Behavioral Health Problems and Related Risk and Protective Factors for Children Experiencing Psychological Maltreatment: Evidence from the Fourth National Incidence Study of Child Abuse and Neglect

Background

Psychological maltreatment has been acknowledged as “the most challenging and prevalent form of child abuse and neglect” and recent studies also demonstrated that children exposed to psychological maltreatment exhibited equal or severer symptoms than victims of physical and sexual abuse (Spinazzola et al., 2014). Nevertheless, less is known about the comprehensive behavioral health needs and related risk and protective factors for children involved with the child welfare system who are suffered from psychological maltreatment. This study fills the gap by 1) examining the prevalence of different behavioral health problems for children experiencing psychological maltreatment; and 2) exploring the individual and family level factors related to children’s behavioral health problems.

Methods

Data were obtained from the Fourth National Incidence Study of Child Abuse and Neglect (NIS-4), a national representative sample with 12694 child maltreatment cases collected from different national agencies. The cases of psychological maltreatment – 5153 cases of emotional neglect and 1308 cases of emotional abuse – were extracted to be analyzed. Descriptive analysis was conducted to show the prevalence of 10 DSM-based behavioral health problems result from emotional neglect and abuse respectively; and hierarchal logistic regression models were built to examine the individual and family factors associated with the three most prevalent problems.

Results

The prevalence of problems result from emotional neglect and abuse were: 10.9% and 7.8% for aggressive behavior, 7.8% and 13.7% for anxiety, 7.8% and 10.8% for depression, 6.6% and 7.2% for threats of self-destructive behavioral, 3.3% and 6.8% for low self-esteem, 3.2% and 4.0% for withdrawal, both 1.0% for sleeping disorders, 0.8% and 0.7% for hyperactivity, both 0.9% for psychosis, and 0.6% and 0.4% for PTSD. In general, aggressive behavior, anxiety and depression were three most common behavioral health problems for children experiencing psychological maltreatment.

In terms of cases from emotional neglect, the boy was more likely to exhibit aggressive behavior (OR=2.87, CI=1.81-4.54); the likelihood of child getting depression was lower for those families with one employed parent (OR=0.51, CI=0.31-0.85); as for anxiety, the primary caregiver’s drug abuse (OR=1.94, CI=1.10-3.43) and mental illness problems (OR=1.90, CI=1.01-3.58), two parents unemployment status (OR=2.74, CI=1.17-6.43), and being Hispanic (OR=2.47, CI=1.36-4.50 compared to White) were all risk factors. In terms of cases from emotional abuse, anxiety was predicted by the primary caregiver’s mental illness (OR=2.68, CI=1.30-5.54), aggressive behavior was associated with the primary caregiver’s mental illness (OR=2.39, CI=1.01-5.62), African American race (OR=2.51, CI= 1.01-6.24 compared to White), and mother only family (OR=2.19, CI= 1.01-4.74). No significant predictor was found for depression.

 Conclusions and Implications

This study showed the general information of behavioral health problems and related risk and protective factors for children experiencing psychological maltreatment. Given that there are tremendous behavioral health needs and service gaps for children involved with the child welfare system, our study findings have implications for child welfare staff in terms of case screening and assessment of children’s behavioral health needs. Meanwhile, findings of risk and protective factors underscore the importance of interventions on the primary caregiver’s mental health and drug abuse problems.