Disentangling life events, stress and social support: implications for the primary prevention of child abuse and neglect

Childhood socio-economic position and affective symptoms in adulthood: The role of neglect

BACKGROUND

Childhood neglect is more common within low-income families and can have long-term effects on mental health. Despite this, the extent to which it can mediate the well documented longitudinal inverse relationship between childhood socio-economic position (SEP) and adult affective symptoms is yet to be investigated.

METHOD

Data (9595 males and 8959 females) from participants of the National Child Development Study (NCDS) were used to investigate the extent to which prospectively measured neglect mediates the relationship between SEP (age 11) and affective symptoms (ages 23 and 50).

RESULTS

Neglect partially mediated the relationship between childhood SEP and affective symptoms at ages 23 (b = -0.02, [-0.02, -0.02]) and 50 (b = -0.02, [-0.02, -0.01]), after controlling for other family-related adversities. In addition, gender moderated the direct effect of SEP on affective symptoms at both ages 23 (b = -0.06, t = -4.87, [-0.08, -0.03]) and 50 (b = -0.05, t = -3.86, [-0.07, -0.02]), with the relationship being stronger for females; but did not moderate the indirect effect of neglect at either age 23 (b = 0.01, t = 1.09 [-0.01, 0.02]) or 50 (b = 0.00, t = -0.60 [-0.02, 0.01]).

CONCLUSIONS

Neglect in childhood should be viewed as having serious implications for the mental health of both men and women. Greater investments into social support interventions that reduce incidences of neglect are also warranted.

Correlates of Dysfunctional Parenting Attitudes among Low-Income Adolescent Mothers

Various scholars have speculated that adolescent mothers are at risk for negative parenting. It was therefore the purpose of this study to assess dysfunctional attitudes of adolescent mothers through a secondary analysis of a subsample of 157 participants from a large-scale, ongoing longitudinal study. Belsky 's process model of parenting was used as a framework to assess the adolescent mothers' parental attitudes at I year postpartum. Two sets of multiple regression analyses were performed: (a) ordinary least squares regressiont was used to assess predictors of generally dysfunctional parenting attitudes as continluously measured; and (b) logistic multiple regression was used to determine predictors of risk for child abuse and neglect with the dependent measure dichotomized based on normative data. The results of multiple regression analyses supported the Belsky orderinig ofpredictors, in that personal andpsychological resources of the parent were more predictive of dysfunctionalparenting attitudes than contextual sources of stress and support, which were more effective than characteristics of the child.

Toward a cumulative ecological risk model for the etiology of child maltreatment

The purpose of the current study was to further the integration of cumulative risk models with empirical research on the etiology of child maltreatment. Despite the well-established literature supporting the importance of the accumulation of ecological risk, this perspective has had difficulty infiltrating empirical maltreatment research and its tendency to focus on more limited risk factors. Utilizing a sample of 842 mother-infant dyads, we compared the capacity of individual risk factors and a cumulative index to predict maltreatment reports in a prospective longitudinal investigation over the first sixteen years of life. The total load of risk in early infancy was found to be related to maternal cognitions surrounding her new role, measures of social support and well-being, and indicators of child cognitive functioning. After controlling for total level of cumulative risk, most single factors failed to predict later maltreatment reports and no single variable provided odd-ratios as powerful as the predictive power of a cumulative index. Continuing the shift away from simplistic causal models toward an appreciation for the cumulative nature of risk would be an important step forward in the way we conceptualize intervention and support programs, concentrating them squarely on alleviating the substantial risk facing so many of society's families.

Toward a cumulative ecological risk model for the etiology of child maltreatment

The purpose of the current study was to further the integration of cumulative risk models with empirical research on the etiology of child maltreatment. Despite the well-established literature supporting the importance of the accumulation of ecological risk, this perspective has had difficulty infiltrating empirical maltreatment research and its tendency to focus on more limited risk factors. Utilizing a sample of 842 mother-infant dyads, we compared the capacity of individual risk factors and a cumulative index to predict maltreatment reports in a prospective longitudinal investigation over the first sixteen years of life. The total load of risk in early infancy was found to be related to maternal cognitions surrounding her new role, measures of social support and well-being, and indicators of child cognitive functioning. After controlling for total level of cumulative risk, most single factors failed to predict later maltreatment reports and no single variable provided odd-ratios as powerful as the predictive power of a cumulative index. Continuing the shift away from simplistic causal models toward an appreciation for the cumulative nature of risk would be an important step forward in the way we conceptualize intervention and support programs, concentrating them squarely on alleviating the substantial risk facing so many of society's families.

Empathy and child neglect: a theoretical model

OBJECTIVE

To present an explanatory theory-based model of child neglect. This model does not address neglectful behaviors of parents with mental retardation, alcohol or drug abuse, or severe mental health problems. In this model parental behavior aimed to satisfy a child's need is considered a helping behavior and, as a consequence, child neglect is considered as a specific type of non-helping behavior.

HYPOTHESIS

The central hypothesis of the theoretical model presented here suggests that neglectful parents cannot develop the helping response set to care for their children because the observation of a child's signal of need does not lead to the experience of emotions that motivate helping or because the parents experience these emotions, but specific cognitions modify the motivation to help.

IMPLICATIONS

The present theoretical model suggests that different typologies of neglectful parents could be developed based on different reasons that parents might not to experience emotions that motivate helping behaviors. The model can be helpful to promote new empirical studies about the etiology of different groups of neglectful families.

Child maltreatment in families experiencing domestic violence

This study examined the association between physical domestic violence (PDV) and reported child maltreatment in a cohort of children at risk for maltreatment. Participants were 219 6- to 7-year-old children and their caregivers. PDV was measured by combining caregivers' self-reports and children's reports, while child maltreatment was based on state Division of Social Services Central Registry records. Among 219 child-caregiver pairs studied, 42 (19.2%) had at least one maltreatment report in the 2 years following the interviews. PDV consistently predicted child maltreatment, with adjusted odds ratios ranging from 2.96 to 3.46. In addition, we investigated interactions between PDV and other predictors of child maltreatment. Among Aid to Families with Dependent Children (AFDC) participants, PDV was highly associated with child maltreatment. However, this pattern was not observed among subjects who did not have AFDC. There is an increased incidence of child maltreatment reports in families experiencing PDV. AFDC participation intensified the probability of child maltreatment in the presence of PDV. Findings also suggest that in households experiencing PDV, social supports may protect children from maltreatment.

Bereaved Parents and Support Group Participation

The study explored reasons why some bereaved parents participate in a self-help/support group while others do not. Data about forty-three support group participants and forty-two nonparticipants and their deceased children were obtained through questionnaires and telephone interviews. Over 76 percent of nonparticipants were found to have lost their child after a period of anticipatory grief while 80 percent of participants lost their child suddenly or without adequate forewarning. Having adequate support in their immediate environment was the reason stated by most for not joining a group. The majority of group participants mentioned that they needed a place to share grief with other bereaved parents even though their family and friends were supportive. It appears that bereaved parents are more likely to join a support group when they experience a particularly traumatic loss and do not find others who have suffered a similar loss in their usual social network.

Social isolation from communities and child maltreatment: a cross-cultural comparison

OBJECTIVE

The aim of this study is to determine: (1) the differences between Spanish and Colombian cultures in relation to community social support variables, and (2) the relationships between community social support variables and child maltreatment in both cultures.

METHOD

The study was based on 670 nonabusive families and 166 abusive families. The parents were asked to complete the Community Social Support Questionnaire. This instrument measures community social support in terms of Community Integration and Satisfaction, membership in voluntary organizations and community participation, and use of Community Resources of Social Support.

RESULTS

Differences between both cultures were found in the pattern of community social support for the nonabusive groups. However, the relationships between community social support and child maltreatment were similar cross-culturally. Our results indicate that in both cultures abusive parents show lower levels of community integration, participation in community social activities and use of formal and informal organizations than the parents that provide adequate care.

CONCLUSIONS

The results largely support the literature that has repeatedly reported the link between social isolation and child maltreatment and they confirm this relation within two cultural contexts, Colombian and Spanish, quite different from the Anglo-Saxon context, where most of the previous studies have been carried out.

Effects of respite care for children with developmental disabilities: evaluation of an intervention for at risk families

Respite child care programs that provide temporary child care, support, and referral services to families of children with developmental disabilities are thought to be a critical component of formal social support interventions deemed necessary to promote healthy family functioning and prevent child maltreatment. This study describes sociodemographic characteristics, parenting stress levels, foster care placement, and founded child maltreatment rates in families of children with developmental disabilities who were using respite care services in a rural Midwestern state. Comparison of matched pre- and post-test Parenting Stress Index scores indicated significant decreases in Total Stress scores (t=3.27, df=86, p=0.0016), Parent Domain scores (t=3.55, df=86, p=0.0006), and Child Domain scores (t=2.2, df=86, p=0.02) following provision of respite care. Through logistic regression, it was determined that life stress, social support, and service level were significantly related to the occurrence of child maltreatment during enrollment ( p < 0.05). The investigator suggests that public health nurses can enhance their case management strategies when working with the parents of children with developmental disabilities by monitoring for caregiver burnout in addition to ensuring that the child is receiving care appropriate for his or her level of need.

Elder mistreatment: implications for public health dentistry

Elder mistreatment has increasingly been recognized as a serious and complex health issue affecting large numbers of elders each year. Health professionals have been found to lack knowledge regarding assessment, diagnosis, intervention, and reporting criteria of this problem. In dentistry, there have been recent calls for more research and publications as well as requests for professional policy statements and guidelines. Public health dentistry, with its emphasis on prevention, can lend guidance and leadership at the primary, secondary, and tertiary levels. This article reviews the types and prevalence of elder mistreatment, discusses predisposing variables, and offers an ecological model that serves as a guide to interventions directed at all levels of elder mistreatment prevention.

Predicting child maltreatment in the first 4 years of life from characteristics assessed in the neonatal period

OBJECTIVE

To examine the significance of neonatal risk factors from the individual, family, social, and parenting behavior domains of the ecological model of child maltreatment in predicting maltreatment reports in the first 4 years of life, and to examine the extent to which the interactions of life event stress and social support modify those risk factors.

METHOD

Mothers of 708 predominantly at-risk infants were interviewed in their homes soon after their infants' discharge from the hospital. State child abuse and neglect central registry data were tracked every 6 months until the infants reached their fourth birthdays.

RESULTS

The incidence of maltreatment reports was higher in households where the mothers were depressed, complained of psychosomatic symptoms, had not graduated from high school, consumed alcohol, participated in public income support programs, cared for more than one dependent child, or were separated from their own mothers at age 14 years (p < .1). In interaction models including these seven predisposing variables, there were significant interactions (p < .01) between social support, as measured by the social well-being index after the birth of the index child, and depression, and between social well-being and stress, as measured by an increase in total life events.

CONCLUSION

Some predisposing risk factors measured soon after birth continue to be significant predictors of child maltreatment reports through the fourth year of life. In general, families with low levels of social support had a higher risk of a maltreatment report. For families with lower levels of maternal depression and/or life event stress, low social support significantly increased the risk of a maltreatment report by as much as a factor of four.

Stress, social support, and substantiated maltreatment in the second and third years of life

OBJECTIVE

The purpose of this research was to determine whether risk factors for a maltreatment report in the first year of life, especially the interaction of life event stress and social support, persist into the second and third years of life.

METHOD

Predominantly low income mothers who had been interviewed shortly after the birth of infants in a longitudinal cohort were re-interviewed around the infants' first birthdays, and reports to North Carolina's Central Registry of Child Abuse and Neglect were tracked for substantiated maltreatment reports.

RESULTS

Variables significantly associated with a substantiated maltreatment report in the second or third year of life (p < .01) were first year maltreatment reports and participation in Medicaid. Three interactions between a stressful life event indicator variable and a social support indicator variable were significant predictors of substantiated second or third year reports (p < .05).

CONCLUSIONS

Even in the presence of significant risk factors from the first year of life, life event stress can increase the risk of a substantiated maltreatment report in the second or third years of life, but social support may moderate the effect of life events.

[Conceptual models of child mistreatment: a biopsychosocial approach]

INTRODUCTION

Currently, the concept of child maltreatment extends over any dysfunction in the parent-child relationship, including in its diagnosis all different forms in which parental dysfunction takes place (from the classic child abuse to subtle types of psychological maltreatment).

METHODOLOGY

Review of original articles of Child Abuse and Neglect in 1991-1996, and of other articles cited in this period in that journal. Search of documents in the Spanish literature on this topic.

RESULTS

Several studies carried out in Spain have shown a prevalence rate of 1.5%, although it is widely recognized that this figure is an underestimate. The view of child maltreatment as a psychosocial phenomenon which causes severe consequences in the child's integrated development, has produced conceptual models which explore the relationships among risk and protective factors involved in the occurrence of child maltreatment. The main risk factors are younger parents, anxiety and depression symptoms, monoparental family, and economic stress. Social support has a protective effect.

CONCLUSION

A better understanding of the dynamics of protective and risk factors for child abuse is needed in order to carry out effective interventions in prevention and intervention programs against child maltreatment.

Assessment of coping strategies of child abusing mothers

OBJECTIVE

Mothers who had physically abused their children were assessed to determine whether these mothers had a general coping skills deficit.

METHOD

Abusing mothers (n = 17) were compared to nonabusing mothers of conduct problem children (n = 16). Coping was measured by several methods, each designed to address the insufficiencies of the others.

RESULTS

In comparison to the nonabusing mothers, independent ratings indicated that abusing mothers exhibited a pattern of coping characterized by greater use of emotion-focused coping strategies and less use of effective problem-focused strategies. Finally, using self report ratings of coping, abusing mothers perceived their coping to be more ineffective than the nonabusing mothers.

CONCLUSIONS

The possibility that the observed coping skills deficit may be indicative of a deficit in emotional responding to stress was discussed and suggestions were given for therapeutic interventions with child abusing mothers.

Moderating effects of physical abuse and perceived social support on the potential to abuse

This study investigated the moderating effects of perceived prepubertal social support on the relationship between prepubertal childhood physical abuse and child abuse potential as well as on the relationship between a childhood history of abuse and conflict and depth in adult relationships. Three hundred and sixty-nine undergraduate men and women were classified as abused or nonabused based on their responses to the Childhood History Questionnaire. Multiple regression analyses revealed interactions of social support and a childhood history of physical abuse on both the potential to abuse and the quality of participants' relationships with their parents. Differences between abused and nonabused individuals were obtained only under conditions of low perceived social support. When social support was perceived to be high, abused and nonabused individuals did not differ in the potential to abuse or in the ratings of the depth of their relationships with parents. Implications of these findings for the intergenerational transmission of abuse are discussed.

Reabuse rates in a sample of children followed for 5 years after discharge from a child abuse inpatient assessment program

Efforts to accurately measure rates of reabuse have been elusive because of problems in definition and methodology. The present study examines reabuse rates across a 5-year follow-up period in a sample of children assessed for child abuse (October 1986-October 1987). Participants consisted of 304 children (7 months-15 years of age), systematically selected from a population of 1,100 children consecutively admitted to a hospital-based, interdisciplinary, child abuse assessment unit. Reabuse was determined by matching sample names against information in a centralized reporting system. Reabuse was studied across demographic and socioeconomic variables, vulnerability days, initial and subsequent type(s) of abuse, and other considerations. At the end of the 61-72 month follow-up period, the sample had a 16.8% incidence of reabuse. The greatest risk of reabuse occurred during the first 2 years following an initial discharge diagnosis of maltreatment. Although no particular initial maltreatment diagnosis was a statistically significant predictor of the likelihood or type of reabuse, neglect was shown to be the most frequent type of reabuse. Children experiencing reabuse were more likely to reside in public housing/apartments, have unmarried and/or unemployed parent(s), and be Medicaid recipients. Opportunities for secondary prevention initiatives and future research are discussed.

Risk of child abuse or neglect in a cohort of low-income children

The purposes of this research were to identify risk factors for reported child abuse or neglect and to examine the roles of stress and social support in the etiology of child maltreatment. Mothers of newborn infants with biomedical and sociodemographic risk factors were recruited from community and regional hospitals and local health departments in 42 counties of North and South Carolina selected for geographic distribution and for large numbers of such newborns. For every four such mothers, the next mother to deliver an otherwise normal newborn was sought. Mothers were interviewed shortly after giving birth, and state Central Registries of Child Abuse and Neglect were reviewed when each infant was 1 year of age. Eight hundred forty-two of 1,111 recruited mothers were successfully interviewed in their homes between March 1986 and June 1987. Seven hundred forty-nine North Carolina births who resided in the state more than 6 months were eligible for inclusion in the analysis. Logistic regression with backward elimination procedures was used in the analysis. Maternal education (p < .01), number of other dependent children in the home (p < .01), receipt of Medicaid (p < .01), maternal depression (p < .05), and whether the maternal subject lived with her own mother at age 14 years (p < .05) were the best predictors of a maltreatment report. Further examination revealed an interaction effect between stressful life events, as measured by life event scores, and social well-being (p < .01). For children born at risk for social and/or medical problems, extreme low income (participation in public income support programs), low maternal education, maternal depression, the presence of any other young children in the home, and a mother's separation at age 14 years from her own mother significantly predict child maltreatment reports in the first year of life. In addition, stressful life events, even if perceived positively, may increase or decrease the risk of maltreatment reports, depending upon the presence of social support.

Family health and mental health six years after economic stress and unemployment

This study is a follow-up of 39 working class couples who were interviewed after suffering economic stress or unemployment and again six years later. Repeated measures related to economics, stress, family functioning, anxiety, and depression were collected and analyzed for couples and for husbands and wives separately. A model of long-term coping was suggested for future testing. Initially stressed families appeared to grow stronger. Mental health correlated negatively to family problems. Depressed wives seemed to maintain their depression over time if they perceived family life as stressful. Irrespective of marital problems, husbands were less likely to stay depressed.

Predicting child abuse potential across family types

The present study was conducted to explore whether stress, family resources, and social support are correlates of the child abuse potential of mothers, and whether prediction functions differ across families with children with disabilities and families with no children with disabilities. The design and analyses were correlational. Statistically and practically significant relationships were found. Stress in family functioning appears to be an important predictor of child abuse potential, and it is suggested that interventions might be designed to target related features of family functioning.

Parenting stress and social support of mothers who physically abuse their children in Hong Kong

Thirty-seven identified abusive mothers were matched on demographic and socioeconomic parameters with a known nonabusive comparison sample in order to examine the role of parenting stress and maternal social support. The mothers were assessed using a personal (demographic) questionnaire, the Parenting Stress Index (PSI), and the Maternal Support Index (MSSI). Demographic data showed that the two groups were comparable on all variables except abusive mothers had significantly more children (p = .01). Abusive mothers showed significantly more stress on total PSI scores (p = .005), as well as in all three of the subjects: Child Domain (p = .007) Parent Domain (p = .02), and Life Stress (p = .016). Abusive mothers scored lower in all seven items on the MSSI. The difference was significant on the MSSI as a whole (p = .007) and on four subsets: number of people to count on in time of need (p = .02), perceived neighborhood support (p = .04), satisfaction with spousal relationship (p = .01), and degree of community involvement (p = .03). The greatest percentage (74.32%) of correct predictions of child abuse was achieved by combining the number of children, the Life Stress Scale and the MSSI. Implications for future research are discussed.

The role of parental stress in physically abusive families

This study examines the role of several components of parental stress in physically abusive and nonabusive families with conduct-disordered children. The 123 families studied were seen in a parenting clinic aimed at improving parent-child interactions in families with a highly oppositional child. Data were collected over a several-week period and included both mother and father self-report measures and independent observations by trained researchers. Parental stress was found to play an important role in abusive families. Physically abusive families were significantly more often low income, had younger mothers with less education, more frequently reported a family history of child abuse, and were more likely to be abusing alcohol or drugs. Abusive mothers reported more stress due to frequent life events, and had a more negative perception of these events. Further, these mothers had higher rates of both depression and state anxiety. Abusive fathers spanked their children significantly more often than the nonabusive fathers, and abusive mothers had the highest frequency of critical statements directed at their children. Children from abusive households had significantly more behavior problems. Finally, abusive mothers reported more marital dissatisfaction and social isolation than their nonabusive counterparts.

A comparison of young teenage, older teenage, and adult mothers on determinants of parenting

A nonrandom socioeconomically homogeneous convenience sample of 150 young adolescent mothers, 260 older adolescent mothers, and 242 older mothers was analyzed according to their standing on key determinants of parenting. The results of a discriminant analysis showed that the young teen mothers differed from the older mothers in terms of knowledge of child development, punitive attitudes toward childrearing, and level of depression. Accuracy of classification was improved with the discriminant function for younger and older mothers, but decreased by 20% for older adolescents.

A factorial analysis of a compound measure of social support

A confirmatory factor analysis of an internally consistent compound measure of social support is presented for a volunteer sample of 740 low-income, predominantly single, young mothers. Five factors with eigen values greater than one emerged and accounted for 55% of the variance. The convergent validity of the empirically identified factors of estrangement, confidant, short-term help, support/encouragement, and crisis intervention was explored through intercorrelations with five variables theoretically related to family and child well being. Level of depressive symptomology correlated most significantly and consistently with low levels of social support. The results of the analysis are discussed in light of previous psychometric analyses of comparable measure of social support and what is known of the coping response of young mothers to stress.