Exposure of Child Maltreatment Leads to a Risk of Mental Illness and Poor Prognosis in Taiwan: A Nationwide Cohort Study from 2000 to 2015
Abstract
:1. Introduction
2. Method
2.1. Data Sources
2.2. Study Design
2.3. Statistical Analysis
3. Results
3.1. Characteristics of Study
3.2. Risk of Mental Illness and Poor Prognosis According to Child Maltreatment Exposure
4. Discussion
4.1. Comparison with Previous Observations
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Injured Type (ICD9-CM: 800–989, 9958) | Total | (n = 1592) | Male | (n = 833) | Female | (n = 759) | Male vs. Female | |
---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | OR (95% CI) | p | |
Skull or Facial Fractures (800–804) | 80 | 5.0 | 77 | 9.2 | <8 | 23.13 (7.25–73.78) | <0.0001 ** | |
Cervical spine and trunk fractures (805–809) | 8 | 0.5 | <8 | <8 | 5.63 (0.68–46.46) | 0.1087 | ||
Upper extremity fractures (810–819) | 106 | 6.7 | 99 | 11.9 | <8 | 14.03 (6.47–30.43) | <0.0001 ** | |
Lower extremity fractures (820–829) | 9 | 0.6 | <8 | <8 | 7.36 (0.92–59.03) | 0.0602 | ||
Dislocation (830–839) | <8 | <8 | <8 | 3.46 (0.39–30.57) | 0.2643 | |||
Sprains and strains of joints and adjacent muscles (840–848) | 29 | 1.8 | 23 | 2.8 | <8 | 3.49 (1.41–8.64) | 0.0068 ** | |
Intracranial injuries, excluding skull fractures (850–854) | 300 | 18.8 | 261 | 31.3 | 39 | 5.1 | 8.17 (5.72–11.67) | <0.0001 ** |
6.08 | 38 | 2.4 | 33 | 4.0 | <8 | 6.08 (2.36–15.69) | 0.0002 ** | |
Open wounds of head, neck and trunk (870–879) | 252 | 15.8 | 222 | 26.7 | 30 | 4.0 | 8.55 (5.75–12.73) | <0.0001 ** |
Open wounds of upper extremities (880–887) | 137 | 8.6 | 120 | 14.4 | 17 | 2.2 | 6.98 (4.15–11.75) | <0.0001 ** |
Open wounds of lower extremities (890–897) | 58 | 3.6 | 45 | 5.4 | 13 | 1.7 | 3.31 (1.77–6.18) | 0.0002 ** |
Vascular damage (900–904) | 10 | 0.6 | <8 | <8 | 6.12 (0.76–49.37) | 0.0891 | ||
Damage, Poisoning, Poisoning (905–909) | <8 | <8 | <8 | -- | -- | |||
Superficial injuries (910–919) | 120 | 7.5 | 98 | 11.8 | 22 | 2.9 | 4.44 (2.76–7.13) | <0.0001 ** |
Contusions without damage to the skin surface (920–924) | 375 | 23.6 | 306 | 36.7 | 69 | 9.1 | 5.74 (4.31–7.63) | <0.0001 ** |
crush injury (925–929) | 9 | 0.6 | 9 | 1.1 | <8 | -- | -- | |
foreign bodies entering the body through orifices (930–939) | 6 | 0.4 | <8 | <8 | 1.81 (0.32–10.13) | 0.4992 | ||
Burns (940–949) | <8 | <8 | <8 | -- | -- | |||
Nerve and Spinal Cord Injury (950–957) | 20 | 1.3 | 17 | 2.0 | <8 | 3.25 (0.93–11.32) | 0.0648 | |
Specific Traumatic Complications and Injuries (958–959) | 85 | 5.3 | 49 | 5.9 | 36 | 4.7 | 1.22 (0.78–1.90) | 0.3892 |
Poisoning due to drugs, drugs and biological substances (960–979) | <8 | <8 | <8 | 0.88 (0.05–14.75) | 0.9276 | |||
Toxic effects due to non-medicinal mainly substances (980–989) | <8 | <8 | <8 | -- | -- | |||
Child abuse (995.50–995.59) | 316 | 19.8 | 43 | 5.2 | 273 | 36.0 | 0.10 (0.07–0.14) | <0.0001 ** |
abused child (995.50) | 23 | 1.4 | 13 | 1.6 | 10 | 1.3 | 1.20 (0.52–2.78) | 0.6695 |
Emotionally or psychologically abused children (995.51) | <8 | <8 | <8 | -- | -- | |||
Neglected Children (Nutrition) (995.52) | <8 | <8 | <8 | -- | -- | |||
Sexually abused children (995.53) | 259 | 16.3 | 8 | 1.0 | 251 | 33.1 | 0.019 (0.009–0.038) | <0.0001 ** |
Emotionally abused children (995.54) | <8 | <8 | <8 | 5.57 (0.67–46.65) | 0.1130 | |||
Shaken Baby Syndrome (995.55) | <8 | <8 | <8 | -- | -- | |||
Other abused and neglected children (995.59) | 9 | 0.6 | <8 | <8 | 1.85 (0.46–7.46) | 0.3891 |
Injury Status (Location, Severity) | Total | (n = 1592) | Male | (n = 833) | Female | (n = 759) | |
---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||
Injured area ‡ | Head/Neck | 281 | 17.7 | 241 | 28.9 | 40 | 5.3 |
Face | 60 | 3.8 | 56 | 6.7 | 4 | 0.5 | |
Thorax | 63 | 4.0 | 57 | 6.8 | 6 | 0.8 | |
Abdomen | 62 | 3.9 | 47 | 5.6 | 15 | 2.0 | |
Extremity | 158 | 9.9 | 137 | 16.4 | 21 | 2.8 | |
Appearance Soft Tissue (External) | 462 | 29.0 | 382 | 45.9 | 80 | 10.5 | |
Injury severity | (RISS) | ||||||
No trauma (ISS = 0) | 842 | 52.9 | 222 | 26.7 | 620 | 81.7 | |
Minor trauma (ISS ≤ 8) | 644 | 40.5 | 515 | 61.8 | 129 | 17.0 | |
Moderate trauma (ISS 9–15) | 76 | 4.8 | 71 | 8.5 | 5 | 0.7 | |
Serious trauma (≥16) | 30 | 1.9 | 25 | 3.0 | 5 | 0.7 |
Injured Type (ICD9-CM: 800–989) | Total | (n = 1592) | Male | (n = 833) | Female | (n = 759) |
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Skull or Facial Fractures (800–804) | 80 | 5.0 | 77 | 9.2 | <8 | |
Cervical spine and trunk fractures (805–809) | 8 | 0.5 | <8 | <8 | ||
Upper extremity fractures (810–819) | 106 | 6.7 | 99 | 11.9 | <8 | |
Lower extremity fractures (820–829) | 9 | 0.6 | <8 | <8 | ||
Dislocation (830–839) | <8 | <8 | <8 | |||
Sprains and strains of joints and adjacent muscles (840–848) | 29 | 1.8 | 23 | 2.8 | <8 | |
Intracranial injuries, excluding skull fractures (850–854) | 300 | 18.8 | 261 | 31.3 | 39 | 5.1 |
chest, abdomen and pelvis (860–869) | 38 | 2.4 | 33 | 4.0 | <8 | |
Open wounds of head, neck and trunk (870–879) | 252 | 15.8 | 222 | 26.7 | 30 | 4.0 |
Open wounds of upper extremities (880–887) | 137 | 8.6 | 120 | 14.4 | 17 | 2.2 |
Open wounds of lower extremities (890–897) | 58 | 3.6 | 45 | 5.4 | 13 | 1.7 |
Vascular damage (900–904) | 10 | 0.6 | 9 | <8 | ||
Damage, Poisoning, Poisoning (905–909) | <8 | <8 | <8 | |||
Superficial injuries (910–919) | 120 | 7.5 | 98 | 11.8 | 22 | 2.9 |
Contusions without damage to the skin surface (920–924) | 375 | 23.6 | 306 | 36.7 | 69 | 9.1 |
crush injury (925–929) | 9 | 0.6 | 9 | 1.1 | <8 | |
foreign bodies entering the body through orifices (930–939) | <8 | <8 | <8 | |||
Burns (940–949) | <8 | <8 | <8 | |||
Nerve and Spinal Cord Injury (950–957) | 20 | 1.3 | 17 | 2.0 | <8 | |
Specific Traumatic Complications and Injuries (958–959) | 85 | 5.3 | 49 | 5.9 | 36 | 4.7 |
Poisoning due to drugs, drugs and biological substances (960–979) | <8 | <8 | <8 | |||
Toxic effects due to non-medicinal mainly substances (980–989) | <8 | <8 | <8 |
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Demographic Variables | Child and Adolescent Victims (n = 1592) | Control Group (n = 6368) | p | |||
---|---|---|---|---|---|---|
n | % | n | % | |||
Gender | Female | 759 | 47.7 | 3036 | 47.7 | >0.999 |
Male | 833 | 52.3 | 3332 | 52.3 | ||
Age | Mean (SD) | 13.9 | (3.0) | 13.9 | (3.0) | 0.4749 |
Median (Min-Max) | 15 | (0–17) | 15 | (0–17) | ||
Urbanization | Highly urbanized town | 265 | 16.6 | 1670 | 26.2 | 0.8145 |
Moderately urbanized town | 473 | 29.7 | 2035 | 32.0 | ||
New town | 387 | 24.3 | 1194 | 18.8 | ||
General townships | 247 | 15.5 | 844 | 13.3 | ||
Aging towns + Remote towns + Outlying islands | 139 | 8.7 | 347 | 5.4 | ||
Agricultural township | 74 | 4.6 | 231 | 3.6 | ||
Missing value | 7 | 0.4 | 47 | 0.7 | ||
Insurance Area | Taipei | 394 | 24.7 | 2249 | 35.3 | 0.8451 |
North District | 223 | 14.0 | 1102 | 17.3 | ||
Central District | 483 | 30.3 | 1054 | 16.6 | ||
South area | 181 | 11.4 | 835 | 13.1 | ||
Kaohsiung and Pingtung | 264 | 16.6 | 899 | 14.1 | ||
Eastern District | 41 | 2.6 | 185 | 2.9 | ||
Missing value | 6 | 0.4 | 44 | 0.7 | ||
Insured Amount | 0–16,499 (TWD) | 511 | 32.1 | 1424 | 22.4 | <0.001 ** |
16,500–20,999 (TWD) | 475 | 29.8 | 1893 | 29.7 | ||
21,000–30,299 (TWD) | 361 | 22.7 | 1507 | 23.7 | ||
≥30,300 (TWD) | 245 | 15.4 | 1544 | 24.2 | ||
Personal or Health insurance | Public insurance | 36 | 2.3 | 361 | 5.7 | <0.001 ** |
dependent occupation | labor protection | 822 | 51.6 | 3869 | 60.8 | |
Farmer | 187 | 11.7 | 612 | 9.6 | ||
Member of Water Conservancy and Fisheries Association | 52 | 3.3 | 185 | 2.9 | ||
low-income households | 133 | 8.4 | 168 | 2.6 | ||
Community insured population | 346 | 21.7 | 1119 | 17.6 | ||
Other + missing values | 16 | 1.0 | 54 | 0.8 |
Poor Prognosis | Violent Injurer (n = 1592) | Not Violent Injurer (n = 6368) | HR (95% CI) | p |
---|---|---|---|---|
Incidence Rate (1/104) | Incidence Rate (1/104) | |||
Psychiatric comorbidity | ||||
Anxiety | 164.7 | 61.9 | 2.41 (1.97–2.94) | <0.0001 ** |
Depression | 114.7 | 32.1 | 3.23 (2.51–4.17) | <0.0001 ** |
Manic disorder | 2.3 | 0.4 | 5.36 (0.89–32.21) | 0.0666 |
Bipolar disorder | 29.0 | 4.1 | 6.54 (3.56–12.04) | <0.0001 ** |
Sleep disorder | 264.1 | 118.6 | 1.91 (1.64–2.23) | <0.0001 ** |
Posttraumatic stress disorder | 16.5 | 1.8 | 9.01 (3.94–20.62) | <0.0001 ** |
Acute stress disorder | 25.9 | 4.7 | 5.42 (2.98–9.84) | <0.0001 ** |
Eating disorders | 5.5 | 3.7 | 1.68 (0.66–4.25) | 0.2727 |
Tobacco use disorder | 40.8 | 13.1 | 2.58 (1.72–3.85) | <0.0001 ** |
Alcoholism | 15.6 | 4.5 | 2.94 (1.53–5.67) | 0.0012 ** |
Alcohol abuse | 11.7 | 2.5 | 4.36 (1.89–10.05) | 0.0006 ** |
Drug dependence | 14.1 | 1.0 | 11.24 (4.11–30.69) | <0.0001 ** |
Drug abuse | 9.4 | 1.0 | 11.76 (3.24–42.74) | 0.0002 ** |
Schizophrenic disorders | 8.6 | 4.1 | 2.18 (1.00–4.73) | 0.0495 * |
Psychotic disorders | 16.4 | 3.3 | 4.47 (2.26–8.84) | <0.0001 ** |
Suicide and self-inflicted injury | 4.7 | 0 | - | - |
Mortality | 16.4 | 13.5 | 1.0 (0.58–1.72) | 0.9963 |
Poor Prognosis | Violent Injurer (n = 833) | Not violent Injurer (n = 3332) | HR (95% CI) | p | ||||||
---|---|---|---|---|---|---|---|---|---|---|
n | % | Total Person Years | Incidence Rate (1/104) | n | % | Total Person Years | Incidence Rate (1/104) | |||
Psychiatric comorbidity | ||||||||||
Anxiety | 94 | 11.3 | 7240 | 129.8 | 142 | 4.3 | 26,522 | 53.5 | 2.14 (1.59–2.88) | <0.0001 ** |
Depression | 53 | 6.4 | 7296 | 72.6 | 67 | 2.0 | 26,617 | 25.2 | 2.27 (1.51–3.43) | <0.0001 ** |
Manic disorder | 7434 | 26,714 | (-) | |||||||
Bipolar disorder | 11 | 1.3 | 7418 | 14.8 | 8 | 0.2 | 26,714 | 3.0 | 3.92 (1.42–10.85) | 0.0084 ** |
Sleep disorder | 151 | 18.1 | 7239 | 208.6 | 253 | 7.6 | 26,433 | 95.7 | 1.86 (1.49–2.34) | <0.0001 ** |
Posttraumatic stress disorder | ≤5 | 4.1 | ≤5 | 1.5 | 2.71 (0.60–12.25) | 0.1947 | ||||
Acute stress disorder | 12 | 1.4 | 7389 | 16.2 | 11 | 0.3 | 26,686 | 4.1 | 4.95 (1.98–12.41) | 0.0006 ** |
Eating disorders | ≤5 | 1.3 | ≤5 | 1.5 | 1.00 (0.11–8.95) | 0.9999 | ||||
Tobacco use disorder | 43 | 5.2 | 7381 | 58.3 | 55 | 1.7 | 26,702 | 20.6 | 2.62 (1.70–4.03) | <0.0001 ** |
Alcoholism | 11 | 1.3 | 7413 | 14.8 | 13 | 0.4 | 26,691 | 4.9 | 2.65 (1.08–6.51) | 0.0341 * |
Alcohol abuse | 7 | 0.8 | 7421 | 9.4 | 8 | 0.2 | 26,714 | 3.0 | 3.16 (0.96–10.38) | 0.0576 |
Drug dependence | 10 | 1.2 | 7410 | 13.5 | ≤5 | 1.1 | 9.19 (2.44–34.59) | 0.0010 ** | ||
Drug abuse | ≤5 | 5.4 | ≤5 | 1.1 | 4.89 (0.85–28.26) | 0.0762 | ||||
Schizophrenic disorders | ≤5 | 5.4 | 15 | 0.5 | 26,700 | 5.6 | 0.98 (0.31–3.11) | 0.9768 | ||
Psychotic disorders | 7 | 0.8 | 7431 | 9.4 | 10 | 0.3 | 26,705 | 3.7 | 1.87 (0.66–5.30) | 0.2370 |
Suicide and self-inflicted injury | 7434 | 26,714 | (-) | |||||||
Mortality | 18 | 2.2 | 7434 | 24.2 | 47 | 1.4 | 26,714 | 17.6 | 1.10 (0.61–1.97) | 0.7566 |
Poor Prognosis | Violent Injurer (n = 759) | Not Violent Injurer (n = 3036) | HR (95% CI) | p | ||||||
---|---|---|---|---|---|---|---|---|---|---|
n | % | Total Person Years | Incidence Rate (1/104) | n | % | Total Person Years | Incidence Rate (1/104) | |||
Psychiatric comorbidity | ||||||||||
Anxiety | 109 | 14.4 | 5088 | 214.2 | 157 | 5.2 | 21,762 | 72.1 | 2.67 (2.03–3.50) | <0.0001 ** |
Depression | 89 | 11.7 | 5089 | 174.9 | 89 | 2.9 | 21,924 | 40.6 | 4.05 (2.93–5.61) | <0.0001 ** |
Manic disorder | ≤5 | 5.6 | ≤5 | 0.9 | 5.36 (0.89–32.21) | 0.0666 | ||||
Bipolar disorder | 26 | 3.4 | 5328 | 48.8 | 12 | 0.4 | 22,072 | 5.4 | 8.62 (3.95–18.8) | <0.0001 ** |
Sleep disorder | 173 | 22.8 | 5030 | 343.9 | 318 | 10.5 | 21,716 | 146.4 | 1.95 (1.59–2.41) | <0.0001 ** |
Posttraumatic stress disorder | 18 | 2.4 | 5324 | 33.8 | ≤5 | 2.3 | 15.37 (5.14–46.02) | <0.0001 ** | ||
Acute stress disorder | 21 | 2.8 | 5340 | 39.3 | 12 | 0.4 | 22,051 | 5.4 | 5.78 (2.63–12.7) | <0.0001 ** |
Eating disorders | 6 | 0.8 | 5384 | 11.1 | 14 | 0.5 | 22,038 | 6.4 | 1.93 (0.68–5.45) | 0.2160 |
Tobacco use disorder | 9 | 1.2 | 5367 | 16.8 | 9 | 0.3 | 22,072 | 4.1 | 2.34 (0.76–7.15) | 0.1374 |
Alcoholism | 9 | 1.2 | 5371 | 16.8 | 9 | 0.3 | 22,059 | 4.1 | 3.32 (1.28–8.63) | 0.0137 * |
Alcohol abuse | 8 | 1.1 | 5384 | 14.9 | ≤5 | 1.8 | 6.04 (1.78–20.53) | 0.0039 ** | ||
Drug dependence | 8 | 1.1 | 5380 | 14.9 | ≤5 | 0.9 | 14.35 (3.04–67.71) | 0.0008 ** | ||
Drug abuse | 8 | 1.1 | 5362 | 14.9 | ≤5 | 0.9 | 26.2 (3.22–213.27) | 0.0023 ** | ||
Schizophrenic disorders | 7 | 0.9 | 5361 | 13.1 | ≤5 | 2.3 | 6.19 (1.78–21.44) | 0.0041 ** | ||
Psychotic disorders | 14 | 1.8 | 5336 | 26.2 | 6 | 0.2 | 22,081 | 2.7 | 9.80 (3.50–27.49) | <0.0001 ** |
Suicide and self-inflicted injury | 6 | 0.8 | 5368 | 11.2 | 0 | 0.0 | 22,085 | 0.0 | - | - |
Mortality | ≤5 | 5.6 | 19 | 0.6 | 22,085 | 8.6 | 0.61 (0.14–2.73) | 0.5184 |
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Huang, S.-H.; Lin, I.-J.; Yu, P.-C.; Wang, B.-L.; Chung, C.-H.; Huang, Y.-C.; Chien, W.-C.; Sun, C.-A.; Wu, G.-J. Exposure of Child Maltreatment Leads to a Risk of Mental Illness and Poor Prognosis in Taiwan: A Nationwide Cohort Study from 2000 to 2015. Int. J. Environ. Res. Public Health 2022, 19, 4803. https://doi.org/10.3390/ijerph19084803
Huang S-H, Lin I-J, Yu P-C, Wang B-L, Chung C-H, Huang Y-C, Chien W-C, Sun C-A, Wu G-J. Exposure of Child Maltreatment Leads to a Risk of Mental Illness and Poor Prognosis in Taiwan: A Nationwide Cohort Study from 2000 to 2015. International Journal of Environmental Research and Public Health. 2022; 19(8):4803. https://doi.org/10.3390/ijerph19084803
Chicago/Turabian StyleHuang, Shi-Hao, Iau-Jin Lin, Pi-Ching Yu, Bing-Long Wang, Chi-Hsiang Chung, Yao-Ching Huang, Wu-Chien Chien, Chien-An Sun, and Gwo-Jang Wu. 2022. "Exposure of Child Maltreatment Leads to a Risk of Mental Illness and Poor Prognosis in Taiwan: A Nationwide Cohort Study from 2000 to 2015" International Journal of Environmental Research and Public Health 19, no. 8: 4803. https://doi.org/10.3390/ijerph19084803