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Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV—learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV. [ABSTRACT FROM AUTHOR]

Objectives: Exposure to child maltreatment is associated with physical, emotional, and social impairment, yet in Canada there is a paucity of community-based information about the extent of this problem and its determinants. We examined the prevalence of child physical and sexual abuse and the associations of child abuse with early contextual, family, and individual factors using a community-based sample in Ontario. Methods: The Ontario Child Health Study is a province-wide health survey of children aged 4 through 16 years. Conducted in 1983, a second wave was undertaken in 1987 and a third in 2000-2001. The third wave (N = 1,928) included questions about exposure to physical and sexual abuse in childhood. Results: Males reported significantly more child physical abuse (33.7%), but not severe physical abuse (21.5%), than females (28.2% and 18.3%, respectively). Females reported significantly more child sexual abuse (22.1%) than males (8.3%). Growing up in an urban area, young maternal age at the time of the first child's birth, and living in poverty, predicted child physical abuse (and the severe category), and sexual abuse. Childhood psychiatric disorder was associated with child physical abuse (and the severe category), while parental adversity was associated with child sexual abuse and severe physical abuse. Siblings of those who experienced either physical abuse or sexual abuse in childhood were at increased risk for the same abuse exposure; the risk was highest for physical abuse. Conclusions: These findings highlight important similarities and differences in risk factors for physical and sexual abuse in childhood. Such information is useful in considering approaches to prevention and early detection of child maltreatment. Clinicians who identify physical abuse or sexual abuse in children should be alert to the need to assess whether siblings have experienced similar exposures. This has important implications for assessment of other children in the home at the time of identification with the overall goal of reducing further occurrence of abuse. (Contains 4 tables and 1 figure.)

Despite advances in child maltreatment research, accurate measurement of exposure remains a key issue. In this study, we evaluated a short form (CEVQ-SF) of the Childhood Experiences of Violence Questionnaire (CEVQ) in a sample of adolescents involved with child protection services in an urban city in Ontario, Canada. Focusing on the two most readily defined maltreatment types, physical and sexual abuse, we evaluated the short form's comparability with the full version of the CEVQ. Both versions had good internal consistency and moderate-to-good 2-week test-retest reliability. The criterion validity of the two CEVQ versions in comparison with the Childhood Trauma Questionnaire was satisfactory. Construct validity for both versions was demonstrated: physically and sexually abused youth had higher odds of reporting clinical traumatic symptoms compared with either type alone. The CEVQ-SF is as reliable and valid as its full version. Implications for its use in large population-based surveys are discussed. (Contains 1 table.)

This study examined factors associated with decisions in favour of out-of-home placement following investigations involving infants at risk of maltreatment. We used data from a sample of children less than 1 year of age (n = 763) investigated by child welfare services across Canada in 2003. We tested unadjusted relationships with placement using Pearson's chi-square statistic. Multivariate logistic regression analyses identified parental substance abuse, mental health problems and few social supports as being associated with an increased likelihood of placement. Child's toxicology at birth, abandonment, physical harm and number of previous family openings also increased the likelihood of placement. Several variables that have been associated with increased placement in previous studies, such as single motherhood and young maternal age, did not show a statistically significant association in our analysis. Among those infants that were placed, there was insufficient power to compare kinship and non-kinship care. This analysis demonstrates the need for the implementation of established prevention programs, such as the Nurse-Family Partnership and substance abuse programs for caregivers.

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship. (Contains 2 tables.) [This research was supported by the Wyeth Canada Inc. Canadian Institutes of Health Research (CIHR) Clinical Research Chair in Women's Mental Health and the CIHR Institutes of Gender and Health; Aging; Human Development, Child and Youth Health; Neurosciences, Mental Health and Addiction; and Population and Public Health.]

Objective: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada. Method: The sample consisted of 8,472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined. Results: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem. Conclusions: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families. [This study was supported by the Canadian Institutes of Health Research, Ontario Graduate Student Scholarship, and the Wyeth-Ayerst Canada Inc., Canadian Institutes of Health Research Clinical Research Chair in Women's Mental Health.]

Objective: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS). Methods: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9,953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse. Results: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS. Conclusions: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse. [This study was also supported by the Wyeth-Ayerst Canada Inc. and Canadian Institutes of Health Research Clinical Research Chair in Women's Mental Health.]

A study interviewed 8,548 participants in the Ontario Mental Health Supplement about parental psychiatric history and childhood physical and sexual abuse. Respondents reporting a parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. (Contains references.) (CR)

Background: Longitudinal studies examining the impact of changes in COVID-19 pandemic-related stressors and experiences, and coping styles on the mental health trajectory of employed individuals during the lockdown are limited. The study examined the mental health trajectories of a sample of employed adults in Hamilton, Ontario during the initial lockdown and after the re-opening following the first wave in Canada. Further, this study also identified the pandemic-related stressors and coping strategies associated with changes in depressive symptoms in employed adults during the COVID-19 pandemic.Methods: The InHamilton COVID-19 longitudinal study involved 579 employees aged 22-88 years from a large public university in an urban area of Hamilton, Ontario at baseline (April 2020). Participants were followed monthly with 6 waves of data collected between April and November 2020. A growth mixture modeling approach was used to identify distinct groups of adults who followed a similar pattern of depressive symptoms over time and to describe the longitudinal change in the outcome within and among the identified sub-groups.Results: Our results showed two distinct trajectories of change with 66.2% of participants displaying low-consistent patterns of depressive symptoms, and 33.8% of participants displaying high-increasing depressive symptom patterns. COVID-19 pandemic-related experiences including health concerns, caregiving burden, and lack of access to resources were associated with worsening of the depressive symptom trajectories. Frequent use of dysfunctional coping strategies and less frequent use of emotion-focused coping strategies were associated with the high and increasing depressive symptom pattern.Conclusions: The negative mental health impacts of the COVID-19 pandemic are specific to subgroups within the population and stressors may persist and worsen over time. Providing access to evidence-informed approaches that foster adaptive coping, alleviate the depressive symptoms, and promote the mental health of working adults is critical. [ABSTRACT FROM AUTHOR]

Children exposed to intimate partner violence (CE-IPV) are at increased risk for later health and social difficulties. To date, studies have primarily focused on CE-IPV as a unitary construct; this may lead to the mistaken assumption that all subtypes of CE-IPV (i.e., exposure to direct or indirect physical abuse, or exposure to emotional abuse) are equally harmful requiring similar responses from child welfare services. The purpose of this study was to examine child welfare responses by CE-IPV subtype in a large Canadian child welfare sample. Using data from the Canadian Incidence Study of Reported Child Abuse and Neglect–2008 (N = 2,184), we examined child welfare responses to CE-IPV subtypes or their co-occurrence. Information was obtained from child welfare workers' reports. Cases with co-occurring subtypes of CE-IPV were more likely to be substantiated and involved multiple incidents compared with that with single CE-IPV subtypes. Cases with direct physical CE-IPV and co-occurring CE-IPV were also more likely to remain open and have an application considered or made to child welfare court. Exposure to emotional IPV was the least likely to warrant interventions by welfare services, including referrals to specialized services. These results suggest that within CE-IPV subtypes, there is evidence of different responses (recommendations and services) once a case has been opened by a worker. Future research is needed to examine the effectiveness of the responses and outcomes for children following child welfare interventions. [ABSTRACT FROM AUTHOR]

Background: Effective strategies for participant retention are critical in health research to ensure validity, generalizability and efficient use of resources. Yet standardized guidelines for planning and reporting on retention efforts have been lacking. As with randomized controlled trial (RCT) and systematic review (SR) protocols, retention protocols are an opportunity to improve transparency and rigor. An RCT being conducted in British Columbia (BC), Canada provides a case example for developing a priori retention frameworks for use in protocol planning and reporting.Methods: The BC Healthy Connections Project RCT is examining the effectiveness of a nurse home-visiting program in improving child and maternal outcomes compared with existing services. Participants (N = 739) were girls and young women preparing to parent for the first time and experiencing socioeconomic disadvantage. Quantitative data were collected upon trial entry during pregnancy and during five follow-up interviews until participants' children reached age 2 years. A framework was developed to guide retention of this study population throughout the RCT. We reviewed relevant literature and mapped essential retention activities across the study planning, recruitment and maintenance phases. Interview completion rates were tracked.Results: Results from 3302 follow-up interviews (in-person/telephone) conducted over 4 years indicate high completion rates: 90% (n = 667) at 34 weeks gestation; and 91% (n = 676), 85% (n = 626), 80% (n = 594) and 83% (n = 613) at 2, 10, 18 and 24 months postpartum, respectively. Almost all participants (99%, n = 732) provided ongoing consent to access administrative health data. These results provide preliminary data on the success of the framework.Conclusions: Our retention results are encouraging given that participants were experiencing considerable socioeconomic disadvantage. Standardized retention planning and reporting may therefore be feasible for health research in general, using the framework we have developed. Use of standardized retention protocols should be encouraged in research to promote consistency across diverse studies, as now happens with RCT and SR protocols. Beyond this, successful retention approaches may help inform health policy-makers and practitioners who also need to better reach, engage and retain underserved populations.Trial Registration: ClinicalTrials.gov, NCT01672060. Registered on 24 August 2012. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Intimate partner violence (IPV) threatens the safety and health of women worldwide. Safety planning is a widely recommended, evidence-based intervention for women experiencing IPV, yet fewer than 1 in 5 Canadian women access safety planning through domestic violence services. Rural, Indigenous, racialized, and immigrant women, those who prioritize their privacy, and/or women who have partners other than men, face unique safety risks and access barriers. Online IPV interventions tailored to the unique features of women's lives, and to maximize choice and control, have potential to reduce access barriers, and improve fit and inclusiveness, maximizing effectiveness of these interventions for diverse groups.Methods/design: In this double blind randomized controlled trial, 450 Canadian women who have experienced IPV in the previous 6 months will be randomized to either a tailored, interactive online safety and health intervention (iCAN Plan 4 Safety) or general online safety information (usual care). iCAN engages women in activities designed to increase their awareness of safety risks, reflect on their plans for their relationships and priorities, and create a personalize action plan of strategies and resources for addressing their safety and health concerns. Self-reported outcome measures will be collected at baseline and 3, 6, and 12 months post-baseline. Primary outcomes are depressive symptoms (Center for Epidemiological Studies Depression Scale, Revised) and PTSD Symptoms (PTSD Checklist, Civilian Version). Secondary outcomes include helpful safety actions, safety planning self-efficacy, mastery, and decisional conflict. In-depth qualitative interviews with approximately 60 women who have completed the trial and website utilization data will be used to explore women's engagement with the intervention and processes of change.Discussion: This trial will contribute timely evidence about the effectiveness of online safety and health interventions appropriate for diverse life contexts. If effective, iCAN could be readily adopted by health and social services and/or accessed by women to work through options independently. This study will produce contextualized knowledge about how women engage with the intervention; its strengths and weaknesses; whether specific groups benefit more than others; and the processes explaining any positive outcomes. Such information is critical for effective scale up of any complex intervention.Trial Registration: Clinicaltrials.gov ID NCT02258841 (Registered on Oct 2, 2014). [ABSTRACT FROM AUTHOR]

Objective: Child abuse can have devastating mental health consequences. Fortunately, not all individuals exposed to child abuse will suffer from poor mental health. Understanding what factors are related to good mental health following child abuse can provide evidence to inform prevention of impairment. Our objectives were to 1) describe the prevalence of good, moderate, and poor mental health among respondents with and without a child abuse history; 2) examine the relationships between child abuse and good, moderate, and poor mental health outcomes; 3) examine the relationships between individual- and relationship-level factors and better mental health outcomes; and 4) determine if individual- and relationship-level factors moderate the relationship between child abuse and mental health.Method: Data were from the nationally representative 2012 Canadian Community Health Survey: Mental Health ( n = 23,395; household response rate = 79.8%; 18 years and older). Good, moderate, and poor mental health was assessed using current functioning and well-being, past-year mental disorders, and past-year suicidal ideation.Results: Only 56.3% of respondents with a child abuse history report good mental health compared to 72.4% of those without a child abuse history. Individual- and relationship-level factors associated with better mental health included higher education and income, physical activity, good coping skills to handle problems and daily demands, and supportive relationships that foster attachment, guidance, reliable alliance, social integration, and reassurance of worth.Conclusions: This study identifies several individual- and relationship-level factors that could be targeted for intervention strategies aimed at improving mental health outcomes following child abuse. [ABSTRACT FROM AUTHOR]

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design ( n = 23,395; household response rate = 79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR = 15.8; 95% CI = 10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse. [ABSTRACT FROM AUTHOR]

The authors present their thoughts in favor of intimate partner violence (IPV) education for health practitioners (HPs). Particular attention is given to the study "A Systematic Review of Intimate Partner Violence Educational Interventions Delivered to Allied Health Practitioners" by S. Sawyer et al in the issue. The authors suggest that IPV education be provided early and use an evidence-based approach.

Exposure to intimate partner violence is increasingly being recognized as a form of child maltreatment; it is prevalent, and is associated with significant mental health impairment and other important consequences. The present article provides an evidence-based overview regarding children's exposure to intimate partner violence, including epidemiology, risks, consequences, assessment and interventions to identify and prevent both initial exposure and impairment after exposure. It concludes with specific guidance for the clinician. [ABSTRACT FROM AUTHOR]

This study examined factors associated with decisions in favour of out-of-home placement following investigations involving infants at risk of maltreatment. We used data from a sample of children less than 1 year of age ( n = 763) investigated by child welfare services across Canada in 2003. We tested unadjusted relationships with placement using Pearson's chi-square statistic. Multivariate logistic regression analyses identified parental substance abuse, mental health problems and few social supports as being associated with an increased likelihood of placement. Child's toxicology at birth, abandonment, physical harm and number of previous family openings also increased the likelihood of placement. Several variables that have been associated with increased placement in previous studies, such as single motherhood and young maternal age, did not show a statistically significant association in our analysis. Among those infants that were placed, there was insufficient power to compare kinship and non-kinship care. This analysis demonstrates the need for the implementation of established prevention programs, such as the Nurse-Family Partnership and substance abuse programs for caregivers. [ABSTRACT FROM AUTHOR]

The voices of elderly people from marginalized groups are rarely solicited, and the relationship between elder maltreatment and belonging to an oppressed group has not been adequately investigated. This article reviews the literature on oppression and elder abuse and describes findings from the secondary analysis of data from focus group discussions on elder abuse held with marginalized older adults and (quasi)professionals caring for them in two Canadian cities. Participants identified that increased vulnerability to elder abuse was related to oppression experienced as a consequence of ageism, sexism, ableism/ disability, racism, heterosexism/homophobia, classism, and various intersecting types of oppression. [ABSTRACT FROM AUTHOR]

Objectives. Reports on child health in Canada often refer to the disproportionate burden of poor health experienced by Aboriginal children and youth, yet little national data are available. This paper describes the health of First Nations and Inuit children and youth based on the First Nations and Inuit Regional Health Survey (FNIRHS). Study design. The FNIRHS combines data from 9 regional surveys conducted in 1996-1997 in Aboriginal reserve communities in all provinces. The target population consisted of all onreserve communities. All households or a random sample of households or adults (depending on province) were selected based on their population representation. Methods. One child was randomly selected from each participating household, except in Ontario and Nova Scotia, where children were randomly selected based upon their population representation. Alberta did not include the section on children's health in their regional survey. Results. Approximately 84% of adults, who were proxy respondents for their child, rated their children's health as very good or excellent. The most frequently reported conditions were ear problems (15%), followed by allergies (13%) and asthma (12%). Broken bones or fractures were the most frequently reported injuries (13%). Respondents reported that 17% of children had behavioural or emotional problems. Overall, 76% of children were reported to get along with the family "very well" or "quite well."Conclusions. While most respondents rated their child's health as very good or excellent, injuries, emotional and behavioural problems, respiratory conditions and ear problems were reported among many Aboriginal children. Issues such as substance abuse, exposure to violence and academic performance were not addressed in the 10 core survey questions. Clearly there is a need for more in-depth information about both the physical and emotional health of Aboriginal children and youth. [ABSTRACT FROM AUTHOR]

Copyright of CJEM: Canadian Journal of Emergency Medicine is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The mental health of Canada’s Aboriginal women has received little scholarly attention. This paper describes the mental health of First Nations women living on reserve in Ontario and compares these findings with results from the National Population Health Survey (NPHS). Reserve communities were randomly selected within urban, rural, remote and special access regions. Depression was measured by the Composite International Diagnostic Interview. Alcohol use and health services utilization questions were identical to those used in the NPHS. Compared with NPHS women, First Nations women reported significantly higher rates of depression (18% vs 9%) but significantly lower rates of alcohol use (55% vs 74% reported drinking in the last year), although significantly greater proportions reported having 5+ drinks on one occasion (43% vs 24%). Given the burden of suffering associated with depression and the twofold risk found here, it is important to examine risk and protective factors specific to First Nations women. The findings of a higher proportion of abstainers, but also a higher proportion of consumers of 5+ drinks among First Nations women relative to NPHS women indicate the need for a more careful investigation, based on community rather than clinical data, of patterns of alcohol use. [ABSTRACT FROM AUTHOR]

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Farther research is needed to understand the mechanism for this complex relationship. [ABSTRACT FROM AUTHOR]

Child maltreatment is associated with a huge burden of suffering, yet there are serious gaps in knowledge about its epidemiology and approaches to intervention. This article describes the development of a proposed national research framework in child maltreatment, as requested by the Department of Justice, Canada, based on (1) a review of the literature, (2) consultation with experts, and (3) application of evaluation criteria for considering research priorities. The article identifies gaps in knowledge about child maltreatment in Canada and proposes a research agenda to make evidence-based policy decisions more likely. Although this work was driven by gaps in Canada's knowledge about child maltreatment, the international scope of the review and consultation process could make the findings useful to broader research and policy audiences. [ABSTRACT FROM AUTHOR]

Elder abuse is recognized as a major problem, with profound effects on the health and quality of life of older persons. In our aging population, elder abuse represents an escalating clinical issue for social workers and health care professionals who provide care to older people. A major gap in our examination of elder abuse is the potential contribution and application of knowledge developed within research derived from other forms of family violence. This paper explores the interconnections among various forms of violence across the lifespan, and the experiences voiced by marginalized elders and their care providers. We interviewed seventy-seven rarely consulted older adults and forty-three formal and informal care-givers of older adults in focus groups in Ontario and Alberta, Canada. Study findings revealed four major themes that describe interconnections among types of abuse: (i) intergenerational cycles of abuse; (ii) violence across the lifespan; (iii) exposure to multiple subtypes of elder abuse; and (iv) ongoing spouse abuse that shifted into elder abuse. The results from this study indicate that victims often 'suffer in silence' and cultural factors, ageism and gender are ubiquitous to elder abuse. Recommendations to reduce elder abuse include education, formal and informal supports and services. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors. Methods: A modified Dillman Tailored Design approach was used to survey 1000 nurses and 1000 physicians by mail in Ontario, Canada. Respondents were randomly selected from professional directories and represented practice areas pre-identified from the literature as those most likely to care for women at the point of initial IPV disclosure: family practice, obstetrics and gynecology, emergency care, maternal/newborn care, and public health. The survey instrument had a case-based scenario followed by 43 questions asking about behaviours and resources specific to woman abuse. Results: In total, 931 questionnaires were returned; 597 by nurses (59.7% response rate) and 328 by physicians (32.8% response rate). Overall, 32% of nurses and 42% of physicians reported routinely initiating the topic of IPV in practice. Principal components analysis identified eight constructs related to whether routine inquiry was conducted: preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures. Each construct was analyzed according to a number of related issues, including clinician training and experience with woman abuse, area of practice, and type of health care provider. Preparedness emerged as a key construct related to whether respondents routinely initiated the topic of IPV. Conclusion: The present study provides new insight into the factors that facilitate and impede clinicians' decisions to address the issue of IPV with their female patients. Inadequate preparation, both educational and experiential, emerged as a key barrier to routine inquiry, as did the importance of the "real world" pressures associated with the daily context of primary care practice. [ABSTRACT FROM AUTHOR]

The article presents a randomized clinical study examining the best method for intimate partner violence screening in health care settings. The trial was conducted at emergency departments, women's health clinics, and family practices in Ontario, Canada. Three screening methods were examined, including a written self-completed questionnaire, a face-to-face interview with medical personnel, or a self-completed questionnaire on the computer. The Partner Violence Screen, the Women Abuse Screening Tool and the Composite Abuse Scale were used. The study found that women prefer the self-completed methods over the face-to-face approach. INSET: Screening Instruments Used in the Study.

Objective: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada.Method: The sample consisted of 8,472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined.Results: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem.Conclusions: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families. [Copyright &y& Elsevier]

Objective: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS).Methods: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9,953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse.Results: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS.Conclusions: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse. [Copyright &y& Elsevier]

Background: Despite growing public concern about child maltreatment, the scope and severity of this significant public health issue remains poorly understood. This article examines the nature and severity of the physical harm associated with reports of child maltreatment documented in the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). Methods: The CIS collected information directly from child welfare investigators about cases of reported child abuse or neglect. A multistage sampling design was used to track child maltreatment investigations conducted at selected sites from October to December 1998. The analyses were based on the sample of 3780 cases in which child maltreatment was substantiated. Results: Some type of physical harm was documented in 18% of substantiated cases; most of these involved bruises, cuts and scrapes. In 4% of substantiated cases, harm was severe enough to require medical attention, and in less than 1% of substantiated cases, medical attention was sought for broken bones or head trauma. Harm was noted most often in cases of physical abuse compared to other forms of maltreatment. Interpretation: Rates of physical harm were lower than expected. Current emphasis on mandatory reporting, abuse investigations and risk assessment may need to be tempered for cases in which physical harm is not the central concern. [ABSTRACT FROM AUTHOR]

Examines the relationship between childhood maltreatment history and adult psychopathology in clinical populations in Ontario. Correlation between physical abuse and psychiatric morbidity; Issues on the social and environmental causes; Concerns on the nature and duration of the abuse.

Investigates the association of childhood abuse and psychiatric disorders in single and married mothers in Ontario. Relationship of childhood abuse with adult mental health of mothers; Comparison of income and health difficulties between single and married mothers; Role of childhood abuse as a predictor of maternal psychiatric morbidity.

Presents a study to update the 1993 report from the Canadian Task Force on the Periodic Health Examination by reviewing evidence for the effectiveness of interventions aimed at preventing child maltreatment. Options; Outcomes; Evidence; Suggestion of education programs for children to prevent sexual abuse.

Offers the results of a Canadian study on the possible long-term psychiatric effects of slapping and spanking in childhood. How those who reported being spanked often or sometimes had a significantly higher rate of anxiety disorders and/or alcohol abuse; Background; Methods; Results; Interpretation.

Provides information on several medical programs for the prevention of mental health problems of children in Canada. Services included in the nurse-family partnership program of the U.S.; Significance of the community-based group parenting program to early childhood development; Efficiency of the lifeskills training program for older children.

Summarizes the recommendation of the Canadian Task Force on the prevention of violence against women. Evaluation of several interventions; Potential benefits and harms; Comparison from the recommendations by the U.S. Preventive Services Task Force.

The article presents author's views on recognizing, detecting and responding to child maltreatment. He discusses several facts related to child health which includes neglection of broad range of physical, mental, cognitive and social problems, long-term health consequences of child abuse and responsibilities of the child protection agency.

Editorial. Commends Muhajarine and D'Arcy for their study, published in the April 6, 1999 issue of the `Canadian Medical Association Journal,' which focuses on physical abuse during pregnancy in Saskatoon, Saskatchewan. How the findings should alert health care professionals to the problem; Assertion the prevalence rates and corresponding population estimates may be underestimates of the extent of physical abuse; Need for a population-based longitudinal study.

Editorial. Examines findings from 1997 reporting on child abuse among Ontario families. What is and is not considered child abuse; Why the findings tell us little about the scope and burden of the problem; Why few data are available; The long-term effectiveness of home visits by nurses; Studies to date, as of May, 1998.

Background: Nationally representative Canadian data on the prevalence of child abuse and its relation with mental disorders are lacking. We used contemporary, nationally representative data to examine the prevalence of 3 types of child abuse (physical abuse, sexual abuse and exposure to intimate partner violence) and their association with 14 mental conditions, including suicidal ideation and suicide attempts. Methods: We obtained data from the 2012 Canadian Community Health Survey: Mental Health, collected from the 10 provinces. Respondents aged 18 years and older were asked about child abuse and were selected for the study sample (n = 23 395). The survey had a multistage stratified cluster design (household response rate 79.8%). Results: The prevalence of any child abuse was 32% (individual types ranged from 8% to 26%). All types of child abuse were associated with all mental conditions, including suicidal ideation and suicide attempts, after adjustment for sociodemographic variables (adjusted odds ratios ranged from 1.4 to 7.9). We found a dose-response relation, with increasing number of abuse types experienced corresponding with greater odds of mental conditions. Associations between child abuse and attention deficit disorder, suicidal ideation and suicide attempts showed stronger effects for women than men. Interpretation: We found robust associations between child abuse and mental conditions. Health care providers, especially those assessing patients with mental health problems, need to be aware of the relation between specific types of child abuse and certain mental conditions. Success in preventing child abuse could lead to reductions in the prevalence of mental disorders, suicidal ideation and suicide attempts. [ABSTRACT FROM AUTHOR]

Evidence indicates that healthcare and social service providers (HSSPs) receive inadequate education related to recognizing and responding to child maltreatment. This is despite the fact HSSPs are identified as an important factor in the primary, secondary, and tertiary prevention of this childhood exposure. The need for online education for HSSPs' is highlighted during the COVID-19 pandemic restrictions and will continue to be relevant afterward. The objective of this commentary is to provide an overview of: (a) educational interventions for HSSPs' related to recognizing and responding to child maltreatment; (b) the development of VEGA (Violence, Evidence, Guidance, Action), which is an online platform of educational resources to support HSSPs to recognize and respond to child maltreatment; and (c) the RISE (Researching the Impact of Service provider Education) project, which is an ongoing multi-province evaluation of VEGA in Canada. It is important to consider ongoing ways that HSSPs can receive education related to recognizing and responding to child maltreatment. The virtual implementation of VEGA and the RISE Project provide a necessary opportunity to continue to increase the capacity of Canada's HSSPs to adequately and safely recognize and respond to child maltreatment, while simultaneously advancing education scholarship for the field of child maltreatment and which will have relevance for the COVID-19 context and beyond. [ABSTRACT FROM AUTHOR]

Objective: Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of concurrent disorders have been developed; however, there exists little guidance outlining their structure and activities. Our objective was to synthesize available information on outpatient child and youth concurrent disorders programs and produce a comprehensive framework detailing the components of such programs., Methods: We used a four-stage critical interpretive synthesis design: (1) systematic review of published and grey literature, (2) data abstraction to identify program components and purposive sampling to fill identified gaps, (3) organization of components into a structured framework, (4) feedback from programs. We employed an iterative process by which programs reviewed data abstraction and framework development and provided feedback., Results: Through systematic review (yielding 1,408 records total and 7 records eligible for inclusion) and outreach strategies (yielding an additional 7 eligible records), we identified 11 programs (4 American, 7 Canadian) and 2 theoretical models from which data could be abstracted. Program activities were categorized into 12 overarching constructs that make up the components of the framework: accessibility, engagement, family involvement, integrated assessment, psychotherapy for patients, psychotherapy for families, medication management, health promotion, case management, vocational support, recreation and social support, and transition services. Program components are informed by the philosophical orientation of the program and models of care. This framework considers health system factors, clinical service factors, program development, and community partnership that impact program structure and activities. Multidisciplinary teams provide care and include addiction medicine, psychiatry, psychology, nursing, social work, occupational therapy, recreation therapy, peer support, and program evaluation., Conclusion: We developed a comprehensive framework describing components of child and youth outpatient concurrent disorders programs. This framework may assist programs currently operating, and those in development, to reflect on their structure and activities., Competing Interests: Declaration of Conflicting InterestsThe authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Harriet MacMillan is supported by the Chedoke Health Chair in Child Psychiatry.

Objectives: Depression is associated with problems in functioning in many aspects of life, including parenting. COVID-19 has increased risk factors for depression. We investigated the prevalence of depression among parents during the pandemic and the association with dysfunctional parenting., Design: Canadian nationwide cross-sectional study., Setting and Participants: The 2020 and 2021 Surveys on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015‒2019). Responding sample sizes for parents were 3121 for the 2020-SCMH; 1574 for the 2021-SCMH and 6076 for the CCHS., Primary Outcome Measures: All three surveys collected information on symptoms of major depressive disorder (MDD). The SCMH measured harsh parenting., Results: Based on data from the 2021-SCMH collected during wave 3 of COVID-19, 14.4% of fathers and 21.2% of mothers screened positive for MDD. These prevalence estimates were similar to those from the 2020-SCMH during wave 2, but at least two times higher than pre-COVID-19 estimates from the CCHS. Multivariate analyses revealed a linear association between MDD and harsh parenting. COVID-19-related stressors were associated with harsh parenting. Among mothers, feeling lonely or isolated because of COVID-19 was a risk factor for harsh parenting; among fathers, being a front-line worker was a risk factor. Meditation was a protective factor for mothers., Conclusions: After years of stability, the prevalence of MDD increased substantially among Canadian parents during the pandemic. Ongoing monitoring is vital to determine if elevated levels of depression persist because chronic depression increases the likelihood of negative child outcomes. Programmes aimed at addressing depression and bolstering parenting skills are needed as families continue to face stressors associated with COVID-19., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Adverse childhood experiences (ACEs) are associated with multimorbidity in adulthood. This link may be mediated by psychosocial and biological factors, but evidence is lacking. The current study evaluates this mediation model., Method: We analyzed data from the Canadian Longitudinal Study of Aging ( N = 27 170 community participants). Participants were 45-85 years at recruitment, when allostatic load and social engagement data were collected, and 3 years older at follow-up, when ACEs and multimorbidity data were collected. Structural equation modeling was used to test for mediation in the overall sample, and in sex- and age-stratified subsamples, all analyses adjusted for concurrent lifestyle confounds., Results: In the overall sample, ACEs were associated with multimorbidity, directly, β = 0.12 (95% confidence interval 0.11-0.13) and indirectly. Regarding indirect associations, ACEs were related to social engagement, β = -0.14 (-0.16 to -0.12) and social engagement was related to multimorbidity, β = -0.10 (-0.12 to -0.08). ACEs were related to allostatic load, β = 0.04 (0.03-0.05) and allostatic load was related to multimorbidity, β = 0.16 (0.15-0.17). The model was significant for males and females and across age cohorts, with qualifications in the oldest stratum (age 75-85)., Conclusions: ACEs are related to multimorbidity, directly and via social engagement and allostatic load. This is the first study to show mediated pathways between early adversity and multimorbidity in adulthood. It provides a platform for understanding multimorbidity as a lifespan dynamic informing the co-occurrence of the varied disease processes represented in multimorbidity.

Introduction: The COVID-19 pandemic has had major economic, social and psychological consequences for adolescents and young adults. It is unclear whether those with a history of adverse childhood experiences (ACEs) were particularly vulnerable. We examined whether a history of ACEs was associated with financial difficulties, lack of emotional support, feeling stressed/anxious, feeling down/depressed, increased alcohol and/or cannabis use and increased conflict with parents, siblings and/or intimate partners among 16- to 21-year-olds during the pandemic., Methods: Data were collected in November and December 2020 from respondents aged 16 to 21 years (n = 664) participating in the longitudinal and intergenerational Well-being and Experiences Study (Wave 3) conducted in Manitoba, Canada. Age-stratified associations between ACEs and pandemic-related stressors/symptoms were examined with binary and multinomial logistic regression., Results: A history of ACEs was associated with pandemic-related financial difficulties (adjusted relative risk ratio [aRRR] range: 2.44-7.55); lack of emotional support (aRRR range: 2.13-26.77); higher levels of feeling stressed/anxious and down/depressed (adjusted odds ratio [aOR] range: 1.78-5.05); increased alcohol and cannabis use (aOR range: 1.99-8.02); and increased relationship conflict (aOR range: 1.98-22.59). Fewer associations emerged for older adolescents and these were not to the same degree as for young adults., Conclusion: Adolescents and young adults with a history of ACEs reported increased odds of pandemic-related stressors and symptoms, and may need more resources and greater support compared to peers without an ACE history. Differences in results for adolescents and young adults suggest that interventions should be tailored to the needs of each age group., Competing Interests: Tracie O. Afifi is an Associate Scientific Editor with Health Promotion and Chronic Disease Prevention in Canada, but has recused herself from the review process for this article. The authors have no conflicts of interest.

Background: Research consistently demonstrates that physical punishment of children including "spanking" is harmful. Interest in effective prevention is growing rapidly. The aim of the current study is to examine spanking beliefs among adolescents and parents in relation to reports of spanking that the adolescents experienced before 11 years of age., Methods: Data were drawn from Wave 1 of a study conducted in 2017-2018 that included adolescents (14-17 years old) and one of their parents/caregivers from Manitoba, Canada (n = 1000 pairs). The study objectives were to examine: 1) spanking beliefs of adolescents and their parents; 2) the correlation between parent and adolescent spanking beliefs; 3) whether parents perceive the words "spank" vs. "hit" differently using intraclass correlation; 4) the association between parents' beliefs about spanking and parent- and adolescent-reported use of it; and 5) the relationship between sociodemographic variables and spanking. The data were analyzed using descriptive statistics, Spearman's correlation, intraclass correlation, and binary and multinomial logistic regression analyses., Results: The prevalence of adolescent-reported and parents'-reported spanking were 46.0% and 39.6%, respectively. The proportions agreeing that spanking is a normal part of parenting were similar among adolescents (22.0%) and parents (18.5%), and were moderately correlated (intraclass correlation = 0.38, SE = 0.038). More than five times as many parents believed that "spanking" is necessary (19.5%) than believed that "hitting" is necessary (3.5%). Parents' positive spanking beliefs were associated with increased likelihood of adolescent- and parent-reported spanking. Few significant associations were found between sociodemographic variables and parent-reported or adolescent-reported spanking., Conclusions: Adolescents' spanking beliefs are related to their parents' spanking beliefs, suggesting that they are transmitted across generations. Public education and law reform are needed to decrease the normalization and perceived necessity of spanking in child-rearing. Efforts should include improving the understanding that spanking is a form of violence against children. With only a few significant differences noted between sociodemographic variables and parent- and adolescent- reported spanking and the prevalent use of spanking across all sociodemographic variable categories, it may be useful to develop universal approaches to awareness-raising and implementation of education strategies in Canada., (© 2022. The Author(s).)

Introduction: Since the outbreak of COVID-19, numerous studies from around the world have reported declines in mental health. However, most of these studies were of low-to-moderate quality and many were based on convenience samples or used mental health measures with low validity, or both. Consequently, it has been difficult to draw conclusions., Methods: Both the 2020 Survey on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015-2019) used the Patient Health Questionnaire-9 to screen for major depressive disorder (MDD) in adults aged 18 or older. The prevalence of MDD was compared between the SCMH and the CCHS. Risk and protective factors for MDD in the SCMH were examined using bivariate and logistic regression analyses., Results: Based on SCMH data, 15.2% (95% CI: 14.2-16.2) of Canadians screened positive for MDD. The prevalence of MDD was more than two times higher in the SCMH (during COVID-19) than in the CCHS (predating COVID-19). In bivariate analysis, Canadians reporting five or more COVID-19-related risk factors were close to 30 times more likely to have MDD than those reporting no risk factors. Mastery and a sense of community belonging were protective factors for MDD., Conclusion: After remaining stable for two decades, the prevalence of depression among Canadians increased substantially with the onset of COVID-19. Ongoing monitoring of this common condition associated with major morbidity is vital to determine if elevated levels of MDD persist as we progress through and beyond future waves of COVID-19., Competing Interests: The authors have no conflicts of interest.

Background: Population-level prevalence estimates for a broad range of adverse childhood experiences (ACEs), which are known to affect health across the lifespan, are currently unavailable in Canada. The purpose of this study was to estimate the prevalence of individual ACEs by sociodemographic factors among middle-aged and older adults., Methods: Data for this cross-sectional analysis were obtained from the first follow-up (2015-2018) of the Canadian Longitudinal Study on Aging (baseline recruitment from 2011 to 2015). Participants included individuals aged 45-85 years and residing in the community in the 10 Canadian provinces. Exposure to ACEs was assessed using a retrospective, self-report questionnaire. Logistic regression was used to obtain the adjusted prevalence estimates of ACEs within groups formed by the sociodemographic characteristics and each variable was adjusted for all other sociodemographic variables., Results: Of the 44 817 participants in the first follow-up, 61.6% (weighted) reported exposure to at least 1 ACE. Exposure to physical abuse (weighted prevalence of 25.7%), intimate partner violence (22.4%) and emotional abuse (21.8%) were the most prevalent types of ACEs. Individuals younger than 65 years (born in 1950-1969), with no postsecondary education or education below a bachelor's degree, or with annual household income less than $20 000 reported greater exposure to ACEs. Reporting for many ACEs was higher among women and those of nonheterosexual orientation. Overall, British Columbia, Alberta, Manitoba, Ontario and Quebec reported relatively higher prevalence for several examined categories of ACEs., Interpretation: Adverse childhood experiences were highly prevalent across all demographic groups with substantial heterogeneity in the distribution among the middle and older age population. The high prevalence of ACEs and their potential negative consequences on health and well-being emphasize the need to develop and promote trauma-informed care to assist individuals affected by ACEs., Competing Interests: Competing interests: None declared., (© 2021 Joule Inc. or its licensors.)