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Journal Article


Clemens V, Berthold O, Witt A, Sachser C, Brahler E, Plener PL, Strauß B, Fegert JM. Eur. Psychiatry 2019; 58: 10-18.


Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany. Electronic address:


(Copyright © 2019, Elsevier Publishing)






BACKGROUND: Adverse childhood experiences (ACE) exhibit long-lasting consequences on later life and are considered as a major public health problem. ACEs can be divided into household dysfunctions, which affect the child indirectly, and direct maltreatment. As a high correlation between ACEs in general is known, we assessed the risk for child maltreatment associated with the occurrence of household dysfunctions. To provide a better understanding for the mechanisms leading to the deleterious sequelae of ACEs, we furthermore assessed whether the long-term consequences of household dysfunction are mediated by child maltreatment and thereby might be targeted by effective child protection programs.

METHODS: A representative sample of the German population above the age of 14 (N = 2531) was assessed in a cross-sectional observational population-based survey.

RESULTS: The data reveal that mental illness of a household member was associated with significantly increased risks for all child maltreatment subtypes (ORs 4.95-5.55), just as household substance abuse (ORs 5.32-6.98), violence against the mother (ORs 4.43-10.26), incarceration of a household member (ORs 6.11-14.93) and parental separation (OR 3.37-4.87). Child maltreatment partially mediated the association of household mental illness, substance abuse and parental separation with later depression, anxiety, life satisfaction and subjective general health status and completely mediated the associations of intimate partner violence (IPV) and incarceration of a household member with anxiety, depression and subjective health status in adulthood.

CONCLUSIONS: ACEs linked to household dysfunction are associated with an increased risk for all subtypes of child maltreatment. The assessed widespread consequences of household dysfunction are mediated by child maltreatment. This underlines the role of prevention of child maltreatment in families with household dysfunction and implies child protection as a priority in any interventions.

Copyright © 2019 Elsevier Masson SAS. All rights reserved.

Language: en


Adverse childhood experiences (ACE); Child maltreatment; Intimate partner violence (IPV); Mentally ill parents; Parental separation; Parental substance abuse


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