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Mental health of children is a major issue worldwide. Worsening
socioeconomic conditions associated with urbanization and migration
have resulted in the need for societies to develop institutions
that advocate for the protection of children. The Caribbean nations
have attempted to highlight the issues of child abuse in the region
through conferences and training seminars.
Child abuse is described as deliberate violence
to a child and/or the intentional withholding of care by parents
or adults responsible for the child (Kempe and Hefler, 1972). There
has been a significant increase in reported cases of various types
of child abuse including physical, sexual and the newer categories
of mental injuries (emotional abuse/neglect) in most parts of the
world. More than 3.1 million reports of child abuse were recorded
in the USA in 1994, an increase of more than 50 percent over the
1985 figure (Alexander, 1995).
In the Caribbean island of Dominica, the incidence
of reported cases doubled between the years 1990 and 1993 from 127
to 252 (Taylor, 1997). This figure reached a high of 416 in 1994
and dropped to 260 in 1995. The reported incidence continued to
rise in subsequent years reaching 267 in 1997 and 303 in 1998, a
trend that is probably due to issues of sensitization and service
Sexual abuse was the most prevalent form of child
abuse in Dominica in 1998, comprising 41.6% of cases registered
in the Child Abuse Register (1999). It is defined as "sexual
exploitation of a child through violent and nonviolent molestation.
This includes a spectrum of behaviors from violent rape to inappropriate
touching or seduction" (Eldemire, 1992).
Neglect represents the second highest number of
cases reported in Dominica for the periods 1995 to 1998. It is defined
as gross or repeated failure to provide for child’s physical
or emotional needs such that there is harm or threatened harm to
the child’s health or welfare (Sharpe, 1992). Physical abuse
is the next most common form of child abuse. It is defined as any
act by "parent" which results in non-accidental physical
injury to the child. The word "parent" in the broad sense
means both parent and caretaker or guardian (Eldemire, 1992).
In all cases of abuse, the psychological scars last
a lifetime. This dictates that the event must not be allowed to
occur. The significant predictors of child sexual abuse perpetrated
by a family member were physical abuse, having no one to confide
in, having no caring female adult, and having an alcoholic father
In order to manage the problem of child abuse in
Dominica more effectively, a comprehensive health plan must be established
which would attempt to identify the children at risk. It is believed
that biological, psychological and social indicators of child welfare
are strongly associated with the occurrence of childhood abuse.
The loss of significant relations early in childhood, their living
arrangements coupled with the use and/or abuse of alcohol and other
drugs by parents predisposes children to abuse.
The aim therefore was to determine whether living
arrangements and personal experiences of childhood influence the
occurrence of abuse of children in Dominica.
The objectives of the study were to:
1) determine the living arrangements of the abused
2) determine the psycho-social status of abused
3) compare abused children, with their age-specific
The use of substances of abuse by parents represented
a significant problem. Alcohol use among the parents of abused children
was significantly higher than their non-abused partners . These
children also identified alcohol use at a significantly higher proportion
among their mothers
The OR is 8.68 and the AR is 88.5%.
The fathers were more likely to be alcohol users
than mothers in both groups, but the prevalence was higher in the
abused children . In addition, there were significant differences
between the two groups as more abused children remembered seeing
their parents in a state of drunkenness. The AR is 82.5%. Furthermore
a significant number of abused children acknowledged that their
parents used illicit drugs. The OR is 6.39 and the AR is 84.3%.
A much higher number of abused children remembered
seeing their parents involved in family violence. The attributable
risk is 64.6%.
This study has demonstrated that the living arrangements of children,
the absence of one or both parents, the shared activities between
parents and children and the use of drugs by parents are predictive
of childhood abuse in Dominica.
Living arrangements of children
Only one-quarter of abused children lived with both parents when
compared with more than one-half of the control group. This finding
was significant and illustrates the importance of family setting
as a protective factor in the wholesome development of children.
The nuclear family type is probably not the most common form of
family organization in the Caribbean (McKenzie,1990) and social
problems such as economic deprivation, child abuse among others
can probably be traced to the other forms of relationships that
prevail in the society.
As expected the children from the control group
expressed greater interest in their family relationship. Those who
lived in other homes apart from parents’ actually lived for
longer period in those homes than their abused counterpart who themselves
were more likely to live in other homes. This symbolized the significance
of stability to these children and its' protective impact on their
Loss of parents
The majority of the children interviewed lost one or both parents
(67.1%). This experience had a significantly worst outcome for the
abused children (81.3%). Although family separation was the most
frequent form of loss reported, migration was a major factor contributing
to the lost of one or both parent.
This finding substantiated an earlier report on
the Situation Analysis of Children and their Families in Dominica
(UNICEF, 1996). It reported that out-migration impacted significantly
on family life in Dominica as women were more likely to migrate
than males. Dominica's children therefore are likely to lose their
main caregivers at crucial stages in their development exposing
them to all kinds of social and economic risk.
In this study the majority of abused children lost
their mothers and even more lost their fathers (72%). Almost forty
percent of the abused children were growing up with neither their
biological mother nor father. It is interesting to note that more
than one fifth of the reports of abuse occurred around the time
of parental loss. In an Argentine study (Morales et al, 1997) social
support was noted as a crucial protective factor against child abuse.
Sharing activities with parents
It is quite normal for children to share activities with their parents
and in this study the majority of the children interviewed were
actively involved with their parents. However the control group
of children reported deeper relationship with their parents. This
difference was most significant in terms of social activities shared
such as playing games and having fun-time.
The activities assessed in this study are all parameters
to measuring the functional state of the family. The noted trend
of parents assisting their children with schoolwork at home or sharing
conversations and social activities favored the non-abused children.
This is similar to findings by Paradise et al. (1994) where he illustrated
those preexisting poor family interactions may contribute importantly
to persistent problematic behavior among abused children.
The abused children were more likely to be involved
in extracurricular activities on schooldays rather than go straight
home. On the other hand the control group attended church more frequently
and this may have served as a protective factor to child abuse.
It is clear therefore that social activities by the children can
impact positively or negatively on their personality shaping. The
church can be seen as a medium of controlled interaction while the
extra-curricular activities after school may not be so well supervised
and posed more risk for unpleasant experiences.
Alcohol and other drug use
The findings of this study supports previous work done on the predictive
value of substances of abuse on the occurrence of child abuse (Chaffin,
1996; Fleming, 1997; Miller, 1999; Kotch, 1999; Ammerman, 1999).
The abused children were more likely to report alcohol use in their
parents. It is interesting to note however that the mothers of the
abused children were consumers of alcohol at a significantly higher
proportion than their female counterparts of the control group.
Miller et al (1999) reported that mothers with that problem were
more punitive towards their children.
Furthermore, the abused children reported that a
significantly higher proportion of their parents were seen in a
drunken state (p= 0.001) and that they used illicit drugs (p= 0.004).
Ammerman et al (1999) confirmed that emotional dysregulation resulting
from substance use disorders predicted the occurrence of child abuse.
In another study done in the United State of America (Chaffin et
al, 1996) substance abuse disorders were strongly associated with
the onset of both abuse and neglect. Sexual abuse was the most common
form of abuse suffered by the children in this study and Fleming
et al (1997) reported in an Australian study that having an alcoholic
father and/or alcoholic mother were significant predictors of childhood
The exposure of children to physical confrontation between their
parents appears to be associated with child abuse. There was a tendency,
in this study, for abused children to report that form of family
violence. In a New Zealand study, Rodriguez and Green (1997) reported
that anger expression was positively correlated with child abuse
potential. Miller et al (1999) also supported this finding when
he reported that history of partners' violence and parental violence
among mothers predicted a higher level of mother-child punitiveness.
In this study, the psycho-social factors that predisposed children
to abuse were loss of one or both parents, not living with both
parents, not sharing social activities with their parents or irregular
attendance at church services. Also children who identified their
parents as users of alcohol, who saw their parents in a drunken
state or reported their parents as illicit drug users were at an
increase risk of abuse. Children who were not interesting in living
with their parents trended towards having an abusive experience.
Health and social workers should be sensitized to the heterogeneous
risk factors associated with child abuse in Dominica. The bio-psychosocial
model must be used to promote awareness and a holistic management
Intervention strategies aimed at decreasing the risk of childhood
abuse must focus on the social integration of the families at risk.
Families where children are socially isolated must be targeted.
There is need to develop treatment and preventive interventions
for parents who use alcohol and other drug. Self-help groups must
be available and accessible for the affected persons; both parents
There is need for cohort studies to be done that would seek to verify
the strength of association between the risk factors for child abuse
Dr Griffin Benjamin
Dr George Mahy
Dr Sharon Harvey
Dr Liris Benjamin