Wendy E. Hovdestad

A systematic review of childhood maltreatment assessments in population-representative surveys since 1990

Background Population-representative surveys that assess childhood maltreatment and health are a valuable resource to explore the implications of child maltreatment for population health. Systematic identification and evaluation of such surveys is needed to facilitate optimal use of their data and to inform future research. Objectives To inform researchers of the existence and nature of population-representative surveys relevant to understanding links between childhood maltreatment and health; to evaluate the assessment of childhood maltreatment in this body of work. Methods We included surveys that: 1) were representative of the non-institutionalized population of any size nation or of any geopolitical region ≥ 10 million people; 2) included a broad age range (≥ 40 years); 3) measured health; 4) assessed childhood maltreatment retrospectively; and 5) were conducted since 1990. We used Internet and database searching (including CINAHL, Embase, ERIC, Global Health, MEDLINE, PsycINFO, Scopus, Social Policy and Practice: January 1990 to March 2014), expert consultation, and other means to identify surveys and associated documentation. Translations of non-English survey content were verified by fluent readers of survey languages. We developed checklists to abstract and evaluate childhood maltreatment content. Results Fifty-four surveys from 39 countries met inclusion criteria. Sample sizes ranged from 1,287-51,945 and response rates from 15%-96%. Thirteen surveys assessed neglect, 15 emotional abuse; 18 exposure to family violence; 26 physical abuse; 48 sexual abuse. Fourteen surveys assessed more than three types; six of these were conducted since 2010. In nine surveys childhood maltreatment assessments were detailed (+10 items for at least one type of maltreatment). Seven surveys’ assessments had known reliability and/or validity. Conclusions and Implications Data from 54 surveys can be used to explore the population health relevance of child maltreatment. Assessment of childhood maltreatment is not comprehensive but there is evidence of recent improvement.

Relationship between child abuse exposure and reported contact with child protection organizations: Results from the Canadian Community Health Survey

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design (n=23,395; household response rate=79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR=15.8; 95% CI=10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse.

Anxiety and/or Depression in 10–15-Year-Olds Investigated by Child Welfare in Canada

PURPOSE To examine five types of child maltreatment and other risk correlates to establish associations with anxiety and/or depression confirmed or suspected in children investigated by child welfare services. METHODS The present study used the data of a subsample of 10-15-year-olds (n = 4,381) investigated by child welfare services across Canada obtained from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003. The analysis took into account the nested structure of the data by considering the variability existing among families and the clustering of siblings within them. Several models were analyzed for the construction of the presented hierarchical model. Striving for parsimony, we included only statistically significant variables in the final model. RESULTS The strongest associations were found with child substance abuse, substantiated emotional maltreatment, primary caregivers mental health problems, and substantiated sexual abuse. Among the child maltreatment variables, substantiated physical abuse and substantiated exposure to domestic violence did not show any statistically significant associations with anxiety and/or depression in the model. CONCLUSION This analysis helped us in understanding child maltreatment and other adverse experiences in childhood that were related to anxiety and/or depression, which can further aid in the development of mental health and child welfare policies and programs.

Policy Makers’ Perspectives on the Utility of a National Study of Child Maltreatment

Reliable national child maltreatment data are needed for developing and modifying policies aimed at preventing child maltreatment and helping child victims of maltreatment. Health Canada hosted a daylong forum in 2002 to solicit feedback from senior Government of Canada policy and program officials involved in child welfare programs and research in regard to the data collected in the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). This article reviews the discussions and debates regarding the utility of the CIS data for government policy makers and reflects on the implications for surveillance and knowledge in the area of child maltreatment. The key themes are definitions and measurement issues, the value of enhanced and additional data, and challenges to linking research and practice.

Commentary on Canadian Child Maltreatment Data

The issue of how to best collect child maltreatment data is a key concern within the Public Health Agency of Canada (PHAC). We argue that maltreatment data can be collected from children, adolescents, and parents with approaches that are accurate, methodologically robust, legal, and ethical. It has been done in other countries. First, we clarify ongoing child maltreatment data collection by the Canadian government and address PHAC initiatives to include child maltreatment questions in national contemporaneous surveys. Second, we identify examples of population-based studies with child, adolescent, and parent respondents. Third, we highlight some measurement considerations. Fourth, we address ethical considerations in conducting this type of research.

Child maltreatment in Disney animated feature films: 1937–2006

Abstract The 45 fully animated, theatrical release feature films produced by Disney between 1937 and 2006 were analyzed for child maltreatment content. All child and adolescent characters were counted and coded for age, role type and incidents of child maltreatment, following US National Incidence Study of Child Abuse and Neglect (NIS) criteria. A total of 561 incidents of child maltreatment were identified among the 1369 child characters in the films. A total of 26 of the 42 (62%) main child characters were maltreated at least once. Findings are discussed in the context of previous research. Implications of the findings for understanding potential effects on film viewers’ understandings of issues around child maltreatment are outlined.

Erratum to: Childhood maltreatment as a risk factor for diabetes: findings from a population-based survey of Canadian adults

It is well established that childhood maltreatment (CM) is a risk factor for various mental and substance use disorders. To date, however, little research has focused on the possible long-term physical consequences of CM. Diabetes is a chronic disease, for which an association with CM has been postulated. Based on data from a sample of 21,878 men and women from the 2012 Canadian Community Health Survey - Mental Health (CCHS - MH), this study examines associations between three types of CM (childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV)) and diabetes in adulthood. Multiple logistic regression models were used to examine associations between CM and diabetes controlling for the effects of socio-demographic characteristics and risk factors for type 2 diabetes. When controlling socio-demographic characteristics, diabetes was significantly associated with reports of severe and frequent CPA (OR = 1.8) and severe and frequent CSA (OR = 2.2). A dose–response relationship was observed when co-occurrence of CSA and CPA was considered with the strongest association with diabetes being observed when both severe and frequent CSA and CPA were reported (OR = 2.6). Controlling for type 2 diabetes risk factors attenuated associations particularly for CPA. CEIPV was not significantly associated with having diabetes in adulthood. CPA and CSA are risk factors for diabetes. For the most part, associations between CPA and diabetes are mediated via risk factors for type 2 diabetes. Failure to consider severity and frequency of abuse may limit our understanding of the importance of CM as a risk factor for diabetes.

The Canadian Incidence Study of Reported Child Abuse and Neglect: Implications for Federal Responses to Child Maltreatment

In Canada, provinces and territories directly deliver services related to child maltreatment, but various federal departments share responsibility for responding in other ways. The Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) is one of the Public Health Agencys contributions. This paper presents an overview of its key findings, and points to some implications for program and policy development. CIS data suggest that neglect is the most common type of child maltreatment in Canada, followed by physical abuse, emotional maltreatment and sexual abuse. Because CIS data suggest that parents and other adult relatives are most often the perpetrators of child maltreatment, and that the maltreatment rarely results in severe physical harm, federal support of parenting education programs may be a useful response to the problem of child maltreatment.

Childhood maltreatment as a risk factor for COPD: findings from a population-based survey of Canadian adults

Objective The aim of this study was to examine the associations between childhood maltreatment (CM) and COPD in adulthood. Methods Data were from 15,902 respondents to the 2012 Canadian Community Health Survey – Mental Health. Multiple logistic regression models were used to examine associations between CM and COPD and the role of smoking and mental and substance use variables as mediators in associations. Results COPD in adulthood was related to CM, with associations differing by sex. Among females, COPD was related to childhood physical abuse (CPA), childhood sexual abuse, and childhood exposure to intimate partner violence, but in the fully adjusted models, the association with CPA did not persist. Among males, COPD was related to childhood exposure to intimate partner violence and severe and frequent CPA, but these associations did not persist in the fully adjusted models. Conclusion Results from this study establish CM as a risk factor for COPD in adulthood. A large part of the association is attributable to cigarette smoking, particularly for males. These findings underscore the importance of interventions to prevent CM as well as programs to assist victims of CM in dealing with tobacco addiction.

The potential use of social media and other internet-related data and communications for child maltreatment surveillance and epidemiological research: Scoping review and recommendations

Abstract Collecting child maltreatment data is a complicated undertaking for many reasons. As a result, there is an interest by child maltreatment researchers to develop methodologies that allow for the triangulation of data sources. To better understand how social media and internet-based technologies could contribute to these approaches, we conducted a scoping review to provide an overview of social media and internet-based methodologies for health research, to report results of evaluation and validation research on these methods, and to highlight studies with potential relevance to child maltreatment research and surveillance. Many approaches were identified in the broad health literature; however, there has been limited application of these approaches to child maltreatment. The most common use was recruiting participants or engaging existing participants using online methods. From the broad health literature, social media and internet-based approaches to surveillance and epidemiologic research appear promising. Many of the approaches are relatively low cost and easy to implement without extensive infrastructure, but there are also a range of limitations for each method. Several methods have a mixed record of validation and sources of error in estimation are not yet understood or predictable. In addition to the problems relevant to other health outcomes, child maltreatment researchers face additional challenges, including the complex ethical issues associated with both internet-based and child maltreatment research. If these issues are adequately addressed, social media and internet-based technologies may be a promising approach to reducing some of the limitations in existing child maltreatment data.