Toward a cumulative ecological risk model for the etiology of child maltreatment

Life Course Models of Child Maltreatment: Effects on General Psychopathology Outcomes in a Longitudinal Sample

The study compared life course models (LCM; accumulation, recency, and sensitive period) of child maltreatment and general psychopathology in a large, national longitudinal data set of 1354 youth ages birth-16 years (657 boys, 53.2% Black, 59.7% <$40K caregiver income). Previous research has supported the accumulation and recency models, albeit with shorter or fewer time periods of outcome measurement. We extend this work by modeling the impact of combined abuse and neglect allegations on a general psychopathology factor (dysregulation profile). Cross-sectional structural equation models were constructed using LCMs and tested across two-year periods from 4-16 years old and compared using Akaike Information Criterion weights. The recency variable generally explained the greatest proportion of variance in psychopathology. Notably, maltreatment more proximal to the time of outcome measurement had the strongest effect, suggesting that more recent maltreatment may have stronger effects on general psychopathology. These results lend support to a recency effect of maltreatment on psychopathology outcomes, although substantive overlaps with the accumulation model are noted.

Impact of maternal institutionalization on children's language development: A multidisciplinary study

Research has uncovered extensive negative effects of institutional rearing on development, including language deficits. However, less is known about how these effects may be passed down vertically from mothers to children. The current study examined this pathway with respect to language development using behavioral and neural measures. Participants were mother-child dyads (children aged 8-71 months) where the mothers were either previously institutionalized in orphanages (n = 20) or not (n = 34). Mothers qualified for the study if they were 16 to 35 years of age, had a child aged 8 months to 5 years, and were native Russian speakers. We hypothesized that mothers with a history of institutionalization would provide a linguistically impoverished environment, leading to lower language scores in their children and altered neural responses to language violations. Contrary to our hypotheses, maternal history of institutionalization was not significantly associated with child language abilities (expressive or receptive) or the frequency of conversational turns. However, mothers with a history of institutionalization spoke fewer words around their female offspring relative to mothers raised in biological families. Event-related potential (ERP) analyses revealed topography differences in children's P400 response during phonological processing associated with maternal institutionalization history. We were also able to predict with above-chance accuracy children whose mothers had a history of institutionalization using machine learning on ERP measures. These findings suggest the need for targeted interventions to support language development in children of mothers with a history of institutionalization.

The Cross-Sectional and Longitudinal Effects of Cumulative Multi-Contextual Risk on Psychotic-Like Experiences among Chinese Rural Adolescents

Psychotic-like experiences (PLEs) are common among adolescents and are associated with an increased risk of psychotic disorders and other mental health issues in adulthood. However, research on PLEs in rural adolescents is limited. Therefore, this study sought to investigate the cross-sectional and longitudinal effects of multiple contextual risk factors on PLEs among 1210 Chinese rural adolescents (45.6% boys; Mage = 13.70 years, SD = 0.81) across a one-year period, utilizing a cumulative risk model. Results revealed that bullying victimization, borderline personality feature (BPF), psychache, depression, and sleep problems were significant risk factors for PLEs. Furthermore, these risk factors demonstrated a cumulative effect on the development of PLEs across time. Additionally, no significant sex differences were observed in the cumulative risk model of PLEs. These findings provide valuable insights into the identification of at-risk adolescents and contribute to the effective implementation of comprehensive preventive measures and interventions targeting PLEs among rural adolescents.

Psychosocial risks and mental health of preschool care providers in Kuala Lumpur, Malaysia: a cross-sectional study

BACKGROUND

Child maltreatment in daycare is a public health issue. As childcare is stressful, high care provider negativity independently predicts more internalizing behaviour problems, affecting children's psycho-neurological development. This study aimed to determine psychosocial factors associated with the mental health of preschool care providers in Kuala Lumpur.

METHODS

A random cluster sampling cross-sectional survey was conducted in 2019. The study involved registered care providers for preschoolers under four years old without acute psychiatric illness. The Center for Epidemiologic Studies Depression Scale (Malay-CES-D) and Karasek's Job Content Questionnaires (Malay-JCQ) were used to assess depression symptoms and psychosocial job-related risks. Logistic regression (p < 0.05) guided by the Hosmer-Lemeshow strategy was used for analysis, with the final model evaluated for assumptions and goodness-of-fit.

RESULTS

A total of 247 providers were recruited from 36 preschools. All respondents were females, with a mean age of 32.1 years old, Malays (70.4%), married (55.0%), attained a diploma and above (50.6%) and had low income (80.1%). The prevalence of depressive symptoms and job strain was 28.7%. Final logistic regression revealed individual factors (married, stressful life events: assault and marital issues), job strain (AOR = 2.33, CI = 1.22, 4.44), and job insecurity (AOR = 1.29, CI = 1.07, 1.56) determine depressive symptoms. Good supervisor support was inversely associated with depression.

CONCLUSIONS

Job strain and insecurity contribute significantly to depressive symptoms among preschool care providers in Kuala Lumpur. The Social and Welfare Department can promote supportive supervision through skill training for supervisors, fostering a positive mental health environment for improving workers' mental health.

Association between negative life events through mental health and non-suicidal self-injury with young adults: evidence for sex moderate correlation

BACKGROUND

Non-suicidal self-injury (NSSI) has exhibited an increasing trend in recent years and is now globally recognized as a major public health problem among adolescents and young adults. Negative life events (NLEs) are positively associated with NSSI. We sought to explore (1) whether sex plays a role in the risk of NLEs leading to NSSI and (2) the role played by mental health (MH).

METHODS

We adopted a multi-stage cluster sampling method to select college students across four grades from May to June 2022. Generalized linear models were used to evaluate the relationships between NLEs, sex, MH and NSSI, presented as incidence-rate ratios (RRs) with 95% confidence intervals (CIs). We examined the complex relationship between these variables using the PROCESS method for moderation analysis.

RESULTS

Following the exclusion of data that did not meet the study requirements, data from 3,578 students (mean age: 20.53 [± 1.65] years) were included. Poisson regression results indicate that high-level NLEs (RR = 0.110, 95%CI: 0.047-0.173) are associated with increased NSSI. Furthermore, interaction effects were observed among sex, NLEs and NSSI. MH and sex moderated the relationship between NLEs and NSSI.

CONCLUSION

Identifying risk factors for NSSI is also important when exploring the interaction between NLEs and MH given the potential for NSSI to significantly increase the risk of later psychopathological symptoms and substance abuse problems. In addition, the significance of sex differences in risk factors for NSSI should be determined. This study evaluated how the impact of NLEs on NSSI can be reduced among adolescents from multiple perspectives.

Effects of social-ecological risk factors and resilience on the relationship between metabolic metrics and mental health among young adults

The correlation between metabolic metrics and mental health remains underexplored, with few in-depth studies examining whether this association exists among college students and whether it might be moderated by socio-ecological risk factors (SERFs) and mediated by resilience. A follow-up study design investigated the association between baseline metabolic metrics, SERFs and resilience and mental health. A multivariable linear regression model using the PROCESS method established the relationship of SERFs, resilience and metabolic metrics with mental health. Participants were 794 adolescents (mean age: 18.64 [±0.90] years). In multivariable linear regression, the high-level SERFs (β = 0.124), resilience (β = -0.042), LCI (β = 0.072), and RFM (β = 0.145) were associated with higher depression symptoms, while CVH (β = 0.602), TyG (β = 0.295), TyG-BMI (β = 0.004), and RC (β = -0.041) were not. An association was also observed between SERFs, resilience, RFM and anxiety. Resilience mediated the relationship between metabolic metrics and depression and anxiety, and SERFs moderated this relationship, demonstrating the relationship between resilience, metabolic metrics, SERFs and mental health. By revealing the potential sociological mechanism underlying the relationship between metabolic metrics and adolescents' mental health, this study provides a theoretical basis for further exploration of the biological foundations of mental health.

Strategies and Adaptations to an Integrated Substance Use and Infant Mental Health Treatment Program During COVID-19

The COVID-19 pandemic resulted in increased parenting stress and substance use. At the same time that mental health and social service needs increased, access to services, including among those receiving treatment, decreased due to stay-at-home orders. Few programs were equipped or prepared to translate their interventions to a virtual format at the start of the pandemic. There is a critical need to identify effective adaptations to substance use and family-focused treatment during the COVID-19 pandemic. Effective program adaptations have continued relevance for the expansion of access to family-focused addiction services beyond the pandemic itself, particularly for rural or other hard to reach populations. Seventy-three semi-structured interviews were conducted with the five agencies participating in the implementation of the In-Home Recovery Program (IHRP), an in-home, substance use disorder (SUD) treatment program. Using a rapid analysis approach two coders analyzed interviews for recurring concepts and themes. Facilitators for adapting services included: (1) the introduction of virtual toxicology screens, (2) helping parents access technology, (3) assisting parents with non-identified children to decrease their stress, and (4) anticipating reoccurrences of substances during the pandemic. Barriers to adapting services included: (1) engaging young children in virtual treatment, (2) privacy, and (3) engaging in telehealth with parents experiencing domestic violence or reoccurrence of substances. Findings reveal virtual substance use treatment is possible. Facilitators to adaptation such as providing access to technology and virtual toxicology screens demonstrate the feasibility and acceptability of utilizing telehealth interventions for substance use. Barriers to adaptations were primarily related to the infant mental health component. Telehealth is likely not appropriate for children below the age of five. Individual sessions focusing on caregiving, rather than dyadic treatment may be more suitable to virtual formats.

Solicitation and Sexualized Interactions of Minors with Adults: Prevalence, Overlap with Other Forms of Cybervictimization, and Relationship with Quality of Life

Sexual solicitation and sexualized interaction with minors by adults constitute one of the most pernicious risks of the Internet. Little is known about the age range in which this phenomenon is most prevalent or the relationship and overlap of this problem with other risks, such as peer-to-peer cybervictimization and cyber dating abuse. Additionally, little empirical evidence exists on whether the overlap between these types of online victimization affects health-related quality of life (HRQoL). This study aimed to: 1) analyze the prevalence of sexual solicitation and interaction according to sex and stage of adolescence; 2) relate this problem to other forms of online victimization (cybervictimization and cyber dating abuse); 3) analyze the overlap between these forms of online victimization and differences in HRQoL scores. A cross-sectional and analytical study with 3,578 adolescents (52.7% girls) aged between 10-15 years was carried out. Of the adolescents in the study sample, 12.6% (n = 448) had received sexual requests and 6.4% (n = 230) had interacted sexually with adults. Sexual solicitation was most common among girls in middle adolescence. Of the participants, 33.9% (n = 1,216) had been involved in some form of online victimization. Peer cybervictimization and cyber dating abuse were positively and significantly correlated with sexualized solicitation/interactions with adults. Victims with the overlapping of all three types of online victimization (2.7%, n = 98) presented the lowest HQRoL scores (p < .001).

Role of body mass index in the relationship between adverse childhood experiences, resilience, and mental health: a multivariate analysis

OBJECTIVES

Depression among adolescents is a global concern. Adverse childhood experiences (ACEs) have been correlated with negative physical and mental health such as obesity and depression; however, increasing evidence has suggested that their correlation might be moderated by BMI and resilience. In this study, we aim to explore (1) whether resilience moderate the risk of mental health by ACEs; (2) whether BMI is a moderator of this relationship.

STUDY DESIGN

Adolescents were obtained from 4 grade college students by a multi-stage convenience sampling method in the period of May to Jun, 2022.

METHODS

We use the Connor-Davidson Resilience scale, Depression, Anxiety and Stress Scale-21 Item (DASS-21) questionnaires to measure the ACEs, BMI, resilience and mental health. The primary exposure was ACEs and the primary outcome was mental health; while resilience and BMI were moderators. Multivariable linear regression model was used to establish the relationship of ACEs, resilience and BMI against mental health status. Moderate analysis was employed by PROCESS method to explore the relationship between these variables.

RESULTS

A total of 3600 individuals were initially enrolled, after excluding 22 with invalid questionnaires, 3578 adolescents were finally included. The mean age was (20.53 ± 1.65) years old. After adjusted for covariates, multivariable linear regression suggest that the high level ACEs (, β =0.58, , 95%CI:0.54,0.62, P < 0.01), resilience (, β=-0.27, 95%CI: , 95%CI: -0.28,-0.26, P < 0.01) were associated with higher depression symptoms, and BMI (, β =0.073, 95%CI: 0.002-0.15, P < 0.05) was associated with higher depression symptoms. There is also the interaction between resilience, ACEs and mental health (depression, anxiety and stress symptoms). In the relationship between ACEs and mental health, resilience and BMI played a moderator role.

CONCLUSIONS

The moderate analysis also provided further evidence of a link between resilience, ACEs, BMI and mental health. The findings shed new light on potential mechanisms between ACEs and mental health, including the effects of the co-interaction of resilience and BMI, adding to previous literature. ACEs may be a profound variable to measure adolescents' psychosocial environment to influence mental health, and resilience moderate this effect and is also moderated by BMI.

Relationship between chronotype and mental behavioural health among adolescents: a cross-sectional study based on the social ecological system

BACKGROUND

Health risk behaviors (HRBs) is a kind of phenomenon behavior that often occurs in adolescence, and also often appears in clusters. Previous studies suggested an association between social ecological risk factors (SERFs) and HRBs. This study explored 1) whether chronotype moderates the risk of HRBs associated with SERFs and 2) whether mental health is a mediator in this relationship.

METHODS

Adolescents were recruited from 39 junior or senior schools (three cities, 13 schools per city) using a multistage cluster sampling method conducted between October, 2020 and June, 2021. The Social Ecological System, Morningness-Eveningness Questionnaire, Brief Instrument on Psychological Health Youths, and Youth Risk Behavior Surveillance questionnaires were used to measure the SERFs, chronotype, mental health and HRBs. Latent category analysis was used to explore the clustering mode of HRBs. The primary exposure was SERFs, and the primary outcome was HRBs; chronotype was a moderator, and mental health was a mediator. The multivariable logistic regression model was used to determine the relationship between SERFs and chronotype and mental behavioral health status. Mediation moderate analysis using the PROCESS method was used to explore the relationship between these variables. Sensitivity analysis was conducted to evaluate the robustness of the model.

RESULTS

In total, 17,800 individuals were initially enrolled. After excluding 947 individuals with invalid questionnaires, 16,853 participants were finally included in the analysis. The mean age of participants was 15.33 ± 1.08 years. After adjusting for covariates, multivariable logistic regression found that high levels of SERFs (odds ratio [OR] = 10.10, 95% confidence interval [CI]: 8.88-11.43, P < 0.01), intermediate chronotype (OR = 5.24, 95% CI: 4.57-6.01, P < 0.01), and eveningness (OR = 1.83, 95% CI: 1.64-2.05, P < 0.01) were associated with higher HRBs frequency. This study also assessed the interaction between chronotype, SERFs and HRBs (OR = 27.84, 95% CI: 22.03-35.19, P < 0.01) and mental health (OR = 18.46, 95% CI: 13.16-25.88, P < 0.01). The moderated mediation analyses examined the relationship between chronotype, SERFs, mental health and HRBs.

CONCLUSIONS

SERFs may be important variables in measuring the effect of the adolescent psychosocial environment on HRBs; this effect is mediated by mental health and moderated by chronotype.

Parental personality disorder and child maltreatment: A systematic review and meta-analysis

BACKGROUND

Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly burden the relationship and interaction between parents and their children.

OBJECTIVE

This meta-analytic review aims to summarize and quantify the influence of parental PD on the occurrence / the risk of child maltreatment.

PARTICIPANTS AND SETTING

Studies had to meet the following inclusion criteria: They had to analyze a sample of parents with a diagnosed PD and the occurrence / risk of maltreating their children. To be included in the narrative synthesis and/or meta-analysis, they had to be case-control, cross-sectional, or longitudinal studies. Literature research was conducted in the databases Web of Science, Psychinfo, and Google Scholar up to January 2023.

METHODS

First, studies were analyzed on a narrative level, and eligible studies for the meta-analysis were identified. Studies were grouped according to the diagnosed PDs. Five different groups were included: borderline PD, antisocial PD, narcissistic PD, nondifferentiated PDs, and Cluster B PDs. Three different random-effects meta-analyses were computed (borderline PD, antisocial PD, Cluster B PDs). Meta-analyses were controlled for publication bias and different covariates (e.g., study quality, sample size).

RESULTS

After screening 41 full texts, 17 studies were included in the narrative synthesis, out of which 14 samples from 11 studies were included in the meta-analysis. Analysis of borderline PD showed an association with the occurrence / risk of child maltreatment (OR = 8.08; 95 % CI [2.51, 25.93]). However, after taking into account possible publication bias, this association was no longer significant. We found a significant and stable association between antisocial PD and the occurrence of / risk of child maltreatment (OR = 4.92; 95 % CI [3.26, 7.43]). Analysis of Cluster B PDs (antisocial, borderline, histrionic, narcissistic) revealed a significant overall association (OR = 4.23; 95 % CI [2.75, 6.5]), indicating that the presence of Cluster B PDs in parents significantly increases the occurrence of / the risk of child maltreatment.

CONCLUSIONS

Analyses indicated a significant association between of Cluster B PDs, and specifically between antisocial and borderline PD, with the occurrence of / the risk of child maltreatment. However, methodological limitations have to be taken into account, because results for borderline PD were no longer significant after controlling for possible publication bias. Moreover, the number of studies included was rather small, and results showed a substantial amount of heterogeneity.

OTHER

This work was not supported by any funding.

The Relationship of Parent Support and Child Emotional Regulation to School Readiness

Using data from the longitudinal Early Head Start Research and Evaluation Project that were obtained when children were 14 through 60 months old, this study aims to explore the transactional effects between parent supportiveness and child emotion regulations skills. An autoregressive model with cross-lagged paths was utilized to examine the developmental trajectories of parent supportiveness and child emotion regulation, the directions of transactional relationships between them, and the transactional effects on the prediction of child cognitive school readiness. Significant autoregressive effects were found in both parent supportiveness and child emotion regulation trajectories. Significant concurrent and longitudinal transactional effects between these two processes were documented. The effects of child emotion regulation, parent supportiveness, and their transactional effects significantly predicted cognitive school readiness. This study exemplifies the use of archival longitudinal data to move beyond current unidirectional empirical understandings of child early psychosocial development toward more integrated perspectives. Equally important, the results provide critical insights for the timing of interventions as well as the involvement of parents in early intervention programs that early childhood educators and family services providers can benefit from.

Prevalence of and Relationship Between Caregiver Adversity Scores and Child Client Eco-systemic Structural Family Therapy (ESFT) Outcome: Implications for Family Based Mental Health Services (FBMHS)

Adverse childhood experiences, especially with primary caregivers, impacts the mental, physical, and relational health of individuals (Felitti et al. in Am J Prev Med, 14(4):245-258. https://doi.org/10.1016/s0749-3797(98)00017-8 , 1998). Therefore, caregiver adversity is important to consider when delivering therapeutic interventions to children (Gardner et al. in Clin Soc Work J 42(1):81-89. https://doi.org/10.1007/s10615-012-0428-8 , 2014; Eslinger et al. in J Child Fam Stud 24(9):2757. https://doi.org/10.1007/s10826-014-0079-1 , 2015; Hagan et al. in J Trauma Stress 30(6):690-697, 2017). This study analyzed archival data to understand the role of caregiver adversity in Eco-Systemic Structural Family Therapy (ESFT) outcomes, within Family Based Mental Health Services. Results indicate caregiver lifetime adversity score did not predict treatment outcome. However, caregiver current adversity and family length of stay were negatively correlated as were length of stay and client discharge level of care. These findings suggest that ESFT benefits families regardless of caregiver childhood adversity level and that clinician attention to caregiver current adversity is important to ensure families receive the full benefits of ESFT. Implications for optimizing ESFT and future directions for ESFT clinical research are discussed.

A Systematic Literature Review of the Contribution Accumulation Makes to Psychological and Physical Trauma Sustained through Childhood Maltreatment

The pervasive effects of cumulative harm resulting from adverse childhood experiences influence all aspects of an individual’s life course. Research highlights a relationship between accumulation and trauma symptomology across all domains of harm and risk. A systematic literature review was conducted to explore and synthesize the current evidence base for the contribution accumulation makes to psychological and physical injury of childhood trauma. A search was conducted relevant to two areas of interest: (a) “cumulative harm” or “cumulative trauma” and (b) “consequences and outcomes”. Database searches and further manual searches yielded a total of 1199 articles, and 12 studies satisfied all the inclusion criteria. Only studies that were peer-reviewed and published between January 2011 and January 2022 were included. The evidence from the review indicated that multiplicity and polyvictimization, parental history and intergenerational transmission of trauma, systemic cumulative harm, and developmental lifespan outcomes were associated with the likelihood and impact of the accumulation of physical and psychological injury. The findings of this review contribute valuable knowledge to allow for a better understanding of the physical and psychological impact of accumulated and chronic childhood trauma. This knowledge will improve intervention, prevention, and management strategies for helping professionals working with traumatized or vulnerable children and adults.

The association between early reports to Child Protective Services and developmental trajectories through middle childhood

BACKGROUND

Longitudinal studies on resilience among children who have experienced maltreatment indicate that resilience is multi-dimensional. However, most research consolidates diverse developmental domains comprising resilience into a single score, which does not allow for detection of potentially heterogeneous associations between risk factors and outcomes of resilience processes.

OBJECTIVE

This study seeks to improve our understanding of the association between early child maltreatment and development through middle childhood (6-12 years) using individual domains considered to be outcomes of resilience processes.

PARTICIPANTS AND SETTING

Participants are 499 children from the Longitudinal Studies of Child Abuse and Neglect.

METHODS

We used latent growth curve models to explore patterns of socialization and daily living skills, and internalizing and externalizing behaviors - outcomes of resilience processes - across three time points in middle childhood, and their association with early maltreatment, defined as referral to Child Protective Services (CPS) before age 6.

RESULTS

In fully adjusted models, children experiencing early maltreatment had poorer baseline scores in activities of daily living (-4.22, 95% CI [-7.38, -1.46]) and externalizing behavior (2.95, 95% CI [1.05, 4.86]), but maltreatment was not associated with change over time in these domains. However, maltreatment was associated with increases in internalizing behavior over time (0.42, 95% CI [0.06, 0.77]).

CONCLUSION

Heterogeneity in patterns of association between maltreatment and outcomes of resilience processes support the utility of examining developmental domains individually, versus as a composite, to identify specific targets for intervention.

Psychological Difficulties Mediate and Self-Efficacy Moderates the Relationship Between Family Cumulative Risk and Hope Among Chinese Children From Low-Income Families

This longitudinal study investigated the role of psychological difficulties and self-efficacy in the relationship between family cumulative risk and hope among children from low-income families. The participants were 392 Chinese children from low-income families; the study extended for 2 years, and participants completed data that were collected with the following questionnaires: the Family Cumulative Risk Index, Children's Hope Scale, Strengths and Difficulties Questionnaire-Difficulties subscale, and General Self-efficacy Scale. The results demonstrated that psychological difficulties played a mediating role in the relationship between family cumulative risk and hope; specifically, family cumulative risk predicted hope of children via psychological difficulties. Self-efficacy moderated the relationship between psychological difficulties and hope. This moderation supported "a drop in the ocean effect"; the protective effect of high self-efficacy worked only when psychological difficulties were at low levels. When psychological difficulties were at high levels, the buffering effect of self-efficacy on family cumulative risk was gradually weakened and eventually lost.

Validation and further development of a risk assessment instrument for child welfare

BACKGROUND

Although many child maltreatment risk assessment instruments have been implemented in child welfare organizations, thorough studies on their predictive validity are scarce.

OBJECTIVE

To examine (1) the predictive validity of a risk assessment instrument that has been widely implemented in the Netherlands, and to examine (2) whether the actuarial risk estimation could be improved and simplified to widen the instrument's applicability to different organizations serving different populations.

PARTICIPANTS AND SETTING

The sample comprised risk assessments (N = 3,681) performed for families enrolled at one of five child welfare agencies in the Netherlands between January 2015 and December 2017.

METHODS

In a follow-up period of at least one year, child maltreatment was operationalized as whether or not child protection orders, residential care, or hotline reports occurred. Area Under the Curve values were calculated to determine the predictive accuracy of the risk classifications. Chi-square Automatic Interaction Detection was used to develop a new risk classification based on a new cumulative risk variable.

RESULTS

The original risk classification and the newly developed and simplified risk classification showed a similar discriminative accuracy for the different outcome measures: Area Under the Curve values were .68 and .69 for child protection orders, .62 and .63 for residential care, and .58 and .60 for hotline reports, respectively.

CONCLUSIONS

The original and new risk classification of the instrument had a medium predictive validity with the latter being simpler, more widely applicable, and based on more valid risk factors.

How societal responses to COVID-19 could contribute to child neglect

BACKGROUND

The ecosystemic approach to children's needs demands a cohesive response from societies, communities, and families. During the COVID-19 pandemic, the choices societies made to protect their community members from the virus could have created contexts of child neglect. With the closure of services and institutions, societies were no longer available to help meet the needs of children.

OBJECTIVE

The purpose of this study is to examine parents' reports on the response their children received to their needs during the COVID-19 crisis.

METHODS

During the period of the spring 2020 lockdown, 414 parents in the province of Quebec, Canada, completed an online questionnaire about the impact of the crisis on the response their children received to their needs.

RESULTS

Compared to parents of younger children, parents of older children reported less fulfillment of their child's needs in three measured domains, namely cognitive and affective, security, and basic care needs.

CONCLUSION

These results are discussed in light of the policies and the resources societies have put in place during the crisis to help families meet the needs of their children. Societies must learn from this crisis to put children at the top of their priorities in the face of a societal crisis. Thoughtful discussions and energy must be given to ensure that, while facing a crisis, the developmental trajectories of children are not sacrificed.

Multiple Maltreatment and Adverse Childhood Experiences: Exploring Cumulative Threats to Attachment Quality

Child maltreatment and other adverse childhood experiences (ACEs) often cooccur and are related to negative socioemotional outcomes; however, limited research differentiates how maltreatment versus other ACEs predict such outcomes. These efforts are necessary to determine whether cumulative ACE screening efforts best predict those at risk for poor outcomes. We examined cumulative childhood ACEs, cumulative maltreatment subtypes, and adult attachment quality in 379 young and middle-aged adults. This sample enabled comparison between emerging adults and older adults who have navigated additional developmental tasks that may counteract the effects of early ACEs. More ACEs and maltreatment experiences predicted insecure anxious, avoidant, and fearful attachment styles; however, maltreatment failed to predict unique variance in attachment quality beyond other ACEs. Results suggest that maltreatment may be best categorized as part of a general cumulative risk profile predicting poor socioemotional outcomes. Findings support burgeoning trends in medical and social service settings assessing ACEs using simple dichotomous screening tools to identify those requiring intervention and support services.

Incidence of and improvement in inappropriate parental behaviors of mothers with young children: a retrospective cohort study conducted in collaboration with a local government

Background

Inappropriate parental behaviors of mothers toward young children require further study; few epidemiological studies have utilized longitudinal analysis of region-based cohorts. This study examined the frequency of incidence of and improvements in inappropriate parental behaviors of mothers with young children and related factors.

Methods

Among the mothers who underwent a checkup in Fukushima City in 2017, 586 mothers with data from 4-, 18-, and 42-month-old checkups were included in analysis. In this retrospective cohort study, an anonymous database was created by transcribing and matching health checkup records with questionnaires stored at the city health center. Data were analyzed using chi-square tests and logistic regression analysis, using the SPSS Ver.20.0.

Results

In 28.5% of mothers, inappropriate parental behaviors were not reported in the 18-month-old data but were reported in the 42-month-old data. In 3.8%, inappropriate parental behaviors were reported in the 18-month-old data but were not reported in the 42-month-old data. The most common inappropriate parental behavior reported was “yelling at the child using emotional words” (18-month-old data, 16.2%; 42-month-old data, 39.5%). Mothers with financial difficulties were 2.19 times (95%CI: 1.13–4.26) more likely to begin inappropriate parental behaviors between 18 and 42 months. Improvements in parental behaviors were significantly higher in mothers under 30 years old (p = 0.03).

Conclusions

It is necessary to identify mothers with financial difficulties early and to examine how to provide childcare and financial support from a local government at the time of child health checkup.

Cumulative Ecological Risk and Problem Behaviors Among Adolescents in Secondary Vocational Schools: The Mediating Roles of Core Self-Evaluation and Basic Psychological Need Satisfaction

Based on the Cumulative Risk Model, a single risk factor cannot play a decisive role, but the cumulative ecological risks may have complex superposition effects on adolescents' problem behaviors. However, although many studies have investigated the specific influences of single external risk factors on problem behaviors, the effect of cumulative ecological risk on problem behaviors and especially the underlying mechanisms therein have been under-investigated. Therefore, this study aimed to explore the effect of cumulative ecological risk on adolescents' problem behaviors, and the mediating effects of core self-evaluation and basic psychological needs satisfaction therein. To achieve this, 1,080 adolescents in secondary vocational schools were surveyed with the questionnaires of cumulative ecological risk, basic psychological need satisfaction, core self-evaluation, externalizing and internalizing problem behaviors. Results showed that: (a) cumulative ecological risk was positively related with both internalizing problem behavior and externalizing problem behavior; (b) core self-evaluation and basic psychological need satisfaction not only respectively but also sequentially mediated the relationship between cumulative ecological risk and two sorts of problem behaviors. These results provide some pivotal implications for the precaution and intervention of the adolescent problem behaviors.

Exploring the interrelatedness of risk factors for child maltreatment: A network approach

BACKGROUND

Theories on the etiology of child maltreatment generally focus on the interaction between multiple risk and protective factors. Moreover, the quadratic model of cumulative risk describes a threshold at which the risk of child maltreatment increases exponentially, suggesting a synergistic effect between risk factors.

OBJECTIVE

This study explored the interrelatedness of risk factors for child maltreatment.

PARTICIPANTS AND SETTING

The sample consisted of risk assessments performed for both high-risk families (n = 2,399; child protection services) and lower risk families (n = 1,904; community outreach services).

METHODS

Network analyses were performed on parental risk factors. Three networks were constructed: a cross-sample network, a high-risk network, and a lower risk network. The relations between risk factors were examined, as well as the centrality of each risk factor in these networks. Additionally, the networks of the two samples were compared.

RESULTS

The networks revealed that risk factors for child maltreatment were highly interrelated, which is consistent with Belsky's multi-dimensional perspective on child maltreatment. As expected, risk factors were generally stronger related to each other in the high-risk sample than in the lower risk sample. Centrality analyses showed that the following risk factors play an important role in the development of child maltreatment: "Caregiver was maltreated as a child", "History of domestic violence", and "Caregiver is emotionally absent".

CONCLUSIONS

We conclude that studying the interrelatedness of risk factors contributes to knowledge on the etiology of child maltreatment and the improvement of both risk assessment procedures and interventions for child maltreatment.

Longitudinal Understanding of Child Maltreatment Report Risks

BACKGROUND

Child maltreatment reports (CMR) are both common and strongly associated with various negative outcomes.

OBJECTIVE

To examine CMR risks by child age, early childhood context, current/cumulative economic status (welfare receipt), race, and other risk factors with a longitudinal dataset.

PARTICIPANTS AND SETTING

The CAN sample included 2,111 children having a CMR ≤ age 3, suggestive of a harmful early childhood context. The AFDC sample included 1,923 children having AFDC but no CMR ≤ age 3, suggestive of early childhood protective factors despite poverty.

METHODS

We estimated the CMR likelihood at each age from 1-17 years based on various risk factors while following up children from 1995-2009.

RESULTS

During follow-up, CMR likelihoods were substantially higher for the CAN sample than for the AFDC sample. The age-CMR relationship was strongly negative for the CAN sample (OR = 0.87, 95% CI = 0.86-0.88). This relationship was weaker for the AFDC sample (OR = 0.92, 0.89-0.95) and became non-significant for children who exited welfare. Current welfare receipt remained a strong predictor of CMR likelihoods for both CAN (OR = 2.32, 1.98-2.71) and AFDC (OR = 2.08, 1.61-2.68) samples. Prior welfare receipt moderately increased CMR likelihoods among those not currently on welfare. Controlling for other risk factors, White children had the highest likelihood of CMR. Other child and parent level vulnerabilities also increased CMR risk over time.

CONCLUSIONS

This study highlights the importance of longitudinal analytic approaches and the utility of cross-sector administrative data in improving our ability to understand and predict CMRs over time.

Responding to the accumulation of adverse childhood experiences in the wake of the COVID-19 pandemic: implications for practice

In early 2020, the world as we knew it began to change dramatically and rapidly with the COVID-19 outbreak. Social distancing restrictions and lockdown measures have been the most effective course of action and an inarguably imperative approach at this time. However, in trying to keep the global population safe, social distancing measures unwittingly placed children already experiencing maltreatment and disadvantage in harm’s way. This paper will consider the evidence base which attests to the importance of considering the accumulation of adversity when seeking to understand risk and impact of child maltreatment and disadvantage. Given the unique and unprecedented circumstances which have accompanied the COVID-19 outbreak, and the dearth of research pertaining to the impact of pandemics on child welfare, the paper draws on an emerging body of literature about the effect of natural disasters, conflict and significant global events on child maltreatment. The paper synthesises the research to date in order to call attention to the cumulative impact of the COVID-19 pandemic on children already experiencing abuse and neglect. The paper concludes with an outline of the implications for practice in the helping professions.

Innovations in Child Welfare Interventions for Caregivers with Substance Use Disorders and Their Children

Families who enter the Child Welfare System (CWS) as a result of a caregiver's substance use fare worse at every stage from investigation to removal to reunification (Marsh et. al 2007). Intervening with caregivers with Substance Use Disorders (SUDs) and their children poses unique challenges related to the structure and focus of the current CWS. Research demonstrates that caregivers with SUDs are at a greater risk for maladaptive parenting practices, including patterns of insecure attachment and difficulties with attunement and responsiveness (Suchman, 2006). Caregivers with SUDs have also often experienced early adversity and trauma. However, traditional addiction services generally offer limited opportunities to focus on parenting or trauma, and traditional parenting programs rarely address the special needs of parents with SUDs. This article details four innovative interventions that integrate trauma-informed addiction treatments with parenting for families involved in the child welfare system. Common mechanisms for change across programs are identified as critical components for intervention. This work suggests the need for a paradigm shift in how cases involving caregivers with substance use disorders are approached in the child welfare system.

Child Sexual Abuse and Criminal Offending: Gender-Specific Effects and the Role of Abuse Characteristics and Other Adverse Outcomes

This study sought to enhance knowledge of the link between child sexual abuse (CSA) and long-term criminality by investigating gender-specific effects and the role of index sexual abuse characteristics, revictimization, and serious mental health problems. An Australian sample of 2,759 documented cases of sexual abuse and 2,677 community controls were linked to statewide police records and public mental health service databases, with a follow-up period of 13-44 years. Four key findings emerged from the analysis: (1) CSA victims were more likely than controls to engage in all types of criminal behaviors including violent, sexual, and other offending; (2) gender moderated the relationship between CSA and criminal offending, with stronger associations found among females for general and violent offending, and among males for sexual offending; (3) certain features of the index sexual abuse (i.e., developmental period, number of perpetrators, relation to perpetrator), further victimization experiences, and the development of serious mental health problems were all associated with an increased likelihood of criminal behavior among CSA victims; (4) CSA victims who engaged in criminal offending were more likely to present with cumulative risks than victims not engaging in criminal offending. Implications for future research and clinical practice are discussed.

Child and family needs profiles among cases substantiated by child protection services

Differential individual and family needs are explored in a sample of children (n = 1455) whose case has been substantiated by Child Protection Services. Using data from Quebec's 2014 cycle of Incidence Study, latent class analyses led to the identification of 5 profiles, each displaying a specific range of individual and family needs. Profile characteristics were explored in order to obtain a deeper understanding of their specific needs, beyond the initial referral motive. Further, referred services were explored in order to verify their adequacy regarding the identified needs. Together, the obtained results support the relevance of a more in-depth needs assessment when child protection services are solicited, and the necessity to better match the referred services to these needs.

School readiness of maltreated children: Associations of timing, type, and chronicity of maltreatment

Children who have been maltreated during early childhood may experience a difficult transition into fulltime schooling, due to maladaptive development of the skills and abilities that are important for positive school adaptation. An understanding of how different dimensions of maltreatment relate to children's school readiness is important for informing appropriate supports for maltreated children. In this study, the Australian Early Development Census scores of 19,203 children were linked to information on child maltreatment allegations (substantiated and unsubstantiated), including the type of alleged maltreatment, the timing of the allegation (infancy-toddlerhood or preschool), and the total number of allegations (chronicity). Children with a maltreatment allegation had increased odds of poor school readiness in cognitive and non-cognitive domains. Substantiated maltreatment was associated with poor social and emotional development in children, regardless of maltreatment type, timing, or chronicity. For children with unsubstantiated maltreatment allegations, developmental outcomes according to the type of alleged maltreatment were more heterogeneous; however, these children were also at risk of poor school readiness irrespective of the timing and/or chronicity of the alleged maltreatment. The findings suggest that all children with maltreatment allegations are at risk for poor school readiness; hence, these children may need additional support to increase the chance of a successful school transition. Interventions should commence prior to the start of school to mitigate early developmental difficulties that children with a history of maltreatment allegations may be experiencing, with the aim of reducing the incidence of continuing difficulties in the first year of school and beyond.

International child abuse prevention: insights from ACT Raising Safe Kids

BACKGROUND

Evidence-based practices are often viewed as lofty goals endorsed by wealthy academics in developed nations, but impossible to implement in other contexts. This article will provide evidence suggesting that, to the contrary, we can indeed scale up western-developed parenting interventions that can be both effective and warmly received by parents in diverse cultural and economic contexts.

METHODS/RESULTS

This paper gives a brief overview of the ACT Raising Safe Kids Program and summarizes the results of evaluation studies done with parents around the world. It discusses specific strategies facilitators use to modify the program as necessary to fit cultural contexts while also maintaining fidelity, implementing the manualized curriculum under varied, and complex circumstances.

CONCLUSIONS

It is hoped that the lessons learned from our work will inspire practitioners to adapt ACT or other programs to diverse contexts, evaluate those programs, and thereby improve the mental health and life trajectories of children and families around the world.

Which maltreated children are at greatest risk of aggressive and criminal behavior? An examination of maltreatment dimensions and cumulative risk

This paper explores the well-documented relationship between child maltreatment and aggressive and criminal behavior, specifically examining several dimensions of maltreatment and cumulative child and family risk. Using data from the provincially representative Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2013), this paper utilizes a developmental lens to examine whether maltreatment dimensions and cumulative risk can differentiate maltreated young people who exhibit aggressive and criminal behaviors and those who do not. A total unweighted sample of 1837 substantiated maltreatment investigations was examined in this analysis using chi-square, t-test, and logistic regression. The findings indicate that 13% of maltreated children and youth served by the Ontario child welfare system exhibited aggression and 6% of maltreated adolescents were involved in the youth justice system. Aggressive children and youth were more likely to experience severe and co-occurring forms of maltreatment and to experience higher levels of cumulative child risk. In adolescence, youth exhibiting aggressive and/or criminal behavior commonly were investigated because of neglect, specifically because their caregivers were no longer willing or able to remain in a caregiving role. Implications for child welfare policy and practice are discussed.

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism.

Association of child maltreatment and depressive symptoms among Puerto Rican youth

This article compares multiple types of child maltreatment among Puerto Rican youth. We seek to expand the limited knowledge of the effects of multiple types of maltreatment on depressive symptoms in a specific Latino population as emerging studies indicate that children who are exposed to one type of maltreatment are often exposed to other types. This study examines the predictive strength of different and multiple types of lifetime child maltreatment (i.e., physical, sexual, and emotional abuse; and neglect), and the effect of youth support from parents, youth coping, youth self-esteem, and place of residence on depressive symptoms among Puerto Rican youth. Secondary data analyses were performed using three annual waves (2000-2004) of data from the Boricua Youth Study. The analytic sample consists of 1041 10-13 year old Puerto Rican youth living in New York and Puerto Rico. Results indicate that: (1) youth who experienced 'sexual abuse only', 'multiple maltreatment' (2 or more types of maltreatment), 'physical abuse only' have a significant increase in depressive symptoms (75.1%, 61.6%, and 40.5% respectively) compared to those without maltreatment; and (2) place of residence, exposure to violence, and mental disorders were significant risk factors. When developing psychosocial interventions, professionals should particularly focus on youth who report past lifetime experience with child maltreatment. Particular attention should be given to children living in the Bronx, New York and similar urban low-income areas who report past lifetime experience with multiple types of child maltreatment and who present symptoms or a diagnosis of co-occurring mental health problems.

The association between childhood maltreatment experiences and the onset of maltreatment perpetration in young adulthood controlling for proximal and distal risk factors

The evidence for association between child maltreatment victimization and later maltreatment perpetration is both scant and mixed. The objective of the present study was to assess the association between childhood maltreatment experiences and later perpetration of maltreatment in young adulthood controlling for proximal young adult functioning, prior youth risk behaviors, and childhood poverty. The study included 6,935 low-income children with (n=4,470) or without (n=2,465) maltreatment reports prior to age 18 followed from ages 1.5 through 11 years through early adulthood (ages 18-26). Administrative data from multiple regional and statewide agencies captured reports of maltreatment, family poverty and characteristics, system contact for health, behavioral risks and mental health in adolescence, and concurrent adult functioning (crime, mental health and poverty). After controlling for proximal adult functioning, repeated instances of neglect or mixed type maltreatment remained associated with young adult perpetration. Females and subjects with adolescent history of runaway, violent behaviors or non-violent delinquency also had higher risk. Greater caregiver education remained associated with reduced risk. The study concludes that prevention of recurrent neglect and mixed forms of maltreatment may reduce risk of maltreatment for future generations. Intervening to increase parental education and decrease adolescent risk behaviors may offer additional benefit.

Parent and Child Reporting of Corporal Punishment: New Evidence from the Fragile Families and Child Wellbeing Study

This paper provides new evidence on parent and child reporting of corporal punishment, drawing on data from the Fragile Families and Child Wellbeing Study, a birth cohort study of families in 20 medium to large US cities. In separate interviews, 9 year olds and their mothers (N=1,180 families) were asked about the frequency of corporal punishment in the past year. Mothers and children were asked questions with slightly different response categorize which are harmonized in our analysis. Overall, children reported more high frequency corporal punishment (spanking or other physical punishment more than 10 times per year) than their mothers did; this discrepancy was seen in both African-American and Hispanic families (but not White families), and was evident for both boys and girls. These results suggest that reporting of frequency of corporal punishment is sensitive to the identity of the reporter and that in particular child reports may reveal more high frequency punishment than maternal reports do. However, predictors of high frequency punishment were similar regardless of reporter identity; in both cases, risk of high frequency punishment was higher when the child was African-American or had high previous levels of behavior problems.

Repeated exposure to high-frequency spanking and child externalizing behavior across the first decade: a moderating role for cumulative risk

This study used the Fragile Families and Child Well-Being Study to examine the effects of repeated exposure to harsh parenting on child externalizing behavior across the first decade of life, and a moderating role for cumulative ecological risk. Maternal report of harsh parenting, defined as high frequency spanking, was assessed at age 1, 3, 5, and 9, along with child externalizing at age 9 (N=2,768). Controlling for gender, race, maternal nativity, and city of residence, we found a cumulative risk index to significantly moderate the effects of repeated harsh parenting on child behavior, with the effects of repeated high-frequency spanking being amplified for those experiencing greater levels of cumulative risk. Harsh parenting, in the form of high frequency spanking, remains a too common experience for children, and results demonstrate that the effects of repeated exposure to harsh parenting across the first decade are amplified for those children already facing the most burden.

Predictors of re-entry into the child protection system in Singapore: a cumulative ecological-transactional risk model

This study examines the risk factors of re-entry for 1,750 child protection cases in Singapore using a cumulative ecological-transactional risk model. Using administrative data, the present study found that the overall percentage of Child Protection Service (CPS) re-entry in Singapore is 10.5% based on 1,750 cases, with a range from 3.9% (within 1 year) to 16.5% (within 8 years after case closure). One quarter of the re-entry cases were observed to occur within 9 months from case closure. Seventeen risk factors, as identified from the extant literature, were tested for their utility to predict CPS re-entry in this study using a series of Cox regression analyses. A final list of seven risk factors (i.e., children's age at entry, case type, case closure result, duration of case, household income, family size, and mother's employment status) was used to create a cumulative risk score. The results supported the cumulative risk model in that higher risk score is related to higher risk of CPS re-entry. Understanding the prevalence of CPS re-entry and the risk factors associated with re-entry is the key to informing practice and policy in a culturally relevant way. The results from this study could then be used to facilitate critical case management decisions in order to enhance positive outcomes of families and children in Singapore's care system.

Spanking and children's externalizing behavior across the first decade of life: evidence for transactional processes

Despite a growing literature associating physical discipline with later child aggression, spanking remains a typical experience for American children. The directionality of the associations between aggression and spanking and their continuity over time has received less attention. This study examined the transactional associations between spanking and externalizing behavior across the first decade of life, examining not only how spanking relates to externalizing behavior leading up to the important transition to adolescence, but whether higher levels of externalizing lead to more spanking over time as well. We use data from the Fragile families and child well-being (FFCW) study to examine maternal spanking and children's behavior at ages 1, 3, 5, and 9 (N = 1,874; 48% girls). The FFCW is a longitudinal birth cohort study of children born between 1998 and 2000 in 20 medium to large US cities. A little over a quarter of this sample was spanked at age 1, and about half at age 3, 5, and 9. Estimates from a cross-lagged path model provided evidence of developmental continuity in both spanking and externalizing behavior, but results also highlighted important reciprocal processes taking hold early, with spanking influencing later externalizing behavior, which, in turn, predicted subsequent spanking. These bidirectional effects held across race/ethnicity and child's gender. The findings highlight the lasting effects of early spanking, both in influencing early child's behavior, and in affecting subsequent child's externalizing and parental spanking in a reciprocal manner. These amplifying transactional processes underscore the importance of early intervention before patterns may cascade across domains in the transition to adolescence.

Development of a Childhood Attachment and Relational Trauma Screen (CARTS): a relational-socioecological framework for surveying attachment security and childhood trauma history

BACKGROUND

Current psychometric measures of childhood trauma history generally fail to assess the relational-socioecological context within which childhood maltreatment occurs, including the relationship of abusers to abused persons, the emotional availability of caregivers, and the respondent's own thoughts, feelings, and actions in response to maltreatment.

OBJECTIVE

To evaluate a computerized approach to measuring the relational-socioecological context within which childhood maltreatment occurs.

METHOD

The psychometric properties of a Childhood Attachment and Relational Trauma Screen (CARTS) were evaluated as a retrospective survey of childhood maltreatment history designed to be appropriate for completion by adults. Participants were undergraduates (n=222), an internet sample (n=123), and psychiatric outpatients (n=30).

RESULTS

The internal reliability, convergent, and concurrent validity of the CARTS were supported across samples. Paired differences in means and correlations between rated item-descriptiveness to self, mothers, and fathers also accorded with findings of prior attachment and maltreatment research, illustrating the utility of assessing the occurrence and effects of maltreatment within a relational-socioecological framework.

CONCLUSIONS

Results preliminarily support a new survey methodology for assessing childhood maltreatment within a relational-socioecological framework. Further psychometric evaluation of the CARTS is warranted.

Using a sibling design to compare childhood adversities in female patients with BPD and their sisters

Abuse and neglect are well-established risk correlates of borderline personality disorder (BPD). The goal of this study was to examine whether BPD probands can be differentiated from their sisters with respect to a range of developmental adversity and maltreatment indicators, including retrospective self-reports of past experiences of childhood abuse and neglect, dysfunctional parent-child relationships and peer victimization and dysfunctional peer relationships. A total of 53 patients with BPD were compared to 53 sisters who were currently free of psychopathology on measures assessing childhood adversities. Both probands and sisters reported similar prevalence of intrafamilial abuse, although BPD patients reported more severe physical and emotional abuse. BPD patients reported higher prevalence of physical abuse by peers. These findings generally support the principle of multifinality, in which similar histories of adversities can be associated with a variety of outcomes, ranging from psychopathology to resilience.