Association between Parental Addiction and Types of Child Abuse in High-School Students of Kerman, Iran.

BACKGROUND: Child abuse is one of the vulnerabilities that threaten child's physical and mental health in childhood and is associated with serious short-term and long-term complications. The present study aimed to review the association of parental addiction with types of child abuse in high-school students of Kerman, Iran.
METHODS: In this cross-sectional study, 360 students were recruited and studied through cluster sampling method. Abuse and the related factors were assessed using a standard self-report 48-item questionnaire.
FINDINGS: Average child abuse among the study subjects was 27.6%. Physical behavior, negligence, and emotional abuse were seen in 9.7%, 23.6%, and 17.9% of the subjects, respectively. Parental addiction had a significant association (P = 0.001) with incidence of all the child abuse domains.
CONCLUSION: Special consideration to families of addicted parents and early identification of child abuse cases may prevent the adverse side effects.

Introduction

Childhood in addition with family health and parental educative and cultural methods have a considerable role in growth and future development of individuals. Presence of a psychopathology such as drug dependency in parents and abusing children can knock out the normal development and provide the context of negative and adverse consequences.1

Child abuse by caregivers is done physically, emotionally, sexually and by neglect.2 Prevalence of child abuse is different in various areas given the related factors.3 Child abuse is occurred in all social classes but is more prevalent among the poor, addicted parents and those with psychiatric and physical illnesses.2 Approximately 80% of parents with poor custody and supervision on their children are suffering from substance-related disorders.4,5

Children of parents addicted to alcohol and substances at risk of neglect, usually experience domestic violence and other violence, physical harm, social isolation and stigma.6,7 Children of addicted parents are deprived from emotional attention and supervision, and loving physical contact of parents due to their involvement in drugs.8 Thus, such children not only have emotional deprivation, but are also at risk of types of abuse consequences such as emotional and behavioral issues, poor academic achievement, antisocial behavior, risk of psychiatric disorders such as depression and anxiety disorders and physical diseases, substance use and abuse, school dropout, legal problems and modeling the behavior of their parents.9,10 Due to poor social skills, particularly problem solving skills and anger management, and also because of drug influence leading instability in parenting methods, addicted parents abuse their family and child more than non-addicted parents.11

As mentioned earlier, types of abuse due to serious short-term and long-term complications on children’s development and growth (children's growing brain) must be taken into serious consideration12 so as to prevent the lasting effects on cognitive, emotional, social, personality, and physical development.13 In addition, it has been proved that one-third of those who had been abused in childhood will be an abuser in the future.14,15 So many studies have been done since 1950s that the phenomenon of child abuse was first raised thus, it is 15 per thousand in Germany, 13.6 in Great Britain and 4.9 per thousand in the Netherlands16,17 and annually over 3 million are reported as the victims of child abuse out of hospitalized children in hospitals of the U.S. While children are often used to hide the fact when asked about the background of being abused with regarding various considerations, later the abuse secret case was revealed about them during many assessment and interviewing sessions.2

Results of a study showed that separated families, families with depressed parents, alcohol consumption by mother, exposure to parental violence in childhood, and low family income significantly had a greater incidence of child abuse.18 The study of Kholasezadeh et al. also suggested that addicted parents to substances were more child abusers than others.19

In many well performed studies, specially local studies, either the case group was not children or adolescents or no questionnaire was used in such an age group.19,20 In other words, they have been mostly done on adults who usually increase the recall bias.2 Moreover, given the increased prevalence of drug addiction in societies, the present study aimed to assess the effect of parental addiction on types of child abuse in high-school students of Kerman, Iran.

Methods

This was a cross-sectional study in which the studied population included all the high-school students in the first to third grades. Similar to previous studies and given the prevalence of child abuse (30%), confidence interval (CI) 95%, and d = 5%, the sample size was calculated 336 people. With respect to the probability of 20% unanswered questionnaires, the final total size calculated 400 people. The studied clusters were the high schools of the city that were randomly selected among all the high schools and they were randomly selected among the first to third grades including 5 females and 5 males high schools. After obtaining the permission from the Provincial Department of Education and approved questionnaire by the authorities, we referred to the high schools.

Thirty to forty subjects i.e. 10 students from every grade were randomly selected in every high school by class attendance sheet and corporation of a school counselor. Following the trust and corporation of students and explaining the study objectives and confidentiality of information, the questionnaires were distributed and they were recollected after completion. Each questionnaire had a fixed digit which whereby facilitated the number of completed questionnaires.

The questionnaire used in this study was a standard questionnaire registered in an authoritative reference21 with two parts. The first part included demographic data and related factors and the second part included 48 items with a self-report scale for assessing child abuse with 8 questions in physical abuse, 28 questions in emotional abuse and 12 questions in neglect of a subject. All the questions were based on a 4-degree scale (never, sometimes, often, and almost always) to be answered.

The sexual abuse questions were excluded from the assessed items due to cultural issues and non-permission of the Provincial Department of Education. Prior to data collection, the data were extracted and analyzed using statistical package for social sciences (SPSS) for Windows 16.0 (Chicago, IL, USA) and application of central tendency and dispersion indices, and chi-square for comparing the frequency of abuse based on various study variables.

Results

Finally by follow-up 360 questionnaires (90.0% of the total questionnaires) were completed. Out of them, 176 subjects (48.9%) were females and 184 subjects (51.1%) were males. Prevalence of substance addiction was reported in 63 parents (17.5%). Parental addiction was identified as an influencing and significant factor on the total score of abuse (P = 0.001). The association of parental addiction was significant with types of physical abuse (P = 0.002), emotional abuse (P = 0.001) and neglect (P = 0.022) (Table 1). Total score of abuse with CI 95% (19.8-36.0) was 27.6%. Among the study subjects, 9.67% experienced physical abuse, 23.6% experienced neglect abuse and 17.9% experienced emotional abuse.

Table 1

Comparison of score in types of child abuse given parental addiction

Child abuse	Number	Score	SD	P
Overall	297	26.7	7.97	0.001
	63	31.9	9.43
Physical	297	8.3	11.4	0.002
	63	15.2	16.1
Emotional	297	16.4	14.4	0.001
	63	24.6	15.7
Neglect	297	22.7	14.8	0.022
	63	27.7	17.9

SD: Standard deviation

The lowest frequency was related to educational level of fathers for 1.7% illiteracy (n = 6) and 1.9% holding PhD degree (n = 7) and the highest frequency was related to 41.7% high-school graduates (n = 150). The lowest and highest educational level in mothers was related to 1.9% illiteracy (n = 7) and 49.4% high-school graduates (n = 178) (Table 2). There was no significant association between total score of abuse and parental educational level (P = 0.530). Besides, there was no significant association between the two genders in terms of types of abuse (P = 0.290) (Table 3).

Table 2

Frequency distribution of students based on parental educational level

	Father		Mother
	Number	Percentage	Number	Percentage
Illiterate	6	1.7	7	1.9
Under high-school graduate	60	16.7	71	19.7
High school graduate	150	41.7	178	49.4
Associate degree	49	13.6	38	10.6
Bachelor's degree	65	18.1	58	16.1
Master's degree	23	6.4	8	2.2
PhD degree	7	1.9	0	0.0

Table 3

Comparing the scores of types of abuse in study subjects separated by sex

Abuse	Boys			Girls			Test result (P)
	Number	Score	SD	Number	Score	SD
Physical	184	10.3	12.4	176	8.9	12.7	0.290
Emotional	184	18.2	14.6	176	17.6	15.3	0.700
Neglect	184	24.4	14.3	176	22.6	16.7	0.350

Discussion

Overall prevalence of abuse in the present study was 27.6% and physical, emotional, and neglect abuse were 9.67%, 23.6%, and 17.9%, respectively. There was no significant association between parental educational level and types of abuse. Parental addiction had a significant association with overall abuse and its types.

According to the previous studies, substance abuse is associated with both little attention and low knowledge of caregivers from children’s growing needs. Besides, due to poor impulse control and low tolerance threshold and mood instability especially at incidence of withdrawal syndrome, addicts show more impulsive and aggressive behaviors.8 In addition, due to direct effects of psychoactive molecules in substances on nervous system of children and other adults live with addicts, they all are susceptible to types of violence and abuse.22 It was found that parental addiction has a major role in child abuse one of whose causes might be the above mentioned reasons.

This study showed that prevalence of types of abuse in Kerman was often lower than other studies16,17,19 which could be due to differences in the definition of abuse or different cultural attitudes about abuse among the study population or low sample size. In fact, dependency of children to families in some societies is high and therefore the rate of intervention, decision-making, and commenting concerning children would be higher. Nevertheless, the probability of involvement is higher than other cultures with lower parent-children relationship and higher children’s autonomy. More comprehensive studies are required with control group for generalizing the findings. It is also necessary to conduct studies with greater sample size and involvement of all age groups as well as using questionnaires to be completed by parents and different urban and rural districts (down town and suburbs).

Addiction is one of the most important problems directly and indirectly causing stress on families. Due to inabilities addicted parents have in controlling emotions particularly anger and problem solving skills8 and also because they are so involved in substances, not only they cannot understand the needs of their children,10 but also if children go to them they would be unable to communicate with them in a friendly manner. In fact, that is why they turn to use drugs because of the very skill deficits and neurobiological vulnerabilities.8,11

In the present study, students with addicted parents significantly experienced all the child abuse domains more than other students. Various studies have suggested that incidence rate of child abuse was closely related to alcohol consumption and addicted to substances and its related stress.11,23 According to the study results by Kholasezadeh et al. on parents, 81.9% of parents who were substance addicts, were child abusers. In addition, 89% of parents with history of addiction in family mentioned the history of child abuse as well.19,23 Miri et al. believed father’s addiction was an influencing factor on incidence of physical abuse, however announced that there was no significant association between mother’s addiction and physical abuse.17

Today, in line with treating disorders related to substance abuse in parents, some assessment and interventional services have also been considered for children and families of such individuals whereby every type of child abuse and home violence is identified and treated earlier.2

One of the factors most of studies have emphasized on was the educational level of parents.16 The present study had a significant association between neglect and father’s education. While there was no significant association between overall score of child abuse, physical behavior and emotional abuse with parental educational level. Other studies did not support the findings of this study. Kholasezadeh et al. in a study in Rafsanjan city reported a significant association between educational level of parents and child abuse.19 Shojaeizadeh also stated that there was a significant association between low educational level and emotional abuse.24 The study of Miri et al. in Bam city reported a significant association between physical abuse and low educational level of parents.17 Study results of Tang in Hong Kong,25 and Qasem et al. in Kuwait26 also supported this matter. The reason of discrepancy in our findings and other studies could be due to low sample size in the present study and different cultural context of Kerman compared to other studied communities. Further studies are required in this field.

Given the findings of the present study, implementing necessary educations for familiarizing families with needs of growing children seems necessary.

First it is recommended to pay attention to child abuse as a serious problem in healthcare systems in line with identification and treatment interventions for parental substance abuse. Second, future studies should be done with larger sample size in various age groups and simultaneous assessment of parents comparatively. Interviewing is a limitation per se, and the responses might be incorrect, however, since questionnaires were anonymous and also students have been ensured about the confidentiality of information, the probability of this error has no overall impact generally. The major limitation of this study was small sample size and lack of a control group and also eliminating questions for sexual abuse. Therefore, conducting such studies in other parts of Iran can be done by considering the mentioned characteristics.

Conclusion

By paying particular attention to families of substance addicts and early identification of potential child abuse, negative consequences could be prevented.