Vlahovicova Kristina, Melendez-Torres G J, Leijten Patty, Knerr Wendy, Gardner Frances
University of Oxford, Oxford, UK.
University of Warwick, Coventry, UK.
Clin Child Fam Psychol Rev. 2017 Sep;20(3):351-365. doi: 10.1007/s10567-017-0232-7.
Child physical abuse is an issue of global concern. Conservative estimates set global prevalence of this type of maltreatment at 25%, its consequences and cost to society escalating with increasing frequency and severity of episodes. Syntheses of the evidence on parenting programs for reducing rates of physical abuse recidivism have, to date, not been able to establish effectiveness. Paucity of data and inconsistent inclusion criteria in past reviews made meta-analysis often impossible or uninformative. The current systematic review updates prior reviews and overcomes some of the methodological issues they encountered by pooling trial-level data from a well-defined scope of trials of parenting interventions aimed at preventing the re-abuse of children by parents with substantiated or suspected physical abuse history. Randomized controlled trials and rigorous non-randomized designs were sought via nine online databases, two trial registries, several clearinghouses and contact with experts. A total of fourteen studies of variable quality were included in this review, four of which had outcomes that enabled meta-analysis. Overall, this review presents evidence supporting the effectiveness of parenting behavioral programs based on social learning theory for reducing hard markers of child physical abuse recidivism. Meta-analysis found that the absolute risk reduction in risk of recidivism was 11 percentage points less for maltreating parents who undergo parenting programs (RD = -0.11, 95% CI [-0.22, -0.004], p = 0.043, I = 28.9%). However, the pooled effect size was not statistically significant when calculated as a risk ratio (0.76, 95% CI [0.54, 1.07], I = 38.4%). Policy makers and practitioners should be made aware that this intervention method is backed by promising evidence featuring modest yet significant reductions in hard markers of child physical abuse, even though the methodological robustness of these findings should be further explored in future research.
儿童身体虐待是一个全球关注的问题。保守估计表明，这种虐待行为在全球的发生率为25%，其后果及对社会造成的代价会随着事件发生频率和严重程度的增加而不断升级。迄今为止，关于减少身体虐待累犯率的育儿项目的证据综合分析尚未能证实其有效性。过去的综述中数据匮乏且纳入标准不一致，这使得荟萃分析往往无法进行或得出的信息毫无价值。当前的系统综述更新了之前的综述，并通过汇总来自明确界定范围的育儿干预试验的试验水平数据，克服了它们所遇到的一些方法学问题，这些试验旨在预防有确凿或疑似身体虐待史的父母再次虐待儿童。通过九个在线数据库、两个试验注册库、几个信息交换中心并与专家联系，寻找随机对照试验和严格的非随机设计。本综述共纳入了14项质量各异的研究，其中四项研究的结果可进行荟萃分析。总体而言，本综述提供的证据支持基于社会学习理论的育儿行为项目在减少儿童身体虐待累犯率硬性指标方面的有效性。荟萃分析发现，接受育儿项目的虐待父母累犯风险的绝对风险降低了11个百分点（风险差=-0.11，95%置信区间[-0.22, -0.004]，p=0.043，I²=28.9%）。然而，以风险比计算时，合并效应量无统计学意义（0.76，95%置信区间[0.54, 1.07]，I²=38.4%）。政策制定者和从业者应意识到，尽管这些研究结果的方法学稳健性有待未来研究进一步探索，但这种干预方法有可靠的证据支持，在减少儿童身体虐待硬性指标方面有适度但显著的降低。
