Disentangling the mental health impact of childhood abuse and neglect

It is unclear whether maltreatment types exert common or specific effects on mental health. In the current study, we aimed to systematically characterize the unique, shared and cumulative effects of maltreatment types on psychiatric symptoms, using data drawn from a community sample of high-risk youth (n = 204, M = 18.85). Analyses controlled for a range of potentially confounding variables, including socio-demographic variables, neighbourhood deprivation and levels of community violence exposure. Outcome measures included multi-informant reports of internalizing difficulties, as well as data on externalizing problems and trauma-related symptoms. We found that (i) consistent with previous studies, maltreatment types were highly interrelated and frequently co-occurred; (ii) symptom severity linearly increased with the number of maltreatment types experienced (more so for self-report vs informant ratings); and (iii) while most forms of maltreatment were significantly associated with mental health outcomes when examined individually, few unique effects were observed when modelling maltreatment types simultaneously, pointing to an important role of shared variance in driving maltreatment effects on mental health. Emotional abuse emerged as the main independent predictor of psychiatric symptomatology – over and above other maltreatment types – and this effect was comparable for males and females (i.e. no significant interaction with sex). Findings contribute to a better understanding of heterogeneity in individual responses to maltreatment.     

Institutional abuse of children in the Austrian Catholic Church: Types of abuse and impact on adult survivors’ current mental health

The aim of this study was to explore the nature and dimensions of institutional child abuse (IA) by the Austrian Catholic Church and to investigate the current mental health of adult survivors. Data were collected in two steps. First, documents of 448 adult survivors of IA (M = 55.1 years, 75.7% men) who had disclosed their abuse history to a victim protection commission were collected. Different types of abuse, perpetrator characteristics, and family related risk factors were investigated. Second, a sample of 185 adult survivors completed the Posttraumatic Stress Disorder Checklist (PCL-C) and the Brief Symptom Inventory (BSI). Participants reported an enormous diversity of acts of violent physical, sexual, and emotional abuse that had occurred in their childhood. The majority of adult survivors (83.3%) experienced emotional abuse. Rates of sexual (68.8%) and physical abuse (68.3%) were almost equally high. The prevalence of PTSD was 48.6% and 84.9% showed clinically relevant symptoms in at least one 1 of 10 symptom dimensions (9 BSI subscales and PTSD). No specific pre-IA influence was found to influence the development of PTSD in later life (e.g. poverty, domestic violence). However, survivors with PTSD reported a significantly higher total number of family related risk factors (d = 0.33). We conclude that childhood IA includes a wide spectrum of violent acts, and has a massive negative impact on the current mental health of adult survivors. We address the long-term effects of these traumatic experiences in addition to trauma re-activation in adulthood as both bear great challenges for professionals working with survivors.     

Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma

Despite an increased awareness regarding the prevalence and impact of childhood trauma, especially childhood sexual abuse (CSA), few studies examine the clinical reporting of such childhood experiences. This study compared the prevalence of childhood trauma recorded in individual's clinical notes to those ascertained with a structured validated questionnaire, examined which forms of childhood trauma were less likely to be reported to the treating mental health team and established which demographic or clinical factors were associated with reporting of childhood trauma. The prevalence of childhood trauma was ascertained using both the Childhood Trauma Questionnaire (CTQ) and a lifetime retrospective clinical note review in 129 individuals attending a general adult mental health service. Individuals were evaluated for the presence of mental health disorders, impulsivity, symptom severity and disability. Using the CTQ, childhood trauma was noted in 77% of individuals and recorded in 38% of individual's clinical notes (p < 0.001). The greatest differences between CTQ reporting and clinical note documentation were noted for emotional neglect (62% versus 13.2%), physical neglect (48.1% versus 5.4%) and CSA (24.8% versus 8.5%). Childhood trauma was associated with increased psychopathology and greater symptom severity, and was particularly prevalent for individuals with personality disorders. This study demonstrated high rates of childhood trauma amongst adults attending a general adult mental health service. Furthermore, we demonstrated high rates of either non-enquiry from mental health professionals and/or high rates of non-documentation of childhood trauma by mental health professionals. Given the disparity between reporting of childhood trauma in clinical notes and findings with the CTQ, the use of a standardised questionnaire for the assessment of childhood trauma should be considered when performing a comprehensive mental health history.     

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.     

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.     

Associations between childhood abuse and interpersonal aggression and suicide attempt among U.S. adults in a national study

The aim of this study is to examine associations among childhood physical, emotional, or sexual abuse and violence toward self (suicide attempts [SA]) and others (interpersonal aggression [IA]). Data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2 (n = 34,653). Multinomial logistic regression examined associations between type of childhood abuse and violence categories, adjusting for demographic variables, other childhood adversity, and DSM-IV psychiatric disorders. The prevalence of reported childhood abuse was 4.60% for physical abuse, 7.83% for emotional abuse, and 10.20% for sexual abuse. Approximately 18% of adults reported some form of violent behavior, distributed as follows: IA, 13.37%; SA, 2.64%; and SA with IA, 1.85%. After adjusting for demographic variables, other childhood adversity, and psychiatric disorders, each type of childhood abuse was significantly related to increased risk for each violence category as compared with the no violence category. Furthermore, the odds ratio of childhood physical abuse was significantly higher for SA with IA when compared with IA, and the odds ratio of childhood sexual abuse was significantly higher for SA and SA with IA when compared with IA. Childhood physical, emotional, and sexual abuse is directly related to the risk for violent behaviors to self and others. Both internalizing and externalizing psychiatric disorders impact the association between childhood abuse and violence. The inclusion of suicidal behaviors and interpersonal aggression and internalizing/externalizing psychiatric disorders within an integrated conceptual framework will facilitate more effective interventions for long-lasting effects of child abuse.     

Childhood maltreatment: A predictor of mental health problems among adolescents and young adults

Child maltreatment is a risk factor for detrimental effects on mental health that may extend to adulthood. This study aimed to examine the association between exposure to childhood maltreatment, socio-demographic factors, and students’ mental health status and self-esteem. A cross-sectional study enrolled a representative sample of 1270 students from Kuwait University. An anonymous self-administered questionnaire included students’ socio-demographic characteristics, history of exposure to childhood physical and/or emotional maltreatment, DASS-21 to assess mental health status, and Rosenberg self-esteem scale was used. Chi-square test and binary logistic regression models were applied. The study found that among participants, 49.6%(95% CI: 64.8%–52.4%), 63.0%(95% CI: 60.3%–65.7%), and 43.8%(95% CI: 41.1%–46.6%) reported having depression, anxiety, and stress respectively. Moreover, 22.5%(95% CI: 20.1%–24.8%) and 18.6%(95% CI:16.5%–20.9%) reported childhood physical and emotional maltreatment, respectively; while 12.7% reported both. Multivariate analysis revealed that experiencing childhood physical and emotional maltreatment were independent contributors to reporting depression and anxiety; while exposure to only emotional maltreatment contributed to reporting stress. Gender, GPA, childhood enrollment in private/public schools, number of close friends, were other contributors to mental health problems. Participants’ median score of self-esteem was 17/30, and only childhood emotional maltreatment was a significant predictor to low self-esteem after adjustment for other confounders. Mental health problems, and experiencing childhood physical and emotional maltreatment were prevalent relatively high among university students. Childhood corporal and emotional maltreatment were independent predictors to adolescents and young adults’ mental health problems. Experiencing childhood emotional maltreatment predicted low self-esteem. Further research to assess culture factors associated with childhood maltreatment is recommended.     

Men with childhood sexual abuse histories: Disclosure experiences and links with mental health

BackgroundThere is limited research on the disclosure experiences of men who have experienced childhood sexual abuse and on how such experiences might impact mental health outcomes.ObjectiveThe current study described men’s disclosure experiences and examined the role of disclosure characteristics on mental well-being (internalizing and externalizing behaviors, substance use, resilience).Participants and settingMen (N = 253) from across Canada and the U.S. were recruited through websites for males with sexual abuse histories. Men aged 18–59 years anonymously completed an online study on their sexual abuse, disclosure experiences, and mental health outcomes.ResultsFindings indicated that 77.9% of men disclosed their sexual abuse, although they waited an average of 15.4 years before sharing their experience. Once disclosed, 64.4% of the men reported a positive response (e.g., support), while 35.6% reported a negative response (e.g., blame). Regression analyses indicated that a greater delay in disclosure predicted greater externalizing behaviors (B = .49, p < .05), although this was a small effect (Cohen’s f ² = 0.02). Additional disclosure variables were associated with components of externalizing (aggressive and rule-breaking behaviors) and internalizing (somatic complaints) behaviors.ConclusionsThese results require replication in future studies. However, they do suggest that efforts need to be undertaken to address the barriers that hinder men from disclosing their sexual abuse and to ensure that men are supported once they disclose.     

How to deal with emotional abuse and neglect: further development of a conceptual framework (FRAMEA)

Objective

To develop further the understanding of emotional abuse and neglect.

Methods

Building on previous work, this paper describes the further development of a conceptual framework for the recognition and management of emotional abuse and neglect. Training in this framework is currently being evaluated. The paper also briefly reviews more recent work on aspects of the definition, harm caused by emotional abuse and neglect and threshold.

Results

The paper arrives at a working definition as ‘persistent, non-physical, harmful interactions with the child by the caregiver, which include both commission and omission.’ There are many forms of harmful caregiver-child interactions, which can be placed in five categories, each category reflecting the fulfillment of one of the child's basic psycho-social needs and requiring a different therapeutic approach for its alleviation. The caregiver-child relationship is embedded within a psycho-social context. It is suggested that greater clarity can be gained about the child and family when information is sorted into the appropriate tiers of concerns: Tier 0 – Social & environmental factors, Tier I – Caregiver risk factors, Tier II – Caregiver-child interactions and Tier III – Child's functioning. It is further suggested that while intervention is required, this is directed towards protection, rather than providing immediate protection of the child. The work takes the form of a time-limited trial of therapeutic work to gauge the capacity of the caregivers to change. This initial work focuses Tiers 0–II. Statutory steps might be required in order to encourage the caregivers to engage. If insufficient progress is achieved, active child protection may be required which might include placing the child in an alternative family. However, some, usually older, children will remain in the emotionally abusive environment and they will require ongoing help and support.

Conclusion

While a greater understanding of emotional abuse and neglect is now possible, further evaluation of the utility of this framework is suggested.     

Emotional abuse in childhood and suicidality: The mediating roles of re-victimization and depressive symptoms in adulthood

This study examined the effects of emotional abuse in childhood, along with physical and sexual abuse, on suicidality in adulthood, and whether and how emotional abuse and depressive symptoms in adulthood mediate the association between the childhood emotional abuse and suicidality. The data were drawn from the 2012 Korean General Social Survey, a nationally representative survey with a multistage area proportional probability sampling method. Random effects regression and the Sobel test were used to analyze the relationships between childhood emotional abuse and suicidality and the mediating effects. Random effects models showed that emotional abuse in childhood was positively associated with suicidality in adulthood, even after controlling for physical and sexual abuse in childhood. Emotional abuse and depressive symptoms in adulthood mediated the association between emotional abuse in childhood and suicidality. Depressive symptoms also mediated between emotional abuse in adulthood and suicidality. These findings suggest that emotional abuse in childhood has indirect harmful effects on suicidality in adulthood. It increases suicidality through higher occurrences of re-victimization and depressive symptoms in adulthood. Practitioners and policy makers should recognize that experiences of emotional abuse in childhood may result in re-victimization in adulthood, which, in turn, lead to suicidality. Early intervention programs to reduce the likelihood of experiencing re-victimization may be critical for people exposed to emotional abuse in childhood.     

A longitudinal perspective on boys as victims of childhood sexual abuse in South Africa: Consequences for adult mental health

Childhood sexual abuse of boys was examined in a longitudinal cohort in South Africa, with data on abuse collected at six age points between 11 and 18 years. Potential personal and social vulnerability of male sexual abuse victims was explored and mental health outcomes of sexually abused boys were examined at age 22–23 years. Reports of all sexual activity – touching, oral and penetrative sex – increased with age and sexual coercion decreased with age. Almost all sexual activity at 11 years of age was coerced, with the highest rates of coercion occurring between 13 and14 years of age; 45% of reports of coerced touching were reported at age 14, 41 percent of coerced oral sex at age 13, and 31% of coerced penetrative sex at age 14. Sexual coercion was perpetrated most frequently by similar aged peers, and although gender of the assailant was less often reported, it can be presumed that perpetration is by males. Boys who experienced childhood sexual abuse tended to be smaller (shorter) and from poorer families. No relationships to measured childhood intelligence, pubertal stage, marital status of mother or presence of the father were found. There was no significant association between reports of childhood sexual abuse and mental health in adulthood and when personal and social vulnerabilities were taken into account.     

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.     

Reflective function mediates the relationship between emotional maltreatment and borderline pathology in adolescents: A preliminary investigation

Deficits in mentalizing, particularly within the context of attachment relationships i.e., reflective function (RF), are posited to result from childhood maltreatment and to influence the development of borderline personality disorder (BPD). Whilst a mentalization-based model of BPD provides a theoretical explanation, direct empirical support for this model, in linking childhood maltreatment to borderline pathology remains limited. This study examined the interrrelationships between childhood maltreatment, RF, and borderline pathology in a mixed adolescent sample, consisting of adolescents with BPD (n = 26) and a group of non-clinical adolescents (n = 25). With the aim of directly testing the mentalization-based model of BPD, we additionally investigated the influence of each form of childhood maltreatment within this developmental pathway. Self-report data supported the hypothesized indirect effect of childhood maltreatment on elevated borderline pathology through lowered RF in adolescents. Both emotional abuse and emotional neglect were found to indirectly influence borderline pathology through adolescent RF, however, only emotional abuse indirectly influenced borderline pathology through RF, after all other maltreatment types were controlled for. Findings support the promotion of mentalization, within attachment-related contexts, as an intervention target for adolescents with borderline pathology and as a potential target of prevention for at-risk children and adolescents with histories of childhood maltreatment, especially emotional abuse. Future research should delineate other underlying mechanisms, independent of RF, which may also link the influence of childhood maltreatment, and in particular, emotional abuse, to BPD.     

Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers

This study examined associations among childhood abuse, emotion dysregulation, and probable posttraumatic stress disorder (PTSD) within a sample of 93 substance use disorder (SUD) patients in residential treatment. SUD patients with probable PTSD (vs. non-PTSD) reported (a) greater severity of childhood sexual, physical, and emotional abuse and (b) significantly higher levels of overall emotion dysregulation and the specific dimensions of difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Additionally, significant positive associations were found between both childhood physical and emotional (but not sexual) abuse on the one hand and dimensions of emotion dysregulation on the other. Further analyses indicated that difficulties controlling impulsive behaviors when distressed accounted for the associations of both childhood physical and emotional abuse with probable PTSD status. Findings of the present study highlight a potential mechanism underlying the relationships between both childhood emotional and physical abuse and PTSD in SUD patients.     

History of abuse and neglect in patients with schizophrenia who have a history of violence

Objective

To determine the prevalence of five forms of abuse/neglect during childhood and adolescence in a group of schizophrenic patients with a history of violence.

Methods

Twenty-eight patients hospitalized in a highly secured psychiatric unit were included. Abuse and neglect during patients’ growth were evaluated with the childhood trauma questionnaire (CTQ). History of substance abuse (consumption of cannabis, and/or alcohol, and/or heroin, and/or cocaine during the year that preceded the hospitalization), incarceration, and death of a close parent were also collected.

Results

We found that 46.4% of patients experienced at least 1 form of abuse and/or neglect during childhood and 21.4% of them had experienced more than 2 forms of abuse and/or neglect. The 2 most frequent forms of neglect and abuse were physical abuse (39.3%) and emotional neglect (17.9%). History of substance abuse was found for cannabis (57.1%), alcohol (57.1%), and cocaine and/or heroin (35.7%). We found that 42.8% of patients had 1 close relative who had died during their growth and that 41.6% of these deaths were violent.

Conclusion

It appears important to systematically search for and assess a history of abuse and neglect during growth in schizophrenic patients with a history of violence, in order to offer specific treatments for this group of patients.     

Previous maltreatment and present mental health in a high-risk adolescent population

Childhood maltreatment is known to increase the risk of future psychiatric disorders. In the present study, we explored the impact of experienced maltreatment on the prevalence and comorbidity of psychiatric disorders in a high-risk population of adolescents in residential care units. We also studied the impact of poly-victimization. The participants of the study were adolescents in residential care units in Norway (n = 335, mean age 16.8 years, girls 58.5%). A diagnostic interview (Child and Adolescent Psychiatric Assessment Interview) was used, yielding information about previous maltreatment (witnessing violence, victim of family violence, community violence, sexual abuse) and DSM-IV diagnoses present in the last three months. Exposure to maltreatment was reported by 71%, and in this group, we found significantly more Asperger's syndrome (AS) (p = .041), conduct disorder (CD) (p = .049), major depressive disorder (MDD) (p = .001), dysthymia (p = .030), general anxiety disorder (GAD) (p < .001), and having attempted suicide (p = .006). We found significantly more comorbid disorders in the maltreated group. Poly-victimization was studied by constructing a scale comprised of witnessing violence, victim of family violence, victim of sexual abuse and household dysfunction. We found that poly-victimization was associated with significantly increased risk of MDD, GAD, AS, CD, and having attempted suicide (p < .01). The complexity of the clinical outcomes revealed in this study suggest that longer-term treatment plans and follow-up by psychiatric services might be needed to a greater extend than for the rest of the child and adolescent population, and that trauma informed care is essential for adolescents in residential youth care.     

Emotion dysregulation as a mediator between childhood emotional abuse and current depression in a low-income African-American sample

Abuse and neglect in childhood are well-established risk factors for later psychopathology. Past research has suggested that childhood emotional abuse may be particularly harmful to psychological development. The current cross-sectional study employed multiple regression techniques to assess the effects of childhood trauma on adulthood depression and emotion dysregulation in a large sample of mostly low-income African Americans recruited in an urban hospital. Bootstrap analyses were used to test emotion dysregulation as a potential mediator between emotional abuse in childhood and current depression. Childhood emotional abuse significantly predicted depressive symptoms even when accounting for all other childhood trauma types, and we found support for a complementary mediation of this relationship by emotion dysregulation. Our findings highlight the importance of emotion dysregulation and childhood emotional abuse in relation to adult depression. Moving forward, clinicians should consider the particular importance of emotional abuse in the development of depression, and future research should seek to identify mechanisms through which emotional abuse increases risk for depression and emotion dysregulation.