Evaluation of sex differences in health-related quality of life outcomes associated with child abuse: Results from the Ontario Child Health Study

Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study

The health impacts of intimate partner violence against women and childhood sexual abuse are not fully understood. Here we conducted a systematic review by comprehensively searching seven electronic databases for literature on intimate partner violence-associated and childhood sexual abuse-associated health effects. Following the burden of proof methodology, we evaluated the evidence strength linking intimate partner violence and/or childhood sexual abuse to health outcomes supported by at least three studies. Results indicated a moderate association of intimate partner violence with major depressive disorder and with maternal abortion and miscarriage (63% and 35% increased risk, respectively). HIV/AIDS, anxiety disorders and self-harm exhibited weak associations with intimate partner violence. Fifteen outcomes were evaluated for their relationship to childhood sexual abuse, which was shown to be moderately associated with alcohol use disorders and with self-harm (45% and 35% increased risk, respectively). Associations between childhood sexual abuse and 11 additional health outcomes, such as asthma and type 2 diabetes mellitus, were found to be weak. Although our understanding remains limited by data scarcity, these health impacts are larger in magnitude and more extensive than previously reported. Renewed efforts on violence prevention and evidence-based approaches that promote healing and ensure access to care are necessary.

Toward Strengthening the Capacity of the Health System: A Cross-Sectional Study of Factors Predicting Quality of Life in 545 Nigerian Children Exposed to Sexual Abuse

In Nigeria, the predictors of quality of life among children exposed to sexual abuse are unknown. Addressing this gap may strengthen the capacity of the health system to care for this population. Thus, this cross-sectional study selected 545 (mean age = 14.4 ± 1.4 years) Nigerian children exposed to sexual abuse. Results show that self-compassion, resilience, and meaning in life jointly predicted quality of life and explained 39% variance. The independent prediction of each predictor variable shows that self-compassion, resilience, and meaning in life have significant independent predictions, with self-compassion showing the greatest independent prediction, followed by resilience and meaning in life. Sex, age, and how long ago respondents were exposed to sexual abuse jointly predicted quality of life and explained 6% variance. However, how long ago respondents were exposed to sexual abuse shows a significant independent prediction. Results offer clinical implications that may strengthen the capacity of the health system to care for this population.

Mental Illness Following Physical Assault Among Children

Importance

Physical assault during childhood is common and can lead to lasting mental health problems. Yet, there are few studies on the patterns of mental illness (ie, timing of onset, type, and acuity) in survivors of physical assault.

Objective

To determine the risk of incident health record diagnoses of mental illness among children who experienced assault compared with children who did not.

Design, Setting, and Participants

This population-based matched cohort study used linked health administrative data sets in Ontario, Canada. Children aged 0 to 13 years who experienced an incident physical assault between 2006 and 2014 were age-matched (1:4) to children who had not experienced assault and followed up for a minimum of 5 years. Data were analyzed from January 2020 to March 2022.

Exposure

Physical assault resulting in hospitalization or an emergency department (ED) visit between the ages of 0 and 13 years.

Main Outcomes and Measures

The primary outcome was incident health record diagnosis of mental illness measured as any physician or hospital mental health care use or completed suicide. Secondary outcome measures included the acuity of incident mental illness and mental illness diagnostic category. Cox proportional hazards regression analysis generated hazard ratios (HR) for incident mental illness.

Results

A total of 21 948 children unexposed to assault and 5487 exposed to assault were included in the study with a mean (SD) age of 7.0 (4.6) years. There were more boys in the group that experienced assault (3006 individuals [54.8%]) compared with the group who did not (9909 individuals [45.1%]). Compared with children unexposed to assault, those exposed were more likely to be in the highest deprivation index quintile (standardized difference, 0.21) and live in rural areas (standardized difference, 0.48). Their mothers more often had active mental illness (standardized difference, 0.35). More than one-third of the exposed children had a health record diagnosis of mental illness (2219 children [38.6%]; incidence rate (IR), 53.3 per 1000 person-years) compared with 23.4% (5130 children; IR, 32.2 per 1000 person-years) of unexposed children, with an overall adjusted hazard ratio (aHR) of 1.96 (95% CI, 1.85-2.08). The greatest risk was observed in the first year following the assault (aHR, 3.08; 95% CI, 2.68-3.54). In both groups, nonpsychotic disorders were the most common type of mental illness. Initial mental illness diagnoses occurred in an acute care setting for 14.0% of exposed children (769 children) vs 2.8% of unexposed children (609 children).

Conclusions and Relevance

In this population-based matched cohort study, children who experienced assault had, on average, a 2 times higher risk of receiving a mental illness diagnosis and were more likely than children who had not experienced assault to present to acute care for mental illness. Early intervention to support mental health of assaulted children is warranted, particularly in the first year following assault.

Child abuse and wellbeing: Examining the roles of self-compassion and fear of self

INTRODUCTION

Childhood abuse is linked to poorer well-being, yet some survivors show no prolonged effect, suggesting multifinality. Men and women also differ in the experience and sequelae of abuse supporting gender-specific analyses. To assist in circumventing poor outcomes associated with child abuse, this study examined fear of self (FoS) and self-compassion (SC) as risk and protective factors between child abuse and well-being.

METHOD

Australian women (N = 1302, M_age = 47.28 [13.63]) completed an online assessment of childhood abuse, psychological distress, perceived quality of life, SC, FoS. Moderated-moderation examined the different abuses as predictors of psychological distress and quality of life (QoL) and FoS and SC as primary and secondary moderators, respectively.

RESULTS

Physical abuse did not predict psychological distress or QoL. FoS and SC were independent predictors of distress and QoL. Similarly, childhood sexual abuse was not found to predict distress or QoL. FoS and SC were independent predictors of distress and QoL. There was also an interaction between childhood sexual abuse and SC in predicting QoL. A moderated-moderation was found for the relationship between child sexual abuse and distress. Psychological abuse predicted distress and QoL, and FoS and SC both moderated this relationship. Moreover, a moderated-moderation was observed for the relationship between psychological abuse and QoL.

CONCLUSIONS

Greater FoS is associated with poorer outcomes for child abuse survivors; SC may mitigate this impact. Psychological abuse was the strongest predictor of well-being. Interventions that increase SC and raise awareness of psychological abuse and its impacts are needed.

Differential prevalence of Adverse Childhood Experiences (ACEs) by gender and substance used in individuals with cannabis, cocaine, opioid, and tobacco use disorders

Background: Adverse childhood experiences (ACEs) show a graded association with the development of substance use disorders (SUDs) and engagement in risky substance use behaviors. Women are overrepresented among individuals with more severe childhood adversity (≥4 types of ACEs) and may be at particular risk for aberrant substance use.Objectives: To assess the prevalence of ACEs among men and women with cannabis, opioid, cocaine, and tobacco use disorders.Methods: Non-treatment-seeking individuals participating in clinical addiction research at a single site completed the ACE questionnaire and provided a detailed substance use history. Data were analyzed using proportional odds models and logistic regression.Results: Most participants (424/565; 75%) reported at least one ACE, and more than one-quarter (156/565; 27%) reported severe childhood adversity. Relative to men (n = 283), women (n = 282) reported more ACEs (OR = 1.49; p = .01) and more experiences of emotional/physical abuse (OR = 1.52; p = .02), sexual abuse (OR = 4.08; p = .04), and neglect (OR = 2.30; p < .01). Participants in the cocaine (OR = 1.87; n = .01) and opioid (OR = 2.21; p = .01) use disorder, but not cannabis use disorder (OR = 1.46; p = .08), studies reported more severe adversity relative to the tobacco group. Relative to tobacco users, emotional/physical abuse (OR = 1.92; p = .02) and neglect (OR = 2.46; p = .01) scores were higher in cocaine users and household dysfunction scores were higher in opioid users (OR = 2.67; p = .01).Conclusion: The prevalence of ACEs differs with respect to both participant gender and primary substance used. Novel SUD treatment strategies that incorporate ACEs may be uniquely beneficial in specific subpopulations of people with SUDs.

Knowledge, attitude, and practice regarding child maltreatment amongst Iranian medical students through internship course: an 18-month longitudinal study

BACKGROUND

Child maltreatment has been a major worldwide problem and has remained a persistent public health challenge in all countries. Physicians have a significant role in the prevention and intervention of child maltreatment. An educated physician that can effectively identify and report child maltreatment can fill one of the most significant gaps in reducing child abuse. This study was performed to examine the knowledge, attitude, and practice regarding child maltreatment among Iranian medical students through an internship course.

METHOD

All the medical students (235 students) of the Iran University of Medical Sciences who passed the internship entrance exam in the 2019-2020 academic year participated in this study. The participants completed a 49-item scale questionnaire built by combining three other validated questionnaires that evaluate their attitude, knowledge, and practice skills in the first month of their internship course and then completed the same questionnaire 18 months later, at the end-point of the internship period.

RESULTS

One-hundred thirty nine (59.1%) participants were female, and 96 (40.9%) were male. The mean age of the subjects was 24.35 ± 0.76. Only 7 (3%) of them formerly received any education about child maltreatment. There was a significant improvement in scores of the knowledge of prevention (p-value = 0.001), the practice of prevention (p-value < 0.001) and the general subscale of the practice section (p-value < 0.001) during the internship course. However, the performance of participants decreased significantly in the subscales of the attitude towards diagnosis (p-value = 0.001) and the attitude towards reporting (p-value < 0.001) of child maltreatment. At the end of the study, the result of graduated physicians was: The total knowledge and attitude of participants were satisfactory, and the majority were at reasonable levels. Although in the practice subscale, 70.6% of the participants didn't identify, 84.7% didn't refer, and 86.4% didn't report a child abuse case in the past year.

CONCLUSION

The knowledge and attitude of Iranian physicians regarding child maltreatment are at a satisfactory level. Although, the practice level has deficiencies. In addition, our findings show that Iranian interns have a shallow experience regarding child maltreatment, particularly despite the higher scores in attitude and knowledge, which can be the reason for deficiencies in the practice level.

Child Neglect and Life Satisfaction among Left-behind Children in Rural China: The Roles of Self-compassion and Gratitude

Child neglect is a social problem that causes great concern and affects the long-term well-being of left-behind rural Chinese children against the backdrop of their parents having to leave them in the care of others for extended periods while they have to go and work in cities. However, previous studies have disproportionally focused on the negative processes through which child neglect may influence their life satisfaction. Guided by positive psychology, this study examined the role of self-compassion and gratitude on the association between child neglect and life satisfaction. Our research questionnaire Likert survey used a sample of 1,091 left-behind children and 754 non left-behind children from Shanxi Province and Hunan Province. The results indicated that left-behind children reported a higher level of child neglect, and that child neglect was negatively associated with left-behind children's life satisfaction through decreased self-compassion and gratitude. The implications of these findings are that policy measures and interventions that focus on increasing the self-compassion and gratitude of neglected left-behind children may have a positive effect on their life satisfaction.

A Systematic Review of the Relationship between Child Sexual Abuse and Substance Use Issues

Child sexual abuse (CSA) and substance use issues later in life have been well documented in the literature. This systematic review from 2009 to 2019 provides an update on what is known about the relationship between CSA and substance use. While the review confirms a clear relationship between CSA and substance use, it also highlights some potential gaps in our current practices, including an acknowledgment of the other risk factors associated with CSA and substance use issues, as well as the need to develop treatment that specifically screens for and addresses CSA in the context of substance use.

Relationship between School Integration, Psychosocial Adjustment and Cyber-Aggression among Adolescents

The aim of this study was to analyze the relationships between sociometric types in the classroom—rejected, preferred, neglected, controversial and average—and psychological discomfort, life satisfaction and cyber-aggression, based on the adolescent’s gender. 2398 adolescents of both sexes participated in the study (49.8% girls), aged between 12 and 18 years (M = 16.03, SD = 1.91). Multivariate analyses of variance were performed. The results showed significant relationships between sociometric types, life satisfaction and cyber-aggression. Rejected adolescents also showed less satisfaction with life and greater cyber-aggression. Furthermore, the boys, regardless of their sociometric type in the classroom, displayed less psychological distress and less involvement in cyber-aggression. Controversial adolescents also showed greater involvement in cyber-aggression. Finally, programs should be promoted for the prevention of social difficulties in the school, based on the promotion of social integration, not only in the classroom, but also on the Internet.

Lifetime traumatic events, health-related quality of life, and satisfaction with life in older adults

PURPOSES

The aims were to assess the association between lifetime traumatic events and post-traumatic stress syndrome (PTSS) and health-related quality of life (HRQOL) and satisfaction with life stratified by gender among a community-dwelling sample of older adults.

METHODS

Data used came from the ESA-Services study (2011-2013) and included a large convenience sample of 1811 older adults. Traumatic events were measured using a list of 14 events. PTSS was measured using the Impact of Event Scale-Revised. HRQOL and life satisfaction were measured with the EQ-5D-3L and the Satisfaction With Life Scale. Multivariate regression analyses were used to assess the association between traumatic events, PTSS, and quality of life.

RESULTS

Respondents had a mean age of 73.90 years (SD: 6.13, range 65-97). Our results showed that exposure to violence (OR 4.88, CI 2.72-8.77), an accident (OR 2.33, CI 1.29-4.22), and sexual abuse (OR 2.26 CI 1.17-4.37) was associated with PTSS only in women. No traumatic event was associated only in men. The interaction between gender and exposure to violence and life-threatening disease of a close one was significant. Experiencing violence (β = -0.04, p < 0.01), a natural disaster (β = -0.04, p = 0.02), a life-threatening disease (β = -0.04, p < 0.01), and sexual abuse (β = -0.04, p < 0.01) were associated with a lower HRQOL only in women. No traumatic event was associated in men. Interactions between event and gender were significant for natural disaster, life-threatening disease of a close one, sexual abuse, and other type of traumatic events. A life-threatening disease (β = -0.90, p < 0.01) was associated with a reduced life satisfaction only in men and the exposure of violence (β = -1.18, p < 0.01) was associated with lower life satisfaction in women.

CONCLUSION

Our study could help healthcare professionals to identify and monitor traumatic events that are at higher risk to be associated with PTSS and a lower quality of life for older men and women.

[Children and adolescents after child abuse and neglect: Do they receive appropriate treatment?]

BACKGROUND

Child abuse and neglect (CAN) is a risk factor for the development of psychiatric disorders. Untreated, disorders can sustain into adulthood.

OBJECTIVES

This study compares rates of psychiatric disorders to mental health care utilization in victims of CAN.

METHODS

From three regions in Germany, 322 children and adolescents aged between 4 and 17 and a non-abusive caregiver were assessed for the child's history of CAN, mental health and mental health care utilization via semi-structured interviews.

RESULTS

Approximately two thirds of the participants (present state 64.29 %; lifetime 69.57 %) suffered from a psychiatric disorder classifiable with ICD-10. Posttraumatic stress disorder (25.16 %), conduct disorders (21.34 %) and attention and hyperactivity disorders (16.15 %) were most frequently diagnosed. Merely 19.88 % were using mental health care at the time of the assessment.

CONCLUSIONS

The provision of mental health care for victims of CAN is insufficient. To improve access to appropriate services for this vulnerable clientele, cooperation between psychiatrists and psychotherapists and the child welfare system is essential. The implementation and dissemination of evidence-based diagnostic methods and treatments must be further advanced.

Child Abuse in Iran: a systematic review and meta-analysis

OBJECTIVE

The aim of the present study was to estimate the pooled prevalence of different types of child abuse in Iran.

METHOD

We systematically searched four English databases (PubMed, Sciencedirect, PsychINFO and Scopus), and three Farsi databases (Magiran, IranMedex and SID) to find out relevant articles that have reported the prevalence of child abuse in Iran. Studies conducted on special samples, special setting or on adult population for history of child abuse were excluded from our study. The total number of obtained articles from English databases was 83. After removing the duplicated articles, 77 manuscripts remained. Next, we screened the articles based on their title and abstract and only 13 articles remained. After screening based on the full text only 5 studies were left. Since Farsi databases did not give us the option to get all the search results together, we read the search results based on their titles and selected the relevant articles. Twenty-four studies were selected based on their title. After screening based on the full text, 8 studies remained. The total number of the studies from both English and Farsi databases that we entered in our review was 13.

RESULT

The prevalence of physical abuse, emotional abuse and neglect in both genders differed from 9.7% to 67.5 %, 17.9% to 91.1% and 23.6% to 80.18%, respectively. The pooled estimate of the prevalence of child physical abuse in both genders was 43.591% (CI -216.146, 303.328%), and the pooled estimate of the prevalence of child emotional abuse was 64.533% (CI -195.205, 324.270). In regards to child neglect, the pooled estimate of the prevalence was 40.945% (CI -274.989, 356.879). The heterogeneity of the studies was not statically significant (I(2) = 0.0%).

CONCLUSION

Child abuse has several negative effects on the health of children and adults. It seems that child abuse in Iran is in a critical condition, so the policy makers should act upon solving this problem and design special programs and develop effective policies to prevent child abuse in Iran.