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Johnson D, Wade M, Andrade BF. Threat, Emotion Dysregulation, and Parenting in a Clinical Sample of Children with Disruptive Behaviour. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01729-8. [PMID: 38967709 DOI: 10.1007/s10578-024-01729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/06/2024]
Abstract
Early-life adversity is associated with the development of internalizing and externalizing problems in children. Despite this, there is a need to understand the mechanisms linking these experiences to psychopathology, especially in clinical samples. This cross-sectional study tested emotion dysregulation as a mechanism linking early-life threat to psychopathology in a clinical sample of children with disruptive behavior problems. We also explored parental positive reinforcement as a protective factor in these pathways. A clinical sample of 606 children aged 6-12 years, referred to a mental healthcare hospital, were included. Parent-reported child threat, and parent- and teacher-reported child emotion dysregulation and psychopathology, were collected. Path analysis was used to explore the mediating effect of emotion dysregulation in the relation between threat and psychopathology. The moderating effects of parental positive reinforcement were explored through moderated-mediation analyses. Emotion dysregulation partially mediated the association between threat and both internalizing (β = .18, P = .006) and externalizing (β = .19, P = .002) problems. Positive reinforcement did not buffer the association between threat and emotion dysregulation (β = .09, P = .62) or the association between emotion dysregulation and internalizing (β = - .003, P = .20) or externalizing (β = - .002, P = .35). Poor emotion regulation may be a transdiagnostic mechanism linking early-threat with internalizing and externalizing problems in clinic-referred children with disruptive behaviors. Factors aside from parental positive reinforcement should be explored as protective factors in these pathways, including those directly implicated in the purported mechanisms linking these factors over time.
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Affiliation(s)
- Dylan Johnson
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Canada
| | - Mark Wade
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Canada
| | - Brendan F Andrade
- Margaret and Wallace McCain Centre for Child Youth and Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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Bull C, Trott M, Najman JM, Arnautovska U, Siskind D, Warren N, Kisely S. Associations between child maltreatment and hospital admissions for alcohol and other substance use-related disorders up to 40 years of age: Results from the Childhood Adversity and Lifetime Morbidity study. Addiction 2024; 119:1253-1263. [PMID: 38634806 DOI: 10.1111/add.16479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIMS Evidence on the associations between child maltreatment (CM), alcohol use disorders (AUDs) and other substance use disorders (SUDs) comes largely from retrospective studies. These rely on self-reported data, which may be impacted by recall bias. Using prospective CM reports to statutory agencies, we measured associations between CM notifications and inpatient admissions for AUDs and SUDs up to 40 years of age. DESIGN, SETTING AND PARTICIPANTS Observational study linking administrative health data from Queensland, Australia to prospective birth cohort data comprising both agency-reported and substantiated notifications of CM. MEASUREMENTS Outcomes were inpatient admissions for AUDs and SUDs based on ICD-10-Australian modification (AM)-coded primary diagnoses. Unadjusted and adjusted logistic regression analyses were undertaken. FINDINGS Ten per cent (n = 609) of the cohort had a history of agency-reported or substantiated CM notifications before age 15. These individuals had higher adjusted odds of being admitted for AUDs and SUDs. For AUDs, the adjusted odds of inpatient admission were 2.86 [95% confidence interval (CI) = 1.73-4.74] greater where there was any previous agency-reported CM and 3.38 (95% CI = 1.94-5.89) greater where there was any previous substantiated CM. For SUDs, the adjusted odds of inpatient admission were 3.34 (95% CI = 2.42-4.61) greater where there was any previous agency-reported CM and 2.98 (95% CI = 2.04-4.36) greater where there was any previous substantiated CM. CONCLUSIONS People with a history of child maltreatment appear to have significantly higher odds of inpatient admissions for alcohol use disorders and other substance use disorders up to 40 years of age compared to people with no history of child maltreatment.
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Affiliation(s)
- Claudia Bull
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Mike Trott
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
| | - Jake Moses Najman
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- School of Social Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Urska Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Dan Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Nicola Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- The ALIVE National Centre for Mental Health Research Translation, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Jankovic C, Higgins DJ, Willis ML. The well-being of young adults: The implications of multi-type child maltreatment and the mediating role of betrayal trauma. CHILD ABUSE & NEGLECT 2024; 153:106840. [PMID: 38733835 DOI: 10.1016/j.chiabu.2024.106840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Research indicates that the nature of the relationship between a victim-survivor and perpetrator of child maltreatment can influence well-being experienced during young adulthood. However, further research is required to substantiate the possible mediating role of betrayal trauma following child maltreatment. OBJECTIVE To explore the relationship between child maltreatment and psychological well-being experienced during young adulthood by examining the extent of maltreatment, the importance of the type of perpetrator, and the potential mediating role of betrayal trauma following child maltreatment. PARTICIPANTS AND SETTING The self-selected sample comprised 468 young adults (aged 18-25 years; M = 21.74 years, SD = 2.47) from Australia and internationally. METHOD Information regarding participants' current well-being, the extent of enduring five types of maltreatment (witnessing family violence, neglect, physical abuse, psychological abuse, and sexual abuse) by their mother, father and other adults during childhood, multi-type maltreatment, and severity of betrayal trauma were obtained via an online survey. RESULTS Using multiple regression analysis, it was found that higher levels of multi-type maltreatment were associated with poorer current well-being. Maltreatment by one's mother or father predicted poorer well-being, maltreatment by another adult did not. Hierarchical regressions revealed young adults' sense of betrayal trauma in close relationships partially mediated the relationship between current well-being and child maltreatment by one's mother, father, and another adult. CONCLUSION Findings show that the extent of child maltreatment experienced, one's sense of betrayal, and the relationship of the child/adolescent to the perpetrator can influence well-being experienced during young adulthood. These findings highlight the therapeutic benefit of clinicians supporting young adults who have endured child maltreatment to process betrayal trauma, to improve their well-being.
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Affiliation(s)
- Cassandra Jankovic
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Daryl J Higgins
- Institute of Child Protection Studies, Australian Catholic University, Fitzroy, Victoria, Australia.
| | - Megan L Willis
- School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, New South Wales, Australia
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Wallace C, Krugman R. More Than What You Eat: A Review on the Association Between Childhood Maltreatment and Elevated Adult BMI. Curr Nutr Rep 2024:10.1007/s13668-024-00558-4. [PMID: 38922364 DOI: 10.1007/s13668-024-00558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE OF REVIEW Obesity is an overwhelmingly common medical entity seen in the adult population. A growing body of research demonstrates that there is a significant relationship between child maltreatment and adult obesity. RECENT FINDINGS Emerging research demonstrates a potential dose-response relationship between various types of child abuse and adulthood BMI. Recent work also explores the potential role of the hypothalamic-pituitary-adrenal (HPA) axis, and other hormonal mediators such as sex-hormone binding globulin and leptin. There are also studies that suggest factors such as depression and socioeconomic and environmental influences mediate this relationship. Comorbidities that have been reported include cardiovascular and metabolic disease, diabetes, and insulin resistance. Preliminary work also demonstrates potential gender and racial disparities in the effect of abuse on adulthood obesity. In this narrative review, we summarize the existing work describing the different child maltreatment types (physical, sexual, emotional, verbal, and child neglect) and their relation to adult obesity, what is known about a potential dose-response relationship, potential mediators and pathophysiology, comorbidities, and preliminary work on gender and racial/ethnic disparities. We review the limited data on interventions that have been studied, and close with a discussion of implications and suggestions for clinicians who treat adult obesity, as well as potential future research directions.
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Affiliation(s)
- Carmelle Wallace
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Richard Krugman
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Kisely S, Bull C, Trott M, Arnautovska U, Siskind D, Warren N, Najman JM. Emergency department presentations for deliberate self-harm and suicidal ideation in 25-39 years olds following agency-notified child maltreatment: results from the Childhood Adversity and Lifetime Morbidity (CALM) study. Epidemiol Psychiatr Sci 2024; 33:e18. [PMID: 38532726 PMCID: PMC11022258 DOI: 10.1017/s2045796024000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS To compare prospective reports of child maltreatment (CM) with emergency department (ED) presentations for deliberate self-harm (DSH) and suicidal ideation in individuals aged between 25 and 39 years old. METHODS Linked records between the Mater-University of Queensland Study of Pregnancy birth cohort and Queensland administrative health data were used, which included notifications to child protection agencies for CM. ED presentations for individuals aged between 25 and 39 years of age for suicidal ideation, suicidal behaviour or poisoning by paracetamol or psychotropic medications where the intention was unclear were examined using logistic regression analyses. RESULTS A total of 609 (10.1%) individuals were the subject of one or more CM notifications for neglect or physical, sexual or emotional abuse before the age of 15 years. Of these, 250 (4.1%) presented at least once to ED for DSH and/or suicidal ideation between 25 and 39 years of age. In adjusted analysis, any notification of CM was associated with significantly increased odds of presenting to ED for these reasons (aOR = 2.80; 95% CI = 2.04-3.84). In sensitivity analyses, any notification of CM increased the odds of the combined outcome of DSH and suicidal ideation by 275% (aOR = 2.75; 95% CI = 1.96-4.06) and increased the odds of DSH alone by 269% (aOR = 2.69; 95% CI = 1.65-4.41). CONCLUSIONS All CM types (including emotional abuse and neglect) were associated with ED presentations for DSH and suicidal ideation in individuals between 25 and 39 years of age. These findings have important implications for the prevention of DSH, suicidal ideation and other health outcomes. They also underscore the importance of trauma-informed care in ED for all individuals presenting with DSH and suicidal ideation.
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Affiliation(s)
- S. Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - C. Bull
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - M. Trott
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - U. Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - D. Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - N. Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - J. Moses Najman
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- School of Social Sciences, The University of Queensland, St Lucia, QLD, Australia
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Gossmann E, Fegert JM. [Emotional Maltreatment of Children and Adolescents - Definitions, Prevalences, Risk Factors and Psychological Consequences]. Prax Kinderpsychol Kinderpsychiatr 2024; 73:28-54. [PMID: 38275228 DOI: 10.13109/prkk.2024.73.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.
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Affiliation(s)
- Emily Gossmann
- Kompetenzbereich Prävention Psychische Gesundheit im Kompetenznetzwerk Präventivmedizin Baden-Württemberg, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie Universitätsklinikum Ulm Steinhövelstraße 5 89075 Ulm Deutschland
| | - Jörg M Fegert
- Kompetenzbereich Prävention Psychische Gesundheit im Kompetenznetzwerk Präventivmedizin Baden-Württemberg, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie Universitätsklinikum Ulm Steinhövelstraße 5 89075 Ulm Deutschland
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Nation A, Pacella R, Monks C, Mathews B, Meinck F. Prevalence of violence against children in the United Kingdom: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2023; 146:106518. [PMID: 37944361 DOI: 10.1016/j.chiabu.2023.106518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Violence against children can have extensive, long-term, and far-reaching adverse impacts on survivors and society. There is currently little consensus in the United Kingdom around the prevalence of violence against children: maltreatment, intimate partner violence, sexual violence, bullying, and community violence, and most existing studies focus on only a single or a few forms of violence. This study aims to produce data to highlight the current magnitude of the problem in the UK, to inform policy, drive action and allow for monitoring of progress over time. OBJECTIVE To produce weighted prevalence estimates by violence type, as well as gender and age sub-categories, to give as full a picture as possible of the current prevalence of violence against children in the UK. PARTICIPANTS AND SETTING The prevalence of violence against children from 23 self-report studies conducted in the United Kingdom was gathered through a systematic review. METHODS Databases were searched from inception to 24th June 2022. Studies were reviewed systematically for appropriate data and meta-analyses were conducted to give pooled prevalence data based on a quality effects model. RESULTS The most prevalent self-reported experience of childhood violence was community violence at 27.33 % (95 % CI [9.84, 48.97]). Prevalence of bullying was also high at 22.75 % (95 % CI [13.25, 33.86]). The most prevalent forms of child maltreatment were domestic violence exposure at 11.9 % (95 % CI [6.34, 18.84]) and emotional maltreatment at 11.84 % (95 % CI [5.58, 19.89]). CONCLUSION National child maltreatment surveys are needed in the UK, using a comprehensive and conceptually robust approach, and valid and reliable instruments, to provide data for researchers and policymakers on the prevalence of all types of violence against children including exposure to multiple types. This allows monitoring of trends over time, can inform strategies for prevention, and can enable monitoring of future progress in reducing violence against children and its associated health and economic burden.
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Affiliation(s)
- Alexandra Nation
- Institute for Lifecourse Development, University of Greenwich, Park Row, Greenwich, London SE10 9LS, United Kingdom.
| | - Rosana Pacella
- Institute for Lifecourse Development, University of Greenwich, Park Row, Greenwich, London SE10 9LS, United Kingdom
| | - Claire Monks
- Institute for Lifecourse Development, University of Greenwich, Park Row, Greenwich, London SE10 9LS, United Kingdom
| | - Ben Mathews
- Australian Centre for Health Law Research, Queensland University of Technology, 130 Victoria Park Road, Brisbane, Queensland 4059, Australia; Johns Hopkins University, Bloomberg School of Public Health, 3400 N Charles Street, Baltimore, MD 21218, United States of America
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, EH8 9LD, United Kingdom; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Optentia, North-West University, Vanderbijlpark, South Africa
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Cohen N, Mathew M, Brent J, Wax P, Davis AL, Obilom C, Burns MM, Canning J, Baumgartner K, Koons AL, Wiegand TJ, Judge B, Hoyte C, Chenoweth JA, Froberg B, Farrar H, Carey JL, Hendrickson RG, Hodgman M, Caravati EM, Christian MR, Wolk BJ, Seifert SA, Bentur Y, Levine M, Farrugia LA, Vearrier D, Minns AB, Kennedy JM, Kirschner RI, Aldy K, Schuh S, Campleman S, Li S, Myran DT, Feng L, Freedman SB, Finkelstein Y. Severe outcomes following pediatric cannabis intoxication: a prospective cohort study of an international toxicology surveillance registry. Clin Toxicol (Phila) 2023; 61:591-598. [PMID: 37603042 DOI: 10.1080/15563650.2023.2238121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION An increasing number of jurisdictions have legalized recreational cannabis for adult use. The subsequent availability and marketing of recreational cannabis has led to a parallel increase in rates and severity of pediatric cannabis intoxications. We explored predictors of severe outcomes in pediatric patients who presented to the emergency department with cannabis intoxication. METHODS In this prospective cohort study, we collected data on all pediatric patients (<18 years) who presented with cannabis intoxication from August 2017 through June 2020 to participating sites in the Toxicology Investigators Consortium. In cases that involved polysubstance exposure, patients were included if cannabis was a significant contributing agent. The primary outcome was a composite severe outcome endpoint, defined as an intensive care unit admission or in-hospital death. Covariates included relevant sociodemographic and exposure characteristics. RESULTS One hundred and thirty-eight pediatric patients (54% males, median age 14.0 years, interquartile range 3.7-16.0) presented to a participating emergency department with cannabis intoxication. Fifty-two patients (38%) were admitted to an intensive care unit, including one patient who died. In the multivariable logistic regression analysis, polysubstance ingestion (adjusted odds ratio = 16.3; 95% confidence interval: 4.6-58.3; P < 0.001)) and cannabis edibles ingestion (adjusted odds ratio = 5.5; 95% confidence interval: 1.9-15.9; P = 0.001) were strong independent predictors of severe outcome. In an age-stratified regression analysis, in children older than >10 years, only polysubstance abuse remained an independent predictor for the severe outcome (adjusted odds ratio 37.1; 95% confidence interval: 6.2-221.2; P < 0.001). As all children 10 years and younger ingested edibles, a dedicated multivariable analysis could not be performed (unadjusted odds ratio 3.3; 95% confidence interval: 1.6-6.7). CONCLUSIONS Severe outcomes occurred for different reasons and were largely associated with the patient's age. Young children, all of whom were exposed to edibles, were at higher risk of severe outcomes. Teenagers with severe outcomes were frequently involved in polysubstance exposure, while psychosocial factors may have played a role.
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Affiliation(s)
- Neta Cohen
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Mathew Mathew
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jeffrey Brent
- Departments of Medicine and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Toxicology Associates, Littleton, USA
| | - Paul Wax
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Adrienne L Davis
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Cherie Obilom
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Joshua Canning
- Department of Medical Toxicology, Banner - University Medical Center, Phoenix, AZ, USA
| | - Kevin Baumgartner
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew L Koons
- Department of Emergency Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine, Allentown, PA, USA
| | - Timothy J Wiegand
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Bryan Judge
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Christopher Hoyte
- Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO, USA
| | - James A Chenoweth
- Department of Emergency Medicine, University of California at Davis, Sacramento, CA, USA
| | - Blake Froberg
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Henry Farrar
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Michael Hodgman
- Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA
| | - E Martin Caravati
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Brian J Wolk
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Steven A Seifert
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Yedidia Bentur
- Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Levine
- Department of Emergency Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Lynn A Farrugia
- UF Health Shands Hospital, University of Florida College of Medicine, Gainesville, FL, USA
| | - David Vearrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alicia B Minns
- Department of Emergency Medicine, University of California San Diego, San Diego, CA, USA
| | - Joseph M Kennedy
- Department of Emergency Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | | | - Kim Aldy
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- American College of Medical Toxicology, Phoenix, AZ, USA
| | - Suzanne Schuh
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | | | - Shao Li
- American College of Medical Toxicology, Phoenix, AZ, USA
| | | | - Lisa Feng
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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Pacella R, Nation A, Mathews B, Scott JG, Higgins DJ, Haslam DM, Dunne MP, Finkelhor D, Meinck F, Erskine HE, Thomas HJ, Malacova E, Lawrence DM, Monks C. Child maltreatment and health service use: findings of the Australian Child Maltreatment Study. Med J Aust 2023; 218 Suppl 6:S40-S46. [PMID: 37004185 PMCID: PMC10952869 DOI: 10.5694/mja2.51892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To examine associations between child maltreatment and health service use, both overall, by type and by the number of types of maltreatment reported. DESIGN, SETTING Cross-sectional, retrospective survey using the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study); computer-assisted mobile telephone interviews using random digit dialling, Australia, 9 April - 11 October 2021. PARTICIPANTS Australians aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from the five age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES Self-reported health service use during the past twelve months: hospital admissions, length of stay, and reasons for admission; and numbers of consultations with health care professionals, overall and by type. Associations between maltreatment and health service use are reported as odds ratios adjusted for age group, gender, socio-economic status, financial hardship (childhood and current), and geographic remoteness. RESULTS A total of 8503 participants completed the survey. Respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.16-1.66), particularly admission with a mental disorder (aOR, 2.4; 95% CI, 1.03-5.6). The likelihood of six or more visits to general practitioners (aOR, 2.37; 95% CI, 1.87-3.02) or of a consultation with a mental health nurse (aOR, 2.67; 95% CI, 1.75-4.06), psychologist (aOR, 2.40; 95% CI, 2.00-2.88), or psychiatrist (aOR, 3.02; 95% CI, 2.25-4.04) were each higher for people who reported maltreatment during childhood. People who reported three or more maltreatment types were generally most likely to report greater health service use. CONCLUSIONS Child maltreatment has a major impact on health service use. Early, targeted interventions are vital, not only for supporting children directly, but also for their longer term wellbeing and reducing their health system use throughout life.
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Affiliation(s)
- Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Alexandra Nation
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - James G Scott
- Child Health Research Centrethe University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Daryl J Higgins
- Institute of Child Protection Studies, Australian Catholic UniversityMelbourneVIC
| | - Divna M Haslam
- Queensland University of TechnologyBrisbaneQLD
- The University of QueenslandBrisbaneQLD
| | - Michael P Dunne
- Queensland University of TechnologyBrisbaneQLD
- Institute for Community Health ResearchHue UniversityHue CityVietnam
| | - David Finkelhor
- Crimes against Children Research CenterUniversity of New HampshireDurhamNHUnited States of America
| | - Franziska Meinck
- University of EdinburghEdinburghUnited Kingdom
- North‐West UniversityPotchefstroomSouth Africa
| | - Holly E Erskine
- The University of QueenslandBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Eva Malacova
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | | | - Claire Monks
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
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Mathews B, Pacella R, Scott JG, Finkelhor D, Meinck F, Higgins DJ, Erskine HE, Thomas HJ, Lawrence DM, Haslam DM, Malacova E, Dunne MP. The prevalence of child maltreatment in Australia: findings from a national survey. Med J Aust 2023; 218 Suppl 6:S13-S18. [PMID: 37004184 PMCID: PMC10953347 DOI: 10.5694/mja2.51873] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To estimate the prevalence in Australia of each type of child maltreatment; to identify gender- and age group-related differences in prevalence. DESIGN, SETTING Cross-sectional national survey; mobile telephone interviews using random digit dialling (computer-generated), Australia, 9 April - 11 October 2021. Retrospective self-report data using validated questionnaire (Juvenile Victimisation Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). PARTICIPANTS People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from five further age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES Proportions of respondents reporting physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence to age 18 years, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study), overall and by gender and age group, and weighted to reflect characteristics of the Australian population aged 16 years or more in 2016. RESULTS Complete survey data were available for 8503 eligible participants (14% response rate). Physical abuse was reported by 32.0% of respondents (95% confidence interval [CI], 30.7-33.3%), sexual abuse by 28.5% (95% CI, 27.3-29.8%), emotional abuse by 30.9% (95% CI, 29.7-32.2%), neglect by 8.9% (95% CI, 8.1-9.7%), and exposure to domestic violence by 39.6% (95% CI, 38.3-40.9%). The proportions of respondents who reported sexual abuse, emotional abuse, or neglect were each statistically significantly larger for women than men. The reported prevalence of physical abuse by respondents aged 16-24 years was lower than for those aged 25-34 years, and that of sexual abuse was lower than for those aged 35-44 years, suggesting recent declines in the prevalence of these maltreatment types. CONCLUSIONS Child maltreatment is common in Australia, and larger proportions of women than men report having experienced sexual abuse, emotional abuse, and neglect during childhood. As physical and sexual abuse may have declined recently, public health policy and practice may have positive effects, justifying continued monitoring and prevention activities.
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Affiliation(s)
- Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - James G Scott
- Child Health Research Centre, the University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - David Finkelhor
- Crimes against Children Research CenterUniversity of New HampshireDurhamNHUnited States of America
| | - Franziska Meinck
- University of EdinburghEdinburghUnited Kingdom
- University of the Witwatersrand JohannesburgJohannesburgSouth Africa
| | - Daryl J Higgins
- Institute of Child Protection StudiesAustralian Catholic UniversityMelbourneVIC
| | - Holly E Erskine
- The University of QueenslandBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | | | - Divna M Haslam
- Queensland University of TechnologyBrisbaneQLD
- Parenting and Family Support Centrethe University of QueenslandBrisbaneQLD
| | - Eva Malacova
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Michael P Dunne
- Queensland University of TechnologyBrisbaneQLD
- Institute for Community Health ResearchHue UniversityHue CityVietnam
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Higgins DJ, Mathews B, Pacella R, Scott JG, Finkelhor D, Meinck F, Erskine HE, Thomas HJ, Lawrence DM, Haslam DM, Malacova E, Dunne MP. The prevalence and nature of multi-type child maltreatment in Australia. Med J Aust 2023; 218 Suppl 6:S19-S25. [PMID: 37004183 PMCID: PMC10952595 DOI: 10.5694/mja2.51868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
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.
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Affiliation(s)
- Daryl J Higgins
- Institute of Child Protection StudiesAustralian Catholic UniversityMelbourneVIC
| | - Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - James G Scott
- The University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - David Finkelhor
- Crimes against Children Research CenterUniversity of New HampshireDurhamNHUnited States of America
| | - Franziska Meinck
- University of EdinburghEdinburghUnited Kingdom
- North‐West UniversityPotchefstroomSouth Africa
| | - Holly E Erskine
- The University of QueenslandBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | | | - Divna M Haslam
- Queensland University of TechnologyBrisbaneQLD
- The University of QueenslandBrisbaneQLD
| | - Eva Malacova
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Michael P Dunne
- Queensland University of TechnologyBrisbaneQLD
- Institute for Community Health ResearchHue UniversityHue CityVietnam
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Haslam DM, Lawrence DM, Mathews B, Higgins DJ, Hunt A, Scott JG, Dunne MP, Erskine HE, Thomas HJ, Finkelhor D, Pacella R, Meinck F, Malacova E. The Australian Child Maltreatment Study (ACMS), a national survey of the prevalence of child maltreatment and its correlates: methodology. Med J Aust 2023; 218 Suppl 6:S5-S12. [PMID: 37004182 PMCID: PMC10953333 DOI: 10.5694/mja2.51869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To describe the aims, design, methodology, and respondent sample representativeness of the Australian Child Maltreatment Study (ACMS). DESIGN, SETTING Cross-sectional, retrospective survey; computer-assisted mobile telephone interviewing using random digit dialling (computer-generated), Australia, 9 April - 11 October 2021. PARTICIPANTS People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from five further age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES Primary outcomes: Emotional abuse, neglect, physical abuse, sexual abuse, exposure to domestic violence during childhood, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). SECONDARY OUTCOMES selected mental disorder diagnoses (Mini International Neuropsychiatric Interview, MINI), selected physical health conditions, health risk behaviours, health service use. RESULTS The demographic characteristics of the ACMS sample were similar to those of the Australian population in 2016 with respect to gender, Indigenous status, region and remoteness category of residence, and marital status, but larger proportions of participants were born in Australia, lived in areas of higher socio-economic status, had tertiary qualifications, and had income greater than $1250 per week. Population weights were derived to adjust for these differences. Associations between the number of calls required to recruit participants and maltreatment rates and health outcomes were not statistically significant. CONCLUSIONS The ACMS provides the first reliable estimates of the prevalence of each type of child maltreatment in Australia. These estimates, and those of associated mental health and health risk behaviours reported in this supplement can inform policy and practice initiatives for reducing the prevalence of child maltreatment and its consequences. Our benchmark study also provides baseline data for repeated waves of the ACMS that will assess the effectiveness of these initiatives.
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Affiliation(s)
- Divna M Haslam
- Queensland University of TechnologyBrisbaneQLD
- Parenting and Family Support Centre, the University of QueenslandBrisbaneQLD
| | | | - Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - Daryl J Higgins
- Institute of Child Protection StudiesAustralian Catholic UniversityMelbourneVIC
| | | | - James G Scott
- Child Health Research Centre, the University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Michael P Dunne
- Queensland University of TechnologyBrisbaneQLD
- Institute for Community Health ResearchHue UniversityHue CityVietnam
| | - Holly E Erskine
- The University of QueenslandBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - David Finkelhor
- Crimes against Children Research CenterUniversity of New HampshireDurhamNHUnited States of America
| | - Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Franziska Meinck
- University of EdinburghEdinburghUnited Kingdom
- University of the Witwatersrand JohannesburgJohannesburgSouth Africa
| | - Eva Malacova
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
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13
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Scott JG, Mathews B. Introducing the Australian Child Maltreatment Study: baseline evidence for a national public health challenge. Med J Aust 2023; 218 Suppl 6:S3-S4. [PMID: 37004180 PMCID: PMC10953424 DOI: 10.5694/mja2.51867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/05/2022] [Accepted: 01/07/2023] [Indexed: 04/03/2023]
Affiliation(s)
- James G Scott
- Child Health Research Centre, the University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
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14
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Mathews B, Thomas HJ, Scott JG. A new era in child maltreatment prevention: call to action. Med J Aust 2023; 218 Suppl 6:S47-S51. [PMID: 37004187 PMCID: PMC10952631 DOI: 10.5694/mja2.51872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - James G Scott
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Child Health Research Centrethe University of QueenslandBrisbaneQLD
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