The burden of child maltreatment in China: a systematic review

A Scoping Review of Parenting Programs for Preventing Violence Against Children in Low- and Middle-Income Countries

Violence against children affects their well-being globally, with a greater burden in low-and middle-income countries (LMICs). This scoping review aimed to summarize the available evidence on parenting programs for reducing violence against children in LMICs and identify knowledge gaps in this area. Six English databases and gray literature were systematically searched to identify studies in LMICs that examined the efficacy of parenting programs to prevent violence against children, before April 15, 2023. A total of 4,183 independent studies were identified, of which 31 met the inclusion criteria. The majority were conducted in Africa and Asia, delivered by trained local community/childcare workers and lay workers, and targeted younger children aged <10 years. Although the core modules varied in terms of number of group sessions and age of the children, the majority emphasized the importance of building a positive relationship with children and nonviolent discipline strategies. The vast majority demonstrated intervention efficacy in reducing general maltreatment and physical and emotional abuse, and improving positive parenting. Ineffective programs for violence tended to be characterized by self-designed programs, small sample sizes, and low corporal punishment levels in the baseline assessment. In conclusion, parenting programs are promising for preventing and reducing the risk factors for violence in LMICs. Future intervention studies should expand to low-income countries outside Eastern Africa with more trials targeting older children, utilizing direct observational assessments, designing core modules relevant to child neglect, involving more male caregivers, and conducting long-term follow-up assessments.

Retrospective ACEs predict complex PTSD symptoms in a large sample of Chinese young adults longitudinally: the moderating role of self-compassion

This longitudinal study in Mainland China (2021-2022) explored the impact of adverse childhood experiences (ACEs) on complex posttraumatic stress disorder (CPTSD) symptoms, with a focus on the role of self-compassion. Among 18,933 surveyed university students, 21.2% reported experiencing at least one ACE. Results revealed a clear relationship between ACEs and CPTSD symptoms. Furthermore, self-compassion, particularly the dimensions of self-judgment and isolation, moderated the association between retrospective ACEs and posttraumatic stress disorder (PTSD) and disturbance in self-organization (DSO) symptoms. These findings highlight the enduring impact of ACEs on CPTSD symptoms and emphasize the importance of early identification and targeted interventions, especially addressing self-judgment and isolation, to mitigate CPTSD risk among young Chinese adults.

Depressive Symptoms in Later Life in China: Situating "Long Arm" of Child Physical Maltreatment Within a Family Context

Objective: This article intends to reveal the long-term effects of physical maltreatment in childhood on depressive symptoms in later life in China. Methods: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS). 8676 respondents aged 45 and older were included in the study. In this study, we use ordinary least squares (OLS) regression models to estimate the long-term impact on children of physical punishment from their parents. Results: We found that individuals who recalled being hit by their mother in early life reported more depressive symptoms than those who recalled being punished by their father. Difficult family contexts (e.g., comparative poverty, family violence, and parent's poor mental health) had a weak association with higher risk of reporting physical maltreatment and more depressive symptoms among respondents in later life. Conclusion: This article extended the exploration of the long-term impact of child physical maltreatment beyond adolescence and into until later adult life. Effective policies to protect children from maltreatment in the form of physical punishment require further attention to the challenges posed by tradition and culture.

Childhood maltreatment and alcohol and tobacco use trajectories in rural Chinese adolescents

BACKGROUND

There is a high prevalence of childhood maltreatment among Chinese children and adolescents, but little is known about its impact on alcohol and tobacco use trajectories and how positive school and neighborhood environments moderate the associations. The objective of this study was to assess the association between multiple forms of childhood maltreatment and longitudinal alcohol and tobacco use trajectories, and to assess the possibility that perceived connections to school and neighborhood moderate these associations.

METHODS

This longitudinal cohort study included 2594 adolescents (9 to 13 years) from a low-income rural area in China. Childhood exposure to abuse and neglect was assessed using the Childhood Trauma Questionnaire. Participants reported past-month alcohol and tobacco use at three time points over 1 year.

RESULTS

Growth curve models revealed that childhood sexual abuse was associated with a higher risk of past-month drinking (OR = 1.53, 95% CI 1.19-2.03, p < 0.001) and smoking (OR = 1.82, 95% CI 1.30-2.55, p < 0.001). Neglect was associated with a higher risk of past-month drinking (OR = 1.52, 95% CI 1.06-1.90, p < 0.05) and smoking (OR = 2.02, 95% CI 1.34-3.02, p < 0.001). None of the maltreatment forms predicted a faster increase in either drinking or smoking. These associations were found independent of personal, family, and contextual characteristics. School and neighborhood connection moderated the association between physical abuse and past-month drinking, such that physical abuse was associated with a greater risk of drinking only for youth who perceived low school or neighborhood connections.

CONCLUSIONS

Findings demonstrate the importance of early experiences of childhood maltreatment for adolescent alcohol and tobacco use. Enhancing school and neighborhood connectedness for physically abused youth may help protect them from alcohol use.

The role of perceived social support from family, friends and significant others in the association between childhood maltreatment on sleep quality in adolescents: Evidence from a weekly diary study

BACKGROUND

Childhood maltreatment is a common problem that can have lasting effects on the physical and mental health of adolescents who have experienced it, including sleep quality.

OBJECTIVE

This study will investigate the relationship between childhood maltreatment and sleep quality in adolescents using a weekly diary method.

PARTICIPANTS AND SETTING

In this study, students from a middle school in central China were recruited as research subjects, and a total of 11 classes with 470 students were investigated.

METHODS

In order to fill in the gaps of previous studies, a weekly diary method was used to collect data. Subjects were required to complete three scales once a week for seven consecutive weeks, including the Childhood Trauma Questionnaire (CTQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Pittsburgh Sleep Quality Index scale (PSQI).

RESULTS

Findings suggest that childhood maltreatment has a negative impact on adolescent's sleep quality at the weekly level (γ01c = -0.07, t = -5.71, p < .001) . The negative effect of childhood maltreatment on sleep quality was significantly reduced with the addition of perceived social support (γ01c' = -0.03, t = -2.83, p < .01). Notably, support from friends (γ01a*γ02b = -0.01) and significant others (γ01a*γ02b = -0.02) also played an important mediating role in child maltreatment and adolescent sleep quality, but family support remained the most important support in adolescents (γ01a*γ02b = -0.04).

CONCLUSIONS

The present study has confirmed the negative correlation between childhood maltreatment and sleep quality in adolescents. Furthermore, it has clarified the mechanism of perceived social support and the separate mediating roles of perceived family support, perceived friend support, and perceived significant other support.

The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China

Childhood trauma is strongly linked to emotional distress. However, few studies have explored the impact of sense of coherence (SOC) on the relationship between childhood trauma and emotional distress in college students. This study aimed to explore its impact on the relationship between childhood trauma and emotional distress. Analyzing data from 2307 Chinese college students, we found that SOC moderated the association between childhood trauma and anxiety/depression levels. Females showed higher SOC and lower anxiety/depression despite experiencing more childhood trauma. Multiple linear regression revealed that anxiety was negatively associated with SOC(P < 0.001) and grade(P = 0.027), and positively with childhood trauma(P < 0.001) and male gender(P = 0.004). Similarly, the depression exhibited similar associations. SOC moderated negatively the relationship between CTQ and anxiety, as well as between CTQ and depression. Childhood trauma is associated with increased emotional distress risk among college students, but a strong SOC can reduce this risk.

Childhood maltreatment patterns and suicidal ideation: mediating roles of depression, hope, and expressive suppression

Childhood maltreatment has long-term negative effects on individuals' physical and mental well-being, and may increase the risk for suicidal ideation. However, how different patterns of childhood maltreatment affect subsequent suicidal ideation and the underlying mediating mechanisms remain unclear, particularly among Chinese adolescents. This study used latent profile analysis to identify patterns of childhood maltreatment among adolescents and explored how these patterns predicted subsequent suicidal ideation via depression, hope, and expressive suppression. This study used a two-wave, 1-year longitudinal design and included 2156 adolescents (Mage = 13.97 years, SDage = 1.61 years; 49.6% females). We identified three patterns of childhood maltreatment: low maltreatment, high psychological neglect, and high maltreatment. Compared with the low maltreatment group, the high maltreatment group indirectly predicted subsequent suicidal ideation 1 year later via depression through hope and expressive suppression, whereas the direct effect on suicidal ideation was not significant. Compared with the low maltreatment group, the high psychological neglect group had a significant direct effect on subsequent suicidal ideation and indirectly predicted suicidal ideation through depression or hope. Identifying patterns of childhood maltreatment among adolescents will assist mental health workers in developing targeted interventions to effectively alleviate suicidal ideation.

'We aren't valued for who we are': Australian nurses' and midwives' perceptions of challenges and barriers to safeguarding children

PURPOSE

Professionals working with children, including nurses and midwives, are foundational to effectively safeguarding children from maltreatment. However, little is known about the full nature and scope of nurses' and midwives' roles in safeguarding children in Australia presenting barriers to effective workforce preparation and support.

DESIGN AND METHODS

This study reports an inductive analysis of qualitative responses (n = 51 Round 1, n = 17 Round 2) from a two-round Delphi study. The Delphi study aimed to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children, and this manuscript presents findings of an inductive analysis of qualitative responses beyond the scope of the Delphi study. Participants were Australian nurses and midwives (n = 51, n = 17) from diverse child-focussed settings.

RESULTS

Nurses and midwives experienced many factors outside of their control that restricted their capacity to safeguard children. Influences included high workloads, burnout, lack of support, poor collaboration, structural barriers and inaccessible services for children.

CONCLUSIONS

Nurses and midwives are advocates for children but experienced many factors preventing them from effectively safeguarding children. Future approaches to reducing child maltreatment must be underpinned by support for frontline professionals to promote workforce capacity and sustainability.

PRACTICE IMPLICATIONS

Despite nurses' and midwives' best intentions, their attempts to prevent and respond to child maltreatment were hampered by systemic factors beyond their control. This study highlighted the need to address broader influences on nursing and midwifery practice to reduce the impacts of child maltreatment and support children to thrive.

Why emotional neglect brings suicidal ideation? The mediating effect of meaning in life and the moderating effect of post-stress growth

BACKGROUND

Emotional neglect during childhood has long-lasting negative effects on individuals, and it is often hidden and unrecognized. Previous research has not fully understood its unique effects on mental health outcomes, especially when considering the co-occurrence with other forms of maltreatment. The meaning-making coping and growth model suggests that individuals achieve positive psychological outcomes by constructively integrating negative experiences into their self-concept, which may be a protective mechanism against the detrimental effects of emotional neglect.

OBJECTIVE

This study aimed to examine the relationship between emotional neglect and suicidal ideation among undergraduates, accounting for the presence of emotional abuse and physical neglect, and to investigate the mediating role of meaning in life and the moderating role of post-stress growth in this relationship.

METHODS

A self-reported survey was conducted with 3132 undergraduate students from a university in South China. The survey assessed emotional neglect, emotional abuse, physical neglect, suicidal ideation, post-stress growth, and meaning in life.

RESULTS

Meaning in life partially mediated the relationship between emotional neglect and suicidal ideation. Post-stress growth moderated the association between emotional neglect and the sense of meaning in life, in particular the moderation effect was stronger when emotional abuse was weaker.

CONCLUSIONS

Meaning in life mediated the relationship between emotional neglect and suicide ideation. Post-stress growth moderated the mediation effect such that it was weakened among individual with a higher level of post-stress growth. This study contributes to the understanding of the psychopathological processes following emotional neglect and the development of positive personal changes thereafter.

Childhood maltreatment and depressed mood in female college students: A daily diary analysis

BACKGROUND

Childhood maltreatment has well-documented relations with depressed mood. However, few studies have used a daily diary methodology to investigate the association between all five forms of childhood maltreatment (emotional, physical, and sexual abuse, emotional and physical neglect) and depressed mood, and the mechanisms underlying the association remain unclear.

OBJECTIVE

The current study sought to examine the associations of multiple forms of childhood maltreatment with depressed mood via a 14-day daily diary methodology, and investigate the mediating effects of self-compassion and perceived social support.

METHODS

A sample of 220 Chinese female college students (Mage = 19.13 years) participated in this study and completed questionnaires regarding childhood maltreatment, self-compassion, perceived social support and depressed mood.

RESULTS

The multilevel regression analysis indicated that only emotional abuse was slightly associated with depressed mood, while emotional neglect, physical abuse, physical neglect, or sexual abuse were not associated with depressed mood. The multilevel mediation analysis further revealed that self-compassion and perceived social support independently mediated the association of childhood emotional abuse with depressed mood.

CONCLUSIONS

Overall, these results emphasize the specific association between childhood emotional abuse and daily depressed mood, and further support self-compassion and perceived social support as explanatory mechanisms linking childhood emotional abuse with later depressed mood.

Interprofessional Education in Child Protection for Preservice Health and Allied Health Professionals: A Scoping Review

Health and allied health professionals are uniquely positioned to collaborate in prevention, early intervention and responses to child maltreatment. Effective collaboration requires comprehensive interprofessional education (IPE), and inadequate collaboration across sectors and professions continually contributes to poor outcomes for children. Little is known about what interprofessional preparation health and allied health professionals receive before initial qualification (preservice) that equips them for interprofessional collaboration and provision of culturally safe care in child protection. This scoping review aimed to identify what is known internationally about IPE in child protection for preservice health and allied health professionals. Thirteen manuscripts reporting 12 studies met the inclusion criteria and were included in the synthesis. Key characteristics of the educational interventions are presented, including target disciplines, core content and their learning objectives and activities. Findings demonstrated primarily low-quality methodologies and educational interventions that had not been replicated beyond their initial context. Many educational interventions did not provide comprehensive content covering the spectrum of prevention, early intervention and responses for all types of child maltreatment, and/or did not clearly indicate how IPE was achieved. Key challenges to delivering comprehensive interprofessional child protection include lack of institutional support and competing priorities across disciplines who must meet requirements of separate regulatory bodies. Consequently, there is a need for further development and robust evaluation of educational interventions to explore how interprofessional collaborative skills for child protection can be developed and delivered in preservice health and allied health professional education.

Nonlinear Moderation Effect of Vagal Regulation on the Link between Childhood Trauma and Adolescent Internalizing and Externalizing Symptoms

Childhood trauma is a leading early adverse environment that increases psychopathological symptoms. Respiratory sinus arrhythmia (RSA) suppression to challenges as a marker of self-regulation is found to linearly moderate the link between early adverse experiences and psychopathological symptoms, but yielding mixed findings. The present study examined the relationships between childhood trauma and internalizing and externalizing symptoms via a 1.5-year longitudinal design and the quadratic moderation effect of RSA suppression on these relationships among adolescents. In November 2021 (T1), the final sample of 275 Chinese adolescents (Mage = 12.94, SDage = 0.79; 49.82% females) completed the short form of Childhood Trauma Questionnaire and the Achenbach Youth Self-Report-2001 and underwent a speech task during which their baseline RSA and stress exposure RSA were obtained. In June 2023 (T2), 251 adolescents completed the Achenbach Youth Self-Report-2001. Results showed that childhood trauma at T1 was positively correlated with internalizing and externalizing symptoms at T1 and T2. RSA suppression to stress quadratically moderated these associations, such that adolescents with moderate rather than higher or lower RSA suppression had the least internalizing and externalizing symptoms at T1 and T2 when exposed to childhood trauma. The findings suggest that moderate RSA suppression to stress as a marker of optimal vagal regulation buffers the risk of developmental psychopathology from early adverse experiences.

Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review

Health professionals play a significant role in identifying and reporting child physical abuse (CPA). However, several studies have pointed out non-reporting behavior among these professionals, evidencing difficulties identifying and reporting suspected cases. This review aimed to explore the frequency and possible barriers in identifying and reporting CPA by health professionals worldwide and to identify associated factors. This scoping review was conducted in the Pubmed, Web Of Science, Scopus, and SciELO databases between July 2019 and December 2020. Analytical and qualitative observational epidemiological studies were selected and published in English, Portuguese, and Spanish, with data on the identification and/or reporting of CPA by health professionals. Twenty studies fulfilled the criteria of this review. The studies were conducted with dentists, nurses, pediatricians, and general practitioners. The frequency of identification of CPA ranged from 50% to 89%, while the frequency of reporting ranged from 8% to 47%. This review revealed that health professionals had a low frequency of reporting of CPA, especially for dentists. In addition, several associated factors and barriers in the identification and reporting of CPA were identified in the studies. These were discussed in five main themes: training and continuing education in CPA, impact on professional practice, experiences and perceptions about child protection services, the threshold for suspicion of the professional, and the professional category.

The efficacy of an evidence-based parenting program in preventing child maltreatment in mainland China

BACKGROUND

There is limited evidence regarding the effectiveness of online parenting programs for preventing child maltreatment in low- and middle-income countries. Therefore, this study aimed to examine the effectiveness of the online Parenting for Lifelong Health for Young Children (PLH-YC) program in preventing child maltreatment among Chinese families specifically.

METHODS

A quasi-experiment was conducted, wherein 274 parents with children aged 2-9 years were assigned to either the online PLH-YC group (n = 135) or a waitlist control group (n = 139). Data were collected at baseline and one week after intervention. A difference-in-differences (DiD) design with propensity score weighting was used to estimate the between-group difference for child maltreatment as well as the associated risk and protective factors.

RESULTS

Compared to the parents in the control group, parents in the online PLH-YC intervention reported a significant reduction in the occurrence of corporal punishment (b = -1.21; 95 % CI [-2.37, -0.03]), emotional abuse (b = -3.09; 95 % CI [-5.36, -0.82]), and general maltreatment (b = -4.94; 95 % CI [-8.86, -1.02]) as well as an increased frequency of positive parenting strategies (b = 6.46; 95 % CI [2.21, 10.72]). Additionally, parents with high levels of depressive symptoms were significantly more likely to drop out of the program, and those with lower education levels engaged in fewer sessions.

CONCLUSION

The online PLH-YC program can benefit families with young children by reducing the incidence of child maltreatment through improved positive parenting strategies. More randomized controlled trials with long-term follow-ups are required to further verify the accuracy of the results obtained in this study.

Association of childhood adversities with psychosocial difficulties among Chinese children and adolescents

BACKGROUND

Adverse childhood experiences (ACEs) have been well recognized as risk factors for various adverse outcomes. However, the impacts of ACEs on psychological wellbeing among Chinese children and adolescents are unknown.

METHODS

In total, 27 414 participants (6592 Grade 4-6 and 20 822 Grade 7-12 students) were included and information on ACEs and various psychosocial outcomes was collected. We identified subgroups with distinct psychosocial statuses using cluster analysis and logistic regression was applied to measure the associations of ACEs [individual, cumulative numbers by categories or co-occurring patterns identified by using multiple correspondence analysis (MCA)] with item- and cluster-specific psychosocial difficulties.

RESULTS

Three and four cluster-based psychosocial statuses were identified for Grade 4-6 and Grade 7-12 students, respectively, indicating that psychosocial difficulties among younger students were mainly presented as changes in relationships/behaviours, whereas older students were more likely featured by deviations in multiple domains including psychiatric symptoms and suicidality. Strongest associations were found for threat-related ACEs (e.g. bullying experiences) with item- or cluster-based psychosocial difficulties (e.g. for cluster-based difficulties, the highest odds ratios = 1.72-2.08 for verbal bullying in Grade 4-6 students and 6.30-12.81 for cyberbullying in Grade 7-12 students). Analyses on cumulative numbers of ACEs and MCA-based ACE patterns revealed similar risk patterns. Additionally, exposure patterns predominated by poor external environment showed significant associations with psychosocial difficulties among Grade 7-12 students but not Grade 4-6 students.

CONCLUSIONS

Chinese adolescents faced different psychosocial difficulties that varied by age, all of which were associated with ACEs, particularly threat-related ACEs. Such findings prompt the development of early interventions for those key ACEs to prevent psychosocial adversities among children and adolescents.

A Meta-Analytic Review of the Impact of Child Maltreatment on Self-Esteem: 1981 to 2021

An increasing number of studies have examined the relationship between child maltreatment and self-esteem. In this study, we assess the magnitude of this association through a meta-analytic approach. Four English databases (PubMed, PsycINFO, PsycARTICLES, and Web of Science), three Chinese databases (China National Knowledge Infrastructure, Wanfang, and Weipu), and grey literature were systematically searched. A total of 254 independent studies, including 550 effect sizes, met the inclusion criteria for this meta-analysis. Child maltreatment was significantly and negatively associated with self-esteem (P C C ¯  = -0.24, p < .001); emotional abuse and neglect were associated with decreased self-esteem (P C C ¯  = -0.23, p < .01; P C C ¯  = -0.22, p < .01, respectively) at a moderate level; and physical abuse, sexual abuse, and physical neglect were negatively associated with self-esteem (P C C ¯  = -0.14, p < .01; P C C ¯  = -0.14, p < .01; P C C ¯  = -0.17, p < .001, respectively) at a small level. Furthermore, the meta-regression results suggested that the aggregated associations between child maltreatment and self-esteem were not inflated by publication bias, but they were moderated by age and culture. General and subtypes of child maltreatment are associated with decreased self-esteem. Evidence-based and culturally sensitive child maltreatment prevention and intervention programs should be developed and implemented as early as possible.

Sexual orientations in association between childhood maltreatment and depression among undergraduates in mainland of China

BACKGROUND

There is growing evidence that sexual minorities including lesbian, gay, bisexual and questioning individuals (LGBQ) have significantly higher rates of childhood maltreatment than heterosexuals. However, few studies focused on the association between different type of childhood maltreatment and depression in LGBQs.

METHODS

Cross-sectional study by random sampling was conducted among the undergraduates in mainland of China. A total of 1920 undergraduates from different majors and colleges completed self-report questionnaires to record depression, childhood maltreatment, sexual orientation and other related information. The associations were examined via a set of logistic regression analysis.

RESULTS

Compared to the participants who had never experienced childhood maltreatment, the participants who reported emotional abuse (p < 0.001) and sexual abuse (p < 0.05) had higher odds of depression. The LGBQs have higher risk of being the victims of childhood maltreatment. The prevalence of depression was much higher in the LGBQ than that in the heterosexuals (33.9 % vs 16.1 %, χ2 = 43.627, p < 0.001). Compared to heterosexual adolescents, LGBQs had significantly higher odds of depression (p < 0.001).

LIMITATIONS

Cross-sectional design, self-reported information, and unable to examine underlying protective factors.

CONCLUSIONS

Emotional abuse, emotional neglect and sexual abuse have stronger association with LGBQ than other kind of childhood maltreatment. Emotional abuse and sexual abuse have stronger association with depression. Sexual abuse has stronger association with depression in LGBQs than heterosexuals. More attention to the mental health should be paid especially in LGBQs to reduce the risk of depression.

Effect of a mental health education intervention on children's life satisfaction and self-confidence in rural China

Children living in rural areas may potentially experience low levels of life satisfaction and face challenges in developing self-confidence. The purpose of the current study was to examine the impact of a mental health education intervention on the life satisfaction and self-confidence of children residing in rural areas of China. A total of 1,001 children from grades 4 to 6 were randomly assigned to an intervention group (475 children, 250 boys, M = 11.57 years, SD = 1.082 years) and a control group (526 children, 279 boys, M = 11.38 years, SD = 0.980 years). Over 16 weeks, the intervention group received a mental health education program, while the control group did not. The levels of life satisfaction (including five dimensions: family, school, environmental, friends, and self-satisfaction) and self-confidence (including three dimensions: self-efficacy, self-assurance, and self-competence) were rated by all children at baseline and post-intervention. Results from paired samples t-test showed that post-intervention, the intervention group exhibited significant improvements in the areas of family, environmental, school, and self-satisfaction as well as self-efficacy, self-assurance, and self-competence. However, there was no significant improvement in friend satisfaction. Conversely, the control group showed decreases in school, environmental, and friend satisfaction, along with decreases in self-efficacy, self-assurance, and self-competence. No significant change was observed in family and self-satisfaction in this group. These findings emphasize the importance of implementing mental health education interventions for rural children, who are at risk for low life satisfaction and self-confidence. Some specific recommendations are provided for policymakers and practitioners.

Childhood abuse as a mediator of the relationship between early family socio-economic status and geriatric depression: A population-based study in China

Previous studies have suggested that childhood socioeconomic status (SES) is linked to geriatric depressive symptoms in many developed countries. However, the potential pathways of the relationship between childhood SES and geriatric depressive symptoms need to be further explored. This study aimed to assess the mediating effect of being abused during childhood on the association between childhood SES and geriatric depressive symptoms, using evidence from a longitudinal study in China. The study cohort included 8137 individuals. Childhood abuse was defined as experiences related to parental violence, sibling abuse, school violence, community violence, and parental quarrel. Results indicated poor childhood SES was associated significantly with geriatric depressive symptoms. The indirect effect of poor childhood SES to high geriatric depressive risk through community violence, sibling abuse, school violence, and parental quarrel were 0.02, 0.01, 0.02, and 0.01, respectively. Our findings shed new light on the literature regarding the impact of childhood SES on elderly depressive symptoms. Furthermore, childhood SES demonstrated a significant correlation with geriatric depressive symptoms through bullying behaviors. The findings highlight the need to promote both childhood social welfare and psychological well-being within the elderly population.

Impact of childhood maltreatment on adult resilience

BACKGROUND

Previous studies suggested that childhood maltreatment is associated with poor health outcomes. While not everyone who experiences abuse as a child goes on to experience poor mental health, some traumatized people are grown to be more resilient than others. Few studies have examined the association between childhood maltreatment and adult resilience. This study aimed to determine different relationships between specific types and features of childhood maltreatment with adult resilience among Chinese with Major Depressive Disorder (MDD) and healthy controls (HCs).

METHODS

A total of 101 patients with MDD and 116 participants in the healthy control (HC) group from Zhumadian Psychiatric Hospital and its nearby communities were included in this analysis. Childhood maltreatment was assessed retrospectively using Childhood Trauma Questionnaire (CTQ). Adults' resilience was assessed by the Connor-Davidson Resilience Scale (CD-RISC). Generalized linear models were applied between childhood maltreatment (specific types and features) and resilience adjusting for covariates.

RESULTS

The total score of CD-RISC and factor scores of strength, optimism, and tenacity in the HC group were higher than those in the MDD group. CTQ total score had a negative association with optimism score among participants in MDD (β=-0.087, P < 0.001) and HC (β=-0.074, P = 0.023) groups. Higher emotional neglect (EN) score (β=-0.169, P = 0.001) and physical neglect (PN) score (β=-0.153, P = 0.043) were related to a worse optimism score in MDD group. Emotional abuse (EA) score was associated with a worse tenacity score (β=-0.674, P = 0.031) in MDD group. For participants in HC group, higher EN and PN scores were related to worse resilience scores (tenacity, strength, and optimism).

CONCLUSIONS

Patients with MDD showed lower optimism than HCs. Childhood maltreatment, especially childhood negect, independently contributed to optimism, with more severe childhood maltreatment predictive of worse performance of optimism. EA in childhood was also linked to worse tenacity in adult patients with MDD.

The Effects of Early-Life Stress on Liver Transcriptomics and the Protective Role of EPA in a Mouse Model of Early-Life-Stress-Induced Adolescent Depression

Early-life stress (ELS) was found to increase the risk of adolescent depression, and clinical evidence indicated that eicosapentaenoic acid (EPA) was decreased in patients with adolescent depression, but the underlying mechanisms are unclear. Here, we utilized an ELS model of maternal separation with early weaning to explore the protective role of EPA in adolescent depression. We found that that ELS induced depression-like behavior rather than anxiety-like behavior in adolescent mice. RNA-sequencing results showed that ELS changed the transcription pattern in the liver, including 863 upregulated genes and 971 downregulated genes, especially those related to the biosynthesis of unsaturated fatty acids metabolism in the liver. Moreover, ELS decreased the expression of the rate-limiting enzymes, fatty acid desaturases 1/2 (FADS1/2), involved in the biosynthesis of EPA in the liver. Additionally, ELS reduced the levels of EPA in the liver, serum, and hippocampus, and EPA administration improved depression-like behavior-induced by ELS. Our results provide transcriptomic evidence that ELS increases the risk of adolescent depression by reducing the synthesis of unsaturated fatty acids in the liver, especially EPA, and suggest that supplementation with EPA should be investigated as a potential treatment for adolescent depression.

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.

Gender-specific associations between types of childhood maltreatment and major depressive disorder: A matched case-control study

INTRODUCTION

Major depressive disorder (MDD) has been found to be nearly twice as prevalent in females as in males. One hypothesis proposed that abused females were particularly prone to MDD. We aim to examine the sex-specific associations between various types of childhood trauma and MDD.

METHODS

In this study, 290 outpatients diagnosed with MDD were recruited from Beijing Anding Hospital, and 290 healthy volunteers were recruited from neighborhoods nearby the hospital, with sex, age, and family history matched. Childhood Trauma Questionnaire-Short Form (CTQ-SF) developed by Bernstein et al. was used to assess the severity of five different types of childhood abuse and neglect. McNemar's test and conditional logistic regression models with potential confounders (i.e., marital status, educational level, and body mass index) controlled were used to explore the sex-specific associations between different types of childhood maltreatment and MDD.

RESULTS

In the full sample, patients with MDD showed a significant higher rate of any childhood maltreatment (i.e., emotional abuse, sexual abuse, physical abuse, emotional neglect, and physical neglect). Among females, all types of childhood abuse were statistically significant. For males, significant differences were only found in emotional abuse and in emotional neglect.

CONCLUSION

It would appear that MDD in the outpatients is associated with any type of childhood trauma in women and emotional abuse or neglect in men.

Gender difference in the associations of childhood maltreatment and non-suicidal self-injury among adolescents with mood disorders

Background

Non-suicidal self-injury (NSSI) is a common feature among adolescents with mood disorders. Although childhood maltreatment has shown to be associated with non-suicidal self-injury (NSSI), previous studies have yielded mixed results in terms of different subtypes of childhood maltreatment and only few studies have investigated the effects of gender. The present cross-sectional study investigated effects of different types of childhood maltreatment on NSSI, as well as the role of gender in these effects.

Methods

In this cross-sectional study, a total of 142 Chinese adolescent inpatients with mood disorders (37 males and 105 females) were consecutively recruited within a psychiatric hospital. Demographic and clinical characteristics were collected. Participants were administered the Childhood Trauma Questionnaire (CTQ), the Functional Assessment of Self-Mutilation (FASM).

Results

76.8% of the sample reported engaging NSSI in the previous 12  months. Female participants were more likely to engage in NSSI than males (p < 0.001). Participants in the NSSI group reported significantly more experiences of emotional abuse (p < 0.001) and emotional neglect (p = 0.005). With regards to gender differences, female participants who have experienced emotional abuse were more likely to engage in NSSI (p = 0.03).

Conclusion

As a whole, NSSI represents a frequent phenomenon among adolescent clinical populations and females were more likely to engage in NSSI than males. NSSI was significantly related to experiences of childhood maltreatment and specifically related to emotional abuse and emotional neglect over and above other types of childhood maltreatment. Females were more sensitive to emotional abuse than males. Our study highlights the importance of screening for subtypes of childhood maltreatment as well as considering the effects of gender.

School-based Psychosocial interventions on mental health among Chinese rural children with traumatic experiences: a protocol using cluster randomized controlled trial

BACKGROUND

The first aim of this study is to test the effectiveness of school-based psychosocial interventions for improving mental health in rural Chinese children with traumatic experiences. The second aim is to examine which individual, family and school related factors could explain the effectiveness of school-based psychosocial interventions. Third, we will investigate whether individual, family, and school related conditions play a moderator role on the effectiveness of school-based psychosocial interventions.

METHODS

This study will conduct a cluster randomized controlled trial (RCT) in a large sample of Chinese rural children. Four rural counties in Shandong (Central China), Henan (Central China), Inner Mongolia (Northern China), and Xinjiang (Western China) will be selected as study settings from which schools will be sampled. Each sampled school will be randomly allocated either the intervention groups or a control group. Randomization will be performed by the research member who is not involved in the intervention stage. In each school students in grade 5 or higher will be recruited to ensure that approximately 50 children aged 10 to 18 years will be included. In each county, one high school, one middle school, and one primary school will be randomly chosen as the intervention group, and the other three similar schools will be chosen as control (waiting list) groups. A standardized and uniform research protocol will be applied in all intervention schools. All school social workers and psychological teachers would receive one week of in-person training following procedures. School-based psychosocial interventions included 14 group sessions for 14 consecutive weeks.

DISCUSSION

This study would develop school-based mental health promotion policy recommendations to improve Chinese rural children's mental health. This study can provide solid evidence for the promotion of school-based intervention in general.

TRIAL REGISTRATION

ChiCTR2300069405, Registered on 15 March 2023.

Childhood adversity and depression in Chinese populations: A multilevel meta-analysis of studies using the Childhood Trauma Questionnaire (CTQ)

To estimate the association between childhood adversity (CA) and depression in Chinese populations in studies using the Childhood Trauma Questionnaire (CTQ), a literature retrieval from established databases between 2005 and 2020 was conducted. A total 40 eligible studies with 145 effect sizes were included in subsequent analyses. Using a multi-level meta-analysis, we found a pooled effect size of r = 0.24, p < 0.001, CI = [0.20, 0.27] for the association between CA and depression. No publication bias was shown by Egger's test, t (160) = -0.27, p = 0.79. The between-study variance was moderate but significant, with 39.75% of the total variance attributable to differences between studies. Results of moderation analysis based on subtypes of CA showed that emotional abuse was associated most strongly with depression. In addition, results of moderation analysis focusing on geographic regions and CTQ subscales showed that the association between SA and depression was stronger in Southern than Central China. Our findings demonstrated clearly the advantages of using a multi-level approach to arrive at a more accurate estimate of pooled effect sizes. The differential associations between CTQ subscales and depression and the moderating effect of geographic regions on the association between sexual abuse and depression point clearly to the need of increased attention to the effects of CA subtypes and socio-cultural factors in future research on CA and mental disorders. These findings provide a preliminary empirical basis for researchers to address specific hypotheses of associations between CA subtypes and specific mental disorders in China.

The prevalence and nature of multi-type child maltreatment in Australia

OBJECTIVES

To determine the prevalence in Australia of multi-type child maltreatment, defined as two or more maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence) and to examine its nature, family risk factors, and gender and age cohort differences.

DESIGN

Retrospective cross-sectional survey using a validated questionnaire.

SETTING AND PARTICIPANTS

Mobile phone random digit-dial sample of the Australian population aged 16 years and older.

MAIN OUTCOME MEASURES

National estimates of multi-type child maltreatment up to age 18 years using the Juvenile Victimisation Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study).

RESULTS

Of 8503 participants, 62.2% (95% CI, 60.9-63.6%) experienced one or more types of child maltreatment. Prevalence of single-type maltreatment was 22.8% (95% CI, 21.7-24.0%), whereas 39.4% (95% CI, 38.1-40.7%) of participants reported multi-type maltreatment and 3.5% (95% CI, 3.0-4.0%) reported all five types. Multi-type maltreatment was more common for gender diverse participants (66.1% [95% CI, 53.7-78.7%]) and women (43.2% [95% CI, 41.3-45.1%]) than for men (34.9% [95% CI, 33.0-36.7%]). Multi-type maltreatment prevalence was highest for those aged 25-44 years. Family-related adverse childhood experiences - especially mental illness and alcohol or substance misuse - increased risk. Exposure to domestic violence was the maltreatment type most often present in multi-type maltreatment patterns.

CONCLUSIONS

Multi-type child maltreatment is prevalent in Australia and more common in women and gender diverse individuals. Child protection services, health practitioners, and prevention and intervention services must assess and manage multi-type maltreatment in children and address its health consequences across the lifespan. Public health policy should consider prevention services or strategies that target multi-type child maltreatment.

Effects of Childhood Maltreatment on Self-Compassion: A Systematic Review and Meta-Analysis

BACKGROUND

This systematic review aims to estimate the extent to which childhood maltreatment influences self-compassion in later life.

METHOD

Four English databases (Web of Science, PsycINFO, PubMed, and PsycARTICLES) and three Chinese databases (China National Knowledge Infrastructure, Wanfang, and Weipu) were systematically searched. We extracted data related to the associations between child maltreatment and self-compassion and pooled them using random effect models.

FINDINGS

A total of 20 eligible studies were included involving 6,877 participants in the analyses. Overall child maltreatment was negatively related to self-compassion (r = -.28, p < .001); emotional abuse and neglect were negatively related to self-compassion (r = -.28, p < .01; r = -.31, p < .01, respectively) at a moderate level; and physical abuse, sexual abuse, and physical neglect were negatively related to self-compassion (r = -.12, p < .01; r = -.10, p < .01; and r = -.22, p < .001, respectively) at a small level.

CONCLUSION

The results indicate that overall and subtypes of maltreatment are associated with decreased self-compassion, and child intervention programs focused on self-compassion should be designed to protect the well-being of individuals with a history of childhood maltreatment.

Parental absence, early reading, and human capital formation for rural children in China

In this study, we adopt the human capital formation framework to understand the association of the various risk and protective factors in the family settings of rural children with their cognitive performance as measured by vocabulary and math test scores. We examine the role of caregiver reading or storytelling to children at younger age and the deprivation of parental care due to labor migration at different stages of childhood on child performance in vocabulary and math tests when they are over 10 years old. Our findings confirm the crucial role of parental presence in child's cognitive development both during early childhood and later ages. Extended periods of parental absence during early and later years of childhood are most pernicious for child cognitive performance. Our analysis also reveals significantly positive effect of caregiver reading and storytelling on children's vocabulary test performance. This study provides strong evidence for the benefits of programs that promote good parenting practice and caregiver involvement in child cognitive development.

Association between childhood sexual abuse and early sexual debut among Chinese adolescents: The role of sexual and reproductive health education

Background

Despite accumulating evidence of the long-term impacts of childhood sexual abuse (CSA), few studies have investigated the association between CSA and early sexual debut among adolescents. In this study, we examine the relationship between CSA and early initiation of sexual intercourse among Chinese youth, and the role of school-based sex education in this association, based on a nationally representative survey.

Methods

Data were collected from the Survey of Youth Access to Reproductive Health in China (YARHC) conducted in 2009. Multivariable logistic regression models were used to investigate the association between CSA experience and early sexual debut, and the interaction terms between sexual and reproductive health education and CSA were included to examine the role of education in the association between CSA and early sexual debut.

Results

Among 4,907 sexually experienced youth, 1,062 (21.6%) made their early sexual debut. After adjusting for sociodemographic characteristics, it was found that CSA experience was significantly associated with early sexual debut, with an adjusted odds ratio of 3.13 (95% CI: 1.67-5.87). Receiving any type of sexuality education (reproductive health, sexually transmitted disease (STD) and HIV prevention, or contraception use) was not associated with a decreased risk of early sexual debut.

Conclusion

Our results indicate a greater risk of early sexual debut among Chinese adolescents with a history of CSA, and only 46.7% sexually experienced youth had received prior sex education, which suggested an inadequacy of school-based sexuality education. To reduce this risk, targeted intervention with timely and adequate sexuality education for both early starters of sexual intercourse and CSA victims is warranted in China.

The relevant research of adverse childhood experiences and "risky drinking" in children of alcoholics in China

OBJECTIVE

To determine whether adverse childhood experiences (ACEs) of children of alcoholics (COA) in male were associated with their current "risky drinking".

METHODS

This case-control study used the Alcohol Use Disorder Identification Test (AUDIT, cutoff is 7) to divide the participants into two groups, a "risky drinking" group (N = 53) and a "non-risky drinking" group (N = 97). Demographic data, Adverse Childhood Experiences-International Questionnaire (ACE-IQ), the Hamilton Anxiety Rating Scale (HAMA), the Hamilton Depression Rating Scale (HAMD) and the Mini-International Neuropsychiatric Interview (MINI) were used for assessment. The specific relationships between ACEs and "risky drinking" were explored.

RESULTS

Respondents ranged in age from 29.70 ± 6.72 years; 74.5% were females; 94.7% were of Han nationality; 56.7% had a level of education above high school; 12% had no formal or stable job. There was difference in attitude to self-drinking between two groups (P < 0.001). The "risky drinking" group was more likely to have experienced a major depressive episode (P < 0.05), nonalcohol psychoactive substance use disorder (P < 0.01) and bulimia nervosa (P < 0.05), and they also experienced more physical abuse (P < 0.05), community violence (P < 0.001) and collective violence (P < 0.01). In a single factor logistic regression, physical abuse, community violence and collective violence were associated with a two to 11- fold increase in "risky drinking" in the adult COA, and in multiple factor logistic regression, community violence showed a graded relationship with "risky drinking".

CONCLUSION

The childhood adverse experiences contribute to "risky drinking" in COA. This finding in the Chinese context have significant implications for prevention not only in China but in other cultures. There must be greater awareness of the role of ACEs in the perpetuation of alcoholism.

Early Childhood Neglect Among 3- to 6-Year-Old Children in China: A Meta-Analysis

BACKGROUND

This review aims to estimate the prevalence of the neglect of 3- to 6-year-old children in China.

METHOD

We systematically searched both English- (Web of Science, PsychINFO, PubMed, and Cochrane Library) and Chinese-language databases (China National Knowledge Infrastructure, Wanfang, Weipu, and Biomedical Database). We extracted data related to the prevalence of early childhood neglect and its subtypes and pooled it using random effects models.

FINDINGS

We included 21 eligible studies, with a total of 35,175 3- to 6-year-old children, in the analyses. The pooled neglect prevalence was 32.1% at a 95% confidence interval (95% CI [27.0%, 37.2%]). The prevalence of physical, emotional, educational, security, and medical neglect was 15.2% (95% CI [11.9%, 18.5%]), 15.2% (95% CI [10.7%, 19.6%]), 10.4% (95% CI [7.4%, 13.4%]), 13.8% (95% CI [9.9%, 17.8%]), and 11.5% (95% CI [8.1%, 14.9%]), respectively. No gender or location differences were found to affect early childhood neglect or its subtypes.

INTERPRETATION

Our results revealed a high prevalence of early childhood neglect-including all its subtypes-among 3- to 6-year-old children in China. Improved child policies and prevention programs tailored to preschool children are needed to protect the well-being of younger children.

Association of Child Sexual Abuse Victimization and Murderous Behaviors and the Mediating Role of Psychological Adjustment among College Students in China

A history of child sexual abuse (CSA) is associated with a variety of psychological issues and conduct disorders in adolescents. However, little is known about the association between CSA and its characteristics and murderous behaviors in young adults. The purpose of this study was to examine this relationship and explore the mediating effect of psychological adjustment (PA). A cross-sectional study was conducted with 4034 college students in Anhui Province, China. The participants were invited to complete self-report questionnaires regarding the history of CSA, self-perceived PA and murderous behaviors. PA was evaluated by two of the most important indicators: resilience and emotional release. Mediation analyses were computed via parallel mediation models. Of the participants, 14.1% reported experiencing CSA. After controlling for potential confounders, CSA victimization was robustly and positively associated with murderous ideation (OR: 2.36, 95% CI: 1.77-3.14), murderous plans (OR: 4.02, 95% CI: 2.63-6.12), murderous preparation (OR: 3.87, 95% CI: 2.37-6.31), and murderous attempts (OR: 5.35, 95% CI: 3.11-9.21). CSA victimization that was persistent and of the combined contact or noncontact types greatly increased the risk of murderous behaviors. A dose-response relationship was observed between the duration of experienced CSA and murderous behaviors. Furthermore, the results of the mediation analysis revealed that PA partially mediated the relationship between CSA victimization and murderous behaviors. Therefore, PA protects against the development of murderous behaviors in abused individuals. These findings have important implications for the prevention and intervention of murderous behaviors in adolescents who experienced CSA, highlighting the importance of considering PA as a protective role in this relationship.

Child Maltreatment and Long-Term Physical and Mental Health Outcomes: An Exploration of Biopsychosocial Determinants and Implications for Prevention

Child maltreatment rates remain unacceptably high and rates are likely to escalate as COVID-related economic problems continue. A comprehensive and evidence-building approach is needed to prevent, detect and intervene where child maltreatment occurs. This review identifies key challenges in definitions, overviews the latest data on prevalence rates, reviews risk and protective factors, and examines common long-term mental health outcomes for children who experience maltreatment. The review takes a systems approach to child maltreatment outcomes through its focus on the overall burden of disease, gene-environment interactions, neurobiological mechanisms and social ecologies linking maltreatment to mental ill-health. Five recommendations relating to the accurate measurement of trends, research on brain structures and processes, improving the reach and impact of teleservices for detecting, preventing and treating child maladjustment, community-based approaches, and building population-focused multidisciplinary alliances and think tanks are presented.

Association between Child Abuse, Depression, and School Bullying among Chinese Secondary School Students

INTRODUCTION

School bullying is a serious social and public health problem. This article aims to explore the association between experiences of childhood abuse and involvement in school bullying, especially considering the mediating effects of depression.

METHODS

The sample of this study was 3059 students (1584 males and 1475 females) aged from 12 to 20, in eleven Chinese secondary schools, which included six middle schools, four high schools, and one vocational high school in both urban and rural areas. The multinomial logit regression and linear regression were conducted by the two gender groups, to determine the mediating effect of depression in the association between child abuse experiences and involvement in school bullying.

RESULTS

This study indicated that female students were less likely to be involved in school bullying. Male students were more represented in the bully-victim group and experienced more physical and mental abuse during childhood. Depression was a mediator between childhood abuse and involvement in school bullying. Nevertheless, there was a gender difference in that depression fully mediated the relationship between the two variables among female students, while it only partially meditated such a relationship for male students.

CONCLUSIONS

These findings indicate that more school-based service interventions and evidence-based research are needed to more thoroughly investigate school bullying and its predictors in China.

PTSD and depressive symptoms in Chinese adolescents exposed to multiple stressors from natural disasters, stressful life events, and maltreatment: A dose-response effect

Objectives

Little is known about the effects and the extent that childhood adversity has on post-traumatic stress disorder (PTSD) and depression.

Study design

A population-based, epidemiological study from the Wenchuan earthquake.

Methods

A total of 5,195 Wenchuan Earthquake adolescent survivors aged 11-18 years from nine high schools in southwest China completed questionnaires that assessed their PTSD and depression symptoms due to childhood maltreatment, stressful life events, and childhood earthquake exposure.

Results

The PTSD and depression prevalences were 7.1 and 32.4%. After controlling for age and gender, the multiple linear regressions revealed that stressful life events had the most significant direct effect on depression (β = 0.491), followed by childhood emotional abuse (β = 0.085), and earthquake exposure (β = 0.077). Similarly, stressful life events (β = 0.583) were found to have more significant direct effects on PSTD, followed by earthquake exposure (β = 0.140); however, childhood emotional abuse was not found to have an effect. The structural equation modeling (SEM) revealed that there were interactions between the three childhood adversities, with all three concurrently affecting both PTSD and depression.

Conclusion

These findings add weight to the supposition that psychological maltreatment, negative life events, and earthquake exposure contribute to PTSD and depression. In particular, the identification of subgroups that have a high prevalence of these childhood adversities could assist professionals to target populations that are at high risk of mental health problems.

Association between childhood physical abuse and suicidal behaviors among Chinese adolescents: The mediation of aggression

BACKGROUND

Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression.

METHOD

A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively.

RESULTS

During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively.

LIMITATIONS

Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment.

CONCLUSIONS

CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.

Childhood maltreatment and depressive disorders in Chinese children and adolescents: A population-based case-control study

OBJECTIVE

The association between childhood maltreatment (CM) and clinically diagnosed depressive disorders (DD) in children and adolescents remains inconclusive, in large part due to a lack of high-quality epidemiological evidence. This study aimed to investigate the association between CM and DD in a large sample of Chinese children and adolescents.

METHODS

The study subjects were chosen from the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), and a population-based and individually-matched case-control study design was adopted.

RESULTS

CM was in general associated with an odds ratio (OR) of 5.38 (95% CI: 3.33, 8.71) for DD in children and adolescents, and a prominent dose-response association was detected. For the five specific types of CM, emotional abuse was independently related to the highest odds of DD (OR=3.90, 95% CI: 2.75, 5.54), followed by physical neglect (OR=2.04, 95% CI: 1.45, 2.87) and physical abuse (OR=1.51, 95% CI: 1.06, 2.13), while insignificant associations were found between DDs and sexual abuse and emotional neglect. Subsequently performed stratified analyses identified noticeable effect modification by important demographic factors.

CONCLUSION

CM was significantly associated with increased risk of DD in Chinese children and adolescents. The major findings of the current study suggest that victims of CM, especially those who had been emotionally abused, were susceptible to early-onset DD. Targeted interventions should be considered.

The relationship between abuse and neglect and adolescent suicidality: A moderated mediation model

Abuse and neglect can lead to suicide in adolescents; however, the internal mechanisms between abuse and neglect and suicidality remain unclear. We hypothesized that abuse and neglect could affect adolescent suicidality, and that mediating and moderating mechanisms exist between these two variables. We tested the mediating effects of stressful life events (misunderstanding and discrimination by others, poor academic performance, failed exams, interpersonal problems, and school punishment) on suicidal tendencies and moderating effects of resilience among 5,852 adolescents from 37 middle schools in five provinces of North, south, East, west, and central China. We used a questionnaire to collect data and adopted structural equation modeling to verify the correlation, mediating, and moderating effects among the variables. The results showed that stressful life events mediated the relationship between abuse, neglect, and suicide. Furthermore, resilience moderated the direct effect and second half of the mediating effect.

Childhood Maltreatment and Life Satisfaction in Chinese Student Preschool Teachers: The Roles of Resilience and Social Support

Although some studies have explored the relationships between childhood maltreatment and life satisfaction, few studies have explored the pathways between those two variables in a sample of student preschool teachers. The current study, thus, attempts to explore the relationships between childhood maltreatment and life satisfaction in Chinese student preschool teachers and to examine the roles of resilience and social support in those relationships. A total of 1218 students majoring in early childhood education were recruited from three Chinese universities to attend this study. Self-reported questionnaires were used to collect data, and structural equation modeling was used to perform data analysis. Results showed that childhood maltreatment was negatively associated with life satisfaction in Chinese student preschool teachers; resilience and social support mediated those relationships. The findings suggest that childhood maltreatment not only has a direct relationship with life satisfaction, but also has an indirect relationship with life satisfaction via resilience and social support. Childhood maltreatment should be considered when enrolling student preschool teachers, and increasing levels of resilience and social support should be meaningful approaches when cultivating student preschool teachers who have experienced childhood maltreatment.

Childhood Maltreatment and Adolescents' Aggression: A Moderated Mediation Model of Callous-Unemotional Traits and Friendship Quality

A growing body of research has documented that childhood maltreatment is associated with increased risk of child aggression. However, little is known about the mediating and moderating mechanisms underlying the relationships between childhood maltreatment and reactive and proactive functions of aggression. Therefore, the present study examined whether callous-unemotional traits mediated the relationships between childhood maltreatment and two subtypes of aggression and whether these mediating processes were moderated by friendship quality. A cross-sectional study was conducted among 2407 adolescents between 11 and 16 years (M _age = 12.75, SD = .58) in Shanxi province, China. Participants filled out questionnaires regarding childhood maltreatment, callous-unemotional traits, aggression, and friendship quality. The results indicated that childhood maltreatment was significantly and positively associated with proactive and reactive aggression, and these relationships were partially mediated by callous-unemotional traits after controlling for demographic variables. Friendship quality moderated the relationship between childhood maltreatment and proactive aggression as well as callous-unemotional traits and proactive aggression. These relationships became weaker for adolescents with high levels of friendship quality. Friendship quality did not moderate the effects of childhood maltreatment and callous-unemotional traits on reactive aggression.

Does Trauma Exacerbate Criminal Behavior? An Exploratory Study of Child Maltreatment and Chronic Offending in a Sample of Chinese Juvenile Offenders

(1) Background: Maltreated children are at increased risk for juvenile delinquency. Extant research has explored the effect of child maltreatment on either the initial risk of juvenile delinquency or general juvenile recidivism. However, little is known regarding the effect of child maltreatment on chronic offending. (2) Methods: Using a sample of 695 male juvenile offenders incarcerated in a centralized juvenile reformatory of the province X located in Southwest China, this study investigates both the prevalence of child maltreatment and the effect of child maltreatment on chronic offending among the juvenile offenders. Descriptive statistical analyses and multinomial logistic regression were utilized to conduct the analyses. (3) Results: A vast majority of the juvenile offenders experienced at least one type of child maltreatment. Moreover, maltreatment was generally found to be more prevalent in chronic offenders than in one-time offenders and recidivists. Results from a series of logistic regression analyses revealed that among five specific maltreatment types, only physical abuse exerted a statistically significant and positive impact on chronic offending. (4) Conclusions: The findings highlight the importance of providing early prevention and intervention programs to juvenile offenders who were physically abused in order to reduce general chronic offending as well as chronic violent offending.

Progress in qualitative study on mental health service demand of children and adolescents with adverse childhood experiences

As a global public health problem, adverse childhood experiences (ACEs) is an important factor leading to serious psychological and behavioral problems in children and adolescents. Mental health service plan based on mental health service needs is the key to effectively improve the psychological problems of children and adolescents with ACEs. Emotional support, life skills training, mental health education, and individualized psychological intervention can effectively improve the mental health of children and adolescents with ACEs. Among them, emotional support is an important way to help individual reduce psychological and behavioral problems; secondly, life skills training can significantly improve the individual's psychosocial ability; and mental health education is a necessary way to promote the development of individual mental health. Individualized psychological intervention can promote individual to obtain more professional mental health service and improve their psychological symptoms, which is crucial for preventing the occurrence of mental health problems. Future research can develop targeted mental health interventions based on the specific mental health service needs.

Suicidal ideation in college students having major depressive disorder: Role of childhood trauma, personality and dysfunctional attitudes

BACKGROUND

Suicide in college students is a major public health concern. Suicidal ideation (SI) is associated with childhood trauma, personality, dysfunctional attitudes and depressive symptoms, but how they interact to predict SI remains unclear.

METHODS

Using cross-sectional design and convenience sampling method, a survey was conducted among 565 college students having major depressive disorder (MDD). The Childhood Trauma Questionnaire, Eysenck Personality Questionnaire, Dysfunctional Attitudes Scale and Hamilton Depression Scale assessed participants' psychosocial factors. Chi-square test, t-test, Pearson correlation, and Structural Equation Model were used in data analysis.

RESULTS

Overall, 66.02% of participants with MDD had SI. Those with SI showed significant differences in physical abuse, emotional abuse, physical neglect, emotional neglect, psychoticism, neuroticism, extroversion, dysfunctional attitudes and depressive symptoms compared with those without SI. Childhood trauma, psychoticism, neuroticism, extroversion and dysfunctional attitudes affected SI through chain mediation. In addition, depressive symptoms, psychoticism, neuroticism and extroversion directly affected SI.

LIMITATIONS

The convenience sampling method may limit the generalizability of the findings. Results may be biased due to the self-report nature of the data collection procedure, the number of research subjects and differences in suicide risk assessment. The cross-sectional study cannot be used to infer causality.

CONCLUSIONS

The factors of childhood trauma, personality and dysfunctional attitudes affect SI through chain mediation. In addition, depressive symptoms and personality independently predict the occurrence of SI.

Associations between childhood maltreatment and educational, health and economic outcomes among middle-aged Chinese: The moderating role of relative poverty

BACKGROUND

Despite substantial evidence in developed countries showing that child maltreatment can lead to serious life-long consequences, relatively few studies so far have examined the associations between childhood maltreatment and adulthood outcomes in developing countries, such as China. It also remains unclear as to the impact of relative poverty on the long-term development of maltreated children.

OBJECTIVE

This study aims to investigate the associations between childhood maltreatment and educational, health, and economic outcomes among middle-aged Chinese, as well as explore the moderating effects of relative poverty.

PARTICIPANTS AND SETTING

The participants of this study were the middle-aged respondents (aged 45 to 59) in the 2011, 2013, and 2015 China Health and Retirement Longitudinal Studies (CHARLS) and the CHARLS Life History Survey (N = 24,114).

METHODS

Physical abuse and emotional neglect were measured to investigate childhood maltreatment. Subjective and objective indicators were used to examine relative poverty. A broad range of midlife outcomes were explored, including educational attainment, physical health, mental health, cognitive functions, labor force participation, wage expenditure, and financial strain. Data analyses were conducted using fixed effects model for panel data and a propensity score matching approach.

RESULTS

Childhood physical abuse and emotional neglect were both significantly associated with lower levels of midlife educational attainment, cognitive functions, individual wages, and household expenditures, as well as higher rates of chronic diseases, depressive symptoms, poverty, and welfare involvement. Childhood physical abuse also predicted higher risks of difficulty performing the activities of daily living (ADL), unemployment, and fewer work hours. Early-life exposure to relative poverty was linked to a greater likelihood of childhood maltreatment and mid-life adversities. It further aggravated the negative impacts of childhood maltreatment on middle-age outcomes.

CONCLUSION

Child maltreatment had a profound effect on long-term child development and midlife outcomes in Chinese contexts. Relative poverty in early life was a moderator that exacerbated the outcomes associated with childhood maltreatment.

Specific type of childhood trauma and borderline personality disorder in Chinese patients

Background

Childhood maltreatment (CM) is a known risk factor for the development of mental disorders. An extensive body of literature about CM and mental health has been developed in wealthy countries, but information about this connection is lacking in developing countries including China.

Aims

To explore the possible relationship between specific types of CM and borderline personality disorder (BPD) in patients with mental disorders in China.

Methods

A survey was conducted in 2006, involving over 3,402 Chinese individuals aged 18-60 years who were randomly selected from the outpatients in the Shanghai Mental Health Center. The patients were screened with the Personality Diagnostic Questionnaire and CM was assessed using the Childhood Trauma Questionnaire. The final sample comprised 178 patients with BPD, 178 patients with other personality disorders (PDs), and 178 patients without PDs.

Results

In Chinese patients, compared to other PDs, patients with BPDs are more likely to have experienced CM. Emotional maltreatment (emotional abuse and neglect) was the strongest predictor of BPD. Female gender and sexual abuse are significant predictors of the self-harm/suicidal risk of BPD patients.

Conclusion

This is a pioneering study conducted on a large set of Chinese clinical samples with paired controls to establish and compare the associations between specific CM and BPD. Further studies in this field are necessary to elucidate the mechanism of how various types of childhood trauma have influenced PDs.

Examining Sexual Crime Severity in China: A General-specific Model on Sex Offending Against Adults

Sexual violence severity has long been viewed as a critical factor of sex offending. However, the criminological viewpoints on sexual violence severity have not received much attention, especially in the Chinese context. By integrating general-criminogenic (inhibitory mechanisms) and specific sex offending (learning mechanisms and contextual factors) perspectives, the current study links the propositions of social control (bonds) theory, self-control theory, differential association theory, and the integrated theory of sex offending, proposing a general-specific model for sexual violence severity. Survey data was collected from 250 Chinese offenders who committed sexual offenses against adults. The mediation analysis found that deviant peer association fully mediates the effects of social control and low self-control on sexual violence severity. The moderation analysis showed that substance abuse exaggerates the impact of deviant peer association on sexual violence severity, while sex purchasing mitigates this relationship. This general-specific model may expand our current understanding of sexual violence severity from both criminological and psychological perspectives.

Why is my world so dark? Effects of child physical and emotional abuse on child depression: The mediating role of self-compassion and negative automatic thoughts

BACKGROUND

The adverse effects of childhood maltreatment on the mental health of individuals have received increasing attention. However, it is unclear whether the effects of invisible emotional abuse and visible physical abuse differ on child depression and the mediating processes under this relationship.

OBJECTIVE

This study aimed to investigate whether self-compassion and negative automatic thoughts mediated the effects of physical abuse and emotional abuse on child depression and the underlying mechanistic differences.

PARTICIPANTS AND SETTING

Using a two-wave longitudinal design, a total of 946 elementary school students completed the self-report questionnaires at two-time points, including child abuse, self-compassion, negative automatic thoughts, and depression.

METHODS

This study constructed structural equation models (SEM) to examine the mediating role of self-compassion and negative automatic thoughts between emotional/physical abuse and child depression.

RESULTS

After controlling for demographic covariates, structural equation modeling (SEM) showed that only physical abuse significantly and positively predicted child depression directly (β = 0.16, p < 0.01). Emotional abuse was positively associated with child depression through self-compassion (β = 0.02, p < 0.05) and negative automatic thoughts (β = 0.02, p < 0.05), while physical abuse influenced child depression only via negative automatic thoughts (β = 0.07, p < 0.001).

CONCLUSIONS

The findings showed a strong association between emotional/physical abuse and child depression, but there were mechanistic differences under these relationships. Therefore, we also need to pay equal attention to the adverse effects of emotional abuse on children.