Predicting long-term outcomes for women physically abused in childhood: contribution of abuse severity versus family environment

Childhood physical maltreatment with physical injuries is associated with higher adult psychopathology symptoms

BACKGROUND

Previous research has neglected the distinction between childhood physical maltreatment (CPM) behaviors and the physical sequelae resulting from CPM. Prior empirical work has combined CPM behaviors (e.g., beat, hit with a belt) and CPM physical sequelae (e.g., bruises, fractures) into a single conceptual category to predict adverse psychological consequences in adults. This is preventing the examination whether specific subgroups of CPM exposure may report a higher risk of psychopathology symptoms in adulthood. The aim of this study was to examine whether distinct experiences of CPM histories (no physical maltreatment, physical maltreatment only, and physical maltreatment with physical sequelae) would be differentially associated with specific psychopathology dimensions in adulthood. symptoms METHOD: Data were drawn from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect (N = 941). Participants completed the Childhood History Questionnaire and the Brief Symptom Inventory.

RESULTS

Three groups were created based on participants' experience of CPM assessed by the Childhood History Questionnaire. Participants who reported that suffered physical sequelae of the CPM exhibited significantly higher symptoms in all psychopathology dimensions than participants with no history of CPM and participants that were exposed to physical maltreatment without sequelae.

CONCLUSIONS

These findings suggest that clinicians should discriminate CPM behavior from CPM physical sequelae in order to increase effectiveness of mental health treatment with adults with history of CPM. Our findings are discussed in light of the evolutionary-developmental frameworks of adaptative development and cumulative risk hypothesis.

Adverse Childhood Experiences and Alcohol Consumption in Midlife and Early Old-Age

AIMS

To examine the individual and cumulative effects of adverse childhood experiences (ACEs) on alcohol consumption in midlife and early old-age, and the role of ACEs in 10-year drinking trajectories across midlife.

METHODS

Data were from the Whitehall II study, a longitudinal British civil service-based cohort study (N = 7870, 69.5% male). Multinomial logistic regression was used to examine the individual and cumulative effects of ACEs on weekly alcohol consumption. Mixed-effect multilevel modelling was used to explore the relationship between ACEs and change in alcohol consumption longitudinally.

RESULTS

Participants who were exposed to parental arguments/fights in childhood were 1.24 (95% CI 1.06, 1.45) times more likely to drink at hazardous levels in midlife (mean age 56 years) after controlling for covariates and other ACEs. For each additional exposure to an ACE, the risk of hazardous drinking versus moderate drinking was increased by 1.12 (95% CI 1.03, 1.21) after adjusting for sex, age, adult socio-economic status, ethnicity and marital status. No associations between ACEs and increased risk of hazardous drinking in early old-age (mean age 66 years) were found. In longitudinal analyses, ACEs did not significantly influence 10-year drinking trajectories across midlife.

CONCLUSION

The effect of exposure to parental arguments on hazardous drinking persists into midlife.

The Role of Family Environment and Multiple Forms of Childhood Abuse in the Shaping of Sexual Function and Satisfaction in Women

Studies suggest that sexual self-schemas are an important cognitive mechanism in the sexual development of women with a history of childhood abuse. This literature is only beginning to explore how multiple forms of abuse (i.e., physical, emotional, and sexual), rather than sexual abuse alone, can influence the development of adult sexuality. Moreover, the extant literature has not carefully considered important factors other than the severity of the abuse that may relate to sexual self-schemas, including family environment and quality of romantic relationships. Findings from this cross-sectional study conducted on 417 heterosexual women (ages 18-25 years) suggest that family dynamics and different types of childhood abuse contribute both directly and indirectly to adult sexual function and satisfaction and that part of those effects were mediated by other factors such as sexual self-schemas and romantic relationship quality. These results, including an exploration of the direct and indirect effects, were discussed in terms of the pervasive effects of abuse on people's lives and the potential treatment targets that can be addressed when trying to reduce sexual problems in women with a history of abuse.

Maladaptive family dysfunction and parental death as risk markers of childhood abuse in women

This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2-3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327-10.755; p <.013), childhood parental substance abuse is a risk marker for childhood sexual (OR: 3.72; 95% CI: 1.480-9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000-6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175-7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168-5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse.

Child maltreatment and adolescent mental health problems in a large birth cohort

OBJECTIVE

To examine whether notified child maltreatment is associated with adverse psychological outcomes in adolescence, and whether differing patterns of psychological outcome are seen depending on the type of maltreatment.

METHODS

The participants were 7,223 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalizing and externalizing scales of the Youth Self Report (YSR) at approximately 14 years of age.

RESULTS

The YSR was completed by 5,172 subjects (71.6%), with increased attrition of cases of notified maltreatment. After adjustment for potential confounders, notified maltreatment was significantly associated with both internalizing behavior and externalizing behavior at 14. When evaluated as non-exclusive categories of maltreatment, physical abuse, neglect, and emotional abuse were each significantly associated with both internalizing and externalizing behavior after adjustment. When evaluated using an expanded hierarchical scheme that included combinations of multi-type maltreatment, the following groups had significantly higher internalizing behavior after adjustment: emotional abuse (with or without neglect), and multi-type maltreatment including physical (but not sexual) abuse with neglect and/or emotional abuse. The following groups were associated with externalizing behavior after adjustment: emotional abuse (with or without neglect), and multi-type maltreatment including physical abuse (with neglect and/or emotional abuse), or sexual abuse (with neglect and/or emotional abuse, and/or physical abuse).

CONCLUSION

This study suggests that child neglect and emotional abuse have serious adverse effects on adolescent mental health and warrant the attention given to other forms of child maltreatment. Additionally, it confirms that young people who are notified for more than one type of maltreatment are at particular risk of adolescent mental health problems.

Subjective well-being in Finnish adolescents experiencing family violence

This article describes the relationship between adolescent subjective well-being and experiences of family violence reported by a sample of 14- to 17-year-old adolescents living in one Finnish municipality (N = 1,393). Survey results found that experiences of family violence were common. The logistic regression model showed that experiences of violence were associated with adolescents' feeling of inner disequilibrium and markedly strong relationships with friends. In additional, adolescents who experienced family violence rated their health as poorer than adolescents from nonviolent homes. They also surprisingly reported being satisfied with their life and did not necessarily identify their need for help. Although adolescents are resilient and have some resources to cope with violence, nurses and other professionals should attend more carefully to adolescents' reports of health and behavioral problems and assess for the presence of family violence and school bullying.

The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis

BACKGROUND

Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes.

METHODS AND FINDINGS

A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships.

CONCLUSIONS

This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence.