Health effects associated with exposure of children to physical violence, psychological violence and neglect: a Burden of Proof study
Flor LS., Stein C., Gil GF., Khalil M., Herbert M., Aravkin AY., Arrieta A., Baeza de Robba MJ., Bustreo F., Cagney J., Calderon-Anyosa RJC., Carr S., Chandan JK., Chandan JS., Coll CVN., de Andrade FMD., de Andrade GN., Debure AN., DeGraw E., Hammond B., Hay SI., Knaul FM., Lim RQH., McLaughlin SA., Metheny N., Minhas S., Mohr JK., Mullany EC., Murray CJL., O’Connell EM., Patwardhan V., Reinach S., Scott D., Spencer CN., Sorensen RJD., Stöckl H., Twalibu A., Valikhanova A., Vasconcelos N., Zheng P., Gakidou E.
The health toll of child maltreatment or violence against children (VAC) has not yet been comprehensively evaluated. Here, in our systematic review and meta-analyses, we focused on the health impacts of physical violence, psychological violence and neglect during childhood. Utilizing the Burden of Proof methodology, which generates conservative measures of association while accounting for heterogeneity between input studies, we evaluated 35 associations between VAC and adverse health outcomes, identifying 27 statistically significant links. The associations between physical violence and major depressive disorder, ischaemic heart disease, alcohol use disorder, eating disorders and drug use disorders were rated as moderately weak, reflecting a small effect size and/or inconsistent evidence. The minimum increased risk ranged from 16% for depression to 2% for drug use disorders. Psychological violence showed similar moderately weak associations with drug use disorders (8% minimum risk increase), migraine (7%) and gynaecological diseases (2%). Neglect was linked to at least a 15% increased risk for anxiety disorders. The other 18 associations were weaker due to smaller effect sizes and/or less consistent evidence. Despite the limitations of the existing evidence, our analysis highlights substantial health impacts for VAC survivors, underscoring the need for health system prioritization and continued efforts to eliminate all forms of VAC.