Patricia Casey: 'Focus on sex abuse risks ignoring effects of child neglect'
The impact of abuse experienced in childhood is one that has been widely discussed in this country and throughout the world. The impact of child sexual abuse, particularly by clerics, has been to the fore for two decades here.
In the UK, publicity has focussed on the role of the authorities, particularly social workers, in not responding vigorously enough to reports of sexual abuse. Most of what is known about abuse pertains to adolescents and to a lesser extent adults. The information is gleaned for the recall of individuals about their experiences and the focus has been largely on sexual abuse.
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However, this method is prone to recall bias, because the studies have been conducted many years after the events were experienced and over time memory becomes distorted. Although physical and emotional abuse are also common, these have been studied less. So, while psychiatrists have a certain amount of knowledge to inform our practice when we are dealing with the victims of abuse, the methods used to gather this data is less than optimal and need to be more rigorous.
The ideal approach would be to take a large group of children and follow them through from infancy through adolescence into adulthood and over time link any history of abuse (all types) with mental health records or alternatively conduct face-to-face interviews with them in adulthood to evaluate their past and current mental health. This would be a mammoth task, but a group of researchers from the Department of Psychiatry at the University of Queensland, Brisbane, Australia, have just completed and published such a study in the online version of the 'British Journal of Psychiatry'.
The investigation began by studying more than 7,000 expectant mothers at their first antenatal visit when personal and health data was collected. The mothers and their children were then reassessed when the children were 3-5 days old, six months, five years, 14 years and 21 years of age. Childhood maltreatment information was gathered from the records of Queensland's child protection agency and it included physical abuse, emotional abuse, neglect and sexual abuse.
The investigators found that 4.5pc of children had verified maltreatment by the time they reached 16. The most common was emotional abuse, followed by physical abuse, then neglect and lastly sexual abuse. Half of them experienced multiple types of abuse.
Those from indigenous backgrounds, those who were on low incomes or whose parents were not living together at the time of their birth were at particular risk. They were at particular risk for anxiety, depression and post-traumatic stress disorder. This risk applied to physical and emotional abuse, to neglect and to those experiencing multiple types of abuse.
Sexual abuse did not appear to be associated with depression or anxiety and this was a surprise, although it was associated with post-traumatic stress disorder. It may be that the numbers experiencing sexual abuse were too small to detect these conditions or that the abuse was reported and the intervention that followed was successful in preventing the development of these mental health disorders.
The implications of this high quality study are important. While much of the focus internationally has been on sexual abuse, the importance of other types of maltreatment also need to be given greater salience in child protection legislation and in the organisations that work with maltreated children.
We need to have a public discussion about emotional abuse and neglect, facets of childhood that have largely been ignored to date. The findings of this study also have major financial implications, since the delivery of protection services will need to be enhanced so as to identify those who are emotionally abused and neglected as well as providing continuing support to those children who are physically and sexually ill-treated.