Attachment--and loss.

In 1996, the World Health Assembly declared violence a major public health issue. To follow up on this resolution, on October 3 this year, WHO released the first World Report on Violence and Health. The report analyses different types of violence including child abuse and neglect, youth violence, intimate partner violence, sexual violence, elder abuse, self-directed violence, and collective violence. For all these types of violence, the report explores the magnitude of the health and social effects, the risk and protective factors, and the types of prevention efforts that have been initiated. The launch of the report will be followed by a 1-year Global Campaign on Violence Prevention, focusing on implementation of the recommendations. This article summarises some of the main points of the world report.

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World report on violence and health

Background: Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes. Methods and Findings: A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR)=1.54; 95% CI 1.16–2.04], emotional abuse [OR=3.06; 95% CI 2.43–3.85], and neglect [OR=2.11; 95% CI 1.61–2.77]); drug use (physical abuse [OR=1.92; 95% CI 1.67–2.20], emotional abuse [OR=1.41; 95% CI 1.11–1.79], and neglect [OR=1.36; 95% CI 1.21–1.54]); suicide attempts (physical abuse [OR=3.40; 95% CI 2.17–5.32], emotional abuse [OR=3.37; 95% CI 2.44–4.67], and neglect [OR=1.95; 95% CI 1.13–3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR=1.78; 95% CI 1.50–2.10], emotional abuse [OR=1.75; 95% CI 1.49– 2.04], and neglect [OR=1.57; 95% CI 1.39–1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships. Conclusions: This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence. Please see later in the article for the Editors’ Summary.

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The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis

Part I: The Basic Account. 1. Language and Cognition: Constructing an Alternative Approach Within the Behavioral Tradition S.C. Hayes, et al. 2. Derived Relational Responding as Learned Behavior S.C. Hayes, et al. 3. Multiple Stimulus Relations and the Transformation of Stimulus Functions D. Barnes-Holmes, et al. 4. Relations Among Relations: Analogies, Metaphors, and Stories I. Stewart, et al. 5. Thinking, Problem-Solving, and Pragmatic Verbal Analysis S.C. Hayes, et al. 6. Understanding and Verbal Regulation D. Barnes-Holmes, et al. 7. Self and Self-Directed Rules D. Barnes-Holmes, et al. 8. Relational Frame Theory: A Precis S.C. Hayes, et al. Part II: Extensions and Applications. 9. Psychological Development Y. Barnes-Holmes, et al. 10. Education Y. Barnes-Holmes, et al. 11. Social Processes B. Roche, et al. 12. Psychopathology and Psychotherapy K.G. Wilson, et al. 13. Religion, Spirituality, and Transcendence D. Barnes-Holmes, et al. Epilogue. References. Index.

Relational Frame Theory: A Post-Skinnerian Account Of Human Language And Cognition

ContextSuicide is a leading cause of death in the United States, but identifying
persons at risk is difficult. Thus, the US surgeon general has made suicide
prevention a national priority. An expanding body of research suggests that
childhood trauma and adverse experiences can lead to a variety of negative
health outcomes, including attempted suicide among adolescents and adults.ObjectiveTo examine the relationship between the risk of suicide attempts and
adverse childhood experiences and the number of such experiences (adverse
childhood experiences [ACE] score).Design, Setting, and ParticipantsA retrospective cohort study of 17 337 adult health maintenance
organization members (54% female; mean [SD] age, 57 [15.3] years) who attended
a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997)
and completed a survey about childhood abuse and household dysfunction, suicide
attempts (including age at first attempt), and multiple other health-related
issues.Main Outcome MeasureSelf-reported suicide attempts, compared by number of adverse childhood
experiences, including emotional, physical, and sexual abuse; household substance
abuse, mental illness, and incarceration; and parental domestic violence,
separation, or divorce.ResultsThe lifetime prevalence of having at least 1 suicide attempt was 3.8%.
Adverse childhood experiences in any category increased the risk of attempted
suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted
suicide during childhood/adolescence and adulthood (P<.001).
Compared with persons with no such experiences (prevalence of attempted suicide,
1.1%), the adjusted odds ratio of ever attempting suicide among persons with
7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1).
Adjustment for illicit drug use, depressed affect, and self-reported alcoholism
reduced the strength of the relationship between the ACE score and suicide
attempts, suggesting partial mediation of the adverse childhood experience–suicide
attempt relationship by these factors. The population-attributable risk fractions
for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and
childhood/adolescent suicide attempts, respectively.ConclusionsA powerful graded relationship exists between adverse childhood experiences
and risk of attempted suicide throughout the life span. Alcoholism, depressed
affect, and illicit drug use, which are strongly associated with such experiences,
appear to partially mediate this relationship. Because estimates of the attributable
risk fraction caused by these experiences were large, prevention of these
experiences and the treatment of persons affected by them may lead to progress
in suicide prevention.

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Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span Findings From the Adverse Childhood Experiences Study

Social behavior and peer status of 87 physically abused 8-12-year-old urban children were compared with those of 87 case-matched nonmaltreated classmates. Peer nominations and peer ratings were collected in classrooms, social networks were assessed by child interview, family variables were assessed by interviewing mothers, and behavior problems were rated by parents and teachers. Significant findings were that abused children had lower peer status and less positive reciprocity with peers chosen as friends; they were rated by peers as more aggressive and less cooperative and by parents and teachers as more disturbed; and their social networks showed more insularity, atypicality, and negativity. Social behavior as perceived by peers accounted for a significant portion of the variance in social status; global disturbance measures did not add to this association. Results are discussed in terms of a context of family violence in the development of social maladjustment.

The effects of physical abuse on children's social relationships.

OBJECTIVE: The present study examined whether physical abuse functions as an additional risk factor for adolescent psychopathology after other important known risk factors are controlled for. METHOD: The authors recruited 99 adolescents aged 12 to 18 years directly from the New York State Department of Social Services after official documentation of physical abuse. The abused adolescents were compared to 99 nonabused adolescents matched for age, gender, race, and community income. Diagnostic interviews and measures of selected risk factors for psychopathology were administered to the adolescents and their parents and then entered into a multiple logistic regression model testing the added risk contributed by physical abuse to adolescent psychopathology. RESULTS: Physical abuse added significantly to other risk factors in accounting for lifetime diagnoses of major depression, dysthymia, conduct disorder, drug abuse, and cigarette smoking. Physical abuse also contributed significantly to prediction of curre...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.155.7.954

Adolescent Physical Abuse: Risk for Adolescent Psychiatric Disorders

This study examines the moderating roles of guardian and peer support and behavioral coping strategies on the relations between youths' community violence exposure and their delinquent behavior. A sample of 667 public school sixth-graders in a large inner-city school district, and their parents or guardians, were interviewed to assess youths' recent exposure to community violence, their delinquent behavior, and proposed moderating variables. Support from guardians buffered the relation between girls' victimization by community violence and delinquency. Support from peers buffered the effects of witnessing community violence on delinquent behavior of boys, but it amplified the effects of victimization for both girls and boys. Avoidant coping behavior buffered the effect of victimization on delinquency for boys but unexpectedly amplified the effect of witnessing violence on delinquency for girls. For both genders, confrontational coping strategies amplified the impact of victimization on delinquency and, for boys only, amplified the impact of witnessing violence as well. Controls were imposed for variables expected to influence the relation between exposure and delinquency, such as ethnicity, family violence, delinquent behavior of friends, and recruitment cohort. Suggestions for future research and implications for intervention are discussed. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 489–512, 2003.

Community violence exposure and delinquent behaviors among youth: The moderating role of coping

The social networks of 32 mothers in families being treated in a hospital-based program for indicated cases of child abuse and neglect were compared to the networks of a demographically comparable control group of 24 mothers whose children were not subject to maltreatment. The clinic mothers were found to be more isolated and more insulated from other people in their -networks. Their isolation reflected a deficiency primarily in their peer connections, and their insularity served to separate their immediate families from their peer connections and from the rest of their families. Child and adolescent maltreatment has become more noticeable to the public in recent years as our information-gathering systems have become more efficient and reports issued have revealed its deleterious effects on children (American Health Association, 1976; American Humane Association, 1978; Konopka, 1975; Straus, Gelles, & Steinmetz, 1980; Child Protective Services, Note 1). Severe maltreatment of children by members of their families is unsanctioned by all social communities. There are cultural differences in disciplinary child-rearing practices that share some of the attributes of violence, as described in Erlanger's (1974) review, but nevertheless, there are limits and standards set by all social groups regulating such behavior and specifying the contexts in which and the extent to which it is permitted. The behavior we are concerned with, child maltreatment severe enough to be indicated by Child Protective Services, falls outside these limits and is considered a problem in every social group. Its persistence within the

Mothers' personal social networks and child maltreatment.

Adolescent personal relationships with parents and peers are studied for their mediating and moderating roles in the effect of preadolescent physical abuse on adolescent violent delinquency. One hundred physically abused preadolescents and 100 matched nonabused classmates were studied at 10 and 16 years. Adolescent attachment to parents and verbal and physical abuse in relationships with parents during adolescence mediated between preadolescent abuse and later violent delinquency. Friends' delinquency in adolescence and verbal and physical abuse with best friends in adolescence moderated the relationship between early abuse and later violent delinquency. Low levels of delinquency among friends significantly decreased risk for violent delinquent outcome for abused as contrasted to nonabused adolescents. Abusive behavior with best friends exacerbated risk for violent delinquent outcome more for abused than for nonabused adolescents. Attachment to friends was not found to play a significant role in the relationship between childhood abuse and adolescent violent delinquency.

Suzanne Salzinger

Papers

The effects of physical abuse on children's social relationships.

Adolescent Physical Abuse: Risk for Adolescent Psychiatric Disorders

Community violence exposure and delinquent behaviors among youth: The moderating role of coping

Mothers' personal social networks and child maltreatment.

Physical child abuse and adolescent violent delinquency: the mediating and moderating roles of personal relationships.