Abuse and neglect in adolescents of Jammu, India: the role of gender, family structure, and parental education

Prevalence and associated factors of adolescent psychological abuse, neglect in Western China a multi-center cross-sectional study

Background: The western region of China has a dense population, relatively underdeveloped economy, and a significant number of left-behind children. Currently, the prevalence of adolescent psychological abuse, neglect, and the factors associated with these issues in the region remain unclear. This study aims to evaluate the current status of adolescent psychological abuse and neglect and its associated factors in this region.Methods: Data were collected from 50 schools in western China through cluster sampling to target adolescents aged 12 to 18. A comprehensive survey form was used to collect socio-demographic characteristics of adolescents. The Child Psychological Abuse and Neglect Scale was employed to assess the current psychological abuse and neglect of adolescents. Independent samples t-tests were used for inter-group comparisons. A Directed Acyclic Graph was constructed for controlling confounding variables. Subsequently, binary logistic regression analysis was performed, and a nomogram risk factors model was developed using R Studio.Results: This study included 12,743 teenagers, with an average age of 15.53(±1.39) years. Among them, 4,965 individuals, accounting for 39.0%, reported experiences of psychological abuse, while 4,167 individuals, accounting for 32.7%, reported experiences of neglect. The rates of psychological abuse and neglect in adolescents are influenced by gender, grade, left-behind experience, parental marital status, and living on campus (P < .05).Conclusion: Adolescents in western China exhibit higher rates of psychological abuse and neglect compared to those in the eastern and northern regions of China. Gender, grade, left-behind experience, and family factors significantly influence the psychological abuse and neglect of adolescents.

Multi-level analysis of the determinants of physical domestic violence against children using longitudinal data from MINIMat mother-child cohort in Bangladesh

Objectives

Despite high levels of physical violence against children (VAC) globally (40-50%), the literature on the determinants of VAC remains inconclusive. Most of the literature on this topic is based on cross-sectional data, and the multi-level nature of the drivers of VAC is widely ignored. This leads to model specification problems and an inability to draw causal inferences. Moreover, despite the higher prevalence of VAC in low-and middle-income countries, studies from high income countries dominate the field. We examined the determinants of physical domestic VAC to address these gaps in the literature.

Methods

Data were collected between 2001 and 2020 from 762 mother-child dyads recruited in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study in Bangladesh. We conducted multi-level logistic regression analyses to identify the determinants of physical domestic VAC.

Results

Prevalence of physical domestic violence against girls (69%) and boys (62%) was extremely high. Community-level prevalence of physical domestic VAC increased the likelihood of physical domestic VAC at the individual level across gender (girls - OR-5.66; 95% CI- 3.11-10.32; boys - OR-7.67; CI- 3.95-14.91). While physical domestic violence against mothers was not associated with physical domestic violence against girls, it reduced the likelihood of such violence against boys by 47%. Having 3 or more siblings predicted physical domestic violence against girls (OR-1.97; 95% CI- 1.01-3.81 for 3 siblings; OR-4.58; 95% CI- 2.12-9.90 for 4 or more siblings), but not against boys. While girls in Hindu families were more likely to experience this violence, the boys were not. Mother's education, employment non-governmental organization (NGO) participation and, household wealth did not predict this violence against any gender.

Conclusion

We contend that physical domestic violence against mothers reflects an emphasized patriarchal culture in a family where a boy is less likely to experience physical domestic violence. Social norms and social learning theories explain the greater likelihood of a child experiencing physical domestic violence in a village with a higher level of such violence. We conclude that social norms around physical domestic VAC and patriarchal culture need to be changed to effectively address this violence.

Mental Health Morbidities and their Correlates among the Adolescents in Kamrup (Metro), Assam: A School-Based Study

Background

India has the largest adolescent population worldwide, and among this group, mental health issues account for 16% of the total global burden of disease and injury. Disturbingly, approximately half of these health conditions manifest before the age of 14 years. To assess the prevalence of depression, anxiety, and stress along with its correlates among the adolescents in the schools of Kamrup (Metro) district, Assam.

Methods and Material

This cross-sectional study was conducted in 10 randomly selected high schools in the study area among the adolescents selected from 8th to 10th standards in the age group of 14 to 17 years. A pre-designed, pre-tested interview schedule, the modified Kuppuswamy scale, and 'Depression Anxiety Stress Scale-21 Items' (DASS 21) questionnaire were used for data collection.

Results

The mean ± 2SD age of the adolescents was 14.74 ± 1.58 years. Among the adolescents, the overall prevalence of depression, anxiety, and stress was found to be 22.2%, 24.4%, and 6.9%, respectively.

Conclusions

The occurrence of mental health morbidities among adolescents is notably widespread, yet researchers have largely overlooked this aspect. This underscores the need for comprehensive investigations into the factors that contribute to these mental health issues.

The co-occurrence of potentially traumatic events (PTEs) and their associations with posttraumatic stress disorder (PTSD) in Indian and Malaysian adolescents

BACKGROUND

Although it is well-established that people can experience multiple traumatic events, there are few studies examining the co-occurrence of such experiences in non-Western nations. The current study sought to examine the occurrence of multiple potentially traumatic experiences (PTEs) and their associations with posttraumatic stress disorder (PTSD) among adolescents from two Asian nations.

METHODS

Latent class analysis (LCA) was employed to model the co-occurrence of PTEs in two school samples of adolescents from India (n = 411) and Malaysia (n = 469). Demographic correlates (i.e., sex, age, household composition, parent education) of the latent classes and the association between latent class membership and probable diagnosis of posttraumatic stress disorder (PTSD) were examined.

RESULTS

The LCA identified three latent classes for the Indian sample: 'Low Risk - moderate sexual trauma', 'Moderate Risk', and 'High Risk'. Similarly, three classes were also identified for the Malaysian sample: 'Low Risk', 'Moderate Risk', and 'High Risk'. Membership of 'Moderate Risk' was associated with male sex in both samples, and with older age and lower levels of parental education attainment in the Malaysian sample. No correlates of 'High Risk' class were identified in either sample. Membership of the 'High Risk' class was significantly associated with probable PTSD diagnosis in both samples, while membership of the 'Moderate Risk' class was associated with probable PTSD diagnosis in the Malaysian sample.

CONCLUSION

Findings from this study correspond with Western studies indicating co-occurrence of PTEs to be common and to represent a salient risk factor for the development of PTSD.

Population-Based Estimates of Associations Between Child Maltreatment Types: A Meta-Analysis

Although it is accepted that experiences of child maltreatment are multidimensional and often include several correlated but distinct experiences, many clinical and research decisions regarding exposure and treatment do not consider their potential overlap or potential independence. The purpose of this meta-analysis-using a single retrospective self-report measure, the Childhood Trauma Questionnaire (CTQ), in population-representative samples-was to investigate the magnitude and specificity of associations between forms of child maltreatment. A systematic review of studies available on PubMed, PsycINFO, and Google Scholar was conducted, resulting in the inclusion of nine journal articles, 11 independent samples, and 25,415 participants. Data were converted from Pearson correlations to Z statistics and pooled using a random effects model. All maltreatment types were positively and significantly associated. Effect sizes varied from medium to large, with (1) physical abuse and emotional abuse (Z = 0.72, 95% CI [.48, .96]), (2) physical neglect and emotional neglect (Z = 0.62, 95% CI [.43, .81]), and (3) emotional abuse and emotional neglect (Z = 0.54, 95% CI [.35, .72]) demonstrating the strongest associations. These analyses provide evidence of the associations between types of child maltreatment, indicate the likelihood of shared risk, and point to characteristics that may link different types of maltreatment. These findings have important clinical implications as they may help guide comprehensive screening for associated maltreatment types as well as intervention and prevention efforts. Limitations include the relatively few studies included and those associated with the CTQ-a retrospective, self-report measure that does not account for the concurrence of experiences.

Prevalence and correlates of child maltreatment among mothers in the Kurdistan province, Western Iran

OBJECTIVE

Parental child maltreatment is a serious public health issue worldwide. As mothers take on a significant proportion of parenting duties in two-parent families, knowledge of maternal risk factors for child maltreatment is essential.

METHODS

In this cross-sectional study, 135 mothers with their last child below 18 years old in Kurdistan province were enrolled. A validated Persian version of the ISPCAN Child Abuse Screening Tool-Parent version, Beck Anxiety Inventory, and Beck Depression Inventory were administered.

RESULTS

The prevalence of severe and moderate physical punishment was 78.5% and 71.9%, respectively. Psychological punishment was reported by 99.3% of respondents, and 48.9% reported neglect. A relationship was found between child physical and emotional abuse and low maternal education (P < 0.01), domestic violence (P = 0.02), maternal exposure to maltreatment during childhood (P = 0.03), maternal depression (p < 0.01), and maternal anxiety (P < 0.01). A relationship was found between neglect and residence in rural areas (P < 0.01), domestic violence, and low maternal education (P = 0.02).

CONCLUSION

Maternal child maltreatment in Iran is increased in mothers with psychological disorders and those with certain demographic characteristics. Clinicians should be alert to these potential risk factors.

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

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

Profiles of abuse and neglect and the association with mental health indicators among a large sample of boys and girls from India

BACKGROUND

Child abuse and neglect (CAN) is a major public health concern, but limited data are available on the occurrence, co-occurrence, and correlates of these phenomena outside Western societies.

OBJECTIVES

The first aim of this study was to establish the prevalence of CAN across two settings (inside and outside the home) among children and adolescents in Mumbai, India. Another aim was to use latent class analysis (LCA) to identify meaningful profiles of maltreatment, and to examine how class membership is associated with mental wellbeing.

PARTICIPANTS AND SETTING

Self-report data was collected from males (n = 4454; M_age = 12.77 years) and females (n = 3850; M_age = 12.87) at secondary schools.

RESULTS

Four latent classes of maltreatment were identified among males, including 'low victimisation' (50.4% of participants), 'intra-familial non-sexual abuse' (34.6%), 'intra- and extra- familial non-sexual abuse' (10.2%), and 'poly-victimisation' (4.8%). Among females, three latent classes were identified including, 'low victimisation' (68.1%), 'intra-familial non-sexual abuse' (28.8%), and 'poly-victimisation' (3.0%). Compared to the 'low victimisation' class, children in the abuse classes demonstrated higher levels of anxiety and depression and increased odds of self-injurious thoughts and behaviours. These associations were augmented for girls relative to boys.

CONCLUSION

There were very few maltreated children who were subjected to just one form of CAN and experiencing co-occurring patterns of abuse and neglect was associated with indicators of poor mental health, especially among girls. These findings highlight the complexity of the situation and will inform policy makers, health professionals and school counsellors.

Gender Differences in Childhood Maltreatment: A Comparative Study of Nightmare Sufferers and Non-sufferers

Child maltreatment has been identified as a significant problem, both within India and outside. According to UNICEF, over the last decade, there has been a growing recognition about this, but the problem has remained unresolved largely due to being underreported and undocumented. Previous research in this area has reported inconsistent gender differences across the world. Besides, there are shreds of evidence to suggest that childhood maltreatment would be associated with nightmares later in life, but a handful of studies exist in this context. Moreover, there is a paucity of research concerning the interaction effect of gender and group (nightmare sufferer vs non-sufferer) on childhood maltreatment. Owing to the insufficient research and inconsistent findings, the present study aimed to investigate gender differences in childhood maltreatment among nightmare sufferers as compared to non-sufferers. A total of 120 participants were selected from New Delhi. The results of two-way ANOVA suggest that the nightmares later in life would be associated with the abuse and neglect experienced during childhood as nightmare sufferer group reported having higher rates of child abuse and neglect than non-sufferers. It also suggests that male participants in general experience childhood maltreatment more than females; however, emotional abuse was experienced by males only if they belonged to the nightmare sufferer group.

Wealth Inequalities in Different Types of Violence Among Brazilian Adolescents: National Survey of School Health 2015

Studies have assessed inequalities in violence by economic status, but few studies have been done with adolescents from middle-income countries. Our objective was to analyze inequalities in verbal bullying, family physical violence, sexual violence, and fights with weapons among Brazilian adolescents in school according to wealth and stratified by sex and skin color. We used data from the Brazilian National Survey of School Health (Pesquisa Nacional de Saúde do Escolar [PeNSE]), carried out in 2015, with a representative sample of Brazilian adolescents attending ninth grade in public and private schools. We created a wealth index based on questions about access to goods and services through principal component analysis; this index was later divided into quintiles. We calculated the slope index of inequality (SII), the concentration index (CIX), and simple measures of inequality, such as ratio and difference. To identify statistically significant differences in sex and skin color inequality, we used the t test. We found high prevalence values of verbal bullying and family physical violence, 23.9% and 14.5%, respectively. In general, when comparing the types of violence according to SII and CIX, we observed a higher prevalence of violence among adolescents in the lower income quintiles, for both sexes and skin colors. We observed higher wealth inequality in sexual violence among girls (CIX = -14.89) when compared with boys (CIX = -4.63) (p = .001). We also observed higher wealth inequality in sexual violence among Whites (CIX = -15.55) when compared with Brown (CIX = -6.23) (p = .009). Wealth inequality aggravates the occurrence of violence among poorer Brazilian adolescents. Also, the identification of vulnerable groups may contribute to target public policies for fighting violence.

Adverse childhood experiences and substance misuse in young people in India: results from the multisite cVEDA cohort

BACKGROUND

Adverse childhood experiences (ACEs) increases vulnerability to externalising disorders such as substance misuse. The study aims to determine the prevalence of ACEs and its association with substance misuse.

METHODS

Data from the Consortium on Vulnerability to Externalising Disorders and Addictions (cVEDA) in India was used (n = 9010). ACEs were evaluated using the World Health Organisation (WHO) Adverse Childhood Experiences International Questionnaire whilst substance misuse was assessed using the WHO Alcohol, Smoking and Substance Involvement Screening Test. A random-effects, two-stage individual patient data meta-analysis explained the associations between ACEs and substance misuse with adjustments for confounders such as sex and family structure.

RESULTS

1 in 2 participants reported child maltreatment ACEs and family level ACEs. Except for sexual abuse, males report more of every individual childhood adversity and are more likely to report misusing substances compared with females (87.3% vs. 12.7%). In adolescents, family level ACEs (adj OR 4.2, 95% CI 1.5-11.7) and collective level ACEs (adj OR 6.6, 95% CI 1.4-31.1) show associations with substance misuse whilst in young adults, child level ACEs such as maltreatment show similar strong associations (adj OR 2.0, 95% CI 1.1-3.5).

CONCLUSION

ACEs such as abuse and domestic violence are strongly associated with substance misuse, most commonly tobacco, in adolescent and young adult males in India. The results suggest enhancing current ACE resilience programmes and 'trauma-informed' approaches to tackling longer-term impact of ACEs in India.

FUNDING

Newton Bhabha Grant jointly funded by the Medical Research Council, UK (MR/N000390/1) and the Indian Council of Medical Research (ICMR/MRC-UK/3/M/2015-NCD-I).

Intergenerational maltreatment in parent-child dyads from Burundi, Africa: Associations among parental depression and connectedness, posttraumatic stress symptoms, and aggression in children

Studies investigating the associations between histories of childhood maltreatment (CM) in parent-child dyads have primarily involved samples from high-income countries; however, CM rates are higher in low- and middle-income countries. The present study aimed to examine the (a) association between maltreatment in parents and maltreatment of their children through risk (i.e., parent depression) and protective (i.e., parent-child connectedness) factors and (b) associations between CM in children with aggression through posttraumatic stress symptoms (PTSS) and peer/sibling victimization. Participants were 227 parent-child dyads from Burundi, Africa, a low-income country. Parents were 18 years of age or older, and children were 12-18 years (M = 14.76, SD = 1.88, 57.7% female). Among parents, 20.7%-69.5% of participants reported a history of physical and emotional abuse and neglect; among children, the rates of sexual, physical, and emotional abuse ranged from 14.5% to 89.4%. A history of CM in parents was associated with CM in children, B = 0.19, p < .01, and CM in parents was indirectly associated with CM in children through parent-child connectedness, β = .04, 95% CI [.01, .10], and parental depression, β = .08, 95% CI [.03, .15]. In children, maltreatment was positively associated with peer/sibling victimization, and CM was associated with aggression, β = .07, 95% CI [.04, 0.11], through PTSS but not via peer/sibling victimization. Continued efforts to improve CM-related preventive strategies and the accessibility of prevention services are needed to reduce CM in low-income countries such as Burundi.

Children's exposure to psychological abuse and neglect: A population-based study in rural Bangladesh

AIM

We aimed to estimate the prevalence and risk factors of child psychological abuse and neglect in a rural area of Bangladesh.

METHODS

Data were obtained from interviewing 1416 children aged 11-17 years administering the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Children between March and April 2017. Linear regression analysis was used to estimate the risks of child psychological abuse and neglect.

RESULTS

The prevalence rates of at least one form of psychological abuse both in the past year and lifetime were more than 97 per cent. Moreover, the rates of at least one form of neglect were about 58 per cent during the past year and 78 per cent over lifetime. Living separately from parents posed children to significant risks of neglect and psychological abuse. Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse. Children with more years of schooling experienced less neglect and psychological abuse.

CONCLUSION

The high prevalence of child psychological abuse and neglect in this study shows child maltreatment as an ignored issue in Bangladesh.

The global challenge of the neglect of children

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Concordance between parents in offspring maltreatment as perceived by emerging adult college students

BACKGROUND

Many studies have examined the link between childhood maltreatment and outcomes, but few have focused on children who experience maltreatment from both their mothers and fathers and how they might differ from children who experience maltreatment from one parent only. Even fewer studies have used dyadic concordance types (e.g., pairs of parents engaging in a behavior or not) to examine how offspring maltreatment impacts offspring psychological problems.

OBJECTIVE

The current study examined the effects of adult offspring physical and psychological maltreatment as perpetrated by mothers only, fathers only, both parents, and neither parent over the past year on emerging adult college student psychological problems while examining parent and adult offspring gender effects.

PARTICIPANTS AND SETTING

Participants included 2374 emerging adult college students at a Southern university.

METHODS

Participants reported on their parents' past year use of physical assault and psychological aggression against them as well as their own psychological problems.

RESULTS

Results suggest that the highest frequency of reported maltreatment occurred from both parents and not one parent only. Males reported higher maltreatment than females except when examining psychological aggression from mothers only, where females reported double the rate as males. Generally, emerging adult college students who reported physical assault or psychological aggression by both parents also reported the highest depressive, anxiety, and antisocial problems.

CONCLUSIONS

Overall, results generally indicated that maltreatment experienced from both parents was associated with more severe psychological outcomes than if experienced from only one parent.

Child Maltreatment in Western China: Demographic Differences and Associations with Mental Health

Background: Child maltreatment has become a serious public health and social problem worldwide. However, knowledge regarding the status of child maltreatment in western China is limited. Objective: The objective of this study was to investigate the status of child maltreatment in western China and its relationship with mental health. Participants and setting: The present study evaluated child maltreatment in a sample of 1511 children (M_age = 11.48 years) from western China. Methods: The participants completed questionnaires designed to collect demographic information and assess their experiences with maltreatment and symptoms of depression and anxiety. Results: In total, 12.3%, 14.0%, 1.3% and 28.1% of the children experienced physical abuse, emotional abuse, sexual abuse and neglect, respectively, while 186 children (12.3%) experienced multiple types of maltreatment. Boys were more likely to experience maltreatment than girls in most cases. Physical abuse, emotional abuse, sexual abuse and neglect had unique effects on depression symptoms. Physical abuse, emotional abuse and neglect, but not sexual abuse, had unique effects on anxiety symptoms. Conclusions: The children who experienced maltreatment had higher levels of depressive and anxiety symptoms. Population-based prevention and educational programs should highlight the serious negative effects of maltreatment, especially emotional abuse and neglect, which have long been ignored in China.

Patterns of childhood maltreatment and intimate partner violence, emotion dysregulation, and mental health symptoms among lesbian, gay, and bisexual emerging adults: A three-step latent class approach

BACKGROUND

Childhood abuse and neglect (CAN) and intimate partner violence victimization (IPV) is prevalent among lesbian, gay, and bisexual individuals (LGB). Identification of distinct patterns of childhood and adult victimization, including technology-mediated and face-to-face IPV, and their cumulative relations to mental/behavioral health challenges, among LGB people is needed to facilitate identification of at-risk individuals.

OBJECTIVE

Using latent class analysis, we first sought to identify patterns of lifetime interpersonal victimization, primarily five types of CAN and IPV in LGB emerging adults. Second, we examined if LGB-status and race/ethnicity predicted class-membership; third, we assessed differences between the latent classes on emotion dysregulation, depressive and anxiety symptoms, and alcohol use.

PARTICIPANTS

Participants were 288 LGB adults between 18-29 years (M = 25.35, SD = 2.76; 41.7% gay/lesbian) recruited via Amazon MTurk.

METHODS AND RESULTS

The 3-step LCA identified five-latent classes: high victimization, childhood emotional abuse and neglect, cybervictimization, adult face-to-face IPV, and lower victimization. People of color (including Hispanics) were more likely to be in the high victimization class, and bisexual individuals, especially bisexual women, in the childhood emotional abuse and neglect class. High victimization and childhood emotional abuse and neglect classes had elevated emotion dysregulation levels and depression and anxiety symptoms, and the high victimization class reported the highest levels of alcohol use.

CONCLUSION

Findings suggest a detrimental effect of cumulative interpersonal victimization on emotion dysregulation and the mental/behavioral health of LGB emerging adults, with bisexuals and LGB-people of color at heightened risk of cumulative victimization and of related mental/behavioral health challenges.

Child sexual abuse in India: A systematic review

Objective

Child Sexual Abuse (CSA) is a pressing human right issue and public health concern. We conducted a systematic review of quantitative and qualitative studies published in the past decade on CSA in India to examine the distribution of the prevalence estimates for both genders, to improve understanding of the determinants and consequences of CSA and identify gaps in the current state of research.

Methods

For this systematic review, we searched electronic literature databases (PubMed, POPLINE, and PsycINFO) for articles published in English on Child Sexual Abuse in India between January 1, 2006 and January 1, 2016 using 55 search terms. Data were extracted from published articles only.

Findings

Fifty-one studies met inclusion criteria for the review. The review indicates that prevalence rates of CSA is high among both boys and girls in India. Due to heterogeneity of study designs and lack of standardised assessments, reported prevalence estimates varied greatly among both genders in different studies. There is a need to conduct representative studies using a validated instrument to obtain valid epidemiological estimates. Commercial sex workers, men who have sex with men, and women with psychiatric disorders were at higher risks for sexual abuse during childhood. In addition, the synthesis of qualitative data across studies included in the review suggests that exposure and perpetration of CSA is a multifaceted phenomenon grounded in the interplay between individual, family, community, and societal factors. The review indicates poor physical, behavioural, social, and mental health outcomes of CSA in India. We conclude with a research agenda calling for quantitative and qualitative studies to explore the determinants and perpetration of child sexual abuse in India from an ecological lens. This research agenda may be necessary to inform the development of a culturally tailored primary prevention and treatment strategy for CSA victims in India.

Ethical and definitional considerations in research on child sexual violence in India

BACKGROUND

While critically important, child sexual violence (CSV) research poses numerous ethical and safety challenges. Recently, the studies dedicated to understanding and addressing CSV in India have been on the rise, but no published ethical guidelines to direct such research currently exist. To help inform ethical and safety recommendations for the design, conduct, and reporting of future CSV research in India and similar settings, we systematically reviewed the ethics and safety practices reported in recent Indian CSV literature.

METHODS

A multi-tiered approach was used to understand current ethical practices and gaps: 1) systematic review of Indian CSV studies published over the past decade, 2) examination of existing guidelines on related topics to develop an ethical framework, 3) development of an ethics checklist based on the recommendations from the surveyed guidelines, and 4) application of the checklist to each of the reviewed studies.

RESULT

Our search yielded 51 eligible studies. From each, data from 6 major thematic areas was extracted: informed consent, confidentiality, selection, training, and protection of study team members, validity of CSV measurement methods, measures to minimize participant harm, and participant compensation. Several gaps were noted: only two-thirds reported approval by ethics committees, obtaining informed consent, and assured participants of confidentiality. Only 25% (13/51) reported assessing ongoing CSV risk and providing necessary support services, none noted whether ongoing CSV was reported to authorities (required by Indian law), and none reported safeguards to protect staff from the effects of conducting CSV research. Further, 43% (22/51) limited surveillance of CSV to one form of abuse and/or used a "loaded term," increasing the potential for underreporting.

CONCLUSIONS

Through enhancing understanding of current ethical practices and gaps in CSV research in India, this systematic review informs reporting protocols and future guidelines for CSV research in India and other similar settings.

Profiles and behavioral consequences of child abuse among adolescent girls and boys from Barbados and Grenada

The current study used latent class analysis to uncover groups of youths with specific abuse (physical, emotional, and sexual) profiles in and outside the family, and identify how membership in each abuse group is associated with behavioral outcomes. Data were collected among a sample of male (n = 662; M_age = 13.02 years) and female (n = 689; M_age = 12.95 years) children and adolescents (9-17 years old) from Barbados and Grenada. Self-report surveys were completed by participants in school settings. Three latent classes of child abuse were distinguished among boys, including 'low abuse' (39.2% of the sample), 'physical and emotional abuse high outside/medium in the family' (43.2%), and 'high overall abuse' (17.6%). Among girls, four unique classes were recovered: 'low abuse' (40.7%), 'high physical and emotional abuse outside the family' (7.6%), 'high emotional and moderate physical abuse' (33.9%), and 'high overall abuse' (17.8%). Compared with members of low abuse groups, youths who reported having experienced high/moderate levels of various forms of violence, including those who were abused in multiple ways and across the two settings ('high overall abuse'), were significantly more likely to engage in violent and hostile behavior. Abused and non-abused youths did not differ on non-violent conflict resolution skills. The significance of present findings for future research and practice is discussed.

Assessing the factor structure of the Childhood Trauma Questionnaire, and cumulative effect of abuse and neglect on mental health among adolescents in conflict-affected Burundi

The present study aimed to examine the factor structure of the Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998), highlight rates of abuse and neglect among Burundian adolescents, compare these rates with those found in high-income nations, and examine the cumulative effect of multiple types of abuse and neglect on depression and PTSD symptoms. Participants were 231 adolescents and youth (M=14.9, SD=1.99, 58.4% female) from five provinces of Burundi, a country in Central Africa affected by war and political violence. Translation and back-translation of the CTQ was carried out to obtain an adaptation of CTQ in Kirundi, the native language of Burundi. With the exception of one item on 'molestation' in the factor of sexual abuse, the five-factor structure of CTQ was obtained comprising latent factors, namely emotional, physical, and sexual abuse, and emotional and physical neglect. The rate of abuse and neglect ranged from 14.7-93.5% with more than 37% reporting 4 or more types of abuse and neglect experiences. Emotional abuse and neglect, and physical neglect were 2-3 times higher among Burundian adolescents when compared with studies from high-income countries using the CTQ. A cumulative effect of multiple types of abuse and neglect was found, such that, those with 4 or more types of maltreatment were higher on symptoms of depression and posttraumatic stress. Findings highlight the need for culturally sensitive, standardized, and validated measures and norms for gauging childhood maltreatment in Burundi and related need for preventative interventions on childhood maltreatment.

Relationship between infant malnutrition and childhood maltreatment in a Barbados lifespan cohort

Childhood malnutrition and maltreatment (abuse, neglect) are both prevalent, particularly in resource-limited settings. Despite their known negative impact on child development, there is surprisingly little research documenting their interrelationships. To address this gap, we administered the Childhood Trauma Questionnaire-Short Form (CTQ-SF), a retrospective structured self-report of childhood abuse and neglect, in a Barbadian cohort of 77 adult survivors of infant malnutrition, limited to the first year of life, and 62 healthy controls from the same classrooms and neighborhoods (mean age ± SD = 43.8±2.3 years). This cohort has been followed since birth. Using factor analysis and comparison with archival data addressing similar constructs, we found evidence for reliability and validity of the CTQ-SF in this population. Linear regression analyses, with and without adjusting for childhood household standard of living at three childhood ages, revealed that a history of infant malnutrition was significantly associated with increased levels of self-reported physical neglect in childhood, and, to a somewhat lesser degree, emotional neglect. This study highlights the co-occurrence of infant malnutrition and self-reported maltreatment in childhood in Barbados, with potential public health implications.

Child Abuse and Neglect Among Children Who Drop Out of School: A Study in Izmir, Turkey

Child abuse and neglect (CAN), and dropping out of school have long been recognized as pervasive social problems globally, and Turkey is no exception. This study aims to explore the prevalence and incidence of CAN in children who drop out of school of Turkey, using the ISPCAN Child abuse Screening Tool, Children's Version, which is an appropriate tool for multinational comparisons. Data from a convenience sample of children who drop out of school age 11, 13, and 16 from Izmir were collected either by interviews or by self-completion. The results show that, compared to children who do not drop out of school, children who drop out of school have higher rates of psychological and physical abuse and neglect within the family. This study not only highlights the need for preventive laws for CAN and dropping out of school, but also points to direction for future research.

Childhood trauma and general cognitive ability: Roles of minimization/denial and gender

The aim of this study was to investigate the effects of minimization and gender on the interaction between childhood trauma and general cognitive ability. The study included 345 students. The data were obtained via an information form, the Childhood Trauma Questionnaire (CTQ), and Raven's standard progressive matrices (RSPM). The mean CTQ total score and the mean sexual abuse, physical, and emotional neglect subscale scores of the male students were significantly higher than those of the female students (p<0.05). The mean minimization score of the female students was greater than that of the male students (p<0.05). However, among the female students with minimization scores of 3, there was a moderate and significant negative correlation between the CTQ and RSPM scores (r=-0.533, p<0.05). This study found that general cognitive ability was influenced by childhood trauma among female students with higher minimization/neglect scores. The results of the current study suggest that ignoring the effects of minimization may be a misleading factor for determining the gender ratio of childhood trauma and evaluating its effect on long-term cognitive functions.

Unique versus cumulative effects of physical and sexual assault on patterns of adolescent substance use

The present study assessed the unique versus cumulative effects of physical and sexual assault, on patterns of substance-use in adolescents. It was hypothesized that experiencing a single assault (physical or sexual) when compared with exposure to both physical and sexual assault would be more strongly related to membership of polysubstance use classes. From the National Survey of Adolescents-1995 (N= 4023) 918 adolescents (age range=12-17 years, M=14.92, 49.6% female) with reports of physical assault and/or sexual assault were selected. Using information on alcohol-use, cigarette-smoking, chewing tobacco, non-prescribed use of medicines, and drug-use, latent class analysis indicated a three class solution for substance-use, namely, Experimental use, Light polysubstance-use, and Polysubstance-use. Multinomial logistic regression analyses indicated that as compared to adolescents exposed to a single type of assault those exposed to both physical and sexual assault were two-to-three times more likely to be in the heavier polysubstance-use class. Females were more likely to be members of the polysubstance-use class than of the experimental use class. Gender did not emerge as a significant moderator. It was concluded that assessing for single type or co-occurring assault can facilitate identification of adolescents at elevated risk for polysubstance-use.

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

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

The association between immigrant generational status, child maltreatment history and intimate partner violence (IPV): evidence from a nationally representative survey

PURPOSE

The extent to which immigrant-specific factors influence the intergenerational transmission of family violence is unknown. The objectives of this paper are to examine the associations between immigrant generational status (IGS), child maltreatment (CM), intimate partner violence (IPV) and acculturation (i.e., the extent to which an individual adopts the values, language and attitudes of a new culture).

METHODS

The sample was drawn from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,653), a nationally representative survey of United States (US) residents aged 20 years and older. Logistic regression was used to estimate the associations between IGS, CM history, IPV, and acculturation.

RESULTS

Compared to 3rd generation (or later) respondents, 1st generation immigrants were less likely to report a history of sexual (AOR = 0.74, CI0.95 = 0.62, 0.90) and emotional abuse (AOR = 0.69, CI0.95 = 0.55, 0.87), but were more likely to report physical neglect (AOR = 1.30, CI0.95 = 1.11, 1.52). After adjusting for covariates, IGS was not associated with IPV among respondents with or without a CM history. Among those without a CM history, highly acculturated 1st generation immigrants (AOR = 1.07, CI0.95 = 1.01, 1.13) were more likely to report perpetrating IPV, with highly acculturated 3rd generation respondents having lower odds of reporting IPV perpetration (AOR = 0.93, CI0.95 = 0.88-1.00).

CONCLUSION

IGS and acculturation are important factors in CM and IPV. Longitudinal studies are needed to clarify the influence of IGS, recency of immigration, acculturation and acculturative stress on the experiences and relationship between CM and IPV.