Experiências adversas na infância: um estudo com autores de agressão sexual / Experiencias infantiles adversas: un estudio con perpretadores de agresiones sexuales / Adverse childhood experiences: a study addressing the perpetrators of sexual violence

This study aimed to describe the Adverse Childhood Experiences (ACE) of perpetrators of sexual violence of children and adolescents and their relationship with the abusers' personal and situational factors (n = 30). Hence, a database composed of the transcripts of interviews was analyzed using content analysis, from which thematic categories emerged as proposed by the Adverse Childhood Experiences International Questionnaire (ACE-IQ). Physical abuse was the most frequently reported (70%). Sexual abuse was reported by almost half of the sample, which presented an increased risk in the face of the death and/or divorce of parents (RR = 4.21) and emotional neglect (RR = 3.2). In addition, the participants with higher ACE-Scores abused children more recurrently and less frequently consumed alcohol or other drugs. The interpretation of the results in light of the literature reinforces the hypothesis that the consequences of adversities during childhood are associated with a higher likelihood of becoming a victim throughout life and manifesting risky behaviors, such as aggressive sexual behavior. Future studies are suggested to apply the ACE-IQ to larger samples and implement a post-test to contribute to more effective interventions to treat this population.

Este estudio tuvo como objetivo analizar las Experiencias Adversas en la Infancia por parte de los perpetradores de agresión de niños y niñas y la asociación con factores personales y situacionales identificados. (n = 30). Para ello, se utilizó el instrumento de cribado del Cuestionario Internacional de Experiencias Adversas en la Infancia (ACE-IQ) para el análisis de los datos. El maltrato físico fue reportado con mayor frecuencia (70%) y el abuso sexual fue mencionado por casi la mitad de la muestra, con su riesgo aumentado ante la muerte y/o divorcio de los padres (RR = 4,21) y negligencia emocional (RR = 3.2). Participantes con ACE-Scores más altos han agredido repetidamente a sus víctimas y con menos necesidad de consumir alcohol y/o otras drogas. Los resultados muestran que las consecuencias de la exposición a la adversidad en la infancia están asociadas no solo a la probabilidad de convertirse en víctima a lo largo de la vida, sino también a caminos de transitar permeados por conductas de riesgo y criminalidad. Se sugiere que más estudios puedan aplicar el ACE-IQ a muestras más grandes, con la realización de una prueba posterior, lo que puede contribuir a intervenciones más efectivas al servicio de esta población.

Este estudo objetivou descrever Experiências Adversas na Infância (EAI) relatadas por autores de agressão sexual de crianças e adolescentes e sua relação com fatores pessoais e situacionais identificados (n = 30). Para tanto, utilizou-se um banco de dados formado por transcrições de entrevistas previamente realizadas, cuja análise de conteúdo considerou categorias temáticas retiradas do Adverse Childhood Experiences International Questionnaire (ACE-IQ). O abuso físico foi o mais relatado (70%) e o abuso sexual mencionado por quase metade da amostra, tendo seu risco aumentado diante da morte e/ou separação dos pais (RR = 4.21) e negligência emocional (RR = 3.2). Participantes com maiores ACE-Scores agrediram de forma mais recorrente e com menor uso de álcool e/ou outras drogas. A interpretação dos resultados à luz da literatura da área reforça a hipótese de que as consequências da exposição à adversidade na infância estão relacionadas tanto à probabilidade de tornar-se vítima ao longo da vida quanto de vir a manifestar comportamentos de risco, como a conduta sexual agressiva. Estudos posteriores poderão aplicar o ACE-IQ diretamente e em amostras maiores, com a realização de pós-teste, o que favorecerá a promoção de intervenções mais eficazes no atendimento a essa população.

Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis / Knowledge and attitudes of dentists in the public health system of Pelotas-RS regarding child maltreatment

O presente estudo objetivou identificar e analisar os conhecimentos e as atitudes dos cirurgiões-dentistas (CD) da rede pública de Pelotas-RSfrente aos maus-tratos infantis (MTI). Os dados foram coletados por um questionário semiestruturado. Coletaram-se informações sociodemográficas, relativas ao trabalho, conhecimentos e atitudes dos CD. Realizou-se uma análise estatística descritiva e associações entre as variáveis independentes com os conhecimentos e atitudes por meio do teste de Exato de Fisher e Qui-quadrado (p<0,05). Dos 45 CD incluídos na amostra, mais dametade afirmaram nunca ter recebido informações sobre o tema, 71,1% entenderam ser responsabilidade do CD a identificação de casos suspeitos, 50% não souberam informar a respeito da implicação legal sobre a falta de notificação e 86,7% acreditaram que se deve avisar ao médico ou enfermeiro para que eles tomem alguma atitude. Observou-se que 60% dos profissionais nunca suspeitaram de um caso e 25% dos que suspeitaram tomaram alguma atitude. Houve associação estatística entre a responsabilidade do CD e o sexo e o tempo de formação, da atitude correta frente a um caso suspeito e a pós-graduação, e ainda, da implicação legal com a idade e tempo de formação. Os conhecimentos e atitudes dos CD sobre MTI foram melhores entre profissionais mais jovens, do sexo feminino, com menor tempo de formados, possuindo ou cursando alguma pós-graduação. Os CD conhecem sua importância frente a essa violência, porém apresentam dificuldades quanto às atitudes a tomar (AU).

The present study aimed to identify and analyze the knowledge and attitudes of dentists inthe public health system in Pelotas-RS regarding child maltreatment(CM).Data were collected through semi-structured questionnaire. Sociodemographic information, work-related dataandknowledge and attitudes of dentists were collected.Descriptive statistical analysis and associations between independent variables and knowledge and attitudesof dentists were performed using Fisher's Exact Test and Chi-Square Test (p<0.05).Of the 45 dentists included in the sample, more than halfreportedthat they had never received information on the subject, 71.1% understood the dentist'sresponsibilityin the identification of suspicious cases, 50% were unable to inform about the legal implication of the lack of notification and 86.7% believed that the doctor or nurse should be notified so that they can take action. It was observed that 60% of professionals never suspected a case of CM and 25%of those who suspected took action. There was statistical association between the dentist'sresponsibilityand gender and the time since graduation,betweencorrect attitude towards a suspiciouscase and postgraduate degree and also betweenlegal implication with age and time since graduation.Knowledge and attitudes of dentists about CM were better among younger professionals, females, with less time since graduation, having or attending some postgraduate course. Dentists know their importance towards this violence, but they show difficulties regarding attitudes that they should take (AU).

Intimate partner violence during pregnancy: prevalence and associated factors.

OBJECTIVE: To identify the prevalence of violence during pregnancy and the association with the socioeconomic, behavioral and clinical characteristics of pregnant women. METHODS: Cross-sectional study in a low-risk maternity hospital in the municipality of Cariacica, Espírito Santo. A total of 330 puerperal women were interviewed from August to October 2017. Information on socioeconomic, behavioral, reproductive and clinical characteristics, as well as life experiences, was collected through a questionnaire. To identify the types of violence, the proper World Health Organization instrument was used. Gross bivariate and multivariate analysis was performed and adjusted for Poisson regression with robust variance. RESULTS: Prevalence was 16.1% (95%CI 2.5-20.4) for psychological violence, 7.6% (95%CI 5.1-11.0) for physical violence and 2.7% (95%CI 1.4-5.2) for sexual violence. Psychological violence remained associated with age, family income, beginning of sexual life, disease in pregnancy, desire to interrupt pregnancy and number of partners. Physical violence was associated with schooling, beginning of sexual life and disease in pregnancy. Sexual violence remained associated with marital status and desire to interrupt pregnancy (p < 0.05). CONCLUSIONS: Psychological violence by an intimate partner was the most prevalent among pregnant women. Women that were younger, had lower income and less schooling, who started their sexual life before the age of 14 and who wished to interrupt pregnancy, experienced violence more frequently during pregnancy.

Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors.

BACKGROUND: Evidences points to the importance of health professionals to recognize child abuse, but also to a high frequency of underreporting, even in countries where reporting is mandatory, like Brazil. OBJECTIVE: To evaluate the frequency of non-reporting behavior of child physical abuse (CPA) among Brazilian primary care health professionals who recognized some cases in their careers and associated factors with reporting. METHODS: Cross-sectional study conducted with a representative sample of dentists, nurses, family physicians, and pediatricians from the Family Health Strategy network in the city of Belo Horizonte, Brazil. A validated self-administered questionnaire for use in Brazil was applied in-person to professionals in 2014 and 2015. Pearson's chi-squared test (p < 0.05) and a binary logistic regression model was used. RESULTS: A total of 715 professionals participated (response rate: 98.89%), 414 (57.3%) recognized cases, of which 171 (41.3%) reported. Reporting was associated with the type of profession, as pediatricians reported cases more than dentists [OR = 6.05 (95% CI: 1.24-29.50)], with the willingness to become involved [OR = 2.01 (95% CI: 1.02-3.97)] and knowledge regarding where to report cases [OR = 2.68 (95% CI: 1.25-5.74)]. Confidentiality was the barrier associated with a lower probability of reporting CPA cases [OR = 0.22 (95% CI: 0.08-0.66)]. CONCLUSIONS: There is a high frequency of non-reporting behavior. Pediatricians reported more CPA cases, followed by family doctors and nurses. Dentists were those who reported fewer cases. Reporting was also associated with a willingness to be involved in detecting/reporting abuse and knowing where to report CPA.

Pathways Linking Childhood Physical Abuse to Alcohol Misuse in Adolescent Boys and Girls: A Prospective Cohort Study From Rio de Janeiro, Brazil.

OBJECTIVE: The purpose of this study was to identify if childhood physical abuse is a risk factor for adolescent alcohol misuse and the specific pathways linking childhood physical abuse and alcohol misuse in boys and girls. METHOD: The study enrolled 785 students from the baseline and first wave of a prospective cohort study developed at six high schools in Rio de Janeiro, Brazil. The Childhood Trauma Questionnaire (CTQ), Conflict Tactics Scale-Form R (CTS-1), and Alcohol Use Disorders Identification Test (AUDIT) were used to identify childhood and adolescence physical abuse and alcohol misuse, respectively. Multigroup path analysis was performed to explore the postulated pathways between the exposures and outcomes. RESULTS: Childhood physical abuse was a significant risk factor for alcohol misuse in adolescence for both sexes. Among girls, childhood physical abuse increased the risk of adolescent revictimization and school delay, which were mediators between childhood physical abuse and alcohol misuse. Among boys, childhood physical abuse has a direct effect on increasing the risk of alcohol misuse. School delay was also a mediator from more social determinants to alcohol misuse in both sexes, whereas not living with the mother in adolescence mediated such effects only among boys. CONCLUSIONS: Childhood physical abuse increases the risk of alcohol misuse in adolescence through different pathways in boys and girls. Strategies aimed at reducing alcohol misuse and other mental health problems in adolescence should incorporate such specificities.

Depression and Abuse During Medical Internships in Peruvian Hospitals.

OBJECTIVE: To estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals. METHODS: We conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs). RESULTS: A total of 402 medical interns participated in the study, the median age was 25 [IQR: 21-33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa=1.15), the number of hours they sleep per day (PRa=1.23), being a woman (PRa=3.33), performing the internship in a province (PRa=0.25), studying at a public university (PRa=0.64), living with parents (PRa=0.65) or alone (PRa=0.33), and having perceived some type of abuse (PRa=1.07). CONCLUSIONS: A quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.

The Impact of Attachment-Disrupting Adverse Childhood Experiences on Child Behavioral Health.

OBJECTIVES: To describe patterns of overall, within-household, and community adverse childhood experiences (ACEs) among children in vulnerable neighborhoods and to identify which individual ACEs, over and above overall ACE level, predict need for behavioral health services. STUDY DESIGN: This was a cross-sectional study that used a sample of 257 children ages 3-16 years who were seeking primary care services with co-located mental healthcare services at 1 of 2 clinics in Chicago, Illinois. The outcome variable was need for behavioral health services (Pediatric Symptom Checklist score ≥28). The independent variables were ACEs, measured with an adapted, 28-item version of the Traumatic Events Screening Inventory. RESULTS: Six ACE items were individually predictive of a clinical-range Pediatric Symptom Checklist score after adjusting for sociodemographic covariates: emotional abuse or neglect (OR 2.93, 95% CI 1.32-6.52, P < .01), natural disaster (OR 3.89, 95% CI 1.18-12.76, P = .02), forced separation from a parent or caregiver (OR 2.95, 95% CI 1.50-5.83, P < .01), incarceration of a family member (OR 2.43, 95% CI 1.20-4.93, P = .01), physical attack (OR 2.84, 95% CI 1.32-6.11, P < .01), and community violence (OR 2.35, 95% CI 1.18-4.65, P = .01). After adjusting for overall ACE level, only 1 item remained statistically significant: forced separation from a parent or caregiver (OR 2.44, 95% CI 1.19-5.01, P = .02). CONCLUSIONS: ACEs that disrupt attachment relationships between children and their caregivers are a significant predictor of risk for child emotional or behavioral problems.

Intimate partner violence during pregnancy: prevalence and associated factors / Violências por parceiro íntimo na gestação: prevalências e fatores associados

ABSTRACT OBJECTIVE To identify the prevalence of violence during pregnancy and the association with the socioeconomic, behavioral and clinical characteristics of pregnant women. METHODS Cross-sectional study in a low-risk maternity hospital in the municipality of Cariacica, Espírito Santo. A total of 330 puerperal women were interviewed from August to October 2017. Information on socioeconomic, behavioral, reproductive and clinical characteristics, as well as life experiences, was collected through a questionnaire. To identify the types of violence, the proper World Health Organization instrument was used. Gross bivariate and multivariate analysis was performed and adjusted for Poisson regression with robust variance. RESULTS Prevalence was 16.1% (95%CI 2.5-20.4) for psychological violence, 7.6% (95%CI 5.1-11.0) for physical violence and 2.7% (95%CI 1.4-5.2) for sexual violence. Psychological violence remained associated with age, family income, beginning of sexual life, disease in pregnancy, desire to interrupt pregnancy and number of partners. Physical violence was associated with schooling, beginning of sexual life and disease in pregnancy. Sexual violence remained associated with marital status and desire to interrupt pregnancy (p < 0.05). CONCLUSIONS Psychological violence by an intimate partner was the most prevalent among pregnant women. Women that were younger, had lower income and less schooling, who started their sexual life before the age of 14 and who wished to interrupt pregnancy, experienced violence more frequently during pregnancy.

RESUMO OBJETIVO Identificar a prevalência das violências durante a gestação e verificar a associação com as características socioeconômicas, comportamentais e clínicas da gestante. MÉTODOS Estudo transversal em uma maternidade de baixo risco do município de Cariacica, Espírito Santo. Foram entrevistadas 330 puérperas de agosto a outubro de 2017. Informações sobre as características socioeconômicas, comportamentais, reprodutivas e clínicas, assim como experiências de vida, foram coletadas por meio de questionário. Para identificar os tipos de violência, foi utilizado o instrumento da Organização Mundial da Saúde. Foi realizada análise bivariada e multivariada bruta e ajustada por regressão de Poisson com variância robusta. RESULTADOS As prevalências foram 16,1% (IC95% 2,5-20,4) para violência psicológica, 7,6% (IC95% 5,1-11,0) para a física e 2,7% (IC95% 1,4-5,2) para a sexual. A violência psicológica manteve-se associada a idade, renda familiar, início da vida sexual, doença na gravidez, desejo de interromper a gestação e número de parceiros. A violência física esteve associada a escolaridade, início da vida sexual e doença na gravidez. Já a violência sexual manteve-se associada a situação conjugal e desejo de interromper a gestação (p < 0,05). CONCLUSÕES A violência psicológica perpetrada pelo parceiro íntimo foi a de maior prevalência entre as gestantes. Mulheres mais jovens, com menor renda e escolaridade, que iniciaram a vida sexual até os 14 anos e que desejaram interromper a gravidez vivenciaram com maior frequência a violência durante a gestação.

Child and adolescent violence: oral story of women who attempted suicide / Violencia en la infancia y adolescencia: historia oral de mujeres que intentaron suicidio / Violência na infância e adolescência: história oral de mulheres que tentaram suicídio

ABSTRACT Objective: To unveil expressions of intrafamily violence experienced in childhood and/or adolescence by women who attempted suicide. Method: This is a study with a qualitative approach based on Oral Story. Participants were ten women with a history of suicide attempt, who experienced intrafamily violence in childhood and/or adolescence. The research was carried out at the Center for the Study and Prevention of Suicide, linked to a Toxicological Information Center in the city of Salvador, Bahia, Brazil. Results: From the orality of women, the study allowed the emergence of the following representative categories of intrafamily abuse experienced in childhood and/or adolescence: psychological violence, rejection, neglect, physical violence and sexual violence. Final considerations: The study alerts to intrafamily violence as an aggravation related to suicidal behavior, offering elements that help in the identification of their expressions, which will raise awareness to suicidal behavior and consequently suicide prevention.

RESUMEN Objetivo: Desvelar las expresiones de la violencia intrafamiliar vivenciadas en la infancia y/o adolescencia por mujeres que intentaron suicidio. Método: Se trata de un estudio con enfoque cualitativo, fundamentado en la Historia Oral. Participaron diez mujeres con historia de intento de suicidio, que experimentaron violencia intrafamiliar en la infancia y/o adolescencia. La investigación fue realizada en el Núcleo de Estudo e Prevenção do Suicídio (Núcleo de Estudio y Prevención del Suicidio), vinculado a un Centro de Información Toxicológica en la ciudad de Salvador, Bahía, Brasil. Resultados: A partir de la oralidad de las mujeres, el estudio permitió emerger las siguientes categorías representativas de la expresión de abuso intrafamiliar vivenciada en la niñez y/o adolescencia: violencia psicológica (rechazo y negligencia), violencia física y violencia sexual. Consideraciones finales: El estudio alerta sobre la violencia intrafamiliar como agravio relacionado al comportamiento suicida, ofreciendo elementos que auxilian en la identificación de sus expresiones, lo que posibilitará atención para el comportamiento suicida y consecuentemente la prevención del suicidio.

RESUMO Objetivo: Desvelar as expressões da violência intrafamiliar vivenciadas na infância e/ou adolescência por mulheres que tentaram suicídio. Método: Trata-se de um estudo com abordagem qualitativa, fundamentada na História Oral. Participaram dez mulheres com história de tentativa de suicídio, que experienciaram violência intrafamiliar na infância e/ou adolescência. A pesquisa foi realizada no Núcleo de Estudo e Prevenção do Suicídio, vinculado a um Centro de Informação Toxicológica na cidade de Salvador, Bahia, Brasil. Resultados: A partir da oralidade das mulheres, o estudo permitiu emergir as seguintes categorias representativas da expressão de abuso intrafamiliar vivenciada na infância e/ou adolescência: violência psicológica (rejeição, negligência), violência física e violência sexual. Considerações finais: O estudo alerta para a violência intrafamiliar enquanto agravo relacionado ao comportamento suicida, oferecendo elementos que auxiliam na identificação de suas expressões, o que possibilitará atenção para o comportamento suicida e consequentemente prevenção do suicídio.

Child and adolescent violence: oral story of women who attempted suicide.

OBJECTIVE: To unveil expressions of intrafamily violence experienced in childhood and/or adolescence by women who attempted suicide. METHOD: This is a study with a qualitative approach based on Oral Story. Participants were ten women with a history of suicide attempt, who experienced intrafamily violence in childhood and/or adolescence. The research was carried out at the Center for the Study and Prevention of Suicide, linked to a Toxicological Information Center in the city of Salvador, Bahia, Brazil. RESULTS: From the orality of women, the study allowed the emergence of the following representative categories of intrafamily abuse experienced in childhood and/or adolescence: psychological violence, rejection, neglect, physical violence and sexual violence. FINAL CONSIDERATIONS: The study alerts to intrafamily violence as an aggravation related to suicidal behavior, offering elements that help in the identification of their expressions, which will raise awareness to suicidal behavior and consequently suicide prevention.

The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study.

BACKGROUND: This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. METHODS: We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. RESULTS: The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42). LIMITATIONS: Disrespect and abuse experiences during childbirth were self-reported. CONCLUSIONS: Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

Emotional and Physical Child Abuse in The Context of Natural Disasters: A Focus on Haiti.

OBJECTIVE: To investigate the social and living conditions of households in Haiti before and after the 2010 earthquake and to determine the prevalence of emotional and physical abuse of children aged 2 to 14 in households after the earthquake. METHODS: Nationally representative samples of Haitian households from the 2005/2006 and 2012 phases of the Demographic and Health Surveys were used. Descriptive data were summarized with frequencies and measures of central tendency. Chi-squared and independent t tests were used to compare pre-earthquake and post-earthquake data. Basic mapping was used to explore patterns of child abuse in relation to proximity to the epicenter. RESULTS: Comparison of pre-earthquake and post-earthquake data showed noteworthy improvements in the education attainment of the household head and possession of mobile phones after the earthquake. The prevalence of emotional, physical, and severe physical abuse in 2012 was estimated to be 78.5%, 77.0%, and 15.4%, respectively. Mapping revealed no conclusive patterns between the proximity of each region to the epicenter and the prevalence of the different forms of abuse. However, the prevalence of severe physical abuse was notably higher in settlement camps (25.0%) than it was in Haiti overall (15.4%). CONCLUSIONS: The high prevalence of child abuse in Haiti highlights an urgent need for interventions aimed at reducing occurrences of household child abuse.

A sex-disaggregated analysis of how emotional violence relates to suicide ideation in low- and middle-income countries.

BACKGROUND: In recent years, research has increasingly focused on examining the relationship between one type of child maltreatment -- emotional violence -- and suicidal behaviors. However, the growing body of empirical evidence supporting these associations has been mostly limited to high-income contexts. OBJECTIVE: This study examines how exposure to emotional violence is associated with suicide ideation in childhood and adolescence in low- and middle-income countries (LMICs), and whether this association differs by sex. PARTICIPANTS AND SETTING: We employ nationally representative samples of 13-24 year-old males and females from the Violence Against Children Surveys in Tanzania (conducted in 2009), Kenya (2010), and Haiti (2012). METHODS: We use logistic regressions to estimate the odds of ever reporting suicide ideation, separately, for each country; models control for self-reported exposure to emotional violence, physical violence from a caregiver, physical violence by an adult in the community, sexual violence, intimate partner violence, and age. Formal moderation by sex for each form of child maltreatment is tested using interaction terms. RESULTS: We find the odds of suicide ideation are consistently and significantly greater for adolescents who report ever exposure to emotional violence. This same consistency is not observed for any other form of maltreatment across countries. The size of the relationship between emotional violence and suicide ideation is statistically significantly larger for males in Kenya only. CONCLUSION: Research in LMICs should explore the mediating factors linking emotional abuse in childhood and adolescence to suicide ideation in adolescence, paying special attention to whether these pathways might operate differently by sex.

Domains of common mental disorders in women reporting intimate partner violence.

OBJECTIVE: to verify associations between the types of intimate partner violence and the domains of common mental disorders in women. METHOD: cross-sectional study with 369 women. The information was obtained through the instruments Self-Reporting Questionnaire and Conflict Tactic Scales. To analyze the data, Pearson's Chi-Square test, Fisher's exact test and Odds Ratio were used. RESULTS: women who reported physical abuse with and without sequela were respectively 2.58 and 3.7 times more likely to have symptoms of anxious depressed mood. The chances of experiencing symptoms of decreased vital energy increased by 2.27 times with psychological aggression, 3.06 times with physical abuse without sequelae and 3.13 times with physical abuse with sequelae. Somatic symptoms did not show statistical association with the types of violence. The propensity to develop symptoms of depressive thoughts increased 3.11 times with psychological aggression, 6.13 times with physical aggression without sequelae, 2.47 times with sexual coercion and 7.3 times with physical aggression with sequelae. CONCLUSION: the types of intimate partner violence are strongly associated with the domains of common mental disorders in women. This finding may contribute to more accurate interventions by health professionals to women victims of violence.

The intertwined effect of lack of emotional warmth and child abuse and neglect on common mental disorders in adolescence.

Adolescence is a vulnerable period for mental health problems. Although child abuse and neglect (CAN) are known risk factors for some of them, it is not clear if the negative consequences on mental health also occur in families where CAN and a warm parent-child relationship coexist. The aim of this study is to explore this gap and investigate the effects of different types of CAN according to levels of warmth in the parent-child relationship on common mental disorders (CMD) in adolescence. This is a cross-sectional study encompassing 487 adolescents attending the ninth grade at 2 public and 4 private schools in Rio de Janeiro, Brazil. CAN was measured by the Child Trauma Questionnaire (CTQ), CMD by the General Health Questionnaire (GHQ-12) and the level of warmth in the parent-child relationship were recalled using short Egna Minnen Betraffände Uppfostran (s-EMBU-23). The adjusted separate effects of different types of CAN and a low level of warmth in the parent-child relationship, and both in tandem, were estimated using multivariate linear regression models. Results indicated that emotional abuse and neglect, physical abuse and neglect, and a low level of warmth in the parent-child relationship are important risk factors for CMD in adolescence. Nevertheless, in families where CAN coexist with a warm and affectionate parent-child relationship, the negative effects of CAN on mental health are attenuated. Evidence indicates that actions to prevent or interrupt CAN and improving parental practices could be effective strategies to reduce CMD in adolescence.

Effects of childhood multiple maltreatment experiences on depression of socioeconomic disadvantaged elderly in Brazil.

Childhood maltreatment is a risk factor for depression in nonelderly individuals. We investigated the effect of childhood abuse and neglect on the development of geriatric depression and its severity in socioeconomically disadvantaged individuals. A cross-sectional study investigated 449 individuals aged 60-103 years sorted by data using the enrollment list health coverage from the city of Porto Alegre, Brazil. The fifteen-item Geriatric Depression Scale was used to assess depression. The Childhood Trauma Questionnaire was used to identify emotional and physical neglect, in addition to emotional, physical, and sexual abuse. Geriatric depression was associated with emotional and physical abuse and neglect. Emotional abuse and neglect, as well as physical abuse, increased the odds of an individual developing severe depression. Correlations were observed for combined forms of maltreatment, with two to five maltreatment types producing mild to moderate symptoms. Similar trends were observed for severe symptoms in a limited number of cases. The cross-sectional design limit causal inference. Retrospective measurement of childhood maltreatment may increase recall and response bias. Late-life depression and its severity significantly correlated with the extent of childhood emotional and physical abuse and neglect. Thus, research should focus on supporting trauma survivors late in life, particularly when they come from low or middle income countries because these patients have higher rates of depression in elderly populations.

Profiles and behavioral consequences of child abuse among adolescent girls and boys from Barbados and Grenada.

The current study used latent class analysis to uncover groups of youths with specific abuse (physical, emotional, and sexual) profiles in and outside the family, and identify how membership in each abuse group is associated with behavioral outcomes. Data were collected among a sample of male (n = 662; Mage = 13.02 years) and female (n = 689; Mage = 12.95 years) children and adolescents (9-17 years old) from Barbados and Grenada. Self-report surveys were completed by participants in school settings. Three latent classes of child abuse were distinguished among boys, including 'low abuse' (39.2% of the sample), 'physical and emotional abuse high outside/medium in the family' (43.2%), and 'high overall abuse' (17.6%). Among girls, four unique classes were recovered: 'low abuse' (40.7%), 'high physical and emotional abuse outside the family' (7.6%), 'high emotional and moderate physical abuse' (33.9%), and 'high overall abuse' (17.8%). Compared with members of low abuse groups, youths who reported having experienced high/moderate levels of various forms of violence, including those who were abused in multiple ways and across the two settings ('high overall abuse'), were significantly more likely to engage in violent and hostile behavior. Abused and non-abused youths did not differ on non-violent conflict resolution skills. The significance of present findings for future research and practice is discussed.

Exposure to Violence and Carotid Artery Intima-Media Thickness in Mexican Women.

BACKGROUND: Violence against women has become a global public health threat. Data on the potential impact of exposure to violence on cardiovascular disease are scarce. METHODS AND RESULTS: We evaluated the association between exposure to violence and subclinical cardiovascular disease in 634 disease-free women from the Mexican Teachers' Cohort who responded to violence-related items from the Life Stressor Checklist and underwent measures of carotid artery intima-media thickness in 2012 and 2013. We defined exposure to violence as having ever been exposed to physical and/or sexual violence. Intima-media thickness was log-transformed, and subclinical carotid atherosclerosis was defined as intima-media thickness ≥0.8 mm or plaque. We used multivariable linear and logistic regression models adjusted for several potential confounders. Mean age was 48.9±4.3 years. Close to 40% of women reported past exposure to violence. The lifetime prevalence of sexual violence was 7.1%, and prevalence of physical violence was 23.5% (7.7% reported both sexual and physical violence). Relative to women with no history of violence, exposure to violence was associated with higher intima-media thickness (adjusted mean percentage difference=2.4%; 95% confidence interval 0.5, 4.3) and subclinical atherosclerosis (adjusted odds ratio=1.60; 95% confidence interval 1.10, 2.32). The association was stronger for exposure to physical violence, especially by mugging or physical assault by a stranger (adjusted mean % difference=4.6%; 95% confidence interval 1.8, 7.5, and odds ratio of subclinical carotid atherosclerosis=2.06; 95% confidence interval 1.22, 3.49). CONCLUSIONS: Exposure to violence, and in particular assault by a stranger, was strongly associated with subclinical cardiovascular disease in Mexican middle-aged women.

A randomized controlled trial of an intervention program to Brazilian mothers who use corporal punishment.

This study evaluated a positive parenting program to Brazilian mothers who used corporal punishment with their children. The intervention was conducted in four agencies serving vulnerable children, and at a home replica laboratory at the University. Mothers who admitted using corporal punishment were randomly assigned between experimental (n=20) and control group (n=20). The program consisted of 12 individual sessions using one unit from Projeto Parceria (Partnership Project), with specific guidelines and materials on positive parenting, followed by observational sessions of mother-child interaction with live coaching and a video feedback session in the lab. The study used an equivalent group experimental design with pre/post-test and follow-up, in randomized controlled trials. Measures involved: Initial Interview; Strengths and Difficulties Questionnaire (SDQ) - parent and child versions; Beck Depression Inventory (BDI); observational sessions with a protocol; and a Program Evaluation by participants. Analysis of mixed models for repeated measures revealed significant positive effects on the BDI and SDQ total scores, as well as less Conduct problems and Hyperactivity in SDQ measures from the experimental group mothers, comparing pre with post-test. Observational data also indicated significant improvement in positive interaction from the experimental group mothers at post-test, in comparison with controls. No significant results were found, however, in children's observational measures. Limitations of the study involved using a restricted sample, among others. Implications for future research are suggested.

Modalidades de Acoso y Violencia Escolar en adolescentes del 8° y 9° grado de la Educación Escolar Básica de dos instituciones públicas de Asunción / Modalities of Harassment and School Violence in adolescents of the 8th and 9th grade of Basic School Education of two public institutions of Asunción

Este trabajo de investigación abarca las modalidades del acoso y violencia escolar en adolescentes según su género de tercer ciclo de la Educación Escolar Básica de dos instituciones educativas Colegio Nacional Pablo Ávila, y Colegio Nacional Ysatide Asunción, Paraguay en el año lectivo 2016. El objetivo general de la investigación es Describir las modalidades de acoso y violencia escolar entre adolescentes del 8° y 9° grado de dos instituciones públicas de Asunción, y los objetivos específicos, son Identificar las modalidades más frecuentes de Acoso y Violencia Escolar señalados por los adolescentes del 8° y 9° grado del tercer Ciclo de la educación Escolar Básica, Indagar sobre las modalidades de acoso y violencia escolar según el género de los adolescentes del 8° y 9° grado del tercer Ciclo de la Educación Escolar Básica. Las informaciones contenidas fueron obtenidas mediante una amplia revisión bibliográfica, páginas electrónicas y de los datos adquiridos en el trabajo de campo. La investigación es del tipo cuantitativa, de nivel descriptivo y diseño no experimental Los resultados muestran que en el institutoeducativo tienen lugar distintas modalidades de acoso y violencia escolar, existiendo variación en los tipos de violencia según el género de los adolescentes. Las modalidades de hostigamiento, exclusión social, Intimidación y la agresión física indirecta son las formas de acoso más frecuentes. Se observa que las modalidades de acoso y violencia escolar varían según el género del adolescente, esto plantea un abordaje diferente considerando las características que se abordan en esta investigación.