Epidemiology of abusive head trauma in West Virginia children <24 months: 2000–2010

BackgroundFew states have published statewide epidemiology of abusive head trauma (AHT).ObjectiveTo examine the statewide epidemiology of AHT in West Virginia (WV), with the primary objective of establishing AHT incidence for comparison to national data, and to use as a baseline for comparison to incidence post-implementation of a statewide AHT prevention program.Participants and settingAHT cases in children less than 2 years old were identified from the 3 tertiary pediatric centers in WV.MethodsCases were identified by using ICD-9 codes for initially identifying those with injuries which might be consistent with AHT, followed by medical record review to determine which of these met the criteria for inclusion as a case. Medical examiner data was used to find additional cases of AHT. Using the number of cases identified along with relevant census data, incidence of AHT was calculated.ResultsThere were 120 cases of AHT treated in WV hospitals from 2000 to 2010, 100 of which were WV residents. The incidence was 36.1/100,000 children <1 year of age and was 21.9 cases per 100,000 children <2 years of age. Incidence in infants increased during the latter years (2006–2010) of the study to 51.8/100,000 compared to the incidence during 2000–2005, which was 24.0/100,000 (p < .01).ConclusionsCompared to US national, state and regional figures, the WV incidence of AHT was among the highest. In addition, the incidence of AHT increased significantly over the study period. Possible factors contributing to the rise in incidence are discussed.     

Physical or psychological child abuse and neglect: Experiences,reporting behavior and positions toward mandatory reporting of pediatricians in Berlin,Germany

BackgroundChild abuse and neglect (CAN) are common, with a high number of undetected victims. Since 2012, the German Federal Child Protection Act grants doctors an opportunity to circumvent their duty of confidentiality if they suspect CAN may be occurring, despite the reporting of CAN not being mandatory.ObjectiveThis study examines pediatricians’ reporting behavior in cases of CAN and what their attitudes are toward mandatory reporting.Participants and settingAll 378 primary care pediatricians and pediatric psychiatrists in the German capital of Berlin were asked to complete a questionnaire anonymously. The questionnaire was sent by mail to all primary care pediatricians (N = 302) and pediatric psychiatrists (N = 76) in private practice.MethodsPatterns of reporting, response tendencies, and correlations with socio-economic factors were described and statistically examined.ResultsThe response rate was 42% (N = 157). Of the pediatricians, 28% report every suspected case to the authorities. The majority, namely 73%, has difficulties in detecting CAN, and 64% would like additional training. Furthermore, 52% are aware of legally guaranteed counseling options being available if CAN is suspected. Whereas 71% consider mandatory reporting necessary to protect children more effectively, 57% are sure it would simplify their work.ConclusionsMore training on diagnosing CAN should be offered to pediatricians. It is necessary to have a full and frank discussion about making reporting mandatory in cases where there is a reasonable suspicion of CAN. Doctors believe that mandatory reporting standardizes and simplifies working procedures. It may possibly reduce the number of undetected cases of CAN and would allow more children and families access to early protection and supporting measures.     

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.     

Economics and violence against children,findings from the Violence Against Children Survey in Nigeria

This study seeks to assess the impact of economic factors on sexual, emotional, and physical violence on Nigerian children and adolescents aged 13–24 years. Data collected from the Nigerian Violence Against Children Survey (VACS), a national, cross-sectional household survey of females and males aged 13–24 years were used to examine sexual, emotional, and physical violence victimization. Data were collected on household economic status, e.g., flooring and roofing materials, transportation. A poverty index was developed using the Simple Poverty Scorecard^™ for Nigeria to determine the impact that economic factors have on these violence measures. Children aged 13–17 years in households with high economic status (ES) were 1.81, 1.78, and 4.91 times, more likely to experience sexual, emotional, and physical violence, respectively, within the last 12 months than those in the lowest ES. Individuals aged 18–24 years in households with high ES were 1.62 and 1.41 times more likely to experience emotional and physical violence, respectively, prior to age 18 than those in the lowest ES. Individuals aged 18–24 years in households with middle or high ES were 1.65 and 1.96, respectively, times more likely to experience physical violence prior to age 18 than those in the lowest ES. Highest tertile ES was significantly associated with sexual, emotional, and physical violence among Nigerians aged 13–24 years. Further research is needed to determine the cause of increased violence amongst high ES households. Targeted interventions towards this ES class are recommended to reduce violence against children in Nigeria.     

"It isn't that we're prostitutes": Child protection and sexual exploitation of adolescent girls within and beyond refugee camps in Rwanda

BackgroundWhile refugee camps can protect children from harm, they can also introduce new risks and vulnerabilities. Research suggests that adolescent girls are at particular risk for gender-based violence and sexual exploitation.ObjectiveThis study aimed to identify existing social and economic vulnerabilities of female adolescents in refugee camps in Rwanda.Participants and settingResearch was carried out in two Congolese refugee camps in Rwanda.MethodsTen focus group discussions (FGDs) were held with 87 boys and 79 girls aged 12–17 years Six FGDs were held with a total of 36 parents and caregivers in the two camps. Key informant interviews were held with nine local and national level stakeholders.ResultsStudy findings centered upon intersectionality. Camps designed for security and containment introduced new forms of vulnerability and threats. Economic stressors threatened the viability of families. Girls had material needs but few options to meet those needs within the camps. Their families expected them to do domestic work at home. Participants reported that the convergence of material deprivation, lack of economic opportunity, and vulnerability led to transactional sex and exploitation within and around the camps. The study concludes that vulnerabilities and threats associated with gender and generation must be examined concurrently with the conditions associated with being a refugee in a setting of protracted displacement.     

How does women’s education influence infant survival? A structural equation model using aggregate data from 95 low- and middle-income countries

Previous studies have shown that women’s education increases infant survival with a magnitude that varies along methodological designs. Besides, the causal chain from women’s education to infant survival has so far remained largely unknown. This cross-country study investigates the relationship between women’s education and infant survival in 95 low- and middle-income countries using a comprehensive set of mediating and control variables. The article applies structural equation modelling on aggregate data, which were produced by the UN, UNESCO, UNICEF and the World Bank. The independent variables are from 2000 to 2009, and the dependent variable, infant mortality, is from 2018. The models are adjusted for income level, population size and extreme epidemic or political instabilities. Structural equation modelling is an advantageous method to specify how women’s education affects infant survival explicitly through the indirect influences of an enhanced child health provision and through an increased reproductive autonomy for women. Overall, women’s education is an equally important variable with poverty alleviation and women’s reproductive autonomy in explaining the cross-country variation in infant survival. The models, taking into account key child health policies, provide new evidence on how women’s education is mediated to better infant survival in low- and middle-income countries.     

Prevalence of child abuse in Kerala,India: An ICAST-CH based survey

BackgroundChild abuse is a major concern in India with frequent reports of extreme maltreatment and fatalities. A dearth of robust and methodologically sound studies has resulted in ambiguity regarding the extent of child abuse in the general population.ObjectivesTo estimate the one-year and lifelong prevalence of exposure to violence, physical abuse, emotional abuse, sexual abuse, and neglect using a validated instrument—the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool – Child, Home Version (ICAST-CH).Participants and Setting: Adolescents (n = 6957) attending randomly selected schools in one city in Kerala, India.MethodsCross-sectional survey using self-report instrument.ResultsThe one-year prevalence of any abuse was 89.9% (95% CI: 89.1–90.7) suggesting that child maltreatment was widespread. Physical and emotional abuses were also very common. Although sexual abuse was least common, a considerable proportion of adolescents reported it; one-year prevalence of sexual abuse was 16.7% and lifetime prevalence was 19.9%. Boys reported more abuse than girls across all the categories of abuse (including sexual abuse). Abuse was more frequent in the higher age groups and classes at school. Abuse was also more frequent in nuclear families and families that reported alcohol use. Children who reported an abusive experience usually faced more than one category of abuse; abuse in one category was significantly associated with abuse in other categories.ConclusionsAbuse of children is alarmingly common. There is an urgent need for improving the awareness surrounding this issue as it is a major public health challenge faced by the country. The priority should be on setting up easily accessible support services for children.     

How is childhood emotional abuse related to major depression in adulthood? The role of personality and emotion acceptance

Accumulated evidence provides support that childhood emotional abuse (CEA) is related to adult major depressive disorder (MDD) outcomes. However, the psychological mechanisms of this relation are still not well understood. Changes in personality and emotion regulation are indicated to play a mediating role what should be examined in this paper. A sample of 123 MDD inpatients was examined in a prospective observational study with two times of measurement. Patients provided data on childhood trauma history, personality disorder (PD) traits and emotion acceptance. Self- and expert-ratings of depressive symptoms were assessed at baseline and at the end of treatment. Treatment duration as an objective indicator of treatment outcome was additionally considered. Partial correlation analyses revealed associations between CEA and self-ratings of MDD symptom severity and symptom improvement independent of sexual and physical abuse. Expert-ratings of depression and treatment duration were not related to CEA. Mediation analyses revealed that particularly the factors borderline psychopathology as well as acceptance of pleasant emotions mediated the association of CEA and self-rated MDD symptoms. Passive-aggressive PD traits mediated the link between CEA and a lower self-rated symptom improvement. CEA affect specific personality traits and acceptance of emotions. This association may play a critical role for self-reported depressive symptoms with implications for prevention, psychoeducation, and treatment of MDD.     

The impact of extrafamilial victimization and poly-victimization on the psychological well-being of English young people

Childhood victimization impacts on the well-being of children and young people, particularly those experiencing an extreme amount of different types of victimization (i.e., poly-victims). However, limited attention has been given to the impact of different categories of extrafamilial victimization (experienced outside of the family), particularly in the UK. The intricacies of the significant detrimental impact poly-victimization has on victims are also poorly understood. In this study, 730 young people, aged 13 to 16 years (mean 13.8 years), from one county in the UK, were surveyed about their lifetime and past year experiences of extrafamilial victimization, the locations in which these occurred, and current trauma symptoms. The results showed that interpersonal forms of extrafamilial victimization (e.g., sexual victimization) were significant predictors of trauma, whilst more indirect forms of extrafamilial victimization (e.g., witnessing the victimization of others) were not. When extrafamilial poly-victimization and number of extrafamilial victim locations were accounted for within regression models, however, this impact was reduced. Poly-victimization within the past year was the strongest predictor of trauma symptoms. Number of victim locations did not significantly predict trauma symptoms above and beyond the impact of poly-victimization, although it was a contributory predictor. These findings suggest that a holistic exploration of a young person's extrafamilial victim experiences is needed in any clinical assessment or research into its psychological impact. Specifically, attention should be given to the experiencing of extreme levels of victimization (e.g., poly-victimization). Further longitudinal research is needed to understand why poly-victimization has the greatest impact on psychological well-being.     

The barriers to a national inquiry into child sexual abuse in the United States

There is an often-overlooked but critical factor at the center of institutional child sexual abuse that must be acknowledged and addressed: adults tend to place the interest of institutions and other adults above the protection of children. As the Australian Royal Commission into Institutional Responses to Child Sexual Abuse has shown, this phenomenon is evident across institutional settings and any institutional reform aimed at improving child safety must therefore guard against this tendency if it is to be effective in protecting children. In the United States there are also other barriers to dealing with child sexual abuse in institutional contexts. State government responses to the challenges of child sexual abuse have varied. However, the federal governmsent has been silent on the problem of religious institutional sexual abuse. This commentary considers how the politics of religious liberty in the United States inhibits action by protecting institutions that cover up child sexual abuse.