Child maltreatment rates assessed in a national household survey of caregivers and youth

Victimization and abuse among children with disabilities: Age adjusted rates in a US national sample

BACKGROUND

Research has indicated that children with disabilities are at higher risk for victimization although the literature on this topic is limited.

OBJECTIVE

We examined rates of assault, sexual victimization, peer-sibling victimization, property crime, maltreatment, and poly-victimization among youth in the United States with and without disabilities. We examined these rates for three age groups (children ages 0-4 years, ages 5-11 years, and ages 12-17 years).

PARTICIPANTS AND SETTING

We use data from the National Survey of Children's Exposure to Violence (NatSCEV), waves I (2008), II (2011), and III (2014). These are cross-sectional nationally representative samples of children and youth ages one month to 17 years (N = 12,634).

RESULTS

Considering children of all ages together, children in all disability categories, except for physical disability, were at higher risk for poly-victimization. Victimization exposure overall is higher among older children (except for assault among very young children with developmental or learning disabilities), though the disparity between children with and without disabilities generally narrows as children get older. Age of the child impacted the relationships between disability and victimization. Very young children with physical disabilities were at heightened risk for most types of victimization while children with internalizing disabilities were at heightened risk for assault, property crime, and maltreatment in middle childhood and adolescence. Children with externalizing disabilities were at heightened risk for most types of victimization across all ages while developmental disabilities appeared to be risk factor for very young children and a potentially protective factor at later ages though these varied by type of victimization.

CONCLUSION

Victimization risk varied by victimization and disability types. This study demonstrates the importance of controlling for demographic characteristics, especially age of the child in estimating the prevalence of victimization among children with disabilities and establishes the importance of type-specific analyses by victimization type, disability type, and age of the child.

Validity and reliability of the 10-Item Adverse Childhood Experiences Questionnaire (ACE-10) among adolescents in the child welfare system

Introduction

Multiple evidence suggests that the vast majority of children in the Child Welfare System (CWS) are victims of early, chronic, and multiple adverse childhood experiences. However, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10) has never been tested in such a particularly vulnerable population as adolescents living in the CWS. We aimed to assess the psychometric properties of the ACE-10 in a community sample of 240 Hungarian adolescents placed in family style group care (FGC) setting.

Methods

Demographic data, the 10-item version of the Adverse Childhood Experiences Questionnaire (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Bullying Measure were used.

Results

Our results showed acceptable internal consistency (α = 0.701) and item-total correlations (rpb = 0.25-0.65, p < 0.001). However, our results also reflect that item 6 ("Parental separation/divorce") is weakly correlated with both the cumulative ACE score and the rest of the questionnaire items. When item 6 is removed, the 9-item version of the ACE produces more favorable consistency results (α = 0.729). Strong and significant associations of the cumulative ACE score with emotional and behavioral symptoms and bully victimization confirm the concurrent criterion validity of both versions of the instrument.

Discussion

Our findings suggest that ACE-9 and ACE-10 are viable screening tools for adverse childhood experiences in the CWS contributing to the advancement of trauma-informed care. We recommend considering the use of either the 9-item or the 10- item version in the light of the characteristics of the surveyed population. The implications and limitations are discussed.

Caregiver Psychological Maltreatment Behaviors Toward Children on TikTok

We examined TikTok user engagement when parents post videos engaging in psychological maltreatment (PM) behaviors towards their children, using the APSAC-endorsed definition of PM. A new TikTok account was created and seeded with PM behavior videos identified previously; similar videos then appeared on the new account's "For You Page" (an algorithmic feed curated by TikTok). Researchers identified 35 creators who had posted at least one PM behavior video, resulting in their full profile being coded (N = 2684 videos) for five engagement metrics, presence of children, and presence of PM behavior. Non-parametric paired comparisons (Mann-Whitney tests) were made within individual creators for: (1) engagement metrics before and after the first PM behavior video, (2) engagement metrics for PM behavior videos versus non-PM videos, (3) engagement metrics for child videos versus non-child videos, and (4) proportion of videos containing children before and after the first PM video. All but one analysis was significant (effect sizes from .28 to .59, average r = .46). We discuss directions for future research, as well as how child welfare and content moderation policy can be updated to change social norms around sharenting.

A Three-Way Interaction of Sex, PER2 rs56013859 Polymorphism, and Family Maltreatment in Depressive Symptoms in Adolescents

The prevalence of depressive symptoms in adolescents is 12-18% and is twice as frequent in females. Sleep problems and thoughts of death are depressive symptoms or co-occurrent phenomena. Family maltreatment is a risk factor for later depressive symptoms and the period circadian regulator (PER) has been studied in relation to neurotransmitters, adaptation to stress, and winter depression. The purpose of this work was to study the relation of the three-way interactions of sex, PER2 rs56013859, and family maltreatment in relation to core depressive symptoms, sleep complaints, and thoughts of death and suicide in self-reports from a cohort of Swedish adolescents in 2012, 2015, and 2018. Cross-sectional and longitudinal analyses with linear and logistic regressions were used to study the relationships to the three outcomes. The three-way interaction was related to core depressive symptoms at both baseline and six years later. In contrast, the model did not show any relation to the other dependent variables. At 13-15 years, a sex-related differential expression was observed: females with the minor allele C:C/C:T exposed to family maltreatment showed higher levels of core depressive symptoms. Six years later, the trend was inverted among carriers of minor alleles.

Differential Pathways from Child Maltreatment Types to Insecure Adult Attachment Styles via Psychological and Social Resources: A Bayesian Network Analysis

Child maltreatment has been linked to insecure adult attachment. However, it is not yet clear how different child maltreatment types are associated with attachment-related anxiety and avoidance in adulthood; and whether resilience against these insecure attachment styles is dependent on risk-specific resources. Therefore, this study explored differential pathways from child maltreatment types to attachment-related anxiety and avoidance in adulthood and examined whether psychological resources (self-esteem) and social resources (perceived social support) show risk-specific effects. An online survey retrospectively assessed experiences of child maltreatment, the level of attachment-related anxiety and avoidance in adulthood, self-esteem, and perceived social support in N = 604 former members of fundamentalist Christian faith communities (mean age = 41.27 years, SD = 12.50; 65.90% female). Cross-sectional data was analyzed using Bayesian network analysis. Only emotional child maltreatment showed direct relationships to insecure adult attachment. Specifically, emotional abuse and emotional neglect were associated with anxious and avoidant adult attachment, respectively. The effects of other child abuse types on adult attachment were mediated through emotional abuse, which indicated patterns of complex traumatization. Self-esteem mediated the effect of emotional abuse on anxious attachment, while perceived social support mediated the effect of emotional neglect on avoidant attachment. Social support was also linked to self-esteem and was therefore also important for individuals with experiences of emotional abuse. This study showed that child maltreatment types and their interactions are meaningfully linked to attachment-related anxiety and avoidance in adulthood. Interventions for survivors of child maltreatment should focus on risk-specific resources to support their resilience.

Child Maltreatment Reporting Practices by a Person Most Knowledgeable for Children and Youth: A Rapid Scoping Review

Child maltreatment is a global public health and child rights crisis made worse by the ongoing COVID-19 pandemic. While understanding the breadth of the child maltreatment crisis is foundational to informing prevention and response efforts, determining accurate estimates of child maltreatment remains challenging. Alternative informants (parents, caregivers, a Person Most Knowledgeable-PMK) are often tasked with reporting on children's maltreatment experiences in surveys to mitigate concerns associated with reporting child maltreatment. The overall purpose of this study was to examine child maltreatment reporting practices in surveys by PMKs for children and youth. The research question is: "What is the nature of the evidence of child maltreatment reporting practices in general population surveys by PMKs for children and youth?" A rapid scoping review was conducted to achieve the study's purpose. A search strategy was conducted in nine databases (e.g., MEDLINE, EBSCO, Scopus, Global Health, ProQuest). The findings from this review indicate that most studies involved PMK informants (i.e., maternal caregivers), included representative samples from primarily Western contexts, and utilized validated measures to assess child maltreatment. Half of the studies assessed involved multi-informant reports, including the PMKs and child/youth. Overall, the congruence between PMK-reported and child/youth-reported child maltreatment experiences was low-to-fair/moderate, and children/youth reported more maltreatment than the PMKs.

Victimization by Caregivers: Prevalence and Risk Factors in Chilean Children and Adolescents

This study examined the prevalence and risk factors associated to victimization by caregivers in a national large sample of Chilean children and adolescents. 19,687 children and adolescents aged 12-17, selected by random probability sampling of 699 public schools in Chile who were surveyed by trained interviewers. Victimization by Caregivers was evaluated through a module of the Juvenile Victimization Questionnaire (JVQ). The prevalence (12 months) for physical abuse were (12.9%), for emotional abuse (27.9%), neglect (5.3%) and parental interference (3.5%). The results suggest as risk factors, sex, age, migration status, disability, geographical location, and type of school. The findings highlight the urgent need to address the issue of child maltreatment and victimization by caregivers in Chilean society and minimize its impact.

A Gene-Environment Interaction Study of Polygenic Scores and Maltreatment on Childhood ADHD

This study explored whether maltreatment moderates the association of polygenic risk for ADHD. Because individuals with low polygenic scores (PGS) for ADHD were previously shown to have better than expected functional outcomes (i.e., cognitive, mental health, social-emotional) than individuals with middle or high ADHD PGS, we hypothesized low ADHD PGS may confer a protective effect from maltreatment in the development of ADHD. Data were from participants with phenotypic and genotypic data in the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 4,722). ADHD PGS were generated from the most recent genome-wide association study on ADHD and categorized into three groups (i.e., low, medium, high) using empirically determined cut-points. A maltreatment factor score was derived from five forms of self-reported maltreatment experiences prior to age 18. ADHD PGS and maltreatment were positively associated with ADHD symptoms, as expected. However, no interaction between ADHD PGS and maltreatment on ADHD symptoms was detected. Despite the increase in predictive power afforded by PGS, the lack of an interaction between ADHD PGS and maltreatment on ADHD symptoms converges with an emerging body of PGS studies that have also failed to detect PGS-environment interplay in mental disorders. We discuss possible reasons for this pattern of results and offer alternative methods for future research in understanding gene-environment interactions.

The association between adverse childhood experiences and childhood obesity: A systematic review

Adverse childhood experiences (ACEs) are associated with numerous physical and mental health issues in children and adults. The effect of ACEs on development of childhood obesity is less understood. This systematic review was undertaken to synthesize the quantitative research examining the relationship between ACEs and childhood obesity. PubMed, PsycInfo, and Web of Science were searched in July 2020; Rayyan was used to screen studies, and the Newcastle-Ottawa Scale was used to assess risk of bias. The search resulted in 6,966 studies screened at title/abstract and 168 at full-text level. Twenty-four studies met inclusion criteria. Study quality was moderate, with greatest risk of bias due to method of assessment of ACEs or sample attrition. Findings suggest ACEs are associated with childhood obesity. Girls may be more sensitive to obesity-related effects of ACEs than boys, sexual abuse appears to have a greater effect on childhood obesity than other ACEs, and co-occurrence of multiple ACEs may be associated with greater childhood obesity risk. Further, the effect of ACEs on development of childhood obesity may take 2-5 years to manifest. Considered collectively, findings suggest a need for greater attention to ACEs in the prevention and treatment of childhood obesity.

Validation and cross-cultural comparisons of the German Childhood Attachment and Relational Trauma Screen (CARTS)

Background: Child maltreatment is embedded in a complex system of familial, societal and cultural influences. However, the microsystemic framework in which child maltreatment occurs has not been sufficiently accounted for in previous measures of trauma history. In order to include this relational context, a novel survey method, the Childhood Attachment and Relational Trauma Screen (CARTS), was developed, focusing specifically on the familial environment and childhood attachment relationships. Prior validation studies of the English and Italian versions of the CARTS have tended to support its use. Objective: The current study aims at evaluating the psychometric properties of the German version of the CARTS as well as conducting cross-cultural comparison analyses. It is part of an international research project of the Global Collaboration on Traumatic Stress which was initiated by the International Society for Traumatic Stress Studies (ISTSS). Method: The sample consisted of n = 140 participants from the German general population aged 18 or older. Further trauma specific measures (GPS, BSI-18, CTQ-SF, ECR-R, PBI) were included for validation. Cross-cultural comparisons were conducted with a German subsample of students in reference to Italian- and English-speaking student samples. Results: Most CARTS subscales showed acceptable internal consistency. Statistically significant relationships were observed with other measures of childhood trauma exposure and parental bonding, as well as PTSD- and other distress-related outcomes. Comparing the German-speaking sample with Italian- and English-speaking samples indicated significant differences with regard to childhood attachment and child maltreatment. Conclusion: The present findings are consistent with previous results concerning the CARTS and advance the validation of this novel survey method within German-speaking samples. Further, the CARTS appears to be sensitive to cross-sample differences in childhood attachment and child maltreatment. Further psychometric evaluations of the CARTS in other languages and within further German-speaking samples are needed.

The Australian Child Maltreatment Study (ACMS): protocol for a national survey of the prevalence of child abuse and neglect, associated mental disorders and physical health problems, and burden of disease

INTRODUCTION

Child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence) is widely understood to be associated with multiple mental health disorders, physical health problems and health risk behaviours throughout life. However, Australia lacks fundamental evidence about the prevalence and characteristics of child maltreatment, its associations with mental disorders and physical health, and the associated burden of disease. These evidence gaps impede the development of public health strategies to better prevent and respond to child maltreatment. The aims of this research are to generate the first comprehensive population-based national data on the prevalence of child maltreatment in Australia, identify associations with mental disorders and physical health conditions and other adverse consequences, estimate attributable burden of disease and indicate targeted areas for future optimal public health prevention strategies.

METHODS AND ANALYSIS

The Australian Child Maltreatment Study (ACMS) is a nationwide, cross-sectional study of Australia's population aged 16 years and over. A survey of approximately 10 000 Australians will capture retrospective self-reported data on the experience in childhood of all five types of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence). A customised, multimodule survey instrument has been designed to obtain information including: the prevalence and characteristics of these experiences; diagnostic screening of common mental health disorders; physical health; health risk behaviours and health service utilisation. The survey will be administered in March-November 2021 to a random sample of the nationwide population, recruited through mobile phone numbers. Participants will be surveyed using computer-assisted telephone interviews, conducted by trained interviewers from the Social Research Centre, an agency with extensive experience in studies of health and adversity. Rigorous protocols protect the safety of both participants and interviewers, and comply with all ethical and legal requirements. Analysis will include descriptive statistics reporting the prevalence of individual and multitype child maltreatment, multiple logistic and linear regression analyses to determine associations with mental disorders and physical health problems. We will calculate the population attributable fractions of these putative outcomes to enable an estimation of the disease burden attributable to child maltreatment.

ETHICS AND DISSEMINATION

The study has been approved by the Queensland University of Technology Human Research Ethics Committee (#1900000477, 16 August 2019). Results will be published to the scientific community in peer-reviewed journals, scientific meetings and through targeted networks. Findings and recommendations will be shared with government policymakers and community and organisational stakeholders through diverse engagement activities, a dedicated Advisory Board and a systematic knowledge translation strategy. Results will be communicated to the public through an organised media strategy and the ACMS website.

Complex PTSD and borderline personality disorder

BACKGROUND

This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD.

MAIN BODY

The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment.

CONCLUSION

The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.

Interventions that address institutional child maltreatment: An evidence and gap map

Background

Child maltreatment has serious short and long-term negative impacts for those experiencing it. Child maltreatment occurring in institutional settings has recently received substantial attention. However, evidence about the effectiveness of interventions that prevent, disclose, respond to, or treat maltreatment that has occurred in these environments is fragmented and can be difficult to access. This evidence and gap map (EGM) collates this research evidence. It was developed as a resource for stakeholders operating in the child health, welfare and protection sectors, including practitioners, organisational leaders, policy developers and researchers, wanting to access high quality evidence on interventions addressing institutional child maltreatment.

Objectives

The objectives of this EGM were twofold: (a) To provide a structured and accessible collection of existing evidence from finalised and ongoing overviews of systematic reviews, systematic reviews and effectiveness studies of interventions addressing institutional child maltreatment-for those who work to fund, develop, implement and evaluate interventions aimed at ensuring children's safety in institutional settings; (b) to identify gaps in the available evidence on interventions addressing institutional child maltreatment-thereby helping to inform the research agendas of funders and other organisations.

Search Methods

A comprehensive search strategy identified relevant studies from published and grey literature, comprising: (1) 10 electronic academic databases; (2) five trial and systematic review registries; (3) nine organisational websites; (4) websites and reference lists of inquiry reports associated with seven international inquiries into child abuse and (4) the lists of included studies within systematic reviews identified by the search strategy. Members of this EGM's Subject Matter Experts group were also invited to forward relevant unpublished studies or grey literature.

Selection Criteria

The selection criteria were developed to identify finalised and ongoing overviews of reviews, systematic reviews and primary studies that reported on the effectiveness of interventions addressing child maltreatment (including sexual abuse, physical abuse, neglect and emotional abuse) within institutional settings. Eligible effectiveness study designs included: randomised controlled trials (RCTs), nonrandomised trials, controlled before-and-after studies and quasi-experimental studies. Reviews were eligible if they reported a systematic literature search strategy.

Data Collection and Analysis

All screening, data extraction, coding and critical appraisals were undertaken by two or more reviewers working independently, with discrepancies resolved via consensus or by a third reviewer. The titles and abstracts of studies identified by the search strategy were screened, and each full text of potentially relevant studies was further assessed for inclusion. Key data were extracted from all included studies and reviews. This included information about: publication details (e.g., year, author, country), inclusion/exclusion criteria (for reviews), study design, institutional setting, target population, type of maltreatment, intervention type and outcomes. Critical appraisal of included systematic reviews was achieved using the AMSTAR 2 tool, and completed RCTs were assessed using the updated Cochrane Risk of Bias 2.0 tool.

Main Results

Number of studies The electronic database search yielded 6318 citations, and a further 2375 records were identified from additional sources. Following deduplication and title/abstract screening, 256 studies remained for full text review. A total of 73 eligible studies (reported across 84 publications) met the inclusion criteria, including: 11 systematic reviews (plus, one update); 62 primary studies (including, three protocols for primary studies). Study characteristics The studies were conducted across 18 countries, however more than half (52%) were undertaken in the United States. Overall, most studies evaluated curriculum-based interventions delivered in educational settings, primarily aimed at the prevention of sexual abuse. Institutional setting: Most studies evaluated interventions in school or early learning environments (n = 8 systematic reviews; n = 58 primary studies). Far fewer studies examined other organisational settings. Out of home care (including foster care, residential care and orphanages), and social service organisations servicing children were minimally represented. No studies were identified where the primary setting was sports clubs, churches/religious organisations, summer/vacation camps, detention centres/juvenile justice settings, or primary/secondary health care facilities. Target population: Most interventions targeted children rather than adults (n = 7 systematic reviews; n = 47 primary studies) from the general population. Fewer studies included populations known to be at an increased risk, or those already exposed to maltreatment. Just over a third of the primary studies conducted an analysis to ascertain differences in the effect of an intervention between the genders. Intervention type: Prevention interventions were the most studied (n = 5 systematic reviews; n = 57 primary studies), with additional studies including prevention approaches alongside other intervention types. Fewer studies evaluated interventions targeting disclosure, institutional responses, or treatment interventions. Type of maltreatment: The vast majority of the studies assessed interventions solely addressing the sexual abuse of children (n = 8 systematic reviews; n = 45 primary studies). The remaining studies addressed other forms of maltreatment, including physical and emotional abuse, or neglect, either in combination or as a sole focus. Outcomes: Primary reported outcomes reflected the bias toward child targeted interventions. Outcome measures captured child wellbeing and knowledge outcomes, including measures of mental health, children's knowledge retention and/or self-protective skills. Measures of maltreatment disclosure or maltreatment occurrence/reoccurrence were less common, and all other outcome categories included in the EGM were minimally or not reported. A third of studies reported on some measure of implementation. Study quality The overall quality of the studies was low to moderate. Most systematic reviews were low-quality (n = 10), with only one high quality review (and update) identified. Most completed RCTs had some concerns relating to the risk of bias (n = 30), and the remainder were considered to be at a high risk of bias (n = 19).

Authors' Conclusions

This EGM has highlighted a substantial need for more high quality studies that evaluate interventions across a broader range of institutional contexts and maltreatment types. The current evidence base does not represent countries with large populations and the greatest incidence of child maltreatment. Few studies focussed on perpetrators or the organisational environment. Further evidence gaps were identified for interventions relating to disclosure, organisational responses and treatment, and few studies assessed interventions targeting perpetrators' maltreatment behaviours, recidivism or desistence. Future studies should also include measure of programme implementation.

Training for mandated reporters of child abuse and neglect: Content analysis of state-sponsored curricula

BACKGROUND

Child abuse and neglect is a public health concern around the world, with well-established impacts and costs to children, families, and society. While mandated reporters make the majority of reports, child abuse is still under-reported and many mandated reporters fail to report known and suspected cases.

OBJECTIVE

This study was designed to evaluate the content of US state-sponsored online mandated reporter training in order to identify gaps and need for improvement in mandated reporter training.

METHODS

A deductive qualitative content analysis of the publicly available curricula was conducted. Variables coded were identified through a literature review and consultation with experts.

RESULTS

Numerous gaps were identified in the curricula including: few trainings identified reasons why reports should be made, only about one fourth included a definition, indicators, and examples of each type of maltreatment, the average number of suggestions for responding to a disclosure made by a child was 3, and few curricula addressed barriers to reporting or the impact of reporting on the reporter.

CONCLUSIONS

The trainings as a whole are not providing mandated reporters with comprehensive information about definitions, examples, and indicators of the major types of childhood maltreatment. In addition, the trainings contain only limited information to motivate reporters to see their role as part of a collective endeavor to protect children, and they are failing to adequately address reluctance about reporting. However, improvements are readily achievable. A partnership approach to curriculum design and delivery is recommended to develop effective training that will promote sound reporting.

Assessing adverse childhood experiences, social, emotional, and behavioral symptoms, and subjective health complaints among Hungarian adolescents

BACKGROUND

Adverse Childhood Experiences (ACEs) can have lifelong adverse impacts; they can play a role in the development of subsequent emotional, cognitive, and social impairments leading to somatic and mental difficulties, as well as health damaging behaviours. Unfortunately, there are currently no research data available in Hungary regarding the frequency of ACEs among adolescents.

AIMS

A cross sectional questionnaire survey was conducted in a community sample of Hungarian adolescents to assess the frequency of ACEs and analyse their association with current social, emotional, and behavioural symptoms (SEB), and subjective health complaints (SHC).

METHODS

Demographic data, ACEs, SEB and SHC status of 516 adolescents aged 12 to 17 were collected. ACEs were assessed using the ACE Score Calculator; for SEB the Strengths and Difficulties Questionnaire, and for SHC some specific items from the Health Behaviour of School Children questionnaire were employed. To analyse the relationship of ACEs to SEB and SHC logistic regression was performed.

RESULTS

Our results showed that the frequency of ACEs, SEB and SHC is high among adolescents. One-fourth of the students reported ≥ 2 categories of childhood exposures, and 7.4% reported having experienced ≥ 4 types of ACEs. The most prevalent forms of child maltreatment were emotional neglect (15.5%) and emotional abuse (14.5%). The most frequent dysfunctional household condition was parental divorce or separation (23.8%), followed by household substance abuse (8.9%) and household mental illness (8.1%). Almost one-fifth of students (17.5%) reported SEB symptoms (peer relationship problems in 21.7%, emotional symptoms in 14.6%, conduct problems in 18.3%, hyperactivity in 15%). The prevalence of SHC was also high: more than half of the students experienced at least one subjective health complaint multiple times a week. Significant associations were found between ACEs and the SEB/SHC reported by students.

CONCLUSIONS

Adverse childhood experiences, social, emotional, and behavioural symptoms, and SHC are common among Hungarian adolescents. The cumulation of ACEs is associated with a higher number of SEB and SHC symptoms. Therefore, prevention programmes, early recognition, risk reduction, and therapy are needed.

Why do child sexual abuse victims not tell anyone about their abuse? An exploration of factors that prevent and promote disclosure

Disclosure rates of child sexual abuse (CSA) to both social supports and law enforcement are concerningly low, although more research is needed to understand factors that impact disclosure. Thus, the present study examined rates of informal (i.e., to a social support) and formal (i.e., to law enforcement) disclosure of CSA, as well as victims' self-reported experiences with telling others about their own abuse and their perceptions of the overall advantages and disadvantages of disclosure. In all, 76 undergraduate women (who collectively experienced 105 instances of abuse) participated in a semi-structured interview regarding their history of CSA. Results revealed that approximately 50% of cases involved the victim informally disclosing, and only 10% of cases being formally disclosed to authorities. The quantitative and qualitative data shed light on a number of factors that lead victims to not disclose, as well as the identification of factors that may promote a victim to share their abuse with others. The implications for improved prevention and responses to CSA disclosure are discussed.

Prevalence of childhood trauma among adults with affective disorder using the Childhood Trauma Questionnaire: A meta-analysis

BACKGROUND

Childhood trauma is associated with major depressive disorder (MDD) and bipolar disorder (BD) in adults. However, no meta-analysis was performed on the prevalence of different types of childhood trauma in adults with affective disorders, using the Childhood Trauma Questionnaire (CTQ).

METHODS

Four databases were used to search articles regarding the prevalence of childhood emotional abuse (CEA), childhood physical abuse (CPA), childhood sexual abuse (CSA), childhood physical neglect (CPN), and childhood emotional neglect (CEN) in patients with MDD and BD using the CTQ.

RESULTS

A total of 17 and 11 articles were found analyzing patients with MDD and BD, respectively. A pooled prevalence rate of 33.0% and 30.0% for CEA, 17.0% and 18.0% for CPA, 19.0% and 22.0% for CSA, 37.0% and 31.0% for CEN, and 31% and 30.0% for CPN was found in patients with MDD and BD respectively. A difference in 95% confidence interval in the CSA rate between men and women was found in patients with MDD in the gender subgroup and in the rate of some types of childhood trauma in the continent subgroup in both patient types.

LIMITATIONS

A limited number of articles were included in some continents, thus, the heterogeneity in the meta-analysis was generally high.

CONCLUSION

The prevalence of CEA, CEN, and CPN in patients with affective disorders was relatively high, whereas that of CPA and CSA was relatively low. These childhood traumas might be affected by continent and gender.

Development and validation of a retrospective self-report measure of childhood neglect

BACKGROUND

Several measures are available to assess childhood physical and sexual abuse, but few measures focus specifically on neglect and little psychometric research on measures exists. This paper aims to fill a gap in the field by describing a new instrument to measure childhood neglect retrospectively and providing information about construct, predictive, and discriminant validity using adults with documented histories of childhood neglect.

METHODS

Data are from a large prospective, longitudinal study of abused and neglected children and matched controls followed up and assessed in adulthood. The current sample (N =717) includes 370 individuals with histories of childhood neglect and 347 demographically matched controls without those histories. Self-reports of childhood neglect were collected in in-person interviews at approximate age 40. Participants responded to a pool of items representing neglect. Missing responses were treated as substantive information in analyses. An optimal set of items was selected using Support Vector Machine (SVM) - a machine leaning algorithm. Neglect severity, diversity and SVM-based propensity scores were tested for predictive, construct and discriminant validity.

RESULTS

The optimal item subset included 10 items. The propensity scale measured with this optimal subset passed all validity tests, showing high predictive validity for neglect, discrimination between documented cases of neglect and abuse, and significant correlation with violence in adulthood (construct validity). The simple severity and diversity scores failed in at least one of the validity tests.

CONCLUSIONS

This new instrument shows promise in detecting experiences of childhood neglect retrospectively. Missing responses were found informative in recollections of childhood neglect.

Risk factors for child abuse, neglect and exposure to intimate partner violence in early childhood: Findings in a representative cross-sectional sample in Germany

BACKGROUND

The KiD 0-3 national main study is a cross-sectional study on adversity in early childhood and parental access to support services, conducted as part of a long-term policy program for early intervention services in Germany.

OBJECTIVE

To identify risk factors for child abuse, neglect and exposure to intimate partner violence (IPV) and investigate if parental use of early intervention programs or contact to child welfare services was associated with reported child maltreatment.

PARTICIPANTS AND SETTING

8063 families with infants and toddlers participated in the survey. Parents answered a written questionnaire during mandatory health checks for the child. The sampling was based on a regionally clustered model of pediatricians' practices.

METHODS

An automatic variable selection process was used to test risk factors and logistic regression models were employed for each outcome.

RESULTS

Significant risk factors (p < 0.05) for child abuse (1.91 %) were child age, IPV and parental stress. Neglect (0.83 %) was associated with couple distress, adverse childhood experiences, young maternal age, cramped housing, and migration history. IPV (2.98 %) was associated with child age, couple distress, depression/anxiety, harsh punishment, adverse childhood experiences, young maternal age, and poverty. Parents were more likely to use selective prevention programs in cases of child abuse and exposure to IPV.

CONCLUSION

Child abuse is mainly associated with proximal risk factors and neglect with distal factors. Exposure to IPV violence is associated with child abuse as well as with an accumulation of adversities. The association between service use and child maltreatment is discussed.

A Meta-analysis Comparing Male Adolescents Who Have Sexually Offended Against Intrafamilial Versus Extrafamilial Victims

This meta-analysis examined whether theoretically and clinically relevant differences exist between male adolescents who have sexually offended against intrafamilial victims (AIV) and male adolescents who have sexually offended against extrafamilial victims (AEV). A total of 26 independent samples (8 published and 18 unpublished) that compared a total of 2169 AIV and 2852 AEV were analyzed. The results of this meta-analysis indicate that categorizing male adolescents who commit sexual offenses based on their relationship to victims is a meaningful distinction. We found that AIV presented with greater atypical sexual interests, increased sexual regulation issues, more severe family dysfunction, more extensive childhood maltreatment histories, and greater internalizing psychopathology than AEV. Conversely, AEV presented with more indicators of antisociality than AIV, suggesting that extrafamilial sexual offending might fit better with a generalist explanation of adolescent sexual offending. Findings highlight the value of assessing family dysfunction and maltreatment history, sexual development and regulation, and general delinquency factors to better understand adolescents who have committed a sexual offense.

Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies

OBJECTIVES

Child maltreatment through physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence, causes substantial adverse health, educational and behavioural consequences through the lifespan. The generation of reliable data on the prevalence and characteristics of child maltreatment in nationwide populations is essential to plan and evaluate public health interventions to reduce maltreatment. Measurement of child maltreatment must overcome numerous methodological challenges. Little is known to date about the extent, nature and methodological quality of these national studies. This study aimed to systematically review the most comprehensive national studies of the prevalence of child maltreatment, and critically appraise their methodologies to help inform the design of future studies.

METHODS

Guided by PRISMA and following a published protocol, we searched 22 databases from inception to 31 May 2019 to identify nationwide studies of the prevalence of either all five or at least four forms of child maltreatment. We conducted a formal quality assessment and critical analysis of study design.

RESULTS

This review identified 30 national prevalence studies of all five or at least four forms of child maltreatment, in 22 countries. While sound approaches are available for different settings, methodologies varied widely in nature and robustness. Some instruments are more reliable and obtain more detailed and useful information about the characteristics of the maltreatment, including its nature, frequency, and the relationship between the child and the person who inflicted the maltreatment. Almost all studies had limitations, especially in the level of detail captured about maltreatment, and the adequacy of constructs of maltreatment types.

CONCLUSIONS

Countries must invest in rigorous national studies of the prevalence of child maltreatment. Studies should use a sound instrument containing appropriate maltreatment constructs, and obtain nuanced information about its nature.

A retrospective approach to examining child abuse disclosure

BACKGROUND

Often times, a child's disclosure is the only forensic evidence available in child abuse cases. Therefore, understanding disclosure patterns of suspected child abuse victims plays a critical role in the forensic investigations of both child physical abuse (CPA) and child sexual abuse (CSA) cases.

OBJECTIVE

To explore adults' retrospective reports about childhood disclosure of CPA and CSA.

PARTICIPANTS AND SETTING

College students (N = 907) were screened for reported histories of CSA (n = 94) or CPA (n = 109).

METHODS

Through an online survey, participants provided anonymous information regarding CSA and CPA experiences along with information about any disclosure events or opportunities that they have encountered since the abuse.

RESULTS

Among the adults reporting CSA histories, 50 % indicated disclosing the abuse during childhood; 80 % indicated any lifetime disclosure. Among the adults indicating CPA histories, 32 % reportedly disclosed the abuse to someone during childhood with 52 % reporting any lifetime disclosure. For both groups, length of delay until disclosure was bimodal with many individuals reporting immediately and many waiting considerable time. Among adults reporting CSA, a minority (16 %) indicated the abuse came to the attention of authorities, with even fewer CPA cases (8%) reporting authorities were aware of their abuse. Denial and recantation in a formal setting was infrequent regardless of abuse type reported.

CONCLUSIONS

Given that participants experiencing CSA and CPA both reported low levels of denial and recantation, forensic investigators and practitioners may benefit from considering consistent interviewing approaches and protocols, regardless of the type of abuse suspected.

Parental Migration, Children's Safety and Psychological Adjustment in Rural China: A Meta-Analysis

Studies concerning left-behind children in rural China have shown that parental absence due to migration is associated with greater risk of child victimization and accidental injuries, and a range of psychosocial problems. The authors conducted this meta-analysis to determine the extent to which left-behind children are affected by parental migration, as compared to children in nonmigrant rural families. A comprehensive literature search was conducted, and 90 studies published before 2017 were included in the data synthesis and analysis. The results revealed that compared to non-left-behind children, rural left-behind children are generally more disadvantaged in regard to child safety (d = 0.27) and psychological adjustment (d = 0.25). The effect sizes, though interpreted as small, revealed that children in rural China are significantly affected by parental migration. Children's educational stage was a significant variable that moderated the effect sizes of child safety and psychological adjustment. The findings of the meta-analysis indicated that mother-only migration may have the most harmful effect on children. In terms of implications for interventions, the results suggest more attention should be given to rural left-behind children and to "mother-absent children" in particular. Future research is warranted to explore the association between left-behind children's psychological adjustment and their exposure to injury and victimization.

Childhood maltreatment and alcohol-related problems in young adulthood: The protective role of parental warmth

BACKGROUND

Alcohol use among young adults is highly prevalent. Individuals exposed to childhood maltreatment are particularly vulnerable to alcohol use and alcohol-related problems. Few studies have examined family protective factors, such as parental warmth, that may mitigate the effects of childhood maltreatment on alcohol-related problems.

OBJECTIVE

The current study seeks to examine the extent to which parental warmth reduces the effect of childhood exposure to maltreatment on alcohol-related problems in young adulthood.

PARTICIPANTS AND SETTING

Participants were young adults (N = 337; mean age = 21.7), who were recruited from an urban community and completed in-person interviews assessing childhood maltreatment, parental warmth, and alcohol-related problems.

METHODS

Multiple hierarchical linear regression models were used to examine whether maternal and paternal warmth reduced the impact of childhood exposure to maltreatment on alcohol-related problems in young adulthood. Common risk factors for alcohol-related problems, including psychological symptoms and peer and parental alcohol use, were also entered into the models.

RESULTS

We found a significant moderating effect of paternal warmth on the associations between childhood emotional abuse and alcohol-related problems (β= -0.29, p < .05). Specifically, the association between emotional abuse and alcohol-related problems was weaker among individuals with higher levels of paternal warmth. Moderating effects of maternal warmth on the maltreatment-problematic alcohol use relation were not supported.

CONCLUSION

The results of this research suggest that parental warmth may not only relate to fewer alcohol-related problems among offspring, but may also modify the associations between childhood emotional abuse and alcohol-related problems during young adulthood.

Predictors of variation in sate reported rates of psychological maltreatment: A survey of statutes and a call for change

BACKGROUND

Psychological maltreatment (PM) is equivalent in harm to other forms of child maltreatment and yet it is not included in all US State child abuse statutes and past research using the National Child Abuse and Neglect Data System (NCANDS, 1998, 2007, 2008) identified 300-480-fold differences in substantiated cases across US States. This variation is inconsistent with the significance of the problem and the availability of reliable operational definitions.

PARTICIPANTS AND SETTING

US State statutes were coded and compared with reported rates of four different forms of child maltreatment in the 2014 and 1998 NCANDS data sets.

METHODS

Data were extracted from NCCANDS and State statutes were coded independently by the authors (kappa = .96).

RESULTS

For 2014, the difference in reported rates of PM between the State with the lowest rate and the State with the highest rate was 523-fold which was much higher than for physical (30-fold) and sexual abuse (20-fold) but not neglect (524-fold). Statutes still use the term "mental injury" from the original Child Abuse Prevention and Treatment Act (Child Abuse Prevention & Treatment Act, 1974) and two thirds did not define it. Reported rates of PM in NCANDS were not correlated with whether PM was defined in the statute but when a harm standard was present, reported rates were statistically lower. Almost 70% of statutes mentioned a current trend (e.g., sexual/human trafficking) demonstrating a willingness by States to amend statutes.

CONCLUSIONS

A common, reliable definition of PM (and other forms of maltreatment) in CAPTA, NCANDS, and US State statutes is necessary for the US to have a surveillance system that allows for the assessment of the effects of policies on reported rates of all forms of maltreatment.

Reported Levels of Upset in Youth After Routine Trauma Screening at Mental Health Clinics

Importance

Clinical guidelines recommend routine screening for trauma at youth mental health clinics. However, many clinicians are concerned that screening may be upsetting both for youths who have been exposed to trauma and for those who have not.

Objectives

To investigate levels of upset following routine trauma screening and whether type of trauma and symptoms of posttraumatic stress were associated with level of upset.

Design, Setting, and Participants

Survey study in which data from routine screening for trauma exposure and trauma-related symptoms were collected from January 1, 2015, to December 31, 2017. Nearly half (n = 40) of all youth mental health clinics in Norway submitted survey data. Participants included youths aged 6 to 18 years referred to treatment.

Main Outcomes and Measures

The trauma screening inventory, Child & Adolescent Trauma Screening Questionnaire, was administered. Self-reported levels of upset after initial screening were scored on a scale ranging from 1 (not upsetting) to 7 (very upsetting).

Results

Among 10 157 youths aged 6 to 18 years (mean [SD] age, 13.0 [3.1] years; 5320 [55.0%] female), surveyed, 8021 (79.1%) reported exposure to at least 1 potentially traumatizing event and a mean (SD) of 2.44 (2.27) different types of events (range, 0-15). Only 453 participants (4.5%) reported high levels of upset, while 2757 participants (27.2%) reported moderate levels of upset and 6942 participants (68.4%) reported no or low levels of upset. Youths who had been exposed to any type of traumatic event reported significantly higher levels of upset compared with those reporting no trauma exposure, and a higher number of reported traumatic events was associated with a higher level of upset (point estimate, 0.23; 95% CI, 0.22-0.24; P < .001). Among participants who reported trauma, exposure to sexual abuse (point estimate, 0.87; 95% CI, 0.77-0.95; P < .001) and higher levels of posttraumatic stress symptoms (point estimate, 0.05; 95% CI, 0.04-0.05; P < .001) were associated with higher levels of upset.

Conclusions and Relevance

A high level of trauma exposure was found among youths referred to youth mental health clinics, but trauma screening was well tolerated, with most participants reporting no or low levels of upset. These findings can be used to support therapists and health care leaders in implementing routine trauma screening to better identify youths who are in need of trauma-focused treatment.

Rates of neglect in a national sample: Child and family characteristics and psychological impact

BACKGROUND

Childhood neglect is an understudied form of childhood maltreatment despite being the most commonly reported to authorities.

OBJECTIVE

This study provides national estimates of neglect subtypes, demographic variations in exposure to neglect subtypes, and examines the psychological impact.

PARTICIPANTS AND SETTING

Pooled data from two representative U.S. samples from the National Surveys of Children's Exposure to Violence (NatSCEV) survey conducted in 2011 and 2014, representing the experiences of children and youth aged 1 month to 17 years (N = 8503).

METHODS

Telephone surveys were used to obtain sociodemographic characteristics, six measures of past year and lifetime exposure to neglect, and assessments of trauma symptoms, suicidal ideation, alcohol use, and illicit drug use.

RESULTS

More than 1 in 17 U.S. children (6.07%) experienced some form of neglect in the past year, and more than 1 in 7 (15.14%) experienced neglect at some point in their lives. Supervisory neglect, due to parental incapacitation or parental absence, was most common. Families with two biological parents had lower rates (4.29% in the past year) than other household configurations (range from 7.95% to 14.10%; p < .05). All types of neglect were associated with increased trauma symptoms and suicidal ideation (for 10-17 year olds), and several were associated with increased risk of underage alcohol and illicit drug use.

CONCLUSION

More attention needs to be paid to the impact of supervisory neglect. These results underscore the importance of prevention strategies that provide the supports necessary to build safe, stable, and nurturing relationships and environments that help children thrive.

Sleep problems and interpersonal violence in youth in care under the Quebec Child Welfare Society

OBJECTIVE

The objective this study was to investigate the relative contributions of gender, common mental health symptoms, and experiences of interpersonal violence to the presence of sleep disturbances in Youth in Care under Child Welfare Society admitted to residential facilities.

METHODS

A sample of 315 teenagers (14-18 years old) completed a self-reported questionnaire upon admission, followed by a medical consultation with a nurse and a physician. Information regarding experiences of interpersonal violence, mental health symptoms, and sleep disturbances was collected using a standardized questionnaire.

RESULTS

Anxiety, ADHD symptoms, and sexual abuse were associated with sleep disturbances, F(10, 264) = 5.95, p < 0.001. Results from hierarchical regression analyses revealed that experiences of interpersonal violence, more specifically sexual abuse, were associated with sleep disturbances over and beyond gender and the presence of mental health symptoms.

CONCLUSIONS

These results highlight practical implications for health professionals in terms of assessment and intervention for vulnerable youth exposed to interpersonal violence. Implications for research and practice are discussed.

Recall and understanding of a communication campaign designed to promote positive parenting and prevent child maltreatment

Evidence-based parenting support programs are among effective strategies for preventing child maltreatment. The launch of mass media campaigns accompanying the implementation of such programs has been recommended to optimize reach and parent enrollment. This paper focuses on a communication campaign developed to support the implementation of the Triple P - Positive Parenting Program in two French-Canadian communities. Proximal outcomes (recall and understanding) were assessed through a randomized telephone survey conducted between January and April 2017 among 1029 mothers of children aged 6 months to 8 years.

Distribution and correlates of the respondents' recall and understanding of the campaign were examined. Results show that 32.1% of respondents recalled having seen the campaign material. Among these, a large majority reported having understood the intended messages (parenting difficulties are normal, seeking help is the right thing to do, and/or effective support is available). However, some respondents also retained unintended messages blaming parents and/or children, and almost half the sample retained mixed messages (intended and unintended). Multivariate logistic regression analyses revealed that community of residence, annual household income, and psychological aggression towards the child at home were three significant correlates of campaign recall + intended messages understood. None of the examined factors were associated with recall + mixed messages understood. Findings suggest a neighborhood effect on the proximal outcomes of the campaign, and a slightly higher reach and understanding among better-off families as well as families struggling with psychologically violent parenting practices. These results are discussed in light of the outcomes of similar campaigns.

•

Among 1029 mothers, 32.1% recalled a media campaign about positive parenting.

•

Most mothers understood the intended message of the campaign.

•

Almost half mothers also retained blaming messages for parents and/or children.

•

Findings suggest a neighborhood effect on campaign recall and understanding.

•

Family characteristics only slightly affected campaign recall and understanding.

A cross-national exploration of societal-level factors associated with child physical abuse and neglect

Children around the world experience violence at the hands of their caregivers at alarming rates. A recent review estimates that a minimum of 50% of children in Asia, Africa, and North America experienced severe physical violence by caregivers in the past year, with large variations between countries. Identifying modifiable country-level factors driving these geographic variations has great potential for achieving population-level reductions in rates of child maltreatment. This study builds on previous research by focusing on caregiver-reported physical abuse and neglect victimisation, examining 22 societal factors representing 11 different constructs among 42 countries from 5 continents at different stages of development. Our findings suggest that gender inequity may be important for both child physical abuse and neglect. Indicators of literacy and development may also be important for child neglect. Given the limitations of the correlational findings and measurement issues, it is critical to continue to investigate societal-level factors of child maltreatment so that interventions and prevention efforts can incorporate strategies that have the greatest potential for population-level impact.

Child physical abuse: factors influencing the associations between self-reported exposure and self-reported health problems: a cross-sectional study

BACKGROUND

Child physical abuse (CPA) is an extensive public health problem because of its associations with poor health outcomes. The aim of this study was to examine which of the background factors of CPA committed by a parent or other caregiver relates to self-reported poor health among girls and boys (13; 15 and 17 years old): perpetrator, last year exposure; severity and frequency; socioeconomic load and foreign background.

METHODS

In a cross-sectional study in a Swedish county (n = 8024) a path analysis was performed to evaluate a model where all background variables were put as predictors of three health-status variables: mental; physical and general health problems. In a second step a log linear analysis was performed to examine how the distribution over the health-status categories was different for different combinations of background factors.

RESULTS

Children exposed to CPA reported poor health to a much higher extent than those who were not exposed. In the path analysis it was found that frequency and severity of abuse (boys only) and having experienced CPA during the last year, was significantly associated with poor health as well as socioeconomic load in the families. Foreign background was significantly negatively associated with all three health indicators especially for girls. Neither mother nor father as perpetrator remained significant in the path analysis, while the results from the log linear analyses showed that mother-abuse did in fact relate to poor general health and mental as well as physical health problems among boys and girls. Father-abuse was associated with poor mental health if severe abuse was reported. Poor mental health was also associated with mild father-abuse if exposure during the last year was reported.

CONCLUSION

Despite the limitations that cross-sectional studies imply, this study provides new knowledge about factors associated with poor health among physically abused children. It describes details of CPA that have significant associations to different aspects of poor health and thus what needs to be addressed by professionals within mental health providers and social services. Understanding how different factors may contribute to different health outcomes for exposed children is important in future research and needs further studies.

[Minor Victims of Violent Acts in the Context of the Victim Reparation Law]

OBJECTIVE

A descriptive analysis of victim compensation applications for children and adolescents as well as sociodemographic and trauma-specific information concerning victims and perpetrators.

METHOD

We did analysis of 100 victim-compensation application files based on a self-developed category system.

RESULTS

The files included solely interpersonal trauma, 59 % of which are type II trauma. The most frequent form is sexual violence. The perpetrators stem mostly from children’s homes or peripherals. 79 % of the victims received a diagnosis of a mental disorder, most often posttraumatic stress disorder.

CONCLUSIONS

Sexually abused children and adolescents make up the majority of the target population in OEG-related trauma outpatient units. Such outpatient units should therefore offer a specific expertise in treating sexually abused children and adolescents.

Youth self-report of child maltreatment in representative surveys: a systematic review

INTRODUCTION

This systematic review identified population-representative youth surveys containing questions on self-reported child maltreatment. Data quality and ethical issues pertinent to maltreatment data collection were also examined.

METHODS

A search was conducted of relevant online databases for articles published from January 2000 through March 2016 reporting on population-representative data measuring child maltreatment. Inclusion criteria were established a priori; two reviewers independently assessed articles to ensure that the criteria were met and to verify the accuracy of extracted information.

RESULTS

A total of 73 articles reporting on 71 surveys met the inclusion criteria. A variety of strategies to ensure accurate information and to mitigate survey participants' distress were reported.

CONCLUSION

The extent to which efforts have been undertaken to measure the prevalence of child maltreatment reflects its perceived importance across the world. Data on child maltreatment can be effectively collected from youth, although our knowledge of best practices related to ethics and data quality is incomplete.

The Role of Sexual Abuse in Trauma Symptoms, Delinquent and Suicidal Behaviors, and Criminal Justice Outcomes Among Females in a Juvenile Justice Diversion Program

Female juvenile justice-involved (JJI) youth experience more sexual abuse (SA) than their non-JJI counterparts or their male JJI counterparts. This study examines SA's role among JJI females ( N = 1,307) in a behavioral health diversion program. Results indicate that SA increases the risk of psychological trauma, particularly posttraumatic stress and depression. SA also increases the odds of suicidal behavior, running away, and substance use. SA females have the same odds of successfully completing behavioral health diversion and being charged with any offense or misdemeanor after termination as non-SA females. Implications of research and future directions are discussed.

HPA-Axis Activation as a Key Moderator of Childhood Trauma Exposure and Adolescent Mental Health

Individual differences in a child's sensitivity to stress may influence whether youth exposed to trauma develop symptoms of psychopathology. We examined the interaction between HPA-axis reactivity to an acute stressor and exposure to different types of childhood trauma as predictors of mental health symptoms in a sample of youth. Youth (n = 121, ages 9-16; 47% female) completed a standardized stress task, including 5 post-stress salivary cortisol samples. Parents also completed the Child Behavior Checklist as a measure of child internalizing and externalizing symptoms in the past month, and completed the Early Trauma Inventory (ETI) as a measure of their child's trauma exposure. More emotional abuse and non-intentional trauma were associated with greater internalizing symptoms. Youth exposed to physical abuse who demonstrated slower HPA-axis reactivity had elevated internalizing and externalizing symptoms. Youth exposed to emotional abuse or non-intentional traumatic events who demonstrated faster HPA-axis reactivity had elevated internalizing and externalizing symptoms. Profiles of exaggerated or attenuated HPA-axis reactivity to acute stress may be risk factors for psychopathology in children facing different stressful social environments.

Gender Inequity Associated with Increased Child Physical Abuse and Neglect: a Cross-Country Analysis of Population-Based Surveys and Country-Level Statistics

Gender inequity is proposed as a societal-level risk factor for child maltreatment. However, most cross-national research examining this association is limited to developing countries and has used limited measures of gender inequity and child homicides as a proxy for child maltreatment. To examine the relationship between gender inequity and child maltreatment, we used caregivers' reported use of severe physical punishment (proxy for physical abuse) and children under 5 left alone or under the care of another child younger than 10 years of age (supervisory neglect) and three indices of gender inequity (the Social and Institutional Gender Index, the Gender Inequality Index, and the Gender Gap Index) from 57 countries, over half of which were developing countries. We found all three gender inequity indices to be significantly associated with physical abuse and two of the three to be significantly associated with neglect, after controlling for country-level development. Based on these findings, efforts to prevent child abuse and neglect might benefit from reducing gender inequity.

Childhood maltreatment and adolescent sexual risk behaviors: Unique, cumulative and interactive effects

Child maltreatment has been associated with sexual risk behaviors. Previous investigators have typically studied only one form of maltreatment, preventing them from exploring interrelations between forms of maltreatment and their impact on sexual risk behaviors. Thus, this study aims to examine the unique, cumulative, and interactive effects of four maltreatment forms (sexual abuse, physical abuse, neglect, and witnessing interparental violence) on sexual risk behaviors. The sample comprised 1940 sexually active adolescents (M_age=15.6; 60.8% girls) attending Quebec (Canada) high schools. Regression results showed that all maltreatment forms were associated with having a higher number of sexual partners, casual sexual behavior, and a younger age at first consensual intercourse. Physical abuse and witnessing interparental violence were associated with inconsistent condom use, and physical abuse was associated with sexually transmitted infections. After controlling for all forms of maltreatment (unique effects), analyses showed that sexual abuse, physical abuse, neglect or witnessing interparental violence remained statistically associated depending on the sexual risk behavior. A greater number of forms of maltreatment was associated with more sexual risk behaviors (cumulative effect). When sexual abuse was not experienced, neglect was associated with a higher number of sexual partners (interactive effects). In general, associations between maltreatment and sexual risk behaviors were similar for both genders. The magnitude of the relationship between a specific form of child maltreatment and sexual risk behaviors may be inaccurately estimated when not controlling for other forms of maltreatment.

Protective factors promoting resilience in the relation between child sexual victimization and internalizing and externalizing symptoms

Sexual victimization has been one of the most frequently studied forms of child victimization. Its effects are common and diverse; however, not all children and youth exposed to sexual victimization eventually develop adjustment problems. A total of 1105 children and youth (590 male and 515 female) aged between 12 and 17 from northeastern Spain were assessed regarding their experiences of sexual victimization, symptoms of psychopathology, and protective factors. The results showed that all forms of sexual victimization were associated with higher levels of emotional and behavioral problems. However, the presence of a low Negative Cognition, high Social Skills and high Confidence seem to act buffering internalizing problems. Additionally, a significant interaction between Sexual Victimization and low Negative Cognition was observed (p<0.5), so that, low Negative Cognition was related to a lower risk of being in the clinical range for internalizing problems. Likewise, high scores on Empathy/Tolerance, Connectedness to School, Connectedness to Family and low Negative Cognition acted as promotive factors in relation to externalizing symptoms, in this case without any interaction effect. The strong relationship found with emotional and behavioral problems highlights the importance of continuing the research on the protective factors underlying resilience in the relationship between sexual victimization and psychopathological symptoms. The findings also support the multi-dimensional and specific nature of resilience and identify some of the protective factors that should be regarded as key intervention targets in adolescents with a history of sexual victimization.

The role of poly-victimization in predicting differences in foster youths' appraisals

The present article examines the role of poly-victimization (i.e., number of categories of maltreatment experiences and total maltreatment exposure) in predicting differences in appraisals for 272 youth in foster care (ages 8-21). Poly-victimization was hypothesized to be predictive of negative appraisal valence (i.e., interpreting the impact of a stressful life event as being bad/negative) and appraisal rigidity (i.e., interpreting the impact of life events as being consistently positive or negative across different events) above and beyond any single category of maltreatment. Results show a high prevalence of poly-victimization, such that those youth who experience only one form of maltreatment (e.g., physical, sexual, psychological, or neglect) are among the minority of maltreated youth. Additionally, results show that total maltreatment exposure, accounting for not only different categories of maltreatment but also different types or forms of maltreatment within those broader categories, is the most predictive of negative appraisal valence, above and beyond single categories of maltreatment and number of categories of maltreatment experienced. Contrary to the study's hypothesis, neither total exposure nor number of maltreatment categories experienced is significantly predictive of appraisal rigidity above and beyond single categories. Correlations also show that less rigid or more flexible appraisals are associated with more maltreatment experiences than are rigid appraisals. The current study highlights the importance of examining maltreatment from a poly-victimization perspective and begins to explain why some youth have more negative appraisals than others.

Associations Between School Connection and Depressive Symptoms From Adolescence Through Early Adulthood: Moderation by Early Adversity

Depressive symptomatology is one of the most common and costly threats to American mental health, making the elucidation of environmental influences on depressive symptoms particularly important. Using the National Longitudinal Study of Adolescent Health, this study explores the interaction between environmental risk and protective factors in the etiology of depressive symptoms by asking whether school connection is associated with lower levels of depressive symptoms through early adulthood, and whether connection serves as a protective or promotive factor for youth who experienced early adversity. Findings highlight the importance of school connection in promoting long-term mental health for all youth and suggest that policies and practice supporting school connection may be effective intervention strategies for youth at risk for depressive symptomatology.

Gender differences in the association between emotional maltreatment with mental, emotional, and behavioral problems in Swedish adolescents

Emotional maltreatment is a common form of child abuse with a powerful negative impact on mental health. The aim of this study was to examine the effect of emotional maltreatment on mental health and mental well-being in a general population of Swedish 12- to 13-year old girls and boys. Data was collected via self-report questionnaires in classroom settings from 1134 students. Emotional maltreatment had significant effects on mental health and mental well-being for both girls and boys. Moreover, there were significant interaction effects between gender and levels of emotional maltreatment. Girls reported decreased mental health and mental well-being at lower degrees of emotional maltreatment compared to boys. Furthermore, girls reported larger decreases in mental health in response to exposure of emotional maltreatment. For internalizing symptoms, mental well-being and psychosomatic symptoms, exposure level of emotional maltreatment seemed to magnify the gender differences. For externalizing symptoms, there were no differences between girls and boys in the group reporting no emotional maltreatment and the increase in externalizing symptoms were of equal magnitude for both genders. Given the impact of emotional maltreatment on mental health in the general population, results from this study implies that a trauma-informed perspective is necessary in understanding gender differences in mental health in early adolescence. Further research is needed in order to understand the underlying processes generating the differences in girls and boys responses to emotional maltreatment.

Between Childhood Maltreatment and Shame

One of the most devastating long-term outcomes of childhood maltreatment is a sense of shame, which is connected to distress and reduced well-being. The aim of the current study was to examine a dual-path model and to test the relations between childhood maltreatment, shame, and well-being as mediated by both self-objectification and a sense of disrupted body boundaries among 531 female college/university students living in Israel. Results from the structural equation modeling analyses indicated that both self-objectification and disrupted body boundaries significantly mediated the association between childhood maltreatment and sense of shame. In addition, both were associated with reduced levels of well-being, through the mediating role of shame. Finally, we discuss the role these paths may play in the detrimental long-term effects of childhood maltreatment and how they may be targeted in clinical interventions for adult survivors.

Examination of the Extent to which Employment Factors are Associated with Reduced Child Maltreatment Potential and Drug Use

Job assistance programs are commonly recommended for parents of children who have been victimized by child maltreatment, particularly when illicit drugs are indicated. However, the relationship between employment factors, substance abuse and risk of child maltreatment has received limited empirical attention. Therefore, the current study examines employment factors in a sample of 72 mothers who were referred by Child Protective Services (CPS) for treatment of substance abuse and child neglect. Child maltreatment potential was found to be negatively associated with number of hours employed and self-reported happiness with employment. The association between child abuse potential and personal income of participants approached significance (p = .057), and the results were not influenced by social desirability. Employment satisfaction significantly contributed to the prediction of child maltreatment potential over and above other employment factors and control variables. These findings suggest that when mothers are involved in CPS their risk of perpetrating child maltreatment may be reduced when they are assisted in gainful employment that is personally satisfying. Happiness with employment was the only employment factor correlated (inversely) with substance use (biological testing, self-report of participants). Future directions are discussed in light of the results, including the importance of considering employment satisfaction when conducting vocational assistance programs in this population.

Family Violence and Other Potentially Traumatic Interpersonal Events Among 9- to 17-Year-Old Children Attending an Outpatient Psychiatric Clinic

Among children visiting child and adolescent mental health care (CAM), the prevalence of exposure to family violence (FV) is reported to exceed prevalence in community samples, as are potentially traumatic interpersonal events (IPE) outside the family. The aim of the study was to relate CAM patients' self-reported experiences of violence exposure to their current psychiatric symptoms and to compare patients exposed to violence with patients who reported no exposure. We asked 305 consecutive 9- to 17-year-old patients in CAM about their current and previous exposure to violence in and outside of the family. Prevalence of exposure to any kind of violence was 67%. Reported exposures were 19% to IPE, 21% to FV, and 27% to both. Children exposed to both FV and IPE were more negatively affected by the events than children exposed to FV or IPE only. Children in the FV + IPE group reported more mental health symptoms than those in the no violence (33%) group. In general, IPE was related to the outcome measures only in combination with FV. Degree of violence exposure seemed to have a dose-response relationship with the diagnosis of post-traumatic stress disorder.

Experience by children and adolescents of more than one type of maltreatment: Association of different classes of maltreatment profiles with clinical outcome variables

Most victims of child abuse have experienced more than one type of maltreatment, yet there is a lack of understanding of the impact of specific combinations of types of maltreatment. This study aimed to identify meaningful classes of maltreatment profiles and to associate them with short-term clinical outcomes. A total of 358 German children and adolescents aged 4-17 with a known history of child maltreatment were included in the study. Through interviews and questionnaires, information was obtained from participants and their primary caregivers on history of maltreatment, sociodemographics, psychopathology, level of psychosocial functioning, and health-related quality of life. Types of abuse were categorized into six major groups: sexual abuse in general, sexual abuse with penetration, physical abuse, emotional abuse, neglect, and exposure to domestic violence. A latent class analysis (LCA) was performed to determine distinct multi-type maltreatment profiles, which were then assessed for their associations with the sociodemographic and clinical outcome variables. The LCA revealed that participants could be categorized into three meaningful classes according to history of maltreatment: (1) experience of multiple types of maltreatment excluding sexual abuse (63.1%), (2) experience of multiple types of maltreatment including sexual abuse (26.5%), and (3) experience of predominantly sexual abuse (10.3%). Members of Class 2 showed significantly worse short-term outcomes on psychopathology, level of functioning, and quality of life compared to the other classes. Three distinct profiles of multiple types of maltreatment were empirically identified in this sample. Exposure to multiple types of abuse was associated with poorer outcomes.

Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to estimate the association between distinct types of child abuse--sexual (CSA), physical (CPA), and emotional (CEA)--and different eating disorders (EDs).

METHODS

Electronic databases were searched through January 2014. Studies reporting rates of CSA, CPA, and CEA in people with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), as compared with individuals without EDs, were included. Pooled analyses were based on odds ratios (ORs), with relevant 95% confidence intervals (CIs), weighting each study with inverse variance models with random effects. Risk of publication bias was estimated.

RESULTS

Thirty-two of 1714 studies assessed for eligibility met the inclusion criteria, involving more than 14,000 individuals. The association between EDs and any child abuse showed a random-effects pooled OR of 3.21 (95% CI = 2.29-4.51, p < .001) with moderate heterogeneity (I2 = 57.2%, p = .005), whereas for CSA, this was 1.92 (95% CI = 1.13-3.28, p = .017), 2.73 (95% CI = 1.96-3.79, p < .001), and 2.31 (95% CI = 1.66-3.20, p < .001), for AN, BN, and BED, respectively. However, adjusting for publication bias, the estimate for CSA and AN was not significant (OR = 1.06, 95% CI = 0.59-1.88, p = .85). Although CPA was associated with AN, BN, and BED, CEA was associated just with BN and BED.

CONCLUSIONS

BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs.

TRIAL REGISTRATION

The protocol was registered in PROSPERO (an international prospective register of systematic reviews) with the reference number CRD42014007360.