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Original Investigation |

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

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. 2015;72(11):1135-1142. doi:10.1001/jamapsychiatry.2015.1792.
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Importance  Several widely held beliefs about child abuse and neglect may be incorrect. It is most commonly assumed that some forms of abuse (eg, physical and sexual abuse) are more harmful than others (eg, emotional abuse and neglect); other assumptions are that each form of abuse has specific consequences and that the effects of abuse differ across sex and race.

Objective  To determine whether widely held assumptions about child abuse and neglect are valid by testing the hypothesis that different types of child maltreatment (CM) actually have equivalent, broad, and universal effects.

Design, Setting, and Participants  This observational study assessed 2292 racially and ethnically diverse boys (1254 [54.7%]) and girls (1038 [45.3%]) aged 5 to 13 years (mean [SD] age, 9.0 [2.0] years) who attended a research summer camp program for low-income, school-aged children from July 1, 1986, to August 15, 2012. Of these children, 1193 (52.1%) had a well-documented history of maltreatment. Analysis was conducted from September 25, 2013, to June 1, 2015.

Main Outcomes and Measures  Various forms of internalizing and externalizing personality and psychopathologic traits were assessed using multiple informant ratings on the California Child Q-Set and Teacher Report Form as well as child self-reported depression and peer ratings of aggression and disruptive behavior.

Results  Structural analysis showed that different forms of CM have equivalent psychiatric and behavioral effects, ranging from anxiety and depression to rule-breaking and aggression. We also found that nonsexual CM alters 2 broad vulnerability factors, internalizing (β = 0.185; SE = 0.028; P < .001) and externalizing (β = 0.283; SE = 0.023; P < .001), that underlie multiple forms of psychiatric and behavioral disturbance. We show that CM has comparable consequences for boys and girls of different races, and our results allowed us to describe a base rate and co-occurrence issue that makes it difficult to identify the unique effects of child sexual abuse.

Conclusions and Relevance  Our findings challenge widely held beliefs about how child abuse should be recognized and treated—a responsibility that often lies with the physician. Because different types of child abuse have equivalent, broad, and universal effects, effective treatments for maltreatment of any sort are likely to have comprehensive psychological benefits. Population-level prevention and intervention strategies should emphasize emotional abuse, which occurs with high frequency but is less punishable than other types of child maltreatment.

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Figure 1.
Internalizing Effect Sizes for Type, Variety, Frequency, and Severity of Child Maltreatment (CM)

Each bar reflects an effect size (success rate difference) from comparing different CM groups with the non-CM group. Effect sizes of 0.1, 0.3, and 0.4 are considered small, medium, and large, respectively. With the exception of the 1 type, S only (n = 14) bars, all displayed bars are significant at P < .01. Even the most mild form of CM was serious enough to reach the threshold for documentation. E indicates emotional abuse; N, neglect; P, physical abuse; and S, sexual abuse.

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Figure 2.
Externalizing Effect Sizes for Type, Variety, Frequency, and Severity of Child Maltreatment (CM)

Each bar reflects an effect size (success rate difference) from comparing different CM groups with the non-CM group. Effect sizes of 0.1, 0.3, and 0.4 are considered small, medium, and large, respectively. With the exception of the 1 type, S only (n = 14) bars, all displayed bars are significant at P < .01. Even the most mild form of CM was serious enough to reach the threshold for documentation. E indicates emotional abuse; N, neglect; P, physical abuse; and S, sexual abuse.

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Figure 3.
Co-occurrence Between Different Types of Child Maltreatment

The size of the circles is proportional to the number of children who experienced each type of maltreatment, and the amount of overlap between the circles is proportional to the co-occurrence of maltreatment types. E indicates emotional abuse; N, neglect; P, physical abuse; and S, sexual abuse.

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Figure 4.
Structural Model Predicting Psychiatric Outcomes From Child Sexual Abuse, Physical Abuse, Emotional Abuse, and Neglect After Controlling for Age and Year of Camp Attendance

Prospectively assessed child maltreatment (CM) variables are presented on the left side and psychiatric outcome variables on the right side. One-headed arrows leading from the latent variables to their indicators represent standardized factor loadings, which are all significant at P < .001. One-headed arrows leading from the latent CM variables to the latent psychiatric variables represent standardized regression paths, the predictive portion of the model. Double-headed arrows represent correlations. CCQ indicates California Child Q-Set; CDI, Children’s Depression Inventory; Emot, emotional abuse; EXT, externalizing; INT, internalizing; Negl, neglect; Peer, peer ratings; Phys, physical abuse; and TRF, Teacher Report Form.

aRegression paths are significant at P < .001.

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