The Joint Effect of Childhood Abuse and Homelessness on Substance Use in Adulthood

Childhood abuse and homelessness are independently associated with substance use. Though childhood abuse and homelessness are strongly correlated, research on the joint effect of exposure to both traumatic life events on substance use is limited. Objective: To estimate independent and joint effects of childhood abuse and homelessness on substance use risk during emerging adulthood and adulthood. Methods: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we measured associations between exposure to physical or sexual abuse in childhood, homelessness in childhood or emerging adulthood, or exposure to both traumas and outcomes of binge drinking, marijuana use, cocaine use, methamphetamine use, and prescription opioid misuse during emerging adulthood (Wave III, ages 18-26 years) and adulthood (Wave IV, ages 24-32 years). Results: In adjusted analyses, exposure to childhood abuse alone, homelessness alone, and both childhood abuse and homelessness were significant correlates of most substance use indicators in emerging adulthood. Those jointly exposed to childhood abuse and homelessness had disproportionate risk of substance use, particularly use of cocaine (adjusted odds ratio (AOR)=4.25, 95% confidence interval (CI): 2.70, 6.71) and methamphetamine (AOR = 6.59, 95% CI: 3.87, 11.21). The independent and combined effects of abuse and homelessness generally persisted into adulthood though associations tended to weaken. Conclusions/Importance: Those with exposure to abuse, homelessness, and both adverse outcomes constitute a high-risk population for substance use. Addressing abuse and homelessness should be a component of preventing drug risk for screening, treatment, and prevention efforts.

Unique Interactions of Interpersonal Trauma and Positive Peer and Family Experiences on Traumatic Distress Among Pediatric Primary Care Patients

Individuals with histories of interpersonal trauma are at increased risk for posttraumatic stress disorder (PTSD). Risk of PTSD is particularly salient during critical periods of development, such as adolescence and emerging adulthood. However, little is known about the unique effects and interactions of protective factors and interpersonal trauma on PTSD symptoms in adolescents and young adults. The current study tested whether positive peer and family experiences decrease the associations between interpersonal trauma and PTSD symptoms and whether these associations differed by victim-perpetrator relationships. Participants included 3,618 adolescents and young adults (aged 14-24 years) who completed the Behavioral Health Screen-a web-based screening tool that assesses psychiatric symptoms and associated risk factors-during a routine visit across 10 primary care sites in Pennsylvania. In support of the stress buffering hypothesis, results revealed that positive peer and family experiences buffered the effects of interpersonal trauma by a romantic partner and an adult in the home. Future research should examine whether programs aimed at improving peer or family relationships improve outcomes for traumatized youth.

Using Friendship Ties to Understand the Prevalence of, and Factors Associated With, Intimate Partner Violence Among Adolescents and Young Adults in Kenya: Cross-Sectional, Respondent-Driven Survey Study

Background

Optimization of innovative approaches is required for estimating the intimate partner violence (IPV) burden among adolescents and young adults (AYA). Further investigation is required to identify risk and protective factors associated with IPV among AYA. There remain significant gaps in understanding these factors among this vulnerable population.

Objective

The goal of our study was to determine the prevalence of IPV among an urban population of AYA and to identify factors associated with IPV among AYA.

Methods

A cross-sectional study design utilizing respondent-driven sampling was adopted. The study was conducted among 887 AYA, aged 15 to 24 years, residing in Nairobi, Kenya. Data were collected through a phone-based survey using the REACH (Reaching, Engaging Adolescents and Young Adults for Care Continuum in Health)-AYA app. Questions on behavioral and psychosocial factors were adopted from different standardized questionnaires. Descriptive, bivariate, and multivariable statistics were used to describe the characteristics of the study sample.

Results

Of the 887 participants, a higher proportion were male (540/887, 60.9%) compared to female (347/887, 39.1%). The prevalence of IPV was 22.3% (124/556). IPV was associated with being unsure if it was okay for a boy to hit his girlfriend, living in a home with physical violence or abuse, and being bullied (P=.005). The likelihood of experiencing IPV was higher among respondents whose friends and family members used alcohol (odds ratio [OR] 1.80, 95% CI 1.09-2.98) and among those who had repeated a class at school in the past two years (OR 1.90, 95% CI 1.11-3.23). Respondents who visited a health facility or doctor for reproductive health services were 2 times more likely to experience IPV (OR 2.23, 95% CI 1.40-3.70). Respondents who had used illicit drugs were 2 times more likely to experience IPV (OR 4.31, 95% CI 2.64-7.04). The probability of experiencing IPV decreased by 63% (OR 0.37, 95% CI 0.16-0.85) among respondents who refused to have sex with someone who was not prepared to use a condom.

Conclusions

IPV remains a significant public health priority because of its impact to society. Our results are in congruence with other similar studies. Efforts toward incorporating appropriate IPV core measures into the comprehensive care package for every AYA seeking health services should be explored. Programs need to address constellations of risk and protective factors linked to IPV in an effort to prevent its occurrence.

At-a-glance - The Child Maltreatment Surveillance Indicator Framework

The federal health portfolio has conducted surveillance on child maltreatment as a public health issue since the 1990s. The Public Health Agency of Canada (PHAC) is now releasing the Child Maltreatment Indicator Framework, to take its place alongside other PHAC frameworks, such as the Suicide Surveillance Indicator Framework. Based on a scoping review of existing reviews and meta-analyses, this Framework, along with the online interactive data tool, presents child maltreatment outcome indicators and risk and protective factors at the individual, family, community and societal levels, disaggregated by sex, age and other sociodemographic variables. This Framework will function as a valuable resource pertaining to an issue that affects at least one in three Canadian adults.

Reducing Physical Aggression in High School Students in KwaZulu-Natal: A Cluster Randomized Trial

Youth violence is of public health and social concern. A South African cluster randomized trial (434 grade 10 students, 16 schools), used the Integrated Model for Behavior Change conceptual framework to implement a 20 module classroom-based intervention program. The study contributes to the literature and used a strong analytical technique since mixed effects linear regression assessed the impact of the intervention on physical violence endpoints and other socioeconomic confounders/factors. The intervention reduced students' experiencing physical violence compared to controls and social pressure for this, yet no differences were found for hitting others. Our results support findings that school programs against violence can reduce students' experience of physical violence, but translation of these findings to reduce the actual hitting of others may need further approaches and/or more time.

Workplace violence against doctors: Characteristics, risk factors, and mitigation strategies

Workplace violence is a major occupational issue concerning doctors that has a significant impact on their physical and psychological well-being. This ultimately affects the health care services of the country. Patient-led episodes of verbal violence are more prevalent in Asian countries, especially in the emergency department, psychiatric wards, and intensive care units, mostly faced by junior doctors and residents. Some common precursors of violence against doctors are patients and their attendants' dissatisfaction and low impulse control, poor administration, miscommunication, infrastructural issues especially differences in services between private and public hospitals, and negative media portrayal of doctors. The assessment of risk factors, development and implementation of workplace violence programs, and addressing underreporting of violent episodes have been suggested as some successful organizational mitigation strategies. Recommendations on the management of workplace violence include the development of participative, gender-based, culture-based, nondiscriminatory, and systematic strategies to deal with issues related to violence. This article aims to present a comprehensive review of workplace violence against doctors, discussing the prevalence, degree of violence, predictors, impact on physical and psychological health and intervention strategies to devise practical actions against workplace violence.

The Indirect Relationship Between Interpersonal Trauma History and Alcohol Use via Negative Cognitions in a Multisite Alcohol Treatment Sample

Although interpersonal trauma history (ITH) is frequently associated with alcohol use disorder (AUD), little is known about specific psychological constructs that may indirectly link these phenomena. This study hypothesized that one such construct may be negative cognitive schemas that often emerge in the aftermath of trauma. Secondary latent variable modeling was conducted using the Project MATCH sample of adults receiving treatment for AUD (N = 1726; 24.3% women; 38.63% ITH). The negative cognitions latent variable provided an excellent fit to the data and showed evidence of strong measurement invariance. As hypothesized, negative cognitions mediated the inverse association between ITH at baseline and percent days abstinent from alcohol 12 weeks later. Findings suggest that negative cognitions may be a specific underlying mechanism and potential treatment target for individuals with ITH and AUD.

A Systematic Review of the Outcome of Child Abuse in Long-Term Care

The aim of the systematic review described in this article was to determine the outcome of child maltreatment in long-term childcare and the scope of the evidence base in this area. Searches of 10 databases were conducted. Forty-nine documents describing 21 primary studies and 25 secondary studies were selected for review. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. Participants in the 21 primary studies included 3,856 abuse survivors and 1,577 nonabused controls. In six primary studies, survivors were under 18 years, and participants in the remaining primary studies were adults with a mean age of 54 years. Reviewed studies were conducted in the United Kingdom, the United States, Finland, Romania, Tanzania, Canada, Ireland, Australia, the Netherlands, Germany, Austria, and Switzerland. Participants were abused in religious and nonreligious residential care centers and foster care. There were significant associations between the experience of child abuse in long-term care and adjustment across the life span in the domains of mental health, physical health, and psychosocial adjustment. Evidence-based trauma-focused treatment should be offered to child abuse survivors. Future research in this area should prioritize longitudinal studies.

Disordered Eating Attitudes and Behaviors in Maltreated Children and Adolescents Receiving Forensic Assessment in a Child Advocacy Center

Previous studies have indicated that childhood sexual abuse (CSA) and other forms of child maltreatment (CM), as well as their subsequent posttraumatic symptoms, are significant risk factors for the development of disordered eating behaviors and attitudes and eating disorders (EDs). However, there are no known reports of CM based on forensic interview and assessment that have been linked to disordered eating behaviors and attitudes, or eating disorders (EDs), especially in children and adolescents. We, therefore, examined the hypothesis that ED-related symptoms would be significantly associated with trauma-related symptoms in children with reported maltreatment. Girls (n = 179, 11.9 ± 2.4 years) and boys (n = 99, 11.7 ± 2.8 years) referred for forensic assessment of alleged maltreatment completed the Kids' Eating Disorders Survey, the Eating Disorders Inventory for Children (EDI-C), the Trauma Symptom Checklist for Children, and the Adolescent Dissociative Experiences Scale, among others. Significant positive correlations between most EDI-C subscale scores and most TSC-C subscale scores (PTSD, dissociation, anxiety, depression, sexual concerns) were found (p ≤.001) in the total sample and girls alone. Participants with credible, substantiated disclosures had significantly higher scores on several ED-related measures than those with non-credible, non-substantiated disclosures. Linear regression analysis indicated that PTSD and dissociative symptoms were significant predictors of EDI-C scores in those with substantiated disclosures (p ≤.001). Findings support the hypothesis that ED-related symptoms are significantly linked to authenticated CM.

A Systematic Review of Reviews of the Outcome of Noninstitutional Child Maltreatment

The aim of the systematic review described in this article was to synthesize available high-quality evidence on the outcomes of noninstitutional child maltreatment across the life span. A systematic review of previous systematic reviews and meta-analyses was conducted. Ten databases were searched. One hundred eleven papers which met stringent inclusion and exclusion criteria were selected for review. Papers were included if they reported systematic reviews and meta-analyses of longitudinal or cross-sectional controlled studies, or single-group cohort primary studies of the outcomes of child maltreatment in the domains of physical and mental health and psychosocial adjustment of individuals who were children lived mainly with their families. Using AMSTAR criteria, selected systematic reviews and meta-analyses were found to be of moderate or high quality. Searches, study selection, data extraction, and study quality assessments were independently conducted by two researchers, with a high degree of interrater reliability. The 111 systematic reviews and meta-analyses reviewed in this article covered 2,534 independent primary studies involving 30,375,962 participants, of whom more than 518,022 had been maltreated. The magnitude and quality of this evidence base allow considerable confidence to be placed in obtained results. Significant associations were found between a history of child maltreatment and adjustment in the domains of physical health, mental health, and psychosocial adjustment in a very wide range of areas. The many adverse outcomes associated with child maltreatment documented in this review highlight the importance of implementing evidence-based child protection policies and practices to prevent maltreatment and treat child abuse survivors.

The Effect of Traumatic Events on the Longitudinal Course and Outcomes of Youth with Bipolar Disorder

BACKGROUND

Exposure to severe Traumatic Events (TEs) has been associated with poor course and outcomes among individuals with Bipolar Disorder (BD). However, there is limited research on TEs among youth with BD, and few studies are longitudinal. This study prospectively followed a large sample of BD youth, examining the associations of lifetime TEs with their mood and functioning.

METHODS

BD participants (n=375; mean age=17; range 8-25y) were assessed, on average, every 7 months for a median 8.7 years. Psychopathology and lifetime trauma history were prospectively evaluated using the Longitudinal Interval Follow-Up Evaluation, and a traumatic events screening.

RESULTS

Accounting for covariates, participants with one or more lifetime TEs (84%) showed earlier BD onset, poorer psychosocial functioning, worse mood symptoms, and more suicidal ideation, comorbidities, and family psychopathology than those without TEs. TEs during recovery periods increased recurrence risk (p<0.02). More TEs were associated with poorer mood course, particularly among victims of violence/abuse (p<0.02). Abused participants (34% physical; 17% sexual) showed earlier onset of substance use disorders, more suicidality and comorbidities compared to those without abuse. Comparisons of mood course before and after abuse occurred, and with participants without abuse, showed worsening mood symptoms after, specifically hypo/mania (p<0.03).

LIMITATIONS

Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; given approximate dates causality cannot be inferred; TEs severity was not assessed.

CONCLUSIONS

Severe TEs, particularly abuse, were associated with poorer course and outcomes among BD youth. Prompt screening of trauma and early intervention may be warranted to minimize TEs impact.

Acceptability of Family Violence: Underlying Ties Between Intimate Partner Violence and Child Abuse

Intimate partner violence (IPV) and child abuse (CA) are two forms of family violence with shared qualities and risk factors, and are forms of violence that tend to overlap. Acceptability of violence in partner relationships is a known risk factor in IPV just as acceptability of parent-child aggression is a risk factor in CA. We hypothesized that these acceptability attitudes may be linked and represent the expression of a general, underlying nonspecific acceptance of violence in close family relationships. The sample involved 164 male IPV offenders participating in a batterer intervention program. Implicit measures, which assess constructs covertly to minimize response distortions, were administered to assess acceptability of partner violence against women and acceptability of parent-child aggression. To determine whether acceptability attitudes regarding both forms of violence were related to a higher order construct tapping general acceptance of family violence, Bayesian confirmatory factor analyses were conducted. Findings supported a hierarchical (bifactor) model with a general factor expressing a nonspecific acceptance of family violence, and two specific factors reflecting acceptability of violence in intimate partner and parent-child relationships, respectively. This hierarchical model supporting a general acceptance of violence in close family relationships can inform future research aiming to better understand the connections between IPV and CA.

The Presence of Anemia in Children with Abusive Head Trauma

OBJECTIVES

To evaluate the incidence of anemia in patients with abusive head trauma (AHT), noninflicted traumatic brain injury (TBI), and physical abuse without AHT and the effect of anemia on outcome.

STUDY DESIGN

In a retrospective, single-center cohort study, we included children under the age of 3 years diagnosed with either AHT (n = 75), noninflicted TBI (n = 77), or physical abuse without AHT (n = 60) between January 1, 2014, and December 31, 2016. Neuroimaging was prospectively analyzed by pediatric neuroradiologists. Primary outcome was anemia at hospital presentation. Secondary outcomes included unfavorable outcome at hospital discharge, defined as a Glasgow Outcome Scale between 1 and 3, and intracranial hemorrhage (ICH) volume.

RESULTS

Patients with AHT had a higher rate of anemia on presentation (47.3%) vs noninflicted TBI (15.6%) and physical abuse without AHT (10%) (P < .001). Patients with AHT had larger ICH volumes (33.3 mL [10.1-76.4 mL] vs 1.5 mL [0.6-5.2 mL] ; P < .001) and greater ICH/total brain volume percentages than patients with noninflicted TBI (4.6% [1.4-8.2 %] vs 0.2% [0.1-0.7%]; P < .001). Anemia was associated with AHT (OR, 4.7; 95% CI, 2.2-10.2) and larger ICH/total brain volume percentage (OR, 1.1; 95% CI, 1.1-1.2) in univariate analysis. Unfavorable outcome at hospital discharge was associated with anemia (OR, 4.4; 95% CI, 1.6-12.6) in univariate analysis, but not after controlling for covariates.

CONCLUSIONS

Patients with AHT were more likely to present to the hospital with anemia and increased traumatic ICH volume than patients with noninflicted TBI or physical abuse without AHT. Children with anemia and AHT may be at increased risk for an unfavorable outcome.

Dedicated care pathways in Italian hospital emergency rooms for women who are victims of violence and abuse: Italian National Guidelines (DPCM 24.11.2017 - G.U. n. 24 issued 30.01.2018)

Gender-based violence affects one third of women globally with death the ultimate consequence after repeated violence. Government intervention is imperative. This article focuses on recent Italian legislation that provides a framework to assist victims of violence in Italian Emergency Rooms.

Developmental Timing of Childhood Physical and Sexual Maltreatment Predicts Adult Depression and Post-Traumatic Stress Symptoms

Child physical and sexual maltreatment have emerged as documented risk factors for a wide range of health problems in adulthood, including depression and post-traumatic stress symptoms. Prior research focuses on generalized childhood adversities without accounting for how different critical details about the maltreatment may affect outcomes in adulthood. The present study examines the impact of two critical details, timing and type of child maltreatment, on depression and post-traumatic stress symptoms in adulthood. Participants (N = 104) completed the Maltreatment and Abuse Chronology of Exposure scale (MACE) and the Inventory of Depression and Anxiety Scale-Second Version (IDAS-II). Hierarchical multiple regressions compared three different models of child maltreatment predictors and their differential utility for predicting depression and post-traumatic stress symptoms in adulthood: (a) number of child maltreatment experiences, (b) severity of child maltreatment, and (c) timing of child maltreatment. Results indicate that severity of child maltreatment and timing of child maltreatment are greater predictors for adult depression and post-traumatic stress symptoms than number of child maltreatment experiences. Compared with other developmental periods, early childhood sexual maltreatment experiences (5 years of age and below) and late childhood physical maltreatment experiences (13 years of age and above) were stronger predictors of adult depression and post-traumatic stress symptoms. Children maltreated during these age groups may be prioritized for prevention and intervention efforts, particularly when there are limited resources. Clinical interviews with maltreated children should also be expanded to include information about developmental timing and severity of maltreatment, which have ramifications for later health problems. Implications for assessment of maltreated children, prevention of adult depression and post-traumatic stress symptoms, and future research directions are discussed.

Emotional and Physical Child Abuse in The Context of Natural Disasters: A Focus on Haiti

OBJECTIVE

To investigate the social and living conditions of households in Haiti before and after the 2010 earthquake and to determine the prevalence of emotional and physical abuse of children aged 2 to 14 in households after the earthquake.

METHODS

Nationally representative samples of Haitian households from the 2005/2006 and 2012 phases of the Demographic and Health Surveys were used. Descriptive data were summarized with frequencies and measures of central tendency. Chi-squared and independent t tests were used to compare pre-earthquake and post-earthquake data. Basic mapping was used to explore patterns of child abuse in relation to proximity to the epicenter.

RESULTS

Comparison of pre-earthquake and post-earthquake data showed noteworthy improvements in the education attainment of the household head and possession of mobile phones after the earthquake. The prevalence of emotional, physical, and severe physical abuse in 2012 was estimated to be 78.5%, 77.0%, and 15.4%, respectively. Mapping revealed no conclusive patterns between the proximity of each region to the epicenter and the prevalence of the different forms of abuse. However, the prevalence of severe physical abuse was notably higher in settlement camps (25.0%) than it was in Haiti overall (15.4%).

CONCLUSIONS

The high prevalence of child abuse in Haiti highlights an urgent need for interventions aimed at reducing occurrences of household child abuse.

Peer Victimization of Maltreated Youth: Distinct Risk for Physically Abused Versus Neglected Children

BACKGROUND

Although child abuse is associated with peer victimization in adolescence, few studies have assessed if maltreated children experiencing only neglect are at increased risk as well. The purpose of this study is to assess the risk of peer victimization for maltreated youth who have been physically abused versus neglected to guide targeted bully prevention efforts in schools.

METHODS

Utilizing LONGSCAN archived data collected between 1991 and 2012, children physically abused or neglected in the first 12 years of life were assessed for physically aggressive peer victimization at age 16, compared to nonmaltreated children, with a total sample size of 650 participants. Logistic regression analysis assessed odds of peer victimization based on maltreatment profile.

RESULTS

Children physically abused were twice as likely to experience physically aggressive peer victimization, compared to the nonmaltreated group. Children experiencing only neglect were not at greater odds of being physically victimized by peers.

CONCLUSIONS

This study demonstrates physically abused children's risk of problems with aggressive peer victimization, in contrast to children neglected who are not at increased risk. These results contribute to our understanding of risk of peer victimization, and can inform targeted bully prevention efforts in schools for the child with a history of maltreatment.

Physical Violence Against Children and Adolescents in Porto: A 5-Year Study

The aim of the present study was to analyze the prevalence of physical violence against children and adolescents (PVCA) in a 5-year period in the city of Porto, Portugal. All forensic reports between 2009 and 2013 in the clinical services of the North Branch of the National Institute of Legal Medicine and forensic sciences were analyzed. Victims were classified according to sex, age, relationship with perpetrator, traumatic consequences of the event, and year of occurrence. Statistical analysis was performed using SPSS (Version 22.0). Continuous variables were described when appropriated frequencies were displayed. The association between variables was evaluated using chi-square, Fisher's exact test, or Kruskal-Wallis test, when appropriate and a logistic regression was performed. The margin of error for the statistical tests was 5.0%. A total of 2,148 occurrences were evaluated. Most subjects were male, and mean victim age was 13 years. The single most frequent perpetrator was an unknown individual, but most offenders were known to the victim. The majority site of injury was the face. The larger number of complaints of aggression maintained a similar frequency over the 5 years analyzed. A physical examination to confirm the reasons between the complaint and the type of aggression was performed and shown a high relationship. Adolescents were more susceptible to violence than younger children were. The most affected region was the face.

Parents' Own Experience of Verbal Abuse Is Associated with their Acceptance of Abuse towards Children from Youth Sports Coaches

Verbal or physical abuse from coaches has negative effects on young athletes, and the parents of athletes also have an influence on the sports environment. It is therefore important to understand parents' attitudes towards abuse against their children from the coaches. This study aimed to elucidate the characteristics of parents who accept the infliction of verbal or physical abuse on their children from coaches of youth sports teams. A cross-sectional study using self-report questionnaires was conducted with parents of young athletes (n = 6,493). Multivariate logistic regression models were used to assess the factors associated with parents' acceptability of verbal or physical abuse against their children. The proportion of parents who were accepting of verbal or physical abuse was 21.5%. Acceptability of verbal or physical abuse was significantly associated with male (odds ratio: 1.67, 95% confidence interval: 1.43-1.95), younger age (1.24, 1.09-1.41), lower educational attainment (1.32, 1.17-1.50), smoking habits (1.42, 1.23-1.63), experience of playing on a team with high levels of competition during their junior or high school days (1.31, 1.15-1.50), and experience of verbal and physical abuse by their own former coaches (3.59, 3.03-4.26 and 1.17, 1.02-1.35). About 58% and 28% of parents had experienced verbal and physical abuse from their own former coaches, and parents who had experienced verbal abuse themselves were most likely to be accepting of verbal or physical abuse towards their children. Educating parents is considered to be important for preventing and eradicating abuse against young athletes.

Childhood Victimization and Physical Health in Women: The Mediating Role of Adult Attachment

Research has shown that female survivors of childhood abuse (CA) are more likely than nonabused women to experience long-term physical health concerns. Adult attachment may influence this relationship given that attachment insecurity has been linked to poorer physical health and postulated mechanisms of action are similar. This study used structural equation modeling to investigate whether adult attachment insecurity mediates the relationship between four types of CA and self-reported physical health in 538 undergraduate women. CA prevalence rates ranged from 11.7% (sexual abuse) to 34.9% (psychological abuse). In separate structural equation models, direct pathways were significant between CA and adult attachment insecurity, CA and adult physical health, and adult attachment insecurity and adult physical health. Adult attachment insecurity was found to partially mediate health outcomes in CA survivors, S-B χ² = 116.60 (58), p < .001; comparative fit index = .95; Tucker-Lewis index = .94; root mean square error of approximation = .05; and confidence interval = [.03, .06]. Physical health is a significant concern for survivors of CA, and these results suggest improving attachment security may represent an important avenue of intervention.

Intimate partner violence (IPV) types are common among Turkish women from high socioeconomic status and have differing effects on child abuse and contentment with life

OBJECTIVE

Intimate partner violence (IPV) against women is an important public health problem. In this study, we aimed to investigate the exposure of IPV types, child abuse and decrease in life contentment of married women from high socioeconomic status in Turkey.

METHODS

Data were collected using an online/written questionnaire and Contentment with Life Scale. The questionnaire included definitions of physical, emotional, economic and sexual IPV and asked how many times they experienced these types of abuse.

RESULTS

We found that physical, emotional, economic and sexual IPV exposure were 19%, 45.2%, 12.5%, and 6%, respectively, which suggest that IPV types were common in this group, too. Physical child abuse was higher among physical and emotional IPV victims (p=0004, p=0.02, respectively), while emotional child abuse was higher only among physical IPV victims (p=0.01). On the other hand, exposure to economic and sexual IPV was not related to any type of child abuse in this sample (p>0.05). Physical and economic IPV victims were statistically older (p=0.004, p<0.001, respectively), married for longer time (p<0.001 for both) and had relatively lower education level (p<0.001 for both), while sexual IPV victims had lower education level than non-victims (p=0.03). We demonstrated that physical-emotional and sexual intramarital IPV significantly reduce the women's contentment with life scores when compared with non-victims (p=0.02, p<0.001 and p=0.03, respectively).

CONCLUSION

IPV exposure is also severe among married women with high socioeconomic levels and is associated with child abuse in the family and a decrease in life contentment. Lengthened education period among women with similar socioeconomic levels may be an additional protective factor for IPV by delaying the age of marriage and increasing the individual income.

Self-reporting DSM-5/ICD-11 clinically significant intimate partner violence and child abuse: Convergent and response process validity

Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) and International Classification of Diseases-11th Revision (ICD-11; proposed) now include criteria for clinically significant (a) intimate partner violence (IPV) and neglect and (b) child abuse and neglect. However, existing measures of IPV and child abuse do not allow for assessment of established criteria. The current study examines the convergent and response process validity of the Family Maltreatment (FM) measure of clinically significant physical and psychological IPV and child abuse. Participants (N = 126) completed the FM via computer and measures of IPV (Revised Conflict Tactics Scale; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) and child abuse (Parent-Child Conflict Tactics Scale; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998) via paper-and-pencil. Participants who endorsed acts of aggression on the FM completed an audio-recorded computerized interview recounting the 2 most severe incidents. Verbalized incidents (n = 138) were coded for clinically significant family maltreatment. Results largely supported the convergent validity of the FM. Agreement of acts endorsed on the FM with those endorsed on convergent measures was excellent for IPV and physical child abuse, yet poor for psychological child abuse. Further, in support of the response process validity of the FM, comparison with observer ratings of interviews indicated few "false positives" and no "false negatives" on the FM across the examined types of clinically significant IPV and child abuse. In summary, the FM is a promising measure for the assessment of clinically significant physical and psychological abuse as defined in the DSM-5 and ICD-11 (proposed). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Temporal Impact of Economic Insecurity on Child Maltreatment: A Systematic Review

Economically insecure children experience 3-9 times more maltreatment than economically secure children. Although economic insecurity is associated with child physical abuse, neglect, and psychological maltreatment, there have been no systematic reviews dedicated to the relation between familial economic insecurity and child maltreatment. This is problematic because multiple forms of familial economic insecurity-including debt, material hardship, income, unemployment, and income transfers-are related to child maltreatment. These findings, however, are not causal or reliably replicated across studies. Until we identify the state of the evidence concerning the temporal association between economic insecurity and child maltreatment, our ability to reduce child maltreatment may be limited. In this systematic review (PROSPERO registration # CRD42017081445), we searched PsycINFO, PubMed, Scopus, ProQuest Dissertations, and the gray literature for English-language, peer-reviewed articles and dissertations published between 1970 and 2016. We synthesized evidence from 26 longitudinal studies on the temporal relation between economic insecurity and child maltreatment. Income losses, cumulative material hardship, and housing hardship were the most reliable predictors of child maltreatment. Implications for research, policy, and practice are discussed.

Childhood Trauma in Persons With Schizophrenia and a History of Interpersonal Violence

BACKGROUND

Childhood trauma is a risk factor for psychosis as well for violent behavior and offending later in life. Childhood trauma comprises subdomains of abuse and neglect that may be differently related to later violence among patients with schizophrenia. The aim of this study was to map the subdomains of childhood trauma associated with violent offending in schizophrenia.

METHODS

Information on childhood trauma from predominantly male patients with a DSM-IV diagnosis of schizophrenia and a history of violent offending (interpersonal violence) (SCZ-V, n = 19), schizophrenia patients without a history of violence (SCZ-NV, n = 34), and healthy controls (HC, n = 66) was obtained with the Childhood Trauma Questionnaire (CTQ). Differences between groups in total maltreatment scores and the five subdomains including physical, emotional, and sexual abuse, as well as physical and emotional neglect were analyzed.

RESULTS

SCZ-V had the highest median CTQ scores for all sub-domains. SCZ-V reported significantly higher total CTQ scores than SCZ-NV and HC. SCZ-V had significantly higher scores than HC on all subdomains, and significantly higher than SCZ-NV on physical and emotional neglect. SCZ-NV had higher scores on all domains except sexual abuse compared to HC.

CONCLUSION

SCZ-V patients had higher exposure to childhood trauma than SCZ-NV, and both schizophrenia groups had higher exposure than HC. The results suggest that childhood physical and emotional neglect may be of specific importance to later violence in schizophrenia.

Verbal Abuse from Coaches Is Associated with Loss of Motivation for the Present Sport in Young Athletes: A Cross-Sectional Study in Miyagi Prefecture

Verbal and physical abuse from coaches has negative effects on young athletes. Although the abuse can lead to the athletes' dropping out, no studies have reported on this topic. The purpose of this study was to elucidate the association between experience of verbal or physical abuse from coaches and loss of motivation for the present sport in young athletes. School-aged athletes (age range, 6-15 years, n = 6,791) were assessed using a self-reported questionnaire. Multivariate logistic regression models were used to assess the association between experience of verbal or physical abuse and loss of motivation for the present sport. Variables considered in the models were sex, age, body mass index, presence of bodily pain, team levels, number of training days per week, number of training hours per day on weekdays and weekends, and frequency of participation in games. The prevalence of loss of motivation for the present sport was 8.1%. Experience of verbal or physical abuse was significantly associated with loss of motivation for the present sport and the adjusted odds ratios (95% confidence intervals) were 1.93 (1.54-2.42, p < 0.001) for verbal abuse and 1.76 (1.27-2.42, p = 0.001) for physical abuse. Findings of this study suggest that experience of verbal or physical abuse from coaches is associated with loss of motivation for the present sport. Eradication of verbal and physical abuse from coaches is important for young athletes to continue sport participation.

Prevalence and Factors Associated With Physical Abuse at Home Among School-Going Adolescents in Malaysia: A Population-Based Nationwide Study

We assessed the current situation of physical abuse among adolescents at home in Malaysia. A total of 27 497 school-going adolescents answered a self-administered questionnaire during the Malaysian National Health and Morbidity Survey 2017. A complex sampling analysis was applied to identify factors associated with physical abuse among adolescents using multivariate logistic regression analysis. The prevalence of physical abuse at home among students was 11.8%. Our result shows that adolescents aged 13 years had significantly higher odds of such abuse, with odds decreasing as the adolescents age. Girls and adolescents from Indian ethnicity (minority ethnic group) had higher odds of such abuse. Other associated factors were mental health problems, substance abuse, and problems at school. Physical abuse among adolescents at home should be countered with appropriate measures.

Increased prevalence of psychopathy and childhood trauma in homicide offenders with schizophrenia compared to nonviolent individuals with schizophrenia

Purpose: Schizophrenia is associated with an increased homicide risk. Personality pathology, particularly antisocial personality disorder and psychopathic traits, has been associated with increased violence risk in schizophrenia. Childhood trauma, more specifically physical abuse, has been associated with violence risk in healthy populations and in individuals with mental illness. It is, however, unclear how childhood trauma relates to homicide in schizophrenia. This is, to our knowledge, the first study to concurrently examine personality pathology and childhood trauma in a group consisting solely of homicide offenders with schizophrenia (HOS). HOS is compared to nonviolent participants with the same diagnosis (non-HOS). Additionally, currently assessed demographical and clinical characteristics of a Norwegian sample of HOS are reported. Materials and methods: Two groups of participants with schizophrenia were recruited in collaboration with in and outpatient clinics across Norway, HOS (n= 26) and non-HOS (n= 28). Assessments of personality pathology and childhood trauma were conducted, and information about clinical and demographical characteristics was registered. Results: HOS participants had significantly higher psychopathy scores, and more frequently reported moderate to severe childhood physical abuse than non-HOS participants. When simultaneously added to a logistic regression model, only psychopathy uniquely contributed to explaining group membership. Conclusions: Psychopathy and physical abuse was more prevalent among HOS participants compared to non-HOS, but only psychopathy independently predicted homicidal status. These results confirm the importance of including an evaluation of psychopathic traits in violence risk assessments of individuals with schizophrenia.

Violence against children in Latin America and the Caribbean: What do available data reveal about prevalence and perpetrators?

OBJECTIVE

To describe the prevalence of recent physical, sexual, and emotional violence against children 0 - 19 years of age in Latin America and the Caribbean (LAC) by age, sex, and perpetrator.

METHODS

A systematic review and analysis of published literature and large international datasets was conducted. Eligible sources from first record to December 2015 contained age-, sex-, and perpetrator-specific data from LAC. Random effects meta-regressions were performed, adjusting for relevant quality covariates and differences in violence definitions.

RESULTS

Seventy-two surveys (2 publications and 70 datasets) met inclusion criteria, representing 1 449 estimates from 34 countries. Prevalence of physical and emotional violence by caregivers ranged from 30% - 60%, and decreased with increasing age. Prevalence of physical violence by students (17% - 61%) declined with age, while emotional violence remained constant (60% - 92%). Prevalence of physical intimate partner violence (IPV) ranged from 13% - 18% for girls aged 15 - 19 years. Few or no eligible past-year estimates were available for any violence against children less than 9 years and boys 16 - 19 years of age; sexual violence against boys (any age) and girls (under 15 years); IPV except for girls aged 15 - 19 years; and violence by authority figures (e.g., teachers) or via gangs/organized crime.

CONCLUSION

Past-year physical and emotional violence by caregivers and students is widespread in LAC across all ages in childhood, as is IPV against girls aged 15 - 19 years. Data collection must be expanded in LAC to monitor progress towards the sustainable development goals, develop effective prevention and response strategies, and shed light on violence relating to organized crime/gangs.

Individual- and County-Level Religious Participation, Corporal Punishment, and Physical Abuse of Children: An Exploratory study

Parental religiosity has been associated with corporal punishment. However, most of this research has focused exclusively on Christians and has not examined physical abuse. In addition, little is known about how the larger religious environment might be associated with discipline behaviors. In this exploratory study, we examine how individual- and county-level religious attendance are related to corporal punishment and physical abuse. We sampled and surveyed 3,023 parents of children aged 12 and younger from 50 mid-sized California cities. We used weighted Poisson models to calculate the frequency of corporal punishment and physical abuse in the past year. Parents who attend religious groups used corporal punishment more frequently than parents who did not attend religious groups. However, those who lived in counties with greater rates of religious participation used corporal punishment less frequently than those living in counties with lower rates of religious participation. There were no effects for religious participation on physical abuse at the individual or county level. This exploratory study suggests that parents who attend religious groups may be more likely to use some types of physical discipline with children. Religious groups could be imparting parenting norms supporting corporal punishment at the individual level. More research examining specific doctrines and faiths is needed to validate the study findings.

The physical health costs of positive adaptation to childhood adversity

Theories of allostatic load suggest that recurrent adaptive adjustments in contexts of adversity may have a negative impact on physical well-being. To test this hypothesis, this study evaluated 6-year-old children's ego-resilience and physical abuse experiences on behavior problems and physical illness at the age of 8 years. A significant interaction between ego-resilience and physical abuse exposure indicated that, although ego-resilience buffered physically abused children from internalizing problems, it also predicted more physical illness in that group. Findings contribute to the growing body of evidence suggesting that efforts to mobilize an adaptive response in contexts of adversity may exact a cost on physical well-being.

Who's Watching the Children? Caregiver Features Associated with Physical Child Abuse versus Accidental Injury

OBJECTIVE

To compare caregiver features and caregiving arrangements of children with physical abuse vs accidental injuries.

STUDY DESIGN

Data came from a prospective, observational, multicenter study investigating bruising and psychosocial characteristics of children younger than 4 years of age. Using logistic regression, we examined how abuse vs accidental injury and severity of injury were associated with caregiver sex, relation to the child, whether caregiving arrangements were different than usual at the time of injury, and length of the main caregiver's relationship with his/her partner.

RESULTS

Of 1615 patients, 24% were determined to have been physically abused. Abuse was more likely when a male caregiver was present (OR 3.31, 95% CI 2.38-4.62). When the male was the boyfriend of the mother (or another female caregiver), the odds of abuse were very high (OR 169.2, 95% CI 61.3-614.0). Severe or fatal injuries also were more likely when a male caregiver was present. In contrast, abuse was substantially less likely when a female caregiver was present (OR 0.25, 95% CI 0.17-0.37) with the exception of a female babysitter (OR 3.87, 95% CI 2.15-7.01). Caregiving arrangements that were different than usual and caregiver relationships <1 year were also associated with an increased risk of abuse.

CONCLUSIONS

We identified caregiver features associated with physical abuse. In clinical practice, questions regarding caregiver features may improve recognition of the abused child. This information may also inform future abuse prevention strategies.

Radiation doses in diagnostic imaging for suspected physical abuse

OBJECTIVE

To measure the actual radiation dose delivered by imaging techniques commonly used in the radiography of suspected physical abuse and to make this information available to health professionals and families.

METHODS

Data were collected retrospectively on children under 3 years referred for skeletal surveys for suspected physical abuse, non-contrast CT head scan or radionuclide imaging of the bones in Starship Children's Hospital, Auckland, New Zealand from January to December 2015. Patient size-specific conversion coefficients were derived from International Commission on Radiologic Protection tissue weighting factors and used to calculate effective dose.

RESULTS

Seventy-one patients underwent an initial skeletal survey, receiving a mean effective dose of 0.20 mSv (95% CI 0.18 to 0.22). Sixteen patients had a follow-up survey with a mean effective dose of 0.10 mSv (95% CI 0.08 to 0.11). Eighty patients underwent CT head which delivered a mean effective dose of 2.49 mSv (95% CI 2.37 to 2.60). Thirty-nine patients underwent radionuclide bone imaging which delivered a mean effective dose of 2.27 mSv (95% CI 2.11 to 2.43).

CONCLUSIONS

In a paediatric centre, skeletal surveys deliver a relatively low effective radiation dose, equivalent to approximately 1 month of background radiation. Non-contrast CT head scan and radionuclide bone imaging deliver similar doses, equivalent to approximately 1 year of background radiation. This information should be considered when gaining informed consent and incorporated in patient education handouts.

Reluctance Versus Urge to Disclose Child Maltreatment: The Impact of Multi-Type Maltreatment

Child maltreatment is a major public health issue in Israel. According to a recent Israeli national epidemiological survey, approximately half of Jewish and Arab girls and boys between the ages 12 and 17 experienced at least one type of child maltreatment, at any severity level. The purpose of the present study was to investigate the influence of multi-type maltreatment on Israeli children and youth survivors' reluctance versus urge to disclose; with the effects of gender, age, and ethnicity taken into account. The study is important since non-disclosure has deleterious effects in terms of continuation of the abuse, delays in criminal prosecution and commencement of treatment. A self-report questionnaire incorporating the following instruments was administered: the Juvenile Victimization Questionnaire, the Childhood Trauma Questionnaire, and the Disclosure of Trauma Questionnaire. The sample consisted of 6,253 Jewish and Arab children and youth who reported experiencing at least one lifetime child maltreatment event. Study results indicated that children and youth's reluctance to disclose is positively associated with their emotional reactions to disclosure, as well as with higher instances of child maltreatment exposure; whereas urge to talk is negatively correlated with their emotional reactions to disclosure.

Comparing Children's and Caseworkers' Reports of Physical Violence

In cases of suspected child maltreatment, the caseworkers' evaluations of the harm and risk to the child are vital in determining if children are being abused and ultimately whether services are provided to the family. These evaluations are dependent on information caseworkers are able to uncover during their investigation, but may not reflect the experiences of the child. Using data from the National Survey of Child and Adolescent Well-Being (NSCAW-I), this study first compares how consistent children's claims of physical victimization are with caseworkers' assessments of harm, severity of risk, and whether there is physical abuse occurring. Second, we examine whether any discrepancies are influenced by the demographic characteristics of the child. Based on cross-tabulations, mean tests of difference, and one-way ANOVA, we find a high degree of overlap in children's reports of violence with caseworkers' reports of harm, the potential for risk, and the presence of physical abuse. However, there are also important differences. Among children who reported acts of physical violence occurred "lots of times," 23% of the cases were viewed by the caseworker as causing "no harm" to the child and over 60% were not regarded as physical abuse. The children's age and sex are both significant predictors of discrepancies, with more discrepancies between caseworkers and young children or teens as well as boys. Implications of this study are that additional training is needed to help caseworkers build rapport with the children. We also suggest that Child Protective Services (CPS) should implement alternative ways for children to report their experiences other than face-to-face interviews with caseworkers.

Abuse in Colombian elderly and its association with socioeconomic conditions and functionality

Objective:

To describe the presence of abuse in elderly people in Colombia and its association with socio-demographic and functional conditions.

Methods:

Cross-sectional and descriptive research. Data were taken from the SABE Colombia Survey, a population study, with a national representative sample of 23,694 adults aged over 60 years. Presence and type of abuse by partners or family members, members were investigated. Generalized linear models with Poisson link function were used to estimate the causes of the prevalence of abuse by area of residence, region, age, sex, dependence on activities of daily living and living arrangements.

Results:

15.1% of the elderly in Colombia reported some type of abuse, and over 50% reported more than one form of abuse. Abuse proportion is greater in people who are aged 60-69, in women, people with lower levels of education, people who belong to lower socioeconomic status, people who live alone, people who live with children, and people in urban areas. The most frequent abuse form is psychological, followed by neglect and physical abuse. Dependence on basic and instrumental daily living activities increases the probabilities of suffering abuse.

Conclusions:

Home is a risky place for the elderly people, especially for those with functional dependence, those who belong to low socioeconomic strata and women. Results should encourage debate among researchers, professionals and decision makers on public policy about necessary actions and means to change violent family dynamics in homes with elderly people.

Social determinants of health and maxillofacial injuries in children and adolescents victims of violence: A novel GIS-based modelling application

BACKGROUND

Physical violence against children and adolescents comprises a serious public health problem and often results in oral and maxillofacial traumas. Social determinants may favour the occurrence of these events, but few studies have critically evaluated the interaction between social and geographical risk factors.

AIMS

To investigate the spatiotemporal distribution of oral and maxillofacial traumas resulting from violence against children and adolescents through geostatistical techniques.

METHODS

This study was an ecological analysis of cases of trauma caused by violence against Brazilian children and adolescents using aggregated data from victims attended at a Center of Forensic Medicine and Forensic Dentistry between January 2012 and December 2015. Data were analysed through modelling based on geographic information system (GIS).

RESULTS

Two distinct patterns of longitudinal trajectory of oral and maxillofacial trauma related to violence against children and adolescents were identified (TP1 and TP2, P < 0.05). The spatial regression analysis revealed a statistically significant association between higher incidence of cases and areas with worse socioeconomic conditions (β = 0.047, SE = 0.020, P < 0.05).

CONCLUSION

Neighbourhoods with considerable socio-spatial vulnerability for violence against children and adolescents and maxillofacial traumas were identified.

Rates and profile of victimization in a sample of Egyptian patients with major mental illness

BACKGROUND

Patients with major mental illness have an increased risk of victimization. Nevertheless, this topic was not thoroughly studied in Egyptian patients with major mental illness.

OBJECTIVES

The objectives of this study are to investigate the rates of victimization and understand its profile, psycho-demographic and clinical correlates among a sample of Egyptian patients with major mental illness.

PARTICIPANTS AND METHODS

A total of 300 patients (100 patients with schizophrenia, 100 with bipolar and 100 with major depression) were recruited from the inpatient wards and outpatient clinics at Ain Shams University. They were subjected to a demographic questionnaire, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI) and a Victimization Questionnaire (VQ).

RESULTS

In our study population, 130 (43.3%) of patients were victimized, of them 52 (40%) were diagnosed with major depressive disorder, 48 (36.9%) with bipolar disorder and 30 (23.1%) with schizophrenia. Victimization was more in female, married, unemployed individuals and those living in rural areas. Patients exposed to domestic violence or abuse during childhood had higher rates of victimization. All victimized patients were subjected to emotional victimization, 64.6% were physically victimized and 53.8% were subjected to miscellaneous types of victimization. Patients were victimized mainly by acquaintance followed by family members. The majority of patients did not report their victimization and considered it as a personal issue or not important enough to be reported.

CONCLUSION

Patients with major mental illness are susceptible to significant victimization. Clinicians should explore possible history of abuse or victimization in their patients, empower and support the victimized ones.

Physical violence against children and adolescents in Recife: a 5-year retrospective study

The aim of the present study was to analyze the prevalence results of physical violence against children and adolescents in a 5-year period in Recife, Brazil. Inter-personal violence is one of the most recognizable forms of child aggression and has become as an imperative public health issue. All violence related forensic reports performed between 2009 and 2013 in the clinical services of the Institute of Legal Medicine Antônio Percivo Cunha were analyzed. Victims were classified according to sex, age, relationship with perpetrator, injuries and year of occurrence. Statistical analysis was performed using the SPSS (version 22.0). Continuous variables were described and when appropriate, frequencies were displayed and compared. The association between variables was evaluated using chi-square and Fisher's exact test. The margin of error for the statistical tests was 5.0%. A total of 9783 occurrences were evaluated, involving mainly male subjects (n=5447, 55.7%). Victims' mean age was 13.9 years, the most common perpetrators were victims' acquaintances (n=2538, 25.9%). Facial injuries were the most frequent affecting a little over a fifth of the total sample (n=3673, 20.1%). These findings support the important role dentists can play in identifying and reporting physical violence against children and adolescents.

Anxiety and depression in women with and without chronic pelvic pain: prevalence and associated factors

Objectives: To investigate the prevalence of anxiety, depression and mixed anxiety and depressive disorder (MADD) and factors associated with these conditions in women with chronic pelvic pain (CPP) compared to a pain-free control group.

Methods: A cross-sectional study was conducted with 100 women with CPP and 100 without CPP. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate the presence of anxiety and depression. Sociodemographic, behavioral and clinical characteristics were investigated. Fisher’s exact test was used to compare characteristics between groups. A log-binomial regression model was used, with adjustment for age, skin color, schooling, body mass index and pain. Prevalence ratios (PR), together with their 95% confidence intervals (CI), were calculated to investigate factors associated with anxiety, depression and MADD.

Results: The prevalence of anxiety was 66% in the CPP group and 49% in the controls (p=0.02). Depression was identified in 63% of the women with CPP and in 38% of the controls (p<0.01). MADD was present in 54% of the CPP group and in 28% of the controls (p<0.01). In the adjusted analysis, CPP (PR=1.3; 95%CI: 1.1–1.6), physical abuse (PR=1.5; 95%CI: 1.2–1.8) and sexual abuse (PR=1.5; 95%CI: 1.1–1.8) were independently associated with anxiety. Women of 25 to 34 years of age were less likely to have anxiety (PR=0.6; 95%CI: 0.4–0.8). CPP (PR=1.6; 95%CI: 1.2–2.2), physical abuse (PR=1.3; 95%CI: 1.1–1.7) and sexual abuse (PR=1.7; 95%CI: 1.3–2.2) were independently associated with depression. CPP (PR=1.9; 95%CI: 1.3–2.7), smoking (PR=1.5; 95%CI: 1.1–2.1), physical abuse (PR=1.4; 95%CI: 1.1–1.9) and sexual abuse (PR=1.4; 95%CI: 1.1–1.8) were independently associated with MADD.

Conclusions: The prevalence of anxiety, depression and MADD was higher in women with CPP compared to the pain-free controls. Factors associated with mental disorders were identified. The independent association between CPP and anxiety, depression and MADD was noteworthy. These findings suggest that systematic management of psychological factors could contribute towards improving the mental health of these women.

Isn't pregnancy supposed to be a joyful time? A cross-sectional study on the types of domestic violence women experience during pregnancy in Malawi

Background

Domestic violence against pregnant women exists in Malawi but its magnitude and types were, until recently published data, unknown due to scanty published data on the subject. This study aimed at identifying types of abuse women experience during pregnancy.

Methods

The study design was cross-sectional descriptive quantitative using a random sample of 292 pregnant women attending an antenatal clinic at Nsanje District Hospital, southern region of Malawi. A structured questionnaire was administered to each pregnant woman that consented to participate. Data was analyzed using SPSS software version 16. Descriptive statistics were computed for demographic data and type of violence.

Results

The findings indicate that a majority (59%) of women experienced more abuse during pregnancy, compared to 12.5% prior to current pregnancy. The women were psychologically (29%), sexually (28%) and physically (14%) abused during pregnancy. There was a significant association (P<0.05) between domestic violence and witnessing abuse as a child in the home. Additionally, domestic violence was significantly associated (P<0.05) with a woman being pregnant. No significant association (P>0.05) was found between domestic violence and other demographic variables; age, low education level and low income.

Conclusion

The pregnancy period is not a joyful time for all women. The study found high levels of psychological, sexual and physical domestic abuse among pregnant women. We advocate for community awareness creation on domestic violence, strengthening victim support units and One-Stop centres, and training health workers to screen for and counsel victims during antenatal care.

Development of the Intimate Partner Violence During Pregnancy Instrument (IPVPI)

Background: Intimate partner violence (IPV) during pregnancy can lead to negative consequences for both the mother and offspring. Although IPV is recognized as a worldwide public health issue, its prevalence is considered to be underestimated because cases are likely underreported, suggesting that there might be unmeasured IPV. The aim of this study was to develop an instrument to detect IPV in pregnant women.

Methods: A total of 6,590 women in Aichi prefecture, Japan, who took part in a 3 or 4 month infant health checkup program, participated in the study. Questionnaires assessing history of IPV during pregnancy (physical abuse and verbal abuse), maternal characteristics, partner's characteristics, and household characteristics were mailed to women before, or distributed at, the checkup. Women returned the questionnaires to the checkup sites or mailed them back to the health centers. A prediction model for history of IPV was then generated using potential risk factors selected based on the literature.

Results: Among 6,530 women who responded to either question on IPV during pregnancy (response rate = 67.3%), the rate of participants who experienced any IPV during pregnancy was 11.1% (physical IPV = 1.2%; verbal IPV = 10.8%). Multiple logistic regression analyses showed that maternal age (<25 years old), multiparity, history of artificial abortion, negative feelings when the pregnancy was confirmed (e.g., confused), having no one to provide support during pregnancy, having relationship problems with their partner, paternal smoking during pregnancy, and difficult financial status were associated with any abuse from the partner. Based on the analysis, the Intimate Partner Violence during Pregnancy Instrument (IPVPI) was developed, comprising of eight questions to detect unmeasured IPV in pregnant women, and showed moderate predictive power (area under receiver operating characteristic curve = 0.719, 95% confidence interval: 0.698 to 0.740) ranging from 0 to 16 with a cut-off point of 2 (sensitivity = 79.5%, specificity = 47.1%).

Conclusion: The IPVPI, which allows to ask indirect questions rather that asking directly about experience of IPV, might be helpful to detect unmeasured IPV in pregnant women in fields of primary healthcare and obstetrics. Further research longitudinal studies are needed to improve the sensitivity and specificity of the IPVPI.

Abused Children Experience High Anger Exposure

Childhood maltreatment is a critical problem in the United States. Much attention has been paid to the negative outcomes suffered by victims of abuse. Less attention has been devoted to understanding the emotional environments of maltreated children. One assumption, which has stood without empirical test, is that abused children encounter a high degree of anger in their home environments. Anger exposure is thought to be a source of stress for children in abusive environments and a potential link between the experience of abuse and the development of health and behavioral problems. We tested this notion by assessing data on over 1,000 parents and guardians of 3- to 17-year-old children who were participants in child development studies. Abuse was measured via records from Child Protective Services regarding substantiated and unsubstantiated claims of abuse as well as parent/guardian report. We compared self-reported experiences of anger from parents/guardians of children who have experienced abuse with those who have not. We found support for the claim that caregivers of abused children experience and express high levels of anger. Better characterization of the emotional environments in which abused children develop is critical for understanding how and why abuse affects children and has important implications for informing interventions.

Development of an electronic medical record-based child physical abuse alert system

Objective

Physical abuse is a leading cause of pediatric morbidity and mortality. Physicians do not consistently screen for abuse, even in high-risk situations. Alerts in the electronic medical record may help improve screening rates, resulting in early identification and improved outcomes.

Methods

Triggers to identify children < 2 years old at risk for physical abuse were coded into the electronic medical record at a freestanding pediatric hospital with a level 1 trauma center. The system was run in "silent mode"; physicians were unaware of the system, but study personnel received data on children who triggered the alert system. Sensitivity, specificity, and negative and positive predictive values of the child abuse alert system for identifying physical abuse were calculated.

Results

Thirty age-specific triggers were embedded into the electronic medical record. From October 21, 2014, through April 6, 2015, the system was in silent mode. All 226 children who triggered the alert system were considered subjects. Mean (SD) age was 9.1 (6.5) months. All triggers were activated at least once. Sensitivity was 96.8% (95% CI, 92.4-100.0%), specificity was 98.5% (95% CI, 98.3.5-98.7), and positive and negative predictive values were 26.5% (95% CI, 21.2-32.8%) and 99.9% (95% CI, 99.9-100.0%), respectively, for identifying children < 2 years old with possible, probable, or definite physical abuse.

Discussion/Conclusion

Triggers embedded into the electronic medical record can identify young children with who need to be evaluated for physical abuse with high sensitivity and specificity.

The Cycle of Violence Revisited: Childhood Victimization, Resilience, and Future Violence

The individual and social protective factors that help break the cycle of violence are examined. Specifically, this study investigates (a) the individual and social protective factors that reduce violent offending among previously victimized children, and (b) whether certain protective factors are more or less important depending on the type and frequency of childhood victimization experienced. Data on young adults from Wave III of the National Longitudinal Study of Adolescent to Adult Health are used (N = 13,116). Negative binomial regression models are estimated to examine the protective factors that promote resiliency to violent offending among individuals who reported being physically and sexually victimized as children. Results indicate that a number of individual and social protective factors reduce violent offending in young adulthood. With a few exceptions, these factors are specific to the type, frequency, and comorbidity of abuse experienced. The results suggest a number of promising approaches to break the cycle of violence among previously victimized children. Future research should move beyond explaining the cycle of violence to examine how the cycle may be broken.

Mental Health in the Cree Peoples of Northern Quebec: Relationships Among Trauma, Familial Psychological Distress, and Mood or Anxiety Disorders

OBJECTIVE

This study examined the physical and mental health of Cree adults, as well as the personal, clinical, and environmental factors associated with the presence of lifetime anxiety and mood disorders.

METHODS

Mental health was assessed using the computerised version of the Diagnostic Interview Schedule (CDIS-IV), and standardised instruments were used to assess physical health, addiction severity, and psychological distress in 506 randomly selected participants from 4 Northern Cree communities in Quebec.

RESULTS

Overall, 46.1% of participants reported chronic medical problems, 42.1% were current smokers and 34.5% met the DSM-IV criteria for an anxiety or mood disorder. Individuals with an anxiety or mood disorder were younger, predominantly female, and with higher educational levels, and a large proportion (47.7%) met the lifetime criteria for substance dependence. Hierarchical regression determined that anxiety or mood disorders were associated with serious problems getting along with parents, a history of physical and sexual abuse, and a lifetime diagnosis of substance dependence. Overall, 29.7% of Cree adults reported sexual abuse, 47.1% physical abuse, and 52.9% emotional abuse.

CONCLUSIONS

This study highlights the high rates of physical and mental health problems in Cree communities and the association among parental history of psychological problems, history of abuse, and psychological distress. Participants expressed a desire for additional medical and psychological treatments to address the patterns of abuse, trauma, and mental disorders that are burdening the Cree communities in Northern Quebec.

A new role for imaging in the diagnosis of physical elder abuse: results of a qualitative study with radiologists and frontline providers

Pediatric radiologists play a key role in the detection of child abuse through the identification of characteristic injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, they currently play little to no part in this effort. We examine the reasons behind this limited role, and potential strategies to expand it, by interviewing attending faculty from Emergency Radiology, Geriatrics, Emergency Medicine, Pediatric Radiology, and Pediatrics. Our interviews revealed that radiologists' contribution to elder abuse detection is currently limited by gaps in training, gaps in knowledge about imaging correlates, and gaps in inter-team clinical communication. Specifically, radiographic interpretation of elder trauma is severely restricted by lack of communication between frontline providers and radiologists about patients' injury mechanism and functional status. Improving this communication and re-conceptualizing ED workflow is critical to expanding and optimizing radiologists' role in elder abuse detection.

The risk factors of abusive relationships for nontraditional students

OBJECTIVE

To examine the effect of nontraditional student status on abusive relationships, namely emotional, physical, and sexual abuse.

PARTICIPANTS

The 2011-2014 American College Health Association National College Health Assessment (ACHA-NCHA) II data (N = 102,563) were utilized for the analysis.

METHODS

Logistic regression models were employed as the outcome variables were dichotomous.

RESULTS

Non-traditional students compared to traditional ones indeed had higher odds ratios of having abusive relationships. Nontraditional students compared to traditional students, however, were more likely to experience emotional and physical abuse, but not sexual abuse.

CONCLUSIONS

The prevention programs and policies related to abusive relationships need to be address differently based on the results of this study, which is also essential for nontraditional students to adjust and succeed in higher education and further their careers.

[Child Protection in Families with Parental Mental Illness]

Child Protection in Families with Parental Mental Illness Children and adolescents from families with parental mental illness face an increased risk to experience abuse, neglect and maltreatment. The effects of imminent, intermittent or chronic distress on the development of the child and to differentiate these from neglect or maltreatment are not easily assignable in such families. Questionnaires and diagnostic instruments can be supportive tools for professionals in hospitals and private practices to identify and differentiate between burdens of children and families and potential endangerment. Different instruments are presented for the assessment of child abuse: For professionals the "Wahrnehmungsbogen für Kinderschutz" (Thurn et al., 2017). As methods of screening at risk the "Eltern-Belastungsbogen zur Kindeswohlgefährdung" (Deegener, Spangler, Körner, Becker, 2009) and the Childhood Trauma Questionnaire (Wingenfeld et al., 2010). For the comprehensive assessment of abuse, we present the Maternal Interview Child Maltreatment (Cicchetti, Toth, Manly, 2003). The prevalence of mentally ill parents is presented based on two samples of patients attending the child protection outpatient clinic or and the trauma outpatient clinic of the Charité. In the child protection outpatient clinic 15.8 % of the mothers and 11.4 % of the fathers fulfilled criteria for psychiatric disorders. In the trauma outpatient clinic we diagnosed a parental mental disorder in 20 % of all cases. A fictitious case report reveals the emotional maltreatment of a child by its mentally ill mother, which suffers from an isolated delusional disorder. Empirical based classification tools seem to be very appropriate to ascertain physical and sexual maltreatment and child neglect in children of parents with mental disorders, as permanent or severe neglect is frequently detectable in these families.

Physical abuse of the elderly: a 4-year retrospective evaluation in the emergency department

AIM

Elderly physical abuse (EPA) is defined as injury or assault to or the restriction of an elderly person. Although EPA is an important social problem, its diagnosis is difficult because of tendency to cover up the event. In this study, patients aged 65 years and over who presented at the emergency department (ED) for forensic reasons and in whom physical abuse was suspected were examined. The aim of this study was to raise ED awareness of EPA and thereby to contribute to treatment plans for these patients in the ED.

METHODS

The study was conducted over a 4-year period between January 2013 and January 2017. Patients were selected retrospectively from the hospital information system according to the following criteria: (i) admission to ED with trauma; (ii) aged 65 and older; and (iii) evaluated as having forensic trauma by an ED specialist based on either the patient's history or the specialist's observations and suspicions.

RESULTS

The patients included 80 men (69%) and 36 women (31%), with a mean age of 73.92 ± 7.08 years. The length of ED stay was 0-1 h in 27.6% of patients and 1-6 h in 46.6%. When the causes of physical trauma were examined, general assault was seen as the most prevalent, occurring in nearly 63% of the patients.

CONCLUSIONS

There may be three conclusions for the current study: First, although EPA is a rare problem for patients referred to emergency services, health professionals should be suspicious when examining patients 65 years or older because of the difficulties of diagnosing EPA. Second, in patients with no history of suspicious trauma or suspicious radiological imaging results, EPA is also common. Third, because of the undetected EPA mechanism, patients should be examined forensically in suspicious cases and deaths.

The Effect of Intimate Partner Violence and Probable Traumatic Brain Injury on Mental Health Outcomes for Black Women

Severe intimate partner violence (IPV) including loss of consciousness from head injuries and/or strangulation can result in traumatic brain injury (TBI), a brain pathology characterized by altered brain function, cognitive impairment, and mental health disorders, including depression and posttraumatic stress disorder (PTSD). This study examines the prevalence of probable TBI (defined as loss of consciousness from a blow to the head and/or strangulation) and its association with comorbid PTSD and depression among Black women, who experience both higher rates of IPV and greater mental health burden than White and Latina women. Data come from a retrospective cohort study of 95 Black women with abuse history including IPV, forced sex, and childhood maltreatment. About one-third of women (n=32) had probable TBI. Among them, 38% (n=12) were hit on the head, 38% (n=12) were strangled to unconsciousness, and 25% (n=8) were strangled and hit on the head. Women with IPV history and probable TBI had significantly greater odds of various physical injuries including those that required medical care compared to other abused women. Probable TBI significantly increased comorbid PTSD and depression by 8.93 points (SE=3.40), after controlling for past violence (F _{(4, 90)}=3.67, p<.01). Findings from this study reinforce the need to screen women who lost unconsciousness due to IPV for TBI and facilitate referrals to IPV interventions and mental health treatment.