Child physical abuse, declining trend in prevalence over 10 years in Sweden

Is parental unemployment associated with increased risk of adverse childhood experiences? A systematic review and meta-analysis

BACKGROUND

Unemployment has adverse consequences for families and can put children at risk of harm. This study presents a systematic review and meta-analysis of global evidence on associations between parental unemployment and adverse childhood experiences (ACEs).

METHODS

Systematic literature searches across four databases identified cross-sectional, cohort or case-control studies measuring associations between parental employment and individual or cumulative ACEs in children. Available risk estimates were extracted and pooled odds ratios calculated using random-effects models.

RESULTS

Of 60 included studies, 37 provided risk estimates suitable for pooling across seven ACE types. Paternal/any parental unemployment was associated with a 29% increased risk of sexual abuse, 54% increased risk of neglect, 60% increased risk of physical abuse and around 90% increased risk of child maltreatment and parental mental illness. No associations were found between maternal unemployment and ACEs. Pooling estimates from representative general population studies also identified increased risk of child maltreatment with paternal/any parental unemployment (82%) but not maternal unemployment.

CONCLUSIONS

Children who grow up with parental unemployment can be at increased risk of ACEs. A combination of socioeconomic measures to increase employment opportunities and parental support targeting fathers and mothers may help break multigenerational cycles of abuse and deprivation.

The selective child welfare funnel. Children's exposure to violence and CWS investigations in Sweden

BACKGROUND

Research indicates that child welfare services reach out to children exposed to violence unequally depending on the child's social background, living conditions and violence type.

OBJECTIVE

Based on the notion of selective recognition of vulnerability and risk, this study explores which children CWS pursue to a complete child welfare investigation.

PARTICIPANTS AND SETTING

A register was set up including all children (n = 1764) between 7 and 12 years that were investigated for suspected exposure to violence by CWS in the municipality of the City of Stockholm, Sweden, in 2019.

METHODS

This cohort was systematically compared to demographic data and national self-report prevalence studies to explore possible biases regarding which children CWS investigates. Descriptive analysis, cluster analysis and logistic regressions were used.

RESULTS

The results confirm previous research that children exposed to violence have reduced access to material resources and inferior living conditions compared to non-exposed children. Physical abuse is more prevalent among boys of foreign backgrounds in stable, two-parent families residing in higher-status suburbs. Conversely, neglect is more common among children of Swedish backgrounds in low-income, single-parent households living in low-status suburbs. In comparison with self-reported prevalence studies, sexual and psychological abuse seem underrepresented in the study group, while neglect and violence in the family are relatively more frequently investigated compared to self-reported prevalence studies.

CONCLUSIONS

The results indicate that CWS should develop its methods to reach certain vulnerable groups that are underrepresented for safeguarding and support, for example, girls exposed to sexual abuse.

Routine conversations about violence conducted in Swedish child health services-A mixed methods study of nurses' experiences

AIM

To evaluate an intervention where nurses in child health care services routinely talk to and inform parents about violence.

METHODS

The intervention included providing information during home visits and individual conversations with mothers and fathers/partners in connection with screening for parental depression. A convergent mixed-methods design was used with a documentation form for each child (n = 475) and results from focus group interviews with nurses. Quantitative data were analysed using descriptive statistics and qualitative with manifest content analysis.

RESULTS

Almost all families participated in the intervention; individual conversations were conducted with nearly all the mothers, and to a somewhat lesser extent with the fathers/partners. Initially, the nurses felt slightly uncomfortable about these conversations, but described experiencing development and professionalisation in their role of talking about violence. Parents' reactions were generally positive and they expressed appreciation for this topic being raised.

CONCLUSION

The results show that the intervention has been carried out successfully. The newborn period is a phase in which mothers and fathers are interested and receptive to knowledge and support in sensitive matters. Prerequisites for implementation were the preparation phase for the nurses, the use of routine questioning and a questionnaire as a basis for the conversations.

Confidentiality matters! Adolescent males' views of primary care in relation to psychosocial health: a structural equation modelling approach

OBJECTIVE

To investigate to what degree adolescent males (1) value confidentiality, (2) experience confidentiality and are comfortable asking sensitive questions when visiting a general practitioner (GP), and (3) whether self-reported symptoms of poor mental health and health-compromising behaviours (HCB) affect these states of matters.

DESIGN

Cross-sectional.

SETTING

School-based census on life, health and primary care in Region Sörmland, Sweden.

SUBJECTS

2,358 males aged 15-17 years (response rate 84%).

MAIN OUTCOME MEASURES

The impact of poor mental health and HCBs on adolescent males' valuing and experiencing private time with the GP, having professional secrecy explained, and being comfortable asking about the body, love and sex, analysed with structural equation modelling.

RESULTS

Almost all respondents valued confidentiality regardless of their mental health or whether they engaged in HCBs: 86% valued spending private time with the GP, and 83% valued receiving a secrecy explanation. Among those who had visited a GP in the past year (n = 1,200), 74% had experienced private time and 42% a secrecy explanation. Three-quarters were at least partly comfortable asking sensitive questions. Adolescent males with HCBs were more likely to experience a secrecy explanation (approximative odds ratio [appOR] 1.26; p = 0.005) and to be comfortable asking about sex than their peers (appOR 1.22; p = 0.007). Respondents reporting experienced confidentiality were more comfortable asking sensitive questions (appOR 1.25-1.54; p ≤ 0.010).

CONCLUSION

Confidentiality matters regardless of poor mental health or HCBs and makes adolescent males more comfortable asking sensitive questions. We suggest that GPs consistently offer private time and explain professional secrecy.Key PointsConfidentiality for adolescent males has been scantily studied in relation to mental health and health-compromising behaviours.In this study, most adolescent males valued confidentiality, regardless of their mental health and health-compromising behaviours.Health-compromising behaviours impacted only slightly, and mental health not at all, on experiences of confidentiality in primary care.When provided private time and an explanation of professional secrecy, adolescent males were more comfortable asking the GP sensitive questions.

Emotional Dysregulation and Trauma Symptoms Mediate the Relationship Between Childhood Abuse and Nonsuicidal Self-Injury in Adolescents

Background

Nonsuicidal self-injury (NSSI) is common in adolescents. Emotion dysregulation has been identified as a core mechanism in the development and maintenance of NSSI and it is therefore an important target when addressing NSSI. The pathogenic connection between different kinds of childhood abuse, difficulties in emotion regulation and NSSI needs further investigation. The objective of this study was to examine whether difficulties with emotion regulation and trauma symptoms, separately and together, mediate the relationships between sexual, physical and emotional abuse and NSSI.

Method

Cross-sectional data was collected from 3,169 adolescent high-school students aged 16-19 years (M = 18.12, SD = 0.45). Data from self-reported experiences of childhood abuse, current difficulties with emotion regulation (measured with the Difficulties with Emotion Regulation Scale, DERS-16) and trauma symptoms (measured with the Trauma Symptom Checklist for Children, TSCC), and NSSI were collected. Structural Equation Modeling (SEM) was used to test the proposed relationships between variables.

Results

The prevalence of life-time NSSI was 27.4%. Prevalence of reported childhood abuse was 9.2, 17.5, and 18.0% for sexual, physical, and emotional abuse, respectively. Childhood abuse, difficulties with emotion regulation and trauma symptoms exhibited significant positive associations with NSSI in adolescents. Emotional dysregulation and trauma symptoms were both found to mediate the relationship between childhood abuse and NSSI. Latent variable models were found to fit data well.

Conclusion

Results indicate that increased levels of emotional dysregulation and trauma symptoms in relation to childhood abuse contribute to the increased risk of NSSI. Further, results point to some aspects of emotional dysregulation and trauma symptoms being more important in this regard. Clinical implications are discussed.

Childhood exposure to physical and emotional violence over a 57-year period in Sweden

AIMS

The aim of the present study was to examine the prevalence of childhood experiences of physical violence (CPV) and emotional violence (CEV) at the hands of parents over a 57-year period among adults born between 1937 and 1993.

METHODS

In 2012, a survey among women and men aged 18-74 years in Sweden was undertaken to examine the lifetime prevalence of physical, psychological and sexual violence and associations with current health in adulthood. Questionnaires were based on the Adverse Childhood Experiences study and a previous national survey of violence exposure. Descriptive statistics were used to analyse the frequency of exposure to CPV and CEV, and changes over time were analysed using analysis of variance and logistic regression.

RESULTS

A total of 10,337 individuals participated (response rates: 56% for women and 48% for men). CPV decreased significantly over the time period studied, particularly for those born after 1983. This decrease was more evident for male respondents. Throughout the time period studied, the proportion of women reporting CEV was higher than for men. Among both genders there was a steady rise in CEV rates from those born in the late 1930s to those born in the mid-1980s, after which there was a decline that was more marked for men.

CONCLUSIONS

A significant group of children in Sweden experience violence at the hands of parents. However, our data corroborate previous national studies that children's exposure to violence has decreased. Clear gender differences indicate that these changes have affected girls and boys differently.