Watching with Argus eyes: Characterization of emotional and physiological responding in adults exposed to childhood maltreatment and/or recent adversity.

Exposure to adverse experiences is a well-established major risk factor for affective psychopathology. The vulnerability of deleterious sequelae is assumed in maladaptive processes of the defensive system, particularly in emotional processing. More specifically, childhood maltreatment has been suggested to be associated with the recruitment of specific and distinct defensive response profiles. To date, it remains unclear whether these are specific or generalizable to recent adversity in adulthood. This pre-registered study aimed to investigate the impact of exposure to childhood and recent adversity on emotional processing in 685 healthy adults with the "Affective Startle Modulation" Paradigm (ASM). First, we replicated higher trait anxiety and depression levels in individuals exposed to both types of adversity. Second, we observed increased general skin conductance reactivity in individuals exposed to recent adversity. Third, individuals exposed to childhood maltreatment showed reduced, while individuals exposed to recent adversity showed increased discrimination between pictures of negative and neutral valence, compared with non-exposed individuals in SCR. No association between exposure to adversity and fear potentiated startle was observed. Furthermore, explorative analyses revealed moderate dimensional and categorical agreement between two childhood maltreatment questionnaires and provide insight into potential adversity-type specific effects. Our results support experience-dependent plasticity in sympathetic nervous system reactivity and suggest distinct response profiles in affective modulation in individuals exposed to early versus recent adversity. We emphasize the need to further explore distinct adversity profiles to further our understanding on specific psychophysiological profiles and their potential implication for prevention and intervention.

Social Isolation During the COVID-19 Pandemic Impacts the Link between Child Abuse and Adolescent Internalizing Problems.

Collective traumas have a notable impact on adolescent well-being. While some youth face increased risk for mental health problems (e.g., those with maltreatment histories), many demonstrate resilience following traumatic events. One contributing factor to well-being following trauma is the degree to which one isolates from others. Accordingly, we examined the association between maltreatment and internalizing problems during the COVID-19 pandemic as moderated by social isolation. Among adolescents reporting pre-pandemic emotional abuse, those experiencing less isolation reported the lowest levels of anxiety symptoms. Among adolescents reporting pre-pandemic physical abuse, those experiencing less isolation reported the greatest levels of anxiety and depressive symptoms. The findings highlight a public health-oriented approach to youth well-being during collective trauma that extends beyond mitigating disease transmission.

COVID-19 impacts and adolescent suicide: The mediating roles of child abuse and mental health conditions.

BACKGROUND: Considerable research has established the harmful impacts of the COVID-19 pandemic on children's and adolescents' health and well-being. However, the literature has been constrained by studies using less representative samples, hindering the generalization of the findings. OBJECTIVE: This study aimed to investigate the associations of employment disruption and school closures during the pandemic with suicidal ideation and behavior in children and adolescents-and to consider the potential mediating effects of child psychological and physical abuse and subsequent mental health conditions. PARTICIPANTS AND SETTING: This study used the Adolescent Behaviors and Experiences data (n = 4692) - a nationally representative survey administered by the CDC of the United States from January to June 2021. METHODS: Logistic regression models were conducted to investigate the associations. A series of multiple mediation models were performed. RESULTS: School closures directly reduced child psychological and physical abuse and suicidal ideation and behavior. Employment disruption did not directly predict suicidal ideation and behavior but primarily through child abuse. Mental health's mediation role was significant in the associations between child psychological abuse and suicidal ideation and behavior, but no evidence suggested the same mediating pattern for the physical abuse-suicidal ideation and behavior relationship. Within the covariates, sexual orientation was the most consistent and highest risk factor. CONCLUSIONS: This study contributes to current knowledge on disaster impact, child abuse, and suicidal ideation and behavior, and it can also provide policy and intervention awareness for social workers.

From parental issues of job and finance to child well-being and maltreatment: A systematic review of the pandemic-related spillover effect.

BACKGROUND: Covid-19 pandemic jeopardized family well-being at the population level internationally. Pandemic-related job/financial difficulties in parents have a spillover effect on their child's well-being and issues of child maltreatment. OBJECTIVE: The current review sought to systematically summarize and analyze this pandemic-related spillover effect. PARTICIPANTS AND SETTINGS: In the home setting, participants involved 11,100 adolescents, 9144 parents/caregivers, and another 7927 parent-children dyads. METHODS: An extensive literature search in 13 electronic databases was conducted. A total 21 eligible papers published from 2020 to 2022 were included for further thematic analysis. RESULTS: A significant positive relationship between the pandemic-related spillover effect from parental job or financial issues to child maltreatment and child's mental/behavioral issues was established. The internal mechanisms demonstrated that this relationship was intermediated or moderated by the interactions of parental mental health issues, parenting practice, and family relationships. Families with particular factors may be more vulnerable and sensitive to the spillover effect during the pandemic. The work-from-home arrangement was found as positively related to enhanced parenting warmth and parent-child relationship in some cases who had relatively high familial social-economic status. CONCLUSIONS: Findings of current review provided the evidences from empirical data. During the Covid-19 pandemic, spillover effect from parental job/financial issues significantly influenced the child well-being and family functioning. Future efforts for intervention/service design should be made to enhance familial protective factors and support those families with vulnerable factors.

The prevalences, changes, and related factors of child maltreatment during the COVID-19 pandemic: A systematic review.

BACKGROUND: The impact of the COVID-19 pandemic has been extensive and drastic during the twenty-first century. The increasing phenomenon of child maltreatment during the pandemic is a significant public health concern. OBJECTIVE: This study is the first systematic review to analyze and summarize the prevalence rates, risk factors, and protective factors related to child maltreatment during the COVID-19 pandemic. METHODS: Four electronic databases (PubMed, Web of Science, Scopus, Embase) were systematically searched. Some potential studies were also identified from the reference lists of previously included articles. The quality of the included studies was assessed by the National Institutes of Health (NIH) Quality Assessment Tool and Critical Appraisal Skills Program (CASP) Quality Assessment Tool. RESULTS: A total of 35 articles were included in the analysis, with 16 having prevalence information and 22 having factor information. Sixteen studies were conducted in the US, the other 17 studies were from 12 countries, and only two studies contained mixed countries. The prevalences of child maltreatment during the pandemic varied widely in different types and measurements. The pandemic rates of physical abuse, psychological abuse, neglect, and sexual abuse were 0.1 %-71.2 %, and 4.9 %-61.8 %, 7.3 %-40 % and 1.4 %-19.5 %, respectively. There was a decline in allegations of child maltreatment and an increase in severe cases of child maltreatment during the COVID-19 pandemic. Lockdown measures and their side effects were the main risk factors contributing to child maltreatment. CONCLUSIONS: This review calls for targeted measures to prevent child maltreatment during the COVID-19 pandemic and current and future lockdowns and more future replication studies conducted in countries other than the US.

Are Children Harmed by Being Locked up at Home? The Impact of Isolation during the COVID-19 Pandemic on the Phenomenon of Domestic Violence.

The phenomenon of violence against children is a very complex one. There are many types of child abuse, and they are culturally dependent to a significant degree. Although studies show that children generally only suffer from mild COVID-19 infection, some social restrictions introduced during the pandemic, such as home isolation, may have many severe consequences on the population's mental health. Studies on this topic suggest that violence against children increased during lockdown due to the COVID-10 pandemic. This narrative review summarizes this available literature on the subject and discusses the different forms of violence against children, their cultural aspects, the impact of the COVID-19 pandemic on the phenomenon of violence, the long-term consequences of the above, and forms of assistance for abused minors.

The neurobiology of childhood trauma, from early physical pain onwards: as relevant as ever in today's fractured world.

Background: The situation in the world today, encompassing multiple armed conflicts, notably in Ukraine, the Coronavirus pandemic and the effects of climate change, increases the likelihood of childhood exposure to physical injury and pain. Other effects of these worldwide hardships include poverty, malnutrition and starvation, also bringing with them other forms of trauma, including emotional harm, neglect and deliberate maltreatment. Objective: To review the neurobiology of the systems in the developing brain that are most affected by physical and emotional trauma and neglect. Method: The review begins with those that mature first, such as the somatosensory system, progressing to structures that have a more protracted development, including those involved in cognition and emotional regulation. Explored next are developing stress response systems, especially the hypothalamic-pituitary-adrenal axis and its central regulator, corticotropin-releasing hormone. Also examined are reward and anti-reward systems and genetic versus environmental influences. The behavioural consequences of interpersonal childhood trauma, focusing on self-harm and suicide, are also surveyed briefly. Finally, pointers to effective treatment are proffered. Results: The low-threshold nature of circuitry in the developing brain and lack of inhibitory connections therein result in heightened excitability, making the consequences of both physical and emotional trauma more intense. Sensitive and critical periods in the development of structures such as the amygdala render the nervous system more vulnerable to insults occurring at those points, increasing the likelihood of psychiatric disorders, culminating in self-harm and even suicide. Conclusion: In view of the greater excitability of the developing nervous system, and its vulnerability to physical and psychological injuries, the review ends with an exhortation to consider the long-term consequences of childhood trauma, often underestimated or missed altogether when faced with adults suffering mental health problems.

Antecedentes: La situación en el mundo actual, que abarca múltiples conflictos armados, mayormente en Ucrania, la pandemia del Coronavirus y los efectos del cambio climático, aumenta la probabilidad de exposición infantil a lesiones físicas y dolor. Otros efectos de estas dificultades mundiales incluyen pobreza, desnutrición y hambruna, también traen consigo otras formas de trauma, incluyendo daño emocional, negligencia y maltrato deliberado.Objetivo: Revisar la neurobiología de los sistemas en el cerebro en desarrollo que se ven más afectados por el trauma físico y emocional y la negligencia.Método: La revisión comienza con aquellos que maduran primero, como el sistema somatosensorial, progresando hacia estructuras que tienen un desarrollo más prolongado, incluidas las involucradas en la cognición y regulación emocional. A continuación se exploraron los sistemas de respuesta al estrés en desarrollo, especialmente el eje hipotálamo-hipófisis-adrenal y su regulador central, la hormona liberadora de corticotrofina. También se examinaron los sistemas de recompensa y anti-recompensa e influencias genéticas versus ambientales. Tambien se investigaron brevemente, las consecuencias conductuales del trauma infantil interpersonal, centrándose en las autolesiones y suicidio. Finalmente, se ofrecieron indicaciones para un tratamiento eficaz.Resultados: La naturaleza de bajo umbral de los circuitos en el cerebro en desarrollo y la falta de conexiones inhibitorias en ellos dan como resultado una mayor excitabilidad, lo que hace que las consecuencias del trauma físico y emocional sean más intensas. Los periodos críticos y sensibles en el desarrollo de estructuras como la amígdala hacen que el sistema nervioso sea más vulnerable a las agresiones que ocurren en esos puntos, lo que aumenta la probabilidad de trastornos psiquiátricos, culminando en autolesiones e incluso suicidio.Conclusión: En vista de la mayor excitabilidad del sistema nervioso en desarrollo y su vulnerabilidad a las lesiones físicas y psicológicas, la revisión termina con una exhortación a considerar las consecuencias a largo plazo del trauma infantil, con frecuencia subestimado o ignorado totalmente cuando nos enfrentamos con adultos que sufren de problemas de salud mental.

Association of loneliness and social network size in adulthood with childhood maltreatment: Analyses of a population-based and a clinical sample.

BACKGROUND: Perceived loneliness and objective social network size are related but distinct factors, which negatively affect mental health and are prevalent in patients who have experienced childhood maltreatment (CM), for example, patients with persistent depressive disorder (PDD) and borderline personality disorder (BPD). This cross-diagnostic study investigated whether loneliness, social network size, or both are associated with self-reported CM. METHODS: Loneliness and social network size were assessed in a population-based sample at two time points (Study 1, N = 509), and a clinical group of patients with PDD or BPD (Study 2, N = 190) using the UCLA Loneliness Scale and the Social Network Index. Further measures were the Childhood Trauma Questionnaire, and standard depression rating scales. Linear regression analyses were applied to compare associations of loneliness or social network size with CM. Multiple mediation analyses were used to test the relative importance of loneliness and social network size in the relationship between CM and depressive symptoms. RESULTS: In both studies, loneliness showed a stronger association than social network size with CM. This was particularly marked for emotional neglect and emotional abuse. Loneliness but not social network size mediated the relationship between CM and depressive symptoms. CONCLUSIONS: Loneliness is particularly associated with self-reported CM, and in this respect distinct from the social network size. Our results underline the importance of differentiating both psychosocial constructs and suggest focusing on perceived loneliness and its etiological underpinnings by mechanism-based psychosocial interventions.

The Short- and Long-Term Impact of COVID-19 Lockdown on Child Maltreatment.

BACKGROUND: The COVID-19 pandemic has brought a new threat to child health and safety. Some studies suggest that social isolation and economic stress have exacerbated child abuse and neglect, whereas other studies argue that orders to stay at home are likely to promote parent-child relationships during this stressful time. Due to a lack of prospective studies including before-during-after lockdown assessments, the impacts of lockdown measures on child maltreatment are unclear. METHODS: This study retrospectively investigated child maltreatment of 2821 Chinese children and adolescents from 12 to 18 (female, 59%) before, during and after lockdown, and identified risk factors. Potential predictors including socio-economic and individual mental health status were collected. RESULTS: During Chinese lockdown, children and adolescents reported that the proportions of decrease (range 18-47.5%) in emotional abuse and neglect, physical abuse and neglect, sexual abuse, and witnessing domestic violence were greater than that of increase (range 5.1-9.1%). Compared with before lockdown (1.6%), the prevalence of sexual abuse significantly increased 8 months (2.9%) after the lifting of lockdown (p = 0.002). Being male, suffering from depression, state anhedonia, and experiencing psychotic symptoms at baseline were associated with increased sexual abuse after lockdown. CONCLUSIONS: The impact of lockdown on child maltreatment was beneficial in the short-term but detrimental in the long-term in China.

Unemployment and child maltreatment during the COVID-19 pandemic in the Republic of Korea.

BACKGROUND: Risk factors for child maltreatment have been exacerbated during the COVID-19 pandemic, especially due to economic downfalls leading to parental job losses and poor mental health. OBJECTIVE: This study aimed to examine the association between child maltreatment and unemployment rate in the Republic of Korea. PARTICIPANTS AND SETTING: Nationally representative data at the province level were used. METHODS: The monthly excess number of hotline calls related to child maltreatment during the COVID-19 pandemic was estimated for each province. Fixed effects regressions was used to examine the relationship between the excess number of hotline calls and unemployment rate. RESULTS: The average excess number of hotline calls was significantly negative in the early stage of the pandemic, but became significantly positive afterwards except for some months with averages not statistically different from zero. The regression results showed that an increase of male unemployment rate by 1% was significantly associated with an increase in the excess number of hotline calls by 0.15-0.17 per 10,000 children for most dependent variables for the first year of the COVID-19 pandemic. The statistical significance of female unemployment rate was mixed with the opposite sign of the coefficient to that of male unemployment. Overall unemployment rate was not significant. CONCLUSIONS: This study suggests that disruptions in child welfare services should be avoided to prevent underreporting of or delayed responses to suspected cases. Also, policies need to be designed considering potential pathways from economic downfalls, especially male unemployment, to child maltreatment.

A profile analysis of COVID-19 stress-related reactions: The importance of early childhood abuse, psychopathology, and interpersonal relationships.

BACKGROUND: There is little argument that COVID-19 is potentially highly stressful for many people, however, little research has broken down COVID-19-related distress into different aspects clustering together, and how these clusters differ in terms of the vulnerability of the individuals. OBJECTIVE: The primary aim of the present study was to identify distinct profiles of individuals' reactions to COVID-19-related stress, and analyze potential differences and risk and protective factors associated with these profiles in relation to childhood abuse, psychopathology, and interpersonal relationships. PARTICIPANTS AND SETTING: Data was collected online among a convenience sample of 914 men and women in Israel. METHODS: A Latent Profile Analysis (LPA) for estimating distinct profiles in people's COVID-19-related distress was applied. Next, profiles were compared in childhood abuse, psychopathology, perceived social support and relationship satisfaction. RESULTS: Five distinct profiles were identified: The distressed (23.75%), the worried (38.96%), the financially and socially distressed (15.20%), the caregivers (13.65%), and the untroubled (8.44Profiles in which individuals had more COVID-19 related distress are characterized by more childhood abuse, psychopathology, and less social support and relationship satisfaction. CONCLUSION: An assessment of the psychological implications of COVID-19 (when screening the population and creating prevention/intervention programs) should take into account the different responses individuals have when facing COVID-19, and their vulnerability, including their history of abuse, psychopathology, social support and relationship satisfaction, so that these programs will be better tailored to each type of distress experienced.

Child internalizing symptoms during the COVID-19 pandemic among maltreating and non-maltreating families: Examining the effects of family resources and the Reminiscing and Emotion Training intervention.

BACKGROUND: The effects of the COVID-19 pandemic on child functioning have been especially pronounced among low-income families. Protective factors, including sensitive reminiscing and sufficient family resources, may reduce the negative effects of the pandemic on child adjustment. OBJECTIVE: The current study investigated how family resources during the pandemic, race, maltreatment, and pre-pandemic involvement in an emotion socialization intervention (Myears ago = 4.37, SD = 1.36) were associated with child internalizing symptoms during the pandemic. PARTICIPANTS AND SETTING: The study utilized longitudinal data following 137 maltreating and low-income nonmaltreating mother-child dyads (Mage = 9.08, SD = 1.88; 54.7% Male). METHODS: Mother-child dyads engaged in a randomized controlled trial of the Reminiscing and Emotion Training (RET; Valentino et al., 2019) intervention prior to the pandemic. Dyads discussed shared, past emotional experiences, and during the pandemic, mothers reported on their family resources and their child's internalizing symptoms. A path analysis examined the effects of family resources, race, maltreatment, and the RET intervention on child internalizing symptoms. RESULTS: Family resources during the pandemic were significantly and inversely associated with child internalizing symptoms, b = -0.07, SE = 0.02, p < .01. There was a significant indirect effect of RET on child internalizing symptoms through sensitive reminiscing and a prior assessment of child maladjustment (95% CI [-0.294, -0.001]). CONCLUSIONS: These findings suggest adequate family resources and sensitive maternal emotion socialization may be protective against child internalizing symptoms during the pandemic.

Predictors of family violence in North Carolina following initial COVID-19 stay-at-home orders.

BACKGROUND: Although there is evidence that family violence increased in the United States during the COVID-19 pandemic, few studies have characterized longitudinal trends in family violence across the course of initial stay-at-home orders. OBJECTIVE: The purpose of the present study is to investigate patterns and predictors of family violence, such as child maltreatment and harsh punishment, during the first eight weeks of the pandemic after initial stay-at-home orders in North Carolina. PARTICIPANTS AND SETTING: Participants included 120 families with children ages 4-11 (53% non-White, 49% female) and a primary caregiver (98% female) living in rural and suburban areas in North Carolina. Participants were recruited based on high risk of pre-pandemic family violence exposure. METHODS: Caregivers completed weekly surveys during the pandemic assessing family violence, caregiver employment status, and caregiver emotion reactivity. In addition, all caregivers completed pre-pandemic surveys on family violence. RESULTS: Mixed-effects models revealed that family violence was highest following initial stay-at-home orders and decreased linearly over time. Higher pre-pandemic child violence exposure and caregiver unemployment were associated with higher initial family violence. Higher caregiver emotion reactivity was associated with changes in family violence across time. CONCLUSIONS: We observed high levels of family violence following stay-at-home orders, especially in families with higher baseline violence, higher caregiver emotion reactivity, and caregiver unemployment or underemployment. These associations suggest that vulnerable families may respond to the additional stressor of stay-at-home orders with increased violence and thus need additional support in moments of crisis.

Child Maltreatment During the COVID-19 Pandemic: A Systematic Rapid Review.

The present study is systematic rapid review on the nature of the relationship between the COVID-19 pandemic and child maltreatment. Database searches on December 28, 2020, identified 234 unique citations; 12 were ultimately included in our analysis. Included articles measured child maltreatment inclusive of physical, psychological, and sexual abuse, and child neglect during the COVID-19 pandemic. Compared with the prepandemic period, 5 articles found an increase in child maltreatment, 6 articles found a decrease, and 1 study found no difference. There existed variation in geography of study location, age of child maltreatment victims, and types of child maltreatment assessed.

Violence and abuse experiences and associated risk factors during the COVID-19 outbreak in a population-based sample of Norwegian adolescents.

BACKGROUND: The lockdowns occurring across society because of the COVID-19 pandemic have had far-reaching consequences for children and adolescents. One immediate concern was what the impact of the comprehensive disease control measures on rates of violence and abuse against children and adolescents would be. OBJECTIVE: We aimed to establish rates of child abuse and degree of family conflict during the first COVID-19 lockdown spring 2020. Additionally, we aimed to investigate associations between preexisting and concurrent risk factors and abuse during these unique times. PARTICIPANTS AND SETTING: A total of 3545 Norwegian 13- to 16-year-olds participated in this study. A total of 1944 of these had provided data 1 year before the lockdown. METHODS: We used a web survey format to assess abuse exposure and associated risk factors. The survey was administered in schools during school hours in June 2020, shortly after the reopening of schools after the first lockdown. RESULTS: In this sample 8.2% reported psychological abuse during lockdown, 2.4% had experienced physical abuse and 1.4% sexual abuse. For online sexual abuse, the rate was 5.6% during this time period. Adolescents did not report an increase in family conflict. Concurrently perceived family affluence and family risk factors were most strongly associated with physical abuse during lockdown (OR = 11.01(95% CI 5.32-22.84); OR = 5.36 (95% CI 2.69-10.67)), but also other types of child maltreatment. Analyses across assessment points suggested that prior victimization was the most accurate predictor of abuse experiences during lockdown (OR = 3.84 (95% CI 2.85-5.20)). CONCLUSIONS: The negative consequences of the COVID-19 preventative measures struck the adolescent population unevenly. The findings underscore the need for targeted measures to mitigate the negative outcomes of health-related crises for adolescents in risk groups such as those with low family affluence and prior abuse experiences.

Emotion Regulation and Distress During the COVID-19 Pandemic: The Role of Childhood Abuse.

The COVID-19 pandemic may be experienced as traumatogenic and may fuel or exacerbate psychological distress and trauma-related symptoms. Based on trauma research, one might expect that survivors of childhood abuse would be susceptible to these negative outcomes during the pandemic, and that among this population a stronger relation between emotion regulation difficulties and symptomatology would be found. Aiming to explore these suppositions, an online survey was conducted among 710 Israeli adults. Of them, 370 were childhood abuse survivors. A history of childhood abuse, COVID-19-related stressors, overall psychological distress, and peritraumatic stress symptoms during the pandemic were assessed via self-report measures. Participants with a history of childhood abuse had elevated overall psychological distress as well as peritraumatic stress symptoms during the pandemic, compared to nonabused participants, above and beyond demographic characteristics and COVID-19-related stressors. Emotion regulation difficulties were related to elevated psychological distress and peritraumatic stress symptoms among both childhood abuse survivors and nonabused participants. Nonetheless, a history of childhood abuse moderated the relations between the emotion regulation difficulty of being unable to engage in goal-directed behaviors when distressed (on one hand) and mental outcomes (on the other): Although the associations between inability to engage in goal-directed behaviors, overall psychological distress, and peritraumatic stress symptoms were nonsignificant among nonabused participants, they were significant among childhood abuse survivors. The current findings suggest that a history of childhood abuse might be a risk factor for distress in the face of COVID-19, and that childhood abuse survivors would benefit from clinical interventions that promote emotion regulation skills during this ongoing global health crisis.

Calculating the impact of COVID-19 pandemic on child abuse and neglect in the U.S.

BACKGROUND: COVID-19 has had a major impact on child abuse and neglect (CAN) in the U.S. leading to a change in the number of reported screened-in CAN investigations, missed prevention cases, and missed CAN cases. OBJECTIVES: To estimate the deficit number of CAN investigations and resultant estimated number of missed prevention and CAN cases due to the COVID-19 pandemic in the U.S. from March 2020 to December 2020. METHODS: Secondary data analyses of administrative child welfare data from January 2013 to December 2020 from New York City, Florida, New Jersey and Wisconsin were conducted. Spline regression modeling controlling for autocorrelation was utilized to explore any significant changes once the pandemic began in March 2020 in the number of screened-in CAN investigations. The seven-year monthly average of screen-in CAN investigations for March through December from 2013 to 2019 was calculated and compared to the numbers of CAN investigations for March 2020 to December 2020. The resultant number of missed prevention cases and CAN cases was estimated for the four jurisdictions and used to approximate the number of missed prevention cases and CAN cases in the U.S., as well as the projected estimation of national lifetime economic costs. RESULTS: Prior to the pandemic, there were insignificant monthly increases of 0.7 CAN investigations in NYC and 6.2 CAN investigations in Florida, a significant monthly increase 4.2 CAN investigations in New Jersey and an insignificant monthly decrease in 0.6 CAN investigations in Wisconsin. Once the pandemic began, there were significant monthly decreases (p < .001) in each of the four jurisdictions, including 1425.6 fewer CAN investigations in NYC, 3548.0 fewer CAN investigations in Florida, 963.0 fewer CAN investigations in New Jersey and 529.1 fewer CAN investigations in Wisconsin. There were an estimated 60,791 fewer CAN investigations in these four jurisdictions from March 2020 to December 2020 of which there were approximately 18,540 missed prevention and CAN cases suggesting up to $4.2 billion in lifetime economic costs. It was estimated that were 623,137 children not investigated for CAN in the U.S. during the same 10-month period. This suggests that there were an estimated 85,993 children were missed for prevention services and about 104,040 children were missed for CAN with a potential lifetime economic impact of up to $48.1 billion in the U.S. CONCLUSIONS: The COVID-19 pandemic has led to a precipitous drop in CAN investigations where almost 200,000 children are estimated to have been missed for prevention services and CAN in a 10-month period. There are opportunities for the child welfare jurisdictions to work with partner education, public health, social service and other providers to strategically approach this very grave issue in order to mitigate its impact on this very vulnerable population.

A comparison of child abuse and neglect encounters before and after school closings due to SARS-Cov-2.

BACKGROUND: Risk factors for child abuse and neglect and commonly used reporting mechanisms were highly affected by SARS-Cov-2 pandemic; yet, little is known about the effects of SARS-Cov-2 on rates of child abuse and neglect. OBJECTIVE: To compare overall rates, demographics, types of abuse and acuity of child abuse and neglect encounters seen at one university health system for the 6 months before and after school closings due to the SARS-Cov-2 pandemic. PARTICIPANTS AND SETTING: Data was extracted from a database of billed ICD10 codes for child abuse and neglect including sexual abuse codes. There were 579 encounters for patients <18 years of age and 476 unique patients. METHODS: In addition to ICD10 code and pre/post school closing, each encounter was identified to be inpatient, outpatient and/or emergency department. Demographic data such as age, gender, ethnicity, and race were extracted. Incident rate ratios in addition to descriptive statistics, Mann-Whitney U test, two-sample t-test, or the chi-square test of association were used in the analysis. RESULTS: No significant differences were identified for total rates of child abuse and neglect encounters (p = .08), physical abuse (p = .91) nor child maltreatment (p = .86) codes or in the age (p = .46), gender (p = .58), and race/ethnicity (p = .15) of patient encounters pre- versus post-school closings. The sexual abuse incidence and inpatient encounters increased by 85% (IRR = 1.85, p < .0001; IRR = 1.85, p = .004, respectively). CONCLUSIONS: Our findings provide a unique contribution to the existing literature in that we identified a significant increase in the incidence of sexual abuse and higher patient acuity as evidenced by higher rates of inpatient encounters after school closing due to SARS-Cov-2.