Family
Advocacy
Research
Digests

RESEARCH REVIEWCURRENT RESEARCH FOR FAMILY ADVOCACY PROGRAMS • Volume 3, Issue 1 • Winter 2018
In this Issue
Research Review (RR) is a publication of the Joining Forces Joining Families group. RR consists ofsummaries of family maltreatment research for family advocacy, medical, and social service providers. These summaries provide tips on issues not commonly encountered and innovations for researchand practice. We present four summaries on intimate partner violence (IPV) including a discussion
on measuring IPV, on coercive control, and on infidelity. Six child maltreatment articles summarize
common risks for maltreatment. Among these are economic hardships, inattentive parenting practices, injuries and deaths with firearms, and suicides associated with bullying and emotional abuse.
Finally, we describe a long-term study of home visiting in which child maltreatment was reduced
partially due to improvements in mothers’ life course trajectory.
IN T I MATE PARTNER VIOLENCEHow Do People Argue? The Conflict Tactics Scale (CTS)
is One Measure of Intimate Partner Violence (IPV)The CTS (Straus, 1979) and a later version, the CTS-2(Straus, Hamby, Boney-McCoy, & Sugarman, 1996), arestandardized instruments that are widely used in researchand practice to evaluate how couples attempt to resolve
conflicts. The CTS consists of 19 items involving three scales:reasoning, verbal aggression, and physical assault. Each of the
19 items is answered by a respondent and also answered by(or for) the respondent’s partner for a total of 38 items. The
CTS was considered innovative when it was first developed
because it asked for specific behaviors rather than generalterms like abuse.
The CTS has been criticized because investigators used its
data to support the argument that violence by husbands andCONTENTSHow Do People Argue? The Conflict Tactics Scale (CTS) is
One Measure of Intimate Partner Violence (IPV)…… 1
What is Coercive Control?……………………………… 2
Threats of Intimate Partner Violence are Forms of
Coercive Control……………………………………… 3
Infidelity and Intimate Partner Violence: Once a Cheater,
Always a Cheater?…………………………………… 4
Many Impacts of Family Economic Hardship…………… 5

wives is approximately equal, a concept referred to as gendersymmetry (Dobash, Dobash, Wilson, & Daly, 1992). The CTS2 was an attempt to respond to criticisms of the CTS. The
CTS-2 has 39 items for each respondent for a total of 78 items
comprising the following scales: negotiation, psychologicalaggression, physical assault, injury, and sexual coercion.
Jones, Browne, and Chou (2017) reviewed the extensive
data on the CTS and the CTS-2 and concluded that, in spiteof efforts to address the limitations of the CTS, many of thesame shortcomings remain. Criticisms of the CTS and CTS-2
include the following: (1) behaviors reported are open tointerpretation, (2) the context of the violence and the events
precipitating it are unknown, (3) the violence is artificially
Continued on page 2Child Deaths and Injuries by Firearms…………………… 6
Parental Insensitivity and Neglect are Associated with
Unintentional Child Injury…………………………… 6
Preventing Child Maltreatment through Home Visiting
Programs…………………………………………… 7
Bullying Victimization is a Significant Predictor of
Suicidal Ideation in Children and Adolescents……… 8Child Emotional Abuse Predicts Suicidal Ideation……… 8

such as stalking, threats, financial abuse, and other coercive
tactics.

How Do People Argue?, from p. 1
delimited, (4) severity is poorly operationalized, and (5) it
fails to connect the outcomes with the acts.
In spite of the criticisms, the CTS and the CTS-2 are still
the most widely used instruments for measuring IPV andcan be clinically useful. These instruments can be used toassess risk to the victim, particularly when there are highscores on the physical assault, injury, and sexual coercion
scales. When these scores are high, steps to safeguard thevictim should be considered. Higher scores on the psychological aggression scale suggest that the respondents should
increase their awareness of its harm in their relationship.
Higher scores on the negotiation scale suggest that couples
are trying to resolve their conflicts without violence.
In addition to evaluation based on the scores on thescales, clinical use should include evaluation for the contextsof violence and risks to the victim that are not measured

References

Dobash RP, Dobash RE, Wilson M, & Daly M. (1992). The
myth of sexual symmetry in marital violence. Social Problems; 39(1): 71–91.
Jones RT, Browne K, & Chou S. (2017). A critique of the
Revised Conflict Tactics (CT) Scales-2 (CTS-2). Aggression
and Violent Behavior; 37: 83-90.
Straus MA. (1979). Measuring intrafamily conflict and violence: The Conflict Tactics Scales. Journal of Marriage andthe Family; 41(1): 75–88.
Straus, MA, Hamby SL, Boney-McCoy S, & Sugarman, DB.
(1996). The Revised Conflict Tactics Scales (CTS2) development and preliminary psychometric data. Journal of
Family Issues; 17(3): 283–316.

The CTS and the CTS-2 are the most widely used measures of tactics used by couples in IPV conflicts
IN T I MATE PARTNER VIOLENCE

What is Coercive Control?
Coercive control is a conceptualization of how one partner
in an intimate relationship exercises dominance over another.
It is often considered the central mechanism in intimate
partner violence (IPV). It consists of controlling the behaviors of one’s partner through such tactics as economic abuse,decision-making, acting to exercise ownership over the otherperson by limiting freedom of movement, sexual demands,
not allowing the partner to work, deprivation of resources,
explicit and implicit threats, and stalking. Hamberger, Larsen,
and Lehrner (2017) address whether there is a common understanding of its meaning and how it is measured.

This review article identifies three aspects of coercive
control: (1) intentionality of the behavior by the abuser, (2)the negative perception of the controlling behavior by thevictim, and (3) the ability of the abuser to gain control bymeans of a credible threat and the capitulation of the victim to the threat. A challenge for research, policy, and social
services in studying and understanding the role of coercive
control is that it lacks a uniformly agreed upon definition
and measure. Hamberger et al. extensively describe various attempts to define coercive control as it is presented inContinued on page 3

JOINING FORCES
Joining Families

RESEARCH REVIEW
Editor-in-Chief
James E. McCarroll, PhD
e-mail to James.McCarroll.ctr@usuhs.mil(301) 377-9479

Editorial Advisor
LTC Ricky J. Martinez. PhD, MSC, USA
Family Advocacy Program Manager
Installation Management Command
Department of the Army

Joining Forces Joining Families—Research Review is a
publication of the Family Violence and Trauma Project,
Center for the Study of Traumatic Stress, Departmentof Psychiatry, Uniformed Services University, Bethesda,
Maryland 20814, and the U.S. Army Installation
Management Command, Fort Sam Houston, TX 78234.

Editorial Consultant
Joshua C. Morganstein, MD
Captain, U.S. Public Health Service
Associate Professor/Assistant Chair and Scientist
Center for the Study of Traumatic Stress
Department of Psychiatry, Uniformed Services University

2 • RESEARCH REVIEW | Joining Forces/Joining Families

Winter 2018

What is Coercive Control?, from p. 2
scientific literature. Is coercive control a goal or intention of
the perpetrator? Is it an internal motivation of the perpetrator such as for violence or for control? Is it measured by theperpetrator’s behavior? Is it the outcome of coercion in a relationship? If coercive control is a subjective experience, is theperpetrator conscious of the coercive behavior?
The authors review 22 paper and pencil instruments that
attempt to measure coercive control. Some look at behaviors,
frequency of behaviors, or both. However, it is unclear how
any patterns impact risk and subsequent behaviors of victims
and perpetrators. The authors propose that a definition of
coercive control should involve the perspectives of both thevictim and the perpetuator. It should include not only theperpetrator’s behavior, but also the context within which

the behavior takes place, and its consequences. The measure
should also be cumulative rather than a single-incident focus.
These are difficult challenges.
Family advocacy providers should be aware that coercive
control may be present in an intimate relationship: the pattern of actions and intentions of the perpetrator, the responses of the victim, and the effects on the relationship. They
should also be clear about how they assess coercive control in
relationships. The authors suggest that a structured interview
of each partner may be the most effective means of understanding coercive control in an intimate relationship.

Reference

Hamberger LK, Larsen SE, & Lehrner A. (2017). Coercive
control in intimate partner violence. Aggression and Violent Behavior; 37: 1–11.

Coercive control is often the central mechanism in IPV. A structured interview of each partner
may be the most effective means of understanding coercive control in an intimate relationship.
IN T IMATE PARTNER VIOLENCE

Threats of Intimate Partner Violence are Forms of Coercive Control
Coercive control includes not only physical abuse, butalso tactics that create an ongoing sense of fear and chronic
stress. Threats are a form of coercive control in intimate partner violence (IPV). The U.S. Department of Justice reported
that from 1993–1998 about two-thirds of IPV victims wereattacked while one-third were threatened (Rennison, 2002).
Threats to female and male victims consisted of threats to kill
(32% and 27%, respectively) “other threats” (52% and 41%),threaten with a weapon (18% and 22%), threaten to hit, slap,
or knock victim down (13% and 15%), throw object at victim(4% and 11%), and rape (1% females).
Threats can be a common aspect of IPV and the more
severe and frequent the threats, the worse the outcome.
Logan (2017) investigated explicit threats to 210 women withprotective orders against abusive partners. A high frequencyof threats of harm was associated with the highest rates ofabuse, violence, distress, and fear. Ninety-four percent of
the women endorsed at least one of the 11 threats inquired.
Threats of harm were reported in 90% of cases at least once:
81% were threatened with serious harm, 76% were threatenedwith death, and 41% were threatened with a knife or gun.
These women received threats of harming friends and family,
actual threats to friends and family, and threats to harm children and pets, coworkers, and supervisors. These threats were

only moderately correlated suggesting that they are specificrisk factors for harm and may be unique to each situation.
Threats have important implications for safety planning, notonly for the victim, but also to others threatened.
Explicit threats are common in relationships in which
there is IPV. Threats of violence are, at a minimum, psychological abuse and a form of coercive control. However, threatsof harm are also a criminal act of assault. Threats of harm toa victim as well as to a wide variety of others, including pets
and property, are serious issues for law enforcement, medical,
and social service providers. Service providers should assess
for the presence of threats and the types of threats in relationships in which there is IPV. Referring victims for law enforcement and legal assistance can prevent injury and death ofvictims.

References

Logan TK. (2017). “If I can’t have you nobody will”: Explicit
threats in the context of coercive control. Violence andVictims; 32(1): 126–140.
Rennison CM. (2002). Intimate Partner Violence. Bureau of
Justice Statistics Special Report NCJ 178247. Washington,
DC, U.S. Department of Justice, Office of Justice Statistics.

Threats are a form of coercive control that create an ongoing sense of fear and chronic
stress. Service providers should assess for the presence of threats and the types of threats
http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 3

IN T I MATE PARTNER VIOLENCE

Infidelity and Intimate Partner Violence:
Once a Cheater, Always a Cheater?
Concerns about infidelity are often associated with intimate partner violence (IPV). Published research on infidelity
is rare due to the sensitive nature of the topic in romantic
relationships. IPV is multi-determined; there is seldom asingle reason for it. Fifty-two couples who had received
pre-marital counseling, but later divorced reported that the
major contributors were lack of commitment, infidelity, andconflict/arguing (Scott, Rhoades, Stanley, Allen & Markman,
2013). The most common “final straw” [authors quotes] reasons were infidelity, domestic violence, and substance abuse.
A study of 422 married couples in rural Malawi found thatthe perception of a partner’s infidelity was significantly associated with both the perpetrator’s and the partner’s risk forsexual coercion and physical violence (Conroy, 2014). In addition to actual, perceived or feared infidelity, sexual jealousy
is another motive for intimate partner violence and homicide(Harris, 2003). Sexual jealousy can be a form of coercive
control of a partner.
Concerns about infidelity are often brought to the attention of social service providers in the context of IPV, marital
relationships, and premarital counseling. When infidelity has
been suspected or known, there is concern for whether thisis a pattern and is likely to occur again. In other words, “Is acheater always a cheater?” A longitudinal study of 484 individuals, including 155 men and 329 women, who were in acurrent romantic relationship collected data every six months
for five years (Knopp, Scott, Ritchie, Rhoades, Markman, &Stanley, 2017). Participants were asked if they had had sexual
relations with someone other than their partner. Extra-sexual
involvement (ESI) was examined over two relationships.
Forty-five percent of those who engaged in ESI in their first
relationship also reported ESI in their second relationship.
This was compared to 18% of participants who did not report
ESI in their first relationship, but did report it in the second
relationship.
Twenty-two percent of participants who knew of partner
ESI in their partner’s prior relationship reported known partner ESI in the current relationship compared to 9% who did
not know of ESI by their partner in the prior relationship, but

knew of it in the current relationship. Thirty-seven percent ofparticipants who suspected their partner of ESI in the priorrelationship reported suspecting their partner in the current
relationship compared to 6% who did not suspect their partner of ESI in the partner’s prior relationship, but did suspectthem in the current. Gender, income, and marital status were
not associated with ESI.
This study shows that previous infidelity is a strong risk
factor for future infidelity, but it may or may not always betrue. Of participants who reported ESI in their first relationship, less than 50% reported ESI in their second relationship.
However, it should also be noted that since infidelity is ahighly emotionally charged topic, its concealment is highly
likely and difficult to measure.
There are clinical implications to these results. Wheninfidelity is an issue in martial conflict, the presence of IPVshould be considered. Clinicians and chaplains could explore
whether infidelity has occurred in previous relationships inan attempt to encourage individuals to make relationshipdecisions that reduce the likelihood of future infidelity.

References

Conroy AA. (2014). Marital infidelity and intimate partner
violence in rural Malawi: A dyadic investigation. Archives
of Sexual Behavior; 43: 1303–1314.
Harris C. (2003). A review of sex differences in sexual
jealousy, including self-report data, psychophysiologicalresponses, interpersonal violence, and morbid jealousy.
Personality and Social Psychology Review; 7(2): 102–128.
Knopp K, Scott S, Ritchie L, Rhoades GK, Markman HJ, &Stanley SM. (2017). Once a cheater, always a cheater? Serial infidelity across subsequent relationships. Archives of
Sexual Behavior; doi.org/10.1007/s10508-017-1018-1.
Scott SB, Rhoades GK, Stanley SM, Allen ES, & Markman HJ.
(2013). Reasons for divorce and recollections of premarital intervention: Implications for improving relationshipeducation. Couple and Family Psychology; 2(2): 131–145.

When infidelity is an issue in martial conflict, the presence of IPV should be considered.

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Winter 2018

C HILD MALTREATMENT

Many Impacts of Family Economic Hardship
Economic hardship for families can come from manysources such as job loss, divorce, death of a family member andothers. Economic hardship is often leads to poverty which, inturn, is associated with child maltreatment. The Ontario Incidence Study of Reported Child Abuse and Neglect–2013 examined the characteristics of children in families investigatedby child welfare authorities (Lefebre, Fallon, van Wert, & Filippelli, 2017). In 9% of all cases, the family suffered economic
hardship: ran out of money for food, housing, or utilities. Few
social supports as well as mental health and substance abusein caregivers were more likely compared to families in which
economic hardship did not occur. In addition, developmental concerns and academic difficulties of children were more
frequently noted compared to families without such hardship(43% vs. 21%). In families with economic hardship, physical neglect, including failure to adequately care for the child(inadequate nutrition, clothing, and unhygienic and dangerous
living conditions) was more likely to be substantiated thanother neglect subtypes. The authors concluded that families
facing economic hardship have multiple complex needs andthat child welfare needs to consider how to best promote positive child adaptation in the face of these adversities.
A study of women who had borne children within thepast 2–7 months in California (2011–2014) found that 51%
experienced some form of economic hardships in childhood(Braverman, Heck, Egerter, Rinki, Marchi, & Curtis, 2017).
The economic hardships included hunger, having to move
due to problems paying rent or mortgage, and the family’s inability to pay for basic needs. Almost 12% reported the highest level of economic hardship. Intermediate or higher levelsof economic hardships in childhood were linked to maternal
health and well-being: poverty, food insecurity, homelessness
or no regular place to sleep, intimate partner violence, andbinge drinking. The authors noted that economic issues were
not included in classic studies of adverse childhood experiences, but should be since economic hardships are linked toadverse maternal health.

A national study of fatalities of children ages 0–4 in the
U.S. from 1999–2014 found that higher poverty concentrations were associated with increased rates of child abuse
fatalities (Farrell et al., 2017). Forty-five percent of childfatalities ages 0–4 years old were less than one year old and
56% were boys. Counties in the U.S. with the highest poverty
concentration had three times the rate of child fatalities compared with counties with the lowest poverty rates.
The studies reported here show a strong relationship between economic hardship and a variety of health issues, suchas child maltreatment, child fatalities, and maternal health.
The complex needs of such families are significant challenges
to public health. While low levels of economic stress may notindicate a hardship at the time they occur, taking measures
to prevent future economic hardship can be beneficial tofamily well-being and prevent later adverse circumstances
for children and families. Social service guidance on financial responsibility can help with planning, accounting, anddisposition of finances, but including an explanation of therisks associated with economic hardship during counseling
can lead to better family health and prevent adverse consequences before it is too late.

References

Lefebre R, Fallon B, van Wert M, & Filippelli J. (2017). Examining the relationship between economic hardship andchild maltreatment using data from the Ontario Incidence
Study of Reported Child Abuse and Neglect-2013 (OIS2013). Behavioral Sciences; 7(6): 1–13.
Braverman P, Heck K, Egerter S, Rinki C, Marchi K, & Curtis
M. (2017). Economic hardship in childhood: A neglectedissue in ACE studies? Maternal and Child Health. doi:
10.1007/s10995-017-2368-y.
Farrell CA, Fleegler EW, Monuteaux MC …Lee LK. (2017).
Community poverty and child abuse fatalities in the
United States. Pediatrics. doi: 10.1542/peds.2016–1616.

Household poverty may consist of diverse complex needs such as running out of money forbasic needs, failure to pay rent or mortgage, food insecurity, homelessness or no regular place tosleep, intimate partner violence, and binge drinking.

http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 5

C HILD MALTREATMENT

Child Deaths and Injuries by Firearms
Firearm violence is a serious public health problem in
the U.S. and it significantly affects children. Such violence
does not occur in isolation. Firearm injuries to children canbe intentional or unintentional, fatal and non-fatal. Children
are exposed to firearms in a variety of ways such as intimate
partner violence (IPV), suicide, and community violence thatinvolves homicide, robbery, and threats, as well as legal uses
such as hunting and sports, including marksmanship training
and target practice.
Firearm-related deaths are the third leading cause ofdeath in children 1-17 and the second leading cause of
injury-related death of this age group. There were an average of 1,300 child deaths per year for the period 2012–2014,
for an overall rate of 1.8 per 100,000. The greatest percentage
of deaths was homicide (53%, n=693), followed by suicides(38%, n=493), and unintentional injuries (6%, n=82). An
average of 5,700 children were treated in an ER for a firearmrelated assault, self-harm, or an unintentional injury for an
average annual rate of 7.9 per 100,000.
The rates of homicide and suicide during 2012-2014 weregreatest in the age group 13–17 years, 2.6 and 2.3 per 100,000,
respectively. Boys are the primary victims of child firearm
deaths, about 82%. Their annual rate was 4.5 times that ofgirls, 2.8 and 0.6 per 100,000, respectively. For 13–17 year
old boys, the rate was six times higher than same age girls,
8.6 and 1.4 per 100,000. African-American children havethe highest rate of firearm homicide (3.5 per 100,000) while

white and American Indian children have the highest rates offirearm suicide (2.2 per 100,000 each).
Firearm homicides of younger children are often precipitated by IPV, whereas homicides of older children are more
likely to be precipitated by crime. Firearm suicides of children often occur as a result of a crisis in the past or upcoming 2 weeks (42%) and relationship problems (71%) with anintimate partner or a friend or family member. Mental healthproblems are also present, including depression (34%). Abouta quarter of them (26%) disclosed their suicidal intent to others and approximately 60% were completed with a handgun.
The circumstances of firearm deaths and injuries areimportant factors to emphasize for child and family safety.
Playing with a gun is the most common cause of unintentional firearm deaths of children. Gun safety practices suchas storing guns unloaded, storing weapons and ammunition
separately, and using gun safety locks are essential elements
of prevention of childhood deaths by firearm. However, in
addition to physical security, adult supervision is required,
particularly in times of child or parent crises to prevent
impulsive acts.

Reference

Fowler KA, Dahlberg LL, Haileyesus T, Gutierrez, C, & Bacon
S. (2017). Childhood firearm injuries in the United States.
Pediatrics; 140(1): e1-e11. doi: 10.1542/peds.2016-3486.

Playing with a gun is the most common cause of unintentional firearm deaths of children.
CHILD MALTREATMENT

Parental Insensitivity and Neglect are Associatedwith Unintentional Child Injury
In 2015, for each age group from 1–18, unintentional
injury was the leading cause of death in the U.S. www.cdc.
gov/injury/wisqars/LeadingCauses.html. Research on theprevention of unintentional injury has generally focused on
environmental safety such as playground equipment and carseats. Another route to improve children’s safety is throughimproving parenting practices that implement safety precautions (Jaques, Weaver, Weaver, & Willoughby, 2017). Unintentional injuries are largely due to car crashes (lack of appropriate car seats) and poisonings (lack of parental supervision in
the home of storage of medications and cleansers). Parenting
behaviors that are insensitive to a child’s needs and development can result in children’s injuries, particularly wheninsensitive behavior involves abuse or neglect (Azar, 2002).
6 • RESEARCH REVIEW | Joining Forces/Joining Families

High-risk mothers of children five years and younger completed a questionnaire of specific injury prevention behaviors.
Risk was categorized for each age group. The questionnairemeasured parenting behaviors (sensitivity and parental neglect); parenting satisfaction, interest, and efficacy; safety risks(poisoning and car seats); and demographics. Younger mothers (18–25) stored medications and cleansers correctly 69% of
the time compared to older mothers (26–40) who stored themcorrectly 89% of the time. Mothers (ages not specified) whoseparenting was developmentally insensitive (yelling, spanking,putting child in time out at an inappropriate age) were 4.84
times more likely to put their child in an incorrect size car seator take the child out while the car was moving.
This article raises important issues for the prevention ofContinued on page 7
Winter 2018

CHILD MALTREATMENT

Preventing Child Maltreatment through Home Visiting Programs
Home visiting can reduce child maltreatment as well as
impact the life course of mothers who are at risk for childmaltreatment. This study summarized the reported the results of a 15-year follow-up evaluation of participants in the
Elmira (NY) trial of the Nurse Family Partnership in which
first time pregnant women at high risk for child maltreatment (low socioeconomic status, unmarried, under age 19)
were randomly assigned to receive home visits from nurses.
Home visits to the treatment group (n=77) were conductedduring pregnancy (mean number of prenatal visits= 8.6)
and from birth through the child’s second birthday (meannumber of home visits for each participant=22.8). Controls
consisted of a combined group of mothers (n=177) whosechildren were given sensory and developmental screening at
12 and 24 months and another group that received prenatal
and well childcare through the child’s second birthday. Bothintervention and control groups included women who had
experienced low-to moderate-levels of intimate partner
violence (IPV), defined as less than 28 incidents of partnerperpetrated violence since the birth of the child as measured
by the Conflict Tactics Scale (Straus, 1979).
During the home visits, the mothers received education about health-related behaviors, care provided to theirchildren, and maternal life course development (family planning, education, and employment). With these programs formothers, there were many possible outcomes for them andfor their children.
The study found that among all women who had experienced IPV, those who received home visits had significantly
reduced confirmed child maltreatment cases compared
to control women. Home visited mothers also spent fewer

months on public assistance and had fewer subsequent children than control mothers. Both of these two latter outcomes
were significant predictors of child maltreatment. These two
mediators, fewer months on public assistance and fewer
subsequent births, explained almost 50% of the total effect ofpre- and postnatal home visiting on child maltreatment for
the home visited mothers. In other words, child maltreatment
was reduced through the mediation of pregnancy planning(fewer children) and improved economic circumstances (decreased reliance on public assistance). An important implication of this research is that an emphasis by home visitors onmaternal life-course planning and development can promote
long-term improvements in their parenting and as well as
reducing child maltreatment.
Attention by home visitors, clinicians, and other social
service providers to the long-term personal development ofmothers who have experienced IPV has many positive effects
in addition to reducing child maltreatment. While the resultsof interventions, such as the ones demonstrated in this study,
may not be immediately noticed, the long-term effects can besignificant through reducing poverty and child maltreatment.

References

Eckenrode J, Campa MI, Morris PA … Olds DL. (2017). The
prevention of child maltreatment through the Nurse Family Partnership Program: Mediating effects in a long-term
follow-up study. Child Maltreatment; 22(2): 92–99.
Straus MA. (1979). Measuring interfamily conflict and violence: The Conflict Tactics (CT) Scales. Journal of Marriage and the Family; 41: 75–88.

Emphasis by home visitors on maternal life-course planning and development can promote
long-term improvements in their parenting and as well as reducing child maltreatment.
Parental Insensitivity, from p. 6
unintentional childhood injuries due to parental behaviors,
particularly by young mothers. The research summarized
here expands the scope of child maltreatment to include thelinks between insensitive parenting and abusive and neglectful behavior that can result in unintentional childhood injuries. Medical and social service providers have an opportunity to educate their patients on the importance of these links
and thereby reduce childhood injuries and fatalities throughunintentional injuries.

References

Azar S. (2002). Parenting and child maltreatment. In M.
H. Bornstein (Ed.), Handbook of Parenting: Vol. 4. Social
conditions and applied parenting (2nd ed.), pp 361–388.
Mahwah, NJ: Lawrence Erlbaum.

Jaques ML, Weaver TL, Weaver NL, & Willoughby L. (2017).
The association between pediatric injury risk and parenting behaviours. Child Care, Health and Development;
doi:10.1111/cch.12528.

Parenting behaviors that are insensitive to a child’s needs and development can resultin children’s injuries, particularly when insensitive behavior results in abuse or neglect.
http://www.CSTSonline.org

RESEARCH REVIEW | Joining Forces/Joining Families • 7

CHILD MALTREATMENT

Bullying Victimization is a Significant Predictor of
Suicidal Ideation in Children and Adolescents
Parents’ staying attuned to their children’s friends andother relationships are important aspects of parenting andappropriate child care. Bullying is one outcome of childhood
relationships. It is a complex form of interpersonal violence
that includes physical assault, verbal and emotional violence,social exclusion, and cyberbullying. In addition to faceto-face bullying victimization, cyberbullying can be more
harmful in that it can be anonymous, widely distributed, andlonger lasting.
Adolescents often visit emergency rooms for mental
health complaints that are related to a history of bullying
victimization. Of adolescents between the ages of 8-17 (104males and 166 females, ages 8–17, mean age=14.4 years)
who visited a hospital emergency room in Kingston, Canada,
between 2011-2015, 77% reported having been bullied
during their lifetime and 69% had current suicidal ideation(67% females and 33% males). Being the victim of bullying
was the most significant predictor of suicidal ideation inchildren and adolescents after controlling for age, sex, school

grade, psychiatric diagnosis, and abuse. Being the victim of
all types of bullying was significantly greater for those whoreported suicidal ideation: 83% reported verbal bullying, 26%each reported physical bullying and cyberbullying, and 32%
reported multiple types.
Medical providers in emergency rooms may not be awareof the relationship between being the child or adolescentvictim of bullying and mental consequences such as suicidal
ideation. Both suicidal ideation and being bullied, at present
and in the past, should be queried in children and adolescents visiting emergency rooms.

Reference

Alavi N, Reshetukha T, Prost E, Antoniak K, Patel C, Sajid
S, & Groll D. (2017). Relationship between bullying andsuicidal behavior in youth presenting to the emergency
department. Journal of the Canadian Academy of Childand Adolescent Psychiatry; 26(2): 70–77.

CHILD MALTREATMENT

Child Emotional Abuse Predicts Suicidal Ideation
Suicide is consistently a leading manner of death forchildren, adolescents, and young adults (www.cdc.gov/injury/
wisqars/LeadingCauses.html). Research has found increased
suicidal behavior (attempted and completed suicides) invictims of child maltreatment. Further exploring the relationship of child maltreatment to the risk of suicidal behavior isan important route to establishing preventive measures. A
longitudinal study measuring emotional abuse and suicidal
ideation of 682 community youth over three years foundthat emotional abuse uniquely predicted suicidal ideationeven after controlling for prior suicidal ideation, sex, age, anddepression symptom severity.
In the study, children and youth between ages 7-18 years
completed initial baseline questionnaires on emotional abuseand depressive symptoms and then again at both 18 and 36
months after their initial questionnaire. Telephone interviews
occurred every six months. Structured clinical interviews occurred for suicidal ideation initially and every six months for
36 months. Results found that emotional abuse, particularlyin the form of repeated threats and verbal insults, increased

the risk for suicidal ideation. Severe depressive symptoms did
not moderate this relationship.
This research emphasizes the effects of emotional abuseon adverse outcomes for children and youth. Emotional
abuse is a complex phenomenon consisting of childhood
emotional trauma, distressed interpersonal relationships
inside and outside the family, as well as community violence. Medical and social service providers, when evaluating
children for abuse and neglect, should evaluate for suicidal
behavior in children and youth as a result of emotional abuse
and make referrals when suicidal thoughts or behaviors are
identified.

Reference

Miller AB, Jenness JL, Oppenheimer CW, Gottleib ALB,
Young JF, & Hankin BL. (2017). Childhood emotional
maltreatment as a robust predictor of suicidal ideation:
A 3-year multi-wave prospective investigation. Journal of
Abnormal Child Psychology; 45: 105-116.

Emotional abuse of children and youth uniquely predicts suicidal ideation even after
controlling for prior suicidal ideation, sex, age, and depression symptom severity.
8 • RESEARCH REVIEW | Joining Forces/Joining Families

Winter 2018