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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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Elif - Aydan Akın / Hasan Sabriye Gümüş Anatolian High School  / Poster of Video Cover

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Elif - Aydan Akın / Hasan Sabriye Gümüş Anatolian High School  / Poster of Video Cover

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Elif - Aydan Akın / Hasan Sabriye Gümüş Anatolian High School / Poster of Video Cover

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Elif - Aydan Akın / Hasan Sabriye Gümüş Anatolian High School / Poster of Video Cover

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Bilge/Emel teacher - GULSER MEHMET BOLLUK ANATOLIAN HIGH SCHOOL

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Bilge/Emel teacher - GULSER MEHMET BOLLUK ANATOLIAN HIGH SCHOOL

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GMBAL

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GMBAL

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GMBAL

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GMBAL

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Zeynep~Işıl Teacher Elazığ Anatolian High School

Emotional abuse can be defined as the totality of behaviors that damage people's self-confidence, self-respect, value,and concepts such as judgment,forgiveness and love.
In emotional abuse,which can be expressed as the use of psychological violence rather than pysical violence,one side tries to control the other with different forms of pressure. Today, the emotional abuse faced by the woman and even the child can also cause the psychological collapse of the human being.

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ELAZIĞ ANATOLİAN HİGH SCHOOL

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According to the average percentage values ​​of primary education teachers' opinions; 23.5% of the teachers included emotional violence behaviors as attacking the style of communication, 12% attacking social relations, 13.5% reputational and 16.5% task-oriented behaviors. According to these averages, approximately 17% of primary school teachers participating in the study are victims of emotional violence.

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Zenan- Oya Seçil AKTAŞ/ Baltaşı Secondary School

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Zenan- Oya Seçil AKTAŞ/ Baltaşı Secondary School

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Mark Tomlinson, Academic Editor

Abstract

Background

Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes.

Methods and Findings

A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships.

Conclusions

This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence.

Please see later in the article for the Editors' Summary

Introduction

Child maltreatment is defined as all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment, or commercial or other exploitation of children that results in actual or potential harm to a child's health, survival, development, or dignity in the context of a relationship of responsibility, trust, or power [1]. Four types of maltreatment are commonly recognised: sexual abuse, physical abuse, emotional abuse (also referred to as psychological abuse), and neglect ().

Table 1

Physical abuse

Physical abuse of a child is defined as the intentional use of physical force against a child that results in-or has a high likelihood of resulting in-harm for the child's health, survival, development, or dignity. This includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning, and suffocating. Much physical violence against children in the home is inflicted with the object of punishing.

Sexual abuse

Sexual abuse is defined as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared, or else that violates the laws or social taboos of society. Children can be sexually abused by both adults and other children who are-by virtue of their age or stage of development-in a position of responsibility, trust, or power over the victim.

Emotional and psychological abuse

Emotional and psychological abuse involves both isolated incidents, as well as a pattern of failure over time on the part of a parent or caregiver to provide a developmentally appropriate and supportive environment. Acts in this category may have a high probability of damaging the child's physical or mental health, or his/her physical, mental, spiritual, moral, or social development. Abuse of this type includes the following: the restriction of movement; patterns of belittling, blaming, threatening, frightening, discriminating against, or ridiculing; and other non-physical forms of rejection or hostile treatment.

Neglect

Neglect includes both isolated incidents, as well as a pattern of failure over time on the part of a parent or other family member to provide for the development and well-being of the child-where the parent is in a position to do so-in one or more of the following areas: health, education, emotional development, nutrition, shelter, and safe living conditions. The parents of neglected children are not necessarily poor.

There is a great deal of uncertainty around estimates of the frequency and severity of child maltreatment worldwide. Furthermore, much violence against children remains largely hidden and unreported because of fear and stigma and the societal acceptance of this type of violence [2]. Globally, prevalence of reported child sexual abuse varies from 2% to 62%, with some of this variation explained by a number of methodological factors including definition of abuse, method of data collection, and type of sample assessed [3]. In high-income countries, the annual prevalence of physical abuse ranges from 4% to 16%, and approximately 10% of children are neglected or emotionally abused [4]. Eighty percent of this maltreatment is perpetrated by parents or parental guardians [4], and poverty, mental health problems, low educational achievement, alcohol and drug misuse, having been maltreated oneself as a child, and family breakdown or violence between other family members are all important risk factors for parents abusing their children [5].

There is growing recognition that different forms of interpersonal violence have a large public health impact [6]. In children, the consequences of violence can vary widely. Physical injuries and, in extreme cases, death are direct consequences. World Health Organization (WHO) estimates of child homicide suggest that infants and very young children are at greatest risk, with rates for the 0- to 4-y age group about double those for 5- to 14-y-olds as a result of their dependency and vulnerability [5]. However, in the majority of non-fatal cases, the direct physical injury causes less morbidity to the child than the long-term impact of the violence on the child's neurological, cognitive, and emotional development and overall health [5].

Child maltreatment is a major public health problem, yet a lack of understanding of its serious lifelong consequences and of the cost and burden on society has hampered investment in prevention policies and programs. In order to effectively respond to the problem, the WHO 2006 report on prevention of child maltreatment [5] recommended expanding the scientific evidence base for the magnitude, consequences, and preventability of child maltreatment.

The relationship between child sexual abuse and adverse psychological consequences in adults is well established [7]-[9], and in the WHO comparative risk assessment study, Andrews and colleagues [3] carried out a systematic review and meta-analysis summarising the evidence of a relationship between child sexual abuse and subsequent mental disorders. This review is currently being updated in the new iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study, aiming to provide global estimates of attributable burden for 1990 to 2010 [10], but other forms of child maltreatment have been omitted.

Exposure to non-sexual child maltreatment, namely, physical abuse, emotional abuse, and neglect, is associated with increased risk of a wide range of psychological and behavioural problems, including depression, alcohol abuse, anxiety, and suicidal behaviour, and with increased risk of HIV and herpes simplex virus type 2 (HSV2) infection [11]-[14]. However, the long-term health consequences of these other forms of child maltreatment have not been systematically examined. To address these omissions, clarify the present state of empirical research, and enable the quantification of the health impacts of child neglect, physical abuse, and emotional abuse at the population level using burden of disease and comparative risk assessment methodology, we conducted a systematic review of the scientific literature and quantitative meta-analyses. To the best of our knowledge, this is the first meta-analysis to summarise the evidence for associations between individual types of non-sexual child maltreatment and outcomes related to mental and physical health.

Methods

General recommendations from the PRISMA 2009 revision [15], with regard to processing and reporting of results, were taken into account ( Text S1). The meta-analysis conforms to the guidelines outlined by the Meta-analysis of Observational Studies in Epidemiology recommendations [16]. Methods and inclusion criteria were specified in advance and documented in a review protocol ( Text S2).

Inclusion and Exclusion Criteria

This systematic review and meta-analysis incorporated retrospective and prospective cohort, cross-sectional, and case-control studies meeting the following inclusion criteria: (1) the study reported original, empirical research published in a peer-reviewed journal, (2) the study considered non-sexual child maltreatment as a potential risk factor for loss of health, and (3) the related health outcomes or behavioural risk factors were among those listed in the Global Burden of Diseases, Injuries, and Risk Factors Study [10]. Studies reporting exposure only to combined types of abuse were excluded. Included studies reported odds ratios (ORs) and confidence intervals (CIs) comparing those exposed and not exposed by type of abuse or, alternatively, provided the information from which effect sizes and confidence intervals could be calculated ( Text S2).

Search Strategy

Three electronic databases (Medline, EMBASE, and PsycINFO up to 26 June 2012) were searched using full text and Medical Subject Headings (MeSH) terms to identify studies reporting an association between non-sexual child maltreatment and health outcomes ( Text S2). Truncation of terms was used to capture variation in terminology. The search was not restricted to the English language, nor restricted by any other means. Searches were conducted using synonyms and combinations of the following search terms: "maltreatment", "physical abuse", "psychological abuse", and "emotional abuse", and automatic explosion of the terms "child abuse" and "child neglect". The search was also not restricted to any particular health outcome. Instead, the broader terms "risk", "adverse effect", "consequences", "harm", and "association" were used to encompass all studies that investigated any adverse outcome of non-sexual child maltreatment. In addition, reference lists of selected studies were screened for any other relevant study, and additional studies were also identified through contact with study authors. Articles in languages other than English were translated.

Data Collection and Quality Assessment

The full-text article of any study that appeared to meet the inclusion criteria was retrieved for closer examination. Two reviewers (R. E. N. and M. B.) independently assessed articles for eligibility. Disagreements were resolved by consensus. The coders were not masked to the journals or authors of the studies reviewed. A standardised data extraction sheet was developed, and data retrieved included publication details, country where study was conducted, methodological characteristics such as sample size and study design, exposure and outcome measures, type of abuse, and health outcomes ( Text S2). The data extraction sheet included a quality assessment tool () to rate the methodological quality of each study based on the Newcastle-Ottawa Scale for assessing the quality of observational studies [17]. Quality assessment was completed independently by two reviewers, and disagreements were resolved by discussion. One author was contacted for further information.

Table 2

Not representative, selected group, volunteers, or no description = 0

Data on child maltreatment collected retrospectively = 0

Drawn from a different source or no description = 0

Self-reported or structured interview or self-administered questionnaire or no description = 0

Marks and bruises (physical abuse), questions from scales (e.g., Childhood Trauma Questionnaire), published surveys, or own system = 0

Questions from published health surveys/screening instruments, own system, symptoms described, no system, not specified, or self-reported = 0

Completeness poor (<80%) or no statement = 0

No = 0 (univariate analysis or controls for age/sex only)

Statistical Analyses

Weighted summary measures were computed using MetaXL, version 1.2 [18], a tool for meta-analysis in Microsoft Excel, with ORs chosen as the principal summary measure. Heterogeneity was quantitatively assessed using the Cochran's Q and I ² statistics to evaluate whether the pooled studies represent a homogeneous distribution of effect sizes. Evidence of publication bias was investigated by means of funnel plots using the standard error on the y-axis [19].

Meta-analyses were complicated by the presence of significant heterogeneity in the data, likely due to a combination of true variance in these relationships and variability produced by differences in the methodology used to measure exposure and outcomes. We hypothesised that effect size may differ according to the methodological quality of the studies. MetaXL implements a process to explicitly address study heterogeneity caused by differences in study quality. This so-called quality effects (Doi and Thalib) model [20] is a modified version of the fixed-effects inverse variance method that additionally allows giving greater weight to studies of high quality versus studies of lesser quality by using the quality scores assigned to each study to weigh studies not only according to sample size but also by study quality [20],[21]. Forest plots were made to visualise individual as well as pooled effects.

To address the effects of important study characteristics and explore heterogeneity, we additionally conducted several pre-specified subgroup analyses (depending on data availability) by the following: gender of participants in the sample, geographic location (high income versus low-to-middle income), type of sample (population-based versus non-representative samples), measurement of abuse (self-reported versus official records), assessment of health outcome (structured clinical interview versus self-reported), prospective versus retrospective assessment of abuse and neglect, and appropriate adjustment versus no or inadequate adjustment for confounders.

Results

Out of 285 articles assessed for eligibility, 124 studies provided evidence of a relationship between non-sexual child maltreatment and various health outcomes for use in subsequent meta-analyses (). The majority ( n = 112) were from Western Europe, North America, Australia, and New Zealand. Data from low- and middle-income countries were sparse. Only 16 studies used a prospective cohort design that followed abused or neglected children over time to identify later health outcomes (). The remaining studies included cohort, cross-sectional, and case-control studies that measured the maltreatment retrospectively, usually by self-report in adolescence or adulthood. Most of the studies included in our meta-analysis presented data from regional or nationally representative samples (). The results of primary meta-analyses are presented in -, with Figures S1, S2, S3, S4, S5, S6, S7, S8, S9, S10, S11, S12, S13, S14, S15, S16, S17, S18, S19, S20, S21, S22, S23, S24, S25, S26, S27, S28, S29, S30, S31, S32, S33, S34, S35, S36, S37, S38, S39, S40, S41, S42 showing the forest plots of these meta-analyses. Details of subgroup analyses are presented in Tables S1, S2, S3, S4, S5, S6, S7, S8, S9, S10, S11.

Table 3

First Author [Reference]

Year

Setting

Sample Size ( N)

Percent Female

Type of Maltreatment

Child Maltreatment Measurement

Assessment of Health Outcome

Health Outcomes

Ascertainment of Exposure to Child Maltreatment/Study Type

Sample

Table 4

Table 6

Mental Disorders

Physically abused (OR = 1.54; 95% CI 1.16-2.04), emotionally abused (OR = 3.06; 95% CI 2.43-3.85), and neglected (OR = 2.11; 95% CI 1.61-2.77) individuals were found to have a higher risk of developing depressive disorders than non-abused individuals (; Figures S1, S2, S3). The test for heterogeneity was highly significant, with p<0.01 for both abuse types and neglect. Funnel plots indicate the possibility of publication bias for physical abuse, as it appears that some smaller, less precise studies have a greater effect size than the larger studies, and there are no smaller studies to the left (negative) side of the graph, suggesting that some negative studies may never have been published ( Figure S4).

For physical abuse, emotional abuse, and neglect, OR estimates in males were higher than in females, but the difference was not statistically significant ( Table S1). The odds of developing depressive disorders with exposure to physical abuse were greatest in prospective studies. Although the OR point estimate was higher in subgroup analyses of studies where exposure to physical abuse was court-substantiated by official records-which would include the more severe cases of abuse (OR = 2.41; 95% CI 1.32-4.41)-compared with self-reported physical abuse (OR = 1.56; 95% CI 1.11-2.19) and physical punishment (OR = 1.20; 95% CI 0.88-1.61), the 95% CIs were overlapping, and these differences were not statistically significant. There was a stronger association between physical abuse and a diagnosis of major depressive disorder using structured interviews (OR = 1.82; 95% CI 1.44-2.30) than when depressive disorders were diagnosed by symptom scales (OR = 1.52; 95% CI 1.03-2.24), but again these differences were not statistically significant ( Table S1). Restricting the physical abuse analysis to studies from high-income countries increased the odds of developing depressive disorders to 1.58 (95% CI 1.18-2.12), but the association was not significant in low-to-middle-income countries ( Table S1).

However, for neglect in childhood, similar odds of developing depressive disorders were observed in high- and low-to-middle-income countries. Data from two studies suggest a dose-response relationship, with depression more likely with frequent neglect compared with neglect that occurred only sometimes in childhood [13],[22]. A dose-response relationship was also reported for emotional abuse and depressive disorders, but not for physical abuse and depressive disorders ( Table S1).

Physical abuse (OR = 1.51; 95% CI 1.27-1.79), emotional abuse (OR = 3.21; 95% CI 2.05-5.03), and neglect (OR = 1.82; 95% CI 1.51-2.20) were associated with a significantly increased risk of anxiety disorders ( Figures S5, S6, S7, S8). For physical abuse, significant associations were also observed with post-traumatic stress disorder (PTSD) and panic disorder diagnoses ( Table S2). A dose-response relationship was observed with physical abuse but not with emotional abuse and neglect [22], with anxiety disorders more likely with frequent physical abuse than with abuse that occurred only sometimes in childhood ( Table S2). Physical abuse, emotional abuse, and neglect were also associated with an almost 3-fold increased risk of developing eating disorders ( Figures S9, S10, S11, S12), and physical abuse was associated with a 5-fold increased risk of developing bulimia nervosa meeting Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria. Most of the evidence came from retrospective studies, and only one prospective study [23] reported a strong association with neglect in childhood ( Table S3). A dose-response relationship was also observed, with bulimia nervosa more likely with more severe and repeated physical abuse [24] ( Table S3).

Physical abuse and neglect were also associated with a doubling of the odds of childhood behavioural and conduct disorders ( Figures S13, S14, S15). With respect to physical abuse, higher odds of developing conduct and childhood behavioural disorders were observed in prospective than in retrospective studies, but differences were not statistically significant. Studies with non-representative samples had significantly increased effect size for the association between physical abuse and childhood behavioural problems and conduct disorder (OR = 5.98; 95% CI 2.73-13.10) compared with population-based studies (OR = 2.02; 95% CI 1.58-2.58) ( Table S4).

Physical abuse significantly increased the risk of alcohol problem drinking (risky drinking, alcohol abuse/dependence, binge drinking) (OR = 1.26; 95% CI 1.03-1.55) ( Figure S16) and non-problem drinking (current or ever alcohol use), but the effect did not persist in prospective studies ( Table S5). In a subgroup analysis, physical abuse was also significantly associated with a diagnosis of alcohol abuse/dependence meeting DSM criteria (OR = 1.40; 95% CI 1.21-1.64) ( Table S5). Alcohol problem drinking was also associated with emotional abuse (OR = 1.27; 95% CI 1.11-1.46) ( Figure S17) but not with neglect in childhood (OR = 1.09; 95% CI 0.87-1.35) ( Figure S18). For alcohol problems, there was no evidence of a dose-response relationship with respect to frequency of abuse and neglect ( Table S5) [13]. Gender differences were observed, with the effect of physical abuse on alcohol problems stronger among males, and with females at an increased risk of alcohol problem drinking with exposure to neglect in childhood, but with overlapping confidence intervals ( Table S5). Publication bias did not appear to play a role in the association between physical abuse and alcohol problem drinking ( Figure S19).

Although primary analyses suggest an increased risk of drug use associated with physical abuse (OR = 1.92; 95% CI 1.67-2.20), emotional abuse (OR = 1.41; 95% CI 1.11-1.79), and neglect (OR = 1.36; 95% CI 1.21-1.54) ( Figures S20, S21, S22, S23), there was only borderline significance in prospective studies, with a stronger consistent association observed in retrospective studies, albeit with overlapping confidence intervals ( Table S6). A dose-response relationship between emotional abuse and neglect and drug use was not consistently seen.

Physically abused (OR = 3.00; 95% CI 2.07-4.33), emotionally abused (OR = 3.08; 95% CI 2.42-3.93), and neglected (OR = 1.85; 95% CI 1.25-2.73) individuals had a significantly increased risk of suicidal behaviour compared with non-abused individuals (). These significant associations continued in subgroup analyses by type of suicidal behaviour, with physically abused (OR = 3.40; 95% CI 2.17-5.32), emotionally abused (OR = 3.37; 95% CI 2.44-4.67), and neglected (OR = 1.95; 95% CI 1.13-3.37) individuals at a significantly increased risk of suicide attempt ( Figures S24, S25, S26, S27) and suicide ideation ( Table S7). There were no prospective studies investigating non-sexual child maltreatment and suicide attempt or ideation. Only one prospective study [25] was found investigating the association between self-inflicted injuries and exposure to physical abuse and neglect. Six studies [13],[26]-[30] presented the results by gender for physical abuse and suicide attempt and ideation, but no statistically significant differences were observed. One study showed that exposure to frequent childhood neglect was more strongly associated with suicidal behaviour than exposure to neglect that occurred sometimes [13] ( Table S7).

Sexually Transmitted Infections and Risky Sexual Behaviour

Physically abused (OR = 1.78; 95% CI 1.50-2.10), emotionally abused (OR = 1.75; 95% CI 1.49-2.04), and neglected (OR = 1.57; 95% CI 1.39-1.78) individuals were found to have a significantly higher risk of sexually transmitted infections (STIs) and/or risky sexual behaviour than non-abused individuals (; Figures S28, S29, S30, S31). For physical abuse and neglect, the association with STIs and risky sexual behaviour was significant in prospective and retrospective studies ( Table S8). HIV infection was about twice as common in physically abused (OR = 2.51; 95% CI 1.16-5.42), emotionally abused (OR = 1.82; 95% CI 1.34-2.47), and neglected (OR = 2.50; 95% CI 0.77-8.15) individuals as in controls, although for neglect the difference did not reach conventional levels of significance, probably because of weak statistical power. Physical abuse was also associated with an increased risk of other STIs (OR = 1.53; 95% CI 1.13-2.07) and risky sexual behaviour (OR = 1.95; 95% CI 1.58-2.40) (). A dose-response relationship was observed for HIV infection, with a larger effect size reported with more frequent physical and emotional abuse in childhood [13] ( Table S8).

Table 5

Chronic Diseases, Lifestyle Risk Factors, and Other Physical Health Outcomes

With regard to obesity, a significantly increased risk was observed for physical (OR = 1.32; 95% CI 1.06-1.64) and emotional abuse (OR = 1.24; 95% CI 1.13-1.36) but not for neglect (OR = 1.07; 95% CI 0.97-1.19) in the primary analysis ( Figures S32, S33, S34, S35). Subgroup analysis by assessment of outcome indicated that neglect was associated with a higher risk of developing self-reported obesity, but there was no association with obesity defined by waist circumference or body mass index (BMI) measurements ( Table S9). In the subgroup analysis by ascertainment of exposure to physical abuse, there was a strong association with obesity in one prospective study, but the magnitude of the effect was reduced in retrospective studies ( Table S9). A dose-response relationship between physical and emotional abuse and obesity has been observed [31] ( Table S9).

Physical (OR = 1.78; 95% CI 1.26-2.52) ( Figure S36) and emotional abuse (OR = 1.65; 95% CI 1.46-1.87) ( Figure S37) were associated with a significantly increased risk of current smoking, but the association was not significant for neglect in childhood (OR = 1.20; 95% CI 0.98-1.48). One study showed a dose response, with smoking more likely with physical abuse that occurred 3-5 times than with abuse that occurred 1-2 times, but this relationship did not continue into those who had been abused more than six times compared with those who had been abused 3-5 times [32] ( Table S10).

Forty-two studies investigated the relationship between non-sexual child maltreatment and lifestyle risk factors, chronic diseases, and other physical health outcomes in adulthood. There is suggestive evidence of a significant association between child physical abuse and arthritis, ulcers, and headache/migraine in adulthood. However, for most other outcomes, including type 2 diabetes ( Table S11; Figures S39, S40, S41, S42), hypertension, low exercise, cardiovascular diseases, respiratory diseases, neurological disorders, and cancer, these associations were mostly weak and inconsistent, with little adjustment for lifetime confounders. Pooled estimates were statistically significant in only a limited number of cases (). A recent prospective investigation of a group of individuals with documented histories of child abuse and neglect followed into middle adulthood provides some evidence that child abuse and neglect may increase the risk of a range of directly measured physical health outcomes after controlling for mental health problems, substance use, smoking, and BMI [33] (). However, there were insufficient studies examining the association between non-sexual child maltreatment and some of these health outcomes, including anaemia, underweight/malnutrition, hepatitis C, tuberculosis, hearing loss, vision loss, oral health, diarrhoea, allergies, uterine leiomyoma, back pain, breast cancer, and schizophrenia, to undergo meta-analysis ().

Discussion

To the best of our knowledge, this article presents the first systematic review and meta-analysis of published studies assessing the association between non-sexual child maltreatment and mental and physical health outcomes. We identified 124 studies that examined the association between physical abuse, emotional abuse, and neglect in childhood and various health outcomes.

Does Non-Sexual Child Maltreatment Cause Adverse Health Outcomes?

Evidence for a causal relationship between non-sexual child maltreatment and health outcomes was evaluated within the Bradford Hill framework on the grounds of the following important criteria: strength and consistency of the association, the temporal relationship of the association, evidence of a biological gradient or dose-response relationship, biological plausibility, and consideration of alternate explanations [34] ( Table S12).

Temporality

Both prospective and retrospective studies consistently showed an association between exposure to child physical abuse, emotional abuse, and neglect and adverse health outcomes. The availability of prospective studies provides conclusive evidence of a temporal relationship between exposure to non-sexual child maltreatment and the later development of mental health outcomes, drug use, and STIs and risky sexual behaviour, as in these studies abuse and neglect preceded the onset of health problems in adulthood.

However, only 16 studies were prospective, while the majority of the studies were cross-sectional and relied on adult retrospective report of abuse and neglect in childhood. By definition, these studies cannot prove a temporal relationship between exposure to child maltreatment and the onset of health outcomes. Furthermore, retrospective, self-reported information regarding abuse in childhood may be subject to recall bias, where those with adjustment problems may be more prone to recall or disclose exposure to abuse and neglect. In many cases participants were asked to report on events that would have occurred many years before, and the issue of potentially unreliable recall threatens the validity of the published literature on child maltreatment. At least with respect to child sexual abuse, evidence suggests moderate to good consistency of reports over time [35]. It has also been suggested that biases are probably towards under-reporting rather than over-reporting of abuse [36]. Nevertheless, given that retrospective reports were often the only measure of abuse available, particularly with regard to emotional abuse, we accepted these within the context of the limitations stated.

Although the strength of prospective studies includes the temporal ordering of maltreatment and subsequent health outcomes, with an objective measurement of exposure to abuse, these studies are usually conducted in non-representative samples. Official cases of abuse may only detect those who come to professional attention, and this may alter the strength of the association between non-sexual child maltreatment and adult morbidity. These official cases are also generally skewed towards the lower end of the socioeconomic spectrum and may not be generalisable to child abuse and neglect cases that occur in middle- or upper-class children [33]. Those participants who have been identified by child protection agencies as having been exposed to physical abuse or neglect may have received interventions to prevent later pathology. Furthermore, some individuals in the "never maltreated" category may actually have experienced maltreatment, given that child maltreatment tends to be under-reported. The validity of the various study designs to investigate the long-term health consequences of child maltreatment has been a source of ongoing debate [37],[38]. In this meta-analysis we have included prospective and retrospective studies. The subgroup analyses show that with both methodologies there is robust evidence of a significant association between child non-sexual maltreatment and various health outcomes.

Strength of the Association

Associations between child physical abuse, emotional abuse, and neglect and mental disorders, drug use, and suicidal behaviour have been reported in prospective studies and/or large population-based studies. The strength of the relationship between abuse and mental disorders was generally reduced when the effects of important mediating variables were taken into account. Despite some variability, overall, child physical abuse, emotional abuse, and neglect were found to approximately double the likelihood of adverse mental health outcomes when combined in a meta-analysis.

Consistency of the Association

As shown in the forest plots of the effects by study, there was strong consistency and agreement in the estimated effect measures across studies, particularly for neglect and physical abuse, although we suspect publication bias for some of the outcomes. Risk estimates were comparable across different types of samples, for both non-representative and representative populations ( Tables S1, S2, S3, S4 and S6, S7, S8). The findings persisted across different study designs, samples, and geographic regions investigated. It can be concluded that there is a highly consistent association between child physical abuse, emotional abuse, and neglect and adverse mental health outcomes, drug use, and STIs and risky sexual behaviour. We did not observe evidence of strong consistent associations for alcohol problems, chronic diseases, or lifestyle risk factors.

Dose-Response Relationship

We found evidence of a dose-response relationship between adverse health outcomes and non-sexual child maltreatment, such that those experiencing more severe abuse or neglect were at greater risk of developing mental disorders than those experiencing less severe maltreatment [39]. In the Chapman et al. [40] study, increasing severity of childhood adversity corresponded with poorer mental health outcomes. Consistent dose-response relationships with repeated, frequent, or severe abuse have been reported for mental disorders and physical abuse [13],[24],[41] and emotional abuse and neglect [13],[22]. Furthermore, there is evidence to suggest that experiencing multiple types of maltreatment may carry more severe consequences, with those exposed to multiple types of abuse at increased odds of developing mental disorders [42],[43], and the risk increases with the magnitude of multiple abuse [44]. Dose-response relationships with repeated frequent or severe abuse have also been reported for STIs and physical and emotional abuse [13], obesity and emotional and physical abuse [31], and smoking and physical abuse [32].

Plausibility

With respect to biological plausibility, animal models of mental disorders do not exist, making it particularly difficult to understand the underlying biological mechanisms. Progress in understanding has to be made by association and inference rather than experimental data [3]. There are nevertheless several potential mechanisms that may explain the observed association between abuse and neglect in childhood and increased risk of mental health problems. Neurobiological development can be physiologically altered by maltreatment during a child's early years, which can in turn negatively affect a child's physical, cognitive, emotional, and social growth, leading to psychological, behavioural, and learning problems that persist throughout the life course [45],[46]. Moreover, cumulative trauma may further increase risk [47], and some victims of abuse may try to manage the subsequent distress through the use of alcohol, prescription medication, tobacco, or other drugs.

There is emerging evidence that the origins of most adult disease are found among developmental and biological disruptions in childhood. These early life experiences can affect adult mental and physical health either by cumulative damage over time or by the biological embedding of adversities during sensitive developmental periods [48]. There is generally a lag of many years before early adverse experiences are expressed in the form of disease [48]. Andrews and colleagues concluded that despite the lack of a biological link between child sexual abuse and mental disorders, a causal relationship was plausible [3], and that child maltreatment is most likely a contributory cause that acts via other intermediates.

Consideration of Alternate Explanations

It is important to note that the role of genes, environment, and gene-environment interactions in the causation of mental disorders is not well understood. Twin studies provide one of the best ways to examine the interplay between genetic and environmental influences [3], but to the best of our knowledge, these are only available for child sexual abuse. The relationship between abuse and neglect in childhood and subsequent health effects is complex. Although childhood abuse and neglect does result in adverse health outcomes, these outcomes are not independent of broader socioeconomic contexts. Lifestyle factors, access to health care, and neighbourhood characteristics may act as mediators between child abuse and neglect and long-term health consequences [49]-[51]. Exposure to child maltreatment often co-occurs within the context of other family dysfunction, social deprivation, and other environmental stressors that are also associated with mental disorders. Child maltreatment may be a marker of other family problems that together lead to the development of mental disorders. In addition, findings from many studies do not take into account the likely contribution of hereditary influences on the predisposition to mental disorders. Children of depressed parents may be at greater risk of depression through both exposure to maltreatment by their parents and genetic predisposition [43]. Hence, some of the effect of child abuse and neglect on mental disorders may still be explained by confounding. However, the effect of abuse on mental disorders remained significant in the majority of studies included in these meta-analyses after controlling for these co-occurring factors.

Assessment of Causality

In summary, there was robust evidence of significant associations between exposure to non-sexual child maltreatment and increased likelihood of a range of mental disorders, suicide attempts, drug use, STIs, and risky sexual behaviour. An increase in the likelihood of alcohol problem use was not consistently seen. There is weak to limited evidence suggesting a relationship between non-sexual child maltreatment and certain physical disorders and risk factors (), but more research is required to confirm these relationships.

Table 8

Study Limitations

Although these findings and conclusions seem to be relatively consistent and robust, they should be interpreted in light of a number of limitations of our analysis.

This meta-analysis may be subject to publication bias because non-significant findings are less likely to be published [52]. This problem is increased when statistical models are employed because often only significant estimates are reported in many studies. This may result in the association between child abuse and neglect and outcomes being overstated, particularly for depressive disorders and anxiety, where publication bias may have played a role. For some of the other conditions there were too few studies to make conclusions with respect to publication bias.

The analysis also suffers from inconsistencies in how child abuse and neglect are defined and measured across the studies, as shown in . In studies using child protection records, exposure to physical abuse was defined to include injuries such as bruises, welts, burns, abrasions, lacerations, wounds, cuts, and fractures. Some studies used the Barnett-Cicchetti Maltreatment Classification System [53] which defines physical abuse as a caregiver or responsible adult inflicting physical injury upon a child by other than accidental means. In other studies physical abuse was defined as having been hit, kicked, or punched so hard that the individual had marks or bruising or needed medical attention. Some studies referred to physical punishment [13],[54],[55] and corporal punishment [56], which may exclude more severe physical abuse, as well as physical assault by caregivers [57]. Emotional abuse definitions also varied considerably and included verbal abuse and being humiliated by a caregiver. Most studies involving neglect referred simply to "neglect", while others distinguished between physical and emotional neglect. Similarly, definitions of childhood were not consistent across studies. The complexity of defining and measuring child abuse has been noted in several studies [58]-[60].

Measurement bias with respect to health outcomes and the questionable reliability of self-reported data may also have affected the results. We dealt with this issue in the meta-analysis by adjusting the quality score and performing subgroup analyses. For mental disorders, studies using well-validated and standardised diagnostic instruments were assigned a higher quality score than studies using self-report symptom scales.

Another limitation of meta-analyses of observational studies is that, since individuals cannot be randomly allocated to case groups, the influence of confounding variables cannot be fully evaluated. While most studies presented multivariable adjusted ORs controlling for a range of socio-demographic and study design variables, a few studies presented unadjusted associations between child maltreatment and health outcomes, or adjusted for age and sex only. We again dealt with this issue in our meta-analysis by adjusting the quality score of studies with inadequate control for confounding and by carrying out separate analyses depending on data availability. Some studies also statistically controlled for exposure to other forms of maltreatment by including the different types of abuse in the same model in order to determine the independent contribution of each abuse type. Generally, in studies presenting results from various unadjusted and adjusted models, the association between abuse and physical and mental health outcomes was attenuated when controlling for the effects of mediating variables [61]-[72] and other forms of abuse [73]-[79]. However, findings from a recent prospective cohort study indicate that for some physical health outcomes additional control for socioeconomic status, unhealthy behaviour, smoking, and mental health problems seems to play varying roles in attenuating or intensifying these complex relationships [33]. Furthermore, we cannot exclude that residual confounding or unmeasured potential confounders may still remain. Despite evidence of weak associations between non-sexual child maltreatment and chronic diseases, further studies are needed that ensure adequate adjustment for lifetime confounders, because the attributable burden would be appreciable.

Significant heterogeneity exists in the primary analysis of physical and emotional abuse, even after our attempts to control for study quality in quality effects models, and the heterogeneity remained significant in most of the subgroup analyses. Given this situation, combining the effects may not be justified. With respect to neglect, pooled estimates in primary and subgroup analyses did not show significant heterogeneity for many outcomes.

Recommendations

Inconsistencies in the measurement and definition of child maltreatment highlight the importance of international efforts to standardise studies to enhance the comparability of findings. These include defining the cutoff age for childhood (0-18 y, as specified by the United Nations), and breaking this period into smaller age bands that can reflect age-specific patterns [5]. Researchers should select methodologies and instruments with international comparisons in mind. Identical questionnaires, research designs, and interviewing techniques should ideally be used for surveys in different countries [5]. In reality, however, all survey methods will require at least some adaptation to local conditions, and efforts to ensure comparability should involve choosing definitions of abuse and neglect, and questionnaire items, that represent an advanced level of knowledge [80]. To minimise how participants' subjective perceptions and definitions shape the answers, it is recommended that self-report studies clearly specify the behaviours and experiences being investigated, and that each sub-type of abuse and neglect is explored using multiple behaviourally specific questions, instead of a single-item "label question" [81].

Examples of international efforts to increase comparability across studies include the WHO's establishment of a global adverse childhood experiences research network, and the International Society for Prevention of Child Abuse and Neglect's Child Abuse Screening Tools (ICAST). The WHO network has developed an international version of the Adverse Childhood Experiences (ACE) questionnaire (the ACE International Questionnaire), for administration to people aged 18 y and older, which is currently being validated through trial implementation as part of broader health surveys in several countries [82]. The ICAST initiative has involved the development of three instruments that ask parents about their use of different behaviours for discipline, young adults (18-24 y) about their exposure to child abuse and neglect in childhood, and older children about their own recent experiences of violence [83].

Child maltreatment deserves increased investment in preventive and treatment strategies. Currently, there is a paucity of evidence-based interventions to reduce child maltreatment. Further research is urgently needed to identify programs that reduce the prevalence of child maltreatment, thereby alleviating an important risk factor for later health problems. Evidence-based systemic interventions that improve parenting strategies and family functioning may be more effective and economical than attempting to treat the wide-ranging deleterious health outcomes in adulthood that arise from maltreatment in the early years of life [48],[84].

A broad range of protective factors have been identified that assist in promoting resilience in children exposed to adversity. Self control, problem-solving skills, secure relationships with caregivers, and safe schools and neighbourhoods are known to reduce the risk of adverse consequences in children exposed to trauma [85],[86]. There is mounting evidence that exposure to childhood adversity interacting with particular genetic dispositions such as the short allele of the serotonin transporter gene [87] and genes involved in the regulation of the hypothalamic-pituitary axis [88],[89] can result in problems with stress regulation and increased risk of anxiety and depression. Epigenetic changes have also been postulated as a mechanism by which transgenerational resilience or vulnerability may occur [90]. In spite of the increased knowledge in this field, it remains a challenge to translate this research into interventions at a population level that can reduce the vulnerability of children exposed to maltreatment [91].

Conclusion

This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. There is also emerging evidence that neglect in childhood may be as harmful as physical and emotional abuse. Although these conclusions have been drawn before from single empirical studies, in this article they are demonstrated in aggregate quantitative effects, to our knowledge for the first time.

This review contributes to a better understanding and measurement of the non-injury health impacts of child maltreatment globally and enables quantification of the burden attributable to physical and emotional abuse and neglect at the population level using comparative risk assessment methodology [92]. All forms of child maltreatment should be considered as part of the cluster of interpersonal violence risk factors in future global comparative risk assessments. Attributable burden is likely to be substantial, given the high prevalence of these forms of child maltreatment, the strong associations reported in our analysis, and the fact that related health outcomes are among the leading causes of disease burden globally. Despite the magnitude of the problem and increasing awareness of its high social costs, preventing child maltreatment is not a political priority in most countries. It is imperative that epidemiology and public health approaches find their proper place at the forefront of national and international efforts to understand and prevent child maltreatment [93].

Acknowledgments

Sophie Moore is gratefully acknowledged for her contribution to the systematic review. Lars Eriksson and Keryl Michener, University of Queensland Health Sciences Library, are thanked for their assistance in designing the search strategy.

Abbreviations

Funding Statement

This work was supported by a University of Queensland Start-up-Grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Alexander Butchart is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.

References

1. Krug EG, Dahlberg LL, Mercy JA, Zwi A, Lozano R (2002) World report on violence and health. Geneva: World Health Organization.

2. Pinheiro PS (2006) World report on violence against children. New York: United Nations.

3. Andrews G, Corry J, Slade T, Issakidis C, Swanston H (2004) Child sexual abuse. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, editors. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization. pp. 1851-1940.

5. Butchart A, Phinney Harvey A, Kahane T, Mian M, Furniss T (2006) Preventing child maltreatment: a guide to action and generating evidence. Geneva: World Health Organization and International Society for Prevention of Child Abuse and Neglect.

14. Runyan D, Wattam C, Ikeda R, Hassan F, Ramiro L (2002) Child abuse and neglect by parents and other caregivers. In: Krug EG Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Geneva: World Health Organization.

17. Wells G, Shea B, O'Connell D, Petersen J, Welch V, et al.. (2012) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute. Available: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 1 November 2012.

18. Barendregt J, Doi SA (2012) MetaXL version 1.2 [computer program]. Brisbane: EpiGear International.

35. Fergusson DM, Mullen PE (1999) Childhood sexual abuse: an evidence based perspective. Thousand Oaks (California): SAGE.

53. Barnett D, Manly JT, Cicchetti D (1993) Defining child maltreatment: the interface between policy and research. In: Cicchetti D, Toth SL, editors. Advances in applied developmental psychology: child abuse, child development and social policy. Norwood (New Jersey): Ablex Publishing.

59. Giavonnoni JM (1989) Definitional issues in child maltreatment. In: Cicchetti D, Carlson V, editors. Child maltreatment: theory and research on the causes and consequences of child abuse and neglect. New York: Cambridge University Press. pp. 3-37.

173. Wilson HW, Widom CS (2009) Sexually transmitted diseases among adults who had been abused and neglected as children: a 30-year prospective study. Am J Public Health 99 Suppl 1 S197-S203. [[ PubMed] PMC free article] [ Google Scholar]

177. Benson PL (1990) The troubled journey: a portrait of 6th- to 12th-grade youth. Minneapolis (Minnesota): Search Institute.

178. Sinha A, Singh R (1993) The Adjustment Inventory for School Students (AISS). Agra (India): National Psychological Corporation.

182. Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. San Antonio (Texas): Psychological Corporation.

184. Centers for Disease Control and Prevention (2000) Measuring healthy days: population assessment of health-related quality of life. Atlanta (Georgia): Centers for Disease Control and Prevention.

185. Kovacs M (1992) Children's depression inventory manual. North Tonawanda (New York): Multi-Health Systems.

192. Costello EJ, Edelbrock CS, Duncan MK, Kalas R (1984) Testing of the NIMH Diagnostic Interview Schedule for Children (DISC) in a clinical population: final report to the Center for Epidemiological Studies, NIMH. Pittsburgh (Pennsylvania): University of Pittsburgh.

194. Robins LN, Helzer JE, Cottler L, Goldring E (1989) National Institute of Mental Health Diagnostic Interview Schedule Version III Revised (DIS-III-R). St Louis (Missouri): Washington University.

199. Puig-Antich J, Chambers W (1978) The schedule of affective disorders and schizophrenia for school-aged children. New York: New York Psychiatric Institute.

206. Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of psychiatric symptoms. London: Cambridge University Press.

208. Yates TM, Carlson EA (2003) Self-Injurious Behavior Questionnaire. Minneapolis (Minnesota): University of Minnesota.

210. Spitzer RL, Williams JB, Gibbon M, First M (1990) Structured Clinical Interview for DSM-III-R (nonpatient edition). Washington (District of Columbia): American Psychiatric Press.

211. First M, Spitzer R, Williams J, Gibbon M (1995) Structured Clinical Interview for DSM-IV-Patient Edition (SCID-P). Washington (District of Columbia): American Psychiatric Press.

213. Achenbach TM (1991) Manual of the Youth Self-Report and 1991 profile. Burlington (Vermont): Department of Psychiatry, University of Vermont.

# data[].attributes.attachment_link.title
The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis

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Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise ...

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Emine/Seda Yavuz-Ahmet Kabaklı Fen Lisesi

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Emine/Seda Yavuz-Ahmet Kabaklı Fen Lisesi

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Types of violence against children

Most violence against children involves at least one of six main types of interpersonal violence that tend to occur at different stages in a child’s development.

Maltreatment (including violent punishment) involves physical, sexual and psychological/emotional violence; and neglect of infants, children and adolescents by parents, caregivers and other authority figures, most often in the home but also in settings such as schools and orphanages.

Bullying (including cyber-bullying) is unwanted aggressive behaviour by another child or group of children who are neither siblings nor in a romantic relationship with the victim. It involves repeated physical, psychological or social harm, and often takes place in schools and other settings where children gather, and online.

Youth violence is concentrated among children and young adults aged 10–29 years, occurs most often in community settings between acquaintances and strangers, includes bullying and physical assault with or without weapons (such as guns and knives), and may involve gang violence.

Intimate partner violence (or domestic violence) involves physical, sexual and emotional violence by an intimate partner or ex-partner. Although males can also be victims, intimate partner violence disproportionately affects females. It commonly occurs against girls within child marriages and early/forced marriages. Among romantically involved but unmarried adolescents it is sometimes called “dating violence”.

Sexual violence includes non-consensual completed or attempted sexual contact and acts of a sexual nature not involving contact (such as voyeurism or sexual harassment); acts of sexual trafficking committed against someone who is unable to consent or refuse; and online exploitation.

Emotional or psychological violence includes restricting a child’s movements, denigration, ridicule, threats and intimidation, discrimination, rejection and other non-physical forms of hostile treatment.

When directed against girls or boys because of their biological sex or gender identity, any of these types of violence can also constitute gender-based violence.

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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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ismail/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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Taha/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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Taha/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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Taha/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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Taha/Aydan Akın - Hasan Sabriye Gümüş Anatolian High School

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Impact on Children and Youth

Children and youth who are exposed to domestic violence experience emotional, mental, and social damage that can affect their developmental growth. Some children lose the ability to feel empathy for others. Others feel socially isolated, unable to make friends as easily due to social discomfort or confusion over what is acceptable. In order to respond to the overwhelming issues associated with domestic violence, child welfare professionals need to understand these issues and know how to identify them as well as assess and provide treatment to children and youth affected by domestic violence. This section provides information and resources on the impact that domestic violence has on children and youth as well as resources on how to respond it.

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     Emotional Abuse

One of the most common types of abuse in daily life is emotional abuse. [25] Emotional abuse is the situation in which children and adolescents are subjected to attitudes and behaviors that affect them or are deprived of the care, love and care they need, in accordance with social and cognitive standards. [26] Instead of emotional abuse, concepts such as psychological abuse, emotional abuse, mental abuse, and verbal abuse are also used in the sources. [27]


Emotional abuse; It is the denial of showing interest / affection, humiliation, constant criticism, jealousy, rejection, and the denial of the victim's right to be affected. [28] This can sometimes be purely verbal, and it can be implied to the child that he is constantly hated, ugly, unloved, stupid, or burdened with the family. [29]


Behaviors that cause emotional abuse are mostly shown by adults in the child and adolescent's immediate environment. These behaviors are listed as follows: 1. Rejection, 2. Humiliation, 3. Alone, isolation, separation, 4. Intimidation, intimidation, threatening, 5. Criminalization, 6. Not meeting their emotional needs. In addition, "frequent criticism", "anticipation of responsibility over the age of children and adolescents", "discrimination among siblings", "disregard, disregard, humiliation", "sarcasm", "nicknames", "excessive pressure and authority. Can be listed among the main adult and parental behaviors that create emotional crush. [30]


Effects of Emotional Abuse


The view that psychological maltreatment leads to negative developmental and behavioral consequences in children is shared by many researchers. The most frequently cited effects are psychological characteristics such as aggression, introversion, depression, emotional maladjustment, anti-social behavior and anxious attachment. In addition, anxiety, insomnia, neurotic symptoms, various psychosomatic disorders or more severe mental reactions have been observed in children subjected to psychological maltreatment. [31]


In children who are exposed to such behaviors of adults, situations such as distancing from the family, being nervous, developing a dependent personality, developing feelings of worthlessness, and engaging in incompatible and aggressive behaviors may occur. [32]


Especially emotional scars heal later than bodily wounds. [33] The effects may continue as children who are exposed to emotional abuse reach adulthood. [34] The long-term effects of emotional abuse allow psychiatrists and psychologists to define it even after many years. [35] Emotional abuse caused by approaches such as the constant criticism and humiliation of the child, having wishes and expectations beyond their abilities, being approached with excessive anger or aggressive attitudes, being intimidated, excessive restriction of their behavior or being overly tolerant causes negative mental symptoms in the child for a lifetime. . [36] Being insulted, humiliated, ridiculed or excessively criticized does not leave a forgotten effect on a person, as it is thought. On the contrary, studies show that exposure to such verbal treatment has a long-lasting effect, as does physical and sexual abuse. Children and adolescents react to verbal assault with feelings of embarrassment, guilt, worthlessness, anger and inadequacy and vividly remember the memories of the attack even after years. [37] Difficulty in establishing a relationship and inability to continue the relationship, frequent job changes, unhappiness, depression, suicide attempts, alcohol or substance use are among the possible consequences of emotional abuse. [38] Emotional abuse doesn't necessarily have bad consequences for every child. [39]


Emotional abuse occurs at all levels of society. However, it has been determined that it is more common and more common in families living in isolation from society. The common characteristic of abusive families is that the abuse continues from generation to generation. [40] The parent who abused the child is usually a person who was abused in his childhood. [41] Like their own children, these abusive parents spent their childhood with the image of being worthless, loveless, and bad people. They are people who grew up in completely insecure, unforgiving environments where there is no love, joy or emotion. [42] Inadequate parenting, which causes children to feel physically and mentally inadequate at younger ages, emerges as one of the biggest factors in children's failure in life. [43] 


Negative and insufficient emotional communication within the family also has a negative effect on the child's skills and intelligence. [44] Such children who do not feel safe and who have feelings of being unwanted and unloved do not develop a healthy personality, and their success at school decreases. [45]


Children who have been abused and deprived of many things grow up as people who are unable to take advantage of the opportunities offered to them, have difficulty in making friendships, and who refrain from expressing even their own ideas, even if they leave the home environment. [46]


It has been observed that the child's exposure to family abuse plays a role in most of the short stature for which no organic reason can be found. [47] When removed from the environment of abuse, growth hormone secretion increases and height increases in the child. [48] ​​It seems that emotional abuse can cause growth retardation and even psychosocial short stature.

                                                   
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Irmak/Aydan Akın-HASGAL
Irmak/Aydan Akın-HASGAL
Over time, emotional abuse and neglect can have serious long term effects on a child's social, emotional and physical health and development. This includes:
Emotional abuse can change how a child behaves, such as:

1) wanting attention or becoming clingy
2) developing risky behaviour, like stealing, bullying or running away
3) acking confidence or causing anger problems
4) finding it difficult to make and maintain healthy relationships later in life
5) mental health problems; including depression, anxiety and suicidal thoughts
6)self-harm
VISUALS

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Rotari Damian/Teacher Ciurea Larisa/ Liceul Teoretic Gaudeamus
Rotari Damian/Teacher Ciurea Larisa/ Liceul Teoretic Gaudeamus
Alper-Aydan Akın-Has
Alper-Aydan Akın-Hasan Sabriye Gümüş Anatolian High School
Canser-Aydan Akın- Hasan Sabriye Gümüş Anatolian High School
Canser-Aydan  Akın- Hasan Sabriye Gümüş Anatolian High School
İrem/Eda Kılıç Ahmet
İrem/Eda Kılıç Ahmet Kabaklı Science High School 
İrem / Eda Kılıç Ahm
İrem / Eda Kılıç Ahmet Kabaklı Science High School 
Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School
Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School
AZRA/SEVAL TEACHER
AZRA/SEVAL TEACHER 
Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School
Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School
Elif -Aydan Akın /Hasan Sabriye Gümüş Anatolian High School
Elif -Aydan Akın /Hasan Sabriye Gümüş Anatolian High School
Irmak/Aydan Akın-HASGAL
Irmak/Aydan Akın-HASGAL

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ismail-aydan akın /Hasan Sabriye Gümüş Anatolian High School

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ismail-aydan akın /Hasan Sabriye Gümüş Anatolian High School

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Emotional abuse is a common form of abuse that occurs in close relationships. It is also known as psychological abuse, and includes verbal abuse.

Emotional abuse is about one person maintaining power or control over another person. It usually takes place between intimate partners, or comes from a parent to a child. It can also happen in situations such as schools or workplaces (for example, in the case of bullying).

For children, emotional abuse may include:

emotional neglect (not expressing love, not showing affection or not playing with the child)

rejection or hostility towards the child

insulting or humiliating comments made towards the child

inappropriate parenting (such as having excessive expectations of the child, or exposing them to  domestic violence.)

not recognising the child as a separate individual (using the child to satisfy a parent’s needs or wishes)

isolating or confining the child, or failing to create opportunities for the child to learn, explore or socialise with others

Emotional abuse can have serious negative effects on the physical and mental health of adults and children.

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Elif Sena-Eda Kılıç/Ahmet Kabaklı Science Hıgh School

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Elif Sena-Eda Kılıç/Ahmet Kabaklı Science Hıgh School

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Emotional violence causes children to be exposed to negative attitudes by their parents and

It is the inability to meet the needed love and attention. Saying derogatory words,

to give names, to scare, to prevent him from seeing his friends,

Many situations, such as forcing him to do things he does not want to do, leaving him alone, or leading him to crime, enter into emotional violence. Pausing, blocking, in the child who is exposed to emotional violence in the familyBehaviors that cause regression may occur. Inhibit the positive development of the child.

Hitting and behaviors that do not include physical violence are also within the scope of emotional violence. An important situation that should not be forgotten here is the effects of emotional violence,

It is a later recovery from the effects of physical violence.

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Rotari Damian/Teacher Ciurea Larisa/ Liceul Teoretic Gaudeamus

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Rotari Damian/Teacher Ciurea Larisa/ Liceul Teoretic Gaudeamus

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Emirhan-Seda Şahin Yavuz(Ahmet Kabaklı Science High School)

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Emirhan-Seda Şahin Yavuz(Ahmet Kabaklı Science High School)

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Violence against women can be experienced not only physically, but also in the form of economic, sexual and emotional violence. Emotional violence occurs in the form of excessive criticism, threatening, humiliating, insulting, embarrassing, not communicating at all, emotionally neglecting, lying, belittling, ignoring.

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Emotional abuse is to control person by using emotions to criticize, embarrass, shame, blame, or manipulate another person;
Emotional abuse is one of hardest forms of abuse to recognize;
Is can be subtle and insidious or overt and  manipulative. Ether way, it chips away at the victim s self esteem and they begin to doubt their perceptions and reality.
Victims of emotional abuse often become victims without knowing it.
Fear, humiliation, low, self- esteem are just some of the immediate effects that should make you think.

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Utkan-Eda Kılıç/Ahmet Kabaki Science High School

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Utkan-Eda Kılıç/Ahmet Kabaki Science High School

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Globally, it is estimated that up to 1 billion children aged 2–17 years, have experienced physical, sexual, or emotional violence or neglect in the past year (World Healt Organization)

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Alper-Aydan Akın-Hasan Sabriye Gümüş Anatolian High School 

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Alper-Aydan Akın-Hasan Sabriye Gümüş Anatolian High School 

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440 children from 49 primary schools were interviewed. According to the results of the research percentage of children who suffered emotional violence in Turkey it was reported as 67.9%

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Canser-Aydan Akın- Hasan Sabriye Gümüş Anatolian High School

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Canser-Aydan Akın- Hasan Sabriye Gümüş Anatolian High School

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Around 1 billion children between the ages of 2 and 17 are exposed to emotional abuse in 2019 in our world.  3 out of 4 children between the ages of 2 and 4 are subjected to emotional abuse by their parents.

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Alper-Aydan Akın-Hasan Sabriye Gümüş Anatolian High School

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Canser-Aydan  Akın- Hasan Sabriye Gümüş Anatolian High School

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Canser-Aydan  Akın- Hasan Sabriye Gümüş Anatolian High School

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İrem/Eda Kılıç Ahmet Kabaklı Science High School

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İrem / Eda Kılıç Ahmet Kabaklı Science High School

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ELÇİN (CENNET EROL)-Gülser Mehmet Bolluk Anatolian High School

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ELÇİN (CENNET EROL)-Gülser Mehmet Bolluk Anatolian High School

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When children are exposed to this kind of emotional violence, they feel unloved, worthless, and their self-esteem decreases. In addition, children who have been subjected to emotional abuse have difficulty in establishing healthy relationships with their peers or adults.
What are the Symptoms Indicating Emotional Abuse in Children?
-Fear of parents
-Saying they hate parents
-Talking bad about themselves (I'm stupid)


-Being emotionally immature compared to their peers
-Instant change in speech (e.g. stuttering)
-Instant change in behavior (decrease in academic achievement, tics, wetting, stealing, eating & sleeping patterns, etc.)

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Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School

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Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School

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an average of 8 million children occurring at home each year
witnessed violence, domestic violence
89% even though they don't make it feel
Experienced, not subjected to violence
45% of children under the age of 12 have been reported at home.

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domestic violence
While 52% of the children who witnessed had behavioral problems, 39% had adaptation problems to school.
25% started to abuse, 60% at home
He stated that he was responsible for the crimes.

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According to the researches, it has been learned that emotional violence against children has increased in the last 20 years. Emotional violence against children has increased by 40%.

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Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School

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Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School

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Elif -Aydan Akın /Hasan Sabriye Gümüş Anatolian High School

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Elif -Aydan Akın /Hasan Sabriye Gümüş Anatolian High School

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Damlanur - Emel Teacher / Gülser-Mehmet Bolluk Anatolian High School

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Damlanur - Emel Teacher / Gülser-Mehmet Bolluk Anatolian High School

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What is emotional violence?
Psychological violence (also known as psychological abuse, emotional violence, or emotional abuse) is a form of aggression in which the perpetrator pressures the victim to emotionally intimidate and humiliate, sanction or punish him from society.

How emotional violence arises?
 Emotional violence occurs in the form of excessive criticism, threatening, humiliating, insulting, embarrassing, not communicating at all, emotionally neglecting, lying, belittling, ignoring.

What Are the Types of Emotional Violence?
Humiliation,
Trial,
Making fun of
Excessive Criticism,
Insulting,
Blame,
Nicknames,
Punishment,
Threatening,
Embarrassment,
Do not command,
Do not swear,
Anger,
Do not lie,
Manipulation.

What are the consequences of emotional violence?
Over time, exposure to emotional abuse can lead to anxiety, i.e. anxiety disorder, post-traumatic stress disorder, depression, lack of sexual desire, sexual pain, chronic pain, or other physical symptoms.

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Emotional Abuse

One of the most common types of abuse in daily life is emotional abuse. [25] Emotional abuse is the situation in which children and adolescents are subjected to attitudes and behaviors that affect them or are deprived of the care, love and care they need, in accordance with social and cognitive standards. [26] Instead of emotional abuse, concepts such as psychological abuse, emotional abuse, mental abuse, and verbal abuse are also used in the sources. [27]

Emotional abuse; It is the denial of showing interest / affection, humiliation, constant criticism, jealousy, rejection, and the denial of the victim's right to be affected. [28] This can sometimes be purely verbal, and it can be implied to the child that he is constantly hated, ugly, unloved, stupid, or burdened with the family. [29]

Behaviors that cause emotional abuse are mostly shown by adults in the child and adolescent's immediate environment. These behaviors are listed as follows: 1. Rejection, 2. Humiliation, 3. Alone, isolation, separation, 4. Intimidation, intimidation, threatening, 5. Criminalization, 6. Not meeting their emotional needs. In addition, "frequent criticism", "anticipation of responsibility over the age of children and adolescents", "discrimination among siblings", "disregard, disregard, humiliation", "sarcasm", "nicknames", "excessive pressure and authority. Can be listed among the main adult and parental behaviors that create emotional crush. [30]

Effects of Emotional Abuse

The view that psychological maltreatment leads to negative developmental and behavioral consequences in children is shared by many researchers. The most frequently cited effects are psychological characteristics such as aggression, introversion, depression, emotional maladjustment, anti-social behavior and anxious attachment. In addition, anxiety, insomnia, neurotic symptoms, various psychosomatic disorders or more severe mental reactions have been observed in children subjected to psychological maltreatment. [31]

In children who are exposed to such behaviors of adults, situations such as distancing from the family, being nervous, developing a dependent personality, developing feelings of worthlessness, and engaging in incompatible and aggressive behaviors may occur. [32]

Especially emotional scars heal later than bodily wounds. [33] The effects may continue as children who are exposed to emotional abuse reach adulthood. [34] The long-term effects of emotional abuse allow psychiatrists and psychologists to define it even after many years. [35] Emotional abuse caused by approaches such as the constant criticism and humiliation of the child, having wishes and expectations beyond their abilities, being approached with excessive anger or aggressive attitudes, being intimidated, excessive restriction of their behavior or being overly tolerant causes negative mental symptoms in the child for a lifetime. . [36] Being insulted, humiliated, ridiculed or excessively criticized does not leave a forgotten effect on a person, as it is thought. On the contrary, studies show that exposure to such verbal treatment has a long-lasting effect, as does physical and sexual abuse. Children and adolescents react to verbal assault with feelings of embarrassment, guilt, worthlessness, anger and inadequacy and vividly remember the memories of the attack even after years. [37] Difficulty in establishing a relationship and inability to continue the relationship, frequent job changes, unhappiness, depression, suicide attempts, alcohol or substance use are among the possible consequences of emotional abuse. [38] Emotional abuse doesn't necessarily have bad consequences for every child. [39]

Emotional abuse occurs at all levels of society. However, it has been determined that it is more common and more common in families living in isolation from society. The common characteristic of abusive families is that the abuse continues from generation to generation. [40] The parent who abused the child is usually a person who was abused in his childhood. [41] Like their own children, these abusive parents spent their childhood with the image of being worthless, loveless, and bad people. They are people who grew up in completely insecure, unforgiving environments where there is no love, joy or emotion. [42] Inadequate parenting, which causes children to feel physically and mentally inadequate at younger ages, emerges as one of the biggest factors in children's failure in life. [43]

Negative and insufficient emotional communication within the family also has a negative effect on the child's skills and intelligence. [44] Such children who do not feel safe and who have feelings of being unwanted and unloved do not develop a healthy personality, and their success at school decreases. [45]

Children who have been abused and deprived of many things grow up as people who are unable to take advantage of the opportunities offered to them, have difficulty in making friendships, and who refrain from expressing even their own ideas, even if they leave the home environment. [46]

It has been observed that the child's exposure to family abuse plays a role in most of the short stature for which no organic reason can be found. [47] When removed from the environment of abuse, growth hormone secretion increases and height increases in the child. [48] ​​It seems that emotional abuse can cause growth retardation and even psychosocial short stature.

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duygusal şiddetin çocuklar üzerindeki etkisi

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Over time, emotional abuse and neglect can have serious long term effects on a child's social, emotional and physical health and development. This includes:
Emotional abuse can change how a child behaves, such as:

1) wanting attention or becoming clingy
2) developing risky behaviour, like stealing, bullying or running away
3) acking confidence or causing anger problems
4) finding it difficult to make and maintain healthy relationships later in life
5) mental health problems; including depression, anxiety and suicidal thoughts
6)self-harm

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Bilge/Emel teacher/Gulser Mehmet Bolluk Anatolian High School

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Bilge/Emel teacher/Gulser Mehmet Bolluk Anatolian High School

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Globally, it is estimated that up to 1 billion children aged 2–17 years, have experienced physical, sexual, or emotional violence or neglect in the past year(2019). Nearly 3 in 4 children - or 300 million children - aged 2–4 years regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers.

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Children in many age groups around the world are exposed to emotional violence 6 out of 10every day, which means they can play with their futures.

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SHARAFAT BAYRAMOV

EMEL SEVER

AYDAN AKIN

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Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School 

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Elif-Aydan Akın /Hasan Sabriye Gümüş Anatolian High School 

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What is Emotional Abuse ?
Emotional abuse is any type of abuse that involves the continual emotional mistreatment of a child . It's sometimes called physchological abuse . Emotional abuse is particulary damaging to a child's self-esteem and emotional wellbeing .

Types of Emotional Abuse
Typically , repeated incidents of abuse build up over time and cause lasting effects upon a child's development and wellbeing . However a single incident can cause serious harm as wel l.
Some examples of emotional abuse include:
—Continually ignoring or rejecting a child .
—Exposing a child to domestic violence .
—Constantly criticising , humiliating or blaming a child .
—Constantly swearing , yelling or screaming at a child .
—Bullying , teasing , insulting or belittling a child .

Impacts of Emotional Abuse
—Difficulty regulating emotions .
—Suicidal thoughts or attempts .
—Behavioural problems or disordes.
—Destructive , aggressive or anti-social behaviours .
—Difficulty expressing themselves .

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Three-quarters of children between the ages of 2 and 4, or 300 million children in the world, are subjected to psychological assault and / or physical punishment by caregivers in their homes;
In 30 countries with accessible data, approximately 6 out of 10 children 1 year old regularly face violent disciplinary measures. Almost a quarter of 1 year old children are physically shaken as punishment, and one in 10 children receive blows to the face, head or ears.
Globally, one in four children under the age of five, or 177 million children, live with mothers who have been subjected to violence by their spouse / partner.