Child Maltreatment Research Articles

Evaluating the effectiveness of Smoke-Free Home SafeCare, an integrated intervention, among families at risk for secondhand smoke exposure and child maltreatment in the United States: a study protocol for a hybrid type 1 trial

BackgroundSecondhand smoke exposure (SHS) and child maltreatment (CM) are preventable yet have negative lifelong impacts on health. When considered together, the risk for negative health outcomes may be compounded, especially for people living in low-resource settings. Evidence-based interventions exist for preventing CM and reducing SHS among families with low resources; however, no programs jointly target SHS exposure and maltreatment risk.MethodsThis study is a hybrid type 1 trial to examine the effectiveness of a systematically braided intervention to target CM risk and SHS in the home. Fifty SafeCare Providers will be randomized to deliver either standard SafeCare (i.e., the SafeCare model alone; active treatment control; n = 25) or Smoke-Free Home SafeCare (SFHSC; treatment condition; n = 25), the braided intervention that includes both SafeCare and the Smoke-Free Homes: Some Things are Better Outside intervention to N = 500 families. Aim 2 is to assess family-level outcomes. The primary outcome is a full home smoking ban, validated by air nicotine monitors; secondary outcomes include parenting and smoking outcomes. Aim 3 is to evaluate process and implementation outcomes, including cost–benefit. We will use multilevel models and ROC analyses to evaluate and validate the primary outcome. We will use tests of non-inferiority to evaluate secondary outcomes. Cost-effectiveness analyses will be used to assess cost–benefit of SFHSC.DiscussionThis study will be the first to document the outcomes of a multi-component intervention to address cumulative risk factors that impact cancer risk among children whose parents are at risk or involved in child-protective services. Integrating an evidence-based intervention that targets SHS exposure in the home with a broadly disseminated CM prevention intervention may be a sustainable way to help reduce the compounded effects of SHS in the home and CM.Trial registrationClinicaltrials.gov, NCT05000632. Registered on August 11, 2021.

The association between patterns of exposure to adverse life events and the risk of chronic kidney disease: a prospective cohort study of 140,997 individuals

Exposure to adverse life events is linked to somatic disorders. The study aims to evaluate the association between adverse events at varying life stages and the risk of chronic kidney disease (CKD), a condition affecting about 10% population worldwide. This prospective cohort study included 140,997 participants from the UK Biobank. Using survey items related to childhood maltreatment, adulthood adversity and catastrophic trauma, we performed latent class analysis to summarize five distinct patterns of exposure to adverse life events, namely “low-level exposure”, “childhood exposure”, “adulthood exposure”, “sexual abuse” and “child-to-adulthood exposure”. We used Cox proportional hazard regression to evaluate the association of patterns of exposure to adverse life events with CKD, regression-based mediation analysis to decompose the total effect, and gene-environment-wide interaction study (GEWIS) to identify interactions between genetic loci and adverse life events. During a median follow-up of 5.98 years, 2734 cases of incident CKD were identified. Compared with the “low-level exposure” pattern, “child-to-adulthood exposure” was associated with increased risk of CKD (hazard ratio 1.37, 95% CI 1.14 to 1.65). BMI, smoking and hypertension mediated 11.45%, 9.79%, and 4.50% of this total effect, respectively. Other patterns did not show significant results. GEWIS and subsequent analyses indicated that the magnitude of the association between adverse life events and CKD differed according to genetic polymorphisms, and identified potential underlying pathways (e.g., interleukin 1 receptor activity). These findings underscore the importance of incorporating an individual’s psychological encounters and genetic profiles into the precision prevention of CKD.

Differential effects of lifetime stressors on major depressive disorder severity: a longitudinal community-based cohort study.

Stressors across the lifespan are associated with the onset of major depressive disorder (MDD) and increased severity of depressive symptoms. However, it is unclear how lifetime stressors are related to specific MDD subtypes. The present study aims to examine the relationships between MDD subtypes and stressors experienced across the lifespan while considering potential confounders. Data analyzed were from the Zone d'Épidémiologie Psychiatrique du Sud-Ouest de Montréal (N = 1351). Lifetime stressors included childhood maltreatment, child-parent bonding, and stressful life events. Person-centered analyses were used to identify the clusters/profiles of the studied variables and multinomial logistic regression analyses were performed to examine the relationships between stressors and identified MDD subtypes. Intersectional analysis was applied to further examine how distal stressors interact with proximal stressors to impact the development of MDD subtypes. There was a significant association between proximal stressors and melancholic depression, whereas severe atypical depression and moderate depression were only associated with some domains of stressful life events. Additionally, those with severe atypical depression and melancholic depression were more likely to be exposed to distal stressors such as childhood maltreatment. The combinations of distal and proximal stressors predicted a greater risk of all MDD subtypes except for moderate atypical depression. MDD was characterized into four subtypes based on depressive symptoms and severity. Different stressor profiles were linked with various MDD subtypes. More specific interventions and clinical management are called to provide precision treatment for MDD patients with unique stressor profiles and MDD subtypes.

The Influence of Childhood Emotional Abuse and Neglect on Love Addiction: The Indirect Effect of Vulnerable Narcissism Among Female and Male Emerging Adults.

Childhood maltreatment is a key precursor to vulnerable narcissism since it likely lead to a narcissistic injury that triggers defenses against rage and abandonment. In later life, this pattern may contribute to a maladaptive model of love relationships. The present study explored the association between different types of childhood maltreatment (i.e., emotional, physical, and sexual abuse; physical and emotional neglect) and love addiction via vulnerable narcissism in a community sample of 505 cisgender emerging adults (M = 24.90, SD = 2.67; 76.6% assigned female at birth (AFAB); 68.5% heterosexual) residing in Italy. Data collection relied on self-report questionnaires administered online through the Qualtrics platform, and study hypotheses were tested using structural equation modeling. The results showed that childhood emotional abuse and emotional neglect directly influenced love addiction, while physical and sexual abuse, as well as physical neglect, showed no significant effects. Greater childhood emotional abuse and neglect were associated with increased vulnerable narcissism, leading to higher levels of love addiction. Gender differences emerged, with the indirect effect of vulnerable narcissism on the relationship between emotional neglect and love addiction significant only for AFAB. The findings emphasize the risk of love addiction in emerging adults with a history of childhood emotional abuse and neglect, highlighting the importance of addressing childhood emotional maltreatment and vulnerable narcissistic personality traits in interventions to treat this condition.

Violence in contact and custody proceedings-Acase of child endangerment in the family court-Where are efficient child protection measures?

Against the background of 30years of discussion in medicine and law about unfounded accusations and the existence of reasonable suspicion of intra-family violence in contact and custody proceedings, this article emphasises the importance of focusing on child protection by all professionals.Based on acase report in connection with the Federal Ministry of Justice's handout "Dealing with violence in custody and contact proceedings", the article describes the relevance of child protection in Austrian case law and the means by which it is undermined. In the name of science, ideological diagnoses are used instead of evidence-based treatment diagnoses [1]. "Professionals from the healthcare system, youth welfare, justice and education should cooperate in child protection with the aim of recognising, identifying and ending child abuse, maltreatment and/or neglect as such (cf. §3 KKG) [2]."In legal practice, however, practitioners in the psychosocial, psychosomatic and psychotherapeutic fields are often not recognised as witnesses because of the assumption they are influenced by parents or patients themselves. In Austria, the evaluation of evidence is the responsibility of the judge and it is often assumed that practitioners cannot take an objective position towards their patients and their relatives. Specialist medical or psychological experts are therefore of crucial importance. When taking their oath, they have committed themselves to objectivity and impartiality in the recording of findings and orientation towards scientific principles and standards ("state of the art") and their application, as well as to continuous further training and education in the preparation of expert opinions [3].The specific case in question is achild with adiagnosis of post-traumatic stress disorder following suspected sexualised violence, enuresis and enkopresis in connection with the traumatic experiences.The connection between violent situations and child and adolescent psychiatric disorders and the course of the custody and contact proceedings are described. Relevant legal interests such as the will of the child, the best interests of the child, attachment tolerance and protection against violence are addressed and put up for discussion. Topics such as domestic, psychological, sexualised, institutional violence and intimate terror are presented.The case report is an example of how child psychiatrists deal with points relevant to the Federal Ministry of Justice's handbook "Dealing with violence in custody and contact proceedings", which was published in January 2024. It represents aguideline for the area of court proceedings, assessment and treatment.

Childhood illnesses as risk indicators of adult mental health symptomatology

BackgroundLinks between childhood illnesses such as acne and migraines and co-occurring or subsequent mental health symptomatol-ogy are not well understood. Early medical histories have seldom been examined as adversity risk indicators.Participants and procedureThis survey analysis of college students (N = 2,636) examined links between four forms of childhood illness (migraine head-aches, acne, asthma, and enuresis) and adult mental health symptomatology.ResultsFour medical conditions often diagnosed in childhood or adolescence were prevalent enough in the college sample to test as risk indicators for lifetime mental health concerns. All four medical illnesses significantly raised the odds (ORM = 2.04) of lifetime depressive and anxiety disorder diagnoses. Current symptomatology was also raised for all but one (enuresis) medi-cal condition. These effects were found after controlling for respondent age and various forms of childhood maltreatment (sexual, physical, and/or emotional abuse).ConclusionsHeightened awareness of medical histories during clinical intake assessments seems warranted. Adversity researchers might also consider the inclusion of childhood medical conditions as future maladjustment risk indicators. Study limitations included the cross-sectional design and unclearly specified timing of the self-reported psychological and health recollections. The role of modulating variables such as gender, ethnicity, socioeconomic status, and family climate in physical-mental health relationships warrants continued focus.

Child maltreatment elevated the risk of late-life chronic pain: a biopsychosocial framework from the UK Biobank cohort.

Understanding the development of chronic pain (CP) is challenging due to its multifactorial etiology. Child maltreatment (CM), encompassing various types of neglect and abuse affecting more than one-third of the population, is a critical aspect of early-life adversity with long-lasting impacts. It is increasingly recognized for its role in altering biopsychosocial processes, potentially increasing vulnerability to CP. However, the exact path connecting CM to CP is not fully elucidated, primarily attributable to limitations in prior research, including insufficient sample sizes, inadequate consideration of comprehensive mediative variables, and a lack of longitudinal data. To address these gaps, our study utilizes a large-scale dataset (n = 150,989) comprising both cross-sectional and longitudinal data, along with an extensive range of biopsychosocial variables. Our findings reveal that all types of CMs, except physical neglect, significantly increase the risk of CP, and all types of CPs, except headache, were affected by CM. Furthermore, we demonstrate that individuals with CM histories are more predisposed to comorbid CP conditions. Importantly, biopsychosocial factors are found to explain over 60% of the association between CM and CP, with psychological factors playing a key role. This study not only characterizes the relationship between CM and CP but also underscores the influence of psychosocial elements in this dynamic interplay. These findings offer important insights into the long-term impacts of CM and provide a foundation for developing targeted therapeutic and preventive strategies for CP.

Interactions of the CSF3R polymorphism and early stress on future orientation: evidence for the differential model of stress-related growth.

This study aims to explore the concept of future orientation, which encompasses individuals' thoughts about the future, goal-setting, planning, response to challenges and behavioural adjustments in evolving situations. Often viewed as a psychological resource, future orientation is believed to be developed from psychological resilience. The study investigates the curvilinear relationship between childhood maltreatment and future orientation while examining the moderating effects of genotype. A total of 14,675 Chinese adults self-reported their experiences of childhood maltreatment and their future orientation. The influence of genetic polymorphism was evaluated through genome-wide interaction studies (GWIS; genome-wide association study [GWAS] using gene × environment interaction) and a candidate genes approach. Both GWAS and candidate genes analyses consistently indicated that rs4498771 and its linked single-nucleotide polymorphisms, located in the intergenic area surrounding CSF3R, significantly interacted with early trauma to influence future orientation. Nonlinear regression analyses identified a quadratic or cubic association between future orientation and childhood maltreatment across some genotypes. Specifically, as levels of childhood maltreatment increased, future orientation declined for all genotypes. However, upon reaching a certain threshold, future orientation exhibited a rebound in individuals with specific genotypes. The findings suggest that individuals with certain genotypes exhibit greater resilience to childhood maltreatment. Based on these results, we propose a new threshold model of stress-related growth.

Why do prospective and retrospective measures of childhood maltreatment differ? Qualitative analyses in a cohort study

BackgroundResearch indicates that prospective and retrospective measures of maltreatment often identify different groups of individuals, yet the reasons for these discrepancies remain understudied. ObjectiveThis study explores potential sources of disagreement between prospective and retrospective measures of maltreatment, utilising qualitative data from interviewers' notes. Participants and settingThe Environmental Risk Longitudinal Twin Study includes 2232 children followed from ages 5–18. Prospective measures relied on caregiver interviews and researcher observations from ages 5–12, while retrospective measures involved self-reports via the Childhood Trauma Questionnaire at age 18. MethodsWe purposively sampled written interviewer notes from 36 participants who reported more types of maltreatment retrospectively than prospectively (‘new reports’ group) and 31 participants who reported fewer types retrospectively than prospectively (‘omitted reports’ group). We conducted a framework analysis of the notes, comparing between the two groups to explore explanations for measurement disagreement. ResultsThree categories of themes emerged related to measurement discrepancies: challenges with prospective measures, highlighting reasons given by the ‘new reports’ group for why maltreatment went undetected or was not adequately responded to prospectively; challenges with retrospective measures that highlight difficulties with openness and accuracy of self-reports; and differences in appraisals of violence or distressing childhood experiences between the two groups that might lead to new or omitted retrospective reports. ConclusionsOur findings underscore potential mechanisms underlying the disagreement between prospective and retrospective measures, contributing to better understanding of these different constructs and more balanced interpretation of related findings.

Parental History of Childhood Maltreatment and Offspring Attachment Insecurity and Disorganization: Two Meta-Analyses.

Research findings have shown that parental history of childhood maltreatment (CM) increases the risk of insecure and disorganized attachment in offspring. However, the extent of the detrimental effects of childhood trauma on attachment in the next generation is unclear. The current meta-analyses aimed at synthesizing the available literature on the link between parental history of CM and offspring attachment insecurity and disorganization (with no restriction of offspring age). In total, 25 studies (23 unique samples; N = 2,592) comprising u = 61 effect sizes were included. Offspring age ranged from 12 to 79 months (Mweighted = 18.69; SDweighted = 11.53). Findings from two three-level random effects meta-analyses revealed a weak but significant combined effect of parental history of CM on child attachment insecurity (k = 20, u = 35, r = .06) and a non-significant effect on child attachment disorganization (k = 12, u = 26, r = .03). For the meta-analysis on disorganization, effect sizes were weaker in more recent studies, and trim and fill analyses provided evidence of publication bias. These findings provide a nuanced view of the intergenerational transmission of childhood trauma phenomenon, whereby parents' self-reported history of CM does not appear decisive for child attachment. Conclusions could not be drawn for specific types of CM because of the small number of studies. Research with more objective measures of parental exposure to CM is needed to gain a more comprehensive view of the possible intergenerational effects of CM on child attachment.

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 1,324 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.

Association between self-reported child maltreatment and risk of hospital-treated infectious diseases in middle-aged and older adults: A UK Biobank cohort study.

This study aimed to explore the association between child maltreatment and hospital-treated infectious diseases in middle-aged and older adults. 145,151 participants aged 38-72 years from the UK Biobank between 2006 and 2010 were enrolled and interviewed. Child maltreatment included five types: physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse. Patterns of maltreatment were identified using latent class analysis (LCA). Cox regression was employed to estimate the associations between child maltreatment (number of types, individual types, and patterns) and infectious diseases. Further, we evaluated potential mediators using mediation analysis. Over a median follow-up of 13.4 years, 22,688 participants (12.26 per 1000 person-years) were hospitalized for an infectious disease. Participants reporting any maltreatment had elevated infectious diseases risk (HR 1.18, 95 % CI: 1.15-1.21) than those without maltreatment. A dose-response relationship was observed between the number of maltreatment types and infectious disease (one, HR 1.09 [95 % CI 1.06-1.13]; two, HR 1.17 [95 % CI 1.12-1.23]; three to five, HR 1.48 [95 %CI 1.41-1.55]; Ptrend < 0.001). Each type of maltreatment was associated with increased infectious diseases risk. LCA identified four patterns (low maltreatment, child neglect, child abuse, and poly-maltreatment), with those experiencing poly-maltreatment exhibiting the highest infectious diseases risk (HR 1.51, 95 % CI: 1.43-1.59). The association between child maltreatment and infectious diseases was mediated by C-reactive protein, phenotypic age acceleration, loneliness, psychiatric disorders, and unhealthy lifestyles. Child maltreatment may increase susceptibility to a broad spectrum of infectious diseases in adulthood, highlighting the need for early-life maltreatment prevention policies.

Graduate qualities for preservice health and welfare professionals for collaborative prevention and early intervention for child maltreatment: a qualitative study

AimThis study explored Australian nursing, midwifery and social work perspectives on needs within pre-service education to enable interprofessional public health responses to child maltreatment. BackgroundChild maltreatment is a global public health concern, but little is known about how well health and welfare professionals are equipped for interprofessional responses to child maltreatment during initial pre-service qualification. DesignQualitative, World Café approach with online roundtable discussions. MethodsTwenty-five participants attended one of three online roundtables in October 2023. Participants were nurses, midwives and social workers from Australia with expertise in tertiary education, professional regulation and/or child protection. Data were analysed through inductive thematic analysis. ResultsGraduates are not well-equipped during their pre-service education for collaborative responses to child maltreatment. Findings identified four core areas of focus so health and welfare professionals can effectively collaborate to respond to child maltreatment. Core areas are described as graduate qualities and encompass broad domains of knowledge, skills and values which are transferable across multiple areas of practice. ConclusionsOur study proposes core qualities which are essential for health and welfare professional pre-service education to equip graduates for collaborative responses to child maltreatment. Key barriers included lack of shared interprofessional language and priorities, meaning future work should establish consensus on essential knowledge, skills and values. A shared understanding which acknowledges disciplinary nuances is vital to inform curriculum that equips future professionals to collaboratively mitigate harms from child maltreatment.

Journal Digest: Cannabis Use and Head/Neck Cancer, Spousal CVD and Dementia, Childhood Maltreatment and Personal Space, and More

Journal Digest: Cannabis Use and Head/Neck Cancer, Spousal CVD and Dementia, Childhood Maltreatment and Personal Space, and More

Refining criteria for a neurodevelopmental sub-phenotype of bipolar disorders: a FondaMental Advanced Centers of Expertise for Bipolar Disorders study

Bipolar disorder (BD) is a complex and heterogeneous psychiatric disorder. Neurodevelopmental factors were suggested to contribute to the etiology of BD, yet a specific neurodevelopmental phenotype of the disorder remains unidentified. Our objective was to define and characterize a neurodevelopmental phenotype (NDP) in BD and validate its associations with clinical outcomes, polygenic risk scores (PGS), and treatment responses. We analyzed the FACE-BD cohort of 4,468 BD patients, a validation cohort of 101 BD patients, and two independent replication datasets of 274 and 89 BD patients. Using factor analyses, we identified a set of criteria for defining NDP. We next developed a scoring system for NDP-load and assessed its association with prognosis, neurological soft signs, polygenic risk scores for neurodevelopmental disorders, and responses to treatment using multiple regressions, adjusted for age and sex with bootstrap replications. Our study established a NDP in BD consisting of nine clinical features: advanced paternal age, advanced maternal age, childhood maltreatment, attention deficit hyperactivity disorder (ADHD), early onset of BD, early onset of substance use disorders, early onset of anxiety disorders, early onset of eating disorders, specific learning disorders. Patients with higher NDP-load showed a worse prognosis and increased neurological soft signs. Notably, these individuals exhibited a poorer response to lithium treatment. Furthermore, a significant positive correlation was observed between the NDP-load and PGS for ADHD suggesting potential overlapping genetic factors or pathophysiological mechanisms between BD and ADHD. The proposed NDP constitutes a promising clinical tool for patient stratification in BD.

Telehealth in Home Visiting for New Mothers: Are Outcomes Different if the First Visits Are in Person?

Home visiting programs for new parents have a broad range of goals, including improvements in maternal and child health, reductions in child maltreatment, and improvements in child development. Before 2020, few home visits were conducted through phone or video encounters, i.e., telehealth home visiting (teleHV). However, rapid adoption of teleHV was required by the coronavirus disease 2019 (COVID-19) pandemic. To understand how conducting initial visits via teleHV was associated with outcomes, we performed a secondary data analysis to make use of the natural experiment created by COVID-19. Utilizing data from the Nurse-Family Partnership, a US national evidence-based model, we compared outcomes for families whose initial home visits were in person (enrolled 10/2019 to 1/2020; n = 7066) to those whose first visits were through teleHV (enrolled 4/2020 to 12/2020; n = 14,587). TeleHV at intake was associated with a higher likelihood of elevated depressive symptoms at 12 months (OR = 1.37; 95% CI 1.07, 1.76), a lower likelihood of retention to child’s age 12 months (OR = 0.67; 95% CI 0.58, 0.78), a higher likelihood of early drop from the program (OR = 1.77; 95% CI 1.48, 2.12), and fewer screening assessments completed (b = − 0.06; 95% CI − 0.07, − 0.04). No differences were detected between groups for the likelihood of breastfeeding at child’s age 6 months, elevated intimate partner violence (IPV) risk, 90% of attempted visits completed, or time to attrition. COVID-19 may have led families in different groups to have different experiences during key points of child development; however, as both groups’ involvement in the program occurred primarily during the pandemic, they were both subject to comparable influences. These findings suggest that in-person visits have some advantages in the first months of program involvement.

Fathers who experienced childhood maltreatment: aggression and testosterone.

Fathers who experienced childhood maltreatment: aggression and testosterone.

Reframing Child Protection in Emergency Medicine

Child maltreatment remains a concerning source of morbidity and mortality in the United States, where more than 600,000 children are victims of abuse each year, with well-described, long-term consequences for physical and mental health. However, the US child welfare system is characterized by systemic racism and inequity. Black and Native American children are more likely to be evaluated and reported for suspected abuse despite evidence that race does not independently change their risk of being abused. Once reported to child protective services (CPS), these children are more likely to be removed from their homes and less likely to be reunited with their families than White children. Much of the inequity in this system starts at the front door, where a growing body of research demonstrates that bias regularly infiltrates decision-making in the initial clinical evaluation and management of suspected abuse. Minority children presenting to emergency departments (ED) are more likely to receive diagnostic testing and are more likely to be referred to CPS. In this editorial, we argue for the application of an equity lens to child protection in the ED. We discuss how emergency physicians can balance efforts to protect children from abuse with the imperative to protect children and families from the harms of an inequitable child welfare system. Our discussion concludes with concrete recommendations for emergency clinicians to participate in active bias mitigation and thoughtfully navigate their responsibilities as mandated reporters.

Kenyans' perspectives on parenting roles and strategies used to raise young children in Kenya.

Research and parenting programs across the world emphasize two dimensions of parenting: warmth and control. Cross-country literature demonstrates many commonalities across samples on warmth; however, differences are evident with control, largely due to cultural and contextual nuances. Scant literature exists on parenting in Kenya, where half of Kenyans report experiencing child maltreatment typically by parents. Kenyan culture is a unique developmental niche important to understand and inform policies and parenting program development to reduce maltreatment. The purpose of this study was to understand perspectives on parenting strategies with young children, from a sample of Kenyans with varying experiences involving children (e.g., parents, community members). To our knowledge, this study is the first qualitative assessment of parenting practices among children under age 6 in Kenya. The 91 participants (62% female, all ≥ 18 years) completed interviews or focus groups. Based on a thematic data analysis, five themes emerged: (a) parental roles, (b) expressions of warmth, (c) cultural practices with children, (d) control strategies, and (e) factors impacting effective parenting. This study's findings have several implications for both informal and formal supports of families with young children. The findings offer insight into how Kenyans engage in parental warmth and control strategies, including those that are seen as culturally acceptable or harmful, and can inform the development or adaptation of parenting programs for Kenya. Furthermore, these findings offer important considerations for local and federal leaders in how to advance Kenya's policies and efforts to reduce childhood violence and promote healthy child development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of Psychological Abuse, Physical Abuse, Sexual Abuse, and Neglect During Childhood on Criminal Behavior among Prisoners at Forensic Mental Health Department

Introduction: Childhood maltreatment, including physical, emotional, sexual abuse, and neglect, has been consistently linked to a higher likelihood of aggressive and criminal behaviour in adulthood. This phenomenon, often referred to as the "cycle of violence," perpetuates across generations. Furthermore, victimization during childhood can lead to a broad range of mental health problems, including personality disorders, psychosis, schizophrenia, and substance abuse. These issues are particularly prevalent among individuals within the forensic mental health system. Objectives: The study aims to evaluate the impact of psychological abuse, physical abuse, sexual abuse, and neglect during childhood on criminal behaviour among prisoners at forensic mental health department. Methods: A cross-sectional descriptive study was conducted to determine the impact of child abuse on criminal behaviour among prisoners in the Forensic Medicine Department. The study was during the period from December 19, 2022 to 15th of July 2024. The research has been carried out at Baghdad City's Al-Rashad Training Hospital. non-probability purposive sample procedures, this study sampling method relied on our judgment when identifying and selecting prisoners in the forensic medicine department, after their consent, who could provide the best information to achieve the objectives of the study. We choose purposive sampling because we want to focus in depth on relatively small samples (150) to get the most accurate results. a purposive sample of (110) prisoners was selected from Al-Rashad Training Hospital. Results: The findings indicate that prisoners having moderate to high level of psychological abuse during childhood among items. Prisoners having moderate to high level of physical abuse during childhood among items. The findings indicate that prisoners having moderate to high level of sexual abuse during childhood among items. The prisoners having moderate to high level of neglect during childhood among items. The prisoners have high level of criminal behaviour. There are significant relationships between (psychological, physical, sexual abuse) during childhood and criminal behaviour. Conclusions: Prisoners experience a moderate to high level of psychological abuse, physical abuse, and neglect during childhood, and the prisoners also experience a moderate to high level of sexual abuse during childhood.