Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment

Worldwide prevalence estimates suggest that child physical abuse (8.0%), sexual abuse (1.6%), emotional abuse (36.3%), and neglect (4.4%) are common.1,2 These forms of abuse and neglect are collectively referred to as child maltreatment (CM). At least 4 assumptions pervade the scientific literature on CM: (1) harmfulness (CM causes substantial harm), (2) nonequivalence (some forms of CM are more harmful than others), (3) specificity (each form of CM has specific consequences), and (4) nonuniversality (the effects of CM differ across sex and race).

The strongest assumption is that CM causes harm. In a meta-analysis, nonsexual forms of CM (physical abuse, emotional abuse, and neglect) were associated with a wide range of mental health problems, including depression, anxiety, eating disorders, substance use, and suicidal behavior.3 Evidence from research on sexual abuse is less consistent. Although early literature reviews concluded that child sexual abuse predicts a range of psychiatric outcomes,46 later meta-analyses based on community samples7 and college samples8 suggested that child sexual abuse is weakly associated with later adjustment problems. Unsurprisingly, these findings are controversial9 and have been criticized10,11 and defended12,13 on several occasions.

The nonequivalence assumption is evident in the legal system, where some forms of CM are felonies but others are legal, and in the scientific literature, which focuses predominantly on sexual and physical abuse.14 However, meta-analytic data do not show appreciable differences in harm across types of CM.3Furthermore, study-level comparisons are confounded by differences in samples and methods, and individual-level comparisons are rare and usually fail to model patterns of CM co-occurrence. The ubiquity of the assumption of nonequivalence must therefore be based on factors other than comparative evidence of harm, such as cultural mores and differences in the ability to measure and document maltreatment.

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David D. Vachon, PhD1; Robert F. Krueger, PhD2; Fred A. Rogosch, PhD3; Dante Cicchetti, PhD3,4
[-] Author Affiliations
1Department of Psychology, McGill University, Montreal, Quebec, Canada
2Department of Psychology, University of Minnesota, Minneapolis
3Mount Hope Family Center, Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, New York
4Institute of Child Development, University of Minnesota, Minneapolis
JAMA Psychiatry. Published online October 14, 2015. doi:10.1001/jamapsychiatry.2015.1792