Substantial risk of abuse seen in siblings of abused children

1. In this longitudinal cohort study, siblings of children who were abused had a 60-fold increase in the risk of abuse.

2. The strongest variables associated abuse in both siblings were female sex of first sibling, indigenous status, and maternal age less than 20 years old.

Evidence Rating Level: 2 (Good)

Study Rundown: Child abuse takes many forms, including neglect, physical abuse, emotional abuse, and sexual abuse. The consequences are often substantial and may impact a child’s long-term health and well-being. This longitudinal birth cohort study investigated the likelihood and predictors of abuse among siblings of abused children. Report of abuse to a statutory agency in the first sibling was associated with a 60-fold increased risk of reported abuse in the second sibling. Neglect in one sibling had the strongest association with neglect in the second sibling, followed by sexual and then emotional abuse. In general, the type of abuse was congruent between siblings. This study may have limited generalizability due to the single-center design, and may underestimate abuse by only including instances reported to statutory agencies. Despite these limitations, the results indicate that abuse among one child is associated with a high risk of abuse among siblings. Attention should be directed towards identifying and intervening when familial and situational risk factors of abuse are identified.

Click to read the study in PEDIATRICS

Click to read an accompanying editorial in PEDIATRICS

Relevant Reading: The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

In-Depth [retrospective cohort]: This longitudinal cohort study collected baseline data at the first antenatal visit of 7223 pregnant women in Brisbane, Australia between 1981-1984. In total, 520 sibling pairs were included, with 354 (68%) completing a sexual abuse survey at age 21. Four types of abuse were reported: physical abuse, emotional abuse, sexual abuse and neglect. Reports were obtained from statutory agencies, as well as retrospective reports of sexual abuse from participants at age 21. Overall, 12% of firstborns were abused by age 16, with the majority being subject to neglect (n=47). Reports of abuse in both siblings occurred at a rate of 8.5% (n=44), which is a 60-fold increase in risk. At the 21-year follow-up survey, 18.5% reported childhood sexual abuse, with 58% of reports occurring among siblings with similar experiences. Multiple demographic variables increased the risk of abuse, with the strongest predictor being maternal age under 20 years (aOR = 1.91, 95% CI: 1.14-3.15). Additional variables that predicted risk included low income, female sex (first sibling), indigenous status, limited maternal education, maternal depression, and parents living apart.

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