Afifi, T. O., MacMillan, H. L., Boyle, M., Taillieu, T., Cheung, K., & Sareen, J. (2014). Child abuse and mental disorders in Canada. Canadian Medical Association Journal, cmaj-131792.
Childhood adversity, including physical abuse, sexual abuse, neglect, witnessing violence, and loss of an attachment figure early in life is well known to result in a number of health and mental health problems later in life. Afifi and colleagues refer to child abuse at a significant public health problem worldwide. Despite the well known effects of child abuse, until recently there has been little research on the estimates of abuse and its outcomes in Canada. In their study, Afifi and colleagues looked at three types of child abuse (physical abuse, sexual abuse, and intimate partner violence) and its effects on 14 mental conditions including suicide and substance abuse. The authors used data from the 2012 Canadian Community Health Survey that included a representative sample of respondents aged 15 years and older living in the 10 provinces representing over 25,000 Canadians. The household survey response rate was close to 80%, and those over the age of 18 (N = 23,395) were asked about child abuse that occurred before the age of 16. Physical abuse was defined as any instances of being slapped, punched, kicked, burned etc. Sexual abuse was defined as being forced into any unwanted sexual activity by being threatened. Exposure to partner violence was classified as having seen or heard parents, step-parents, or guardians hitting each other. The prevalence of any of these 3 types of child abuse was 32.1%, with physical abuse being most common (26.1%), followed by sexual abuse (10.1%) and exposure to intimate partner violence (7.9%). Women were more likely than men to have experienced childhood sexual abuse (14.4% versus 5.8%) and exposure to intimate partner violence (8.9% versus 6.9%) as children. Men were more likely than women to have experienced child physical abuse (31.0% versus 21.3%). All forms of child abuse were associated with an increase in later mental illness, such that those who experienced any form of child abuse were over 3 times more likely to have a later mental illness. Obsessive–compulsive disorder was associated specifically with sexual abuse, eating disorders were specifically associated with physical abuse, post traumatic stress disorder was specifically associated with sexual abuse and certain types of physical abuse. All 3 types of abuse were associated with drug abuse/dependence, suicidal ideation, and suicide attempts. Exposure to a higher number of abuse types (i.e., sexual abuse, physical abuse, and intimate partner violence) was associated with more mental illnesses, and the effect was worse for women.
Child abuse is an important public health problem in Canada and is associated with a number of mental health problems in adulthood. Health care providers should be aware of the relation between specific types of child abuse and certain mental conditions. Clinicians working in the mental health field should acquire skills in assessing patients for exposure to abuse, and should understand the implications for treatment.