Scientific background

xScientific background 

Childhood Maltreatment

It is recognized as a huge problem in both developed(1) and developing(2) countries.

Defined as “any act or series of acts … by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child”(3). It may include abusive acts, such as physical, sexual and emotional abuse or neglectful caregiving, namely physical or emotional neglect. Bullying and exposure to domestic violence are also included as maltreatment types.

Agencies for children protection underestimate the occurring cases(4), referring only about 1/10 of the real rates.

The clandestine nature and the lack of specific signs makes it difficult to detect and fully eradicate(5).

Per year, and based on official registers, Gilbert et al(1) suggested that 4% to 16% of children are physically abused, 10% are neglected or psychologically maltreated, and 5 to 10% girls and 5% boys are sexually abused.

For community adults, it has been described self-reported prevalence rates ranging from 4.5% for sexual abuse, 11.8% for physical neglect, 28.4% for physical abuse and 41.5% for neglect(6).

Radford et al found a prevalence of 24.5% of childhood maltreatment among young community adults(7).

Immediate and long-lasting consequences are widely studied(8).

Long-term consequences

Mental health diseases(9,10) such as post traumatic stress disorder(11) mood and anxiety (12), personality (13),  and psychotic problems(14).

Physical health diseases, namely neurological and musculoskeletal disorders, respiratory problems, cardiovascular disease, gastrointestinal and metabolic disorders(15).

Chronic illness such as depression(16), asthma(17), chronic fatigue(18) and migraine(19).

High risk health behaviors(20,21), namely substance abuse(22), eating disorders(23,24), high risk sexual behavior(25), criminality(26,27), self-harm(28) and aggression(29).

Less psychological well-being(30).

Neurobiological alterations(31), on epigenetic(32), brain structure(33) and biochemical(34) systems.

Dysfunctional psychological characteristics like low self-esteem/negative self-associations(35,36), poor social skills(37,38), impaired risk perception(39), attachment problems(40) and emotion regulation deficits(41–44) as mediators of the relation childhood maltreatment and adult psychopathology.

Revictimization(45).

Intergenerational transmission of childhood maltreatment(46).

Resilience

Despite the wide array of negative consequences identified among adults exposed to childhood maltreatment, about 44% were found to be resilient(47).

Stable familial environment and supportive relations were found to be protective factors(48). In the individual level were also identified the low neuroticism, personal control, optimism, less trauma beliefs and positive self-esteem.

Having resilience as a dynamic concept(49), actions can be taken to improve it in a way to reduce childhood maltreatment consequences(47).

Shifting from no resilient to resilient routes was found to be possible in young adults, and it was related with good levels of autonomy and having good external social support(50).

Interventions on proximal factors to the subject and on malleable environment influences can improve resilience (51).

Therapy for abused and neglected adults

Teicher and Samson (52) suggested that maltreated subjects diagnosed with depressive, anxiety or substance use problems have an earlier age at onset, more comorbidity, greater risk of suicide and greater symptom severity, and have worst results with treatment than non maltreated subjects. Thus, childhood maltreatment appeared as a distinctive feature even among clinical samples.

Specific programs have been developed for adults diagnosed with clinical disorders – Briére´s self-trauma integrative model(53) and Cloitre´s STAIR program(54) are examples. Both models suggest that subjects need to develop coping strategies before process the memories/consequences of child abuse/neglect. 

Emotion regulation and social competence are selected targets for intervention in a first phase, as suggested by Dorrepal et al(57). 

Other therapeutic approaches target other features such as betrayal(55) or shame and guilt(56) feelings in the first phase of the therapy process.

Psycho-education and behavioral-cognitive techniques showed promising results(57).

Scientific results support the benefits of emotional regulation interventions for at-risk and clinical populations(58).

Empowerment based interventions are regarded as good resources for community based interventions(59–61).

Is there a need for public health interventions for community adults?

Low quality of life(62), worst economical wellbeing(63) and the increased health-risk behaviors(20) were found to be correlated with childhood maltreatment in adults.

Large economical costs(64), low work productivity and increased used of medical services(65) were also reported.

Childhood maltreatment has been conceptualized as a violation of human rights by Pinheiro, 2006(66).

Preventive programs for children(67) are implemented.

Therapeutic protocols for both children/adolescents(68,69) and adults(56,70,71) are available.

However, there is a paucity of knowledge about tertiary prevention for adults.

Population based strategies are required to face the wide scope of childhood maltreatment consequences(8,72).

Our research initiative

We aim to screen expert opinions about the need and adequacy of public health actions to mitigate the consequences of childhood maltreatment in community adults. 

The research questions we aim to answer are:

•   Is there a need for public health actions to mitigate adult consequences of childhood maltreatment?

• Who should be firstly targeted? 

• How to assess subjects?

• Which sort of intervention strategies might be used?

• What implementation methods can be applied?

•  What are the ethical principles that should be considered?

•  What are the expected benefits?

• Are there recognized disadvantages?

Method

Various professional perspectives may shed light on non-consensual questions and bring new standpoints for ambiguous questions. Following this framework, we use the Delphi method – a structured communication tool based on the knowledge and experience of experts. Scientific literature review and expert opinions were merged to create a questionnaire. This questionnaire is now being scrutinized by professionals working in the field of childhood maltreatment. Feedback of results will be given to the participants.  

Expected results

We expect to screen and document opinions of experienced professionals about the researched topic. Generated information will be shared with participants and will be made available for the scientific community and for health care systems.

References

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