Annerbäck Eva-Maria, Svedin Carl Göran, Dahlström Örjan
1Centre for Clinical Research in Sörmland, Sörmland County Council, Uppsala University, Eskilstuna, Sweden.
2Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Child Adolesc Psychiatry Ment Health. 2018 Jul 25;12:38. doi: 10.1186/s13034-018-0244-1. eCollection 2018.
Child physical abuse (CPA) is an extensive public health problem because of its associations with poor health outcomes. The aim of this study was to examine which of the background factors of CPA committed by a parent or other caregiver relates to self-reported poor health among girls and boys (13; 15 and 17 years old): perpetrator, last year exposure; severity and frequency; socioeconomic load and foreign background.
In a cross-sectional study in a Swedish county (n = 8024) a path analysis was performed to evaluate a model where all background variables were put as predictors of three health-status variables: mental; physical and general health problems. In a second step a log linear analysis was performed to examine how the distribution over the health-status categories was different for different combinations of background factors.
Children exposed to CPA reported poor health to a much higher extent than those who were not exposed. In the path analysis it was found that frequency and severity of abuse (boys only) and having experienced CPA during the last year, was significantly associated with poor health as well as socioeconomic load in the families. Foreign background was significantly negatively associated with all three health indicators especially for girls. Neither mother nor father as perpetrator remained significant in the path analysis, while the results from the log linear analyses showed that mother-abuse did in fact relate to poor general health and mental as well as physical health problems among boys and girls. Father-abuse was associated with poor mental health if severe abuse was reported. Poor mental health was also associated with mild father-abuse if exposure during the last year was reported.
Despite the limitations that cross-sectional studies imply, this study provides new knowledge about factors associated with poor health among physically abused children. It describes details of CPA that have significant associations to different aspects of poor health and thus what needs to be addressed by professionals within mental health providers and social services. Understanding how different factors may contribute to different health outcomes for exposed children is important in future research and needs further studies.
儿童身体虐待（CPA）是一个广泛的公共卫生问题，因为它与不良健康后果相关。本研究的目的是调查父母或其他照顾者实施的CPA的哪些背景因素与自我报告的13岁、15岁和17岁女孩和男孩的健康状况不佳有关：施暴者、去年的暴露情况；严重程度和频率；社会经济负担和外国背景。
在瑞典一个县进行的横断面研究（n = 8024）中，进行了路径分析以评估一个模型，其中所有背景变量作为三个健康状况变量的预测因素：心理、身体和总体健康问题。第二步进行对数线性分析，以检查不同背景因素组合下健康状况类别分布的差异。
遭受CPA的儿童报告健康状况不佳的比例远高于未遭受CPA的儿童。在路径分析中发现，虐待的频率和严重程度（仅针对男孩）以及去年经历过CPA，与健康状况不佳以及家庭中的社会经济负担显著相关。外国背景与所有三个健康指标均呈显著负相关，尤其是对女孩而言。在路径分析中,无论是母亲还是父亲作为施暴者都不再具有显著性，而对数线性分析的结果表明，母亲实施的虐待实际上与男孩和女孩的总体健康不佳以及心理和身体健康问题有关。如果报告存在严重虐待，父亲实施的虐待与心理健康不佳有关。如果报告去年有暴露情况，轻度父亲虐待也与心理健康不佳有关。
尽管横断面研究存在局限性，但本研究提供了关于身体虐待儿童健康状况不佳相关因素的新知识。它描述了与健康状况不佳的不同方面有显著关联的CPA细节，因此心理健康服务提供者和社会服务领域的专业人员需要关注这些方面。了解不同因素如何可能导致受暴露儿童出现不同的健康结果，在未来研究中很重要，并且需要进一步研究。
