Carolina Jernbro

Multiple psychosomatic symptoms can indicate child physical abuse - results from a study of Swedish schoolchildren

Aim:  To examine whether children with self‐reported experiences of either physical abuse alone or combined with intimate partner violence report more psychosomatic symptoms than other children and to explore whether these possible associations are enhanced by school‐related factors, chronic condition and demographic factors.

Quality of life among Swedish school children who experienced multitype child maltreatment.

The aim of this study was to examine the overlap between child maltreatment types and their association with quality of life among school children.

Bully, bullied and abused. Associations between violence at home and bullying in childhood

Aims: The aim was to examine experiences of bullying among Swedish adolescents and whether victims and perpetrators were also exposed to violence in the home, with particular focus on how abuse severity affected the risk of exposure to bullying. Methods: A nationally representative sample of pupils aged 14–15 responded to a questionnaire exploring exposure to corporal punishment and other types of violence. Results were analysed using Pearson’s chi-square and multiple logistic regression, adjusting for factors regarding the child, the parents and the families’ socioeconomic status. Results: Among the 3197 respondents, a significant proportion reported at least one incident of either bullying victimisation (girls 36%, boys 26%) or bullying perpetration (girls 24%, boys 36%). Physical and emotional violence in the home, including witnessed intimate partner violence, were significantly associated with both bullying victimisation and bullying perpetration. Odds ratios for exposure to bullying rose with increasing frequency and severity of abuse. Adjusted odds ratios ranged from 1.6 for any event of abuse vs. single episodes of bullying to 20.3 for multiple types of abuse vs. many episodes of bullying. The child’s gender and the presence of a chronic health condition were consistently associated with nearly all levels of abuse and bullying. Conclusions: Bullying experiences are common among youth and are clearly associated with abuse. Frequent bullying, whether as victim or perpetrator, warrants particular vigilance, as it appears to be an indicator of severe violence in the home.

Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden

INTRODUCTION Injuries are one of the leading causes of death and disability among children in Sweden and attention-deficit/hyperactivity disorder (ADHD) has previously been associated with an increased risk of injury in pediatric populations elsewhere in the world. Current evidence regarding the possible link between autism spectrum disorder (ASD) and injury risk appears limited, even though some potentially risk-increasing symptoms overlap. The purpose of this study was thus to study the association between both ADHD and ASD concerning the risk of injury among Swedish schoolchildren. METHODS Two samples were used: a population-based register study containing data from 18,416 children ranging from the ages of 6-17years collected by school nurses during 2012/2014 (Survey A), and a national cross-sectional study of 3202 ninth-grade children (~15years old) collected from 92 schools in 2011 (Survey B). The data were analyzed using χ(2)-tests and log-binomial generalized linear models to obtain risk ratios (RR), comparing cases reportedly affected by ADHD or ASD to unaffected controls. RESULTS After adjusting for confounders, ADHD was associated with a 65% increased risk of injury (RR 1.65 [95% CI: 1.32-2.05] in Survey A, and a 57% increased risk of injury (RR 1.57 [95% CI: 1.27-1.95]) in Survey B. ASD was not significantly associated with any differences in injury risk (RR 0.81 [95% CI: 0.57-1.14]). CONCLUSIONS The results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD but not for children with ASD. Future studies should focus on causal mechanisms mediating the association between ADHD and injuries in order to facilitate injury prevention strategies. PRACTICAL APPLICATIONS Parents and teachers of schoolchildren with ADHD should be made aware of the elevated injury risks associated with the diagnosis. Safety experts and injury control professionals should consider the development of specialized prevention strategies in order to reduce these risks.

Disclosure of Child Physical Abuse and Perceived Adult Support among Swedish Adolescents

Child abuse is a major public health problem which is largely hidden in the society.The main aim of the thesis was to study child maltreatment from children’s and young people’s perspectives focusing on prevalence, health, disclosure and support.The thesis is based on four studies. Quantitative and qualitative data from three national surveys of child maltreatment, including children in different age groups and young adults, have been analysed.The results showed that child maltreatment is prevalent and there is a large degree of overlap between maltreatment types. Neglect and witnessing intimate partner violence were the types that overlapped most with other types of maltreatment. Child maltreatment was strongly associated to psychosomatic symptoms and impaired quality of life. Young people who have been victims of child maltreatment described the psychological consequences, such as painful memories, low self-esteem and depression. The psychological abuse was described as particularly detrimental. Victims of sexual abuse expressed feelings of shame and guilt. About half of the severely abused children did not disclose the abuse, mainly because of lack of trust in adults. Many children felt that they did not receive adequate support when they disclosed the maltreatment, particularly because they experienced a lack of child perspective among professionals. Children and young people experienced positive support from the school health services which they considered to have a particularly important role in the detection and support of maltreated children. The results emphasize an increased awareness among professionals to recognise and respond to child maltreatment.

Psychological and physical violence towards children with disabilities in Finland and Sweden

This article describes psychological aggression and physical violence by Swedish and Finnish mothers (N = 3420) towards their 0- to 12-year-old children with disabilities (N = 286) by comparing such behaviour with the mothers of children without disabilities (N = 3134). The survey data are based on representative samples from Finland and Sweden of mothers’ reports of their behaviour towards their child in conflict situations. Mothers of children with disabilities reported more psychological aggression towards their child than did mothers of children without disabilities. Mothers used psychological aggression, especially towards children with neurological/psychological disabilities. However, the only significant difference regarding physical violence was repetitive use of mild physical violence. Overall, the analysis suggests that children with neurological/psychological disabilities are more exposed to both psychological and physical violence than children without disabilities or children with somatic/developmental disabilities.

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

ABSTRACT Purpose: Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. Method: We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). Results: The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. Conclusions: The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.

Does gender moderate the association between intellectual ability and accidental injuries? Evidence from the 1953 Stockholm Birth Cohort study

In this paper, we test for gender differences in the effects of intellectual ability on accidental injury risks using longitudinal data from the 1953 Stockholm Birth Cohort study (n=14,294). Intellectual ability was measured using IQ tests issued during a school survey at age ∼13, and outcome and covariate data was collected via record linkage to population and health registers, following the cohort from childhood to 55 years of age. We used ICD codes to identify accidental injuries resulting in hospital admissions and deaths, and shared frailty models to quantify the effects of IQ, while allowing for within-individual dependencies and recurrent events. The models included tests for the moderating effects of gender, as well as childhood family variables (parental socioeconomic status), and cohort member mediators (highest achieved education, socioeconomic status and income at the time of the event). The results indicate an inverse association between childhood IQ and subsequent accidental injury events, where 1 SD decrease in IQ implies a 17.8% increase in injury risk. We also found evidence that gender moderates this relationship, where the effect size was twice as large for men than for women (21.8% vs 9.3% per 1 SD decrease). Adult socioeconomic status can explain roughly half of the observed association. Potential explanations for these results are discussed.

437 Child maltreatment from the perspectives of children and young people – prevalence, health, disclosure and support

Background Child abuse is a major public health problem which is largely hidden in the society. The main aim was to study child maltreatment from the perspectives of children and young people focusing on prevalence, health, disclosure and support. Methods Quantitative and qualitative data from three Swedish national surveys of child maltreatment in the years 2000, 2006 and 2011, including children in different age groups and young adults, have been analysed. Results The results showed that child maltreatment is prevalent and there is a large degree of overlap between maltreatment types. Neglect and witnessing intimate partner violence were the types that overlapped most with other types of maltreatment. Child maltreatment was strongly associated to psychosomatic symptoms and impaired quality of life. Young people who have been victims of child maltreatment described the psychological consequences, such as painful memories, low self-esteem and depression. The psychological abuse was described as particularly detrimental. Victims of sexual abuse expressed feelings of shame and guilt. About half of the severely abused children did not disclose the abuse, mainly because of lack of trust in adults. Many children felt that they did not receive adequate support when they disclosed the maltreatment, particularly because they experienced a lack of child perspective among professionals. Children and young people experienced positive support from the school health services which they considered to have a particularly important role in the detection and support of maltreated children. Conclusions Child abuse is a complex problem where different types of child abuse largely overlap. It is important to consider this overlap when the health outcomes are studied. Child abuse is also a hidden problem since many children do not disclose the abuse. This requires an increased awareness among professionals to recognise and respond to child maltreatment.