Separation and other stress in child abuse

The prediction of child maltreatment in Greek families

OBJECTIVE

The study had two aims: First, to identify characteristics of physically maltreating families in the Attica region of Greece; and second, to produce a checklist of high risk predictors which may be used for screening, as an assessment, to enable secondary prevention of physical abuse and neglect.

METHOD

A case control design was used with individual matching. The sample comprised 197 physically abused and neglected children and their families referred to a multidisciplinary team. These were compared with 163 control children and their families attending a community health center.

RESULTS

The findings suggest that abusing families differ from controls on a number of variables related to child, parental, and family characteristics. The statistical analysis produced a checklist of 15 Predictors. Their classification into High, Medium, and Low Predictors pointed out that the most prominent characteristics were those associated with parents' own adverse life experiences, mental health problems, bad quality of relationship between spouses, and parental neglect of the child's hygiene. The predictive ability of the checklist produced a sensitivity of 92% and a specificity of 96% (logistic regression) and a sensitivity of 86.8% and a specificity of 96.3% (discriminant function). The use of this checklist for screening is discussed with emphasis on methodological and ethical issues. Special emphasis is given on the cultural relevance of such an application within the Greek cultural milieu.

CONCLUSION

The findings indicate that secondary prevention of child maltreatment in Greece is feasible by using a checklist of risk factors as predictors. Such screening should be accompanied by clinical assessment based on qualitative aspects of mother-infant interaction. Special emphasis should be given to the cultural relevance of this approach while ethical issues should be considered.

Analysis of child abuse cases admitted in pediatric service in Japan. I. Two types of abusive process in low birth-weight infants

A very high rate (43.0%) of low birth-weight (LBW) was shown in 331 abused/neglected cases reported from pediatric clinics of major hospitals in Japan. Of 87 LBW cases, 82.8% had medical problems and/or unsatisfactory reunion after non-home care and were abused at a particular age when each of the problems may have caused difficulties in caring. Two types of processes to abuse these intractable LBW were estimated: (i) abusers with psychiatric, mental problems or poor knowledge abused their children during the first 2 years, presumably because of an inability in child rearing; and (ii) abusers with neurosis or abnormal personality abused at ages over 2 years, complained of difficulties with rearing their children, and were suspected to be unable to cope with the difficulties. In both types, a combination of child and parental problems increased at risk. Obstetricians and neonatologists, who first encounter both high-risk mothers while pregnant and LBW, should give due care to the prevention of child abuse.

Effects of unemployment on mental health in the contemporary family

This article summarizes research conducted in the past 20 years concerning mental health effects of involuntary job loss. The majority of studies and previous reviews focus on unemployment effects on men. Although these studies are also reviewed, this article highlights studies of (a) the involuntarily unemployed woman, (b) the spouse of the unemployed person, and (c) their children. Within each of these research areas, the authors consider studies grouped according to their methodological strength for drawing causal inferences about the impact of job loss on psychological status, ranging from cross-sectional to longitudinal to prospective studies. The implications of the unemployment literature not only for future research but also for clinical practice are addressed. Knowledge of family effects of this stressful life circumstance is critical to developing effective treatment plans for patients who, although perhaps not the direct victims of job loss themselves, may nevertheless present with problems indirectly caused or exacerbated by unemployment within the family.

Risk factors for injury during adolescence

Injuries kill more American adolescents than all other diseases combined. It is unclear, however, if adolescents are able or willing to provide the information necessary to characterize their risk for injury. Our objective was to determine if adolescents hospitalized for severe injury are more likely than those hospitalized for acute illness to describe risk factors for injury such as: previous injury, family dysfunction, recent stress, or substance use. All patients completed the Offer Self-Image Questionnaire, the Life-Events Scale for Adolescents, the Adolescent Alcohol-Involvement Scale, and the NIDA Adolescent Drug Use Survey. There were no differences between injured and ill adolescents in demographics, impulse control, emotional tone, perceived family function, alcohol scores, or use of cigarettes, marijuana, or other illicit drugs. The groups differed significantly in sex, previous serious injury, previous hospitalization for injury, injury after alcohol or drug use, and life-event scores. The most common life stresses reported were parental or sibling hospitalization, death of a grandparent, school failure or suspension, getting a summer job, and breaking up with a girl/boy friend. Two variables comprised a stepwise logistic regression model designed to differentiate injured from ill adolescents: male sex and life-event score. We conclude that adolescent boys with recent stressful events may be at high risk for unintentional injury.

Unemployment and child abuse

The employment state of men living in the homes of children at the time that child abuse was diagnosed was determined. The series included a wide range of abuse, including non-accidental injury, failure to thrive, neglect, and emotional deprivation. Two cohorts of children seen during 1974-9 and 1980-5 were compared; these periods were chosen because a large increase in unemployment began in Sheffield in 1980. Although the proportion of the men without work was significantly increased during the second period, this increase could not be ascribed to the rise in either long term or short term unemployment among those who had previously been in regular employment. It was accounted for by a rise in the proportions of single parent families and families in which the resident man had never had regular employment. This may reflect an increase in pregnancies among young mothers. There was no evidence to support the belief that the loss of a job in otherwise stable families leads to an increase in child abuse.

Maternal and child factors for reported child abuse among Chinese in Hong Kong

We have investigated the factors predisposing to child abuse in Hong Kong Chinese, using a case-control approach. The response rate for the cases was low because access was obtained only via the authorities, and refusals were common before we were able to make personal contact with the families. Neighbourhood controls were used, and provided matching for socio-economic factors. The factors found to be significant for child abuse in Hong Kong Chinese include: psychological impairment of the mothers, assisted delivery, and separation of the child from the mother in the first year of life. All these factors probably have an adverse effect on mother-to-infant bonding, which predisposes to child abuse. Child abuse was precipitated by feeding and school problems in this Chinese series which involved children much older than in the West. The implications for the prevention of child abuse in Hong Kong are discussed.

"We get on each other's nerves": unemployment and the family

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Persisting characteristics of parents of battered children

To study the personality of mothers whose children had suffered from child abuse in the past, a group of 36 such mothers was compared with a control group of mothers matched for social class. There was no difference between the two groups in pregnancy experience, in general health or in the number of family problems they had. The mothers from the study group had higher expectations for their children and perceived their children as having more personality problems than did the control mothers. The study-group mothers were less likely to have been brought up by their own parents, had more negative feelings towards their fathers, and were more likely to have received help for an emotional disorder than the control mothers. On formal testing, they were more likely to have suspicious, assertive, and demanding personality characteristics. As the majority of abused children remain in their natural families, these maternal factors are likely to influence the emotional development of their children. The children, as well as the parents, from families where child abuse has occurred should receive long-term supportive treatment to try to ameliorate some of the effects of these parental characteristics.

Mother-to-infant bonding

The concept of maternal 'bonding', i.e. rapid mother-to-neonate attachment, appears frequently in psychiatric, paediatric and social work discussions of childhood psychopathology and child abuse. 'Bonding' is used as a diagnostic concept, and one which has to bear the weight of important explanatory, descriptive and predictive statements. In turn, it is related aetiologically to post-partum contact and separations of mother and infant. The authors present a critical review of the concept, exploring its empirical basis, and the implications (logical and illogical) that flow from its application in practice. They conclude that the usage of the term 'bonding' is often misleading, because of a tendency to reify and simplify attachment phenomena; in addition, there are no indications from animal investigations and no evidence from human studies which directly support the notion of a 'sensitive period' in the formation of mother-to-infant attachments. They also describe the negative and pessimistic implications of using this concept in social work and clinical practice. Alternative ways of conceptualising these early parent-child events are suggested.

Research strategies and methodologic standards in studies of risk factors for child abuse

A major focus of studies of child abuse has been the identification of children who are at high risk for abuse. Despite this emphasis, little has been written about the research methodology in such studies. This paper reviews the three major research strategies to investigate risk factors: (1) randomized controlled trials, (2) prospective or observational cohort studies, and (3) retrospective or case-control studies. In addition, eight methodological standards are presented that should help to minimize bias in studies of risk factors for child abuse. These standards are: (1) clear description of abuse, (2) choice of a specific control group, (3) equal demographic and clinical susceptibility, (4) clear definition of the risk factor or protective factor, (5) unbiased ascertainment of the risk factor, (6) clear temporal sequence between risk factor and abuser, (7) equal detection of child abuse, and (8) unequal review of abused and nonabused subjects. Most studies of risk factors for child abuse have used either a case-control or, less frequently, an observational cohort design, both of which are nonexperimental research strategies. In such studies, the use of comparable control groups (standards 2 and 3) and equal detection of abuse in exposed and nonexposed children (standard 7) are of major importance in minimizing bias.