Child Maltreatment Series 1: Burden and Consequences of Child Maltreatment in High-Income Countries

Centre for Evidence-Based Child Health and MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK.
The Lancet (Impact Factor: 45.22). 01/2009; 373(9657):68-81. DOI: 10.1016/S0140-6736(08)61706-7
Source: PubMed

ABSTRACT Child maltreatment remains a major public-health and social-welfare problem in high-income countries. Every year, about 4-16% of children are physically abused and one in ten is neglected or psychologically abused. During childhood, between 5% and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse, and up to three times this number are exposed to any type of sexual abuse. However, official rates for substantiated child maltreatment indicate less than a tenth of this burden. Exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences. Child maltreatment substantially contributes to child mortality and morbidity and has longlasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour, which persist into adulthood. Neglect is at least as damaging as physical or sexual abuse in the long term but has received the least scientific and public attention. The high burden and serious and long-term consequences of child maltreatment warrant increased investment in preventive and therapeutic strategies from early childhood.

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Available from: Elspeth Webb, Jan 14, 2014
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    • "The prevalence of adverse childhood events, such as childhood sexual abuse (CSA) or childhood physical abuse (CPA), in the general public is surprisingly high with estimates of up to a quarter of all children affected in high-income countries (Gilbert et al. 2009; Radford et al. 2013). CSA and CPA are often considered the most toxic forms of childhood adversity (CA); however, in recent years, death of a significant other, separation from a parent figure and placement in institutional care during early childhood have also been recognized as having detrimental consequences for mental health (Read et al. 2005; Morgan et al. 2007; Read & Bentall, 2012). "
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    ABSTRACT: Background: The relationship between childhood adversity (CA) and psychotic disorder is well documented. As the adequacy of the current categorical diagnosis of psychosis is being increasingly questioned, we explored independent associations between different types of CA and specific psychotic symptom dimensions in a well-characterized sample of first-episode psychosis (FEP) patients. Method: This study involved 236 FEP cases aged 18-65 years who presented for the first time to psychiatric services in South London, UK. Psychopathology was assessed with the Positive and Negative Syndrome Scale and confirmatory factor analysis was used to evaluate the statistical fit of the Wallwork/Fortgang five-factor model of psychosis. CA prior to 17 years of age (physical abuse, sexual abuse, parental separation, parental death, and being taken into care) was retrospectively assessed using the Childhood Experience of Care and Abuse Questionnaire. Results: Childhood sexual abuse [β = 0.96, 95% confidence interval (CI) 0.40-1.52], childhood physical abuse (β = 0.48, 95% CI 0.03-0.93) and parental separation (β = 0.60, 95% CI 0.10-1.11) showed significant associations with the positive dimension; while being taken into care was associated with the excited dimension (β = 0.36, 95% CI 0.08-0.65), independent of the other types of CA. No significant associations were found between parental death and any of the symptom dimensions. Conclusions: A degree of specificity was found in the relationships between different types of CA and psychosis symptom dimensions in adulthood, suggesting that distinct pathways may be involved in the CA-psychosis association. These potentially different routes to developing psychosis merit further empirical and theoretical exploration.
    Psychological Medicine 09/2015; DOI:10.1017/S0033291715001816 · 5.94 Impact Factor
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    • "Additionally, some of these factors have been proposed to act as predisposing or maintaining factors. Childhood maltreatment is a major public health problem, and there is evidence that it has long-term consequences [3]. "
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    ABSTRACT: Introduction: Personality Disorders (PDs) and childhood traumatic experiences have been considered risk factors for Chronic Fatigue Syndrome (CFS). However, the relationship between these factors and their associated psychopathological impact has not been explored in this population. This study was designed to evaluate the association between different childhood traumas and the presence and number of PDs and current psychopathology in a sample of CFS patients. Material and methods: For this purpose, 166 CFS patients were evaluated with the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and the Child Trauma Questionnaire. Other instruments were used to assess the associated psychopathology and the impact of fatigue. Results: Of the total sample, 55 (33.1%) presented childhood trauma, the most frequent of which were emotional neglect (21.7%) and emotional abuse (18.1%). Considering PD presence, 79 (47.6%) patients presented some PD. There were no differences in frequency of physical childhood trauma in patients with and without PD. However, patients with PD had more frequently experienced emotional childhood trauma (OR=2.18, p=0.034). Severity of childhood trauma was related to a higher number of PDs, more severe depressive symptoms (p=0.025) and suicide risk (p=0.001). Patients with PD and any childhood trauma presented more severe depressive and irritable symptoms and a higher suicide risk than those without any PD and non-childhood traumatic event. These patients' psychopathological symptoms were similar to those of patients with childhood trauma and without PD. Conclusions: These results suggest that emotional childhood trauma but not physical childhood trauma is related to higher frequency of PD presence. More severe childhood emotional and physical traumas are related to a higher number of PDs and to more severe psychopathological symptoms.
    Comprehensive psychiatry 09/2015; 62:13-19. DOI:10.1016/j.comppsych.2015.06.010 · 2.25 Impact Factor
    • "Also, childhood victims of CM may develop aggressive behavior problems or become perpetrators of violence and crime during adolescence and adulthood. All these examples illustrate that there are broad societal consequences of FV (Ehrensaft & Cohen, 2012; Gilbert et al., 2009). FV also has consequences for the individuals directly involved. "
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    ABSTRACT: This review examines the association between alcohol and illicit drug use and the perpetration of intimate partner violence (IPV) and child maltreatment (CM). In clinical populations, alcohol use is related to IPV, although other variables are also known to influence this relationship. Studies in specialized social/health care and in the community have also demonstrated the association between alcohol use and IPV. Although data on the association between illicit drug use and IPV are less clear, in most studies perpetration seems related to the use of cannabis and cocaine. The occurrence of CM is related to alcohol use in specialized social/health care and community populations but has not been extensively investigated in clinical samples. These findings also apply to studies on the association between illicit drug use and CM. Moreover, many studies on CM fail to distinguish between the effects of alcohol and those of illicit drugs. This review concludes with recommendations for future research about substance use and family violence and discusses implications for prevention and treatment. © The Author(s) 2015.
    Trauma Violence & Abuse 08/2015; DOI:10.1177/1524838015589253 · 3.27 Impact Factor
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