centers on child abuse and neglect
F. Snoeren, C. Hoefnagels, S. M. A. A. Evers, F. Lamers-Winkelman Submitted at Journal of Interpersonal Violence (under revision)
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Introduction
Quality of life has been defined by the World Health Organization as ‘the individuals’ perception of their position in life in the context of the culture and value systems in which they live, in relation to their goals, expectations, standards and concerns’ (World Health Organization Quality of Life Group [WHOQOL Group], 1995, p. 1405). This definition highlights the view that quality of life is multi-dimensional, including perceptions of physical health, psychological health, interpersonal relationships and social roles (WHOQOL Group, 1995). The concept of quality of life has become more important as it adds a client perspective to objective measures and can therefore be successfully used in health-related research (Gielen, McDonnell, Wu, O’Campo, & Faden, 2001; Peeters & Stiggelbout, 2010; Klassen, Anthony, Khan, Sung, & Klaassen, 2011), as well as in clinical practice (e.g. Bastiaansen, Koot, Bongers, Varni, & Verhulst, 2005). Recently, quality of life has also become an important part of research into childhood maltreatment. Adults who have been maltreated as children report lower quality of life than people without an abusive past (Afifi, Murray, Cox, de Graaf, ten Have, et al., 2007; Al-Fayez, Oheari, & Gado, 2012; Corso, Edwards, Fang, & Mercy, 2008). The present study focused on two gaps in the current quality of life literature. In the first place, studies into outcomes of maltreated children have been limited, even though maltreated children are a vulnerable group because they are at risk for developing mental and other health problems (Gilbert, Widom, Browne, Fergusson, Webb, et al., 2009). Second, research has focused on long-term outcomes, so information on the association between child maltreatment and current quality of life outcomes is lacking.
There are several possible explanations for the limited number of studies in which children are used as informants. First, quality of life in children is subject to developmental differences, which complicates research because age-related differences have to be addressed, for example by developing different questionnaire versions for different age groups. As a result, proxies such as parents have usually been asked to report on children’s quality of life. However, research findings have shown discrepancies between child and proxy reports (Eiser & Morse, 2001; Rajmil, Fernandez, Gispert, Rue, Glutting, et al., 1999; Theunissen, Vogels, Koopman, Verrips, Zwinderman, et al., 1998; Whiteman & Green, 1997). Quality of life research has found greater agreement between child and proxy reports regarding the physical, i.e. more observable, dimensions, and less agreement regarding the social and emotional, i.e. less observable, quality of life dimensions (Eiser & Morse, 2001). Also, parents may not make reliable proxies in case of child maltreatment, because they
Abstract
Studies have shown that adults who have been maltreated as children report lower quality of life than people without an abusive past. Quality of life research focusing on maltreated children has been limited, as have studies examining quality of life outcomes shortly after child maltreatment. The primary aim of this study was to examine the quality of life of maltreated children shortly after a report to an advice and reporting center on child abuse and neglect. As a secondary aim, the extent to which socio-demographic and maltreatment characteristics were associated with quality of life was examined. Participants were 228 maltreated children aged 5-16 years (M = 9.99;
SD = 3.20) and their primary caretaker. Children completed the Pediatric Quality of Life Inventory.
One-sample t-tests were used to compare the self-reported quality of life of the maltreated children with scores from available norm populations consisting of healthy children. Stepwise multiple regression analyses were used to explore whether socio-demographic and maltreatment characteristics were associated with quality of life of maltreated children. Significant differences were found between the study sample and three different norm populations regarding the overall quality of life and the psychosocial health dimension of quality of life. Quality of life of children aged 8 and 9 years seemed to be more negatively affected by maltreatment than that of children in other age groups. The socio-demographic characteristic of financial problems in the family was associated with lower quality of life. Future research should address the long-term effects of child maltreatment on quality of life.
Keywords: Child maltreatment, Self-reported quality of life, Socio-demographic characteristics, Maltreatment characteristics
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may be the abusers (Corso & Lutzker, 2006). Since several studies have shown that children can be used as reliable informants as long as they are offered a valid age-appropriate instrument, the value of including children in research by using child self-reports is increasingly being recognized (Bell, 2007; Eiser & Morse, 2001; Fuchs, 2005).
The second gap addressed by our study is that many studies into child maltreat- ment have examined long-term quality of life outcomes. This may lead to bias, in particular to underreporting of childhood adversities due to memory problems, such as dissociation (Corso et al., 2008; Felitti, Anda, Nordenberg, Williamson, Spitz, et al., 1998). Also, quality of life outcomes assessed shortly after or during the maltreatment can be expected to differ from outcomes reported years later.
The primary aim of the present study was therefore to examine the quality of life of maltreated children aged 5 to 16 years, using child self-reports, shortly after a child maltreatment report to a Dutch advice and reporting center on child abuse and neglect (Advies- en Meldpunt Kindermishandeling; AMK). To place the outcomes in perspective, quality of life outcomes of maltreated children were compared with norm populations, while also considering possible age-related differences.
The secondary aim of this study was to examine whether socio-demographic characteristics (child characteristics and socio-economic characteristics of the family) and maltreatment characteristics are associated with quality of life outcomes of maltreated children. Several studies have emphasized the importance of identifying factors that are associated with quality of life. This may help to distinguish children who are at risk for adverse outcomes and to identify factors that can be modified to improve quality of life (Barnett & Hunter, 2012; Jirojanukul, Skevington, & Hudson, 2003; Ravens-Sieberer, Erhart, Gosch, & Wille, 2008). There is extensive literature on the association between quality of life and child characteristics, such as age and gender, as well as socio-economic characteristics such as parental education level, employment status and/or financial situation (Gaspar, Ribeiro, Gaspar de Matos, Leal, & Ferreira, 2012; Ravens-Sieberer et al., 2008). Lower quality of life was found for older children and for girls (Michel, Bisegger, Fuhr, & Abel, 2009; Ravens-Sieberer et al., 2008). In addition, adverse socio-economic characteristics seem to have a negative impact on children’s quality of life (Gaspar et al., 2012; Jirojanakul et al., 2003; Ravens-Sieberer et al., 2008; Varni, Limbers, & Burwinkle, 2007). However, whether these characteristics can be generalized to adverse quality of life in a sample consisting of maltreated children is not clear.
Moreover, little information is available on the association between different types of maltreatment, including accumulation of several types of maltreatment
(‘multiple maltreatment’), and quality of life outcomes (Jonzon & Lindblad, 2005; Simon, Herlands, Marks, Mancini, Letamendi, et al., 2009). Our study focused on the following types of maltreatment: physical abuse, emotional abuse, emotional neglect, physical neglect and sexual abuse.