Lifetime and past-year prevalence of children's exposure to violence in 9 Balkan countries: the BECAN study

"We don't know how to talk": Adolescent meaning making and experiences of participating in research on violence in Romania, South Africa, and the Philippines

BACKGROUND

Current evidence on adolescent participation in violence research has primarily measured distress, harm or upset using quantitative methods. There are relatively few studies which have employed qualitative methods to understand adolescent emotional experiences, and to articulate the experiences of participation from their own perspective.

OBJECTIVE

This study aimed to assess adolescents' experiences of participating in research on violence in different contexts, namely Romania, South Africa, and the Philippines.

METHODS

A purposive sample of adolescents (N = 53, 51 % female) were recruited from rural, urban, and peri-urban areas in Romania, the Eastern Cape Province of South Africa, and Metro Manila, Philippines. Semi-structured one-on-one in-depth interviews and drawings sought adolescent perspectives on their experiences of participation, including the emotions they felt, and their perceptions of research on violence.

RESULTS

Drawing on analysis of interviews and drawings, adolescents reported a layered emotional experience, ranging from sadness, anger, apprehension, and upset, to joy, relief, and laughter. Their emotional experiences were driven by participation as a relational encounter, both with the researchers involved, as well as with other children and young people they encountered. Adolescents emphasized participation as enabling disclosure of difficult experiences, and the creation of awareness of violence.

CONCLUSIONS

Adolescent perspectives of participation in research on violence are nuanced and encompass their lived experience as well as the fundamentally relational nature of participation. Adolescents experienced increased awareness of topics in violence and perceived research participation as enabling disclosure and possible help-seeking. Measures of participation impact developed along with adolescents, which reflect this complexity, are needed.

Methodological adjustments for experimental studies including neurodiverse participants: A checklist for before, during, and after laboratory visits

In this paper, we developed an experimental checklist for laboratory experiments including neurodiverse participants, particularly those with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and dyslexia. The checklist suggests additions to the basic requirements for ethical laboratory-based studies with human participants. The suggestions emphasize physical comfort, the agency of participants concerning environmental adjustments, clarity of communication, and a focus on participants' overall well-being. Those methodological guidelines aim to help researchers in facilitating inclusive and accessible laboratory environments for neurodiverse participants in order to: •Enhance research validity by minimizing the influence of factors that affect responses in neuroscience experiments.•Facilitate research recruitment by encouraging continued participation in future studies and increasing word-of-mouth.•Improve research dissemination by fostering a more positive perception of the research process amongst neurodiverse individuals and encouraging community involvement.

On the complex relationship between resilience and hair cortisol levels in adolescence despite parental physical abuse: a fourth wave of resilience research

Introduction

To understand the family's role in adolescents' mental health development and the connection to neurodevelopmental disorders related to experienced parental physical abuse, we first explored resilience pathways longitudinally and secondly, connected the identified patterns to adolescents' hair cortisol levels that are rooted in the hypothalamic-pituitary-adrenal axis as the main stress response system and connected brain structure alterations.

Methods

We analyzed longitudinal online questionnaire data for three consecutive high school years (from seventh to ninth grade) and four survey waves from a representative sample of n = 1609 high school students in Switzerland on violence-resilience pathways. Furthermore, we collected students' hair samples from a subsample of n = 229 at survey wave 4. About 30% of the participating adolescents had been physically abused by their parents. Out of the overall sample, we drew a subsample of adolescents with parental abuse experiences (survey wave 1 n = 509; survey wave 2 n = 506; survey wave 3 n = 561; survey wave 4 n = 560).

Results

Despite the odds, about 20-30% of adolescents who have experienced parental physical abuse escaped the family violence cycle and can be called resilient. By applying a person-oriented analytical approach via latent class and transition analysis, we longitudinally identified and compared four distinct violence-resilience patterns. We identified violence resilience as a multidimensional latent construct, which includes hedonic and eudaimonic protective and risk indicators. Because resilience should not solely be operationalized based on the lack of psychopathology, our latent construct included both feeling good (hedonic indicators such as high levels of self-esteem and low levels of depression/anxiety and dissociation) and doing well (eudaimonic indicators such as high levels of self-determination and self-efficacy as well as low levels of aggression toward peers).

Discussion

The present study confirmed that higher cortisol levels significantly relate to the comorbid pattern (internalizing and externalizing symptoms), and further confirmed the presence of lasting alterations in brain structures. In this way, we corroborated the insight that when studying the resilience pathways and trajectories of abused adolescents, biological markers such as hair cortisol significantly enhance and deepen the understanding of the longitudinal mechanisms of psychological markers (e.g., self-determination, self-esteem, self-efficacy) that are commonly applied in questionnaires.

Co-Occurrence of Intimate Partner Violence Against Mothers and Maltreatment of Their Children With Behavioral Problems in Eastern Europe

This study investigates the co-occurrence of intimate partner violence (IPV) against mothers and their risk of perpetrating child maltreatment (CM) in North Macedonia, the Republic of Moldova, and Romania. Risk factors for IPV, CM, and their co-occurrence were identified. Two samples (N1 = 112, N2 = 701) of mothers with children with behavioral problems were assessed. IPV was reported by 64% of mothers, CM by 96%, and their co-occurrence by 63%. Mothers exposed to emotional IPV reported more physical and emotional CM. Mothers exposed to physical IPV reported more physical CM. Motheŕs own history of CM and offspring's behavior problems were associated with IPV and CM co-occurrence.

Effectiveness of structured teaching program on parents' knowledge about child physical abuse

BACKGROUND

The issue of child physical abuse (CPA) is complex and challenging to study. According to World Health Organization fact sheets for 2020, about 3 in 4 children between 2 and 4 years of age regularly face physical maltreatment by parents or caregivers. It may cause a lifelong impact on physical and mental health.

OBJECTIVE

To assess the parents' knowledge and to evaluate the effectiveness of the structured teaching program (STP) regarding child physical abuse (CPA) among parents.

METHODS AND MATERIALS

The pre-experimental, "One-group Pre-test Post-test design" was adopted for this study. Parents of children who were admitted for treatment in the child psychiatry centre (CPC) of a tertiary care referral center between January 2019 and January 2020 were recruited for this study. Thirty parents were recruited with a convenience sampling technique. The study was conducted through an online platform (Zoom). Pre-test and post-tests were conducted through Google survey form. Data were collected with a self-developed knowledge questionnaire on CAP. An online structured teaching program (STP) was administered for three alternative days after the pre-test assessment. The post-test assessment was conducted at a two-point time, that is immediately after the STP and after the one-week gap. Descriptive and inferential statistics were used to analyze the data. "One-group Pre-test Post-test design" was adopted for this study. Parents of children who were admitted for treatment in the child psychiatry centre (CPC) of a tertiary care referral center between January 2019 and January 2020 were recruited for this study. Thirty parents were recruited with a convenience sampling technique. The study was conducted through an online platform (Zoom). Pre-test and post-tests were conducted through Google survey form. Data were collected with a self-developed knowledge questionnaire on CAP. An online structured teaching program (STP) was administered for three alternative days after the pre-test assessment. The post-test assessment was conducted at a two-point time, that is immediately after the STP and after the one-week gap. Descriptive and inferential statistics were used to analyze the data.

RESULTS

The pre-test knowledge assessment means score regarding child physical abuse was found to be 12, with a standard deviation of 1.73. In the post-test one, 17.30 ± 1.39 and in the post-test two, 16 ± 1.55 with P < 0.001. Analysis revealed statistically significant improvement was found in the post-test knowledge regarding child physical abuse among the parents. There was no significant (p < 0.05) relationship found between the socio-demographic variables of the participants and their pre-intervention knowledge scores on child physical abuse.

CONCLUSIONS

The study findings reveal that parents have a fair knowledge of CPA and the STP was effective and feasible to administer in improving the subjects' knowledge regarding child physical abuse.

Mental health and psychological well-being of Kenyan adolescents from Nairobi and the Coast regions in the context of COVID-19

BACKGROUND

Despite the high burden of mental health problems during adolescence and its associated negative consequences, it has remained neglected especially in sub-Saharan Africa. The 2019 novel Coronavirus disease (COVID-19) pandemic has placed additional stress on adolescent mental health. However, there are few studies documenting the burden of mental health problems and even fewer mental health services in the region. In relation to the limited body of knowledge, the present study aims to determine the psychological well-being of adolescents and to assess the risks and associated factors of mental health problems among adolescents in the context of COVID-19 pandemic in Kenya.

METHODS

We conducted a cross-sectional survey in 2022 among adolescents aged 13-19 years living in Nairobi, and the Coast region of Kenya. We utilized standardized psychological assessment tools including the Patient Health Questionnaire, Generalized Anxiety Scale, Strengths and Difficulties Questionnaire, The World Health Organization- Five Well-Being Index Scale, and the Pandemic Anxiety Scale, to evaluate the psychological wellbeing of the adolescents. A linear regression model was used to evaluate the correlates associated with quality of life, pandemic anxiety, and emotional and behavioural problems among adolescents. Subsequently, a logistic regression model was used to assess factors associated with depression and general anxiety disorders. Variables with a p-value < 0.25 in the univariate model were included in the multivariable regression model.

RESULTS

The results are based on 797 participants who met the inclusion criteria. We found the prevalence of depression to be relatively higher among out-of-school adolescents at 36.0% compared to school-going adolescents at 20.6%. Furthermore, out-of-school adolescents had significantly higher anxiety scores when compared to their school-going counterparts (27.7% vs 19.1%) respectively. In-school adolescents had a better quality of life scores, lower pandemic anxiety scores, and lower emotional and behavioral problems scores compared to their out-of-school counterparts. Key risk factors associated with depression include; being out-of-school (OR = 1.96 (95% CI 1.33- 2.88) p-value = 0.001), loneliness (OR = 10.68 (95% CI 4.49-22.86) p-value < 0.001), and living in an unsafe neighborhood (OR = 2.24 (95% CI 1.52-3.29) p-value < 0.001). An older age (OR = 1.16 (95% CI 1.03-1.30) p-value = 0.015), being out-of-school (OR = 1.81 (95% CI 1.19-2.77) p-value = 0.006), and living in an unsafe neighborhood (OR = 2.01 (95% CI 1.33-3.04) p-value = 0.001 were key factors associated with anxiety. Furthermore, key factors positively correlated with quality of life include; high socioeconomic status (ß (Std.Err) = 0.58 (0.14) p-value < 0.001, talking to friends often (ß (Std.Err) = 2.32 (0.53) p-value < 0.001, and being close to parents (ß (Std.Err) = 1.37 (0.62) = 0.026.

CONCLUSION

Our findings imply that mental health support services targeting adolescents in the country should be prioritized, especially for those who are out-of-school.

The science of child and adolescent mental health in Greece: a nationwide systematic review

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Mental Health Disorders Due to Disaster Exposure: A Systematic Review and Meta-Analysis

Natural disasters are complex, global issues that affect people individually, families, and communities, upsetting their emotional wellbeing. This research aims to comprehend the connections between disasters and their effects on mental health. We conducted a systemic review and meta-analysis on the effect of disasters on mental health disorders using defined search terms across three major databases. The search technique adhered to the PECO framework. The study locations were dispersed across Asia, Europe, and America. An electronic search was established in the Cochrane Central Register of Controlled Trials in the Cochrane Library, PubMed, and Medline databases. A random-effects meta-analysis was carried out. The I² statistic was used to explore heterogeneity. In the random-effects analysis, Tau-squared, τ², or Tau² evaluates the effects seen between the study variances. Publication bias was examined. The outcomes of the included studies on mental health issues (n = 48,170) brought on by catastrophic disasters were pooled using a random-effects meta-analysis. The three main mental health illnesses attributed to the disaster catastrophe in most studies were generalized anxiety disorder (GAD), depression, substance use, adjustment disorder, and post-traumatic stress disorder (PTSD). Storms, including cyclones and snowstorms, had an impact on 5,151 individuals. 38,456 people were harmed by flooding, and 4,563 people were affected by the earthquake. The included studies showed prevalence rates for mental health disorders ranging from 5.8% to 87.6%. The prevalence rates were between 2.2% and 84% for anxiety, 3.23% and 52.70% for depression, and 2.6% and 52% for PTSD, respectively. The point effect estimates of studies included the flood, storm/cyclone, and earthquake were 0.07 (95% confidence interval [CI]: 0.02-0.12), 0.18 (95% CI: 0.03-0.32), and 0.15 (95% CI: 0.03-0.27), respectively, which revealed a statistically significant positive effect (p-value: < 0.05) with a narrow 95% CI indicating more precise population estimates. However, the pooled effect estimates were not of a large effect size of 0.129 (95% CI: 0.05-0.20). This study found a link between disaster and poorer outcomes for mental health. The risk of psychological morbidity and fatalities increased with relocation and disruption of essential services. Flooding was the most frequent calamity. The "medium human development countries" were found to have the highest prevalence rate of mental health disorders in our meta-analysis. The "very high human development" and "high human development" nations, however, also had a higher prevalence rate of mental health disorders following catastrophic events. This study could aid in the creation of thorough strategies for the mitigation and avoidance of mental health problems during natural disasters. Increased community resilience, improved access to healthcare services, and a suitable mitigation strategy can all help to improve the situation of the disaster's vulnerable population.

Resilience trajectories and links with childhood maltreatment in adolescence: a latent growth modeling approach

BACKGROUND

The current definitions of resilience can be addressed as a process, an outcome, or a trait. Empirical studies should be carried out to determine the most appropriate definition for it. Therefore, the main aim of the current study was to investigate changes in adolescents' resilience over two years and explore the links between resilience and different forms of child maltreatment.

METHODS

The three-wave longitudinal study "Stress and resilience in adolescence" (STAR-A) sample was comprised of a general school-based sample of Lithuanian adolescents [baseline N = 1295, 56.7% females; M(SD)_age = 14.24 (1.26)]. Resilience was measured using the 14-item Resilience Scale (RS-14), lifetime exposure to maltreatment was measured at wave 1 using a questionnaire developed by the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), risk of psychopathology-using the Strengths and Difficulties Questionnaire (SDQ). The changes in resilience scores over the period of two years were investigated using the latent growth modeling approach.

RESULTS

The analyses revealed two classes of resilience-stable higher and stable lower. We found that experience of at least one form of abuse was significantly more prevalent in the lower resilience group in comparison to the higher resilience group. Also, adolescents with lower resilience had a higher probability of psychopathology.

CONCLUSIONS

This study provided meaningful insights into the stability of resilience over time in adolescence and its relation to various types of child maltreatment. Experiences of maltreatment, as well as risk for psychopathology, were linked to lower resilience in adolescence.

Patterns and trajectories of children's maltreatment experiences in Taiwan: Latent transition analysis of a nationally representative longitudinal study

BACKGROUND

Little is known about the patterns of child maltreatment change over time and vary according to gender and child protective services (CPS) experience in Taiwan.

OBJECTIVE

To examine the latent status and the trajectories of child maltreatment and to identify effects that gender and CPS have on these statuses and trajectories in Taiwan.

PARTICIPANTS AND SETTING

A national proportionately stratified sample of 6233 4th-grade students were recruited from 314 elementary schools in Taiwan, and followed up at 6th and 8th graders. A total of 1908 students completed valid data at all three time points was analyzed.

METHODS

Latent class analysis and latent transition analysis were used to identify the number of latent variables and the patterns of child maltreatment. Multiple-group model was used to test with gender difference.

RESULTS

Four latent maltreatment statuses were identified: high all maltreatment, high psychological maltreatment, high neglect, and no/low maltreatment. A reduction in maltreatment severity occurred over time was found. The percentage of students in the "high all maltreatment" and "high neglect" groups decreased whereas those in the "high psychological maltreatment" and "no/low maltreatment" groups increased. Differences in the transition probabilities of latent maltreatment status by gender was revealed. The percentage of CPS recipients in the "high all maltreatment" decreased over time.

CONCLUSIONS

This study highlighted the dynamic nature of child maltreatment and described the timing, continuity, and change that characterizes children's exposure to maltreatment in Taiwan. Policies and interventions geared toward early detection, mitigation, and prevention of child maltreatment are needed.

The effects of sexual abuse on female adolescent brain structures

Objective

Sexual abuse (SA) is known for its effects on brain structures in adolescents. We aimed to explore if SA has any effect on limbic and prefrontal cortex (PFC) structures. We hypothesized that children with SA would have a thinner PFC with larger amygdala and hippocampus that lead to aberrations in threat detection, orientation and response circuit; that would be highly adaptive in a dangerous environment in the short term.

Method

We included 57 SA and 33 healthy control (HC) female participants. In addition to psychiatric evaluation, we acquired 3 T MR images from all participants. We compared prefrontal cortical thicknesses, hippocampus and amygdala volumes between groups.

Results

The age and education levels of study groups were matched, however, IQ scores and socioeconomic status (SES) scores of the SA group were lower than the controls. Total CTQ scores of the SA group were higher than the HC. Nevertheless, the mean value of sexual abuse scores was above the cut-off scores only for the SA participants. SA participants had larger right and left hippocampus and right amygdala volumes than the controls. SA group had reduced inferior frontal gyrus cortical thickness (T=3.5, p<0.01, cluster size=694 mm2, x=51 y=-30 z=6) than HC group. None of the structural findings were correlated with total or sexual abuse CTQ scores.

Conclusion

Children with SA history has structural abnormalities in threat detection, orientation and response circuit. SA victims with no psychiatric diagnosis have a high probability of psychiatric problems with a possible contribution of these aberrations. SA cases that do not have a diagnosis must not be overlooked as they may have structural changes in emotion related brain regions. Careful follow-up is needed for all of all SA cases.

"What does that mean?": The content validity of the ISPCAN Child Abuse Screening Tool - Child version (ICAST-C) in Romania, South Africa, and the Philippines

BACKGROUND

The International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool (Children's Version), known as the ICAST-C Version 3, is used widely to assess violence against children, but there is limited psychometric evidence, especially on content validity.

OBJECTIVE

This study aimed to assess the content validity of the ICAST-C with adolescents in Romania, South Africa, and the Philippines.

METHODS

A purposive sample of adolescents (N = 53, 51 % female) were recruited from urban areas in Romania, the Eastern Cape Province of South Africa, and Metro Manila, Philippines. Semi-structured one-on-one in-depth cognitive interviews sought adolescent perspectives on the relevance, comprehensibility, and comprehensiveness of the ICAST-C. Data were analysed using template analysis.

RESULTS

The ICAST-C was broadly perceived to be relevant and comprehensive in measuring violence against children in all study locations. However, there were issues with the comprehensibility of the measure, described at three levels: interpreting items, undertaking coherent elaborations of relevant behaviors and places, and generating a coherent response to the questions.

CONCLUSIONS

Suggestions to revise the ICAST-C include, among others, adding a practice or how-to section on answering the survey, clarifying the intent of questions, especially on neglect and sexual abuse, emphasizing that questions cover all locations, and asking more positive questions. Pilot studies testing the content validity and cultural appropriateness are needed as a matter of practice in large self-report surveys.

Creation and evaluation of a participatory child abuse and neglect workshop for medical students

BACKGROUND

Since child abuse and neglect (CAN) is prevalent worldwide, medical students should acquire basic knowledge, skills, and confidence in identifying and addressing CAN. Although significant educational efforts have been previously described, none has focused on using participatory methods to teach medical students CAN.

PURPOSE

To: 1) develop a participatory educational workshop in CAN for medical students, 2) gather, train, and establish a peer-to-peer teaching group, and 3) assess the effectiveness of the workshop in gain of knowledge and improvement of self-confidence for participants.

METHODS

A two-hour workshop was created with role-playing, the use of mannikins and peer-to-peer teaching. A 15-item knowledge and a 9-item self-confidence questionnaire were used before, right after, and six months after each workshop.

RESULTS

Nine workshops in two academic pediatric departments with a total attendance of 300 6th year medical students were conducted. For the 69 students who completed the questionnaires at all three times, there were statistically significant gains in knowledge right after (p < .001) and six months after (p < .0001) the workshops. Similarly, self-confidence increased right after (p < .0001) and six months after (p < .001) the workshops. Self-selection bias testing indicated that these 69 students who completed all three questionnaires were representative of those who completed the pre-testing and the testing right after.

CONCLUSIONS

We successfully established a peer-to-peer teaching group to conduct nine participatory workshops that improved the participants' knowledge and self-confidence in CAN. This feasible and novel active learning approach may help address inadequacies in medical curricula.

Child, adolescent, and caregiver mental health difficulties and associated risk factors early in the COVID-19 pandemic in South Africa

At the onset of the COVID-19 pandemic in early 2020 in South Africa, many safety measures were implemented to protect the lives of the population. Ironically, these same safety measures have negatively impacted on the lives of children and their caregivers resulting in increased mental health problems. This study forms part of the multicountry Co-SPACE (COVID-19: Supporting Parents, Adolescents and Children during Epidemics) study that explores how families are coping during the COVID-19 pandemic, and what caregivers can do to help support their children's mental health. This paper aims to gain a better understanding of the mental health status of families specifically in South Africa in the early onset of the pandemic during restrictive lockdown measures, and identify certain risk factors that might contribute towards deteriorating mental health. Two hundred and fifty-four South African parents and carers of children and adolescents completed an online survey about their child's mental health as well as their own mental health during and post- hard lockdown in South Africa. Data collection took place over the period of the first and second waves of the COVID-19 pandemic in South Africa. Results showed that children experienced significantly higher mental health problems than adolescents (p = 0.016). Younger children were particularly negatively affected by lockdown and had more mental health problems than adolescents (p = 0.023); including emotional problems (p = 0.017), misconduct (p = 0.030), and hyperactivity (p = 0.001). Additionally, the presence of special educational needs/neurodevelopmental disorders (SEN/ND) was associated with more mental health problems (p = 0.001). Surprisingly, single parent households, which is another well-known risk factor showed no differences in mental health problems compared to nuclear families. There was also a reciprocal relationship between parental/carer mental health and child/adolescent mental health, with higher level of endorsement of mental health problems in children by parents/caregivers who themselves associated with higher levels of depression, anxiety and stress (all p's < 0.001). These results highlight the dramatic impact that COVID-19 had on children, adolescents and parents in South Africa early in the pandemic, and emphasises the need for specific support structures to be implemented within the SEN/ND community, as well as for younger children and single parent households.

Child protection training for professionals to improve reporting of child abuse and neglect

BACKGROUND

Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed.

OBJECTIVES

To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list.

SELECTION CRITERIA

All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect).

DATA COLLECTION AND ANALYSIS

We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence.

MAIN RESULTS

We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence).  We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence).

AUTHORS' CONCLUSIONS

The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.

Effectiveness of an online suicide prevention program for college faculty and students

Objective: Suicide prevention programs help college staff and students identify students at-risk for suicide. Kognito is an online, simulation-based suicide prevention program. The purpose of the current study was to evaluate Kognito's effectiveness in changing suicide prevention attitudes and behavior. Participants: 170 college students and 140 college staff completed the training module and three surveys. Methods: College staff and students from 24 public, private, and community colleges and universities in Maryland completed Kognito modules and pre-, post-, and 3-month follow-up assessments. Results: Both college staff and students exhibited significant improvements in reported Preparedness, Likelihood, and Self-Efficacy in gatekeeper attitudes. Students reported significant gains in gatekeeper intervention behaviors. Conclusions: The current results suggest that Kognito is associated with attitudinal change for college staff and students, but only college students demonstrated statistically significant behavioral impact for both being more likely to ask about suicide and refer peers to counseling.

Remarkable high frequency of insecure attachment in children with ADHD persists in a three-year follow-up

BACKGROUND

Studies have pointed to a complicated and mutual relationship between attention deficit hyperactivity disorder (ADHD) and attachment. In an observational follow-up study conducted in 2015 60 children from 7 years to 12 years recently diagnosed with ADHD were included and assessed according to attachment representation showing 85% of the children to be insecurely attached.

AIM

The aim of this study was to investigate the stability of this remarkably high frequency of insecure attachment in the same cohort of children.

METHODS

Children previously assessed using the child attachment interview (CAI) when diagnosed with ADHD were contacted three years later for a follow-up CAI assessment.

RESULTS

At follow-up, 31 children participated in the CAI-interviews. Since their diagnosis with ADHD, the children had received treatment as usual. The CAI-interviews showed a continued high rate of insecure attachment with 90% of the children classifying as insecurely attached compared to expected 38% in the normal population. Of these, the majority of children (77%) were classified as dismissing.

CONCLUSION

Our findings suggest that targeting ADHD-symptoms with our current treatment strategies does not in itself improve attachment security. Attachment security may in turn be a factor of importance when evaluating general functioning and prognosis.

Comparison of adverse childhood experiences of working and nonworking adolescents

BACKGROUND

Although adverse childhood experiences (ACEs) in adolescents are partially presented at the national level, few studies of ACEs in working adolescents by comparing them with those who are not working that provide an opportunity for international comparison have been conducted.

OBJECTIVE

This study was aimed to compare the ACEs of working and nonworking adolescents.

METHODS

This study was conducted in Turkey with 213 working adolescents enrolled in the vocational training center and 457 nonworking adolescents enrolled in high schools between the ages of 15 and 18.

RESULTS

As a result of the study, the prevalence and incidence of psychological and physical ACEs and neglect in nonworking adolescents were found to be higher than the prevalence and incidence in working adolescents.

CONCLUSIONS

Research should be conducted to define the awareness of neglect and abuse among working and nonworking adolescents and to explain the reasons why nonworking adolescents experience more ACEs.

The Association of Abuse and Depression With Suicidal Ideation in Chinese Adolescents: A Network Analysis

BACKGROUND

Abuse experiences in adolescents are associated with the risk of depression and suicide. Thus, there is an urgent need to develop prevention and intervention measures for clinicians, policymakers, and researchers.

METHODS

Network analysis method was used to analyze the cross-sectional data of Chinese adolescents in this study. The Patient Health Questionnaire for Adolescents (PHQ-A) was used for assessing depression, in which item 9 of the PHQ-A was used to assess suicide ideation, and International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool-Children's Home Version (ICAST-CH) was used for assessing abuse.

RESULTS

The prevalence of suicidal ideation among Chinese adolescents was 21.46% (95% CI, 20.79-22.16%). The prevalence of moderate or severe depression was 16.76%, and the prevalence of violence exposure, psychological victimization, neglect, and physical victimization was 33.5%, 59.5%, 28.37%, and 31.51% in the past years, respectively. Network analysis results showed that the most central nodes in the network of abuse and depression were "unimportant," "not cared," and "pushed." The bridge nodes were "suicidal ideation" and "unimportant." The nodes "sadness," "failure," and "unimportant" explained the largest proportion of the variance of suicidal ideation in our network. Differences were found in the structure of both abuse and depression networks between adolescents with or without suicidal ideation.

LIMITATIONS

The self-reporting-based cross-sectional surveys and community sample groups limit the inference of causality and the generalization of the results.

CONCLUSION

This study shows that "unimportant" is the central and bridge nodes in the abuse and depression networks and also explains a part of variance of suicidal ideation. The effect of "unimportant" should be considered in the prevention and intervention of depression and suicide in adolescents with abuse experience. Future study is needed to confirm its role in clinical intervention.

The ethics of child maltreatment surveys in relation to participant distress: Implications of social science evidence, ethical guidelines, and law

Epidemiological surveys measuring the prevalence of child maltreatment generate essential knowledge that is required to enhance human rights, promote gender equality, and reduce child abuse and neglect and its effects. Yet, evidence suggests Institutional Review Boards (IRBs) may assess the risk of these studies using higher than normal thresholds, based on a perception they may cause high distress to participants. It is essential for IRBs and researchers to have an accurate understanding of the nature and extent of participant distress associated with these studies, and of the duties of researchers towards survey participants, so that meritorious research is endorsed and duties to participants discharged. Assessment by IRBs of the ethics of such research must be appropriately informed by scientific evidence, ethical principles, and legal requirements. This article adds to knowledge by considering participant distress in child maltreatment surveys and its appropriate ethical and operational treatment. We provide an updated overview of scientific evidence of the frequency and severity of distress in studies of child maltreatment, a review of ethical requirements including a focus on beneficence and participant welfare, and a new analysis of researchers' legal duties towards participants. Our analyses demonstrate that participant distress is infrequent and transitory, that researchers can satisfy ethical requirements towards participants, and that legal liability does not extend to emotional distress. Informed by these bodies of knowledge, we distil key principles of good epidemiological practice to provide solutions to operational requirements in these surveys, which both fulfil ethical requirements to participants, and demonstrate trauma-informed practice.

Survival states as indicators of learning performance and biological stress in refugee children: a cross-sectional study with a comparison group

BACKGROUND

Our goal was to accurately detect young children at risk for long-term psychiatric disturbances after potentially traumatic experiences in the course of relocation. In addition to detailed assessment of parent-rated parent and child symptomatology, we focused on disruptive behaviors in the education environment summarized as survival states, as these frequently lead to clinical referral.

METHODS

We screened 52 refugee children aged 3-7 (M = 5.14 years, SD = 1.17) for symptoms of Posttraumatic Stress Disorder (PTSD) with the Child and Adolescent Trauma Screening (CATS) in parent rating. The parents' mental health was assessed using the Refugee Health Screener (RHS-15). Furthermore, the child's educators were asked to evaluate the pathological survival states of the child and we made a general assessment of the children's symptoms with the Strengths and Difficulties Questionnaire (SDQ) rated by parents and educators. Children in the refugee sample completed a working memory learning task (Subtest Atlantis from the Kaufmann Assessment Battery for Children, KABC-II) and delivered saliva samples for testing of the cortisol level.

RESULTS

The parental rating of their child's PTSD symptoms was significantly related to their own mental well-being (r = .50, p < .001). Children with survival states in educator ratings exhibited weaker learning performance (F = 3.49, p < .05) and higher evening cortisol levels (U = 113, z = - 1.7, p < .05, one-tailed).

CONCLUSIONS

Survival states are promising indicators for children's learning performance and distress level complementary to parent rating of child PTSD, which is highly intercorrelated with the parents' own symptom load.

TRIAL REGISTRATION

Trial registration number: DRKS00021150 on DRKS Date of registration: 04.08.2020 retrospectively registered.

Factor structure and internal consistency of the ISPCAN Child Abuse Screening Tool Parent Version (ICAST-P) in a cross-country pooled data set in nine Balkan countries

OBJECTIVE

Researchers are increasingly using parental report measures in population-based surveys of violence against children. No research thus far has examined the factor structure of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool Parent Version (ICAST-P), a non-commercialized measure for prevalence studies.

METHODS

This paper uses secondary data from the Balkan Epidemiological Study on Child Abuse and Neglect (BECAN) which included 25,202 primary caregivers of school-going children in three grades (aged 11, 13 and 16). Primary caregivers completed the ICAST-P 2010-2011, which measures children's exposure to physical and psychological violence and neglect by caregivers and sexual violence by any perpetrator. Confirmatory factor analysis (CFA) was used to assess the reliability and the factor structure of the ICAST-P for a four-dimensional model and a bifactor model, with one general factor and four group factors representing the specific components of each set of items. Measurement invariance could not be tested.

RESULTS

Lifetime prevalence for physical violence was 66.7 %, for psychological violence 66.6 %, for sexual violence 3.1 % and for neglect 9.1 %. CFA showed adequate fit for the hypothesized four-dimensional model, however, improved fit was shown for a bifactor model with abuse as the general factor. Internal consistency was good for physical and psychological violence, but not neglect and sexual violence. Hierarchical omega showed good internal consistency for the general factor.

CONCLUSIONS

Parents report that their children experience high levels of violence. The factor structure of the ICAST-P is best captured using a bifactor modelling approach.

Patterns of emotional and behavioural challenges in children living with HIV: results from a hyperendemic South African setting

This study examined the patterns of emotional and behavioural problems in children from an HIV hyperendemic sub-Saharan Africa setting. A cross-sectional questionnaire survey was administered to 198 parents/caregivers of children living with HIV aged 2-12 years, attending a paediatric HIV out-patient service at a public sector hospital in KwaZulu-Natal Province, South Africa. The parent version of the Strengths and Difficulties Questionnaire (SDQ) which consists of five sub-scales (i.e. emotional difficulties, conduct problems, hyperactivity/inattention symptoms, peer problems and prosocial behaviours) were used to capture data on emotional and behavioural problems in children. The results indicated that over half of sampled children (n = 115, 58.1%) had abnormal levels of problems in at least one sub-scale, with adjusted regression indicating that academic difficulties and delayed milestones were significantly associated (i.e. greater total SDQ score as a continuous measure). Lower parental/caregiver educational attainment (i.e. not having tertiary education) was the only parent/caregiver characteristic associated with greater emotional and behavioural problems. Given the high prevalence of emotional and behavioural problems and its link to academic difficulties and delayed milestones, the need for screening and developmental support for children living with HIV may be warranted.

The global challenge of the neglect of children

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

A psychometric analysis of a short form of the Chinese version of the ISPCAN child abuse screening tools - Children's home version (SC-ICAST-CH) using multidimensional item response theory

BACKGROUND

The development of measures of child maltreatment for the Chinese population were limited until the Chinese version of the ISPCAN Child Abuse Screening Tools - Children's Home version (ICAST-CH-C) was proposed. Although the ICAST-CH-C was found to be effective in assessing the scope and prevalence of child maltreatment, it has several potential drawbacks. The time that is required to complete the ICAST-CH-C scale is longer than usual for a 36-item scale, because many of its items have one or more follow-up questions. Moreover, each item requires child victims to recall unpleasant experiences. Both phenomena can cause increases in invalid responses and in turn damage the data quality.

OBJECTIVE

The goal of this study was to propose a short form of the ICAST-CH-C (called the SC-ICAST-CH) to reduce the test length and response time in order to improve the measurement quality.

PARTICIPANTS AND SETTING

A dataset from a national survey of 5236 adolescents in Taiwan was used.

METHODS

A multidimensional version of the rating scale model (MRSM) was fitted to the data. The model parameters were estimated with the ConQuest software.

RESULTS

The results indicated the reliability of the SC-ICAST-CH was fairly good, with only 61 % of the original test length. Disordered thresholds were found in all five subscales; the underlying reasons for this phenomenon need further investigation. Specific cultural differences related to item retention/removal decisions were also discussed.

CONCLUSION

The efficient, shorter SC-ICAST-CH was shown to be a valid and reliable instrument for assessing the prevalence of child maltreatment.

Measuring violence against children: The adequacy of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) child abuse screening tool - Child version in 9 Balkan countries

OBJECTIVE

Violence against children is a global public health concern. Researchers are increasingly using self-report measures of physical, psychological, and sexual violence and neglect for population-based surveys. The current gold-standard measure, the 45-item ISPCAN Child Abuse Screening Tool has been used across the world. This study assesses its adequacy for measuring abuse across countries.

METHODS

Multiple group confirmatory factor analyses were used to assess the configural, metric and scalar invariance of the measure across nine Balkan countries. Data were collected using a three-stage stratified random sampling frame of 42,194 school-attending children in three grades (aged 11,13 and 16 years) from schools in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, North Macedonia, Romania, Serbia, and Turkey. Children completed the ICAST-C, which measures children's exposure to physical, psychological, and sexual violence, neglect and witnessing household violence in the past year and across the lifespan.

RESULTS

The analyses show partial scalar invariance for the ICAST-C constructs children's exposure to physical and psychological violence, neglect and witnessing household violence across the nine countries and partial scalar invariance for the constructs of children's exposure to physical, psychological and sexual violence, neglect and witnessing household violence across eight countries (Turkey did not measure sexual violence).

CONCLUSIONS

The ICAST-C can be used to validly compare levels of physical, psychological, and sexual violence, neglect and witnessing violence in school-aged children across countries. It can also be used to validly compare the relations between these forms of violence and their covariates, predictors, and outcomes across countries.

A national educational campaign to raise awareness of child physical abuse among health care professionals

Education is necessary to improve child physical abuse detection and management. A few studies have described national child abuse training programs, but none has measured changes in knowledge among participants. A collaboration of child abuse experts from the USA, an academic pediatric department, and a non-governmental organization in child protection aimed at (a) training hospital physicians in a train-the-trainer course for the detection and management of child physical abuse and (b) conducting workshops and measuring attendance and gain of knowledge of participants. A train-the-trainer and a national curriculum were created. A 78-item and a 20-item knowledge questionnaire were used pre and post the train-the-trainer course and all workshops, respectively. Nineteen physicians from all pediatric departments of the seven medical schools in Greece attended the course. Eight workshops in seven cities took place with a total attendance of 1220 health care professionals. Gain of knowledge was demonstrated for participants in the train-the-trainer course (p = 0.0015) and local workshops (p < 0.001).Conclusion: We successfully engaged physicians from all medical schools in Greece and conducted a train-the-trainer module and eight workshops in major cities that improved the participants' knowledge in child physical abuse. This approach may help address physician deficiencies in emerging areas of child abuse clinical practice. What is Known: • Education is necessary to improve child physical abuse detection and management. • Although national training programs have been described, none has measured participants' changes in knowledge. What is New: • A collaboration of child abuse experts, all medical schools in Greece, and a non-governmental organization resulted in a national educational campaign in child physical abuse and gains in knowledge for participants. • This approach may help address deficiencies in emerging areas of clinical practice.

Cohort profile: Norwegian youth study on child maltreatment (the UEVO study)

PURPOSE

Exposure to childhood maltreatment is not uncommon, and is linked to both short-term and long-term health problems. Population-based surveys for adolescent samples provide excellent opportunities for addressing the substantial burden of early-life adversities, because collecting information close in time to exposure may increase accuracy of assessment. Still few large studies have been conducted, following individuals through adolescence. Therefore, the UEVO cohort was created with the aim of investigating prevalence of child maltreatment throughout childhood and adolescence, and its effects on health and functioning in a long-term perspective in a representative sample of Norwegian adolescents.

PARTICIPANTS

The baseline for the cohort includes a representative sample of 9240 Norwegian adolescents (response rate 86.6%) aged 12-16 years, surveyed in January and February 2019. The cohort to be followed over time comprises the 5502 adolescents who agreed to be recontacted for subsequent data collection waves.

FINDINGS TO DATE

The overall prevalence figures from the first wave of measurement have been published in a comprehensive national report on child maltreatment in Norway.

FUTURE PLANS

A second study wave will commence in 2021, including about half of the original cohort (longitudinal), as well as a new sample starting at age 12. For participants above age 16, original survey data will be connected to national registries (pending indvidual consent), enabling the study of real-life functioning within the areas of healthcare utilisation, school drop-out, work-force participation and prescription of medication.

What to do when a child reports sexual harassment and sexual assault to a medical professional

Global exposure of children to sexual abuse is widespread. Disclosure may be extremely upsetting for both families and medical professionals. This review provides medical practitioners with practical tips for a stepwise approach of the child who discloses sexual abuse. Having secured a private examination room, the physician should approach the child and caregivers separately to determine the level of concern for abuse and the urgency of the situation. The medical evaluation is based on the information gathered, including a complete physical examination, inspection of the genitalia, collection of forensic evidence, and testing for sexually transmitted diseases. On a case-by-case basis, the need for surgical intervention, prophylactic treatment, and immunization is discussed. Finally, important questions for the medical team to address are outlined with the goal of supporting the child and his/her family and ultimately stopping the abuse.

Child sexual abuse among medical school students: experiences and perceptions

Given that 5-25% of the adult population report child sexual abuse (CSA), most clinicians will care for victims. Data regarding CSA experiences among medical students are limited and the association of medical students' own history of CSA with relevant perceptions has not been previously examined. The aim of this study was to assess CSA perceptions and exposure of medical students, while exploring their associations. For this purpose, a link was created and made available on a site accessed solely by the Athens medical school undergraduates from February 20 to March 20 2019, comprising a 12-item questionnaire to assess the knowledge and past experience of CSA. This was based on a larger published questionnaire, which was translated and adapted. The questionnaire was then transcripted online, and after pilot testing, was disseminated using the Google documents® platform. Out of 261 responses, CSA was reported by 48 participants (18%), of which 39 were women. Thirty five reported contact CSA. Thirty seven victims (77%) reported previous disclosure of the event, but 18 of them were not protected post disclosure. CSA victims were less likely to agree with the perception that most perpetrators are mentally ill or disabled (p = 0.043), and more likely to strongly disagree with the statement that reputable families are protected from sexual abuse (p = 0.019). In agreement with existing data in general populations globally, about one in five medical students had exposure to CSA. In addition, a potential association of their own experiences with shaping perceptions regarding the identity of CSA perpetrators and affected families for medical students is highlighted.

Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies

OBJECTIVES

Child maltreatment through physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence, causes substantial adverse health, educational and behavioural consequences through the lifespan. The generation of reliable data on the prevalence and characteristics of child maltreatment in nationwide populations is essential to plan and evaluate public health interventions to reduce maltreatment. Measurement of child maltreatment must overcome numerous methodological challenges. Little is known to date about the extent, nature and methodological quality of these national studies. This study aimed to systematically review the most comprehensive national studies of the prevalence of child maltreatment, and critically appraise their methodologies to help inform the design of future studies.

METHODS

Guided by PRISMA and following a published protocol, we searched 22 databases from inception to 31 May 2019 to identify nationwide studies of the prevalence of either all five or at least four forms of child maltreatment. We conducted a formal quality assessment and critical analysis of study design.

RESULTS

This review identified 30 national prevalence studies of all five or at least four forms of child maltreatment, in 22 countries. While sound approaches are available for different settings, methodologies varied widely in nature and robustness. Some instruments are more reliable and obtain more detailed and useful information about the characteristics of the maltreatment, including its nature, frequency, and the relationship between the child and the person who inflicted the maltreatment. Almost all studies had limitations, especially in the level of detail captured about maltreatment, and the adequacy of constructs of maltreatment types.

CONCLUSIONS

Countries must invest in rigorous national studies of the prevalence of child maltreatment. Studies should use a sound instrument containing appropriate maltreatment constructs, and obtain nuanced information about its nature.

Perceived Skill and Willingness to Address Child Sexual Abuse: Assessing Serbian and Montenegrin Pediatricians

Most research on pediatricians' reporting of child sexual abuse (CSA) is based in western countries. Only recently have studies focused on low-income countries. We are the first to survey pediatricians in Serbia and Montenegro on their encounters, competence and beliefs regarding CSA. Pediatricians in Serbia (n = 358) were recruited during a professional conference; pediatricians in Montenegro (n = 121) were sent an online survey. Demographic information was not obtained. Frequencies and percentages were calculated. A quarter of pediatricians in both countries felt competent detecting medical evidence of CSA. Twenty-seven percent in Serbia and 7% in Montenegro felt adequately trained to assess and diagnose CSA. Forty percent believed that CSA occurs predominately in poor, unstable or disorganized families. Twenty-nine percent in Montenegro and 15% in Serbia believed that complete strangers perpetrate CSA. Both Serbian (23%) and Montenegrin (30%) pediatricians were uncomfortable asking questions about possible abuse. One third of pediatricians in both countries were interested in further training. CSA is underreported at a concerning rate in Serbia and Montenegro, yet only a third of pediatricians in both countries were interested in further training. Future studies should focus on barriers to reporting in these regions, to increase awareness and competencies related to CSA.

Exploring the Link Between Emotional Child Abuse and Anorexia Nervosa: A Psychopathological Correlation

Eating disorders (ED) are well known psychiatric disorders associated with dysregulated eating behaviors and related thoughts and emotions. Common eating disorders are bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorders (BED). There is an active link between child abuse and eating disorders, emotional child abuse being the important subtype of CA and has a strong comorbid psychopathological relationship with EDs, including AN. The PubMed database was searched for the related articles about child abuse, including emotional childhood maltreatment and their psychopathology associated with EDs, especially AN. No filters were used for the date of publication and article types. Childhood abuse, including physical, sexual, and emotional maltreatment, has an active link with psychopathology associated with dysregulated eating behaviors. However, emotional childhood maltreatment including emotional abuse, neglect, and/or exposure to intimate partner violence (IPV) has been least studied, but studies have shown a strong relationship with the symptoms of anorexia nervosa such as weight concern, negative self-image, and maladaptive emotional response. Emotional dysregulation is the crucial psychopathological factor involved in mediating the effects of emotional childhood maltreatment and symptoms of anorexia nervosa and is strongly associated with long-term morbidity in patients with AN. Conducting more clinical studies in the future would help explore the temporal causation, and this association may help the practitioners to develop new diagnostic and therapeutic strategies in the management of AN.

Caregivers' Perceptions and Attitudes Toward Child Maltreatment: A Pilot Case Study in Tel Aviv, Israel, and Cleveland, USA

The purpose of this pilot cross-national study was to uncover similarities and differences in three areas that might affect the development of community-based programs targeting child maltreatment: behaviors considered to be maltreatment, perceived contributors to maltreatment, and whether the government or neighbors can do anything about maltreatment. Data were obtained from two neighborhood-based, cross-sectional surveys of adult caregivers of minors: one in Cleveland, USA, the other in Tel Aviv, Israel. The sample consisted of a total of 120 caregivers, in each city 20 residing in a low-SES neighborhood, 20 in a medium-SES neighborhood, and 20 in an elevated-SES neighborhood. Participants were asked (a) to provide three examples of behaviors they considered to be child abuse, (b) to rate the degree to which each of 13 factors contribute to child maltreatment, and (c) to rate the degree to which they agreed with a range of attitudes about maltreatment. The same coding scheme was used in both sites. Logistic regression analyses assessed city differences in dichotomous outcomes, while linear regression analyses assessed city differences in ratings of continuous outcomes. Analyses adjusted for individual and neighborhood characteristics, and accounted for residential clustering in neighborhoods. Primary results indicated that residence in Tel Aviv was associated with greater odds of citing emotional/psychological abuse compared to Cleveland residents. Also compared to Cleveland residents, Tel Aviv residents (a) viewed family structure, family values, religion, child-raising knowledge, and personal history of maltreatment as contributing less to maltreatment, (b) were less likely to agree that anyone could abuse a child or that spanking is necessary, and (c) had substantially greater odds of endorsing the government's ability to address child maltreatment. Concerning study implications, this investigation demonstrated the importance of context in shaping constructions of child maltreatment and the need for caution in replicating interventions without due consideration of potential differences in context, policy, and public opinion.

The role of attachment anxiety in the relationship between childhood trauma and schizophrenia-spectrum psychosis

Childhood trauma (CT) is a comprehensive concept encompassing experiences of sexual, physical, and emotional abuse, and neglect during childhood and adolescence. Patients with schizophrenia-spectrum psychosis (SSP) display higher rates of CT than healthy controls. Among the potential mediators of this association, insecure attachment has gained attention and empirical validation. The present study aimed to extend existing knowledge on this field by exploring the role of the two attachment dimensions, attachment anxiety and attachment avoidance, in the CT-SSP association. A clinical sample of 63 SSP inpatients was compared to a healthy control group on CT and attachment style measures. Correlations between CT, attachment dimensions and psychopathology were sought. Mediation analyses were also performed to examine whether attachment anxiety and/or attachment avoidance mediated the CT-SSP association. Patients displayed higher rates of CT and insecure attachment than controls. Attachment anxiety and severity of Mother Antipathy were linked to severity of hallucinations. Attachment anxiety was recognized as the sole mediator of the CT-SSP association. Our findings suggest that individuals with severe CT and increased attachment anxiety represent a risk population warranting early clinical attention, regular monitoring and tailored therapeutic interventions aimed at reducing the psychological impact of trauma.

Prevalence of child abuse in Kerala, India: An ICAST-CH based survey

BACKGROUND

Child abuse is a major concern in India with frequent reports of extreme maltreatment and fatalities. A dearth of robust and methodologically sound studies has resulted in ambiguity regarding the extent of child abuse in the general population.

OBJECTIVES

To estimate the one-year and lifelong prevalence of exposure to violence, physical abuse, emotional abuse, sexual abuse, and neglect using a validated instrument-the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool - Child, Home Version (ICAST-CH).

PARTICIPANTS AND SETTING

Adolescents (n = 6957) attending randomly selected schools in one city in Kerala, India.

METHODS

Cross-sectional survey using self-report instrument.

RESULTS

The one-year prevalence of any abuse was 89.9% (95% CI: 89.1-90.7) suggesting that child maltreatment was widespread. Physical and emotional abuses were also very common. Although sexual abuse was least common, a considerable proportion of adolescents reported it; one-year prevalence of sexual abuse was 16.7% and lifetime prevalence was 19.9%. Boys reported more abuse than girls across all the categories of abuse (including sexual abuse). Abuse was more frequent in the higher age groups and classes at school. Abuse was also more frequent in nuclear families and families that reported alcohol use. Children who reported an abusive experience usually faced more than one category of abuse; abuse in one category was significantly associated with abuse in other categories.

CONCLUSIONS

Abuse of children is alarmingly common. There is an urgent need for improving the awareness surrounding this issue as it is a major public health challenge faced by the country. The priority should be on setting up easily accessible support services for children.

Children's exposure to physical abuse from a child perspective: A population-based study in rural Bangladesh

Background

Although child physical abuse (CPA) is considered as a major global public health problem, it has not yet been recognized as such in Bangladesh. Very few studies have assessed the prevalence and victims’ characteristics of multiple forms of CPA.

Objective

This population-based study assessed the prevalence of CPA committed by adults in a rural area of Bangladesh and examined its association with demographic and socio-contextual factors.

Methods

Data were obtained using ISPCAN Child Abuse Screening Tool for Children (ICAST-C) in a random sample of 1416 children (49% girls, 51% boys) aged 11 to 17 years by face-to-face interviews during March-April 2017. The response rate was 91.5%. To estimate predictors of CPA, physical abuse was categorized into frequent and less frequent groups.

Results

The prevalence of at least one form (≥ 1), two forms (≥2) and three or more forms (≥ 3) of CPA were estimated approximately to 99%, 95% and 83% in their lifetime and 93%, 79%, and 57% in the past year respectively. Hitting (except on buttocks), standing/kneeling and slapping were the most common physical abuse whereas given drugs or alcohol, pinched, burned or scalded, beaten-up and locked up were less reported. Female children were faced severe forms of CPA more than that of males. Male children, younger age groups, witnessing adults using weapons at home, bullied by siblings and low level of maternal education were found to be significant risk factors for both ≥ 1 form and ≥ 2 forms of frequent CPA whereas adding also adult shouting in a frightening way was found as a significant risk factor for ≥ 2 forms of frequent CPA.

Conclusion

Self-reported prevalence of CPA is extremely common in the Bangladeshi rural society. The prevalence was associated with demographic and socio-contextual characteristics of the children such as being younger, witnessing domestic violence and maternal low education. The findings provide evidence to support parents and policy-makers to take effective measures to implement policy and programme on alternative up-bringing methods and creating awareness of negative effects of CM which in turn help Bangladesh to line up with UN Convention on the Rights of the Child, which the country signed in 1990.

Adaptation and Psychometric Evaluation of the Children's Knowledge of Abuse Questionnaire (CKAQ-RIII) in Greek Elementary School Children

The purpose of the present study was to culturally adapt and validate the Children's Knowledge of Abuse Questionnaire-RIII (CKAQ-RIII), a tool that examines children's understanding of sexual abuse concepts, for use in Greek elementary schools. A sample of 467 Greek school children between the ages of 6-9 was recruited from a private school. The CKAQ-RIII was administrated three times, before and immediately after a Child Sexual Abuse (CSA) prevention intervention program, as well as during a one-year follow-up evaluation. A subsample of the original population (N = 113) completed the one year follow up administration of CKAQ-RIII, along with the Body Awareness (BA) and the Emotional Differentiation (ED) subscales of the Emotion Awareness Questionnaire (EAQ). Internal consistency was high for the inappropriate touch scale (ITS) of the CKAQ-RIII and moderate for the appropriate touch subscale (ATS). Inter-item analysis showed that the majority of items were in an acceptable range. Pearson correlation coefficients analyses revealed strong associations between the two subscales of ITS and ATS, and the overall scores of the questionnaire. A mixed-subjects analysis of variance on the ITS showed an increase in knowledge post intervention, with third graders (8-9 year olds) generally scoring higher at baseline and demonstrating greater knowledge gains post intervention. A mixed-subjects analysis of variance was also conducted for the ATS where no significant increase in knowledge was found. Furthermore, analysis revealed a good concurrent criterion validity with good levels of agreement between CKAQ-RIII and ED, whereas no relationship was established between CKAQ-RIII and BA.

Resilience and Poly-Victimization among Two Cohorts of Norwegian Youth

Previous research shows that there is a significant and positive relationship between being a victim of violence and experiencing high levels of psychological problems among young people. Conversely, resilience is negatively associated with psychological problems among young people in general, and this negative association is particularly strong among victims of violence. Our study examines resilience among young people (aged ≥ 18 years) who reported being victims of multiple forms of violence during childhood and adolescence using data from two national youth surveys administered in Norway in 2007 (N = 7033) and 2015 (N = 4531), respectively. We first compared the score of resilience, as measured by the Resilience Scale for Adolescents (READ), and the prevalence of poly-victimization, as identified by the number of young people in our study who were exposed to three of the four forms of violence (i.e., non-physical violence, witnessing violence against parents, physical violence, and sexual abuse). Second, we tested our hypothesis using our data and found that resilience-individuals' capacity to handle adversity, as well as their use of social and cultural resources when facing adversity-moderates the association between poly-victimization and the onset of psychological problems.

Adaptation and psychometric properties of the ISPCAN Child Abuse Screening Tool for use in trials (ICAST-Trial) among South African adolescents and their primary caregivers

Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African sample. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior, discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.