Causation between child behavior problems and physical abuse in the area affected by the Great East Japan earthquake and tsunami

Abstract

Introduction Research has shown a reciprocal relationship between child behavior problems and maltreatment and has not come to conclusion about their causation. On the other hand, a study that targeted children living in the area affected by the Great East Japan Earthquake and Tsunami, exposure of which can be considered as random, found those with trauma experiences related to the earthquake were more likely to have clinically significant behavior problems. This study aims to examine causal association between child behavior problems and physical abuse by using trauma experiences related to the Great East Japan Earthquake and Tsunami as an instrument variable. Methods The target population of this study is children who were enrolled in a class of 3- to 5-year-olds in preschools in Iwate, Miyagi, and Fukushima prefectures at the time of the Great East Japan Earthquake and Tsunami on March 11, 2011. Questionnaire surveys and interviews were conducted for these children and their caregivers between September 2012 and June 2013. Frequency of use of corporal punishment and physical abuse was measured through questionnaires for caregivers, using three items of Alabama Parenting Questionnaire (APQ). Caregivers were also asked to assess child behavior problems with Child Behavior Checklist (CBCL). Trauma experiences caused by the earthquake and tsunami, such as losing of friends and witnessing someone being swept away by the tsunami, were asked in the interviews for children. A total of 184 sample was used for analysis after excluding those who did not report outcome, exposure, and instrument variables. Ordinary least squares (OLS) regression and two-stage least squares (2SLS) regression analysis using instrument variables was employed. Results Among the children, 15.2% (N = 28) reported their experience either of losing friends or witnessing someone being swept away by the tsunami. Mean score of corporal punishment and physical abuse assessed with APQ (3–15) was 5.5 (SD: 1.8), and mean T score of CBCL (0–100) was 55.6 (SD: 9.4). Among the children, 17.9% had clinically significant behavior problems and 13.0% were considered to be borderline clinical. The OLS regression analysis, which does not address endogeneity, suggested that children with more behavior problems were more likely to be physically abused. However, when instrument variable method was used to address endogeneity, the positive association between child behavior problems and physical abuse was not found. Conclusions Our findings did not support that child behavior problems can cause use of corporal punishment and physical abuse. It is important to further explore ways to buffer the impact of physical abuse on children.