Elsevier

Child Abuse & Neglect

Volume 28, Issue 2, February 2004, Pages 167-180
Child Abuse & Neglect

Prevalence and demographic correlates of childhood maltreatment in an adult community sample

https://doi.org/10.1016/j.chiabu.2003.09.012Get rights and content

Abstract

Purpose: This study had two aims: (1) to determine the prevalence of five categories of retrospectively reported childhood maltreatment in an adult community sample and (2) to examine relationships between three theoretically and practically chosen demographic variables and childhood maltreatment.

Method: Participants were a representative sample of 967 adult men and women in the metropolitan Memphis, Tennessee area. They completed a telephone survey that included a reliable, valid questionnaire assessing five types of childhood maltreatment (i.e., emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and demographic questions. Simultaneous logistic regression analyses were used to identify demographic correlates of specific trauma types.

Results: Prevalence of childhood maltreatment ranged from approximately 30% for women to over 40% for men. Approximately 13% of participants reported multiple forms of maltreatment. The most common forms of trauma for both men and women were physical abuse, physical neglect, and emotional abuse, all of which were highly likely to co-occur. Race, sex, and current educational level were each associated with an increased likelihood of childhood maltreatment; differential relationships with particular maltreatment types were also observed.

Implications: These findings highlight the importance of research on the prevalence of and risks for multiple types of childhood maltreatment, particularly in the somewhat neglected area of emotional abuse and neglect. These findings can be used to highlight the need for preventive interventions aimed at the negative sequelae of childhood maltreatment and to tailor preventive interventions to the needs and expectations of those at high risk.

Résumé

But: Cette étude avait deux buts: 1. Déterminer la prévalence de cinq catégories de mauvais traitements signalés rétrospectivement dans un échantillon communautaire d’adultes; et 2. examiner les relations entre trois variables démographiques choisies selon un point de vue théorique et pratique et des traumatismes subis dans l’enfance.

Méthode: Les participants ont composé un échantillon représentatif de 967 adultes hommes et femmes du Memphis métropolitain, région du Tennessee. Ils ont répondu à une enquête téléphonique qui comportait un questionnaire validé évaluant cinq types de mauvais traitements envers des enfants (mauvais traitements affectifs, négligence affective, sévices physiques, négligence physique, et abus sexuels) ainsi que des questions d’ordre démographique. Des analyses simultanées de régression logistique ont été utilisées pour identifier les correspondances démographiques de types spécifiques de traumatismes.

Résultats: La prévalence des traumatismes infantiles a varié de 30% chez les femmes à 40% chez les hommes. Autour de 13% des participants ont rapporté des traumatismes multiples. Les formes les plus courantes de sévices pour les hommes et les femmes consistaient en sévices physiques, négligence physique et sévices psychologiques. Tous étaient très susceptibles de survenir simultanément. La race, le sexe et le niveau d’éducation étaient en corrélation avec les traumatismes infantiles. Les relations différentielles entre les éléments mis en corrélation et les types de traumatismes étaient également évidents.

Implications: Ces résultats mettent en évidence l’importance de la recherche sur la prévalence et les risques de types multiples de mauvais traitements, particulièrement dans le domaine quelque peu négligé des traumatismes psychologiques. Ces résultats peuvent être utilisés pour souligner la nécessité d’interventions de prévention visant les séquelles négatives des traumatismes infantiles et pour construire sur mesure des interventions concernant les besoins et les attentes de ceux qui courent de grands risques.

Resumen

Objetivo: Este estudio tuvo dos objetivos: (1) determinar la prevalencia de cinco categorı́as maltrato infantil notificado retrospectivamente en una muestra comunitaria de adultos y (2) examinar la relación entre tres variables demográficas, elegidas por razones teóricas y prácticas, y el trauma infantil.

Método: Los participantes estaban formados por un total de 967 varones y mujeres adultos del área metropolitana de Memphis, Tennesse. Llevaron a cabo una encuesta telefónica que incluı́a un cuestionarios válido y fiable que evalúa cinco tipos de maltrato infantil (maltrato emocional, negligencia emocional, maltrato fı́sico, maltrato emocional y abuso sexual) y variables demográficas. Se utilizaron análisis de regresión logı́stica para identificar los correlatos demográficos de los tipos especı́ficos de trauma.

Resultados: La prevalencia del trauma infantil osciló entre un 30% para las mujeres y un 40% para los varones. Aproximadamente un 13% de los participantes notificaron múltiples traumas. Tanto para mujeres como para hombres, los traumas más frecuentes fueron el maltrato fı́sico, la negligencia fı́sica y el maltrato emocional, todos ellos con una elevada tendencia a ocurrir conjuntamente. La raza, el género y el nivel educativo actual correlacionaron con el trauma infantil. Fueron también evidentes las relaciones diferenciales entre los correlatos y los tipos de trauma.

Conclusiones: Estos hallazgos subrayan la importancia de la investigación sobre la prevalencia y los riesgos de los múltiples tipos de maltrato y de manera especial en algunos aspectos poco estudiados del trauma emocional. Estos hallazgos pueden ser utilizados para subrayar la necesidad de intervenciones preventivas dirigidas a las secuelas negativas del trauma infantil y al diseño de intervenciones preventivas adecuadas a las necesidades y expectativas de quienes están en citación de riesgo.

Introduction

Numerous studies have examined the community epidemiology of childhood maltreatment and its negative sequelae in adulthood. Reported prevalence estimates of maltreatment vary widely from study to study (e.g., 3% to 36% for sexual abuse, Finkelhor, 1994a), but are generally quite high. In a recent review of studies examining the prevalence of sexual abuse, Gorey and Leslie (1997) reported a 22.3% prevalence of sexual abuse among women and an 8.5% prevalence among men using an aggregate of 25 samples. The province-wide Ontario Health Supplement reported similarly high prevalences of physical abuse—21.1% among women and 31.2% among men (MacMillan et al., 1997).

The experience of childhood abuse and neglect is often accompanied by wide-ranging mental and physical health consequences for adult survivors. Studies have linked childhood maltreatment to such varied psychological phenomena as suicidality, depression, dissociation, anxiety, and substance abuse (Dhaliwal, Gauzas, Antonowicz, & Ross, 1996; Dube et al., 2003; Johnson et al., 2002; Malinosky-Rummell & Hansen, 1993; Mullen, Martin, Anderson, Romans, & Herbison, 1996). Additional studies have linked childhood maltreatment to a variety of adverse health outcomes, including infectious diseases, pain disorders, cancer, and heart disease (Felitti et al., 1998, Imbierowicz & Egle, 2003; Walker et al., 1999, Walker et al., 1999). Maltreatment has also been linked to greater numbers of physician diagnoses and higher health care costs among adult survivors (Walker et al., 1999, Walker et al., 1999; Walker et al., 1999, Walker et al., 1999). In sum, much research indicates that childhood maltreatment is a disturbingly common phenomenon with numerous problematic aftereffects.

One way of decreasing the impact of childhood maltreatment upon adult survivors is to develop prevention programs that address trauma-specific issues and outcomes. For example, the Skills Training in Affect and Interpersonal Regulation/ Prolonged Exposure program aims to prevent revictimization among sexual abuse survivors (Cloitre, 1998). A first step towards the development of such preventive interventions is to determine the number of persons at risk so that appropriate levels of resources can be devoted to such efforts. The development of successful preventive interventions also depends in part on knowing the demographic characteristics of potential intervention participants. Such knowledge can be used to target interventions to groups or communities most likely to have persons at risk and to identify points of access to these targeted groups (e.g., churches, community organizations) (Mrazek & Haggerty, 1994). Knowledge regarding the background of potential participants can also be used to match the needs and expectations of participants by suggesting preventive intervention content (e.g., addressing culture-specific attributions regarding abuse), format (e.g., highly structured vs. unstructured), and delivery (e.g., by paraprofessional members of the same demographic group vs. by mental or physical health professionals). Given the importance of information on the prevalence and correlates of maltreatment to the development of successful interventions, such information for all types of maltreatment is needed.

Despite this need for information on all types of childhood maltreatment, relatively little is known about the prevalence and correlates of emotional abuse and neglect. For example, a recent review of risk factors for childhood emotional maltreatment (Black, Slep, & Heyman, 2001) revealed only one study addressing demographic correlates of this form of maltreatment in a community sample. Most of the literature on childhood maltreatment focuses overwhelmingly on sexual abuse and, secondarily, on physical abuse and neglect. This focus on sexual and physical trauma may be due to the fact that these types of trauma are most often the focus of child protection agency reports (Zellman & Faller, 1996) and thus may have the greatest direct impact on government resources. Nonetheless, emotional abuse and neglect may also have significant long-term physical and psychological consequences, including many of the difficulties previously listed (Felitti et al., 1998, Imbierowicz & Egle, 2003, Johnson et al., 2002, Mullen et al., 1996; Walker et al., 1999, Walker et al., 1999). Thus, information on the prevalence and correlates of emotional maltreatment seems especially needed.

Along with the lack of information on emotional maltreatment, there is also a paucity of information on the prevalence and correlates of exposure to multiple forms of abuse and neglect. Most large-scale epidemiological studies have reported on only one or a few types of maltreatment, usually sexual and physical (e.g., Brown, Cohen, Johnson, & Salzinger, 1998; Finkelhor, Hotaling, Lewis, & Smith, 1990; MacMillan et al., 1997, Vogeltanz et al., 1999). Moreover, we found only one study that examined demographic predictors of exposure to multiple maltreatment types in a community sample (i.e., MacMillan et al., 1997). Since there are some data indicating that having been the victim of more than one form of maltreatment increases risk for adverse physical and mental health outcomes (Felitti et al., 1998; Moeller, Bachmann, & Moeller, 1993; Mullen et al., 1996), it seems important to obtain additional information on individuals who have experienced multiple types of maltreatment along with information on the scope and nature of multi-type maltreatment.

To provide such information, we examined the prevalence and demographic correlates of childhood abuse and neglect in a large community sample, using a retrospective, self-report methodology with a standardized, reliable instrument. We examined five types of childhood maltreatment, covering a broad range of traumatic experience: emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse. We chose potential demographic correlates on both practical and theoretical bases. First, we sought to examine variables that are relatively objective and easily obtainable, in order to maximize the utility of our findings for research and clinical purposes (e.g., identifying at-risk populations to target interventions aimed at preventing negative sequelae of childhood maltreatment). Second, we sought to examine variables that, theoretically, could help describe the occurrence of underinvestigated forms of childhood maltreatment (i.e., emotional abuse and neglect) and the experience of multiple maltreatment types (i.e., co-occurring maltreatment). Belsky (1980) provides some direction for such investigations. He suggests that individual differences in perpetrators and child victims, as well as broader forces of community and culture, all can contribute to the occurrence of child maltreatment. In a recent review of etiological theories in child maltreatment (Azar, Povilaitis, Lauretti, & Pouquette, 1998), this wide-ranging perspective was quite evident; numerous factors at the level of the individual, community, and culture have been used to explain maltreatment. Of these, several appear to cut across trauma types, including cultural values (e.g., legitimacy of physical punishment), socioeconomic status/stress (e.g., due to poverty), and power differentials (e.g., based on sex or the notion of children as property). Consequently, we examined demographic indices of these factors, using race as an index of culture, respondents’ educational level as an index of socioeconomic status, and sex as an index of power differential. Information is provided on (1) the prevalence of each maltreatment type, (2) the prevalence of co-occurring maltreatment, and (3) demographic correlates of each maltreatment type and of co-occurring maltreatment.

Section snippets

Respondents

Respondents were 1,007 residents of the metropolitan Memphis, Tennessee area between the ages of 18 and 65 years in 1997. Respondents were asked to participate in a study of criminal victimization and traumatic stress. For the purposes of the current study, only data from persons indicating an ethnic/racial identity of Black or White were used; this encompassed 97.5% of respondents, and is representative of the demographics of the sampled population. Demographic information for this subsample (N

Prevalence of childhood maltreatment

Table 1 displays the demographic characteristics of the sample. The prevalence of childhood maltreatment is displayed for the entire sample and for men and women separately in Table 2; the prevalence is displayed for individual maltreatment types and for co-occurring maltreatment. Statistically significant differences in prevalence between the sexes are also noted in Table 2. Approximately one third (35.1%) of the sample met criteria for at least one form of childhood maltreatment; 13.5% met

Discussion

This study reports on the prevalence, co-occurrence, and demographic correlates of childhood maltreatment in a community sample. It expands on previous work most notably by examining a full range of childhood traumas: emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse. Consequently, we were able to report not only on the prevalence of each form of maltreatment but also on the prevalence of co-occurring types of maltreatment, including those that have been

References (34)

  • P.E Mullen et al.

    The long-term impact of the physical, emotional, and sexual abuse of children: A community study

    Child Abuse & Neglect

    (1996)
  • N.D Vogeltanz et al.

    Prevalence and risk factors for childhood sexual abuse in women: National survey findings

    Child Abuse & Neglect

    (1999)
  • E.A Walker et al.

    Adult health status of women with histories of childhood abuse and neglect

    The American Journal of Medicine

    (1999)
  • Azar, S. T., Povilaitis, T. Y., Lauretti, A. F., & Pouquette, C. L. (1998). The current status of etiological theories...
  • J Belsky

    Child maltreatment: An ecological integration

    American Psychologist

    (1980)
  • D.P Bernstein et al.

    Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1997)
  • Bernstein, D. P., & Fink, L. (1998). Childhood Trauma Questionnaire: A retrospective self-report manual. San Antonio,...
  • Cited by (257)

    View all citing articles on Scopus

    Supported in part by a VA Merit Review Grant and a grant (MH64122) from the National Institutes of Mental Health to M.B.S.

    1

    Present address: Department of Psychology, California State University, San Bernardino, San Bernardino, CA, USA.

    View full text