Cited by 113Child Abuse and TraumaChild Welfare and AdoptionChild and Adolescent Psychosocial and Emotional Development

The DOI matches its Crossref record; 55 of the 58 references it cites were found in a registry or an index; none of the 32 sources its claims cite is checked for support yet.

Physical Abuse, Emotional Abuse, and Neglect and Childhood Behavior Problems: A Meta-Analysis of Studies in Mainland China

Open access
Cui, Naixue, Liu, Jianghong·2020·Trauma, Violence, & Abuse

Abstract

The relationship between three types of child maltreatment, including physical abuse, emotional abuse and neglect, and childhood behavior problems in Mainland China, has not been systematically examined. This meta-analysis reviewed findings from 42 studies conducted in 98,749 children in Mainland China and analyzed the pooled effect sizes of the associations between child maltreatment and childhood behavior problems, heterogeneity in study findings, and publication bias. In addition, this study explored cross-study similarities/differences by comparing the pooled estimates with findings from five existing meta-analyses. Equivalent small-to-moderate effect sizes emerged in the relationships between the three types of maltreatment and child externalizing and internalizing behaviors, except that emotional abuse related more to internalizing than externalizing behaviors. Considerable heterogeneity exists among the 42 studies. Weak evidence suggests that child gender and reporter of emotional abuse may moderate the strengths of the relationships between child maltreatment and behavior problems. No indication of publication bias emerged. Cross-study comparisons show that the pooled effect sizes in this meta-analysis are about equal to those reported in the five meta-analyses conducted in child and adult populations across the world. Findings urge relevant agencies in Mainland China to build an effective child protection system to prevent child maltreatment.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 42 studies in 98,749 children in Mainland China found small-to-moderate associations between physical abuse, emotional abuse, and neglect and childhood externalizing/internalizing behavior problems. Emotional abuse was more strongly related to internalizing than externalizing behaviors, and pooled estimates were comparable to five existing global meta-analyses.

Key findings

  • Physical abuse was associated with externalizing behaviors (Hedges’s g = .503, 95% CI [0.358, 0.649]) and internalizing behaviors (g = .493, 95% CI [0.469, 0.518]).
  • Emotional abuse was associated with externalizing (g = .348, 95% CI [0.150, 0.547]) and internalizing behaviors (g = .592, 95% CI [0.489, 0.695]); the internalizing association was larger than the externalizing association (Q = 5.961, p = .015).
  • Neglect was associated with externalizing (g = .266, 95% CI [0.087, 0.444]) and internalizing behaviors (g = .460, 95% CI [0.340, 0.580]); these did not differ significantly.
  • Considerable heterogeneity was present (majority of I² values > 75%, p < .001); no publication bias was indicated, and cross-study comparison showed pooled estimates about equal to five existing meta-analyses.

Methods

  • Systematic search of two Chinese databases and three English databases in May 2016 plus reference lists; included 42 studies (46 articles) of children under 18 from Mainland China, total N = 98,749, average mean age 12.13 years, average 48.7% girls.
  • Random-effects meta-analyses were run separately by maltreatment type and behavior problem level; effect sizes were calculated as Hedges’s g from correlations, odds ratios, means/SDs, or frequencies/proportions; heterogeneity was assessed with I² and Q, moderators via meta-regression/Q statistics, and publication bias via fail-safe N, funnel plot, and trim-and-fill.
  • Cross-study comparison used five existing meta-analyses identified through a Scopus search from 2012 onward, with pooled estimates converted to Cohen’s d for comparability.

Limitations

  • The paper states that definitions and measures of physical abuse, emotional abuse, and neglect varied considerably across the 42 studies, including differences in whether mild physical abuse was included and which neglect domains were assessed.
  • The paper states that participants were relatively homogeneous (students attending regular schools in Han-populated regions), most studies were cross-sectional (only two longitudinal), so causality cannot be inferred; moderator analyses for child gender, reporter, and abuser were limited to few studies, and effect sizes were unadjusted.
  • Evident from the text: some pooled estimates had wide confidence intervals, and the authors describe the moderator evidence as weak.

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Integrity signals

Registry

Crossref · 10.1177/1524838018757750

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

54 Own result · 21 Not checked yet · 11 Own interpretation · 6 Own method · 4 No basis given

Verify all 32 references — free account

Show all 65 claims

  • It may state two separate claims as one. 20
  • Probably not a substantial claim. 15
  • The quote only partly states this claim. 1
31 of 31
  • The paper relies on this without support.

    The relationship between three types of child maltreatment and childhood behavior problems in Mainland China had not been systematically examined before this meta-analysis.

    “The relationship between three types of child maltreatment, including physical abuse, emotional abuse and neglect, and childhood behavior problems in Mainland China, has not been systematically examined.”
  • The paper relies on this without support.

    Existing reviews focused on studies conducted in child and adult populations together and failed to differentiate between them.

    “First, they focused on studies conducted in child and adult populations together and failed to differentiate between them.”
  • The paper relies on this without support.

    Whether different types of child maltreatment relate to different behavior problems equally or differently was still unclear.

    “Second, whether different types of child maltreatment relate to different behavior problems equally or differently is still unclear.”
  • The paper relies on this without support.

    Many possible factors that could contribute to heterogeneity in relationships between child maltreatment and behavior problems had not been analyzed in existing meta-analyses.

    “Third, many possible factors that could contribute to the heterogeneity in relationships between child maltreatment and behavior problems have not been analyzed in the existing meta-analyses.”
  • The paper relies on this without support.

    Whether child or parental gender moderates the average effect size of the association of child maltreatment and behavior problems was unclear.

    “however, whether child or parental gender moderates the average effect size of the association of child maltreatment and behavior problems is unclear.”
  • The paper relies on this without support.

    Cross-study similarities and differences in the pooled estimates of the associations between child maltreatment and behavior problems among existing meta-analyses had not been analyzed.

    “Lastly, the cross-study similarities and differences in the pooled estimates of the associations between child maltreatment and behavior problems among existing meta-analyses have not been analyzed.”
  • The paper relies on this without support.

    The instruments used in the included studies validly measure child maltreatment and childhood behavior problems.

    “Nine studies used the CTSPC, 6 used the CTQ , 5 used self-developed instruments, and the remaining 22 studies used other tools to assess child maltreatment.”
    “First, considerable variations exist in how researchers defined and measured physical abuse, emotional abuse, and neglect across the 42 studies.”
  • The paper relies on this without support.

    The child maltreatment assessed in the included studies was perpetrated by parents, guardians, or other family members in the household.

    “Findings from the 42 studies conducted among 98,749 Chinese children supported the hypothesis that physical abuse, emotional abuse, and neglect by parents, guardians, and other family members in the household are undoubtedly associated with a broad spectrum of behavior problems in childhood.”
  • The paper relies on this without support.

    The 42 included studies are representative enough of children in Mainland China for the pooled associations to generalize to Chinese children.

    “Second, child participants in the 42 studies were diverse in gender, age, and geographic region. However, they were relatively homogenous considering that all were students attending regular schools in the regions where Han Chinese people populate.”
  • The paper relies on this without support.

    Effect sizes from the present meta-analysis and the five comparison meta-analyses are comparable enough for direct cross-study comparison.

    “The point estimates of the pooled effect size in the present study were consistently and slightly larger than the estimates in the other five meta-analyses, especially regarding physical and emotional abuse.”
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Each contradiction between two passages listed here was confirmed by an independent check.

3 of 3

Citations

Cites

Show all 58 references

Research works printed but not linked: 30

  1. *Chen X. (2015). The relationship among psychological maltreatment and neglect, resilience, and depression of junior middle students (Master’s thesis). Harbin Normal University, Heilongjiang, China.
  2. *Cheng P., 2010, Chinese Journal of Clinical Psychology, 18, 250
  3. *Du A., 2014, Sichuan Journal of Mental Health, 27, 10
  4. *Ge X., 2013, Chinese Journal of Epidemiology, 34, 5
  5. Gershoff E. T, 2010, Law & Contemporary Problems, 73, 31
  6. *Li P. (2013). Relational aggression, self-supporting personality, and psychological abuse and neglect (Master’s thesis). Qufu Normal University, Shandong, China.
  7. *Li Y., 2012, Chinese Journal of Clinical Psychology, 20, 813
  8. *Liu A., 2012, Journal of Psychological Science, 35, 911
  9. *Liu B., 2012, Chinese Journal of Clinical Psychology, 20, 842
  10. *Liu J., 2016, Chinese Journal of School Health, 37, 567
  11. *Luo A., 2013, Chinese Journal of Clinical Psychology, 21, 236
  12. *Ma M., 2011, Chinese Journal of Epidemiology, 32, 130
  13. *Pan C. (2010). The revision of Child Psychological Maltreatment Scale and the epidemiological investigation of child psychological maltreatment (PhD dissertation). Central South University, Hunan, China.
  14. *Su J., 2015, Chinese Journal of School Health, 36, 1326
  15. *Tan J. (2014). The correlation study of child abuse and children’s emotional and behavioral problems in an elementary school of Changsha (Master’s thesis). Central South University, Hunan, China.
  16. *Tao F., 2006, Chinese Journal of Pediatrics, 44, 688
  17. United Nations Children’s Fund, 2012, Measuring and monitoring child protection systems: Proposed core indicators for the East Asia and Pacific Region
  18. *Wan Y. (2015). The role of pain processing in the relationship between childhood physical abuse and non-suicidal self-injury behaviors among middle school students (PhD dissertation). Anhui Medical University, Anhui, China.
  19. World Health Organization, 2006, Preventing child maltreatment: A guide to taking action and generating evidence
  20. *Wu Y., 2011, Chinese Journal of Clinical Psychology, 19, 502, 494
  21. *Xiao Y., 2008, Chinese Journal of School Health, 24, 1028
  22. *Xu T. (2015). The research about parents’ harsh discipline and children’s temperament and behavior problems (Master’s dissertation). Shanxi University, Shanxi, China.
  23. *Yang M., 2012, Chinese Journal of Special Education, 12, 64
  24. *Yu T., 2013, Child Journal of School Doctor, 27, 161
  25. *Zhang L., 2008, Medicine and Society, 21, 52
  26. *Zhang W., 2013, Chinese Journal of Public Health, 29, 1165
  27. *Zhang Z., 2003, Chinese Journal of Mental Health, 17, 852
  28. *Zhu M., 2013, Chinese Journal of Special Education, 10, 80
  29. *Zhu M., 2010, Paper presented at the 2010 International Conference on Psychology Psychological Sciences and Computer Science (PPSCS)
  30. *Zou F., 2012, Chinese Journal of School Health, 33, 1077

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Metadata

Authors
Cui, N., & Liu, J.
Affiliations
  • Shandong University (CN)
  • University of Pennsylvania (US)
Corresponding author
Cui, Naixue
Venue
Trauma, Violence, & Abuse
Published
2018-02-13
Volume
21
Issue
1
Pages
206-224
ISSN
  • 1524-8380 (ISSN-L)
  • 1552-8324
OpenAlex
W2788691505
Cited by
113
References
58
Citations by year
2026: 21 · 2025: 24 · 2024: 15 · 2023: 15 · 2022: 18 · 2021: 12 · 2020: 5 · 2019: 2 · 2018: 1
FWCI
0.84
Type
journal article
Language
en
Open access
Locations
  • Trauma Violence & Abuse (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
Office of Nursing Research at University of Pennsylvania School of Nursing
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Sociology and Political Science › Child Welfare and Adoption
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
child abuse, physical abuse, emotional abuse, child neglect, child behavior problems, externalizing problems, internalizing problems, child protection, mainland China, gender differences
MeSH terms
Emotional Abuse, Adolescent, Behavioral Symptoms, Child, Child Abuse, Child Behavior Disorders, China, Female, Humans, Male

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