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Child Abuse Negl. 2010 Oct;34(10):742-51. doi: 10.1016/j.chiabu.2010.02.011. Epub 2010 Oct 6.

Cumulative risk exposure and mental health symptoms among maltreated youth placed in out-of-home care.

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Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, School of Medicine, University of Colorado Denver, Denver, CO, USA.



Maltreated children placed in out-of-home care are at high risk for exhibiting symptoms of psychopathology by virtue of their exposure to numerous risk factors. Research examining cumulative risk has consistently found that the accumulation of risk factors increases the likelihood of mental health problems. The goal of the current study was to elucidate the relation between cumulative risk and mental health symptomatology.


The study consisted of a sample of 252 maltreated youths (aged 9-11) placed in out-of-home care.


Analyses confirmed the high-risk nature of this sample and identified seven salient risk variables. The cumulative risk index comprised of these seven indicators was a strong predictor of mental health symptoms, differentiating between children who scored in the clinical range with regard to mental health symptoms and those who did not. Finally, the data supported a linear model in which each incremental increase in cumulative risk was accompanied by an increase in mental health problems.


This is the first known study to examine cumulative risk within a sample of youths in out-of-home care.

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