Child maltreatment in the "children of the nineties" a longitudinal study of parental risk factors

Maternal, prenatal and postnatal risk factors for early child physical abuse: a French nationwide cohort study

Background

Identifying risk factors for early child physical abuse (CPA) is crucial for understanding its mechanisms and defining effective preventive interventions. We aimed to identify maternal, prenatal and postnatal factors associated with early CPA.

Methods

This cohort study was based on comprehensive data from the Mother-Child EPI-MERES nationwide register and included all infants born alive in France between 2010 and 2019. Factors associated with early CPA (before age 1) were identified with a multilevel Cox regression model with random intercepts at the regional level.

Findings

Among the 6,897,384 included infants, 2994 (40/100,000) had a diagnosis of early CPA, at a median age of 4 months. Independent factors most strongly associated with early CPA were maternal low financial resources (adjusted hazard ratio [aHR] 1.91; 95% confidence interval [95% CI] 1.67-2.18), maternal age <20 years versus 35-40 years (aHR 7.06; 95% CI 6.00-8.31), maternal alcohol use disorder (aHR 1.85; 95% CI 1.48-2.31), opioid use disorder (aHR 1.90; 95% CI 1.41-2.56), intimate partner violence (aHR 3.33; 95% CI 2.76-4.01), diagnosis of a chronic mental disorder (aHR 1.50; 95% CI 1.14-1.97) or somatic disorder (aHR 1.55; 95% CI 1.32-1.83), hospitalisation for a mental disorder (aHR 1.88; 95% CI 1.49-2.36), very preterm birth (aHR 2.15; 95% CI 1.68-2.75), and diagnosis of a chronic severe neurocognitive disorder in the infant (aHR 14.37; 95% CI 11.85-17.44).

Interpretation

Independent risk factors of early CPA identified at the national level in France may help in understanding CPA mechanisms and developing effective prevention programs including risk-stratification tools to optimise the allocation of parenting interventions to parents who could most benefit from them.

Funding

Ile-de-France regional council, L'Oréal-UNESCO For Women In Science France Young Talent Award, French National Observatory for Child Protection [ONPE], French Association of Ambulatory Paediatrics [AFPA], HUGO university hospitals network, Mustela Foundation and Sauver la Vie prizes.

Paternal Filicide in Sweden: Background, Risk Factors and the Cinderella Effect

An overrepresentation of stepchildren as victims of filicide has been explained as a consequence of 'discriminative parental solicitude'. The idea being that Darwinian selection has favoured parental love and concern only for biological children, and when such parental feelings are absent, as in stepparents, conflicts with a child could easier escalate to lethal violence. An alternative explanation for this overrepresentation of stepchildren is that risk factors for filicide, such as criminal behaviour and mental health problems, are more prevalent in stepparents. This study focused on paternal filicide in Sweden and investigated (i) if stepchildren are overrepresented as victims of filicide compared with biological children, (ii) if filicides are committed in a context that implies a 'conflict with the child victim' and (iii) if stepfathers and biological fathers differ in characteristics associated with filicide risk. The analyses showed that stepchildren were overrepresented as victims compared with children of fathers in families with two biological parents and this overrepresentation was even higher in young children. Children of single biological fathers and children of non-residential biological fathers were also overrepresented as victims of filicide. Less than 20 percent of the filicides were committed in the context of a 'conflict with the child' and in these cases only stepchildren were overrepresented as victims. In the population at large, both stepfathers and single biological fathers had higher rates of mental health problems, violent criminality and illegal possession of drugs compared with fathers in families with two biological parents.

Adverse Childhood Experiences and Adult Mental Health Outcomes

Importance

Exposure to adverse childhood experiences (ACEs) has consistently been associated with multiple negative mental health outcomes extending into adulthood. However, given that ACEs and psychiatric disorders cluster within families, it remains to be comprehensively assessed to what extent familial confounding contributes to associations between ACEs and clinically confirmed adult psychiatric disorders.

Objective

To investigate whether associations between ACEs and adult mental health outcomes remain after adjusting for familial (genetic and environmental) confounding.

Design, Setting, and Participants

This Swedish twin cohort study used a discordant twin pair design based on monozygotic (MZ) and dizygotic (DZ) twins. A total of 25 252 adult twins (aged 18-47 years) from the Swedish Twin Registry born between 1959 and 1998 were followed up from age 19 years until 2016, with a maximum follow-up time of 39 years. Data were analyzed from April 2022 to November 2023.

Exposures

A total of 7 ACEs, including family violence, emotional abuse or neglect, physical neglect, physical abuse, sexual abuse, rape, and hate crime, were assessed with items from the Life Stressor Checklist-Revised in a web-based survey.

Main Outcomes and Measures

Adult (ages >18 years) clinical diagnosis of psychiatric disorders (ie, depressive, anxiety, alcohol or drug misuse, or stress-related disorders) were obtained from the Swedish National Patient Register.

Results

Of 25 252 twins included in the study (15 038 female [59.6%]; mean [SD] age at ACE assessment, 29.9 [8.7] years), 9751 individuals (38.6%) reported exposure to at least 1 ACE. A greater number of ACEs was associated with increased odds of any psychiatric disorder in the full cohort (odds ratio [OR] per additional ACE, 1.52; 95% CI, 1.48-1.57). The association remained but ORs per additional ACE were attenuated in DZ (1.29; 95% CI, 1.14-1.47) and MZ (1.20; 95% CI, 1.02-1.40) twin pairs. Individuals who were exposed to sexual abuse compared with those who were not exposed had increased odds of any clinically confirmed psychiatric disorder in all comparisons: full cohort (OR, 3.09; 95% CI, 2.68-3.56), DZ twin pairs (OR, 2.10; 95% CI, 1.33-3.32), and MZ twin pairs (1.80; 95% CI, 1.04-3.11).

Conclusions and relevance

This study found that associations between ACEs and adult mental health outcomes remained after controlling for shared genetic and environmental factors, which was particularly evident after multiple ACEs or sexual abuse. These findings suggest that targeted interventions may be associated with reduced risks of future psychopathology.

Fathers' mental Ill-health and child maltreatment: A systematic review of the literature

Background

Parental mental ill-health is often described as a risk factor for child maltreatment. Yet the literature commonly foregrounds maternal mental ill-health. To obtain a more complete picture, it is crucial to also understand the associations between fathers' mental health and child maltreatment.

Aim

To provide a narrative synthesis of evidence about the relationship between fathers' mental health and child maltreatment.

Method

Four electronic databases were searched, identifying 5479 citations. 151 studies were brought to full-text review. 37 were included in the study.

Results

Studies revealed mixed evidence for associations between forms of paternal mental ill health and child maltreatment, with stronger evidence for paternal depression and weak or no evidence for PTSD and anxiety. Many confounding factors were identified across the papers.

Discussion

The small number and limited range of good quality studies indicate the need to correct the relative invisibility of fathers within research about mental health and child maltreatment. At present, the available evidence is not sufficient to draw firm conclusions about the association between fathers' mental health and child maltreatment or appropriate policy and practice responses.

Use of technology in evidence-based programs for child maltreatment and its impact on parent and child outcomes

Introduction

Technology has been used in evidence-based child maltreatment (CM) programs for over a decade. Although advancements have been made, the extent of the application of technology in these programs, and its influence on parental and child outcomes, remains unclear within the context of changes that emerged because of the COVID-19 pandemic. This scoping review provides a contextualized overview and summary of the use of technology in evidence-based parenting and child programs serving families impacted by child maltreatment and the effects of technology-enhanced programs on target outcomes.

Materials and methods

Using Arksey and O'Malley's methodological framework, we searched seven databases to identify peer-reviewed and grey literature published in English from 2000 to 2023 on evidence-based programs, according to the California Evidence-Based Clearinghouse (CEBC), that included technological supports for two populations: at-risk parents for child maltreatment prevention, and children and youth 0-18 years exposed to child maltreatment. All study designs were included.

Results

Eight evidence-based parenting programs and one evidence-based child trauma program were identified as using technology across a total of 25 peer-reviewed articles and 2 peer-reviewed abstracts meeting inclusion criteria (n = 19 on parent-level programs; n = 8 on child-level programs). Four studies were published in the context of COVID-19. Two main uses of technology emerged: (1) remote programmatic delivery (i.e., delivering all or part of the program virtually using technology) and (2) programmatic enhancement (i.e., augmenting program content with technology). Improvements across parenting and child mental health and behavioral outcomes were generally observed.

Discussion

Technology use in evidence-based child maltreatment programs is not new; however, the small sample since the start of the COVID-19 pandemic in this review that met inclusion criteria highlight the dearth of research published on the topic. Findings also suggest the need for the inclusion of implementation outcomes related to adoption and engagement, which could inform equitable dissemination and implementation of these programs. Additional considerations for research and practice are discussed.

The effect of working tax credits on child maltreatment rates: A systematic review

BACKGROUND

Socioeconomic status and poverty are strongly associated with Child Maltreatment. Multiple studies have described the effects of working tax credits on Child Maltreatment with heterogeneous results. There is yet to be a comprehensive review of this research.

OBJECTIVES

This study aims to review all research which explores the effect of working tax credits on child maltreatment.

METHODS

Three databases (Ovid Medline, Scopus and Web of Science) were searched. Title and abstracts were screened according to a set of eligibility criteria. Data were extracted from eligible studies, and risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool. Results were synthesised narratively.

RESULTS

Nine studies were included. Of these, five papers investigated overall reports of child maltreatment, with three finding a positive effect of tax credits. Results suggested a protective effect against child neglect, however, no significant effect was found with respect to physical or emotional abuse. Three of four papers found that working tax credits resulted in decreased rates of entry to foster care. Mixed results were found with respect to self-reported child protective services contact. A range of methodological and temporal differences between studies was identified.

CONCLUSIONS

Overall, some evidence found that in work tax credits are protective against child maltreatment and that they are most effective in reducing neglect. Policymakers can take courage in these results, as they represent an example whereby the "risk factors" of child maltreatment can be countered in order to reduce rates of it.

Synergistic effects of childhood adversity and polygenic risk in first-episode psychosis: the EU-GEI study

BACKGROUND

A history of childhood adversity is associated with psychotic disorder, with an increase in risk according to the number of exposures. However, it is not known why only some exposed individuals go on to develop psychosis. One possibility is pre-existing polygenic vulnerability. Here, we investigated, in the largest sample of first-episode psychosis (FEP) cases to date, whether childhood adversity and high polygenic risk scores for schizophrenia (SZ-PRS) combine synergistically to increase the risk of psychosis, over and above the effect of each alone.

METHODS

We assigned a schizophrenia-polygenic risk score (SZ-PRS), calculated from the Psychiatric Genomics Consortium (PGC2), to all participants in a sample of 384 FEP patients and 690 controls from the case-control component of the EU-GEI study. Only participants of European ancestry were included in the study. A history of childhood adversity was collected using the Childhood Trauma Questionnaire (CTQ). Synergistic effects were estimated using the interaction contrast ratio (ICR) [odds ratio (OR)exposure and PRS - ORexposure - ORPRS + 1] with adjustment for potential confounders.

RESULTS

There was some evidence that the combined effect of childhood adversities and polygenic risk was greater than the sum of each alone, as indicated by an ICR greater than zero [i.e. ICR 1.28, 95% confidence interval (CI) -1.29 to 3.85]. Examining subtypes of childhood adversities, the strongest synergetic effect was observed for physical abuse (ICR 6.25, 95% CI -6.25 to 20.88).

CONCLUSIONS

Our findings suggest possible synergistic effects of genetic liability and childhood adversity experiences in the onset of FEP, but larger samples are needed to increase precision of estimates.

Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies

OBJECTIVE

Childhood maltreatment is associated with mental health problems, but the extent to which this relationship is causal remains unclear. To strengthen causal inference, the authors conducted a systematic review and meta-analysis of quasi-experimental studies examining the relationship between childhood maltreatment and mental health problems.

METHODS

A search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed, English-language articles from database inception until January 1, 2022. Studies were included if they examined the association between childhood maltreatment and mental health problems using a quasi-experimental method (e.g., twin/sibling differences design, children of twins design, adoption design, fixed-effects design, random-intercept cross-lagged panel model, natural experiment, propensity score matching, or inverse probability weighting).

RESULTS

Thirty-four quasi-experimental studies were identified, comprising 54,646 independent participants. Before quasi-experimental adjustment for confounding, childhood maltreatment was moderately associated with mental health problems (Cohen's d=0.56, 95% CI=0.41, 0.71). After quasi-experimental adjustment, a small association between childhood maltreatment and mental health problems remained (Cohen's d=0.31, 95% CI=0.24, 0.37). This adjusted association between childhood maltreatment and mental health was consistent across different quasi-experimental methods, and generalized across different psychiatric disorders.

CONCLUSIONS

These findings are consistent with a small, causal contribution of childhood maltreatment to mental health problems. Furthermore, the findings suggest that part of the overall risk of mental health problems in individuals exposed to maltreatment is due to wider genetic and environmental risk factors. Therefore, preventing childhood maltreatment and addressing wider psychiatric risk factors in individuals exposed to maltreatment could help to prevent psychopathology.

A genetically informed Registered Report on adverse childhood experiences and mental health

Children who experience adversities have an elevated risk of mental health problems. However, the extent to which adverse childhood experiences (ACEs) cause mental health problems remains unclear, as previous associations may partly reflect genetic confounding. In this Registered Report, we used DNA from 11,407 children from the United Kingdom and the United States to investigate gene-environment correlations and genetic confounding of the associations between ACEs and mental health. Regarding gene-environment correlations, children with higher polygenic scores for mental health problems had a small increase in odds of ACEs. Regarding genetic confounding, elevated risk of mental health problems in children exposed to ACEs was at least partially due to pre-existing genetic risk. However, some ACEs (such as childhood maltreatment and parental mental illness) remained associated with mental health problems independent of genetic confounding. These findings suggest that interventions addressing heritable psychiatric vulnerabilities in children exposed to ACEs may help reduce their risk of mental health problems.

Childhood Abuse and Neglect, Exposure to Domestic Violence and Sibling Violence: Profiles and Associations With Sociodemographic Variables and Mental Health Indicators

Research indicates substantial overlap between child abuse and neglect (CAN), exposure to domestic violence and sibling abuse, with multiple victimisation experiences conferring greater risk for adverse mental health outcomes than does exposure to a single subtype. The application of latent class analysis (LCA) to child maltreatment has gained momentum, but it remains the case that few studies have incorporated a comprehensive range of subtypes, meaning that real-life patterns in victimisation experiences cannot be accurately modelled. Based on self-report data from an ethnically diverse sample (N = 2813) of 10-17 year olds in the United Kingdom, the current study used LCA to model constellations among nine types of maltreatment in the home (physical, emotional and sexual abuse; physical and emotional neglect; exposure to physical and verbal domestic violence, or a drug-related threat; and sibling violence). A four-class solution comprising of a low victimisation class (59.3% of participants), an emotional abuse and neglect class (19.0%), a high verbal domestic violence class (10.5%) and a maltreatment and domestic violence class (11.2%) provided the best fit for the data. Associations with sociodemographic variables were examined, revealing differences in the composition of the classes. Compared to the low victimisation class, participants in the verbal domestic violence class, emotional abuse and neglect class and especially the maltreatment and domestic violence class, reported higher symptoms of anxiety and depression and an increased likelihood of non-suicidal self-injury, suicide ideation and suicide attempt. The findings carry important implications for understanding patterns of child maltreatment, and the implications for preventative strategies and support services are discussed.

[Fathers in Early Parenting Programs. Impulses from the European and International Fatherhood Research]

Prevention and intervention programs (early parenting programs) which are provided by regional multi-professional networks for families with infants are still addressed to mothers, primarily. The question is whether the European and international fatherhood research can supply valuable suggestions for a better involvement of fathers. We discuss determinants of lived fatherhoods that range from educated fathers of national middle class over fathers with migrant backgrounds up to educationally and economically disadvantaged fathers. We elucidate barriers which stand in the way of father involvement in the current parenting programs, and exemplary describe how the resistance could be successfully overcome.

Intergenerational Transmission of Violence Among Substance-Abusing Chinese Parents: Roles of Detachment and Social Support

Despite a large population of registered people with drug addiction, child protection in substance-abusing families is a neglected issue in China. The present study aims to investigate the association between parents' childhood abuse history and the risk of abusing their own children in substance-abusing Chinese families and also to examine the mediating role of detachment and moderating role of social support during the intergenerational transmission of abuse. A total of 173 men and 116 women were selected using cluster sampling from two compulsory drug rehabilitation centers in Jiangsu Province. Results indicated that one's childhood abuse history was positively associated with the current perpetration of child abuse for both fathers and mothers. Detachment mediated the linkage between a history of childhood maltreatment and perpetration of child abuse in all types of abuse for both men and women except for women's sexual abuse. Social support from family members buffered the intergenerational transmission of child abuse for fathers but not for mothers. Child maltreatment in substance-abusing families is an urgent issue that needs measures to prevent the intergenerational transmission of violence in China. Intervention programs could involve helping parents cope with their childhood abuse history through rebuilding secure attachment and facilitating social support for their parenting practices, especially for fathers.

A Multispecialty Approach to the Identification and Diagnosis of Nonaccidental Trauma in Children

Child abuse is a preventable phenomenon of considerable concern resulting in significant child mortality and morbidity. We analyze various abuse lesions such as radiological (visceral and skeletal lesions and those associated with head trauma) and cutaneous (burns, bruises, bites, etc.) to enhance streamlined identification of injuries in cases of physical child abuse. For effective results, it is essential to remain mindful of all background factors, such as the caregiver setting and the prevalence of child maltreatment in the concerned community while acknowledging the possibility of natural causes (genetic diseases such as osteogenesis imperfecta and hemophilia, or acquired abnormalities) that can mimic NAT and cause confusion in diagnosis and treatment. The margin of error in cases of abuse is negligible, therefore, making its diagnosis a momentous as well as challenging clinical task. An ineffective diagnosis can have detrimental emotional consequences for the family and may even expose the child to future potentially fatal episodes of abuse. Hence, there is a need to direct special focus on the importance of accurate history taking and immediate, responsible reporting to authorities, as well as to child protective services. Therefore, considering the multifactorial approach this subject requires, this review aims to delve into prevalence statistics, various risk factors, and their effect on psychological health to offer a near-complete regulation to ensure an effective understanding of NAT on part of doctors, social workers, and other relevant authorities.

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.

Families in the COVID-19 pandemic: parental stress, parent mental health and the occurrence of adverse childhood experiences-results of a representative survey in Germany

Parenting during the COVID-19 pandemic is highly challenging, with parents having to meet various demands simultaneously. An increase in adverse childhood experiences (ACEs) has been widely predicted, but empirical evidence is still scarce. This study aimed to (1) generate representative data on pandemic-related stress, parental stress, general stress, parental subjective and mental health, and the occurrence of ACEs; (2) identify risk factors for an increase in ACEs, and (3) provide qualitative data on parents' experiences. A representative survey was conducted in Germany in August 2020 with 1024 parents of underage children (M_age = 41.70, 50.9% female). More than 50% of parents reported being stressed by social distancing and the closure of schools and childcare facilities. Parental stress increased significantly during the pandemic (d = 0.21). Subgroups of parents also reported very high levels of depressive symptoms (12.3%) and anxiety (9.7%). Up to one-third of the sample reported ACEs in the child's lifetime. In this group, 29.1% reported an increase in children witnessing domestic violence during the pandemic, and 42.2% an increase verbal emotional abuse. These families were characterized by higher parental stress, job losses, and younger parent and child age. Positive aspects of the pandemic related primarily to personal or family life (e.g. slower pace of life, increase in family time). While some parents coped well, a particularly negative pattern was observed in a subgroup of families that experienced an increase in ACEs. Parental stress emerged as important target point for interventions addressing the negative sequelae of the pandemic.

The economic costs of child maltreatment in UK

Child maltreatment is a major public health problem with significant consequences for individual victims and for society. In this paper, we quantify for the first time the economic costs of fatal and nonfatal child maltreatment in the UK in relation to several short-, medium-, and long-term outcomes ranging from physical and mental health problems to labor market outcomes and welfare use. We combine novel regression analysis of rich data from the National Child Development Study and the English Longitudinal Study of Aging with secondary evidence to produce an incidence-based estimate of the lifetime costs of child maltreatment from a societal perspective. The discounted average lifetime incidence cost of nonfatal child maltreatment by a primary caregiver is estimated at £89,390 (95% uncertainty interval £44,896 to £145,508); the largest contributors to this are costs from social care, short-term health, and long-term labor market outcomes. The discounted lifetime cost per death from child maltreatment is estimated at £940,758, comprising health care and lost productivity costs. Our estimates provide the first comprehensive benchmark to quantify the costs of child maltreatment in the UK and the benefits of interventions aimed at reducing or preventing it.

Parental Mental Health Problems and the Risk of Child Maltreatment: The Potential Role of Psychotherapy

Parental mental health is a risk factor for numerous issues affecting a child’s physical and psychological development, especially the perpetration of child maltreatment. This paper aims to contribute a theoretical review of the risks faced by some children living in families with parental mental health problems and argues that psychotherapy has an essential role in resolving emotional and interpersonal difficulties, based on the example of Emotion Focused Therapy (EFT). This model has revealed benefits in interventions with several types of patients and is consequently a promising model for preventing the risk of aggressive behaviors. The programs addressing both parents and children have been proven to contribute to more informed and effective interventions.

The Toxic Triad: Childhood Exposure to Parental Domestic Violence, Parental Addictions, and Parental Mental Illness as Factors Associated With Childhood Physical Abuse

Childhood physical abuse can result in serious behavioral, mental health, and physical health conditions. There is a need for improved strategies to identify households in which childhood physical abuse occurs. This article explores three potential correlates of childhood physical abuse: childhood exposure to parental domestic violence, parental addictions, and parental mental illness. Secondary analyses were conducted using the regionally representative 2010 Brief Risk Factor Surveillance Survey (BRFSS) of adults (n = 9,241 men, n = 13,627 women) and the analyses were replicated in the 2012 BRFSS (n = 11,656 men, n = 18,145 women). Bivariate and logistic regression analyses were conducted. Approximately one-quarter of the sample was Hispanic and/or Non-White. In 2010, 78.3% of men who had been exposed to all three of these early adversities reported that they had experienced childhood physical abuse compared with 7.5% of males who did not experience these adversities. Women reported similar levels of childhood physical abuse (66.9% for those reporting all three factors, 5.9% for those with zero risk factors). The 2012 BRFSS analyses resulted in comparable findings. Domestic violence, even in the absence of parental addictions and mental illness, was associated with a high prevalence of childhood physical abuse (between 34% and 38%). Currently, the World Health Organization cautions against routine screening for child abuse due to the high rate of false positives. We propose a two-step strategy to improve targeting: first, identifying households in which two or more adversities exist, and subsequently screening children in these households. Our findings will help improve the targeting of screening and outreach efforts to children most at risk, thereby minimizing the risk of false positives. Our data provide support for universal screening for childhood physical abuse in cases of domestic violence, particularly for those families where parental addictions and/or parental mental illness also exist.

Child maltreatment in the time of the COVID-19 pandemic: A proposed global framework on research, policy and practice

BACKGROUND

Child protection is and will be drastically impacted by the COVID-19 pandemic. Comprehending this new reality and identifying research, practice and policy paths are urgent needs.

OBJECTIVE

The current paper aims to suggest a framework for risk and protective factors that need to be considered in child protection in its various domains of research, policy, and practice during and after the COVID-19 pandemic.

STRATEGY

From an international collaboration involving researchers and child protection professionals from eight countries, the current paper examines various factors that were identified as playing an important role in the child protection system.

THE INITIAL SUGGESTED FRAMEWORK

Through the use of an ecological framework, the current paper points to risk and protective factors that need further exploration. Key conclusions point to the urgent need to address the protection of children in this time of a worldwide pandemic. Discussion of risk and protective factors is significantly influenced by the societal context of various countries, which emphasizes the importance of international collaboration in protecting children, especially in the time of a worldwide pandemic.

CONCLUSION

The COVID-19 pandemic has stressed the urgent need to advance both theory and practice in order to ensure children's rights to safety and security during any pandemic. The suggested framework has the potential to advance these efforts so that children will be better protected from maltreatment amidst a pandemic in the future.

Developmental pathways from maternal history of childhood maltreatment and maternal depression to toddler attachment and early childhood behavioral outcomes

The current study examined the development of toddler attachment and early childhood behavior among children of mothers with a history of childhood maltreatment and current major depressive disorder. Maternal depression, maternal sensitivity, and toddler attachment were assessed as mediators of the association between maternal history of childhood maltreatment and child internalizing and externalizing behavior. Participants were from a low-income, largely racial minority urban sample and included 123 mothers with (n = 69) and without (n = 54) major depressive disorder at baseline and their children assessed at 12, 26, and 36 months old. Findings suggest maternal depression and maternal sensitivity mediated the association between maternal history of childhood maltreatment and disorganized attachment. Maternal depression, but not disorganized attachment, mediated the association between maternal history of childhood maltreatment and child symptomatology. Results suggest that supporting mothers through depression and processing their adverse childhood experiences are critical in fostering positive child development.

Parenting in poor health: Examining associations between parental health, prescription drug use, and child maltreatment

RATIONALE

Child maltreatment and problematic parenting are related to negative outcomes for children. Poor parental health could be a risk factor for problematic parenting through several mechanisms: 1) inadequate emotional regulation and coping; 2) impairment of parental capacity; and, 3) impairment of the parent-child relationship.

OBJECTIVE

This study examines relationships between self-rated parental health, prescription drug use, and a broad array of negative parenting outcomes.

METHODS

A sample of general population parents of children aged ten and younger was recruited from 30 mid-sized cities in California (n = 681). Weighted mixed-effects negative binomial and logistic regression models were used to examine associations between poor parental health, prescription drug use and child maltreatment (physical abuse, supervisory neglect, and physical neglect), and problematic parenting (psychological aggression and corporal punishment).

RESULTS

Parents in poor health used physical abuse, corporal punishment, and psychological aggression more frequently and had higher odds of supervisory neglect. Parents who were taking more prescription medications had higher odds of physical neglect. Exploratory analyses suggested that prescriptions for certain medical conditions both increased and decreased the risk of problematic parenting.

CONCLUSIONS

Poor health and prescription drug use are not uncommon and present largely under-recognized risk factors for a spectrum of adverse parenting outcomes. Our study provides additional evidence that parents in poor health are at heightened risk of negative parenting, and need targeted intervention supports to support family well-being.

[Paternal Risk and Protective Factors for Endangerment of Child Well-Being and their Consideration in the Risk Inventories Used Throughout Germany]

Paternal Risk and Protective Factors for Endangerment of Child Well-Being and their Consideration in the Risk Inventories Used Throughout Germany In view of the current family and role models, paternal risk and protective factors can have a significant impact on the risk of violence within a family and should therefore - in addition to the factors on the part of the mother, the child and the closer or other family systems - be taken into consideration when estimating the endangerment of child well-being. In this article we explore which empirical findings on paternal risk and protective factors for abuse, neglect and sexual abuse (sexual violence) in childhood and adolescence were published in international research literature from 1980 to 2019. Seventeen risk factors and four protective factors could be identified, which in 33 quantitative original studies showed a risk-increasing or a buffering influence on violence experiences in families on the part of the father. In addition, the risk inventories used in practice in Germany were analyzed with regard to the paternal risk and protective factors, in order to be able to illustrate the application of the empirically identified factors in early intervention, youth welfare and health care. The article used results from a benchmark survey on risk inventories from 2009. These results were compared with current findings from 2018 as part of a research update. In 2009, 67 % of the instruments "often" contained items on the father, while this was found for 12 % of the instruments in 2018. At the same time, in 2018, 53 % of the risk inventories were "often" asked about custodians, parents or main caregivers. The article thus reflects developments in research and practice in risk assessment for child well-being, in which especially the fathers, who unlike the mothers are often not explicitly addressed during screenings and interventions for families with psychosocial problems, are taken into consideration. The knowledge about the influence of the fathers can feed into the preventive interventions in early interventions and complement them meaningfully.

Physical, Emotional, and Sexual Victimization Across Three Generations: a Cross-Sectional Study

Using data gathered from grandparents (G1), parents (G2), and young adults (G3), this study examines the continuity of intergenerational victimization (physical, emotional, and sexual) across three generations. The study included data from 168 participants within three generations: grandparents, G1 (19.2% male, 80.8% female, M = 78.13 years old); parents, G2 (25.5% male, 74.5% female, M = 50.13 years old); and young adults, G3 (40% male, 60% female, M = 21.10 years old). The data is analyzed at two levels: (1) bivariate analyses to address relationships between the variables studied by Spearman's correlations, and (2) a path model to examine the intergenerational abuse simultaneously considering all variables. Overall, path modeling showed that experienced abuse demonstrated continuity from G1 to G2 and from G2 to G3. Specifically, findings indicated that grandparents' physical and psychological victimization has a direct effect on parents' sexual and physical abuse victimization, respectively. Additionally, parents' physical victimization has a direct effect on young adults' psychological and sexual victimization, while parents' psychological victimization has a direct effect on young adults' physical and sexual victimization. These findings highlight the need for preventive interventions focused on breaking intergenerational cycles of abuse.

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

BACKGROUND

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

OBJECTIVES

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

PARTICIPANTS AND SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effects of Early-Life Stress on the Brain and Behaviors: Implications of Early Maternal Separation in Rodents

Early-life stress during the prenatal and postnatal periods affects the formation of neural networks that influence brain function throughout life. Previous studies have indicated that maternal separation (MS), a typical rodent model equivalent to early-life stress and, more specifically, to child abuse and/or neglect in humans, can modulate the hypothalamic-pituitary-adrenal (HPA) axis, affecting subsequent neuronal function and emotional behavior. However, the neural basis of the long-lasting effects of early-life stress on brain function has not been clarified. In the present review, we describe the alterations in the HPA-axis activity-focusing on serum corticosterone (CORT)-and in the end products of the HPA axis as well as on the CORT receptor in rodents. We then introduce the brain regions activated during various patterns of MS, including repeated MS and single exposure to MS at various stages before weaning, via an investigation of c-Fos expression, which is a biological marker of neuronal activity. Furthermore, we discuss the alterations in behavior and gene expression in the brains of adult mice exposed to MS. Finally, we ask whether MS repeats itself and whether intergenerational transmission of child abuse and neglect is possible.

Mapping the literature on parents with mental illness, across psychiatric sub-disciplines: a bibliometric review

BACKGROUND

Research on parental mental illness is often carried out in disorder specific research silos. Drawing on the different research areas, it is possible to leverage and combine existing knowledge, and identify insights that can be transferred across research areas. In this study, we identify the overarching structure of research on parents with psychiatric disorders, and the structure of the different research areas, as defined by psychiatric disorder groups in ICD-10, and identify both topics that are commonly examined, and topics that received attention in only a few of the research areas.

METHODS

We use bibliometric science mapping to examine keywords in 16,734 articles, showing the overarching structure of research on parents with mental illness, both overall and within ICD-10 psychiatric disorder categories. The search was conducted using the Scopus database for journal articles published between 1999 and 2018, with no restrictions on language.

RESULTS

Co-occurrence analysis of the keywords in the 16,734 articles on parental mental illnesses in different psychiatric disorder categories, indicate there are six general themes in the literature: 'expectant mothers and early motherhood', 'substance use and abuse', 'Socio-economic status' (SES) and support practices', 'biomedical research', 'diagnoses, symptoms and treatment', and 'child-parent interaction and context'. Although the same themes are covered in different areas, the contexts, in terms of content and relation to other topics, vary between the research areas. Some topics are heavily researched in some areas, but seem to be neglected in others.

CONCLUSIONS

This study provides data both in interactive maps and an extensive table, allowing readers to dive deep into their topic of interest, and examine how this connects to other topics, which may in turn guide identification of important gaps in the literature, and ultimately inspire and generate novel research avenues.

Social work contact in a UK cohort study: Under-reporting, predictors of contact and the emotional and behavioural problems of children

BACKGROUND

There is little evidence on the degree of underreporting of social work contact in survey studies. There are also few studies about the emotional and behavioural problems of children in families who have contact with social workers, despite the adversities they face.

OBJECTIVE

We examine underreporting of social work contact; the predictors of social work contact with families; and links between social work contact and emotional and behavioural outcomes for children.

PARTICIPANTS AND SETTING

The Avon Longitudinal Study of Parents and Children follows the health and development of 14,062 children born in 1991-2 to women living in and around the City of Bristol. The study includes self-reported information about mothers' contact with social workers and children's emotional and behavioural outcomes using the Strengths and Difficulties Questionnaire (SDQ).

METHODS

Self-reporting of social work contact in ALSPAC is compared with administrative data from the child protection register to examine rates of underreporting. We use a fixed-effects model to account for measurement error in estimating the association between social work contact and potential predictors, namely gender of the child and maternal factors: marital status, trouble with law, hospitalisation, cannabis and alcohol use, employment, financial difficulty and experience of cruelty from a partner. SDQ scores are explored using linear regression with lagged indicators of social work contact.

RESULTS

The probability of a false negative for self-report of social work contact ranged from 22% to 34% across three survey waves. Mothers who married within the last 12 months were less likely to receive social work contact (OR: 0.13, CI95%: 0.01-1.34). Those who had either been hospitalised (OR: 1.52, CI95%: 1.01 - 2.28) or increased their rate of alcohol consumption (OR: 2.14, CI95%: 0.91 - 5.07) within the last 12 months were more likely to receive such contact. Overall children whose mothers report social work contact were much more likely to have emotional and behavioural problems within the first seven years of their lives (p < 0.01).

CONCLUSION

There is potentially a high degree of underreporting of social work contact in social surveys and cohort studies. Researchers should adopt methods to account for this issue in the future. The risk of emotional and behavioural problems is greater among children whose mothers have had contact with social workers compared to other children with seemingly similar adversities.

The association between neurocognition and sexual abuse within a children's psychiatric inpatient program

Objective: The aim of this study was to understand the detrimental effects of sexual abuse on neuropsychological variables including child's intelligence, executive functioning (EF), and learning/memory within a pediatric inpatient population.Method: This study examined the effect of sexual abuse on children's intelligence, EF, and learning/memory by conducting a retrospective chart review for 144 children (aged 7-12) who completed a neuropsychological assessment during a psychiatric inpatient hospitalization. Of the 144 children, participants were matched two to one by gender and age, with one group (n = 52) categorized by reported sexual abuse and the other group (n = 92) categorized by no reported sexual abuse. The neuropsychological measures included the Wechsler Abbreviated Scale of Intelligence (WASI-I/II) or Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Wide Range Assessment of Memory and Learning - Second Edition (WRAML-2): Story Memory Immediate/Delayed Recall and Delayed Recognition, Trail Making Test-B, Stroop Interference Test: Color-Word Condition, WRAML-2: Sentence Memory and Conners Continuous Performance Test-Second Edition.Results: Statistical analysis showed that participants with reported sexual abuse had significantly (p< .05) lower intelligence, EF, and learning/memory skills than those without reported sexual abuse. Only working memory and cognitive flexibility differences remained after controlling for clinical variables (e.g., PTSD, amount of total abuse types).Conclusions: These findings contributed to the limited research on the detrimental effects of sexual abuse in a pediatric inpatient population. They demonstrated a relationship between early sexual abuse and neuropsychological deficits, specifically executive function and IQ deficits.

Fuel to the fire: The escalating interplay of attachment and maltreatment in the transgenerational transmission of psychopathology in families living in refugee camps

Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent–child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.

Viewing the Cycle of Violence Through a Gendered Pathways Lens: Perceived Parental Tolerance of Violence, Peer Influence, and Child Aggressive Behavior

The purpose of the present study was to determine whether a child's perception of adult tolerance of violence interfaced with peer associations and violent offending. It was hypothesized that a child's perception of his or her parents' tolerance for violence would predict the peer influence effect for aggressive behavior in boys but not girls. Control variables included the parent's stated tolerance of violence, the child's personal attitude toward violence, recent parental divorce or separation, and child maltreatment within the past 12 months. Using the first three waves of the National Youth Survey (NYS), the relationships between perceived parental tolerance of violence and the peer influence and selection effects were examined. A negative binomial path analysis of the male subsample (n = 736) revealed that perceived parental tolerance of violence predicted the peer influence effect (peer violence leading to participant violent offending) but not the peer selection effect (participant violent offending leading to peer violence) in boys. In girls (n = 679), neither pathway was significant. The current findings indicate that in boys, perceived parental attitudes toward violence help account for the cycle of violence, perhaps by encouraging the child's association with violent peers. Programs designed to change these perceptions and the parental/community attitudes these perceptions may reflect could be an effective means of intervention for violent youth.

Mothers' Perspectives on Follow-up for Postpartum Depression Screening in Primary Care

OBJECTIVE

To qualitatively assess mothers' perspectives on barriers to and facilitators of follow-up of at-risk postpartum depression (PPD) screening test results.

METHODS

We conducted semistructured qualitative telephone interviews with 17 women who scored in the moderate or high-risk range on the Edinburgh Postpartum Depression Scale. Interviews explored personal experience with depressive symptoms, barriers and facilitators to receiving mental health care postpartum, and suggestions for primary care follow-up of at-risk screens. The team created a coding structure that was updated during review of transcripts. Findings were triangulated and external validity assessed via discussions with a mother who experienced PPD, a perinatal social worker, and a perinatal psychologist.

RESULTS

Personal health/attitude, family/friends, community, and health care system factors influenced mothers' follow-up of at-risk PPD screening test results. Health and personal attitude factors included anxiety, physical and emotional exhaustion, self-care and recognition of symptoms, and living up to personal and family expectations. Family/friend factors included material and emotional support and competing priorities. Community factors included child care affordability and availability, access to transportation, geographic access to resources, social networks, and community mental health stigma. Health care factors included pediatrician taking the mother's symptoms seriously, adequate time with the pediatrician, mother and pediatrician focus on the child's health, and access to mental health referrals.

CONCLUSION

Addressing barriers to follow-up after PPD screening may enable better service access for at-risk families.

Perinatal Determinants of Child Maltreatment in Japan

Background: Child maltreatment induces significant health problems, both during childhood and into adulthood. To prevent child maltreatment, it is important to detect perinatal risk factors for earlier intervention. The aim of this study was to evaluate the perinatal risk factors associated with child maltreatment during pregnancy. Methods: A case-control study was conducted to compare perinatal data from the Maternal and Child Health Handbook between the case and control groups. Cases were collected from children registered in two Child Guidance Centers in Japan. The control group consisted of 3.5-year-old children in a city in Osaka Prefecture whose mothers responded to questionnaires containing information from the Maternal and Child Health Handbook. The association between perinatal factors and child maltreatment was assessed using multiple logistic regression analysis. Results: The data of 70 cases and 345 controls were collected. The following were found to be perinatal factors related to child maltreatment: teenage pregnancy (OR: 257.3, 95% CI: 17.3-3832.7), a mother aged 20-24 years (OR: 22.8, 95% CI: 4.4-117.8), a father who is older than the mother by 10 years or more (OR: 14.1, 95% CI: 2.1-94.8), an unmarried mother (OR: 15.7, 95% CI: 2.6-93.6), maternal mental disorder (OR: 48.9, 95% CI: 9.3-258.3), the first maternal prenatal visit being later than 20 weeks (OR: 132, 95% CI: 12.7-1384.7), little prenatal care (<10 visits) (OR: 21.4, 95% CI: 2.9-157.1), a low-birth-weight baby (OR: 5.1, 95% CI: 1.1-24.1), and congenital disease (OR: 7.9, 95% CI: 1.1-56.4). Conclusions: This study revealed that young mothers, fathers much older than mothers, unmarried mothers, and maternal mental disorder, mothers with late first visit or little perinatal care, and low-birth-weight babies and babies with congenital disease were associated with child maltreatment. These findings can be used to detect high-risk families for child maltreatment during or after pregnancy.

Childhood maltreatment and polygenic risk in bipolar disorders

BACKGROUND

Childhood maltreatment is a well-known risk factor for developing a more severe and complex form of bipolar disorders (BD). However, knowledge is scarce about the interactions between childhood maltreatment and underlying genetic vulnerability on the clinical expression of BD.

METHOD

We assigned a BD-polygenic risk score (BD-PRS), calculated from the Psychiatric Genomics Consortium, to each individual in a sample of 402 cases with BD. The lifetime clinical expression of BD was characterized using structured interviews and patients completed the Childhood Trauma Questionnaire (CTQ) to assess the severity of childhood maltreatment.

RESULTS

Cases who reported more severe childhood maltreatment had a lower BD-PRS (rho = -0.12, P = .01), especially when considering emotional abuse (rho = -0.16, P = .001). An interaction between BD-PRS and childhood maltreatment was observed for the risk of rapid cycling (P = .01). No further interactions between BD-PRS and childhood maltreatment were observed for other clinical characteristics (age at onset, suicide attempts, number of mood episodes, mixed features, substance use disorders and psychotic symptoms).

CONCLUSION

Our study is the first to show that less genetic risk may be needed to develop a more unstable form of BD when exposed to childhood maltreatment. Our study supports childhood trauma as an independent risk factor for BD.

Perinatal mental health and risk of child maltreatment: A systematic review and meta-analysis

BACKGROUND

Mental health problems in parents have been identified as a risk factor for child maltreatment. The perinatal period (from conception to 1 year) is a critical period but it is unclear whether perinatal mental health problems are also associated with increased risk.

OBJECTIVE

To review evidence on perinatal mental health and risk of child maltreatment.

METHODS

Searches were conducted on six databases and 24 studies reported in 30 papers identified. Studies were conducted in seven countries, mainly the USA (n = 14). Sample sizes ranged from 48-14,893 and most examined mothers (n = 17). Studies were conducted in community (n = 17) or high-risk (n = 7) samples.

RESULTS

The majority of studies found a relationship between parental perinatal mental health problems and risk of child maltreatment, but inconsistent findings were observed between and within studies. The few studies that examined fathers (n = 6) all found a relationship between fathers' mental health and risk of child maltreatment. Meta-analysis of 17 studies (n = 22,042) showed perinatal mental health problems increased risk of child maltreatment by OR 3.04 (95% CI 2.29-4.03). This relationship was moderated by type of sample, with larger effects for risk of child maltreatment in high-risk samples. The relationship was not moderated by type of mental illness, child maltreatment; methodological or measurement factors.

CONCLUSION

The association between perinatal mental health and risk of child maltreatment is similar to that observed at other times during childhood. Methodological heterogeneity and inconsistent findings mean conclusions are tentative and need to be considered alongside other individual, family and social/cultural risk factors.

A Controlled Trial in Community Pediatrics to Empower Parents Who Are at Risk for Parenting Stress: The Supportive Parenting Intervention

The goal of the Supportive Parenting Intervention is to prevent and/or decrease parenting stress and provide a sense of empowerment to parents with a newborn child. We evaluated the effectiveness of the Supportive Parenting Intervention in terms of parenting skills, social support, self-sufficiency, resilience, and child psychosocial health. A controlled trial with pre- and post-intervention testing was conducted in the setting of community pediatrics among parents at risk for developing parenting stress. The 177 parents in the control group received care-as-usual, whereas the 124 parents in the intervention group received six home visits by a trained Youth Health Care nurse during the first 18 months of the child’s life. The result with respect to parenting skills, social support (both from family and friends, and the partner), self-sufficiency, and resilience at the 18-month follow-up was either unchanged or (p < 0.05) worse compared to the respective baseline score for both groups. We found no significant difference between intervention and control group with respect to the child’s Child Behavior Check List (CBCL). This study shows no positive effect with respect to the indicators of parental empowerment. We recommend research to strengthen the intervention and its application in daily practice, for example by increasing the intervention duration, and to evaluate it in a large randomized controlled trial.

Childhood Maltreatment, Gender Nonconformity, and Adolescent Sexual Orientation: A Prospective Birth Cohort Study

This study tested whether associations between childhood maltreatment and adolescent sexual orientation were accounted for by childhood gender nonconforming behavior (GNCB) in a prospective birth cohort (N = 5,007). Childhood parental maltreatment (physical and emotional) and GNCB were assessed on multiple occasions up to age 6 years, and sexual orientation at 15.5 years. Boys with a history of maltreatment were significantly more likely to be nonheterosexual. Using propensity score weighting, maltreatment was associated with a 3.5% (p = .03) increase in the prevalence of nonheterosexuality accounting for confounders not including GNCB, and by 2.9% (p = .06) when also accounting for GNCB. These findings suggest that maltreatment is associated with an increased prevalence of nonheterosexuality in boys but may be explained by confounding factors including GNCB.

Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): a systematic review

BACKGROUND

'Adverse childhood experiences' (ACEs) are associated with increased risk of negative outcomes in later life: ACEs have consequently become a policy priority in many countries. Despite ACEs being highly socially patterned, there has been very little discussion in the political discourse regarding the role of childhood socioeconomic position (SEP) in understanding and addressing them. The aim here was to undertake a systematic review of the literature on the relationship between childhood SEP and ACEs.

METHODS

MEDLINE, PsycINFO, ProQuest and Cochrane Library databases were searched. Inclusion criteria were: (1) measurement of SEP in childhood; (2) measurement of multiple ACEs; (3) ACEs were the outcome; and (4) statistical quantification of the relationship between childhood SEP and ACEs. Search terms included ACEs, SEP and synonyms; a second search additionally included 'maltreatment'. Overall study quality/risk of bias was calculated using a modified version of the Hamilton Tool.

RESULTS

In the ACEs-based search, only 6 out of 2825 screened papers were eligible for qualitative synthesis. The second search (including maltreatment) increased numbers to: 4562 papers screened and 35 included for synthesis. Eighteen papers were deemed 'high' quality, five 'medium' and the rest 'low'. Meaningful statistical associations were observed between childhood SEP and ACEs/maltreatment in the vast majority of studies, including all except one of those deemed to be high quality.

CONCLUSION

Lower childhood SEP is associated with a greater risk of ACEs/maltreatment. With UK child poverty levels predicted to increase markedly, any policy approach that ignores the socioeconomic context to ACEs is therefore flawed.

PROSPERO REGISTRATION NUMBER

CRD42017064781.

The intergenerational transmission of childhood maltreatment: Nonspecificity of maltreatment type and associations with borderline personality pathology

One generation's experience of childhood maltreatment is associated with that of the next. However, whether this intergenerational transmission is specific to distinct forms of maltreatment and what factors may contribute to its continuity remains unclear. Borderline personality pathology is predicted by childhood maltreatment and characterized by features (e.g., dysregulated emotion, relationship instability, impulsivity, and inconsistent appraisals of others) that may contribute to its propagation. Among 364 older adults and 573 of their adult children (total n = 937), self-reported exposure to distinct forms of childhood maltreatment (i.e., emotional, physical, and sexual abuse, and emotional and physical neglect as assessed by the Childhood Trauma Questionnaire) showed homotypic and heterotypic associations across generations with little evidence that latent factors unique to specific forms of maltreatment show generational continuity. General nonspecific indices of childhood maltreatment showed evidence of intergenerational transmission after accounting for demographic factors and parent socioeconomic status (b = 0.126, p = 9.21 × 10−4). This continuity was partially mediated by parental borderline personality pathology (assessed longitudinally through a variety of measures and sources, indirect effect: b = 0.031, 95% confidence interval [0.003, 0.060]). The intergenerational continuity of childhood maltreatment may largely represent general risk for nonspecific maltreatment that may, in part, be propagated by borderline personality pathology and/or shared risk factors.

Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the intergenerational transmission of child maltreatment

It has long been claimed that "maltreatment begets maltreatment," that is, a parent's history of maltreatment increases the risk that his or her child will also suffer maltreatment. However, significant methodological concerns have been raised regarding evidence supporting this assertion, with some arguing that the association weakens in samples with higher methodological rigor. In the current study, the intergenerational transmission of maltreatment hypothesis is examined in 142 studies (149 samples; 227,918 dyads) that underwent a methodological quality review, as well as data extraction on a number of potential moderator variables. Results reveal a modest association of intergenerational maltreatment (k = 80; d = 0.45, 95% confidence interval; CI [0.37, 0.54]). Support for the intergenerational transmission of specific maltreatment types was also observed (neglect: k = 13, d = 0.24, 95% CI [0.11, 0.37]; physical abuse: k = 61, d = 0.41, 95% CI [0.33, 0.49]; emotional abuse: k = 18, d = 0.57, 95% CI [0.43, 0.71]; sexual abuse: k = 18, d = 0.39, 95% CI [0.24, 0.55]). Methodological quality only emerged as a significant moderator of the intergenerational transmission of physical abuse, with a weakening of effect sizes as methodological rigor increased. Evidence from this meta-analysis confirms the cycle of maltreatment hypothesis, although effect sizes were modest. Future research should focus on deepening understanding of mechanisms of transmission, as well as identifying protective factors that can effectively break the cycle of maltreatment.

Is Child Abuse Associated with Adolescent Obesity? A Population Cohort Study

BACKGROUND

Child abuse is associated with obesity in adulthood through multiple mechanisms. However, little is known about the relationship between abuse and obesity during adolescence. The aim of this study was to investigate, using a birth cohort, whether there is an association between child abuse and overweight or obesity in adolescence.

METHODS

This study utilizes data from the Avon Longitudinal Study of Parents and Children, a prospective cohort study based in South West England. Using data from the 4205 children with complete data at 13 and 16 years, we analyzed body mass index (BMI) and anonymous parental report of abuse. Abuse was categorized as emotional, physical, or sexual. A sub-sample of 3429 had BMI recorded at 18 years, enabling a longitudinal analysis of BMI trajectories.

RESULTS

Using linear and logistic regression analysis, adjusting for sex and family adversity, no association was found between child abuse and BMI, BMI Z-scores, overweight, or obesity, at 13 or 16 years, with all confidence intervals straddling the null. There was weak evidence of a negative association between physical and emotional abuse and BMI trajectories between 13 and 18 years.

CONCLUSIONS

No relationship was found between child abuse and adolescent obesity in this cohort. This challenges the assumption that adolescent obesity is linked to previous child abuse, as demonstrated for obesity in adult life. A further longitudinal study utilizing both parental and child reports with data record linkage, to improve reporting of abuse, and including neglect as an abuse category, would be desirable.

Parental substance use disorder and child abuse: risk factors for child maltreatment?

Although the literature consistently shows an association between parental substance use disorders (SUDs) and child abuse, it is unknown what factors discern non-abusive and abusive parents with SUDs. This study aims to investigate which specific risk factors are associated with child abuse in clinically treated parents with SUDs in the Netherlands. It examines two groups of parents with SUDs in a clinical setting, with and without known instances of child abuse. These groups were compared on SUD-related factors such as the type and severity of the SUDs, and variables addressing psychological disability such as comorbid diagnoses and quality of life. Other than a marginally significant difference in severity of addiction and a lower mean age of the parents in the child abuse group, no significant differences were found. The small sample size and the inherent difficulty of studying SUDs in a clinical sample is likely to have affected the results.

Differences in Psychopathology between Offspring of Parents with Bipolar I Disorder and Those with Bipolar II Disorder: A Cross-Sectional Study

OBJECTIVE

The aim of this study was to evaluate differences in psychopathology between offspring of parents with bipolar I disorder (BP-I) and those with bipolar II disorder (BP-II).

METHODS

The sample included 201 offspring between 6 and 17 years of age who had at least one parent with BP-I or BP-II. The offspring were diagnostically evaluated using the Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. Psychopathology and Clinical characteristics were evaluated, including lifetime DSM-5 diagnoses, depression, and childhood trauma. Lifetime DSM-5 diagnoses were also compared between schoolchildren aged 6 to 11 years and adolescents aged 12 to 17 years.

RESULTS

In lifetime DSM-5 diagnoses, offspring of parents with BP-I had significantly increased risk of developing MDD and BP-I than those with BP-II. Regarding clinical characteristics, ADHD rating scale and childhood trauma scale were significantly higher in offspring of parents with BP-I than that in those with BP-II.

CONCLUSION

The present study supports that BP-I may be etiologically distinct from BP-II by a possible genetic liability. Our findings indicate that additional research related to bipolar offspring is needed to enhance understanding of differences between BP-I and BP-II.

Disentangling the Cycle: Potential Mediators and Moderators in the Intergenerational Transmission of Parent-Child Aggression

Although a cycle of harsh and abusive parenting has been recognized for decades, this cycle is not inevitable. Indeed, the mechanisms underlying such patterns, and the resources parents may access to disrupt this cycle, require further study. Research investigating those processes has either relied on cross-sectional designs or largely assessed mediators or moderators at one time point. The current investigation of parent-child aggression (PCA) risk utilized a longitudinal design to consider possible mediators and moderators across three time points. Mothers and fathers reported on their personal history of physical and psychological abuse during the last trimester of the mother's pregnancy; their PCA risk was assessed concurrently when their child was 6 months and when their child was 18 months. Current findings support several mediators for mothers, although fewer for fathers, prenatally, but mediation was not observed across time. Similarly, several moderators of the effect of personal history of physical and psychological aggression on PCA risk were identified prenatally but not across time. Thus, several qualities believed to account for, or mitigate, the intergenerational transmission of PCA may not be consistent-underscoring the continued need to identify factors that account for the cyclical process versus what may interrupt intergenerational transmission.

Targeted Estimation of the Relationship Between Childhood Adversity and Fluid Intelligence in a US Population Sample of Adolescents

Many studies have shown inverse associations between childhood adversity and intelligence, although most are based on small clinical samples and fail to account for the effects of multiple co-occurring adversities. Using data from the 2001-2004 National Comorbidity Survey Adolescent Supplement, a cross-sectional US population study of adolescents aged 13-18 years (n = 10,073), we examined the associations between 11 childhood adversities and intelligence, using targeted maximum likelihood estimation. Targeted maximum likelihood estimation incorporates machine learning to identify the relationships between exposures and outcomes without overfitting, including interactions and nonlinearity. The nonverbal score from the Kaufman Brief Intelligence Test was used as a standardized measure of fluid reasoning. Childhood adversities were grouped into deprivation and threat types based on recent conceptual models. Adjusted marginal mean differences compared the mean intelligence score if all adolescents experienced each adversity to the mean in the absence of the adversity. The largest associations were observed for deprivation-type experiences, including poverty and low parental education, which were related to reduced intelligence. Although lower in magnitude, threat events related to intelligence included physical abuse and witnessing domestic violence. Violence prevention and poverty-reduction measures would likely improve childhood cognitive outcomes.