Seminar and lecture literature
Week 1 - General introduction and consequences of CAN
Hinojosa & Hinojosa (2024) – Positive and adverse childhood experiences and mental health
outcomes of children.
This study utilizes data from the National Survey of Children’s Health (NSCH, 2017–
2020).
Methode.
- 22,628 children
- Aged 6–17
- Dependent variable
o Mental health diagnosis: Parents reported whether their child had been
diagnosed with a mental health condition (e.g., ADHD, anxiety, depression, or
behavioral disorders).
- Independent variables
o Adverse Childhood Experiences (ACEs)
Living in poverty
Experiencing racial discrimination
Parental divorce or death
Parental incarceration
Witnessing household violence
Being a victim of violence
Living with a family member with mental illness or substance abuse
issues
o Positive childhood experiences (PCEs):
Supportive relationships (e.g., good family communication, non-
parental mentorship)
Social engagement (e.g., participation in sports, clubs, or volunteering)
Safe, stable environments (e.g., neighborhood safety, social support)
Results
Descriptives:
22% at least 1 mental health diagnosis.
46% at least 1 ACE
7% 4 or more ACEs.
97% of children had at least one PCE
17% had 4 or more PCEs.
Key findings:
Higher ACE counts were strongly associated with an increased likelihood of a mental
health diagnosis.
Higher PCE counts were associated with a lower likelihood of a mental health
diagnosis.
PCEs moderated the relationship between ACEs and mental health, but only when
ACE exposure was low.
o At low ACE levels, PCEs had a strong protective effect.
o At high ACE levels (4+), PCEs had little impact on reducing mental health
diagnoses.
Children with 0 ACEs and 4 PCEs had a 13% likelihood of a mental health diagnosis.
, Children with 4 or more ACEs, even with 4 PCEs, had a 27% likelihood of a
diagnosis.
At high ACE levels, the protective effect of PCEs was significantly reduced.
Conclusion.
This study confirms that while positive childhood experiences help mitigate the effects of
adversity on mental health, their impact weakens when ACE exposure is high. These findings
underscore the importance of early intervention and primary prevention strategies to reduce
ACEs and promote resilience in children.
Clemens et al. (2018) – Association of child maltreatment subtypes and long-term physical
health in a German representative sample.
This study investigates the relationship between different subtypes of child
maltreatment and long-term physical health outcomes using a cross-sectional observational
approach.
Method.
2510 German adults
Measures:
o Child maltreatment covering five subtypes:
Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
o Health outcomes included self-reported:
Obesity
Diabetes
Cancer
Hypertension
COPD
Myocardial infarction
Stroke
Results.
30.8% experienced at least 1 type of child maltreatment.
The likelihood of developing physical health issues increased with the number of
maltreatment subtypes experienced.
Higher intensity of each maltreatment subtype was associated with higher rates of all
physical health conditions.
Cumulative effect = the more subtypes of maltreatment a person experienced, the
higher the risk of chronic disease in adulthood.
Emotional and physical neglect showed stronger associations with hypertension and
myocardial infarction compared to sexual abuse.
Conclusion
Child maltreatment is strongly linked to increased risks of major health conditions in
adulthood. The findings suggest a dose-response relationship, where greater maltreatment
exposure leads to worse health outcomes. The study highlights the urgent need for early
,interventions and preventive strategies to mitigate the long-term health consequences of
childhood adversity.
Strathearn et al. (2020) – Long-term cognitive, psychological, and health outcomes
associated with child abuse and neglect.
The article is a longitudinal prenatal cohort study spanning two decades, to compare the long-
term effects of different types of maltreatment.
Method.
- N = 5200 at 14 years
- N = 3778 at 21 years
- Self-reports & cognitive testing
Results
Psychological maltreatment (emotional abuse and/or neglect) was associated with
the greatest number of adverse outcomes in almost all areas of assessment.
Sexual abuse was associated with:
o Early sexual debut and youth pregnancy
o Attention problems
o Posttraumatic stress disorder symptoms
o Depression
Physical abuse was associated with:
o Externalizing behavior problems
o Depressive symptoms
o IPV experience
o PTSD
o Delinquency (in men)
o Drug abuse.
Neglect (but not emotional abuse) was associated with having multiple sexual
partners, cannabis abuse and/or dependence, and experiencing visual hallucinations.
Emotional abuse (but not neglect) revealed increased odds for psychosis, injecting-
drug use, experiencing harassment later in life, pregnancy miscarriage, and reporting
asthma symptoms.
Both abuse and neglect were associated with significant cognitive delays and
educational failure during adolescence and adulthood.
Mehta et al., (2021) – Child Maltreatment and Long-Term Physical and Mental Health
Outcomes: An Exploration of Biopsychosocial Determinants and Implications for Prevention.
Aim: The article offers an overview of definitions, current prevalence rates, risk and
protective factors, and common long-term mental health outcomes for children who
experience maltreatment.
Definitions and prevalence
- Defines child maltreatment as comprising four main types:
o Sexual abuse
o Physical abuse
o Emotional
o Psychological abuse
o Neglect
, Increasingly, exposure to intimate partner violence (IPV) is also regarded as a fifth
form.
- Child maltreatment viewed as a form of adverse childhood experiences (ACEs), a
broad term that also includes exposure to family mental health problems,
incarceration, substance use, parental separation, poverty, bullying, racial
discrimination, and separation from immigrant parents.
- Acknowledges challenges in estimating the prevalence of child maltreatment
o Disparities between official child protection agency data, informant studies,
and self-report studies.
o Self-report studies generally show higher prevalence rates than official data,
indicating underreporting.
Health and economic burden
CAN is not only a child protection or criminal justice issue, but also a significant public
health concern with substantial economic consequences. Maltreated children may experience
long-term impacts on their mental, physical, and reproductive health, leading to economic
implications for healthcare, welfare, justice systems, and productivity. The economic burden
of child maltreatment includes direct costs for healthcare, child welfare, criminal justice, and
education, as well as indirect costs related to morbidity and mortality.
Systemic factors
Systemic determinants of CAN within Bronfenbrenner's social-ecological model,
emphasizing the importance of communities, families, and schools in protecting children. It
explores neurobiological mechanisms, such as alterations in the hypothalamic-pituitary-
adrenal (HPA) axis and brain structures, as well as epigenetic processes, such as DNA
methylation, which mediate the interaction between child maltreatment and genetic factors.
These biological changes can increase the risk of psychiatric and physical disorders.
DNA methylation = involves the addition of methyl groups to the DNA cytosine base often
resulting in altered gene expression.
Risk factors
The article identifies various risk factors for child maltreatment at different levels, including
individual, family, and community factors.
- Family-level risk factors:
o Low education
o Low socioeconomic disadvantage (low SES)
o Parental stress
o Mental health issues
o Substance use
o Lack of emotional support.
- Community-level risk factors:
o Dangerous and economically disadvantaged neighborhoods
o Housing stress
o Availability of drugs and alcohol.
For asylum-seeking children and families, the risk of child maltreatment in
detention center settings is further elevated.
Prevention and intervention approaches
Week 1 - General introduction and consequences of CAN
Hinojosa & Hinojosa (2024) – Positive and adverse childhood experiences and mental health
outcomes of children.
This study utilizes data from the National Survey of Children’s Health (NSCH, 2017–
2020).
Methode.
- 22,628 children
- Aged 6–17
- Dependent variable
o Mental health diagnosis: Parents reported whether their child had been
diagnosed with a mental health condition (e.g., ADHD, anxiety, depression, or
behavioral disorders).
- Independent variables
o Adverse Childhood Experiences (ACEs)
Living in poverty
Experiencing racial discrimination
Parental divorce or death
Parental incarceration
Witnessing household violence
Being a victim of violence
Living with a family member with mental illness or substance abuse
issues
o Positive childhood experiences (PCEs):
Supportive relationships (e.g., good family communication, non-
parental mentorship)
Social engagement (e.g., participation in sports, clubs, or volunteering)
Safe, stable environments (e.g., neighborhood safety, social support)
Results
Descriptives:
22% at least 1 mental health diagnosis.
46% at least 1 ACE
7% 4 or more ACEs.
97% of children had at least one PCE
17% had 4 or more PCEs.
Key findings:
Higher ACE counts were strongly associated with an increased likelihood of a mental
health diagnosis.
Higher PCE counts were associated with a lower likelihood of a mental health
diagnosis.
PCEs moderated the relationship between ACEs and mental health, but only when
ACE exposure was low.
o At low ACE levels, PCEs had a strong protective effect.
o At high ACE levels (4+), PCEs had little impact on reducing mental health
diagnoses.
Children with 0 ACEs and 4 PCEs had a 13% likelihood of a mental health diagnosis.
, Children with 4 or more ACEs, even with 4 PCEs, had a 27% likelihood of a
diagnosis.
At high ACE levels, the protective effect of PCEs was significantly reduced.
Conclusion.
This study confirms that while positive childhood experiences help mitigate the effects of
adversity on mental health, their impact weakens when ACE exposure is high. These findings
underscore the importance of early intervention and primary prevention strategies to reduce
ACEs and promote resilience in children.
Clemens et al. (2018) – Association of child maltreatment subtypes and long-term physical
health in a German representative sample.
This study investigates the relationship between different subtypes of child
maltreatment and long-term physical health outcomes using a cross-sectional observational
approach.
Method.
2510 German adults
Measures:
o Child maltreatment covering five subtypes:
Emotional abuse
Physical abuse
Sexual abuse
Emotional neglect
Physical neglect
o Health outcomes included self-reported:
Obesity
Diabetes
Cancer
Hypertension
COPD
Myocardial infarction
Stroke
Results.
30.8% experienced at least 1 type of child maltreatment.
The likelihood of developing physical health issues increased with the number of
maltreatment subtypes experienced.
Higher intensity of each maltreatment subtype was associated with higher rates of all
physical health conditions.
Cumulative effect = the more subtypes of maltreatment a person experienced, the
higher the risk of chronic disease in adulthood.
Emotional and physical neglect showed stronger associations with hypertension and
myocardial infarction compared to sexual abuse.
Conclusion
Child maltreatment is strongly linked to increased risks of major health conditions in
adulthood. The findings suggest a dose-response relationship, where greater maltreatment
exposure leads to worse health outcomes. The study highlights the urgent need for early
,interventions and preventive strategies to mitigate the long-term health consequences of
childhood adversity.
Strathearn et al. (2020) – Long-term cognitive, psychological, and health outcomes
associated with child abuse and neglect.
The article is a longitudinal prenatal cohort study spanning two decades, to compare the long-
term effects of different types of maltreatment.
Method.
- N = 5200 at 14 years
- N = 3778 at 21 years
- Self-reports & cognitive testing
Results
Psychological maltreatment (emotional abuse and/or neglect) was associated with
the greatest number of adverse outcomes in almost all areas of assessment.
Sexual abuse was associated with:
o Early sexual debut and youth pregnancy
o Attention problems
o Posttraumatic stress disorder symptoms
o Depression
Physical abuse was associated with:
o Externalizing behavior problems
o Depressive symptoms
o IPV experience
o PTSD
o Delinquency (in men)
o Drug abuse.
Neglect (but not emotional abuse) was associated with having multiple sexual
partners, cannabis abuse and/or dependence, and experiencing visual hallucinations.
Emotional abuse (but not neglect) revealed increased odds for psychosis, injecting-
drug use, experiencing harassment later in life, pregnancy miscarriage, and reporting
asthma symptoms.
Both abuse and neglect were associated with significant cognitive delays and
educational failure during adolescence and adulthood.
Mehta et al., (2021) – Child Maltreatment and Long-Term Physical and Mental Health
Outcomes: An Exploration of Biopsychosocial Determinants and Implications for Prevention.
Aim: The article offers an overview of definitions, current prevalence rates, risk and
protective factors, and common long-term mental health outcomes for children who
experience maltreatment.
Definitions and prevalence
- Defines child maltreatment as comprising four main types:
o Sexual abuse
o Physical abuse
o Emotional
o Psychological abuse
o Neglect
, Increasingly, exposure to intimate partner violence (IPV) is also regarded as a fifth
form.
- Child maltreatment viewed as a form of adverse childhood experiences (ACEs), a
broad term that also includes exposure to family mental health problems,
incarceration, substance use, parental separation, poverty, bullying, racial
discrimination, and separation from immigrant parents.
- Acknowledges challenges in estimating the prevalence of child maltreatment
o Disparities between official child protection agency data, informant studies,
and self-report studies.
o Self-report studies generally show higher prevalence rates than official data,
indicating underreporting.
Health and economic burden
CAN is not only a child protection or criminal justice issue, but also a significant public
health concern with substantial economic consequences. Maltreated children may experience
long-term impacts on their mental, physical, and reproductive health, leading to economic
implications for healthcare, welfare, justice systems, and productivity. The economic burden
of child maltreatment includes direct costs for healthcare, child welfare, criminal justice, and
education, as well as indirect costs related to morbidity and mortality.
Systemic factors
Systemic determinants of CAN within Bronfenbrenner's social-ecological model,
emphasizing the importance of communities, families, and schools in protecting children. It
explores neurobiological mechanisms, such as alterations in the hypothalamic-pituitary-
adrenal (HPA) axis and brain structures, as well as epigenetic processes, such as DNA
methylation, which mediate the interaction between child maltreatment and genetic factors.
These biological changes can increase the risk of psychiatric and physical disorders.
DNA methylation = involves the addition of methyl groups to the DNA cytosine base often
resulting in altered gene expression.
Risk factors
The article identifies various risk factors for child maltreatment at different levels, including
individual, family, and community factors.
- Family-level risk factors:
o Low education
o Low socioeconomic disadvantage (low SES)
o Parental stress
o Mental health issues
o Substance use
o Lack of emotional support.
- Community-level risk factors:
o Dangerous and economically disadvantaged neighborhoods
o Housing stress
o Availability of drugs and alcohol.
For asylum-seeking children and families, the risk of child maltreatment in
detention center settings is further elevated.
Prevention and intervention approaches
