搜索结果：Child maltreatment

Childhood maltreatment and adolescent mental health problems are unequally distributed, with the highest burdens among marginalised groups including females and those experiencing socioeconomic disadvantage. However, little is known about how the psychological consequences of maltreatment vary across intersecting social positions (e.g., socioeconomically disadvantaged females). Prior quantitative work has largely focused on average differences across a limited number of groups, obscuring non-additive intersectional patterning. Because social realities are structured by overlapping systems of privilege and oppression (e.g., relating to gender, socioeconomic position, ethnicity, age, and place), we leveraged recent methodological advances to address this gap. Accordingly, this study aimed to (i) map inequalities in adolescent emotional problems and the effects of maltreatment across intersectional positions; and (ii) describe the extent to which inequalities in emotional problems reflect additive and non-additive (intersectional) effects. Data were analysed from 19 590 students aged 11-16 years who participated in the OxWell 2023 Student Survey in England, United Kingdom. Within a random-coefficient Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), individuals were nested in 180 intersectional strata defined by combinations of social positions relating to gender, ethnicity, household poverty, school year group, and school-level deprivation (also entered as additive main effects). Emotional problems (Revised Child Depression and Anxiety Scale; RCADS-11) were regressed on maltreatment exposure (Short Childhood Maltreatment Questionnaire) as the primary effect of interest. Stratum-specific predicted emotional problems and maltreatment effects were estimated, and between-stratum variance was partitioned into additive and residual non-additive components. Maltreatment was associated with higher levels of emotional problems, with stratum-specific increases ranging from +3.20 to +6.14 scale points. Socioeconomically disadvantaged females and individuals who selected 'other' or 'prefer not to say' for gender showed the highest levels of emotional problems and among the strongest maltreatment effects. Between-stratum inequalities in emotional problems were largely accounted for by maltreatment exposure and the additive contributions of the included social positions. However, residual non-additive effects were also evident, particularly among individuals exposed to maltreatment, where 5.25% of between-stratum variance remained unaccounted for by additive effects (compared with 3.46% among those not exposed). In this large community sample of adolescents in England, the detrimental effects of maltreatment on emotional problems appear pervasive but not uniform across intersectional social positions. Applying an intersectional MAIHDA framework suggests that inequalities in adolescent emotional problems largely reflect additive social patterning, with additional non-additive contributions suggestive of intersectional dynamics that are more pronounced with maltreatment exposure. These findings motivate deeper investigation into the social-structural mechanisms that shape vulnerability and resilience in adolescence, and support the need for trauma-informed, equity-focused interventions and policy action to reduce unequal exposure to maltreatment and the contexts that amplify its harms.

Evidence suggests that the mental health effects of maternal exposure to childhood maltreatment may be transmitted to the next generation, possibly via alterations in maternal stress-sensitive endocrine functioning during gestation, with potential implications for fetal programming. However, empirical evidence supporting this mechanism remains limited. We investigated whether maternal exposure to childhood maltreatment, assessed using the Childhood Trauma Questionnaire, was associated with the levels of 15 steroid hormones and the trajectories of 18 steroid hormones and their substrate-to-product ratios, serving as proxies of metabolizing enzyme activity during pregnancy. Maternal morning plasma samples were collected in mid pregnancy (median 20.29, Interquartile Range [IQR] 19.57-21.14) from 563 mothers, and across early (median 13.0, IQR 12.57-13.43), mid (median 19.29, IQR 19.0 - 19.71), and late (median 27.0, IQR 26.57-27.50) pregnancy from 188 mothers. Mothers with moderate-to-severe compared with none-to-low childhood maltreatment had significantly higher mid-pregnancy levels of aldosterone. They also had significantly higher increases in the levels of corticosterone, aldosterone, 11-deoxycortisol, cortisol, cortisone, androstenedione, and testosterone, and in the corticosterone/11-dehydrocorticosterone ratio from early to late pregnancy. These associations were not explained by mother-, child-, and study design-related covariates. These findings show that maternal exposure to childhood maltreatment may alter maternal steroid hormone functioning during gestation, potentially contributing to its intergenerational programming effects. The results highlight potential targets for prevention to mitigate the intergenerational transmission of these effects.

Childcare facilities are a vital social infrastructure that supports children's development and enables parents to balance work and family life. Ensuring children's safety in these settings is therefore a fundamental social responsibility. Research on safety in childcare settings has accumulated, but it has largely developed around separate themes such as injury, incident prevention, and maltreatment. As a result, fatal incidents in childcare facilities have rarely been examined as temporal processes across multiple cases. Therefore, this study aimed to examine how institutional, organizational, and practical conditions were involved in the course of fatal incidents in licensed childcare facilities in Japan and to provide a theoretical understanding of the processes through which such incidents occurred. The analysis employed Trajectory Equifinality Modeling (TEM), a qualitative method that enables the visualization of multiple trajectories, obligatory passage points, bifurcation points, and equifinality points. Ten publicly available investigation reports on fatal incidents in licensed childcare facilities in Japan were qualitatively analyzed. The findings showed that fatal incidents should not be understood simply as failures occurring immediately before death. Rather, they were formed through processes in which institutional, organizational, and practical conditions accumulated and converged over time. Across cases, loss of psychological leeway among childcare staff and inadequate supervision systems emerged as recurrent obligatory passage points. Beyond these points, adult-centered caregiving that seeks to make children comply and blind spots left unchecked functioned as bifurcation points separating trajectories toward fatal incidents from trajectories toward safe childcare. TEM analysis also suggested that childcare that ensures children remain visible and the prevention of abusive childcare practices may support a contrasting trajectory toward safe childcare. These findings suggest that fatal incidents in licensed childcare facilities cannot be reduced to individual error alone, but need to be understood in relation to institutional, organizational, and practical conditions.

The progression from suicidal ideation to attempt is a multi-stage process, yet it is unknown how different victimization contexts contribute uniquely to each stage. We compared the associations of school-based peer bullying and family-based childhood maltreatment with suicidal ideation, suicide planning, and suicide attempts in adolescents to identify the primary intervention target for halting suicidality at each step. A multicenter, school-based survey of 18,910 Chinese students aged 12-22 years was conducted. Participants were categorized into four groups: none, peer bullying only, childhood maltreatment only, and both. Logistic regression and population attributable fraction analyses were applied. Overall, 10.9% reported peer bullying only, 18.7% maltreatment only, and 8.9% both. Peer bullying showed a stronger association with suicidal ideation than maltreatment (OR 1.35; 95% CI:1.14-1.60), particularly among females&#x2009;<&#x2009;15 years (OR 1.68; 95% CI:1.21-2.32). Childhood maltreatment had a stronger link to suicide attempts (OR 1.34; 95% CI: 1.06-1.70) and a higher PAF (13% vs. 2% for peer bullying). Among ideators, maltreatment increased progression to attempts (OR 1.70, 95% CI: 1.32-2.19). Notably, co-exposure sharply raised the risk of suicide attempts (PAF: 25%).

Child maltreatment has profound adverse effects on various aspects of an individual's development and can even influence the next generation. This study investigated risk factors for child abuse potential within a population of highly burdened families and explored how these factors interact in the intergenerational transmission of maltreatment. Families receiving support from the German early prevention program "Fr&#xfc;he Hilfen" completed clinical interviews and standardized questionnaires at one time point. All subjects included met at least one risk factor for child abuse (inclusion criteria: low socioeconomic status, parental mental illness or teenage parenthood). Participants came from diverse cultural backgrounds. Child abuse potential was assessed using the CAPI, a screening instrument that measures parental stress and associated risk factors rather than actual abuse outcomes. A multiple regression analysis identified parental psychopathology (b&#x2009;=&#x2009;.52, p&#x2009;=&#x2009;.024), attachment quality (b&#x2009;=&#x2009;1.07, p&#x2009;=&#x2009;.001) and low socioeconomic state (b&#x2009;=&#x2009;-.83, p&#x2009;=&#x2009;.018) as key risk factors for child abuse potential. A mediation analysis indicated an indirect pathway whereby parental child maltreatment experiences were associated with poorer mental health (b&#x2009;=&#x2009;.32, p&#x2009;=&#x2009;.002), which in turn was linked to lower attachment quality (b&#x2009;=&#x2009;1.71, p&#x2009;=&#x2009;.006) and higher child abuse potential (b&#x2009;=&#x2009;.12, p&#x2009;=&#x2009;.002). Affective disorders emerged as particularly significant risk factors among all mental disorders (b&#x2009;=&#x2009;6.39, p&#x2009;=&#x2009;.015). These findings underscore the need for accessible psychiatric and psychotherapeutic support for parents with histories of childhood maltreatment to support healthy parent-child relationships. https://www.drks.de/drks_web/, German Clinical Trials Register DRKS00022075.

Addressing the growing child and adolescent mental health crisis is a global priority, particularly in low- and middle-income countries (LMICs). Although the literature demonstrates that experiencing maltreatment may negatively impact mental well-being and experiencing social support may positively impact mental well-being, the relationship between mental well-being and co-occurring maltreatment and social support is unknown. This study examined the relationship between maltreatment, social support, and mental well-being. Study data is from the longitudinal Positive Outcomes for Orphans (POFO) study of orphaned and separated children and youth/young adults (OSC) (n&#xa0;=&#xa0;2535) from five LMICs (Cambodia, Ethiopia, India, Kenya, and Tanzania). We used bivariable analyses to calculate relationships between 1) mental well-being and maltreatment and 2) mental well-being and social support. Then, we used generalized linear models (GLMs) to examine relationships between 1) mental well-being and maltreatment, 2) mental well-being and social support, and 3) mental well-being, maltreatment, and social support. Models were controlled for age, gender, health, parental status and other traumas. Maltreatment was associated with increased well-being difficulties (Coeff&#xa0;=&#xa0;2.068, SE&#xa0;=&#xa0;0.249, CI&#xa0;=&#xa0;1.579-2.559), while social support was associated with decreased well-being difficulties. In a GLM examining social support and maltreatment, social support reduced well-being difficulties (Coeff&#xa0;=&#xa0;-0.137, SE&#xa0;=&#xa0;0.010, CI&#xa0;=&#xa0;-0.157- -0.119), even in the concurrent presence of maltreatment (Coeff&#xa0;=&#xa0;-0.131, SE&#xa0;=&#xa0;0.010, CI&#xa0;=&#xa0;-0.151- -0.111). Three subtypes of social support were associated with reduced mental well-being difficulties: emotional support, tangible support, and positive social support. Findings indicate that measuring both maltreatment and social support may result in a more comprehensive understanding of youth emotional difficulties. Interventions that facilitate social support may promote emotional well-being and may be particularly useful in communities where trauma-informed mental health services are inaccessible.

Trauma-related symptoms can overlap with core symptoms of ADHD. However, there is limited evidence of exploration of how trauma exposure, particularly trauma burden and trauma type, relates to ADHD and whether these associations differ in their impact on psychosocial functioning compared to neurotypical (NT) children. To examine the associations between trauma exposure, trauma burden and trauma type and ADHD status and to assess whether these factors are differentially associated with behavioral, psychological and social functioning in children with ADHD compared to NT peers. Participants (N&#xa0;=&#xa0;242) comprised of an ADHD (n&#xa0;=&#xa0;141, 58.26%) and a NT group and were a subset of children whose parents completed the adverse childhood experience questionnaire. Behavioral and psychosocial functions were examined using the child behavior checklist. Children with ADHD were more likely to be exposed to trauma and to report higher trauma burden. Exposure to a single traumatic event resulted in a higher trauma burden and higher internalizing and externalizing problems in children with ADHD compared to NT children. They also had higher exposure to events related to household dysfunction, compared to NT children, after adjusting for socio-demographic factors. For trauma type, household dysfunction associated with higher internalizing problems and abuse-related trauma associated with higher internalizing and social difficulties in those with ADHD when compared to NT children with similar trauma exposures. Trauma burden and type can have differential effects on behavioral and psychosocial problems in children with ADHD.

Many children who experience child maltreatment fatalities (CMF) or near fatalities (CMNF) are previously known to the child welfare system (CWS). Although in-home services and foster care (FC) are tools for preventing CMF/CMNF, relatively little research has examined how each is associated with subsequent CMF/CMNF. Using a nested case-control design and linked administrative data from Pennsylvania, this study examined how in-home services and FC following an initial CWS case were associated with the odds of future CMF and CMNFs (n = 171 cases and 777 controls). Relative to receiving no services, in-home services were not associated with reduced odds of CMF/CMNF (OR = 1.27, p = 0.201), whereas FC was associated with lower odds (OR = 0.54, p = 0.061), though this association did not reach statistical significance at p < .05. Relative to in-home services, FC was significantly associated with 58% lower odds of CMF/CMNF (OR = 0.42, p = 0.010). Although replication with larger samples is needed, findings suggest that FC, but not in-home services, is associated with reductions in CMF/CMNFs in the years following CWS involvement.

In India, sexual offenses against children are gender neutralized and addressed by the Protection of Children from Sexual Offences (POCSO) Act of 2012. Still, the medical/legal literature, clinical suspicion, and judicial discourse continue to be implicitly gendered, resulting in poor detection rates of sexual offenses against male children and inadequate interpretation thereof. The available evidence base is consistent in indicating that a large proportion of child sexual abuse victims are males. Social stigma, delayed presentation, and lack of physician knowledge complicate underreporting and diagnosis. Male children present late and mostly without any visible physical injury, making it challenging to interpret and legally prove. This short communication proposes a structured and evidence-based classification of sexual offenses against male children, explicitly in line with the current Indian legal system. The classification includes penetrative sexual assaults, nonpenetrative sexual assaults, sexual harassment, sexual exploitation, and child sexual abuse materials, including aggravated and institutional abuses, in relation to the relevant sections of Bharatiya Nyaya Sanhita. Through the integration of patterns of abuse common in male victims, which include anal/sexual/penetrative abuse, coercive acts, non-contact crimes, and online abuse, with corresponding legal provisions under the POCSO Act, this classification scheme aims to address the gaps between medical diagnosis and legal determination. In addition, the article provides information on major medico-legal concerns, including the mandatory reporting law, the absence of tangible evidence, and the importance of meticulous medical documentation of the history of the abuse, behavioral symptoms, and evidence from the Internet. Collaboration among experts from various disciplines, such as pediatric medicine, forensic science, law enforcement agencies, and child protection services, is also vital. Male children should be considered vulnerable victims, too. With a POCSOoriented and male-friendly classification scheme, improved awareness and understanding in cases of child sexual abuse in India can be achieved.

Sleep plays a foundational role in early childhood development. Yet, children exposed to early adversity, such as those in foster care, are at elevated risk for sleep disturbances that may contribute to later emotional and behavioral difficulties. This longitudinal study investigated the association between early sleep disturbances and subsequent internalizing and externalizing symptoms in young children in foster care. A sample of 133 caregiver-child dyads participated in assessments at two time points: when children were approximately 25&#xa0;months and 48&#xa0;months old. Sleep was assessed through caregiver-reported measures across three days and two nights, and child mental health symptoms were measured using the Child Behavior Checklist (CBCL). Cross-lagged panel modeling revealed a significant association between early sleep disturbances and later mental health symptoms, both internalizing and externalizing. These findings underscore the potential lasting impact of early sleep disturbances on emotional development in children in foster care and highlight the need for early identification and intervention to promote healthy developmental outcomes among children facing early adversity.

Spine fractures in child abuse are rare, reported in 0.1% to 2.7%, but increase to 10% when additional fractures are detected on skeletal surveys. These fractures, often involving noncontiguous segments, occur in younger children and pose diagnostic challenges due to limited evidence, vertebral ossification variation, rib overlap on radiographs and Magnetic Resonance Imaging (MRI) resolution limitations. To assess the accuracy of radiograph and whole- spine MRI in detecting spine fractures in suspected non-accidental trauma and to identify the strengths and limitations of each modality. In this IRB approved 8-years retrospective study (2015-2022), we included children with reported spine fractures who underwent both skeletal survey radiographs and whole-spine MRI within seven days. Controls were randomly selected patients with both imaging modalities but without reported fractures. All studies were anonymized and independently reviewed by two pediatric radiologists blinded to clinical information and other imaging. The gold standard was defined as fractures identified with moderate to high confidence on both radiographs and whole-spine MRIs, or by consensus review. Sensitivity and specificity for each modality were calculated for each radiologist. Agreement was assessed using kappa statistics. Sixty-five children were included: 16 children with spine fractures (77 total fractures) and 49 children without fractures. Most fractures (81.8%) were in the thoracic spine, especially T2-T3 and T8-T10. The specificity of diagnosing children with spine fracture by radiography and whole-spine MRI was high (93.9%-100%); however, radiographic sensitivity was low to moderate (31.3% and 62.5%, by radiologists 1 and 2) and moderate for whole-spine MRI (75.0% and 68.8%, for radiologists 1 and 2). The interobserver agreement was weak for radiography (kappa 0.53; 0.26-0.81) and for whole-spine MRI (kappa 0.59; 0.34-0.85). Limbus variation was found in 6/65 children (9.2%) at the level of L1-L3. Both radiography and whole-spine MRI have high specificity in diagnosing spine fractures, but each has limited sensitivity when used alone. Diagnosis of a fracture is best achieved by evaluation of both imaging modalities. Radiologists should also be aware of limbus vertebra in the lumbar spine that can mimic a compression fracture. Raw data for this study is not publicly available to preserve individuals' privacy.

A predictive risk model (PRM) was trained to stratify risk among children investigated for alleged maltreatment based on the likelihood of future child protection involvement. In the current brief, we assess the model's ability to differentiate risk of adverse events not used to build the model (i.e., arrest, death) among adolescent populations investigated following reported maltreatment to guide prevention-oriented services. Child welfare and vital statistics records were obtained through a data use agreement. Among adolescents born in 2000 and 2001 and investigated for alleged maltreatment between ages 11 and 17 (n&#x2009;=&#x2009;72,340), risk scores were calculated using a random forest algorithm based on information available at the time of maltreatment report. The records of these adolescents were then linked to arrest and death records. Among adolescents investigated for maltreatment, 5.8% experienced a juvenile arrest or death before age 21. Of those who experienced an arrest or death, 43.9% fell in the highest risk decile. A PRM trained to predict foster care placement had strong external validity in predicting both future arrests and deaths. The average time from investigation to adverse event indicates a meaningful window for interventions to be delivered focused on supporting and stabilizing adolescents and their families.

Child neglect, defined as a parent or guardian's failure to provide basic needs such as food, clothing, shelter, or medical care, is a widespread global public health issue with long-term consequences for child development. To implement an artificial intelligence-based analysis of street-level imagery to detect built and natural environmental characteristics and to associate these indices with neighborhood-level child neglect risk, while controlling for socioeconomic factors. Street-level imagery, the Area Deprivation Index (ADI), and child neglect incidents were aggregated to census block groups (CBGs; n&#xa0;=&#xa0;141) within neighborhoods in Los Angeles, California, USA. We analyzed Google Street View images randomly sampled within neighborhoods using semantic segmentation, a computer vision (CV) technique, to quantify environmental features. These measures were aggregated into CBGs and combined into indices representing natural surveillance, natural environment, lighting, and land-use mix. Zero-inflated negative binomial models, incorporating the child population as an offset, were estimated to evaluate associations with neighborhood neglect rates while controlling for the ADI. Higher levels of natural surveillance, natural environment, lighting, and land use mix were each associated with reduced neighborhood neglect risk, controlling for area-level deprivation. AI analysis of street imagery benefits child welfare research by translating environmental features into measurable indices that reflect residents' subjective perceptions and objective realities. Research can use these tools to improve evidence-based policy, aiding neighborhood strategies and prevention efforts to reduce child neglect.

Caregiver substance use is a leading risk factor for child maltreatment and removal from the home. To address this risk, since 2006, Congress has authorized funding for the Regional Partnership Grants (RPG) program. RPG supports partnerships between child welfare agencies, substance use treatment providers, and other social service systems to improve outcomes for children in or at risk of out-of-home placement due to a caregiver's substance use. Although research has demonstrated RPG's effectiveness in improving families' outcomes, less is known about what makes this program effective. This paper uses data collected from over 2,500 families and linear regression models to examine how specific features of RPG service receipt-including the types of services and how much of each service families receive-are associated with a range of outcomes for adults and children. We found that completing services, attending more service contacts, and receiving more services from a peer recovery support specialist were favorably associated with several outcomes. In contrast, the associations between the types of services families received and their outcomes were mixed. These findings inform efforts by child welfare agencies, substance use treatment providers, and others to structure services in ways that are most likely to benefit families.

Despite growing attention of the effects of childhood trauma on suicidality, its links to day-to-day fluctuations in suicide risk indicators (defeat, entrapment) and the mediating roles of daily sleep and hassle appraisals remain unclear. This study (1) tests associations between childhood trauma and daily sleep, hassles, and suicide risk indicators; (2) examines mediation by daily sleep and hassle appraisals; and (3) assesses whether trauma moderates daily sleep/hassle-suicide risk relationships. A total of 168 participants with a recent history of suicide ideation or attempt completed a 7-day daily-diary protocol with two surveys per day. Each morning, participants reported on the previous night's sleep; each evening, they reported on that day's hassles and suicide risk indicators (defeat, entrapment, reasons for living). Multilevel models showed that childhood trauma was associated with higher pre-sleep arousal, more negative appraisals of daily hassles, and higher daily defeat and entrapment. Indirect pathways were identified whereby childhood trauma affected daily suicide risk via heightened pre-sleep arousal and more negative hassle appraisals. Finally, both daily pre-sleep arousal and hassle appraisals were linked to same-day suicide risk. These findings underscore the disruptive impact of childhood trauma on everyday stress-health processes and the complex mechanisms through which sleep dynamics and cognitive appraisals of hassles contribute to suicide risk. The results have implications for refining interventions by attenuating pre-sleep arousal and appraisal processes in individuals with a history of childhood trauma.