Intergenerational continuity of child physical abuse: how good is the evidence?
Intergenerational continuity of child physical abuse: how good is the evidence?
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DOI：
10.1016/s0140-6736(00)02656-8
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发表时间：
2000-09-02
期刊：
影响因子：
168.9
通讯作者：
Dobbs, S
中科院分区：
文献类型：
--
作者：
Ertem, IO;Leventhal, JM;Dobbs, S
背景 人们普遍认为，童年时期遭受过身体虐待的人比没有受到虐待的人更有可能虐待自己的孩子，但检验这一观点的实证研究尚未得到系统回顾。本研究的目的是根据一项假设的随机对照试验得出的八项方法标准，系统地评估调查儿童身体虐待代际传播的研究设计。方法我们回顾了 1965 年至 2000 年之间以英文发表的研究，这些研究提供了两代人身体虐待的信息，并纳入了一个对照组。两名研究人员独立评估每项研究是否符合方法学标准。 结果 在确定的 10 项研究（4 项队列研究、1 项横断面研究和 5 项病例对照研究）中，有 4 项研究显示，父母在儿童时期受过虐待的儿童遭受虐待的相对风险显着增加（相对风险 4.75-37.8），但在其他 3 项研究中，相对风险小于 2。 大多数研究报告都清楚地描述了儿童时期虐待父母和虐待儿童的情况。五项研究未能避免回忆和检测偏差；五是不能确保控制本身不被滥用；八个没有提供足够的后续行动；其中六份报告没有说明登记的家长是否对虐待行为负责。大多数研究没有控制干预因素，例如父母一代遭受虐待期间及其子女受到虐待时的社会人口特征。只有一项研究满足所有八项标准（虐待传播的相对风险 12.6 [95% CI 1.82-87.2]），一项研究满足六项标准（1.05 [0.53-2.06]）。 解释 一项满足所有八项方法标准的研究为儿童身体虐待的代际连续性提供了证据，但满足六项标准的研究并不支持这一假设。使用我们的模型和方法标准应该可以提高研究的科学质量，这些研究检查风险因素对可能持续几代人的不良结果的影响。
Background There is widespread belief that individuals who were physically abused during childhood are more likely to abuse their own children than those who were not abused, but the empirical studies examining this belief have not been systematically reviewed. The aim of this study was to evaluate systematically, based on eight methodological standards derived from a hypothetical randomised controlled trial, the design of studies investigating the intergenerational transmission of child physical abuse.Methods We reviewed studies published between 1965 and 2000 in English that provided information about physical maltreatment in two generations and included a comparison group. Two investigators independently assessed whether each study met the methodological standards.Findings In the ten studies identified (four cohort, one cross-sectional, and five case-control), the relative risks of maltreatment in the children of parents who were abused during childhood were significantly increased in four studies (relative risks 4.75-37.8), but in three other studies the relative risks were less than 2. Most study reports provided a clear description of abuse of parents during childhood and abuse of their children. Five studies failed to avoid recall and detection bias; five did not ensure that controls were not themselves maltreated; eight did not provide adequate follow-up; and in six the report did not state whether the enrolled parent was responsible for the maltreatment. Most studies did not control for intervening factors, such as sociodemographic characteristics during the time of abuse of the parent generation and at the time their children were abused. Only one study met all eight criteria (relative risk of abuse transmission 12.6 [95% CI 1.82-87.2]) and one met six (1.05 [0.53-2.06]).Interpretation The one study that met ail eight methodological standards provided evidence for the intergenerational continuity of child physical abuse, but that which met six standards did not support the hypothesis. Use of our model and methodological standards should improve the scientific quality of studies examining the effects of risk factors for adverse outcomes that may continue across generations.