The burden of child maltreatment in China: a systematic review

We searched PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure for papers published from the inception of each database to 31 December 2013 using search term combinations of China with child abuse, emotional abuse, physical abuse, sexual abuse or child neglect -and their Chinese equivalents.Languages were restricted to English and Chinese.Two reviewers identified and screened potentially relevant articles in Chinese and English and independently assessed the quality of each study that met the inclusion criteria.To identify additional relevant studies, we contacted 18 researchers and organizations involved in child protection in China and checked the reference lists of key narrative reviews on child maltreatment in or around China.6,13,14,16,17 Prevalence studies were included if they met the following criteria: (i) published in a peer-reviewed journal; (ii) partici-Objective To estimate the health and economic burdens of child maltreatment in China.Methods We did a systematic review for studies on child maltreatment in China using PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure databases.We did meta-analyses of studies that met inclusion criteria to estimate the prevalence of child neglect and child physical, emotional and sexual abuse.We used data from the 2010 global burden of disease estimates to calculate disability-adjusted life-years (DALYs) lost as a result of child maltreatment.Findings From 68 studies we estimated that 26.6% of children under 18 years of age have suffered physical abuse, 19.6% emotional abuse, 8.7% sexual abuse and 26.0%neglect.We estimate that emotional abuse in childhood accounts for 26.3% of the DALYs lost because of mental disorders and 18.0% of those lost because of self-harm.Physical abuse in childhood accounts for 12.2% of DALYs lost because of depression, 17.0% of those lost to anxiety, 20.7% of those lost to problem drinking, 18.8% of those lost to illicit drug use and 18.3% of those lost to self-harm.The consequences of physical abuse of children costs China an estimated 0.84% of its gross domestic product -i.e.50 billion United States dollars -in 2010.The corresponding losses attributable to emotional and sexual abuse in childhood were 0.47% and 0.39% of the gross domestic product, respectively.Conclusion In China, child maltreatment is common and associated with large economic losses because many maltreated children suffer substantial psychological distress and might adopt behaviours that increase their risk of chronic disease.