In this study, we aimed to discover the associations between different patterns in the changes of child abuse year-to-year and sleep quality among Korean adolescents aged 13 to 15 years. As a result, the sleep quality of children who experienced child abuse was found to be low. Children who were victims of child abuse in the current year were more likely to have lower sleep quality, as did those who were victims of child abuse in the prior year, but not in the current year. Thus, child abuse can be considered a chronic factor related to poor sleep quality in adolescents.
A considerably large number of children are suffering from child abuse, which can lead to insufficient sleep, consequently leading to an unhealthy state. In our study, children with child abuse had a poorer sleep quality compared to children without child abuse. We divided the pattern of change in child abuse experience year-to-year into two groups: children who had no experience of child abuse in the prior year and those who had experience of child abuse. However, when a child who had not been abused by their parents in the prior year, but experienced child abuse in the current year, the quality of sleep dropped by about half. On the contrary, among children who had been abused by parents in the prior year, but not in the current year, their sleep quality was still low but showed an improvement compared to those experiencing steady abuse by their parents
We interpreted the results of our study to indicate that child abuse is a traumatic event for adolescences and that it impacted their sleep quality. As a child, abuse becomes a traumatic event [1, 29] that can trigger reduced sleep quality. Child abuse and poor sleep quality have negative effects on children; previous studies have demonstrated these relationships [7, 22, 24, 29, 30] and our result shared the consistent findings. In our results, the sleep quality seemed to be improved when the abuse stopped; however, in children continuously abused, the event is no longer an acute trauma but rather becomes a chronic trauma. Among our study population, those who experienced abuse in congestive years have the lowest sleep quality. For children who experienced abuse from their own parents, the child abuse remains a traumatic event that affects their sleep, even if they are no longer receiving abuse [7, 14, 20, 25].
Children with experience of abuse tend to develop sleep problems more frequently, which may continue in their adulthood [22, 27]. The sleep problem appeared regardless of abuse type. The study of Greenfield et al. reported the association between child abuse and higher risk of global sleep pathology and also they found abuse is more related to the sleep quality than sleep quantity, similar to our study. Greenfield et al. and Noll et al. conducted analyses on sexually abused children and sleep disturbance that showed such an experience is integrated to sleep quality. The impact of poor sleep quality on health can trigger various health issues including psychological issues in adolescents and adulthood [10, 15, 17, 19]. The effect of sleep is essential to maintaining good health. Without sufficient sleep, sleep disorders, depression, mood disorders, low self-esteem, and weight problems may ensue [10, 12, 13, 15-18, 21]. Foley et al. studied the association between sleep disturbance and chronic disease and Gregory and Sadeh reviewed the linkage of adolescents’ sleep disturbance and emotional behavior difficulties. Kamphuis et al. addressed poor sleep as the potential risk factor for aggressive and violence behavior. Similarly, Bower et al.’s study have analyzed the affection of sleep quality and daily life which resulted in finding that poor sleep quality is related to a low positive affect on daily life. Through these problems, it becomes hard for abuse victims to adjust to their surroundings and develop unhealthy outcomes [1, 6, 29]. Moreover, poor sleep quality influences towards psychological problems [31, 32] which hinder adolescents from achieving the proper psychological development. Such cases show that abused children are more likely to suffer from depression, emotion regulation disorders, aggressive behaviors, post-traumatic stress disorder, and sleep disorders; these develop as they grow [5, 8, 22, 28, 29]. To a child, the experience of abuse can become embedded as a chronic stressor with consistent abuse or as an acute stressor after only a short-term experience. Regardless of its duration and stress level, the experience negatively affects the child.
Sleep quality is closely related to the early detection of child abuse and psychological development. Monitoring the sleep quality of abused children allows the prevention of developing psychological issues, which can potentially lead to mental illness. In order to help children in family abuse, protection should be provided. Furthermore, sleep quality could be considered as indicator to diagnosis medical and/or social problems. Once the child has access to effective support from their family and a secure environment, their sleep quality is expected to improve. In turn, this should improve health and encourage positive social behavior [16, 19]. However, it may be hard to change the parents’ behavior, even though this would be the best solution. In addition to family support, social support mediates between the experience of abuse and its consequences . Many studies have demonstrated that social support can help children with an experience of abuse to feel protected . These children also face additional stressors as a result of abuse, such as separation from their family, experiences in foster care, and life-long victimization . Moreover, government level of intervention should be reinforced. Child abuse is hard to detect, and the rate of reported child abuse has increased about five times between 2001 to 2015 in Korea . The possible reason Korea and the United States have different age pattern in child abuse is due to the report system. As child abuse reporting is not highly motivated in Korea, the detection of child abuse at an early age is difficult. Therefore, more cases are reported in school aged children and adolescents. The abuse experience remains a traumatic event in the long-term. Therefore, within the community, the public should pay attention to abused children and provide safe shelters. The government enacted the Act on Punishment of Child Abuse Crime in 2014, which has resulted in a huge increment in reported child abuse cases to national agencies in Korea . There are many promotions and campaigns to advocate child abuse and child protection regulations and laws worldwide. The government should develop and implement detailed policies and regulations to prevent child abuse. To protect the victims of child abuse, such policies should have a practical approach and consistent support.
The study was conducted using longitudinal data comprising a large number of children selected for the survey panel. This design provided a strong validity to examine sleep quality and its causality. The use of random sampling by stratification at the national level also adds strength to the validity of this study. While previous studies focused on discovering the long-term effects of child abuse [1, 4, 7], we focused on the effects of child abuse shortly after the event. In addition, we applied a lag time effect to the child abuse experience to determine the effects of changes in the event. We set the baseline population after eliminating those who had poor sleep quality previously and analyzed cases of new-onset poor sleep quality. Furthermore, we analyzed the effects of child abuse on the quality of sleep and sleep duration. We concluded that sleep quality is more related to the incidence of child abuse than sleep duration.
Despite the strengths of this study, there are some limitations to consider. First, the data was collected via self-report, and there is hence a risk of bias occurring during the data collection. Also, study population’s age is limited to 13 – 15 because there was no national survey regarding child abuse experience for younger aged children. Second, the measure of sleep quality was not based on a diagnosis of sleep disorders, claims data, or obtained through the scientific method. However, sleep quality is a highly subjective element by the individual, for which it is acceptable to utilize self-reported data in children and adolescents . However, further investigations with a quantitative measure such as a sleep quality index or using clinically proven data are suggested. Third, in our study, we found that a cell phone addiction related to poor sleep quality, similar to in previous research . As cell phone addiction is increasing in adolescents, we recommend conducting further studies to elucidate the relationship between child abuse and cell phone addiction and to study the inverse relation, that is, whether child abuse triggers extreme use of cell phones, since we observed a non-significant tendency.
The analyses of the relationships between the patterns of change in the child abuse experience year-to-year and sleep quality provided a consistent implication that the abuse by their parents affected the children negatively, regardless of whether it was discontinued.