Mary I. Benedict

The association of childhood sexual abuse with depressive symptoms during pregnancy, and selected pregnancy outcomes

OBJECTIVES The objectives were: (1) to investigate the association during pregnancy of sexual abuse before the age of 18 on depressive symptomatology in pregnancy, controlling for the presence of negative life events and challenges; and (2) to investigate the association of selected pregnancy outcomes (maternal labor and delivery factors, infant birth weight and gestational age) with sexual abuse before age 18. METHODS Three hundred fifty-seven primiparous women aged 18 years and older were interviewed between 28-32 weeks gestation with reference to current functioning and past history (Objective 1). Medical record information was abstracted after delivery for pregnancy, labor and delivery factors, and pregnancy outcomes (Objective 2). RESULTS Thirty-seven percent of the women reported past sexual abuse. Prevalence was not associated with ethnic background, educational level, or hospital payment source. Previously sexually-abused pregnant women reported significantly higher levels of depressive symptomatology, negative life events, and physical and verbal abuse before and during pregnancy. There were no significant associations found between past sexual abuse and labor or delivery variables or newborn outcomes. CONCLUSIONS Previously sexually-abused pregnant women reported a wider constellation of past and current functioning problems than nonabused women although past sexual abuse was not associated with pregnancy outcome. Prenatal care provides a unique opportunity to evaluate the impact of life history and current life events during pregnancy, and to develop a coordinated intervention plan.

Reported maltreatment in children with multiple disabilities.

This study examined a population of children with multiple disabilities to investigate whether functional, developmental, or perinatal factors could differentiate children reported and substantiated as maltreated from those not so reported. Data were collected from medical records of a cohort of 500 children evaluated between 1973 and 1984 at the Kennedy Institute in Baltimore, Maryland. Maltreatment reporting was documented through the State of Maryland Abuse Registry and the counties of residence of all study children. Results indicated that the profiles of demographic and family characteristics associated with child maltreatment reporting in this population are consistent with the literature, but child functional and developmental characteristics were not confirmed as risk factors for substantiated maltreatment reports. Indeed, contrary to investigator expectations, the more severely disabled children, in terms of functioning, appeared at less risk of maltreatment than did disabled children functioning at more age-appropriate levels.

Types and frequency of child maltreatment by family foster care providers in an urban population.

Types and frequency of child abuse and neglect reports in family foster care in Baltimore, Maryland as compared to reports among nonfoster families are reported. Data on maltreatment incidents in foster homes were abstracted from Child Protective Services investigation records for the years 1984-1988. Comparisons were made to community reports. Results indicated that foster families had over a three-fold increased frequency of maltreatment reports as compared to nonfoster families. Report frequency was highest for physical abuse with a seven-fold risk of report as compared to nonfoster families. Overall, 20% of foster care reports were substantiated as compared to 35% of nonfoster reports, although the risk of having a substantiated report was significantly higher in foster care. The distribution of report types in foster care differed from those in the community with physical abuse the most frequent allegation in foster care, as compared to neglect as the most frequent allegation in the community. Explanations for these findings including differences in criteria for report and substantiation are advanced.

The Reported Health and Functioning of Children Maltreated While in Family Foster Care.

The ability to assess accurately risk factors for maltreatment while in family foster care is essential for developing prevention and intervention strategies. Yet information about children involved in maltreatment episodes while in foster care is severely limited. This correlational study reports on characteristics, health, and functioning parameters of all 78 children with substantiated maltreatment reports between 1984-1988 in an urban foster care program as compared to a random sample of 229 nonmaltreated children in foster care in the same time period. Almost 50% of the substantiated maltreatment was sexual abuse with the remainder physical abuse and neglect. Problems in health, development, and functioning were reported in the social services record for a large number of all children, but children sexually abused while in care were significantly more likely to have a nonkinship placement, and to have mental health and development problems identified. Physical abuse and neglect while in foster care were not associated with child health and functioning characteristics. The implications of these results are discussed within the context of the data source used.

Maternal perinatal risk factors and child abuse

A retrospective matched pair study was designed to compare maternal perinatal factors such as abnormal pregnancy history and labor and delivery experience in families who subsequently were reported as physically abusive to one or more of their children as compared to non-abusive families. The study population consisted of the mothers of 532 children reported to the Baltimore (Maryland) Department of Social Services as physically abused during the years 1975-77. The comparison group was handmatched to the study group from State of Maryland birth certificates on the basis of the abused childs birth year and sex, maternal race, education and hospital of delivery. The study population was 67% black with a mean maternal education of 10.5 completed years. The abused children were 59% male with 48% less than 2 years of age. Results indicated that selected medical definitions of abnormal pregnancy, labor and delivery did not identify families at differential risk of maltreatment. However, mothers in maltreating families were younger, had shorter birth intervals, less prenatal care and were significantly more likely to have had a stillbirth or reported abortion or a prior child death. Study limitations are addressed as are suggestions for future research.

PHYSICAL DISABILITIES AS RISK FACTORS FOR CHILD MALTREATMENT: A Selected Review

The child maltreatment literature, which implies that children with physical disabilities may be at increased risk for abuse or neglect, is evaluated with reference to theoretical, definitional, and methodological concerns. Research issues are discussed and suggestions made for further delineating and defining the nature of any linkages that may exist.

Current parental stress in maltreating and nonmaltreating families of children with multiple disabilities.

Questionnaires were mailed to families of children with multiple disabilities to investigate whether differences in parental perception of stress and burden of care could be identified in those families who had previously been reported and substantiated as abusive or neglectful as compared to those families who had not been so reported. Two hundred and fifty-seven parents completed Friedrichs revised version of Holroyds Questionnaire on Resources and Stress (QRS-F), an instrument designed to measure stress and burden of care in families of children with disabilities. Twenty-five (9.7%) had previously substantiated maltreatment reports. Results suggest that a history of maltreatment is not related to the familys currently perceived stress levels as measured by the Friedrich scale. Implications of the results are discussed.

Racial differences in health care utilization among children in foster care

Abstract Health services utilization patterns of foster children in Baltimore City, MD are described and health services utilization is compared between black and white foster children. Utilization data were obtained on a sample of 417 children receiving health service payments through the Maryland Medical Assistance program and data cover one year for all children. Black and white children were found to have similar family, and health status characteristics. The total sample had a mean number of 4.6 outpatient visits during the study year with 16.8% having no health care utilization. White children had significantly more mean visits overall (7.1) than did black children (3.9), significantly higher utilization when examined by provider type or reason for visit, and a significantly higher use of ancillary services. A larger proportion of black children had no utilization during the study period. Possible explanations and policy implications of these results are discussed.