Long-Term Impact of Parental Post-Traumatic Stress Disorder Symptoms on Mental Health of Their Offspring After the Great East Japan Earthquake.

Longitudinal studies of the long-term psychological impact of the Great East Japan Earthquake (GEJE) on parents and their children have been limited. The current study aimed to monitor parents' post-traumatic stress disorder (PTSD) symptoms and behavioral problems among their children over time and to analyze their long-term associations among the survivors of the GEJE. We used data from the GEJE Follow-up for Children study, which recruited 4- to 6-year-old children and those children's parents immediately after the GEJE in March 2011, with ongoing follow-up. Children's total, internalizing, and externalizing behavioral problems were assessed using the Child Behavior Checklist (CBCL), and parental probable PTSD was assessed using the Impact of Event Scale-R (IES-R), in 2012 (baseline) and 2014 (follow-up). Parental PTSD symptoms and children's behavioral problems declined slightly over time, and both showed a significant correlation between the surveys (r = 0.55-0.77, P < 0.001). The association between parental PTSD symptoms and children's behavioral problems was investigated using multivariate logistic regression analysis adjusting for baseline children's behavioral problems and other potential confounders. Cross-sectionally, while no significant association was detected in 2012, all types of children's behavioral problems exhibited significant positive associations with parental PTSD symptoms in multiple logistic regression analysis adjusted odds ratio (AOR) = 3.03, 3.30, and 5.34 for total, internalizing, and externalizing behavior problems, respectively. Maternal educational attainment level (higher than high school education) showed a significant negative association with children's total and externalizing behavioral problems (AOR = 0.30 and 0.13, respectively) in 2014. Longitudinally, parental PTSD symptoms in 2012 showed a significant association with children's internalizing behavioral problems in 2014 after adjusting for children's behavioral problems in 2012 and parental PTSD symptoms in 2014 (AOR = 4.62). These results suggest that the effect of the GEJE on parental PTSD symptoms and children's behavioral problems was long-term, lasting for at least 3 years. These possibilities should be carefully considered in mental health support for parents and their offspring in areas affected by the GEJE.

Impact of Parenting Style on Clinically Significant Behavioral Problems Among Children Aged 4-11 Years Old After Disaster: A Follow-Up Study of the Great East Japan Earthquake.

Objective: The purpose of this study was to investigate the influence of parenting style on children's behavior problems after the Great East Japan Earthquake in 2011. Methods: Participants were children exposed to the 2011 disaster at preschool age (n = 163). Data were collected from August 2012 to March 2013, and from July 2014 to March 2015 (2 and 4 years, respectively, after the earthquake), thus participants were aged 4-11 years when assessed. Parenting style was assessed by caregivers using the Alabama Parenting Questionnaire (APQ), which measures parental involvement, positive parenting, poor monitoring/supervision, inconsistent discipline, and corporal punishment in the second year after the disaster. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which identifies internalizing, externalizing, and total problems in the second and fourth year after the disaster. Results: The results show that corporal punishment in the second year after the disaster had negative influence on CBCL internalizing score (coefficient: 0.78, 95%CI: 0.12-1.45, p = 0.023), externalizing score (coefficient: 0.74, 95%CI: 0.09-1.39, p = 0.025), and total score in the fourth year after the disaster (coefficient: 0.85, 95%CI: 0.16-1.55, p = 0.016), after adjusted for children's age, sex, the number of trauma experiences, maternal education, the number of siblings, temporally housing experience, and CBCL each scores in the second year after the disaster. Other parenting style did not affect children's behavioral problems. Conclusion: The result suggests that inadequate rearing after a natural disaster had negative impact on the behavior problems of the affected children in 4 years later of the disaster. Specifically, corporal punishment had negative influence on children's behavior problems.

Disaster-related trauma and blood pressure among young children: a follow-up study after Great East Japan earthquake.

The 11 March 2011 earthquake and tsunami in Japan resulted in ~19,000 lost lives and the displacement of nearly a quarter million people owing to extensive property damage and evacuation from the nuclear meltdown in Fukushima. We sought to prospectively examine whether exposure to disaster-related trauma affected blood pressure levels among young children. We sampled children in three affected prefectures (Miyagi, Fukushima, Iwate) and one unaffected prefecture (Mie). The participants (mean age 6.6 years) and their caregivers answered a baseline survey (N = 320) and a follow-up survey 4 years after the earthquake (N = 227, follow-up rate 71%). Disaster-related trauma was assessed at the baseline, and blood pressure measurements were taken at the follow-up. We converted blood pressure data into age/sex/height-specific z-scores. In linear regression models, we controlled for body mass index, income, age, sex, and housing situation (living in the same house as before the disaster, in a shelter, or in a new house). The number of traumatic experiences was related to diastolic blood pressure in a dose-dependent manner but was not related to systolic blood pressure. Children reporting four or more traumatic experiences had marginally significant elevated diastolic blood pressure (ß = 0.43, p = 0.059). Among specific types of disaster trauma, witnessing a fire was significantly related to higher diastolic blood pressure (ß = 0.60, p = 0.009). In conclusion, disaster-related trauma was associated with higher diastolic blood pressure among young children 4 years after the traumatic events.

Developmental abnormalities of the brain exposed to childhood maltreatment detected by diffusion tensor imaging.

Objective: This study aimed to investigate brain developmental alterations in individuals exposed to childhood maltreatment (CM) with dissociative experiences and motor coordination symptoms using diffusion tensor imaging on a 3Tesla (3T) magnetic resonance (MR) system. Methods: Five individuals exposed to CM who manifest behavioral and developmental problems with dissociative experiences and motor coordination symptoms (age range: 14-18 years; all female), as well as seven age- and gender-matched normal control individuals, participated in the study using a 3T MR system. Diffusion characteristics, as indexed by fractional anisotropy (FA), were assessed for cerebral white matter structures. A preliminary whole brain analysis was performed complementary to an anatomically guided region of interest (ROI) analysis. Results: In individuals exposed to CM, scattered decreases in FA were detected in multiple brain regions over the frontoparietal and temporal areas in the whole brain map. ROI analysis subsequently identified significant decreases in FA (p < 0.05) in the right parietal white matter area as well as in the right prefrontal, bilateral premotor, bilateral orbitofrontal, and temporal white matter areas in CM-exposed individuals compared to that in controls. Conclusion: The observed altered diffusion characteristics indicate attendant developmental abnormalities within the white matter structures, which are associated with the observed clinical and behavioral patterns including dissociative experiences and coordination symptoms in individuals exposed to CM. The study provides objective evidence regarding the effects of CM on brain microstructure.

Feasibility and psychometric properties of the UCLA PTSD reaction index for DSM-5 in japanese youth: A multi-site study.

The purpose of this study was to determine the reliability and validity of the UCLA PTSD Reaction Index for DSM-5 (PTSD-RI-5) among Japanese youth. This is the first study to explore psychometrics of the DSM-5 version of the PTSD-RI-5, as well as the first multisite study of an Asian population. This article presents psychometric characteristics of the PTSD-RI-5 derived from a sample of Japanese children and adolescents (N = 318). The PTSD-RI-5 total scale displayed good internal consistency reliability (α = 0.85). Correlations of PTSD-RI scores with the posttraumatic stress scores on the TSCC-A for the entire sample provided evidence of convergent validity. The four-factor structure of the PTSD-RI-5 was supported through confirmatory factor analysis in this sample. In conclusion, a DSM-5 version of the PTSD-RI-5 can be regarded as an adequate instrument for clinical and research purposes in Japan.

National survey of hospital child protection teams in Japan.

This study aimed to investigate the penetration rate of child protection teams (CPTs) in medical institutions and associations between CPT functions and hospital services. We collected data in October of 2015 from 377 hospitals in Japan offering pediatric organ transplantation. The questionnaire included questions regarding the existence of a CPT, the number of child maltreatment cases discussed and reported per year, CPT functions including 21 items about staffing, manuals, meeting, prevention, education, and collaboration, and the services provided by the hospital. Of the 377 institutions, 122 (32.4%) answered the survey. There were significant associations between CPT functions and the number of pediatric beds (r = .27), number of pediatricians (r = .27), number of outpatients (r = .39), number of emergency outpatients (r = .28), and emergency medical care (p = .009). In a multiple regression analysis, CPT functions were significantly associated with the number of CPT members, pediatric outpatient numbers, and pediatric emergency outpatient numbers. Japan has no CPT guidelines that outline what CPTs should offer in terms of structure, staffing, functions, and systems. Hospitals with many pediatric and emergency outpatients are expected to play major roles in providing services such as specialty care, intensive care, and education. They are also expected to play a role in detecting and managing child maltreatment, and have, by their own initiative, improved their capacities to achieve these goals.

Maternal impulse control disability and developmental disorder traits are risk factors for child maltreatment.

Previous work has suggested that maternal developmental disorder traits related to autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are significantly associated with child maltreatment. However, there may be other important maternal characteristics that contribute to child maltreatment. We hypothesized that maternal impulse control disability may also affect child maltreatment in addition to maternal developmental disorder traits. We aimed to test this hypothesis via a cohort study performed in Tokyo (n = 1,260). Linear regression analyses using the Behavioural Inhibition/Behavioural Activation Scales, the self-administered short version of the Pervasive Developmental Disorders Autism Society Japan Rating Scale, the short form of the Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale, and the Child Maltreatment Scale, revealed that excessive inhibition of behaviour and affect, which is impulse control disability, is significantly associated with child maltreatment (b = 0.031, p = 0.018) in addition to maternal developmental disorder traits (ASD: b = 0.052, p = 0.004; ADHD: b = 0.178, p < 0.001). Logistic regression analyses revealed that ASD (adjusted odds ratio [AOR] = 1.083, p = 0.014) and high behavioural inhibition (AOR = 1.068, p = 0.016) were significantly associated with moderate child maltreatment, while ADHD was associated (AOR = 1.034, p = 0.022) with severe child maltreatment. These maternal characteristics may inform the best means for prevention and management of child maltreatment cases.

Suicide risk among young children after the Great East Japan Earthquake: A follow-up study.

On 11 March 2011, the Great East Japan Earthquake and subsequent tsunami hit East Japan. We aim to investigate the impact of trauma experiences related to the earthquake on suicide risk among young children, stratified by child sex. Participants at baseline were children who were exposed to the 2011 disaster at preschool age (affected area, n=198; unaffected area, n=82, total n=280). From July 2013 to May 2014, suicide risk was assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in a follow-up interview conducted by a child psychiatrist or psychologist (N=210, follow-up rate: 75%). Among young girls in the affected area, 12 out of 65 (18.5%) showed suicidal ideation, which is significantly higher than girls in the unaffected area (4.7%, p for chi-square=0.036). In the multivariate model adjusted for potential confounders and mediators, the odds ratio for 4 or more trauma experiences related to the earthquake was 5.74 (95% confidence interval: 0.83-39.6, p=0.076) compared to no trauma experience related to the earthquake. Among young boys, trauma exposure was not associated with suicidal ideation. Our findings showed that young girls who experienced earthquake-related trauma at preschool age had a higher suicidal ideation 3 years after the earthquake.

Training program for Japanese medical personnel to combat child maltreatment.

BACKGROUND: In 2014, we created a training program for personnel in medical institutions in Japan to combat child maltreatment. The aim of the present study was to document the effectiveness of this program. METHODS: Participants completed a questionnaire before and after the training lecture. The questionnaire designed for the training program included demographic questions such years of practice and area of specialty (i.e. physician, nurse, social worker, public health nurse, technician, and others), as well as experience of suspected child maltreatment cases and training in dealing with such cases. The questionnaire included 15 statements designed to ascertain practical knowledge and attitudes relevant to addressing child maltreatment. Baseline score measured before the lecture was compared with that obtained after the lecture. RESULTS: A total of 760 participants completed the survey, including 227 physicians, 223 nurses, 38 technologists, 27 social workers, 11 public health nurses, and 174 with other occupations, and 60 participants who left their occupation as blank. There was a significant difference between the baseline score of participants with versus without experience in suspected child maltreatment or training to deal with child maltreatment (F = 16.3; P < 0.001). After the lecture, the average score rose above the baseline (11.18 vs 10.57). The rate of correct answers for nine questionnaire items increased significantly. CONCLUSIONS: Professionals from a range of fields need clinical skills and judgement to decide if a child's injuries are due to maltreatment. The combination of increased clinical experience along with a high-quality didactic lecture, appears to be the most effective method of raising awareness and enhancing skills.

Symptoms of Post-Traumatic Stress Disorder Among Young Children 2 Years After the Great East Japan Earthquake.

OBJECTIVE: The aim of this study was to investigate the prevalence of post-traumatic stress disorder (PTSD) and its association with each traumatic experience among 5- to 8-year-old children 2 years after the Great East Japan Earthquake. METHOD: Children ages 5-8 years who were in selected preschool classes on March 11, 2011, in 3 prefectures affected by the earthquake and 1 prefecture that was unaffected, participated in the study (N=280). PTSD symptoms were assessed through questionnaires completed by caregivers and interviews by psychiatrists or psychologists conducted between September 2012 and May 2013 (ie, 1.5-2 years after the earthquake). RESULTS: Among children who experienced the earthquake, 33.8% exhibited PTSD symptoms. Of the different traumatic experiences, experiencing the earthquake and the loss of distant relatives or friends were independently associated with PTSD symptoms; prevalence ratios: 6.88 (95% confidence interval [CI]: 2.06-23.0) and 2.48 (95% CI: 1.21-5.08), respectively. CONCLUSION: Approximately 1 in 3 young children in the affected communities exhibited PTSD symptoms, even 2 years after the Great East Japan Earthquake. These data may be useful for preventing PTSD symptoms after natural disasters and suggest the importance of providing appropriate mental health services for children. (Disaster Med Public Health Preparedness. 2017;11:207-215).

Does social capital reduce child behavior problems? Results from the Great East Japan Earthquake follow-up for Children Study.

PURPOSE: We sought to investigate the association between social capital and child behavior problems in Iwate prefecture, Japan, in the aftermath of the 2011 Great East Japan Earthquake. METHODS: Children and their caregivers were recruited from four nursery schools in coastal areas affected by the tsunami, as well as one in an unaffected inland area (N = 94). We assessed the following via caregiver questionnaire: perceptions of social capital in the community, child behavior problems (Child Behavior Checklist, Strength and Difficulty Questionnaire), post-traumatic stress disorder (PTSD) symptoms, child's exposure to trauma (e.g. loss of family members), and caregiver's mental health (Impact of Event Scale-R for PTSD symptoms; K6 for general mental health). We collected details on trauma exposure by interviewing child participants. Structural equation modeling was used to assess whether the association between social capital and child behavior problems was mediated by caregiver's mental health status. RESULTS: Children of caregivers who perceived higher community social capital (trust and mutual aid) showed fewer PTSD symptoms. Furthermore, caregiver's mental health mediated the association between social trust and child PTSD symptoms. Social capital had no direct impact on child behavior problems. CONCLUSIONS: Community social capital was indirectly associated (via caregiver mental health status) with child behavior problems following exposure to disaster. Community development to boost social capital among caregivers may help to prevent child behavior problems.

Antenatal Risk Factors of Postpartum Depression at 20 Weeks Gestation in a Japanese Sample: Psychosocial Perspectives from a Cohort Study in Tokyo.

BACKGROUND: Prevalence of postnatal depression (PND) is high (Western countries, 10-15%; Japan, 17%). PND can cause parenting impairment and affect family health (e.g. child behaviors, cognitive development and physical health). This study aimed to reveal the risk factors of PND during the pregnancy period in a Japanese sample, and to identify the psychosocial risk factors of PND that should be appended to existing obstetric interview sheets. A cohort study with a Japanese sample was conducted. METHODS: All 14 obstetrics hospitals in the Setagaya ward, Tokyo, Japan, participated in this study. Pregnant women who booked their delivery between December 2012 and May 2013 were enrolled. Data used for this study were collected at 20 weeks gestation, a few days and one month postnatal. The questionnaires consisted of psychosocial factors and the Edinburgh Postnatal Depression Scale (EPDS). To identify PND risk factors, multivariate analyses were performed. RESULTS: A total of 1,775 women participated in this study. Eventually, the data of 1,133 women were used for the multivariate analyses. The demonstrated significant risk factors include EPDS score, primipara, "a perceived lack of family cohesion", "current physical illness treatment" and "current psychiatric illness treatment". CONCLUSION: This study highlights the importance of mental health screening using psychological measures during the pregnancy period. In addition, family environment, parity, physical and psychiatric illness should be paid attention by professionals in maternal and child health. The results also suggest that mothers' feelings of developing their families should be supported.

Factors Influencing Time Lag Between Initial Parental Concern and First Visit to Child Psychiatric Services Among ADHD Children in Japan.

The aim of this study was to examine the factors associated with a time lag between initial parental concern about ADHD symptoms and the first visit to a hospital in Japan that offers child psychiatric services. We investigated the demographic characteristic, symptoms, diagnosis, and healthcare system factors including duration between initial parental concern about symptoms and the first visit to a hospital (N = 387). The mean time lag between initial parental concern and the first visit to a hospital was 2.6 years. Risk factors for a longer time lag include the young age of a child, behavioral problems of the child, lower maternal education, difficulty in determining appropriate medical institution, referral route, and the distance from home to the hospital. A more established connection between a hospital with child psychiatric services and other health institutions is recommended for earlier referral to an appropriate hospital.

Clinically significant behavior problems among young children 2 years after the Great East Japan Earthquake.

BACKGROUND: On March 11, 2011, a massive undersea earthquake and tsunami struck East Japan. Few studies have investigated the impact of exposure to a natural disaster on preschool children. We investigated the association of trauma experiences during the Great East Japan Earthquake on clinically significant behavior problems among preschool children 2 years after the earthquake. METHOD: Participants were children who were exposed to the 2011 disaster at preschool age (affected area, n = 178; unaffected area, n = 82). Data were collected from September 2012 to June 2013 (around 2 years after the earthquake), thus participants were aged 5 to 8 years when assessed. Severe trauma exposures related to the earthquake (e.g., loss of family members) were assessed by interview, and trauma events in the physical environment related to the earthquake (e.g. housing damage), and other trauma exposure before the earthquake, were assessed by questionnaire. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which encompasses internalizing, externalizing, and total problems. Children who exceeded clinical cut-off of the CBCL were defined as having clinically significant behavior problems. RESULTS: Rates of internalizing, externalizing, and total problems in the affected area were 27.7%, 21.2%, and 25.9%, respectively. The rate ratio suggests that children who lost distant relatives or friends were 2.36 times more likely to have internalizing behavior problems (47.6% vs. 20.2%, 95% CI: 1.10-5.07). Other trauma experiences before the earthquake also showed significant positive association with internalizing, externalizing, and total behavior problems, which were not observed in the unaffected area. CONCLUSIONS: One in four children still had behavior problems even 2 years after the Great East Japan Earthquake. Children who had other trauma experiences before the earthquake were more likely to have behavior problems. These data will be useful for developing future interventions in child mental health after a natural disaster.

Association of maternal developmental disorder traits with child mistreatment: a prospective study in Japan.

Maternal mental disorders are known risk factors for child mistreatment. However, little is known about the involvement of maternal developmental disorder traits. The aim of this study was to examine maternal traits related to Pervasive Developmental Disorder (PDD) and Attention Deficit Hyperactivity Disorder (ADHD), and their possible association with child mistreatment. Maternal PDD and ADHD were assessed through a self-administered questionnaire (N=846) during mid-pregnancy using the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) and Adult ADHD Self-Report Scale (ASRS). The mothers completed another questionnaire on child mistreatment when the offspring was approximately 18 months of age. The associations between maternal PDD and ADHD traits and child mistreatment score were analyzed using linear regression models adjusted for covariates. Mothers who exhibited stronger PDD traits showed significantly higher child mistreatment score, even after adjustment for maternal characteristics at baseline and ADHD traits. At the same time, ADHD traits were significantly associated with child mistreatment after adjustment of covariates, although the association became non-significant after adjustment of PDD traits. Mothers who showed PDD and ADHD traits during pregnancy were more likely to mistreat their children. It is essential to educate mothers with such traits with appropriate, easy-to-follow childcare instructions, preferably in simple language combined with pictorial aids.

Rationale and study design of the Japan environment and children's study (JECS).

BACKGROUND: There is global concern over significant threats from a wide variety of environmental hazards to which children face. Large-scale and long-term birth cohort studies are needed for better environmental management based on sound science. The primary objective of the Japan Environment and Children's Study (JECS), a nation-wide birth cohort study that started its recruitment in January 2011, is to elucidate environmental factors that affect children's health and development. METHODS/DESIGN: Approximately 100,000 expecting mothers who live in designated study areas will be recruited over a 3-year period from January 2011. Participating children will be followed until they reach 13 years of age. Exposure to environmental factors will be assessed by chemical analyses of bio-specimens (blood, cord blood, urine, breast milk, and hair), household environment measurements, and computational simulations using monitoring data (e.g. ambient air quality monitoring) as well as questionnaires. JECS' priority outcomes include reproduction/pregnancy complications, congenital anomalies, neuropsychiatric disorders, immune system disorders, and metabolic/endocrine system disorders. Genetic factors, socioeconomic status, and lifestyle factors will also be examined as covariates and potential confounders. To maximize representativeness, we adopted provider-mediated community-based recruitment. DISCUSSION: Through JECS, chemical substances to which children are exposed during the fetal stage or early childhood will be identified. The JECS results will be translated to better risk assessment and management to provide healthy environment for next generations.

[Clinical features of girls with Asperger disorders].

OBJECTIVES: Symptoms of Asperger disorder (AD) in girls are often different from those in boys. In this study, the characteristics of girls with AD were examined. METHODS: We retrospectively examined the records of 63 boys and 33 girls with AD. We evaluated the age, main problems, complications, and the Wechsler Intelligence Scale for Children (3rd Ed) scores. RESULTS: About 73% of girls were diagnosed with AD between 10 and 15 years of age, and they had physical complications or problems in the autonomic nervous system. Girls scored significantly lower in Mathematics score, and Block Design score than boys. CONCLUSIONS: The results suggest that there are differences in the AD symptoms exhibited by boys and girls. Further research is required to clarify the behavioral, neurological, and genetic links to these gender differences. In order to prevent secondary complications, it is necessary to establish specific diagnostic criteria for girls with AD.

Electroretinography combined with spectral domain optical coherence tomography to detect retinal damage in shaken baby syndrome.

In order to correlate anatomical changes with visual function in shaken baby syndrome, we performed electroretinography and spectral domain optical coherence tomography on a 2-month-old girl and a 9-month-old girl after the retinal hemorrhages absorbed. Both patients had significant abnormalities in spectral domain optical coherence tomography images of the macular area. The amplitudes of the focal macular electroretinograms were more severely decreased than those of the full-field electroretinograms. Combining spectral domain coherence tomography with focal macular electroretinograms might better estimate the functional damage to the macula in patients with shaken baby syndrome.

FISH identification of Helicoverpa armigera and Mamestra brassicae chromosomes by BAC and fosmid probes.

Since the Bombyx mori genome sequence was published, conserved synteny between B. mori and some other lepidopteran species has been revealed by either FISH (fluorescence in situ hybridization) with BAC (bacterial artificial chromosome) probes or linkage analysis. However, no species belonging to the Noctuidae, the largest lepidopteran family which includes serious polyphagous pests, has been analyzed so far with respect to genome-wide conserved synteny and gene order. For that purpose, we selected the noctuid species Helicoverpa armigera and Mamestra brassicae, both with n = 31 chromosomes. Gene-defined fosmid clones from M. brassicae and BAC clones from a closely related species of H. armigera, Heliothis virescens, were used for a FISH analysis on pachytene chromosomes. We recognized all H. armigera chromosomes from specific cross-hybridization signals of 146 BAC probes. With 100 fosmid clones we identified and characterized all 31 bivalents of M. brassicae. Synteny and gene order were well conserved between the two noctuid species. The comparison with the model species B. mori (n = 28) showed the same phenomenon for 25 of the 28 chromosomes. Three chromosomes (#11, #23 and #24) had two counterparts each in H. armigera and M. brassicae. Since n = 31 is the modal chromosome number in Lepidoptera, the noctuid chromosomes probably represent an ancestral genome organization of Lepidoptera. This is the first identification of a full karyotype in Lepidoptera by means of BAC cross-hybridization between species. The technique shows the potential to expand the range of analyzed species efficiently.

Testing a cascade model of linkage between child abuse and negative mental health among battered women in Japan.

This study examined the following hypotheses: (1) a child abuse history (CAH), domestic violence (DV), and child abuse by an intimate partner might have a crucial and specific influence but act differently on women's negative mental health; (2) CAH, DV, child abuse by an intimate partner, and negative mental health might be predictors of maternal child abuse, with complex interactions. A self-administered questionnaire survey was conducted among a sample of mothers (N=304) and their children (N=498) staying in 83 Mother-Child Homes in Japan to assess the women's CAH and DV experiences, along with their current mental health problems, including dissociated, depressed, and traumatic symptoms. A structural equation modeling (SEM) was adapted to test whether a complex theoretical model fits the actual relationship among a set of observed measures. Our model confirmed the linkage with broader aspects of violence within the family such as CAH and DV, focusing on women's mental health problems reported by them. In addition, CAH, DV, child abuse by intimate partner, and maternal mental health might have a crucial and specific but act influence on maternal child abuse.