PhD Candidate James Doidge, University of South Australia Supervisors: Prof Leonie Segal, University of South Australia, A/Prof Paul Delfabbro, University of South Australia

1. Intergenerational pathways between
child maltreatment, health and
socioeconomic disadvantage
Findings from an Australian population-based birth cohort
PhD
Candidate
James Doidge, Uni. of South
Australia
Supervisors Prof Leonie Segal, Uni. of South
Australia
A/Prof Paul Delfabbro, Uni. of
Adelaide
ATP
Collaborators
Dr Ben Edwards, AIFS
Prof John Toumbourou, Deakin Uni.
Dr Darryl Higgins, AIFS
Ms Suzanne Vassallo, AIFS
BASPCAN Congress 2015
James.Doidge@unisa.edu.au

2. The Australian Temperament Project
 Population-based stratified cluster sample of 2,443 infants and
their families
 15 waves of data collection over 29 years from birth, from:
 Parents (all waves)
 Cohort members (since age 11)
 Nurses (1st wave)
 Teachers (3 waves)
 From the available data, 369 fields were selected,
representing ~130 variables of interest, reflecting10 underlying
domains:
 Indicators of child maltreatment (physical, sexual, emotional,
neglect, witnessing domestic violence) from retrospective self-
report
 Risk factors for child maltreatment (economic factors, social
factors, parental mental health and substance use, child health,
child temperament) from parents and cohort members
 Consequences of child maltreatment (economic, social, physical
health and mental health) from cohort members
BASPCAN Congress 2015 | James Doidge | University of South Australia

3. Conceptual model
BASPCAN Congress 2015 | James Doidge | University of South Australia
⋯⋯
𝐺𝑒𝑛𝑒𝑟𝑎𝑡𝑖𝑜𝑛𝑖 𝐺𝑒𝑛𝑒𝑟𝑎𝑡𝑖𝑜𝑛𝑖+1
𝐴𝑑𝑢𝑙𝑡ℎ𝑜𝑜𝑑
𝐶ℎ𝑖𝑙𝑑ℎ𝑜𝑜𝑑 Child
maltreatment
Poor health,
psychosocial and
economic outcomes
Poor health,
psychosocial and
economic outcomes
Child
maltreatment
𝜆1
𝜆2
𝜆3
𝜆4
𝜆1

4. Analysis
BASPCAN Congress 2015 | James Doidge | University of South Australia
1. In-depth analysis of missing data
 Stepped inverse-probability weighting and multiple
imputation, incorporating measures of missingness
2. Analysis of parent and child-level risk factors for
child maltreatment
 Bivariate odds ratios and a series of multivariate
regressions, to identify key causal risk factors
3. Analysis of outcomes of child maltreatment
 Bivariate odds ratios and a series of multivariate
regressions, to identify key consequences
4. Mediation analysis/path modelling

5. 1. Analysis of missing data
BASPCAN Congress 2015 | James Doidge | University of South Australia
 Inverse-probability weighting for loss to follow-up/non-
response in wave 14 (majority of missing data).
 Stepped by wave of follow-up, including variables measured
both at baseline and immediately prior to loss to follow-up.
 Everything that was at least weakly associated with
missingness or child maltreatment was included in the
weighting
 Child maltreatment was associated with missingness – both
parental response and cohort member response
 Only about half of the association was explained by other
variables, so the missing at random assumption is unlikely to
hold in research on child maltreatment, but:
 Measures of missingness were included in the missingness
models, weakening the assumption in this case
 Multiple imputation to account for remaining missing data
amongst people with information about child
maltreatment

6. Prevalence of child maltreatment
BASPCAN Congress 2015 | James Doidge | University of South Australia
Type of child maltreatment Prevalence (%)
Complete
cases
(n = 951)
Weighted
excluding
missingness
Weighted
including
missingness
Participants
with weight
> 5 (n = 58)
Emotional abuse 17.0 18.4 19.7 27.9
Emotional abuse (very true) 3.4 3.3 3.6 3.3
Neglect 2.8 2.8 2.8 1.6
Physical abuse 5.9 6.6 7.2 16.4
Sexual abuse 5.9 6.7 7.1 11.5
Witnessed domestic violence 4.4 4.8 4.7 4.9
Any child abuse or neglect 23.8 25.2 26.5 36.1
Any child abuse or neglect
(emotional = very true)
16.3 16.9 17.6 26.2
Single type 16.0 16.7 17.1 18.6
Multiple types 8.3 9.0 9.8 18.8

7. Prevalence of child maltreatment
BASPCAN Congress 2015 | James Doidge | University of South Australia
Type of child maltreatment Prevalence (%)
Complete
cases
(n = 951)
Weighted
excluding
missingness
Weighted
including
missingness
Participants
with weight
> 5 (n = 58)
Emotional abuse 17.0 18.4 19.7 27.9
Emotional abuse (very true) 3.4 3.3 3.6 3.3
Neglect 2.8 2.8 2.8 1.6
Physical abuse 5.9 6.6 7.2 16.4
Sexual abuse 5.9 6.7 7.1 11.5
Witnessed domestic violence 4.4 4.8 4.7 4.9
Any child abuse or neglect 24.3 25.7 26.9 37.9
Any child abuse or neglect
(emotional = very true)
16.3 16.9 17.6 26.2
Multiple types 8.3 9.0 9.8 19.0
Multiple types
(emotional = very true)
4.2 4.7 4.9 6.9

8. Multiple abuse
BASPCAN Congress 2015 | James Doidge | University of South Australia
Type of maltreatment Proportion reporting
multiple types (%)
Emotional abuse 47.1
Emotional abuse (very true) 68.2
Neglect 70.1
Physical abuse 66.1
Sexual abuse 58.4
Witnessed domestic violence 90.1
Any child abuse or neglect 36.5
Any child abuse or neglect (emotional = very true) 27.8

9. 2. Risk factors for child maltreatment
BASPCAN Congress 2015 | James Doidge | University of South Australia
Risk factor Odds ratio for maltreatment
Unadjusted Models 1-5 Model 6 Model 7
Economic factors
At least 'somewhat' poor 3.00*** 2.44*** 2.29*** 2.00***
Parental unemployment 2.46*** 1.89*** 1.68** 1.85**
Home ownership 2.20** 1.42 1.40 1.15
Father's education 1.42* 0.89 0.91 0.94
Father’s occupation 1.79*** 1.37 1.35 1.38
Mother's education 2.00*** 1.93** 1.81** 1.70*
Mother's occupation 1.39 0.73 0.76 0.77
Social factors
Household mobility 1.72 0.55 0.35*
Parental immigration (non-ES) 1.66** 2.04*** 1.64* 2.00**
Father <22yo 1.25 1.26 0.92 2.18
Gender=male 0.97 0.96 1.12 1.15
School mobility 2.76*** 2.99*** 2.81***
More than 4 children in family 1.22 0.96 0.98 0.82
Mother <22yo 1.43 1.32 0.94 0.64
Parental separation or divorce 2.89*** 3.04*** 2.11***
Parental mental health & substance use
Either parent smoked 1.82*** 1.60** 1.22 1.06
Father ex or heavy drinker 2.15** 1.52 1.27 1.20
Mother ex or heavy drinker 4.70*** 3.59** 3.50** 5.49***
Parental mental illness 2.53*** 2.17** 1.93* 1.74
Parental substance use problem 2.29** 1.72 1.35 0.99

10. Risk factors for any child maltreatment
BASPCAN Congress 2015 | James Doidge | University of South Australia
Risk factor Odds ratio for maltreatment
Unadjusted Models 1-5 Model 6 Model 7
Child health
At least 2 investigated health problems by
age 3
1.40 1.41 1.24
Below 3rd pc weight at 4-8 months 0.75 0.90 0.89
Birthweight <3rd pc 1.68 2.53* 2.98**
Birthweight >97th pc 0.65 0.67 0.61
Dysmature 0.32* 0.29* 0.23**
Gestational age <37 weeks 0.71 0.92 0.82
Perinatal stress 0.62 0.65 0.59*
Retrospective self-report of cognitive or
behavioural problems while growing up
1.98** 1.76** 1.45
Retrospective self-report of physical health
problems while growing up
1.85** 1.68* 1.66
Temperament
Highest tertile of activity factor scale, 1983 0.79 0.77 0.71
Highest tertile of approach factor scale, 1983 1.01 0.99 0.90
Highest tertile of behaviour problems
composite, 1983
1.05 1.02 1.05
Highest tertile of cooperation factor scale,
1983
0.91 0.90 0.77
Highest tertile of irritability factor scale, 1983 1.01 1.01 0.91
Highest tertile of rhymicity factor scale, 1983 0.98 0.95 0.87
Mother's overall rating more difficult 1.10 0.95 1.01

11. Determinants of child maltreatment
BASPCAN Congress 2015 | James Doidge | University of South Australia
With respect to specific type of maltreatment:
 Economic factors were stronger determinants of
physical abuse and domestic violence
 Parental mental health & substance use had greater
implications for sexual abuse and domestic violence
Overall, we estimated that
 42% of child maltreatment was attributable to economic
factors
 25% was attributable to social factors (largely
unmodifiable)
 12% was attributable to parental mental health &
substance use (but measurement may have been poor)
 35% was attributable to factors not measured in this
study

12. Select health consequences
BASPCAN Congress 2015 | James Doidge | University of South Australia
0%
10%
20%
30%
40%
50%
60%
Very poor Poor Fair Good Excellent
Overall rating of physical health at age 22-23 years
Health in early adulthood by exposure to
child maltreatment
None
Single
Multiple

13. Select health consequences
BASPCAN Congress 2015 | James Doidge | University of South Australia
Outcome Type of
maltreatment
Unadjusted Restricted Full
Poorer overall
rating of
health
Single 1.68*** 1.58** 1.44*
Multiple 3.26*** 3.00*** 2.70***
Obesity Single 1.29 1.35 1.29
Multiple 2.05* 2.14 2.27*
Smoking Single 1.72** 1.69** 1.69**
Multiple 1.03 1.06 1.08
Amphetamine
use
Single 2.06*** 1.97*** 1.88***
Multiple 1.58 1.47 1.47
Restricted model includes: all economic factors, gender, parental age,
immigration, family size, and all indicators of parental mental health
Full model includes: all economic factors, all social factors, all indicators of
parental mental health, and all indicators of child health
*p < 0.10; **p < 0.05; ***p < 0.01

14. Select economic consequences
BASPCAN Congress 2015 | James Doidge | University of South Australia
Outcome Type of
maltreatment
Unadjusted Restricted Full
Income in men at
age 27-28
Single +$7 +$67 +$70
Multiple –$108 –$50 –$65
Income in
women at age
27-28
Single –$27 –$18 –$2
Multiple –$242*** –$213*** –$189***
Restricted model includes: all economic factors, gender, parental age,
immigration, family size, and all indicators of parental mental health
Full model includes: all economic factors, all social factors, all indicators of
parental mental health, and all indicators of child health
*p < 0.10; **p < 0.05; ***p < 0.01