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2013 | OriginalPaper | Hoofdstuk

44. Somatische en psychische gevolgen van kindermishandeling

Auteurs : A.H. Teeuw, F. Boer

Gepubliceerd in: Medisch handboek kindermishandeling

Uitgeverij: Bohn Stafleu van Loghum

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Inleiding

Het meemaken van kindermishandeling in de jeugd kan levenslange gevolgen hebben voor zowel de lichamelijke als psychische gezondheid. In onderzoek is aannemelijk gemaakt dat er een directe relatie bestaat tussen de mate van negatieve ervaringen in de jeugd en de ernst van de problemen in de volwassenheid, een zogenoemde dosis-effectrelatie. Het in H. 43 beschreven adverse childhood experiences (ACE-)onderzoek is hier baanbrekend geweest. Het ging hier om een doorsnede (dus niet longitudinaal) onderzoek waarbij mishandeling via zelfrapportage retrospectief werd vastgesteld. Bevindingen van cohortstudies waarbij prospectief wordt vastgesteld of (en welke vorm van) kindermishandeling optreedt en waarbij de kinderen in de tijd gevolgd worden om vast te stellen welke uitkomsten er optreden, geven betrouwbaarder resultaten. Bij deze studies kan de mishandeling en de uitkomst in de tijd worden vastgesteld, is objectieve vaststelling van de mishandeling mogelijk, wordt recall bias voorkomen en treedt er geen selectieve inclusie op. Recall bias kan belangrijk zijn, want het is de vraag of de langetermijngevolgen het gevolg zijn van de actuele mishandeling, wat er zich na de mishandeling in het leven van het kind voordeed of de cognitieve betekenis die iemand aan de mishandeling heeft gegeven. Selectieve inclusie treedt vooral op bij de bestudering van klinische populaties (volwassenen die met een bepaalde aandoening bekend zijn in de gezondheidszorg). Bijzonder belangrijk is dat bij prospectieve cohortstudies correctie mogelijk is voor sociale en individuele verstorende factoren. Echter studies waarin alleen kinderen met officieel vastgestelde mishandeling worden geïncludeerd, hebben weer als nadeel dat de langetermijneffecten bij deze kinderen bij wie de mishandeling door professionals is herkend weer heel anders kunnen zijn dan bij de niet-herkende slachtoffers van kindermishandeling. Prevalentiecijfers en effectgrootte worden beïnvloed door een meer of minder representatieve groep te bestuderen. Het is dus telkens lastig de waarde van de uitkomsten van een individuele studie of een review goed in te schatten. Gilbert et al. geven dit goed weer in een tabel in hun artikel ‘Burden and consequences of child maltreatment in high-income countries’ gepubliceerd in 2009.
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Metagegevens
Titel
Somatische en psychische gevolgen van kindermishandeling
Auteurs
A.H. Teeuw
F. Boer
Copyright
2013
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-313-9185-1_44