305 Profiles of maltreated children aged 0–3 years old and their families: the singapore experience

Background:Child maltreatment is associated with long-term conditions (LTCs) in adulthood. Its relationship to multimorbidity (≥2 LTCs) is less clear. We explore the relationship between child maltreatment, multimorbidity and factors complicating management.Methods:Cross-sectional analysis of 157,357 UK Biobank participants. Experience of four maltreatment types (physical/sexual/emotional/neglect) was identified. We explored the relationship between type, number and frequency of maltreatment and LTC count (0, 1, 2, 3, ≥4) using multinomial logistic regression. Binary logistic regression assessed the relationship between maltreatment and self-rated health, loneliness, social isolation, frailty and widespread pain in those with multimorbidity, adjusting for sociodemographics and lifestyle factors.Results:52,675 participants (33%) experienced ≥1 type of maltreatment; 983 (0.6%) experienced all four. Type, frequency and number of types of maltreatment were associated with higher LTC count. People experiencing four types of maltreatment were 5 times as likely to have a LTC count of ≥4 as those experiencing none (odds ratio (OR): 5.16; 99% confidence interval (CI): 3.77-7.07). Greater number of types of maltreatment was associated with higher prevalence of combined physical/mental health LTCs (OR: 2.99; 99% CI: 2.54–3.51 for four types of maltreatment). Compared to people who reported no maltreatment, people experiencing all four types of maltreatment were more likely to have poor self-rated health (OR: 3.56; 99% CI: 2.58–4.90), loneliness (OR: 3.16; 99% CI: 2.17–4.60), social isolation (OR: 1.45; 99% CI: 1.03–2.05), widespread pain (OR: 3.19; 99% CI: 1.87–5.44) and frailty (OR: 3.21; 99% CI: 2.04–5.05).Conclusion:Peoplewith a history of maltreatment have higher LTC counts and potentially more complicated management needs reinforcing calls for early intervention.

This study aimed to explore the role of parental aggression and parental childhood maltreatment experience in the maltreatment of children in Zhejiang Province, eastern China. The study sites were two urban and two rural schools. Children aged ten to 16 years and their parents completed separate questionnaires, which included: parental childhood maltreatment; parental aggressive tendency; and maltreatment of children. Questionnaires were completed by 611 parents and 821 children. Fifty‐eight per cent of parents reported maltreatment of their children. Higher parental aggression scores were associated with an increased risk for all types of child maltreatment (relative risk ratios (RRRs) or odds ratios (ORs) ranged from 1.06–1.07 for each point higher on the aggression scale). Parental childhood maltreatment was significantly associated with an increased risk of moderate/severe physical maltreatment of children (OR = 1.80 (1.08, 3.00)); parental aggression was an explanatory factor for this association. Parental childhood maltreatment was positively associated with emotional maltreatment of children (OR = 1.89 (1.27, 2.83)). This was partly explained by parental aggression. In conclusion, high levels of child maltreatment were admitted by parents in China, suggesting the need for parenting education. Parents with a higher aggressive tendency were more likely to maltreat children. Parental aggressive tendency was an explanatory factor for the intergenerational transmission of maltreatment, indicating the possibility of identifying parents' aggressive tendencies for early prevention. © 2018 John Wiley & Sons, Ltd.‘Explore[s] the role of parental aggression and parental childhood maltreatment experience in the maltreatment of children in Zhejiang Province’Key Practitioner Messages Child maltreatment of all types is common in China. What is especially striking is the finding that nearly a fifth of parents admitted to moderate/severe maltreatment of their children. Parents with a higher aggressive tendency were more likely to use all types of maltreatment with their children. Parental aggression was an explanatory factor for the intergenerational transmission of moderate/severe physical maltreatment and emotional maltreatment. ‘Child maltreatment of all types is common in China’

A Prospective Examination of Service Use by Abused and Neglected Children Followed Up Into Adulthood

Childhood maltreatment is associated with risky sexual behaviors (RSBs). Previous systematic reviews and meta-analysis focused only on the relationship between childhood sexual abuse and RSBs, thus the association between childhood maltreatment and RSBs has yet to be systematically and quantitatively reviewed. We aimed to provide a systematic meta-analysis exploring the effect of childhood maltreatment and its subtypes on subsequent RSBs in adolescence and adulthood. PubMed, Google Scholar, EMBASE, Medline were searched for qualified articles up to April 2019. We calculated the pooled risk estimates using either the random-effect model or fixed-effect model. The potential heterogeneity moderators were identified by subgroup and sensitivity analysis. Overall, childhood maltreatment was significantly associated with an early sexual debut (odds ratio (OR) = 2.22; 95% confidence interval (CI): 1.64–3.00), multiple sexual partners (OR = 2.22; 95% CI: 1.78–2.76), transactional sex (OR = 3.05; 95% CI: 1.92–4.86) and unprotected sex (OR = 1.59; 95% CI: 1.22-2.09). Additionally, different types of childhood maltreatment were also significantly associated with higher risk of RSBs. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. Childhood maltreatment is significantly associated with risky sexual behaviors. The current meta-analysis indicates it is vital to protect children from any types of maltreatment and provide health education and support for maltreated individuals.

Problem A current problem is that although child maltreatment has been demonstrated to be negatively associated with both executive functioning and trauma appraisal (leading to feelings of shame, self-blame, etc.), there is not an established model within the literature that explains the relationship between child maltreatment, executive functioning, and trauma appraisal. The purpose of this study was to develop a model that displayed the relationship between child maltreatment, executive functioning, and trauma appraisal. Additionally, this study sought to discover differences in trauma appraisal and executive functioning based on the type of child maltreatment experienced. Method This study employed a quantitative, non-experimental, exploratory, cross-sectional, and correlational design. Data was derived from questionnaires administered to participants who were not randomly assigned to conditions or groups. Participants aged 18-22 years old were chosen in order to acquire those who had more recently experienced child maltreatment. Participants resided within the United States and were administered questionnaires via Alchemer, an online research platform. Participants were screened using the following question, and those who respond Yes were included in the study: "Prior to age 18, have you ever experienced physical abuse, sexual abuse (consensual or non-consensual), emotional abuse, or neglect from a parent or adult who was responsible for your care (e.g., family friend, teacher, etc.)?" In addition to collecting demographic information, the survey measured type of child maltreatment, executive function, and trauma appraisal. Child maltreatment was measured via the Childhood Trauma Questionnaire (CTQ) and its subscales: physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect. Executive function was measured via the Behavior Rating Inventory of Executive Function – Adult (BRIEF-A) and its subscales: behavior regulation and metacognition. Trauma appraisal was measured via the Trauma Appraisal Questionnaire (TAQ) and its subscales: fear, shame, anger, alienation, self-blame, and betrayal. Structural equation modeling, multivariate analyses of variance (MANOVA), independent sample t-tests, and Pearson correlation analyses were used to explore the overarching relationship and sub-relationships between child maltreatment, executive function, and trauma appraisal. Results Upon some revision, the SEM model showed emotional abuse and physical abuse to be the strongest indicators of child maltreatment. Child maltreatment was a significant predictor of executive function, indicating that more frequent child maltreatment was associated with greater impairment in executive function. Child maltreatment and executive function were both significant predictors of trauma appraisal, with child maltreatment having the strongest effect. All child maltreatment types were significantly correlated with each other with the exception of emotional neglect not being correlated with sexual abuse. All correlations between child maltreatment and trauma appraisal were positive. Emotional abuse had the strongest correlation with the betrayal trauma appraisal. The results also indicated significantly more impairment in behavior regulation, metacognition, and global executive function for individuals who had experienced 4+ maltreatment types, which was the most common experience with 23.4% of participants experiencing 4 and 48.5% experiencing all 5 types of maltreatment for a total of nearly 72% of participants experiencing multiple types of maltreatment. Post hoc analyses revealed emotional abuse to be highly positively correlated with behavior regulation and metacognition (i.e., emotional abuse was associated with behavioral and cognitive executive dysfunction). Child maltreatment was most commonly last experienced during adolescence. Results showed individuals who last experienced maltreatment during adolescence reported higher feelings of betrayal than those who last experienced maltreatment when they were age 5 or younger. In regard to trauma appraisal and engagement in a coping activity, it was found that those who did engage in a coping activity endorsed significantly more shame, betrayal, self-blame, and anger. Conclusions The effects of child maltreatment are prominent, and the resulting harm can have variable effects in the domains of executive function and trauma appraisal. Child maltreatment was found to be both directly and indirectly related to trauma appraisal and directly related to executive dysfunction. This study not only adds to the growing body of literature surrounding child maltreatment, executive function, and trauma appraisal, but it also serves as justification for clinicians to develop specific, tailored, and individualized interventions to adequately meet the needs of clients who may present with executive function difficulties or a maltreatment history.

The Australian Child Maltreatment Study (ACMS) is a landmark study for our nation. The ACMS research team has generated the first nationally representative data on the prevalence of each of the five types of child maltreatment in Australia, and their associated health impacts through life. We also identified information about the context of maltreatment experiences, including how old children are when it occurs, and who inflicts it. This knowledge about which children are most at risk of which types of abuse and neglect, at which ages, and by whom, is needed to develop evidencebased population approaches required to reduce child maltreatment in Australia. The concerning prevalence of maltreatment and its devastating associated outcomes present an urgent imperative for nation-building reform to better protect Australian children and reduce associated costs to individuals, families, communities and broader society. The ACMS collected data from 8500 randomly selected Australians aged 16-65 years and older. We included an oversample of 3500 young people 16-24 years of aged to generate particularly strong data about child maltreatment in contemporary Australian society, to assess its associated impacts in adolescence and early adulthood, and to allow future prevalence studies to detect reductions in prevalence rates over time. Our participants aged 25 and over enabled us to understand prevalence trends at different times in Australian history, and to measure associated health outcomes through life. Participants provided information on childhood experiences of each of the five types of child abuse and neglect, and other childhood adversities, mental health disorders, health risk behaviours, health services utilisation, and more. Our findings provide the first nationally representative data on the prevalence of child maltreatment in Australia. Moreover, the ACMS is the first national study globally to examine maltreatment experiences and associated health and social outcomes of all five forms of child maltreatment. Taken together, our findings provide a deep understanding of the prevalence, context and impact of child abuse and neglect in Australia and make an important contribution to the international field. This brief report presents the main findings from the ACMS for a general public audience. These main findings are further detailed in seven peer-reviewed scholarly articles, published in a special edition of the Medical Journal of Australia, Australia’s leading medical journal. Forthcoming work will examine other important questions about the impacts of specific maltreatment experiences to generate additional evidence to inform governments and stakeholders about optimal prevention policy and practice. There is cause for hope. In recent years, there have been reductions in physical abuse, and in some types of sexual abuse. These reductions are extremely important. They mean that fewer children are suffering, and they indicate that change is possible. Policies and programs to reduce these types of maltreatment are having an effect. Yet, there are other concerning trends, with some types of maltreatment becoming even more common, including emotional abuse, some types of sexual abuse, and exposure to domestic violence. And new types of sexual victimisation are also emerging. As a society, we have much work to do. We know that child maltreatment can be reduced if we work together as governments, service sectors, and communities. We need to invest more, and invest better. It is a moral, social and economic imperative for Australian governments to develop a coordinated long-term plan for generational reform. We have found that: 1. Child maltreatment is widespread. 2. Girls experience particularly high rates of sexual abuse and emotional abuse. 3. Child maltreatment is a major problem affecting today’s Australian children and youth – it is not just something that happened in the past. 4. Child maltreatment is associated with severe mental health problems and behavioural harms, both in childhood and adulthood. 5. Child maltreatment is associated with severe health risk behaviours, both in childhood and adulthood. 6. Emotional abuse is particularly harmful, and is much more damaging than society has understood.

Variation in Educational Services Receipt Among US Children With Developmental Conditions

Characterization of Neurological Complications Among Children with Sickle Cell Disease in the United States: Findings from the 2007-2018 National Health Interview Survey (NHIS)

BackgroundChild maltreatment causes substantial morbidity and mortality in the U.S. Morbidity associated with child maltreatment can reduce health-related quality of life. Accurately measuring the reduction in quality of life associated with child maltreatment is essential to the economic evaluation of educational programs and interventions to reduce the incidence of child maltreatment. The objective of this study was to review the literature for existing approaches and instruments for measuring quality-of-life for child maltreatment outcomes.MethodsWe reviewed the current literature to identify current approaches to valuing child maltreatment outcomes for economic evaluations. We also reviewed available preference-based generic QOL instruments (EQ-5D, HUI, QWB, SF-6D) for appropriateness in measuring change in quality of life due to child maltreatment.ResultsWe did not identify any studies that directly evaluated quality-of-life in maltreated children. We identified 4 studies that evaluated quality of life for adult survivors of child maltreatment and 8 studies that measured quality-of-life for pediatric injury not related to child maltreatment. No study reported quality-of-life values for children younger than age 3.Currently available preference-based QOL instruments (EQ-5D, HUI, QWB, SF-6D) have been developed primarily for adults with the exception of the Health Utilities Index. These instruments do not include many of the domains identified as being important in capturing changes in quality of life for child maltreatment, such as potential for growth and development or psychological sequelae specific to maltreatment.ConclusionRecommendations for valuing preference-based quality-of-life for child maltreatment will vary by developmental level and type of maltreatment. In the short-term, available multi-attribute utility instruments should be considered in the context of the type of child maltreatment being measured. However, if relevant domains are not included in existing instruments or if valuing health for children less than 6 years of age, direct valuation with a proxy respondent is recommended. The choice of a proxy respondent is not clear in the case of child maltreatment since the parent may not be a suitable proxy. Adult survivors should be considered as appropriate proxies. Longer-term research should focus on identifying the key domains for measuring child health and the development of preference-based quality-of-life instruments that are appropriate for valuing child maltreatment outcomes.

This comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using the I2 statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from 68 studies based on n = 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76-3.64], physical abuse (OR 2.52, 95% CI 2.09-3.04) and emotional abuse (OR 2.49, 95% CI 1.64-3.77) were associated with two- to three-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52-10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.

Introduction: Child maltreatment was proven to negatively impact the academic performance of children and adolescents; reduced academic achievements, problems completing homework assignments and was marginally associated with being frequently absent from school. Objectives: To identify the impact of child maltreatment on school performance among adolescents in National Guard schools. Materials and methods: The study was conducted at National Guard schools in Riyadh, Saudi Arabia. Students aged 12– 19 years were invited to participate. A total of 674 participants completed the survey instrument, which included demographics, exposure to different types of abuse and overall level of academic performance. Results: Participant mean age was 15.6±1.6 years, of which 53% were male. Ninety five per cent lived with both parents, 2% with a single parent and 3% with step parents. Four per cent lived with alcoholic parents or guardians, and 7% had lived with a family member who had been arrested or imprisoned. Poor performance (failure in exam) was more likely among the students who: lived with alcoholics versus non alcoholics (33% vs. 11%, P <0.01), lived with a family member that had been imprisoned versus non-imprisoned (26% vs. 11%, P <0.01), were psychologically abused versus not abused (21% vs. 10%, P <0.01), were physicallyabused versus not abused (19% vs. 9%, P <0.01). Predisposing factors to poor performance in school included living with alcoholic parents or guardians [odd ratio (OR)=2.8, confidence interval (CI)=1.1 to 6.7], psychological abuse (OR=1.7, CI=1.0 to 3.0) and physical abuse (OR=1.7, CI=1.0 to 2.8). Conclusions: Increase the awareness of the impact of child maltreatment on school performance among families, schools and the community. Recommend to the Ministry of Education to consider counselling of students with poor performance due to adverse child experiences and maltreatment.

BackgroundChildhood maltreatment is strongly associated with delinquency and the repeated crime. Specific types of childhood maltreatment have been found to have differential effects on recidivism in juvenile offenders, but studies of adult probationers have not been performed. This study investigated the relationship between having a history of childhood maltreatment and mental-health problems and the independent contribution of specific types of maltreatment and mental-health problems to the criminal recidivism of adult probationers.MethodThis study included 183 adult probationers (107 males and 76 females) with a mean age of 40.1 (SD = 11.8) years. Type of childhood maltreatment was assessed using the Childhood Trauma Questionnaire, which consists of five subscales (emotional neglect and abuse, physical neglect and abuse, and sexual abuse). Additionally, we used the Mini International Neuropsychiatric Interview to assess participants for the presence of psychiatric disorders and assessed levels of emotional dysregulation and resilience. Hierarchical logistic regression analysis was performed to determine whether the types of childhood maltreatment were independently associated with repeated crime, after adjusting for demographic factors and mental-health problems.ResultsThe overall prevalence of mental illness in the childhood maltreatment group was significantly higher than in the no childhood maltreatment group (56.1 % vs. 38.2 %, p = 0.017). The maltreated group had a higher rate of major depressive disorder, a higher level of emotional dysregulation, and a lower level of resilience than the group that was not maltreated. Recidivism was uniquely associated with physical neglect (Adjusted Odds Ratio [AOR], 2.862; 95 % Confidence Interval [95 % CI], 1.213–6.752) and the presence of at least one psychiatric disorder (AOR, 3.791; 95 % CI, 1.703–8.443).ConclusionsChildhood maltreatment deserves further attention in adult probationers because it is potentially associated with higher rates of psychiatric morbidity and recidivism. In particular, physical neglect during childhood plays a critical role in repeated crime, independent of mental-health problems for high-risk adults involved with the criminal justice system. Rigorous evaluations of the relevance of childhood maltreatment in the assessment and treatment of criminal offenders are needed.

Association of child maltreatment and depressive symptoms among Puerto Rican youth

In this article, supplementary data analyses regarding the association between different types of child maltreatment (CM) and diabetes as well as mediation analyses examining the role of personality functioning are provided (original research article: ‘Associations of different types of child maltreatment and diabetes in adulthood – the mediating effect of personality functioning: findings from a population-based representative German sample’) (Zara et al., 2023). Analyses are based on a representative sample of the German population (N = 5,041). Data was acquired through a representative survey conducted by the independent research institute USUMA Berlin. CM, personality functioning, a diabetes diagnosis as well as symptoms of depression and anxiety were assessed using self-report questionnaires (CTQ, OPD-SQS, PHQ-4).Correlation analyses for all used variables were conducted. Independent t-tests were performed to examine whether symptoms of depression and anxiety are elevated in patients with diabetes and CM (compared to no CM). Regarding the odd ratios (ORs) calculated to examine the association between types of CM and diabetes as well as mediation analyses investigating the role of personality functioning in these associations, sensitivity analyses with persons ≥ 30 years are provided. The additional analyses are intended to add to the body of research showing that patients with diabetes experience symptoms of depression and anxiety more frequently compared to the general population (Kampling and Kruse, 2020; Chireh et al., 2019; Smith et al., 2018), examine the association between different types of CM and diabetes, and explore the role of personality functioning in the association between CM and diabetes.

Previous research suggests that child maltreatment is associated with adverse outcomes, but the potential impact on cognitive and educational outcomes into adulthood has rarely been studied using a birth cohort design. The aim of this study is to investigate whether child maltreatment is associated with adverse outcomes in cognitive function, high school completion and employment by the age of 21. Longitudinal birth cohort study commencing in the prenatal period, with mothers and infants followed up to age 21. Of the original birth cohort of 7223, 3778 (52.3%) young people participated at age 21. Child maltreatment was identified by linkage with prospectively collected data from the relevant government agency. Associations between child maltreatment (abuse and neglect) and the outcomes were adjusted for relevant sociodemographic and perinatal variables. After full adjustment, young people who had been notified as cases of child maltreatment had reduced performance on the Peabody Picture Vocabulary Test by over a quarter of a standard deviation (coefficient = -2.85, p = 0.004). Maltreated young people also had three times the odds of failing to complete high school (odds ratio = 3.12, p < 0.001) and more than twice the odds of not being engaged in either study or employment at age 21 (odds ratio = 2.38, p < 0.001). Both abuse and neglect were similarly associated with adverse outcomes. Child maltreatment, including both abuse and neglect, is associated with adverse cognitive, educational and employment outcomes in young adulthood. This adds further impetus to efforts to prevent child maltreatment and assist young people who have experienced it.