Queensland Children's Medical Research Institute, University of Queensland, Herston, Australia.
PLoS Med. 2012;9(11):e1001349. doi: 10.1371/journal.pmed.1001349. Epub 2012 Nov 27.
Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes.
A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships.
This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence.
儿童性虐待被认为是一生中精神障碍的可改变风险因素。然而，其他形式的儿童虐待的长期后果尚未得到系统研究。本研究的目的是总结与儿童身体虐待、情感虐待和忽视可能相关的证据，以及随后的精神和身体健康结果。
使用 Medline、EMBASE 和 PsycINFO 电子数据库进行了系统回顾，截至 2012 年 6 月 26 日。纳入了检查非性虐待儿童虐待作为健康丧失风险因素的队列研究、横断面研究和病例对照研究。所有荟萃分析均基于质量效应模型。在评估的 285 篇文章中，有 124 篇符合预先确定的荟萃分析纳入标准。观察到身体虐待、情感虐待和忽视与抑郁障碍（身体虐待 [比值比 (OR) = 1.54；95%CI 1.16-2.04]、情感虐待 [OR = 3.06；95%CI 2.43-3.85] 和忽视 [OR = 2.11；95%CI 1.61-2.77]）、药物使用（身体虐待 [OR = 1.92；95%CI 1.67-2.20]、情感虐待 [OR = 1.41；95%CI 1.11-1.79] 和忽视 [OR = 1.36；95%CI 1.21-1.54]）、自杀企图（身体虐待 [OR = 3.40；95%CI 2.17-5.32]、情感虐待 [OR = 3.37；95%CI 2.44-4.67] 和忽视 [OR = 1.95；95%CI 1.13-3.37]）以及性传播感染和风险性行为（身体虐待 [OR = 1.78；95%CI 1.50-2.10]、情感虐待 [OR = 1.75；95%CI 1.49-2.04] 和忽视 [OR = 1.57；95%CI 1.39-1.78]）之间存在关联。使用布拉德福德·希尔标准评估因果关系的证据。虽然有证据表明虐待与慢性疾病和生活方式风险因素之间存在关联，但需要进一步研究来证实这些关联。
本研究对证据的综述表明，非性虐待儿童虐待与一系列精神障碍、药物使用、自杀企图、性传播感染和风险性行为之间存在因果关系。所有形式的儿童虐待都应被视为对健康的重要风险因素，对全球疾病负担的主要贡献者有相当大的影响。对儿童虐待的严重长期后果的认识应鼓励更好地识别那些处于危险中的人，并制定有效的干预措施来保护儿童免受暴力侵害。
