Assessment Of Child Abuse Research Articles

Complex posttraumatic stress disorder (CPTSD) is uniquely linked to suicidality beyond posttraumatic stress disorder (PTSD) in adults with childhood maltreatment: A multinational study across four countries

BackgroundSuicide is a leading cause of death worldwide, with childhood maltreatment identified as a significant risk factor for suicidal behavior in adulthood. The link between childhood maltreatment and suicidality is well-documented; however, the role of complex posttraumatic stress disorder (CPTSD), which includes an additional symptom cluster of disturbances in self-organization (DSO) compared to posttraumatic stress disorder (PTSD), remains underexplored. This study aimed to investigate the association between meeting the criteria for ICD-11 PTSD or CPTSD and suicidality in adults with a history of childhood maltreatment across culturally diverse samples. MethodsData were collected across four sites: the United States, the United Kingdom, China, and Malaysia. The Childhood Trauma Questionnaire (CTQ), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and International Trauma Questionnaire (ITQ) were used to assess childhood maltreatment, suicidality, and PTSD or CPTSD, respectively. Linear regressions were conducted to examine the associations, controlling for demographic variables (age, sex, ethnicity, educational level, and subjective socioeconomic status) as well as the severity of maltreatment (CTQ total scores). ResultsAmong the 1324 participants who experienced childhood maltreatment, meeting the criteria for CPTSD was significantly associated with higher suicidality compared to not meeting the criteria for either PTSD or CPTSD (B(SE) = 1.68 (0.30), p < .001), or only meeting the criteria for PTSD (B(SE) = 1.38 (0.43), p < .001). In contrast, meeting the criteria for PTSD alone was not significantly associated with suicidality (B(SE) = 0.35 (0.46), p = .45). These associations remained consistent across different cultural settings. ConclusionThe study findings highlight the unique association of CPTSD with suicidality in adults with a history of childhood maltreatment, suggesting that the DSO symptom cluster of CPTSD, which distinguish it from PTSD, play a critical role in the development of suicidality in this population. Targeting these symptoms may be essential for effective intervention strategies. Screening for childhood maltreatment and CPTSD in individuals at risk of suicide is crucial for guiding treatment planning.

Comparison between Thai and Indian Adolescents' Self-Figure Drawing as Child Abuse Art-Based Assessment.

The current study compared Self-Figure drawings from Thai and Indian adolescents to assess the cross-cultural applicability of a child abuse assessment tool. The research aims to understand the extent to which distinctions or similarities arise in Self-Figure drawings among adolescents from two culturally similar yet distinct backgrounds characterized by differences in religious affiliations, socioeconomic contexts, and political environments. Employing a mixed-methods approach, the study utilized quantitative measures, including the Traumatic Events Checklist (TEQ-5) and Medical Somatic Dissociation Questionnaire (MSDQ), alongside a qualitative analysis of Self-Figure drawings. Ethical approval was obtained with waived informed consent, and a convenience sample of 386 adolescents aged 13-18 years (193 from Thailand [M = 14.8, SD = 1.73; 135 females (69.9%) and 58 males (30.1%)], and 193 from India [M = 15.2, SD = 1.64; 135 females (69.9%) and 58 males (30.1%)]), who reported experiencing child abuse, participated in the study by completing questionnaires and drawing themselves. The analysis revealed that Thai adolescents had higher MSDQ scores, while Indian adolescents exhibited more prominent pictorial indicators. Indian participants reported experiencing a broader range of event types, whereas Thai adolescents predominantly depicted verbal or emotional abuse. Variations in pictorial indicators were found significant, except for hair, cheek or chin, omitted legs or feet, and omitted eyes. These findings contribute to the understanding of how cultural factors influence adolescents' self-representations through drawing. The differences in pictorial indicators highlight the nuanced variations within similar cultures, emphasizing the cultural specificity of self-expression.

Childhood Trauma Questionnaire-based child maltreatment profiles to predict efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus non-specific psychotherapy in adults with early-onset chronic depression: cluster analysis of data from a randomised controlled trial

Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression. We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study. 253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in β -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046). CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health. The German Research Foundation and the German Federal Ministry of Education and Research.

Childhood emotional maltreatment and romantic relationship satisfaction: the mediating role of early maladaptive schemas

ABSTRACT Objective Survivors of childhood emotional maltreatment (CEM) often report lower levels of romantic relationship satisfaction in later life, yet the mechanisms through which this occurs are unclear. Theoretical and empirical evidence suggests a potential pathway underlying this association is early maladaptive schemas (EMS), however, research is limited. The present study sought out to clarify the association between CEM and current romantic relationship satisfaction, and whether EMS mediate this relationship. Method The final sample consisted of 230 undergraduate psychology students. An anonymous online survey was administered assessing childhood maltreatment, EMS and current romantic relationship satisfaction. Data pertaining to possible covariates were also collected. Results CEM was found to be negatively correlated with relationship satisfaction. The results of path analysis additionally revealed emotional deprivation as the only early maladaptive schema to mediate this relationship. Conclusions These findings contribute to the understanding of how CEM may be related to relationship satisfaction, via EMS. In particular, they suggest experiences of CEM may strengthen the belief that others will not meet one’s emotional needs, which in turn, may be associated with reduced levels of romantic relationship satisfaction. Implications for clinical interventions to support adult survivors of CEM are discussed.

The Relations Among Childhood Maltreatment and Later Intimate Partner Violence Victimization With and Without a Weapon in a Sample of Pregnant Black Individuals.

Black pregnant and postpartum individuals are at risk for intimate partner violence (IPV), and those with a history of childhood maltreatment and IPV are even more likely to be re-victimized during pregnancy. However, it is unknown if specific types of child maltreatment predict later IPV with and without a weapon better than others. The current study sought to (i) document the prevalence of childhood maltreatment and IPV and (ii) examine the relations among types of childhood maltreatment and later IPV with and without a weapon within a sample of Black individuals seeking prenatal care at a large public hospital in the southeastern United States. Participants (n = 186; mean age = 27.2 years, SD = 5.3) completed measures assessing childhood maltreatment and IPV with and without a weapon. Approximately 68.5% of participants (n = 124) endorsed experiencing childhood maltreatment, while 42.6% (n = 78) endorsed experiencing IPV. The bivariate relations among five childhood maltreatment types (i.e., sexual, physical, and emotional abuse, physical and emotional neglect) and IPV with and without a weapon were assessed. All childhood maltreatment subtype scores-except childhood physical neglect-were significantly higher among participants who reported a history of IPV with or without a weapon compared to participants who denied a history of IPV with or without a weapon. Logistic regression models revealed childhood sexual abuse emerged as the only significant predictor of experiencing IPV with a weapon (B = 0.10, p = .003) and IPV without a weapon (B = 0.11, p = .001). For every point increase in childhood sexual abuse subtype score, the odds of experiencing IPV with and without a weapon increased by 10% (OR = 1.10, 95%CI [1.04, 1.18]) and 12% (OR = 1.12, [1.05, 1.20]), respectively. Findings suggest that screening for childhood sexual abuse may provide a critical opportunity for maternity care providers to identify individuals at increased risk for IPV victimization with and without a weapon.

Emotion regulation as a mediator in the relationship between childhood maltreatment and symptoms of social anxiety among college students

Objective The current study explored emotion regulation strategies (ie, suppression, cognitive reappraisal, experiential avoidance) as mediators in the relationship between childhood maltreatment and social anxiety. Participants One hundred and ninety-three undergraduate students (M age = 19.5 years; 83.9% female) were recruited from a public university in the northeastern United States. Methods Participants completed measures assessing childhood maltreatment, emotion regulation strategies, and social anxiety. Results Structural equation modeling was used to examine the mediation paths. Childhood maltreatment was negatively associated with cognitive reappraisal and experiential avoidance, and positively associated with suppression. Higher suppression was associated with higher social anxiety, and higher experiential avoidance was associated with lower social anxiety. The association between childhood maltreatment and symptoms of social anxiety was mediated by suppression and experiential avoidance, but not cognitive reappraisal. All other paths were nonsignificant. Conclusions Findings suggest that treatments for childhood maltreatment should aim to bolster experiential avoidance and minimize suppression to address social anxiety symptoms.

A prospective study of sexual risk patterns associated with delinquency and justice involvement among child welfare system-involved male adolescents in the United States.

Early sexual activity and teen pregnancy are known risk factors for delinquency and justice involvement among male adolescents. However, less is known about these patterns among child welfare system (CWS)-involved boys who face significant social barriers and past/current traumatic experiences. We prospectively examined these associations among male adolescents who identified as low and high risk for child-maltreatment via a secondary data analysis of the Longitudinal Studies of Child Abuse and Neglect dataset-a large scale assessment of children, their parents, and their teachers in the United States to understand issues of child abuse and neglect. We extracted and examined data from 657 boys who were identified as at-risk for maltreatment or with histories of substantiated maltreatment at ages 6, 8, 12, 14, and 16. We used structural equation modeling to examine the relationship between sexual activity (i.e., age of sexual debut, actively having sex, and sex resulting in a child) and changes in delinquency and justice involvement. Male adolescents who have engaged in sex and/or have fathered a child had greater increases in delinquency over time compared to those who have not had sex. Further, fathering a child was significantly associated with justice involvement, especially for the high-risk group. Results indicate that greater efforts should be taken to ascertain CWS-involved male adolescents' sexual health practices and parenting status. Male adolescents in the CWS require support with accessing developmentally appropriate sexual health education and family services.

Intergenerational effects of child maltreatment on adolescents’ anxiety and depression in Ethiopia: the important mediating and moderating roles of current psychological distress

BackgroundChild abuse is widespread around the world, and one continent with particularly high rates is Africa. Research in high- and middle-income countries shows the cascading effect of parental history of child abuse and neglect on adolescents’ maltreatment and, in turn, on mental health problems. This cascade has been reported in young children but has rarely been studied in parent-adolescent dyads or in low-income countries (LICs). The goal of this study was to test intergenerational associations of child abuse and neglect and to examine how these experiences are in turn associated with youth anxiety and depression in an LIC.MethodsA total of 231 adolescents (age: 13–21 years) and 185 of their parents (n = 90 fathers and n = 95 mothers) were recruited from secondary schools in Addis Abeba, Ethiopia. Using a cross-sectional design, participants completed a set of questionnaires assessing child maltreatment (in adolescence and own past history in parents), parental psychological distress, youth depression and anxiety, and sociodemographic factors.ResultsThe frequencies of child maltreatment exposure were 68% for adolescents and 65% for their parents (when they were a child). Fifty-one percent and 42% of adolescents had borderline to clinical levels of anxiety and depression symptoms, respectively. Adolescents of parents with a history of child abuse and neglect also reported higher exposure to maltreatment themselves (p < 0.001). Current paternal, but not maternal, psychological distress mediated this intergenerational association of maltreatment experiences (95% CI [1.164, 9.467]). We further found parents’ psychological distress to be a significant moderator of the indirect pathways of the intergenerational effect of child maltreatment on adolescents’ anxiety and depression (95% CI [− 0.770, − 0.012]).ConclusionsWe found child maltreatment to be intergenerationally associated, and this effect subsequently affected adolescents’ anxiety and depression through different pathways supporting the cascading effects across generations. Intervention plans may be effective through an array of possible indirect pathways and encourage the implementation of multiple access points to facilitate change in the lives of affected youth in Africa.

Early Adverse Family Experiences and Elevated Adrenocorticotropic Hormone Predict Non-Suicidal Self-Injury in Females with Non-Psychotic Mental Disorders and Suicidal Ideation.

Nonsuicidal self-injurious behavior (NSSI), prevalent in patients with non-psychotic mental disorders (NPMD), is associated with numerous adverse outcomes. Despite active research into the clinical and psychological aspects of NSSI, the underlying biological mechanisms remain obscure. Early adverse experiences are believed to induce long-lasting changes in neuroendocrine mechanisms of stress control playing a key role in NSSI development. The aim of the study was to evaluate parameters potentially predicting development of NSSI in female patients with NPMD and suicidal ideation. Eighty female patients over 18 years with NPMD and suicidal ideation (40 with and 40 without NSSI) and 48 age matching women without evidence of mental illness (healthy controls) were enrolled. Diagnostic interviews and self-report measures were used to assess childhood maltreatment, presence, frequency, and characteristics of suicidal and self-injurious thoughts and behaviors, the Beck Depression Inventory scale to assess severity of depression. Hypothalamic-pituitary-adrenal axis markers, hormones, and neurotrophic factors were measured in blood serum. The likelihood of developing NSSI in patients with NPMD and suicidal ideation was associated with early adverse family history and elevated adrenocorticotropic hormone levels. Dysregulation of hypothalamic-pituitary-adrenal axis as a result of early chronic stress experiences may represent critical biological mechanism promoting the development of NSSI behaviors in patients with NPMD.

Comparison of ACE-IQ and CTQ-SF for child maltreatment assessment: Reliability, prevalence, and risk prediction

BackgroundChild maltreatment has profound effects on mental health. The Childhood Trauma Questionnaire Short Form (CTQ-SF) and the Adverse Childhood Experiences International Questionnaire (ACE-IQ) are commonly used retrospective assessment tools for evaluating child maltreatment. ObjectiveThis study aims to conduct a comprehensive comparison of the CTQ-SF and ACE-IQ, encompassing internal consistency, prevalence, and the predictive efficacy of trauma-related outcomes. It also seeks to enhance the scoring method of ACE-IQ based on the established comparability between the two instruments. Participants and setting1484 college students from northern China were recruited, assessing demographic characteristics and outcomes related to traumatic experiences, including post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder (CPTSD), borderline personality disorder (BPD), anxiety, and depression. MethodsA contingency correlation analysis was performed to evaluate the degree of agreement between the CTQ-SF and ACE-IQ. Binary logistic regression models were utilized to compare the predictive capabilities of distinct instruments. ResultsCTQ-SF and ACE-IQ instruments display favorable internal consistency and notable correlations across shared categories. However, the predictive relationships between trauma type and adverse outcomes are inconsistent across instruments. The ACE-IQ, encompassing 13 trauma categories, demonstrate a lower AIC and BIC index, indicating a superior model fit for elucidating outcomes. ConclusionThis study introduces a scoring methodology for ACE-IQ, improving the comparability of the two measures and emphasizing the importance of capturing the full range of maltreatment types a child may have experienced. These findings have significant implications for clinical and epidemiological research, providing valuable insights for understanding the impact of child maltreatment.

Self-esteem buffers the stress sensitizing effect of childhood maltreatment on adolescent nonsuicidal self-injury

BackgroundAdversity in childhood increases the risk of psychopathology, perhaps by influencing sensitivity to recent stressful life events (SLEs). However, little is known about the stress-sensitizing effect of childhood adversity on nonsuicidal self-injury (NSSI), whether stress sensitization exists in specific types of SLEs, and the stress-buffering effect of self-esteem. This study aimed to investigate whether exposure to child maltreatment increases adolescent's vulnerability to the effects of dependent and independent SLEs on later NSSI and whether self-esteem buffers this risk. MethodsWe conducted a two-wave study with 18-month intervals. 601 Chinese adolescents completed self-report measures of child maltreatment, SLEs, self-esteem, and NSSI. ResultsResults supported the stress sensitization hypothesis for child maltreatment regarding dependent SLEs, with dependent SLEs significantly predicting later NSSI only in maltreated adolescents. Moreover, self-esteem buffered the relationship between dependent SLEs and NSSI in maltreated adolescents but amplified the relationship in non-maltreated adolescents. In the maltreated group, dependent SLEs predicted increased NSSI only in those with low self-esteem. In contrast, in the control group, dependent SLEs were significantly associated with NSSI in individuals with high self-esteem. LimitationsWe did not collect information on the timing of exposure to child maltreatment. Future studies that assess child maltreatment during critical periods of development may be able to identify sensitive period in which maltreatment sensitizes individuals to stress in adolescents. ConclusionFindings provide preliminary evidence that child maltreatment has a stress-sensitizing effect on adolescent NSSI. Improving self-esteem may mitigate the associations between SLEs and NSSI in adolescents exposed to child maltreatment.

What do child maltreatment reports to child protective services tell us about the needs families and communities are experiencing?

Intake reports from child protective service (CPS) agencies are the foundation for subsequent decisions and services within the child welfare system. They provide valuable information for understanding children’s needs, yet the unstructured way that information is captured makes the information ascertained in these reports difficult to summarize. Utilizing CPS intake reports from a mid-sized urban county in the southeastern United States (N = 2,724), our study had three aims: (1) develop a coding system to abstract information from narrative CPS intake reports, (2) examine the prevalence of maltreatment subtypes, and (3) compare prevalence of maltreatment subtypes by screen-in/screen-out decisions. Improper discipline/physical abuse was the most common maltreatment subtype (34.6 %); over 40 % of reports involved a physical act toward the child not resulting in injury. Salient risk factors included caregiver drug use (20.6 %) and domestic violence (19 %). While substantialdiscrepancieswere not foundbetween screened-in and screened-out caseswith respect tomaltreatment types,maltreatment type-specific codes, or contributory factors, they were found for reporter typeand child age. Our coding system to extract and assess child maltreatment intake narrative data can provide local agencies with descriptive information about why children come to their agency’s attention and provide nuanced details regarding the children’s and families’ needs. This coding framework could be used to develop validated intake tools to better document and categorize child maltreatment which could inform the assessment/investigation process and create targeted prevention and intervention services for families that come to the attention of CPS.

Structural Validity and Internal Consistency of the Adolescents and Children Risk of Abuse and Maltreatment Parental Scale (ACRAM-PS).

There is a clear need for developing a comprehensive, unbiased, and psychometrically sound tool to assess child maltreatment. The aim of this study is to examine the structural validity, internal consistency, and convergent validity of a newly developed child maltreatment assessment instrument. A total of 286 professionals of the child protection system participated in the study, completing a total of 645 cases of children and adolescents. The Adolescents and Children Risk of Abuse and Maltreatment Parental Scale (ACRAM-PS), the Childhood Trauma Questionnaire Short Form (CTQ-SF) and other demographic variables were measured. Structural validity, internal consistency, and convergent validity of the ACRAM-PS were tested. This scale obtained good structural validity, internal consistency, and convergent validity as hypothesized patterns of correlations occurred as expected. This instrument implies a considerable improvement as it is comprehensive, psychometrically sound and, it has been articulated by its own users. It can significantly contribute to establish a common language among professionals, improve multidisciplinary communication, and optimize prevention, detection, and early intervention in child maltreatment.

An Investigation of the Mediating Roles of Emotion Regulation Difficulties, Distress Tolerance, Self-Compassion, and Self-Disgust in the Association Between Childhood Trauma and Nonsuicidal Self-Injury

Objective Childhood maltreatment has been associated as a risk factor with the development of nonsuicidal self-injury (NSSI), with difficulty in emotion regulation explaining the association. However, little is known about the potential factors that make some individuals with maltreatment history more vulnerable to difficulties in emotion regulation and, in turn, engage in NSSI. The current study aimed to examine the roles of distress tolerance, self-compassion, and self-disgust in the association between childhood maltreatment types and emotion regulation difficulty, which was expected to predict NSSI. Method The sample included 397 university students between the ages of 18 and 30. Participants completed self-report scales assessing childhood maltreatment, emotion regulation difficulty, distress tolerance, self-compassion, self-disgust, and NSSI using the paper-pencil and online methods. The mediation model suggested for the association between childhood maltreatment types and NSSI was tested using path analysis. Results Low distress tolerance, low self-compassion, high self-disgust, and resulting high emotion regulation difficulty mediated the indirect effect of emotional neglect on NSSI. Conclusion The current study sheds light on various factors in the development and maintenance of NSSI and reveals three developmental pathways from emotional neglect in childhood to engaging in NSSI. HIGHLIGHTS Emotional neglect may be a distal risk factor for nonsuicidal self-injury (NSSI). Low distress tolerance and self-compassion and high self-disgust may increase the risk of NSSI. Emotion regulation difficulty may make people engage in NSSI to regulate emotions.

Are child maltreatment and intimate partner violence associated with adult disordered eating?

Disordered eating is one of the most prevalent mental health concerns (Galmiche et al., 2019, Quick & Byrd-Bredbenner, 2013, Neumark-Sztainer et al., 2006). Studies show that child maltreatment increases the likelihood of disordered eating symptoms in adulthood (Caslini et al., 2016, Hazzard et al., 2019). However, these studies overlook abuse experiences later in life, such as intimate partner violence which may also be a significant contributing factor (Bundock et al., 2013). The proposed study will help identify whether childhood maltreatment and IPV are independent predictors and/or if the combination of the two are synergistic risk factors for adult disordered eating. We use data from 14,332 people from Wave III of the National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants completed questionnaires assessing child maltreatment, intimate partner violence, and disordered eating symptoms. We will perform a series of logistic regression models to examine a) whether child maltreatment and intimate partner violence are independently associated with disordered eating and b) whether exposure to the combination of both child maltreatment and intimate partner violence is associated with worse outcomes for adult disordered eating compared to exposure to only one or none at all. We also propose a supplemental analysis to establish the robustness of these effects when accounting for the highest parental education, federal poverty percentage level, race/ethnicity, gender, and age. Disordered eating is a serious mental health concern, especially in an emerging adult population. Child maltreatment is consistently associated with disordered eating in adulthood. However, the independent or synergistic role of more recent abuse experiences, such as intimate partner violence, remains largely unknown. The proposed study provides insight into how both childhood abuse and intimate partner violence may be associated with disordered eating independently or in combination.

Childhood maltreatment contributes to the medical morbidity of individuals with bipolar disorders.

Individuals with bipolar disorders (BD) are at risk of premature death, mainly due to medical comorbidities. Childhood maltreatment might contribute to this medical morbidity, which remains underexplored in the literature. We assessed 2891 outpatients with BD (according to DSM-IV criteria). Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Lifetime diagnoses for medical disorders were retrospectively assessed using a systematic interview and checked against medical notes. Medical morbidity was defined by the sum of medical disorders. We investigated associations between childhood maltreatment (neglect and abuse) and medical morbidity while adjusting for potential confounders. One quarter of individuals had no medical comorbidities, while almost half of them had at least two. Multivariable regression showed that childhood maltreatment (mainly abuse, but also sexual abuse) was associated with a higher medical morbidity. Medical morbidity was also associated with sex, age, body mass index, sleep disturbances, lifetime anxiety disorders and lifetime density of mood episodes. Childhood maltreatment was associated with an increased prevalence of four (i.e. migraine/headache, drug eruption, duodenal ulcer, and thyroid diseases) of the fifteen most frequent medical disorders, however with no difference in terms of age at onset. This large cross-sectional study confirmed a high medical morbidity in BD and its association with childhood maltreatment. The assessment of childhood maltreatment in individuals with BD should be systematically included in routine care and the potential impact on physical health of psycho-social interventions targeting childhood maltreatment and its consequences should be evaluated.

Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder.

Suicidal ideation (SI) is a risk factor for suicidal behaviour. To ascertain the clinical correlates and prognostic impact of severe SI, we analysed 249 outpatients with major depressive disorder (MDD) and suicidal thoughts included in the COmbining Medications to Enhance Depression outcome (CO-MED) trial. Patients with severe SI (36%) were younger at disease onset ( P = 0.0033), more severely depressed ( P = 0.0029), had more lifetime suicidal behaviour ( P < 0.0001) and psychiatric comorbidities (panic disorder: P = 0.0025; post-traumatic stress disorder: P = 0.0216), and a history of childhood maltreatment (neglect: P = 0.0054; emotional abuse: P = 0.0230; physical abuse: P = 0.0076; sexual abuse: P = 0.0016) than those experiencing low-moderate SI. After controlling for depression score, severe SI was positively correlated with lifetime suicidal behaviour (OR [95% CI]: 1.26 [1.12-1.41]), panic disorder (1.05 [1.00-1.12]), and childhood maltreatment (neglect: 1.93 [1.13-3.30]; physical abuse: 2.00 [1.11-3.69]; sexual abuse: 2.13 [1.17-3.88]), and inversely correlated with age of onset (0.97 [0.95-0.99]) and sleep-onset insomnia (0.76 [0.61-0.96]). Finally, the occurrence of serious lifetime suicidal behaviour was predicted by SI severity (2.18 [1.11-4.27]), bipolar score (1.36 [1.02-1.81]), and childhood sexual abuse (2.35 [1.09-5.05]). These results emphasise the importance of assessing childhood maltreatment and bipolar liability in MDD to estimate suicidal behaviour risk.

Unleashing the Potential of AcciMap in Identifying and Anticipating Systemic Failures: A Case Study of Child Abuse Prevention through Design

This study proposes a new application of AcciMap, a tool initially created within safety science. AcciMap assists designers by identifying and anticipating systemic conditions that have contributed to prior failures and may influence the implementation of new design interventions. For validation, we applied AcciMap to analyze factors contributing to child abuse cases in South Korea. This process identified potential facilitators and barriers related to the implementation of a child abuse assessment checklist developed by the research team. We found that AcciMap enables designers to apply systems thinking to complex problems. It allows the consideration of potential implementation issues for new design interventions across multiple levels, helping designers understand and anticipate the complex systemic structures affecting their intervention. By exploring how AcciMap can be used for in-depth sociotechnical system analysis, this study contributes to advancing our understanding of systemic design.

Child Maltreatment Reporting Practices by a Person Most Knowledgeable for Children and Youth: A Rapid Scoping Review.

Child maltreatment is a global public health and child rights crisis made worse by the ongoing COVID-19 pandemic. While understanding the breadth of the child maltreatment crisis is foundational to informing prevention and response efforts, determining accurate estimates of child maltreatment remains challenging. Alternative informants (parents, caregivers, a Person Most Knowledgeable-PMK) are often tasked with reporting on children's maltreatment experiences in surveys to mitigate concerns associated with reporting child maltreatment. The overall purpose of this study was to examine child maltreatment reporting practices in surveys by PMKs for children and youth. The research question is: "What is the nature of the evidence of child maltreatment reporting practices in general population surveys by PMKs for children and youth?" A rapid scoping review was conducted to achieve the study's purpose. A search strategy was conducted in nine databases (e.g., MEDLINE, EBSCO, Scopus, Global Health, ProQuest). The findings from this review indicate that most studies involved PMK informants (i.e., maternal caregivers), included representative samples from primarily Western contexts, and utilized validated measures to assess child maltreatment. Half of the studies assessed involved multi-informant reports, including the PMKs and child/youth. Overall, the congruence between PMK-reported and child/youth-reported child maltreatment experiences was low-to-fair/moderate, and children/youth reported more maltreatment than the PMKs.

Assessing Childhood Maltreatment Exposure in Patients Without and With a Diagnosis of Substance Use Disorder.

Childhood maltreatment (CM), widely held as a risk factor for substance use disorders (SUDs), is commonly assessed using the Childhood Trauma Questionnaire (CTQ). Retrospective self-reports are, however, potentially subject to bias. We used a unique patient sample with prospectively documented CM to examine the performance of the CTQ and how this is affected by the presence of SUD. Analysis was based on a total of 104 individuals. Subjects with prospectively recorded CM were identified from a specialized childhood trauma unit in Linköping, Sweden (n = 55; 31 with SUD, 61% females; 24 without SUD, 71% females). Clinical controls had SUD but no CM (n = 25, 48% females). Healthy controls had neither SUD nor CM (n = 24, 54% females). We analyzed the agreement between retrospective CTQ scores and prospectively documented CM by κ analysis and assessed the performance of the CTQ to identify CM exposure using receiver operating characteristic (ROC) analysis. Agreement between prospectively and retrospectively recorded CM exposure was poor for sexual abuse (36.6%, Cohen κ = 0.32, P = 0.008) and physical abuse (67.3%, κ = 0.35, P = 0.007). Overall CTQ performance was fair (ROC: area under the ROC curve = 0.78, optimal cutoff = 36.5, sensitivity = 0.65, specificity = 0.75). However, performance was excellent in the absence of SUD (area under the ROC curve = 0.93, cutoff = 32.0, sensitivity = 0.88, specificity = 0.88), but poor in participants with lifetime SUD (area under the ROC curve = 0.62, cutoff = 42.0, sensitivity = 0.60, specificity = 0.36). These data support the CTQ as a tool to assess CM exposure but suggest that it may be less useful in patients with SUD.