Prevalence of different forms of child maltreatment among Taiwanese adolescents: a population-based study

Prevalence and pattern of child maltreatment at home among secondary school students in Ibadan North Local Government, Oyo State, Nigeria

BACKGROUND

Child maltreatment is an action that endangers a child's health or survival and is often committed by individuals in positions of responsibility, trust, or power. The extent of maltreatment among secondary school students in developing countries, including Nigeria, requires further exploration, and evaluating this burden can inform preventive interventions.

OBJECTIVE

The study aimed to evaluate the prevalence, pattern and factors associated with maltreatment at home among secondary school students in Ibadan North LGA, Oyo State, Nigeria.

PARTICIPANTS AND SETTING

A cross-sectional study including 422 students in secondary school was conducted in randomly selected secondary schools in Ibadan North LGA, Nigeria using a multistage-sampling procedure to select students.

METHODS

The study used a pre-tested, semi-structured, questionnaire administered by the interviewer, incorporating questions on sociodemographic and the child home version of the ISPCAN Child Abuse Screening Tool (ICAST-CH). Data analysis involved descriptive statistics and the Chi-square test, done by setting the significance level at 5 %.

RESULTS

Respondents had a mean age of 13.9 ± 1.8 years, with 52.1 % being female and 69.5 % living with their parents. More than a quarter (26.8 %) of the respondents experienced all forms of maltreatment, with emotional and physical maltreatment rates at 85.3 % and 81.8 %, respectively, and neglect and sexual maltreatment at 47.4 % and 55.9 %. Age, school type, Parental education, and living arrangements were significantly associated with experience of all forms of maltreatment.

CONCLUSIONS

All child maltreatment forms were significantly present among the students. Measures like engaging parents/guardians through parenting programs and sensitization efforts are crucial in reducing the occurrence of maltreatment.

Teachers' Responses to Child Maltreatment

Purpose

Teachers play an important role in detecting and reporting child maltreatment by virtue of their extensive contact with children. Current research, while limited, shows a tendency among teachers to under-detect and under-report various forms of child abuse and neglect. Methods: Using data from a pilot evaluation of child maltreatment training for teachers, we examined teachers' self-reported behaviours for different forms of maltreatment. Participants included 45 experienced teachers from a large urban centre in the province of Ontario (Canada) who rated their likelihood of, and rationale for, detecting and reporting maltreatment based on four case vignettes.

Results

Accuracy rates for detection and reporting were highest for sexual abuse (95% and 93%), followed by neglect (87% and 75%), emotional abuse (86% and 70%), and physical abuse (58% and 27%). Differences in detection and reporting rates were only significant between physical abuse and other maltreatment types (sexual abuse and neglect for detection; sexual abuse, neglect, and emotional abuse for reporting), with accurate detection and reporting rates being significantly lower for physical abuse. Teachers stated that the physical abuse vignette lacked convincing evidence of child maltreatment. Further, many teachers indicated that additional information was needed to determine whether the vignette represented physical abuse and, as such, was reportable.

Conclusion

Our findings suggest the need for more targeted interventions to improve teachers' decision-making with potential child maltreatment scenarios, especially for physical abuse, so that children who are experiencing maltreatment may be more accurately detected and reported to child protection.

Patterns and trajectories of children's maltreatment experiences in Taiwan: Latent transition analysis of a nationally representative longitudinal study

BACKGROUND

Little is known about the patterns of child maltreatment change over time and vary according to gender and child protective services (CPS) experience in Taiwan.

OBJECTIVE

To examine the latent status and the trajectories of child maltreatment and to identify effects that gender and CPS have on these statuses and trajectories in Taiwan.

PARTICIPANTS AND SETTING

A national proportionately stratified sample of 6233 4th-grade students were recruited from 314 elementary schools in Taiwan, and followed up at 6th and 8th graders. A total of 1908 students completed valid data at all three time points was analyzed.

METHODS

Latent class analysis and latent transition analysis were used to identify the number of latent variables and the patterns of child maltreatment. Multiple-group model was used to test with gender difference.

RESULTS

Four latent maltreatment statuses were identified: high all maltreatment, high psychological maltreatment, high neglect, and no/low maltreatment. A reduction in maltreatment severity occurred over time was found. The percentage of students in the "high all maltreatment" and "high neglect" groups decreased whereas those in the "high psychological maltreatment" and "no/low maltreatment" groups increased. Differences in the transition probabilities of latent maltreatment status by gender was revealed. The percentage of CPS recipients in the "high all maltreatment" decreased over time.

CONCLUSIONS

This study highlighted the dynamic nature of child maltreatment and described the timing, continuity, and change that characterizes children's exposure to maltreatment in Taiwan. Policies and interventions geared toward early detection, mitigation, and prevention of child maltreatment are needed.

Prevalence and Risk Factors Associated With Physical and/or Sexual Abuse Among Female Middle School Students: A Cross- Sectional Study in Kinshasa, DRC

This cross-sectional study sought to broaden the limited evidence on violence against young adolescent girls in non-conflict zones within the Democratic Republic of the Congo (DRC). Our goal was to estimate the prevalence of and the predictors of physical and/or sexual abuse among girls aged 11-18 years in Kinshasa. A total of 3,100 girls from five randomly selected schools were recruited by our team and given the questionnaires; among them, 3,011 (97.1%) participants completed the questionnaires and were included in the study for further analysis. After collecting all valid responses, the overall prevalence of physical and/or sexual abuse was sorted into the following categories: experienced physical abuse without a weapon (recorded by 70.1% of respondents), experienced physical abuse with a weapon (66.3% of respondents), attempted rape without penetration (76.5% of respondents), experienced attempted rape with penetration (73.9% of respondents), and experienced verbal sexual harassment (93.0%).Our logistic regression analysis indicated that specific kinds of living arrangements (such as only living with the father, mother, or a caregiver; odds ratio ranged 1.8 to 6.9) and places of residence (such as living in lower-class or middle-class districts; odds ratio ranged 1.7 to 6.2) had the strongest associations with higher risk pertaining to whether the respondent had experienced physical and/or sexual abuse in the past. Meanwhile, factors such as the students' level of education (both middle grade and upper grade) and occupation of the father (specifically whether holding a part-time job or retired) were deemed to be more protective. However, physical and/or sexual abuse prevalence was found to be high among middle school girls in Kinshasa. Therefore, we recommend that drastic policies and strategies aimed at socioeconomic issue and living condition ameliorations among families should be implemented to curtail physical and sexual abuse in the nonconflict zones of the DRC.

The Association of Abuse and Depression With Suicidal Ideation in Chinese Adolescents: A Network Analysis

Background

Abuse experiences in adolescents are associated with the risk of depression and suicide. Thus, there is an urgent need to develop prevention and intervention measures for clinicians, policymakers, and researchers.

Methods

Network analysis method was used to analyze the cross-sectional data of Chinese adolescents in this study. The Patient Health Questionnaire for Adolescents (PHQ-A) was used for assessing depression, in which item 9 of the PHQ-A was used to assess suicide ideation, and International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool-Children's Home Version (ICAST-CH) was used for assessing abuse.

Results

The prevalence of suicidal ideation among Chinese adolescents was 21.46% (95% CI, 20.79-22.16%). The prevalence of moderate or severe depression was 16.76%, and the prevalence of violence exposure, psychological victimization, neglect, and physical victimization was 33.5%, 59.5%, 28.37%, and 31.51% in the past years, respectively. Network analysis results showed that the most central nodes in the network of abuse and depression were "unimportant," "not cared," and "pushed." The bridge nodes were "suicidal ideation" and "unimportant." The nodes "sadness," "failure," and "unimportant" explained the largest proportion of the variance of suicidal ideation in our network. Differences were found in the structure of both abuse and depression networks between adolescents with or without suicidal ideation.

Limitations

The self-reporting-based cross-sectional surveys and community sample groups limit the inference of causality and the generalization of the results.

Conclusion

This study shows that "unimportant" is the central and bridge nodes in the abuse and depression networks and also explains a part of variance of suicidal ideation. The effect of "unimportant" should be considered in the prevention and intervention of depression and suicide in adolescents with abuse experience. Future study is needed to confirm its role in clinical intervention.

Psychological Abuse and Social Support in Chinese Adolescents: The Mediating Effect of Self-Esteem

Although previous studies have explored relationships between psychological abuse and social support, the pathways from psychological abuse to social support are still unclear, particularly in Chinese adolescents. This cross-sectional study attempts to delineate the prevalence of psychological abuse and explore the relationships between psychological abuse, social support, and self-esteem under the Chinese cultural context. Data were obtained from 417 Chinese adolescents aged 15-18 years old. All of them completed the Child Psychological Abuse and Neglect Scale, Rosenberg Self-Esteem Scale (SES), and Multidimensional Scale of Perceived Social Support (MSPSS). Results indicated that the prevalence of psychological abuse in Chinese adolescents was 25.66%, and psychological abuse was negatively associated with self-esteem and social support, respectively. Self-esteem partially mediated the relationships between psychological abuse and social support. Findings highlight the importance of improving self-esteem in survivors of psychological abuse for decreasing the negative effects on social support. Additionally, the significance and limitations of the results were discussed.

Association between schizoid tendencies and aggressive behaviors: mediating and moderating influences in childhood trauma and life events among Chinese adolescents

BACKGROUND

This study investigated an association between schizoid tendencies and aggressive behaviors in Chinese adolescents, and explored the underlying mechanism.

METHODS

The data of 3094 adolescents aged 12 to 16 years were collected from an epidemiological survey in China. All the subjects or their parents completed the Achenbach's Child Behavior Checklist, the Childhood Trauma Questionnaire-Short Form, and the Adolescent Self-rating Life Event Checklist (ASLEC).

RESULTS

Relative to the non-schizoid group, adolescents with schizoid tendencies (male or female) showed significantly higher scores for aggressive behaviors, emotional abuse, and ASLEC. Regarding females only, those with schizoid tendencies had significantly higher (lower) scores for physical abuse and emotional neglect (physical neglect). The aggressive behaviors score was predicted by scores for schizoid tendencies (β_male = 0.620, β_female = 0.638, both P < 0.001) and ASLEC (β_male = 0.125, β_female = 0.061, both P < 0.01), and by childhood trauma score (males: emotional neglect [β = 0.045, P = 0.021]; females: emotional abuse and sexual abuse [β = 0.118 and - 0.062, both P < 0.01]). The ASLEC and childhood trauma scores mediated the association between scores for schizoid tendencies and aggressive behaviors, specifically, emotional neglect (emotional abuse and sexual abuse) in males (females). In females, the interaction between scores for childhood trauma and ASLEC affected the aggressive behaviors score (P = 0.023).

CONCLUSIONS

Schizoid tendencies are associated with aggressive behaviors among Chinese adolescents. Recent life events and childhood trauma mediated an association between schizoid tendencies and aggressive behaviors. The interaction between childhood trauma and recent life events affected aggressive behaviors in females. Aggressive behaviors in adolescents may be ameliorated by reducing childhood trauma and life events.

Syndemic Conditions, Sexual Risk Behavior, and HIV Infection Among Men Who Have Sex with Men in Taiwan

Men who have sex with men (MSM) continue to constitute the majority of HIV incidence in Taiwan. This study examined the associations between five co-occurring psychosocial health conditions (PHCs)-childhood physical abuse (CPA), childhood sexual abuse (CSA), intimate partner violence (IPV), internalized homophobia (IH), and methamphetamine use (MU), and two outcomes (HIV infection and condomless anal sex) among a community sample of 1,000 Taiwanese MSM (mean age 28.5 years). Compared to MSM who had never experienced any PHC, MSM with one or more PHCs had greater than twofold higher odds of being HIV-positive, and those with three or more PHCs had twofold higher odds of having condomless anal sex. Interactive effects on HIV infection were identified from CPA + CSA + MU and CPA + IPV + MU. An interactive effect on condomless anal sex was detected between IH and MU. In order to control the escalating HIV epidemic among MSM in Taiwan, interventions are needed to address syndemic psychosocial health conditions.

The prevalence and impact of maltreatment of child laborers in the context of four South Asian countries: A scoping review

BACKGROUND

Child maltreatment is a global health concern, which adversely affects millions of children. Among them, child laborers are highly susceptible to maltreatment due to their economic vulnerability and workplace practices.

OBJECTIVES

This review seeks to identify the extent, risk factors and psychological impairments associated with the maltreatment of child laborers in four South East Asian countries.

METHODS

A scoping review was adopted, in accordance with the PRISMA framework. Scopus, Medline, PsycINFO, ProQuest, Web of Sciences, and grey literature from relevant institutional websites were searched. Search date parameters were 1960-2020. A thematic synthesis and a proportion test were adopted to analyse data.

RESULTS

A total of 9 studies were retrieved. The physical maltreatment against child laborers (15.14 %) was found across all studies with high heterogeneity (from 2.3%-73.27%). The prevalence of emotional maltreatment was more than three times that of physical abuse. Sexual abuse rate was measured (16.82 %) followed by neglect against child laborers (12.9 %). Witness victimization, financial exploitation, forced work, and work intensification were also observed as notable forms of maltreatment. A thematic analysis suggests that the victims and caregivers' characteristics and socio-cultural practices are strong predictors of maltreatment. Parental dysfunctions were also associated with rates of child labor victimization followed by poverty. The review found maltreated children were often traumatized and manifest specific phobias (38.79 %), social phobias (30.2 %), conduct disorders (20.6 %), and obsessions (18.21 %), which are significantly associated (p < 0.05) across studies.

CONCLUSIONS

While the methodical study base is limited, the results of this review can inform further research on violence against child laborers.

Multiple Factors Associated With Child Abuse Perpetration: A Nationwide Population-Based Retrospective Study

Differences in child abuse perpetration between individuals with and without mental disorders remain obscure. This study compared the risk difference and further investigated the association between the category of mental disorders and child abuse perpetration. A total of 681,970 adults from the 2002 to 2013 Taiwan National Health Insurance Research Database were analyzed, including 340,985 patients with psychiatric disorders (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 290.x-319.x) and 340,985 sex- and age-matched individuals without psychiatric disorders. Child abuse perpetration (ICD-9-CM N-codes 995.5x and E-code E967) was the outcome variable. Matched analyses indicated that the risk of child abuse among patients with psychiatric disorders (0.25%) was significantly higher than that among those without psychiatric disorders (0.16%; odds ratio [OR] = 1.464, p < .0001). Among the six categories of mental disorders, the prevalence rates of committing child abuse were significantly higher for personality disorders, substance use, and affective disorders (0.56%, 0.45%, and 0.40%, respectively; p < .0001). Compared with anxiety disorders, substance use disorders were significantly associated with higher odds of child abuse perpetration (OR = 2.032, p < .05), especially physical abuse (OR = 2.018, p < .0001). Psychiatric morbidity was associated with higher odds of child abuse, with substance use determined as the major risk category. Screening high-risk families by using the associated factors is crucial.

Impacts of childhood adversity forms and drinker self-schema on undergraduate drinking behaviors and depression

PURPOSE

Drinking behaviors and depression are common and highly correlated behaviors in undergraduates. Child adversity and drinker self-schemas have been recognized as significant risk factors of drinking behaviors and depression. However, how the various child adversity forms differentially influence the formation of drinker self-schema and behaviors is underexplored. We aimed to determine whether drinker self-schema serves as a mechanism underlying the influence of child adversity forms on drinking frequency, drinking problems, and depressive symptoms.

METHODS

A cross-sectional, correlational study design with an anonymous, internet-based survey was conducted. Participants were 330 first- and second-year undergraduates enrolled in a four-year college/university as full-time students in Taiwan. Path analysis was performed to examine the direct and indirect effects (through drinker self-schema) of child adversity forms on drinking frequency, drinking problems, and depressive symptoms. Gender and friend's alcohol use were the covariates.

RESULTS

Psychological abuse, psychological neglect, physical neglect, and household substance use were associated with drinker self-schema, which was associated with drinking frequency, drinking problems, and depressive symptoms. Physical abuse was associated with drinking frequency. Household substance use and parent(s) treated violently were associated with drinking problems. Psychological neglect and household mental illness were associated with depressive symptoms. Moreover, psychological abuse and psychological neglect had indirect effects on drinking frequency and drinking problems through drinker self-schema.

CONCLUSIONS

Different forms of childhood adversity are differently associated with drinker self-schema, drinking behaviors, and depression. Drinker self-schema serves as an underlying mechanism linking psychological maltreatments to drinking behaviors.

The global challenge of the neglect of children

BACKGROUND

The neglect of children is a serious global problem. The 1989 United Nations Convention on the Rights of the Child (CRC) was a major international achievement spurring national efforts to prevent and address neglect. However, the scope of neglect worldwide and progress in addressing it remain unclear.

OBJECTIVE

This analysis assessed the current state of child neglect through much of the world, including its prevalence and efforts to address it.

METHOD

The scope of neglect was assessed through a literature review of recent peer-reviewed research and analysis of the United Nations Children's Fund (UNICEF) child protective services (CPS) and early childhood development data. National responses to neglect in 73 countries were described in the International Society for the Prevention of Child Abuse and Neglect's World Perspectives 2016 data and through illustrative case studies of recent CRC country reports for Australia, China, India and Mozambique.

RESULTS

Neglect is prevalent throughout the world, although its extent and form vary. Most countries recognize neglect as a form of maltreatment and have basic CPS policies and some system in place, but implementation of prevention and intervention services remains inadequate even in high-income countries. Economic and other barriers inhibit progress to address the neglect of children.

CONCLUSIONS

Progress has been made in establishing basic child protections and other safeguards for neglect in most countries, but significant barriers and inadequacies remain. Implementation of the CRC is uneven and there are large gaps in needed services. Much work remains to better assess and address this serious problem, in every country.

Effects of childhood adversity trajectories on mental health outcomes in late adolescence: The buffering role of parenting practices in Taiwan

BACKGROUND

Childhood adversities (CAs) have been linked with unfavorable development; however, the chronic trajectories of multiple CAs and possible heterogeneous effects are understudied.

OBJECTIVES

This study examined the trajectories of multiple CAs and their associations with mental health outcomes in adolescence and investigated the buffering effect of parenting practices.

PARTICIPANTS AND SETTING

We used population-representative data from the Taiwan Education Panel Survey (2005 and 2007, n = 10,416).

METHODS

This study was based on retrospectively self-reporting of six CAs, namely physical abuse, family economic hardship, parental problematic drinking, parental catastrophic health problems, parental divorce, and parental death, at three developmental periods: early childhood, middle childhood, and early adolescence. Group-based multitrajectory modeling and multiple regressions were used to identify distinct trajectories of multiple CAs and evaluate the association estimates.

RESULTS

A total of four trajectory groups were identified: increasing family economic hardship (12.3 %), chronic physical abuse (3.3 %), chronic parental problematic drinking (2.8 %), and low adversity (81.6 %). The chronic physical abuse group had the highest levels of depressive symptoms (β = 6.61, p < .001) and suicidal ideation (Adjusted Odds Ratio [AOR] = 2.67, p < .001), whereas the chronic parental problematic drinking group had the highest level of substance abuse (AOR = 4.59, p < .001). Positive parental practices buffered the harmful effects of increasing family economic hardship in late adolescence, particularly for depressive symptoms and substance abuse.

CONCLUSIONS

Adverse mental health outcomes varied among groups with distinct multiple CA trajectories. The provision of social services to train or support positive parenting practices in families experiencing economic hardship is a potentially valuable resilience strategy.

A psychometric analysis of a short form of the Chinese version of the ISPCAN child abuse screening tools - Children's home version (SC-ICAST-CH) using multidimensional item response theory

BACKGROUND

The development of measures of child maltreatment for the Chinese population were limited until the Chinese version of the ISPCAN Child Abuse Screening Tools - Children's Home version (ICAST-CH-C) was proposed. Although the ICAST-CH-C was found to be effective in assessing the scope and prevalence of child maltreatment, it has several potential drawbacks. The time that is required to complete the ICAST-CH-C scale is longer than usual for a 36-item scale, because many of its items have one or more follow-up questions. Moreover, each item requires child victims to recall unpleasant experiences. Both phenomena can cause increases in invalid responses and in turn damage the data quality.

OBJECTIVE

The goal of this study was to propose a short form of the ICAST-CH-C (called the SC-ICAST-CH) to reduce the test length and response time in order to improve the measurement quality.

PARTICIPANTS AND SETTING

A dataset from a national survey of 5236 adolescents in Taiwan was used.

METHODS

A multidimensional version of the rating scale model (MRSM) was fitted to the data. The model parameters were estimated with the ConQuest software.

RESULTS

The results indicated the reliability of the SC-ICAST-CH was fairly good, with only 61 % of the original test length. Disordered thresholds were found in all five subscales; the underlying reasons for this phenomenon need further investigation. Specific cultural differences related to item retention/removal decisions were also discussed.

CONCLUSION

The efficient, shorter SC-ICAST-CH was shown to be a valid and reliable instrument for assessing the prevalence of child maltreatment.

Childhood neglect and suicidal behavior: Findings from the National Comorbidity Survey Replication

BACKGROUND

Although child neglect is common, there has been comparatively little research on it or its specific forms and their effects on mental health in adulthood.

OBJECTIVE

This study aimed to examine the association between exposure to different forms of childhood neglect and lifetime suicidal behavior among a nationally representative sample of adults in the U.S. general population.

METHODS

Data were analyzed from 5665 adults that were drawn from the National Comorbidity Survey Replication (NCS-R). Information was obtained on 'care', 'supervisory' and 'medical' neglect in childhood and lifetime suicidal behavior (ideation, plan, attempt). Lifetime psychiatric disorders were based on the World Mental Health - Composite International Diagnostic Interview. Logistic regression analysis was used to examine the associations.

RESULTS

In fully adjusted models, any neglect was associated with significantly increased odds for all forms of suicidal behavior (suicidal ideation, odds ratio [OR]: 1.80, 95 % confidence interval [CI]: 1.42-2.29; plan, OR: 2.27, 95 % CI: 1.78-2.91; attempt, OR: 2.05, 95 % CI: 1.63-2.59, all p < 0.001). In unadjusted analyses all individual forms of neglect were significantly associated with all forms of suicidal behavior. However, when all forms of neglect were included together in the fully adjusted models, care neglect was no longer significantly associated with any form of suicidal behavior.

CONCLUSION

Different forms of childhood neglect are associated with suicidal behavior in adults independent of common mental disorders. Future studies should focus on childhood neglect subtypes in order to better understand the effects of neglect on adult mental health.

Association between child abuse exposure and the risk of psychiatric disorders: A nationwide cohort study in Taiwan

BACKGROUND

Child abuse affects children physiologically and psychologically, increasing the risk of future psychiatric disorders.

OBJECTIVE

To assess whether child abuse victims have a higher incidence of future psychiatric disorders or substance abuse.

PARTICIPANTS AND SETTING

The participants consisted of a nationwide, population-based cohort selected in accordance with the Taiwan National Health Insurance Research Database. All children were enrolled between 2000 and 2015.

METHODS

This was a retrospective study with a matched-cohort design. Children who experienced child abuse were identified using International Classification of Disease codes and compared with children who had not experienced child abuse by measuring rates of anxiety disorders, depressive disorders, bipolar disorders, sleep disorders, posttraumatic stress disorder/acute stress disorder, eating disorders, substance-related disorders (alcohol use disorder and illicit drug use disorder), psychotic disorders, and organic mental disorders.

RESULTS

The psychiatric disorder risk was significantly higher in victims of child abuse than in controls (adjusted hazard ratio, 2.15; 95 % confidence interval, 1.92-2.40; P < 0.001). The Kaplan-Meier analysis revealed a significantly higher 15-year cumulative incidence of psychiatric disorders among child abuse victims than among controls (394.57 vs. 317.56 events per 100,000 person-years; log-rank test, P <  0.001).

CONCLUSIONS

In Taiwan, child abuse is associated with increased psychiatric disorder and substance abuse risk. Individuals involved in caring for abused children, including family members, pediatricians, nurses, and social workers, as well as policy makers, should be aware of this risk. Early referral of child abuse victims to pediatric psychiatrists may help detect high-risk cases and facilitate early intervention.

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.

Prevalence of child maltreatment in Ecuador using the ICAST-R

OBJECTIVES

While the link between childhood experiences of physical, emotional, and sexual abuse and mental health problems has been largely studied, there is limited information regarding the prevalence of child maltreatment in developing countries, particularly in South America. The present study is an effort to investigate the prevalence of child maltreatment in Ecuador using the ISPCAN Child Abuse Screening Tool Retrospective version (ICAST-R).

METHOD

A student sample (males = 1579; females = 1554) from the seven largest universities in Quito, Ecuador, completed the ICAST-R.

RESULTS

Our findings indicate that 69.6 % of participants experienced child maltreatment. Physical abuse was reported by 47.6 % of respondents; this commonly involved being beaten by parents. Emotional maltreatment was reported by 53 % of the participants; mostly through insults by same-sex peers and parents. Sexual abuse was reported by 15.5 % of the participants. The most prevalent forms of sexual abuse included being coerced into touching another person's genitals, having their genitals touched by others, or having someone expose their genitals to them. Sexual abuse was more prevalent amongst females (males = 12.9 %; females = 18.1 %, OR = 1.49; CI = 1.22-1.81), and physical abuse was more prevalent amongst males (males = 50.5 %; females = 44.6 %, OR = 0.79; CI = 0.69-0.91).

CONCLUSIONS

Our study shows evidence of a high prevalence of child maltreatment in Ecuador. We also identify significant gender differences in the type of abuse experienced, and in the context in which this abuse takes place. These results are important given the negative consequences of child maltreatment. More research applying ICAST to different populations is recommended to further validate the present findings and facilitate international comparisons.

Who Gets Protection? A National Study of Multiple Victimization and Child Protection Among Taiwanese Children

This study aims to examine the prevalence of multiple types of child victimization and the effects of multiple types of victimization on children's mental health and behavior in Taiwan. The study also examines the child-protection rate and its correlates among children experiencing various types of victimization. This study collected data with a self-report questionnaire from a national proportionately stratified sample of 6,233 fourth-grade students covering every city and county in Taiwan in 2014. After calculating the 1-year prevalence of child victimization, the study found that bullying was the most prevalent (71%), followed by physical neglect (66%), psychological violence (43%), inter-parental violence (28%), community violence (22%), physical abuse (21%), and sexual violence (9%). As the number of victimization types increased, children were more likely to report greater posttraumatic symptoms, psychiatric symptoms, suicide ideation, self-harm thoughts, and violent behaviors. Gender, neonatal status, parental marital status, and other family risks were significantly associated with elevated incidences of the victimization types. Only 20.6% of the children who had experienced all seven types of victimization had received child protective services. A child was more likely to receive child protective services if he or she had experienced sexual violence, community violence, inter-parental violence exposure, higher family risks, higher suicidal ideation, or living in a single-parent or separated family. In conclusion, this study demonstrates the cumulative effects and the harmful effects that children's experience of multiple types of victimization can have on the children's mental health and behavior. The present findings also raise alarms regarding the severity of under-serving in child-victimization cases. These results underscore the importance of assessing, identifying, and helping children with multiple victimization experiences.

Effects of childhood adversity and resilience on Taiwanese youth health behaviors

BACKGROUND

Adverse childhood experiences (ACEs) can leave negative impacts on one's health behaviors or social functioning later in life. Resilient characteristics have been shown to mitigate effects against risk behaviors in developing adolescents. However, clinical and research attention has rarely been given to jointly consider the effects of ACEs and resilient characteristics on health behaviors in Taiwanese youth.

METHOD

A total of 200 individuals aged 15-22 years were recruited from primary care settings, communities, and schools. Participants completed questionnaires assessing their ACEs, resilient characteristics, and health behaviors. Univariate analysis was firstly used to describe the correlates of ACEs and resilient characteristics. Further multivariate logistic regression analysis was used to examine the association of both factors with health behaviors.

RESULTS

More than half (61.5%) of those surveyed had been exposed to at least one category of ACE. Verbal (37%) and physical (21%) abuses were the most common types of ACEs. The counts in the ACE categories were associated with being involved in physical fights (odds ratio 1.28 [confidence interval 1.01-1.63]), property damage (1.29 [1.03-1.61]), running away from home (1.30 [1.05-1.60]), bullying victimization (1.37 [1.16-1.61]), and sleep problems/tiredness (1.25 [1.03-1.52]). Meanwhile, resilience scores were associated with decreased odds of infrequent seatbelt use (0.47 [0.23-0.97]), low fruit and vegetable intake (0.42 [0.21-0.86]) unsatisfied body image (0.46 [0.22-0.97]), and sleep problems/tiredness (0.37 [0.18-0.79]).

CONCLUSIONS

ACEs and resilience characteristics play a significant role in shaping youth health behaviors. Further research should be undertaken to identify ways to build resilience against health risks in youth with prior ACE exposure.

Prevalence of child abuse in Kerala, India: An ICAST-CH based survey

BACKGROUND

Child abuse is a major concern in India with frequent reports of extreme maltreatment and fatalities. A dearth of robust and methodologically sound studies has resulted in ambiguity regarding the extent of child abuse in the general population.

OBJECTIVES

To estimate the one-year and lifelong prevalence of exposure to violence, physical abuse, emotional abuse, sexual abuse, and neglect using a validated instrument-the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool - Child, Home Version (ICAST-CH).

PARTICIPANTS AND SETTING

Adolescents (n = 6957) attending randomly selected schools in one city in Kerala, India.

METHODS

Cross-sectional survey using self-report instrument.

RESULTS

The one-year prevalence of any abuse was 89.9% (95% CI: 89.1-90.7) suggesting that child maltreatment was widespread. Physical and emotional abuses were also very common. Although sexual abuse was least common, a considerable proportion of adolescents reported it; one-year prevalence of sexual abuse was 16.7% and lifetime prevalence was 19.9%. Boys reported more abuse than girls across all the categories of abuse (including sexual abuse). Abuse was more frequent in the higher age groups and classes at school. Abuse was also more frequent in nuclear families and families that reported alcohol use. Children who reported an abusive experience usually faced more than one category of abuse; abuse in one category was significantly associated with abuse in other categories.

CONCLUSIONS

Abuse of children is alarmingly common. There is an urgent need for improving the awareness surrounding this issue as it is a major public health challenge faced by the country. The priority should be on setting up easily accessible support services for children.

Factors associated with online victimisation among Malaysian adolescents who use social networking sites: a cross-sectional study

OBJECTIVE

To determine the prevalence of online interpersonal victimisation and its association with patterns of social networking site (SNS) use, offline victimisation, offline perpetration and parental conflict among Malaysian adolescents using SNS.

METHODS

A cross-sectional study of students from randomly selected public secondary schools in the state of Negeri Sembilan was conducted using an anonymous self-administered questionnaire. The questionnaire examined patterns of SNS use and included measures of online victimisation, online perpetration, offline victimisation and parental conflict. A response rate of 91% from a total of 1634 yielded a sample of 1487 students between 15 years and 16 years of age.

RESULTS

Ninety-two per cent of respondents had used at least one SNS. More than half of SNS users (52.2%) reported experiences of online victimisation over the past 12 months. Boys were significantly more likely to experience online harassment compared with girls (52.2% vs 43.3%, p<0.001). There were no significant gender differences in experiences of unwanted sexual solicitation. Adolescents who engaged in perpetration behaviours online had almost six times higher odds of reporting frequent online victimisation compared with online behaviours involving personal disclosure. There was a significant dose-response relationship between engagement in multiple types of online behaviour and the risk of frequent online victimisation. Both online and offline perpetrations were associated with an increased risk of victimisation. Those who were victimised offline or experienced parental conflict were twice as likely to report online victimisation.

CONCLUSION

Interventions to prevent online electronic aggression should target perpetration behaviour both online and offline. Youth should be equipped with skills in communication and decision-making in relationships that can be applied across a spectrum of contexts both online and offline.

Psychological maltreatment, coping strategies, and mental health problems: A brief and effective measure of psychological maltreatment in adolescents

Psychological maltreatment is an important social and public health problem and associated with a wide range of short and long-term outcomes in childhood to adulthood. Given the importance of investigating mitigating factors on its effect, the purpose of the present study is to investigate the mediating effect of active and avoidant coping strategies on the association between psychological maltreatment and mental health- internalizing and externalizing- problems in adolescents. Participants of the study consisted of 783 adolescents, ranging in age from 14 to 18 years (M=15.57, SD=0.88), with 52.9% female and 47.1% male. Several structural equation models were conducted to investigate the mediating role of coping strategies on the effect of psychological maltreatment on adolescents' internalizing and externalizing problems. Findings from mediation analyses demonstrated the mediating effect of active and avoidant coping strategies on the association between psychological maltreatment and mental health problems. The outcomes support adolescents use more avoidant coping strategies and fewer active coping strategies in the face of psychological maltreatment experiences, and this affects their mental health. Taken together, these results should contribute to the design of prevention and intervention services in order to promote mental health.

Factors associated with the type of violence perpetrated against adolescents in the state of Pernambuco, Brazil

To analyze the factors associated with the types of violence against adolescents reported in Pernambuco, Brazil, from 2009 to 2012. Prevalence study conducted through an electronic database from the Violence Surveillance Official System in a population of 5259 adolescents (aged 10-19 years). Poisson regression was used, with significance level at 5%. There was a significant increase of 204% in the number of violence reports, and the number of reporting units increased by 92.6%. When separately evaluated, physical violence was the most prevalent type, accounting for 44.7% of the reports. Taking as independent variables the age range of 15-19 years, female, having no disability, and public roads as place of occurrence, the positively and independently associated factors were: male gender (OR 1.5, 95% CI 1.4-1.6) with physical violence; having deficiency (OR 1.7, 95% CI 1.5-2.0) with psychological violence; age range of 10-14 years (PR 2.4, 95% CI 2.2-2.6) with sexual assault; and male (OR 3.9, 95% CI 2.0-7.5), having disabilities (PR 4.6, 95% CI 2.7-9.7), and occurrence in residence (PR 2.8, 95% CI 1.3-6.1) with neglect. Age between 10 to 14 years was associated with the occurrence of sexual assault; male with the occurrence of physical violence and neglect; having disabilities with psychological violence and neglect; and occurrence in the residence was associated with neglect.

Association between child maltreatment and prospective and retrospective memory in adolescents: The mediatory effect of neuroticism

The purpose of this study was to examine the relationship between child maltreatment and prospective and retrospective memory in children/adolescents by investigating the mediating role of neuroticism. In total, 662 children/adolescents aged 10-16 years were recruited from a middle school in China, and they completed questionnaires comprising the Childhood Trauma Questionnaire, Prospective and Retrospective Memory Questionnaire, and the Neuroticism subscale of the NEO Five-Factor Inventory. The severity of maltreatment was positively associated with the severity of impairment of memory (prospective and retrospective considered together) in children/adolescents. Children/adolescents exposed to maltreatment tended to display higher levels of neuroticism. Neuroticism partially mediated the association between child maltreatment and memory in all the subjects. The results of multigroup analyses showed neuroticism fully mediated the relationship between child maltreatment and memory for boys, in which the effect size of indirect effect was 0.52, and partially mediated the association for girls with 0.44 effect size of indirect effect. Early intervention aimed to reduce neuroticism might contribute to a better prognosis in children/adolescences with poor memory function.

Poly-victimization and psychopathology among Spanish adolescents in residential care

The aim of this study was to analyze the effect of poly-victimization on symptom severity among adolescents being cared for by the child welfare system in a southwestern European country. The sample consisted of 127 youths (62 males and 65 females) aged 12-17 years (M=14.60, SD=1.61) who were recruited from short- and long-term residential centers. The Juvenile Victimization Questionnaire (Finkelhor, Hamby, Ormrod, & Turner, 2005) and the Youth Self-Report (Achenbach & Rescorla, 2001) were used to assess interpersonal victimization experiences and psychopathology, respectively. Victim (n=68), low poly-victim (n=48), and high poly-victim (n=18) groups had comparable rates of psychopathology severity, with the exception of rule-breaking behavior, which was more severe among those with more victimization experiences (Cramer's V=.342). Poly-victimization was shown to be a significant predictor of clinically severe rule-breaking behavior, thought problems, and anxiety/depression symptoms. Among victimization types, sexual and electronic victimization significantly predicted withdrawn/depressed and aggressive behavior, and attention problems, respectively. The results of this study highlight the importance of assessing a wide range of victimization experiences among adolescents in care, since poly-victimization seems to underlie the serious psychological problems these youth present.

Psychological maltreatment, emotional and behavioral problems in adolescents: The mediating role of resilience and self-esteem

In this study, structural equation modeling was used to examine the mediating role of resilience and self-esteem in the relationships between psychological maltreatment-emotional problems and psychological maltreatment-behavioral problems in adolescents. Participants were 937 adolescents from different high schools in Turkey. The sample included 502 female (53.6%) and 435 male (46.4%) students, 14-19 years old (mean age=16.51, SD=1.15). Results indicated that psychological maltreatment was negatively correlated with resilience and self-esteem, and positively correlated with behavioral problems and emotional problems. Resilience and self-esteem also predicted behavioral problems and emotional problems. Finally, psychological maltreatment predicted emotional and behavioral problems mediated by resilience and self-esteem. Resilience and self-esteem partially mediated the relationship between psychological maltreatment-behavioral and psychological maltreatment-emotional problems in adolescents. Thus, resilience and self-esteem appear to play a protective role in emotional problems and behavioral problems in psychologically maltreated individuals. Implications are discussed and suggestions for psychological counselors and other mental health professionals are presented.

Child maltreatment in Taiwan for 2004-2013: A shift in age group and forms of maltreatment

Cases of child maltreatment are being increasingly reported in Taiwan. However, the trend or changes of child maltreatment in Taiwan are fragmentary and lack empirical evidence. This study analyzed the epidemiological characteristics of substantiated child maltreatment cases from the previous decade, using mortality as an indicator to investigate the care of children who experienced substantiated maltreatment in the past to determine any new developments. Data for analysis and estimates were retrieved from the Department of Statistics in the Ministry of the Interior from 2004 to 2013. Trend analyses were conducted using the Joinpoint Regression Program. The child maltreatment rate in Taiwan was found to have nearly tripled from 2004 to 2013. A greater increase in the maltreatment of girls than boys and the maltreatment of aboriginal children than non-aboriginal children was noted from 2004 to 2013. When stratified by age group, the increase in maltreatment was most pronounced in children aged 12-17 years, and girls aged 12-17 years experienced the greatest increase in maltreatment. In terms of the proportional changes of different maltreatment forms among substantiated child maltreatment cases, child neglect was decreasing. The increase in sexual abuse was higher than for any other form of maltreatment and surpassed neglect by the end of 2013. Furthermore, the mortality rate of children with substantiated maltreatment record is increasing in Taiwan, whereas the mortality rate among children without any substantiated maltreatment record is decreasing. The results of this study highlight the need for policy reform in Taiwan regarding child maltreatment.

Severity of maltreatment and personality pathology in adolescents of Jammu, India: A latent class approach

The aims of the present study were to identify discrete classes of adolescents based on their reporting of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect of several levels of severity using a person-centered analytic approach (i.e., latent class analysis), and to compare the latent classes on 17 dimensions of personality pathology. It was hypothesized that based on types of maltreatment and severity levels within each type there would be discrete latent classes, and that classes of adolescents exposed to a larger number of maltreatment types with higher severity (i.e., moderate-severe) would report higher levels of personality pathology than adolescents in classes exposed to less types with less severity, after controlling for age and gender. Participants were 702 adolescents from Jammu, India (13-17 years, 41.5% females). The latent classes were based on three levels of severity for each type of maltreatment assessed via the Childhood Trauma Questionnaire (Bernstein et al., 2003). Four distinct classes of adolescents, namely, Moderate-severe abuse and physical neglect (Class 1), Low to moderate-severe abuse (Class 2), Moderate-severe neglect (Class 3), and Minimal abuse or neglect (Class 4) were found. Classes with higher percentages of adolescents reporting abuse and neglect with higher severity (Classes 1 and 2) reported higher levels of personality pathology than the other classes. There are distinct classes of adolescents' identifiable based on levels of severity and types of abuse and neglect, which are differentially associated with specific dimensions of personality pathology. Implications for research and practice are discussed.

Turkish School Counselors' Experiences of Reporting Child Sexual Abuse: A Brief Report

This article reports results from a qualitative study conducted with a purposive sample of 25 Turkish school counselors who reported child sexual abuse. Participants were asked to identify resources they consulted, describe how they felt, and identify sources of support and barriers in the reporting process. The laws (68%) were the most consulted resource, while negative feelings (84%) were cited the most. The most cited sources of support were colleagues, lawyers, and school principals (20% each), while school principals also ranked first as barriers (44%), followed by incest victims' families (32%). Participants predominantly desired safety and security of the reporter ensured (48%). Implications for a more functional child protection system and a reporter-friendly legal system in Turkey are discussed.