Handgrip force of maltreating mothers in reaction to infant signals

Handgrip force responses to infant signals were examined in a sample of 43 maltreating and 40 non-maltreating mothers. During a standardized handgrip paradigm, mothers were asked to squeeze a handgrip dynamometer at maximal and at half of their maximal handgrip strength while listening to infant crying and laughter sounds. Maltreating mothers used excessive force more often while listening to infant crying and laughter than non-maltreating mothers. Of the maltreating mothers, only neglectful mothers (n = 20) tended to use excessive force more often during crying than non-maltreating mothers. Participants did not rate the sounds differently, indicating that maltreating mothers cannot be differentiated from non-maltreating mothers based on their perception of infant signals, but show different behavioral responses to the signals. Results imply that, in response to infant signals (i.e., crying or laughing), maltreating mothers may be insufficiently able to regulate the exertion of physical force.     

Psychological maltreatment,emotional and behavioral problems in adolescents: The mediating role of resilience and self-esteem

In this study, structural equation modeling was used to examine the mediating role of resilience and self-esteem in the relationships between psychological maltreatment-emotional problems and psychological maltreatment-behavioral problems in adolescents. Participants were 937 adolescents from different high schools in Turkey. The sample included 502 female (53.6%) and 435 male (46.4%) students, 14–19 years old (mean age = 16.51, SD = 1.15). Results indicated that psychological maltreatment was negatively correlated with resilience and self-esteem, and positively correlated with behavioral problems and emotional problems. Resilience and self-esteem also predicted behavioral problems and emotional problems. Finally, psychological maltreatment predicted emotional and behavioral problems mediated by resilience and self-esteem. Resilience and self-esteem partially mediated the relationship between psychological maltreatment-behavioral and psychological maltreatment-emotional problems in adolescents. Thus, resilience and self-esteem appear to play a protective role in emotional problems and behavioral problems in psychologically maltreated individuals. Implications are discussed and suggestions for psychological counselors and other mental health professionals are presented.     

The role of attachment in the relationship between child maltreatment and later emotional and behavioral functioning

The experience of childhood maltreatment is an important predictor of unfavorable emotional and behavioral outcomes. Because little research examined explanatory variables in the relationship between childhood maltreatment experiences and later outcomes, this study examined the role that attachment serves in this relationship. Four hundred twenty-four participants completed questionnaires assessing the variables of interest for this study. Results indicated that both childhood maltreatment experiences (particularly emotional abuse) and attachment (particularly to mothers and peers) are significant predictors of later emotional and behavioral outcomes. Further, attachment contributed unique and significant variance to the relationship between childhood maltreatment experiences and later outcomes. Such findings suggested that secure attachment may serve as a protective factor against maladaptive emotional and behavioral outcomes as children reach emerging adulthood, even in the context of childhood maltreatment experiences. The importance of studying the relationships among these variables is discussed.     

Broken bonds: A meta-analysis of emotion reactivity and regulation in emotionally maltreating parents

BackgroundEmotional maltreatment is the most pervasive but least studied form of abuse.ObjectiveIn the present study, we examined the role of emotion reactivity and emotion regulation in emotional child maltreatment.MethodsWe identified nine studies that compared levels of parental emotion reactivity and regulation in emotionally maltreating families with levels in non-maltreating families.ResultsOur meta-analytic findings revealed that, in comparison to non-maltreating parents, parents who are emotionally maltreating their children report higher levels of negative affect, depression, verbal aggression, and anger. We also found that in comparison to non-maltreating parents, emotionally maltreating parents report lower levels of emotional control, emotion regulation, and coping strategies.ConclusionsWe outline the theoretical and practical implications of these results, and emphasize how research into the etiology of child maltreatment may provide the basis for more effective prevention, screening, and treatment practices designed to eradicate emotional maltreatment.     

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.     

Shifting definitions of emotional maltreatment: an analysis child welfare investigation laws and practices in Canada

Objective

Although there is growing evidence that the emotional dimensions of child maltreatment are particularly damaging, the feasibility and appropriateness of including emotional maltreatment (EM) in child welfare statutes continues to be questioned. Unlike physical and sexual abuse where investigations focus on discreet incidents of maltreatment, EM is not as easily defined and delimited. Through a review of legislation and child welfare investigation practices in Canada, this paper examines (1) whether Canadian child welfare services respond to EM with the same level of perseverance as with other forms of maltreatment and (2) the extent to which the introduction in 2008 of a more specific EM taxonomy distinguishes between EM and family problems that could lead to EM.

Method

Following an analysis of the legislative framework for EM across Canada, investigations practices in Canada are examined using data from the 1998, 2003 and 2008 cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). Using data from the 2008 cycle, EM investigations are compared to other maltreatment investigations for all of Canada (N = 15,980). Changes in EM investigations over time are then compared using data from the three cycles of the study, excluding Québec because of limited data availability in 2003 (N = 5,360 in 1998, 11,562 in 2003 and 14,050 in 2008).

Results

EM is included as a form of reportable maltreatment in all provincial and territorial statutes in Canada. Over 11,000 cases of EM were substantiated in Canada in 2008, at a rate of 1.86 cases per 1,000 children. While EM investigations were substantiated at a lower rate as other forms of maltreatment, a higher proportion of EM cases were referred for specialized services, kept open for on-going child welfare services, lead to an out of home placement, and lead to an application to child welfare court. Using a broad definition of EM the number of investigations classified as EM in Canada, excluding Québec, nearly tripled from 1998 to 2003. In 2008, using more specific definitions focusing on caregiver definitions, the number of investigations classified as EM nearly returned to their 1998 level, with nearly twice as many cases being classified as risk of future maltreatment.

Conclusion

EM is a well established category for child welfare intervention in Canada, however, more emphasis should be given to distinguishing between EM and family problems that place children at risk of EM.     

Childhood maltreatment and alcohol-related problems in young adulthood: The protective role of parental warmth

BackgroundAlcohol use among young adults is highly prevalent. Individuals exposed to childhood maltreatment are particularly vulnerable to alcohol use and alcohol-related problems. Few studies have examined family protective factors, such as parental warmth, that may mitigate the effects of childhood maltreatment on alcohol-related problems.ObjectiveThe current study seeks to examine the extent to which parental warmth reduces the effect of childhood exposure to maltreatment on alcohol-related problems in young adulthood.Participants and settingParticipants were young adults (N = 337; mean age = 21.7), who were recruited from an urban community and completed in-person interviews assessing childhood maltreatment, parental warmth, and alcohol-related problems.MethodsMultiple hierarchical linear regression models were used to examine whether maternal and paternal warmth reduced the impact of childhood exposure to maltreatment on alcohol-related problems in young adulthood. Common risk factors for alcohol-related problems, including psychological symptoms and peer and parental alcohol use, were also entered into the models.ResultsWe found a significant moderating effect of paternal warmth on the associations between childhood emotional abuse and alcohol-related problems (β= -0.29, p < .05). Specifically, the association between emotional abuse and alcohol-related problems was weaker among individuals with higher levels of paternal warmth. Moderating effects of maternal warmth on the maltreatment-problematic alcohol use relation were not supported.ConclusionThe results of this research suggest that parental warmth may not only relate to fewer alcohol-related problems among offspring, but may also modify the associations between childhood emotional abuse and alcohol-related problems during young adulthood.     

Emotional maltreatment in Canada: prevalence, reporting and child welfare responses (CIS2)

Objectives

To determine the prevalence and characteristics of reports of emotional maltreatment (EMT) in Canada, as well as changes in these reports between 1998 and 2003.

Methods

This study is based on a secondary analysis of data collected in the first and second Canadian Incidence Study. Emotional maltreatment (excluding exposure to intimate partner violence) investigations were categorized into six groups: emotional abuse, emotional neglect, and other maltreatment as the only investigated form of maltreatment, and these same three groups were examined when they co-occurred with another form of maltreatment.

Results

Both the rate of emotional-abuse-only investigations and emotional-neglect-only investigations increased almost threefold from 1998 to 2003. Substantiated emotional neglect investigations had the highest rate of transfer to ongoing services. Half of the investigations involving single forms of emotional maltreatment occurred for six months or more. Finally, emotional neglect cases (in single form and when it co-occurs with another form of maltreatment) were more likely to be associated with emotional harm and longer duration of maltreatment.

Conclusions

In 2003, EMT represented a significant increasing form of maltreatment and is detected nearly twice as often in situations in which abuse or neglect are also reported. Reports of emotional abuse are two and a half times more frequent than reports of emotional neglect. Nevertheless, lack of emotional engagement may also be difficult to identify, since an omission is more difficult to detect. Reports of EMT often reveal situations of chronic victimization that have been the subject of previous reports and are associated with greater emotional impact.     

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.     

Educational and emotional health outcomes in adolescence following maltreatment in early childhood: A population-based study of protective factors

Although childhood maltreatment is associated with long-term impairment, some children function well despite this adversity. This study aimed to identify the key protective factors for good educational attainment and positive emotional health in adolescents who experienced maltreatment in early childhood. Data were analyzed from the Avon Longitudinal Study of Parents and Children, a large UK prospective cohort study. The sample was defined by maternally reported exposure to physical or emotional maltreatment by a parent prior to 5 years. 1118 (8.0%) children were emotionally maltreated and 375 (2.7%) were physically maltreated before the age of 5. There were too few cases of sexual abuse to be considered. Positive outcomes were operationalized as achieving 5 or more grade A*-C GCSE exam grades at 16 years and scores above the cohort median on the self-report Warwick-Edinburgh Mental Wellbeing Scale and Bachmann Self-Esteem Scale at 17.5 years. The associations of individual, family and community covariates with successful adaptation to the adversity of maltreatment were investigated using logistic regression.School related factors, including engagement in extracurricular activities, satisfaction with school and not being bullied were the most important in facilitating resilience in educational attainment, self-esteem and wellbeing. Good communication and social skills was the most protective individual trait. There was insufficient evidence to suggest that family factors were associated with resilience to maltreatment. School-based interventions are recommended to promote positive adaptation following parental maltreatment. Future research should evaluate outcomes across the life-course to understand whether the protective influences of school persist into adulthood.     

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.     

Child maltreatment and marijuana problems in young adults: Examining the role of motives and emotion dysregulation

It is well established that childhood maltreatment is an important predictor of marijuana use, but few studies have examined the mechanisms underlying this relationship. The current study examines marijuana motives as mediators of the relationship between childhood maltreatment and marijuana use in a sample of young adults. In addition, pathways from childhood maltreatment to emotion dysregulation, coping motives, and marijuana use were explored. Participants were 125 young adults (ages 19–25, 66.9% female) recruited through online community advertising. All participants completed questionnaires assessing childhood maltreatment, emotion dysregulation, marijuana motives, past year and past three-month marijuana use, and marijuana problems. Correlational analyses revealed bivariate relationships between childhood maltreatment, emotion dysregulation, marijuana motives and marijuana problems (rs = .24–.50). Mediation analyses revealed that coping motives mediated the relationship between childhood maltreatment and marijuana problems, and emotion dysregulation was associated with marijuana problems both directly and indirectly via coping motives. The present findings highlight emotion dysregulation and coping motives as important underlying mechanisms in the relationship between childhood maltreatment and marijuana problems.     

Intergenerational transmission of child maltreatment: Predictors of child emotional maltreatment among 11 to 17 years old children residing in communities of Karachi,Pakistan

ObjectiveFamilies where parents had childhood history of victimization may likely to abuse their children; hence contributing as an important predictor of child emotional maltreatment (CEM). This study aimed to determine the relationship of intergenerational abuse with CEM among 11–17 years old children residing in peri-urban and urban communities of Karachi, Pakistan.MethodStructured interviews were conducted with 800 children and parents-pair using validated questionnaire “International Child Abuse Screening Tool for Child (ICAST-C)” comprised of 4 domains. Domain of child emotional maltreatment was considered as outcome (CEM-score). The relationship between Parental history of childhood victimization and CEM-Score was measured using linear regression.ResultsThe average CEM-score was came to be 19+5.2 among children whom parental history of childhood victimization was present (P < 0.001). The estimated mean CEM-score increased by 5.59 units (95% CI= {2.61, 8.51}) among children whom parents had a history of childhood victimization (Intergenerational abuse) with severe physical familial abuse.ConclusionThe current study provided evidence on intergenerational transmission of maltreatment suggesting early prevention to break the cycle of child maltreatment through generations. Preventive measures can be taken, once a parental history of childhood victimization has been identified, by providing appropriate services to those families who belong to lower socioeconomic status, where mothers are young, presence of siblings’ rivalry/ bullying and/or violence among family members. However, these factors do not explain a complete causality of the intergenerational transmission therefore additional factors, for instance parenting styles must be taken into consideration.     

Fatal and non-fatal child maltreatment in the US: An analysis of child,caregiver, and service utilization with the National Child Abuse and Neglect Data Set

The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national-comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. We discuss the results with regard to child welfare practice and research.     

Child maltreatment reporting in the general population: Examining the roles of community,collective efficacy,and adverse childhood experiences

According to bystander theory, factors such as the community environment, collective efficacy, and history of adverse childhood experiences could be related to likelihood of reporting or intervening against maltreatment. An online survey was conducted with 946 general population Californians obtained through mixed-mode random probability and quota-based recruitment methods. Using an experimental vignette design, participants were randomly assigned to two scenarios: a) potential child abuse occurring in their neighborhood; b) potential child abuse in an unfamiliar neighborhood. Weighted multivariate logistic regression models assessed relationships between the vignette condition, collective efficacy, appraisal of the behavior, and likelihood of reporting or intervening. The results suggested that perceiving the vignette as occurring in your own neighborhood was associated with lower odds of viewing the behavior as appropriate and considering it abusive. Higher collective efficacy scores were associated with lower odds of viewing the incident as inappropriate but higher odds of personally intervening. Adverse childhood experiences were positively related to reporting the incident to child protective services and intervening. Bystanders may be more likely to give parents in their own neighborhood "the benefit of the doubt" by viewing their abusive behaviors as less severe, potentially leading to underreporting. Neighborhood collective efficacy might increase willingness to personally intervene, but not contact systems such as child protective services or police, suggesting that enhanced trust in communities does not extend to these institutions. Our findings have implications for neighborhood and education interventions to enhance understanding of and willingness to intervene on behalf of children.     

Vulnerability or resilience to early substance use among adolescents at risk: The roles of maltreatment and father involvement

Although research has indicated that maltreated children are at higher risk of adolescent substance use, it remains unclear whether the type and timing of maltreatment affect the likelihood of adolescent substance use. Research has also found father involvement to be a potential protective factor against adolescent substance use, but the role of quality vs. quantity of father involvement as well as gender differences in the effects of father involvement on substance use among at-risk adolescents have not been studied. The current study adds value to the existing literature by filling these gaps in knowledge. We conducted a secondary data analysis with a sample of 685 at-risk adolescents drawn from the Longitudinal Studies of Child Abuse and Neglect. The study found a connection between early childhood (birth to 5) physical abuse and adolescent substance use, but not for later childhood physical abuse or other forms of child maltreatment. The quality of father involvement was found to be a protective factor, regardless of child gender; quantity of father involvement was not significant. Based on these findings, development of intervention strategies focusing on prevention of early childhood physical abuse and promoting positive father-child relationships are important prevention strategies for adolescent substance use. Additionally, professionals working with at-risk adolescents need to be cognizant of the implications of early childhood physical abuse and act accordingly to mitigate the increased potential for adolescent substance use.     

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.     

The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers,children and young people and young adults

Objectives

To measure the prevalence of maltreatment and other types of victimization among children, young people, and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardized scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people, and young adults taking into account other types of childhood victimization, different perpetrators, non-victimization adversities and variables known to influence mental health.

Methods

A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people, and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health.

Results

2.5% of children aged under 11 years and 6% of young people aged 11–17 years had 1 or more experiences of physical, sexual, or emotional abuse, or neglect by a parent or caregiver in the past year, and 8.9% of children under 11 years, 21.9% of young people aged 11–17 years, and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were also found; 7.2% of females aged 11–17 and 18.6% of females aged 18–24 reported childhood experiences of sexual victimization by any adult or peer that involved physical contact (from sexual touching to rape). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization, and to have higher levels of trauma symptoms.

Conclusions

The past year maltreatment rates for children under age 18 were 7–17 times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age-related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children's mental health.     

The impact of maltreatment characteristics and revicitimization on functioning trajectories in children and adolescents: A growth mixture model analysis

Person-centered approaches are considered promising methods for a deeper understanding of the causes and consequences of maltreatment. So far, only few studies have employed such approaches in the study of maltreatment. The aim of the present study was to examine the impact of maltreatment-related variables on trajectories after maltreatment. Growth mixture modelling (GMM) was used to examine different trajectories of functioning in 206 children and adolescents (M = 9.8 years) with a history of child maltreatment. Trajectories were analyzed in regards to maltreatment characteristics and revictimization using multinomial logistic regression. The participants were followed up over a 12 months period including three assessments. Four trajectories were identified: resilient (22.9%), worsening (15.1%), recovering (32.2%), chronic (29.8%). Revictimization (OR: 2.6–5.5), a longer period between first and last reported incident of maltreatment (OR: 0.033 – 0.038) and consequently the age at first (OR: 0.039 – 0.054) and age at last reported incident (OR: 20.3–26.9) were significant predictors of a worsening functioning trajectory. Having experienced neglect predicted a worsening trajectory in contrast to a chronic and resilient trajectory (OR = 4.8–5.2). Findings suggest that a clinical follow-up of children with a history of maltreatment is crucial as this population represents a high risk sample. A worsening trajectory was closely associated with revictimization. Functioning trajectories seem to be directly linked to chronicity and timing of maltreatment. Implications are discussed.     

Childhood maltreatment,psychopathology and well-being: The mediator role of global self-esteem,attachment difficulties and substance use

Childhood maltreatment is known to be associated with a broad variety of psychopathology and deteriorated well-being in adolescent populations. In the present nationwide study, we aimed to explore global self-esteem, attachment difficulties and substance use as possible mediators of these associations in a high-risk adolescent population. We included 400 adolescents (aged 12–20 years) living in residential youth care in Norway (response rate 67%). The participants completed a semistructured psychiatric interview (Child and Adolescent Psychiatric Assessment (CAPA)), a study-specific questionnaire, a revised version of the Self-Perception Profile for Adolescents (SPPA) and the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). Information was also provided by the adolescent’s primary contact at the institution. Two models were tested using structural equation modelling; one assessed the association between childhood maltreatment and psychopathology, and one assessed the association between childhood maltreatment and well-being. Childhood maltreatment, psychopathology, well-being, global self-esteem and attachment difficulties were treated as latent variables, and substance use was added as an observed variable. The results of this study showed that global self-esteem was a mediator of paths in both models, whereas attachment difficulties and substance use were not. Preventing decline in health and well-being in high-risk adolescents is a main goal, and this study suggests that improving self-esteem, in addition to providing psychiatric health services, could be an important tool for achieving this goal.