Harsh discipline relates to internalizing problems and cognitive functioning: findings from a cross-sectional study with school children in Tanzania

Association Between Harsh Disciplinary Methods and Child Functioning in Children Aged 7-14 Years in Punjab, Pakistan

Despite having adverse physical and mental health outcomes, harsh disciplinary methods are commonly practiced all over the world. This study aims to measure the harsh disciplinary actions taken by parents and their association with child functioning in children, aged 7 to 14 years in Punjab, Pakistan. This study is based on secondary data obtained from the United Nations Children's Fund (UNICEF's) Multiple Indicator Cluster Survey, conducted in the Punjab province from 2017 to 2018. Parents/caregivers of 19,721 children were included in the analysis. Questionnaire-based interviews were conducted, and the data collection form included sociodemographic information, questions on different "Methods of Child Discipline" and the "Child functioning module." The data was analyzed using STATA 15.0. Multiple logistic regression analysis was conducted to calculate the adjusted odds ratio and 95% CI exploring the association between harsh disciplinary methods and child functioning. More than 50% of children were exposed to severe physical, psychological, and emotional disciplinary methods. Exposure to severe physical aggression was associated with increased difficulty in learning (2.60 [1.27, 5.31]), remembering (2.83 [1.47, 5.44]), controlling behavior (1.63 [1.21, 2.18]), anxiety (1.98 [1.25, 3.13]), depression (2.57 [1.57, 4.22]) and making friends (1.94 [1.01, 3.79]). Whereas moderate physical aggression and psychological aggression were associated with (1.48 [1.19, 1.84]) and 1.5 times (1.20, 1.84) increase in difficulty in controlling behavior, respectively. Nonviolent actions were associated with protective odds for self-care (0.33 [0.17, 0.65]), communication (0.51 [0.27, 0.96]), learning (0.56 [0.33, 0.95]), remembering (0.62 [0.39, 0.90]), concentration (0.50 [0.31, 0.80]), anxiety (0.60 [0.46, 0.79]) and depression (0.67 [0.49, 0.92]). Severe disciplinary methods are detrimental to the child's personal care, mental, social, emotional, and psychological well-being, whereas nonviolent actions are associated with positive child functioning. In a third-world country such as Pakistan, this topic is widely undiscovered and understudied, thus emphasizing the need for awareness and education of parents and healthcare providers.

The impact of coercive and assertive communication styles on children's perception of chores: an experimental investigation

Introduction

This article presents the findings of an experimental study aimed at investigating the impact of coercive and assertive communication on children's emotional responses and behavioral tendencies within parent-child interactions.

Methods

The study tested four hypotheses related to children's feelings, personalization bias, the need to express their point of view, and the desire to retreat to their room alone. Short audio stimuli recorded by a female assistant, representing a mother addressing her child, were utilized to create five different communication situations. The experimental procedure involved participants listening to the audio stimuli and answering related questions. The study included 123 participants between the ages of 9 and 13, with an equal gender distribution.

Results

The results of One-Way ANOVA tests indicated significant differences among the four types of communication in terms of unpleasant feelings, personalization bias, listening to a personal point of view, and retreating into a personal room. The findings suggest that coercive communication elicited more negative emotional responses and stronger tendencies toward personalization bias, expressing personal opinions, and seeking solitude compared to assertive communication.

Discussion

The implications of these findings highlight the importance of promoting positive and respectful communication strategies in parent-child relationships to foster children's emotional well-being and healthy behavioral development.

Corporal Punishment and Child Development in Low- and- Middle-Income Countries: Progress, Challenges, and Directions

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.

Harsh Parenting and Trajectories of Emotional and Behavioural Difficulties in Autistic Children

Autistic children show higher rates of co-occurring emotional and behavioural difficulties compared to other children in the general population. However, the environmental factors which contribute to the development of emotional (internalising) and behavioural (externalising) difficulties in autistic individuals are poorly understood. This study sought to investigate the association between harsh parenting (smacking, shouting, telling off) and the trajectories of emotional and behavioural difficulties in autistic children from ages 3 to 7. A sample comprising of 349 autistic children participated from the UK's Millennium Cohort Study. Associations between harsh parenting and child emotional and behavioural difficulties were modelled using multilevel growth curve models. In autistic children, harsh parenting was associated with total emotional and behavioural difficulties and behavioural (but not emotional) problems concurrently. Moreover, harsh parenting was not associated with changes in emotional and behavioural difficulties over time. Harsh parenting may have an important role in externalising problems in young autistic children indicating the need for public health strategies which educate parents on its effects.

Exploring children's formal help-seeking behaviour for violence in Zimbabwe: analysis of national survey and routine service provider data

OBJECTIVES

To explore knowledge of formal services and help-seeking behaviour for violence among Zimbabwean children aged 18 years and under.

DESIGN

We use cross-sectional data from the 2017 Zimbabwe Violence Against Children Survey (VACS), which is nationally representative and had a 72% response rate for female participants and 66% for males; and anonymised routine data from one of the largest child protection service providers' (Childline Zimbabwe) call database.

SETTING

Zimbabwe.

PARTICIPANTS

We analysed data from 13 to 18 year old participants in the 2017 VACS and pertaining to respondents aged 18 years and under from Childline Zimbabwe's call database.

MEASURES/ANALYSIS

We describe characteristics of children, and fit unadjusted and logistic regression models to estimate associations between selected characteristics and help-seeking knowledge and behaviours.

RESULTS

1339 of 4622 children aged 13-18 years surveyed for the 2017 VACS in Zimbabwe (29.8%) reported experience of lifetime physical and/or sexual violence. Of these, 829 (57.3%) children did not know where to seek formal help, 364 (33.1%) children knew where to seek help but did not, and 139 (9.6%) children knew where to seek help and did seek help. Boys were more likely to know where to seek help, but girls were more likely to actually seek help. During the 6-month period when VACS survey data were being collected, Childline received 2177 calls where the main reason for the call was recorded as violence against someone aged 18 years or under. These 2177 calls contained more reports from girls and children in school, versus the national profile of children who had experienced violence. Few children who did not seek help reported not wanting services. Most children who did not seek help reported that they felt at fault or that their safety would be put at risk by disclosure.

CONCLUSION

Both awareness of services and help-seeking are gendered, suggesting that different strategies may be needed to support boys and girls to access the help they want. Childline in particular may be well placed to expand its outreach to boys and to receive more reports of school-related violence, and should consider efforts to reach out-of-school children.

Intrusive parenting in early childhood: A review and meta-analysis

This systematic review and meta-analysis examines similarities and differences in intrusive parenting between mothers and fathers and relations between intrusive parenting and early childhood development. The authors integrated 55 studies and differentiated cognitive skills and socio-emotional problems as developmental outcomes. The present study employs three-level meta-analyses to reliably estimate effect sizes and examine a range of moderators. It finds a moderate effect size of similarities in intrusive parenting within a family (r = 0.256, confidence interval [CI] = [0.180, 0.329]). No significant differences were observed in intrusiveness level between mothers and fathers (g = 0.035, CI = [-0.034, 0.103]). Intrusive parenting had a significant positive association with children's socio-emotional problems (r_mother  = 0.098, CI_mother  = [0.051, 0.145]; r_father  = 0.094, CI _father  = [0.032, 0.154]) but was not related to cognitive skills. Moderator analyses suggest that East Asian mothers exhibit higher intrusiveness levels than fathers, whereas Western parents display no significant differences. Overall, these results reveal more similarities than differences in intrusive parenting and that culture likely plays a role in shaping gender-specific parenting behaviors.

Externalizing problems mediate the relation between teacher and peer violence and lower school performance

BACKGROUND

The association between children's exposure to family violence and poor academic outcomes is well-established. Less is known about how exposure to violence in the school context, i.e., by teachers and by peers, affects academic functioning. Moreover, the role of children's mental health problems in this link has hardly been examined.

OBJECTIVES

We examined direct and indirect associations between children's experiences of violence by teachers and peers and children's mental health and school functioning while controlling for children's experiences of parental violence.

PARTICIPANTS

Using a multistage random sampling approach, we obtained a representative sample of 914 students (50.5 % girls, M_age = 12.58 years) from 12 primary schools in Tanzania.

METHODS

In structured interviews, students' experiences of violence and mental health problems were assessed. Students' academic performance and absenteeism were documented using school records. Associations were examined using structural equation modeling.

RESULTS

Experiences of more teacher and peer violence were each significantly associated with higher externalizing problems (teachers: β = 0.27 [95 %-CI: 0.12, 0.47]; peers: β = 0.17, [95 %-CI: 0.07, 0.32]). Higher externalizing problems were significantly associated with poorer academic performance (β = -0.13, [95 %-CI: -0.23, -0.02]), implying significant indirect associations between students' experiences of teacher violence (β = -0.04, [95 %-CI: -0.08, -0.01]) and peer violence (β = -0.02, [95 %-CI: -0.05, -0.01]) and their academic performance via externalizing problems.

CONCLUSION

Exposure to violence at school may impair children's academic performance indirectly by increasing attention and behaviour problems. Further investigations in longitudinal studies and implementation of interventions to reduce violence in schools are indicated.

Cross-National Comparisons of Internalizing Problems in a Cohort of 8952 Adolescents from Five European Countries: The EU NET ADB Survey

Various factors such as family relationships, socioeconomic indicators, socio-cultural aspects, mental health problems and demographic variables, have been associated with internalizing problems in adolescence. The purpose of this study was to examine the prevalence of internalizing problems in adolescents from five European countries in comparison with risk factors. Using data from the European Network for Adolescent Behavior (EU NET ADB) survey, a cross-sectional school-based study of adolescents (from 14 to 17.9 years) was conducted. Data were retrieved from self-report questionnaires derived from Greece, Spain, the Netherlands, Iceland and Romania. Multiple logistic regression analysis overall and by country was held through estimation of odds ratios (OR) and 95% confidence intervals (95% CI). A total of 8952 adolescents participated in the study. According to the results, Greece (7.6%) and Romania (2.4%) presented with the lowest rates of internalizing problems, while Iceland presented the highest (11.1%). Internalizing problems were associated with lower school grades (adjusted OR = 1.21, 95% CI: 1.08-1.36), while the higher education level of parents was associated with lower odds of internalizing problems (adjusted OR = 0.75, 95% CI: 0.62-0.92). In country-specific analyses, factors that affected the likelihood of internalizing problems were gender, age, maternal and paternal unemployment. Variations detected in adolescents' internalizing problems were determined by the socio-cultural context of each country. Cultural differences should be addressed thoroughly in further research, in order to better understand and intervene in aspects of internalizing problems in adolescence.

Parental reports of stress and anxiety in their migrant children in China: The mediating role of parental psychological aggression and corporal punishment

BACKGROUND

Both ecological system theory and developmental contextualism framework have pointed out that family is one of the most direct microsystem environmental factors affecting children adjustment, especially for migrant children. As two major family microsystem factors, parenting stress and harsh discipline may be closely related to migrant children's anxiety.

OBJECTIVE

This study examined the predictive effects of both mothers' and fathers' parenting stress on Chinese migrant children's anxiety one year later in the single model and the mediating role of mothers' and fathers' harsh discipline (psychological aggression and corporal punishment).

PARTICIPANTS

Participants were 483 mother-father dyads with at least one elementary school-age child of Chinese migrant families.

METHODS

Parenting stress, parental harsh discipline (psychological aggression and corporal punishment), and children's anxiety were all reported by mothers and fathers. Structural equation modeling (SEM) was used to examine the direct effects of both maternal and paternal parenting stress (T1) on child anxiety (T3), and the mediating roles of both maternal and paternal harsh discipline (psychological aggression and corporal punishment) (T2) in the effects.

RESULTS

Our findings indicated that maternal but not paternal parenting stress had direct effects on Chinese migrant children's anxiety one year later, and both maternal and paternal parenting stress had indirect effects on migrant children's anxiety through parental psychological aggression but not corporal punishment.

CONCLUSIONS

Findings from the present study highlight the importance of simultaneously considering the influence of both maternal and paternal parenting on child adjustment.

Factors Contributing to Violent Discipline in the Classroom: Findings From a Representative Sample of Primary School Teachers in Tanzania

The need for intervention strategies aiming to reduce teachers' use of violent discipline methods has been expressed repeatedly, especially for countries where this practice is socially and legally accepted. Nevertheless, initial targets for interventions are not clearly identified, as factors contributing to teachers' use of violence are still understudied. In the present study, we examined the interplay between teachers' own experiences of violence, their attitudes, current stress, and their use of violent discipline in a representative sample of 173 Tanzanian primary school teachers (53.7% female, M_age = 38.1 years, SD_age = 10) using structural equation modeling. Our model showed good model fit (χ² [48, n = 173] = 78.058 (p = .004), CFI = .962, TLI = .948, RMSEA = .060 [90% CI [.034, .084], PCLOSE = .233], SRMR = .048). Results indicated direct associations between positive attitudes toward violent discipline (β = .41), stress (β = .23), and teachers' own experiences of violence (β = .21) with teachers' use of violence. Teachers' own experiences of violence were significantly associated with positive attitudes (β = .39), and these significantly mediated the association between teachers' own experiences of violence and their use of violent discipline (β =.23). Our findings underscore the relevance of past experiences, societal norms, and current working conditions in understanding teachers' violence against students. Interventions aiming to reduce teachers' use of violent discipline may focus on stress management, societal norms, personal beliefs on violent discipline, and how teachers' own previous experiences of violence may influence teacher's disciplining behavior.

Assessment of whole school approach intervention to reduce violence affecting children in and around schools in Kenya and Tanzania: protocol for a before-and-after, mixed-methods pilot study

INTRODUCTION

National violence against children (VAC) surveys in Tanzania and Kenya reported that approximately three-quarters of children in Tanzania experienced physical violence while 45.9% of women and 56.1% of men experienced childhood violence in Kenya. In response to VAC, Investing in Children and their Societies-Strengthening Families & Protecting Children (ICS-SP) developed the whole school approach (WSA) for reducing VAC in and around schools. Objectives of this evaluation are to: (1) determine intervention's feasibility and (2) the extent to which the WSA reduces prevalence and incidence of VAC in and around schools in Kenya and Tanzania; (3) gain insights into changes in stakeholders' knowledge, attitudes and practices in relation to VAC following intervention implementation and (4) provide evidence-based recommendations for refining intervention content, delivery and theory of change (ToC).

METHODS AND ANALYSIS

The study is a mixed-methods, controlled before-and-after, quasi experimental pilot designed to assess the delivery and potential changes in knowledge, attitudes, behaviours and VAC prevalence and incidence in and around schools following the WSA intervention implementation in Kenya and Tanzania. The preintervention phase will entail stakeholder enhancement of the WSA ToC and baseline cross-sectional surveys of teaching and non-teaching staff and parents (knowledge, attitude and practices), pupils (VAC incidents and school climate) and school safety audits. The WSA intervention implementation phase will include an intervention delivery process assessment and random school visits. In the postintervention phase, end-line surveys will be conducted similarly to baseline. Focus group discussions and in-depth interviews will be held with ICS-SP staff, training facilitators, teachers, parents and pupils to gain insights into acceptability, delivery and potential intervention effects. Quantitative and qualitative data will be analysed using SPSS V.25 and NVIVO V.12, respectively.

ETHICS AND DISSEMINATION

Ethics approvals were received from Amref Health Africa in Kenya (AMREF-ESRC P910/2020) and National Health Research Ethics Committee (NatHREC) in Tanzania (NIMR/HQ/R.8a/Vol.IX/3655). Dissemination will be through research reports.

Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda

Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda.

METHODS

In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 - Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables.

RESULTS

In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19-1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34-5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26-223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108-1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36-23.1, p = .001) and being female (OR = .054, 95% CI: 0.30-1.00, p = .005).

CONCLUSION

Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children's mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children.

Development, validation, and pilot implementation of the minimum datasheet for a domestic violence registry system: The case of a developing country

Background

Domestic violence (DV) is a universal issue and an important public health priority. Establishing a DV Registry System (DVRS) can help to systematically integrate data from several sources and provide valid and reliable information on the scope and severity of harms. The main objective of this study was to develop, validate, and pilot-test a minimum datasheet for a DVRS to register DV victims in medical facilities.

Materials and methods

This study was conducted in two main phases. Phase one includes developing the datasheet for registration of DV in the DVRS. In phase two, the datasheet designed in the previous step was used in a pilot implementation of the DVRS for 12 months to find practical challenges. The preliminary datasheet was first developed using information on similar registry programs and guidelines of the World Health Organization (WHO) and then reviewed by four expert panels. Through a two-round Delphi technique, experts evaluated the instrument using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The consistency of the responses was evaluated by test-retest analysis. Finally, two physicians in two forensic medical clinics registered the victims of physical and/or sexual violence perpetrated by a family member.

Results

Preliminary datasheet consisted of 31 items. In the first round of Delphi, fifteen items had good content validity (I-CVI and CVR) and were kept, and seven items were moved to the next round. Also, in the first round of Delphi, experts suggested adding three items, including history of the violence, custody of the child, and custody of the elderly. All items evaluated in the second round were kept due to good CVR and CVI scores. As a result of Test-retest correlation coefficients for self-reprted items, two items including perpetrator’s alcohol and drug use status were excluded (r(30) = +.43, and +.38, p< .01, two-tailed, respectively). Finally, 24 items were included in the datasheet including 15 items for individuals’ characteristics (victims’ characteristics and perpetrators’ characteristics), eight items for incidents’ characteristics, and one item for past history of violence experience. A total of 369 cases were registered from September 23, 2019, to July 21, 2020. The majority of the reported cases were female (82%) and were 19–40 years old. No physical and/or sexual violence was reported from rural areas, which calls upon researchers to explore how services for detecting and treating the victims can be made accessible to these areas.

Conclusion

DVRS can show trends in DV by age, sex, the context of the violence, and incidence characteristics at every point in time. This is particularly valuable in planning and prioritizing research areas and interventions for DV prevention. Additionally, DVRS can be linked to other disease registry programs which can contribute to continuity and coordination of care, and major research in the future. Although a DVRS can be a promising initiative in identifying the areas in need of urgent interventions, there is no guarantee for its proper implementation due to limited resources and other challenges.

The nexus of family environment with youth street criminal behavior in Khyber Pakhtunkhwa Pakistan

This empirical work focuses on the impact of unsupportive and harsh family practices on youth criminal behaviour. The present study hypothesizes that the harsh practices and low support of a family are the contributing factors for street crimes and that family practices increase the intensity of youth street criminality, particularly in a Pakistani society. While studying youth delinquent behaviour in a Pakistani society, this study employs general strain theory (GST), which has not been employed in any research in Pakistan till date. Thus, the authors examined the variables of the study from the view point of general strain theory (GST). A diverse sample size of 300 street criminals, housed in different jails of Khyber-Pakhtunkhwa (KPK) was selected randomly. However, from each jail, the sample respondents were selected through proportion allocation strategy. Moreover, primary data were collected through structured interviews and analyzed through a series of steps, which involved exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structure equation modeling (SEM). These analyses helped in determining the relationship between family harsh practices, and low family support, with youth participation in street crimes. Findings of this study offer evidence that family harsh practices and low family support directly trigger youth participation in street crimes. The present study does not only confirm the hypothetical statement of GST regarding positive and negative stimuli but also add up the significant contribution in the existing literature from the context of Pakistani society. Initiating awareness programs and sessions regarding different parental skills by sociologist and psychologist on community level, as well as the need for the sociologists and psychologist to provide assistance while addressing psychological issues of offenders are some of the recommendations based on the study findings.

Associations of Early-Life Threat and Deprivation With Executive Functioning in Childhood and Adolescence: A Systematic Review and Meta-analysis

IMPORTANCE

Many studies have demonstrated an association between early-life adversity (ELA) and executive functioning in children and adolescents. However, the aggregate magnitude of this association is unknown in the context of threat and deprivation types of adversity and various executive functioning domains.

OBJECTIVE

To test the hypothesis that experiences of deprivation are more strongly associated with reduced executive functioning compared with experiences of threat during childhood and adolescence.

DATA SOURCES

Embase, ERIC, MEDLINE, and PsycInfo databases were searched from inception to December 31, 2020. Both forward and reverse snowball citation searches were performed to identify additional articles.

STUDY SELECTION

Articles were selected for inclusion if they (1) had a child and/or adolescent sample, (2) included measures of ELA, (3) measured executive functioning, (4) evaluated the association between adversity and executive functioning, (5) were published in a peer-reviewed journal, and (6) were published in the English language. No temporal or geographic limits were set. A 2-reviewer, blinded screening process was conducted.

DATA EXTRACTION AND SYNTHESIS

PRISMA guidelines were used to guide data extraction and article diagnostics (for heterogeneity, small study bias, and p-hacking). Article quality was assessed, and data extraction was performed by multiple independent observers. A 3-level meta-analytic model with a restricted maximum likelihood method was used. Moderator analyses were conducted to explore heterogeneity.

MAIN OUTCOMES AND MEASURES

Primary outcomes included measures of the 3 domains of executive functioning: cognitive flexibility, inhibitory control, and working memory.

RESULTS

A total of 91 articles were included, representing 82 unique cohorts and 31 188 unique individuals. Deprivation, compared with threat, was associated with significantly lower inhibitory control (F1,90 = 5.69; P = .02) and working memory (F1,54 = 5.78; P = .02). No significant difference was observed for cognitive flexibility (F1,36 = 2.38; P = .12). The pooled effect size of the association of inhibitory control with deprivation was stronger (Hedges g = -0.43; 95% CI, -0.57 to -0.29) compared with threat (Hedges g = -0.27; 95% CI, -0.46 to -0.08). The pooled effect size of the association of working memory with deprivation was stronger (Hedges g = -0.54; 95% CI, -0.75 to -0.33) compared with threat (Hedges g = -0.28; 95% CI, -0.51 to -0.05).

CONCLUSIONS AND RELEVANCE

Experiences of both threat and deprivation in childhood and adolescence were associated with reduced executive functioning, but the association was stronger for exposure to deprivation. Efforts to address the consequences of ELA for development should consider the associations between specific dimensions of adversity and specific developmental outcomes.

Parental Harsh Discipline and Preschooler's Inhibitory Control in China: Bidirectional Relations and Gender Differences

The goals of this study were to examine the bidirectional associations between parental harsh discipline and Chinese preschool children's inhibitory control and to further explore the possible gender differences in these associations. Participants were Chinese preschool children and their parents. At Time 1 (T1) and Time 2 (T2), both fathers and mothers, respectively, reported their use of psychological aggression and corporal punishment, and children's inhibitory control was assessed by laboratory tasks and maternal rating. Structural equation modeling revealed that child inhibitory control significantly predicted both paternal and maternal psychological aggression and corporal punishment 1 year later, but the predictions from both types of parental harsh discipline to child inhibitory control were nonsignificant. Multiple-group analyses further suggested that boys' but not girls' inhibitory control could significantly predict paternal corporal punishment 1 year later, and no child gender differences existed for parental psychological aggression or for maternal corporal punishment. The findings suggest that the longitudinal associations between parental hash discipline and preschool children's inhibitory control in China may differ according to the types of harsh discipline and parental and children's gender.

All in the family: parental substance misuse, harsh parenting, and youth substance misuse among juvenile justice-involved youth

PURPOSE

Research consistently connects parental and youth substance misuse, yet less is known about the mechanisms driving this association among justice-involved youth. We examine whether harsh parenting is an explanatory mechanism for the association between parental substance use and parental mental health and youth substance use disorder in a sample of justice-involved youth.

METHODS

Data were drawn from the Northwestern Juvenile Project, a large-scale longitudinal survey of mental health and substance misuse in a representative sample of youth in juvenile detention. Harsh parenting, child maltreatment, youth alcohol and cannabis use disorder, and parental substance misuse and mental health were assessed among 1,825 detained youth (35.95% female) at baseline, three-year follow-up, and four-year follow-up.

RESULTS

At baseline, over 80% of youth used alcohol and/or cannabis; at the four-year follow-up, 16.35% and 19.69% of the youth were diagnosed with alcohol and cannabis use disorder, respectively. More than 20% of youth reported their parent misused substances and 6.11% reported a parent had a severe mental health need. Black youth experienced significantly fewer types of harsh parenting compared to White youth. Multivariate path analyses revealed harsh parenting mediated the association between parental substance misuse and mental health on youth alcohol and cannabis use disorder. Harsh parenting that does not rise to the level of child maltreatment mediated the association between parental substance misuse and mental health on youth alcohol use disorder; in contrast, child maltreatment did not mediate these associations. Multigroup analyses revealed the effect of harsh parenting on youth alcohol and cannabis use disorder did not vary across sex or race-ethnic subgroups.

CONCLUSIONS

Harsh parenting represents one mechanism for the intergenerational continuity of alcohol and cannabis misuse and should be regularly assessed for and addressed in juvenile justice settings.

Psychopathology mediates between maltreatment and memory functioning in Burundian refugee youth

BACKGROUND

The detrimental impact of child maltreatment on children and adolescents' academic achievement and later socioeconomic wellbeing is well known. However, it is still unclear (1) whether maltreatment is actually linked to youth's long- and short-term memory deficits and (2) whether potential impairments are due to maltreatment per se or related psychopathology.

OBJECTIVE

Based on the Attentional Control Theory, we investigated a mediational model in which maltreatment would be related to psychopathology (internalizing symptoms, posttraumatic stress symptoms, posttraumatic cognitions), which would in turn be related to impaired memory functioning.

PARTICIPANTS AND SETTING

We drew on a sample of 155 Burundian refugee youth (aged 11 to 15) currently living in refugee camps in Tanzania and at high risk of experiencing ongoing maltreatment by parents.

METHODS

Youth reported on their experiences of maltreatment and psychopathology in structured clinical interviews and completed visuospatial memory tasks involving a short-term and a working memory component (Corsi Block Tapping Test) and delayed recall from long-term memory (Rey-Osterrieth Complex Figure).

RESULTS

Structural equation modeling showed that psychopathology mediated the association between increased maltreatment and reduced working memory capacity (β = -0.07, p = .02), with a trend towards mediation for short-term memory (β = -0.05, p = .06). Higher levels of maltreatment, but not psychopathology, were directly linked to long-term memory deficits (β = -0.20, p = .02).

CONCLUSIONS

Preventive efforts targeting maltreatment and interventions focusing on related psychopathology are needed to counter memory deficits and their potential negative implications for academic and socioeconomic outcomes.

Child maltreatment, cognitive functions and the mediating role of mental health problems among maltreated children and adolescents in Uganda

BACKGROUND

Child maltreatment poses high risks to the mental health and cognitive functioning of children not only in childhood but also in later life. However, it remains unclear whether child maltreatment is directly associated with impaired cognitive functioning or whether this link is mediated by mental health problems. Our study aimed at examining this research question among children and adolescents in Uganda.

METHODS

A sample of 232 school-going children and adolescents with a mean age of 14.03 (SD = 3.25) was assessed on multiple forms of maltreatment using the Maltreatment and Abuse Chronology Exposure-Pediatric Version (pediMACE). Executive functions were assessed by the Tower of London task and working memory by the Corsi Block Tapping task, while mental health problems were assessed using the Child PTSD Symptom Scale for PTSD and the Center for Epidemiological Studies Depression Scale for Children (CES-DC).

RESULTS

In total, 232 (100%) of the participant reported to have experienced at least one type of maltreatment in their lifetime including emotional, physical, and sexual violence as well as neglect. We found a negative association between child maltreatment and executive functions (β = - 0.487, p < 0.001) and working memory (β = - 0.242, p = 0.001). Mental health problems did not mediate this relationship.

CONCLUSIONS

Child maltreatment seems to be related to lower working memory and executive functioning of affected children and adolescents even after controlling for potential cofounders. Our study indicates that child maltreatment the affects children's cognitive functionality beyond health and well-being.

Mental health problems moderate the association between teacher violence and children's social status in East Africa: A multi-informant study combining self- and peer-reports

School victimization has been negatively associated with children's social status. However, previous studies have primarily focused on peer victimization, leaving a significant knowledge gap regarding violence by teachers. We hypothesized that, when almost all children experience violence by teachers, not only the experience of violence, but also other factors, for example, mental health problems, may influence children's social preference and centrality. We therefore examined potential moderation effects of children's internalizing and externalizing problems. We implemented a multistage cluster randomized sampling approach to randomly chose fifth- and sixth-grade students from primary schools throughout Tanzania. Using a multi-informant approach, data were collected from 643 children (51.0% girls, Mage = 12.79 years). Results showed inconsistent direct associations between teacher violence and social status, whereas mental health problems were consistently associated with lower social status. Significant interaction effects were found for internalizing problems; that is, teacher violence was associated with lower social status for increasing internalizing problems. However, no interaction effects were found for externalizing problems. The findings underline the burden of exposure to violence by teachers and the importance of mental health for children's social functioning. Knowledge about interrelations can be applied in interventions to effectively reduce violence by teachers toward students.

Holes in the wall: Examining gaps in knowledge in child and adolescent mental health in Tanzania - Scoping review

OBJECTIVES

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania.

METHODS

An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research.

RESULTS

Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience.

CONCLUSION

There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

Prevalence of violence by teachers and its association to students' emotional and behavioral problems and school performance: Findings from secondary school students and teachers in Turkey

BACKGROUND

Teacher violence toward students is a common public health risk associated with various negative outcomes. Though previous studies examined the prevalence of teacher violence toward students and its association with negative outcomes, little is known about the association between teacher violence and school performance, and the mediating role of students' emotional and behavioral problems, particularly in developing countries.

OBJECTIVE

This study sought to investigate the prevalence of teacher violence toward students, its association with school performance, and the mediating role of emotional and behavioral problems.

PARTICIPANTS AND SETTING

Data were collected from 293 students (M = 12.59, SD = 1.07) and 205 teachers (M = 37.20, SD = 8.41) using a structured sampling approach.

METHODS

Our cross-sectional study used a multi-informant approach: both teachers and students reported on violence by teachers. Students reported also on other types of violence, emotional and behavioral problems, and school performance.

RESULTS

Of all students, 55 % reported that they were exposed to teacher violence at least once in the past month, while 83 % of teachers reported having used any type of violence against students. Path analysis indicated direct associations between teacher violence toward students and students' behavioral and emotional problems (β = 0.21) and school performance (β = -0.15), and an indirect association between teacher violence and school performance (β = -0.05) via emotional and behavioral problems.

CONCLUSIONS

Teacher violence toward students was highly prevalent and associated with emotional and behavioral problems and lower school performance. Prevention programs and social policies aiming to reduce violence by teachers are urgently needed.

Punitive Violence against Children: A Psychoeducational Parenting Program to Reduce Harsh Disciplining Practices and Child Beating in the Home

While parental harsh disciplining of children is a global concern, children living in Nigeria often experience particularly high levels of harsh discipline. Constrained by the lack of parenting skills to effectively manage children, most Nigerian parents rely too heavily on the use of violent methods in the disciplining of their children, which poses a huge threat to their well-being and development. Given the high levels of harsh parenting and the lack of understanding of its harms, we set out to develop a program of intervention called Psychoeducational parenting program to prevent violence against children (PEPVAC), guided by psychological principles of social learning theory, to help parents reverse the trend. We tested the effectiveness of the program using a quasi-experimental design with questionnaire and observation as data collection tools. Participants were 300 parents of children age 3-12 years, who endorsed using harsh discipline. Parents (n = 150) who received the 8-week intervention were compared with parents in the control group (n = 150). A mixed-model ANOVA revealed that the PEPVAC parents demonstrated a reduced use of harsh disciplinary tactics and a decreased incidence of parents beating their children compared to parents in the control group who continued with business-as-usual. Findings suggest that PEPVAC can be a useful intervention tool in the prevention of punitive violence against children, especially in a culturally-oriented country like Nigeria with over 91 million population of children who are at risk of disciplinary violence in the home.

Fuel to the fire: The escalating interplay of attachment and maltreatment in the transgenerational transmission of psychopathology in families living in refugee camps

Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent–child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.

Reducing violent discipline by teachers using Interaction Competencies with Children for Teachers (ICC-T): study protocol for a matched cluster randomized controlled trial in Tanzanian public primary schools

Background

Despite the existing national and international plans of action to end violent discipline strategies used by teachers in schools, they still prevail in Tanzanian schools. This underlines the need to implement school-based interventions that aim at reducing violent discipline by teachers. In this study, we will evaluate the feasibility and effectiveness of the preventative intervention Interaction Competencies with Children – for Teachers (ICC-T) in Tanzanian primary schools. Following its success in secondary schools, we hypothesize that the intervention will reduce teachers’ positive attitudes towards and their use of violent discipline at school.

Methods/design

The study will be conducted in six randomly selected regions in Tanzania. We have already randomly selected two schools in each region (12 in total) that fulfill our inclusion criteria. From each region, one school will be randomly assigned to the intervention and the other to the monitoring group (no intervention). Eighty students between the ages of 9 to 12 years (N = 960) and 20 teachers from each school (N = 240) will be included in the trial. We will collect data directly before the intervention (t1) and 6 months after the intervention (t2) both at intervention and monitoring schools. Using guided questionnaire assessments, we will measure violence by teachers using students’ reports on their exposure to and teachers’ reports on their use of violence using the Conflict Tactics Scale. Furthermore, we will assess teachers’ positive attitudes towards violent discipline using a modified version of the Conflict Tactic Scale. The feasibility of the intervention will be evaluated using purpose-built measures assessing the demand, applicability, acceptability, and integration of core elements into daily work in the participating schools.

Discussion

The proposed study will allow us to test the feasibility and effectiveness of an intervention aiming to reduce positive attitudes towards and the use of violent discipline by teachers in school settings. With the reduction of violent discipline by teachers, this study contributes to national and international efforts towards ending violence against children as well as the attainment of the United Nations’ Sustainable Development Goals that also aim to prevent all types of maltreatment of children.

Trial registration

ClinicalTrials.gov, NCT03893851. Registered on 28 March 2019.

Prevalence of family violence and mental health and their relation to peer victimization: A representative study of adolescent students in Southwestern Uganda

BACKGROUND

Despite global efforts to end violence against children in all settings, reports reveal that violence against children is still highly prevalent, especially in low-and middle- income countries. Violence in childhood is associated with a host of negative outcomes, and exposure in one setting can easily spill over to other contexts. For instance, exposure to family violence was not only related to mental health problems but also seems to be a risk factor for peer victimization.

OBJECTIVES

The present study aimed to examine the prevalence of maltreatment within the family and adolescents' mental health problems and their relation to peer victimization. We also aimed to gain new insights into the perceptions of adolescents concerning maltreatment within their families.

METHODS

Data were collected from April to November 2017 in a representative sample of 702 students from 12 public secondary schools in Southwestern Uganda who responded to self-administered questionnaires.

RESULTS

Overall, 95% of the students experienced at least one type of family violence in the past month. Students (81.3%) had endorsed some level of acceptance of violent discipline as a valid strategy in response to any misbehavior. Maltreatment within the family was related to peer victimization (β = .47) and this relation was mediated by mental health problems (0.002, 95%-CI: 0.001-0.004).

CONCLUSIONS

The results indicated a high prevalence of maltreatment within Ugandan families that was associated with peer victimization. This underscores the need to implement interventions aiming to reduce maltreatment and violence in order to protect children from potentially negative consequences.

Childhood abuse and community violence: Risk factors for youth violence

OBJECTIVE

To investigate the joint effect of child abuse and neglect (CAN) and community violence (CV) on adolescents with peers that commit youth violence (YV).

METHODS

This is a school-based cross-sectional study of 699 students enrolled in four public and nine private schools in the municipality of Rio de Janeiro, Brazil. Participants were selected through a complex cluster sampling procedure. CAN was identified using the Childhood Trauma Questionnaire (CTQ). Exposure to CV was assessed by asking students if they have witnessed cases of lethal violence in the community. YV was measured indirectly through questions about having friends who have committed acts of crime. Multivariate logistic models were used to study the effects of emotional, physical, and sexual abuse and emotional and physical neglect in childhood on YV, controlled for confounders, according to different levels of CV.

RESULTS

Emotional abuse OR = 3.32 (CI 95%: 1.79-6.17), sexual abuse OR = 2.33 (CI 95%: 1.20-4.54), and physical neglect OR = 1.81 (CI 95%: 1.02-3.20) increased the odds of YV in adolescents, whether cooccurring with CV or not. Physical abuse OR = 3.95 (CI 95%: 2.29 - 6.80) and emotional neglect OR = 2.93 (CI 95%: 1.83-4.72) are only risk factors for YV involvement when associated with CV.

CONCLUSIONS

These findings highlight the relevance of CAN and CV as risk factors for YV and the potential increase in adolescents' vulnerability when exposed to both. Policies aiming at preventing and dealing with CAN are essential strategies to reduce YV, especially in areas with high levels of CV.

Risk or resource: Does school climate moderate the influence of community violence on children's social-emotional development in the Democratic Republic of Congo?

Exposure to community violence is thought to create risk for the social and emotional development of children, including those children living in low-income, conflict-affected countries. In the absence of other types of community resources, schools may be one of the few community resources that can help buffer children from the negative effects of community violence exposure. We sampled 8,300 students ranging in age from 6-18 years in 123 schools from the eastern Democratic Republic of Congo to examine whether and how two distinct dimensions of positive school climate can protect two key features of children's social-emotional development in the presence of community violence. Multi-level models tested the hypothesis that students' perceptions of a positive school climate moderated the relation between community violence and self-reported mental health problems and peer victimization. Findings support the hypothesis. Specifically, a positive school climate protected against mental health problems and peer victimization in the presence of high community violence. Students who experienced high community violence and a negative school climate generally demonstrated the worst development. We find complex interactions between the dimensions of school climate and exposure to violence on student social-emotional development that highlight the salience of children's contexts for developmental studies in low-income countries. We use dynamic developmental systems theory and differential impact to discuss the dual potential of schools as a buffer against the effects of violence or as a source of compounded risk.

The intersection of school corporal punishment and associated factors: Baseline results from a randomized controlled trial in Pakistan

Violence against youth is a global issue; one form of youth victimization is school corporal punishment. We use baseline assessments from a cluster randomized controlled trial to examine the prevalence of school corporal punishment, by gender, and the relationship to levels of peer violence at school, parent corporal punishment, youth food security and youth academic performance and school attendance in Pakistan. Forty homogenous public schools in the urban city of Hyderabad, Pakistan were chosen for randomization into the trial evaluating a youth violence prevention intervention. 1752 6th graders, age 11-14 years, were selected as the target population. Since schools are segregated by gender in Pakistan, data are from interviews in 20 boys' schools and 20 girls' schools. Overall, 91.4% of boys and 60.9% of girls reported corporal punishment at school in the previous 4 weeks and 60.3% of boys had been physically punished at home in the past 4 weeks compared to 37.1% of girls. Structural equation modeling revealed one direct pathway for both boys and girls from food insecurity to corporal punishment at school while indirect pathways were mediated by depression, the number of days missed from school and school performance and for boys also by engagement in peer violence. Exposure to corporal punishment in school and from parents differs by gender, but in both boys and girls poverty in the form of food insecurity was an important risk factor, with the result that poorer children are victimized more by adults.

Parents' use of physical and verbal punishment: cross-sectional study in underprivileged neighborhoods

OBJECTIVE

To estimate the past-year prevalence of parental use of verbal and physical discipline in an urban sample.

METHOD

A cross-sectional study was conducted in two underprivileged neighborhoods with nearly 80,000 inhabitants. Complex sampling was used. The households were selected by applying two-stage probabilistic sampling with stratification. A total of 401 households (sample error=0.1) were selected by maximizing the variance (p=0.5). The cluster sampling indicated 33 census units (sample error=0.05). The Brazilian Portuguese version of the WorldSAFE Core Questionnaire was used to assess parental use of moderate verbal discipline, harsh verbal discipline, moderate physical discipline, and harsh physical discipline. This questionnaire asks how often mothers (respondent) and/or their husband or partner use specific disciplinary tactics.

RESULTS

The mean age of children and adolescents was 9 years (SD: 4.5). The prevalence of harsh verbal discipline was approximately 37% (28.3% [95% CI: 23.4-33.3%] for more than three times). The prevalence of harsh physical discipline was approximately 30% (21.8% [CI: 18.2-25.4%] for more than three times). Boys had higher odds of receiving harsh physical discipline [OR: 1.56, p<0.05]. Children and adolescents with learning problems and developmental delays had higher odds of being exposed to harsh discipline than their peers without these problems. Children and adolescents with chronic health conditions (e.g., asthma) had lower odds of receiving harsh physical discipline (OR: 0.4; p<0.05).

CONCLUSIONS

Parental abuse was embedded within children and adolescents rearing practices in these two underprivileged neighborhoods.

Reducing violence by teachers using the preventative intervention Interaction Competencies with Children for Teachers (ICC-T): A cluster randomized controlled trial at public secondary schools in Tanzania

The high global prevalence of school violence underlines the need for prevention. However, there are few scientifically evaluated intervention approaches that aim at preventing violence by teachers. We evaluated the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T). In a cluster randomized controlled trial we assessed attitudes towards and use of violence by teachers (self-reported and reported by students) at eight schools in four regions in Tanzania. Two regions were randomly assigned as intervention regions. Data were assessed in the months before and three months after intervention. In total, 158 teachers (58% females; age: 32.08 years, SD = 5.65) and 486 students (54% females; age: 15.61 years, SD = 0.89) participated in this study. The feasibility was very good: Participants' acceptance was high and they reported a good integration of the core elements in their working routine. The significantly stronger decrease in the use of emotional and physical violence reported both by teachers and students as well as the stronger decrease in positive attitudes of teachers towards physical and emotional violence in the intervention schools at follow-up provide initial evidence of the efficacy. However, further evidence for the sustainability of its effect is needed.

Reducing violence against children by implementing the preventative intervention Interaction Competencies with Children for Teachers (ICC-T): study protocol for a cluster randomized controlled trial in Southwestern Uganda

BACKGROUND

An adolescent's school is often the second most important place for his development and education after the home. However, reports highlight the recurrence of the use of violent discipline in schools. There are few school-based interventions that aim at reducing violence at school that have been implemented and evaluated in sub-Saharan Africa. To reduce violent disciplinary measures used at school, we aim to implement and evaluate the feasibility and efficacy of the preventative intervention Interaction Competencies with Children for Teachers (ICC-T).

METHODS/DESIGN

The study will be conducted in six randomly selected districts of the Ankole region in southwestern Uganda. We shall randomly select two mixed-day secondary schools from each district that fulfill our inclusion criteria. Schools will be randomly assigned to the intervention condition, where ICC-T will be implemented, and control schools (no intervention). Sixty students between the ages of 12 and 17 years and at least 15 teachers per school will be included in the trial. We aim to collect pre-assessment data directly before the intervention (t1) and 3 months after the intervention (t2) in both intervention and control schools. Using self-administered questionnaires, we will measure students' exposure to violence using the Conflict Tactics Scale (CTS), their psychological well-being using the Strengths and Difficulties Questionnaire (SDQ), and teachers' positive attitudes towards violent disciplining and teachers' use of violent disciplinary methods (CTS). The implementation feasibility of ICC-T in the cultural context of southwestern Uganda will be assessed with purpose-built measures that follow the guidelines for feasibility studies assessing the demand, applicability, acceptability, and integration of core elements in the daily work.

DISCUSSION

The proposed study will allow us to test the feasibility and efficacy of a preventative intervention seeking to reduce violent disciplinary measures in school settings using a scientifically rigorous design. The proposed study provides the opportunity to contribute to the attainment of goal number 16.2 of the United Nations' Sustainable Development Agenda 2015-2030, which aspires to end all forms of violence against children.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03051854 . Registered on 14 February 2017.

Mental health problems and their association to violence and maltreatment in a nationally representative sample of Tanzanian secondary school students

PURPOSE

Little is known about the prevalence of mental health problems among adolescents in Sub-Saharan Africa. Research consistently determined violence and maltreatment to be important risk factors. In this study, we examined the prevalence of mental health problems among adolescents in Tanzania, as well as the association with exposure to violence and maltreatment.

METHODS

We administered a set of questionnaires (e.g., strength and difficulties questionnaire; conflict tactic scale) to a nationally representative sample of 700 Tanzanian secondary school children (52% girls; age 14.92 years, SD = 1.02) and 333 parents or primary caregivers (53% females; age 43.47 years, SD = 9.02).

RESULTS

41% of the students reported an elevated level of mental health problems (emotional problems 40%, peer problems 63%, conduct problems 45%, hyperactivity 17%) in the past 6 months. Concordantly, 31% of parents reported observing an elevated level of mental health problems in their children (emotional problems 37%, peer problems 54%, conduct problems 35%, hyperactivity 17%). After controlling for other risk factors, we found significant associations between physical violence by parents and adolescent's mental health problems reported by students (β = 0.15) and their parents (β = 0.33).

CONCLUSIONS

Our findings suggest a high prevalence of mental health problems using screening tools among secondary school students in Tanzania as well as an association between physical violence by parents and adolescents' mental health problems. Our findings emphasize the need to inform the population at large about the potentially adverse consequences associated with violence against children and adolescents.

A cross-sectional exploratory study of knowledge, attitudes, and practices of emergency health care providers in the assessment of child maltreatment in Maputo, Mozambique

BACKGROUND

In Mozambique, and other low-income countries (LICs), there is little information on the burden of child maltreatment (CM). Emergency care services (ECS) play an important role in recognizing, treating, and intervening in situations of CM. We aim to identify knowledge, attitudes, and practices regarding CM among health care providers in ECS at Mavalane General Hospital in Maputo, Mozambique.

METHODS

This exploratory cross-sectional study evaluates the knowledge, attitudes, and practices of health care providers to diagnose and treat cases of CM. A 25 min, pilot-tested verbal interview questionnaire was administered to 49 physicians and nurses working in ECS at Mavalane General Hospital. Interviews were completed between October-November 2010. Data were managed and analyzed in SPSS 14.0 and descriptive statistics were generated.

RESULTS

Of 49 health care providers, 83.6% reporting receiving no, or very little CM education or training. Only 61.2% had knowledge of physical abuse as a main form of child maltreatment and 38.8% were able to identify corresponding symptoms of physical abuse. Sexual abuse as a main form of CM was mentioned by 26.5 and 2% cited its symptoms. While 87.7% of health care providers strongly agreed or agreed that they hold an important role in preventing CM, 51.1% also strongly disagreed or disagreed that they feel confident diagnosing and treating CM cases. In regards to follow-up, 14.3% strongly disagreed or disagreed that they know where to refer victims for further follow-up and an additional 14.3% did not know whether they agreed or disagreed.

CONCLUSION

This study revealed knowledge gaps in emergency health care provider knowledge of the main forms of CM and their symptoms. The fact that a majority of health care providers in our sample did not receive information specific to CM in their medical education and training could explain this gap, as well as their unawareness of where to refer victims. Given that health care providers believe they play an important role in identifying and treating CM, future research should focus on raising physician awareness of CM and developing education and training materials grounded in cultural contexts to build response capacity in Mozambique and other LICs.

Child neglect and its relation to emotional and behavioral problems: A cross-sectional study of primary school-aged children in Tanzania

Child maltreatment is known to engender negative emotional and behavioral consequences. Although neglect is the most frequent form of maltreatment, it has thus far only received little attention, especially when looking at low-resource countries. The current study investigated possible associations between neglect and internalizing and externalizing problems. As neglect and abuse often co-occur, the latter was controlled for. In total, 409 Tanzanian primary school students (52% boys, M = 10.5 years, range = 6-15) participated in the cross-sectional study. Structured clinical interviews were conducted assessing maltreatment, internalizing problems, and externalizing problems. Overall, 31% (n = 128) of the children reported at least one type of physical neglect and 31% (n = 127) of emotional neglect. Using structural equation modeling, we found a significant association between neglect and internalizing (β = 0.59, p &lt; .01) and externalizing problems (β = 0.35, p &lt; .05). However, these associations could only be detected in younger children (ages 6-9), whereas in older children (ages 10-15), mental health problems were significantly related to violence and abuse. Our findings suggest that the current age may influence the association between maltreatment type and the development of internalizing and/or externalizing problems.

Violence and maltreatment in Tanzanian families-Findings from a nationally representative sample of secondary school students and their parents

Though the Sustainable Development Goals of the United Nations aim to end all forms of violence against minors, child maltreatment remains a globally prevalent phenomenon. Despite the fact that parents in numerous countries apply violent discipline methods to control children's behavior, little is known about the prevalence of maltreatment and violent discipline in Sub-Saharan Africa. In this study, we examined the prevalence of maltreatment and violent discipline from both the adolescents' and parents' perspectives. In addition, we explored risk factors that could be associated with violent discipline by parents. We administered questionnaires to a nationally representative sample of 700 Tanzanian secondary school students (52% girls, mean age: 14.92 years, SD = 1.02, range: 12-17) and 333 parents or primary guardians (53% females; mean age: of 43.47 years, SD = 9.02, range: 19-71). More than 90% of all students reported exposure to violent discipline by a parent within the past year. Concurrently, more than 80% of parents acknowledged using violent discipline techniques. Using a path model, we found that violent discipline by parents was associated with parental stress. Other risk factors contributed to a higher stress level but were not directly linked to maltreatment. Our findings indicate high levels of violent discipline in Tanzanian families. There is a pressing need to design and implement interventions that prevent children from experiencing violence at home. Reducing parents' stress levels may be a starting point for intervention. Yet, due to the high levels of violent discipline, societal beliefs also need to be considered.

Teachers' stress intensifies violent disciplining in Tanzanian secondary schools

Violent forms of discipline in schools continue to be widespread across the globe despite their damaging effects. Since little is known about factors influencing the extent of violence applied by teachers, this study aimed to investigate the influence of teachers' stress, work satisfaction, and personal characteristics on their disciplining style. Using structural equation modeling, associations between violent discipline, burnout symptoms, and job perceptions (pressure and difficulties in class) reported by 222 teachers from 11 secondary schools in Tanzania in 2015 were analyzed. Results indicated a direct association between perceived stress and emotional violent discipline (β=.18, p<.05) as well as physical violent discipline (β=.37, p<.001). Perceived stress also mediated the association between job perceptions and both forms of violent disciplining. The model showed good model fit (χ² [44, n=222]=67.47 (p=.013), CFI=.94, TLI=.91, IFI=.94, RMSEA=.049 [90%-CI=.02-.07, PCLOSE=.50], SRMR=.06). Our findings suggest that teachers' personal perceptions of their work as well as their stress burden play a role in their disciplining styles. Our findings underline the importance of integrating topics, such as stress and coping as well as positive, nonviolent discipline measures into the regular teacher's training and in addition to develop and evaluate school-based preventative interventions for teachers.

The Family Stress Model as it Applies to Custodial Grandfamilies: A Cross Validation

There is scant research on how the parenting practices of custodial grandmothers affect the psychological adjustment of grandchildren in their care. Yet, the findings from a handful of prior studies suggest the relevance of the Family Stress Model (FSM) to these caregivers. The present study further tested the FSM with baseline data from 343 custodial grandmothers (Mage= 58.5 years) enrolled in a clinical trial of the efficacy of interventions for improving the well-being of their families. Not only was this "help-seeking" sample atypical of prior FSM studies, but also unique to the present study was our addition of multiple parenting practices, self-reported and clinical ratings of grandmothers' distress, and reports of grandchildren's internalizing and externalizing difficulties from grandchildren and grandmothers. Mplus 7.31 was used to test a model where the effect of grandmother distress on grandchildren's internalizing and externalizing difficulties was hypothesized to be indirect through five distinct parenting practices. The findings regarding both the measurement and structural models fit the observed data well, and invariance was largely found across grandchildren's gender and age (4-7 vs. 8-12). Although grandchildren's self-reported internalizing and externalizing difficulties were unrelated to grandmothers' distress and parenting practices, the grandmothers' reports of these outcomes were generally related to their own distress and parenting practices as hypothesized. However, considerable variation was found across the five parenting practices in terms of their relationships to the other FSM constructs. We conclude that data from multiple informants and measures of assorted parenting practices are essential to future research and practice.

The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation

BACKGROUND

Child and adolescent mental health in Africa remains largely neglected. Quick and cost-effective ways for early detection may aid early intervention. The Strengths and Difficulties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review to examine existing studies that have used the SDQ in Africa.

METHODS

A comprehensive scoping review methodology was used to identify all peer-reviewed studies ever published that have used the SDQ in Africa. Data were extracted and analysed to assess the countries, languages and SDQ versions used, the purpose of the SDQ studies, psychometric properties of the SDQ, and to consider knowledge gaps for future in-country and cross-country studies.

RESULTS

Fifty-four studies from 12 African countries were identified, most from South Africa. Many different languages were used, but authorized SDQs in those languages were not always available on the SDQinfo website. Authors frequently commented on challenges in the translation and backtranslation of mental health terminology in African languages. The SDQ was typically used to investigate internalisation/externalization disorders in different clinical populations, and was most frequently used in the evaluation of children and adolescents affected by HIV/AIDS. Sixteen studies (29.6%) administered the SDQ to participants outside the intended age range, only 4 (7.4%) used triangulation of all versions to generate assessments, and eight studies (14.8%) used only subscales of the SDQ. Only one study conducted thorough psychometric validation of the SDQ, including examination of internal consistency and factor analysis. Where 'caseness' was defined in studies, UK cut-off scores were used in all but one of the studies.

CONCLUSIONS

The SDQ may be a very useful tool in an African setting, but the scoping review suggested that, where it was used in Africa researchers did not always follow instrument guidelines, and highlighted that very little is known about the psychometric properties of the SDQ in Africa. We recommend comprehensive evaluation of the psychometric properties of the SDQ in various African languages, including internal consistency, factor structure, need for local cut-off values and ensuring cultural equivalence of the instrument.

PTSD symptom severity relates to cognitive and psycho-social dysfunctioning - a study with Congolese refugees in Uganda

Background: In the ongoing conflict in the Democratic Republic of the Congo (DRC), civilians have been heavily exposed to traumatic stressors. Traumatizing experiences cumulatively heighten the risk for trauma-related disorders, and with it affect cognitive and psycho-social functioning. Objectives: We aimed at investigating the association between trauma-related disorders and cognitive and psycho-social functioning and hypothesized that PTSD symptom severity would negatively correlate with executive functioning, working memory and psycho-social functioning in everyday life. Method: In total, 323 Congolese refugees (mean age: 31.3 years) who arrived in the Ugandan Nakivale refugee settlement after January 2012 were assessed regarding their exposure to traumatic events, PTSD symptom severity (posttraumatic symptom scale interview), executive functioning (Tower of London), working memory performance (Corsi block tapping task) and psycho-social dysfunctioning (Luo functioning scale). Results: Hierarchical regression analyses indicated a significant negative association between PTSD symptom severity and working memory (β = -0.32, p < 0.001), as well as executive functions (β = -0.19, p = 0.003). Furthermore, the impairment of psycho-social functioning in everyday life was positively related with PTSD symptom severity (β = 0.70, p < 0.001), and negatively with executive functioning (β = -0.15, p = 0.003). However, working memory performance was not significantly related to psycho-social dysfunctioning (β = 0.09, p > 0.05). Conclusion: Trauma survivors not only suffer from the core PTSD symptoms but also from impaired cognitive functioning. PTSD symptom severity seems furthermore to be related to impaired psycho-social functioning. Our findings suggest that trauma-related mental health problems may heighten the risk for poverty and lack of prospect and further aggravate the consequences of war and conflict.

Maltreatment and Mental Health Outcomes among Ultra-Poor Children in Burkina Faso: A Latent Class Analysis

Objectives

Research about the mental health of children in Francophone West Africa is scarce. This paper examines the relationships between adverse childhood experiences, including exposure to violence and exploitation, and mental health outcomes among children living in ultra-poverty in rural Burkina Faso.

Methods

This paper utilizes baseline data collected from 360 children ages 10–15 and 360 of their mothers recruited from twelve impoverished villages in the Nord Region of Burkina, located near the Sahel Desert and affected by extreme food insecurity. We used a Latent Class Analysis to identify underlying patterns of maltreatment. Further, the relationships between latent classes and mental health outcomes were tested using mixed effected regression models adjusted for clustering within villages.

Results

About 15% of the children in the study scored above the clinical cut-off for depression, 17.8% for posttraumatic stress disorder (PTSD), and 6.4% for low self-esteem. The study identified five distinct sub-groups (or classes) of children based on their exposure to adverse childhood experiences. Children with the highest exposure to violence at home, at work and in the community (Abused and Exploited class) and children not attending school and working for other households, often away from their families (External Laborer class), demonstrated highest symptoms of depression and trauma. Despite living in adverse conditions and working to assist families, the study also identified a class of children who were not exposed to any violence at home or at work (Healthy and Non-abused class). Children in this class demonstrated significantly higher self-esteem (b = 0.92, SE = 0.45, p<0.05) and lower symptoms of trauma (b = -3.90, SE = 1.52, p<0.05).

Conclusions

This study offers insight into the psychological well-being of children in the context of ultra-poverty in Burkina Faso and associated context-specific adverse childhood experiences. Identifying specific sub-groups of children with increased exposure to life stressors has implications for program developers. Study findings indicate a further need to explore the mental health consequences of traumatic experiences within the context of ultra-poverty and to develop integrated economic and psychosocial interventions that prevent or mitigate childhood adversities linked with the family-level poverty and violence in the family.