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


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.

    • "Our findings highlight the importance of witnessing domestic violence during childhood as a key risk factor for perpetrating violence toward others in adulthood. Research into this childhood exposure is relatively limited compared to other forms of maltreatment (Gilbert et al., 2009) and has concentrated on generalized antisocial behavior and where the later adverse effects have been thought greater following childhood physical abuse (Wilson & Widom, 2009). Further research may examine the replicability of our findings on direct pathways between witnessing domestic violence and multiple types of adult violence, could explore whether the mechanisms proposed by social learning theory are responsible for this pathway , and could develop and test interventions based on social learning theory for preventing adult violence in children who witness domestic violence. "
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    ABSTRACT: Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21–34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.
    No preview · Article · Feb 2016 · Child abuse & neglect
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    • "Simply put, participants who reported more childhood experiences of abuse and neglect were more likely to be psychiatric patients. Though causality cannot be inferred from a cross-sectional sample, this result is consistent with previous metanalytic research that addresses issues of causality[1], and indicates that retrospectively-assessed childhood trauma has a causal role in increasing the risk for a wide range of psychiatric illness, including psychotic illness, mood disorders, dissociative disorders, anxiety disorders, substance use disorders, and personality disorders[1,2,62,63]. Numerically, comparing our results with Baker's review of another large (n > 1400), heterogenous, combined sample of clinical and community CTQ scores demonstrates a striking similarity between mean scores on the two subscales which showed the largest differences between clinical and community samples in our study: EA (10.1 vs 7.8) and EN (12.5 vs 9.4) compared with Baker's EA (11.4 vs 8.5) and EN (12.5 vs 9.7)[17]. "
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    ABSTRACT: Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ's discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias-as detected by the MD subscale-has a small but significant moderating effect on the CTQ's discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.
    Full-text · Article · Jan 2016 · PLoS ONE
    • "This could be especially the case for peer sexual abuse among Nordic adolescents; however, the prevalence ranges are so wide (due to methodological dissimilarities) that caution should be practiced in the interpretation of these findings. Victim's gender, age, and relationship to the perpetrator Consistent with previous research (Gilbert et al., 2009;Radford et al., 2013;Stoltenborgh et al., 2011), markedly more females than males reported experiences of sexual abuse in childhood. Although it could not be explored in the present study, the gender difference in victimization seems to be more pronounced in adolescence than in prepuberty (Finkelhor et al., 2005;Radford et al., 2013;Trocmé et al., 2005). "
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    ABSTRACT: This review examined child sexual abuse in the Nordic countries focusing on prevalence rates and victims' age and relationship to the perpetrator. The results show a prevalence of child sexual abuse (broadly defined) between 3-23% for boys and 11-36% for girls. The prevalence rates for contact abuse were 1-12% for boys and 6-30% for girls, while 0.3-6.8% of the boys and 1.1-13.5% of the girls reported penetrating abuse. The findings suggest an increased risk of abuse from early adolescence. In adolescence, peers may constitute the largest group of perpetrators. The results highlight the need for preventive efforts also targeting peer abuse. Future research should include cross-national and repeated studies using comparable methodology.
    No preview · Article · Jan 2016 · Journal of Child Sexual Abuse
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