By Lucy Fitton, a Clinical Psychologist at the NHS in London –
The link between childhood maltreatment and violence perpetration later in life has been a research interest for many years, however, there has yet to be a systematic review using meta-analytic measures to measure the magnitude of this association.
Could you describe the aim of the study?
We aimed to address this gap in the literature and explore important variables that might influence this association. We focused on reviewing prospective studies that measured childhood maltreatment before violent outcomes. Prospective studies were of interest to us they provide a more accurate estimation of the association between childhood maltreatment and violent outcomes. They are less liable to factors such as forgetting, willingness to disclose traumatic experiences, and hindsight bias (where reports of childhood maltreatment may be over-reported as a means to explain current difficulties).
What is the key take-home message from the study?
After reviewing 18 eligible papers we confirmed that overall there was a statistically significant association between childhood maltreatment and violent outcomes. We were able to calculate Odds Ratios to find that childhood maltreatment modestly increased the risk of later violent outcomes by an Odds Ratio of 1.8 (with a 95% confidence interval 1.4 – 2.3). There was a high level of heterogeneity among the studies we reviewed (I2 = 92%), that is, we identified a high variation in study findings that were not due to chance alone.
We completed meta-regression and subgroup analyses to explore the impact different variables have on the association between child maltreatment and violent outcomes. Risk of violence was elevated in samples with a higher number of females, those that used case-linkage methods (for example where early medical records were linked with later criminal records) compared to those that individually followed participants up over time, in higher quality investigations (as measured by a quality assessment tool), when general population or matched control comparison samples were used rather than selected population controls (for example those from a specific socio-economic backgrounds), and when violent outcomes were recorded in older individuals.
What are the implications of these findings?
The confirmation of the association between childhood maltreatment and violent outcomes adds to the literature emphasizing the importance of preventative strategies and treatment initiatives for child maltreatment. It indicates that addressing child maltreatment has an important role in the prevention of violence. Educational interventions such as parenting programmes and classes for children and adolescents (informing them about victimization and perpetration) could reduce future violence perpetration. There is a need for early identification of child maltreatment and timely social and psychological interventions addressing maltreatment and associated trauma. Comprehensive safeguarding practices, interdisciplinary working, and specialist training for those working in the healthcare, educational, and criminal justice context is also vital. Our findings highlight that past childhood maltreatment should be considered when working with violent individuals.
What are the recommendations for future studies in this area?
We emphasize the importance of well-matched comparison samples in future studies in this area, especially as there is an overlap between social and demographic risk factors for maltreatment and violence. Persistent effort to prevent loss to follow-up is also considered important for future research. Maintaining the original sample ensures the most accurate representation of the sample producing the most reliable findings. As has been suggested by other authors, there is a risk that those lost to follow-up could be the most antisocial, and potentially violent, participants skewing the results.
The statistical analysis we completed were limited by the variables examined and reported in the papers reviewed. It would be interesting to know whether a dose-response relationship exists between child maltreatment and violent outcomes. To help determine this, future studies can record more information on maltreatment frequency and severity. We did not identify differences between the type of maltreatment on violent outcomes and often studies combined different forms of abuse or neglect. Nevertheless, examining differences in the type of maltreatment could be a continued area for exploration as this could inform theories on the ‘cycles of violence’ and outcomes following specific types of maltreatment. We were unable to explore moderators in the association between child maltreatment and violent outcomes, it would be useful to understand what role variables, such as revictimization, may have.
Lucy Fitton is a Clinical Psychologist working in the NHS in London. Her primary clinical and research interests are in forensic psychology and trauma.
Link to the primary paper: http://journals.sagepub.com/doi/abs/10.1177/1524838018795269?journalCode=tvaa
Childhood Maltreatment and Violent Outcomes: A Systematic Review and Meta-Analysis of Prospective Studies. Trauma, Violence, & Abuse. doi: 10.1177/1524838018795269
Lucy’s LinkedIn Profile https://www.linkedin.com/in/lucy-fitton-b8539b57/
Lucy’s ResearchGate Page https://www.researchgate.net/profile/Lucy_Fitton2