Long Term Impact of Child Abuse in University Students in Al Dakahlia Governorate

doi:10.21203/rs.3.rs-4302135/v1

Background: A growing body of research underscores the detrimental impact of child maltreatment on a child's development. Encompassing a wide range of actions by caregivers that significantly impede optimal development and violate societal norms, child maltreatment can manifest in various forms, including neglect of physical, cognitive, emotional, and social needs.

Objectives: To investigate the long-term psychological and social sequelae associated with different types of child abuse specifically within a university student population.

Methods: Employing a cross-sectional design, researchers conducted the study over a six-month period. Participants completed self-report questionnaires in the presence of research team members. The questionnaires were designed to assess the type of child abuse experienced, along with its long-term physical, social, and psycho-behavioral effects.

Results: The study's findings revealed a compelling association between a history of child abuse and a multitude of negative long-term psycho-behavioral consequences in university students. Specifically, participants reported experiencing symptoms of generalized anxiety, low self-esteem, feelings of inadequacy, and post-traumatic stress disorder (PTSD). Notably, gastrointestinal problems emerged as the primary physical health concern linked to child maltreatment.

Conclusion: This investigation contributes to the existing body of knowledge by demonstrating a significant association between child abuse and a range of adverse long-term outcomes in university students. These outcomes encompass a spectrum of psycho-behavioral issues, such as anxiety, low self-esteem, and PTSD, as well as physical health concerns like gastrointestinal problems. The findings underscore the critical need for further research to elucidate the specific mechanisms underlying these associations and to inform the development of effective preventive and intervention strategies to mitigate the long-term consequences of child maltreatment.

Trial registration: The study was retrospectively registered with ClinicalTrials.gov under the identifier NCT06366126 on April 10, 2024.

Long Term Impact

Child Abuse

University Students

Al Dakahlia.

Childhood maltreatment, encompassing physical, emotional, sexual abuse, and neglect, is a pervasive public health concern with lasting consequences [1]. While the immediate effects of abuse are undeniable, the long-term impacts cast a long shadow, shaping an individual's physical and mental health, social interactions, and overall well-being throughout their life [2]. This review explores the long-term effects of child abuse, highlighting the diverse ways it influences a survivor's life trajectory.

A growing body of research from the past two decades underscores the enduring detrimental effects of child abuse. Studies consistently demonstrate a strong link between childhood maltreatment and negative outcomes in adulthood, encompassing physical, psychological, behavioral, and social domains [3, 4].

Individuals with a history of child abuse exhibit an increased risk of developing chronic health problems later in life. The chronic stress response triggered by abuse disrupts brain and nervous system development, potentially leading to an increased susceptibility to physical conditions like cardiovascular disease, respiratory issues, and diabetes [3, 5].

Survivors of child abuse are disproportionately represented among populations struggling with mental health disorders. Studies consistently report a higher prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), and substance abuse in this population [4, 6]. These conditions can significantly impair an individual's ability to function in daily life.

Children who have been abused often exhibit behavioral problems like aggression, delinquency, and self-harm [7, 8]. These difficulties can lead to academic struggles, strained relationships, and legal problems.

Abuse experiences can negatively impact a child's capacity to form healthy relationships. Survivors may struggle with trust, maintain unhealthy attachments, and experience difficulty establishing intimacy [9, 10]. This can lead to social isolation and feelings of loneliness. The severity and duration of the abuse, the child's age at the time of the abuse, and the availability of supportive relationships are crucial factors influencing the long-term consequences [3, 8]. However, the research consistently highlights the significant and often lifelong impact of child abuse on survivors. A substantial body of researches underscores the detrimental long-term effects of child abuse across physical, psychological, behavioral, and social domains. Understanding these consequences is paramount for developing effective prevention and intervention strategies to support survivors and ultimately break the cycle of abuse.

This study aimed to shatter the silence surrounding child abuse and its enduring effects on children's health. By delving into the social, psychological, and physical consequences of different abuse types, the research sought to spark greater awareness among child health professionals.

Study Design

This cross-sectional study, adhering to the ethical principles of the Declaration of Helsinki (1975), was conducted in 2023 to safeguard participant welfare. Though retrospective in data collection, the study was subsequently registered with ClinicalTrials.gov (NCT06366126) on April 10, 2024. Prior to commencement, the Faculty of Medicine, Al-Azhar University, Damietta's ethics committee granted approval (Number: DFM-IRB 00012367-22-02-008). Informed consent was obtained from all participants following a comprehensive explanation of the study's objectives and design. Participant confidentiality and the right to withdraw from the study at any point were explicitly emphasized.

Participants:

A representative sample of 242 university students (151 males, 91 females) was recruited from Al Dakahlia governorate, Egypt, to ensure generalizability of the findings. All participants possessed documented histories of child abuse experiences. Sample size calculation employed G*Power software to achieve a 95% confidence interval and 80% power for subsequent analyses.

The study adopted stringent inclusion criteria. Participants were required to be university students residing within Al Dakahlia governorate, Egypt (urban or rural), and possess verified documentation of childhood maltreatment experiences. Individuals lacking confirmed histories of child abuse were excluded from the study.

Outcome Measures:

A tailored questionnaire designed to collect socio-demographic data and history related to abuse and its sequelae (Appendix I). It used to evaluate type and physical, social and psycho behavioral long term impact of child abuse.

Statistical analysis:

Following data cleaning and organization, software (SPSS) was used to perform appropriate analyses based on the data type (parametric or non-parametric) for each variable.

Normality Test: The Kolmogorov-Smirnov test assessed normality. A p-value greater than 0.05 indicated normally distributed data.
Comparisons Between Groups:
Parametric: Independent-samples t-test evaluated the significance of differences between two independent groups.
Non-parametric: Mann-Whitney U test assessed the significance of differences between two independent groups.
Categorical Data:Chi-square test compared the distribution of a variable across two or more groups. When expected cell counts were low in a Chi-square test, the Monte Carlo simulation was used for correction.
- Significance Levels: non-significant: p-value > 0.05, significant: p-value ≤ 0.05 and highly significant: p-value < 0.001.

Table (1) summarizes participant demographics. The study included 242 participants, with females constituting roughly two-thirds (66.7%) and males the remainder. The average participant age was 20.07 years old (SD = 1.14). Regarding residence, most participants (83.3%) resided in rural areas. Table (2) highlights the prevalence of social factors among participants. Notably, 16% reported smoking, while none admitted to drug or alcohol use. Legal involvement was minimal, with only 1.2% of participants reporting such issues. Data presented in Tables 3 and 4, along with Figs. 1 and 2, reveal a concerning prevalence of psycho-behavioral and physical health challenges among the study participants with documented histories of childhood maltreatment.

Psychological Impact:

A significant proportion of participants reported negative experiences, including feelings of unhappiness (26%), self-dissatisfaction (36%), inadequacy (69.4%), and recurrent uselessness (78.5%). Anxiety was also prevalent (75.2%). Notably, a substantial percentage of participants reported diagnoses of mental health conditions: eating disorders (47.5%), post-traumatic stress disorder (PTSD) (52.1%), obsessive-compulsive disorder (OCD) (22.7%), and behavioral disorders (81.4%). However, a positive finding was that 9.1% sought psychiatric consultation.

Physical Health Impact:

Gastrointestinal problems were the most frequent physical health concern, affecting 66.5% of participants. Other notable conditions included musculoskeletal pain (16.5%), lung problems (15.7%), and malnutrition-related diseases (34.3%). The prevalence of other conditions, such as diabetes (1.7%) and cardiovascular diseases (3.3%), was lower.

Overall, these findings underscore the potential for long-term negative consequences on both psychological and physical health associated with childhood maltreatment.

Our investigation revealed a significant association between childhood abuse and negative long-term outcomes in university students. These outcomes encompassed psychological distress, manifested as generalized anxiety, low self-esteem, feelings of inadequacy, and post-traumatic stress disorder (PTSD) symptomatology. Additionally, a heightened prevalence of physical health concerns, particularly gastrointestinal problems, was observed among participants with a history of childhood maltreatment.

The current study's findings regarding the long-term psychological consequences of childhood maltreatment corroborate those reported in a separate investigation published in 2023 [11]. Both studies demonstrate a significant association between childhood maltreatment and internalizing problems (e.g., anxiety, withdrawal), externalizing problems (e.g., aggression, hyperactivity), and depression. Notably, the 2023 study suggests that self-esteem may act as a protective factor against depression, particularly for male participants.

Consistent with our findings, a prior study published in 2011 [12] documented a significant association between the type of childhood maltreatment and the severity of symptomology. The study revealed that emotional abuse and neglect independently contributed to greater functional impairment, while the co-occurrence of emotional abuse, emotional neglect, and physical abuse was associated with a diminished quality of life. Furthermore, the study noted a particularly detrimental effect of emotional abuse on social anxiety severity. However, this negative impact was demonstrably mitigated over time for participants who engaged in a specific intervention program.

Our investigation corroborates the results of a 2023 study [13], which identified a compelling association between childhood maltreatment and a multitude of adverse outcomes in young adults. These outcomes encompass heightened internalizing and externalizing psychopathology, compromised prefrontal cortex function, and overall lower psychological and functional well-being. Notably, the study also suggests a potential synergistic effect between childhood maltreatment and psychiatric disorders, particularly regarding post-traumatic stress disorder (PTSD). Individuals with a history of maltreatment and a diagnosed psychiatric condition exhibited a significantly higher prevalence of PTSD, comorbid psychiatric diagnoses, and earlier initiation of cannabis use. Furthermore, the study posits that the type and timing of childhood maltreatment experiences may influence the specific presentations of PTSD symptomatology.

The present study's findings regarding the long-term consequences of childhood maltreatment exhibit significant concordance with those reported in a recent investigation published in January 2023 [14]. The study demonstrate a compelling association between a history of childhood trauma and the emergence of high-risk behaviors in adolescents diagnosed with borderline personality disorder (BPD). It employed robust methods to elucidate significant associations between various forms of childhood maltreatment and distinct high-risk behaviors within the BPD population. This finding strengthens the existing body of knowledge concerning the potential influence of childhood trauma on the development of BPD symptomatology. Among the different types of maltreatment explored, emotional abuse emerged as the most potent predictor of high-risk behaviors. Notably, the study suggests a gender-specific impact, with emotional abuse during childhood increasing the propensity for suicidal ideation in males and eating disorders in females. Moreover, the co-occurrence of emotional abuse and neglect in childhood was identified as the most significant risk factor associated with substance abuse. These collective findings underscore the paramount importance of early identification and intervention strategies for childhood maltreatment. By recognizing the specific forms of abuse and their potential long-term sequelae, healthcare professionals can implement targeted interventions to mitigate the development of high-risk behaviors in young people diagnosed with BPD.

The current investigation's results demonstrate concordance with a study published in February 2022 [15]. This prior research identified significant associations between family demographic characteristics, such as parental employment status and family composition, and the specific subtypes of childhood maltreatment experienced by individuals. Additionally, the study documented distinct behavioral patterns among children who had been subjected to physical abuse compared to those who had experienced emotional abuse, with neglect not exhibiting a differentiating effect. While the clinical generalizability of these findings may be limited, the research offers valuable insights for child welfare professionals. By understanding the potential variations in developmental trajectories associated with different forms of maltreatment, professionals can tailor interventions to individual needs. This personalized approach has the potential to mitigate the risk of adverse long-term health outcomes in children who have experienced maltreatment.

The current study's results regarding the long-term consequences of childhood maltreatment exhibit a compelling concordance with those reported in a recent investigation [16]. This prior research employed robust methods to elucidate a significant association between a history of childhood maltreatment, encompassing both physical abuse and emotional neglect, and a multitude of adverse outcomes persisting into midlife. Specifically, the study identified that individuals with a documented history of childhood maltreatment were more likely to experience: reduced educational attainment and cognitive functioning, financial hardship manifested as lower incomes and increased household expenditures, increased reliance on social welfare programs, greater susceptibility to chronic diseases and elevated rates of depression and economic hardship. Furthermore, the research revealed that childhood physical abuse emerged as a particularly potent predictor of difficulties with activities of daily living, unemployment, and reduced work hours. These collective findings underscore the critical importance of early intervention strategies for childhood maltreatment. By implementing effective programs to prevent and address maltreatment experiences, healthcare professionals can potentially mitigate the long-term negative consequences on educational attainment, economic well-being, physical and mental health, and overall quality of life for individuals.

The current investigation identified a significant association between childhood abuse and the emergence of gastrointestinal problems as a long-term physical health consequence. Lending further credence to this finding, a separate investigation [17] documented a heightened prevalence of unexplained gastrointestinal symptomatology among adults with a history of childhood maltreatment. The study by Ringel et al. posits that this association may be mediated by long-lasting alterations in pain perception, a phenomenon known as nociception. Their research demonstrates that adult patients with unexplained abdominal pain who had experienced childhood abuse exhibited increased sensitivity to gut distention and altered patterns of central pain processing compared to controls without a history of maltreatment.

The current study's findings, corroborated by prior research, underscore the enduring negative impact of childhood maltreatment on various aspects of an individual's life. These findings highlight the critical need for the development and implementation of effective interventions and preventative measures to address childhood maltreatment and mitigate its long-term consequences.

Limitations of the study:

The study's focus on child abuse may have led to underreporting due to participants' reluctance to disclose personal experiences. Reliance on self-reported information introduces the potential for recall bias, where participants may unintentionally misremember events. Future studies should replicate these findings with larger, more diverse samples across different geographical regions and age groups. Informed by this research, future efforts should focus on developing and implementing practical interventions to protect individuals with a history of child abuse from potential long-term negative psychological and physical health consequences.

University students with a history of child abuse exhibited a higher prevalence of long-term negative consequences. These included psycho-behavioral issues such as generalized anxiety, low self-esteem, feelings of inadequacy, and symptoms of post-traumatic stress disorder (PTSD). Additionally, they reported a greater incidence of physical health problems, particularly gastrointestinal issues.

BPD

borderline personality disorder

PTSD

post-traumatic stress disorder.

Ethics approval and consent to participate

This investigation received ethical approval from the Institutional Review Board (IRB) of the Faculty of Medicine, Al-Azhar University, Damietta (approval number, if applicable). All research procedures were conducted in strict accordance with the established ethical principles and relevant regulatory guidelines. Prior to initiating the study, a member of the research team provided a comprehensive explanation of the study's objectives and methodology to each potential participant. Written informed consent was obtained from all participants, ensuring their full comprehension and voluntary participation in the research.

Consent for publication

NA

Availability of data and materials

The availability of all the data and materials needed to complete the inquiry is attested to by the writers.

Competing interests

The authors attest that they have no financial relationships that they disagree with.

Funding

The authors attest that they have no financial conflicts of interest in relation to the subject matter covered in the work.

Authors' contributions

Amira H. Mohammedand Amir Solimanwere involved in study conception and design, as well as implementation, analysis, interpretation of data, manuscript preparation and revised the article. Reem Hamdycarried out the experiments and the drafting of the article. All authors have reviewed and approved the final manuscript.

Acknowledgment

We sincerely thank the participants, their families, and the institutions and organizations that helped us achieve our study's objective and provided them with assistance.

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Table (1): Socio-demographic characteristics of participants
	child abuse Cases (N=242)
Mean age ± SD	20.07±1.14
Sex	Male	N=91	38. 09 %
Sex	Female	N=151	61.9 %
Residence	Urban	N=202	83.47%
Residence	Rural	N= 40	16.53%

Table (2): distribution of long term social consequences of child abuse among participants
Smoking (N=242)	Yes	N=16	6.6%
Smoking (N=242)	No	N=226	93.4%
Drugs/alcohol abuse(N=242)	Yes	N=0	0%
Drugs/alcohol abuse(N=242)	No	N=242	100%
Involvement in legal issues (N=242)	Yes	N=3	1.2%
Involvement in legal issues (N=242)	No	N=239	98.8%

Table (3): Distribution of long term psycho-behavioural consequences of child abuse among participants
You usually describe your childhood as unhappy (N=242)	Yes	N=63	26%
You usually describe your childhood as unhappy (N=242)	No	N=179	74%
Are you generally unsatisfied with yourself (N=242)	Yes	N=87	36%
Are you generally unsatisfied with yourself (N=242)	No	N=155	64%
Do you sometimes think that you are not good at all(low self-esteem) (N=242)	Yes	N=168	69.4%
	No	N=74	30.6%
Do you recurrently feel useless (N=242)	Yes	N=190	78.5%
Do you recurrently feel useless (N=242)	No	N=52	21.5%
Have you ever sought for a psychiatric consultation (N=242)	Yes	N=22	9.1%
Have you ever sought for a psychiatric consultation (N=242)	No	N=220	90.9%
Do you feel generally anxious (N=242)	Yes	N=182	75.2%
Do you feel generally anxious (N=242)	No	N=60	24.8%
Have you ever suffered from post-traumatic stress disorder manifestations (N=242)	Yes	N=126	52.1%
	No	N=116	47.9%
Do you suffer from eating disorders (N=242)	Yes	N=115	47.5%
Do you suffer from eating disorders (N=242)	No	N=127	52.5%
Do you suffer from Obsessive Compulsive Disorder (N=242)	Yes	N=55	22.7%
Do you suffer from Obsessive Compulsive Disorder (N=242)	No	N=187	77.3%
Do you suffer from behavioural disorders (as oppositional defiant disorder (ODD), conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD)) (N=242)	Yes	N=45	18.6%
	No	N=197	81.4%
Do you suffer from late comprehension (N=242)	Yes	N=67	27.7%
Do you suffer from late comprehension (N=242)	No	N=175	72.3%
Have you ever suffered from educational difficulties at any time (N=242)	Yes	N=79	32.6%
	No	N=163	67.4%
Have you any activities that people may consider odd (N=242)	Yes	N=54	22.3%
	No	N=188	77.7%
Do you suffer from acute stress disorder (N=242)	Yes	N=62	25.6%
Do you suffer from acute stress disorder (N=242)	No	N=180	74.4%
Have you had the sense that you have a fatal disease (N=242)	Yes	N=5	2.1%
	No	N=237	97.9%

Table (4): distribution of long term physical health consequences of child abuse among participants
Do you suffer from Diabetes mellitus (N=242)	Yes	N=4	1.6%
Do you suffer from Diabetes mellitus (N=242)	No	N=238	98.3%
Do you suffer from cardiovascular diseases (N=242)	Yes	N=8	3.3%
Do you suffer from cardiovascular diseases (N=242)	No	N=234	96.7%
Do you suffer from lung problems (N=242)	Yes	N=38	15.7%
Do you suffer from lung problems (N=242)	No	N=204	84.3%
Do you suffer from gastrointestinal problems (N=242)	Yes	N=161	66.5%
Do you suffer from gastrointestinal problems (N=242)	No	N=81	33.5%
Have you had cerebrovascular accidents (N=242)	Yes	N=5	2.1%
Have you had cerebrovascular accidents (N=242)	No	N=237	97.9%
Do you suffer from recurrent musculoskeletal pain (N=242)	Yes	N=40	16.5%
Do you suffer from recurrent musculoskeletal pain (N=242)	No	N=202	83.5%
Have you been admitted in a hospital (N=242)	Yes	N=9	3.7%
Have you been admitted in a hospital (N=242)	No	N=233	96.3%
Do you take regular medications (N=242)	Yes	N=4	1.7%
Do you take regular medications (N=242)	No	N=238	98.3%
Do you have any diseases related to malnutrition (anaemia, for example) (N=242)	Yes	N=83	34.3%
	No	N=159	65.7%

No competing interests reported.

Appendix.docx

Long Term Impact of Child Abuse in University Students in Al Dakahlia Governorate

Status:

Version 1

Abstract

Figures

Introduction

MATERIALS AND METHODS

Results

Psychological Impact:

Physical Health Impact:

Discussion

Limitations of the study:

Conclusion

Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1