The Prevalence and Patterns of Maltreatment, Childhood Adversity, and Mental Health Disorders in an Australian Out-Of-Home Care Sample.

This study aimed to explore key characteristics of the out-of-home care subgroup of a nationally representative Australian sample. To ensure that mental health services are appropriately targeted, it is critical that we understand the differential impacts of childhood experiences for this cohort. Using the Australian Child Maltreatment Study (N = 8503), we explored patterns of childhood maltreatment and adversity of participants who reported ever being placed in out-of-home care, such as foster care or kinship care. In addition, the prevalence of current and lifetime diagnosis of four mental health disorders were explored. Results showed that the care experienced subgroup reported more types of maltreatment and adverse experiences than the control group. They were also more likely to meet diagnostic threshold for post-traumatic stress disorder, generalised anxiety disorder and major depressive disorder than the control group. These findings can be used to guide mental health practitioners to target interventions more effectively within the out-of-home care cohort.

How Risky is Online Sexting by Minors?

What proportion of minors who engage in sexting find themselves involved in an episode of image abuse? The data come from a US nationally representative sample of 2639 respondents aged 18-28 reporting about experiences before the age of 18, of whom 23% had engaged in sexting as minors. Among those who sexted the rate of image abuse was 37%, a risk ratio of 13.2 compared to those who did not engage in sexting. For females who sexted the victimization rate was particularly high, but sexting increased risk for females and males. Among the minors who only sexted occasionally (vs those who sexted frequently) the rate of abuse was still high (35%) and the reduction in risk modest. When we controlled for other background and demographic risk factors like adversities and prior sexual abuse, it did not substantially reduce the large risk entailed with sexting. Various harm reduction strategies may be needed to supplement messages about dangers and risks.

Contexts and Characteristics of Imaged-Based Sexual Exploitation and Abuse of Children: Incident Dynamics in a National Sample.

This paper describes incident characteristics and dynamics associated with six specific forms of image-based sexual exploitation and abuse of children (IBSEAC). Data were collected on a national sample of 2639 individuals aged 18-to-28 from a probability-based online panel. Respondents completed a self-administered survey questionnaire, providing detailed follow-up information on their experiences of image-based sexual victimization before the age of 18. A total of 607 incidents of IBSEAC were included in the analyses. Findings show substantial diversity in incident characteristics within and across the six forms of IBSEAC (nonconsensual sharing of sexual images, nonconsensual taking or making of images, forced image recruitment, threatened sharing, voluntary image sharing with an older adult, and commercial sexual exploitation involving images). Some notable patterns include frequent involvement of perpetrators who are other youth or young adults, who are known in-person to the victim, and who are intimate partners. The diversity and complexity of dynamics revealed in this study underscores the need for careful design and evaluation of prevention programs and the core messages directed at youth.

Prevalence of Technology-Facilitated Abuse Among Sexual and Gender Minority Youths.

Importance: Digital communication and imaging technologies have created new opportunities for technology-facilitated abuse (TFA) and necessitate a better understanding of how and why the risk for TFA varies across different groups of youths. Objectives: To compare the prevalence of TFA among youths across 5 different sexual and gender identity groups, and to identify risk factors that may explain variations in TFA risk. Design, Setting, and Participants: A US nationally representative online survey was conducted among 2639 young adults recruited from the KnowledgePanel online panel from November 19 to December 29, 2021. Individuals aged 18 to 28 years were asked retrospectively about TFA and a variety of other youth experiences in childhood (aged <18 years). Main Outcomes and Measures: Participants were asked about their sexual and gender identities, 11 types of TFA occurring before the age of 18 years, and several potential risk factors. Prevalence rates of any TFA were compared across sexual and gender identity groups, and analyses were conducted to identify risk factors that help explain group differences. Weights were developed to compensate for gender, education, race and ethnicity, household income, census region, and metropolitan status disproportions. Results: Among the 2510 respondents (mean [SD] age, 24.8 [2.8] years) who provided gender and sexual identity information, 46.5% (95% CI, 41.9%-51.1%) were cisgender heterosexual females, 25.2% (95% CI, 21.6%-29.1%) were cisgender sexual minority females, 18.3% (95% CI, 14.4%-22.9%) were cisgender heterosexual males, 6.8% (95% CI, 4.6%-9.9%) were cisgender sexual minority males, and 3.3% (95% CI, 2.0%-5.4%) were gender minority individuals. The prevalence of TFA occurring before the age of 18 years was highest among sexual minority females (55.3%; 95% CI, 48.0%-62.4%) and gender minority individuals (53.4%; 95% CI, 33.5%-72.2%). Rates of sexting were highest among cisgender sexual minority females (38.8%; 95% CI, 19.1%-58.8%) and gender minority individuals (36.7%; 95% CI, 19.1%-58.8%) and represented the strongest risk factor for TFA exposure (odds ratio, 5.7; 95% CI, 4.0-8.0). However, it explained little variation in TFA across groups once early in-person adversity, sexual abuse, bullying, and maltreatment were taken into account. Conclusions and Relevance: This study demonstrates the risk of TFA among sexual and gender minority youths and the need to target prevention efforts toward these vulnerable groups. In addition to strategies to reduce risky behavior, efforts to lower the risk of early sexual abuse, bullying, and maltreatment are likely to also be effective in decreasing TFA among these marginalized groups.

Characteristics and Dynamics of Cyberstalking Victimization Among Juveniles and Young Adults.

Using the nationally representative Ipsos online KnowledgePanel, the sample included three hundred thirty-six 18- to 28-year-olds who retrospectively reported first cyberstalking incidents as juveniles (9- to 17-year-olds) or adults. Half of the sample first experienced cyberstalking as juveniles and half first experienced it as adults. Juveniles were more likely to have more than two perpetrators in the same episode, to experience more violent threats, and to avoid people because of what happened. Few reported the incident to the police, with juveniles less likely to report it to the police. Cyberstalking of juveniles appears just as or more serious than cyberstalking of adults.

Prevalence of Diverse Genders and Sexualities in Australia and Associations With Five Forms of Child Maltreatment and Multi-type Maltreatment.

This study presents the most comprehensive national prevalence estimates of diverse gender and sexuality identities in Australians, and the associations with five separate types of child maltreatment and their overlap (multi-type maltreatment). Using Australian Child Maltreatment Study (ACMS) data (N = 8503), 9.5% of participants identified with a diverse sexuality and .9% with a diverse gender. Diverse identities were more prevalent in the youth cohort, with 17.7% of 16-24 years olds identifying with a diverse sexuality and 2.3% with a diverse gender. Gender and sexuality diversity also intersect - for example, with women (aged 16-24 and 25-44) more likely than men to identify as bisexual. The prevalence of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence was very high for those with diverse sexuality and/or gender identities. Maltreatment was most prevalent for participants in the youth cohort with diverse gender identities (90.5% experiencing some form of child maltreatment; 77% multi-type maltreatment) or diverse sexualities (85.3% reporting any child maltreatment; 64.3% multi-type maltreatment). The strong association found between child maltreatment and diverse sexuality and gender identities is critical for understanding the social and mental health vulnerabilities of these groups, and informing services needed to support them.

The prevalence of child sexual abuse with online sexual abuse added.

BACKGROUND AND OBJECTIVE: Research efforts are measuring various forms of online sexual abuse. There is a need to incorporate such measures of online sexual abuse into the calculation of overall prevalence rates for child sexual abuse. PARTICIPANTS: A sample of 2639 respondents aged 18-to-28 was recruited from a nationally representative online panel. METHODS: Using an online questionnaire, respondents were assessed via self-report about 9 types of online sexual abuse in childhood and were also assessed with 2 questions that have been used to assess generic child sexual abuse prevalence in previous surveys. RESULTS: The addition of the online abuse to the generic questions about child sexual abuse raised the overall prevalence rate from 13.5 % to 21.7 %. The rate for females increased from 19.8 % to 31.6 % and for males from 6.2 % to 10.8 %. The largest independent contribution to the overall combined increase were the offenses involving non-consensual image sharing and voluntary online sexual interactions with an impermissibly older adult partner. The inclusion of the online sexual abuse exposures also increased the ability to identify the survivors with the highest levels of current psychological distress. CONCLUSION: The study highlights the importance of counting and including online sexual abuse in efforts to estimate the overall prevalence of childhood sexual abuse. The paper proposes 2 or 3 questions that could be added to sexual abuse questionnaires to assess these online offenses efficiently.

Randomized Control Trial of a School-Based Curriculum that Teaches About Multiple Forms of Abuse.

Most school-based prevention curricula for young children fail to address multiple types of abuse and limit instruction to a single day, despite evidence that polyvictimization is common and children learn better when allowed to practice material repeatedly. This study utilized a cluster randomized control trial design to evaluate a multi-abuse prevention program, the Monique Burr Foundation for Children (MBF) Child Safety Matters®, based on varying lesson structure. Participants included nine Florida schools consisting of 843 children in grades K-2. Schools were randomized within cluster to implement in two lessons, four lessons, or after study data collection (i.e., control group). Lessons averaged 34 minutes (SD = 8.8 minutes) in length for 2-lesson group and 23.6 minutes (SD = 6.9 minutes) for the 4-lesson condition. Knowledge was assessed before implementation and on average 11 weeks after implementation. There were no statistical differences between clusters. Controlling for pre-test scores, schools in the four-lesson group scored highest on a measure of knowledge of potentially risky and unsafe situations (M = 69.68, SE = .80) on post-test, followed by schools in the two-lesson group (M = 67.31, SE = .77), followed by schools in the control group (M = 62.92, SE = .76). Results support use of more frequent, shorter lessons for prevention programs and the promise of addressing multiple forms of child victimization.

Child sexual abuse by different classes and types of perpetrator: Prevalence and trends from an Australian national survey.

BACKGROUND: Little evidence exists about the prevalence of child sexual abuse (CSA) inflicted by different relational classes of perpetrators (e.g., parents; institutional adults; adolescents), and by individual types of perpetrators (e.g., fathers and male relatives; male teachers and male clergy; known and unknown adolescents). OBJECTIVE: To generate evidence of the prevalence of CSA by different perpetrators, and trends by victim gender and age group. PARTICIPANTS AND SETTING: The Australian Child Maltreatment Study collected information about CSA victimisation from a nationally-representative sample of 8503 individuals aged 16 and over. METHODS: We analysed data about 42 perpetrator types, collapsed into eight classes. We generated national prevalence estimates of CSA inflicted by each perpetrator class and individual perpetrator type, and compared results by victim gender and age group. RESULTS: Australian CSA prevalence was 28.5%, with the following prevalence by perpetrator classes: other known adolescents (non-romantic): 10.0%; parents/caregivers in the home: 7.8%; other known adults: 7.5%; unknown adults: 4.9%; adolescents (current/former romantic partners): 2.5%; institutional caregivers: 2.0%; siblings: 1.6%; unknown adolescents: 1.4%. Women experienced more CSA by all perpetrator classes except institutional caregivers. Age group comparison showed significant declines in CSA by parents/caregivers, and other known adults; and increases in CSA by adolescents (current/former romantic partners). Individual perpetrator type comparison showed declines in CSA by fathers, male relatives living in the home, non-resident male relatives, and other known male adults; and increases in CSA by known male adolescents, current boyfriends, and former boyfriends. CONCLUSIONS: CSA by adults has declined, indicating positive impacts of prevention efforts. However, CSA by adolescents has increased. Further declines in CSA by adults are required and possible. Targeted prevention of CSA by adolescents must be prioritised.

The mental health of officials who regularly examine child sexual abuse material: strategies for harm mitigation.

BACKGROUND: The current study aims to better understand the mental health and subjective well-being of investigators and forensic examiners exposed to child sexual abuse material (CSAM) by examining which components of this work are associated with elevated mental health conditions and decreased well-being, as well as the intra-personal and organizational variables that may mitigate harm and improve well-being. METHODS: Police investigators, forensic examiners, and others connected with the criminal justice system from across the United States who were exposed to CSAM as part of their professions (N = 500) completed an anonymous online survey. Participants were recruited through connections with the National Criminal Justice Training Center. RESULTS: Duration, frequency, amount, and content of CSAM exposure was not related to poorer mental health with the exception of exposure to violent CSAM which was related to elevated post-traumatic stress symptoms. Several agency-level practices and policies, such as the availability of an Officer Wellness Program and more frequently knowing the final case resolution, were related to better mental health and well-being. Harm mitigation strategies, such as talking to other officers investigating the case and taking breaks from the material being viewed, were also related to better mental health. CONCLUSIONS: Findings indicate that police agencies have options for implementing agency-level procedures and practices that have the potential to reduce the negative impact of CSAM investigations. Additionally, many investigators use strategies that are correlated with greater well-being, suggesting opportunities for improving training programs.

Victimization and abuse among children with disabilities: Age adjusted rates in a US national sample.

BACKGROUND: Research has indicated that children with disabilities are at higher risk for victimization although the literature on this topic is limited. OBJECTIVE: We examined rates of assault, sexual victimization, peer-sibling victimization, property crime, maltreatment, and poly-victimization among youth in the United States with and without disabilities. We examined these rates for three age groups (children ages 0-4 years, ages 5-11 years, and ages 12-17 years). PARTICIPANTS AND SETTING: We use data from the National Survey of Children's Exposure to Violence (NatSCEV), waves I (2008), II (2011), and III (2014). These are cross-sectional nationally representative samples of children and youth ages one month to 17 years (N = 12,634). RESULTS: Considering children of all ages together, children in all disability categories, except for physical disability, were at higher risk for poly-victimization. Victimization exposure overall is higher among older children (except for assault among very young children with developmental or learning disabilities), though the disparity between children with and without disabilities generally narrows as children get older. Age of the child impacted the relationships between disability and victimization. Very young children with physical disabilities were at heightened risk for most types of victimization while children with internalizing disabilities were at heightened risk for assault, property crime, and maltreatment in middle childhood and adolescence. Children with externalizing disabilities were at heightened risk for most types of victimization across all ages while developmental disabilities appeared to be risk factor for very young children and a potentially protective factor at later ages though these varied by type of victimization. CONCLUSION: Victimization risk varied by victimization and disability types. This study demonstrates the importance of controlling for demographic characteristics, especially age of the child in estimating the prevalence of victimization among children with disabilities and establishes the importance of type-specific analyses by victimization type, disability type, and age of the child.

Perpetrators' Identity in Online Crimes Against Children: A Meta-Analysis.

Public and police concern about internet crimes against children has been primarily typified as a stranger danger problem. However, existing research suggests a variety of perpetrator ages and relationships to the victim. A more accurate estimate will help inform prevention efforts. This study provides a meta-analysis examining the identity of perpetrators in internet crimes against children. Databases were searched for published and unpublished studies using a detailed search strategy. In total, 32 studies met full inclusion criteria. Inclusion criteria was the following: (1) the victim sample consisted of children under the age of 18 years or young adults (18-25) asked to respond retrospectively; (2) the study victims experienced abuse through the use of technology; (3) the study reported the identity of the perpetrator, either the relationship to the victim or the age of the perpetrator; (4) the study was available in English. The overall proportion of offenders under the age of 18 as a proportion of all identified offenders was 44% (95% CI: 0.28-0.60). The overall proportion of acquaintance and family offenders as a proportion of all identified offenders was 68% (95% CI: 0.62-0.75). Between study variability was explained by data source, with higher proportion of juvenile offenders in studies using survey data. This meta-analysis confirms that most perpetrators of online crimes against children are not strangers to their victims and a large portion of perpetrators are juveniles. Prevention education needs to focus more on inappropriate behavior from anyone in addition to the dangers about communicating with strangers.

Help-Seeking From Websites and Police in the Aftermath of Technology-Facilitated Victimization.

This study looked at experiences of help-seeking from websites and police following an episode of technology-facilitated abuse. It used data from a nationally representative online panel of adults aged 18 to 28, sampled from Ipsos Knowledge Panel. A total of 1,952 unique victimization episodes from childhood and adulthood were identified and used in analyses. Participants were asked about whether they experienced 11 different types of technology-facilitated abuse (TFA), whether the incident was reported to the website or police, barriers to reporting, and features of the website's or law enforcement's response. Other follow-up information included victim gender, age, relationship to the perpetrator, and negative emotional impact (NEI) associated with the incident. Results found very low rates of reporting to both websites (7.3%) and law enforcement (4.8%). Image-based offenses had higher rates of reporting. A greater NEI significantly increased the odds of reporting to each source. Participants were largely unsatisfied with response from websites and police. Only 42.2% said the website did something helpful and only 29.8% found police helpful. Our findings suggest a need for major improvements in how websites and law enforcement respond to victims of technology-facilitated offenses. They need to have more helpful information and more ways of offering support. Websites need more specifics about the types of violations that warrant reporting, clearer signposts, and encouragement about how to get help and a better publicized commitment to a rapid and serious review. Law enforcement needs more education and training to avoid dismissive and judgmental reactions and to ensure sympathetic and respectful responses.

Child sexual abuse images and youth produced images: The varieties of Image-based Sexual Exploitation and Abuse of Children.

BACKGROUND AND OBJECTIVE: This paper presents a categorization of sexual image crimes and abuse that occur against children, and it compares their frequency, dynamics, and emotional impact. PARTICIPANTS: A national sample of 2639 respondents aged 18-to-28 disclosed 369 childhood episodes involving a variety of image abuse. METHODS: Online self-administered questionnaire. RESULTS: The analysis classified the cases into five incident types: 1) adult made images (child sexual abuse images), 2) images non-consensually made by other youth, 3) voluntarily provided self-made images that were non-consensually shared by other youth, 4) voluntarily provided self-made images non-consensually shared by adults, and 5) voluntarily provided self-made images to adults that entailed an illegal age difference or were part of a commercial transaction. We propose to refer to this aggregation of types as Image Based Sexual Exploitation and Abuse of Children (IBSEAC). Only 12 % of the image episodes qualified as adult produced, child sexual abuse images. Such adult produced image experiences were also not higher in negative emotional impact than the youth produced images. Only 10 % of the episodes involved images of children under age 13. CONCLUSION: The study highlights the predominance of youth made sexual images among the image exploitation and abuse affecting youth according to self-report. It also highlights the difference between what victim surveys reveal about the problem and what is inferred from police record studies.

The association between child maltreatment and health risk behaviours and conditions throughout life in the Australian Child Maltreatment Study.

OBJECTIVE: To estimate associations between all five types of child maltreatment (emotional abuse, neglect, physical abuse, sexual abuse, and exposure to domestic violence) and health risk behaviours and conditions. DESIGN, SETTING, PARTICIPANTS: Nationally representative survey of Australian residents aged 16 years and older conducted by computer-assisted telephone interviewing. MAIN OUTCOME MEASURES: Associations between child maltreatment and the following health risk behaviours and conditions: current smoker, binge drinking (at least weekly in past 12 months), cannabis dependence (according to the Cannabis Severity of Dependence Scale), obesity (based on body mass index), self-harm in past 12 months, and suicide attempt in past 12 months. RESULTS: A total of 8503 participants completed the survey. All five types of child maltreatment were associated with increased rates of all of the health risk behaviours and conditions that we considered. The strongest associations were in the youngest age group (16-24-year-olds). Sexual abuse and emotional abuse were associated with the highest odds of health risk behaviours and conditions. Cannabis dependence, self-harm and suicide attempts were most strongly associated with child maltreatment. Experiencing more than one type of child maltreatment was associated with higher rates of health risk behaviours and conditions than experiencing one type of child maltreatment. CONCLUSIONS: Child maltreatment is associated with substantially increased rates of health risk behaviours and conditions. Prevention and intervention efforts should be informed by trauma histories, and holistic psychosocial care should be incorporated into programs focusing on behaviour change.

The Australian Child Maltreatment Study (ACMS), a national survey of the prevalence of child maltreatment and its correlates: methodology.

OBJECTIVES: To describe the aims, design, methodology, and respondent sample representativeness of the Australian Child Maltreatment Study (ACMS). DESIGN, SETTING: Cross-sectional, retrospective survey; computer-assisted mobile telephone interviewing using random digit dialling (computer-generated), Australia, 9 April - 11 October 2021. PARTICIPANTS: People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from five further age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES: Primary outcomes: Emotional abuse, neglect, physical abuse, sexual abuse, exposure to domestic violence during childhood, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). SECONDARY OUTCOMES: selected mental disorder diagnoses (Mini International Neuropsychiatric Interview, MINI), selected physical health conditions, health risk behaviours, health service use. RESULTS: The demographic characteristics of the ACMS sample were similar to those of the Australian population in 2016 with respect to gender, Indigenous status, region and remoteness category of residence, and marital status, but larger proportions of participants were born in Australia, lived in areas of higher socio-economic status, had tertiary qualifications, and had income greater than $1250 per week. Population weights were derived to adjust for these differences. Associations between the number of calls required to recruit participants and maltreatment rates and health outcomes were not statistically significant. CONCLUSIONS: The ACMS provides the first reliable estimates of the prevalence of each type of child maltreatment in Australia. These estimates, and those of associated mental health and health risk behaviours reported in this supplement can inform policy and practice initiatives for reducing the prevalence of child maltreatment and its consequences. Our benchmark study also provides baseline data for repeated waves of the ACMS that will assess the effectiveness of these initiatives.

The prevalence of child maltreatment in Australia: findings from a national survey.

OBJECTIVES: To estimate the prevalence in Australia of each type of child maltreatment; to identify gender- and age group-related differences in prevalence. DESIGN, SETTING: Cross-sectional national survey; mobile telephone interviews using random digit dialling (computer-generated), Australia, 9 April - 11 October 2021. Retrospective self-report data using validated questionnaire (Juvenile Victimisation Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). PARTICIPANTS: People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from five further age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES: Proportions of respondents reporting physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence to age 18 years, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study), overall and by gender and age group, and weighted to reflect characteristics of the Australian population aged 16 years or more in 2016. RESULTS: Complete survey data were available for 8503 eligible participants (14% response rate). Physical abuse was reported by 32.0% of respondents (95% confidence interval [CI], 30.7-33.3%), sexual abuse by 28.5% (95% CI, 27.3-29.8%), emotional abuse by 30.9% (95% CI, 29.7-32.2%), neglect by 8.9% (95% CI, 8.1-9.7%), and exposure to domestic violence by 39.6% (95% CI, 38.3-40.9%). The proportions of respondents who reported sexual abuse, emotional abuse, or neglect were each statistically significantly larger for women than men. The reported prevalence of physical abuse by respondents aged 16-24 years was lower than for those aged 25-34 years, and that of sexual abuse was lower than for those aged 35-44 years, suggesting recent declines in the prevalence of these maltreatment types. CONCLUSIONS: Child maltreatment is common in Australia, and larger proportions of women than men report having experienced sexual abuse, emotional abuse, and neglect during childhood. As physical and sexual abuse may have declined recently, public health policy and practice may have positive effects, justifying continued monitoring and prevention activities.

The prevalence and nature of multi-type child maltreatment in Australia.

OBJECTIVES: To determine the prevalence in Australia of multi-type child maltreatment, defined as two or more maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence) and to examine its nature, family risk factors, and gender and age cohort differences. DESIGN: Retrospective cross-sectional survey using a validated questionnaire. SETTING AND PARTICIPANTS: Mobile phone random digit-dial sample of the Australian population aged 16 years and older. MAIN OUTCOME MEASURES: National estimates of multi-type child maltreatment up to age 18 years using the Juvenile Victimisation Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study). RESULTS: Of 8503 participants, 62.2% (95% CI, 60.9-63.6%) experienced one or more types of child maltreatment. Prevalence of single-type maltreatment was 22.8% (95% CI, 21.7-24.0%), whereas 39.4% (95% CI, 38.1-40.7%) of participants reported multi-type maltreatment and 3.5% (95% CI, 3.0-4.0%) reported all five types. Multi-type maltreatment was more common for gender diverse participants (66.1% [95% CI, 53.7-78.7%]) and women (43.2% [95% CI, 41.3-45.1%]) than for men (34.9% [95% CI, 33.0-36.7%]). Multi-type maltreatment prevalence was highest for those aged 25-44 years. Family-related adverse childhood experiences - especially mental illness and alcohol or substance misuse - increased risk. Exposure to domestic violence was the maltreatment type most often present in multi-type maltreatment patterns. CONCLUSIONS: Multi-type child maltreatment is prevalent in Australia and more common in women and gender diverse individuals. Child protection services, health practitioners, and prevention and intervention services must assess and manage multi-type maltreatment in children and address its health consequences across the lifespan. Public health policy should consider prevention services or strategies that target multi-type child maltreatment.

Child maltreatment and health service use: findings of the Australian Child Maltreatment Study.

OBJECTIVES: To examine associations between child maltreatment and health service use, both overall, by type and by the number of types of maltreatment reported. DESIGN, SETTING: Cross-sectional, retrospective survey using the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study); computer-assisted mobile telephone interviews using random digit dialling, Australia, 9 April - 11 October 2021. PARTICIPANTS: Australians aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from the five age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES: Self-reported health service use during the past twelve months: hospital admissions, length of stay, and reasons for admission; and numbers of consultations with health care professionals, overall and by type. Associations between maltreatment and health service use are reported as odds ratios adjusted for age group, gender, socio-economic status, financial hardship (childhood and current), and geographic remoteness. RESULTS: A total of 8503 participants completed the survey. Respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.16-1.66), particularly admission with a mental disorder (aOR, 2.4; 95% CI, 1.03-5.6). The likelihood of six or more visits to general practitioners (aOR, 2.37; 95% CI, 1.87-3.02) or of a consultation with a mental health nurse (aOR, 2.67; 95% CI, 1.75-4.06), psychologist (aOR, 2.40; 95% CI, 2.00-2.88), or psychiatrist (aOR, 3.02; 95% CI, 2.25-4.04) were each higher for people who reported maltreatment during childhood. People who reported three or more maltreatment types were generally most likely to report greater health service use. CONCLUSIONS: Child maltreatment has a major impact on health service use. Early, targeted interventions are vital, not only for supporting children directly, but also for their longer term wellbeing and reducing their health system use throughout life.

The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study.

OBJECTIVES: To examine the associations between experiences of child maltreatment and mental disorders in the Australian population. DESIGN: Population-representative survey conducted by computer-assisted telephone interviewing. SETTING, PARTICIPANTS: Australian residents aged 16 years and older. MAIN OUTCOME MEASURES: Mental disorder diagnoses of lifetime major depressive disorder, current alcohol use disorder (mild, moderate and severe), current generalised anxiety disorder and current post-traumatic stress disorder. RESULTS: More than one in three Australians (3606/8503 surveyed participants; 38.0%; 95% CI, 36.7-39.3%) met the diagnostic criteria for a mental disorder. The prevalence of mental disorders in non-maltreated participants was 21.6% (95% CI, 19.9-23.3%; n = 851). This increased to 36.2% (95% CI, 33.5-38.9%; n = 764) for those who experienced a single type of maltreatment and 54.8% (95% CI, 52.6-56.9%; n = 1991) for participants who experienced multi-type maltreatment. Compared with non-maltreated Australians, maltreated participants had about three times the odds of any mental disorder (odds ratio [OR], 2.82; 95% CI, 2.47-3.22), generalised anxiety disorder (OR, 3.14; 95% CI, 2.48-3.97), major depressive disorder (OR, 3.19; 95% CI, 2.68-3.80) and severe alcohol use disorder (OR, 2.62; 95% CI, 1.83-3.76), and almost five times the odds of post-traumatic stress disorder (OR, 4.60; 95% CI, 3.00-7.07). Associations between experiences of child maltreatment and mental disorders were strongest for sexual abuse, emotional abuse and multi-type maltreatment. The strength of the associations did not differ by gender. Adjustment for childhood and current financial hardship and for current socio-economic status did not significantly attenuate the associations. CONCLUSIONS: Mental disorders are significantly more likely to occur in individuals who experience child maltreatment, particularly multi-type maltreatment. Prevention of child maltreatment provides an opportunity to substantially reduce the prevalence of mental illness and improve the health of the Australian population.