Child abuse and neglect
Literature summary (including take home messages to help study)
Ilse van Meurs 2024-2025
Literature (first author + year)
HC1: Hinojosa (2024), Clemens (2018), Strathearn (2020), Mehta (2021)
HC2: Danese (2020), McLaughlin, Weissman (2019), McLaughlin (2019), McCrory (2022)
HC3: Drury (2016), Maestripieri (2005), Stevens (2015)
HC4: Lester (2016), Cecil (2016), Turecki (2016)
HC5: Zeanah (2017), Humphreys (2020), McLaughlin (2016), Koss (2014)
HC6: Walsh (2010), Ioannidis (2020), Masten (2023)
HC7: Van Ijzendoorn (2020), Fisher (2016), Toth (2015), Dozier (2018)
Hinojosa & Hinojosa (2024) Positive and adverse childhood experiences
and mental health outcomes of children (HC1)
WHAT IS THE ARTICLE ABOUT?
How Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs)
influence the mental health of children.
Take home message article
● ACEs have a cumulative effect: more ACEs increase the odds of mental health problems
● PCEs have a moderation effect: more PCEs means less negative outcomes, even if you experience ACEs
METHOD
A sample was taken from the National Survey of Children’s Health. The 22,628 children
were aged 6-17. They used parent report.
● ACEs included: abuse, neglect, household dysfunction, exposure to violence,
parental incarceration, poverty
● PCEs included:
● supportive relationships: family communication/resilience, mentorship
● safe, stable environment: neighborhood safety and support
● opportunities for constructive social engagement: sport, other activities
Mental health outcomes: diagnosed conditions like anxiety, depression, ADHD
RESULTS
● with each additional ACE, there was a significant increase in the odds of reporting
a mental health issue (cumulative effect: more ACE’s → more mental health issues)
● with each additional PCE, there was a significant decrease in the odds of reporting a
mental health condition (moderation effect) → more PCEs means less mental
health issues, even if you experienced ACEs
● when ACEs are high (4+), children with more PCEs have similar reports of mental
health conditions
● more likely diagnosed with mental health issues: white children, boys, older children,
kids with special needs. Less likely to be diagnosed: black and other racial minorities
LIMITATIONS
● parent report
● causality: everything is measured at the same time point; it’s not a longitudinal study
● more PCEs should be added
, Clemens et al. (2018) Association of child maltreatment subtypes and
long-term physical health (HC1)
WHAT IS THE ARTICLE ABOUT?
They assessed the association between the subtypes and intensity of child maltreatment
and long-term physical health outcomes in Germany.
Take home message article
● experiencing CM increases the likelihood of major chronic health issues in adulthood
○ physical neglect + physical abuse: strongest predictors
● the intensity + number of subtypes of maltreatment increases health problems > dose-response
METHOD
A random selection of households, N = 2510, mean age = 48.4 and 53.3% is female. They
used the CTQ (Childhood Trauma Questionnaire)
RESULTS
Graph: higher Odds Ratio (OR) = stronger association
between a type of maltreatment and the health condition
● experiencing any form of child maltreatment
significantly increases the likelihood of major
chronic health issues in adulthood
○ physical neglect and physical abuse:
strongest predictors of health problems
○ sexual abuse: only significantly associated
with obesity, diabetes, cancer, COPD and
strokes (weakest significance for sexual abuse)
● intensity of maltreatment increases health problems → dose-response relationship
● the number of maltreatment subtypes increases health problems
LIMITATIONS
1. results are based on retrospective self-report (hard to look back correctly)
2. only one questionnaire
3. mechanisms: why are the results happening?
Strathearn et al. (2020) Long-term cognitive, psychological, and health
outcomes associated with child abuse and neglect (HC1)
WHAT IS THE ARTICLE ABOUT?
They analyzed the long-term impact of child maltreatment on cognitive, psychological,
addiction, sexual health and physical outcomes.
Take home message article
Children who experienced child abuse and neglect had 1) lower cognitive scores, 2) negative educational /
employment outcomes, 3) more mental health problems, 4) more addiction / substance use, 5) more sexual health
problems, 6) more physical health problems
- emotional neglect and emotional abuse: associated with biggest number of adverse outcomes
, METHOD
Longitudinal study of 40 years, N = 5200 at 14 years old and N = 3778 at 21 years. They
used self report and cognitive testing. The study is based on data from the Mater-University
of Queensland Study on Pregnancy (MUSP) in Australia.
46 different outcomes were assessed and grouped into 5 clusters:
1) cognition and education, 2) psychological and mental health, 3) addiction and
substance abuse, 4) sexual health, 5) physical health
RESULTS
When children experienced child abuse/neglect:
1. lower cognitive scores
2. negative educational / employment outcomes
3. mental health problems
4. more substance use & addiction
5. sexual health problems
6. physical health problems
→ emotional abuse and neglect had the most prominent associations with adverse
outcomes
LIMITATIONS
● only 7.1% (n = 511) experienced child abuse and neglect
● self-report
Mehta et al. (2021) Child maltreatment and long-term physical and
mental health outcomes: An exploration of biopsychosocial
determinants and implications for prevention (HC1)
not explained in the lecture, but on the literature list for 2 lectures: read it well
WHAT IS THE ARTICLE ABOUT?
In this study they examine how child maltreatment (abuse and neglect) leads to long-term
mental and physical health issues. It explores how biological, psychological and social
factors interact to increase the risk of health problems. They also discuss prevention
strategies and policy recommendations to address child abuse.
Take home message article
● This study provides strong evidence that child maltreatment is a public health crisis with severe,
long-lasting effects (in mental health, physical health, brain structure/function, epigenetics).
● Risk factors for CM: parental factors (<21, mental health issues, substance abuse, domestic violence) and
community factors (poverty, social isolation, unsafe neighborhoods)
● Protective factors that reduce risk of CM: positive parent-child relationships, strong social support network,
access to mental health care + parenting programs
● Prevention & interventions: school-based, family-based and community-based approaches
● Implications: prevention, early intervention and systemic changes to reduce the impact of child abuse
METHOD
They identified 5 major types of child maltreatment and their global prevalence rates:
physical abuse (22.6%), sexual abuse (12.7%), emotional abuse (36.3%), neglect (16.3%
physical, 18.4% emotional), and exposure to domestic violence.
● the key issue is that only 5% of physical abuse and 8% of sexual abuse are reported
to child protection agencies, leading to major underestimation of the real numbers
, RESULTS
Long-term health outcomes
Children who experience maltreatment are at risk for:
1. Mental health outcomes: depression and anxiety, post-traumatic stress disorder
(PTSD), substance abuse (alcohol & drugs), suicidal thoughts & self-harm, psychosis
& schizophrenia
2. Physical health outcomes: obesity, heart disease, stroke and diabetes, weaker
immune system, higher rates of chronic pain conditions
3. Brain structure & Function changes: altered brain development (memory,
emotions, decision-making), an overactive amygdala (processes fear), a smaller
hippocampus (memory)
● an overactive amygdala leads to anxiety and PTSD
● a smaller hippocampus increases the risk of depression
4. Epigenetics: altered DNA due to abuse: child maltreatment can ‘switch off’ or
‘switch on’ certain genes. DNA methylation (chemical changes in DNA) alter the
stress response system, making survivors more vulnerable to mental health issues
● some biological effects of abuse may be reversible with therapy/interventions
Costs of child maltreatment
In the United States, child maltreatment costs 2 trillion dollars annually. China reported an
economic loss of 50 billion per year due to child abuse-related health issues.
Risk and protective factors
Risk factors for child maltreatment
● Parental factors: young parents (<21 years old), parents with mental health issues /
substance abuse problems, domestic violence in the household
● Community & social factors: poverty & unemployment, social isolation, living in
unsafe neighborhoods
Protective factors that reduce risk of child maltreatment
● positive parent-child relationships
● strong social support networks (family, school, community services)
● access to mental health care and parenting programs
Prevention and intervention strategies
● School-based intervention programs: teaching children how to recognize and
report abuse, trauma-informed education to help teachers support abused children,
anti-bullying programs to prevent peer victimization
● Family-based interventions: parenting programs to improve family dynamics and
prevent abuse, therapy for abusive parents to change harmful behavior patterns,
home visit programs for at-risk families to monitor child safety
● Community-based approaches: strengthening child protection laws and reporting
systems, increasing funding for social services, using technology to reach isolated
families
Policy recommendations
Key recommendations to reduce child maltreatment
1. Better data collection: improve survey tools to track CAN, encourage self-reporting
mechanisms to capture unreported cases
2. Neuroscience and genetics research: study how therapy and social support can
reverse abuse-related brain damage
3. Expanding telehealth services: use online mental health resources for abused
children and families
4. Stronger community support networks: build local coalitions of educators, health
workers and social services to work together
5. Increased government funding: allocate more resources to prevention programs
rather than focusing only on legal punishment
Literature summary (including take home messages to help study)
Ilse van Meurs 2024-2025
Literature (first author + year)
HC1: Hinojosa (2024), Clemens (2018), Strathearn (2020), Mehta (2021)
HC2: Danese (2020), McLaughlin, Weissman (2019), McLaughlin (2019), McCrory (2022)
HC3: Drury (2016), Maestripieri (2005), Stevens (2015)
HC4: Lester (2016), Cecil (2016), Turecki (2016)
HC5: Zeanah (2017), Humphreys (2020), McLaughlin (2016), Koss (2014)
HC6: Walsh (2010), Ioannidis (2020), Masten (2023)
HC7: Van Ijzendoorn (2020), Fisher (2016), Toth (2015), Dozier (2018)
Hinojosa & Hinojosa (2024) Positive and adverse childhood experiences
and mental health outcomes of children (HC1)
WHAT IS THE ARTICLE ABOUT?
How Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs)
influence the mental health of children.
Take home message article
● ACEs have a cumulative effect: more ACEs increase the odds of mental health problems
● PCEs have a moderation effect: more PCEs means less negative outcomes, even if you experience ACEs
METHOD
A sample was taken from the National Survey of Children’s Health. The 22,628 children
were aged 6-17. They used parent report.
● ACEs included: abuse, neglect, household dysfunction, exposure to violence,
parental incarceration, poverty
● PCEs included:
● supportive relationships: family communication/resilience, mentorship
● safe, stable environment: neighborhood safety and support
● opportunities for constructive social engagement: sport, other activities
Mental health outcomes: diagnosed conditions like anxiety, depression, ADHD
RESULTS
● with each additional ACE, there was a significant increase in the odds of reporting
a mental health issue (cumulative effect: more ACE’s → more mental health issues)
● with each additional PCE, there was a significant decrease in the odds of reporting a
mental health condition (moderation effect) → more PCEs means less mental
health issues, even if you experienced ACEs
● when ACEs are high (4+), children with more PCEs have similar reports of mental
health conditions
● more likely diagnosed with mental health issues: white children, boys, older children,
kids with special needs. Less likely to be diagnosed: black and other racial minorities
LIMITATIONS
● parent report
● causality: everything is measured at the same time point; it’s not a longitudinal study
● more PCEs should be added
, Clemens et al. (2018) Association of child maltreatment subtypes and
long-term physical health (HC1)
WHAT IS THE ARTICLE ABOUT?
They assessed the association between the subtypes and intensity of child maltreatment
and long-term physical health outcomes in Germany.
Take home message article
● experiencing CM increases the likelihood of major chronic health issues in adulthood
○ physical neglect + physical abuse: strongest predictors
● the intensity + number of subtypes of maltreatment increases health problems > dose-response
METHOD
A random selection of households, N = 2510, mean age = 48.4 and 53.3% is female. They
used the CTQ (Childhood Trauma Questionnaire)
RESULTS
Graph: higher Odds Ratio (OR) = stronger association
between a type of maltreatment and the health condition
● experiencing any form of child maltreatment
significantly increases the likelihood of major
chronic health issues in adulthood
○ physical neglect and physical abuse:
strongest predictors of health problems
○ sexual abuse: only significantly associated
with obesity, diabetes, cancer, COPD and
strokes (weakest significance for sexual abuse)
● intensity of maltreatment increases health problems → dose-response relationship
● the number of maltreatment subtypes increases health problems
LIMITATIONS
1. results are based on retrospective self-report (hard to look back correctly)
2. only one questionnaire
3. mechanisms: why are the results happening?
Strathearn et al. (2020) Long-term cognitive, psychological, and health
outcomes associated with child abuse and neglect (HC1)
WHAT IS THE ARTICLE ABOUT?
They analyzed the long-term impact of child maltreatment on cognitive, psychological,
addiction, sexual health and physical outcomes.
Take home message article
Children who experienced child abuse and neglect had 1) lower cognitive scores, 2) negative educational /
employment outcomes, 3) more mental health problems, 4) more addiction / substance use, 5) more sexual health
problems, 6) more physical health problems
- emotional neglect and emotional abuse: associated with biggest number of adverse outcomes
, METHOD
Longitudinal study of 40 years, N = 5200 at 14 years old and N = 3778 at 21 years. They
used self report and cognitive testing. The study is based on data from the Mater-University
of Queensland Study on Pregnancy (MUSP) in Australia.
46 different outcomes were assessed and grouped into 5 clusters:
1) cognition and education, 2) psychological and mental health, 3) addiction and
substance abuse, 4) sexual health, 5) physical health
RESULTS
When children experienced child abuse/neglect:
1. lower cognitive scores
2. negative educational / employment outcomes
3. mental health problems
4. more substance use & addiction
5. sexual health problems
6. physical health problems
→ emotional abuse and neglect had the most prominent associations with adverse
outcomes
LIMITATIONS
● only 7.1% (n = 511) experienced child abuse and neglect
● self-report
Mehta et al. (2021) Child maltreatment and long-term physical and
mental health outcomes: An exploration of biopsychosocial
determinants and implications for prevention (HC1)
not explained in the lecture, but on the literature list for 2 lectures: read it well
WHAT IS THE ARTICLE ABOUT?
In this study they examine how child maltreatment (abuse and neglect) leads to long-term
mental and physical health issues. It explores how biological, psychological and social
factors interact to increase the risk of health problems. They also discuss prevention
strategies and policy recommendations to address child abuse.
Take home message article
● This study provides strong evidence that child maltreatment is a public health crisis with severe,
long-lasting effects (in mental health, physical health, brain structure/function, epigenetics).
● Risk factors for CM: parental factors (<21, mental health issues, substance abuse, domestic violence) and
community factors (poverty, social isolation, unsafe neighborhoods)
● Protective factors that reduce risk of CM: positive parent-child relationships, strong social support network,
access to mental health care + parenting programs
● Prevention & interventions: school-based, family-based and community-based approaches
● Implications: prevention, early intervention and systemic changes to reduce the impact of child abuse
METHOD
They identified 5 major types of child maltreatment and their global prevalence rates:
physical abuse (22.6%), sexual abuse (12.7%), emotional abuse (36.3%), neglect (16.3%
physical, 18.4% emotional), and exposure to domestic violence.
● the key issue is that only 5% of physical abuse and 8% of sexual abuse are reported
to child protection agencies, leading to major underestimation of the real numbers
, RESULTS
Long-term health outcomes
Children who experience maltreatment are at risk for:
1. Mental health outcomes: depression and anxiety, post-traumatic stress disorder
(PTSD), substance abuse (alcohol & drugs), suicidal thoughts & self-harm, psychosis
& schizophrenia
2. Physical health outcomes: obesity, heart disease, stroke and diabetes, weaker
immune system, higher rates of chronic pain conditions
3. Brain structure & Function changes: altered brain development (memory,
emotions, decision-making), an overactive amygdala (processes fear), a smaller
hippocampus (memory)
● an overactive amygdala leads to anxiety and PTSD
● a smaller hippocampus increases the risk of depression
4. Epigenetics: altered DNA due to abuse: child maltreatment can ‘switch off’ or
‘switch on’ certain genes. DNA methylation (chemical changes in DNA) alter the
stress response system, making survivors more vulnerable to mental health issues
● some biological effects of abuse may be reversible with therapy/interventions
Costs of child maltreatment
In the United States, child maltreatment costs 2 trillion dollars annually. China reported an
economic loss of 50 billion per year due to child abuse-related health issues.
Risk and protective factors
Risk factors for child maltreatment
● Parental factors: young parents (<21 years old), parents with mental health issues /
substance abuse problems, domestic violence in the household
● Community & social factors: poverty & unemployment, social isolation, living in
unsafe neighborhoods
Protective factors that reduce risk of child maltreatment
● positive parent-child relationships
● strong social support networks (family, school, community services)
● access to mental health care and parenting programs
Prevention and intervention strategies
● School-based intervention programs: teaching children how to recognize and
report abuse, trauma-informed education to help teachers support abused children,
anti-bullying programs to prevent peer victimization
● Family-based interventions: parenting programs to improve family dynamics and
prevent abuse, therapy for abusive parents to change harmful behavior patterns,
home visit programs for at-risk families to monitor child safety
● Community-based approaches: strengthening child protection laws and reporting
systems, increasing funding for social services, using technology to reach isolated
families
Policy recommendations
Key recommendations to reduce child maltreatment
1. Better data collection: improve survey tools to track CAN, encourage self-reporting
mechanisms to capture unreported cases
2. Neuroscience and genetics research: study how therapy and social support can
reverse abuse-related brain damage
3. Expanding telehealth services: use online mental health resources for abused
children and families
4. Stronger community support networks: build local coalitions of educators, health
workers and social services to work together
5. Increased government funding: allocate more resources to prevention programs
rather than focusing only on legal punishment
