Multi-type childhood maltreatment: associations with health risk behaviours and mental health problems in adolescence
| Date | 09 September 2014 |
| Pages | 191-206 |
| Published date | 09 September 2014 |
| DOI | https://doi.org/10.1108/JCS-09-2013-0033 |
| Author | Mariella Mangion,Sandra C. Buttigieg |
Multi-type childhood maltreatment:
associations with health risk behaviours
and mental health problems in
adolescence
Mariella Mangion and Sandra C. Buttigieg
Mariella Mangion is a
Consultant Paediatrician,
based at Mater Dei Hospital,
Msida, Malta.
Sandra C. Buttigieg is an
Associate Professor, based at
Health Services Management,
Faculty of Health Sciences,
University of Malta, Msida,
Malta and Consultant Public
Health, Mater Dei Hospital,
Msida, Malta.
Abstract
Purpose – The purpose of this paper is to determine whether multi-type child maltreatment is associated
with health-risk behaviours and mental ill-health in adolescence.
Design/methodology/approach – In total, 406 15-16-year-old students from Maltese schools answered
the “Child maltreatment physical and mental health”questionnaire (Nguyen et al., 2010). This assessed
demographics, health risk behaviour, mental health and child maltreatment.
Findings – Of the four categories of maltreatment measured (physical, sexual, emotional and neglect), 27.4
per cent of the young people experienced one type, 16.6 per cent two types, 11.1 per cent three and 6.5
per cent four.For health-risk behaviours, there were positive relationships between multi-type maltreatment
and school fights (r ¼0.27, po0.01), breaking school rules (r ¼0.19, po0.01), illicit drug use (r ¼0.14,
po0.05) and alcohol use (r ¼0.10, po0.05). As regards mental health, multi-type maltreatment
was positively associated with depression (r ¼0.38, po0.01) and anxiety (r ¼0.23, po0.01), and negatively
associated with self-esteem (r¼0.26, po0.01).
Practical implications – Early recognition of multi-type maltreatment and its consequences enables
providers of children’s services to offer the required diverse range of services. Additionally, policy makers
should ensure the adoption of multi-sectoral and collaborative inter-agency approaches so as to effectively
and holistically manage child maltreatment, not only during the acute childhood phase but also during
adolescence and adulthood, when consequences are expected to emerge.
Originality/value – This study raises awareness about the prevalence of multi-type child maltreatment
in Malta. It also highlights the negative association between cumulative exposure to multi-type child
maltreatment and mental health outcomes and risky behaviours.
Keywords Mental health, Children, Adolescence, Child maltreatment, Malta, Health risk behaviour
Paper type Research paper
Introduction
Child maltreatment is a public health concern, as well as a social welfare problem (Gilbert
et al., 2009b). Kempe et al. (1962) first described it as the occurrence of brain injury and
death due to violent shaking of infants. For the purpose of this study, we will utilise the World
Health Organisation definition for child maltreatment (World Health Organisation 1999, p. 13),
namely:
Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual
abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or
potential harm to the child’s health, survival, development or dignity in the context of a relationship
of responsibility, trust or power.
The authors would like to thank the
reviewers of this journal for their
useful suggestions. The first and
second named authors both
contributed equally to this work.
DOI 10.1108/JCS-09-2013-0033 VOL. 9 NO. 3 2014, pp. 191-206, CEmerald Group Publishing Limited, ISSN 1746-6660
j
JOURNAL OF CHILDREN’S SERVICES
j
PAGE 191
Children often experience more than one category of maltreatment and the consequent health
outcomes vary according to the different combinat ions of maltreatment exp erienced
(Moran et al., 2004; Arata et al., 2007). The scientific literature provides a robust body of
evidence documenting the association between specific categories of child maltreatment and
adverse risk behaviour and health outcomes. Although the literature on the impact of multi-type
maltreatment on health outcomes is still developing, there is evidence that childhood abuse and
neglect has long-lasting effects that manifest themselves in adolescence and adulthood, namely
adverse mental health, drug and alcohol misuse, obesity and criminal behaviour (Gilbert et al.,
2009b). While multidisciplinary strategic collaborations are becoming increasingly necessary to
safeguard children, senior child agency managers have a limited evidence-base to inform their
collective learning and development (Horwath and Morrison, 2011). Further research evidence
in this field will help child services manage victims of multi-type child maltreatment efficiently and
effectively during the period of abuse and through adolescence, while also providing guidance
on linking with other services for adequate management of consequences in adulthood.
Furthermore, the neglect of adolescents by services and their families is a major issue that
frequently goes unnoticed. Thus, a better understanding of what constitutes adolescent neglect
might lead to prompter identification and service response (Hicks and Stein, 2010), as well as
avoidance of adverse consequent effects.
The aim of this study was to determine whether multi-typemaltreatment is associated with health
risk behavioursand mental ill health in Maltese adolescents,in order to have a clearer indicationof
the necessary children’s services required. Additionally, this study holistically analysed all the
categories of childmaltreatment as defined by the WHO, namely physical, sexual and emotional
abuse and neglect.There are currently no studies thathave looked at health risk behaviours and
mental health consequences of child maltreatment in Maltese adolescents.
Prevalence of child maltreatment
Official statistics are difficult to obtain worldwide. For example, in the Lancet, it was stated
that “Every year, about 4-16% of children are physically abused and one in ten is neglected or
psychologically abused. During childhood, between 5% and 10% of girls and up to 5% of boys
are exposed to penetrative sexual abuse, and up to three times this number are exposed to any
type of sexual abuse” (Gilbert et al., 2009b, p. 68). Further estimates in different countries are
reported in Table I. Official rates for confirmed cases of child maltreatment indicate less than
a tenth of this burden (Gilbert et al., 2009b). Therefore, child protection agencies may only be
picking up the tip of the iceberg. There is also limited evidence of the effectiveness of services
in improving objective measures of abuse and neglect, due in part to methodological issues
Table I Prevalence of child maltreatment
Country Authors Type of study Prevalence
USA Hussey et al. (2006) Cross-Sectional
Survey
41.5% supervision neglect; 24.5%
physical assault; 11.8% physical neglect;
4.5% contact abuse
Canada Trocme
´et al. (2005) National Incidence
Study
18.67 per 1,000 children investigated
UK May-Chalal and Cawson
(2005)
Cross-Sectional
Survey
16% experienced maltreatment; 7%
physical abuse; 6% absence of care; 5%
absence of supervision; 6% emotional
abuse; 11% contact sexual abuse;
Netherlands Euser et al. (2009) National Incidence
Study
30 cases per 1,000 children investigated
China Leung et al. (2008) Cross-Sectional
Survey
Psychological maltreatment 78.3%;
severe physical maltreatment 17.9%;
corporal punishment 23.2%; sexual
abuse 0.6%
Malta Appogg (2009) Audit 1,053 referrals to child protection agency
PAGE 192
j
JOURNAL OF CHILDREN’S SERVICES
j
VOL. 9 NO. 3 2014
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