Wanda M. Hunter

Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas

Context. Child maltreatment remains a significant public health and social problem in the United States. Incidence data rely on substantiated reports of maltreatment known to official social service agencies. Objective. The objective of this study was to describe the epidemiologic features of child physical and sexual abuse, on the basis of maternal self-reports. Design, Setting, and Participants. Computer-assisted, anonymous, cross-sectional, telephone surveys (N = 1435) were conducted with mothers of children 0 to 17 years of age in North and South Carolina. Mothers were asked about potentially abusive behaviors used by either themselves or their husbands or partners in the context of other disciplinary practices. They were also asked about their knowledge of any sexual victimization their children might have experienced. Main Outcome Measures. The incidence of physical and sexual maltreatment determined through maternal reports. Results. Use of harsh physical discipline, equivalent to physical abuse, occurred with an incidence of 4.3%. Shaking of very young children as a means of discipline occurred among 2.6% of children <2 years of age. Mothers reported more frequent physical discipline of their children, including shaking, for themselves than for fathers or father figures. Nearly 11 of 1000 children were reported by their mothers as having been sexually victimized within the past year. The incidence of physical abuse determined with maternal self-reports was 40 times greater than that of official child physical abuse reports, and the sexual abuse incidence was 15 times greater. For every 1 child who sustains a serious injury as a result of shaking, an estimated 150 children may be shaken and go undetected. There was no statistically significant difference in the overall rates of physical or sexual maltreatment between the 2 states. Conclusions. Official statistics underestimate the burden of child maltreatment. Supplemental data obtained with alternative strategies can assist policymakers and planners in addressing needs and services within communities and states. These data support the need for continued interventions to prevent maltreatment.

Adverse Behavioral and Emotional Outcomes from Child Abuse and Witnessed Violence

This article examines mental health outcomes of children who have witnessed violence in their social environment and/or have been physically abused. Participants (n = 167) come from a longitudinal study on child maltreatment. Outcomes—including depression, anger, and anxiety—are measured by the Child Behavior Checklist and the Trauma Symptom Checklist for Children. The authors used adjusted multivariate analyses to test the statistical significance of associations. The majority of children were female (57%) and non-White (64%). One third had been physically victimized; 46% had witnessed moderate-high levels of violence. Results confirm that children are negatively affected by victimization and violence they witness in their homes and neighborhoods. Victimization was a significant predictor of child aggression and depression; witnessed violence was found to be a significant predictor of aggression, depression, anger, and anxiety. Implications will be discussed.

Longscan: A consortium for longitudinal studies of maltreatment and the life course of children

The National Research Council (1993) has issued an urgent call for theory-based, longitudinal research to examine the antecedents and consequences of child maltreatment. Many of the concerns raised by the National Research Council are addressed by LONGSCAN (LONGitudinal Studies of Child Abuse and Neglect), a consortium including a coordinating center and five independent prospective longitudinal investigations sharing common protocols for data collection, entry, and management. The children in the five investigations vary by their level of risk, ranging from a community sample with no identified risk beyond low income status, to children placed in foster care. The longitudinal study has been designed with six age-specific data collection points extending from 4 through 20 years of age. The conceptual model, organization, and analytic strategy for LONGSCAN are described.

Impact of legal intervention on sexually abused children

OBJECTIVE Examining the psychologic risks of court and related interventions on child sexual abuse victims. DESIGN A prospective cohort study with follow-up at 5 months. SETTING Eleven county social service departments in central North Carolina. SUBJECTS 100 sexually abused children, ages 6 to 17 years, were recruited from consecutive referrals by social service departments; 75 completed the study. MEASUREMENTS AND RESULTS Using a structured psychiatric inventory, the Child Assessment Schedule, we found a high degree of distress at referral. The level of distress fell by 26% over the next 5 months (p less than 0.001). The 33 children not involved in criminal proceedings improved 30%, in comparison with a 17% improvement in the 22 children waiting for the proceedings (p = 0.042). The 12 children who had testified in juvenile court improved 42% on the Anxiety subscale, in comparison with a 17% improvement in all other subjects (p less than 0.01). With mathematical modeling that controlled for the factors of vaginal or anal penetration, the relationship to the perpetrator, an estimate of verbal IQ, duration of abuse, and whether counseling was received, it was estimated that children waiting for court proceedings at the follow-up examination were only one twelfth as likely to have improved by one standard deviation on the Depression subscale (p less than 0.05). A second model revealed that children who testified in juvenile court were 20.11 times more likely to improve by one standard deviation on the CAS Anxiety subscale (p less than 0.05). CONCLUSIONS Testimony in juvenile court may be beneficial for the child, whereas protracted criminal proceedings may have an adverse effect on the mental health of the victim.

International Variations in Harsh Child Discipline

BACKGROUND: Although the history of recognition of child abuse in Europe and North America extends over 40 years, recognition and data are lacking in other parts of the world. Cultural differences in child-rearing complicate cross-cultural studies of abuse. OBJECTIVE: To ascertain rates of harsh and less-harsh parenting behavior in population-based samples. METHODS: We used parallel surveys of parental discipline of children in samples of mothers in Brazil, Chile, Egypt, India, Philippines, and the United States. Data were collected between 1998 and 2003. The instrument used was a modification of the Parent-Child Conflict Tactics Scale, along with a study-developed survey of demographic characteristics and other parent and child variables. Women (N = 14 239) from 19 communities in 6 countries were surveyed. We interviewed mothers aged 15 to 49 years (18–49 years in the United States) who had a child younger than 18 years in her home. Sample selection involved either random sampling or systematic sampling within randomly selected blocks or neighborhoods. RESULTS: Nearly all parents used nonviolent discipline and verbal or psychological punishment. Physical punishment was used in at least 55% of the families. Spanking rates (with open hand on buttocks) ranged from a low of 15% in an educated community in India to a high of 76% in a Philippine community. Similarly, there was a wide range in the rates of children who were hit with objects (9%–74% [median: 39%]) or beaten by their parents (0.1%–28.5%). Extremely harsh methods of physical punishment, such as burning or smothering, were rare in all countries. It is concerning that ≥20% of parents in 9 communities admitted shaking children younger than 2 years. CONCLUSIONS: Physical and verbal punishments of children are common in high-, middle-, and low-income communities around the world. The forms and rates of punishment vary among countries and among communities within countries. A median of 16% of children experienced harsh or potentially abusive physical discipline in the previous year.

Are Father Surrogates a Risk Factor for Child Maltreatment

Most research on the effect of father figures in the home on the incidence of child maltreatment has been cross-sectional and has focused on sexual abuse. This prospective studys purpose is to determine if the presence of a father surrogate in the home affects the risk of a subsequent child maltreatment report. In a longitudinal sample of at-risk children, North Carolinas Central Registry for Child Abuse and Neglect was used to determine the maltreatment history of children from birth to age 8 years. Children who had a father surrogate living in the home were twice as likely to be reported for maltreatment after his entry into the home than those with either a biological father (odds ratio = 2.6, 95% confidence interval = 1.4-4.7) or no father figure in the home (odds ratio = 2.0, 95% confidence interval = 1.1-3.5).

Directly Questioning Children and Adolescents About Maltreatment A Review of Survey Measures Used

The methodological, legal, and ethical issues related to questioning children about their maltreatment experiences in research studies are complex. A review of the literature was conducted examining what studies to date have directly asked children about victimization and how study investigators dealt with the human participants issues related to subsequent disclosure. This article examines how different studies have defined and operationalized abuse in survey questions for children, reports prevalence rates when available, describes the differing methods used to collect child self-report data, and highlights how investigators have dealt with the ethical issues related to informed consent and disclosure up to this point.

Suicidal Ideation Among 8-Year-Olds Who Are Maltreated and At Risk: Findings From the LONGSCAN Studies

Suicidal ideation was examined among 1,051 8-year-old children identified as maltreated or at risk for maltreatment. Of these children, 9.9% reported suicidal ideation. Many variables, including maltreatment, had bivariate associations with suicidal ideation. Severity of physical abuse, chronicity of maltreatment, and the presence of multiple types of maltreatment strongly predicted suicidal ideation. In multivariate analyses of the domains of proximity, only ethnic background remained significant among demographic variables, only witnessed violence and maltreatment remained significant among family or contextual variables, and only child psychological distress, substance use, and poor social problem solving remained significant among child variables. The effects of ethnicity, maltreatment, and witnessed violence on suicidal ideation were mediated by child functioning. There were few interactions between maltreatment and other factors to predict suicidal ideation. Children who are maltreated and those exposed to community and domestic violence are at increased risk of suicidal ideation, even by age 8.

The world studies of abuse in the family environment (WorldSAFE): a model of a multi-national study of family violence

The World Studies of Abuse in the Family Environment (WorldSAFE) designed and implemented a study of family violence – intimate partner violence and child abuse and neglect – using standardized methods to cover over 12,000 women in eighteen communities within five lesser-developed countries. The rationale, process and methods for developing the population-based survey are described. Standardized methods included common training of investigators and field staff, sampling strategies, eligibility criteria, instruments, data collection methods, operational definitions, analysis strategies and data management. Special features of the WorldSAFE model are described – namely an ecological conceptual framework, an extensive and broad-based dissemination strategy, and community advisory boards. The World Studies of Abuse in the Family Environment (WorldSAFE) Steering Committee and principal investigators are as follows: Bhopal (India): Gandhi Medical College, S.S. Bhambal (MD) and A.K. Upadhyaya (MD) Chapel Hill (USA): University of North Carolina at Chapel Hill, Shrikant Bangdiwala (PhD); Wanda Hunter (MPH); Desmond K. Runyan (MD, DrPH); and Laura S. Sadowski (MD, MPH) Chennai (India): Chennai Medical College, Saradha Suresh (MD) and Shuba Kumar (PhD) Delhi (India): All India Institute of Medical Sciences, R.M. Pandey (PhD) Ismailia (Egypt): Suez Canal University Faculty of Medicine, Fatma Hassan (MD, PhD) Lucknow (India): King Georges Medical College, M.K. Mitra (MD) and R.C. Ahuja (MD) Manila (the Philippines): University of the Philippines School of Medicine, Laurie Ramiro (PhD); M. Lourdes Amarillo (MS); Bernadette Madrid (MD) Nagpur (India): Government Medical College, Dipty Jain (MD) São Paulo (Brazil): Escola Paulista de Medicina, Isabel Bordin (MD) and Cristiane Silvestre De Paula Temuco (Chile): Universidad de La Frontera, Sergio R. Muñoz (PhD) and Beatriz Vizcarra Thiruvananthapuram (India) formerly Trivandrum: Government Medical College, M.K.C. Nair (MD) and Rajamohanan Pillai (MD) Vellore (India): Christian Medical College, L. Jeyaseelan (PhD) and Abraham Peedicayil (MD)

Partner Violence as a Risk Factor for Mental Health Among Women From Communities in the Philippines, Egypt, Chile, and India

Although studies have documented the association between Intimate Partner Violence (IPV) and mental health, few have been done in developing countries. In this study, the association between IPV and mental health in women from different developing countries was established. Women, 15 to 49 years old with at least one child 18 years old or younger, were randomly selected from communities in Chile, Egypt, India, and the Philippines (N = 3974). The Self Report questionnaire (SRQ) was used to assess mental health. Women with a score on the SRQ of 8 or more, or who reported ever attempting suicide, were classified as having poor mental health. Physical IPV was defined as being slapped, hit, kicked, beaten or threatened by a male partner during the past year. Psychological violence included being insulted or belittled, threatened or abandoned. Between 22.5% (in Egypt) to 41% (in Chile) of participating women reported a score of eight or more on the SRQ. High scores on the SRQ were significantly associated with current physical and psychological IPV in the samples from all participating countries except Chile. Twelve percent of women in Chile, 2.6%, in Egypt, 7.5% in India and 1.6% in the Philippines reported attempting suicide. Suicide attempts were also associated with current physical IPV in the Philippines, Egypt, and India, and with psychological violence in Egypt and India. IPV is a significant risk factor for poor mental health in these developing countries. Efforts to reduce IPV should be considered as part of a mental health program.