Adolescent health outcomes: associations with child maltreatment and peer victimization | BMC Public Health

Data and sample

The current study involved a province-representative sample of adolescents from the 2014 Ontario Child Health Study (OCHS). [33]. This study of children ages four to 17 was conducted in Ontario, Canada; the questionnaires were administered by Statistics Canada. A total of 10,802 children from 6,537 households participated (response = 50.8%) [33]. The sample for this study was restricted to a subset of adolescents aged 14 to 17, including the selected child and his siblings, who completed individual questionnaires on a laptop computer (not= 2910). Ethical approval for the original investigation was granted by the Hamilton Integrated Research Ethics Board at McMaster University. Further details of the OCHS 2014 methods have been reported previously. [33].


child abuse

Exposure to child maltreatment included measurement of physical abuse, sexual abuse, emotional abuse, physical neglect, and EIPV. Physical abuse, sexual abuse, and EIPV were assessed using items adapted from the Childhood Experiences of Violence Questionnaire (CEVQ), which produces valid and reliable scores. [34]while items on emotional abuse and physical neglect were drawn from the National Longitudinal Study of Adolescent to Adult Health [35]. For each item, respondents were asked to think about things that could have happened “at any time in their childhood”. Physical abuse was assessed with three items asking how often they were (a) slapped in the face, head or ears or hit or spanked with something hard by an adult, (b) pushed, grabbed, shoved or had something thrown at them by an adult, or (c) been kicked, bitten, punched, burned or physically assaulted by an adult. Sexual abuse was assessed with two items asking how often an adult (a) forced or attempted to force the respondent into unwanted sexual activity with threats or physical violence, or (b) touched the respondent against her will in any sexual way. Emotional abuse was assessed with an item asking how often parents/guardians said things that hurt the respondent’s feelings or made them feel unwanted or unloved. Physical neglect was assessed with an item asking how often parents/guardians failed to take care of the respondent’s basic needs (eg, keeping them clean, providing food or clothing). Finally, the EIPV was assessed with two items asking how often the respondent saw or heard parents/guardians (a) say hurtful or mean things to each other or to another adult at home or (b) hitting or hitting another adult at home. The response options for each item were: ‘Never’, ‘1-2 times’, ‘3-5 times’, ‘6-10 times’ and ‘More than 10 times’. Each type of CD was coded separately according to the cut-offs used previously, which varied according to the severity and frequency of each element. [34]. Specifically, physical abuse required a response of three or more times to one or both of the first two items and/or a response of at least once to the third item; sexual abuse required a response of at least once to one or both items; emotional abuse required a response of six or more times to the single item; physical neglect required a single-item response at least once; and EIPV required a response of six or more times to the first item and/or three or more times to the second item. Finally, the five types of MC were then combined into a dichotomous measure of any lifetime MC.

Peer victimization

PV was measured using the School Crime Supplement of the National Crime Victimization Survey [36]. Respondents who had attended school for at least one month since September 2014 were asked how many times during the current school year had another student: ‘made fun of you, called you names or insulted”, “spread rumors about you”, “threatened you”, “pushed, shoved, tripped or spat on you”, “tried to make you do things that you didn’t mean to do, for example, gave them money or other things”, “purposely excluded you from activities”, “purposely destroyed your property”, “posted hurtful information about you on the Internet”, “threatened or insulted you by e-mail, instant messaging, text message or online game”, “deliberately excluded you from an online community”, or “insulted or insulted you at school in connection with your race, religion, ethnicity or national origin”, “…any disability you may have” or “…your gold sexual orientation”. Although not often included, recent research has shown that discriminatory PV is common among adolescents [28] and is associated with poorer mental health [37]. The response options for each item were: “Never”, “Once or twice this school year”, “Once or twice this month”, “Once or twice this week”, and “Almost every day”. Consistent with previous research, responses were dichotomized into “once or twice this month” or more often versus “never” or “once or twice this school year.” [38]. All items were then combined into a dichotomous measure of any PV from the previous month.

Cumulative exposure

The two dichotomous variables for lifetime exposure to MC and exposure to PV in the previous month were summed into a cumulative exposure variable. However, rather than simply looking at a number of exposures (0, 1, 2), we separated those who reported exposure to CM only versus PV only, resulting in a categorical variable with four mutually exclusive: no CM or PV, CM only, PV only, and both CM and PV.

Nonsuicidal self-harm and suicidality

The adolescents were asked about NSSI and suicidal ideation with the following questions: “During the past 12 months, have you ever deliberately harmed yourself without intending to kill yourself? and “In the past 12 months, have you ever seriously considered killing yourself or killing yourself?” “. Response options were “yes” or “no”. Those who responded affirmatively to this last item regarding suicidal ideation were then asked about suicide plans and attempts in the past year with the following questions: “During the past 12 months, have you plan on how you would kill yourself or commit suicide? ” (response options: “yes” or “no”) and “How many times have you actually tried to kill yourself or kill yourself? which included the response options “Never”, “Once” and “More than once”” and were coded as “once or more” as opposed to “never” due to limited cell sizes .

Mental disorders

The 2014 OCHS Emotional Behavioral Scales (OCHS-EBS) checklist, which has demonstrated its validity and reliability [39], assessed six mental health disorders: generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social phobia (SP), major depressive disorder (MDD), oppositional defiant disorder (ODD), and pipes (TC). Teenagers were asked to self-report symptoms of each disorder experienced in the past six months (e.g., “I worry a lot.”) with response options: “Never or not true”, “Sometimes or rather true” and “Often or very true. Responses were assigned a score of zero to two, respectively, and summed into an overall score for each disorder (with symptoms of GAD, SAD, and SP combined in any anxiety disorder). Use an existing approach to create binary classifications [39]each score was dichotomized using cutoffs informed by global prevalence estimates: any anxiety disorder (6.5%), MDD (2.6%), ODD (3.6%), and CD (2. 1%) [40]. Anxiety and MDD were combined into a single variable indicating the presence of one or both internalizing disorders and TOP and CD were combined into a single variable indicating the presence of one or both internalizing disorders. ‘externalization. Finally, internalizing and externalizing disorders were combined as a dichotomous variable of any mental health disorder.

Physical health status

Long-term physical health problems self-reported by adolescents and diagnosed by a medical professional included allergies, bronchitis, diabetes, heart problems/diseases, epilepsy, cerebral palsy, kidney problems/diseases, asthma or any other long-term health problem. A single dichotomous indicator of any state of physical health was created.


Teen’s sex (male, female), age (14-17), ethnicity (white, non-white/multi-ethnicity), parent/guardian-reported household income (less than $25,000, $25,000 to $49,999, $50,000-$74,999, $75,000-$99,999, $100,000 or more), single-parent household status (yes, no) based on demographic information collected from parent/guardian, and urbanity (large urban, small-medium urban and rural) based on current census population counts were included.

Data analysis

First, the socio-demographic characteristics describing the sample were calculated. Second, weighted prevalence estimates of CM, PV, and each outcome were calculated for the total sample and by gender. Gender differences were tested with unadjusted logistic regression analysis with men as the reference group. Third, the prevalence of each outcome by CM and PV exposure was calculated, stratified by sex. Fourth, a series of nested sequential logistic regression models adjusted for sociodemographic characteristics (i.e. gender and in the total sample. Model 1 assessed CM, Model 2 assessed PV, Model 3 included both CM and PV, and Model 4 tested the interaction between CM and PV. Models with statistically significant interaction terms were then examined using plots of prevalence data for each variable of outcome by presence or absence of CM and stratified by presence or absence of PV Finally, cumulative effects were examined by testing the association between the variable CM/PV at four mutually exclusive levels (no CM or PV, CM only, PV only, both CM and PV) and each result using logistic regression adjustment for all covariates (including gender) in the entire sample without exposure to CM or PV as a group reference . Differences between each exposure category were then examined by sequentially changing the reference category in each regression model. After reviewing the data, it was determined that due to small cell sizes, cumulative effects stratified by sex could not be examined. Bootstrap weights (Fay adjustment: 0.8) calculated by Statistics Canada were applied to all analyzes to ensure that the results were representative of the target population and to produce valid variance estimates. Statistical significance was set at p

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