Childhood trauma,PTSD, and psychosis: Findings from a highly traumatized,minority sample

Trauma, especially early life trauma, is a risk factor for the development of both posttraumatic stress disorder and psychosis. The goal of the present study was to determine specific associations between exposure to childhood abuse, PTSD symptoms, and current psychotic disorder. Subjects were recruited from a public, urban hospital (N = 328, >90% African American). Psychotic disorders were measured using the MINI International Neuropsychiatric Interview, PTSD was measured using the Clinician Administered PTSD Scale, child abuse was measured with the Childhood Trauma Questionnaire, and lifetime trauma exposure was measured with the Traumatic Events Inventory. Logistic regression analyses showed that both child abuse and current PTSD were statistically significant predictors of psychotic disorder beyond the effects of lifetime trauma load. When PTSD symptom clusters were examined, avoidance and numbing symptoms showed unique association with psychotic disorder independent of demographic variables and trauma exposure. Using bootstrapping techniques, we found a full indirect effect of PTSD on the association between child abuse and, suggesting a particularly important role of PTSD symptoms in relation to psychotic disorder in the presence of early life trauma. Because this is a cross-sectional study, continued research is needed to determine causality of such models. Identifying co-occurring psychosis and PTSD, particularly in populations with high levels of trauma exposure, is critical and will likely aid in more successful treatment interventions.     

The association between perceived injunctive norms toward corporal punishment,parenting support,and risk for child physical abuse

The use of corporal punishment (CP) is a strong risk factor for many poor outcomes for children including child maltreatment. The use of CP occurs within social contexts which are important to understand. Although it is known that perceived social norms regarding CP are related to its use, the specific role that a mother’s primary support person plays in influencing attitudes toward and use of CP remains unknown. The current study assessed linkages between maternal perceived social support in parenting and perceived injunctive norms of CP from her primary source of support, with maternal attitudes toward and use of CP. Survey data were collected from female primary caregivers (N = 436) of children age 2 to 7 years (mean age = 3.7) enrolled in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in Southeastern Louisiana. Most frequently, the biological father of the child (37.9%) and the maternal grandmother of the child (24.2%) were identified as the participant’s primary source of social support in parenting. Perceived injunctive norms of this support person toward CP use were significantly and positively associated with attitudes toward, AOR = 5.97, 95% CI = [4.04, 8.82], and use of CP, AOR = 3.77, 95% CI = [2.55, 5.59]. However, perceived social support was not associated with these outcomes and also did not moderate these associations. Findings suggest that efforts to reduce maternal risk for child physical abuse and use of CP must include the mother’s primary source of social support if they are to be successful.     

Child maltreatment in the “Children of the Nineties:” deprivation, class, and social networks in a UK sample

Aim: To determine risk factors for child maltreatment within the socio-economic environment of a contemporary UK child population.Methods: The research is based on a large cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14,256 children participating in the study, 115 have been identified as having been placed on local child protection registers prior to their 6th birthday. Data on the socio-economic environment of the families have been obtained from a series of questionnaires administered during pregnancy and the first 3 years of life. Risk factors have been analyzed using logistic regression analysis.Results: Four indicators of deprivation all showed significant relationships with registration. Adjusted odds ratios were 2.33 for paternal unemployment; 7.65 for council housing; 2.16 for overcrowding; and 2.33 for car ownership. There was a strong relationship between the number of indicators of deprivation and the risk of maltreatment. In a second model, maternal unemployment, high mobility (> 3 house moves in the previous 5 years) and a poor social network were also significant with odds ratios of 2.82, 2.81, and 3.09, respectively.Conclusions: This study confirms the importance of social factors in the etiology of child maltreatment. Social deprivation is an important determinant of child maltreatment, and encompasses a number of different aspects, including financial security, housing situation and material benefits; in addition, the job situation of the parents and the stability and richness of their social networks all have a significant impact on risk of maltreatment. Interventions at both an individual and a community level are important to support families and reduce the risk of maltreatment.     

Mediating effects of parental psychological distress and individual-level social capital on the association between child poverty and maltreatment in Japan

Child poverty is well known as a major risk factor for child maltreatment. However, it is not known whether parental psychological distress and individual-level social capital mediate the association. We examined the mediation effect of these two factors on the association between child poverty and maltreatment. In the Adachi Child Health Impact of Living Difficulty (A-CHILD) Study, a questionnaire was administered to all caregivers of first-grade children in every public elementary school in Adachi City between July and November 2015, and valid responses were used for analysis (N = 3944). Logistic and Poisson regression analyses were employed to examine the association between child poverty and maltreatment. Child poverty was defined in this study as meeting one of these criteria: 1) household income less than 3 million yen; 2) deprivation of specific material items that children or the household requires, or 3) experience of being unable to pay for lifeline utilities. Child maltreatment (physical abuse, neglect, and psychological abuse) was answered by parents. We confirmed a robust association between child poverty and maltreatment. Mediation analysis indicated that parental psychological distress mediated more than 60% of the association between child poverty on physical abuse and psychological abuse, while individual-level social capital mediated only 10% of the association with any type of maltreatment. In addition, structural equation modeling analysis revealed that the association was mediated by both parental psychological distress and social capital simultaneously. The findings suggest that supporting parental psychological distress may be an effective intervention to remedy the negative impact of child poverty on maltreatment.     

The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis

BackgroundChild maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders.MethodsPublished cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment.ResultsAll forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14–2.87]; sexual abuse [OR = 2.11, 1.83–2.44]; physical abuse [OR = 1.78, 1.57–2.01]; emotional abuse [OR = 2.35, 1.74–3.18]; neglect [OR = 1.65, 1.35–2.02]; and exposure to IPV [OR = 1.68, 1.34–2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders (‘any child maltreatment’ [OR = 1.68, 1.33–2.4]; sexual abuse [OR = 1.90, 1.6–2.25]; physical abuse [OR = 1.56, 1.39–1.76]; and neglect [OR = 1.34, 1.09–1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD).ConclusionsThere is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.     

Childhood maltreatment and the persistence of smoking: A longitudinal study among adults in the US

The current study examined the relationship between childhood maltreatment—emotional, physical, and severe physical maltreatment—and the initiation and persistence of smoking. Data were drawn from the Midlife Development in the United States (MIDUS) Survey Waves 1 and 2. Frequency of childhood emotional, physical, and severe physical maltreatment (never, rare, intermittent, frequent) reported at Wave 1 was examined in relation to ever smoking, smoking daily, and persistent daily smoking at Waves 1 and 2. Logistic regression analyses were used to calculate odds ratios (with 95% confidence intervals), which were then adjusted for potential confounders. Childhood emotional, physical, and severe physical maltreatment were associated with increased odds of ever smoking, smoking daily, and persistent smoking at Waves 1 and 2. The majority of these associations remained significant after adjusting for confounding variables. These results suggest a history of trauma may play a prominent role in recalcitrant cigarette smoking and suggest that the success rates of treatments for smoking cessation may be improved by integrating trauma treatment where appropriate.     

Childhood emotional maltreatment and mental disorders: Results from a nationally representative adult sample from the United States

Child maltreatment is a public health concern with well-established sequelae. However, compared to research on physical and sexual abuse, far less is known about the long-term impact of emotional maltreatment on mental health. The overall purpose of this study was to examine the association of emotional abuse, emotional neglect, and both emotional abuse and neglect with other types of child maltreatment, a family history of dysfunction, and lifetime diagnoses of several Axis I and Axis II mental disorders. Data were from the National Epidemiological Survey on Alcohol and Related Conditions collected in 2004 and 2005 (n = 34,653). The most prevalent form of emotional maltreatment was emotional neglect only (6.2%), followed by emotional abuse only (4.8%), and then both emotional abuse and neglect (3.1%). All categories of emotional maltreatment were strongly related to other forms of child maltreatment (odds ratios [ORs] ranged from 2.1 to 68.0) and a history of family dysfunction (ORs ranged from 2.2 to 8.3). In models adjusting for sociodemographic characteristics, all categories of emotional maltreatment were associated with increased odds of almost every mental disorder assessed in this study (adjusted ORs ranged from 1.2 to 7.4). Many relationships remained significant independent of experiencing other forms of child maltreatment and a family history of dysfunction (adjusted ORs ranged from 1.2 to 3.0). The effects appeared to be greater for active (i.e., emotional abuse) relative to passive (i.e., emotional neglect) forms of emotional maltreatment. Childhood emotional maltreatment, particularly emotionally abusive acts, is associated with increased odds of lifetime diagnoses of several Axis I and Axis II mental disorders.     

Childhood Maltreatment and School Problems: A Danish National Study

The association between child maltreatment (CM) and educational outcomes have been well documented. However, there is a paucity of research that explores the association between different types of maltreatment and other school problems that may affect the educational outcomes of maltreated children. This study examined the association between different types of CM and school changes, concentration problems, and special educational needs. Gender differences were also examined. Structured interviews were conducted with 2,980 participants. Significant associations emerged between CM, in particular, multiple maltreatment experiences and school problems. Males had higher concentration difficulties and special educational needs. More research attention is needed into optimal learning environments and interventions that support maltreated children more effectively.     

The dark side of social support: Understanding the role of social support,drinking behaviors and alcohol outlets for child physical abuse

The purpose of this study is to examine how parental drinking behavior, drinking locations, alcohol outlet density, and types of social support (tangible, emotional, and social companionship) may place children at greater risk for physical abuse. Data on use of physical abuse, drinking behaviors, types of social support, social networks, and demographic information were collected via telephone interviews with 3,023 parent respondents in 50 cities in California. Data on alcohol outlet density were obtained by the California Department of Alcoholic Beverage Control. Multilevel Poisson models were used to analyze data for the drinking levels in the entire sample and dose-response drinking models for drinkers. Social companionship support was related to more frequent use of physical abuse. Having a higher percentage of social companionship support network living within the neighborhood was related to more frequent physical abuse in the full sample. This relationship was moderated by on-premise alcohol outlet density. With regards to drinking behaviors, drinking behaviors from ex-drinkers to frequent heavy drinkers used physically abusive parenting practices more often than lifetime abstainers. The dose-response models show that each additional drinking event at a bar or home/party was related to more frequent use of physical abuse. Practitioners working with parents who abuse their children should be aware that not all social support is beneficial. Findings build evidence that child maltreatment is influenced by the interaction between individual and ecological factors.     

Abusive head trauma: A perpetrator confesses

Objectives

To present a detailed confession from a perpetrator of Shaken Baby syndrome.

Methods

Case study.

Results

We present a confession of Shaken Baby syndrome describing how the perpetrator severely injured a 3 year old with repeated bursts of acceleration-deceleration (shaking). The child sustained retinal and intracranial hemorrhage. Details of the confession and circumstances by which it was obtained lead us to believe its accuracy.

Conclusions

Accurate perpetrator confessions offer useful windows into realities and pathophysiology of abusive head trauma.     

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.     

Child abuse potential inventory and parenting behavior: Relationships with high-risk correlates

The primary purpose of this research was to examine the construct validity of the Child Abuse Potential Inventory by comparing maltreating and high-risk parents' CAP Inventory abuse scores to their behavior during interactions with their children. A second purpose was to determine the degree to which CAP Inventory scores and parenting behavior were related to several known correlates of abuse, as measured by parent and teacher reports. Participants (n = 41) included abusive and high-risk parents and their children referred to a treatment group. Correlational analyses revealed that CAP Inventory scores and observed parenting style yielded highly related findings, supporting construct validity of the CAP Inventory. However, the CAP Inventory and observed behavior index showed a different pattern of relationships to the risk correlates. Implications for assessment of risk status are discussed and recommendations are provided for continued research.     

Child maltreatment severity and adult trauma symptoms: Does perceived social support play a buffering role?

Objectives

The current study investigates the moderating effect of perceived social support on associations between child maltreatment severity and adult trauma symptoms. We extend the existing literature by examining the roles of severity of multiple maltreatment types (i.e., sexual, physical, and emotional abuse; physical and emotional neglect) and gender in this process.

Methods

The sample included 372 newlywed individuals recruited from marriage license records. Participants completed a number of self-report questionnaires measuring the nature and severity of child maltreatment history, perceived social support from friends and family, and trauma-related symptoms. These questionnaires were part of a larger study, investigating marital and intrapersonal functioning. We conducted separate, two-step hierarchical multiple regression models for perceived social support from family and perceived social support from friends. In each of these models, total trauma symptomatology was predicted from each child maltreatment severity variable, perceived social support, and the product of the two variables. In order to examine the role of gender, we conducted separate analyses for women and men.

Results

As hypothesized, increased severity of several maltreatment types (sexual abuse, emotional abuse, emotional neglect, and physical neglect) predicted greater trauma symptoms for both women and men, and increased physical abuse severity predicted greater trauma symptoms for women. Perceived social support from both family and friends predicted lower trauma symptoms across all levels of maltreatment for men. For women, greater perceived social support from friends, but not from family, predicted decreased trauma symptoms. Finally, among women, perceived social support from family interacted with child maltreatment such that, as the severity of maltreatment (physical and emotional abuse, emotional neglect) increased, the buffering effect of perceived social support from family on trauma symptoms diminished.

Conclusions

The results of the current study shed new light on the potential for social support to shield individuals against long-term trauma symptoms, and suggest the importance of strengthening perceptions of available social support when working with adult survivors of child maltreatment.     

Fatal child abuse in Georgia: the epidemiology of severe physical child abuse

Decisions about the occurrence of child abuse are increasingly difficult to make because concepts of what qualifies as reportable child abuse may be broadening. We examined this question by comparing 51 fatal child abuse cases occurring in Georgia between July 1975 and December 1979 to non-fatal cases and to the Georgia population. Overall rates of fatal child abuse were higher for male perpetrators compared with female and black perpetrators compared with white. However, the latter finding varied with economic and geographic status. The highest child abuse fatality rates were found in poor, rural, white families (3.3/100,000 children) and in poor, urban, black families (2.4/100,000 children). Risk factors for fatal abuse included early childhood (RR 6:1), parental teenage childbearing (RR 4:1), and low socioeconomic status. These characteristics were similar to those of the severe child abuse cases noted in the early child abuse literature. Non-fatal cases did not clearly share these risk factors. Severe abuse, here represented by fatal cases, is a distinct subset of reported child abuse, but characteristics associated with it are frequently attributed to all reportable child abuse. Medical personnel should be aware that they cannot rely on the presence or absence of these characteristics in screening for risk of reportable child abuse. Child abuse research should use restricted, stated case definitions. When intervention and prevention programs are being organized, they should not generalize research findings to all forms of child abuse.     

Childhood sexual abuse,mental health,and religion across the Jewish community

Current estimates of childhood sexual abuse among Jews in the United States are only available for females and do not include a spectrum of religiosity. We examined sexual abuse, mental health, and religion, in a religiously diverse sample of male and female Jewish adults from North America, using a novel methodology to minimize sampling/response biases. A total of 372 diversely religious Jews participated. Prevalence of any form of childhood sexual abuse was statistically equivalent to national rates, except that females reported less involuntary penetration (OR = 0.53). All Jewish religious groups reported equivalent levels of sexual abuse, except that history of involuntary penetration was greater among formerly (but not presently) Orthodox Jews (OR = 3.00). Across our sample, sexual abuse was associated with increased likelihood of psychiatric diagnosis (OR = 1.34), greater mental distress (F ranging from 2.99 to 9.08, p < .05 for all analyses), lower religious observance (F = 4.53, p = .03), and lower intrinsic religiosity (F = 4.85, p = .03). Further, across our sample we observed a moderate buffering effect of spiritual/religious factors against mental distress (ΔR² values ranging from 0.028 to 0.045, p <.01 for all analyses). Thus, we found childhood sexual abuse to occur across the spectrum of Jewish religious affiliation and greater prevalence among formerly Orthodox individuals. Furthermore, history of childhood sexual abuse was associated with greater risk for psychiatric distress and less religious involvement, however spiritual/religious engagement and belief appeared to facilitate resilience in the context of abuse.     

Childhood sexual abuse: Long-term effects on psychological and sexual functioning in a nonclinical and nonstudent sample of adult women

The purpose of this study was to explore how the experience of childhood sexual abuse is related to long-term psychological and sexual functioning in a nonclinical and nonstudent community sample of women. Questionnaires were distributed to 1,500 nurses and returned anonymously. Fifty-four women who had been sexually abused as children (age 15 or younger) responded. These subjects were then matched with 54 nonabused control subjects. Although there was no difference on a measure of self-esteem, the abused group reported more symptoms of distress on the Global Severity Index and on seven out of nine subscales of the Derogatis Brief Symptom Inventory. They also reported more disturbance on a scale which examined psychological symptoms that have been commonly reported in the literature to be particularly associated with sexual abuse. These differences between the abused and nonabused groups were evident even after controlling for differences in subjects' perceptions of parental emotional support. Unlike the results for psychological adjustment, however, the abused subjects did not differ from the control subjects on self-reported levels of sexual satisfaction or sexual dysfunction.     

Childhood maltreatment experiences and problematic sexual outcomes in adult males who have sexually offended: Further evidence of the potency of male caregiver psychological abuse

BackgroundAlthough research on the developmental antecedents of sexual offending has tended to focus on sexual abuse, recent research in juveniles and adults who have sexually offended suggests that psychological abuse perpetrated by a male caregiver may be a particularly important factor in the development of problematic sexual interests and behaviors.ObjectiveThis study aimed to extend previous findings by investigating the association between psychological abuse by a male caregiver and problematic sexual outcomes in a sample of adult males who had sexually offended.ParticipantsParticipants were 529 adult males incarcerated for sexual offenses, 21% of whom were civilly committed.MethodsChildhood maltreatment and problematic sexual outcomes were assessed using the Multidimensional Assessment of Sex and Aggression, a contingency-based inventory that assesses domains related to sexual aggression. Hierarchical regressions were calculated examining the association between childhood abuse types and sexual outcomes.ResultsChildhood sexual abuse was associated with child sexual (β = .247, p < .001) and other paraphilic interests (β = .189, p < .001). Male caregiver psychological abuse also emerged as marginally associated with child sexual interest (β = .100, p = .059), even after controlling for other abuse types.ConclusionsThese results partially replicate recent findings in a juvenile sample and challenge conventional developmental theories of sexual offending, by suggesting that male caregiver psychological abuse may play a role in the etiology of child sexual interest among males who have sexually offended. This study also suggests a possible gender symmetry effect moderating the developmental consequences of abuse.     

Risk factors for child neglect: A meta-analytic review

Knowledge of risk factors and their effects is vital for successfully preventing and reducing child neglect. This study provides a meta-analytic update of research on risk factors for child neglect. A total of 315 effect sizes were extracted from 36 primary studies and classified into 24 risk domains. Effects of 15 risk domains were significant and ranged from small (r = .110) to large (r = .372) in magnitude. Most risks were found at the parental level, such as having a history of antisocial behavior/criminal offending (r = .372); having a history of mental/psychiatric problems (r = . 259); having mental/physical problems (r = .207); and experiences of abuse in own childhood (r = .182). The effect of mother-related risk factors was not significantly different from the effect of father-related risk factors. It is concluded that child neglect is determined by multiple risk domains and that especially parent-related risk factors are important in preventing and reducing child neglect. Implications of the results for clinical practice are discussed.     

Attachment insecurity mediates the relationship between childhood trauma and eating disorder psychopathology in a clinical sample: A structural equation model

Objectives

Childhood maltreatment occurs often among those with an eating disorder and is considered a nonspecific risk factor. However, the mechanisms by which childhood maltreatment may lead to an eating disorder are not well understood. The current study tests a model in which attachment insecurity is hypothesized to mediate the relationship between childhood maltreatment and eating disorder psychopathology.

Method

Treatment seeking adults with eating disorders (N = 308) completed questionnaires about childhood maltreatment, eating disorder psychopathology, and adult attachment.

Results

Structural equation models indicated that childhood trauma had a direct effect on eating disorder symptoms. Also, attachment anxiety and avoidance each equally mediated the childhood maltreatment to eating disorder psychopathology relationship.

Conclusions

Attachment insecurity, characterized by affect dysregulation and interpersonal sensitivities may help to explain why eating disorder symptoms may be one consequence of childhood maltreatment in a clinical sample. Clinicians treating primarily those with trauma might assess for disordered eating as a potential manifestation of the sequelae of trauma and attachment insecurity.     

Childhood history of abuse and child abuse potential: The role of parent's gender and timing of childhood abuse

It has been suggested that being physically abused leads to someone becoming a perpetrator of abuse which could be associated to parents’ gender, timing of the physical abuse and specific socio-demographic variables. This study aims to investigate the role the parents’ gender, timing of childhood abuse and socio-demographic variables on the relationship between parents’ history of childhood physical abuse and current risk for children. The sample consisted of 920 parents (414 fathers, 506 mothers) from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect who completed the Childhood History Questionnaire and the Child Abuse Potential Inventory. The results showed that fathers had lower current potential risk of becoming physical abuse perpetrators with their children than mothers although they did not differed in their physical victimization history. Moreover, the risk was higher in parents (both genders) with continuous history of victimization than in parents without victimization. Prediction models showed that for fathers and mothers separately similar socio-demographic variables (family income, number of children at home, employment status and marital status) predicted the potential risk of becoming physical abuses perpetrators. Nevertheless, the timing of victimization was different for fathers (before 13 years old) and mothers (after 13 years old). Then our study targets specific variables (timing of physical abuse, parents’ gender and specific socio-demographic variables), which may enable professionals to select groups of parents at greater need of participating in abuse prevention programs.