Introduction: Approximately 3 million child maltreatment (CM) referrals are made each year to state and social service agencies (U.S. Department of Health and Human Services- Children’s Bureau, 2012). This number appears to be an underestimate of the size of the problem however. Survey data collected by the Children’s Bureau of the U.S. Department of Health and Human Services estimates that about six million children are maltreated in the U.S. per year. CM negatively impacts the mental and physical health and social outcomes of victims in childhood and adulthood. For example, CM has been linked to obesity and overweight in children and adults. Similar to CM, overweight and obesity are also associated with various long-term and short-term health conditions for children and adults. Beyond the specific provision of food and modeling of eating and exercise behaviors, other family factors have been shown to relate to obesity including disorganized family environments, low parental supervision, maternal antipathy, child maltreatment, and family dysfunction. Objective: To examine the relationship between CM and obesity using a large sample of twin and sibling pairs, I will first examined the simple relationship between various form of abuse and obesity, and then, following the methodology of Vámosi et al. (2011), examine twin and sibling pairs to look at differences in experiences of CM and obesity. Methods: The current study used the Midlife Development in the United States (MIDUS), a public use longitudinal data set with information in the areas of physical, emotional/mental, and lifestyle characteristics of individuals in their 20’s, 40’s, and 60’s. The data set also includes nationally representative data about sibling and twin pairs. The MIDUS I had a sample of 7,108 participants. The MIDUS II was a follow-up of the MIDUS I and included 4,963 participants. The main variables I used were Body Mass Index (BMI) and CM, which was measured through the Conflict Tactics Scale. I controlled for various variables that contribute to overweight or obesity, such as socioeconomic status, educational attainment, physical activity, and depression. The comparison of twin and non-twin sibling data was of particular interest because of the strong genetic component of obesity. Results: Analyses were conducted using SPSS. I first examined simple correlations between abuse variables and obesity. Next, I conducted regression analyses examining the relationship between abuse and obesity, while controlling for gender, educational attainment, age, and several other variables associated with CM and obesity. The third analyses focused on examining differences in the abuse – obesity relationship between twin and sibling pairs. There was a small, negative relationship between BMI continuous and emotional abuse and physical abuse. There was a small, positive relationship between each form of abuse and BMI categories. Discussion: Although statistically significant results were found, they were small. The relationship between obesity and overweight and experience of CM is valid after controlling for various predictors, like health insurance, depression, and self-rated physical and emotional health. Public health practitioners should be sensitive to the physical health of victims of CM, especially concerning obesity and overweight. Many public health practitioners focus on the mental and emotional health of victims of CM, but they should also be made aware of the impact that CM has on physical health. There are several limitations. Regarding the CM variables, participants may have had difficulties recalling events from their childhood, so recall bias is a major limitation. Another limitation is that much of the data is self-reported which could have led to some data, like BMI, being inaccurate. Finally, we do not know the quality of the phone interviews or how well phone interviewers were trained.

This two-study dissertation aimed to develop a comprehensive understanding of mental health need identification, service referral process, availability of services, and type of mental health services in Ontario for children who have experienced maltreatment with a specific focus on childhood sexual abuse (CSA). The first study was descriptive and involved an email questionnaire completed by Directors of Service in each of the 53 Ontario Children’s Aid Societies (CAS). While the primary purpose of study 1 was to inform the sample for study 2, it also provided information about the identification of mental health needs and the referral process to mental health services for children who have experienced maltreatment. Based on the finding that the majority of mental health service referrals are made to community-based psychologists (80%), study 2 was designed to assess the availability, type, and empirical support of treatments provided by Ontario psychologists and psychological associates to children who have experienced CSA. Through the first provincial census of child and adolescent psychology clinicians registered with the College of Psychologists of Ontario, this study addressed the following questions: (1) What are the demographic, work setting, and treatment provision characteristics of these clinicians? (2) Within this population, what is the proportion and distribution of clinicians who provide treatment to children who have experienced CSA?; (3) To what extent do these treatment services map onto empirically-supported treatments (ESTs) for children who have experienced CSA?; and (4) How do clinicians’ demographic, work setting, treatment provision characteristics, and attitudes toward ESTs predict their approach to intervention? Results indicated that clinicians who worked with children who have experienced CSA differed significantly from other clinicians in terms of age, work setting, self-reported theoretical orientation, and clients’ primary presenting problems. Moreover, clinician age, self-reported theoretical orientation, time devoted to clinical training activities, and general attitudes toward ESTs predicted the use of ESTs among clinicians who work with children who have experienced CSA. Limitations and implications for future research are addressed within each study.

This two-study dissertation aimed to develop a comprehensive understanding of mental health need identification, service referral process, availability of services, and type of mental health services in Ontario for children who have experienced maltreatment with a specific focus on childhood sexual abuse (CSA). The first study was descriptive and involved an email questionnaire completed by Directors of Service in each of the 53 Ontario Children’s Aid Societies (CAS). While the primary purpose of study 1 was to inform the sample for study 2, it also provided information about the identification of mental health needs and the referral process to mental health services for children who have experienced maltreatment. Based on the finding that the majority of mental health service referrals are made to community-based psychologists (80%), study 2 was designed to assess the availability, type, and empirical support of treatments provided by Ontario psychologists and psychological associates to children who have experienced CSA. Through the first provincial census of child and adolescent psychology clinicians registered with the College of Psychologists of Ontario, this study addressed the following questions: (1) What are the demographic, work setting, and treatment provision characteristics of these clinicians? (2) Within this population, what is the proportion and distribution of clinicians who provide treatment to children who have experienced CSA?; (3) To what extent do these treatment services map onto empirically-supported treatments (ESTs) for children who have experienced CSA?; and (4) How do clinicians’ demographic, work setting, treatment provision characteristics, and attitudes toward ESTs predict their approach to intervention? Results indicated that clinicians who worked with children who have experienced CSA differed significantly from other clinicians in terms of age, work setting, self-reported theoretical orientation, and clients’ primary presenting problems. Moreover, clinician age, self-reported theoretical orientation, time devoted to clinical training activities, and general attitudes toward ESTs predicted the use of ESTs among clinicians who work with children who have experienced CSA. Limitations and implications for future research are addressed within each study.

The purpose of the study was to examine whether athletic participation as a child and/or adolescent acts as a protective factor for youth who endure childhood maltreatment. After screening for childhood maltreatment, our 269 participants were separated into either an athlete group or a non-athlete group and compared using two one-way multivariate analyses of covariance (MANCOVA). Emotional neglect served as the covariate due to non-athletes' significantly higher emotional neglect scores than athletes. The first MANCOVA compared athletes and non-athletes on positive outcomes, which included measures of post-traumatic growth, three adaptive coping strategies, and self-compassion. In the second MANCOVA, we assessed for differences between athletes and non-athletes on negative outcomes, which included measures of traumatic, depressive, and anxious symptomology and a maladaptive coping strategy. Neither MANCOVA reached significance, rejecting our hypothesis that athletes would be more resilient than non-athletes to the negative impact of childhood maltreatment. Discussion considers possible reasons for the lack of significance, such as the recency of athletic participation or the specific type of maltreatment experienced, as well as limitations and directions for future research.

The purpose of this study was to identify risk factors for repeated child maltreatment in Iceland. Only cases that had never been reported to child protection services before were included in this study (N=77 total). Each case was followed for 18 months. In all cases the first reported incident was neglect. In the study, a group of cases that had only been reported once (single incident) was compared with another group of cases that had been reported two or more times (repeated incidents). Risk factors were identified and compared on different levels according to an ecological model: 1) Demographics, 2) Parental figure problems, 3) Children's characteristics, 4) Family problems, 5) Social support. In addition, the two groups were compared on parental non-cooperation and services received. In a logistic regression model, the groups differed significantly on the following factors; the mother figures in the repeated incidents group had lower education level and the mothers in that group had more personal problems than the mother figures in the repeated incidents group. In addition, the repeated incidents group experienced more family dynamic problems than the single incident group.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20053号 / 医博第4161号 / 新制||医||1018(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 佐藤 俊哉, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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INTRODUCTION: As evidenced in the literature, when maltreated children are admitted into state care, they are frequently not afforded sufficient mental health treatment. Concomitantly, foster parents are often not given proper training in providing complex care for these children. As such, the current study aimed to examine the role that foster care has in the development of psychopathology in maltreated children and their caregivers. METHODS: Participants included 234 maltreated youths (ages 7 to 17) presenting for treatment at a community mental health center specializing in childhood trauma. Children and adolescents currently residing in foster care as well as in their biological home environments were included. RESULTS: Results of multiple regression models indicated that a history of foster care plays a significant role in the association between children and adolescents who have witnessed domestic violence and internalizing disorders, externalizing disorders, and parenting stress. DISCUSSION: Results from this study revealed that a lack of foster care history plays a significant role in moderating the development of psychopathology in children and adolescents who have witnessed domestic violence. This association was also found with parenting stress. Future research needs to further explicate the specific roles that a child’s living situation can play in future psychological impairment.

This study examined mother-infant attachment relationships as identified by a social work team working with a highly vulnerable cohort. Infants in the ultra-high risk population are most at risk of poor attachment styles. Mothers often have a history of childhood abuse and adversity, criminality, substance abuse, and poor mental health. When combined with socio-environmental aspects within families a high incidence of poor attachment is likely. This study investigated Social Workers’ identification of attachment issues using qualitative methodology in the form of document analysis of Social Worker case notes and semi-structured interviews with Social Workers. Results indicate that the accuracy and frequency of identifying attachment varied and that often the focus was on individual behaviours rather than the dynamic attachment processes of the mother-infant dyad. Disturbance in the attachment relationship was most clearly and accurately identified in cases that involved a major disruption to the mother-infant relationship. Attachment styles were identified as secure in almost every non-crisis case, particularly in the infant’s early years. Possible early manifestations of insecure attachment styles were not viewed through the lens of attachment theory, but rather in the context of behavioural and parenting problems. The potency of the Social Worker-mother relationship emerged as a factor that may in and of itself be crucial in helping mothers attach to their infants.

Researchers have consistently identified two distinct types of aggression: A “hot-blooded”, impulsive, reactive form of aggression, and a “cold-blooded”, premeditated, instrumental form of aggression. Despite the relevance of psychopathology to the prediction of violent offending, there has been limited research on the role of mental health factors in subtypes of severe criminal violence. Childhood maltreatment history has also demonstrated associations with both psychopathology and violence, yet has not been investigated in subtypes of severe violence in adults. In the current study, the relationships between mental health history, substance use, personality pathology, maltreatment, and subtypes of criminal violence were examined in a sample of 144 incarcerated male offenders. Domain-specific multinomial logistic regression analyses indicated that the likelihood of reactive violence was predicted by the severity of alcohol use history and polysubstance intoxication at the time of the offence. Whereas there was a trend for stimulant use history to be predictive of reactive violence, stimulant intoxication at the time of offence was exclusively associated with instrumental violence. Severity of opiate use history revealed a trend for association with the likelihood of instrumental violence. Specific Axis I mental health problems, personality pathology, and maltreatment history were not predictive of violence subtype. Although psychopathy was not a significant individual predictor of violence subtype, the interaction between substance intoxication and specific psychopathic traits contributed significantly to the prediction of violence subtype. A final logistic regression model identified stimulant intoxication, polysubstance intoxication, and alcohol use history as key predictors of violence subtype. This model allowed for the prediction of subtype of violence at a rate higher than chance. In addition to risk-factor analyses, person-focused analyses identified four clusters of offenders in the current sample: A High Psychopathology cluster, a Low Psychopathology cluster, an Antisocial cluster, and a Moderate Schizoid Traits cluster. Clusters differed significantly on psychopathology profiles, and were marginally different on maltreatment history. However, clusters demonstrated limited association with subtype of violence. Findings from this research have important implications for violence risk prediction, offender profiling, and developing targeted intervention services.