The intergenerational transmission of child maltreatment: A three-level meta-analysis

The impact of maternal childhood maltreatment on child externalizing behaviour and the mediating factors underlying this association: a three-level meta-analysis and systematic review

Child maltreatment can negatively impact not only survivors but also survivors' children. However, research on the intergenerational effect of maternal childhood maltreatment on child externalizing behaviour has yielded contradictory results and has not yet been systematically synthesised. The current three-level meta-analysis and systematic review aimed to provide a quantitative estimate of the strength of the association between maternal childhood maltreatment and child externalizing behaviour and to summarise research on potential mediating factors of this association. PsycINFO, PubMed, and Embase were searched and 39 studies with 82 effects sizes were included in the meta-analysis. Results revealed a small significant association between maternal childhood maltreatment and child externalizing behaviour (r = 0.16; 95% CI 0.12-0.19; publication bias-adjusted effect size: r = 0.12, 95% CI 0.08-0.16). Maternal mental health, particularly depressive symptoms, maternal parenting and children's maltreatment exposure were the most frequently examined mediators of this association, with relatively robust mediating effects for children's maltreatment exposure and maternal depressive symptoms, but mixed evidence for the mediating role of maternal parenting. This meta-analysis provides evidence for a small but significant association between maternal childhood maltreatment and children's externalizing behaviour, emphasizing the need to develop effective preventive and intervention strategies to minimise the effects of childhood maltreatment on the next generation.

Gratification and its associations with problematic internet use: A systematic review and meta-analysis using Use and Gratification theory

Problematic Internet Use (PIU) has been a growing issue for two decades, and many researchers have sought to explain its occurrence. Use and Gratification Theory (UGT) has guided empirical studies investigating the associations between gratification and PIU. However, their results appear equivocal. This study aimed to synthesize research findings applying UGT and pinpoint the associations between different gratifications and PIU. Effect sizes were pooled to obtain an overall effect size. Gratifications were then classified into four types (i.e., content, social, self-presentation, and process) according to the suggestions of previous studies and the measurement of included studies. Based on 216 effect sizes from 57 samples with 38,492 participants (mean age = 24.3; 55.1 % female), random effect model analyses yielded a medium effect size (r = 0.303, p <.001, 95 % CI [0.263, 0.343]), indicating a positive association between general gratification and PIU. Subgroup analyses revealed that all four gratifications were positively associated with PIU; self-presentation showed the largest effect size, followed by process gratification.This study enhances the conceptual relevance of UGT in understanding PIU and highlights the importance of process and self-presentation gratification as predictors for PIU in certain contexts, such as among university students and in Asian countries.

Maternal victimization and neglected offspring: Child marriage, IPV and depression symptoms among Salar Muslim women

BACKGROUND

Child neglect is prevalent in western rural China, yet there is limited research among ethnic minority communities. The Salar, a Turkic-Muslim ethnic minority residing primarily in western China, also face this specific problem. The group is deeply influenced by ethnicity, Islam and Chinese Confucianism, which in turn makes women vulnerable to child marriage and IPV. These victimizations, coupled with various life stressors, further complicate the challenges of providing adequate care for their children.

OBJECTIVE

This study hypothesizes a relationship between child neglect and maternal child marriage, IPV victimization, and depression symptoms.

PARTICIPANTS AND SETTING

201 married Salar women from five villages in Xunhua Salar Autonomous County, China, were randomly selected to participate in the study.

METHOD

A probability proportional to size (PPS) sampling approach was used to collect a random representative multi-stage cluster sample in 2022. Random effects Poisson regression models were used to test the hypotheses.

RESULTS

The participants reported a 65.6 % rate of child neglect and a 30.8 % rate of IPV in the past year. 37.6 % experienced child marriage. Results revealed significant associations between child neglect and child marriage, IPV, and depression symptoms. A two-way interaction between IPV and depression symptoms was strongly positively associated with child neglect.

CONCLUSIONS

This research indicates that Salar Muslim mothers who have experienced child marriage, adulthood victimization, and depression are at a higher risk of neglecting their children. The findings represent a valuable initial step toward researching and addressing the protection needs of women and children from Muslim ethnic minorities in China.

Intergenerational mental health effects of traumatic victimization in Nepal: A 3-D theory study

BACKGROUND

Intergenerational transmission of trauma is a major focus of international research. Epigenetic, complex-trauma, and intergenerational abuse pattern transmission theoretical explanations all have existing empirical support. Three-D theory argues that in addition to trauma victimization severity, victimization invasiveness and exploitativeness have important independent effects. Moreover, 3-D theory claims that a positive 3-way interaction occurs between trauma victimization invasiveness, exploitativeness, and severity. This study examines the 3-D hypotheses in the context of intergenerational trauma effects on adolescent depression symptoms and suicidal ideation in generation two. Three-D theory may play a particularly important role in intergenerational trauma effects for female victims in the context of conservative South Asian sex role norms.

OBJECTIVE

Test for main effects, two-way, and three-way interaction effects of invasiveness, exploitativeness, and severity of traumatic victimization on intergenerational transmission to adolescent depression and suicidal ideation in generation two. Pathways from maternal depression and borderline personality symptoms as well as physical and sexual abuse and neglect of the adolescent child were also tested.

PARTICIPANTS

and setting. Participants were a nationally representative, random, multi-stage cluster sample of 1089 Nepali mothers and their 15-17 year old adolescent children.

METHODS

Regression models with adjustments for clustering within municipality were used to test the hypotheses.

RESULTS

One in four Nepali adolescents had considered suicide; more than half had high depression scores. A three-way interaction effect between maternal trauma invasiveness, exploitativeness, and severity was positively associated with adolescent depression symptoms. A two-way interaction effect between exploitativeness and severity of maternal trauma was positively associated with adolescent suicidal ideation. Maternal depression, BPD symptoms, and very severe physical abuse of the adolescent were also associated with adolescent depression symptoms.

CONCLUSION

Further research is needed to measure and investigate invasiveness, exploitativeness, and severity of traumatic victimization as they bear on intergenerational transmission of trauma. Examination of intergenerational transmission of self-concept as a potential vector is recommended.

Divorce and physical health: A three-level meta-analysis

Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.

Identifying effective moderators of cognitive behavioural trauma treatment with caregiver involvement for youth with PTSD: a meta-analysis

Children can develop post-traumatic stress disorder (PTSD) and mental health symptoms after traumatic events. This meta-analysis evaluated the influence of moderators of cognitive behavioural trauma treatment (CBTT) with caregiver involvement in traumatized children. A total of 28 studies were included, with 23 independent samples and 332 effect sizes, representing the data of 1931 children (M age = 11.10 years, SD = 2.36). Results showed a significant medium overall effect (d = 0.55, t = 2.478, p = 0.014), indicating CBTT with caregiver involvement was effective in treating PTSD (d = 0.70), with somewhat smaller effect sizes for internalizing, externalizing, social, cognitive and total problems (0.35 < d > 0.48). The positive treatment effect was robust; we found somewhat smaller effect sizes at follow-up (d = 0.49) compared to post-test (d = 0.57) assessments. Furthermore, several sample (i.e. child's age, gender, and trauma event), programme (i.e. the duration of treatment, number of sessions), study (i.e. control condition, type of instrument, informant, type of sample), and publication (i.e. publication year and impact factor) characteristics moderated the treatment outcomes of the child. In sum, the results of our meta-analysis might help to improve the effectiveness of cognitive behavioural trauma treatment for youth with PTSD, and guide the development of innovative trauma interventions that involve caregivers. Implications for theory and practice are discussed.

Intergenerational transmission of childhood maltreatment and offspring behavioral adjustment problems and competence

BACKGROUND

Previous studies have consistently highlighted that exposure to childhood maltreatment adversely affects the developmental domains of subsequent generations. Little, however, is known about the relationship between maternal childhood maltreatment history and adolescent development, as well as the mediator role of offspring childhood maltreatment.

OBJECTIVE

The current study attempts to investigate the mediating role of offspring childhood maltreatment in the relationship between maternal childhood maltreatment history and offspring behavioral adjustment problems and competence.

METHODS

Participants were 1102 adolescents aged 10-15 years (Mage = 12.14, SD = 1.22) and their mothers (Mage = 39.40, SD = 5.31). Participating adolescents filled out self-report instruments assessing their childhood maltreatment by their mothers, self-esteem, academic performance, loneliness, and prosocial and aggressive behaviors between October 2018 and May 2019. In addition, we collected data from mothers on their childhood maltreatment history.

RESULTS

We analyzed the data through a structural equation model. The findings revealed insignificant direct effects of maternal childhood maltreatment history on offspring behavioral adjustment problems and competence. Yet, indirect effects demonstrated that offspring maltreatment by mothers mediated the relationship between maternal childhood maltreatment history and offspring behavioral adjustment problems and competence. Maternal childhood maltreatment history was significantly associated with offspring maltreatment (β = 0.30; p < .001), which in turn was linked to a higher level of behavioral adjustment problems (β = 0.40; p < .001) and a lower level of competence (β = -0.71; p < .001).

CONCLUSION

The research findings extend our understanding of the relationship between maternal childhood maltreatment history and offspring behavioral adjustment problems and competence, identifying the mediating role of offspring maltreatment.

The Prevalence, Predictors, and Health Consequences of Disagreement in Reports of Child Maltreatment Exposure

The purpose of this study was to examine the prevalence, predictors, and consequences of disagreement between prospective caregiver and retrospective child reports of childhood physical and emotional maltreatment. The design was a secondary analysis of data from the Avon Longitudinal Study of Parents and Children, a three-decade long UK-based birth cohort. Prospective caregiver reports were in poor to fair agreement with retrospective child reports for physical and emotional maltreatment exposure, with caregivers tending to underreport exposure. Disagreement between reporters was associated with increased risk of depressive symptoms and substance use severity, but decreased risk for mental health diagnoses. Screening measures of childhood maltreatment exposure should take caution against using measures from different reporters interchangeably (i.e., from mother versus child). Disagreement in reports may indicate unmet need for mental health evaluation.

Going Beyond Childhood and Gender-Based Violence: Epigenetic Modifications and Inheritance

Being exposed to childhood or gender-based violence is associated with subsequent adverse events in individual lives. Not only can it cause psychological distress but violence survivors suffer from a range of long-term adverse health outcomes, including higher morbidity, higher mortality, and higher risk of chronic diseases. Epigenetics may be involved in the determinisms of these long-term detrimental effects. A large body of evidence supports this biological mechanism to explain violence-related health impairment in the long term. However, studies specifically focusing on violence are scant and nonunivocal. Epigenetic modifications of genes involved in stress response and in the hypothalamus-pituitary-adrenal axis regulation are the most commonly and consistently reported. Promising evidence also emerged for the use of epigenetic clocks. Finally, although very limited, there is evidence supporting the notion that long-term health impairment may be transmitted from one generation to the other. Overall, despite promising, available evidence is yet incomplete. The overlap with pure psychological mechanisms of health impairment exposes the findings to confounders and hampers strong conclusions. Based on a literature search on PubMed/Embase, our narrative review aims to illustrate the evidence concerning the potential bond between epigenetics and violence, including also possible impacts on later generations. The goal is to encourage further research to help the development of a more holistic approach for such a vulnerable and often neglected population. Further research is warranted to precisely disentangle the role of epigenetics in mediating the long-term health impairment associated with childhood or gender-based violence. Advances in this area may open new avenues of treatment. Epigenetic modifications may indeed be reversible and could be an attractive therapeutic target to minimize the long-term consequences of childhood or gender-based violence.

Diffusion tensor imaging of white-matter structural features of maltreating mothers and their associations with intergenerational chain of childhood abuse

Child abuse causes lifelong adverse outcomes for both physical and mental health, although many are resilient. Efforts to prevent this issue from the parental side require an understanding of the neurobiological basis that leads abusive parents to perpetrate abuse and the influence of the intergenerational chain of childhood abuse. Therefore, this study was conducted to compare the brain white-matter fiber structures between 11 maltreating mothers who had been recognized as having conducted child abuse prior to the intervention and 40 age-matched control mothers using tract-based spatial statistics. There was a significantly reduced axial diffusivity (AD) and a similar trend in fractional anisotropy (FA) in the right corticospinal tract in maltreating mothers compared to control mothers. Therefore, maltreating mothers may have excessive control over the forcefulness of voluntary movements. These features also decreased as the number of childhood abuse experiences increased, suggesting that an intergenerational chain of child abuse may also be involved. Other aspects observed were that the higher the current depressive symptoms, the lower the AD and FA values; however, they were not related to parental practice or empathy. These results corroborate the neurobiological features that perpetrate behaviors in abusive mothers.

The role of emotion recognition in the intergenerational transmission of child maltreatment: A multigenerational family study

BACKGROUND

Understanding how child maltreatment is passed down from one generation to the next is crucial for the development of intervention and prevention strategies that may break the cycle of child maltreatment. Changes in emotion recognition due to childhood maltreatment have repeatedly been found, and may underly the intergenerational transmission of child maltreatment.

OBJECTIVE

In this study we, therefore, examined whether the ability to recognize emotions plays a role in the intergenerational transmission of child abuse and neglect.

PARTICIPANTS AND SETTING

A total of 250 parents (104 males, 146 females) were included that participated in a three-generation family study.

METHOD

Participants completed an emotion recognition task in which they were presented with series of photographs that depicted the unfolding of facial expressions from neutrality to the peak emotions anger, fear, happiness, and sadness. Multi-informant measures were used to examine experienced and perpetrated child maltreatment.

RESULTS

A history of abuse, but not neglect, predicted a shorter reaction time to identify fear and anger. In addition, parents who showed higher levels of neglectful behavior made more errors in identifying fear, whereas parents who showed higher levels of abusive behavior made more errors in identifying anger. Emotion recognition did not mediate the association between experienced and perpetrated child maltreatment.

CONCLUSIONS

Findings highlight the importance of distinguishing between abuse and neglect when investigating the precursors and sequalae of child maltreatment. In addition, the effectiveness of interventions that aim to break the cycle of abuse and neglect could be improved by better addressing the specific problems with emotion processing of abusive and neglectful parents.

Child Adult Relationship Enhancement in Primary Care (PriCARE) theory of change: A promising intervention to reduce child maltreatment

Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention programs. Because problematic parent-child relationships lie at the core of CM, interventions targeting this relationship hold promise as CM prevention strategies. Evidence-based positive parenting interventions, as discussed here, are manualized behavioral interventions that focus on teaching caregivers positive parenting skills and techniques to improve the effectiveness of their parenting and improve their relationship with their child. In this article, we describe one specific parenting intervention, Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con CARIÑO, and review the proposed mechanisms through which PriCARE may contribute to CM prevention. PriCARE is a 6-session group parenting intervention for parents of 2-to-6-year-old children. PriCARE was developed and iteratively adapted with input from racially and ethnically diverse families, including low-income families, and was designed specifically for implementation in primary care with inclusion of strategies to align with usual care workflow to increase uptake and retention. PriCARE has the potential to reduce risk of CM directly through improving parenting behaviors and indirectly through the impact of those changes in parenting behaviors on child behaviors. PriCARE has also been shown to reduce parenting-related stress. Finally, by strengthening and bringing warmth to the parent-child relationship, PriCARE may buffer against the negative health consequences associated with CM and childhood adversity.

Beyond abuse and neglect: validation of the childhood interpersonal trauma inventory in a community sample of adults

Introduction

Childhood trauma is not restricted to abuse or neglect and other potentially traumatic experiences need to be pondered in practice and research. The study aimed to collect validity evidence of a new measure of exposure to a broad range of potentially traumatic experiences, the Childhood Interpersonal Trauma Inventory (CITI), by evaluating whether the CITI provides important additional information compared to a gold standard measure of childhood trauma.

Methods

The sample consisted of 2,518 adults who completed the CITI and self-reported measures of trauma (Childhood Trauma Questionnaire; CTQ) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; Dissociative Experiences Scale).

Results

First, the sensitivity to properly detect participants having been exposed to childhood maltreatment, as measured by the CTQ (here used as the gold standard), ranged between 64.81% and 88.71%, and the specificity ranged between 68.55% and 89.54%. Second, hierarchical regressions showed that the CITI predicted between 5.6 and 14.0% of the variance in psychiatric symptoms while the CTQ only captured a very small additional part of variance (0.3 to 0.7%). Finally, 25% (n = 407) of CTQ-negative participants screened positive at the CITI. The latter reported higher severity of psychiatric symptoms than participants without trauma, suggesting that the CITI permits the identification of adults exposed to significant traumas that remain undetected using other well-validated measures.

Discussion

The findings underscore the utility of the CITI for research purposes and the latter's equivalence to a gold standard self-reported questionnaire to predict negative outcomes.

Intergenerational effects of child maltreatment on adolescents' anxiety and depression in Ethiopia: the important mediating and moderating roles of current psychological distress

BACKGROUND

Child abuse is widespread around the world, and one continent with particularly high rates is Africa. Research in high- and middle-income countries shows the cascading effect of parental history of child abuse and neglect on adolescents' maltreatment and, in turn, on mental health problems. This cascade has been reported in young children but has rarely been studied in parent-adolescent dyads or in low-income countries (LICs). The goal of this study was to test intergenerational associations of child abuse and neglect and to examine how these experiences are in turn associated with youth anxiety and depression in an LIC.

METHODS

A total of 231 adolescents (age: 13-21 years) and 185 of their parents (n = 90 fathers and n = 95 mothers) were recruited from secondary schools in Addis Abeba, Ethiopia. Using a cross-sectional design, participants completed a set of questionnaires assessing child maltreatment (in adolescence and own past history in parents), parental psychological distress, youth depression and anxiety, and sociodemographic factors.

RESULTS

The frequencies of child maltreatment exposure were 68% for adolescents and 65% for their parents (when they were a child). Fifty-one percent and 42% of adolescents had borderline to clinical levels of anxiety and depression symptoms, respectively. Adolescents of parents with a history of child abuse and neglect also reported higher exposure to maltreatment themselves (p < 0.001). Current paternal, but not maternal, psychological distress mediated this intergenerational association of maltreatment experiences (95% CI [1.164, 9.467]). We further found parents' psychological distress to be a significant moderator of the indirect pathways of the intergenerational effect of child maltreatment on adolescents' anxiety and depression (95% CI [- 0.770, - 0.012]).

CONCLUSIONS

We found child maltreatment to be intergenerationally associated, and this effect subsequently affected adolescents' anxiety and depression through different pathways supporting the cascading effects across generations. Intervention plans may be effective through an array of possible indirect pathways and encourage the implementation of multiple access points to facilitate change in the lives of affected youth in Africa.

Improving Parent-Child Relationships for Young Parents in the Shadow of Complex Trauma: A Single-Case Experimental Design Series

This study provides a preliminary evaluation of a dyadic intervention for young parents with a history of complex trauma, Holding Hands Young Parents (HHYP). Four mothers (17-22 years) and toddlers (12-33 months) completed the intervention, designed to improve parent-child relationships, parental self-regulation, self-efficacy and mental health, and child behaviour/emotional problems. An A-B single case experimental design series with follow-up and randomised baseline, used observational and self-report measures throughout. Linear mixed models demonstrated improvement in reciprocity and parental sensitivity over the treatment phase, with no evidence of shifts in scores at beginning or end of treatment. There was no evidence for changes in child engagement, negative states, intrusiveness or withdrawal. Reliable Change Index indicated improvement in parent-reported self-regulation, self-efficacy, stress and child emotional/behavioural problems from baseline to follow-up for all four mothers; depression showed reliable change for three. This study demonstrates relational change between young parents and their toddlers and provides preliminary data on the HHYP protocol.

The Role of Psychopathology and Emotion Regulation in the Intergenerational Transmission of Childhood Abuse: A Family Study

Previous studies have shown that parents with a history of childhood abuse are at increased risk of perpetrating child abuse. To break the cycle of childhood abuse we need to better understand the mechanisms that play a role. In a cross-sectional extended family design including three generations (N = 250, 59% female), we examined the possible mediating role of parental psychopathology and emotion regulation in the association between a history of childhood abuse and perpetrating child abuse. Parents' own history of childhood abuse was associated with perpetrating abuse toward their children, and externalizing (but not internalizing) problems partially mediated this association statistically. Implicit and explicit emotion regulation were not associated with experienced or perpetrated abuse. Findings did not differ across fathers and mothers. Findings underline the importance of (early) treatment of externalizing problems in parents with a history of childhood abuse, to possibly prevent the transmission of child abuse.

Case conceptualization in child welfare: an underused resource to improve child, family, and provider outcomes

Case conceptualization, formally known as case formulation, is one tool that assists in determining the best course of action for children and families experiencing family violence that has been under-utilized in child welfare. In this article we present a step-by-step case conceptualization process that considers the child welfare context. We then present a hypothetical case example of a 10-year-old child referred by a child welfare worker to evidence-based treatment for mental health and behavioural concerns. Mental health services are not helpful for the child and further consultation is enlisted. To more effectively guide intervention and treatment planning and ultimately improve outcomes for the child, we present case conceptualization as a process that incorporates relevant aspects of the child and family's history and circumstance. We conclude with a succinct case conceptualization and treatment plan to show how the prognosis of the child can be improved when case conceptualization is employed.

Maternal Childhood Maltreatment and Adolescent Internalizing Problems: The Mediating Role of Maternal Depressive Symptoms and Offspring Childhood Maltreatment

Research has demonstrated the predictive effect of maternal childhood maltreatment on adolescent internalizing problems. However, few studies have explored the mediating mechanisms of how mothers' experiences of childhood maltreatment are transmitted to their offspring's internalizing problems over time. The present multi-informant study investigated the potential mediating effects of maternal depressive symptoms and offspring's childhood maltreatment experiences on the relation between maternal childhood maltreatment and adolescent internalizing problems. A total of 823 Chinese youth (43.4% girls; Mage = 10.26 years, SD = 0.94) and their mothers participated in a two-wave longitudinal study with one-year intervals. Mothers reported their experiences of childhood maltreatment and depressive symptoms, while youth reported their childhood maltreatment experiences and internalizing problems. Findings of path analysis indicated that maternal emotional abuse at T1 could significantly predict adolescent internalizing problems at T2, after controlling for a baseline of adolescent internalizing problems. Maternal emotional abuse, emotional neglect, and physical neglect at T1 can influence adolescent internalizing problems at T2 through maternal depressive symptoms at T1 to adolescent internalizing problems at T1. Maternal emotional abuse at T1 displayed statistically significant indirect effects on adolescent internalizing problems at T2 successively through the pathway from adolescent emotional abuse at T1 to adolescent internalizing problems at T1. The findings supported the cycle of maltreatment hypothesis. The present study highlights the intergenerational link between maternal childhood maltreatment and adolescent internalizing problems, as well as reveals the mediating mechanisms in this relation.

[Emotional Maltreatment of Children and Adolescents - Definitions, Prevalences, Risk Factors and Psychological Consequences]

The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.

Exploring the complex links between childhood exposure to intimate partner violence, maltreatment, and self-regulation: A three-wave cross-lagged study

BACKGROUND

Intimate partner violence (IPV) often co-occurs with childhood maltreatment and negatively impacts children's development. While previous research has shown a direct link between these experiences and children's self-regulation, less is known about the potential unique effect and bidirectional associations between them.

OBJECTIVE

The present study aims to investigate the bidirectional effects among maternal IPV experiences, child maltreatment, and children's behavioral self-regulation.

PARTICIPANTS AND SETTING

4,402 participants from three waves of the longitudinal study of the Future of Families and Child Wellbeing Study (FFCWS) were included in the study.

METHODS

Cross-lagged path analyses were conducted to examine the longitudinal reciprocal relationships among IPV, child maltreatment, and children's behavioral regulation when children were 3, 5, and 9 years old.

RESULTS

IPV exposure at ages 3 and 5 was negatively associated with levels of behavioral self-regulation at ages 5 and 9, even after accounting for physical maltreatment, psychological maltreatment, or neglect. Neglect at ages 3 and 5 was found to be associated with lower levels of behavioral self-regulation at later ages, when IPV exposure was considered in the models. Lower levels of behavioral self-regulation at age 3 were found to be linked with higher levels of psychological maltreatment, physical maltreatment, neglect, and IPV exposure at age 5.

CONCLUSION

This study revealed bidirectional effects between maternal IPV experiences, child maltreatment, and children's behavioral self-regulation. Furthermore, the study demonstrated that exposure to IPV during early childhood significantly predicts long-term behavioral self-regulation difficulties, even after controlling for the effects of child maltreatment.

Maternal History of Adversity and Subsequent Mother-Child Interactions at Early Ages: A Systematic Review

Adverse childhood experiences (ACEs) can negatively impact physical, emotional, cognitive, and social development, consequently affecting the next generation. The aim of the present study was to systematically review evidence from empirical studies on the association between maternal history of adversity in childhood (maltreatment and household dysfunction) and subsequent mother-child interactions at an early age. A search was performed in the PubMed, Web of Science, PsycINFO, EMBASE, Scopus, LILACS, and SciELO databases to identify studies, including measures of maternal childhood adversities and mother-child interaction, published between 2016 and 2022. Twenty-nine studies met the inclusion criteria. The results showed that in 90% of the studies, maternal childhood adversities negatively impacted subsequent mother-child interactions in early childhood, reducing maternal displays of affection, emotional availability, sensitivity, mother-child communication, and bonding. Biological factors (e.g., genetic and hormonal) and maternal emotional recognition moderated these associations. In addition, biological factors (i.e., neurobiological and hormonal) and psychosocial factors (e.g., depression, executive functioning, and violence) acted as mediators. Preventive interventions should be implemented to break out of the intergenerational cycle of violence that impacts mother-child interactions.

The Association Between Child Abuse and Aggressive Behavior: A Three-Level Meta-Analysis

Child abuse is considered to be an essential factor in the development of aggressive behavior. The intensity of the positive relations between child abuse and aggressive behavior differed considerably among researches despite the fact that abundant studies have observed this relation. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, a three-level meta-analysis was employed to obtain reliable estimates for the sizes of effects and investigate some potential moderators of the relation between child abuse and aggressive behavior. The present study obtained 51 studies (30,566 participants; 680 effect sizes) through performing the detailed literature search. It was found that child abuse was positively associated with aggressive behavior in the current study. In addition, the present meta-analysis observed significant moderating effects for type of child abuse, culture, measurement of child abuse, and publication year in the association between child abuse and aggressive behavior. This study suggests that child abuse is a predictor for the development of aggressive behavior in humans. Moreover, child abuse is an important aspect for consideration in efforts toward strengthening of interventions targeting individuals' aggressive behavior.

Physically Violent Parental Practices: A Cross-Cultural Study in Cameroon, Switzerland, and Togo

Violence against children and adolescents is a widespread problem. However, most studies conducted in this field has been carried out in Western countries and studies are needed in non-Western countries, especially in Sub-Saharan Africa, where rates of child physical violence are high. The present study aimed firstly to document the different forms of physical violence and attitudes toward corporal punishment (CP) across Cameroon, Switzerland, and Togo. The second objective aimed, on the one hand, to understand the influence of cultural context, childhood physical abuse, and parental attitudes on physically violent parental practices in these three different cultural contexts. On the other, this study aimed to investigate the mediating role of childhood physical abuse and parental attitudes on the effect of cultural contexts on parental practices. Five hundred and forty-seven parents from Togo, Cameroon, and Switzerland filled out questionnaires concerning violent parental practices (ICAST-P), childhood physical abuse (CTQ-SF), and parental attitudes in favor of CP. Firstly, results highlighted some cultural differences regarding parental attitudes and practices. Secondly, the hierarchical regression showed that physical violence could be partially predicted by the cultural context, childhood abuse, and attitudes in favor of CP. Finally, childhood abuse and parental attitudes mediated the link between the cultural context and parental practices. This study underscores the importance of considering the cultural context when examining parental practices. Moreover, these results provide a better understanding of these types of parental practices in less studied contexts.

Intergenerational Transmission of Parental Adverse Childhood Experiences and Children's Outcomes: A Scoping Review

Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents' ACEs on children's outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children's outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children's outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018-2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children's outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children's outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.

Child Maltreatment

Child maltreatment is associated with significant morbidity, and prevention is a public health priority. Given evidence of interpersonal and structural racism in child protective service assessment and response, equity must be prioritized for both acute interventions and preventive initiatives aimed at supporting children and their families. Clinicians who care for children are well positioned to support families, and the patient-centered medical home, in collaboration with community-based services, has unique potential as a locus for maltreatment prevention services. Clinicians can advocate for policies that support families and decrease the risk of child maltreatment.

The mediating role of attachment and anger: exploring the impact of maternal early-life maltreatment on child abuse potential

Background

Maternal early-life maltreatment (ELM) increases the risk of subsequent child maltreatment, but the underlying mechanisms of these intergenerational effects remain largely unknown. Identifying these mechanisms is crucial for developing preventive interventions that can break the cycle of abuse. Notably, previous research has shown that ELM often results in attachment insecurity and altered anger characteristics. Therefore, this study determines whether these characteristics mediate the relationship between maternal history of ELM and child abuse potential.

Methods

The study sample included 254 mothers, of whom 149 had experienced ELM to at least a moderate degree. Maternal ELM was assessed using the Childhood Experience of Care and Abuse (CECA) interview. Attachment insecurity, trait anger and anger expression, and maternal abuse potential were assessed using the Vulnerable Attachment Questionnaire (VASQ), State-Trait Anger Expression Inventory (STAXI), and Child Abuse Potential Inventory (CAPI), respectively.

Results

The severity of maternal ELM predicted higher child abuse potential, with attachment insecurity and anger suppression mediating this effect. Specifically, higher levels of maternal ELM were associated with greater attachment insecurity and increased anger suppression, resulting in a higher child abuse potential. Although higher levels of trait anger were directly associated with higher child abuse potential, this parameter did not mediate the relationship with ELM. In addition, no significant associations were observed between outwardly expressed anger and ELM or child abuse potential. All analyses were adjusted for maternal mental disorders, years of education, and relationship status.

Discussion

Attachment insecurity and anger suppression may serve as pathways linking the maternal history of ELM to the risk of child abuse, even when considering maternal psychopathology. Overall, our findings indicate that interventions aimed at strengthening attachment and improving anger suppression may be beneficial for all mothers with ELM history and high child abuse potential, not just those who suffer from mental illness.

Maternal childhood maltreatment trauma resolution: Development of a novel narrative coding measure and implications for intergenerational parenting processes

Child maltreatment constitutes a significant environmental risk for children, with carryover effects into future generations. There is a need to characterize protective factors that may buffer against the intergenerational transmission of maltreatment. The current study addresses this gap through two primary aims: 1) the development and validation of a novel measure assessing resolution of maternal childhood maltreatment trauma using narrative coding methods and 2) the evaluation of maternal maltreatment trauma resolution as a buffering factor that may moderate associations between maternal neglect histories and sensitive parenting of offspring. Results of reliability analyses from this sample of 210 diverse, low-income mothers suggest the novel childhood maltreatment trauma resolution measure is highly reliable. Furthermore, results highlight the generalizability, criterion validity, and concurrent and predictive validity of the measure. Results from cross-sectional analyses show that trauma resolution moderates associations between maternal physical neglect histories and sensitive parenting, such that under high maternal trauma resolution, there is no longer a negative association between neglect histories and sensitive parenting. Results from longitudinal analyses also show a protective effect of maternal trauma resolution, such that trauma resolution has a protective-enhancing effect on maternal sensitivity. Implications for research and clinical practice with families are discussed.

Intergenerational transmission of child protective services involvement: Exploring the role of ACEs and domestic violence among families who receive home visiting services

BACKGROUND

Adverse childhood experiences (ACEs) are associated with negative outcomes over the life course and across generations, including domestic violence (DV) and child maltreatment. However, no studies have examined the connection between parents' ACEs and their child's risk of child protective services (CPS) involvement or possible mechanisms of transmission.

OBJECTIVE

In addition to describing the prevalence and correlates of CPS involvement, our primary aims are to test whether parental adversity in childhood is associated with CPS involvement and whether DV victimization mediates the ACE-CPS association.

PARTICIPANTS AND SETTING

The sample included 3039 primary caregivers and 3343 children served by home visiting programs in Wisconsin between 2014 and 2019.

METHODS

Using matched home visiting and CPS records, we generated prevalence estimates of screened-in CPS reports and assessed bivariate associations between CPS involvement and ACEs, DV, and household demographics. We then conducted a two-stage path analysis to test the association between ACEs and CPS involvement and whether DV mediated the ACE-CPS association.

RESULTS

Overall, 22.8 % of caregivers had a screened-in report. Prevalence rates were higher among women who endured ACEs and DV, and they varied by demographic characteristics. ACEs were directly linked to DV and CPS involvement, and there was an indirect pathway linking ACEs to CPS involvement through DV exposure.

CONCLUSIONS

Home visiting programs serve families that frequently interact with the child welfare system. By enhancing the trauma-responsive potential of these interventions, it may be possible to interrupt intergenerational mechanisms that contribute to child abuse and neglect and CPS involvement.

Co-Occurrence of Intimate Partner Violence Against Mothers and Maltreatment of Their Children With Behavioral Problems in Eastern Europe

This study investigates the co-occurrence of intimate partner violence (IPV) against mothers and their risk of perpetrating child maltreatment (CM) in North Macedonia, the Republic of Moldova, and Romania. Risk factors for IPV, CM, and their co-occurrence were identified. Two samples (N1 = 112, N2 = 701) of mothers with children with behavioral problems were assessed. IPV was reported by 64% of mothers, CM by 96%, and their co-occurrence by 63%. Mothers exposed to emotional IPV reported more physical and emotional CM. Mothers exposed to physical IPV reported more physical CM. Motheŕs own history of CM and offspring's behavior problems were associated with IPV and CM co-occurrence.

Transmit Radiant Individuality to Offspring (TRIO) study: investigating intergenerational transmission effects on brain development

Intergenerational transmission is a crucial aspect of human development. Although prior studies have demonstrated the continuity of psychopathology and maladaptive upbringing environments between parents and offspring, the underlying neurobiological mechanisms remain unclear. We have begun a novel neuroimaging research project, the Transmit Radiant Individuality to Offspring (TRIO) study, which focuses on biological parent-offspring trios. The participants of the TRIO study were Japanese parent-offspring trios consisting of offspring aged 10-40 and their biological mother and father. Structural and functional brain images of all participants were acquired using magnetic resonance imaging (MRI). Saliva samples were collected for DNA analysis. We obtained psychosocial information, such as intelligence, mental health problems, personality traits, and experiences during the developmental period from each parent and offspring in the same manner as much as possible. By April 2023, we completed data acquisition from 174 trios consisting of fathers, mothers, and offspring. The target sample size was 310 trios. However, we plan to conduct genetic and epigenetic analyses, and the sample size is expected to be expanded further while developing this project into a multi-site collaborative study in the future. The TRIO study can challenge the elucidation of the mechanism of intergenerational transmission effects on human development by collecting diverse information from parents and offspring at the molecular, neural, and behavioral levels. Our study provides interdisciplinary insights into how individuals' lives are involved in the construction of the lives of their descendants in the subsequent generation.

Intergenerational Continuity of Childhood Adversity and Its Underlying Mechanisms Among Teen Mothers and Their Offspring

The present study investigates how parenting stress mediates the intergenerational continuity of childhood adversity in teenage mothers. Childhood adversity experiences of caregivers significantly affect their offspring's exposure to childhood adversity. However, little is known about the mechanisms linking childhood adversity across generations. The study measures how parental distress and parent-child dysfunctional interaction mediate the association between teen mothers' childhood adversity and their offspring's adversity, measuring when the offspring reached 11.5 years of age. The results revealed that parental distress, but not parent-child dysfunctional interaction, mediated the association between teen mothers' child abuse and their offspring's household dysfunction. This suggests that parental distress may be a crucial intervention target to prevent the intergenerational continuity of childhood adversity. The findings imply that efforts to prevent the intergenerational continuity of childhood adversity may be more successful if the public and professionals have a broader understanding of the associations between early adversity and parenting contexts. In conclusion, the study shed light on the potential mechanisms underlying the intergenerational continuity of childhood adversity and highlights the importance of targeting parenting stress, specifically parental distress, as an intervention strategy to prevent the perpetuation of childhood adversity across generations.

Self-reported child maltreatment and cardiometabolic risk in 30-year-old adults

BACKGROUND

Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect.

AIMS

To assess the association between five types of self-reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort.

METHODS

This was a study of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later. Body mass index, bioimpedance and fasting lipid levels/insulin resistance were measured. Details on self-reported CM were collected using the Child Trauma Questionnaire. We adjusted for birth weight, parental income and relationship at participants' birth, as well as maternal age and alcohol or tobacco use. We also adjusted for participants' smoking, depression, educational level, marital and employment status at follow up.

RESULTS

One-fifth reported maltreatment (n = 362), most commonly emotional neglect (n = 175), followed by emotional abuse (n = 128), physical neglect (n = 123), sexual (n = 121) and physical abuse (n = 116). On adjusted analyses, there were significant associations for CM, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and HDL levels. Results for other outcomes were more equivocal.

CONCLUSIONS

Of child maltreatment types, emotional abuse and neglect show the strongest associations with obesity and several cardiometabolic risk factors, therefore highlighting the public health importance of early intervention to reduce childhood adversity.

Victims of Child Abuse Dropping Out of Trauma-Focused Treatment: A Meta-Analysis of Risk Factors

A substantial number of children who experienced child maltreatment drop out of evidence-based trauma-focused treatments (TF-CBT). Identifying child, family, and treatment-related factors associated with treatment dropout is important to be able to prevent this from happening and to effectively treat children's trauma-related symptoms. Methods: A quantitative review was performed based on a systematic synthesis of the literature on potential risk factors for dropout of trauma-focused treatment in maltreated children. Results: Eight studies were included, that examined TF-CBT, reporting on 139 effects of potential risk factors for dropout. Each factor was classified into one of ten domains. Small but significant effects were found for the "Demographic and Family" risk domain (r = .121), with factors including being male, child protective services involvement or placement, and minority status, and for the "Youth Alliance" risk domain (r = .207), with factors including low therapist-child support and low youth perception of parental approval. Moderator analyses suggested that family income and parental education may better predict the risk for TF-CBT dropout than other variables in the "Demographic and Family" domain. Conclusions: Our results provide a first overview of risk factors for dropout of trauma-focused treatments (TF-CBT) after child maltreatment, and highlight the role of the therapeutic relationship in this.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00500-2.

Child maltreatment, social capital, maternal mental health and duration of program involvement: Assessment from a community-based empowerment program in Kenya

Multisystem, multi-level interventions are required to enable resilient, nurturing environments for children facing adversity. This study assesses parenting behavior associated with participation in a community-based, adapted microfinance program, and mediated by program-affiliated social capital, maternal depression and self-esteem among Kenyan women. Participants in the intervention, Kuja Pamoja kwa Jamii (KPJ, Swahili for "Come Together to Belong"), gather weekly to engage in trainings and group-based microfinance. Groups selected for the study had participated in the program for 0-15 months at the time of the first interview. Women (n = 400) completed surveys in June 2018 and June 2019. Measures included duration of program exposure, group-affiliated social capital (i.e. trust, belonging, cohesion, and expectation of mutual benefit), depression, self-esteem, and conflict tactics. We used regression analyses and generalized structural equation models to explore associations between program exposure, social capital, psychosocial variables and child maltreatment. Each standard deviation increase in duration of program exposure decreased odds of child physical abuse by 40% and child neglect by 35%. Each standard deviation in the social capital index predicted a significant reduction in odds of child physical abuse (aOR: 0.67), and child neglect (aOR: 0.71). Self-esteem and depression fully mediated observed associations between social capital and child maltreatment. Findings recommend further investigation of the potential for adapted microfinance programs to deliver parenting interventions, improve mental health and foster resilience-enabling social capital. A randomized control trial is required to validate the potential of the assessed intervention to improve parenting behaviors and supportive social conditions.

Selective processing in attention and memory in schizophrenia: A meta-analysis of the negative priming effect

Individuals with schizophrenia show impairments in a variety of selective attention tasks. Research on the negative priming (NP) effect in schizophrenia has yielded mixed evidence. This meta-analysis aimed to examine the NP effect exhibited by patients with schizophrenia and the impact of study methodology on findings. The methods and reporting of this meta-analysis followed the PRISMA guideline. Eligible studies were identified through primary literature search in MEDLINE, PsycInfo, PsycArticles, and Embase and secondary search based on included studies and important reviews. Three-level random effects-models were used to summarize between-group differences in the raw NP score, as well as the NP ratio and baseline reaction time (RT) as secondary outcomes. We identified 1383 studies published between 1966 and 2022 and reviewed 27 studies that consist of 627 patients with schizophrenia and 653 controls in total. Compared to healthy controls, patients with schizophrenia showed a mildly reduced raw NP score with marginal significance, Hedges' g = -0.16, 95% confidence interval (CI) -0.35 to 0.02, p = 0.084. However, analysis of a subsample of studies indicated a significant, moderate reduction in the NP ratio among patients, g = -0.52, 95% CI -0.91 to -0.14; p = 0.014. Moderator analyses revealed a longer illness duration as predictive of a more reduced NP effect. This meta-analysis lends tentative evidence to impaired attention or memory process as measured by the NP task in schizophrenia. More research is needed to substantiate our results and clarify the impact of study design and patient characteristics on findings.

Attachment, Mentalizing and Trauma: Then (1992) and Now (2022)

This article reviews the current status of research on the relationship between attachment and trauma in developmental psychopathology. Beginning with a review of the major issues and the state-of-the-art in relation to current thinking in the field of attachment about the impact of trauma and the inter-generational transmission of trauma, the review then considers recent neurobiological work on mentalizing and trauma and suggests areas of new development and implications for clinical practice.

Conducting Violence Research Across Multiple Family Generations and with Young Children: Findings from a Mixed-Methods Pilot Study in South Africa

This paper presents findings from a pilot study focused on examining intergenerational violence in a three-generation sample, which included young children, in a rural area of South Africa. The aims of the pilot study were to investigate the feasibility of participant recruitment, consent, and interviewing; length and burden of the study questionnaires; appropriateness and acceptability of the measures used; and young children's (age 4-7) ability to comprehend the measures and participate meaningfully in interviews asking about violence. Data were collected for 4 months with three groups of participants, often within families (young adults, their children, and the young adults' former caregivers), using cognitive interviews, quantitative questionnaires, and qualitative in-depth interviews. All groups participated in arts-based methods and child interviews included visual and tactile aids. Pilot study findings demonstrated feasible recruitment within families for a three-generation study using comprehensive consent protocols and mandatory reporting information. Adults and young children were able to participate in the extensive interviews (2-3 h and 1 h, respectively) without significant burden. The employed measures were appropriate and acceptable to the setting, though minor revisions were made to improve comprehension of certain items. Young children were able to engage and participate meaningfully in the research, though they were not able to answer abstract reasoning items in cognitive interviews and children who were less developmentally advanced required more play- and arts-based accommodations to support their participation. Future research around sensitive topics, such as violence, appears feasible within families and including young children as participants even in resource-poor settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42448-023-00157-w.

The Effects of Severe Childhood Physical and Sexual Abuse on Adult Socioeconomic Prosperity

Our study utilizes Adverse Childhood Experience (ACE) scores to estimate the relationship between forced sexual intercourse and physical abuse on socioeconomic outcomes in adulthood. ACEs have been shown to have long-term negative impacts on health, mental health, and cognition. We expand upon the literature that analyzes the effects of ACEs on human capital investment and adult socioeconomic outcomes by focusing on the ACE scores pertaining to repeated physical and forced sexual abuse in childhood. Specifically, we estimate probit models using data from the Behavioral Risk Factor Surveillance System to measure the marginal effects of childhood sexual abuse (CSA) and physical abuse on the probability of high school completion, unemployment, and the likelihood of living in poverty in adulthood. We find adults who suffered physical abuse in childhood are more likely to live in poverty. Adult survivors of CSA are less likely to finish high school and more likely to live in poverty. The likelihood of high school noncompletion increases when the individual suffered both forms of abuse. We also find that only those who suffered both forms of abuse in childhood had a greater likelihood of being unemployed and high school noncompletion. We find the negative socioeconomic impact in adulthood is larger for women than for men, implying gender heterogeneity in outcomes of CSA and physical abuse. Researchers should control for the correlation between sexual abuse and physical abuse in childhood, particularly in women, when estimating their effects on socioeconomic outcomes.

The effects of maternal prenatal depression on child mental health: The moderating role of maternal childhood trauma

BACKGROUND

There is a large body of evidence suggesting that maternal prenatal depression significantly predicts mental health problems in children. However, little is known about the role of maternal childhood trauma within this effect.

METHODS

The current study utilized a sample of 187 mother-child dyads (51.3 % boys) from the Shanghai Sleep Birth Cohort (SSBC), a six-year prospective longitudinal study. The effects of maternal depression at late pregnancy (Center for Epidemiological Survey-Depression Scale) on the child mental health at six years old (Strengths and Difficulties Questionnaire) were analyzed, with different types of maternal childhood trauma (Childhood Trauma Questionnaire) being examined as moderators.

RESULTS

The results showed that maternal prenatal depression positively predicted child mental health problems (β = 0.13, p < .05) and there was a significant moderating effect of maternal childhood emotional abuse (β = -0.05, p < .05); that is, in mothers with high childhood emotional abuse, child mental health problems remained high regardless of maternal prenatal depression (β = -0.02, p = .78), while in mothers with low childhood emotional abuse, maternal prenatal depression significantly predicted child behavioral and emotional problems (β = 0.20, p < .05).

LIMITATIONS

Relatively high socio-economic status samples, retrospective reports of maternal childhood trauma and the single reporter were the limitations of this study.

CONCLUSIONS

The findings provided new insights into the impact of maternal prenatal depression on child mental health, highlighting the importance of intervention efforts targeting mothers with prenatal depression and childhood trauma history.

Interrupting the intergenerational cycle of violence: protocol for a three-generational longitudinal mixed-methods study in South Africa (INTERRUPT_VIOLENCE)

BACKGROUND

Violence is a global social and human rights issue with serious public health implications across the life-course. Interpersonal violence is transmitted across generations and there is an urgent need to understand the mechanisms of this transmission to identify and inform interventions and policies for prevention and response. We lack an evidence-base for understanding the underlying mechanisms of the intra- and intergenerational transmission of violence as well as potential for intervention, particularly in regions with high rates of interpersonal violence such as sub-Saharan Africa. The study has three aims: 1) to identify mechanisms of violence transmission across generations and by gender through quantitative and qualitative methods; 2) to examine the effect of multiple violence experience on health outcomes, victimisation and perpetration; 3) to investigate the effect of structural risk factors on violence transmission; and 4) to examine protective interventions and policies to reduce violence and improve health outcomes.

METHODS

INTERRUPT_VIOLENCE is a mixed-methods three-generational longitudinal study. It builds on a two-wave existing cohort study of 1665 adolescents in South Africa interviewed in 2010/11 and 2011/12. For wave three and possible future waves, the original participants (now young adults), their oldest child (aged 6+), and their former primary caregiver will be recruited. Quantitative surveys will be carried out followed by qualitative in-depth interviews with a subset of 30 survey families. Adults will provide informed consent, while children will be invited to assent following adult consent for child participation. Stringent distress and referral protocols will be in place for the study. Triangulation will be used to deepen interpretation of findings. Qualitative data will be analysed thematically, quantitative data using advanced longitudinal modelling. Ethical approval was granted by the University of Edinburgh, University of the Witwatersrand, North-West University, and the Provincial Department of Health Mpumalanga. Results will be published in peer-reviewed journals, policy briefs, and at scientific meetings.

DISCUSSION

The proposed study represents a major scientific advance in understanding the transmission and prevention of violence and associated health outcomes and will impact a critically important societal and public health challenge of our time.

Child Adult Relationship Enhancement in Primary Care (PriCARE): study design/protocol for a randomized trial of a primary care-based group parenting intervention to prevent child maltreatment

BACKGROUND

Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention programs. Problematic parent-child relationships lie at the heart of CM. Parents who maltreat their children are more likely to have punitive parenting styles characterized by high rates of negative interaction and ineffective discipline strategies with over-reliance on punishment. Thus, parenting interventions that strengthen parent-child relationships, teach positive discipline techniques, decrease harsh parenting, and decrease child behavioral problems hold promise as CM prevention strategies. Challenges in engaging parents, particularly low-income and minority parents, and a lack of knowledge regarding effective implementation strategies, however, have greatly limited the reach and impact of parenting interventions. Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con CARIÑO is a 6-session group parenting intervention that holds promise in addressing these challenges because PriCARE/CARIÑO was (1) developed and iteratively adapted with input from racially and ethnically diverse families, including low-income families and (2) designed specifically for implementation in primary care with inclusion of strategies to align with usual care workflow to increase uptake and retention.

METHODS

This study is a multicenter randomized controlled trial with two parallel arms. Children, 2-6 years old with Medicaid/CHIP/no insurance, and their English- and Spanish-speaking caregivers recruited from pediatric primary care clinics in Philadelphia and North Carolina will be enrolled. Caregivers assigned to the intervention regimen will attend PriCARE/CARIÑO and receive usual care. Caregivers assigned to the control regimen will receive usual care only. The primary outcome is occurrence of an investigation for CM by child protective services during the 48 months following completion of the intervention. In addition, scores for CM risk, child behavior problems, harsh and neglectful parenting behaviors, caregiver stress, and caregiver-child interactions will be assessed as secondary outcome measures and for investigation of possible mechanisms of intervention-induced change. We will also identify PriCARE/CARIÑO implementation factors that may be barriers and facilitators to intervention referrals, enrollment, and attendance.

DISCUSSION

By evaluating proximal outcomes in addition to the distal outcome of CM, this study, the largest CM prevention trial with individual randomization, will help elucidate mechanisms of change and advance the science of CM prevention. This study will also gather critical information on factors influencing successful implementation and how to optimize intervention referrals, enrollment, and attendance to inform future dissemination and practical applications.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.gov (NCT05233150) on February 1, 2022, prior to enrolling subjects.

Does Hope Reverberate Between Generations?

Intergenerational transmission refers to the transmission of stories, traits, abilities, ideas, behaviors, and various outcomes from parents to their children. To date, there has been little research on the intergenerational transmission of positive behavior, traits, and actions. To determine whether hope may be transmitted from one generation to the next, a qualitative study was performed, using narrative inquiry and thematic analysis. Over 4 months, four mothers of children with mental illness were engaged in repeated conversations about stories of hope related to their past and how they envisioned hope in their children. Findings indicated that hope could be transmitted to the next generation, either explicitly (verbally) or implicitly (i.e., expressed through actions involving one's children). We conclude that also positive patterns may be transmitted both explicitly and implicitly from one generation to the next. Transmitting hope between generations played a significant role in the mothers' experiences of hope.

Elucidating the relations between adverse childhood experiences, age of exposure to adversity, and adult posttraumatic stress symptom severity in pregnant women

BACKGROUND

Adverse childhood experiences (ACEs) are typically assessed within two subscales: child maltreatment (CM) and household dysfunction (HD). More research is needed about how the CM and HD subscales differentially contribute to adult posttraumatic stress symptoms (PTSS), accounting for additional adversities.

OBJECTIVE, PARTICIPANTS, AND SETTING

In a sample of 137 pregnant women exposed to recent intimate partner violence (IPV) in the United States, this study aimed to (1) explore the contributions of ACEs subscales to pregnant women's PTSS severity, (2) examine the inclusion of the witnessing IPV ACE in the CM subscale, and (3) contextualize the contributions of the ACEs subscales to women's PTSS by examining the moderating effect of age of first ACE exposure.

METHODS

The study used linear, multiple, and hierarchical regression analyses and the Hotelling-Williams test.

RESULTS

The CM subscale predicted pregnant women's PTSS significantly better than the HD subscale, controlling for past-year IPV (t(134) = 2.69, p = .008). Adding the witnessing IPV ACE to the CM subscale did not significantly improve the subscale's prediction of PTSS (ΔR² = 0.07, p = .290). Age of first exposure did not significantly moderate the effects of the CM (β = 0.12, p = .140) or HD (β = -0.10, p = .238) ACEs subscales on PTSS.

CONCLUSIONS

Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of CM have stronger predictive validity for PTSS than HD. Cumulative victimization may be more influential than age of exposure to adversity.

Examining the intergenerational transmission of parental invalidation: Extension of the biosocial model

This study examined the intergenerational transmission of parental invalidation and whether parental difficulties in emotion regulation mediated the association between past experiences of invalidation and current invalidating parenting practices. We also aimed to investigate whether gender might influence the transmission of parental invalidation. We recruited a community sample of 293 dual-parent families (adolescent and their parents) based in Singapore. Parents and adolescents each completed measures of childhood invalidation, whereas parents additionally reported on their difficulties in emotion regulation. Results based on path analyses demonstrated that past parental invalidation experienced by fathers positively predicted current perceived invalidation by their children. The association between mothers' childhood invalidation and current invalidating practices was fully mediated by mothers' difficulties with emotion regulation. Further analyses revealed that parents' current invalidating behaviors were not predicted by their past experiences of paternal or maternal invalidation. These findings point to the importance of considering the family invalidating environment as a whole when examining the influence of past experienced parental invalidation on emotion regulation and invalidating behaviors of second-generation parents. Our study provides empirical support for the intergenerational transmission of parental invalidation and highlights the need to address childhood experiences of parental invalidation in parenting programs.

Child maltreatment and victimization

It is estimated that up to 25% of all children growing up worldwide experience child maltreatment, making it a global emergency with substantial individual and public health consequences. This chapter addresses one of the most societally pervasive consequences of child maltreatment which is known as the "cycle of victimization." This concept depicts the increased risk of maltreated individuals to victimize others later in life, both within and outside the family environment. To understand the architecture of this victimization cycle, the chapter further sheds light on neurocognitive mechanisms aiding different forms of victimization and the buffering role of social support that could help break the cycle of victimization. Advancing our understanding of these complex and interrelated mechanisms will ultimately facilitate the design and implementation of more targeted early treatments and (preventive) interventions and support a move toward a safer society.

Risk factors of self-reported physical child abuse during the COVID-19 pandemic in Japan: work-related changes in men and fear of COVID-19 in women

Background

There is no global consensus on whether pandemic-related factors are related to child abuse. How the pandemic reinforces the risk factors of child abuse might depend largely on individuals' current and past lifestyles in each country. Some changes of lifestyles continue after the pandemic, and it is important to understand which factors are strongly associated with child abuse. We analyzed the pandemic-related characteristics of offenders and non-offenders of self-reported child physical abuse from Internet survey data in Japan and discussed how the pandemic affected physical child abuse and what caused the difference by gender.

Methods

We conducted a cross-sectional study on physical child abuse by caregivers based on the Internet survey conducted from September to October 2021. We divided the participants who were living with their child aged less than 14 years into offenders and non-offenders based on the answer to the question about physical child abuse. The population distribution of the sample was compared to that of caregivers under the same conditions in a large Japanese dataset. The association between their characteristics and physical child abuse was analyzed by univariable and multivariable analysis.

Results

The caregivers analyzed in the cohort had similar population distributions to those in the large Japanese dataset. As risk factors of male offenders, "work from home 4-7 days/week," "decreased work," "normal relationships with household members (compared to good relationships)," "COVID-19 infected, both themselves and household members, within a year," "unwillingness to receive COVID-19 vaccination because the license process of the vaccine is doubtful," "high levels of benevolent sexism," and "history of child abuse" were observed. As risk factors of female offenders, "bad relationships with household members (compared to good relationships)," "fear of COVID-19," "COVID-19 infected, both themselves and household members, within a year," "feelings of discrimination related to COVID-19 in the past two months," and "history of child verbal abuse" were observed.

Conclusions

Among male offenders, a significant relationship was observed regarding work-related changes, which may have been reinforced by the pandemic. Furthermore, the extent of the influence and fear of losing jobs caused by these changes may have varied according to the strength of gender roles and financial support in each country. Among female offenders, a significant relationship was observed regarding fear of infection itself, which is consistent with the findings of other studies. In terms of factors related to dissatisfaction with families, in some countries with prominent stereotyped gender roles, men are thought to experience difficulties adapting to work-related changes induced by crises, while women are thought to experience intense fear of the infection itself.

Multigenerational patterns of parenting-at-risk: A test of interpersonal specificity using copy process theory

OBJECTIVES

This study tests ways in which the perception of intergenerational continuity in parenting behaviors among child-maltreatment (CM) and non-CM families conform to Benjamin's (2006) Copy Process Theory, which considers three copy processes: Identification (be like him/her), Recapitulation (behave as if he/she is still present and in charge), and Introjection (treat myself as he/she treated me).

METHOD

Across two home visits and a laboratory session, 171 mothers of preschoolers (M = 3.7 years) completed the SASB Intrex Questionnaire relative to herself, her history with her parents, and her present relationship with her child.

RESULTS

Mothers' retrospective reports of her interactions with caregivers were correlated with the quality of self-reported parenting processes in interactions with her preschooler. Analyses indicated high rates of intergenerational copying in both samples for each copy process. While copying in general was observed in nearly all mothers (roughly 80%-90%) and emphasized warm, securely attached patterns, the copying of hostility and/or lack of affiliation occurred in copied profiles for about one-third of mothers. About the more problematic profiles, CM mothers tended to rate themselves as being in the child-like position they experienced in their own childhood, with themes involving hostile control perceived from their child. By contrast, non-CM mothers copied disaffiliative themes primarily in relation to themselves.

CONCLUSION

Findings verify that interpersonal patterns and internalized relational histories are important keys for understanding CM risk. The use of a method that offers interpersonal specificity at the level of individual profiles has application to clinical practice with at-risk parents.

Parental protection in fathers with negative caregiving experiences: Heightened amygdala reactivity to infant threatening situations

Parental protection is an important, yet understudied, aspect of parenting behavior. Predictors of the quality of protection and potential underlying neural mechanisms are still unknown. In this study, we examined whether negative caregiving experiences in fathers' own childhood are related to protective behavior and neural reactivity to infant threatening situations. Paternal protective behavior was measured with self- and partner-reported protective behavior and behavioral observations in an experimental set-up (auditory startling task) in 121 first-time fathers (mean age child = 19.35 weeks, SD = 11.27). Neural activation during exposure to videos of infant-threatening (vs. neutral) situations was measured with functional magnetic resonance imaging (fMRI). We found a significant and positive association between negative caregiving experiences and amygdala reactivity to infant-threatening situations. A history of negative caregiving experiences was not significantly related to reported or observed paternal protective behavior. Our findings suggest that fathers with negative caregiving experiences show emotional hyperreactivity to cues of infant threat.

Testing an attachment- and trauma-informed intervention approach for parents and young children after interparental violence: protocol for a randomized controlled trial

BACKGROUND

Interparental violence has persistent adverse effects on victimized parents and children. Young children, including infants and toddlers, are at particular risk to develop long-lasting negative outcomes, and yet specific evidence on effective intervention approaches for this vulnerable group is still lacking. This study will test the effectiveness of an attachment- and trauma-informed intervention approach in a sample of parent-child dyads who have experienced severe interparental violence. We test the individual and combined effects of two interventions: (1) "Nederlandse Interventie Kortdurend op Atypisch oudergedrag" (NIKA; Dutch, short-term intervention focused on atypical parenting behavior) aimed at improving the attachment relationship and (2) eye movement desensitization and reprocessing (EMDR) therapy aimed at reducing parental post-traumatic stress disorder (PTSD) symptoms.

METHODS

This study uses a multicenter randomized controlled design across multiple domestic violence shelters in the Netherlands. We aim to recruit 150 parent-child dyads with children aged between 0.5 and 6 years old. The study design consists of two phases. During the first phase for testing the effect of NIKA only, eligible dyads are randomly allocated to either NIKA or a waitlist usual care group. A pre-test is conducted prior to the treatment period and a post-test takes place directly afterwards (6 weeks after the pre-test). Phase 2 follows directly for testing the effects of EMDR and the combination of NIKA and EMDR. Parents who report clinical PTSD symptoms are randomly allocated to either EMDR therapy or a waitlist usual care group. Parents who do not report clinical PTSD symptoms only receive care as usual. Six weeks later, a post-test of phase 2 is conducted for all participating dyads. Primary study outcomes are disrupted parenting behavior, sensitive parenting behavior, and parental PTSD symptoms. Secondary study outcomes include PTSD symptoms and behavioral and emotional problems of the child.

DISCUSSION

This study will inform and enhance the clinical field by providing new insights regarding effective treatment combinations for traumatized parents and their young children after interparental violence.

TRIAL REGISTRATION

Netherlands Trial Register (NTR) NL9179 . Registered 7 January 2021.

Traumatic head injury due to child maltreatment: epidemiology, cost analysis, and impact of prevention

BACKGROUND

Traumatic head injury due to child maltreatment (THI-CM), also known as abusive head trauma (AHT), is a significant public health problem due to the wide array of consequences affecting multiple domains of a child's health and development. Several studies have evaluated its cost on healthcare systems, families, and societies. Many jurisdictions have implemented caregiver education programs to prevent THI-CM.

OBJECTIVES

This paper aims to provide a brief overview of the epidemiology and cost analysis of THI-CM and discuss its prevention and the intergenerational transmission of child maltreatment.

METHODS

Although not systematic, a literature search of original articles published from 2000 to 2022 in English and French was undertaken using the following databases: PubMed, EMBASE (Ovid), and PsycINFO (OVID). The search combined terms related to traumatic head injury and child maltreatment, with terms related to its cost and prevention. Studies of children aged 0-5 years old were included. The authors completed a screen of the titles and abstracts to determine relevance with respect to this article.

RESULTS

Globally, although THI-CM accounts for a small proportion of cases of child maltreatment, there is a high incidence of death and neurological sequelae compared to other causes of head trauma.The incidence of THI-CM is likely underestimated due to the lack of standardized definitions, differences in reporting, and challenges in identifying less severe cases. Cost analysis studies reveal the significant short- and long-term costs associated with THI-CM. Caregiver education programs have been studied and implemented in many centers and have shown varying but promising results.

CONCLUSION

A multi-pronged approach to prevention efforts should be considered to support families and help to prevent THI-CM and maltreatment throughout childhood.