This study aims to predict women's vulnerability to domestic violence using a machine learning approach, leveraging data from the Liberian Demographic and Health Survey (LDHS) conducted in 2019-2020. We employed seven machine learning algorithms to achieve this goal, including ANN, KNN, RF, DT, XGBoost, LightGBM, and CatBoost. Our analysis revealed that the LightGBM and RF models achieved the highest accuracy in predicting women's vulnerability to domestic violence in Liberia, with 81% and 82% accuracy rates, respectively. One of the key features identified across multiple algorithms was the number of people who had experienced emotional violence. These findings offer important insights into the underlying characteristics and risk factors associated with domestic violence against women in Liberia. By utilizing machine learning techniques, we can better predict and understand this complex issue, ultimately contributing to the development of more effective prevention and intervention strategies.

Adverse childhood experiences and all-cause mortality risk in adulthood

BACKGROUND

Adverse Childhood Experiences (ACEs) have been associated with mortality risk in adulthood. It is unclear, however, whether ACEs perpetrated beyond parents may be associated with mortality risk, if the risk is accumulative or plateaus at a certain frequency, whether associations differ dependent on ACE types, whether types interact with one another, or if observed effects differ by sex.

OBJECTIVE

To examine associations between ACEs and mortality risk.

PARTICIPANTS AND SETTING

6319 participants (age range 25-74 years, mean [SD] 46.91 [12.95] years; 51.6 % female) followed from 1995/96 to 2018 as part of the survey of Midlife Development in the United States.

METHODS

ACE variables were self-reported exposure to 20 ACE types from five categories: physical abuse, emotional abuse, socioeconomic disadvantage, adverse family structure, and poor health at age 16 years. Cox proportional hazards models were used to estimate mortality risk.

RESULTS

ACEs were accumulatively associated with increased mortality risk in adjusted models (HR = 1.033; p ≤ .001, 95 % CI, 1.014-1.053). The association was linear. Only physical abuse (HR = 1.05; p = .024, 95 % CI, 1.01-1.10) remained significantly predictive of increased mortality risk adjusting for other types. No interaction by sex or amongst ACE types was observed.

CONCLUSIONS

ACEs may be cumulatively associated with increased mortality risk, such that each individual ACE increases risk. Physical abuse may be an important ACE type within a mortality risk context. Individual ACE types warrant further study as each type may have their own differential impact on mortality risk.