Childhood adversities and adult use of potentially injurious physical discipline in Japan.

HHS Public Access Author manuscript Author Manuscript

J Fam Violence. Author manuscript; available in PMC 2016 May 01. Published in final edited form as: J Fam Violence. 2015 May 1; 30(4): 515–527. doi:10.1007/s10896-015-9692-z.

Childhood adversities and adult use of potentially injurious physical discipline in Japan Maki Umeda, MA, MPH1, Norito Kawakami, MD1, Ronald C. Kessler, PhD2, Elizabeth Miller, MD, PhD3, and The World Mental Health Japan Survey Group 2002–2006

Author Manuscript

1Department

of Mental Health, the University of Tokyo Graduate School of Medicine

2Department

of Health Care Policy, Harvard Medical School

3Division

of Adolescent Medicine, Children’s Hospital of Pittsburgh of UPMC

Abstract

Author Manuscript

Using data derived from the World Mental Health Japan Survey (n = 1,186), this study examined the intergenerational continuity of potentially injurious physical discipline of children in a community sample from Japan with a special focus on the confounding effects of 11 other types of childhood adversities (CAs) and the intervening effects of mental disorders and socioeconomic status. Bivariate analyses revealed that having experienced physical discipline as children and five other CAs was significantly associated with the use of physical discipline as parents in the Japanese community examined. However, childhood physical discipline was the only CA that remained significant after adjusting for the other CAs. The association of childhood physical discipline with adult perpetration was independent of the respondents’ mental disorders and household income. No significant gender differences were found in the associations between childhood physical discipline and adult perpetration. The current study on Japan provided empirical support consistent with results found in other countries regarding the intergenerational transmission of child physical abuse.

Keywords Intergenerational transmission; child physical abuse; childhood adversity; Japan; physical discipline; World Mental Health Survey

Author Manuscript

Child physical abuse is a major public health concern worldwide because of the high prevalence and serious effects on the health and development of abused children (Cicchetti & Toth, 2005; Gilbert et al., 2009; Malinosky-Rummell & Hansen, 1993). The prevalence of child physical abuse varies widely across countries (Akmatov, 2011), and it has been estimated that 4 to 16% of children are physically abused each year in high income countries (Gilbert et al., 2009). The wide range in prevalence found across countries likely reflects the influence of social and cultural factors, such as parenting norms and practices and income and education level of the society, on the occurrence and reporting of child physical abuse

Correspondence: Maki Umeda, Department of Mental Health, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan, [email protected], Tel +81-3-5841-3364, Fax +81-3-5841-3392.

Umeda et al.

Page 2

Author Manuscript

(Akmatov, 2011; Belsky, 1993; Coulton, Crampton, Irwin, Spilsbury, & Korbin, 2007; Durrant, 2008; Gracia & Herrero, 2008; Wong, Chen, Goggins, Tang, & Leung, 2009). In the case of Japan, approximately 7% of community residents surveyed reported that they had sometimes/often experienced physical violence by their parents during childhood (Fujiwara, Kawakami, & World Mental Health Japan Survey Group, 2011). Suspected cases of child abuse reported to Child Protection Centers in Japan have risen threefold during the last decade since the implementation of the Child Abuse Prevention Act in 2000. Over 40% of these cases involved physical abuse (Ministry of Health Labor and Welfare Japan, 2011). Identification of early risk factors is urgently needed to decrease the incidence of child physical abuse both in Japan and internationally.

Empirical Evidence on the Intergenerational Transmission of Child Physical Author Manuscript

Abuse

Author Manuscript

One hypothesis grounded in social learning theory that has been widely examined is that physical abuse victimization during childhood increases the likelihood of perpetration of child physical abuse in adulthood (Doumas, Margolin, & John, 1994; Kaufman & Zigler, 1987; Straus, Gelles, & Smith, 1990). This assertion has been generally supported by empirical studies (Ertem, Leventhal, & Dobbs, 2000; Muller, Hunter, & Stollak, 1995). However, many of these studies failed to differentiate the specific effects of child physical abuse from those of other types of maltreatment. Moreover they did not introduce controls for the effects of other maltreatment that might account for or attenuate the associations of childhood physical victimization with adult perpetration (Coohey & Braun, 1997; Doumas et al., 1994; Ertem et al., 2000; Ferrari, 2002; Gage & Silvestre, 2010; Milner, Robertson, & Rogers, 1990; Muller, 1996; Newcomb & Locke, 2001; Plant, Barker, Waters, Pawlby, & Pariante, 2013). Studies that examined the association of childhood physical abuse with subsequent perpetration using models that were adjusted for other types of childhood maltreatment yielded mixed results. One study found that childhood victimization was no longer a significant predictor of adult perpetration of child physical abuse (Renner & Slack, 2006), while others found that childhood victimization remains important (Fujiwara, Okuyama, & Izumi, 2010; Kim, 2009; Roustit et al., 2009).

Author Manuscript

However, the primary weakness of these studies is the limited number of childhood adversities measured, which generally included only physical abuse, sexual abuse, and neglect. Recent research has underscored the extent to which childhood adversities co-occur and have synergistic effects in predicting later psychological and behavioral problems (Benjet, Borges, & Medina-Mora, 2010; Dong et al., 2004; Dube, Felitti, Dong, Giles, & Anda, 2003; Kessler, Davis, & Kendler, 1997; Medley & Sachs-Ericsson, 2009; Miller et al., 2011; Turner, Finkelhor, & Ormrod, 2006), including child physical abuse (Ertem et al., 2000). Thus, failure to include a broader range of co-occurring adversities may result in overestimating the effects of childhood physical abuse.

J Fam Violence. Author manuscript; available in PMC 2016 May 01.

Umeda et al.

Page 3

Author Manuscript

Intervening Effect of Mental Disorders and Socioeconomic Status (SES) in Adulthood

Author Manuscript

Mental disorders and low adult socioeconomic status (hereafter, SES) are thought to have intervening effects on the intergenerational continuity of child physical abuse since they have been reported both as consequences of child physical abuse and risk factors for adult perpetration of child physical abuse (Banyard, Williams, & Siegel, 2003; Berlin, Appleyard, & Dodge, 2011; Currie & Widom 2010; Dixon, Browne, & Hamilton-Giachritsis, 2005; Kessler et al., 2010; Lee, Perron, Taylor, & Guterman, 2010; Zielinski, 2009). Empirical studies investigating the effect of mental disorders on the association between childhood physical abuse and adult perpetration of child physical abuse have considered only a limited number of mental disorders (e.g., major depression, PTSD, substance abuse) and found that these disorders partially attenuated the association (Fujiwara et al., 2010; Milner et al., 2010; Pears & Capaldi, 2001). A more exhaustive assessment of mental disorders might identify more powerful intervening effects. Economic deprivation has also been shown to be a strong predictor of child physical abuse (Baumrind, 1994; Jakupčević & Ajduković, 2011; Lee & Goerge, 1999; Sidebotham & Heron, 2006) and is linked with strong intergenerational continuity (Beller & Hout, 2006). However, only a few studies have examined the intervening effect of adult SES on the specific association of childhood physical abuse with adult perpetration of that abuse, and these have been limited by small samples (Haapasalo & Aaltonen, 1999; Slep & O'Leary, 2007). Studies using larger community samples are lacking.

Aim and Hypothesis Author Manuscript Author Manuscript

Additionally, the above studies have largely been limited to North America and Northern Europe; few community-based studies on this topic have been conducted elsewhere including in East Asia (Chiba, 2006; Ma, Chen, Xiao, Wang, & Zhang, 2011). This study aims to extend this line of analysis by adjusting for the effects of a broad array of other CAs and considering the intervening effects of mental disorders and SES. The World Mental Health Japan Survey (WMH-J), a large community-based survey of the prevalence and correlates of mental disorders in Japan, where potentially injurious child physical discipline was assessed retrospectively, was utilized in this analysis (Kawakami et al., 2005). We hypothesized that retrospectively reported childhood physical discipline would be significantly associated with the use of physical discipline in parenthood, and that this association would be attenuated but not entirely explained by other CAs. Secondarily, we hypothesized that this association would be attenuated by the respondents’ own mental disorders and adult household income. Gender differences in these associations were also explored in light of previous findings suggesting that the effects of childhood physical abuse are different for men and women (Cappell & Heiner, 1990; Cullerton-Sen, Cassidy, MurrayClose, Cicchetti, & Crick, 2008; Doumas et al., 1994; Heyman & Slep, 2002; Newcomb et al., 2001).


Umeda et al.

Page 4

Author Manuscript

Method Sample The WMH-J is a cross-sectional survey of the prevalence and correlates of mental disorders that was carried out in collaboration with the World Health Organization (WHO) World Mental Health surveys (WMH) (Kessler & Üstün, 2008). It was implemented between 2002 and 2006 at 11 sites in six prefectures (Kawakami et al., 2005). The selection of survey sites was based on a combination of geographic variation, cooperation of local governments, and availability of site investigators. Survey participants were aged 20 years or older and were randomly selected from voter registration lists or resident registries at each site. Predesignated respondents were excluded from participation if they (1) were deceased or institutionalized, (2) had moved from the survey site, or (3) could not speak Japanese.

Author Manuscript

Data Collection

Author Manuscript

Participants were interviewed face-to-face using the Japanese translation of the WHO Composite International Diagnostic Interview (CIDI), Version 3.0, a fully- structured interview that was developed to make diagnoses in a research setting when administered by trained lay interviewers (Kessler & Üstün, 2004). The interview was administered in two parts utilizing computer-assisted implementation, which controlled skip logic and included built-in consistency checks aimed at minimizing data collection errors. All respondents were administered Part I, which included assessments of core disorders and basic sociodemographic information (n = 4,134, 55.1% response rate). All Part I respondents with a history of any core disorder and a probability sample of 10–20% of other Part I respondents were then administered Part II, which included assessments of disorders of additional interest and potential correlates that included retrospective reports about childhood experiences and reports about adult parenting behaviors (n = 1,682). The Part II data were weighted to adjust for the under-sampling of Part I respondents without a history of core CIDI disorders and post-stratified to adjust for residual discrepancies between the sample and population in a variety of socio-demographic and geographic variables (Kawakami et al., 2005). This report focuses on the subset of respondents in this weighted Part II sample who either had living biological children or living non-biological children whom the respondent had raised for five years or longer. Respondents who either did not have children (n = 364) or did not respond to a question about adult use of child physical discipline (n = 132) were excluded from the analysis. Consequently, the total sample for this analysis was 1,186 respondents.

Author Manuscript

The recruitment and consent procedures were approved by the human subject committees of Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Japan National Center of Neurology and Psychiatry; Nagasaki University Graduate School of Biomedical Sciences; Yamagata University Graduate School of Medical Science; and Juntendo University Graduate School of Medicine.


Umeda et al.

Page 5

Measures

Author Manuscript

Potentially injurious physical descipline in childhood and other CAs— Respondents were asked three parallel questions about how often they had received physical discipline up through age 16. These questions focused on the frequency of (1) pushing, grabbing, or shoving; (2) throwing an object at; and (3) slapping, hitting, or punching, and were developed from the more detailed questions in the Conflict Tactic Scales (CTS) (Straus, 1979). Response options were often, sometimes, rarely, and never. Those who responded with often or sometimes to any of these three questions were coded as having received physical discipline. A separate dichotomous question included in the checklist of traumatic experiences used to assess post-traumatic stress disorder asked respondents if they were ever beaten up by parents or caretakers. A positive response to this question was also used to define the respondent as having experienced childhood physical discipline.

Author Manuscript

A number of other dichotomous measures of CA were also created based on responses to questions in the CIDI: i.

Witnessing inter-parental violence was defined as present if the respondent reported either sometimes or often to witnessing any of the following acts between the parents or caretakers while growing up: slapping, hitting, pushing, grabbing, shoving, or throwing an object at each other.

Author Manuscript

ii. Neglect was defined based on responses to a series of questions developed in the social welfare literature (Courtney, Piliavin, Grogan-Kaylor, & Nesmith, 2001) about being made to do chores that were too difficult or dangerous, being left alone or unsupervised, and not being provided school supplies, meals and/or medical treatment. A dichotomous scoring rule for these responses was based on an analysis of frequency distribution in a previous WMH report (Scott et al., 2008). iii. Childhood sexual abuse was coded as positive based on a scheme developed in a previous WMH report (Scott et al., 2008), using responses to questions about childhood experiences of repeated sexual assault, molestation, or rape.

Author Manuscript

iv. Parental psychopathology when the respondent was a child were assessed using a modified version of the Family History Research Diagnostic Criteria Interview (Andreasen, Endicott, Spitzer, & Winokur, 1977) for parental major depression, generalized anxiety disorder, panic disorder, and substance use disorders. Each type of parental psychopathology was coded as a separate dichotomy. Having any parent with major depression, generalized anxiety disorder, and/or panic disorder was defined as having parental mental disorders. Having any parent with substance use disorders were separately defined as parental substance use disorders. v.

Parental criminal behavior was coded as positive based on respondent reports that one or both of their parents had been involved in property crime or experienced imprisonment.

vi. Parental losses until respondents were 16 years’ old were assessed based on respondent’s reports. Each of the following three types of loss was coded dichotomously: parental death, parental divorce, and any other separation from one


Umeda et al.

Page 6

Author Manuscript

or both parents due to parent’s absence (e.g., hospitalization and desertion) or respondent’s absence (e.g., adoption, boarding school, foster care, and left home before age 16). vii. Life-threatening physical illness during childhood was assessed with a modified version of a standard chronic conditions checklist (Merikangas et al., 2007) that inquired about the lifetime occurrence and first experience of a wide range of lifethreatening illnesses and injuries.

Author Manuscript

viii. Childhood family poverty was defined as present if the respondent either reported that his or her family received money from a governmental assistance program during the respondent’s childhood, or if the male or the female chief breadwinner was absent and the other head of the family did not work throughout most or all of the respondent’s childhood, or if the respondent’s childhood family had neither a male nor female breadwinner. Adult perpetration of potentially injurious physical discipline—Use of potentially injurious physical discipline in adulthood was assessed by responses to the same three questions about frequency of physically aggressive behaviors towards children that were used to assess childhood physical discipline (i.e., frequency of pushing, grabbing, or shoving; throwing an object at; and slapping, hitting, or punching). As with the victimization questions, the perpetration questions asked how frequently the respondent did these things to any of his or her children with the response options of often, sometimes, rarely, and never. A response of either sometimes or often to any of these questions was used to create a dichotomous measure of engaging in potentially injurious physical discipline in adulthood.

Author Manuscript

Respondent’s mental disorders—Lifetime prevalence of common mental disorders was evaluated in a series of fully-structured diagnostic assessments for DSM-IV disorders in the CIDI (Kessler et al., 2004). Thirteen types of mental disorders from four clusters were included: mood disorders cluster (bipolar I and II disorders, major depressive disorder, and dysthymia), anxiety disorders cluster (generalized anxiety disorder, panic disorder, agoraphobia without panic disorder, post-traumatic stress disorder, social phobia, and specific phobia), impulse control disorders cluster (intermittent explosive disorder), and substance abuse cluster (alcohol and drug abuse with or without dependence). Several WMH surveys have determined that the diagnoses of these disorders based on the CIDI have generally good concordance with independent diagnoses based on blinded clinical reappraisal interviews carried out by trained clinical interviewers (Haro et al., 2006)

Author Manuscript

Household income—A standard grid with thirty-six categories was used to assess total household income before taxes in the year of interview. The midpoint of the income range in the selected category was used to assign household income (the lower bound of the highest category, 100,000,000 yen, was equivalent to approximately USD 1,000,000). This quantitative variable was then divided by the number of household members to create a measure of income per family member. This ratio measure was then classified into four categories defined as low (less than 50% of the median value), low-average (50 to 100% of


Umeda et al.

Page 7

Author Manuscript

the median value), high-average (1 to 3 times the median value), and high (more than 3 times the median value). Other socio-demographic variables—Other socio-demographic variables included in the analysis were gender and age at the time of interview (grouped as 20 to 34, 35 to 49, 50 to 64, and 65 years or older). Statistical Analysis

Author Manuscript

Bivariate associations of physical discipline on one’s child in adulthood with each childhood adversity were assessed in cross-tabulations and evaluated for significance with χ2 tests. In addition, logistic regression was used with adjustments for gender and age. Multivariate associations of the full set of childhood adversities with use of physical discipline in adulthood were examined in multiple logistic regression analysis. Logistic regression coefficients and their standard errors were exponentiated and were reported for ease of interpretation as odds ratios (ORs) with 95% confidence intervals (95% CIs). All models were adjusted for gender and age. The additive multivariate effects of all 12 CAs were examined by entering all adversities (Model 1) plus the numbers of CAs (Model 2) in one model. Dummy variables for exactly two to four or more adversities were created in reference to 0 or one adversity, where those who experienced four and more types of CAs were combined into one category because of the small number (weighted prevalence of 0.8%). The ORs for the number of CAs were considered as interactions among the CAs on the premise that all combinations in the same number of adversities were constant (Gustafson, Kazi, & Levy, 2005). A lifetime history of mental disorders (Model 3) plus household income (Model 4) were included as controls in subsequent models. Before entering mental disorders in the model, we preliminarily tested different models for mental disorders predicting adult use of physical discipline to select the best composite set of mental disorders using Akaike Information Criterion (AIC): four clusters of mental disorders, four clusters and number of mental disorders, thirteen types of mental disorders, and thirteen types and number of mental disorders. Since the model including the four clusters was a better fit compared to the other models, we decided to use the four clusters to adjust for mental disorders in the multivariate models (Model 3 & 4). Coefficients in these models were compatible (data are available upon request). Interactions between gender and each CA were then included in the multivariate model (Model 2) that adjusted for the types and number of CAs. A global test was further conducted using the likelihood ratio test to determine whether any gender differences were evident in the effects of the CAs on adult use of physical discipline. Statistical significance was consistently evaluated using 0.05 level two-sided tests and the Taylor series linearization method was applied to estimate designbased standard errors. All analyses were conducted using the SAS® statistical package (SAS Institute, Cary, NC, USA).

Author Manuscript Author Manuscript

Results Prevalence and Socio-Demographic Correlates of Adult Perpetration The reported prevalence of adult use of potentially injurious physical discipline was 9.2%. This prevalence was significantly higher among females (11.9%) than males (5.7%; χ21 =


Umeda et al.

Page 8

Author Manuscript

10.2, p = 0.001), but not significantly associated with the respondent’s age at the time of the interview (χ23 = 5.1, p = 0.164) (Table 1). Prevalence of using physical discipline in adulthood was significantly higher among respondents with a history of mental disorders compared to those without (14.2% vs. 8.1%, χ21 = 9.0, p = 0.003), but did not vary significantly with household income (χ23 = 6.3, p = 0.100). Association of Childhood Adversities with Adult Perpetration Eight out of 12 CAs considered here were positively associated with adult use of physical discipline when examined one at a time using a chi-squared test (Table 2). Inspection of bivariate associations adjusting for gender and age revealed that six of the 12 associations were statistically significant, and that the strongest OR was observed for childhood physical discipline (4.85). The number of CAs was also associated with adult use of potentially injurious physical discipline, with increasing ORs as the number of CAs increased.

Author Manuscript

All 12 ORs were reduced in size in a multivariate model that included all the adversities as predictors (Table 3, Model 1). Childhood physical discipline was the only adversity that remained statistically significant in this model, with an OR of 4.09. Adding the number of CAs slightly increased the OR for childhood physical discipline to 4.84. The OR did not change substantially when mental disorders were included (4.86) (Model 3). The OR increased to 5.50 when a control was introduced for adult household income (Model 4). Among the controls, only the lifetime history of substance abuse cluster (Model 3 & 4) and being in the lowest income stratum (Model 4) had significant associations with adult engagement in potentially injurious physical discipline (data are available upon request). Using a different set of control variables for mental disorders, i.e., cluster and number, type, or type and number of mental disorders, yielded almost identical results.

Author Manuscript

Gender Differences No gender difference was found in the association of childhood physical discipline with adult use of physical discipline (p = 0.892). Childhood neglect showed a significantly greater association with use of physical discipline among men than women (OR = 25.8; 95% CI = 1.9–353.2, p = 0.015). A global test for gender differences in the effects of CAs on adult use of physical discipline shows that the vector of ORs for the adversities did not differ significantly for men compared to women (χ211 = 9.6, p = 0.565).

Discussion

Author Manuscript

This study examined the associations between childhood physical discipline and adult use of potentially injurious physical discipline against one’s child using a community sample from Japan. Consistent with our expectation, potentially injurious childhood physical discipline had a strong and independent association with adult perpetration compared to all other CAs examined. Our results provide empirical support consistent with the intergenerational continuity of child physical abuse, replicating findings from previous studies (Coohey et al, 1997; Doumas et al., 1994; Fujiwara et al., 2010; Gage et al., 2010; Haapasalo et al., 1999; Kim, 2009; Milner et al., 2010), but also expanding them with the advantage of having more extensive controls for other CAs, lifetime mental disorders, and adult household income.


Umeda et al.

Page 9


Among the 12 CAs examined, childhood physical discipline was the only one that remained significant in a multivariate model that examined the joint associations of all the adversities with adult perpetration. The link connecting childhood physical discipline to adult use of physical discipline appears to be specific. The observed association is consistent with the possibility that the use of violence as a means of childrearing would increase the likelihood of engaging in potentially injurious physical discipline among one’s offspring. Learning and approval of a violent parenting style, together with attachment disruption caused by direct aggression and hostility towards children, are plausible causal pathways for the association (Deater-Deckard, Lanford, Dodge, Pettit, & Bates, 2003; Dodge, Pettit, Bates, & Valente, 1995; Lee & Hoaken, 2007; Montes, de Paúl, & Milner, 2001; Muller et al., 1995; Slep et al., 2007). On the other hand, a considerable decrease in the ORs of other CAs (i.e., interparental violence, neglect, parental mental disorders, parental criminal behavior, and poverty) or the number of CAs in the multiple logistic regression analysis suggests that these adversities are associated with physical discipline of one’s own child through or in combination with other adversities, rather than independently.

Author Manuscript

The association between potentially injurious childhood physical discipline and the adult use of such discipline was independent of one’s own mental disorders and adult household income. In contrast to our hypothesis, the intervening effects of mental disorders and household income were limited in magnitude, with a negligible negative indirect effect through mental disorders and a small negative indirect effect through household income. This result contradicts findings from previous studies where mental disorders partially attenuated the association between childhood physical abuse and adult perpetration of child physical abuse (Fujiwara et al., 2010; Medley et al., 2009; Milner et al., 2010; Pears et al., 2001). A longitudinal study in UK found that the presence of antenatal depressions was a key determinant of intergenerational transmission of child maltreatment (Plant et al., 2013). However, this study did not investigate the specific effect of childhood physical abuse on future perpetration of child physical abuse. Further studies are needed to identify the intervening effect of mental disorders on the intergenerational continuity specific to child physical abuse and to see if the intervening effect would be consistently observed in different socio-cultural settings.

Author Manuscript

The negative indirect effect through household income may be due to the fact that childhood physical discipline was associated with decreased odds of being in the lowest household income stratum in adulthood in the current sample, although not significantly (data are available upon request). This created an indirect effect that reduces the odds of adult use of physical discipline on one’s child. However the reason for this negative indirect effect could not be determined by the current study. In the absence of a protective effect from household income, the effect of childhood physical discipline on the adult use of physical discipline may be even higher than it is (Black, Heyman, & Slep, 2001), leading to the increased OR of childhood physical discipline with adult perpetration when adult household income was controlled. No gender differences were found in the association of potentially injurious childhood physical discipline with the adult use of physical discipline. The global test also indicated that the effects of CAs as a whole did not significantly differ between genders. Replications


Umeda et al.

Page 10

Author Manuscript

are needed in other studies to determine how stable these patterns are; this would further address the fact, noted by others, that a shortage exists in research on gender differences in the long-term effects of childhood physical abuse on one’s parenting behaviors in adulthood (Gershoff, 2002). Limitations

Author Manuscript

The following issues need to be addressed in the interpretation of our findings. First, the absence of significant independent associations between many of the CAs may be because of the frequent co-occurrence of CAs (Appendix), especially in the case of witnessing interparental violence, which was a possible independent risk factor for physical abuse perpetration in previous studies (Herrenkohl, Sousa, Tajima, Herrenkohl, & Moylan, 2008; Heyman & Slep, 2002; Jouriles, McDonald, Slep, Heyman, & Garrido et al., 2008). Our post hoc analysis did not find any significant interactions of childhood physical discipline and other CAs in the association of childhood physical discipline and the physical discipline of one’s child in adulthood (data are available upon request). It is possible that the strong regulatory force of a group over individuals and the intensive support from extended family, neighbors, and teachers in Japanese society may alleviate the negative impact of other childhood adversities on one’s parenting behaviors in later life (Yamamura, 2011).

Author Manuscript

Second, the potentially injurious physical discipline measured in this study included corporal punishment that is not necessarily defined as child physical abuse in the Japanese legal context. This difference needs to be addressed in the interpretation and application of our results because those who employed physical violence to the extent that it caused actual injury may have different risk factors and mechanisms associated with doing so compared to those who used violence but did not injure children. The Child Abuse Prevention Act defines child physical abuse as a type of violence that actually or potentially causes injury to children, and the mere use of physical force is not legally prohibited in Japan. We were not able to distinguish legally defined child physical abuse from corporal punishment because the WMH survey did not measure actual injury or threat of injury resulting from aggressive acts by parents. However, we believe that the inclusion of corporal punishment in our analysis will address the importance of avoiding the use of physical violence as a means of parenting because reducing the use of any violence in parenting eventually results in reducing the risk of child physical abuse that is severe enough to cause injury to children (Straus, 2000).

Author Manuscript

Third, the social approval of child physical discipline in Japan may have strengthened the intergenerational continuity of potentially injurious physical discipline. Sixty five % of parents believed that corporal punishment is a necessary part of childrearing (Iwai, 2010), and no law protects children from corporal punishment unless it actually or potentially causes injury in Japan. This social background may have contributed to justifying violence by parents, and transfer the use of violence in parenting from generation to generation. Replicating these studies in a cross-national setting will expand our knowledge on how cultural and social systems affect the intergenerational continuity of physical abuse/ discipline.


Umeda et al.

Page 11

Author Manuscript

Forth, in this cross-sectional study, the measurement of both CAs and adult use of physical discipline relied on the retrospective reporting of the incidents by respondents. It was likely that recall errors and unwillingness to disclose adverse experiences may have resulted in underestimating the prevalence (Fisher, Bunn, Jacobs, Moran, & Bifulco, 2011; Shaffer, Huston, & Egeland, 2008; Widom & Shepard, 1996). For example, sexual abuse is often underreported by Japanese respondents due to the stigma and embarrassment attached to sexual victimization (Dussich, 2001). If that is a case, the impact of childhood sexual abuse on the adult use of potentially injurious physical discipline may be underestimated.

Author Manuscript

Fifth, we did not measure the timing of the CAs. The absence of this information may have resulted in underestimating the associations because the age of the children at the time of the adversities most likely affects the consequences of these adversities (Gershoff, 2002; Milner et al., 1990). Sixth, while we included a lifetime history of the respondents’ common mental disorders and their household income at the time of survey, this would not accurately reflect the state of their mental health and economic conditions at the time they used physical force against their children. This choice was made at the risk of underestimating their intervening effect because we were not able to identify the timing of adulthood perpetration of child physical abuse. Future studies using a larger study sample, multiple sources of information, and a prospective study design are needed to address these limitations.

Conclusion

Author Manuscript

This study adds to the growing body of evidence that childhood physical discipline is a strong and consistent risk factor for the use of physical force against children in one’s parenting in Japan, even after adjusting for multiple co-occurring childhood adversities, adult mental disorders and socioeconomic disadvantage. It is necessary to acknowledge that in our sample 75% of the respondents who experienced physical discipline during childhood did not use potentially injurious physical force on their offspring (Table 2). However, our findings underscore that the use of physical force in parenting is likely to increase the risk of child physical abuse in the succeeding generations. They further support the assessment that physically abused children should be highly prioritized targets for care and support to prevent child physical abuse in subsequent generations.

Author Manuscript

In Japan, the care provided to abused children in social services is significantly less comprehensive compared to that in other countries. For example, the number of pediatric social workers is approximately one-fifth of that in Korea, NZ, US and Canada (Saimura, 2011), and most children in the child protection system are institutionalized in large facilities with over 50 children (Ministry of Health, Labor and Welfare, 2013). The lack of resources for abused children should be addressed and overcome so that child physical abuse can be prevented in successive generations. Future research needs to incorporate extended mediating factors over the life course to elucidate mechanisms involved and to develop effective prevention strategies.

Acknowledgements The WMH-J 2002–2006 Survey Group members other than those listed in the author byline are as follows: Yutaka Ono, MD (Health Center, Keio University), Yoshibumi Nakane, MD (Division of Human Sociology, Nagasaki


Umeda et al.

Page 12

Author Manuscript

International University Graduate School), Yoshikazu Nakamura, MD, MPH, FFPH (Department of Public Health, Jichi Medical School), Akira Fukao, MD (Department of Public Health, Yamagata University, Graduate School of Medical Science), Itsuko Horiguchi, PhD (Department of Public Health, Juntendo University Graduate School of Medicine), Hisateru Tachimori, PhD (National Institute of Mental Health, National Center of Neurology and Psychiatry), Noboru Iwata, PhD (Department of Clinical Psychology, Hiroshima International University), Hidenori Uda, MD (Director General of the Health, Social Welfare, and Environmental Department, Osumi Regional Promotion Bureau, Kagoshima Prefecture), Hideyuki Nakane, MD (Division of Neuropsychiatry, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences), Makoto Watanabe, MD, PhD (Department of Preventive Cardiology, National Cardiovascular Center), Masashi Oorui, MD (Yamagata Prefectural Tsuruoka Hospital), Kazushi Funayama, MD, PhD (Yokohama City Turumi Public Health and Welfare Center), Yoichi Naganuma, PSW, MSc (National Institute of Mental Health, National Center of Neurology and Psychiatry), Toshiaki A. Furukawa, MD (Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine), Yukihiro Hata, MD (Department of Psychiatry, Field of Social and Behavioral Medicine, Kagoshima University Graduate School of Medical and Dental Sciences), Masayo Kobayashi, MD (Department of Public Health, Jichi Medical School), Tadayuki Ahiko, MD (Murayama Public Health Center, Yamagata Prefecture), Yuko Yamamoto, PhD (Department of Public Health, Juntendo University Graduate School of Medicine), Tadashi Takeshima, MD (National Institute of Mental Health, National Center of Neurology and Psychiatry), Takehiko Kikkawa, MD (Department of Human Well-being, Chubu Gakuin University).

Author Manuscript

The study was supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health from the Japan Ministry of Health, Labour, and Welfare (H13-SHOGAI-023, H14-TOKUBETSU-026, H16KOKORO-013, H19-KOKORO-IPPAN-011). We would like to thank staff members, filed coordinators, and interviewers of the WMH Japan 2002–2006 Survey. The WMH Japan 2002–2006 Survey was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We also thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. These activities were supported by the US National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R01-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/publications.php

Reference


Akmatov MK. Child abuse in 28 developing and transitional countries─Results from the Multiple Indicator Cluster Surveys. International Journal of Epidemiology. 2011; 40:219–227. [PubMed: 20943933] Andreasen NC, Endicott J, Spitzer RL, Winokur G. The family history method using diagnostic criteria. Reliability and validity. Archives of General Psychiatry. 1977; 34(10):1229–1235. [PubMed: 911222] Banyard VL, Williams LM, Siegel JA. The Impact of Complex Trauma and Depression on Parenting: An Exploration of Mediating Risk and Protective Factors. Child Maltreatment. 2003; 8(4):334–349. [PubMed: 14604179] Baumrind D. The social context of child maltreatment. Family Relations. 1994; 43(4):360–360. Beller E, Hout M. Intergenerational social mobility: The United States in comparative perspective. The Future of Children. 2006; 16(2):19–26. [PubMed: 17036544] Belsky J. Etiology of child maltreatment: A developmental-ecological analysis. Psychological Bulletin. 1993; 114(3):413–434. [PubMed: 8272464] Benjet C, Borges G, Medina-Mora ME. Chronic childhood adversity and onset of psychopathology during three life stages: Childhood, adolescence and adulthood. Journal of Psychiatric Research. 2010; 44(11):732–740. [PubMed: 20144464] Berlin LJ, Appleyard K, Dodge KA. Intergenerational Continuity in Child Maltreatment: Mediating Mechanisms and Implications for Prevention. Child Development. 2011; 82(1):162–176. [PubMed: 21291435] Black DA, Heyman RE, Slep AMS. Risk factors for child physical abuse. Aggression and Violence Behavior. 2001; 6:121–188. Cappell C, Heiner RB. The ingergenerational transmission of family aggression. Journal of Family Violence. 1990; 5(2):135–152.


Umeda et al.

Page 13

Author Manuscript Author Manuscript Author Manuscript Author Manuscript

Chiba H. Child maltreatment and its correlates among general population in Chiba (Chiba-ken no Ippan Jinkou ni okeru Oya kara Ko eno Futekisetsu na Kakawari no Jittai to sono Youin Bunseki). Syukutoku Shinri Kenkyu. 2006; 3:19–26. [in Japanese]. Cicchetti D, Toth SL. Child Maltreatment. Annual Review of Clinical Psychology. 2005; 1(1):409– 438. Coohey C, Braun N. Toward an integrated framework for understanding child physical abuse. Child Abuse & Neglect. 1997; 21(11):1081–1094. [PubMed: 9422828] Coulton CJ, Crampton DS, Irwin M, Spilsbury JC, Korbin JE. How neighborhoods influence child maltreatment: A review of the literature and alternative pathways. Child Abuse & Neglect. 2007; 31:1117–1142. [PubMed: 18023868] Courtney ME, Piliavin I, Grogan-Kaylor A, Nesmith A. Foster youth transitions to adulthood: A longitudinal view of youth leaving care. Child Welfare. 2001; 80(6):685–717. [PubMed: 11817658] Currie J, Widom CS. Long-Term Consequences of Child Abuse and Neglect on Adult Economic WellBeing. Child Maltreatment. 2010; 15(2):111–120. [PubMed: 20425881] Cullerton-Sen C, Cassidy AR, Murray-Close D, Cicchetti D, Crick NR. Childhood maltreatment and the development of relational and physical aggression: The importance of a gender-informed approach. Child Development. 2008; 79(6):1736–1751. [PubMed: 19037946] Dearter-Deckard K, Lanford JE, Dodge KA, Pettit GS, Bates JE. The development of attitudes about physical punishment: An 8-year longitudinal study. Journal of Family Psychology. 2003; 17(3): 351–360. [PubMed: 14562459] Dixon L, Browne K, Hamilton-Giachritsis C. Risk factors of parents abused as children: A mediational analysis of the intergenerational continuity of child maltreatment (Part I). Journal of Child Psychology and Psychiatry. 2005; 46(1):47–57. [PubMed: 15660643] Dodge KA, Pettit GS, Bates JE, Valente E. Social information-processing patterns partially mediate the effect of early physical abuse on later conduct problems. J Abnorm Psychol. 1995; 104(4): 632–643. [PubMed: 8530766] Dong M, Anda RF, Felitti VJ, Dube SR, Williamson DF, Thompson TJ, Giles WH. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect. 2004; 28(7):771–784. [PubMed: 15261471] Doumas D, Margolin G, John RS. The intergenerational transmission of aggression across three generations. Journal of Family Violence. 1994; 9(2):157–175. Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The impact of adverse childhood experiences on health problems: Evidence from four birth cohorts dating back to 1900. Preventive Medicine. 2003; 37(3):268–277. [PubMed: 12914833] Durrant JE. Physical punishment, culture, and rights: current issues for professionals. Journal of Developmental and Behavioral Pediatrics. 2008; 29:55–66. [PubMed: 18300726] Dussich J. Decisions not to report sexual assault: a comparative study among women living in Japan who are Japanese, Korean, Chinese, and English-Speaking. International Journal of Offender Therapy and Comparative Criminology. 2001; 45:278–301. Ertem IO, Leventhal JM, Dobbs S. Intergenerational continuity of child physical abuse: How good is the evidence? The Lancet. 2000; 356(9232):814–819. Ferrari AM. The impact of culture upon child rearing practices and definitions of maltreatment. Child Abuse & Neglect. 2002; 26(8):793–813. [PubMed: 12363332] Fisher HL, Bunn A, Jacobs C, Moran P, Bifulco A. Concordance between mother and offspring retrospective reports of childhood adversity. Child Abuse & Neglect. 2011; 35:117–122. [PubMed: 21354622] Fujiwara T, Kawakami N. World Mental Health Japan Survey Group. Association of childhood adversities with the first onset of mental disorders in Japan: Results from the World Mental Health Japan, 2002–2004. J Psychiatr Res. 2011; 45(4):481–487. [PubMed: 20728903] Fujiwara T, Okuyama M, Izumi M. The cycle of violence: childhood abuse history, domestic violence and child maltreatment among Japanese mothers. Psychologia. 2010; 53(4):211–224. Gage A, Silvestre EA. Maternal violence, victimization, and child physical punishment in Peru. Child Abuse & Neglect. 2010; 34(7):523–533. [PubMed: 20605631] J Fam Violence. Author manuscript; available in PMC 2016 May 01.

Umeda et al.

Page 14


Gershoff ET. Corporal punishment by parents and associated child behaviors and experiences: A metaanalytic and theoretical review. Psychol Bull. 2002; 128(4):539–579. [PubMed: 12081081] Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009; 373(9657):68–81. [PubMed: 19056114] Gracia E, Herrero J. Beliefs in the necessity of corporal punishment of children and public perceptions of child physical abuse as a social problem. Child Abuse & Neglect. 2008; 32:1058–1062. [PubMed: 19027163] Gustafson P, Kazi AM, Levy AR. Extending logistic regression tomodel diffuse interactions. Statistics in Medicine. 2005; 24:2089–2104. [PubMed: 15887285] Haapasalo J, Aaltonen T. Mothers' abusive childhood predicts child abuse. Child Abuse Review. 1999; 8(4):231–250. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Kessler RC. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research. 2006; 15(4):167–180. [PubMed: 17266013] Herrenkohl TI, Sousa C, Tajima EA, Herrenkohl RC, Moylan CA. Intersection of child abuse and children's exposure to domestic violence. Trauma Violence Abuse. 2008; 9(2):84–99. [PubMed: 18296571] Heyman RE, Slep AMS. Do Child Abuse and Interparental Violence Lead to Adulthood Family Violence? Journal of Marriage and Family. 2002; 64(4):864–870. Iwai H. Social tolerance for the use of physical punishment by parents: An analysis of attitude toward physical punishment using JGSS-2008. JGSS Research Series. 2010; 10:49–59. [in Japanese]. Jakupčević KK, Ajduković M. Risk factors of child physical abuse by parents with mixed anxietydepressive disorder or posttraumatic stress disorder. The Croatian Medical Journal. 2011; 52(1): 25–34. [PubMed: 21328717] Jouriles EN, McDonald R, Slep AMS, Heyman RE, Garrido E. Child abuse in the context of domestic violence: Prevalence, explanations, and practice implications. Violence and Victims. 2008; 23(2): 221–235. [PubMed: 18624091] Kaufman J, Zigler E. Do abused children become abusive parents? American Journal of Orthopsychiatry. 1987; 57(2):186–192. [PubMed: 3296775] Kawakami N, Takeshima T, Ono Y, Uda H, Hata Y, Nakane Y, Kikkawa T. Twelve-month prevalence, severity, and treatment of common mental disorders in communities in Japan: Preliminary finding from the World Mental Health Japan Survey 2002–2003. Psychiatry and Clinical Neurosciences. 2005; 59(4):441–452. [PubMed: 16048450] Kessler RC, Davis CG, Kendler KS. Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine. 1997; 27(5):1101–1119. [PubMed: 9300515] Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Williams DR. Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. The British Journal of Psychiatry. 2010; 197(5):378–385. [PubMed: 21037215] Kessler RC, Üstün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research. 2004; 13(2):93–121. [PubMed: 15297906] Kessler, R.; Üstün, TB. The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. Cambridge: Cambridge University Press; 2008. Kim J. Type-specific intergenerational trasmission of neglectful and physically abusive parenting behaviors among young parents. Children and Youth Services Review. 2009; 31:761–767. Lee BJ, Goerge RM. Poverty, early childbearing, and child maltreatment: A multinomial analysis. Children and Youth Services Review. 1999; 21(9–10):755–780. Lee SJ, Perron BE, Taylor CA, Guterman NB. Paternal psychosocial characteristics and corporal punishment of their 3-year-old children. Journal of Interpersonal Violence. 2010; 26(1):71–87. [PubMed: 20522884] Lee V, Hoaken PN. Cognition, emotion, and neurobiological development: mediating the relation between maltreatment and aggression. Child Maltreat. 2007; 12(3):281–298. [PubMed: 17631627] J Fam Violence. Author manuscript; available in PMC 2016 May 01.

Umeda et al.

Page 15


Ma Y, Chen J, Xiao W, Wang F, Zhang M. Parent's self-reporting of child physical maltreatment in Yuncheng City, China. Child Abuse & Neglect. 2011; 35(8):592–600. [PubMed: 21871663] Malinosky-Rummell R, Hansen DJ. Long-term consequences of childhood physical abuse. Psychological Bulletin. 1993; 114(1):68–79. [PubMed: 8346329] Medley A, Sachs-Ericsson N. Predictors of parental physical abuse: The contribution of internalizing and externalizing disorders and childhood experiences of abuse. Journal of Affective Disorders. 2009; 113:244–254. [PubMed: 18603302] Merikangas KR, Ames M, Cui L, Stang PE, Üstün TB, Von Korff M, Kessler RC. The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Archives of General Psychiatry. 2007; 64(10):1180–1188. [PubMed: 17909130] Miller E, Breslau J, Chung WJ, Green JG, McLaughlin KA, Kessler RC. Adverse childhood experiences and risk of physical violence in adolescent dating relationships. Journal of Epidemiology and Community Health. 2011; 65(11):1006–1013. [PubMed: 21321063] Milner JS, Robertson KR, Rogers DL. Childhood history of abuse and adult child abuse potential. Journal of Family Violence. 1990; 5(1):15–34. Milner JS, Thomsen CJ, Crouch JL, Rabenhorst MM, Martens PM, Dyslin CW, Merrill LL. Do trauma symptoms mediate the relationship between childhood physical abuse and adult child abuse risk? Child Abuse & Neglect. 2010; 34(5):332–344. [PubMed: 20359748] Ministry of Health, Labor and Welfare Japan. Investigation of murdered cases by child maltreatment (the 7th report) and the responses to report of child maltreatment (Kodomo Gyakutai ni yoru Shibou Jireitou no Kensyo Kekka (Dai7ji Houkoku Gaiyou) oyobi Jidou Gyakutai Soudan Taiou Kensutou). 2011. Retrieved November, 27, 2011, from http://www.mhlw.go.jp/stf/houdou/ 2r9852000001jiq1.html [in Japanese] Ministry of Health, Labor and Welfare Japan. Social care services for children: Reference material (Syakaitekiyougo no genjyo ni tsuite: sankoshiryou). 2013. Retrieved August, 6, 2013, from http:// www.mhlw.go.jp/bunya/kodomo/syakaiteki_yougo/dl/yougo_genjou_01.pdf [in Japanese] Montes MP, de Paúl J, Milner JS. Evaluations, attributions, affect, and disciplinary choices in mothers at high and low risk for child physical abuse. Child Abuse and Neglect. 2001; 25(8):1015–1036. [PubMed: 11601595] Muller RT. Family Aggressiveness Factors in the Prediction of Corporal Punishment: Reciprocal Effects and the Impact of Observer Perspective. Journal of Family Psychology. 1996; 10(4):474– 489. Muller RT, Hunter JE, Stollak G. The intergenerational transmission of corporal punishment: A comparison of social learning and temperament models. Child Abuse & Neglect. 1995; 19(11): 1323–1335. [PubMed: 8591089] Newcomb MD, Locke TF. Intergenerational cycle of maltreatment: A popular concept obscured by methodological limitations. Child Abuse & Neglect. 2001; 25:1219–1240. [PubMed: 11700694] Pears KC, Capaldi DM. Intergenerational transmission of abuse: A two-generational prospective study of an at-risk sample. Child Abuse & Neglect. 2001; 25(11):1439–1461. [PubMed: 11766010] Plant DT, Barker ED, Waters CS, Pawlby S, Pariante CM. Intergenerational transmission of maltreatment and psychopathology: The role of antenatal depression. Psychological Medicine. 2013; 43:519–528. [PubMed: 22694795] Renner LM, Slack KS. Intimate partner violence and child maltreatment: Understanding intra- and intergenerational connections. Child Abuse & Neglect. 2006; 30(6):599–617. [PubMed: 16782195] Roustit C, Renahy E, Guernec G, Lesieur S, Parizot I, Chauvin P. Exposure to interparental violence and psychosocial maladjustment in the adult life course: Advocacy for early prevention. Journal of Epidemiology and Community Health. 2009; 63(7):563–568. [PubMed: 19477880] Saimura J. Systems for child abuse prevention and the challenges (Kodomo gyakutai boushiseido no genjyo to kadai). Judicial Scrivener. 2011; 467:10–15. [in Japanese]. Scott KM, Von Korff M, Alonso J, Angermeyer MC, Benjet C, Bruffaerts R, Posada-Villa J. Childhood adversity, early-onset depressive/anxiety disorders, and adult-onset asthma. Psychosomatic Medicine. 2008; 70(9):1035–1043. [PubMed: 18941133]


Umeda et al.

Page 16


Shaffer A, Huston L, Egeland B. Identification of child maltreatment using prospective and self-report methodologies: A comparison of maltreatment incidence and relation to later psychopathology. Child Abuse & Neglect. 2008; 32(7):682–692. [PubMed: 18638626] Sidebotham P, Heron J. Child maltreatment in the "children of the nineties": A cohort study of risk factors. Child Abuse & Neglect. 2006; 30(5):497–522. [PubMed: 16701895] Slep AMS, O'Leary SG. Multivariate models of mothers' and fathers' aggression toward their children. Journal of Consulting and Clinical Psychology. 2007; 75(5):739–751. [PubMed: 17907856] Straus MA. Measuring intrafamily conflict and violence: The Conflict Tactics (CT) Scales. Journal of Marriage and the Family. 1979; 41:75–88. Straus MA. Corporal Punishment and primary prevention of physical abuse. Child Abuse & Neglect. 2000; 24(9):1109–1114. [PubMed: 11057699] Straus, MA.; Gelles, RJ.; Smith, C. Physical violence in American families: Risk factors and adaptations to violence in 8,145 families. New Brunswick, NJ: Transaction Publishers; 1990. Turner HA, Finkelhor D, Ormrod R. The effect of lifetime victimization on the mental health of children and adolescents. Social Science & Medicine. 2006; 62(1):13–27. [PubMed: 16002198] Widom CS, Shepard RL. Accuracy of adult recollections of childhood victimization: Part 1. Childhood physical abuse. Psychological Assessment. 1996; 8(4):412–421. Wong WCW, Chen WQ, Goggins WB, Tang CS, Leung PW. Individual, familial and community determinants of child physical abuse among high-school students in China. Social Science & Medicine. 2009; 68:1819–1825. [PubMed: 19344989] Yamamura E. The role of social trust in reducing long-term truancy and forming human capital in Japan. Economics of Education Review. 2011; 30(2):380–389. Zielinski DS. Child maltreatment and adult socioeconomic well-being. Child Abuse & Neglect. 2009; 33(10):666–678. [PubMed: 19811826]

Appendix A. Association among 12 childhood adversities: estimated odds ratios (ORs) and 95% confidence intervals (CIs) Author Manuscript Author Manuscript J Fam Violence. Author manuscript; available in PMC 2016 May 01.

J Fam Violence. Author manuscript; available in PMC 2016 May 01. (0.0 – 3.0) -

32.5* (4.3 – 246.3)

(6.7 – 138.4)

Significant at the 0.05 level, two-sided.

*

9.5*

0.1*

(4.6 – 63.7) 2.3 (0.5 – 9.9)

(5.2 – 64.4) 1.5 (0.3 – 6.6)

(1.5 – 39.2)

(0.8 – 12.6)

3.1

17.0*

18.2*

(2.7 – 33.1)

(1.7 – 86.1)

(1.8 – 68.3)

11.9*

(0.7 – 46.7)

5.6

(2.0 – 9.9)

4.5*

(0.0 – 0.5)

2.5

-

4.9 (0.9 – 26.6)

7.6*

(1.6 – 86.7)

(2.7 – 318.7)

-

10.9*

(1.5 – 85.8)

11.4*

(0.3 – 14.6)

2.1

-

-

(0.7 – 22.2)

4.0

(0.4 – 12.3)

2.3

(1.5 – 9.0)

3.7*

OR (95% CI)

Poverty

(1.0 – 6.5)

11.7*

-

(0.3 – 23.5)

29.2*

2.5

(0.4 – 3.2)

1.1

-

-

(0.6 – 7.1)

2.1

(0.2 – 31.3)

2.4

(2.7 – 95.4)

16.1*

3.8 (0.7 – 19.2)

3.0* (1.1 – 8.1)

(2.5 – 14.1)

5.9*

(0.5 – 7.3)

2.0

OR (95% CI)

Physical illness

(0.2 – 10.0)

1.5

(0.7 – 3.7)

1.7

OR (95% CI)

Other parental loss

(0.6 – 66.6)

6.5

(1.9 – 48.1)

9.5*

(1.2 – 12.8)

3.9*

OR (95% CI)

Parental divorce

-

0.4

-

30.4*

-

-

(2.2 – 21.0)

6.8

(0.2 – 3.4)

0.7

(0.9 – 4.6)

2.0

OR (95% CI)

Parental death

(0.5 – 59.1)

5.6

-

-

(14.9 – 144.2)

46.4*

(5.7 – 61.2)

18.7*

OR (95% CI)

Parental criminality

-

-

13.6 (3.0 – 62.2)

(0.9 – 72.7)

8.2

(8.5 – 167.3)

37.7*

(1.4 – 26.4)

6.0*

OR (95% CI)

(0.6 – 16.0)

3.2

-

(4.4 – 24.1)

(1.9 – 29.0)

10.3*

(1.2 – 6.3)

(4.0 – 55.3)

(1.5 – 38.2)

2.7*

7.4*

(4.0 – 21.4)

(8.3 – 43.6)

7.5*

OR (95% CI)

14.9*

9.3*

19.0*

OR (95% CI)

Parental Substance

The OR and 95%CI were calculated, adjusted for gender and age, with those who did not have the adversity as a reference group.

a

Physical Illness

Other parental Loss

Parental divorce

Parental death


Parental substance

Parental mental disorders

Sexual abuse

Neglect

Interparental violence

Physical Discipline

Dependent variables

OR (95% CI)

Author Manuscript

OR (95% CI)

Parental mental disorders

Author Manuscript Sexual abuse

Author Manuscript

Neglect

Author Manuscript

Interparental violencea

Umeda et al. Page 17

Author Manuscript

Author Manuscript

Author Manuscript

J Fam Violence. Author manuscript; available in PMC 2016 May 01. 56.5

259.5 388.7 386.2

    35–49

    50–64

    ≧65

921.9

    None

81.4

18.6

34.1

34.3

22.9

8.7

74.3

29.8

25.9

33.4

30.7

14.2

8.1

14.2

6.7

8.6

11.8

14.4

11.9

5.7

9.2

Weighted prevalenceb %

292.3 305.7 281.6

    Low-Average

    High-Average

    High

25.3

27.5

26.3

20.9

23.2

22.6

26.1

31.2

8.3

7.4

8.9

13.4

6.3

9.0*

5.1

10.2*

χ2c

Row % (Percentage of respondents who had used physical discipline to the total sample of each demographic variable).

Column % (Percentage of each demographic category to the total sample).

233.0

    Low

Household Income (yen) : Median = 2,757,646, Mean = 3,726,783, SD = 4,678,916

210.6

    Any

Common mental disorders in lifetime

98.1

    20–34

75.9

28.2

104.1

Weighted n

Adult use of physical discipline (Crude N = 140)


*

Significance of the difference in demographic variables between those with and without adult use of physical discipline using a Rao-Scott chi-squared test.

c

b

a

639.9

    Female

43.5

(100)

Weighteda %

Age at survey (years) : Mean = 56.9, SD=14.2

492.6

1132.5

    Male

Gender

Total

Weighted n

Total sample (Crude N = 1,186)

Sample characteristics and prevalence of potentially injurious physical discipline of one’s child in adulthood

Author Manuscript

Table 1 Umeda et al. Page 18

Author Manuscript

Author Manuscript

Author Manuscript

J Fam Violence. Author manuscript; available in PMC 2016 May 01. 23.7 (11.0) 23.4 (12.1) 23.0 (7.7) 34.7 (18.5) 28.1 (14.2) 11.6 (4.8) 27.2 (13.6) 9.8 (2.9) 14.0 (8.5) 22.5 (7.3)

    Neglect

    Sexual abuse

    Parent mental disorder

    Parental substance abuse


    Parental death

    Parental divorce

    Other parental loss

    Physical illness

    Poverty

14.5 (3.6) 20.8 (4.9) 29.2 (9.9) 38.8 (20.6) 17.1 (3.4)

    1

    2

    3

    4+

    Anyd

15.3*

3.22

11.26

6.79

3.70

2.69

1

2.73

32.4*

1.86

8.7*

1.27

0.5

0.1

3.10

3.94

5.2*

4.3*

5.95

5.5*

1.58

2.90

0.3

2.18

3.71

3.9*

8.1*

3.69

17.5*

3.0

4.85

ORb

26.0*

χ2

(1.80–5.76)

(1.42–89.30)

(2.79–16.55)

(1.78–7.70)

(1.37–5.28)

(1.30–5.75)

(0.41–8.43)

(0.67–2.40)

(0.77–12.56)

(0.52–4.76)

(1.12–13.94)

(0.78–45.21)

(1.16–7.24)

(0.52–9.12)

(1.10–12.54)

(1.66–8.20)

(2.54–9.24)

(95% CI)

Row % (Percentage of respondents who had used physical discipline to the subsample of with/without the childhood adversity).

6.4 (0.9)

    0

8.8 (1.1)

9.0 (1.1)

9.2 (1.1)

9.0 (1.1)

9.1 (1.2)

9.1 (1.1)

9.0 (1.1)

8.8 (1.1)

9.1 (1.1)

9.0 (1.1)

8.6 (1.1)

7.5 (0.8)

Without childhood adversity (weighted n = 838.5)

One adversity was examined at the time, adjusted for gender and age (those who did not experience the childhood adversity as a reference group). For χ2, DF=1.

b

a

27.7 (7.4)


Number of childhood adversitiesc

25.1 (6.0)

    Physical discipline

Types of childhood adversityb

With childhood adversity (weighted n = 294.0)

Adult use of physical discipline Weighted prevalencea % (SE)

Bivariate association of adult use of potentially injurious physical discipline with childhood adversities

Author Manuscript


Author Manuscript

Author Manuscript

Author Manuscript

The model was estimated using a dummy predictor for any experience of childhood adversities, adjusted for gender and age, without any information about the types of adversities (None as a reference


*

group). For χ2, DF=1.

d

The model was estimated using dummy predictors for number of childhood adversities, adjusted for gender and age, without any information about the types of adversities (0 as a reference group). For χ2, DF=4.

Author Manuscript

c

Umeda et al. Page 20


Author Manuscript

Author Manuscript

Author Manuscript 0.82 1.96 2.39 1.15 1.49 1.67 0.95 1.19 1.76

Parental mental disorder

Parental substance use


Parental death

Parental divorce

Other parental loss

Physical illness

Poverty

(0.25–8.78)

(0.54–5.80)

(0.31–4.55)

(0.40–2.24)

(0.23–12.14)

(0.44–5.04)

(0.21–6.43)

(0.48–11.98)

(0.97–3.94)

(0.07–10.23)

0.62 0.23

    3

    4+

(0.01–5.76)

(0.07–5.28)

(0.13–2.28)

(0.55–9.72)

(0.41–5.22)

(0.46–2.72)

(0.35–13.47)

(0.53–6.18)

(0.15–10.13)

(0.65–20.15)

(0.89–5.80)

(0.08–12.35)

(0.24–21.45)

(0.58–5.64)

(1.99–11.77)

95% CI

Model 2

0.24

0.54

0.52

2.45

1.46

0.96

2.32

1.87

1.22

3.81

2.17

0.91

2.29

1.80

4.86*

AOR

(0.01–6.76)

(0.06–4.88)

(0.13–2.11)

(0.61–9.87)

(0.42–5.04)

(0.35–2.63)

(0.39–13.93)

(0.55–6.41)

(0.15–10.14)

(0.57–25.41)

(0.86–5.46)

(0.06–14.87)

(0.19–27.59)

(0.55–5.85)

(1.98–11.93)

95% CI

Model 3

0.25

0.48

0.51

2.81

1.22

0.88

2.26

1.74

0.76

5.12

2.03

1.09

2.00

1.70

5.50*

AOR

(0.01–10.05)

(0.04–5.68)

(0.12–2.18)

(0.62–12.78)

(0.32–4.69)

(0.27–2.80)

(0.39–13.27)

(0.49–6.23)

(0.08–7.44)

(0.73–35.99)

(0.67–6.16)

(0.05–24.61)

(0.14–28.26)

(0.42–6.92)

(2.25–13.43)

95% CI

Model 4



*

Model 4: The additive multivariate effects of all adversities and the number of reported childhood adversities are examined in one model equation, adjusted for gender, age, lifetime history of 4 clusters of mental disorders, the number of reported mental disorders, and household income (low/low-middle/middle-high/high).

Model 3: The additive multivariate effects of all adversities and the number of reported childhood adversities are examined in one model equation, adjusted for gender, age, lifetime history of 4 clusters of mental disorders, and the number of reported mental disorders.

Model 2: The additive multivariate effects of all adversities and the number of reported childhood adversities are examined in one model equation, adjusted for gender and age.

Model 1: The additive multivariate effects of all adversities are examined in one model equation, adjusted for gender and age.

0.55

2.32

1.46

1.12

2.16

1.81

1.23

3.62

2.27

0.99

2.26

1.81

4.84*

AOR

    2

Number of childhood adversities (ref = 0 or 1)

1.49

Sexual abuse

1.28


Neglect

(2.10–7.95)

4.09*

Physical discipline (0.50–3.26)

(95% CI)

AOR

Model 1

Multivariate associations of childhood adversities with adult use of potentially injurious physical discipline: Adjusted odds ratios (AORs) and the 95% confidence intervals (CIs)

Author Manuscript


Childhood adversities and adult-onset chronic pain: Results from the World Mental Health Survey, Japan.

Childhood Adversities and Adult Headache in Poland and Germany.

Adult discipline as a factor in childhood imitation.

Discipline in early childhood.

Childhood adversities and socioeconomic position as predictors of leisure-time physical inactivity in early adulthood.

Childhood adversities and laboratory pain perception.

Childhood adversities and psychosis: evidence, challenges, implications.

Early menarche and childhood adversities in a nationally representative sample.

Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions.

Childhood adversities and traumata in Lebanon: a national study.

Childhood adversities predict strongly the use of psychotropic drugs in adulthood: a population-based cohort study of 24,284 Finns.

Childhood adversities and distress - The role of resilience in a representative sample.

The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals.

Promotion of the Transition of Adult Patients with Childhood-Onset Chronic Diseases among Pediatricians in Japan.

BDNF Met66 modulates the cumulative effect of psychosocial childhood adversities on major depression in adolescents.

Daily physical activity and alcohol use across the adult lifespan.

Childhood Adversities are Associated with Diabetes Management in Working Age in Finland.

Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse.

Childhood adversities and adolescent depression: a matter of both risk and resilience.

Childhood sexual and physical abuse in adult patients with borderline personality disorder.

General health status and late effects among adolescent and young adult survivors of childhood cancer in Japan.

Childhood cancer mortality in Japan, 1980-2013.

Common approach to childhood obesity in Japan.

Different childhood adversities are associated with different symptom patterns in adulthood.