Aida Dias

In this chapter we summarize the main findings of our research in two sections: the first section briefly reports the results of studies in Portuguese samples, regarding the consequences of CM in adults; the second section provides an overview about the need for public health actions to mitigate CM consequences in adults and documents the main ideas of professionals experienced in the field of CM.

Is exposure to child maltreatment a significant risk factor for poor mental health in adults in the Portuguese community? And is it transmitted across generations? We searched for answers to these questions, inspecting the CM prevalence and its association with psychological symptoms, revictimization and PTSD. To do so, we have selected a well-known instrument to assess CM (CTQ-SF), we have studied its psychometric properties in a Portuguese sample, and we have analyzed the associations between CM forms and diverse mental health outcomes. Further, we studied the hypothesis of CM transmission in families with different levels of father war exposure and post-traumatic disorder.

In Chapter 2 we presented the results of the adaptation of the CTQ-SF for the Portuguese population. The CTQ-SF proved to be a valid measure to assess exposure to CM in adults in the Portuguese population, although the sub-scale of physical neglect showed low internal consistency.

The study of CM prevalence and its associations with psychological symptoms was presented in Chapter 3. We found that 14.7% of Portuguese adults reported exposure to moderate or severe CM. Emotional abuse revealed the largest effect sizes predicting psychological symptoms. Compared to other countries, lower physical and sexual abuse was found in the Portuguese sample.

In Chapter 4, we analyzed the relations between CM, revictimization and PTSD. Exposure to moderate or severe CM increased more than twofold the risk for subsequent revictimization, and more than threefold the risk for PTSD diagnosis. Emotional abuse, physical abuse and physical neglect explained about 14% of the variation on PTSD symptom severity. Remarkably, it was found that exposure to moderate or severe CM increased the risk of exposure to almost any other traumatic event, with strongest associations found for accidents and interpersonal violence.

Chapter 5 addressed the hypotheses about intergenerational transmission of CM consequences in families of war veterans. Results revealed that transmission occurred in different patterns: children of war-exposed fathers with PTSD reported increased levels of emotional neglect, while children of war-exposed fathers without PTSD reported the same abusive experiences their parents experienced during childhood.

In Chapter 6 we discussed the need for public health actions to mitigate consequences of CM in adults. Based on knowledge about resilience and therapeutic protocols, emotional regulation, social functioning and self-concept have been proposed as targets for programs. Technology-based interventions (TBIs) and trauma-informed services are recommended.

Chapter 7 described the application of the Delphi method. More than 90% of participating experts agreed that public health actions are needed. Increasing community awareness was suggested as the preferred strategy. Priority target groups include victims of substantiated CM and adults in treatment for mental health problems. Potential risks identified included medicalizing complaints and promoting victim status.