A review of findings from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS)

Prevalence and associated factors of adolescent psychological abuse, neglect in Western China a multi-center cross-sectional study

Background: The western region of China has a dense population, relatively underdeveloped economy, and a significant number of left-behind children. Currently, the prevalence of adolescent psychological abuse, neglect, and the factors associated with these issues in the region remain unclear. This study aims to evaluate the current status of adolescent psychological abuse and neglect and its associated factors in this region.Methods: Data were collected from 50 schools in western China through cluster sampling to target adolescents aged 12 to 18. A comprehensive survey form was used to collect socio-demographic characteristics of adolescents. The Child Psychological Abuse and Neglect Scale was employed to assess the current psychological abuse and neglect of adolescents. Independent samples t-tests were used for inter-group comparisons. A Directed Acyclic Graph was constructed for controlling confounding variables. Subsequently, binary logistic regression analysis was performed, and a nomogram risk factors model was developed using R Studio.Results: This study included 12,743 teenagers, with an average age of 15.53(±1.39) years. Among them, 4,965 individuals, accounting for 39.0%, reported experiences of psychological abuse, while 4,167 individuals, accounting for 32.7%, reported experiences of neglect. The rates of psychological abuse and neglect in adolescents are influenced by gender, grade, left-behind experience, parental marital status, and living on campus (P < .05).Conclusion: Adolescents in western China exhibit higher rates of psychological abuse and neglect compared to those in the eastern and northern regions of China. Gender, grade, left-behind experience, and family factors significantly influence the psychological abuse and neglect of adolescents.

Mental health disorders as cooccuring and predictive factors of psychotic disorders in sexually abused children

BACKGROUND

Little is known about the factors associated with psychosis in sexually abused children. Many factors have been associated with both sexual abuse and psychosis, and some mental health disorders have been identified as implied in the relationship between childhood trauma and psychosis.

OBJECTIVES

This study aims to identify factors cooccurring with psychotic disorders in sexually abused youth and to determine which predict the development of psychosis in this population.

PARTICIPANTS AND SETTING

Children with a corroborated report of sexual abuse (n = 882) at a Child Protection Agency (CPA) between 2000 and 2010 and whose health data could be retrieved from public health databases were selected for this study.

METHODS

A prospective matched-cohort design was used, with administrative databases from a CPA and a public health system. Logistic regressions were performed to determine which mental health diagnoses were associated with, and which predicted, psychotic disorders.

RESULTS

Logistic regressions revealed that personality disorders were significantly associated with psychotic disorders whereas substance misuse disorders and intellectual disability significantly predicted psychotic disorders.

CONCLUSIONS

Psychotic disorders and personality disorders appear concomitantly in sexually abused youth. Having received a substance misuse disorder diagnosis increases the risk of developing a psychotic disorder in sexually abused youth. Health professionals should be aware of those risk factors to help reduce the severity of youth sexual abuse consequences and, ultimately, prevent psychosis.

Adverse childhood experiences (ACEs) and cardiovascular development from childhood to early adulthood: study protocol of the Niagara Longitudinal Heart Study

INTRODUCTION

Recent reviews have found substantial links between a toxic childhood environment including child abuse and severe household dysfunction and adult cardiovascular disease (CVD). Collectively referred to as adverse childhood experiences (ACEs), this toxic environment is prevalent among children, with recent Canadian estimates of child abuse at 27%-32%, and severe household dysfunction at 49%. Based on these prevalence rates, the potential effect of ACEs on CVD is more significant than previously thought. Yet, how ACEs amplify the risk for later CVD remains unclear. Lifestyle risk factors only partially account for this connection, instead directing attention to the interaction between psychosocial factors and physiological mechanisms such as inflammation. The Niagara Longitudinal Heart Study (NLHS) examines how ACEs influence cardiovascular health (CVH) from childhood to early adulthood. Integrating the stress process and biological embedding models, this study examines how psychosocial and physiological factors in addition to lifestyle factors explain the relationship between ACEs and CVH.

METHODS

This follow-up study combines three baseline studies from 2007 to 2012 that collected CVH measures including child blood pressure, heart rate, left ventricular structure and function, arterial stiffness indices and baroreflex sensitivity on 564 children. Baseline data also include anthropometric, biological, lifestyle, behavioural, and psychosocial measures that varied across primary studies. Now over 18 years of age, we will recruit and retest as many participants from the baseline studies as possible collecting data on ACEs, CVH, anthropometric, lifestyle and psychosocial measures as well as blood, saliva and hair for physiological biostress markers.

ETHICS AND DISSEMINATION

Ethics approval has been received for the NLHS follow-up. Written consent to participate in the follow-up study is obtained from each participant. Results testing all proposed hypotheses will be submitted for publication in peer-reviewed journals.

Childhood Maltreatment and the Risk for Criminal Justice Involvement and Victimization Among Homeless Individuals: A Systematic Review

Homeless individuals are at higher risk of criminal justice involvement (CJI) and victimization compared to their housed counterparts. Exposure to childhood maltreatment (CM; e.g., abuse, neglect) is one of the most significant predictors of CJI and victimization among homeless populations. The aim of this systematic review was to synthesize current knowledge regarding the relationship between CM and CJI and victimization among homeless individuals. Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methods, a systematic search was performed using PsycINFO, MEDLINE, Embase, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature for published studies investigating the relationship between CM and CJI and victimization among homeless samples. We identified 20 studies that met the inclusion criteria. Findings showed that across the majority of studies, CM, and in particular childhood physical (CPA) and sexual (CSA) abuse, is associated with increased risk of both CJI and victimization, regardless of various important factors (e.g., sociodemographic characteristics, psychiatric disorders, substance use). These findings support the need for prevention and treatment for "families at risk" (i.e., for intimate partner violence, child abuse and neglect) and also document the need for trauma-informed approaches within services for homeless individuals. Future research should focus on prospective designs that examine victimization and CJI in the same samples.

Psychotic disorders in sexually abused youth: A prospective matched-cohort study

Child sexual abuse has been identified as a potential risk factor for developing a psychotic disorder. However, little is known about the prevalence of psychotic disorders in youth who were sexually abused during adolescence and young adulthood. Gender differences also remain unclear. This study used administrative databases from a Child Protection Agency and a public health care system. It aimed to investigate the prevalence of psychotic disorders in sexually abused youth between the first substantiated report of sexual abuse and the beginning of adulthood. A second objective was to assess gender differences. Administrative health data for 882 sexually abused youth were compared with 882 matched controls from the general population over a 13-year period using conditional generalized linear mixed models. Stratified analyses by gender (group comparison) and group (gender comparison) were also performed. Sexually abused youth were 10 times more at risk of receiving a diagnosis of psychotic disorder than youth from the general population. There was no gender difference in the prevalence of psychotic disorders among sexually abused youth. These results highlight the importance of targeted prevention of psychotic disorders among sexually abused youth. Future studies should investigate risk factors and developmental trajectories of psychotic disorders in this population.

Genitourinary Health of Sexually Abused Girls and Boys: A Matched-Cohort Study

OBJECTIVE

To compare genitourinary health problems of children and adolescents with a substantiated report of sexual abuse with those of the general pediatric population.

STUDY DESIGN

Via a prospective matched-cohort design, administrative databases between January 1996 and March 2013 were used to document genitourinary problems of 882 sexually abused children and those of 882 matched controls. Generalized linear mixed models determined the association between a substantiated sexual abuse and diagnoses for sexually transmitted infections and urinary and genital health problems.

RESULTS

Adjusted results revealed that up to 12 years after a sexual abuse was substantiated, abused girls had, respectively, 2.1 and 1.4 times more diagnoses for urinary and genital health problems compared with girls from the general population, whereas no difference was found for sexually transmitted infections. Sexually abused boys had an equivalent number of diagnoses as those from the general population for all 3 outcomes. Depending on the genitourinary health problem, abused girls and those from the general population had between 2.5 and 11 times more diagnoses than abused boys or those from the general population.

CONCLUSIONS

This study showed that substantiated childhood sexual abuse is associated with more urinary and genital health problems among girls but not boys. Early prevention and intervention efforts may mitigate the problems such that they do not persist or worsen over time and into adulthood.

Childhood maltreatment is associated with attachment insecurities, dissociation and alexithymia in bipolar disorder

Child maltreatment is a public health issue that is a well-established risk factor for many psychological conditions, including bipolar disorder. The current study is one of the first to investigate associations among child maltreatment, dissociative symptomatology, alexithymia, anxiety, depression, and attachment insecurities. 40 patients with bipolar disorder-I and 40 healthy subjects matched for age, gender, and education participated in the study. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), Childhood Trauma Questionnaire (CTQ-28), Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scale (DASS-21), and Experiences in Close Relationships-Revised (ECR-R) were completed by participants. In comparison to control participants, patients with bipolar disorder-I reported significantly more frequent abusive experiences in childhood, higher levels of attachment insecurities, more severe pathological and somatoform dissociation, as well as higher scores on measures of alexithymia, anxiety, depression and psychological stress. Reports of psychopathology among first-degree relatives (OR = 102.169, 95%IC = 4.596-2271.255; P < 0.01) and childhood emotional trauma (OR = 1.032; 95%CI = 0.782-1.363, P = 0.05) significantly contributed to bipolar disorder-I diagnosis. In contrast, absorption was negatively associated with bipolar illness (OR = 0.852; 95% CI = 0.747-0.973, P < 0.05). Our results showed significant associations between childhood trauma exposure and risk of bipolar disorder. Moreover, the results demonstrate that emotional abuse exposure predicts bipolar illness.

Physical and mental health of children with substantiated sexual abuse: Gender comparisons from a matched-control cohort study

When compared to children from the general population, sexually abused children receive more medical services, both for physical and mental health problems. However, possible differences between sexually abused boys and girls remain unknown. The lack of control group in studies that find gender differences also prevents from determining if the differences are specific to sexual abuse or to gender. The objective of the study was to assess differences in physical and mental health between sexually abused boys and girls in comparison to those from the general population. Administrative databases were used to document physical and mental health problems of 222 males and 660 females with a substantiated report of sexual abuse between 2001 and 2010. A comparison group individually matched to those from the sexually abused group on gender, age and geographic area was also used to document gender differences in the general population. Yearly incidence rates of diagnoses resulting from medical consultations and hospitalizations of males and females were compared over five years after a first substantiated sexual abuse report using the mixed general linear model. Sexually abused girls were up to 2.2 times more likely to consult a physician than sexually abused boys for physical health problems. Similar findings are observed in the general population. Conversely, results revealed that sexually abused boys were up to 2.3 times more likely than females to consult a physician for mental health problems. This gender difference was not apparent in the general population group.

Prevalence, co-occurrence and decennial trends of family violence toward children in the general population

OBJECTIVES

In Quebec, three population-based surveys have documented the prevalence of psychological aggression, and minor and severe physical violence toward children. This paper aims to present 1) the results of the 2012 survey with regard to the frequency and annual prevalence of violence, and 2) the trends in all three forms of violence between 1999 and 2012 according to children's age.

METHODS

The three independent surveys were all conducted through telephone interviews in 1999, 2004 and 2012 by the Institut de la Statistique du Québec and reached a total sample of 9,646 children living with a mother figure. Psychological aggression, and minor and severe physical violence were measured using the Parent Child Conflict Tactics Scales.

RESULTS

The results show that repeated psychological aggression, after having increased between 1999 (48%) and 2004 (53%), slightly decreased in 2012 (49%). Minor physical violence decreased steadily between 1999 and 2012, from 48% to 35%, and severe physical violence remained stable (6%). These three forms of violence varied by the age category of the children. Finally, the results show that the co-occurrence of the use of physical and psychological violence remained high in all three surveys.

CONCLUSION

The results are consistent with trends in North America and are discussed in terms of services to support families.

A review of recent analyses of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS)

INTRODUCTION

The objective of this analysis is to identify, assess the quality and summarize the findings of peer-reviewed articles that used data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) published since November 2011 and data from provincial oversamples of the CIS as well as to illustrate evolving uses of these datasets.

METHODS

Articles were identified from the Public Health Agency of Canada's data request records tracking access to CIS data and publications produced from that data. At least two raters independently reviewed and appraised the quality of each article.

RESULTS

A total of 32 articles were included. Common strengths of articles included clearly stated research aims, appropriate control variables and analyses, sufficient sample sizes, appropriate conclusions and relevance to practice or policy. Common problem areas of articles included unclear definitions for variables and inclusion criteria of cases. Articles frequently measured the associations between maltreatment, child, caregiver, household and agency/referral characteristics and investigative outcomes such as opening cases for ongoing services and placement.

CONCLUSION

Articles using CIS data were rated positively on most quality indicators. Researchers have recently focussed on inadequately studied categories of maltreatment (exposure to intimate partner violence [IPV]), neglect and emotional maltreatment) and examined factors specific to First Nations children. Data from the CIS oversamples have been underutilized. The use of multivariate analysis techniques has increased.

Relationship between child abuse exposure and reported contact with child protection organizations: results from the Canadian Community Health Survey

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design (n=23,395; household response rate=79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR=15.8; 95% CI=10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse.

Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment

OBJECTIVE

Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment.

METHOD

Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children).

RESULTS

Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment.

CONCLUSIONS

More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes.

A systematic review of childhood maltreatment assessments in population-representative surveys since 1990

BACKGROUND

Population-representative surveys that assess childhood maltreatment and health are a valuable resource to explore the implications of child maltreatment for population health. Systematic identification and evaluation of such surveys is needed to facilitate optimal use of their data and to inform future research.

OBJECTIVES

To inform researchers of the existence and nature of population-representative surveys relevant to understanding links between childhood maltreatment and health; to evaluate the assessment of childhood maltreatment in this body of work.

METHODS

We included surveys that: 1) were representative of the non-institutionalized population of any size nation or of any geopolitical region ≥ 10 million people; 2) included a broad age range (≥ 40 years); 3) measured health; 4) assessed childhood maltreatment retrospectively; and 5) were conducted since 1990. We used Internet and database searching (including CINAHL, Embase, ERIC, Global Health, MEDLINE, PsycINFO, Scopus, Social Policy and Practice: January 1990 to March 2014), expert consultation, and other means to identify surveys and associated documentation. Translations of non-English survey content were verified by fluent readers of survey languages. We developed checklists to abstract and evaluate childhood maltreatment content.

RESULTS

Fifty-four surveys from 39 countries met inclusion criteria. Sample sizes ranged from 1,287-51,945 and response rates from 15%-96%. Thirteen surveys assessed neglect, 15 emotional abuse; 18 exposure to family violence; 26 physical abuse; 48 sexual abuse. Fourteen surveys assessed more than three types; six of these were conducted since 2010. In nine surveys childhood maltreatment assessments were detailed (+10 items for at least one type of maltreatment). Seven surveys' assessments had known reliability and/or validity.

CONCLUSIONS AND IMPLICATIONS

Data from 54 surveys can be used to explore the population health relevance of child maltreatment. Assessment of childhood maltreatment is not comprehensive but there is evidence of recent improvement.

How has child maltreatment surveillance data been used in Canada?

Background

Recently, a survey was performed as part of a larger study at the Public Health Agency of Canada (PHAC) to develop and pilot a series of tools to measure the uptake and use of PHAC-produced or -supported knowledge products by its key partners and stakeholders. This article aims to i) examine the uptake and use of the Canadian Incidence Study of Reported Child Abuse and Neglect 2008 (CIS-2008) and to ii) assess the utility of a knowledge uptake survey for collecting performance measurement data.

Methods

Using the knowledge utilization ladder as a theoretical framework, a short survey was developed around the themes of reception, cognition, conversation, reference, effort, influence, and implementation. The survey was administered electronically to potential end-users of the CIS-2008. The final sample comprised 85 respondents.

Results

The results demonstrated that the majority of the respondents were aware of CIS-2008 and had read and used it. A wide array of disciplines and sectors were identified as end-users. Types of use included discussion of CIS data with social workers, child welfare and health advocates, students, medical and legal professionals, and senior government decision makers. Further, CIS was referenced in reports, articles, policy research, community programs, and funding proposals and was used to influence or support the development of policies, programs, and projects. Valuable information on the use of surveillance reports, such as CIS-2008, can be gathered from a brief survey that was easy to administer, cost effective, and that respondents needed minimal time to complete.

Conclusions

Piloting of the survey demonstrated that the tool, while not perfect, is quite useful for capturing performance measurement information; CIS-2008 is appreciated and used. There is an increased recognition of the importance of the CIS as a unique source of Canadian child maltreatment surveillance data that can influence and lead to the implementation of new programs and policies. Although suggestions for improvement of the CIS-2008 were provided, the present findings offer support for ongoing national child maltreatment surveillance.