Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark.
Department of Forensic Medicine, Palle Juul-Jensens Boulevard 99, Aarhus University, 8200, Aarhus N, Aaurhus, Denmark.
Eur J Pediatr. 2024 Jan;183(1):357-369. doi: 10.1007/s00431-023-05291-8. Epub 2023 Oct 27.
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. Trial registration: The study was pre-registered on Open Science Framework, https://osf.io/fh2sr . What is Known: • Parental physical disease severity has been studied previously as a risk indicator of physical child abuse, but based on heterogeneous definitions. • Previous studies have not studied parental physical disease severity preceding physical child abuse. What is New: • Parental severe physical disease was not prospectively associated with severe documented physical child abuse in a survival model, a G-model and a number of sensitivity analyses, respectively. • Results should be replicated in samples from populations without universal health care, and using different categories of disease.
成功预防躯体虐待儿童取决于改善风险评估。当家庭压力源超过资源时，虐待的风险被认为会增加。严重的躯体疾病会增加压力，父母的躯体疾病已被研究为躯体虐待儿童的一个危险因素，但定义存在异质性。本研究评估了父母躯体疾病严重程度与严重记录的躯体虐待儿童之间的关系。模型基于丹麦 1997 年至 2018 年间 0-17 岁儿童及其父母的数据。严重记录的躯体虐待儿童被定义为卫生当局在治疗或死亡率登记册中记录的针对儿童的暴力行为，或法院确认的警察当局记录的暴力行为。父母躯体疾病严重程度被定义为儿童父母 Charlson 合并症指数评分的总和。在两种模型类型中检查了因果关系：一种是比较暴露与非暴露儿童的生存模型，该模型在基线时调整了协变量，另一种是 G 模型，该模型考虑了时间变化的协变量，包括收入和父母精神疾病。两种模型均未显示父母躯体疾病严重程度与严重记录的躯体虐待儿童之间存在关联，生存模型的 RR 为 0.99 和 95%CI（0.93-1.05），G 模型的 RR 为 1.08（未计算 CI）。结论：在所研究的模型中，父母躯体疾病严重程度不是严重记录的躯体虐待儿童的危险因素。个体躯体疾病类别仍有待研究。试验注册：该研究在开放科学框架上进行了预先注册，网址为 https://osf.io/fh2sr。已知：• 先前的研究已经研究了父母躯体疾病的严重程度作为躯体虐待儿童的风险指标，但基于异质的定义。• 先前的研究没有研究躯体虐待儿童之前父母的躯体疾病严重程度。新内容：• 在生存模型、G 模型和一些敏感性分析中，分别观察到父母严重躯体疾病与严重记录的躯体虐待儿童之间无前瞻性关联。结果应在没有全民医疗保健的人群样本中复制，并使用不同类别的疾病。
