A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Childhood Abuse, Nonsuicidal Self-Injury, and Suicide Attempts: An Exploration of Gender Differences in Incarcerated Adults

The relationship between types of childhood abuse, suicide attempts, and nonsuicidal self-injury (NSSI) was examined in a sample of 415 incarcerated adults (268 men, 147 women). Men and women were equally likely to experience childhood abuse, although women were more likely to report sexual abuse and men were more likely to report emotional neglect. Sexual abuse was the only type of abuse found to predict NSSI and suicide attempts in women. For men, physical abuse and physical neglect were significant predictors of NSSI and suicide attempts, respectively. Gender differences exist and should be examined in future research in this area.

Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: A structural equation model

The present study investigated the mediating effects of emotion dysregulation on the relationship between child maltreatment and psychopathology. An adult sample (N=701) from diverse backgrounds of psychopathology completed the Childhood Trauma Questionnaire (CTQ), the Difficulties in Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the negative affect subscale of the Positive and Negative Affect Schedule (PANAS) in a cross-sectional online survey. Correlational analyses showed that all types of child maltreatment were uniformly associated with emotion dysregulation, and dimensions of emotion dysregulation were strongly related to psychopathology. Limited access to strategies for emotion regulation emerged as the most powerful predictor. Structural equation modeling analyses revealed that emotion dysregulation partially mediated the relationship between child maltreatment and psychopathology, even after controlling for shared variance with negative affect. These findings emphasize the importance of emotion dysregulation as a possible mediating mechanism in the association between child maltreatment and later psychopathology. Additionally, interventions targeting specific emotion regulation strategies may be effective to reduce psychopathology in victims of child maltreatment.

The Association Between Unwanted Sexual Experiences and Early-Onset Cervical Cancer and Precancer by Age 25: A Case-Control Study

BACKGROUND

We examined the association between unwanted sexual experiences and cervical cancer, cervical intraepithelial neoplasia 3, adenocarcinoma in situ, diagnosed ≤25 years of age.

METHODS

A case-control study of women ≤55 years who attended gynecological hospitals in Australia between 1983 and 2007. Cases were ≤25 years when diagnosed with disease, control group 1 were "older women" >25 years at diagnosis; control group 2 were "well women" ≤25 years attending preventive health clinics. A self-administered postal survey was utilized. The main outcome measures were prevalence of childhood sexual abuse (<16 years) and unwanted adolescent sexual experiences (between 16 and 18 years) in cases compared to controls.

RESULTS

Of 400 contactable subjects, 251 participated (62.8%). Prevalence of childhood sexual abuse in cases (26.6% [25/94]) was similar to other groups. Prevalence of childhood genital contact abuse in cases with cervical cancer was 45.5% [5/11], compared to older women (20% [10/50], p = 0.08) and well women (13.8% [8/58], p = 0.01), and was marginally more common compared to well women when adjusted for other lifestyle factors (odds ratio [OR]: 4.7 [1.0-22.6], p = 0.05). Prevalence of unwanted adolescent sexual experiences in cases was 28.9% [33/114]. Prevalence of adolescent penile-genital contact experiences in cervical cancer cases was 46.7% [7/15], compared to older women (9.4%, [6/64], p < 0.001) and well women (13.7%, [10/73], p = 0.003), and was more common compared to well women when adjusted for lifestyle (OR: 5.9 [1.4-24.9], p = 0.02) and sexual health risk factors (OR: 5.6 [1.4-22.1] p = 0.01).

CONCLUSIONS

Unwanted sexual experiences with genital contact were a risk factor for invasive cervical cancer ≤25 years, likely due to a complex interplay of biological and environmental factors.

Child Sexual Abuse in Zimbabwe

Although child sexual abuse is a significant public health problem globally, its incidence, prevention, and management is less well described in resource-poor settings. In poorer settings prevention initiatives assume even more importance since resources for managing abused children are severely limited. This article examines the current status of policy and practice related to the prevention of child sexual abuse in Zimbabwe. It identifies implementation challenges and highlights opportunities that could be embraced to reduce CSA in Zimbabwe, based on evidence synthesized from recent work. Although Zimbabwe has a well-established legal and regulatory framework to protect children from child sexual abuse, implementation of existing policies is weak. Financial, human, and material resource constraints are frequently cited to explain limited prevention activity. Effective strategies for the prevention of child sexual abuse should focus on implementing existing legislation, targeting schoolchildren, and getting community involvement. A dedicated budget would help entrench these strategies, but gains can be achieved even in the absence of this.

Global research priorities for interpersonal violence prevention: a modified Delphi study

Objective

To establish global research priorities for interpersonal violence prevention using a systematic approach.

Methods

Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2.

Findings

In round 2, “developing, implementing and evaluating interventions” was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, “scaling up interventions and evaluating their cost–effectiveness” was ranked lowest for all types of violence. In round 3, research into “developing, implementing and evaluating interventions” that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises.

Conclusion

These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority.

The role of substance use coping in the relation between childhood sexual abuse and depression among methamphetamine users in South Africa

OBJECTIVE

Childhood sexual abuse (CSA) is a critical global health issue associated with poor psychosocial outcomes. Individuals with CSA histories are at risk for drug use, which is a growing problem in the Western Cape of South Africa. The present study of methamphetamine users in this region examined whether substance use coping, a contextually relevant type of avoidance-based coping, mediates the relation between CSA and depressive symptoms.

METHOD

Participants included 161 men and 108 women seeking treatment for methamphetamine use. Participants completed a computer-assisted survey and a face-to-face interview with clinic staff to evaluate history of CSA, current substance use severity and coping, and current depressive symptoms.

RESULTS

Nearly a third of participants reported a history of CSA, and the average methamphetamine use severity score exceeded the threshold of high risk. A history of CSA was significantly associated with higher substance use coping and more depression symptoms. Substance use coping was a significant mediator of the association between CSA and depression symptoms.

CONCLUSIONS

In this study of high-risk methamphetamine users, substance use coping emerged as a common means of managing stress, especially for those with a history of CSA, which was further linked to depressive symptoms. These findings underscore the potential benefit of integrating coping interventions and mental health treatment into substance abuse treatment programs, particularly for those with a history of childhood abuse and violence. (PsycINFO Database Record

Pensionnats autochtones : impact intergénérationnel

Les pensionnats autochtones sont des institutions ayant été en activité de la fin du 19e siècle à la fin du 20e siècle, que des enfants autochtones ont été forcés de fréquenter au Canada. Des enquêtes ont démontré que plusieurs jeunes fréquentant ces institutions y ont été victimes de négligence et de mauvais traitements. Les conséquences négatives découlant des mauvais traitements durant l’enfance ont été amplement documentées, notamment à travers les travaux de la Commission de vérité et réconciliation du Canada. Néanmoins, très peu d’études quantitatives ont été réalisées à ce sujet. L’objectif de cette recherche est de documenter, chez une population autochtone du Québec, les impacts associés à la fréquentation des pensionnats chez les survivants, mais également chez leurs enfants devenus adultes. Au total, 301 participants autochtones ont été rencontrés. Parmi les participants, 26,9 % ont fréquenté les pensionnats et 45,5 % ont un parent qui les a fréquentés. Les résultats indiquent que la fréquentation des pensionnats est associée à une probabilité plus élevée d’avoir vécu des traumas (agression sexuelle, agression physique, violence conjugale, etc.) dans l’enfance ou à l’âge adulte. Les résultats révèlent également que la fréquentation des pensionnats est associée à plusieurs difficultés, notamment à la consommation problématique d’alcool ou de drogues, au jeu problématique et à la détresse psychologique. Les résultats de cette étude soulignent l’importance de tenir compte des conséquences des traumatismes historiques et intergénérationnels liés aux pensionnats dans notre compréhension de la situation actuelle des peuples autochtones du Canada.

The Mediating Role of Emotion Dysregulation in the Relations Between Childhood Trauma History and Adult Attachment and Borderline Personality Disorder Features: A Study of Italian Nonclinical Participants

In order to evaluate if emotion dysregulation significantly mediates the relationships between childhood abuse and adult attachment and borderline personality disorder features, 354 community Italian adults were administered the Borderline Personality Inventory (Leichsenring, 1999a), the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), the Child Abuse and Trauma Scale (Sanders & Becker-Lausen, 1995), and the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994). Hierarchical regression analyses showed that both childhood abuse and adult attachment were positively associated with emotion dysregulation and borderline personality features; however, only emotional abuse and the attachment dimension of need for approval were common predictors of both dependent variables. No significant interaction effects were detected in regression analyses. Mediation analyses provided support for partial mediation, revealing a significant mediating role of emotion dysregulation in the relationships between both emotional abuse and need for approval and borderline personality features in this community sample.

Associations between nonauditory hallucinations, dissociation, and childhood adversity in first-episode psychosis

Although repeated associations have been found between adversity exposure (particularly exposure to childhood sexual abuse), dissociation, and auditory hallucinations in the context of psychosis, there is little comparable research examining hallucinations in other modalities. This study aimed to determine whether cumulative adversity exposure influences the likelihood of experiencing visual, tactile, olfactory, and gustatory hallucinations among psychosis patients and whether measures of dissociation are significantly associated with nonauditory hallucinations when exposure to childhood adversity and psychological distress are adjusted for. Self-report measures and a retrospective case-control design were applied to assess nonauditory hallucinations, dissociation, psychological distress, and childhood adversity exposure in a sample of first-episode psychosis patients reporting nonauditory hallucinations (n = 36) and controls from the same clinical population without nonauditory hallucinations (n = 31). Case participants reported higher levels of dissociation, psychological distress, and exposure to childhood rape than the control group. Dissociation remained significantly associated with nonauditory hallucinations when we adjusted for childhood sexual abuse, other types of childhood adversity, and a combined measure of emotional distress. Indication of a dose-response relationship was detected, in that total number of adversities was significantly associated with reporting more than one modality of nonauditory hallucination. Observed associations between auditory hallucinations and dissociation in psychosis may extend to other hallucination modalities. It is suggested that more research attention be paid to the etiology and impact of nonauditory hallucinations in psychosis samples.

Perceived Needs for Support Program for Family With Child Sexual Abuse Victim in South Korea: Focus Group Interview With Therapists and Mothers

This study assessed perceived needs for psychological support program for family with victim of child sexual abuse in South Korea. We conducted two separate focus group interviews with five therapists who served child sexual abuse victims and families as well as four mothers of a child sexual abuse victim. Consensual qualitative research analysis revealed four domains: Emotional support for parents, psychoeducation, family therapy, and tailored and flexible service delivery. Core ideas of the four domains were identified. The results were consistent with the family support program contents developed in Western countries and suggested culture-specific contents and culturally sensitive service delivery. Clinical implications for developing family support program in South Korea were discussed.

Men's Perpetration of Partner Violence in Bangladesh: Community Gender Norms and Violence in Childhood

Men's perpetration of intimate partner violence (IPV) is common, but its multilevel determinants are understudied. We leveraged novel data from a probability sample of 570 junior men (married, 18-34 years) from 50 urban and 62 rural communities who took part in the Bangladesh survey of the 2011 UN Multi-Country Study of Men and Violence. We tested whether more equitable community gender norms among senior men (N=938; married, 35-49 years) was negatively associated, and a junior man's greater exposure to childhood violence was positively associated, with his lifetime count (or scope) of physical IPV acts perpetrated. We also tested whether more equitable community gender norms mitigated the association of more violence in childhood with the lifetime scope of physical IPV acts perpetrated. Among younger married men, 50% reportedly ever perpetrated physical IPV, the mean lifetime scope of physical IPV types perpetrated was 1.1 (SD 1.3) out of 5.0 listed. A majority (64%) reported childhood exposure to violence. In multilevel Poisson models, a man with more childhood exposure to violence had a higher log scope (Est. 0.31, SE 0.04, p<.001) and a man living amidst the most equitable gender norms had a lower log scope (Est. -0.52, SE 0.19, p<.01) of physical IPV acts perpetrated; however, no significant cross-level interaction was observed. Interventions that address the trauma of childhood violence and that promote more equitable community gender norms may be needed to mitigate IPV perpetration by younger men.

Adapting and retesting evidence-based child maltreatment prevention programs: a case study in Canada

This special issue of Health Promotion and Chronic Disease Prevention in Canada is timely, as child maltreatment is a significant public health problem; globally, the number affected is at least in the hundreds of millions. One-quarter of adults report having been physically abused and over one-third emotionally abused as children; one in 5 women and one in 13 men report having been sexually abused. Recent national surveys of violence against children conducted in Africa and in other low- and middle-income countries reveal rates of childhood physical, sexual and emotional abuse even higher than the global rates.

Is there a role for paediatric Sexual Assault Nurse Examiners in the management of child sexual assault in Australia?

In Australia, paediatricians and Child Protection Specialists provide the medical and forensic examinations of child victims of sexual assault. There are workforce challenges in the recruitment and retention of doctors to undertake child sexual assault (CSA) work particularly in remote and rural areas. Pediatric Sexual Assault Nurse Examiner (PSANE) programs have existed in the USA and the UK for many years. Using Rapid Evidence Assessment (REA) methodology, a systematic search of the literature was performed to ascertain what is known about SANE programs, to evaluate the evidence for their effectiveness across a number of domains (accessibility, health and legal outcomes and cost effectiveness) and to inform policy on models of care and elements of best practice which may be appropriate for local implementation in Australia. This review showed that despite the limited evidence available and significant gaps in the evidence, SANEs provide a high standard of medical care and are not detrimental to the legal process. By providing recommendations regarding the potential value, effectiveness and feasibility of establishing a PSANE program in Australia, this article may be of interest to other high income countries facing similar workforce challenges in meeting the needs of children with alleged sexual assault.

The prevalence and impact of childhood sexual abuse on HIV-risk behaviors among men who have sex with men (MSM) in India

Background

Childhood sexual abuse (CSA) is a significant global public health problem, which is associated with negative psychosocial outcomes and high-risk sexual behaviors in adults. Men who have sex with men (MSM) often report higher prevalence of CSA history than the general population, and CSA may play a key role in MSM’s greater vulnerability to HIV.

Methods

This study examined the prevalence of CSA history and its impact on the number of recent HIV-related risk behaviors (unprotected anal intercourse, high number of male and female sexual partners, alcohol use, drug use, and sex work in prior 6 months) and lifetime risk behaviors and experiences (high number of lifetime male and female sexual partners, early sexual debut, injection drug use, sex work, and intimate partner violence) among 11,788 adult MSM recruited via respondent driven sampling across 12 sites in India, with additional insights from thematic analysis of qualitative research with 363 MSM from 15 sites.

Results

Nearly a quarter (22.4 %) of participants experienced CSA, with substantially higher prevalence of CSA in the South and among kothis (feminine sexual identity). Qualitative findings revealed that older, trusted men may target young and, especially, gender nonconforming boys, and perpetrators’ social position facilitates nondisclosure. CSA may also initiate further same-sex encounters, including sex work. In multivariable analysis, MSM who experienced CSA had 21 % higher rate of recent (adjusted rate ratio [aRR = 1.21], 95 % confidence interval [CI]: 1.14–1.28), and 2.0 times higher lifetime (aRR = 2.04, 95 % CI: 1.75–2.38) HIV-related behaviors/experiences compared with those who did not.

Conclusion

This large, mixed-methods study found high overall prevalence of CSA among MSM (22.4 %), with substantially higher prevalence among MSM residing in the South and among more feminine sexual identities. Qualitative findings highlighted boys’ vulnerabilities to CSA, especially gender nonconformity, and CSA’s role in further sexual encounters, including sex work. Additionally, CSA was associated with an elevated rate of recent, and an even higher rate of lifetime HIV-related risk factors. Our results suggest an acute need for the development of CSA prevention interventions and the integration of mental health services for MSM with histories of CSA as part of HIV-prevention efforts.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3446-6) contains supplementary material, which is available to authorized users.

Coping Self-Efficacy Mediates the Association Between Child Abuse and ADHD in Adulthood

OBJECTIVE

To investigate whether individual differences in coping self-efficacy mediated the association of child abuse and symptoms of ADHD in young adults.

METHOD

Self-reported measures of coping self-efficacy, child abuse, and ADHD were obtained from 66 adults.

RESULTS

Adults who reported childhood physical or sexual abuse (prior to the age of 17) had significantly higher levels of ADHD than those who did not. Individual differences in coping self-efficacy fully mediated the association between child abuse and ADHD symptoms in adulthood, such that individuals who endorsed child abuse had lower coping self-efficacy, and coping self-efficacy negatively predicted ADHD symptoms.

DISCUSSION

The findings suggest a potential causal mechanism by which childhood physical and sexual abuse may result in ADHD symptoms later in life. Interventions that improve coping skills may be useful in preventing later ADHD symptoms among adults with a childhood history of physical and sexual abuse.

Emotional and Sexual Correlates of Child Sexual Abuse as a Function of Self-Definition Status

Among individuals defined as having been sexually abused based on legal criteria, some will self-report having been abused and some will not. Yet, the empirical correlates of self-definition status are not well studied. Different definitions of abuse may lead to varying prevalence rates and contradictory findings regarding psychological outcomes. The present study examined whether, among legally defined sexual abuse survivors, identifying oneself as having experienced childhood sexual abuse (CSA) was associated with more severe abuse, negative emotional reactions toward the abuse, and current sexual reactions. A convenience sample of 1,021 French-speaking Canadians completed self-report questionnaires online. The prevalence of legally defined CSA was 21.3% in women and 19.6% in men, as compared to 7.1% in women and 3.8% in men for self-defined CSA. Among legally defined sexual abuse survivors, those who identified themselves as CSA survivors had been abused more frequently, were more likely to report a male aggressor, and more often described abuse by a parental figure than those who did not self-identify as abused. Further, self-defined CSA was associated with more negative postabuse reactions and sexual avoidance, whereas those not identifying as sexually abused were more likely to report sexual compulsion.

The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients

Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (β=.18, p<.05) and impulsivity (β=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (β=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.

Sexual Violence Against Female and Male Children in the United Republic of Tanzania

During a household survey in Tanzania, a nationally representative sample of females and males aged 13-24 years reported any experiences of sexual violence that occurred before the age of 18 years. The authors explore the prevalence, circumstances, and health outcomes associated with childhood sexual violence. The results suggest that violence against children in Tanzania is pervasive, with roughly three in 10 females and one in eight males experiencing some form of childhood sexual violence, and its health consequences are severe. Results are being used by the Tanzanian government to implement a National Plan of Action.

Is Anybody Listening? The Literature on the Dialogical Process of Child Sexual Abuse Disclosure Reviewed

We conducted an exploratory review of the current literature on child sexual abuse disclosure in everyday contexts. The aim of this study was to provide an overview of relevant publications on the process of child sexual abuse disclosure, in order to generate new directions for future research and clinical practice. The findings of the exploratory review show that disclosure is a relational process, which is renegotiated by each interaction and evolves over an extended period of time. The characteristics and reactions of the interaction partner appear to be as critical to this process as the behavior and words of children themselves. Methodological limitations of the review and the publications are discussed, as well as directions for future research and implications for practice.

Paraphilic Sexual Interests and Sexually Coercive Behavior: A Population-Based Twin Study

Prior research with selected clinical and forensic samples suggests associations between paraphilic sexual interests (e.g., exhibitionism and sexual sadism) and sexually coercive behavior. However, no study to date used a large, representative and genetically informative population sample to address the potential causal nature of this association. We used self-report data on paraphilic and sexually coercive behavior from 5990 18- to 32-year-old male and female twins from a contemporary Finnish population cohort. Logistic regression and co-twin control models were employed to examine if paraphilic behaviors were causally related to coercive behavior or if suggested links were confounded by familial (genetic or common family environment) risk factors. Results indicated that associations between four out of five tested paraphilic behaviors (exhibitionism, masochism, sadism, and voyeurism, respectively) and sexually coercive behavior were moderate to strong. Transvestic fetishism was not independently associated with sexual coercion. Comparisons of twins reporting paraphilic behavior with their paraphilic behavior-discordant twin further suggested that associations were largely independent of shared genetic and environmental confounds, consistent with a causal association. In conclusion, similar to previously reported predictive effects of paraphilias on sexual crime recidivism, paraphilic behavior among young adults in the general population increases sexual offending risk. Further, early identification of paraphilic interest and preventive interventions with at-risk individuals might also reduce perpetration of first-time sexual violence.

Determining prevalence of maltreatment among children in the kingdom of Saudi Arabia

PURPOSE

The aim of this study is to find out the overall prevalence rates for the major forms of abuse among adolescents in the Kingdom of Saudi Arabia and the differences in prevalence by age, gender and living arrangement.

METHODS

The cross-sectional study was conducted in secondary high schools in five of the 13 main regions of Kingdom of Saudi Arabia during 2012. Through a multistage stratified sampling technique, a sample (n = 16 939) of adolescents (15-19 years) were identified and invited to participate. The ISPCAN Child Abuse Screening Tool - Child was used for data collection. The previous year's occurrence of violence exposure, psychological, physical and sexual abuse, and neglect were assessed.

RESULTS

Nearly 90% of the adolescents were between 16 and 18 years of age, and over 80% were cared for by both of their biological parents. Annual prevalence of various forms of abuse in the year before the 2012 assessment ranged between 0.10 and 0.65, with the lowest rate for sexual abuse and the highest for psychological abuse. Significantly, greater rates of all forms of abuse/exposure were found when participants lived with their mother or father only (versus with both), and even greater rates for all when they lived with their biological parent and a step-parent. Rates for violence exposure, psychological abuse and neglect were significantly greater for girls, and rate of sexual abuse was greater for boys.

CONCLUSIONS

More attention should be given to the effect of adolescent maltreatment particularly among girls. In addition, sexual abuse prevention programme should be targeted among boys.

Postrape care services to minors in Kenya: are the services healing or hurting survivors?

Child sexual abuse is a global problem and a growing concern in Sub-Saharan Africa. It constitutes a profound violation of human rights. To address this problem, Kenya has established the Sexual Offences Act. In addition, Kenya has developed national guidelines on the management of sexual violence to grant minors access to health care. However, little is known about the experiences of sexually abused minors when they interact with the health and legal system. Accordingly, this study uses a triangulation of methods in the follow-up of two adolescent girls. Health records were reviewed, interactions between the girls and service providers were observed, in-depth interviews were conducted with the girls, and informal discussions were held with guardians and service providers. Findings indicated that the minors’ rights to quality health care and protection were being violated. Protocols on postrape care delivery were unavailable. Furthermore, the health facility was ill equipped and poorly stocked. Health providers showed little regard for informed assent, confidentiality, and privacy while offering postrape care. Similarly, in the justice system, processing was met with delays and unresponsive law enforcement. Health providers and police officers are in grave need of training in sexual and gender-based violence, its consequences, comprehensive postrape care, and sexual and reproductive health rights to ensure the protection of minors’ rights. Health administrators should ensure that facilities are equipped with skilled health providers, medical supplies, and equipment. Additionally, policies on the protection and care of sexually abused minors in Kenya require amendment.

Bridging the gaps: a global review of intersections of violence against women and violence against children

Background

The international community recognises violence against women (VAW) and violence against children (VAC) as global human rights and public health problems. Historically, research, programmes, and policies on these forms of violence followed parallel but distinct trajectories. Some have called for efforts to bridge these gaps, based in part on evidence that individuals and families often experience multiple forms of violence that may be difficult to address in isolation, and that violence in childhood elevates the risk of violence against women.

Methods

This article presents a narrative review of evidence on intersections between VAC and VAW – including sexual violence by non-partners, with an emphasis on low- and middle-income countries.

Results

We identify and review evidence for six intersections: 1) VAC and VAW have many shared risk factors. 2) Social norms often support VAW and VAC and discourage help-seeking. 3) Child maltreatment and partner violence often co-occur within the same household. 4) Both VAC and VAW can produce intergenerational effects. 5) Many forms of VAC and VAW have common and compounding consequences across the lifespan. 6) VAC and VAW intersect during adolescence, a time of heightened vulnerability to certain kinds of violence.

Conclusions

Evidence of common correlates suggests that consolidating efforts to address shared risk factors may help prevent both forms of violence. Common consequences and intergenerational effects suggest a need for more integrated early intervention. Adolescence falls between and within traditional domains of both fields and deserves greater attention. Opportunities for greater collaboration include preparing service providers to address multiple forms of violence, better coordination between services for women and for children, school-based strategies, parenting programmes, and programming for adolescent health and development. There is also a need for more coordination among researchers working on VAC and VAW as countries prepare to measure progress towards 2030 Sustainable Development Goals.

The Contribution of Cognitive Strategies to the Resilience of Women Survivors of Childhood Sexual Abuse and Non-Abused Women

This study examines the contribution of four strategies—self-forgiveness, realistic control, unrealistic control, and hope—to the resilience of 100 women survivors of childhood sexual abuse (CSA), as compared with 84 non-sexually abused women. The findings show that CSA survivors exhibited lower resilience, lower self-forgiveness, lower hope, and higher levels of posttraumatic symptoms (PTS). They also indicate that resilience was explained by the participants’ financial status, PTS severity, and two cognitive strategies—self-forgiveness and hope. Finally, PTS and hope mediated the relation between CSA and resilience.

On the incidence and prevalence of child maltreatment: a research agenda

Research on child maltreatment epidemiology has primarily been focused on population surveys with adult respondents. Far less attention has been paid to analyzing reported incidents of alleged child maltreatment and corresponding agency responses. This type of research is however indispensable to know how well a child protection system works and if the most vulnerable are identified and served. Notable findings of child maltreatment epidemiological research are summarized and directions for future studies discussed.

Impact of a new mandatory reporting law on reporting and identification of child sexual abuse: A seven year time trend analysis

Child sexual abuse is widespread and difficult to detect. To enhance case identification, many societies have enacted mandatory reporting laws requiring designated professionals, most often police, teachers, doctors and nurses, to report suspected cases to government child welfare agencies. Little research has explored the effects of introducing a reporting law on the number of reports made, and the outcomes of those reports. This study explored the impact of a new legislative mandatory reporting duty for child sexual abuse in the State of Western Australia over seven years. We analyzed data about numbers and outcomes of reports by mandated reporters, for periods before the law (2006-2008) and after the law (2009-2012). Results indicate that the number of reports by mandated reporters of suspected child sexual abuse increased by a factor of 3.7, from an annual mean of 662 in the three year pre-law period to 2448 in the four year post-law period. The increase in the first two post-law years was contextually and statistically significant. Report numbers stabilized in 2010-2012, at one report per 210 children. The number of investigated reports increased threefold, from an annual mean of 451 in the pre-law period to 1363 in the post-law period. Significant decline in the proportion of mandated reports that were investigated in the first two post-law years suggested the new level of reporting and investigative need exceeded what was anticipated. However, a subsequent significant increase restored the pre-law proportion, suggesting systemic adaptive capacity. The number of substantiated investigations doubled, from an annual mean of 160 in the pre-law period to 327 in the post-law period, indicating twice as many sexually abused children were being identified.

Sexual harassment victimization in adolescence: Associations with family background

Sexual harassment has been studies as a mechanism reproducing inequality between sexes, as gender based discrimination, and more recently, as a public health problem. The role of family-related factors for subjection to sexual harassment in adolescent has been little studied. Our aim was to study the role of socio-demographic family factors and parental involvement in adolescent's persona life for experiences of sexual harassment among 14-18-year-old population girls and boys. An anonymous cross-sectional classroom survey was carried out in comprehensive and secondary schools in Finland. 90953 boys and 91746 girls aged 14-18 participated. Sexual harassment was elicited with five questions. Family structure, parental education, parental unemployment and parental involvement as perceived by the adolescent were elicited. The data were analyzed using cross-tabulations with chi-square statistics and logistic regressions. All types of sexual harassment experiences elicited were more common among girls than among boys. Parental unemployment, not living with both parents and low parental education were associated with higher likelihood of reporting experiences of sexual harassment, and parental involvement in the adolescent's personal life was associated with less reported sexual harassment. Parental involvement in an adolescent's life may be protective of perceived sexual harassment. Adolescents from socio-economically disadvantaged families are more vulnerable to sexual harassment than their more advantaged peers.

Patterns and predictors of violence against children in Uganda: a latent class analysis

OBJECTIVE

To explore patterns of physical, emotional and sexual violence against Ugandan children.

DESIGN

Latent class and multinomial logistic regression analysis of cross-sectional data.

SETTING

Luwero District, Uganda.

PARTICIPANTS

In all, 3706 primary 5, 6 and 7 students attending 42 primary schools.

MAIN OUTCOME AND MEASURE

To measure violence, we used the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional. We used the Strengths and Difficulties Questionnaire to assess mental health and administered reading, spelling and maths tests.

RESULTS

We identified three violence classes. Class 1 (N=696 18.8%) was characterised by emotional and physical violence by parents and relatives, and sexual and emotional abuse by boyfriends, girlfriends and unrelated adults outside school. Class 2 (N=975 26.3%) was characterised by physical, emotional and sexual violence by peers (male and female students). Children in Classes 1 and 2 also had a high probability of exposure to emotional and physical violence by school staff. Class 3 (N=2035 54.9%) was characterised by physical violence by school staff and a lower probability of all other forms of violence compared to Classes 1 and 2. Children in Classes 1 and 2 were more likely to have worked for money (Class 1 Relative Risk Ratio 1.97, 95% CI 1.54 to 2.51; Class 2 1.55, 1.29 to 1.86), been absent from school in the previous week (Class 1 1.31, 1.02 to 1.67; Class 2 1.34, 1.10 to 1.63) and to have more mental health difficulties (Class 1 1.09, 1.07 to 1.11; Class 2 1.11, 1.09 to 1.13) compared to children in Class 3. Female sex (3.44, 2.48 to 4.78) and number of children sharing a sleeping area predicted being in Class 1.

CONCLUSIONS

Childhood violence in Uganda forms distinct patterns, clustered by perpetrator and setting. Research is needed to understand experiences of victimised children, and to develop mental health interventions for those with severe violence exposures.

TRIAL REGISTRATION NUMBER

NCT01678846; Results.

Child sexual abuse: Raising awareness and empathy is essential to promote new public health responses

Child sexual abuse is a major global public health concern, affecting one in eight children and causing massive costs including depression, unwanted pregnancy, and HIV. The gravity of this global issue is reflected by the United Nations' new effort to respond to sexual abuse in the 2015 Sustainable Development Goals. The fundamental policy aims are to improve prevention, identification, and optimal responses to sexual abuse. As shown in our literature review, policymakers face difficult challenges because child sexual abuse is hidden, psychologically complex, and socially sensitive. This article offers new ideas for international progress. Insights about needed strategies are informed by an innovative multidisciplinary analysis of research from public health, medicine, social science, psychology, and neurology. Using an ecological model comprising individual, institutional, and societal dimensions, we propose that two preconditions for progress are the enhancement of awareness of child sexual abuse, and of empathic responses towards its victims.Journal of Public Health Policy advance online publication, 12 May 2016; doi:10.1057/jphp.2016.21.

Child maltreatment and quality of life: a study of adolescents in residential care

BACKGROUND

Childhood maltreatment is an important risk factor for mental and physical health problems. Adolescents living in residential youth care (RYC) have experienced a high rate of childhood maltreatment and are a high-risk group for psychiatric disorders. Quality of life (QoL) is a subjective, multidimensional concept that goes beyond medical diagnoses. There is a lack of research regarding the associations between childhood maltreatment and QoL. In the present study, we compare self-reported QoL between adolescents in RYC in Norway with and without maltreatment histories, and adolescents from the general population. We also study the impact of number of types of adversities on QoL.

METHODS

Adolescents aged 12-23 years living in RYC in Norway were invited to participate in the study; 400 participated, yielding a response rate of 67 %. Maltreatment histories were assessed through interviews with trained research assistants, and completed by 335 adolescents. Previous exposure to maltreatment was reported by 237 adolescents. The Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents (KINDL-R) was used. Nonexposed peers in RYC (n = 98) and a sample of adolescents from the general population (n = 1017) were used for comparison. General linear model analyses (ANCOVA) were conducted with five KINDL-R life domains as dependent variables. Linear regression was used to study the effect of number of types of adversities.

RESULTS

Exposed adolescents in RYC reported poorer QoL than peers in control groups. Compared with nonexposed peers in RYC, the 95 % confidence intervals for mean score differences on the KINDL-R subdomains (0-100 scale) were 1.9-11.4 (Physical Well-being), 2.2-11.1 (Emotional Well-being), -0.7-10.0 (Self-esteem), and 1.8-10.9 (Friends). Compared with the general population sample, the 95 % confidence intervals for mean score differences were 9.7-17.6 (Physical Well-being), 7.9-15.3 (Emotional Well-being), 3.6-12.5 (Self-esteem), and 5.3-12.8 (Friends). Number of types of adversities was associated with a poorer QoL score on all subdomains (Physical- and Emotional Well-being, Self-esteem, Friends, and School).

CONCLUSIONS

Childhood maltreatment was associated with a poorer QoL score. We suggest the use of QoL and maltreatment measures for all children and adolescents in RYC.

Global Status Report on Violence Prevention 2014

INTRODUCTION

Interpersonal violence affects millions of people worldwide, often has lifelong consequences, and is gaining recognition as an important global public health problem. There has been no assessment of measures countries are taking to address it. This report aims to assess such measures and provide a baseline against which to track future progress.

METHODS

In each country, with help from a government-appointed National Data Coordinator, representatives from six to ten sectors completed a questionnaire before convening in a consensus meeting to decide on final country data; 133 of 194 (69%) WHO Member States participated. The questionnaire covered data, plans, prevention measures, and victim services. Data were collected between November 2012 and June 2014, and analyzed between June and October 2014. Global and country-level homicides for 2000-2012 were also calculated for all 194 Members.

RESULTS

Worldwide, 475,000 people were homicide victims in 2012 and homicide rates declined by 16% from 2000 to 2012. Data on fatal and, in particular, non-fatal forms of violence are lacking in many countries. Each of the 18 types of surveyed prevention programs was reported to be implemented in a third of the 133 participating countries; each law was reported to exist in 80% of countries, but fully enforced in just 57%; and each victim service was reported to be in place in just more than half of the countries.

CONCLUSIONS

Although many countries have begun to tackle violence, serious gaps remain, and public health researchers have a critical role to play in addressing them.

The Continuum of Disclosure: Exploring Factors Predicting Tentative Disclosure of Child Sexual Abuse Allegations During Forensic Interviews and the Implications for Practice, Policy, and Future Research

When a child sexual abuse investigation ensues, many children do not disclose readily to professionals. Defining disclosure beyond the disclosure versus nondisclosure dichotomy is essential, yet little research exists on factors associated with a continuum of disclosure, including active and tentative disclosure. Through the coding of 196 forensic interviews using content analysis and subsequent regression analysis, findings suggest that children of color, children abused by adults, unintentional initial disclosure, and those lacking family support were more likely to tentatively disclose in this study. Implications include a need to understand tentative disclosure as part of a normal continuum of disclosure within court proceedings and investigations of abuse allegations.

Childhood Sexual Violence Against Boys: A Study in 3 Countries

BACKGROUND AND OBJECTIVE

Globally, little evidence exists on sexual violence against boys. We sought to produce the first internationally comparable estimates of the magnitude, characteristics, risk factors, and consequences of sexual violence against boys in 3 diverse countries.

METHODS

We conducted nationally representative, multistage cluster Violence Against Children Surveys in Haiti, Kenya, and Cambodia among males aged 13 to 24 years. Differences between countries for boys experiencing sexual violence (including sexual touching, attempted sex, and forced/coerced sex) before age 18 years were examined by using χ(2) and logistic regression analyses.

RESULTS

In Haiti, Kenya, and Cambodia, respectively, 1459, 1456, and 1255 males completed surveys. The prevalence of experiencing any form of sexual violence ranged from 23.1% (95% confidence Interval [CI]: 20.0-26.2) in Haiti to 14.8% (95% CI: 12.0-17.7) in Kenya, and 5.6% (95% CI: 4.0-7.2) in Cambodia. The largest share of perpetrators in Haiti, Kenya, and Cambodia, respectively, were friends/neighbors (64.7%), romantic partners (37.2%), and relatives (37.0%). Most episodes occurred inside perpetrators' or victims' homes in Haiti (60.4%), contrasted with outside the home in Kenya (65.3%) and Cambodia (52.1%). The most common time period for violence in Haiti, Kenya, and Cambodia was the afternoon (55.0%), evening (41.3%), and morning (38.2%), respectively. Adverse health effects associated with violence were common, including increased odds of transactional sex, alcohol abuse, sexually transmitted infections, anxiety/depression, suicidal ideation/attempts, and violent gender attitudes.

CONCLUSIONS

Differences were noted between countries in the prevalence, characteristics, and risk factors of sexual violence, yet associations with adverse health effects were pervasive. Prevention strategies tailored to individual locales are needed.

Does the gender of parent or child matter in child maltreatment in China?

Child maltreatment is a public health problem worldwide, and China is no exception. However, the pattern of child maltreatment remains unknown, including whether the gender of children and their parents has an impact on the occurrence of maltreatment. This study aims at examining the rates and frequency of child maltreatment, including physical abuse, psychological abuse and neglect perpetrated by mothers and fathers. We also test whether the interaction between parents' gender and their child's gender affects the occurrence of child maltreatment in China. 997 children from the China Jintan Child Cohort Study participated in the present study and reported their maltreatment experience perpetrated by their mothers and fathers using the questionnaire, Parent-Child Conflict Tactics Scale (CTSPC_CA). Generalized linear model analyses show that boys were more likely than girls to report physical abuse, and, in particular, boys were more likely than girls to be physically abused by their fathers. On the other hand, mothers were more likely than fathers to exhibit psychological aggression and use corporal punishment for both boys and girls. There was no difference based on the child's or parent's gender in the occurrence of neglect. The findings present empirical evidence that enhances the understanding of the pattern of child maltreatment in China, provide implications for social workers and health professionals to identify children at risk of child maltreatment, and shed light on future research studies.

Discriminant factors for adolescent sexual offending: On the usefulness of considering both victim age and sibling incest

Understanding the pathways and circumstances of juvenile sexual offending is of utmost importance. However, juvenile sexual offenders (JSO) represent an especially diverse group of individuals, and several categorizations have been proposed to obtain more homogeneous subgroups. Victim age-based and family relation-based categorizations are particularly promising because they seem theoretically and clinically relevant. Empirical results however are still inconsistent, and most studies have not considered these two dimensions jointly. The first goal of this study was to further examine the value of subgrouping JSO according to the age of their victim. A second goal was to determine the supplementary value, if any, of considering sibling incest. Based on a sample of 351 male JSO, it was first confirmed that sexual abuse of children was more strongly related to asociality (social skill deficits) than sexual abuse of peers, the latter being more closely associated with antisociality (general delinquency). The relevance of considering mixed-type JSO (with both child and peer victims) separately was also confirmed. More importantly, multivariate statistical analyses demonstrated that adding sibling incest to the equation was useful. JSO of intra-familial child were significantly more likely to have been victimized during their own childhood compared to JSO with extra-familial victims. Nevertheless, adolescents who had committed sibling incest obtained middle ground results on most variables (except for crime severity), suggesting that they constitute a distinct but not extreme, subgroup. This study confirmed the utility of using both the age and the family relation with the victim in characterizing juvenile sexual offending.

Mothers' Experiences with Pastoral Care in Cases of Child Sexual Abuse

This article reports on case study research with four mothers who asked for help from their pastors when they learned, or had reason to believe, that their husbands had sexually abused children in their families. In their own words, mothers gave accounts of how the pastors responded. Some were helpful and knowledgeable, some appeared bewildered, and others were hostile and blaming toward the women. This article will sensitize pastors and other pastoral counselors to issues that child sexual abuse raises. In addition, the research responds to Mahoney's (J Marriage Fam 72:805-827, 2010) observations about the scarcity of knowledge on whether religion helps or harms families during times of stress.

The Good School Toolkit for reducing physical violence from school staff to primary school students: a cluster-randomised controlled trial in Uganda

Background

Violence against children from school staff is widespread in various settings, but few interventions address this. We tested whether the Good School Toolkit—a complex behavioural intervention designed by Ugandan not-for-profit organisation Raising Voices—could reduce physical violence from school staff to Ugandan primary school children.

Methods

We randomly selected 42 primary schools (clusters) from 151 schools in Luwero District, Uganda, with more than 40 primary 5 students and no existing governance interventions. All schools agreed to be enrolled. All students in primary 5, 6, and 7 (approximate ages 11–14 years) and all staff members who spoke either English or Luganda and could provide informed consent were eligible for participation in cross-sectional baseline and endline surveys in June–July 2012 and 2014, respectively. We randomly assigned 21 schools to receive the Good School Toolkit and 21 to a waitlisted control group in September, 2012. The intervention was implemented from September, 2012, to April, 2014. Owing to the nature of the intervention, it was not possible to mask assignment. The primary outcome, assessed in 2014, was past week physical violence from school staff, measured by students' self-reports using the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool—Child Institutional. Analyses were by intention to treat, and are adjusted for clustering within schools and for baseline school-level means of continuous outcomes. The trial is registered at clinicaltrials.gov, NCT01678846.

Findings

No schools left the study. At 18-month follow-up, 3820 (92·4%) of 4138 randomly sampled students participated in a cross-sectional survey. Prevalence of past week physical violence was lower in the intervention schools (595/1921, 31·0%) than in the control schools (924/1899, 48·7%; odds ratio 0·40, 95% CI 0·26–0·64, p<0·0001). No adverse events related to the intervention were detected, but 434 children were referred to child protective services because of what they disclosed in the follow-up survey.

Interpretation

The Good School Toolkit is an effective intervention to reduce violence against children from school staff in Ugandan primary schools.

Funding

MRC, DfID, Wellcome Trust, Hewlett Foundation.

The association between peer victimization, PTSD, and dissociation in child victims of sexual abuse

BACKGROUND

Sexually abused children present a host of psychological difficulties, including dissociation and post-traumatic stress (PTSD) symptoms. Negative repercussions associated with sexual abuse may interfere with children's ability to interact competently with their peers, and might put them at risk for peer victimization. The aims of the study were 1) to describe peer victimization experiences of sexually abused children using a multi-informant approach (self, parents, teachers), and 2) to examine if peer victimization experiences are associated with clinical levels of PTSD and dissociation after controlling for relevant variables.

METHOD

Participants were 158 children (104 girls and 54 boys; Mean age=9.10) and their non-offending parents consulting after the disclosure of sexual abuse. Children, parents, and teachers completed a measure assessing peer victimization (Self-Report Victimization Scale). Measures of trauma-related symptoms (PTSD and dissociation) were used as outcome variables.

RESULTS

More than half (60%) of sexually abused children reported being picked on, 51% reported sustaining verbal victimization and a third (35%) physical victimization by peers in the school context. Inter-informant agreement was higher between parents and teachers than between self-reports and adults' reports. Peer victimization experiences increased the odds by up to three-fold for clinical levels of dissociation and PTSD symptoms.

LIMITATIONS

Our findings are based on cross-sectional data, and therefore, causal relationships cannot be inferred. No control group was included in the study.

CONCLUSIONS

Results have significant relevance for prevention and intervention. Clinicians should include assessment of peer victimization experiences when evaluating sexually abused school-aged children. Prevention initiatives in terms of peer victimization could indirectly prevent worsening of symptoms in abused children.

Sexual offending runs in families: A 37-year nationwide study

BACKGROUND

Sexual crime is an important public health concern. The possible causes of sexual aggression, however, remain uncertain.

METHODS

We examined familial aggregation and the contribution of genetic and environmental factors to sexual crime by linking longitudinal, nationwide Swedish crime and multigenerational family registers. We included all men convicted of any sexual offence (N = 21,566), specifically rape of an adult (N = 6131) and child molestation (N = 4465), from 1973 to 2009. Sexual crime rates among fathers and brothers of sexual offenders were compared with corresponding rates in fathers and brothers of age-matched population control men without sexual crime convictions. We also modelled the relative influence of genetic and environmental factors to the liability of sexual offending.

RESULTS

We found strong familial aggregation of sexual crime [odds ratio (OR) = 5.1, 95% confidence interval (CI) = 4.5-5.9] among full brothers of convicted sexual offenders. Familial aggregation was lower in father-son dyads (OR = 3.7, 95% CI = 3.2-4.4) among paternal half-brothers (OR = 2.1, 95% CI = 1.5-2.9) and maternal half-brothers (OR = 1.7, 95% CI = 1.2-2.4). Statistical modelling of the strength and patterns of familial aggregation suggested that genetic factors (40%) and non-shared environmental factors (58%) explained the liability to offend sexually more than shared environmental influences (2%). Further, genetic effects tended to be weaker for rape of an adult (19%) than for child molestation (46%).

CONCLUSIONS

We report strong evidence of familial clustering of sexual offending, primarily accounted for by genes rather than shared environmental influences. Future research should possibly test the effectiveness of selective prevention efforts for male first-degree relatives of sexually aggressive individuals, and consider familial risk in sexual violence risk assessment.

Québec Incidence Study on the situations investigated by child protective services: Major findings for 2008 and comparison with 1998

OBJECTIVE

The Québec Incidence Study on situations investigated by child protective services (QIS) has been conducted in 5-year cycles since 1998 in collaboration with all 16 Québec child protection agencies. It provides reliable estimates of the incidence and characteristics of investigated children. The aim of this paper is to discuss major findings from the QIS-2008 and to compare them with the findings from QIS-1998.

METHODS

Two representative samples of children who were investigated by child protection services during the same three-month time frame in 1998 (N = 4,771) and in 2008 (N = 3,079) were constituted. Caseworkers were asked to complete the QIS data collection form for each sampled child. Annual estimates of the number of children investigated with different characteristics were computed and compared across both cycles. Statistical tests were performed to identify significant differences.

RESULTS

While the rate of children investigated increased between 1998 and 2008, the rate of substantiated cases remained stable at 12 and 11 per 1,000 children in the population respectively. Furthermore, substantiated cases in 2008 were less severe than in 1998 along several dimensions, such as co-occurrence, emotional harm and duration.

CONCLUSION

Combined with the stability in the rate of substantiated cases, the decline in the severity of the situations seems encouraging but questions the necessity of a CPS intervention for some of these families. These findings are consistent with the ones reported in other countries, but Québec rates are below the rates estimated for Canada, where substantiated maltreatment almost doubled during the same time frame. Aspects of social policies in Québec may play a role in this situation and need to be examined in future research.

Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions

BACKGROUND

Literature supports a strong relationship between childhood maltreatment and mental illness but most studies reviewed are cross-sectional and/or use recall to assess maltreatment and are thus prone to temporality and recall bias. Research on the potential prospective impact of maltreatment reduction on the incidence of psychiatric disorders is scarce.

METHOD

Electronic databases and grey literature from 1990 to 2014 were searched for English-language cohort studies with criteria for depression and/or anxiety and non-recall measurement of childhood maltreatment. Systematic review with meta-analysis synthesized the results. Study quality, heterogeneity, and publication bias were examined. Initial screening of titles and abstracts resulted in 199 papers being reviewed. Eight high-quality articles met eligibility criteria. Population attributable fractions (PAFs) estimated potential preventive impact.

RESULTS

The pooled odds ratio (OR) between any type of maltreatment and depression was 2.03 [95% confidence interval (CI) 1.37-3.01] and 2.70 (95% CI 2.10-3.47) for anxiety. For specific types of maltreatment and depression or anxiety disorders, the ORs were: physical abuse (OR 2.00, 95% CI 1.25-3.19), sexual abuse (OR 2.66, 95% CI 1.88-3.75), and neglect (OR 1.74, 95% CI 1.35-2.23). PAFs suggest that over one-half of global depression and anxiety cases are potentially attributable to self-reported childhood maltreatment. A 10-25% reduction in maltreatment could potentially prevent 31.4-80.3 million depression and anxiety cases worldwide.

CONCLUSION

This review provides robust evidence of childhood maltreatment increasing the risk for depression and anxiety, and reinforces the need for effective programs and policies to reduce its occurrence.

Global Prevalence of Past-year Violence Against Children: A Systematic Review and Minimum Estimates

CONTEXT

Evidence confirms associations between childhood violence and major causes of mortality in adulthood. A synthesis of data on past-year prevalence of violence against children will help advance the United Nations' call to end all violence against children.

OBJECTIVES

Investigators systematically reviewed population-based surveys on the prevalence of past-year violence against children and synthesized the best available evidence to generate minimum regional and global estimates.

DATA SOURCES

We searched Medline, PubMed, Global Health, NBASE, CINAHL, and the World Wide Web for reports of representative surveys estimating prevalences of violence against children.

STUDY SELECTION

Two investigators independently assessed surveys against inclusion criteria and rated those included on indicators of quality.

DATA EXTRACTION

Investigators extracted data on past-year prevalences of violent victimization by country, age group, and type (physical, sexual, emotional, or multiple types). We used a triangulation approach which synthesized data to generate minimum regional prevalences, derived from population-weighted averages of the country-specific prevalences.

RESULTS

Thirty-eight reports provided quality data for 96 countries on past-year prevalences of violence against children. Base case estimates showed a minimum of 50% or more of children in Asia, Africa, and Northern America experienced past-year violence, and that globally over half of all children-1 billion children, ages 2-17 years-experienced such violence.

LIMITATIONS

Due to variations in timing and types of violence reported, triangulation could only be used to generate minimum prevalence estimates.

CONCLUSIONS

Expanded population-based surveillance of violence against children is essential to target prevention and drive the urgent investment in action endorsed in the United Nations 2030 Sustainable Development Agenda.

Self-reported suicide attempts and exposure to different types of violence and neglect during childhood: Findings from a young adult population survey in Latvia

Aims: Suicide rates in Latvia are among the highest in the EU. Among 18–25 year-old young adults, it is the second leading cause of death. This study investigates the prevalence of self-reported suicide attempts in young adults and examines its association with neglect or violence of a physical, emotional or sexual nature. Methods: A questionnaire was administered to 1259 young adults 18–25 years of age, selected by targeted quota sampling from secondary and vocational schools. Results: The prevalence of self-reported suicide attempts was 6.1%. Physical and emotional adverse experiences showed clear associations with attempted suicide. Although prevalence of reported physical neglect was higher than for physical violence (27.0% versus 16.3%, respectively) the latter posed a higher risk for attempted suicide (OR = 4.0; 95% CI, 2.4–6.6). Conversely, emotional violence had a higher prevalence than emotional neglect (31.5% vs. 23.6%, respectively), but neglect showed a stronger association with attempted suicide (OR = 4.4; 95% CI, 2.6–7.3). Conclusions: The high OR for attempted suicide associated with emotional neglect, together with findings that emotional violence had the highest prevalence, and that emotional neglect and emotional violence showed the highest population attributable risk fraction (PopAR%) of 46.8 and 40.4, respectively, suggested that emotional factors merit special attention in further investigations of attempted suicide among young adults in Latvia. The targeted quota sampling method from five cities representing all regions of Latvia and 43.8% of its population, ensure national relevance of our findings for policy and program development by legislative, educational and public health institutions.

Lifetime Prevalence and Characteristics of Child Sexual Victimization in a Community Sample of Spanish Adolescents

The purpose of this study was to investigate the lifetime prevalence and characteristics of self-reported child sexual victimization and associations between sexual victimization and sociodemographic characteristics and victimological profiles in community adolescents in Spain. The Juvenile Victimization Questionnaire (Finkelhor, Hamby, Ormrod, & Turner, 2005) was applied to a sample of 1,105 community adolescents (M = 14.52 years, SD = 1.76). Experience of sexual victimization (with or without physical contact) was reported by 8.8% of the sample, at a mean age of 13 years old. Sexual victimization was more prevalent in girls (14.2%) and in older adolescents (10.6%). Offenders were mainly male (87.6%) and were mostly friends, neighbors, or schoolmates (52.6%). No injuries resulted from victimization (4.3%), although the percentage of penetration or attempted penetration was very high (30.6%). Only 9.3% of victims reported the incident to the police or the justice system. In regard to victimological profiles, sexual victims also experienced other forms of victimization (M = 7.16; SD = 3.39): boys reported more conventional crimes, peer and sibling victimization, and witnessing community violence than other victims, whereas sexually victimized girls reported more caregiver victimization and property crimes. Sexually victimized youth present a distinctive sociodemographic and victimological profile. Professionals need to be aware of these characteristics in order to conduct adequate prevention programs. We also need to assess a wide range of victimization experiences when treating sexual abuse victims in order to make adolescents less vulnerable to violence.

Emotion Regulation in Sexually Abused Preschoolers

Emotion regulation is closely related to mental health in children and adults. Low emotion regulation competencies have been found in school-aged sexually abused girls. The aim of the present study was to investigate emotion regulation competencies in sexually abused preschool girls and boys using a multi-informant approach. Emotion regulation was assessed in 62 sexually abused and 65 non-abused preschoolers using the Emotion Regulation Checklist and the MacArthur Story Stem Battery. Both parents and educators reported lower emotion regulation competencies in sexually abused preschoolers, especially boys, than in non-abused children. The narrative task completed by the children also revealed lower emotion regulation competencies in sexually abused boys. These findings could have an important impact on intervention programs offered to these at-risk children.