Relationship and community factors related to better mental health following child maltreatment among adolescents

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative samples and focuses on individual-level factors. To address these gaps, the present study examined the association between relationship- and community-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. Data were drawn from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,148; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. Having supportive parent and family relationships were significantly associated with good mental health (AOR ranging from 2.1 to 7.1). Positive community and school experiences were also significantly associated with good mental health (AOR ranging from 2.0 to 9.8). In most models, support from friends and siblings was not related to better mental health. Factors to be tested for efficacy in interventions targeted to adolescents with a history of child maltreatment include encouraging supportive parent and family relationships, and fostering positive community and school experiences.     

Individual-level factors related to better mental health outcomes following child maltreatment among adolescents

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample.The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,123; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above.     

Effects of academic performance on the relationship between child maltreatment and deviant behavior: A national study in Taiwan

BackgroundChild maltreatment has been found to significantly increase the risk of deviant behavior. Academic performance has been shown to have an indirect effect on the relationship between child maltreatment and deviant behavior. However, not all adolescents who have been maltreated engage in deviant behavior, so the relationship between child maltreatment and deviant behavior has remained unclear.ObjectiveThe aim of this research was to examine the potential mediating and/or moderating effects of academic performance on the relationship between child maltreatment and deviant behavior.Participants and settingThe data in this study were from a nationwide study examining the consequences of childhood maltreatment in Taiwan. The database consisted of data from 2321 adolescents.MethodsA secondary data analysis was conducted. Self-report data were obtained on childhood maltreatment experiences, academic performance, and deviant behaviors. Path analyses and a generalized linear model were used to examine the effects of academic performance on the relationship between child maltreatment and deviant behavior.ResultsMost participants were male (61.4%), with a mean age of 15.9 years. The mean scores of self-rated academic performance and deviant behavior were 2.86 and 8.2, respectively. A total of 83% participants reported having experienced childhood maltreatment. In this study, academic performance was found to have a moderating rather than a mediating effect on the relationship between child maltreatment and deviant behavior. Among adolescents who had been maltreated during childhood, those who self-rated poorer academic performance were more likely to have a higher deviant behavior score than those who self-rated better academic performance.ConclusionsGood academic performance can be a buffer that reduces the risk of deviant behavior among individuals with a history of childhood maltreatment. Healthcare professionals and educators can tailor early prevention and intervention educational programs targeted toward adolescents with experience of childhood abuse or poor academic performance to prevent the incidence of deviant behavior and thus break the cycle of violence.     

The relationship between child protection contact and mental health outcomes among Canadian adults with a child abuse history

Despite being a primary response to child abuse, it is currently unknown whether contact with child protection services (CPS) does more good than harm. The aim of the current study was to examine whether contact with CPS is associated with improved mental health outcomes among adult respondents who reported experiencing child abuse, after adjusting for sociodemographic factors and abuse severity. The data were drawn from the 2012 Canadian Community Health Survey-Mental Health (CCHS-2012), which used a multistage stratified cluster design (household-level response rate = 79.8%). Included in this study were individuals aged 18 years and older living in the 10 Canadian provinces (N = 23,395). Child abuse included physical abuse, sexual abuse, and exposure to intimate partner violence (IPV). Mental health outcomes included lifetime mental disorders, lifetime and past year suicidal ideation, plans, and attempts, and current psychological well-being and functioning and distress. All models were adjusted for sociodemographic factors and severity of child abuse. For the majority of outcomes, there were no statistically significant differences between adults with a child abuse history who had CPS contact compared to those without CPS contact. However, those with CPS contact were more likely to report lifetime suicide attempts. These findings suggest that CPS contact is not associated with improved mental health outcomes. Implications are discussed.     

Perinatal mental health and risk of child maltreatment: A systematic review and meta-analysis

BackgroundMental health problems in parents have been identified as a risk factor for child maltreatment. The perinatal period (from conception to 1 year) is a critical period but it is unclear whether perinatal mental health problems are also associated with increased risk.ObjectiveTo review evidence on perinatal mental health and risk of child maltreatment.MethodsSearches were conducted on six databases and 24 studies reported in 30 papers identified. Studies were conducted in seven countries, mainly the USA (n = 14). Sample sizes ranged from 48-14,893 and most examined mothers (n = 17). Studies were conducted in community (n = 17) or high-risk (n = 7) samples.ResultsThe majority of studies found a relationship between parental perinatal mental health problems and risk of child maltreatment, but inconsistent findings were observed between and within studies. The few studies that examined fathers (n = 6) all found a relationship between fathers’ mental health and risk of child maltreatment. Meta-analysis of 17 studies (n = 22,042) showed perinatal mental health problems increased risk of child maltreatment by OR 3.04 (95% CI 2.29–4.03). This relationship was moderated by type of sample, with larger effects for risk of child maltreatment in high-risk samples. The relationship was not moderated by type of mental illness, child maltreatment; methodological or measurement factors.ConclusionThe association between perinatal mental health and risk of child maltreatment is similar to that observed at other times during childhood. Methodological heterogeneity and inconsistent findings mean conclusions are tentative and need to be considered alongside other individual, family and social/cultural risk factors.     

Longitudinal association of child maltreatment and cognitive functioning: Implications for child development

Although research investigating associations among child maltreatment, cognitive functioning, and academic achievement has grown in recent years, important questions remain. In particular, assessing the influence of maltreatment apart from that of other co-occurring and confounding factors remains difficult. This study was developed to further the field’s understanding by investigating cognitive functioning in association with time-variant maltreatment patterns. Using multiple time-variant linear mixed models, we investigated the relationships between maltreatment timing and three domains of cognitive functioning (i.e., knowledge, comprehension, and analysis). In general, the cognitive functioning of students who experienced maltreatment was lower than that of their peers who had yet to experience maltreatment at the time of testing. Results of LMM indicated that the cognitive functioning of students who experienced maltreatment concurrent with the testing year fluctuated over time whereas the cognitive functioning of students who experienced maltreatment prior to or after the testing year remained stable. Students who experienced concurrent maltreatment showed the lowest functioning of any group. While maltreatment timing was a significant predictor of cognitive functioning over time, the addition of poverty into the model resulted in a non-significant effect of maltreatment timing. Additional research is needed to disentangle the longitudinal effect of maltreatment on cognitive functioning and address the interacting role of poverty and chronic maltreatment.     

Identifying children at high risk for a child maltreatment report

Objective

To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect.

Method

The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models.

Results

Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education ≤ high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, CI = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, CI = 1.07-1.47, p < .01).

Conclusions

Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.     

The relationship between cigarette taxes and child maltreatment

Prior research suggests that income and child maltreatment are related, but questions remain about the specific types of economic factors that affect the risk of maltreatment. The need to understand the role of economics in child welfare is critical, given the significant public health costs of child maltreatment. One factor that has been overlooked is regressive taxation. This study addresses this need by examining whether state-level changes in cigarette tax rates predict changes in state-level child maltreatment rates. The results of both a fixed effects (FE) and a fixed effects instrumental variables (FE-IV) estimator show that increases in state cigarette tax rates are followed by increases in child abuse and neglect. An additional test finds that increases in the sales tax (another tax deemed to be regressive) also predict increases in child maltreatment rates. Taken as a whole, the findings suggest that regressive taxes have a significant effect on the risk of child maltreatment.     

Fatal child maltreatment in England, 2005-2009

Objective

This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.

Methods

Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment).

Results

A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death.

Conclusions

Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.     

Gender differences in the association between emotional maltreatment with mental,emotional, and behavioral problems in Swedish adolescents

Emotional maltreatment is a common form of child abuse with a powerful negative impact on mental health. The aim of this study was to examine the effect of emotional maltreatment on mental health and mental well-being in a general population of Swedish 12- to 13-year old girls and boys. Data was collected via self-report questionnaires in classroom settings from 1134 students. Emotional maltreatment had significant effects on mental health and mental well-being for both girls and boys. Moreover, there were significant interaction effects between gender and levels of emotional maltreatment. Girls reported decreased mental health and mental well-being at lower degrees of emotional maltreatment compared to boys. Furthermore, girls reported larger decreases in mental health in response to exposure of emotional maltreatment. For internalizing symptoms, mental well-being and psychosomatic symptoms, exposure level of emotional maltreatment seemed to magnify the gender differences. For externalizing symptoms, there were no differences between girls and boys in the group reporting no emotional maltreatment and the increase in externalizing symptoms were of equal magnitude for both genders. Given the impact of emotional maltreatment on mental health in the general population, results from this study implies that a trauma-informed perspective is necessary in understanding gender differences in mental health in early adolescence. Further research is needed in order to understand the underlying processes generating the differences in girls and boys responses to emotional maltreatment.     

Community interaction and child maltreatment

The way in which parents interact with their environment may have implications for their likelihood of abuse and neglect. This study examines the parent–environment relationship through community involvement and perception, using social disorganization theory. We hypothesize mothers who participate in their communities and have positive perceptions of them may be less likely to maltreat their children because of the potential protective capacity of neighborhood supports. Using information from the 5 year Fragile Families and Child Wellbeing Study (n = 2991), the mother's self-reported acts of psychological and physical maltreatment and neglect are measured. A mother's community involvement index is the number of community activities a mother was involved in, and community perception is measured by two five-item Likert scales assessing perception of community collective efficacy. We analyze the relationship between community variables and each of mother's maltreatment behaviors as well as the interaction between community factors using a series of nested logistic regressions. Higher levels of community involvement are associated with lower levels of psychological aggression. More positive perception of community social control is associated with lower levels of physical assault. A moderation effect of community perception suggests that a mother's perception of her community changes the relationship between community involvement and psychological child abuse. The results provide important policy and empirical implications to build positive and supportive communities as a protective factor in child maltreatment. Getting parents involved in their communities can improve the environment in which children and families develop, and decrease the likelihood that maltreatment will occur.     

Less money,more problems: How changes in disposable income affect child maltreatment

A number of research studies have documented an association between child maltreatment and family income. Yet, little is known about the specific types of economic shocks that affect child maltreatment rates. The paucity of information is troubling given that more than six million children are reported for maltreatment annually in the U.S. alone. This study examines whether an exogenous shock to families’ disposable income, a change in the price of gasoline, predicts changes in child maltreatment. The findings of a fixed-effects regression show that increases in state-level gas prices are associated with increases in state-level child maltreatment referral rates, even after controlling for demographic and other economic variables. The results are robust to the manner of estimation; random-effects and mixed-effects regressions produce similar estimates. The findings suggest that fluctuations in the price of gas may have important consequences for children.     

The protective role of mentalizing: Reflective functioning as a mediator between child maltreatment,psychopathology and parental attitude in expecting parents

BackgroundChildhood maltreatment impacts parenting and has intergenerational consequences. It is therefore crucial to identify clinically responsive resilience-promoting factors in pregnant women and expecting men with history of childhood maltreatment. Mentalization, or reflective functioning, appears as a promising concept to understand risk and resilience in the face of childhood maltreatment.ObjectiveThis study evaluated the multivariate relationship between exposure to childhood maltreatment, reflective functioning, psychological symptoms and parental attitude in expecting parents.MethodsTwo hundred and thirty-five pregnant women and 66 expecting fathers completed self-report assessment measures of childhood trauma, reflective functioning, depression, post-traumatic stress disorder, parental sense of competence and antenatal attachment. Twenty-eight percent (n = 85) of the community sample reported personal histories of childhood maltreatment.ResultsStructural equation modeling indicated that reflective functioning (a) partially mediated the association between childhood maltreatment and psychological symptoms during pregnancy and (b) independently predicted participants’ perception of parental competence and psychological investment toward the unborn child.ConclusionOverall, this study provides empirical evidence of the protective role of reflective functioning during the prenatal period in parents with histories of childhood maltreatment.     

The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents

Objectives

Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion – a concept of positive acceptance of self. While not applied previously to a child welfare sample, self-compassion may be of value in understanding impairment among maltreatment victims. This may be most pertinent in adolescence and young adulthood, when self-identity is a focal developmental process.

Methods

The present sample was drawn from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study, which followed randomly selected adolescents receiving child protection services across two years within an urban catchment area. Child maltreatment was assessed at baseline using the Childhood Trauma Questionnaire ( [Bernstein et al., 1994] and [Bernstein et al., 2003] ). Mental health, substance and alcohol use problems, suicide attempt, and self-compassion were assessed at the two-year follow-up point. There were 117 youths, aged 16–20 years (45.3% males) who completed the self-compassion scale (Neff, 2003). Bivariate correlations were computed between adolescent self-compassion and each form of self-reported maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect). Finally, hierarchical, stepwise regression was used to examine unique contributions of child maltreatment subtypes in predicting adolescent self-compassion, as well as maltreatment-related impairment.

Results

Higher childhood emotional abuse, emotional neglect, and physical abuse were associated with lower self-compassion. Controlling for age and gender, emotional abuse was significantly associated with reduced self-compassion, even when the effects of emotional neglect and physical abuse were taken into account. Youths with low self-compassion were more likely to have psychological distress, problem alcohol use, and report a serious suicide attempt, as compared with those with high self-compassion. A number of maltreatment-related areas of impairment, identified by screening instruments, were significantly associated with lower self-compassion.

Conclusion

Self-compassion may be a fruitful aspect of research to pursue in an effort to better understand the impact of childhood emotional abuse on adolescent functioning, particularly considering the under-researched group of those receiving child protective services.     

Emotion dysregulation as a mechanism linking child maltreatment exposure and self-harm behaviors in adolescents

Although child maltreatment exposure is a recognized risk factor for self-harm, mechanisms underlying this relationship remain unclear. Self-harm may function as a compensatory strategy to regulate distressing emotions. This cross-sectional study examines if emotion dysregulation mediates between the severity of maltreatment exposure and self-harm, adjusting for demographic variables and depressive symptoms. Participants were 108 adolescent patients recruited from a psychiatric hospital in Singapore (mean age 17.0 years, SD = 1.65; 59.3% female). Study measures included the Childhood Trauma Questionnaire (CTQ-SF), Functional Assessment of Self-Mutilation (FASM), Difficulties in Emotion Regulation Scale (DERS), and the Patient Health Questionnaire (PHQ-8). Path analysis was conducted to examine the direct and indirect effects of maltreatment exposure on self-harm via emotion dysregulation, controlling for demographic variables and depressive symptoms. Indirect effects were tested using bootstrapped confidence intervals (CI). Results showed that self-harm was highly prevalent in our sample (75.9%). Emotion dysregulation and depressive symptoms were found to be associated with higher self-harm frequency. In addition, results from path analysis showed that the association between the severity of maltreatment exposure and self-harm frequency was significantly mediated by emotion dysregulation B = 0.07, p < 0.05, 95% CI [0.02, 0.16]. Thus, emotion dysregulation may be a proximal mechanism linking maltreatment exposure and adolescent self-harm. Notably, self-harm may represent maladaptive attempts to manage emotion dysregulation that may have resulted from maltreatment. Findings from the study have implications for the prevention and treatment of self-harm in maltreated youth.     

Obesity prevalence among youth investigated for maltreatment in the United States

The objective of this study is to determine the prevalence and correlates of obesity among youth investigated for maltreatment in the United States. Participants were drawn from the National Survey of Child and Adolescent Well-Being II, a national probability study of 5,873 children aged birth to 17 years under investigation for maltreatment in 2008. From child weight reported by caregivers, we estimated obesity (weight-for-age ≥95th percentile) prevalence among children aged 2 through 17 (n = 2,948). Sex-specific logistic regression models by developmental age were used to identify obesity risk factors, including child age, race/ethnicity, and maltreatment type. Obesity prevalence was 25.4% and was higher among boys than girls (30.0% vs. 20.8%). African American adolescent boys had a lower risk for obesity than white boys (OR = 0.28, 95% CI [0.08, 0.94]). Compared with girls aged 2–5 with a neglect allegation, girls with a sexual abuse allegation were at greater risk for obesity (OR = 3.54, 95% CI [1.01, 12.41]). Compared with adolescent boys with a neglect allegation, boys with a physical abuse allegation had a lower risk for obesity (OR = 0.24, 95% CI [0.06, 0.99]). Adolescent girls with a prior family history of investigation were at greater risk for obesity than those without a history of investigation (OR = 3.97, 95% CI [1.58, 10.02]). Youth investigated for maltreatment have high obesity rates compared with national peers. Opportunities to modify and evaluate related child welfare policies and health care practices should be pursued.     

The prevalence of child maltreatment in the Netherlands across a 5-year period

The prevalence of child maltreatment in the Netherlands was in 2005 first systematically examined in the Netherlands’ Prevalence study on Maltreatment of children and youth (NPM-2005), using sentinel reports and substantiated CPS cases, and in the Pupils on Abuse study (PoA-2005), using high school students’ self-report. In this second National Prevalence study on Maltreatment (NPM-2010), we used the same three methods to examine the prevalence of child maltreatment in 2010, enabling a cross-time comparison of the prevalence of child maltreatment in the Netherlands. First, 1,127 professionals from various occupational branches (sentinels) reported each child for whom they suspected child maltreatment during a period of three months. Second, we included 22,661 substantiated cases reported in 2010 to the Dutch Child Protective Services. Third, 1,920 high school students aged 12–17 years filled out a questionnaire on their experiences of maltreatment in 2010. The overall prevalence of child maltreatment in the Netherlands in 2010 was 33.8 per 1,000 children based on the combined sentinel and CPS reports and 99.4 per 1,000 adolescents based on self-report. Major risk factors for child maltreatment were parental low education, immigrant status, unemployment, and single parenthood. We found a large increase in CPS-reports, whereas prevalence rates based on sentinel and self-report did not change between 2005 and 2010. Based on these findings a likely conclusion is that the actual number of maltreated children has not increased from 2005 to 2010, but that professionals have become more aware of child maltreatment, and more likely to report cases to CPS.