Maltreatment experience in childhood and average excess body mass from adolescence to young adulthood

BackgroundPrior studies have suggested maltreatment is a strong predictor of later weight outcomes, such that maltreatment experiences in childhood increase the likelihood of being overweight or obese in adulthood. Estimates of this relationship may be biased due to: 1) inadequate selection of covariates; 2) improper operationalization of child maltreatment; and 3) restricting analyses to cross-sectional outcomes.ObjectivesEvaluate how latent classes of child maltreatment experiences are associated with a longitudinal BMI measure from adolescence to adulthood.ParticipantsData from the National Longitudinal Study of Adolescent to Adult Health.MethodsWe evaluated how previously developed latent classes of child maltreatment experiences were associated with average excess BMI from adolescence to adulthood using multivariate linear regression.ResultsIn the unadjusted model, individuals in the poly-maltreatment class (b = 0.46, s.e. = 0.20) and individuals who experienced adolescent-onset maltreatment (b = 0.36, s.e. = 0.11) had higher average excess BMI compared to individuals in the no maltreatment class. After adjusting for confounders, the relationship between poly-maltreatment and average excess BMI abated, whereas the relationship between adolescent-onset maltreatment and average excess BMI sustained (b = 0.28, s.e. = 0.11).ConclusionsContrary to previous findings, our analyses suggest the association between maltreatment experiences and longitudinal weight outcomes dissipates after controlling for relevant confounders. We did find a relationship, however, between adolescent-onset maltreatment and average excess BMI from adolescence to adulthood. This suggests the importance of maltreatment timing in the relationship between maltreatment and weight.     

Mediating effects of bullying involvement on the relationship of body mass index with social phobia,depression, suicidality,and self-esteem and sex differences in adolescents in Taiwan

The aims of this study were to examine the mediating effect of bullying involvement on the relationships between body mass index (BMI) and mental health problems, including social phobia, depression, suicidality, and low self-esteem among adolescents in Taiwan. The moderation effect of sex on the mediating role of bullying involvement was also examined. Five thousand two hundred and fifty-two students of high schools completed the questionnaires. Victimization and perpetration of passive and active bullying were assessed using the Chinese version of the School Bullying Experience Questionnaire. BMI was calculated from self-reported weight and height measurements. The Social Phobia Inventory, the Mandarin Chinese version of the Center for Epidemiological Studies-Depression Scale, the suicidality-related questionnaire from the epidemiological version of the Kiddie-Schedule for Affective Disorders and Schizophrenia, and the Rosenberg Self-Esteem Scale were applied to assess social phobia, depression, suicidality, and low self-esteem, respectively. The mediating effect of bullying involvement on the associations between increased BMI and mental health problems was examined by the Sobel test. The moderation effect of sex on the mediating role of bullying involvement was tested by the multiple-group structural equation model. Victimization of passive and active bullying and perpetration of passive bullying, but not perpetration of active bullying, had a mediating effect on the relationships between increased BMI and all four mental health problems. Sex did not have a significant moderation effect on the mediating role of bullying involvement. Bullying involvement should be a target of prevention and intervention in developing a strategy to improve mental health among adolescents with increased BMI.     

Barriers and facilitators to disclosing sexual abuse in childhood and adolescence: A systematic review

Children and young people often choose not to disclose sexual abuse, thus preventing access to help and allowing perpetrators to continue undetected. A nuanced understanding of the barriers (and facilitators) to disclosure is therefore of great relevance to practitioners and researchers. The literature was systematically searched for studies related to child and adolescent disclosures of sexual abuse. Thirteen studies were reviewed and assessed for methodological quality. Results of the review illustrate the heterogeneous nature of these empirical studies. Findings demonstrate that young people face a number of different barriers such as limited support, perceived negative consequences and feelings of self-blame, shame and guilt, when choosing to disclose. Being asked or prompted, through provision of developmentally appropriate information, about sexual abuse facilitates disclosure. The review highlights the need for robust, longitudinal studies with more sophisticated methodology to replicate findings. The review identifies the need for developmentally appropriate school-based intervention programmes that facilitate children’s disclosure by reducing feelings of responsibility, self-blame, guilt and shame. In addition, prevention programmes should encourage family members, friends and frontline professionals to identify clues of sexual abuse, to explicitly ask children about the possibility of sexual abuse and also to respond supportively should disclosures occur. Facilitating disclosure in this way is key to safeguarding victims and promoting better outcomes for child and adolescent survivors of sexual abuse.     

Protective factors associated with resilient functioning in young adulthood after childhood exposure to violence

Children may be subjected to many forms of violence and a significant number will experience multiple victimizations. These children are at high risk for developing psychological and emotional difficulties that may last into adulthood. Despite the increased risk for psychopathology, a substantial percentage of young adults exhibit resilient functioning following a history of childhood violence. This study examines the role of social support, spirituality, and emotional intelligence in promoting resilience during emerging adulthood. Participants included 321 young adult American college students, age 18–24, who experienced childhood violence, including community violence, interpersonal aggression, child maltreatment, peer/sibling victimization, and/or sexual assault. Findings revealed that this sample was highly victimized, with an average of 9 violent experiences reported during childhood. Hierarchical multiple regression analyses indicated that after controlling for exposure to childhood victimization, other potentially traumatic events, and current depression and anxiety symptoms, higher resilience during emerging adulthood was associated with greater spirituality, greater emotional intelligence, and support from friends (but not from family). Findings suggest that the potency of protective factors outweighs that of adversity and psychopathology when predicting resilient functioning. By identifying variables that can enhance resilience, this study offers unique insight into how functioning may be improved by both individual and environmental factors.     

Economics and violence against children,findings from the Violence Against Children Survey in Nigeria

This study seeks to assess the impact of economic factors on sexual, emotional, and physical violence on Nigerian children and adolescents aged 13–24 years. Data collected from the Nigerian Violence Against Children Survey (VACS), a national, cross-sectional household survey of females and males aged 13–24 years were used to examine sexual, emotional, and physical violence victimization. Data were collected on household economic status, e.g., flooring and roofing materials, transportation. A poverty index was developed using the Simple Poverty Scorecard^™ for Nigeria to determine the impact that economic factors have on these violence measures. Children aged 13–17 years in households with high economic status (ES) were 1.81, 1.78, and 4.91 times, more likely to experience sexual, emotional, and physical violence, respectively, within the last 12 months than those in the lowest ES. Individuals aged 18–24 years in households with high ES were 1.62 and 1.41 times more likely to experience emotional and physical violence, respectively, prior to age 18 than those in the lowest ES. Individuals aged 18–24 years in households with middle or high ES were 1.65 and 1.96, respectively, times more likely to experience physical violence prior to age 18 than those in the lowest ES. Highest tertile ES was significantly associated with sexual, emotional, and physical violence among Nigerians aged 13–24 years. Further research is needed to determine the cause of increased violence amongst high ES households. Targeted interventions towards this ES class are recommended to reduce violence against children in Nigeria.     

Body mass index, waist circumference, and cardiometabolic risk factors in young and middle-aged Chinese women

Objective: To assess the associations between body mass index (BMI), waist circumference (WC), and cardiometabolic risk factors in young and middle-aged Chinese women. Methods: A total of 3011 women (1938 young women, 1073 middle-aged women), who visited our health care center for a related health checkup, were eligible for study. BMI and WC were measured. The subjects were divided into normal and overweight/obesity groups based on BMI, and normal and abdominal obesity groups based on WC. Cardiometabolic variables included triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), and blood pressure (BP). Results: The prevalence of overweight/obesity was significantly higher in middle-aged women (32.4%) than in young women (12.0%). The prevalence of abdominal obesity was also higher in middle-aged women (60.3%) than in young women (36.2%). There were significant differences in the comparison of all related cardiometabolic variables between different BMI (or WC) categories in young and middle- aged women groups, respectively. After adjustment for age, partial correlation analysis indicated that both BMI and WC were correlated significantly with all related cardiometabolic variables. After adjustment for age and WC, although the correlation coefficient r′was attenuated, BMI was still correlated significantly with all related cardiometabolic variables in young and middle-aged women. After adjustment for age and BMI, partial correlation analysis showed that WC was correlated significantly with TG, FBG, HOMA-IR, and HDL-C in young women and significantly with TG, HOMA-IR, and HDL-C in middle-aged women. Conclusions: The prevalence of overweight/obesity and abdominal obesity was high in Chinese young and middle-aged women. BMI was a better predictor of cardiovascular disease and diabetes than WC in young and middle-aged women, and moreover, measurement of both WC and BMI may be a better predictor of cardiovascular disease and diabetes mellitus than BMI or WC alone.     

Exposure to violence,typology, and recidivism in a probation sample of domestic violence perpetrators

The present study investigated the predictive utility of self-reported domestic violence perpetrators’ exposure to violence in their family of origin and patterns related to this exposure through the use of longitudinal analyses on a sample of 228 men on probation in Lake County, Illinois. Differences in typology, recidivism, recidivism frequency, and violent behavior survival patterns in men with a history of domestic violence perpetration and with varying levels of family of origin violence exposure were examined. Findings suggest that those who witnessed interparental violence (either alone, or in combination with experiencing violence) were most likely to be classified as Generally Violent offenders (e.g., perpetrators who direct violence toward their family and others), compared to those who did not report experiencing or witnessing violence. In addition, results also indicate that men who experienced both witnessing interparental violence and receiving physical abuse in childhood were more likely to recidivate more frequently compared to those who did not report experiencing or witnessing violence. No significant findings for typology and recidivism were noted. Clinical and policy/practice implications are discussed.     

Association of autistic traits in adulthood with childhood abuse,interpersonal victimization,and posttraumatic stress

Persons with autistic traits may be at elevated risk for interpersonal victimization across the life course. Children with high levels of autistic traits may be targeted for abuse, and deficits in social awareness may increase risk of interpersonal victimization. Additionally, persons with autistic traits may be at elevated risk of posttraumatic stress disorder (PTSD) symptoms subsequent to trauma. We examined retrospectively reported prevalence of childhood abuse, trauma victimization and PTSD symptoms by autistic traits among adult women in a population-based longitudinal cohort, the Nurses’ Health Study II (N = 1,077). Autistic traits were measured by the 65-item Social Responsiveness Scale. We estimated odds ratios (OR) for childhood sexual and physical/emotional abuse and PTSD symptoms by quintiles of autistic traits. We examined possible mediation of PTSD risk by abuse and trauma type. Women in the highest versus lowest quintile of autistic traits were more likely to have been sexually abused (40.1% versus 26.7%), physically/emotionally abused (23.9% versus 14.3%), mugged (17.1% versus 10.1%), pressured into sexual contact (25.4% versus 15.6%) and have high PTSD symptoms (10.7% versus 4.5%). Odds of PTSD were elevated in women in the top three quintiles of autistic traits compared with the reference group (OR range = 1.4 to 1.9). Childhood abuse exposure partly accounted for elevated risk of PTSD in women with autistic traits. We identify for the first time an association between autistic traits, childhood abuse, trauma victimization, and PTSD. Levels of autistic traits that are highly prevalent in the general population are associated with abuse, trauma and PTSD.     

Associations between adolescent experiences of violence in Malawi and gender-based attitudes,internalizing, and externalizing behaviors

Little is known about adolescent exposure to and factors associated with violence in Malawi. The aim of this research was to describe the prevalence of exposure to violence among adolescents in Malawi, and test the hypotheses that such exposures are associated with gender-based violent attitudes, and with internalizing and externalizing problems. In 2014, 561 primary school pupils were interviewed (50% girls), and logistic regression analysis was performed on gender-stratified data, adjusting for sociodemographic differences. Both girls and boys had witnessed domestic violence (28.5% & 29.6%), experienced emotional abuse at home (23.1% & 22.9%), physical abuse at home (28.1% & 30.4%), physical abuse at school (42.4% & 36.4%), and been bullied (33.8% & 39.6%). Among girls, internalized violent attitudes towards women were associated with emotional abuse at home (OR 2.1) and physical abuse at school (OR 1.7). Condoning rape was associated with physical abuse at school (OR 1.9). Bullying perpetration was associated with emotional abuse at home (OR 4.5). Depression was associated with emotional abuse at home (OR 3.8) and physical abuse at school (OR 2.4). Among boys, violent attitudes towards women and condoning rape were not associated with violence exposure. Bullying perpetration was associated with having been a victim of bullying (OR 2.9) and physical abuse at school (OR 2.7). Depression was associated with emotional abuse at home (OR 2.9), domestic violence (OR 2.4) and physical abuse at school (OR 2.5). These findings can inform programs designed to reduce violence victimization among Malawian girls, both in homes and schools.     

Exposure to intimate partner violence and internalizing symptoms: The moderating effects of positive relationships with pets and animal cruelty exposure

BackgroundIt is estimated that more than half of children living in households where intimate partner violence (IPV) occurs are also exposed to animal cruelty (AC). Although prior research links bonds with pets with higher levels of socioemotional competence among school-age children, exposure to AC may negate the protective effects of pet ownership and/or exacerbate the potentially deleterious effect of IPV on children’s mental health.ObjectiveThe current study evaluates whether and to what extent the associations between exposure to IPV and several indicators of children’s mental health vary as a function of children’s positive engagement with pets and exposure to AC.Participants and SettingParticipants included 204 children (aged 7–12 years; 47% female; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western U.S. state.MethodMultiple moderation analysis evaluated whether the association between children’s exposure to IPV and internalizing and posttraumatic stress symptoms vary as a function of children’s positive engagement with pets and exposure to AC.ResultsAnalyses revealed several moderation effects for positive engagement with pets (e.g., internalizing problems: [b = −.15, t(195) = −2.66, p = .008]; posttraumatic stress symptoms: [b = −.13, t(195) = −2.24, p = .026]), whereas exposure to AC only moderated the association between IPV and anxious/depressed symptoms (b = .32, t(195) = −2.41, p = .017).ConclusionsThese findings highlight the potential protective effects of positive engagement with pets and importance of screening for exposure to AC when engaging in trauma-informed work with children exposed to IPV.     

Growing up with parental alcohol abuse: exposure to childhood abuse, neglect, and household dysfunction

OBJECTIVE: This study is a detailed examination of the association between parental alcohol abuse (mother only, father only, or both parents) and multiple forms of childhood abuse, neglect, and other household dysfunction, known as adverse childhood experiences (ACEs). METHOD: A questionnaire about ACEs including child abuse, neglect, household dysfunction, and exposure to parental alcohol abuse was completed by 8629 adult HMO members to retrospectively assess the relationship of growing up with parental alcohol abuse to 10 ACEs and multiple ACEs (ACE score). RESULTS: Compared to persons who grew up with no parental alcohol abuse, the adjusted odds ratio for each category of ACE was approximately 2 to 13 times higher if either the mother, father, or both parents abused alcohol (p < 0.05). For example, the likelihood of having a battered mother was increased 13-fold for men who grew up with both parents who abused alcohol (OR, 12.7; 95% CI: 8.4-19.1). For almost every ACE, those who grew up with both an alcohol-abusing mother and father had the highest likelihood of ACEs. The mean number of ACEs for persons with no parental alcohol abuse, father only, mother only, or both parents was 1.4, 2.6, 3.2, and 3.8, respectively (p < .001). CONCLUSION: Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences. Improved coordination of adult and pediatric health care along with related social and substance abuse services may lead to earlier recognition, treatment, and prevention of both adult alcohol abuse and adverse childhood experiences, reducing the negative sequelae of ACEs in adolescents and adults.     

The intertwined effect of lack of emotional warmth and child abuse and neglect on common mental disorders in adolescence

Adolescence is a vulnerable period for mental health problems. Although child abuse and neglect (CAN) are known risk factors for some of them, it is not clear if the negative consequences on mental health also occur in families where CAN and a warm parent-child relationship coexist. The aim of this study is to explore this gap and investigate the effects of different types of CAN according to levels of warmth in the parent-child relationship on common mental disorders (CMD) in adolescence. This is a cross-sectional study encompassing 487 adolescents attending the ninth grade at 2 public and 4 private schools in Rio de Janeiro, Brazil. CAN was measured by the Child Trauma Questionnaire (CTQ), CMD by the General Health Questionnaire (GHQ-12) and the level of warmth in the parent-child relationship were recalled using short Egna Minnen Betraffände Uppfostran (s-EMBU-23). The adjusted separate effects of different types of CAN and a low level of warmth in the parent-child relationship, and both in tandem, were estimated using multivariate linear regression models. Results indicated that emotional abuse and neglect, physical abuse and neglect, and a low level of warmth in the parent-child relationship are important risk factors for CMD in adolescence. Nevertheless, in families where CAN coexist with a warm and affectionate parent-child relationship, the negative effects of CAN on mental health are attenuated. Evidence indicates that actions to prevent or interrupt CAN and improving parental practices could be effective strategies to reduce CMD in adolescence.     

Factors affecting disclosure among Israeli children in residential care due to domestic violence

Disclosure of child abuse may enable initiating interventions to end maltreatment and mediate its negative physical and psychological consequences. The present study reviews the field of disclosure and examines factors affecting disclosure among a service population of abused children who were placed in residential care due to various forms of abuse (e.g., physical, sexual, emotional, neglect and witnessing domestic violence). The sample consisted of 286 Israeli (Hebrew and Arabic speaking) children aged 12–17 (mean = 14 ± 1). Following approval of the Ethics committee of the University and parents’ written consent, participants were administered a self-report questionnaire that included the following measures: a Socio-Demographic Questionnaire, the Childhood Trauma Questionnaire (CTQ), the Juvenile Victimization Questionnaire (JVQ), and the Disclosure of Trauma Questionnaire (DTQ). Results indicated that the three key factors enhancing the likelihood of disclosure were: moral factors, external initiatives and intolerable physical pain. The three key factors inhibiting disclosure were feelings of shame, fear of losing social support and uncertainty as to how and to whom to disclose. Results also showed that children preferred to disclose to their nuclear family members (parents and siblings) in comparison with professionals.     

A sex-disaggregated analysis of how emotional violence relates to suicide ideation in low- and middle-income countries

BackgroundIn recent years, research has increasingly focused on examining the relationship between one type of child maltreatment -- emotional violence -- and suicidal behaviors. However, the growing body of empirical evidence supporting these associations has been mostly limited to high-income contexts.ObjectiveThis study examines how exposure to emotional violence is associated with suicide ideation in childhood and adolescence in low- and middle-income countries (LMICs), and whether this association differs by sex.Participants and settingWe employ nationally representative samples of 13–24 year-old males and females from the Violence Against Children Surveys in Tanzania (conducted in 2009), Kenya (2010), and Haiti (2012).MethodsWe use logistic regressions to estimate the odds of ever reporting suicide ideation, separately, for each country; models control for self-reported exposure to emotional violence, physical violence from a caregiver, physical violence by an adult in the community, sexual violence, intimate partner violence, and age. Formal moderation by sex for each form of child maltreatment is tested using interaction terms.ResultsWe find the odds of suicide ideation are consistently and significantly greater for adolescents who report ever exposure to emotional violence. This same consistency is not observed for any other form of maltreatment across countries. The size of the relationship between emotional violence and suicide ideation is statistically significantly larger for males in Kenya only.ConclusionResearch in LMICs should explore the mediating factors linking emotional abuse in childhood and adolescence to suicide ideation in adolescence, paying special attention to whether these pathways might operate differently by sex.     

Interpersonal violence: identification of associated features in a clinical sample

Violence is a burdensome problem in daily psychiatric practice, even though the diagnosisof a mental disorder is not sufficient to determine a violent behavior; therefore, other factors are involved. We predicted that the participants could be distributed in two groups (e.g. high versus low violence-maltreatment groups) because this grouping would better describe specific patterns of associations in a clinical sample. We aimed to investigate the relation between interpersonal violence and maltreating experiences in childhood. Affective states and personal functioning were also explored as meaningful outcomes. Consecutive patients (N = 101) admitted to a psychiatric unit were evaluated with the Risky Families Questionnaire, the Psychological Maltreatment Review, the Karolinska Interpersonal Violence Scale (KIVS), the Positive and Negative Affect Schedule and the Personal and Social Performance Scale. Single, with average education and unemployed individuals showed significantly higher KIVS scores. High levels of interpersonal violence (IV) in childhood correlated with a harsh family climate in early life. Moreover, IV correlated with perceived parental maltreatment and did not with parental support. The cluster analysis identified two clusters of patients. The first (n = 41) showed negative dysfunctional experiences; the second (n = 60) showed a more positive perception of parental support.The impairment of social functioning and emotions regulation are both involved in this complex relation. The study supports the hypothesis of a clustering of patients that needs tailored management of violence causes and consequences.     

Self-reported disciplinary practices among women in the child welfare system: association with domestic violence victimization

OBJECTIVE: To examine the association between physical domestic violence victimization (both recent and more than a year in past measured by self-report) and self-reported disciplinary practices among female parents/caregivers in a national sample of families referred to child welfare. METHODS: Cross-sectional survey of more than 3,000 female caregivers in the National Survey of Child and Adolescent Well-being (NSCAW) study, a nationally representative sample of children and their families referred to child welfare agencies for investigation of abuse and neglect. Women reported physical domestic violence victimization and their disciplinary practices for their child on different versions of the Conflict Tactics Scales. RESULTS: Four hundred and forty-three women reported prior year domestic violence, 1,161 reported domestic violence but not in the past 12 months, and 2,025 reported no domestic violence exposure. Any prior domestic violence exposure was associated with higher rates of self-reported psychological aggression, physical aggression and neglectful disciplinary behaviors as compared to those with no domestic violence victimization in bivariate comparisons. After controlling for child behavior, demographic factors, and maternal characteristics, those with remote and recent domestic violence victimization employed more self-reported psychological aggression, while only caregivers with recent DV reported more physical aggression or neglectful behaviors. CONCLUSIONS: In a national child welfare sample, self-reported aggressive and neglectful parenting behaviors were common. In this sample, domestic violence victimization is associated with more self-reported aggressive and neglectful disciplinary behaviors among female caregivers. The mechanism for these associations is not clear. PRACTICE IMPLICATIONS: Rates of aggressive and neglectful disciplinary practices are especially high among female parents/caregivers exposed to domestic violence. Child welfare agencies should plan routine and structured assessments for domestic violence among parents/caregivers and implement parenting interventions to reduce harmful disciplinary practices for those families identified.     

Youth victimization in Sweden: Prevalence,characteristics and relation to mental health and behavioral problems in young adulthood

The present study examines multiple types of victimization simultaneously, their prevalence and characteristics in childhood and adolescence, and it examines the associations between victimization and poly-victimization on the one hand and single and multiple mental health and behavioral problems on the other. The sample consisted of 2,500 Swedish young adults (20–24 years) who provided detailed report of multiple types of lifetime victimization and current health and behaviors via an interview and a questionnaire. Results showed that it was more common to be victimized in adolescence than in childhood and more common to be victimized repeatedly rather than a single time, among both males and females. Males and females were victimized in noticeably different ways and partially at different places and by different perpetrators. With regard to mental health and behavioral problems, anxiety, post-traumatic stress, self-harm, and criminality were clearly overrepresented among both males and females who had experienced any type of victimization. Poly-victimization was related to single and multiple mental health and behavioral problems among both males and females. We conclude that professionals need to conduct thorough evaluations of victimization when completing mental health assessments among troubled youths, and that youth might benefit from the development of interventions for poly-victimized youth.     

The relation between abuse and violent delinquency: the conversion of shame to blame in juvenile offenders

Objective

While the relationship between abusive parenting and violent delinquency has been well established, the cognitive and emotional processes by which this occurs remain relatively unidentified. The objective of this work is to apply a conceptual model linking abusive parenting to the conversion of shame into blaming others and therefore to violent delinquency.

Methods

A retrospective study of 112 adolescents (90 male; 22 female; ages 12-19 years; M = 15.6; SD = 1.4) who were incarcerated in a juvenile detention facility pending criminal charges, completed measures of exposure to abusive and nonabusive discipline, expressed and converted shame, and violent delinquency.

Results

Findings tend to confirm the conceptual model. Subjects who converted shame (i.e., low expressed shame, high blaming others) tended to have more exposure to abusive parenting and showed more violent delinquent behavior than their peers who showed expressed shame. Subjects who showed expressed shame (i.e., high expressed shame, low blaming others) showed less violent delinquency than those who showed converted shame.

Conclusions

Abusive parenting impacts delinquency directly and indirectly through the effects of shame that is converted. Abusive parenting leads to the conversion of shame to blaming others, which in turn leads to violent delinquent behavior.

Practice implications

For juvenile offenders, the conversion of shame into blaming others appears to contribute to pathological outcomes in relation to trauma. Translation of this work into clinical practice is recommended.     

Responding to abuse: Children's experiences of child protection in a central district,Uganda

Part of a comprehensive response to violence against children involves child protection systems, but there are few data available on such systems in low-income countries. This study describes the characteristics and help seeking behavior of children referred to local child protection services and the quality of the first-line response in one district in Uganda. Participants included 3,706 children from 42 primary schools who participated in a baseline survey on violence as part of the Good Schools Study (NCT01678846, clinicaltrial.gov). Children who disclosed violence were referred according to predefined criteria based on the type, severity, and timeframe of their experiences. Children were followed up to 4 months after the study ended. First-line responses by receiving agencies were classified into 3 categories: plan for action only, some action taken, and no plan and no action taken. Appropriateness of responses was based on which agency responded, timeliness of the response, quality of the documentation, and final status of the case. From the baseline survey, 529 children (14%) were referred. Girls were more likely to be referred and to meet the criteria for a serious case (9% girls, 4% boys). In total, 104 referrals (20%) had some kind of concrete action taken, but only 20 (3.8%) cases met all criteria for having received an adequate response. Nearly half (43%) of referred children had ever sought help by disclosing their experiences of violence prior to the baseline survey. In our study areas, the first-line response to children's reports of abuse was poor even though some referral structures are in place.