Dimitrinka Jordanova Peshevska

Relationships and Community Risk Factors for Elder Abuse and Neglect: Findings from the First National Prevalence Study on Elder Maltreatment

Abstract OBJECTIVES: The objective of the study was to mesaure the 12-months prevalence of elder abuse and neglect in private huousehold and to examine the relationship and community level risk factors for elder abuse and neglect. METHOD: Total of 960 respondents aged 65 years and above in private households, from all eight statistical regions participated in the study. Nationally stratified quota sampling procedure was applied, through four stages. Information was collected in face-to face interview on sociodemographic, healthy life style, physical and mental health, and abuse and neglect types characteristics of elder population. Data were examined using descriptive statistics, binary logistic regression, and odd ratios (OR). Statistical significance was set up at p < 0.05. RESULTS: The respondents reported prevalence of psychological abuse 25.7%, followed by financial abuse 12 %, neglect 6.6%, physical abuse 5.7%, physical injury 3.1%, and sexual abuse 1.3% (reported only in female respondents) in the previous 12-months. Living with close relatives, dissatisfaction with the household income, less equipped households, lacking property of house/flat are associated risk factors for elder maltreatment on relationship level. Living in the northeast, southeast, and Polog region are associated risk for elder maltreatment. CONCLUSION: Study findings emphasised the previous data obtained with regards to the community and relationships risk factors for elder maltreatment.

Childhood Abuse, Household Dysfunction and the Risk of Attempting Suicide in a National Sample of Secondary School and University Students

Abstract OBJECTIVES: One of the main objectives of this paper is to analyze the associations between childhood abuse, household dysfunction and the risk of attempting suicide among young adolescents in the country. METHOD: A representative sample consisted of total 1277 students (58.6% female and 41.6% male), aged 18 and above in year four of 664 secondary school and 613 first- and second-year university students. The data were obtained using Adverse Childhood Experiences Study Questionnaires (Family Health History Questionnaire) for collecting information on child maltreatment, household dysfunction and other socio-behavioural factors, applying WHO/CDCrecommended methodology. Statistical significance was set up at p<0.05. RESULTS: Emotional neglect, physical abuse and physical neglect were the most frequent abusive experiences students had. Overall, suicide attempts were reported by 3.1 % of respondents (4.7% by females and 0.8% by males). Those respondents who had been emotionally abused were almost three times as likely to attempt suicide, physical abuse almost doubles the chances of attempting suicide, substance abuse in the family increased the chances 2.3 times for attempting suicide, violent treatment of the mother almost quadrupled them for attempted suicide, having a family member who had been in prison increased the odds of almost 3.5 times for attempting suicide. Attempted suicide was found to be 1.5 times more likely as the number of ACEs reached 3 and 3.4 times more likely as the number of adverse childhood experiences reached four or more. CONCLUSION: Identifying and treating children, adolescents and young adults who have been affected by adverse childhood experiences may have substantial value in our evolving efforts to prevent suicide

PW 1018 Abuse and neglect in childhood associated with individual, relational and contextual factors among adolescents

Introduction Research and evidence present strong association between adverse experiences of abuse and neglect in childhood with resilience. Exploring the resilient factors and why some children stand out despite early adverse experiences in childhood is essential, because it can children to develop their entire capacity. The main purpose of this paper is to describe and analyse the associations between child abuse and neglect and individual, relational, contextual factors in adolescents. Method Representative retrospective two stage quota sample of 620 adolescents (university students) was applied in the study. The adolescents were first-and second-year university students recruited from the 12 faculties as of the main public university in the country ‘St Cyril and Methodius, Skopje’. The data were obtained using Adverse Childhood Experiences Study International Questionnaires for collecting information on child abuse and neglect, while the individual, relational and contextual resilient factors were measured using the Child and Youth Resilience Measure – Youth version. The study was conducted from February to May 2017. Statistical significance was set up at p<0.05. Results The findings showed statistically significant negative correlation between individual (r=−0.159), relational (r=−0.263), and contextual factors (r=−0.147) and resilience in total (r=−0.232) with psychological abuse. The findings also confirmed statistically significant negative correlation between the individual (r=−0.194), relational (r=−0.224), contextual (r=−0.109) factors, and resilience in total (r=−0.215) with physical abuse. Findings confirmed statistically significant negative correlation between the individual (r=−0.125), relational (r=−0.228), contextual (r=−0.101) factors and resilience in total (r=−0.154) with neglect in childhood. Conclusion Protective resilient factors on individual, relational, and contextual level in childhood are critical determinants that contribute to the development of resilience in young children and adolescents enabling safety and healthy growth for upcoming generations.

255 Situation analysis on child maltreatment prevention in several South East European countries

Background Child maltreatment is a serious public health problem that has graved impact on health and well-being of children. The current situation of child maltreatment in Macedonia, Montenegro, Serbia and Albania, aimed to identify the gaps and needs, and take further actions for prevention in line with the recommendations of the European report on preventing child maltreatment and the WHO European child maltreatment prevention action plan 2015–2020. Methods In the period of November 2014 to October 2015 the situation analysis have been conducted in four respected countries. The analysis relies on: 1) assessments with the relevant stakeholders by semi-structured interviews and 2) computer-based search in the area of: policy framework, legal framework, researches and study data obtained; and surveillance data. Results Macedonia and Albania has prohibited corporal punishment in all settings, and in Montenegro and Serbia needs to be additionally legalised in home setting, still the prevalence rates of physical violence are high in all countries from 21% in Macedonia up to 40% in Albania. The policy framework targeting child abuse and neglect have been implemented in Macedonia and Serbia covering both protection and prevention. In Montenegro and Albania, the policy has tackled child abuse and neglect in other cross-cutting policy documents. Majority of the services are provided by the protection services and less on implementing evidence based preventing programmes. The heath, social, police, education and justice sectors need coordinated approach in delivering the quality services for recording, detection, treatment, prevention and protection of children. The relevant data suggest persisting of inequalities. Conclusions Policy and legal frameworks in the countries supports suitable platform for child maltreatment prevention in the respected countries. Still there is a need for comprehensive policy with an emphasis on prevention. Additionally, the legal framework in the countries should enable ban of corporal punishment in all settings and reinforcement. The response should facilitate multisectoral approach and collaboration and tailored programmes, plans that combat social inequalities such as: rural/urban, regional, children living in poverty and families at risk.

Mental Health, Physical Health and Other Individual Risk Factors for Elder Maltreatment: Findings from the National Study

Abstract OBJECTIVES: The first Macedonian National Prevalence study of elder maltreatment in private settings was conducted in 2011 and 2012. This article provides an overview of the risk factors on individual level regarding the ecological model of human development. METHOD: The study involved 960 respondents who provided answers to a face-to-face survey questionnaire and a Geriatric Depression Scale. The Mini-Mental State Examination test was used as a pre selection criterion. The achieved sample was weighted to be representative on the Macedonian population aged 65 and over. RESULTS: Being women, being married, with elementary school education, suffering from certain chronic diseases, sensory impairment, are potential risk factors on individual level for elderly Maltreatment. CONCLUSION: The findings support the previous quantitative data obtained in other countries, as well as the concept of ecological framework.

Relationship between Child Maltreatment and Alcohol Abuse - Findings from Adverse Childhood Experience Study in Republic of Macedonia

Abstract OBJECTIVES: The aim of the study is to determine the relationship between of the problem of alcohol abuse and child maltreatment. METHOD: The ACE study was administered by the University Clinic of Psychiatry, Department for Child and Adolescent Psychiatry. The ACE study used a representative sample of students in year four of secondary school (aged 18 and above) and first- and second-year university students. The sample consisted of 664 secondary school students (258 males and 406 females.The university student sample consisted of 613 (343 female and 270 male) students from four universities. The data were obtaining by applying ACE Study Questionnaires. RESULTS: Individuals who experience psychological abuse are more prone to develop alcoholism. One of the most serious risk factors for abuse and neglect of children was alcoholism, as a form of household dysfunction. Overall, 13.4% of students lived with someone who misused alcohol. Overall, 10.7% lived with someone who was alcoholic. The association to each ACE was highest among respondents who grew up with two alcohol-abusing parents compared with persons with no alcohol-abusing parents. The health-risk behaviours of most concern included among the others alcohol use (by 82.2% of students). Alcohol use is widespread among students and its prevalence rate is almost 28% by both sexes, and they start drinking at the age of 14-15. CONCLUSION: Among the most frequent household dysfunctions was alcohol use by a family member and about 82% of respondents had ever used alcohol.

Gender as Individual Risk Factor for Elderly Abuse: Findings from First National Prevalence Study in Macedonia

Abstract BACKGROUND: National prevalence study of elderly abuse in Macedonia intended to explore prevalence and risk factors of elder abuse and neglect. This paper is focused on influence of the gender as individual risk factor, according to ecological model, on elderly abuse and neglect. METHODS: Culturally validated questionnaire and Geriatric Depression scale was used for data collection. Mini Mental State Examination (MMSE) test, was used for sample selection. Cutting score was 20. The research was conducted through face-to-face interviews on the sample of 960 respondents aged 65 and over. RESULTS: Evidenced were 32% abused and neglected from representative sample, living in private households, 19% of abused was female. In Macedonian study women are 1.6 times often victims of abuse than man. Only female respondents reported sexual abuse. CONCLUSION: Being female is risk factor for being exposed on any type of abuse and neglect, excluding financial abuse

Preventing Interpersonal Violence in Europe

Abstract AIM: To describe the burden of interpersonal violence, risk factors and discuss the need for evidence based action to reduce the public health threat of interpersonal violence. METHODS: Global Health Estimates data were used to describe the mortality and meta-analyses from previous reports were used to describe the prevalence of the different types of interpersonal violence and to discuss the options for evidence informed prevention programmes. RESULTS: In the 53 countries of the WHO European Region, violence kills about 160,000 people each year, and of these around 31,000 die from interpersonal violence, 123,000 from self-inflicted violence and 2,000 from war. Deaths are just the tip of the iceberg and for every death there are numerous admissions to hospital and emergency departments. Interpersonal violence is thought to be one of the most frequently experienced yet commonly overlooked forms of violence. Based upon data from meta-analyses of population surveys in Europe: the prevalence in children under 18 years of sexual abuse is 9.6% (13.4% in girls and 5.7% in boys); physical abuse is 22.9% and 29.1% for emotional abuse; the prevalence of intimate partner violence (physical and or sexual violence) is 19.3% in high-income countries and 25.6% in low- and middle-income countries, suggesting that about 49 million women aged 14-49 years have been abused. Surveys of older people over 60 years, suggest that the past year prevalence of physical abuse is 2.7%, sexual abuse 0.7%, emotional abuse 19.% and financial abuse 3.8%, suggesting the numbers experiencing elder maltreatment in Europe run into the tens of millions CONCLUSION: Community surveys can play an important role to better understand the scale and risk factors of different types of interpersonal violence. Readers are called upon to support a coordinated public health response to prevent this societal and health threat.

Evaluation the risk of violence between individuals with paranoid disorder

Introduction The connection between psychiatric disorders and aggressive behaviour, especially homicides, as extreme shape of human aggression, is confirmed with many surveys. The purpose of the investigation is to analyse psycho pathological, psychological and social characteristics of subgroups of patients, which have been diagnosed as paranoid states and which is with risk of aggressive manifestation, including homicides. Material and Methods The investigation was conducted in the Psychiatric Hospital- Demir Hisar and the Community Mental Health Centre-Prilep. Experimental and control group has 50 patients. In the first group, the patients were homicide perpetrators, and in the second group, they were not perpetrators of any criminal act. Both groups were submitted to BPRS (Brief Psychiatric Rating Scale), LOBI (List Of Basic Information), Paranoid Scale, Scale of Aggression (Cattel) MM PI and Forensic Questionnaire. Conclusions Investigation shows increased values of the most of the variables of the experimental group, compared with the same variables of the control group. Discussion The specific psycho pathological variables, which are connected with committing homicide, are anxiety, hostility, grandiosity, aggression, uncooperativeness and excitement. The psychological variables are the increase values of the paranoid symptoms and aggression, socio pathological orientation and the increase value of the hysteric scale. They are separated according to the significance in the homicide desire of the persons with paranoid states. The evaluation of these variables in everyday clinical practice of the persons with paranoid states means the base for prevention and prediction of the aggressive behaviour, including homicide.