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Cuartas J, Gershoff ET, Bailey DH, Gutiérrez MA, McCoy DC. Physical punishment and lifelong outcomes in low‑ and middle‑income countries: a systematic review and multilevel meta-analysis. Nat Hum Behav 2025:10.1038/s41562-025-02164-y. [PMID: 40325199 DOI: 10.1038/s41562-025-02164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 03/03/2025] [Indexed: 05/07/2025]
Abstract
Research from high-income countries has found negative outcomes associated with physical punishment. Yet, the extent to which such research evidence generalizes to children in low- and middle-income countries (LMICs) is largely unknown. The objective of the current pre-registered study (PROSPERO: CRD42022347346 ) was to conduct a meta-analysis of the associations between childhood physical punishment and individual outcomes in LMICs. We identified eligible articles by searching for keywords related to physical punishment in six languages across 11 databases, with search periods from April to August 2021 and June to July 2024. This process yielded 5,072 unique records, of which 189 studies, comprising 1,490 unique effect sizes and representing 92 LMICs, met our inclusion criteria. Findings from random-effects multilevel meta-analyses indicated that physical punishment was associated with detrimental outcomes, including mental health problems, worse parent-child relationships, substance use, impaired social-emotional development, negative academic outcomes and heightened externalizing behaviour problems, among others. Despite some variation by contextual and study-level characteristics, all subgroup estimates were consistent in direction. Sensitivity checks indicated that these findings were not typical of other non-violent methods of discipline but were specific to physical punishment and psychological aggression. The analysis confirmed that physical punishment is associated with detrimental outcomes for individuals in LMICs. Additional research is needed to inform the design, implementation, and evaluation of policies and interventions to prevent the physical punishment of children and adolescents worldwide.
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Affiliation(s)
- Jorge Cuartas
- Department of Applied Psychology, New York University, New York, NY, USA.
- Centro de Estudios sobre Seguridad y Drogas (CESED), Universidad de los Andes, Bogotá, Colombia.
- Harvard Graduate School of Education, Cambridge, MA, USA.
| | - Elizabeth T Gershoff
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA
- Population Research Center, The University of Texas at Austin, Austin, TX, USA
| | - Drew H Bailey
- School of Education, University of California at Irvine, Irvine, CA, USA
| | - Maria Alejandra Gutiérrez
- Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
- Echocardiographic Core Laboratory, Yale University, New Haven, CT, USA
| | - Dana C McCoy
- Harvard Graduate School of Education, Cambridge, MA, USA
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Cuartas J. Corporal Punishment and Child Development in Low- and- Middle-Income Countries: Progress, Challenges, and Directions. Child Psychiatry Hum Dev 2023; 54:1607-1623. [PMID: 35482219 DOI: 10.1007/s10578-022-01362-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 01/08/2023]
Abstract
Most studies and reviews of studies on the developmental consequences of corporal punishment have focused on samples from the U.S. and other high-income countries. This study conducted a rapid review of the literature on the associations between corporal punishment and children's cognitive and social-emotional development in low- and- middle-income countries (LMICs). Information from more than 42 studies of children younger than 18 years living in 64 LMICs was reviewed. Overall, the reviewed studies show associations between corporal punishment and negative cognitive and social-emotional outcomes, and there is no evidence that corporal punishment may relate to any positive developmental outcome in LMICs. Yet, issues of internal and external validity are common in the literature. The current evidence indicates that corporal punishment might increase the risk of detrimental child outcomes in LMICs, but further research with stronger methodological designs including samples from multiple settings is warranted.
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Affiliation(s)
- Jorge Cuartas
- Harvard Graduate School of Education, Cambridge, MA, USA.
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia.
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Ma J, Han Y, Kang HR. Physical punishment, physical abuse, and child behavior problems in South Korea. CHILD ABUSE & NEGLECT 2022; 123:105385. [PMID: 34800844 DOI: 10.1016/j.chiabu.2021.105385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/15/2021] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Prior literature has demonstrated the associations of parental physical punishment with child behavior problems and increased risk of physical abuse. In South Korea, physical punishment is a common parenting practice. In 2021, legislative reforms eliminated legal grounds for parental physical punishment in South Korea. However, research on physical punishment, physical abuse, and child behavior problems in the Korean context is scarce. OBJECTIVE This study examined whether physical punishment and physical abuse have unique associations with child behavior problems and whether physical punishment is associated with increased exposure to physical abuse. PARTICIPANTS AND SETTING Data came from the 2010 Korean Child and Youth Panel Survey (KCYPS), a nationally representative sample of South Korean children who attended 1st grade in 2010. Our analyses were based on three waves of the KCYPS (N = 2,180). METHODS We employed fixed-effects regression to examine the associations of physical punishment and physical abuse with child behavior problems and the association of physical punishment with physical abuse after controlling for time-invariant characteristics. RESULTS Exposure to physical punishment and physical abuse was associated with higher levels of aggression, depression, and lower levels of academic behavior regulation. Physical punishment was associated with increased risk of physical abuse. CONCLUSIONS Our findings suggest that physical punishment is a risk for child behavior problems and physical abuse in South Korea. Child maltreatment prevention efforts should focus on shifting favorable social norms around physical punishment and promoting non-physical disciplinary practices.
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Affiliation(s)
- Julie Ma
- University of Michigan-Flint, 303 East Kearsley Street, Flint, MI 48502, USA.
| | - Yoonsun Han
- Seoul National University, Gwanak-gu, Seoul, South Korea
| | - Hae Rin Kang
- Seoul National University, Gwanak-gu, Seoul, South Korea
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Sullivan K, Zhu Q, Wang C, Boyanton D. Relations Among Peer Victimization, Aggression, and School Climate Among Elementary School Students in China. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2021.1898290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wang H, Abbey C, She X, Rozelle S, Ma X. Association of Child Mental Health with Child and Family Characteristics in Rural China: A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5107. [PMID: 34065853 PMCID: PMC8150989 DOI: 10.3390/ijerph18105107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022]
Abstract
Assessing the mental health problems encountered by school children and understanding the contributing factors are crucial to inform strategies aimed at improving mental health in low-resource contexts. However, few studies have investigated the mental health problems among disadvantaged children in poorer countries. This study examines the prevalence of mental health problems in rural China and their association with child and family characteristics. The study uses survey data from 9696 children in 120 rural primary schools and measures child mental health using the Strengths and Difficulties Questionnaire (SDQ). Overall, 17.9% of the sample children were found to be in the abnormal range of the SDQ total difficulties scores. The mean score was 12.93 (SD = 4.94). Abnormal scores were associated with child and family characteristics, including older child age (Odds Ratio, OR = 0.704, 95% CI: 0.611, 0.810; p < 0.001), gender (OR = 1.235, 95% CI: 1.112, 1.371; p < 0.001), and academic performance (OR = 0.421, 95% CI: 0.369, 0.480; p < 0.001). Reading time was found to be protective for mental health. Risk factors include excessive screen time (OR = 1.685, 95% CI: 1.409, 2.016; p < 0.001) and being bullied (OR = 3.695, 95% CI: 3.301, 4.136; p < 0.001). Our study suggests that future mental health illness prevention programs in rural China should consider targeting different aspects of children's social contexts.
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Affiliation(s)
- Huan Wang
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA; (H.W.); (C.A.); (S.R.)
| | - Cody Abbey
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA; (H.W.); (C.A.); (S.R.)
| | - Xinshu She
- Stanford School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Scott Rozelle
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, CA 94305, USA; (H.W.); (C.A.); (S.R.)
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100871, China
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Cui N, Liu J. Physical Abuse, Emotional Abuse, and Neglect and Childhood Behavior Problems: A Meta-Analysis of Studies in Mainland China. TRAUMA, VIOLENCE & ABUSE 2020; 21:206-224. [PMID: 29439616 PMCID: PMC10064579 DOI: 10.1177/1524838018757750] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The relationship between three types of child maltreatment, including physical abuse, emotional abuse and neglect, and childhood behavior problems in Mainland China, has not been systematically examined. This meta-analysis reviewed findings from 42 studies conducted in 98,749 children in Mainland China and analyzed the pooled effect sizes of the associations between child maltreatment and childhood behavior problems, heterogeneity in study findings, and publication bias. In addition, this study explored cross-study similarities/differences by comparing the pooled estimates with findings from five existing meta-analyses. Equivalent small-to-moderate effect sizes emerged in the relationships between the three types of maltreatment and child externalizing and internalizing behaviors, except that emotional abuse related more to internalizing than externalizing behaviors. Considerable heterogeneity exists among the 42 studies. Weak evidence suggests that child gender and reporter of emotional abuse may moderate the strengths of the relationships between child maltreatment and behavior problems. No indication of publication bias emerged. Cross-study comparisons show that the pooled effect sizes in this meta-analysis are about equal to those reported in the five meta-analyses conducted in child and adult populations across the world. Findings urge relevant agencies in Mainland China to build an effective child protection system to prevent child maltreatment.
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Affiliation(s)
- Naixue Cui
- School of Nursing, Shandong University, Jinan, Shandong, China
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Almurtaji Y, Everatt J, Almenaye NS, Alazemi AS, Alradaan DAH. Gender and behavioural differences in Kuwait primary schools. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2018. [DOI: 10.1080/13632752.2017.1370283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yousuf Almurtaji
- Public Authority for Applied Education & Training, Sabah Alsalem, Adailiya, Kuwait
| | - John Everatt
- University of Canterbury, Christchurch, New Zealand
| | | | - Ahmad S. Alazemi
- Public Authority for Applied Education & Training, Sabah Alsalem, Adailiya, Kuwait
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Wang F, Zhou X, Hesketh T. Psychological adjustment and behaviours in children of migrant workers in China. Child Care Health Dev 2017; 43:884-890. [PMID: 28752588 DOI: 10.1111/cch.12499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In China, there are around 274 million rural-urban migrants, an estimated 61 million children left behind in rural areas by parents, and 29 million children who accompany their parents to cities. The aim of this study was to compare the psychosocial adjustment and behaviours of left-behind children and migrant children. METHODS Full data were available for 761 left-behind children and 1,392 migrant children aged 11 to 17 in Zhejiang Province, eastern China. Participants completed a questionnaire focusing on migration status, risks behaviours, and psychological well-being, measured with the Strengths and Difficulties Questionnaire. RESULTS There were more left behind girls and more urban migrant boys (p < .001). The mean scores on the Strengths and Difficulties Questionnaire were all higher in left-behind children than migrant children: for emotional symptoms (3.82 vs. 3.03, p < .001), conduct problems (2.55 vs. 2.41, p = .048), hyperactivity (4.25 vs. 3.81, p < .001), and total difficulties (13.46 vs. 12.00, p = .020), whereas the prosocial score was lower (6.68 vs. 6.90, p < .001), all indicating lower levels of well-being in left-behind children. Overall, 11.4% of left-behind children and 8.8% of migrant children scored in the abnormal range for total difficulties. Left behind girls were particularly vulnerable to emotional problems. Left-behind children were more likely to admit to stealing and cheating on exams, but there were no differences in other risks behaviours, such as smoking and drinking. CONCLUSIONS Migration with parents, rather than separation from parents, was associated with better psychological well-being and fewer behavioural problems. Our findings have relevance for migrant parents in helping to inform decisions about where to raise their children as well as for policymakers in countries where migration is a major issue. When children are left behind, models of community support need to be considered, especially for those who are most vulnerable.
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Affiliation(s)
- F Wang
- The Institute of Social and Family Medicine, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - X Zhou
- The Institute of Social and Family Medicine, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - T Hesketh
- The Institute of Global Health, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, P.R. China.,The Institute for Global Health, UCL, London, UK
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Wang JN, Liu L, Wang L. Prevalence and associated factors of emotional and behavioural problems in Chinese school adolescents: a cross-sectional survey. Child Care Health Dev 2014; 40:319-26. [PMID: 23952583 DOI: 10.1111/cch.12101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Emotional and behavioural problems are key health issues in adolescence. The aim of this study was to evaluate the prevalence of emotional and behavioural problems in Chinese school adolescents and to explore associated factors. METHODS This cross-sectional study was conducted during the period of November/December 2009. A questionnaire including the Strengths and Difficulties Questionnaire (SDQ) self-reported version, and the characteristics of child (age, gender, only child and study pressure), parents (parent-adolescent relationship and parental expectations) and families (living area, family structure, socio-economic status and negative life events) was distributed to our study population. A total of 5220 Chinese adolescents (aged 11-18) from 30 public schools in Liaoning province completed the questionnaire. Multivariate logistic analysis was used to explore the factors associated with emotional and behavioural problems. RESULTS The average problem score was 11.28 (SD = 5.86) and the 10.7% scored above the cut-off for emotional and behavioural problems. Factors that increased the risk of having emotional and behavioural problems were: poor parent-adolescent relationship, experiencing more negative life events, older age, having study pressure, living in rural areas, boys and lower parental expectations. CONCLUSIONS The prevalence of emotional and behavioural problems among Chinese adolescents was lower level compared with those reported in other countries. We found parent-adolescent relationship, negative life events and age to be the strongest contributing factors of emotional and behavioural problems.
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Affiliation(s)
- J-N Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, China
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Wang J, Liu L, Wu H, Yang X, Wang Y, Wang L. Agreement between parents and adolescents on emotional and behavioral problems and its associated factors among Chinese school adolescents: a cross-sectional study. BMC Psychiatry 2014; 14:114. [PMID: 24735388 PMCID: PMC3991878 DOI: 10.1186/1471-244x-14-114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies about informant agreements on adolescents' emotional and behavioral problems have been conducted in Western countries, but this subject has not been well researched in China. The aim of this study was to evaluate the pattern of parent-adolescent agreement on adolescents' problems and its associated factors among school-age adolescents in China. METHODS This cross-sectional study was conducted in November and December of 2010. A questionnaire including the Child Behavior Checklist (CBCL), the Youth Self-Report (YSR), the Family Environment Scale (FES) and the characteristics of the child (age and gender), parents (parent-adolescent relationship and parental expectations) and family (family structure, negative life events) was distributed to our study population. A total of 2,199 Chinese adolescents (aged 11-18) from 15 public schools in Liaoning Province, who completed the questionnaire, became our final participants. Pearson's correlation coefficient was used to assess parent-adolescent agreement, and linear regression analysis was used to explore the associated factors of parent-adolescent discrepancies on emotional and behavioral problems. RESULTS The parent-adolescent agreement on emotional and behavioral problems was high (mean r = 0.6). The scores of YSR were higher than those of CBCL. Factors that increased informant discrepancies on emotional and behavioral problems were boys, older age, the experience of negative life events, low levels of cohesion and organization, and high levels of conflict in the family. CONCLUSIONS A high level of parent-adolescent agreement on emotional and behavioral problems was found. Adolescents reported more problems than their parents did. Family environment is an important factor to be considered when interpreting informant discrepancies on the mental health of Chinese adolescents.
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Affiliation(s)
- Jiana Wang
- Department of Social Medicine, School of Public Health, China Medical University, No. 92 Beier Road, Heping District, Shenyang, Liaoning 110001, People’s Republic of China
| | - Li Liu
- Department of Social Medicine, School of Public Health, China Medical University, No. 92 Beier Road, Heping District, Shenyang, Liaoning 110001, People’s Republic of China
| | - Hui Wu
- Department of Social Medicine, School of Public Health, China Medical University, No. 92 Beier Road, Heping District, Shenyang, Liaoning 110001, People’s Republic of China
| | - Xiaoshi Yang
- Department of Social Medicine, School of Public Health, China Medical University, No. 92 Beier Road, Heping District, Shenyang, Liaoning 110001, People’s Republic of China
| | - Yang Wang
- Department of Social Medicine, School of Public Health, China Medical University, No. 92 Beier Road, Heping District, Shenyang, Liaoning 110001, People’s Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, No, 92 Beier Road, Heping District, Shenyang, Liaoning 110001, People's Republic of China.
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Gong AT, Furnham A. Mental health literacy: Public knowledge and beliefs about mental disorders in mainland China. Psych J 2014; 3:144-58. [DOI: 10.1002/pchj.55] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 12/30/2013] [Indexed: 11/07/2022]
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Chen Y, Zhu L, Chen Z. Family income affects children's altruistic behavior in the dictator game. PLoS One 2013; 8:e80419. [PMID: 24265820 PMCID: PMC3827203 DOI: 10.1371/journal.pone.0080419] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/02/2013] [Indexed: 11/28/2022] Open
Abstract
This study aimed to examine how family income and social distance influence young rural Chinese children’s altruistic behavior in the dictator game (DG). A total of 469 four-year-old children from eight rural areas in China, including many children left behind by parents who had migrated to urban areas for work, played the DG. Stickers comprised the resource, while recipients in the game were assumed to be either their friends or strangers, with the social distance (i.e., strangers compared to friends) as a between-subjects variable. Children donated significantly more stickers to their friends than to strangers. Moreover, children from lower income families donated more stickers than children from higher income families. However, no gender and parental migrant status differences in children’s prosocial behaviors were evident in this sample. Findings of this study suggest that children’s altruistic behaviours to peers are influenced by family characteristics since preschool age. The probable influence of local socialization practices on development and the possible adaptive significance were discussed.
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Affiliation(s)
- Yongxiang Chen
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Liqi Zhu
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- * E-mail:
| | - Zhe Chen
- Department of Human and Community Development, University of California, Davis, California, United States of America
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