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BackgroundAlthough experiences of violence are detrimental and may occur throughout the lifespan, few studies have examined the long-term health correlates of violence in both childhood and adulthood.ObjectiveTo examine the association of exposure to child maltreatment (CM) as well as severe violence in adulthood with mental and physical health problems and health-related risk behaviors in adulthood.MethodsThe study was cross-sectional and applied a novel survey instrument among a random sample of 10 337 Swedish women and men aged 18-74. Logistic regression was applied to calculate odds ratios.ResultsExposure to 0, 1, 2 or 3 or more types of CM showed graded associations for depression, anxiety, self-harm and PTSD in adulthood. Irritable bowel syndrome, fibromyalgia and obesity showed modest correlations. No significant associations were found between CM and ischemic heart disease (IHD), type 2 diabetes or cancer, although the ORs were in line with several previous ACE studies. When exposure to severe violence in adulthood was added to CM, odds ratios increased dramatically for mental health problems and health-related risk behaviors, suggesting that revictimization may moderate or mediate this relationship.ConclusionsThe results underscore the importance of studying violence exposure in a life-course perspective and suggest that the relationship between childhood adversities and long-term physical health problems in adulthood may be affected by the traumatic effects of revictimization in adult life. This points to the importance of early identification of child maltreatment and provision of robust services to protect children, treat symtoms of trauma, and enhance resilience to decrease the risk of poor health outcomes.

Improved prediction of physical child abuse could aid in developing preventive measures. Parental physical disease has been tested previously as a predictor of documented physical child abuse but in broad categories and with differing results. No prior studies have tested clinically recognizable categories of parental disease in a high-powered dataset. Using Danish registries, data on children and their parents from the years 1997-2018 were used to explore several parental physical disease categories' associations with documented physical child abuse. For each disease category, survival analysis using pseudovalues was applied. When a parent of a child was diagnosed or received medication that qualified for a category, this family and five comparison families not in this disease category were included, creating separate cohorts for each category of disease. Multiple analyses used samples drawn from 2,705,770 children. Estimates were produced for 32 categories of physical diseases. Using Bonferroni-corrected confidence intervals (CIc), ischemic heart disease showed a relative risk (RR) of 1.44 (CIc 1.13-1.84); peripheral artery occlusive disease, RR 1.39 (CIc 1.01-1.90); stroke, RR 1.19 (1.01-1.41); chronic pulmonary disease, RR 1.33 (CIc 1.18-1.51); ulcer/chronic gastritis, RR 1.27 (CIc 1.08-1.49); painful condition, 1.17 (CIc 1.00-1.37); epilepsy, RR 1.24 (CIc 1.00-1.52); and unspecific somatic symptoms, RR 1.37 (CIc 1.21-1.55). Unspecific somatic symptoms were present in 71.87% of families at some point during the study period.

Conclusion: Most parental physical disease categories did not show statistically significant associations, but some showed predictive ability. Further research is needed to explore preventive potential.

What is Known:center dot Few and broad categories of parental physical disease have been examined as risk factors for severe physical child abuse; no prior study has used several categories as predictors.What is New:center dot Unspecific symptoms, ischemic heart disease, peripheral artery occlusive disease, stroke, chronic pulmonary disease, stomach ulcer/chronic gastritis, painful condition, and epilepsy all showed to be potential predictors, with unspecific symptoms being the most prevalent.

Successful prevention of physical child abuse is dependent on improvements in risk assessment. The risk of abuse is assumed to increase when family stressors overcome resources. Severe physical disease can increase stress, and parental physical disease has been studied as a risk factor for physical child abuse, but with heterogeneous definitions. This study evaluated the relation between parental physical disease severity and severe documented physical child abuse. Models were based on data on children aged 0–17 years in Denmark between 1997 and 2018, and their parents. Severe documented physical child abuse was modeled as violence against a child registered by either health authorities in treatment or mortality registries, or police authorities in cases confirmed by the courts. Parental physical disease severity was modeled as the sum of Charlson Comorbidity Index scores for the child’s parents. The causal connection was examined in two model types: a survival model comparing exposed with non-exposed children, adjusted for covariates at baseline, and a G-model, taking time-varying covariates, including income and parental psychiatric disease into account. Neither model showed an association between parental physical disease severity and severe documented physical child abuse, with RR 0.99 and 95% CI (0.93–1.05) for the survival model and RR 1.08 for the G-model (CI not calculated).

Conclusion: In the model studied, parental physical disease severity was not a risk factor for severe documented physical child abuse. Individual categories of physical disease remain to be examined.

Background: The Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents’ perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model.

Objective: The aim of the present study was to explore parents’ perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden.

Participants and setting: Eighteen parents (13 women and five men) in two Swedish counties participated in the study.

Methods: Semi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis.

Results: Three themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse’s professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health.

Conclusions: The study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family’s situation during the child’s upbringing and an opportunity to access support if needed.

Background: Physical revictimization has been sparsely examined, and in particular the risk of revictimization within the context of closely related perpetrators.

Objective: To elucidate the relative contributions of exposure to physical violence in childhood and in youth by perpetrators close to the victim and situational factors in childhood to the risk of physical IPV in adulthood against the social-ecological background of the Trauma-Informed Theory of Individual Health Behavior (TTB). Trust was used as a proxy for resilience.

Participants and setting: A representative sample of 10,337 women and men aged 18-74 in Sweden.

Methods: A combined online and postal survey was used. Attrition bias was adjusted for by a calibration and weighting procedure based on official register information. Logistic regression was applied to calculate odds ratios (OR).

Results: Physical abuse by a parent before the age of 15 was associated with approximately 2-3 fold increased odds of physical adult partner violence. The strongest correlation applied to victimization by a partner at age 15-17, where the risk for men was three times that for women. Dysfunctional family conditions and social risk behaviors in adolescence were also associated with adult IPV, while sociodemographic variables had no explanatory value.

Conclusions: Our results indicated that exposure to physical violence by perpetrators close to the victim was the most potent risk factor for exposure to physical IPV in adulthood and that exposure at multiple ages increased this risk. Trust was clearly associated with lower odds of revictimization. Our findings support the tenets of TTB and suggest that they may be extended to the concept of revictimization.

Background

Psychosocial risk factors in the home may impair children’s health and development and increase their risk of maltreatment. The Safe Environment for Every Kid (SEEK) model helps address these problems, and aims to strengthen families, support parents and parenting, and thereby promote children’s health, development, wellbeing and safety. The SEEK model includes use of the Parent Screening Questionnaire (SEEK-PSQ) at routine preventive child health visits, assessment of their responses and, when indicated, referral to relevant services. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the SEEK-PSQ (PSQ-S). 

Methods

This study is part of a cluster-randomised controlled trial of SEEK in the Swedish child health services. To validate the PSQ-S, parents (n=852) with children 0-18 months of age were invited to complete a survey comprising the PSQ-S as well as evidence-based standardized instruments for the targeted psychosocial risk factors. Data from 611 (72%) parents were analysed regarding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each risk factor.

Results

As a whole, the PSQ-S had a sensitivity of 93%, specificity of 52%, PPV of 67% and NPV of 87%. For mothers and fathers combined, sensitivity was 80% for economic worries, 89% for depressive symptoms, 78% for parental stress, 47% for intimate partner violence (IPV) and 70% for alcohol misuse. Specificity was highest for IPV and alcohol misuse (91%) and lowest for depressive symptoms (64%). NPV values were high (81-99%) and PPV values were low to moderate (22-69%) for the targeted problems. Sensitivity was higher for mothers compared to fathers for economic worries, depressive symptoms and IPV. This difference was particularly evident for IPV (52% for mothers, 27% for fathers). 

Conclusion

The SEEK-PSQ-S demonstrated good psychometric properties for identifying economic worries, depressive symptoms, parental stress and alcohol misuse but low sensitivity for IPV. The PSQ-S as a whole showed high sensitivity and NPV, indicating that most parents with or without the targeted psychosocial risk factors were correctly identified.

Trial registration

ISRCTN registry, study record 14429952 (https://doi.org/10.1186/ISRCTN14429952)

Registration date 27/05/2020.

Background: Child maltreatment (CM) is often hidden, and the youngest children are often thosemost exposed. CM can be prevented through programs that address risk factors, but few primaryprevention strategies have been evaluated.Objective: To examine the experiences of nurses using the Safe Environment for Every Kid (SEEK)model compared to nurses using current standard practice in the Swedish child health services(CHS) to address psychosocial risk factors in the family environment.Participants and setting: Nurses at 27 child health centers in the CHS in the county of Dalarna,Sweden participated in the study. A survey was answered by 55 nurses and 18 nurses participatedin focus-group interviews.Methods: A convergent mixed methods research design with focus-group interviews and surveydata was used. Qualitative Content Analysis was used to analyze the interview data and MannWhitney U test was used to analyze the survey data.Results: The qualitative analysis identified four categories – “Framing the prerequisites for suc-cessful practice”; “Managing the mission of the CHS”; “Meeting the family as a professional”; and“Working with psychosocial risk factors can be emotional” – under the overarching theme“Universal application of a structured method adds value to experience-based knowledge whenaddressing psychosocial risk factors”. Survey data showed that SEEK nurses rated to a greaterdegree that they possessed adequate knowledge, competence and sense of security to addresspsychosocial risk factors in their work.Conclusions: This study indicates that using SEEK can strengthen the nurses in identifying andresponding to families in need of psychosocial support.

Aims: The aim of the present study was to examine the prevalence of childhood experiences of physical violence (CPV) and emotional violence (CEV) at the hands of parents over a 57-year period among adults born between 1937 and 1993.

Methods: In 2012, a survey among women and men aged 18–74 years in Sweden was undertaken to examine the lifetime prevalence of physical, psychological and sexual violence and associations with current health in adulthood. Questionnaires were based on the Adverse Childhood Experiences study and a previous national survey of violence exposure. Descriptive statistics were used to analyse the frequency of exposure to CPV and CEV, and changes over time were analysed using analysis of variance and logistic regression.

Results: A total of 10,337 individuals participated (response rates: 56% for women and 48% for men). CPV decreased significantly over the time period studied, particularly for those born after 1983. This decrease was more evident for male respondents. Throughout the time period studied, the proportion of women reporting CEV was higher than for men. Among both genders there was a steady rise in CEV rates from those born in the late 1930s to those born in the mid-1980s, after which there was a decline that was more marked for men.

Conclusions: A significant group of children in Sweden experience violence at the hands of parents. However, our data corroborate previous national studies that children’s exposure to violence has decreased. Clear gender differences indicate that these changes have affected girls and boys differently.

Aim To examine how child health nurses perceive the routine assessment of psychosocial risk factors in the family environment as well as their self-reported competence and the present organisational conditions in this context. Method A mixed-methods design was used, including three focus group interviews and a web-based survey. Qualitative data were analysed using systematic text condensation. Quantitative data were analysed at the descriptive level. Results Nurses expressed that identifying psychosocial risk factors was both important and relevant to their work. They had little formal training and education on most psychosocial risk factors, and they lacked structured methods to address them. In areas where nurses reported more formal education and a structured methodology (depression, parental stress), they rated to a higher degree that they possessed sufficient skills and sense of security. The nurses perceived that they seldom came into contact with families with financial problems, hazardous alcohol use or intimate partner violence. Conclusions There is a gap between the nurses' attitudes regarding the importance of helping families in need and their ability to do so with the current level of training and methodological support. The results suggest that, in many cases, psychosocial problems remain undetected.