The Great Recession and risk for child abuse and neglect

Early Childhood Income Instability and Mental Health in Adolescence: Parenting Stress and Child Maltreatment as Mediators

Ample research has examined how point-in-time or static measures of economic deprivation are associated with children's mental health outcomes. Less is known about the relationship between early childhood unstable income and mental health outcomes. Using the Future of Families and Child Wellbeing Study, this study examined (1) the latent patterns of early childhood economic well-being, predicted by income level and instability (i.e., direction and frequency of income change); (2) the association of income deprivation patterns with subsequent anxiety and depression symptoms, paying particular attention to the mediating roles of parenting stress and child maltreatment risk. The latent class analysis results suggested four distinct groups representing different combinations of income level and instability. Structural equation modeling results indicated indirect links between income deprivation patterns and mental health outcomes, through parenting stress and physical and psychological abuse. Findings indicated the importance of policies and programs promoting economic stability over the long run.

Examining resilience among child protection professionals during COVID-19: A global comparison across 57 countries

BACKGROUND

The COVID-19 pandemic led to numerous challenges for child protection professionals (CPPs). However, limited research has investigated the interwoven concepts of coping, resilience, and mental distress among CPPs during COVID-19 on a global scale.

OBJECTIVES

This study aimed to explore CPPs' practice, resilience, and mental distress during COVID-19, the relationship between their resilience and mental distress, the global stability of the Multi-System Model of Resilience (MSMR), and how CPPs' resilience varied according to the Human Development Index (HDI).

METHODS

Data were collected from 420 CPPs in 57 countries across five continents between July and September 2021. Participants completed an online questionnaire on demographics, resilience, mental distress, coping, and perceptions of child protection during the pandemic in their native languages. The analyses compared the countries grouped according to HDI using means comparisons, correlations, and multiple linear regressions. A two-path analysis was also performed to identify variables associated with behavioral resilience engagement and mental distress.

RESULTS

The findings indicated that CPPs' perceptions of COVID-19's impact on child maltreatment varied in correlation with their country's HDI. There were also significant HDI-based differences regarding the perceived opportunity to engage in resilient behavior and its helpfulness. Years of professional experience, internal resilience, and external resilience were shown to be significant predictors of mental distress among CPPs during the pandemic, and resilience mediated how years of experience predicted mental distress.

CONCLUSIONS

This study emphasized the importance of experience and internal resilience for CPPs' psychological well-being. It also provides empirical evidence to support the MSMR theory on a global scale. Additionally, it demonstrates how the perceived changes in child maltreatment during COVID-19 may be associated with regional HDI. Lastly, the opportunities CPPs had to engage in resilient behavior and how much this helped them was associated with regional HDI, but not in the way originally predicted. Study results also hold implications for how practice and policy may be altered to help CPPs cope better during times of crisis and generally.

Identifying child maltreatment during virtual medical appointments through the COVID-19 pandemic: A physician-based survey

Background

Throughout the COVID-19 pandemic there has been a documented decline in reports to child protective services, despite an increased incidence of child maltreatment. This is concerning for increasing missed cases. This study aims to examine if and how Canadian paediatricians are identifying maltreatment in virtual medical appointments.

Methods

A survey was sent through the Canadian Paediatric Surveillance Program (CPSP) to 2770 practicing general and subspecialty paediatricians. Data was collected November 2021 to January 2022.

Results

With a 34% (928/2770) response rate, 704 surveys were eligible for analysis. At least one case of child maltreatment was reported by 11% (78/700) of respondents following a virtual appointment. The number of cases reported was associated with years in medical practice (P = 0.026) but not with the volume (P = 0.735) or prior experience (P = 0.127) with virtual care, or perceived difficulty in identifying cases virtually (Cramer's V = 0.096). The most common factors triggering concern were the presence of social stressors, or a clear disclosure. The virtual physical exam was not contributory. Nearly one quarter (24%, 34/143) required a subsequent in-person appointment prior to reporting the case and 32% (207/648) reported concerns that a case had been identified late, or missed, following a virtual appointment. Some commented that clear harm resulted.

Conclusions

Many barriers to detecting child maltreatment were identified by paediatricians who used virtual care. This survey reveals that virtual care may be an important factor in missed cases of child maltreatment and may present challenges to timely identification.

Why do parents employ helicopter parenting in the post-COVID-19 era? An actor-partner interdependence mediation model

INTRODUCTION

In the post-COVID-19 era, small-scale and long-term recurrences of the pandemic can exacerbate future economic uncertainty. Previous studies have found that stressful situations are strongly associated with a controlling type of parenting. The relationship between parental perceptions of future economic uncertainty (PFEU) and helicopter parenting is currently unclear. This study aimed to examine the dyadic relationship between PFEU and helicopter parenting among Chinese parents in the postpandemic era and its underlying mechanisms from a family system perspective.

METHODS

Questionnaire data were collected from 395 pairs of parents (Mfather  = 43.65 ± 5.30, Mmother  = 40.71 ± 5.16, Madolescent  = 13.17 ± 0.87, 45.3% male) in Jiangxi Province, China in October 2021. An actor-partner interdependence mediation model was established.

RESULTS

The results indicated that fathers' and mothers' PFEU were positively associated with their own helicopter parenting. Additionally, paternal parenting stress mediated the relationship between fathers' and mothers' PFEU and paternal helicopter parenting, whereas mothers' parenting stress mediated the association between mothers' PFEU and paternal and maternal helicopter parenting.

CONCLUSIONS

The current research provides important insights for improving Chinese family education practices in the postpandemic era.

Evaluation of Psychological and Physical Violence towards Children and Adolescents before and during the COVID-19 Pandemic in the Lodz Voivodship

BACKGROUND

It has been shown that the course of COVID-19 infection in the under-18 population was in many cases sparsely symptomatic. In contrast, the impact of the pandemic on the psychological state is quite different. The risk of psychopathological symptoms in children and adolescents increased and the course of already present psychiatric disorders has often been exacerbated.

OBJECTIVES

Thus, this study aimed to evaluate the prevalence of psychological and physical violence among children and adolescents and its change during the COVID-19 pandemic, as well as to investigate various factors that might affect violence.

METHODS

In this survey study, 782 responses were included, with 480 collected during the second and 302 during the fourth wave of COVID-19. In this cross-sectional study, an anonymous questionnaire was used to collect demographic data, medical history, mental state, psychopathological symptoms, as well as the presence of psychological, physical violence, and suicidal self-harm behaviors before (retrospectively) and during the COVID-19 pandemic in the under-18 population of the Lodz Voivodship. The survey was prepared using Google Forms.

RESULTS

A decrease in the prevalence of physical violence during both waves of the pandemic has been observed (6.39% vs. 3.45%; p < 0.001), with only a similar trend present for psychological violence 16.75% vs. 14.71%; p = 0.081). No difference between physical and psychological violence was present in different pandemic waves, type of flat or house individuals lived in, availability of one's room, number of people living in the house, number of siblings, and type of school classes (p > 0.050). Older children (>15 years old) were more likely to be victims of psychological violence before and during the pandemic (both p < 0.001). A statistically significant model was obtained for psychological violence before (p < 0.001, R2 = 0.011) and during the pandemic (p = 0.007, R2 = 0.032). Risk factors for psychological violence before the pandemic included male gender (B = 0.531, p = 0.009, OR = 1.700), older age (B = 0.869, p = 0.001, OR = 2.385), and smaller city size (B = -0.187, p = 0.004, OR = 0.829), while for psychological violence during the pandemic, the risk factors were only male gender (B = 0.482, p = 0.022, OR = 1.620) and older age (B = 0.555, p = 0.046, OR = 1.742). No statistically significant models were created for physical violence (p > 0.050).

CONCLUSIONS

The observed decrease in physical violence during the COVID-19 pandemic suggests that in the studied group, home environment was not the main source of physical violence. Yet, we did not find any predicting factors for this form of violence. Violence, both physical and psychological, is a dangerous phenomenon in the under-18 population both in the pre-pandemic period and in crisis situations such as the pandemic.

Is fair representation good for children? effects of electoral partisan bias in state legislatures on policies affecting children's health and well-being

Increasing evidence suggests that state policies impact constituents' health, but political determinants of health and health inequities remain understudied. Using state and year fixed-effects models, we determined the extent to which changes in electoral partisan bias in lower chambers of U.S. state legislatures (i.e., discrepancy between statewide vote share and seat share) were followed by changes in five state policies affecting children and families (1980-2019) and a composite of safety net programs (1999-2018). We examined effects on each policy and whether the effect was modified when bias was accompanied by unified party control. Next, we determined whether the effect differed depending on which party it favored. Less bias resulted only in higher AFDC/TANF benefits. Both pro-Democratic and pro-Republican bias was followed by decreased AFDC/TANF benefits and increased Medicaid benefits. AFDC/TANF recipients, unemployment benefits, minimum wage, and pre-K-12 education spending increased following pro-Democratic bias and decreased following pro-Republican bias. Estimated effects on the composite measure of safety net policies were all close to null. Some effects were modulated by unified party control. Results demonstrate that increasing fairness in elections is not a panacea by itself for increasing generosity of programs affecting children's well-being. Indeed, bias can be somewhat beneficial for the expansiveness of some policies. Furthermore, with the exception of unemployment benefits and AFDC/TANF recipients, Democrats have not been using the additional power that comes with electoral bias to spend more on major programs that benefit children. Finally, after decades in which electoral bias was in Democrats' favor, bias has started to shift toward Republicans in the last decade. This trend forecasts more cuts in almost all the policies in this study, especially education and AFDC/TANF recipients. There is a need for more research and advocacy emphasis on the political determinants of social determinants of health, especially at the state level.

Associations between COVID-19-related family hardships/distress and children's Adverse Childhood Experiences during the pandemic: The Environmental influences on Child Health Outcomes (ECHO) program

BACKGROUND

Economic hardships imposed by the pandemic could have implications for children's experiences of adversity in the home, or Adverse Childhood Experiences (ACEs).

OBJECTIVE

This observational cohort study examined associations between COVID-19-related hardships and distress (e.g., job loss, caregiver stress) and the cumulative number of child ACEs reported by caregivers during the pandemic (i.e., March 1, 2020-February 28, 2022).

PARTICIPANTS AND SETTING

The study included children (N = 4345; median age = 6.0 years, interquartile range = 4-9 years) and their parents/caregivers who participated in the NIH-funded Environmental influences in Child Health Outcomes (ECHO) Program.

METHODS

We described socio-demographic characteristics and pandemic-related family hardships/distress and cumulative child ACE scores reported during pre-pandemic and pandemic periods. We used negative binomial regression models to evaluate associations between pandemic-related family hardships and cumulative child ACE scores reported during the pandemic.

RESULTS

Each caregiver-reported hardship/distress was associated with higher child ACE scores reported during the pandemic. After accounting for pre-pandemic child ACE scores, moderate and severe symptoms of pandemic-related traumatic stress among caregivers were associated with 108 % and 141 % higher child ACE scores reported during the pandemic, respectively, compared with no or low caregiver symptoms. In addition, finance-related stress during the pandemic was associated with 47 % higher child ACE scores. After adjusting for pre-pandemic child experiences of neglect, most sources of stress remained significantly associated with higher child ACE scores reported during the pandemic, particularly severe/very severe symptoms of pandemic-related traumatic stress among caregivers. Findings held for children with no known pre-pandemic ACEs.

CONCLUSIONS

This research suggests that caregivers experiencing financial hardships and those with severe pandemic-related traumatic stress may require additional support systems during stressful events.

Effect of the COVID-19 Pandemic on the Epidemiology of Pediatric Traumatic Brain Injury in Brazil

Aim In response to the coronavirus 2019 disease (COVID-19) pandemic, governments worldwide implemented measures to prevent infection, resulting in restricted school activities, restricted children's freedom of movement, and increased risk of violence and injuries at home, including traumatic brain injury (TBI), among children. In Brazil, the consequences of the COVID-19 pandemic on the causes, severity, and mortality of pediatric TBI have not yet been investigated. Thus, our study aimed to determine whether the COVID-19 pandemic has affected the epidemiology of pediatric TBI among Brazilian children. Materials and methods We investigated the patients with TBI aged <18 years who visited a tertiary trauma center in Brazil in 2019 and 2020. TBI-related variables, such as classification, mechanism, clinical manifestations, need for intervention, morbidity, and mortality, were recorded. Furthermore, we used a nationwide databank to collect information on mortality from external causes of trauma and violence in the pediatric population in 2019 and 2020. The Mann-Whitney test was used to compare quantitative variables related to the mechanisms and severity of TBI in both periods in order to determine the impact of the COVID-19 pandemic. Results Of the patients with traumatic brain injury, 1371 visited the trauma center in 2019 and 1052 in 2020. No difference was noted in the incidence rate of abusive head trauma between these periods (p=0.142) or in mortality from violence in Brazil. Recreational causes of pediatric TBI increased during the first year of the COVID-19 pandemic in Brazil and falls from bicycles significantly increased during the pandemic (p<0.001). Conclusion A global reduction in pediatric admissions to emergency rooms as well as no impact on mortality and severity of pediatric TBI were observed during the COVID-19 pandemic in Brazil. Additionally, a public education program regarding child safety during recreational activities, particularly how to avoid falls from bicycles was recommended.

Hospitalization for child maltreatment and other types of injury during the COVID-19 pandemic

BACKGROUND

The possibility that child maltreatment was misclassified as unintentional injury during the COVID-19 pandemic has not been evaluated.

OBJECTIVE

We assessed if child maltreatment hospitalizations changed during the pandemic, and if the change was accompanied by an increase in unintentional injuries.

PARTICIPANTS AND SETTING

This study included children aged 0-4 years who were admitted for maltreatment or unintentional injuries between April 2006 and March 2021 in hospitals of Quebec, Canada.

METHODS

We used interrupted time series regression to estimate the effect of the pandemic on hospitalization rates for maltreatment, compared with unintentional transport accidents, falls, and mechanical force injuries. We assessed if the change in maltreatment hospitalization was accompanied by an increase in specific types of unintentional injury.

RESULTS

Hospitalizations for child maltreatment decreased from 16.3 per 100,000 (95 % CI 9.1-23.4) the year before the pandemic to 13.2 per 100,000 (95 % CI 6.7-19.7) during the first lockdown. Hospitalizations for most types of unintentional injury also decreased, but injuries due to falls involving another person increased from 9.0 to 16.5 per 100,000. Hospitalization rates for maltreatment and unintentional injury remained low during the second lockdown, but mechanical force injuries involving another person increased from 3.8 to 8.1 per 100,000.

CONCLUSIONS

Hospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment.

Pathways to Children’s Behavioral Problems during the COVID-19 Pandemic: Fathers’ Parenting Stress and Parenting Approaches

Although the family stress model theoretically focuses on the roles of both mothers and fathers as predictors of children’s outcomes, studies generally have focused on mothers. The pandemic has brought additional burdens to parents’ daily functioning, including fathers’ involvement in childcare. The current study aimed to examine the contributions of fathers’ parenting stress and parenting approaches to their children’s behavior problems during the COVID-19 pandemic. Particularly, we examined the indirect effects of parenting stress on children’s behavior problems via parenting practices. The participants were 155 fathers (Mage = 36.87, SD = 5.11) and their children (71 girls, 84 boys; Mage = 59.52, SD = 14.98) from Turkish contexts. The fathers reported their parenting stress, approaches, and children’s behavioral problems. The results from the path analysis showed that parenting stress predicted children’s internalizing and externalizing behaviors. Parenting stress also predicted severe punishment and obedience as parts of the parenting approach. Finally, parenting stress was indirectly related to children’s externalizing behaviors via the punishment-based parenting approach of fathers. The findings of the current study highlighted the importance of examining the roles of fathers during the COVID-19 pandemic. Intervention programs targeting reducing fathers’ parenting stress and negative parenting approaches would also be beneficial for reducing children’s behavioral problems.

Sensitive Periods for the Effect of Child Maltreatment on Psychopathology Symptoms in Adolescence

Introduction

Child maltreatment is among the strongest risk factors for mental disorders. However, little is known about whether there are ages when children may be especially vulnerable to its effects. We sought to identify potential sensitive periods when exposure to the 2 most common types of maltreatment (neglect and harsh physical discipline) had a particularly detrimental effect on youth mental health.

Methods

Data came from the Future of Families and Child Wellbeing Study (FFCWS), a birth cohort oversampled from "fragile families" (n = 3,474). Maltreatment was assessed at 3, 5, and 9 years of age using an adapted version of the Parent-Child Conflict Tactics Scales (CTS-PC). Using least angle regression, we examined the relationship between repeated measures of exposure to maltreatment on psychopathology symptoms at age 15 years (Child Behavior Checklist; CBCL/6-18). For comparison, we evaluated the strength of evidence to support the existence of sensitive periods in relation to an accumulation of risk model.

Results

We identified sensitive periods for harsh physical discipline, whereby psychopathology symptom scores were highest among girls exposed at age 9 years (r2 = 0.67 internalizing symptoms; r2 = 1% externalizing symptoms) and among boys exposed at age 5 years (r2 = 0.41%). However, for neglect, the accumulation of risk model explained more variability in psychopathology symptoms for both boys and girls.

Conclusion

Child maltreatment may have differential effects based on the child's sex, type of exposure, and the age at which it occurs. These findings provide additional evidence for clinicians assessing the benefits and drawbacks of screening efforts and point toward possible mechanisms driving increased vulnerability to psychopathology.

Mother-infant emotional availability through the COVID-19 pandemic: Examining continuity, stability, and bidirectional associations

The COVID-19 pandemic may impact the development of infants' social communication patterns with their caregivers. The current study examined continuity, stability, and bidirectional associations in maternal and infant dyadic Emotional Availability (EA) before and during the COVID-19 pandemic. Participants were 110 Israeli mother-infant dyads (51% girls) that were assessed prior to (Mage = 3.5 months) and during (Mage = 12.4 months) the pandemic. At both time points, mother-infant interactions were observed during play (nonstressful context) and tasks designed to elicit infant frustration (stressful context). Maternal and child EA were coded offline. Maternal EA demonstrated no significant mean-level changes from before to during the COVID-19 pandemic, whereas infant responsiveness and involvement increased over time. Stability and bidirectional associations in EA differed by context and were evident only in the stressful context. Mothers' perceived levels of social support further moderated these associations. Specifically, infants' pre-pandemic responsiveness and involvement predicted maternal EA during the pandemic only when mothers reported low levels of social support. Our findings suggest that maternal and child EA were not adversely impacted by the COVID-19 pandemic. However, patterns of EA demonstrated moderate-to-no stability over time, suggesting considerable individual differences in trajectories of EA.

Global prevalence of physical and psychological child abuse during COVID-19: A systematic review and meta-analysis

BACKGROUND

With the onset of COVID-19, most countries issued lockdowns to prevent the spread of the virus globally and child abuse was concerned under such a closed circumstance.

OBJECTIVE

This study aims to estimate the prevalence of physical and psychological child abuse during COVID-19 and moderating variables for those abuses.

PARTICIPANTS AND SETTING

The rates of child abuse reported in 10 studies encompassing 14,360 children were used, which were gathered through a systematic review.

METHODS

We reviewed previous studies systematically for the appropriate data and conducted a meta-analysis.

RESULTS

The prevalence of physical child abuse is estimated at 18 % and that of psychological abuse is estimated at 39 %. Regarding the unemployment rate, it reveals a high correlation with physical abuse (b = 0.09; p < 0.05) but not with psychological one (b = 0.03; no. sig).

CONCLUSIONS

To prevent child abuse during the pandemic, it is suggested to minimize COVID-19-related economic damage to families and explore factors for reducing the gap between low and high-income countries.

Childcare Subsidy Enrollment Income Generosity and Child Maltreatment

In the United States, childcare subsidies are available to low-income working parents to assist with the cost of childcare. The subsidies are provided as block grants to states, which allows for a great deal of flexibility in the specific policies guiding their distribution. Prior research has found a protective link between childcare subsidies and child maltreatment, but the variations in policies have been much less explored. The current study used longitudinal administrative child welfare data from 10 years (2009-2019) linked with state policies regarding the income eligibility requirements of states to examine the impact of these policies on child abuse and neglect among young children (0-5); early school-age children (6-12), and older children (13-17). Using multiple regression and controlling for state demographic characteristics, the study found that more generous policies surrounding income eligibility were related to lower rates of child abuse and neglect investigations at the state level.

Suicidal ideation and suicide attempts in psychiatric patients during the COVID-19: A systematic review and meta-analysis

Current suicidal ideation and suicide attempts among psychiatric patients during the COVID-19 pandemic were studied through systematic review and meta-analysis. We searched the following electronic databases using the relevant search terms: Medline, Embase, PubMed and Web of Science, with the search time as of January 31,2022. Forest plots were obtained using Stata statistical software and a random-effects model was used to conduct a meta-analysis of the prevalence of suicidal ideation. We found 21 eligible studies, 11 of which provided suitable data for meta-analysis. 10 studies explored current suicidal ideation and reported a pooled prevalence of 20.4% (95%CI 14.0-26.8). Six studies examined suicide attempts, with a pooled prevalence of 11.4% (95%CI 6.2-16.6). The prevalence of suicidal ideation and suicide attempts varied by the study method used and by the study sites. This work highlights the need for real-time monitoring of suicidal ideation and suicide in psychiatric patients during the covid-19 pandemic r to inform clinical practice and help identify research questions for future epidemiological studies.

Violence in the Great Recession

Substantial evidence suggests that economic hardship causes violence. However, a large majority of this research relies on observational studies that use traditional violence surveillance systems that suffer from selection bias and over-represent vulnerable populations, such as people of color. To overcome limitations of prior work, we employed a quasi-experimental design to assess the impact of the Great Recession on explicit violence diagnoses (injuries identified to be caused by a violent event) and proxy violence diagnoses (injuries highly correlated with violence) for child maltreatment, intimate partner violence, elder abuse, and their combination. We used Minnesota hospital data (2004-2014), conducting a difference-in-differences analysis at the county level (n = 86) using linear regression to compare changes in violence rates from before the recession (2004-2007) to after the recession (2008-2014) in counties most affected by the recession, versus changes over the same time period in counties less affected by the recession. The findings suggested that the Great Recession had little or no impact on explicitly identified violence; however, it affected proxy-identified violence. Counties that were more highly affected by the Great Recession saw a greater increase in the average rate of proxy-identified child abuse, elder abuse, intimate partner violence, and combined violence when compared with less-affected counties.

US shelter in place policies and child abuse Google search volume during the COVID-19 pandemic

The COVID-19 pandemic has led to unemployment, school closures, movement restrictions, and social isolation, all of which are child abuse risk factors. Our objective was to estimate the effect of COVID-19 shelter in place (SIP) policies on child abuse as captured by Google searches. We applied a differences-in-differences design to estimate the effect of SIP on child abuse search volume. We linked state-level SIP policies to outcome data from the Google Health Trends Application Programming Interface. The outcome was searches for child abuse-related phrases as a scaled proportion of total searches for each state-week between December 31, 2017 and June 14, 2020. Between 914 and 1512 phrases were included for each abuse subdomain (physical, sexual, and emotional). Eight states and DC were excluded because of suppressed outcome data. Of the remaining states, 38 introduced a SIP policy between March 19, 2020 and April 7, 2020 and 4 states did not. The introduction of SIP generally led to no change, except for a slight reduction in child abuse search volume in weeks 8-10 post-SIP introduction, net of changes experienced by states that did not introduce SIP at the same time. We did not find strong evidence for an effect of SIP on child abuse searches. However, an increase in total search volume during the pandemic that may be differential between states with and without SIP policies could have biased these findings. Future work should examine the effect of SIP at the individual and population level using other data sources.

The power of the future: Intergenerational income mobility and child maltreatment in the United States

BACKGROUND

Recent research has shown that the likelihood of children experiencing intergenerational, upward income mobility depends on the community in which they are raised. Whether parents consider their children's economic chances in their parenting decisions, however, is not well understood.

OBJECTIVE

To examine the relationship between county-level income mobility-distinct from income inequality and poverty-and child maltreatment.

PARTICIPANTS AND SETTING

Administrative data from the National Child Abuse and Neglect Data System: Child File for 2406 counties were merged with measures of intergenerational income mobility from Chetty et al. (2014a), including the probability that a child born in the bottom quintile of the national income distribution reaches the top quintile by age thirty.

METHODS

Weighted least squares analyses were used to empirically estimate the relationship between intergenerational income mobility and child maltreatment report rates. Maltreatment reports were also divided into subgroups by age and metropolitan status.

RESULTS

Counties where children have a greater chance of moving up the income ladder have lower child maltreatment report rates, independent from income inequality and poverty rates. This relationship is consistent across all child ages (0-17). The relationship between upward income mobility and substantiated child maltreatment is also negatively correlated among non-metropolitan counties.

CONCLUSIONS

Children experience a lower risk for maltreatment if they are more likely to move up the income ladder in adulthood. Macroeconomic factors and policies that reduce income inequality and enhance economic mobility are likely to prevent child maltreatment.

Growing up unequal: Objective and subjective economic disparities and authoritarian parenting

BACKGROUND

Although there is evidence of economic disparities in parents' financial and time investments in children, little existing empirical work has considered the disparities in authoritarian parenting, a risk for child maltreatment. Similarly, existing research has largely focused on the role of objective markers of socioeconomic status (SES), although perceived subjective social status (SSS) may be equally powerful in shaping disparities in parenting behaviors.

DATA

This article draws on 30 years of General Social Survey data to examine the association between objective socioeconomic status and subjective social status and parents' endorsement of authoritarian parenting practices.

METHODS

We model the association between parents' SES and SSS and approval of authoritarian parenting practices estimated with odds ratios from logistic regressions and examine parental race as a potential moderator.

RESULTS

We find that SES and SSS are both associated with increased odds of endorsing authoritarian parenting, that SSS-based disparities are independent of SES, and that white parents' parenting may be more influenced by both SES and SSS than Black parents' parenting.

CONCLUSIONS

This work provides evidence that SES not only drives gaps in parental investments in children, but also gaps in their endorsement of authoritarian parenting. This is important because authoritarian parenting is not only directly associated with adverse outcomes for children, but is also associated with an increased risk for child maltreatment. It also expands the existing literature by showing that subjective measures of social status are important and distinct from objective measures of SES, and that these associations vary by race.

Mental health & maltreatment risk of children with special educational needs during COVID-19

BACKGROUND

Children with special educational needs (SEN) are more vulnerable during the COVID-19 pandemic with risk of poor mental wellbeing and child maltreatment.

OBJECTIVE

To examine the impact of COVID-19 on the mental health of children with SEN and their maltreatment risk.

PARTICIPANTS AND SETTING

417 children with SEN studying at special schools and 25,427 children with typical development (TD) studying at mainstream schools completed an online survey in April 2020 in Hong Kong during school closures due to COVID-19.

METHOD

Emotional/behavioural difficulties, quality of life and parental stress of children with SEN were compared with typically developed children using mixed effect model. Linear regression analyses were performed to explore factors associated with child emotional/behavioural difficulties and parental stress during the pandemic. Chi-square test was performed to detect the differences in maltreatment risk before and during COVID-19.

RESULTS

Children with SEN had significantly poorer overall quality of life (68.05 vs 80.65, p < 0.01). 23.5% of children had at least one episode of severe physical assault and 1.9% experienced very severe physical assault during COVID-19. Rates of physical assault increased significantly (59.8% vs. 71.2% p < 0.001) while children with mental disorders had increased risk of severe physical assault comparing to those without mental disorders (RR = 1.58, ꭓ² = 5.19 p = 0.023).

CONCLUSION

Children with SEN had poorer mental health than typically developed children during the COVID-19 pandemic. Maltreatment risk for children with SEN is higher in comparison to pre-COVID-19 era. Surveillance of child maltreatment, continuity of medical and rehabilitation care to support children with SEN are essential during a disease pandemic.

Unemployment and child maltreatment during the COVID-19 pandemic in the Republic of Korea

BACKGROUND

Risk factors for child maltreatment have been exacerbated during the COVID-19 pandemic, especially due to economic downfalls leading to parental job losses and poor mental health.

OBJECTIVE

This study aimed to examine the association between child maltreatment and unemployment rate in the Republic of Korea.

PARTICIPANTS AND SETTING

Nationally representative data at the province level were used.

METHODS

The monthly excess number of hotline calls related to child maltreatment during the COVID-19 pandemic was estimated for each province. Fixed effects regressions was used to examine the relationship between the excess number of hotline calls and unemployment rate.

RESULTS

The average excess number of hotline calls was significantly negative in the early stage of the pandemic, but became significantly positive afterwards except for some months with averages not statistically different from zero. The regression results showed that an increase of male unemployment rate by 1% was significantly associated with an increase in the excess number of hotline calls by 0.15-0.17 per 10,000 children for most dependent variables for the first year of the COVID-19 pandemic. The statistical significance of female unemployment rate was mixed with the opposite sign of the coefficient to that of male unemployment. Overall unemployment rate was not significant.

CONCLUSIONS

This study suggests that disruptions in child welfare services should be avoided to prevent underreporting of or delayed responses to suspected cases. Also, policies need to be designed considering potential pathways from economic downfalls, especially male unemployment, to child maltreatment.

Economic instability and child maltreatment risk: Evidence from state administrative data

BACKGROUND

The effects of economic instability and the role of economic conditions preceding child protective services (CPS) involvement have not been fully considered in the child welfare literature.

OBJECTIVE

This paper investigates the link between earnings instability and CPS involvement. Specifically, it examines whether adequate access to safety net programs mitigates the likelihood of child welfare involvement when families encounter negative earnings shocks.

METHODOLOGY

The study used quarterly administrative data from a sample of at-risk families for CPS involvement in Wisconsin. Event history analysis was employed to estimate the relationship between earnings instability and subsequent child maltreatment investigations.

RESULT

Experiencing a negative earnings shock of 30% or more increases the likelihood of CPS involvement by approximately 18%. The effect diminishes and becomes nonsignificant when an earnings decline is compensated by benefit receipt. Each additional earnings drop is associated with a 15% greater likelihood of CPS involvement. Each consecutive quarter with stable income is associated with 5% lower probability of a CPS report. The results are more pronounced for abuse than neglect and are marginally significant for neglect reports.

CONCLUSION

Unfavorable economic instability is linked to greater CPS-involvement risk, particularly for child abuse. Moreover, accessing sufficient social benefits as supplemental income when negative earnings shocks occur serves to effectively buffer against the risk of child maltreatment, particularly among families with young children (ages 0-4).

Economic Precarity, Financial Strain, and Job-Related Stress Among Philadelphia's Public Mental Health Clinicians

OBJECTIVE

Efforts to improve mental health treatment delivery come at a time of rising inequality and cuts or insufficient increases to mental health funding. Public mental health clinicians face increased demands, experience economic stress, and treat underresourced patients disproportionately burdened by trauma. The authors sought to understand clinicians' current economic and psychological conditions and the relationship of these conditions to the delivery of an evidence-based intervention (EBI) designed to treat posttraumatic stress disorder among youths.

METHODS

In July 2020, 49 public mental health clinicians from 16 Philadelphia clinics who were trained in an EBI, trauma-focused cognitive-behavioral therapy (TF-CBT), were surveyed by e-mail. Respondents reported on their economic precarity, financial strain, burnout, secondary traumatic stress (i.e., the stress response associated with caring for people exposed to trauma), and TF-CBT use. Associations between clinicians' job-related stressors and their use of TF-CBT were examined with mixed models. Content coding was used to organize clinicians' open-ended responses to questions regarding financial strain related to the COVID-19 pandemic.

RESULTS

Clinicians' economic precarity, financial strain, and job-related stress were high; 37% of clinicians were independent contractors, 44% of whom wanted a salaried position. Of 37 clinicians with education debt, 38% reported owing ≥$100,000. In the past year, 29% of clinicians reported lack of personal mental health care because of cost, and 22% met the cutoff for experiencing secondary traumatic stress symptoms. Education debt was negatively associated with use of TF-CBT (p<0.001).

CONCLUSIONS

The stress of providing care in underresourced clinical settings may interfere with efforts to integrate scientific evidence into mental health care.

Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study

BACKGROUND AND OBJECTIVE

The reported impacts of the COVID-19 pandemic on child maltreatment in the United States have been mixed. Encounter trends for child physical abuse within pediatric emergency departments may provide insights. Thus, this study sought to determine the change in the rate of emergency department encounters related to child physical abuse.

METHODS

A retrospective study within the Pediatric Emergency Care Applied Research Network Registry. Encounters related to child physical abuse were identified by 3 methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, or age-restricted skeletal survey completion. The primary outcomes were encounter rates per day and clinical severity before (January 2018-March 2020) and during the COVID-19 pandemic (April 2020-March 2021). Multivariable Poisson regression models were fit to estimate rate ratios with marginal estimation methods.

RESULTS

Encounter rates decreased significantly during the pandemic for 2 of 3 identification methods. In fully adjusted models, encounter rates were reduced by 19% in the diagnosis-code cohort (adjusted rate ratio: 0.81 [99% confidence interval: 0.75-0.88], P <.001), with the greatest reduction among preschool and school-aged children. Encounter rates decreased 10% in the injury cohort (adjusted rate ratio: 0.90 [confidence interval: 0.82-0.98], P = .002). For all 3 methods, rates for lower-severity encounters were significantly reduced whereas higher-severity encounters were not.

CONCLUSIONS

Encounter rates for child physical abuse were reduced or unchanged. Reductions were greatest for lower-severity encounters and preschool and school-aged children. This pattern calls for critical assessment to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.

Child maltreatment-related children's emergency department visits before and during the COVID-19 pandemic in Connecticut

BACKGROUND

Previous studies of national emergency department (ED) data demonstrate a decrease in visits coded for physical abuse during the pandemic period. However, no study to date has examined the incidence of multiple child maltreatment types (physical abuse, sexual abuse, and neglect), within a single state while considering state-specific closure policies. Furthermore, no similar study has utilized detailed chart review to identify cases, nor compared hospital data to Child Protective Services (CPS) reports.

OBJECTIVE

To determine the incidence of child maltreatment-related ED visits before and during the COVID-19 pandemic, including characterizing the type of maltreatment, severity, and CPS reporting.

PARTICIPANTS AND SETTING

Children younger than 18 years old at two tertiary-care, academic children's hospitals in X state.

METHODS

Maltreatment-related ED visits were identified by ICD-10-CM codes and keywords in chief concerns and provider notes. We conducted a cross-sectional retrospective review of ED visits and child abuse consultations during the pre-COVID (1/1/2019-3/15/2020) and COVID (3/16/2020-8/31/2020) periods, as well as state-level CPS reports for suspected maltreatment.

RESULTS

Maltreatment-related ED visits decreased from 15.7/week in the matched pre-COVID period (n = 380 total) to 12.3/week (n = 296 total) in the COVID period (P < .01). However, ED visits (P < .05) and CPS reports (P < .001) for child neglect increased during this period. Provider notes identified 62.4% of child maltreatment ED visits, while ICD-10 codes identified only-CM captured 46.8%.

CONCLUSION

ED visits for physical and sexual abuse declined, but neglect cases increased during the COVID-19 pandemic in X state.

Comparison of crosswalk methods for translating ICD-9 to ICD-10 diagnosis codes for child maltreatment

BACKGROUND

A validated source of International Classification of Disease (1CD) 10th revision diagnostic codes to identify child maltreatment has not been developed. Such a reference would be essential for the practical purposes of administrative data-based research and public health surveillance.

OBJECTIVE

To evaluate the validity of diagnosis code classifications for child maltreatment following conversion from ICD 9th edition, clinical modification (ICD-9-CM) to 10th revision.

PARTICIPANTS AND SETTING

Children receiving inpatient or emergency medical care in the United States with ICD-9-CM/ICD-10-CM diagnosis codes for child maltreatment, identified using two large multicenter hospital-based datasets.

METHODS

We evaluated the performance of general equivalence mappings (GEMs) and network-based mappings for previously-validated ICD-9-CM diagnosis codes for child maltreatment in the 2013-2014 PHIS and 2012 KID and resulting ICD-10-CM codes in the 2018-2019 PHIS and 2016 KID datasets.

RESULTS

Of 56 previously-validated ICD-9-CM diagnoses, GEMs identified 15 with a similar proportion of diagnosed children in the KID ICD-9-CM and ICD-10 eras and 14 diagnoses in PHIS. Network-based mapping identified 18 diagnoses with similar proportions in the KID datasets, and 13 diagnoses in PHIS. For six diagnoses, the proportion of children identified in the ICD-10 era using network-based mapping was more than ten times the proportion identified in the ICD-9-CM era.

CONCLUSION

Neither crosswalk method provided consistently reliable conversions, due to both crosswalk methodology and changes introduced by the ICD 10th revision. These findings highlight the need for independent construction and validation of ICD-10-based definitions of child maltreatment as a precursor to administrative data-based research and public health surveillance.

Coping with COVID: pandemic narratives for Australian children

The experience of the COVID-19 pandemic can be recognised as traumatic for the way in which its sudden and unexpected onset disrupted a sense of ordinary life for so many around the world. Adults, and far less so children, were unable to prepare for the danger of the rapidly spreading disease. As such, both were left vulnerable to the experience of trauma and anxiety that surrounds the threat of COVID. Whereas adults, however, have access to a range of resources and strategies for mental health protection, children of various ages need targeted resources to enable them to understand, prepare for, and come to terms with a trauma situation. A great deal of research exists around the value of children developing their own narratives as a means of coming to terms with trauma, such that storytelling is identified as a primary coping device. Similarly, literature exists that compares parental narratives of trauma with those of their children. Moreover, the use of the fairy tale as a cautionary tale has long been examined. What has not been established is the way in which contemporary multimedia narratives – such as television programmes, animations, and digital stories – can be used to develop coping strategies in children and to mitigate anxiety in young people experiencing global or collective trauma. This article examines a selection of such narratives produced for Australian children during the COVID-19 pandemic. Through a cross-disciplinary framework, this work considers how these resources can help (or hinder) mental health recovery in young children under the age of five, as well as strategies for best practice in the future development of trauma-informed resources for this age group.

Caregiver decision-making on young child schooling/care in the face of COVID-19: The influence of child, caregiver, and systemic factors

In March 2020, U.S. schools and daycares largely shut down to manage the novel COVID-19 pandemic. As the country made efforts to reopen the economy, American parents faced difficult decisions regarding returning to work and securing schooling and care for their young children. During the summer and fall of 2020, caregivers (N = 1655) of children (N = 2408; ages 0 - 12 years) completed questionnaires assessing their decision-making process regarding their children's daycare or schooling situation. A mixed method approach (i.e., qualitative, quantitative assessments) was utilized. Outcomes indicated three main themes that impacted caregivers' choices: child factors, caregiver factors, and systemic factors. Caregivers experienced high levels of stress while worrying about their child's and family's health, job responsibilities, and risk of COVID-19 infection rates in their areas. Continued assessment of families and children during this time is warranted.

The Effect of COVID-19 on the Mental Health of Military Connected Children and Adolescents

With a growing body of literature describing the coronavirus disease 2019 (COVID-19) pandemic's effect on children and adolescents, there remain few official reports regarding mental health in military connected youth. With sparse literature available specifically in youth associated with the Armed Forces, published studies on global child and adolescent mental health during the COVID-19 pandemic are first reviewed. Military connected youth have unique needs and experiences. Implications of pandemic-related stressors on their mental health are suggested based on analysis of disaster and deployment literature. Military members have continued to move and deploy throughout the pandemic. Uniformed families have high risk factors for mental health concerns. Managing the mental health of military connected youth will fall heavily on civilian providers, both in primary and subspecialty practices. As such, vigilance for psychological health concerns and familiarity with military resources are vital for the mental wellness of our military pediatric patients. [Pediatr Ann. 2022;51(4):e138-e143.].

Gender-Specific Related Factors for Suicidal Ideation During COVID-19 Pandemic Lockdown Among 5,175 Chinese Adolescents

Background

Suicide was an urgent issue during the pandemic period in adolescents. However, few studies were focused on suicide during the coronavirus disease 2019 (COVID-19) pandemic lockdown.

Methods

An online survey was conducted among 5,175 Chinese adolescents from June 9th to 29th in 2020 to investigate the prevalence of suicidal ideation (SI) during COVID-19 pandemic lockdown. A gender-specific stepwise logistic regression model was used. All analyses were performed with STATA 15.0.

Results

About 3% of the participants had reported having SI during the COVID-19 pandemic lockdown period. The prevalence of female SI (3.64%, 95% CI: 2.97-4.45%) was higher than that of males (2.39%, 95% CI: 1.88-3.05%) (χ² = 6.87, p = 0.009). Quarreling with parents [odds ratio (OR) = 9.73, 95% CI: 5.38-17.59], insomnia (OR = 5.28, 95% CI: 2.81-9.93), previous suicide attempt history (OR = 3.68, 95% CI: 1.69-8.03), previous SI history (OR = 2.81, 95% CI: 1.30-6.06), and feeling depressed during pandemic lockdown (OR = 2.26, 95% CI: 1.22-4.18) were positively associated with the males' SI. However, having emptiness inside (OR = 4.39, 95% CI: 2.19-8.79), quarreling with parents (OR = 3.72, 95% CI: 2.16-6.41), insomnia (OR = 3.28, 95% CI: 1.85-5.80), feeling anxious (OR = 2.62, 95% CI: 1.46-4.70), and longing for father's emotional warmth (OR = 0.38, 0.20-0.72) were associated mostly with females' SI.

Conclusions

Female adolescents, who felt emptiness from their families and their fathers' emotional warmth, were at much higher risk of having SI during COVID-19 lockdown. We must specify a suicide prevention policy and interventions for adolescents in the pandemic crisis based on gender gaps.

The Impact of the COVID-19 Pandemic on Health, Quality of Life and Intrafamilial Relations - A Population-Based Survey in Germany

The occurrence of the novel severe acute respiratory syndrome coronavirus-2 (COVID-19) at the end of 2019 comes along with many challenges. Besides worry for one's own health and the well-being of the family, all measures applied to limit the spread of the coronavirus affected daily life. School closures, economic shutdown and contact restrictions have led to high levels of stress. The impact on health and families has been widely discussed. However, population-based data are scarce. Here, we have assessed health, quality of life and intrafamilial relations depending on the COVID-19 pandemic. Using a three-step random-route approach, a population-based sample of 2,515 persons (52.6% female, average age of 50.3 years) was recruited during the second COVID-19 wave in Germany in winter 2020/21. While the majority of participants reported no change in their health status and the relationship with their partner and children, more than half of participants reported a decreased quality of life since the beginning of the pandemic. Female gender, age above 60 years, a low household income, not living with a partner and the experience of childhood adversity were associated with a higher risk for a worsening of health, quality of life and intrafamilial relations. These had already been well-established risk factors ahead of the pandemic. In order to avoid further increase of inequality in our society and more devastating impact of the pandemic on health and intrafamilial relations, low-level support and intervention programs are urgently needed.

Mogle J, Lee J, Tornello SL, Hostetler ML, Cifelli JA, Bai S, Hotez E. Impact of the COVID-19 Pandemic on Parent, Child, and Family Functioning

To quantify the impact of the COVID-19 pandemic and public health interventions on parent and child mental health and family relationships, we examined change in individual and family functioning in a sample of parents enrolled in a prevention trial; we examined change before the pandemic (2017-2019) when children were an average of 7 years old to the first months after the imposition of widespread public health interventions in the United States (2020) with paired t tests and HLM models. We examined moderation by parent gender, education, family income, and coparenting conflict. We found large deteriorations from before the pandemic to the first months of the pandemic in child internalizing and externalizing problems and parent depression, and a moderate decline in coparenting quality. Smaller changes were found for parent anxiety and parenting quality. Mothers and families with lower levels of income were at particular risk for deterioration in well-being. Results indicate a need for widespread family support and intervention to prevent potential family "scarring," that is, prolonged, intertwined individual mental health and family relationship problems.

Building long-term family resilience through universal prevention: 10-year parent and child outcomes during the COVID-19 pandemic

As the COVID-19 pandemic has been highly stressful for parents and children, it is clear that strategies that promote long-term family resilience are needed to protect families in future crises. One such strategy, the Family Foundations program, is focused on promoting supportive coparenting at the transition to parenthood. In a randomized trial, we tested the long-term intervention effects of Family Foundations on parent, child, and family well-being one to two months after the imposition of a national shelter-in-place public health intervention in 2020. We used regression models to test intervention impact on outcomes reported on by parents in a standard questionnaire format and a series of 8 days of daily reports. We also tested moderation of intervention impact by parent depression and coparenting relationship quality. Relative to control families, intervention families demonstrated significantly lower levels of individual and family problems (general parent hostility, harsh and aggressive parenting, coparenting conflict, sibling relationship conflict, and children's negative mood and behavior problems), and higher levels of positive family relationship quality (positive parenting, couple relationship quality, sibling relations, and family cohesion). For some outcomes, including coparenting conflict, harsh parenting, and child behavior problems, intervention effects were larger for more vulnerable families-that is, families with higher pre-pandemic levels of parent depression or lower levels of coparenting relationship quality. We conclude that targeted family prevention programming is able to promote healthy parent and child functioning during unforeseen future periods of acute stress. The long-term benefits of a universal approach to family support at the transition to parenthood indicate the need for greater investment in the dissemination of effective approaches.

The Effect of Home Foreclosures on Child Maltreatment Rates: A Longitudinal Examination of Neighborhoods in Cleveland, Ohio

Foreclosure rates have been linked to increased levels of neighborhood stress. Neighborhood stressors can impact a number of interpersonal and familial dynamics, including child maltreatment. Despite this, little research has examined the relationship between neighborhood foreclosure rates and aggregate trends in child maltreatment. Using substantiated child maltreatment cases, foreclosure, and census data at the neighborhood level in Cleveland, Ohio we find that home foreclosures are a significant predictor of neighborhood rates of child maltreatment. Importantly, this effect is durable and is not impacted by the housing crisis. Furthermore, this is a direct effect and is not shaped by other neighborhood conditions like poverty, as found in prior research. From a policy perspective, this suggests that policy makers need to be cognizant of the effect of foreclosures on child maltreatment regardless of the historical and economic contexts of the neighborhood.

Not All Homes Are Safe: Family Violence Following the Onset of the Covid-19 Pandemic

Evidence from victim service providers suggests the COVID-19 pandemic led to an increase in family violence. However, empirical evidence has been limited. This study uses novel survey data to investigate the occurrence of family violence during the early months of the COVID-19 pandemic in the United States. Data come from the second wave of the Assessing the Social Consequences of COVID-19 study, an online non-probability sample collected in April and May 2020. Family violence is measured using four variables: any violence, physical violence, verbal abuse, and restricted access. The authors use logistic regression and KHB decomposition to examine the prevalence of family violence during the COVID-19 pandemic. We find that sexual minorities, in particular bisexual people, experienced higher rates of family violence than heterosexual respondents. Women were the only group to report an increase in the frequency of family violence. Household income loss is associated with the incidence of verbal violence. Our findings demonstrate the importance of expanding victim services to address the additional barriers victims face within the pandemic context and beyond, including broad contexts of social isolation and financial precarity experienced by individuals at risk of family violence.

Do macroeconomic shocks in the local labor market lead to child maltreatment and death?: Empirical evidence from Japan

BACKGROUND

Japan is facing a rapid increase in the number of reported child maltreatment cases. Child maltreatment has long-term consequences for the victims, and unemployment rate is considered a strong predictor of it. However, only few studies have analyzed the causal relation between child maltreatment and the unemployment rate-particularly the effects of the latter on the former-in Japan.

METHODS

Using prefecture-level longitudinal data from 2005 to 2016, we employed a fixed effects instrumental variable estimation. The estimation included a weighted average of the national unemployment rate across industries by industrial structures in 2005 as an instrument to identify the causal effects.

RESULTS

The average local unemployment rate changed by approximately 50% from the peak to the bottom in the sample period. A 50% increase in local unemployment rates increased the number of reported child neglect cases and child deaths by 80% and 70% (statistically significant at the 5% level), respectively. Further, it increased cases of death due to external causes, unintentional injuries, and unintentional drowning by 146%, 217%, and 315% (statistically significant at the 5% level), respectively.

CONCLUSION

The local unemployment rate is a risk factor for child maltreatment, resulting in children's death, especially as a result of unintentional drowning-the common cause of death due to child neglect. When the local unemployment rates rise, governments should allocate more financial and human resources for preventive measures to combat child deaths caused by neglect.

Child Abuse Imaging and Findings in the Time of COVID-19

OBJECTIVE

To assess the impact of the COVID-19 pandemic on physical abuse in young children, we compared the following before and during the pandemic: (1) skeletal survey volume, (2) percent of skeletal surveys revealing clinically unsuspected (occult) fractures, and (3) clinical severity of presentation. We hypothesized that during the pandemic, children with minor abusive injuries would be less likely to present for care, but severely injured children would present at a comparable rate to prepandemic times. We expected that during the pandemic, the volume of skeletal surveys would decrease but the percentage revealing occult fractures would increase and that injury severity would increase.

METHODS

We conducted a retrospective study of children younger than 2 years undergoing skeletal surveys because of concern for physical abuse at a tertiary children's hospital. Subjects were identified by querying a radiology database during the March 15, 2019-October 15, 2019 (pre-COVID-19) period and the March 15, 2020-October 15, 2020 (COVID-19) period, followed by chart review to refine our population and abstract clinical and imaging data.

RESULTS

Pre-COVID-19, 160 skeletal surveys were performed meeting the inclusion criteria, compared with 125 during COVID-19, representing a 22% decrease. No change was observed in identification of occult fractures (6.9% pre-COVID vs 6.4% COVID, P = 0.87). Clinical severity of presentation did not change, and child protective services involvement/referral decreased during COVID.

CONCLUSIONS

Despite a >20% decrease in skeletal survey performance early in the pandemic, the percent of skeletal surveys revealing occult fractures did not increase. Our results suggest that decreases in medical evaluations for abuse did not stem from decreased presentation of less severely injured children.

In their own words: Child and adolescent perceptions of caregiver stress during early COVID-19

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated multiple stressors for caregivers of children in the United States, raising concern for increased family conflict, harsh parenting, and child maltreatment. Little is known regarding children's perceptions and experiences of caregiver stress during the COVID-19 pandemic.

OBJECTIVE

To examine how children and adolescents identify and experience caregiver stress during the early COVID-19 pandemic.

METHODS

We analyzed 105 de-identified helpline text and online chat transcripts from children under age 18 who submitted inquiries to the Childhelp National Child Abuse Hotline from March to June of 2020, with COVID-19 as a presenting issue. Inductive, thematic analysis was used to identify how child helpline users: 1) perceived and experienced drivers of caregiver stress and 2) used words to describe manifestations of caregiver stress during the COVID-19 pandemic.

RESULTS

Children experienced multiple drivers of caregiver stress during COVID-19, including intrapersonal (e.g. caregiver health concerns), interpersonal (e.g. parental discord, perceived dislike of child), and extrapersonal (e.g. financial insecurity, sheltering in place) stressors. Regardless of the driver, caregivers' stress was internalized by children. "Anger," "control," and "blame" were most commonly used to label manifestations of caregiver stress, which were often externalizing behaviors, including yelling, name calling, and blaming of others.

CONCLUSION

In text and online chat inquiries to a national child helpline during the COVID-19 pandemic, children described multiple drivers of caregiver stress, often feeling as though they were to blame. Providers serving children should address household stress spillover effects by including caregivers and directly acknowledging children's concerns using their own words.

Emotional and Behavioral Impact of the COVID-19 Epidemic in Adolescents

PURPOSE OF REVIEW

This review of the literature aims to explore the impact of the COVID-19 pandemic and the lockdown on teenagers' mental health. We distinguish two groups: adolescents who had already been diagnosed with a mental disorder and the general population of adolescents.

RECENT FINDINGS

An increase in the number of mental health-related difficulties in adolescents has already been reported in previous health crises. Accordingly, the perceived well-being of teenagers declined during the COVID-19 pandemic. Adolescents with mental disorders were significantly more affected by the lockdown than those in the general population. The effect of the COVID-19 crisis on the mental health of adolescents has been heterogeneous. The first pandemic wave was essentially associated with an increase of internalizing symptoms in adolescents, particularly anxiety, depression and eating disorders. The impact on externalizing symptoms was less clear, and seem to concern mostly adolescents with pre-existing behavioral disorders. During the second and later waves of the pandemic, an upsurge of suicidal ideation and attempts among adolescents have been reported in many countries.

Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany

The COVID-19 pandemic has caused unprecedented changes in the lives of 1.6 billion children and adolescents. First non-representative studies from China, India, Brazil, the US, Spain, Italy, and Germany pointed to a negative mental health impact. The current study is the first nationwide representative study to investigate the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) and mental health of children and adolescents in Germany from the perspective of children themselves. A representative online survey was conducted among n = 1586 families with 7- to 17-year-old children and adolescents between May 26 and June 10. The survey included internationally established and validated instruments for measuring HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), and depression (CES-DC). Results were compared with data from the nationwide, longitudinal, representative BELLA cohort study (n = 1556) conducted in Germany before the pandemic. Two-thirds of the children and adolescents reported being highly burdened by the COVID-19 pandemic. They experienced significantly lower HRQoL (40.2% vs. 15.3%), more mental health problems (17.8% vs. 9.9%) and higher anxiety levels (24.1% vs. 14.9%) than before the pandemic. Children with low socioeconomic status, migration background and limited living space were affected significantly more. Health promotion and prevention strategies need to be implemented to maintain children's and adolescents' mental health, improve their HRQoL, and mitigate the burden caused by COVID-19, particularly for children who are most at risk.

Evaluating child maltreatment and family violence risk during the COVID-19 Pandemic: Using a telehealth home visiting program as a conduit to families

The COVID-19 pandemic has affected many child maltreatment risk factors and may have affected maltreatment among vulnerable families. We surveyed 258 certified providers of an evidence-based home visiting program, SafeCare, about their perception of the impact of the pandemic on the families they serve. We examined if the providers perceived an overall change in child maltreatment and family violence risk among the families with young children they served and factors that may have contributed to changes. Regressions estimated the relationship between providers' assessment of families' ability to social distance, emotional struggles, and access to public resources/services with providers' perception of child maltreatment and family violence risk in the home. Findings indicate that 87% of providers believed maltreatment risk had increased during the pandemic. Providers serving families who were unable to social distance due to employment were more likely to report increased supervisory neglect and material neglect among the families they serve. Providers reporting that families were struggling with elevated frustration levels also reported more family conflict and material neglect among the families they serve. Results from this research can inform strategic decision-making for policies and programs that address the challenges low-income families with young children face in emergency situations.

Parental Social Isolation and Child Maltreatment Risk during the COVID-19 Pandemic

On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. The social isolation and economic stress resulting from pandemic have the potential to exacerbate child abuse and neglect. This study examines the association of parents' perceived social isolation and recent employment loss to risk for child maltreatment (neglect, verbal aggression, and physical punishment) in the early weeks of the pandemic. Participants (N = 283) were adults living in the U.S. who were parents of at least one child 0-12 years of age. Participants completed an online survey approximately 2 weeks after the World Health Organization declared that COVID-19 was a pandemic. The survey asked about recent changes (i.e., in the past 2 weeks) to employment status, parenting behaviors, use of discipline, use of spanking, and depressive symptoms. Nearly 20% of parents had hit or spanked their child in the past two weeks alone. Parents' perceived social isolation and recent employment loss were associated with self-report of physical and emotional neglect and verbal aggression against the child, even after controlling for parental depressive symptoms, income, and sociodemographic factors. Parents' perceived social isolation was associated with parental report of changes in discipline, specifically, using discipline and spanking more often in the past 2 weeks. Associations were robust to analyses that included two variables that assessed days spent social distancing and days spent in "lockdown." Study results point to the need for mental health supports to parents and children to ameliorate the strain created by COVID-19.

Parental Burnout and Child Maltreatment During the COVID-19 Pandemic

The novel coronavirus (COVID-19) has spread across the United States, resulting in significant changes in almost all aspects daily life. These changes place parents at increased risk for parental burnout. Parental burnout is a chronic condition resulting from high levels of parenting-related stress due to a mismatch between the demands of parenting and the resources available for parents to meet those demands. Research on parental burnout has suggested that parents who experience burnout are more likely to engage in child abuse and neglect, placing children at risk for detrimental short- and long-term outcomes. The purpose of this paper is to review the concept of parental burnout, discuss parental burnout in the context of the current COVID-19 pandemic, and focus specifically on the effects of child maltreatment. Implications for practitioners will be discussed.

The neglected ones: Time at home during COVID-19 and child maltreatment

The early months of the COVID-19 pandemic led to extreme social isolation, precarious employment and job loss, working from home while tending to children, and limited access to public services. The confluence of these factors likely affects child health and well-being. We combine early release child maltreatment reports in Indiana with unique and newly available mobile phone movement data to better understand the relationship between staying at home intensively during the COVID-19 pandemic and child maltreatment. Our findings indicate that the prolonged stays at home promoted by the early public health response to COVID-19 resulted in reductions in child maltreatment reports overall and substantiated reports of maltreatment. However, relative to areas that stayed home less, children in areas that stayed home more were more likely to be both reported for and a confirmed victim of maltreatment, particularly neglect. These areas have historically been socioeconomically advantaged and experienced lower rates of maltreatment. We only observe increases in confirmed child maltreatment in metropolitan counties, suggesting that the effects of staying home on child maltreatment may reflect both the differential risk of leaving home and access to services in metropolitan-rather than non-metropolitan-counties. Staying at home has been challenging for many families. Families likely need assistance as the pandemic persists, evolves, and when it ends.

[Mental health and psychological burden of children and adolescents during the first wave of the COVID-19 pandemic-results of the COPSY study]

BACKGROUND

The drastic changes during the COVID-19 pandemic may have a negative impact on the psychological wellbeing of children and adolescents.

OBJECTIVES

COPSY is the first national, representative German study to examine mental health and quality of life of children and adolescents during the pandemic. Results are compared with data of the representative longitudinal BELLA study conducted before the pandemic.

MATERIALS AND METHODS

Internationally established instruments for measuring health-related quality of life and mental health (including anxiety and depressive symptoms) were administered to n = 1586 parents with 7‑ to 17-year-old children and adolescents, of whom n = 1040 11- to 17-year-olds also provided self-reports, from 26 May to 10 June 2020. Data were analyzed using descriptive statistics and bivariate tests.

RESULTS

Seventy-one percent of the children and adolescents and 75% of the parents felt burdened by the first wave of the COVID-19 pandemic. Compared to the time before the pandemic, the children and adolescents reported a lower health-related quality of life, the percentage of children and adolescents with mental health problems almost doubled, and their health behavior worsened. Socially disadvantaged children felt particularly burdened by the COVID-19 pandemic. Two-thirds of the parents would like to receive support in coping with their child during the pandemic.

CONCLUSIONS

The COVID-19 pandemic poses a mental health risk to children and adolescents. Schools, doctors, and society are called to react by providing low-threshold and target-group-specific prevention and mental health promotion programs.

Parental economic insecurity and child health

We explore the effects of parental economic insecurity on their children's hyperactivity and anxiety. Our central argument is that even after controlling for current family income and employment status, parents may have legitimate feelings of economic insecurity, and these may be detrimental for their children. Data from the National Longitudinal Survey of Children and Youth indicate that the health of 2- to 5-year-old children is worse when parents report themselves to be "worried about having enough money to support the family." In particular, boys are more hyperactive and girls are more anxious when parents feel less economically secure. Changes in parenting styles appear to be channels through which parental economic insecurity affects their children.

The effect of child neglect and abuse information studies on parents' awareness levels during the COVID-19 pandemic

The research was conducted in order to increase the knowledge and awareness of parents with children between the ages of 4-6 during the COVID-19 pandemic process, through social media applications and programs. The research was designed as a quasi-experimental study with pre-testing, post-testing, and control groups using a quantitative research method. There are 67 parents in the study group, 32 of which are experimental, and 35 are of a controlled group. Data was obtained using The Personal Information Form, Child Neglect and Abuse Awareness Scale for Parents, and Parental Abuse Scale. The "Child Neglect and Abuse WhatsApp and Online Education Program" was applied to the participants in the experimental group. Each day, three messages were sent to the participants in the experimental group on the subjects of child neglect, physical abuse, emotional abuse and sexual abuse, respectively. In addition, online training was given on the same subjects and in the same order in four sessions over the Zoom application. The participants in the control group did not receive any intervention. Before and after the implementation of the Child Neglect and Abuse WhatsApp and Online Education Program, data collection tools were given to the participants in the experimental and control groups. Paired samples t Test, Wilcoxon Signed Ranks Test were used to analyze the data. As a result of the study, there was no statistically significant difference between the pre-test scores and the post test scores of the parents in the control group. When the differences between the pre and post test scores of the parents in the experimental group and the pre and post tests scores of the parents in the experimental and control groups were compared, it was observed that there was a significant difference in favor of the experimental group. In line with this result, it can be said that the education applied has had an impact on the parents' knowledge and awareness of child neglect and abuse.

The neglected ones: Time at home during COVID-19 and child maltreatment

The early months of the COVID-19 pandemic led to extreme social isolation, precarious employment and job loss, working from home while tending to children, and limited access to public services. The confluence of these factors likely affects child health and well-being. We combine early release child maltreatment reports in Indiana with unique and newly available mobile phone movement data to better understand the relationship between staying at home intensively during the COVID-19 pandemic and child maltreatment. Our findings indicate that the prolonged stays at home promoted by the early public health response to COVID-19 resulted in reductions in child maltreatment reports overall and substantiated reports of maltreatment. However, relative to areas that stayed home less, children in areas that stayed home more were more likely to be both reported for and a confirmed victim of maltreatment, particularly neglect. These areas have historically been socioeconomically advantaged and experienced lower rates of maltreatment. We only observe increases in confirmed child maltreatment in metropolitan counties, suggesting that the effects of staying home on child maltreatment may reflect both the differential risk of leaving home and access to services in metropolitan-rather than non-metropolitan-counties. Staying at home has been challenging for many families. Families likely need assistance as the pandemic persists, evolves, and when it ends.

Contributions of the Fragile Families and Child Wellbeing Study to Child Development

We describe the promise of the Fragile Families and Child Wellbeing Study (FFCWS) for developmental researchers. FFCWS is a birth cohort study of 4,898 children born in 1998-2000 in large US cities. This prospective national study collected data on children and parents at birth and during infancy (age 1), toddlerhood (age 3), early childhood (age 5), middle childhood (age 9), adolescence (age 15), and, in progress, young adulthood (age 22). Though FFCWS was created to understand the lives of unmarried parent families, its comprehensive data on parents, children, and contexts can be used to explore many other developmental questions. We identify six opportunities for developmentalists: (a) analyzing developmental trajectories, identifying the importance of the timing of exposures for later development, (c) documenting bidirectional influences on development, (d) understanding development in context, (e) identifying biological moderators and mechanisms, and ( f ) using an urban-born cohort that is large, diverse, and prospective.