Black and Latinx Primary Caregiver Considerations for Developing and Implementing a Machine Learning-Based Model for Detecting Child Abuse and Neglect With Implications for Racial Bias Reduction: Qualitative Interview Study With Primary Caregivers

BACKGROUND

Child abuse and neglect, once viewed as a social problem, is now an epidemic. Moreover, health providers agree that existing stereotypes may link racial and social class issues to child abuse. The broad adoption of electronic health records (EHRs) in clinical settings offers a new avenue for addressing this epidemic. To reduce racial bias and improve the development, implementation, and outcomes of machine learning (ML)-based models that use EHR data, it is crucial to involve marginalized members of the community in the process.

OBJECTIVE

This study elicited Black and Latinx primary caregivers' viewpoints regarding child abuse and neglect while living in underserved communities to highlight considerations for designing an ML-based model for detecting child abuse and neglect in emergency departments (EDs) with implications for racial bias reduction and future interventions.

METHODS

We conducted a qualitative study using in-depth interviews with 20 Black and Latinx primary caregivers whose children were cared for at a single pediatric tertiary-care ED to gain insights about child abuse and neglect and their experiences with health providers.

RESULTS

Three central themes were developed in the coding process: (1) primary caregivers' perspectives on the definition of child abuse and neglect, (2) primary caregivers' experiences with health providers and medical documentation, and (3) primary caregivers' perceptions of child protective services.

CONCLUSIONS

Our findings highlight essential considerations from primary caregivers for developing an ML-based model for detecting child abuse and neglect in ED settings. This includes how to define child abuse and neglect from a primary caregiver lens. Miscommunication between patients and health providers can potentially lead to a misdiagnosis, and therefore, have a negative impact on medical documentation. Additionally, the outcome and application of the ML-based models for detecting abuse and neglect may cause additional harm than expected to the community. Further research is needed to validate these findings and integrate them into creating an ML-based model.

How do childhood abuse and neglect affect prosocial behavior? The mediating roles of different empathic components

Background

Childhood abuse and neglect are typically considered as two different forms of maltreatment. Previous international studies have found differential effects of abuse and neglect on prosocial behavior, but this and the mediating pathway underlying these associations have not been examined in a Chinese sample. Our study aims to examine the effects of childhood abuse and neglect on prosocial behavior in Chinese participants and test the unique mediating roles of different empathic components in these associations.

Methods

A total of 1,569 young adults (average age = 18.17 years) were recruited from a college that enrolls students from all provinces of China. Participants completed a series of questionnaires, including the Childhood Trauma Questionnaire, Interpersonal Reactivity Index, and Prosocial Tendencies Measure. Path analysis was conducted to determine the mediational relationships.

Results

Emotional neglect had significant direct effect on prosocial behavior (β = -0.108, p < 0.001), and could also impact prosocial behavior through the mediating roles of perspective-taking and empathic concern (effect size = -0.091 and -0.097 respectively, p < 0.001). Emotional abuse affected prosocial behavior only through personal distress (effect size = -0.072, p < 0.001). Physical abuse, sexual abuse and physical neglect have little effect on prosocial behavior and empathy.

Conclusion

Childhood abuse and neglect have distinct influences on prosocial behavior. Emotional abuse and emotional neglect affect prosocial behavior through distinct pathways. This conclusion could help to establish precise interventions for improving prosocial behavior in maltreated individuals.

The journey to reporting child protection violations in sport: Stakeholder perspectives

Sport is a context within which human and children's rights should be respected, promoted, and protected. Yet, research and high-profile cases demonstrate that this is not always the case. To understand the existence (or not) of reporting mechanisms for child protection violations in sport, as well as how existing reporting and response systems operate, the authors, with the support of the Centre for Sport and Human Rights, conducted research on current abuse disclosure and reporting pathways in sport. The purpose was two-fold: to describe global child protection systems and reporting mechanisms, and to identify major areas of stakeholder concern, in terms of effective case resolution, healing, and children's experiences along reporting pathways in sport. Two sources of evidence were tapped. First, a rapid evidence assessment consisting of a literature review and an exploratory survey with 112 global stakeholders was conducted. Second, focus group interviews informed by the evidence assessment were held with nine athletes with lived experiences of abuse in youth sport and 13 global human and children's rights experts primarily working outside of sport. Through this emergent research, a 'pathway' or 'journey' to incident reporting in sport was developed, summarized as 5 'Rs': Readiness, Recognition, disclosure and Reporting, Response, and Remedy, which are similar but not identical to existing trauma frameworks. Each stage of the reporting journey appears to be influenced by a range of contextual, organizational, relational, and individual factors. All told, the disclosure of child protection violations in sport is a complex and dynamic process where myriad factors interact to influence outcomes, including healing. Key recommendations include: (a) establishing a global Safety Net Environment in sport practice with varying applications from region to region, (b) building bridges with specific partner organizations to enhance child protection and safeguarding work in sport and (c) bringing safeguarding to unregulated sporting environments.

Stressors and symptoms associated with a history of adverse childhood experiences among older adolescents and young adults during the COVID-19 pandemic in Manitoba, Canada

INTRODUCTION

The COVID-19 pandemic has had major economic, social and psychological consequences for adolescents and young adults. It is unclear whether those with a history of adverse childhood experiences (ACEs) were particularly vulnerable. We examined whether a history of ACEs was associated with financial difficulties, lack of emotional support, feeling stressed/anxious, feeling down/depressed, increased alcohol and/or cannabis use and increased conflict with parents, siblings and/or intimate partners among 16- to 21-year-olds during the pandemic.

METHODS

Data were collected in November and December 2020 from respondents aged 16 to 21 years (n = 664) participating in the longitudinal and intergenerational Well-being and Experiences Study (Wave 3) conducted in Manitoba, Canada. Age-stratified associations between ACEs and pandemic-related stressors/symptoms were examined with binary and multinomial logistic regression.

RESULTS

A history of ACEs was associated with pandemic-related financial difficulties (adjusted relative risk ratio [aRRR] range: 2.44-7.55); lack of emotional support (aRRR range: 2.13-26.77); higher levels of feeling stressed/anxious and down/depressed (adjusted odds ratio [aOR] range: 1.78-5.05); increased alcohol and cannabis use (aOR range: 1.99-8.02); and increased relationship conflict (aOR range: 1.98-22.59). Fewer associations emerged for older adolescents and these were not to the same degree as for young adults.

CONCLUSION

Adolescents and young adults with a history of ACEs reported increased odds of pandemic-related stressors and symptoms, and may need more resources and greater support compared to peers without an ACE history. Differences in results for adolescents and young adults suggest that interventions should be tailored to the needs of each age group.

Potential Reporters of Suspected Child Maltreatment are Sensitive to the Amount of Evidence and the Potential Consequences of Reporting

The context of suspected maltreatment cases is likely to influence the decision of whether or not to make a formal report. Across one pilot study (N = 368) and two experiments (Exp. 1 N = 444; Exp. 2 N =416), undergraduate students and online community participants reported their anticipated actions and beliefs when confronted with evidence of child maltreatment. Participants reviewed case dossiers built from real-world child neglect cases in which increasing levels of evidence were presented and the consequences of reporting, or not reporting, the maltreatment were made salient to the adult or child. The experiments revealed a clear difficulty in deciding whether or not to report suspected maltreatment. Highlighting the impact on either the child or the adult by describing potential consequences moved participants either closer to (child-salient) or farther from (adult-salient) a formal report. Participants were also sensitive to the amount of evidence to support a suspicion of abuse, which influenced the likelihood of a formal report. This work suggests that increasing the salience of maltreatment consequences to child victims may increase the likelihood that suspected maltreatment will be reported.

Dynamic brain states in spatial neglect after stroke

Previous studies indicated that spatial neglect is characterized by widespread alteration of resting-state functional connectivity and changes in the functional topology of large-scale brain systems. However, whether such network modulations exhibit temporal fluctuations related to spatial neglect is still largely unknown. This study investigated the association between brain states and spatial neglect after the onset of focal brain lesions. A cohort of right-hemisphere stroke patients (n = 20) underwent neuropsychological assessment of neglect as well as structural and resting-state functional MRI sessions within 2 weeks from stroke onset. Brain states were identified using dynamic functional connectivity as estimated by the sliding window approach followed by clustering of seven resting state networks. The networks included visual, dorsal attention, sensorimotor, cingulo-opercular, language, fronto-parietal, and default mode networks. The analyses on the whole cohort of patients, i.e., with and without neglect, identified two distinct brain states characterized by different degrees of brain modularity and system segregation. Compared to non-neglect patients, neglect subjects spent more time in less modular and segregated state characterized by weak intra-network coupling and sparse inter-network interactions. By contrast, patients without neglect dwelt mainly in more modular and segregated states, which displayed robust intra-network connectivity and anti-correlations among task-positive and task-negative systems. Notably, correlational analyses indicated that patients exhibiting more severe neglect spent more time and dwelt more often in the state featuring low brain modularity and system segregation and vice versa. Furthermore, separate analyses on neglect vs. non-neglect patients yielded two distinct brain states for each sub-cohort. A state featuring widespread strong connections within and between networks and low modularity and system segregation was detected only in the neglect group. Such a connectivity profile blurred the distinction among functional systems. Finally, a state exhibiting a clear separation among modules with strong positive intra-network and negative inter-network connectivity was found only in the non-neglect group. Overall, our results indicate that stroke yielding spatial attention deficits affects the time-varying properties of functional interactions among large-scale networks. These findings provide further insights into the pathophysiology of spatial neglect and its treatment.

Adverse childhood experiences and personal values in adolescence: A cross-sectional study using community adult samples in Japan

BACKGROUND

No study has examined whether adverse childhood experiences (ACEs) were related to value priorities and commitment to values during adolescence. We investigated the association between ACEs by age 15 and personal values during adolescence using cross-sectional data from community adult samples in Japan.

METHODS

We conducted a cross-sectional panel study with retrospective assessments. We measured whether the participants experienced childhood victimization of physical abuse, neglect, or parental divorce by the age of 15 years. We also assessed personal value priorities and commitment to values of the participants during adolescence. Analysis of covariance was conducted to compare mean scores of personal priorities and commitment to values between participants with ACEs and those without ACEs.

RESULTS

A total of 2463 participants were included in analysis. The participants reported ACEs by the age of 15 years of 5.1% for physical abuse, 1.8% for neglect, and 2.2% for parental divorce. Having any of the ACEs was significantly associated with lower perceived importance in personal values of avoiding causing trouble (P < 0.0001), and of cherishing family and friends (P < 0.0001). There was no significant association between ACEs and commitment to values.

CONCLUSIONS

The study suggested that ACEs by age 15 years were associated with lower perceived importance in value priorities on avoiding causing trouble and cherishing people in close relationships.

The role of childhood trauma in patients with chronic urticaria

OBJECTIVE

Chronic urticaria (CU) is a common skin disease in which the etiology involves immunological and psychological factors. Childhood traumas may disrupt the development of the neuro-immuno-cutaneous-endocrine system and start a complex pathophysiological process with inflammatory abnormalities, potentially leading to the development of skin disease. In light of this information, we believe that childhood trauma may play a role in the onset and severity of disease in CU patients. Our study aimed to discover a potential relationship between CU and childhood traumatic experiences.

METHODS

This study was conducted with 53 controls and 50 CU patients. The participants were given a questionnaire form that included sociodemographic information, Beck Anxiety Scale, Beck Depression Scale, and Childhood Trauma Questionnaire (CTQ-28).

RESULTS

The rates of childhood trauma were found to be 68% in the patient group, and 54.7% in the control group. The patient group demonstrated higher scores for moderate to severe anxiety and depression. The mean emotional abuse score was significantly higher in early onset (<35 ages) urticaria patients in comparison to late onset urticarial (≥35 ages) and the control group. It was found that depression scores were positively correlated with all abuse sub-types, excluding sexual abuse, and total CTQ-28 scores. Anxiety scores were positively correlated with emotional abuse, physical neglect, emotional neglect, and total CTQ-28 scores.

CONCLUSION

Childhood traumas are associated with the early onset and severity of disease in CU patients as well as the accompanying depression and anxiety.

Newspaper Coverage of Adverse Childhood Experiences and Toxic Stress in the United States, 2014-2020: Consequences, Causes, and Solutions

News media can shape public opinion about child adversity and influence the translation of research into public policy. Research about adverse childhood experiences (ACEs) and toxic stress has increased dramatically in recent years, but little is known about how these concepts are covered in news media. We reviewed how newspapers in the United States have portrayed the consequences of, causes of, and solutions to address ACEs and toxic stress, examined trends in newspaper coverage, and assessed differences in coverage of ACEs versus toxic stress. Quantitative content analysis was conducted of 746 newspaper articles mentioning "adverse childhood experience(s)" and/or "toxic stress" published in 25 U.S. newspapers between January 1, 2014, and May 30, 2020. κ statistics of interrater reliability were calculated, and variables with κ ≥ .60 were retained for quantitative analysis. We found that newspaper coverage of ACEs and toxic stress increased dramatically between 2014 and 2018 and then sharply declined. Only 13.3% of articles mentioned both ACEs and toxic stress. There were many statistically significant (p < .05) differences in the causes, consequences, and solutions identified in articles focused on ACEs versus toxic stress. Coverage of both concepts predominantly focused on consequences for individuals, not society. However, 54.6% of articles identified a structural cause of ACEs and/or toxic stress. Increased volume in newspaper coverage about ACEs and toxic stress could increase public awareness about the relationship between childhood adversity and adult outcomes. There is a need to portray ACEs and toxic stress as complementary concepts more coherently in news media.

Child Maltreatment and Psychiatric Disorders Increase Risk for Stalking Victimization

Stalking is a serious public health problem, estimated to affect about 15% of women and 6% of men. Victims of stalking have been reported to be at increased risk for psychological distress, depression, lowered social and daily functioning, and other forms of victimization. The present study sought to determine whether individuals with documented histories of childhood maltreatment and those with psychiatric disorders are at increased risk for stalking victimization. Participants included maltreated children and matched controls (N = 892) from a Midwestern, metropolitan area who were followed up into adulthood. Psychiatric disorders (major depressive disorder, post-traumatic stress disorder, antisocial personality disorder, and substance use disorders) were assessed at mean age 29 and borderline personality disorder at age 39. Participants reported lifetime stalking using the Lifetime Trauma and Victimization History instrument and based on a separate measure, past year intimate partner stalking victimization. Analyses controlled for sex, race, and age. Depression, PTSD, antisocial, and borderline personality disorders were associated with increased lifetime risk for stalking victimization. Childhood maltreatment, neglect, and psychiatric disorders (substance use, PTSD, antisocial personality, and borderline personality) predicted increased risk for past year stalking victimization. Findings indicated sex differences in lifetime risk of stalking victimization and race differences in past-year stalking victimization. Although the results reveal relationships among child maltreatment, psychiatric disorders, and stalking victimization, the impact of childhood maltreatment is most salient in terms of past year intimate partner stalking victimization, and particularly for individuals with histories of neglect. Future research is needed to better understand these race and sex differences in stalking victimization.

Knowledge and Attitudes of Medical and Nursing Students in Greece Regarding Child Abuse and Neglect

Data on the knowledge and attitudes of healthcare practitioners in training regarding child abuse and neglect (CAN) are scarce. The aim of this study was to investigate the knowledge and attitudes regarding CAN of medical and nursing students in Greek universities. We performed a questionnaire-based e-survey on a convenience sample of students and recruited 609 students (366 medical and 243 nursing). An unsatisfactory level of knowledge in the field was reported overall. Most of the students (92.2%) were aware of their future responsibility to protect vulnerable children and report suspected cases of CAN; at the same time, they were willing to obtain further education. Based on the above, appropriate training in the undergraduate curriculum should be developed in order to strengthen future healthcare practitioners and boost their confidence in dealing with suspected cases of CAN and protect children's welfare.

Associations Between Adverse Childhood Experiences and Trauma Among Young People Who Offend: A Systematic Literature Review

This systematic review synthesized current knowledge about the prevalence of adverse childhood experiences (ACEs) among young people known to have offended and examined evidence of associations between ACEs, trauma symptoms, and offending behavior. A systematic search of English-language, peer-reviewed studies published from the year 2000 onwards was conducted. A final pool of 124 studies that reported quantitative data were included in the review. The Cambridge Quality Checklist for the assessment of studies on offending was used to assess methodological quality of included studies. Pooled data indicated that almost 87% of justice-involved young people across 13 countries experienced at least one traumatic event. The odds of experiencing at least one ACE were over 12 times greater for justice-involved young people compared with nonjustice-involved young people. Prevalence of individual ACEs ranged from 12.2% for childhood sexual abuse to 80.4% for parental separation among justice-involved young people. Those who reported both a higher number and multiple types of ACEs were more likely to be diagnosed with post-traumatic stress symptoms. However, when considering only high-quality studies, there was minimal evidence to suggest that a higher incidence of ACEs predicted trauma symptoms or that trauma symptoms mediated the association between ACEs and offending behavior. Further research is needed to elucidate factors that differentiate young people exposed to ACEs who go on to offend from those who do not. This research is essential to understanding whether ACEs and trauma are drivers of offending behavior and for informing prevention and intervention strategies.

Neglect in Childhood, Problem Behavior in Adulthood

Few studies have reported problem behaviors in adulthood related to the timing of child neglect. The objective was to examine the relationship between classes of child neglect and later behavior. The sample included 473 participants from the prospective Longitudinal Studies of Child Abuse and Neglect (LONGSCAN); their mean age was 23.8 years. They completed an online survey regarding behaviors and experiences in early adulthood. Neglect was assessed via Child Protective Services (CPS) and self-reports of neglect. Latent class analysis (LCA) identified three classes: Late Neglect, Chronic Neglect, and Limited Neglect. There were significant differences between Limited and Late Neglect regarding later intimate partner aggression and violence (IPAV) and psychological distress, and among all classes for criminal behavior. High-risk youth experiencing neglect beginning in mid-adolescence appear especially vulnerable to later criminal behavior, psychological distress, and IPAV. Those working with such youth can help ensure that their needs are adequately met, to prevent or mitigate problems in adulthood.

Factors Associated with Family Belongingness in Children Under Legally Required Health Care

Introduction

It is known that family dysfunctions increase the risk of abuse, neglect and delinquency in children. On the other hand, family belonging was shown as one of the protective factors against these types of risks. In this study, it was aimed to investigate the relationship between family belonging and various risk factors for children and their families who are being treated in a mental health clinic with the decision of health measure.

Method

The study group consisted of 57 adolescents who were treated with a health measure decision, and the control group consisted of 42 adolescents who were treated in the same clinic without any health measure, both groups were over the age of 14. The Parenting Style Scale and The Family Belonging Scale were applied to the participants who took part in the study on a voluntary basis. Data in the sociodemographic information form were updated with the help of parents.

Results

Children with health measure decisions had higher rates of grade repetition, exposure to a negative life event, domestic physical and verbal violence, living in a fragmented family system, presence of mental illness in the mother, and a history of delinquency in family members compared to children in the control group. It was found that children's participation in social activities, and the education and income levels of the parents were lower. Additionally, authoritarian and negligent parenting styles were more pronounced and family belonging was lower in the same group. In the regression analysis, it was revealed that the family belonging of children who had been followed up with a health measure desicion, increases with the participation in social activities and decreases with physical violence.

Conclusion

Our study supported that in studies targeting children at risk or in need of protection, family-oriented interventions are protective, preventive and curative.

Are Adverse Childhood Experiences Associated with Worse Cognitive Function in Older Adults?

OBJECTIVES

Adverse childhood experiences (ACE) are associated with an increased risk for dementia, but this relationship and modifying factors are poorly understood. This study is the first to our knowledge to comprehensively examine the effect of ACE on specific cognitive functions and measures associated with greater risk and resiliency to cognitive decline in independent community-dwelling older adults.

METHODS

Verbal/nonverbal intelligence, verbal memory, visual memory, and executive attention were assessed. Self-report measures examined depression, self-efficacy, and subjective cognitive concerns (SCC). The ACE questionnaire measured childhood experiences of abuse, neglect, and household dysfunction.

RESULTS

Over 56% of older adults reported an adverse childhood event. ACE scores were negatively associated with income and years of education and positively associated with depressive symptoms and SCC. ACE scores were a significant predictor of intellectual function and executive attention; however, these relationships were no longer significant after adjusting for education. Follow-up analyses using the PROCESS macro revealed that relationships among higher ACE scores with intellectual function and executive attention were mediated by education.

CONCLUSIONS

Greater childhood adversity may increase vulnerability for cognitive impairment by impacting early education, socioeconomic status, and mental health. These findings have clinical implications for enhancing levels of cognitive reserve and addressing modifiable risk factors to prevent or attenuate cognitive decline in older adults.

Can early childhood education be compensatory? Examining the benefits of child care among children who experience neglect

Children that experience neglect are at risk for maladaptive outcomes. One potential resource for these children is early childhood education (ECE), but there is currently limited evidence which is compounded by data limitations. This study used data from the National Study of Child and Adolescent Well-being II (N = 1,385) to compare children's cognitive and social-emotional outcomes among children involved in child protective services that experienced either no care, informal care, or formal care, as well as moderation by type of neglect. Results suggest that ECE was related to increased cognitive and social skills and decreased behavior problems, depending on whether the child attended informal or formal care, with some associations being stronger for children that experienced neglect. These findings have implications for practitioners and policymakers in the intersection of ECE and child protective services.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

Developing a novel co-produced methodology to understand 'real-world' help-seeking in online peer-peer communities by young people experiencing emotional abuse and neglect

BACKGROUND

Recent systematic reviews suggest mediating factors (barriers and facilitators) of help-seeking for children and young people (CYP) with a range of mental health problems but highlight the need for a more robust methodology underpinned by theoretical frameworks. Emotional abuse and neglect is the most prevalent and pervasive form of abuse, with many CYP remaining unknown to professional services. These CYP are underrepresented in help-seeking research yet seek help from their peers via anonymous online publicly available message communities.

OBJECTIVES

To sensitively co-develop qualitative methodology to explore 'real-world' data to inform our understanding of help-seeking for these CYP, and define potential mediators (barriers and facilitators) and mechanisms of change associated with online peer support.

METHODS

Co-production with 10 young co-researchers (YCoR; aged 14-18 years) from the NeurOX Young People's Advisory Group (YPAG) included co-development and triangulation to apply different research methods (i.e., interpretative phenomenological, thematic and conversation analyses) to analyse rich ethnographic material from 20 publicly available online message conversations between help-seekers experiencing or questioning emotional abuse and neglect. A theoretical model of adolescent help-seeking proposed by Rickwood et al. was used as a conceptual framework to guide methodological development.

RESULTS

The methodological approach facilitated the identification of barriers and facilitators of help-seeking contextualized to the lives of these CYP: understanding and validating of abuse, emotional competence, fears and uncertainties around disclosure, knowledge, motivational factors and connection/trusted relationships. Notably, positive changes in expressed or perceived 'psychological state' and/or intention to seek help were noticed in 9 of 10 message threads that included a 'conversation' (≥3 posts). Themes associated with change related to connection with supportive peers; compassionate responding and the safeness of the online community. The existing adolescent help-seeking model was found to be too simplistic to account for help-seeking associated with emotional abuse and neglect.

CONCLUSION

The novel methodological approach offers a meaningful way to explore 'real-world' data with YCoR, for a population underrepresented in help-seeking research. Proposed relational mechanisms involve connection, compassion and online communities. Further research coproduced with YCoR with diverse care experiences and characteristics is required to upscale the methodology and further validate and extend the findings.

PUBLIC CONTRIBUTION

The core study was co-produced with 10 YCoRs from the NeurOX YPAG who have been involved in over 135 h on and offline work. Their roles involved co-deciding the direction of the study, evolving methodology, detailed co-analysis and reflective processes throughout all aspects of the study, interpretation, presentation and discussion of the findings with the NSPCC and Childline, and involvement in all communications. Additional consultation and involvement included further interested members of the NeurOX YPAG for the final online workshop and dissemination outputs.

Co-production to understand online help-seeking for young people experiencing emotional abuse and neglect: Building capabilities, adapting research methodology and evaluating involvement and impact

BACKGROUND

Involving young people (YP) as co-researchers (YCoR) in mental health research is important for ethical and epistemological reasons. However, approaches to involve and evaluate 'meaningful involvement' in complex qualitative mental health research, and how to evaluate impacts (or change) for the co-researcher and the research is less well defined.

OBJECTIVES

This co-produced research explored the experiences of YP seeking help for emotional abuse and neglect via an online, peer-peer message board. This practical case study aims to evidence the meaningful role and impacts associated with YCoR involvement in sensitive and complex mental health research using a flexible approach to co-production.

METHODS

During the Covid-19 pandemic, we explored on- and off-line approaches and adapted research methodology to build relationships, knowledge, skills, and confidence with YCoR. The virtual involvement was evaluated against the five principles of co-production. Anonymous, continuous digital feedback, reflective practices and multiple dissemination outputs are used to evaluate the impact of the study on those involved and the research.

RESULTS

Ten members of NeurOX Young People's Advisory Group were involved in the core project. Additional members were invited at later stages and in the dissemination of outputs. We describe a supportive, scaffolded learning approach to build capabilities and embed the lived experience of YCoR in complex qualitative research. A digital blended approach was acceptable to YCoR, principles of co-production were met and the impact/benefits of involvement are described. To demonstrate the epistemological value of involving YP we evidence YPs capabilities for involvement and the 'change' or contribution YCoR made to the research through reflective practices.

CONCLUSIONS

This case study demonstrates how flexible approaches co-production with YCoR can be robust and responsive to balance ethical and epistemological impact in complex mental health research. Supportive, scaffolded practices and safe environments helped build the confidence and capacity of YCoRs to demonstrate valuable phenomenological insights in the analysis. YP's perspectives on how they describe 'meaningful' and impactful involvement illustrate the reciprocal benefits gained through working together.

PUBLIC CONTRIBUTION

This case study describes the YCoR involvement throughout the research and dissemination of outputs. YCoR co-authors were involved in developing the outline and reviewing the draft stages of the manuscript.

Childhood abuse, neglect, codependency, and affecting factors in nursing and child development students

PURPOSE

This study was conducted to determine the relationship of neglect and abuse behaviors experienced by nursing and child development students during their childhood with codependency, and the factors affecting codependency.

DESIGN AND METHODS

This is a descriptive and correlational study. The study was conducted with 292 students who were studying at a Faculty of Health Sciences.

FINDINGS

A positive relationship was found between neglect and abuse behaviors that lead to trauma in childhood, and codependency. It was determined that there was a negative relationship between students' codependency and childhood traumatic experiences and their levels of self-esteem, depression and coping with stress.

PRACTICE IMPLICATIONS

In the educational processes, it is possible to focus on students' unresolved problems with their families, and the signs of codependency.

Adverse childhood experiences and prenatal depression in the maternal and development risks from environmental and social stressors pregnancy cohort

The aim of this study was to examine the association between adverse childhood experiences (ACEs) and risk for depression among 480 predominantly low-income Hispanic/Latina women in the Maternal and Development Risks from Environmental and Social Stressors pregnancy cohort. Models were fitted to evaluate associations between ACEs and prenatal probable depression measured by the Center for Epidemiologic Studies-Depression Scale adjusting for recruitment site, age, income, race/ethnicity, marital status and parity. The ACEs Questionnaire parameterised experiences as counts (0-10), categories (0, 1-3 and 4+ ACEs) and domains. Participants had a significantly higher likelihood of prenatal probable depression per unit increase in ACEs count or if they reported 4+ ACEs relative to 0 ACEs. Higher likelihood of probable depression was also associated with higher counts of each ACEs domains: abuse, neglect and household dysfunction. Findings suggest systematic screening for depressive symptoms in those with a history of childhood adversities may be important in prenatal care practice.Impact StatementWhat is already known on this subject? Experiencing depression during pregnancy has been associated with later adverse maternal mental and physical health outcomes. Emerging studies indicate that adverse childhood experiences (ACEs) may maintain or increase the predisposition to prenatal depression.What do the results of this study add? Although prenatal depressive symptoms are prevalent among racial/ethnic minority samples including Hispanic/Latinas, research determining whether the association between ACEs and prenatal depression varies by nativity is scarce. Overall, ACEs were common among Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) participants and were associated with a higher likelihood of probable depression during pregnancy. These patterns did not significantly differ among the foreign-born versus U.S.-born Hispanic/Latina women, although the associations were stronger among U.S.-born Hispanic/Latina women.What are the implications of these findings for clinical practice and/or further research? Research should continue to focus on the effects of ACEs in communities that have been historically excluded in perinatal mental health services such as pregnant women from racial and ethnic minority groups. It may be important for clinicians to routinely screen for mental health during pregnancy as an adverse, psychological environment may impact both women and children. These findings suggest a need for improvement in systematic screening for depressive symptoms in those with a history of childhood adversities.

Alexithymia in individuals maltreated as children and adolescents: a meta-analysis

BACKGROUND

Children who are maltreated show deficits in emotion recognition, expression, and understanding. The goal of the current meta-analysis was to determine the degree to which maltreatment is associated with deficits in the ability to recognize one's own emotions - a phenomenon known as alexithymia. Alexithymia may be a mechanism explaining the association between childhood maltreatment and various psychological disorders.

METHODS

This meta-analytic review (88 studies, n = 43,076) examined the association between the experience of childhood maltreatment and alexithymia, mainly in adulthood. Additional meta-analyses were run to examine if the strength of the association between maltreatment as a child and alexithymia varied as a function of the type of maltreatment individuals reported and other moderators.

RESULTS

We found significant small effect sizes for all models, indicating higher levels of maltreatment in childhood or adolescence were associated with higher levels of alexithymia. Alexithymia was more strongly associated with forms of neglect than with physical or sexual abuse. The effect sizes also increased as the percentages of females in the sample increased.

CONCLUSIONS

Results suggest that researchers should examine whether alexithymia is a transdiagnostic mechanism in the association between childhood maltreatment and psychopathology and whether targeting alexithymia in treatment could reduce a wide range of symptoms.

Disparities by Gender and Race/Ethnicity in Child Maltreatment and Memory Performance

Adverse childhood experiences, which include child maltreatment, are a major public health issue nationally. Child maltreatment has been linked to poorer cognitive functioning, which can start in childhood and persist into adulthood. However, studies examining the potential disparities by gender and race/ethnicity are lacking. The aim of this study was to assess the gender and racial/ethnic disparities in the association between child maltreatment and memory performance. Data were obtained from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (N = 11,624). Weighted multiple linear regression models were used to assess the associations between sexual abuse, physical abuse, neglect, and child maltreatment score and memory. Models were stratified by gender, race, and ethnicity. Men who were exposed to sexual abuse, neglect and two or three child maltreatment types scored one to three points lower (β = -1.44; 95% CI: -2.83, -0.06; β = -2.41; 95% CI: -3.75, -1.08; β = -3.35; 95% CI: -5.33, -1.37; β = -2.31; 95% CI: -3.75, -0.86) in memory performance compared to men who did not report sexual abuse, neglect, or child maltreatment, respectively. Black respondents who were exposed to sexual abuse scored two points lower (β = -1.62; 95% CI: -2.80, -0.44) in memory performance compared to Black respondents who did not report sexual abuse. Among Other race and Hispanic respondents, those who reported neglect scored four points lower (β = -4.06; 95% CI: -6.47, -1.66; β = -4.15; 95% CI: -5.99, -2.30) in memory performance, respectively, compared to their counterparts who did not report neglect. Gender- and racial/ethnic-responsive memory performance interventions addressing child maltreatment may be beneficial for affected populations.

The Typology and Topography of Child Abuse and Neglect: The Experience of a Tertiary Children's Centre

Effective child protection systems and processes require reliable and accurate data. The aim of this study was to determine what data could be extracted from hospital records in a single site that reflected a child’s journey from admission with suspected abuse to the decisions regarding substantiation made by the multidisciplinary child protection team. A retrospective study of the case records of 452 children referred to a major UK children’s tertiary centre for suspected child maltreatment was undertaken. Child maltreatment was substantiated in 65% of referred cases, with the majority of referrals coming from children living in the most deprived neighbourhoods in the country. Domestic violence and abuse and the child’s previous involvement with statutory bodies were associated with case substantiation. Physical abuse predominated, with soft tissue injuries, including dog bites and burns, most frequent. Burns were related almost exclusively to supervisory neglect. There were also cases of medical neglect. Emotional abuse was associated with exposure to domestic violence and abuse and to self-harm. The strengths and limitations for single-centre data systems were explored, concluding with a recommendation to establish an agreed national and international minimum data set to protect children from maltreatment.