Determining patterns and types of violence against the elderly in the Kingdom of Saudi Arabia

Reports indicate an increase in the incidence of violence against the elderly in the Kingdom of Saudi Arabia (KSA). This study aimed to determine the types and risk factors of elder abuse in KSA. A cross-sectional observational study was conducted of abuse among the elderly (65 years and older; n  = 128) reported in the National Family Safety Registry (NFSR) between April 2017 and December 2021. Most cases involved women (65.6%) and married individuals (54.7%). Physical abuse was the most common type (44.5%), followed by neglect (34.4%). Men, married individuals, people without family support, and people with physical disabilities were more likely to experience physical abuse. Elderly people, single individuals, women, and those lacking family support showed an increased likelihood of neglect. Preventive strategies should be implemented through awareness raising, capacity building, resource allocation, and the exchange of multidisciplinary good practices across sectors.

Levels of Involvement with Child Protection Services Associated with Early Adolescent Police Contact as a Victim and Person of Interest

The relationship between childhood maltreatment and subsequent offending/victimization is well established. However, the magnitude of this relationship for different levels of child protection services (CPS) involvement is poorly understood, due to measurement issues, lack of longitudinal data, and reliance on reports of substantiated maltreatment, which can underestimate the impact of maltreatment. This study examined associations between CPS involvement during childhood (ages 0 to <11 years) and police services contact (as a victim and/or a person of interest) for criminal incidents in early adolescence (11 to ~14 years), differentiated according to levels of CPS involvement (i.e., no risk of significant harm [non-ROSH], unsubstantiated ROSH, substantiated ROSH, and out-of-home care; each examined relative to no CPS contact). Data for 71,465 children were drawn from the New South Wales Child Development Study, an intergenerational, longitudinal investigation that uses administrative records from CPS and police alongside other health, justice, and education data. Multinomial regression analyses were conducted to determine associations between increasing levels of CPS involvement and police contact as a victim only, a person of interest only, and as both victim and person of interest while accounting for covariates (i.e., child's sex, Aboriginal, and/or Torres Strait Islander background, socioeconomic status, maternal age at child's birth, and parental offending history). Children exposed to any of the four levels of CPS involvement had higher odds of police contact, relative to children with no CPS involvement. Odds ratios were higher for contact with police as both a victim and a person of interest, compared to police contact as a victim or a person of interest only. These findings highlight that children with even unsubstantiated CPS reports (i.e., non-ROSH and unsubstantiated ROSH reports) are at heightened risk of police contact compared to children who are unknown to CPS, underlining the need to support all families in contact with CPS.

Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia

Introduction

Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients.

Methods

A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form.

Results

Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=-2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ2=4.805, p=0.028) and schizoid (χ2=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ2=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients.

Discussion

These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.

The Association Between Child Maltreatment and Loneliness Across the Lifespan: A Systematic Review and Multilevel Meta-Analysis

While there is evidence that child maltreatment is positively associated with loneliness, the strength of this association is not yet clear. It is also unclear whether the magnitude and statistical significance of this association varies across groups of individuals. Therefore, this meta-analysis examines whether there are differences in loneliness between individuals with and without maltreatment histories, and which factors may influence the association between child maltreatment and loneliness. A three-level meta-analysis was conducted on 52 studies reporting 116 effect sizes (N = 1,705,493; Mage = 30.93; 49.6% females). Results showed a medium overall effect (g = 0.45, p < .001, 95% CI [0.36, 0.53]), indicating that individuals with maltreatment histories, on average, feel lonelier than individuals without maltreatment histories. Moderator analyses showed that effect sizes were larger for emotional abuse and emotional neglect as compared to other types of child maltreatment and decreased when participants were older at the time of loneliness assessment. These findings suggest that individuals with maltreatment histories, especially those who have been emotionally abused and/or emotionally neglected, are vulnerable to experiencing loneliness across the lifespan. The results also suggest that feelings of loneliness warrant attention in prevention and intervention programs for individuals with maltreatment histories.

Abuse and Neglect of Children With Specific Learning Disorders in Türkiye: A Case-Control Study

BACKGROUND

Although it is often stated that children with special needs are at risk of being abused and neglected, research conducted on the abuse of children with specific learning disorders (SLDs) is limited.

METHODS

This case-control study aims to compare exposure to neglect and abuse among children diagnosed with SLDs (case group) and children with typical development (control group). The study included children aged 6 to 12 years who were referred to the Child and Adolescent Psychiatry Outpatient Clinic and Pediatric Clinic of a hospital in Türkiye. The data collection process included 196 participants and lasted for 7 months in 2020.

RESULTS

Based on the analysis of the data collected with the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Turkish Version (K-SADS-PL-T) and the Abuse Assessment Questionnaire, we determined that children with SLDs were physically and emotionally abused more than the children of the control group. In addition, they witnessed violence between their parents more than the control group. Physical abuse, emotional abuse and witnessing family violence were identified as significant predictors for SLD.

CONCLUSIONS

The presence of SLDs is a significant risk factor for children to be exposed to abuse even in the absence of ADHD as a comorbidity.

Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists: A scoping review

BACKGROUND

Child maltreatment, the abuse or neglect of children aged 0-18 years, is a severe and underreported global problem. Compared with other body parts, the orofacial region displays more signs of child maltreatment. Dentists and dental hygienists are therefore well situated to identify orofacial signs of child maltreatment.

AIM

To map the current literature on orofacial signs of child maltreatment identified by dentists or dental hygienists.

DESIGN

A scoping review was conducted based on systematic searches of Medline (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) for primary qualitative and quantitative studies through June 6, 2022.

RESULTS

Twenty-nine studies were included in this scoping review. Though all child maltreatment types were identified in dental settings, physical abuse and dental neglect were most commonly identified. Reports of caries dominated the orofacial signs, followed by bruises (intra- and extraoral), poor oral hygiene, dental trauma, and lacerations (intra- and extraoral). Case reports were used most commonly to describe orofacial signs of child maltreatment.

CONCLUSION

Dental clinicians identify orofacial signs of all child maltreatment types intraorally. Dentists identify the same extraoral signs as do other healthcare professionals, with bruising being the most common.

Partner Effects of Childhood Maltreatment: A Systematic Review and Meta-Analysis

Although several studies have shown that childhood maltreatment (CM) is associated with a host of negative consequences including romantic relationship difficulties for victims in adulthood, most overlooked the potential effects on the romantic partner. This systematic review and meta-analysis aims to comprehensively synthesize the literature on the association between a person's CM and their partner's individual and couple outcomes. We searched PubMed, PsycNET, Medline, CINAHL, and Eric using search strings related to CM and partner. We identified 3,238 articles after removal of duplicates; 28 studies met the inclusion criteria and relied on independent sample. The studies reported associations between a person's CM and a wide breadth of partner's negative couple outcomes (e.g., communication, sexuality) as well as intra-individual psychological difficulties (e.g., psychological distress, emotion, and stress reactivity). Meta-analytic results showed significant, but trivial to small associations between a person's CM and their partner's lower relationship satisfaction (r = -.09, 95% CI [-.14, -.04]), higher intimate partner violence (r = .08, [.05, .12]), and higher psychological distress (r = .11, [.06, .16]). These associations were similar for women and men and did not differ as a function of sample's mean age, proportion of cultural diversity, and publication year. These findings suggest that a person's CM is related to their partner's outcomes including to the partner's intra-individual outcomes. Prevention and intervention strategies should acknowledge that a person's CM may also affect their romantic partner, considering the couple as a reciprocal system, and offer victims' romantic partners specific services.

Combinations of Parent-Related Risk Factors Explaining Family Violence Toward Children and Spouse

The purpose of the study was to investigate parent-related risk factor combinations that explain family violence (FV), which refers to intimate partner violence and child maltreatment (CM). The data were collected from parents with a 4-year-old child using a nationwide retrospective cross-sectional survey conducted in Finland (FinChildren) (N = 10,737). The research questions were as follows: (a) How are parent-related risk factors associated with FV against children and the spouse? (b) How does the accumulation of parent-related risk factors within three risk factor clusters explain FV? Analyses were carried out using cross-tabulations with χ2 tests, an exploratory factor analysis (EFA), and binary logistic regression analyses. The risk factor clusters built based on the EFA were as follows: parental well-being, parent's childhood adversities, and parent's health. Our results indicated that even a single risk factor predicted the likelihood of FV. In the well-being risk factor cluster, the odds for the occurrence of FV in parents with one well-being risk factor were double (odds ratios [OR] = 2.21; confidence intervals [CI]: [1.99, 2.45]) and in parents with at least four risk factors was six times (OR = 6.05; CI: [4.48, 8.18]) compared to those with no risk factor. We concluded that (a) the more different risk factors parents had, the more likely they were to report FV and (b) the accumulation of risk factors for well-being contributes most to the occurrence of the risk of FV. As a result, we emphasize the importance of identifying families with concurrent risk factors. However, any individual concerns must be addressed with parents and they must be supported in coping with their everyday life.

Dissociative Experiences, Borderline Personality Disorder Features, and Childhood Trauma: Generating Hypotheses from Data-Driven Network Analysis in an International Sample

Dissociation is a multifaceted phenomenon that occurs in various mental disorders, including borderline personality disorder (BPD), but also in non-clinical populations. Severity of childhood trauma (abuse, neglect) plays an important role in the development of dissociation and BPD. However, the complex interplay of different dissociative symptoms, BPD features, and self-reported childhood trauma experiences is not yet fully understood. Graph-theoretical network analysis can help to better understand such multivariate interrelations. Objective: This study aimed to investigate associations between self-reported dissociation, BPD features, and childhood trauma experiences using a graph-theoretical approach. Data was collected online via international mental health platforms and research sites. N = 921 individuals (77.4% female) were included; 40% reported pathological levels of dissociation. Variables were assessed with established psychometric scales (Dissociative Experiences Scale; Personality Assessment Inventory Borderline Features Scale; Childhood Trauma Questionnaire) and analyzed within a partial correlation network. Positive bivariate correlations between all variables were found. When accounting for their mutual influence on each other, dissociation was predominantly connected to BPD features with effect sizes between rp = .028 and rp = .126, while still showing a slight unique relationship with physical neglect (rp = .044). Findings suggest close associations between dissociative experiences and BPD features. While childhood trauma plays an important role in the development of dissociation and BPD, its recall may not fully explain their current co-occurrence. Prospective studies are needed to shed more light on causal pathways to better understand which factors contribute to dissociation and its link to BPD (features).

Violence, Abuse and Neglect in Older Women in Rural and Remote Areas: A Scoping Review and Prevalence Meta-Analysis

This systematic review addressed the issue of the abuse and neglect of older women (age 60 and over) in rural and remote areas, examining these phenomena's prevalence, risk and protective factors, consequences, and associated perceptions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Arksey and O'Malley methodological framework, peer-reviewed articles published until September 2023 were identified in six electronic databases. Out of the manuscripts initially identified (n = 219), 28 articles met the selection criteria. The study's quality was assessed using the Mixed Methods Appraisal Tool. The included studies provided a comprehensive overview of this phenomenon, encompassing data from 6,579 older rural women. Prevalence rates of abuse and neglect exhibited wide variability, with an average of 27.3%. Among the risk factors, financial dependence and incapacity stood out, while higher income and education levels were protective factors, among others. Emotional/psychological abuse emerged as the most common form, with significant impacts on older women's physical and mental health. Cultural norms and gender expectations also influenced perceptions of abuse and victims' coping mechanisms. In a context in which access to specialized resources and services is hampered by significant limitations, community awareness and education prove vital to address this issue, which positions social work as key to addressing these challenges. The prevalence of abuse against older rural women is significant. Emotional abuse stands out as a major issue, underscoring the need for comprehensive interventions accounting for cultural and gender factors.

A parcellation-based connectomic model of hemispatial neglect

BACKGROUND AND PURPOSE

Hemispatial neglect is characterized by a reduced awareness to stimuli on the contralateral side. Current literature suggesting that damage to the right parietal lobe and attention networks may cause hemispatial neglect is conflicting and can be improved by investigating a connectomic model of the "neglect system" and the anatomical specificity of regions involved in it.

METHODS

A meta-analysis of voxel-based morphometry magnetic resonance imaging (MRI) studies of hemispatial neglect was used to identify regions associated with neglect. We applied parcellation schemes to these regions and performed diffusion spectrum imaging (DSI) tractography to determine their connectivity. By overlaying neglect areas and maps of the attention networks, we studied the relationship between them.

RESULTS

The meta-analysis generated a list of 13 right hemisphere parcellations. These 13 neglect-related parcellations were predominantly linked by the superior longitudinal fasciculus (SLF) throughout a fronto-parietal-temporal network. We found that the dorsal and ventral attention networks showed partial overlap with the neglect system and included various other higher-order networks.

CONCLUSIONS

We provide an anatomically specific connectomic model of the neurobehavioral substrates underlying hemispatial neglect. Our model suggests a fronto-parietal-temporal network linked via the SLF supports the functions impaired in neglect and implicates various higher-order networks which are not limited to the attention networks.

Dark side of customs: scalding burns in childhood due to use of traditional teacup and teapot, in Turkey

The most common type of burn among children is scalding burn. This study aims to reveal child abuse and neglect as a specific etiological factor that specific to our country, traditional teapot- and teacup-related scalding burns. Burn cases that admitted to our Burn Center were investigated, and among these, 72 cases suffering from scalding burns were included in the study. The interview forms issued upon admission of these cases were evaluated in detail. Out of 148 scalding burn cases, 48.6% were related to the use of traditional teapots and teacups. After a detailed assessment, all cases were considered neglect-related burns. As a result of considering the role of traditional teapots and teacups in pediatric injuries in our country, parents and caregivers should be warned about these types of injuries. Also, physicians must determine the possibility of child abuse or neglect in all pediatric burn cases.

The non-paretic-hand-to-opposite-ear test: A simple test to detect aphasia and neglect and an indicator of large anterior vessel occlusion in patients with suspected acute stroke

INTRODUCTION

Aphasia and neglect in combination with hemiparesis are reliable indicators of large anterior vessel occlusion (LAVO). Prehospital identification of these symptoms is generally considered difficult by emergency medical service (EMS) personnel. Therefore, we evaluated the simple non-paretic-hand-to-opposite-ear (NPE) test to identify aphasia and neglect with a single test. As the NPE test includes a test for arm paresis, we also evaluated the diagnostic ability of the NPE test to detect LAVO in patients with suspected stroke.

METHODS

In this prospective observational study, we performed the NPE test in 1042 patients with suspected acute stroke between May 2021 and May 2022. We analyzed the correlation between the NPE test and the aphasia/neglect items of the National Institutes of Health Stroke Scale. Additionally, the predictive values of the NPE test for LAVO detection were calculated.

RESULTS

The NPE test showed a strong, significant correlation with both aphasia and neglect. A positive NPE test result predicted LAVO with a sensitivity of 0.70, a specificity of 0.88, and an accuracy of 0.85. Logistic regression analysis showed an odds ratio of 16.14 (95% confidence interval 10.82-24.44) for predicting LAVO.

CONCLUSION

The NPE test is a simple test for the detection of both aphasia and neglect. With its predictive values for LAVO detection being comparable to the results of LAVO scores in the prehospital setting, this simple test might be a promising test for prehospital LAVO detection by EMS personnel. Further prospective prehospital validation is needed.

Associations between child abuse and neglect, and dento-alveolar injuries in a Children's hospital population

BACKGROUND/AIM

The purpose of this study was to identify social variables common to children with dento-alveolar trauma (DAT) and child abuse and neglect (CAN) in a large children's hospital population.

METHODS

Emergency department data from an urban trauma Level 1 children's hospital were queried between December 02, 2017 and September 30, 2022 to identify children with both DAT and CAN. Patients with DAT and CAN were compared to DAT-only children in a case-control study design. Descriptive statistics were used to report characteristics of children in case and control groups. Chi-Squared and Fisher's exact tests were used to compare cases and controls. The level of significance was set at p ≤ .05.

RESULTS

In total, 14 children who had DAT and CAN reported simultaneously comprised the case group. A total of 42 children with DAT-only, age/sex matched with cases, comprised the control group. Mean (SD) age of cases was 10.4 (±4) and controls was 10.1 (±3.9) years-old. Eight cases (57.1%) and 24 controls (57.1%) were female. No statistical differences (p = .05) were present for language, race, insurance coverage, parental custody, legal guardianship, and type of residence for cases versus controls. Five (35.7%) cases had a special need versus 4 (9.5%) controls and was statistically different (p = .03). Nine (64.3%) cases had behavioral problems versus 13 (31%) controls (p = .05). Cases were more likely to have facial injuries than controls (74.3 vs. 31%), however no significant differences were present for total number of injured teeth, head injury or neck injury between cases and controls. In half of cases, the perpetrator reported was the sibling.

CONCLUSIONS

Demographics did not predict CAN in children with dental injuries. Sibling violence should be considered in suspected CAN children.

Association of Childhood Emotional Maltreatment with Adolescents' Psychopathology: A Systematic Review and Meta-Analysis

Childhood Emotional Maltreatment (CEM) is a significant but under-studied risk factor for impaired mental health, with adolescents being particularly susceptible. This systematic review and meta-analysis, prospectively registered in PROSPERO as CRD42022383005, aims to synthesize the findings of studies investigating the association between CEM and adolescent psychopathology, making it the first attempt to the best of our knowledge. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a comprehensive search (PubMed, Scopus, PsycINFO, Science Direct, Embase, and ProQuest) yielded 12,224 studies, from which 72 were included in the qualitative synthesis. The meta-analysis was conducted on 76 effect sizes (ranging from 0.01 to 0.57) extracted from 56 studies. The assessment of publication bias utilized funnel plots, Egger's regression test, and the trim and fill method, if required. Additionally, a predictor analysis investigated the influence of study-level variables on the CEM-psychopathology association. Results revealed a significant positive correlation between CEM and adolescent psychopathology (Pooled association: 0.24-0.41) Furthermore, assessment of publication bias indicated no significant bias. The predictor analysis suggested minimal influence of study-level variables. The study underscores the urgent need to address CEM as a crucial risk factor for adolescent psychopathology. The significant positive correlation between CEM and psychopathological outcomes highlights the detrimental effects of CEM on adolescents. Awareness, prevention efforts, and targeted interventions are essential to mitigate these effects. Further studies with culturally diverse and larger sample sizes are required, with emphasis on methodological rigor, given that most of the identified studies showed a high risk of bias.

Childhood Trauma Questionnaire (CTQ): Greek translation and psychometric validation in general and clinical population

Exposure to childhood trauma experiences shows a high prevalence worldwide, with approximately two-thirds of the general population reporting traumatic experiences during childhood. The valid psychometric assessment of childhood trauma experience represents, however, a significant challenge in clinical research and practice. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) embodies the most valid and internationally widely used tool for the retrospective assessment of traumatic experiences during childhood to date. The purpose of this study was the Greek translation of the questionnaire and its validation in both a general and clinical population. Participants completed electronically the Greek translation of the CTQ-SF, the Early Trauma Questionnaire (ETI-SR-SF), the Trauma Symptom Checklist (TSC-40), the Positive and Negative Affect Scale (PANAS- SF), the Well-Being Index (WHO-5) and the Patient Health Questionnaire (PHQ-4) to examine psychometric properties of the questionnaire (e.g., internal consistency, concurrent, convergent and divergent validity), but also to investigate the relationship between childhood trauma exposure and psychological well-being and symptoms of anxiety and depression. The total study sample (TS) consisted of 722 adults (606 women), of which 155 declared the existence of a psychiatric diagnosis (PD) and 567 constituted the general population (GP) sample. The most common trauma types reported were emotional abuse (29.1%), emotional neglect (23.7%), and physical abuse (24.6%). The CTQ-SF questionnaire showed high levels of internal consistency based on the Cronbach α coefficient (TS = 0.92, PD = 0.92, GP = 0.92), high concurrent and convergent validity and satisfactory convergent validity. In addition, self-reported childhood trauma was highly positively correlated to negative affect and anxiety and depression symptoms, as well as negatively to psychological well-being. Our results confirm that the Greek Version of Childhood Trauma Questionnaire (CTQ-SF) is a reliable and valid tool that can be used for the retrospective assessment of traumatic childhood experiences both in the general and in the clinical adult Greek population.

Patient mortality and the neglect of vital signs' assessment: An audit of a national coronial database

BACKGROUND

Vital signs assessment is critical for patient surveillance and safety. Research has found, however, that this assessment is often neglected in clinical practice. The reasons for this are unclear as few studies have explored this issue. Those studies that have are small, single site studies and found that culture and poor understanding are contributing factors.

AIM

The aim was to explore the link between the clinical neglect of vital signs assessment and patient mortality and provide a better understanding of factors influencing vital signs assessment in the context of acute patient care. Coroners' reports represent an untapped source of information regarding shortfalls in vital signs assessment. Using a framework analysis, an audit was conducted of the Australian National Coronial Information System for cases where vital signs' assessment was mentioned in coronial reports.

RESULTS

Fifty-eight cases met the eligibility criteria, with deceased patients aged from 7 days to 93 years. Key themes related to absence of reassessment of vital signs, inappropriate delegation, passing responsibility to another staff member and not following policy.

CONCLUSIONS

The findings reflect a combination of individual and institutional failings and suggest that vital signs assessment was not considered a priority aspect of care.

RELEVANCE TO CLINICAL PRACTICE

Vital signs assessment must be considered an essential aspect of clinical care in all patients. This important aspect of care should be emphasized across all domains of patient care.

Effects of Community-Based Wraparound Services on Child and Caregiver Outcomes Following Child Protective Service Involvement

This study investigated whether statewide delivery of the wraparound service model (WSM) improved child and caregiver outcomes and reduced subsequent child protective service (CPS) contact among families referred to services following a CPS report. Caregivers (n = 247) completed baseline and 6-month interviews to document self-reported engagement in WSM and non-WSM conditions and assess changes in outcomes. Kernel-weighted difference-in-difference (K-DID) models were used to assess program effects, based on reported condition. Child behavior outcomes improved among WSM-engaged families, but differences by condition were non-significant except for internalizing behaviors. Caregiver receipt of WSM was associated with greater retention of behavioral health services, but did not produce statistically significant improvements in their wellbeing. Households in the WSM condition were more likely to be reported to CPS at 6-month follow-up, but this difference was not significant at 12 months and differences in substantiation were not statistically significant. Supplemental analyses compared alternative means of contrasting group effects, highlighting some differences based on method. The WSM produced few significant differential improvements in child or caregiver outcomes and failed to prevent future CPS involvement. Inadequate program fidelity appeared to be a factor in implementation of the WSM, which may have hampered program effectiveness under real-world conditions.

Child Maltreatment History, Deployment-Related Traumatic Events, and Past 12-Month Cannabis Use Among Veterans in Canada

OBJECTIVE

Cannabis use among veterans in Canada is an understudied public health priority. The current study examined cannabis use prevalence and the relationships between child maltreatment histories and deployment-related traumatic events (DRTEs) with past 12-month cannabis use including sex differences among Canadian veterans.

METHOD

Data were drawn from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (response rate 68.7%; veterans only n = 1,992). Five child maltreatment types and 9 types of DRTEs were assessed in relation to the past 12-month cannabis use.

RESULTS

The prevalence of lifetime and past 12-month cannabis use was 49.4% and 16.7%, respectively. Females were less likely than males to report lifetime cannabis use (41.9% vs. 50.4%; odds ratio [OR] 0.71; 95% CI, - 0.59 to 0.86). No sex differences were noted for past 12-month cannabis use (14.1% vs. 17.0%; OR 0.80; 95% CI, 0.60 to 1.07). Physical abuse, sexual abuse, neglect, any child maltreatment, most individual DRTEs, and any DRTE were associated with increased odds of past 12-month cannabis use after adjusting for sociodemographic and military variables. Some models were attenuated and/or nonsignificant after further adjustments for mental disorders and chronic pain conditions. Sex did not statistically significantly moderate these relationships. Cumulative effects of having experienced both child maltreatment and DRTEs compared to DRTEs alone increased the odds of past 12-month cannabis use. Statistically significant interaction effects between child maltreatment history and DRTE on cannabis use were not found.

CONCLUSIONS

Child maltreatment histories and DRTEs increased the likelihood of past 12-month cannabis use among Canadian veterans. A history of child maltreatment, compared to DRTEs, indicated a more robust relationship. Understanding the links between child maltreatment, DRTEs, and cannabis use along with mental disorders and chronic pain conditions is important for developing interventions and improving health outcomes among veterans.

From Maltreatment to Psychiatric Disorders in Childhood and Adolescence: The Relevance of Emotional Maltreatment

Different forms of maltreatment are thought to incur a cumulative and non-specific toll on mental health. However, few large-scale studies draw on psychiatric diagnoses manifesting in early childhood and adolescence to identify sequelae of differential maltreatment exposures, and emotional maltreatment, in particular. Fine-grained multi-source dimensional maltreatment assessments and validated age-appropriate clinical interviews were conducted in a sample of N = 778 3 to 16-year-olds. We aimed to (a) substantiate known patterns of clinical outcomes following maltreatment and (b) analyse relative effects of emotional maltreatment, abuse (physical and sexual), and neglect (physical, supervisory, and moral-legal/educational) using structural equation modeling. Besides confirming known relationships between maltreatment exposures and psychiatric disorders, emotional maltreatment exerted particularly strong effects on internalizing disorders in older youth and externalizing disorders in younger children, accounting for variance over and above abuse and neglect exposures. Our data highlight the toxicity of pathogenic relational experiences from early childhood onwards, urging researchers and practitioners alike to prioritize future work on emotional maltreatment.

What Does Child Protective Services Investigate as Neglect? A Population-Based Study

Most child protective services (CPS) investigations involve allegations of neglect. Broad and vague definitions have led to concerns that CPS-investigated neglect is driven by poverty-based material hardship. In a representative sample of 295 neglect investigations in California in 2017, structured data and narrative text fields were used to characterize the types of neglect and concurrent parental risk factors investigated by CPS and to assess the rate and nature of investigated physical neglect, defined as inadequate food, housing, or hygiene. The most common types of neglect were inadequate supervision (44%) and failure to protect (29%), followed by physical neglect (14%). Common risk factors identified in neglect investigations were parental substance use (41%), domestic violence (21%), mental illness (18%), and co-reported physical or sexual abuse (29%). Nearly all investigations of physical neglect (99%) included concerns related to substance use, domestic violence, mental illness, co-reported abuse or an additional neglect allegation (i.e., abandonment). Given concerns identified in neglect investigations, economic supports are likely insufficient without an array of behavioral-health supports.

Neglect scoring modifications in the National Institutes of Health Stroke Scale improve right hemisphere stroke lesion volume prediction

BACKGROUND

The National Institutes of Health Stroke Scale (NIHSS) does not equitably assess stroke severity in the two cerebral hemispheres. By attributing a maximum of two points for neglect and seven for language, it undervalues right hemisphere deficits. We aimed to investigate if NIHSS equally predicts right hemisphere lesion volumes in patients with and without neglect, and if a modification of the neglect scoring rules could increase its predictive capacity.

METHODS

We analyzed a prospective cohort of acute right middle cerebral artery ischemic stroke patients. First, we calculated the correlation between NIHSS scores and lesion volume and analyzed the partial correlation of neglect. Then, we applied different modifications in the neglect scoring rules and investigated how they interfered with lesion volume predictive capacity.

RESULTS

A total of 162 ischemic stroke patients were included, 108 with neglect and 54 without. The correlation between lesion volume and NIHSS was lower in patients with neglect (r = 0.540 vs. r = 0.219, p = 0.004) and neglect was a statistically significant covariate in the partial correlation analysis between NIHSS and lesion volume (p = 0.017). With the neglect score tripled and with the duplication or triplication of all neglect modalities, the correlation was significantly higher than with the standard NIHSS (p = 0.043, p = 0.005, p = 0.001, respectively). With these modifications, neglect was no longer a significant covariable in the partial correlation between lesion volume and NIHSS.

CONCLUSION

A modification of NIHSS neglect scoring might improve the scale's capacity to predict lesion volume.

Understanding the prospective associations between neuro-developmental problems, bullying victimization, and mental health: Lessons from a longitudinal study of institutional deprivation

Studies suggest that children who have experienced neglect are at risk for bullying which in turn increases the risk for poor mental health. Here we extend this research by examining whether this risk extends to the neglect associated with severe institutional deprivation and then testing the extent to which these effects are mediated by prior deprivation-related neuro-developmental problems such as symptoms of inattention, hyperactivity and autism. Data were collected at ages 6, 11, 15, and young adulthood (22-25 years) from 165 adoptees who experienced up to 43 months of deprivation in Romanian Orphanages in 1980s and 52 non-deprived UK adoptees (N = 217; 50.23% females). Deprivation was associated with elevated levels of bullying and neuro-developmental symptoms at ages 6 through 15 and young adult depression and anxiety. Paths from deprivation to poor adult mental health were mediated via cross-lagged effects from earlier neuro-developmental problems to later bullying. Findings evidence how deep-seated neuro-developmental impacts of institutional deprivation can cascade across development to impact social functioning and mental health. These results elucidate cascade timing and the association between early deprivation and later bullying victimization across childhood and adolescence.

A role for adverse childhood experiences and depression in preeclampsia

Introduction

Adverse childhood experiences (ACEs) are a measure of childhood adversity and are associated with life-long morbidity. The impacts of ACEs on peripartum health including preeclampsia, a common and dangerous hypertensive disorder of pregnancy, remain unclear, however. Therefore, we aimed to determine ACE association with peripartum psychiatric health and prevalence of preeclampsia using a case-control design.

Methods

Clinical data were aggregated and validated using a large, intergenerational knowledgebase developed at our institution. Depression symptoms were measured by standard clinical screeners: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). ACEs were assessed via survey. Scores were compared between participants with (N = 32) and without (N = 46) prior preeclampsia.

Results

Participants with ACE scores ≥4 had significantly greater odds of preeclampsia than those with scores ≤ 3 (adjusted odds ratio = 6.71, 95% confidence interval:1.13-40.00; p = 0.037). Subsequent speculative analyses revealed that increased odds of preeclampsia may be driven by increased childhood abuse and neglect dimensions of the ACE score. PHQ-9 scores (3.73 vs. 1.86, p = 0.03), EPDS scores (6.38 vs. 3.71, p = 0.01), and the incidence of depression (37.5% vs. 23.9%, p = 0.05) were significantly higher in participants with a history of preeclampsia versus controls.

Conclusions

Childhood sets the stage for life-long health. Our findings suggest that ACEs may be a risk factor for preeclampsia and depression, uniting the developmental origins of psychiatric and obstetric risk.

Child Maltreatment as a Risk Factor for Rejection Sensitivity: A Three-Level Meta-Analytic Review

Theoretical and empirical evidence has suggested that child maltreatment victimization is associated with rejection sensitivity. However, empirical evidence on this association is inconsistent. Therefore, this meta-analysis aimed to examine the overall association between child maltreatment and rejection sensitivity, and to investigate variables that may affect the strength of this association. Studies eligible for inclusion were searched in the databases: Web of Science, Science Direct, PubMed, MEDLINE, and China National Knowledge Infrastructure after which relevant studies were coded. Studies were synthesized in advanced three-level meta-analytic models in R. A total of 16 studies (N = 5,335 participants) yielding 41 effect sizes were included. Results showed that child maltreatment is significantly and positively related to rejection sensitivity (mean r = 0.230; p < .001), and to a small extent. Furthermore, this association is stronger for emotional abuse (r = 0.275) than for physical abuse (r = 0.157). It is not affected by the mean age and gender distribution of primary study samples nor by sample type (community sample versus clinical sample). It is concluded that child maltreatment is a risk factor for developing rejection sensitivity later in life. Therefore, interventions for rejection sensitivity should consider potential trauma resulting from prior child maltreatment experiences.

Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years

BACKGROUND

A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood.

METHOD

A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested.

RESULTS

We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome DISCUSSION: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential.

PUBLIC SIGNIFICANCE

Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care.

Identifying Trajectories of Maltreatment Revictimization and Juvenile Justice Outcome: A Latent Class Analysis of Subtype, Timing, and Chronicity

Continued exposure to abuse or neglect is a strong predictor for immediate and long-term negative developmental outcomes including developmental delays, disabilities, poor school performance, criminal behavior, and mental health issues. The purpose of this study was to identify distinct subgroups of children with repeat victimization based on maltreatment timing, subtype, and chronicity and to examine how the unique subgroups are related to youth's juvenile justice outcome. Using data from Longitudinal Studies of Child Abuse and Neglect, this study included 286 children (47% males, 41% blacks) with more than one report for substantiated maltreatment from birth to age 17. Latent class analysis was employed to identify heterogeneity in the patterns of maltreatment revictimization. Four latent classes emerged: (a) Prevailing Early Neglect (52.6%); (b) Co-occurring Maltreatments in Preschool Age (20.1%); (c) Incremental Neglect with Sexual Abuse in School Age (18.7%); and (d) Co-occurring Maltreatments in School Age (8.6%). Black children were overrepresented in Incremental Neglect with Sexual Abuse in School Age compared to white and other racial groups of children. Ordinal logistic regression analysis indicated that there was no significant difference in the juvenile justice outcome across four subgroups of children with revictimization. Our person-centered investigations of maltreatment subtype, timing, and chronicity highlight the need for precise assessment and prevention strategies based on a more nuanced understanding of various patterns of childhood maltreatment revictimization.

Analysis of Cases Presenting With Concern of Child Abuse or Neglect to a Child Protection Team

Limited data are available on cases presenting for triage by child abuse specialists, particularly data combining patient demographics with presenting concerns and outcomes. This study aims to provide a descriptive analysis of cases presenting to one child abuse medical subspecialty team. Data were collected for all referrals triaged by the Child Protection Program, a child abuse team located within an academic children's medical center. The program triaged a total of 928 cases and completed 345 in-person visits with a medical provider. Nearly, half of all provider visits were for evaluation of children aged 3 years and younger (51%) and for a concern of physical abuse (49%). Of these visits, 26% were determined to be consistent with an accident or medical condition. This descriptive analysis highlights the burden of child abuse cases presenting to one small hospital-based child abuse program, as well as the structural and financial challenges faced by these programs.

Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis

Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.

Safeguarding adults at risk of abuse

Safeguarding adults at risk of abuse presents complex ethical challenges. By knowing what counts as adult abuse, recognising the signs of adult abuse and appropriately addressing suspected adult abuse, nurses contribute to protecting patients' safety, well-being, autonomy and dignity. This article discusses categories and indicators of adult abuse, relevant legislation and standards, the principles of adult safeguarding and the key elements of a nursing assessment of suspected adult abuse. The author highlights that nurses need to approach safeguarding concerns sensitively and strike a balance between acting to safeguard the person and preserving their right to autonomy. There is a need for ongoing education and training to enhance nurses' understanding of safeguarding practices, legislation, policies and standards.

Case report: Brief, intensive EMDR therapy for borderline personality disorder: results of two case studies with one year follow-up

Background

Exposure to adverse childhood events plays an important role in the development of borderline personality disorder (BPD). Emerging evidence suggests that trauma-focused therapy using eye movement desensitization and reprocessing (EMDR) can be beneficial for patients with BPD symptoms. To date, the effects of brief, intensive EMDR treatment for this target group have not been investigated in this population.

Objective

This study aimed to evaluate the effects of a brief and intensive trauma-focused therapy course using EMDR therapy in two patients diagnosed with BPD who did not fulfill the diagnostic criteria for post-traumatic stress disorder (PTSD). It was hypothesized that this approach would be associated with a decline in the core symptoms of BPD, and that this would have an enduring long-term effect on patients' diagnostic status.

Method

Ten sessions of EMDR therapy were carried out across four consecutive treatment days, with the aim of processing patients' core adverse childhood experiences. Both A-criterion-worthy memories (without intrusive reliving) and non-A-criterion-worthy memories that were considered responsible for the patients' most prominent symptoms were targeted. The effects of EMDR therapy on trauma symptom severity and BPD diagnostic status (as established by the Structured Clinical Interview DSM-5) were determined. Additionally, the effects on psychological distress, quality of life, and difficulties in emotion regulation were determined at intake, post-treatment, and at 3-, 6-, and 12-months follow-up.

Results

Both patients showed a strong decline in psychological distress and difficulties in emotion regulation, and reported an improvement in their quality of life. At post-treatment, and at 3-, 6-, and 12-months follow-up they no longer met the DSM-5 criteria for BPD.

Conclusion

The findings of this small case study are in line with mounting evidence that a brief track of intensive trauma-focused therapy can result in long-term remission in patients with BPD. EMDR therapy seems to be a promising treatment approach for patients with BPD; however, the results need to be replicated in clinical trials.

Lifetime Experience of Childhood Abuse and Neglect Among High School Students at Debre Tabor Town, South Gondar Zone, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

Background

Childhood abuse and neglect is defined as any intentional harm or mistreatment of a child that results in actual or potential harm to the child's health, survival and development. It has been linked to an increased risk of a wide range of serious short- and long-term medical and mental health problems. Although it is a complex societal issue, it receives limited research attention in the area.

Objective

To assess lifetime prevalence of childhood abuse and neglect among high school students in Debre Tabor town, south Gondar Zone, Northwest Ethiopia, 2022.

Methods

A cross-sectional study design was used to assess 423 high school students, chosen through a systematic sampling technique. Data were collected using a pre-tested, structured and self-administered international child abuse screening tool, child version (ICAST-C). The effect of independent variables on the outcome variable was explored using logistic regression analyses. The level of significances were determined using an odds ratio with a 95% confidence interval.

Results

Of the 423 study participants, 84.4% had lifetime experience of childhood abuse and neglect. Being female (AOR=4.5, 95% CI: 2.38, 8.60), parental marital status (AOR=5.4, 95% CI: 1.07, 27.3), illiteracy of father (AOR=1.65, 95% CI: 4.5, 6.03), birth order (AOR=4.5, 95% CI: 1.57, 13.0), open family discussion of sexual matters (AOR=0.37, 95% CI:1.74, 7.86), and watching pornography (AOR=0.08, 95% CI: 0.02, 0.40) were significantly associated with lifetime experience of childhood abuse and neglect.

Conclusion

Lifetime experience of childhood abuse and neglect was high as compared with previous studies. Being female, parental marital status, illiterate fathers, watching pornography, and open family discussion of sexual matters were predictors of childhood abuse and neglect. Dealing with this issue should be considered an integral component of high school students' care, including parental education and respite care.

[Prevention of elder abuse during hospitalization: evaluation of health professional's work practices to better understand the risks]

Elder abuse and neglect in institutions is frequent, but is still not studied enough. This study aims to better understand the risks of elder abuse, through daily experiences of health professionals. This is a monocentric, qualitative study, with semi-structured interviews of health professionals working in a geriatric hospital. Geriatrics is a specialty at risk of abuse and neglect. There is a real taboo around this issue. The difficulty for its reporting is multifactorial (tolerance, trivialization of abusive behaviors, isolation, and apprehension of caregivers...). The lack of human, material, and educational resources provided by health institutions does not enable professionals, whoever they may be, to care for patients humanely. The guidance and support of caregivers (training, increased team cohesion, and dedicated time for multidisciplinary reflection) are aimed at improving patient care and quality of care. All health professionals are concerned with elder abuse and neglect. It is necessary to break the taboo around mistreatment, to learn to talk about it among colleagues, and to recognize and evaluate oneself in order to change, evolve, and train others to treat patients the best way possible. Health professionals have to train and learn about the specificities of geriatrics early, repetitively, and continuously during their training. Health professionals must be able to work in a stable environment, with a supportive management. Their work must be valued in a sustainable way. Better working conditions should enable a more caring and compassionate approach by healthcare professionals toward their patients.

The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol

BACKGROUND

Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA).

METHODS/DESIGN

The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains.

RESULTS

Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual's orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search.

CONCLUSIONS

The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.

Disability Law Reform in Australia: Principles, Pragmatism and Politics

This editorial reviews two landmark contributions to disability reform in Australia, both published in 2023 - the 12 volume report of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability and the important Commonwealth Government of Australia report on the operation of the 10-year-old National Disability Insurance Scheme. It contends that each leaves Australia with major steps that need to be taken to enable persons with disability to live in a fairer, safer and more inclusive environment in which their human rights are genuinely respected. The reports contain many challenges where a balance needs to be orchestrated between implementation of principled reform and what is financially feasible. If Australia's governments are to adopt the recommendations in the reports, politics will need to be set aside and collaboration between Federal and State governments will be essential. Attitudes and practices will have to change in government and the general community, laws, protocols and even institutions will need to be reformed, accountability mechanisms will need to be tightened, and considerable sums of money will have to be spent.

Romania's Abandoned Children: The Effects of Early Profound Psychosocial Deprivation on the Course of Human Development

Understanding the impact that early psychosocial neglect has on the course of human development has implications for the millions of children around the world who are living in contexts of adversity. In the US, approximately 76% of cases reported to child protective services involve neglect; world-wide, there are more than 150 million orphaned or abandoned children, including 10.5 million orphaned because of COVID-19. In much of the world, children without primary caregivers are reared in institutional settings. We review two decades of research based on the only randomized controlled trial of foster care as an alternative to institutional care. We report that children randomly assigned to continued care as usual (institutional care) suffer from persistent deficits in social, cognitive, and emotional development, and show evidence of disruptions in brain development. By contrast, children randomly assigned to foster care show improvements in most domains of functioning, although the degree of recovery is in part a function of how old they were when placed into foster care and the stability of that placement. These findings have important implications for understanding critical periods in human development, as well as elucidating the power of the psychosocial environment in shaping multiple domains of human development.

The impact of childhood maltreatment on aggression, criminal risk factors, and treatment trajectories in forensic psychiatric patients

Introduction

Children's development into healthy well-functioning adults can be negatively affected by adversity. Adverse childhood experiences (ACEs) have been shown to lead to a variety of poor life outcomes, ranging from mental health problems (e.g., anxiety or suicidality) through problematic health behaviors to serious physical diseases and even early death. ACEs can also make people more prone to aggressive behavior, criminality, and recidivism. In this study, we investigated the association between ACEs, specifically childhood maltreatment (CM), and forensically relevant factors; aggression, criminal risk factors, and treatment trajectories, as little is known about these associations in forensic psychiatric patients.

Methods

The study includes data derived from two studies in The Netherlands, of which the first study enrolled 128 patients residing in a Forensic Psychiatric Center (FPC) and the second study included 468 patients who were released unconditionally from FPCs between 2009 and 2013. We expected that more CM would be correlated with higher levels of aggression, higher clinical risk factor scores, and less decrease in clinical risk factor scores over time. To investigate this, we applied correlational analyses and linear growth curve modeling on risk assessment scores and self-report as well as staff report questionnaires on CM and aggression.

Results

Consistent with our first hypothesis, patients with higher CM scores also had higher aggression and risk assessment scores. The effect sizes were small to medium (0.12 to 0.34). Unexpectedly, CM did not influence the course of these treatment trajectories, however, we found that patients with histories of CM had a significantly longer length of stay in a forensic facility than patients without CM (respectively, 10.8 years and 9.3 years on average).

Discussion

This study underlines the importance of carefully examining the history of ACEs and CM in forensic psychiatric patients and considering this in forensic risk assessment and risk guided treatment. More research is needed to draw conclusions about whether and how histories of ACEs should be considered and targeted during treatment trajectories.

Factors Associated With Permanency for Children in Out-Of-Home Placement: A Survival Analysis

Achieving permanency is a main goal of the child welfare system. To promote timely achievement of permanency, it is important to understand the determinants associated with permanency outcomes. This study aims to examine the length of time children spend in foster care and identify factors associated with achievement of permanency using administrative data from one state spanning a six-year timeframe and including a final sample of 1,874 children. Determinants associated with achievement of permanency were examined through multivariate survival analyses using Cox proportional hazards regression models. The median length of time in days to achieve permanency was: 188 for reunification, 505 for guardianship, and 932 for adoption. Race/ethnicity, age at removal, number of placement changes, number of siblings, having a removal family team decision meeting (FTDM), and placement type were significantly associated with achievement of permanency. Given the findings, this article proposes implications for practice and policy surrounding racial disproportionality, family engagement, kinship care, and placement stability.

Child maltreatment and resilience in adulthood: a protocol for a systematic review and meta-analysis

Background: Although child maltreatment (CM) has been linked to health problems and poor psychosocial functioning, not all individuals exposed to CM develop or experience negative consequences later in life. This suggests that some individuals show resilience after being exposed to CM. However, conclusions have been limited by inconsistent findings across different CM subtypes and resilience domains.Objective: To develop a protocol for conducting a systematic review and meta-analysis to quantify associations between CM (overall and its subtypes) and resilience (global and its multiple domains) in adulthood, and to examine moderators and mediators of these associations.Method: PubMed, PsycINFO, Embase, Scopus, and Web of Science will be searched to identify relevant studies on the association between CM (exposure) and resilience (outcome) in adults (≥ 18 years). Data will be screened and extracted by at least two independent reviewers. The methodological quality of the included studies will be independently assessed with a modified version of the Newcastle-Ottawa Scale (NOS). If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I2 statistic, and publication bias will be assessed. The effects of potential moderators (e.g. timing and severity of CM, age, sex, family cohesion, socio-economic status, country/region) will be analysed using meta-regression and subgroup analyses, and meta-analytical structural equation modelling will be employed to synthesise indirect mediation effects. Candidate moderators and mediators (e.g. genetic factors, brain functioning, attachment style, personality traits, physical activity, and social support) will be also examined qualitatively.Conclusions: This protocol will facilitate a systematic review and meta-analysis that has the potential to enhance our knowledge about the association between CM exposure in early life and resilience in adulthood. Understanding associations and underlying mechanisms between CM and resilience is potentially important in informing prevention and interventions to sustain health and improve outcomes among adults with a history of CM.PROSPERO registration: CRD42023394120.

A descriptive analysis of children seeking medical attention for problematic sexualized behavior

Introduction

Problematic Sexualized Behavior (PSB) in children is an increasingly prevalent and often misunderstood issue that impacts the well-being of children. Quantifying the numbers of affected children is challenging due to inconsistencies in how these children are identified, as well as misperceptions surrounding the issue and lack of a coordinated community response.

Methods

In this single-center retrospective case review, we attempt to report data on child demographics and case characteristics for children presenting to one Child Protection Program (CPP) medical specialty team for concern of PSB.

Results

A total of 224 children were identified as having engaged in PSB during the study period. 110 (49%) of these children were referred to the CPP for medical evaluation and medically triaged by the team. The remaining 114 children (51%) were identified through the medical triage of the presenting cases as having engaged in PSB with the index children, but were not referred to CPP for medical care themselves. The majority of children who were referred (69%) were the recipient of the PSB, compared to being the displayer of the behavior (20%). Of the recipient cases, the child displaying PSB was also referred to the CPP only 14.5% of the time.

Discussion

These results highlight that the number of children presenting for medical evaluation with concern of PSB is a significant underestimation of the prevalence of PSB in the community. This notable gap in identification of children engaging in PSB prevents service delivery for these children, including medical evaluation. The results also demonstrate that children displaying PSB were disproportionately missing from care and represent a specific area of missed opportunity for intervention and support by medical professionals.

The Associations of Adverse Childhood Experiences (ACEs) With Substance Use in Young Adults: A Systematic Review

Introduction

Young adulthood is a transitional period between adolescence and adulthood. Due to the unique pressures of taking on a new social role and associated uncertainties, young adults are at heightened risk for drug and alcohol use. Furthermore, adverse childhood experiences (ACEs) increases the likelihood of using maladaptive coping strategies such as using substances to avoid or soothe negative emotions. The current review aimed to summarize the associations between exposure to ACEs before the age of 18 years and subsequent drug or alcohol use between the ages of 18 and 25 years.

Methods

The review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the Web of Science, PubMed, and PsycINFO databases was conducted in February 2022.

Results

The initial search yielded 7178 articles, with 777 duplicates. Consequently, 6401 titles were inspected for relevance. After reading the full text, 88 articles were included in the review.

Conclusion

This review provides clear evidence that exposure to multiple ACEs is a robust risk factor for the use of alcohol, cannabis and other drugs by young adults. Poor self-regulation and maladaptive coping strategies were identified as mechanisms explaining this link; however, further detailed research is needed.

Prevalence, Severity and Impact of Visuospatial Neglect in Geriatric Stroke Rehabilitation, a Cross-Sectional Study

OBJECTIVES

Visuospatial neglect (VSN) is a common cognitive deficit of lateralized attention after stroke and can have a negative influence on patients' daily activities, community participation, and caregiver burden. VSN prevalence has been investigated in several mixed-age populations, but rarely in only an older population. As the population in geriatric rehabilitation (GR) is understudied and VSN may influence rehabilitation goals in GR (return home), we examined the prevalence of VSN as well as associations between VSN (severity) and population characteristics and the impact of VSN on functioning, length of stay, and discharge destination after GR.

DESIGN

Multicenter cross-sectional study.

SETTING AND PARTICIPANTS

Stroke patients admitted to GR.

METHODS

Three VSN tests (Star cancelation task, Line bisection task, and Catherine Bergego Scale) were administered in the first 2 weeks of GR admission. To examine VSN severity, a composite score was calculated based on scores of the 3 tests.

RESULTS

A total of 114 stroke patients were included [55.3% female; mean age 80.2 (SD 8.0) years]. VSN prevalence was 47.4%, in which allocentric and egocentric neglect were more prevalent than VSN during activities of daily living. Participants with VSN spent more days in GR compared to participants without VSN (median 68.5 vs 35.5 days) and had fewer home returns. In addition, VSN participants showed less mobility, lower cognitive functioning, and less independence during self-care compared to participants without VSN. Mobility, self-care, cognition, duration of rehabilitation, and home return were negatively associated with VSN severity.

CONCLUSIONS AND IMPLICATIONS

VSN is very prevalent in the GR stroke population. VSN severely hampers older people during daily activities and their rehabilitation process and, therefore, has a major personal and societal impact. Accordingly, systematic assessment of VSN in the early phase of geriatric rehabilitation with multiple VSN screening tests is recommended.

Disentangling Poverty From Neglect: Using a Person-Centered Approach to Examine Risk Factors for Neglect Among Families in Poverty

Approximately 18% of U.S. children under 5 years old live in poverty, which is one of the strongest predictors of child neglect. However, most families in poverty do not engage in neglect and this may be due to heterogeneity in risk factors. This study examined how risk factors co-occurred among families in poverty across early childhood and whether risk profiles were differentially related to physical and supervisory neglect across time. Results suggested there were four risk profiles across early childhood (i.e., years 1 and 3). At year 1, the four profiles in order of prevalence were: Low Risk, High Risk, Depressed and Uninsured, and Stressed with Health Problems. At year 3, the profiles were: Low Risk, High Risk, Depressed with Residential Instability, and Stressed with Health Problems. Overall, the High Risk profile was associated with more physical and supervisory neglect across time compared to the Low Risk profile; however, the Stress with Health Problems profile was also associated with greater physical neglect. These findings illustrate heterogeneity in the risk factors among families in poverty and demonstrate the differential impact of risk exposure on later neglect. Results also provide evidence to practitioners and policymakers about target risk experiences to prevent neglect.

Prevalence of non-accidental burns and related factors in children: A systematic review and meta-analysis

Non-accidental burns (NABs) in children had some adverse effects, such as severe burns, requiring skin grafting, and mortality. Previous studies reported NABs in the form of neglect, suspected abuse, and child abuse. Also, different statistics were estimated for the prevalence of NABs in children. Therefore, the current study aimed to comprehensively review and summarise the literature on the prevalence of NABs in children. Also, factors related to NABs as a secondary aim were considered in this review. Keywords combined using Boolean operators and searches were performed in international electronic databases, such as Scopus, PubMed, and Web of Science. Only studies in English were considered from the earliest to 1 March 2023. The analysis was performed using STATA software version 14. Finally, 29 articles were retrieved for the quantitative analysis. Results found that the prevalence of child abuse, suspected abuse, neglect, 'child abuse or suspect abused', and 'abuse, suspect abused, or neglect' was 6% (ES: 0.06, 95% confidence interval [CI]: 0.05-0.07), 12% (ES: 0.12, 95% CI: 0.09-0.15), 21% (ES: 0.21, 95% CI: 0.07-0.35), 8% (ES: 0.08, 95% CI: 0.07-0.09), and 15% (ES: 0.15, 95% CI: 0.13-0.16) among burns victims, respectively. Also, factors related to NABs are categorised into age and gender, agent and area of burns, and family features. Considering the results of the current study, planning for rapid diagnosis and designing a process to manage NABs in children is necessary.

The association between early traumatic experiences and the five domains of negative symptoms in participants at clinical high risk for psychosis

AIM

Youth at clinical high risk (CHR) for psychosis have high rates of early life trauma, but it is unclear how trauma exposure impacts later negative symptom severity in CHR. The current study examined the association between early childhood trauma and the five domains of negative symptoms (anhedonia, avolition, asociality, blunted affect, alogia).

METHOD

Eighty nine participants completed interviewer-rated measures of childhood trauma and abuse experienced before age 16, psychosis risk, and negative symptoms.

RESULTS

Higher global negative symptom severity was associated with greater exposure to childhood psychological bullying, physical bullying, emotional neglect, psychological abuse, and physical abuse. Greater severity of avolition and asociality was associated with physical bullying. Greater severity of avolition was associated with emotional neglect.

CONCLUSION

Early adversity and childhood trauma is associated with negative symptoms during adolescence and early adulthood among participants at CHR for psychosis.

Reparations for people living with dementia: Recognition, accountability, change, now!

There is a significant and longstanding problem of harm to people living with dementia in long term care institutions ('LTC institutions', referred to by others as 'care homes', 'nursing homes', 'long term care', 'residential aged care facilities'), along with a failure to redress the harm or hold people accountable for this harm. This article reports on an Australian project that found reparations must be a response to harm to people living with dementia in residential aged care. Using a disability human rights methodology, focus groups were conducted with people living with dementia, care partners and family members, advocates and lawyers to explore perspectives on why and how to redress harm to people living with dementia in Australian LTC institutions. Researchers found four key themes provide the basis for the necessity and design of a reparative approach to redress - recognition, accountability, change, now. The article calls for further attention to reparations in dementia scholarship, with a particular focus on the role that can be played in the delivery of reparations by the LTC industry, dementia practitioners, and dementia scholars. Ultimately, this article provides a new understanding of responses to violence, abuse, neglect and other harms experienced by people living with dementia in LTC institutions, which centres justice, rights, and transformative change.

A History of Child Abuse Pediatrics: Training, Research, and Clinical Diagnosis

This article provides an historical review of child maltreatment, focusing on the three most common subtypes: physical abuse, sexual abuse, and neglect. The evolution of recognizing, evaluating, and accurately diagnosing child maltreatment is described. Over time, the establishment of multidisciplinary teams, mandatory reporting, and Child Abuse Pediatrics as a subspecialty of pediatrics has improved the training, research, and clinical diagnosis for all forms of child maltreatment. These advancements have set clinical standards to ensure accurate diagnosis, prevent the misdiagnosis of child abuse and neglect, and continually improve the systems meant to protect children. The expansion of knowledge of child maltreatment continues with attention on early detection of children at risk of developing lifelong physical, psychological, and behavioral consequences from trauma associated with all forms of child maltreatment.

The Indirect Effect of Avoidant Motives for Sex on the Pathways From Childhood Maltreatment to Risky Sex Behaviors

Literature supports a strong link between engagement in risky sex and childhood maltreatment, with engagement in risky sexual behavior proposed as a manifestation of avoidant coping. Sex motives refer to underlying motivations for engaging in sex such as increased intimacy, or peer pressure. Limited research has examined the role of sex motives on the relationship between childhood maltreatment and risky sex. This study sought to examine this path between childhood maltreatment types and later engagement in risky sex through sex motivations that seek to avoid or reduce negative affect (i.e., sex to cope and sex to affirm self-esteem). A sample of sexually active undergraduate women (n = 551) completed a series of questionnaires on childhood maltreatment, risky sexual behavior, and motivations for sexual intercourse as part of a larger parent study on revictimization. Path analysis was conducted to examine differential indirect effects of childhood maltreatment on risky sex (i.e., sex with a stranger and hookup behaviors). Results suggested sex to cope with negative affect mediated the relationship between emotional abuse, sexual abuse, physical neglect, and hookup behavior. Only an indirect path between childhood emotional abuse and sex with a stranger was identified through sex to cope. Emotional abuse was the only maltreatment to predict sex to affirm, but sex to affirm did not predict risky sex outcomes. Findings provide support for differential pathways from various forms of childhood maltreatment, specifically sexual abuse, emotional abuse, and physical neglect, to increased risky sex as a manifestation of avoidant coping. Furthermore, results support the call for more inclusion of nonsexual forms of childhood maltreatment in studies of risky sex and avoidant coping as a potential intervention target for risky sexual behavior regardless of childhood maltreatment type.

Artificial Intelligence and Child Abuse and Neglect: A Systematic Review

All societies should carefully address the child abuse and neglect phenomenon due to its acute and chronic sequelae. Even if artificial intelligence (AI) implementation in this field could be helpful, the state of the art of this implementation is not known. No studies have comprehensively reviewed the types of AI models that have been developed/validated. Furthermore, no indications about the risk of bias in these studies are available. For these reasons, the authors conducted a systematic review of the PubMed database to answer the following questions: "what is the state of the art about the development and/or validation of AI predictive models useful to contrast child abuse and neglect phenomenon?"; "which is the risk of bias of the included articles?". The inclusion criteria were: articles written in English and dated from January 1985 to 31 March 2023; publications that used a medical and/or protective service dataset to develop and/or validate AI prediction models. The reviewers screened 413 articles. Among them, seven papers were included. Their analysis showed that: the types of input data were heterogeneous; artificial neural networks, convolutional neural networks, and natural language processing were used; the datasets had a median size of 2600 cases; the risk of bias was high for all studies. The results of the review pointed out that the implementation of AI in the child abuse and neglect field lagged compared to other medical fields. Furthermore, the evaluation of the risk of bias suggested that future studies should provide an appropriate choice of sample size, validation, and management of overfitting, optimism, and missing data.

Reduced Segregation of Brain Networks in Spatial Neglect After Stroke

Background/Purpose: To investigate the association between the degree of spatial neglect and the changes of brain system segregation (SyS; i.e., the ratio of the extent to which brain networks interact internally and with each other) after stroke. Methods: A cohort of 20 patients with right hemisphere lesion was submitted to neuropsychological assessment as well as to resting-state functional magnetic resonance imaging session at acute stage after stroke. The severity of spatial neglect was quantified using the Center of Cancellation (CoC) scores of the Bells cancellation test. For each patient, resting-state functional connectivity (FC) matrices were assessed by implementing a brain parcellation of nine networks that included the visual network, dorsal attention network (DAN), ventral attention network (VAN), sensorimotor network (SMN), auditory network, cingulo-opercular network, language network, frontoparietal network, and default mode network (DMN). For each patient and each network, we then computed the SyS derived by subtracting the between-network FC from the within-network FC (normalized by the within-network FC). Finally, for each network, the CoC scores were correlated with the SyS. Results: The correlational analyses indicated a negative association between CoC and SyS in the DAN, VAN, SMN, and DMN (q < 0.05 false discovery rate [FDR]-corrected). Patients with more severe spatial neglect exhibited lower SyS and vice versa. Conclusion: The loss of segregation in multiple and specific networks provides a functional framework for the deficits in spatial and nonspatial attention and motor/exploratory ability observed in neglect patients.