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Eur Psychiatry. 2019 May;58:10-18. doi: 10.1016/j.eurpsy.2019.01.018. Epub 2019 Feb 10.

Child maltreatment is mediating long-term consequences of household dysfunction in a population representative sample.

Author information

1
Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany; Department of Psychiatry and Psychotherapy, Section Clinical Neurobiology, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. Electronic address: vera.clemens@uni-ulm.de.
2
Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany. Electronic address: o.berthold@drk-kliniken-berlin.de.
3
Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany. Electronic address: andreas.witt@uniklinik-ulm.de.
4
Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany. Electronic address: cedric.sachser@uniklinik-ulm.de.
5
Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes Gutenberg University of Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany. Electronic address: Elmar.Braehler@medizin.uni-leipzig.de.
6
Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany; Department for Child and Adolescent Psychiatry, Medical University of Vienna, Währingergürtel 18-20, 1090, Vienna, Austria. Electronic address: paul.plener@meduniwien.ac.at.
7
Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Stoystraße 3, 07740, Jena, Germany. Electronic address: bernhard.strauss@med.uni-jena.de.
8
Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany. Electronic address: joerg.fegert@uniklinik-ulm.de.

Abstract

BACKGROUND:

Adverse childhood experiences (ACE) exhibit long-lasting consequences on later life and are considered as a major public health problem. ACEs can be divided into household dysfunctions, which affect the child indirectly, and direct maltreatment. As a high correlation between ACEs in general is known, we assessed the risk for child maltreatment associated with the occurrence of household dysfunctions. To provide a better understanding for the mechanisms leading to the deleterious sequelae of ACEs, we furthermore assessed whether the long-term consequences of household dysfunction are mediated by child maltreatment and thereby might be targeted by effective child protection programs.

METHODS:

A representative sample of the German population above the age of 14 (N = 2531) was assessed in a cross-sectional observational population-based survey.

RESULTS:

The data reveal that mental illness of a household member was associated with significantly increased risks for all child maltreatment subtypes (ORs 4.95-5.55), just as household substance abuse (ORs 5.32-6.98), violence against the mother (ORs 4.43-10.26), incarceration of a household member (ORs 6.11-14.93) and parental separation (OR 3.37-4.87). Child maltreatment partially mediated the association of household mental illness, substance abuse and parental separation with later depression, anxiety, life satisfaction and subjective general health status and completely mediated the associations of intimate partner violence (IPV) and incarceration of a household member with anxiety, depression and subjective health status in adulthood.

CONCLUSIONS:

ACEs linked to household dysfunction are associated with an increased risk for all subtypes of child maltreatment. The assessed widespread consequences of household dysfunction are mediated by child maltreatment. This underlines the role of prevention of child maltreatment in families with household dysfunction and implies child protection as a priority in any interventions.

KEYWORDS:

Adverse childhood experiences (ACE); Child maltreatment; Intimate partner violence (IPV); Mentally ill parents; Parental separation; Parental substance abuse

PMID:
30743239
DOI:
10.1016/j.eurpsy.2019.01.018
[Indexed for MEDLINE]

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