Effects of childhood multiple maltreatment experiences on depression of socioeconomic disadvantaged elderly in Brazil

Childhood maltreatment is a risk factor for depression in nonelderly individuals. We investigated the effect of childhood abuse and neglect on the development of geriatric depression and its severity in socioeconomically disadvantaged individuals. A cross-sectional study investigated 449 individuals aged 60–103 years sorted by data using the enrollment list health coverage from the city of Porto Alegre, Brazil. The fifteen-item Geriatric Depression Scale was used to assess depression. The Childhood Trauma Questionnaire was used to identify emotional and physical neglect, in addition to emotional, physical, and sexual abuse. Geriatric depression was associated with emotional and physical abuse and neglect. Emotional abuse and neglect, as well as physical abuse, increased the odds of an individual developing severe depression. Correlations were observed for combined forms of maltreatment, with two to five maltreatment types producing mild to moderate symptoms. Similar trends were observed for severe symptoms in a limited number of cases. The cross-sectional design limit causal inference. Retrospective measurement of childhood maltreatment may increase recall and response bias. Late-life depression and its severity significantly correlated with the extent of childhood emotional and physical abuse and neglect. Thus, research should focus on supporting trauma survivors late in life, particularly when they come from low or middle income countries because these patients have higher rates of depression in elderly populations.     

From childhood emotional maltreatment to depressive symptoms in adulthood: The roles of self-compassion and shame

BackgroundEmotional abuse is a form of maltreatment that most strongly predicts adult depressive symptoms in community samples. Introject theories suggest that some depressive symptoms stem from survivors having learned to treat themselves the way they were treated by their perpetrators.ObjectiveMalevolent introjects may undermine self-compassion, which may subsequently maintain feelings of shame. Thus, we hypothesized that self-compassion and shame would mediate the path from retrospective reports of maltreatment to concurrent depressive symptoms in adulthood.Participants and SettingParticipants were 244 adult community members and college students living in a Southwestern American metroplex.MethodWe ran a multiple mediator path model with emotional abuse as the independent variable. We specified four covariates: physical abuse, sexual abuse, physical neglect, and emotional neglect, and held constant the variance they explained in self-compassion, shame, and depression.ResultsOur final model accounted for 53.1% of the variance in adult depressive symptoms. A significant indirect effect from emotional abuse passed through both mediators and ended in adult depressive symptoms. We also found an indirect path from emotional neglect to depression passing through both mediators.ConclusionsIt appears emotional abuse and emotional neglect can undermine the formation of self-compassion. Low self-compassion predicts greater shame and depressive symptoms. Our model suggests self-compassion may be a particularly effective intervention point for survivors of emotional maltreatment.     

Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice

OBJECTIVE: There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. METHOD: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. RESULTS: A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. CONCLUSIONS: Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure.     

Elder Abuse in Japan

ABSTRACT

Perceptions of elder abuse were examined in Japanese women (n = 100) and men (n = 46). Japanese women and men both emphasized physical aggression, followed by neglect and blaming, when giving examples of extremely abusive behavior. Physical aggression was also the most frequently mentioned type of moderate elder abuse, followed by neglect, economic maltreatment, emotional abuse, verbal abuse, blame, and psychological abuse. Japanese women provided significantly more psychological neglect responses than verbal aggression responses when giving examples of mild abuse. Paired samples t tests revealed that physical abuse responses were given significantly more often as examples of extreme abuse than of moderate or mild abuse. Findings have implications for addressing the conflict between changing family relationships and traditional cultural values—such as filial piety—in Japanese society.     

Childhood victimization and lifetime revictimization

OBJECTIVE: To examine the fundamental hypothesis that childhood victimization leads to increased vulnerability for subsequent (re)victimization in adolescence and adulthood and, if so, whether there are differences in rates of experiencing traumas and victimizations by gender, race/ethnicity, and type of childhood abuse and/or neglect. METHODS: Using a prospective cohort design, participants are individuals with documented cases of childhood physical and sexual abuse and neglect from the years 1967 through 1971 and a matched control group. Both groups were interviewed in-person (mean age 39.5 years) in 2000-2002 using a new instrument to assess lifetime trauma and victimization history. RESULTS: Abused and neglected individuals reported a higher number of traumas and victimization experiences than controls and all types of childhood victimization (physical abuse, sexual abuse, and neglect) were associated with increased risk for lifetime revictimization. Significant group (abuse/neglect vs. control) by gender and group by race/ethnicity interactions were found. Childhood victimization increased risk for physical and sexual assault/abuse, kidnapping/stalking, and having a family friend murdered or commit suicide, but not for general traumas, witnessing trauma, or crime victimization. CONCLUSIONS: These findings provide strong support for the need for early intervention with abused and neglected children and their families to prevent subsequent exposure to traumas and victimization experiences.     

Post-traumatic stress and related symptoms among juvenile detention residents: Results from intake screening

BackgroundJuvenile justice-involved youth have high rates of trauma exposure, physical and sexual abuse and PTSD. Several factors have been found to be related to PTSD symptoms in youth including number and chronicity of traumatic events.ObjectiveTo simultaneously examine the relationships between allostatic load (defined here as number of traumatic experiences), poly-victimization (exposure to two or more forms of victimization based on 5 of the 6 categories in Ford et al.’s 2010 study), physical/sexual abuse and PTSD in justice-involved youth.Participants and SettingThe sample consisted of 1984 youth in juvenile detention in a Northeastern city. The sample was 73.4% male and the majority of youth were either African American or Hispanic.MethodsClinicians collected demographic and psychosocial information, and measured symptoms of PTSD, depression, and problematic substance use.ResultsResults showed that youth with more traumas, those who experienced poly-victimization and those who experienced physical/sexual assault/abuse were not only more likely to have PTSD, but also more likely to have depression, thoughts of suicide/self-harm, and problematic substance use (as indicated by the presence of 2 or more of 6 possible indicators). Poly-victimization was a stronger correlate of PTSD than number of traumas or physical/sexual assault/abuse. However, among youth with PTSD, number of traumas was associated with co-occurring problems while poly-victimization and physical/sexual assault/abuse were not.ConclusionsFindings can be used to help direct resources to juvenile justice-involved youth who are most in need of treatment.     

Using neuropsychological profiles to classify neglected children with or without physical abuse

OBJECTIVE: The aim of this study is twofold: First, to investigate whether cognitive functions can contribute to differentiating neglected children with or without physical abuse compared to comparison participants; second, to demonstrate the detrimental impact of children being victimized by a combination of different types of maltreatment. METHODOLOGY: Seventy-nine children aged 6-12 years and currently receiving Child Protection Services because of one of two types of maltreatment (neglect with physical abuse, n=56; neglect without physical abuse, n=28) were compared with a control group of 53 children matched for age, gender, and annual family income. The neuropsychological assessment focused on motor performance, attention, memory and learning, visual-motor integration, language, frontal/executive functions, and intelligence. RESULTS: Discriminant analysis identified auditory attention and response set, and visual-motor integration (Function 1), and problem solving, abstraction, and planning (Function 2) as the two sets of variables that most distinguished the groups. Discriminant analysis predicted group membership in 80% of the cases. Children who were neglected with physical abuse showed cognitive deficits in auditory attention and response set, and visual-motor integration (Function 1) and problem solving, abstraction, and planning (Function 2). Children who were neglected without physical abuse differed from the control group in that they obtained lower scores in auditory attention and response set, and visual-motor integration (Function 1). Surprisingly, these same children demonstrated a greater capacity for problem solving, abstraction, and planning (Function 2) than the physically abused neglected and control children. CONCLUSION: The present study underscores the relevance of neuropsychology to maltreatment research. The results support the heterogeneity of cognitive deficits in children based on different types of maltreatment and the fact that neglect with physical abuse is more harmful than neglect alone.     

The role of depression and dissociation in the relationship between childhood trauma and bulimic symptoms among ethnically diverse female undergraduates

OBJECTIVE: The goals of this study were to examine the role of dissociation and depression as possible mediators of the relationship between several forms of childhood trauma and bulimic symptomatology and to explore potential ethnic differences in these relationships. METHOD: Four hundred seventeen female undergraduates participated in this cross-sectional study. They completed measures of dissociative, depressive, and bulimic symptoms, and childhood trauma. Experiences of multiple forms of childhood trauma were measured, including physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. However, only emotional abuse was correlated with bulimic symptoms at p<.01. Therefore, other forms of trauma were excluded from the analyses to control for Type I error. RESULTS: Dissociation was not associated with emotional abuse after controlling for depression; therefore, tests of dissociation as a mediator were discontinued. Depression was significantly associated with emotional abuse after controlling for dissociation. Emotional abuse was significantly associated with bulimia. Finally, emotional abuse and depression together were significantly associated with bulimia after controlling for dissociation. However, emotional abuse became nonsignificant when entered with depression, indicating that depression mediated the relationship between emotional abuse and bulimic symptoms. There were no ethnic differences in this relationship. CONCLUSIONS: It appears that among women who have experienced childhood emotional abuse, depression is more strongly associated with unhealthy eating behaviors than is dissociation. Results also suggest that emotional abuse is a form of childhood trauma particularly relevant to bulimia.     

Long-term effects of child abuse and neglect on emotion processing in adulthood

To determine whether child maltreatment has a long-term impact on emotion processing abilities in adulthood and whether IQ, psychopathology, or psychopathy mediate the relationship between childhood maltreatment and emotion processing in adulthood. Using a prospective cohort design, children (ages 0–11) with documented cases of abuse and neglect during 1967–1971 were matched with non-maltreated children and followed up into adulthood. Potential mediators (IQ, Post-Traumatic Stress [PTSD], Generalized Anxiety [GAD], Dysthymia, and Major Depressive [MDD] Disorders, and psychopathy) were assessed in young adulthood with standardized assessment techniques. In middle adulthood (M_age = 47), the International Affective Picture System was used to measure emotion processing. Structural equation modeling was used to test mediation models. Individuals with a history of childhood maltreatment were less accurate in emotion processing overall and in processing positive and neutral pictures than matched controls. Childhood physical abuse predicted less accuracy in neutral pictures and childhood sexual abuse and neglect predicted less accuracy in recognizing positive pictures. MDD, GAD, and IQ predicted overall picture recognition accuracy. However, of the mediators examined, only IQ acted to mediate the relationship between child maltreatment and emotion processing deficits. Although research has focused on emotion processing in maltreated children, these new findings show an impact child abuse and neglect on emotion processing in middle adulthood. Research and interventions aimed at improving emotional processing deficiencies in abused and neglected children should consider the role of IQ.     

Associations between maternal childhood maltreatment and psychopathology and aggression during pregnancy and postpartum

OBJECTIVE: This study examines the association between maternal childhood maltreatment and psychopathology and aggression in intimate relationships during pregnancy and the postpartum period. METHOD: Forty-four pregnant women who were recruited from an obstetric clinic and local advertising periodical completed questionnaires about childhood maltreatment and psychopathology during their first trimester of pregnancy. Approximately 1 year after the birth of the child, 32 of the original participants completed these same questionnaires. Regression models were used to test the relationship between childhood maltreatment and psychopathology and aggression during pregnancy and 1 year postpartum. RESULTS: Sexual abuse and emotional neglect were related to psychopathology during pregnancy, and emotional neglect and physical abuse and neglect predicted poorer maternal outcomes 1 year postpartum. Contrary to expectations, physical abuse was related to less aggression during pregnancy, and emotional abuse was associated with less pathology postpartum. CONCLUSIONS: The results of this study indicate that childhood maltreatment is associated with poorer maternal mental health during pregnancy and 1 year postpartum and points to the need to improve targeting and treatment of psychopathology during this time.     

Verbal abuse during pregnancy increases frequency of newborn hearing screening referral: The Japan Environment and Children’s Study

BackgroundVerbal abuse during pregnancy has a greater impact than physical and sexual violence on the incidence of postnatal depression and maternal abuse behavior towards their children. In addition, exposure of children (aged 12 months to adolescence) to verbal abuse from their parents exerts an adverse impact to the children’s auditory function. However, the effect of verbal abuse during pregnancy on fetal auditory function has not yet been thoroughly investigated.ObjectiveThe objective of the study was to examine the relationship between intimate partner verbal abuse during pregnancy and newborn hearing screening (NHS) referral, which indicates immature or impaired auditory function.Participants and settingThe Japan Environment and Children’s Study is an ongoing nationwide population-based birth-cohort study designed to determine environmental factors during and after pregnancy that affect the development, health, or wellbeing of children. Pregnant women living in 15 areas of Japan were recruited between January 2011 and March 2014.MethodsMultiple imputation for missing data was performed, followed by multiple logistic regression using 16 confounding variables.ResultsOf 104,102 records in the dataset, 79,985 mother–infant pairs submitted complete data for questions related to verbal and physical abuse and the results of NHS. Of 79,985 pregnant women, 10,786 (13.5%) experienced verbal abuse and 978 (1.2%) experienced physical abuse. Of 79,985 newborns, 787 (0.98%) received a NHS referral. Verbal abuse was significantly associated with NHS referral (adjusted odds ratio: 1.44; 95% confidence interval: 1.05–1.98).ConclusionsVerbal abuse should be avoided during pregnancy to preserve the newborn’s auditory function.     

Maternal history of child maltreatment and maternal depression risk in the perinatal period: A longitudinal study

Existing research is limited, with only a few studies considering each single type and multiple types of child maltreatment (CM) as well as multiple assessments of maternal depression throughout the perinatal period. The purpose of the study was to assess each type and accumulative types of CM in relation to the risk of maternal depression throughout the perinatal period. In total, 276 pregnant women were recruited from the prenatal clinic at a general hospital in China. Maternal CM history and depression risk were assessed at late pregnancy, postpartum week 1, and postpartum week 4 using the Childhood Trauma Questionnaire (CTQ) and Edinburgh Postnatal Depression Scale (EPDS). The GEE showed that physical and emotional neglect and multiple types of CM were associated with higher overall depression risk across the perinatal period. The multinomial regression models showed physical neglect and multiple types of CM predicted higher risk of both antepartum and postpartum depression. Emotional and sexual abuse and emotional neglect predicted antepartum depression risk, while none of the three types of CM predicted postpartum depression risk. Physical abuse did not predict antepartum and postpartum depression risk. The findings suggest that maternal history of child physical and emotional neglect play significant roles in perinatal depression risk with physical neglect as the most important predictor. Routine screening for maternal CM history and depression risk in prenatal clinics is needed to aid in the early detection and treatment of depression.     

The relation of emotional maltreatment to early adolescent competence: Developmental processes in a prospective study

ObjectivesThis investigation examined developmental pathways between childhood emotional maltreatment and adaptational outcomes in early adolescence. This study utilized a developmental psychopathology perspective in adopting a multidimensional approach to the assessment of different forms of emotional maltreatment and later adjustment outcomes. Specifically, emotional abuse (i.e., verbal criticism, hostility) and emotional neglect (i.e., psychological unavailability) were compared using a process-level analytic approach to examine if and how different forms of emotional maltreatment would contribute to adolescent adjustment via aggression and social withdrawal in middle childhood.MethodsThe current study sample is drawn from a longitudinal, prospective study of a high-risk community sample (N = 196), incorporating a multi-method and multi-informant design. Multiple mediator models were tested via bootstrapping regression techniques.ResultsBivariate correlations revealed that both emotional neglect and emotional abuse were associated with increased aggression and social withdrawal in middle childhood, and lower ratings of socioemotional competence in early adolescence. However, the mediational model, which controlled for child gender and concurrent physical and sexual maltreatment, was only significant for the contribution of emotional abuse to lower adolescent competence via social withdrawal in middle childhood. Post hoc analyses revealed that this association was only significant for boys.ConclusionsWhile social withdrawal in middle childhood significantly explained the observed relation between emotional abuse and decreased competence in adolescence, this process did not emerge as salient in understanding the relation between emotional neglect and adolescent adaptation. Furthermore, these developmental processes appeared to vary by gender. The results are in need of replication and extension to other outcome domains, but represent an important contribution to the empirical study of specific forms of emotional maltreatment.Practice implicationsEmotional maltreatment is generally overlooked and unrecognized as compared to physical or sexual forms of maltreatment. This study adds to the accumulating empirical evidence that the effects of emotional maltreatment are disabling, enduring, and should be carefully assessed by clinicians. Furthermore, this assessment should specify the particular form of emotional maltreatment that has occurred, as the results of the study indicate that developmental processes and adjustment outcomes may vary according the type of emotional maltreatment (i.e., emotional abuse, emotional neglect) that is experienced. Finally, clinicians must recognize that a single maltreatment type may vary in its impact on subsequent adjustment, as significant gender differences emerged in the current study that point to the role of individual differences that warrant further investigation.     

Sexual, physical, verbal/emotional abuse and unexplained chest pain

Objectives

Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained chest pain, and to identify whether any potential relationship is being driven by an association with psychological distress.

Methods

Subjects were identified from 2 previous random population surveys that included people with irritable bowel syndrome (IBS) and/or functional dyspepsia (FD) and healthy controls. People in the unexplained chest pain group (n = 27) had chest pain in the past 12 months that was not heartburn or heart disease. People in the comparison group (n = 60) did not have chest pain for more than 12 months. Self-reported abuse and psychological variables were assessed using validated measures.

Results

Emotional/verbal abuse (20.8% versus 4.4%, P = 0.032) and physical abuse (16.7% versus 2.2%, P = 0.028) were significantly more common in people with unexplained chest pain versus the comparison group. Only a history of emotional/verbal abuse was a significant independent predictor of meeting criteria for unexplained chest pain (OR = 5.66; 95%CI 1.01–31.80, P = 0.049) even after controlling for IBS and/or FD (OR = 5.45; 95%CI 0.96–30.83, P = .05), but not when depression was controlled for (OR = 4.70; 95%CI 0.90–27.61), P = 0.08.

Conclusions

A history of childhood emotional/verbal abuse is a risk factor for having unexplained chest pain but the association may be moderated by psychological distress, specifically depression.     

Trends in child maltreatment in the US Army, 1975-1997.

OBJECTIVE: To examine trends by year in reports of victims of child maltreatment in the US Army Central Registry (ACR) during the period 1975-97. We report the rates/1,000 children of Army families of initial substantiated cases from 1988-97 and the number of cases of maltreatment as a percentage of total victims for each year from 1975-97. Army data are compared to published reports from military service child abuse registries. METHODS: Numbers of cases of child maltreatment for each year were obtained from the ACR for major, minor, and total physical abuse, sexual abuse, emotional abuse, and neglect. Population figures for numbers of children were obtained from the Defense Manpower Data Center. RESULTS: The rates/1,000 for neglect have decreased by 24% from 1991-97, although the decrease has not been steady. The rates/1,000 of minor physical abuse declined 28% from 1993-97. The rates/1,000 of major physical abuse were basically unchanged from 1988-96, although the highest rate was recorded in 1997. The rates/1,000 of sexual abuse were also basically unchanged with the exception of increases in 1992-94 after which time the rates/1,000 returned to the pre-1992 levels. The rates/1,000 of emotional abuse cases more than doubled from 1988-97. CONCLUSIONS: While minor physical abuse and neglect have shown decreases over the past decade, major physical abuse has remained virtually unchanged and sexual and emotional abuse have shown fluctuations. All these forms of maltreatment are challenges to the Army Family Advocacy Program.     

Childhood abuse and community violence: Risk factors for youth violence

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

The impact of individual forms of childhood maltreatment on health behavior

OBJECTIVE: This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. METHOD: Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. RESULTS: Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. IMPLICATIONS: The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes.     

The association of child abuse and neglect with adult disability in schizophrenia and the prominent role of physical neglect

ObjectiveTo assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia.MethodNinety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by the Childhood Trauma Questionnaire (CTQ) and for functional impairment by the World Health Organization Disability Assessment Schedule (WHO/DAS). The schizophrenia diagnosis was assessed by ICD-10 and DSM-IV criteria according to the Operational Criteria Checklist for Psychotic Illness (OPCRIT).ResultsChildhood trauma in general was associated with increased disability in adulthood, reflected by impaired Overall Behavior (p = .023) and Global Evaluation (p = .032). Analysis of specific traumatic domains revealed that increased childhood physical neglect was associated with functional impairment in Overall Behavior (p < .000), Social Role Performance (p = .037) and Global Evaluation (p = .014). Higher emotional abuse was associated with impaired Overall Behavior (p = .026), and higher emotional neglect with poor Global Evaluation (p = .047). Additionally, earlier onset of illness was associated with lower level of functioning evidenced by impairment in Overall Behavior (p = .042). Linear regression using WHO/DAS sections (Overall Behavior, Social Role Performance and Global Evaluation) as dependent variables and CTQ subscales indicated that only physical neglect had an effect on adult functionality.ConclusionsChildhood trauma was associated with functional and social impairment in adult patients with schizophrenia. Specific types of abuse and neglect, such as physical neglect and emotional abuse and neglect, influenced disability, and the most robust association was physical neglect. Studies involving more patients, with normal controls and additional measurements of biological liability, should be conducted to confirm this association and to increase the understanding of gene-environment relationship in schizophrenia and pathways to disability.Practice implicationsFurther investigation is warranted to clarify the association between childhood trauma and disability in schizophrenia, as well as to develop standardized instruments for the assessment of trauma and earlier detection of risk along with education of patients and families about adequate care, in an effort to reduce the incidence of disability in schizophrenia.     

The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: A latent class analysis

Children investigated for maltreatment are particularly vulnerable to experiencing multiple adversities. Few studies have examined the extent to which experiences of adversity and different types of maltreatment co-occur in this most vulnerable population of children. Understanding the complex nature of childhood adversity may inform the enhanced tailoring of practices to better meet the needs of maltreated children. Using cross-sectional data from the National Survey of Child and Adolescent Well-Being II (N = 5870), this study employed latent class analysis to identify subgroups of children who had experienced multiple forms of maltreatment and associated adversities among four developmental stages: birth to 23 months (infants), 2–5 (preschool age), 6–10 (school age), and 11–18 years-old (adolescents). Three latent classes were identified for infants, preschool-aged children, and adolescents, and four latent classes were identified for school-aged children. Among infants, the groups were characterized by experiences of (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) caregiver divorce. For preschool-aged children, the groups included (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) emotional abuse. Children in the school-age group clustered based on experiencing (1) physical neglect/emotional neglect and abuse/caregiver treated violently, (2) physical neglect/household dysfunction, (3) emotional abuse, and (4) emotional abuse/caregiver divorce. Finally, adolescents were grouped based on (1) physical neglect/emotional abuse/household dysfunction, (2) physical abuse/emotional abuse/household dysfunction, and (3) emotional abuse/caregiver divorce. The results indicate distinct classes of adversity experienced among children investigated for child maltreatment, with both stability across developmental periods and unique age-related vulnerabilities. Implications for practice and future research are discussed.     

Survivors of institutional abuse in long-term child care in Scotland

BackgroundThe Scottish Child Abuse Inquiry (SCAI) commissioned the research project to document the outcomes of institutional abuse in long-term child care in Scotland.ObjectiveTo profile the experiences of survivors abused in long-term child care in Scotland, and to develop a model which linked maltreatment, risk and protective factors, and outcomes.Participants and Setting225 survivors of historical institutional abuse in Scotland, who made witness statements to SCAI.MethodsData were extracted from witness statements using a coding frame developed through a thematic analysis of a subsample of 52 statements.ResultsSurvivors had been in care in predominantly Catholic and non-religious residential institutions in Scotland for an average of 8 years, having entered at an average age of 6.8 years. They had suffered multiple forms of maltreatment. Maltreatment rates were: physical abuse, 95.6%; emotional abuse, 85.3%; sexual abuse, 60.4%; emotional neglect, 51.1%; and physical neglect, 37.3%. Across the lifespan survivors had negative outcomes in psychosocial adjustment (96%), mental health (84%), and physical health (43%). The effect of maltreatment in care on psychosocial problems was mediated by both risk and protective factors; and on mental health was mediated by risk factors, but not protective factors. Maltreatment in care had a direct effect on physical health which was not mediated by risk or protective factors. The effects of the cumulative number of risk factors on adverse mental health and psychosocial outcomes was greater than that of maltreatment, and protective factors had a limited impact on adverse outcomes.ConclusionsEvidence-based child protection policies and practices should be implemented to prevent institutional abuse and treat child abuse survivors in Scotland.