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Clinical Practice & Epidemiology in Mental Health,
2013,
9,
149-156
149
Open Access
The Prevalence of Four Types of Childhood Maltreatment in Denmark
Mogens N. Christoffersen
a
, Cherie Armour
b,*
, Mathias Lasgaard
c
, Tonny E. Andersen
c
and Ask
Elklit
c
a
b
c
The Danish National Centre for Social Research, Denmark
Department of Psychology, University of Ulster, Coleraine, Northern Ireland
National Centre for Psychotraumatology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M,
Denmark
Abstract:
Objectives:
To estimate the prevalence of four types of childhood maltreatment in Denmark while taking into
considerations how each of the types of maltreatment vary as a function of gender or child-protection status.
Methods:
Data were collected from a Danish national study conducted by The Danish National Centre for Social Research
in 2008 and 2009. The study used a stratified random probability sample of young people aged 24 years. A sample of
4718 young adults were randomly selected by Statistics Denmark using the total birth cohort of all children born in 1984.
The response rate was 63% leaving a total effective sample size of 2980. A structured residential or telephone interview
enquired about a range of respondents maltreatment experiences.
Results:
Maltreatment is experienced by a significant proportion of Danish children. The reported prevalence rates were;
physical neglect (3.0%), emotional abuse (5.2%), physical abuse (5.4%) and sexual abuse (3.4%). All trauma types were
experienced by a greater percentage of females compared to males with the exception of physical abuse and all trauma
types were experienced by a greater percentage of children given child-protection status.
Conclusions:
Female children and children who are given child protection status are those most at risk for experiencing
maltreatment in Denmark. However, variability in prevalence rates of maltreatment across studies is problematic. Meth-
odological variations and variation in abuse definitions may be partly attributable.
Keywords:
Emotional Abuse, Epidemiology, Physical Abuse, Physical Neglect, Sexual Abuse.
INTRODUCTION
Childhood maltreatment is associated with a range of
mental and physical health consequences. These conse-
quences are apparent in childhood and often continue for
many years into adulthood. Individuals who have been sexu-
ally or physically abused are more likely to experience seri-
ous health problems compared to their non-abused counter-
parts [1, 2]. Within the research literature there is a general
consensus regarding the categorisation of types of childhood
maltreatment. The Fourth US National Incidence Study of
Child Abuse and Neglect (NIS-4) [3] identified four types of
childhood maltreatment; physical abuse, sexual abuse, emo-
tional abuse, and neglect. The current study will assess the
prevalence of all four. Physical abuse is defined as an in-
flicted act causing physical injury to the child or exposing
the child to risk of physical injury. Sexual abuse refers to
sexually motivated behaviours between the child and an
older person involving the child or sexual exploitation of the
child, often involving bodily contact, but not necessarily.
Emotional abuse is defined as caregiver behaviours that con-
vey to the children that they are worthless, flawed, unloved,
unwanted, endangered, or only of value in meeting another's
needs. Finally, neglect is defined as failing to give the child
the care needed according to the child's age and development,
for instance having too much responsibility, failure to provide
safe health care, unsafe household conditions, inadequate
clothing and nutrition, and a lack of supervision [3, 4].
PREVALENCE OF MALTREATMENT
The existence of childhood maltreatment is a major con-
cern worldwide. Information with regards to the number of
children who are maltreated is predominantly based on the
number of cases which are reported to the authorities or on
studies which have focused on single types of maltreatment.
However, it is estimated that only a limited number of all
cases of maltreatment are reported to the authorities [5].
More precise knowledge about the prevalence of childhood
maltreatment can be achieved by conducting studies which
utilize large-scale nationally representative samples. To date,
only a limited number of nationally representative studies in
relation to childhood maltreatment have been conducted.
However, these studies have generally focused on specific
types of maltreatment [6-12]. Furthermore, the reported
prevalence rates often differ dramatically. For example, stud-
ies have reported the prevalence of physical abuse ranging
2013 Bentham Open
*Address correspondence to this author at the Department of Psychology,
University of Ulster, Coleraine, BT52 1SA, Northern Ireland;
Tel: 0044 (0)2870123374; E-mail: [email protected]
1745-0179/13
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Clinical Practice & Epidemiology in Mental Health, 2013, Volume 9
Christoffersen et al.
from 4.5% to 47% [6, 8]. In relation to sexual abuse, studies
have reported prevalence rates which range from 3% to 36%
[13]. This could reflect sample specific social and cultural
differences. However, it is also likely to reflect the use of
different methodological procedures.
METHODOLOGICAL ISSUES
The varying prevalence rates of childhood maltreatment
reported across epidemiological studies may be attributed to
methodological differences. For example, studies using con-
venience samples have on occasion reported higher rates of
maltreatment, which may be attributable to sample specific
variations. In addition, the use of retrospective studies has
several limitations. One such limitation being, the temporal
proximity between the occurrence of the event and the event
recall. For example, studies employing retrospective self-
reports about maltreatment, which occurred decades ago,
may not be as precise as studies using self-reports from ado-
lescents where the events occurred more recently and thus
may be easier to recall.
A further issue affecting prevalence rates refers to how
maltreatment is defined. Indeed, the majority of the extant
research has employed broad categories of maltreatment,
albeit some studies have asked questions in relation to spe-
cific events. Unfortunately however, these questions have
often been ambiguous with regards to whether or not they
are actually assessing maltreatment
per se.
May-Chahal and
Cawson [10] for instance, found that 16% of their partici-
pants qualified for the formal definition of sexual abuse
(contact and non-contact abuse), but that only 6% considered
themselves as abused. Furthermore, even studies enquiring
about specific types of maltreatment often use different defi-
nitions of events. For example, although sexual abuse is of-
ten categorised as both contact and non-contact sexual abuse,
there is still no clear cut definition as to what actually consti-
tutes sexual abuse. This trend is also apparent in the defini-
tion of other types of childhood maltreatment. For example,
physical abuse is often defined very broadly, i.e., being hit
by the hand of anyone. However, some studies do attempt to
differentiate between mild and severe physical abuse [6, 8].
Even vaguer definitions exist across studies in relation to
emotional abuse and neglect. Precise definitions of what
constitutes particular types of abuse would be advantageous
from both a research and clinical perspective. The former as
it would facilitate more precise estimates of prevalence and
the latter as it has been reported that when asking about an
individual’s abuse history, specific well-defined types of
maltreatment, promote recognition rather than recall and thus
reduces the subjective interpretations of whether a certain
event was abuse or not [14].
A final issue relates to anonymity in data collecting
methodologies. For example, in an interview situation, the
interviewee may not wish to disclose the abuse due to social
taboos and potential feelings of embarrassment and shame.
A number of alternative interviewing procedures help to
overcome the potential of underreporting, for example, tele-
phone interviewing and Computer Assisted Personal Inter-
viewing if the interview is conducted face to face [10]. How-
ever, it is also important to note that variations in reported
prevalence rates may not be solely attributable to methodo-
logical differences. Indeed, a recent cross-national study of
maltreatment in four nations (Denmark, Iceland, Lithuania,
Faeroe Islands), each employing the same methodological
procedures, reported rather different prevalence rates [7]. For
example, severe childhood neglect was reported as five times
higher in the Faeroe Islands compared to Lithuania. Thus,
the Elklit and Petersen study indicated that cultural differ-
ences may exist over and above the differences which can be
attributed to methodological variation. Indeed, culture spe-
cific norms may influence whether or not you regard your-
self as having been abused.
GENDER DIFFERENCES IN CHILDHOOD MAL-
TREATMENT
Child maltreatment has devastating consequences for
both males and females, however important gender differ-
ences exist. Females are reported as experiencing sexual
abuse to a far greater extent than males. Furthermore, fe-
males seem to be victimized more often in family-related
events whereas males are more often victimized in activities
outside the family [7]. Studies have also reported that gender
affects post-abuse adjustment and symptoms. Sexual abuse
has been associated with gynaecological problems, head-
aches, arthritis, and breast cancer for women and thyroid
disease for men [2]. Furthermore, Banyard, Williams, and
Siegel [15], when comparing females and males who had
experienced sexual abuse, found that females had more men-
tal health symptoms than males. Unfortunately, there are
only a limited number of gender studies, employing non-
clinical samples, available in the extant literature. It is how-
ever, important to note that gender based estimates of abuse
may be biased in that males may underreport sexual abuse
and the consequences thereof, thus artificially increasing the
gender differences [16].
NATIONALLY REPRESENTATIVE
CHILD MALTREATMENT
STUDIES
OF
The majority of studies tend to focus on specific types of
maltreatment, generally either sexual abuse or physical
abuse. Only a limited number of studies have assessed emo-
tional abuse and neglect. Notably, fewer studies assess vari-
ous types of maltreatment using nationally representative
samples. Thus, given that all types of maltreatment have
long-term consequences there is a need for more precise
large-scale epidemiological studies gathering information on
heterogeneous maltreatment types.
AIM OF THE PRESENT STUDY
Childhood maltreatment has been highlighted as having
profound aversive consequences on both physical and psy-
chological health. These aversive consequences are apparent
in childhood but persist for many years to come leading to
adulthood illness and significant psychological distress, e.g.,
PTSD. Indeed, most studies focus on only one specific type
of abuse, despite research which has emphasized that the
target and effectiveness of interventions may vary depending
on the type of maltreatment [2]. The current study aimed to
conduct a detailed assessment of the prevalence of childhood
maltreatment in Denmark. Using a similar approach as May-
Chahal and Cawson [10], the present study asked partici-
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Child Maltreatment in Denmark
Clinical Practice & Epidemiology in Mental Health, 2013, Volume 9
151
pants questions regarding specific experiences of four types
of maltreatment; physical abuse, sexual abuse, emotional
abuse and physical neglect, a method less flawed by subjec-
tive interpretations of whether maltreatment has occurred or
not. The current study also aims to assess whether the preva-
lence of childhood maltreatment varies as a function of gen-
der or child care status.
METHODS
Procedure
Data were collected from a Danish national study con-
ducted by The Danish National Centre for Social Research in
2008 and 2009. The study used a stratified random probabil-
ity sample of young people aged 24 years. The study was
founded by the Danish Research Council. A sample of 4718
young adults with Danish citizenship was randomly selected
by Statistics Denmark using the total birth cohort of all chil-
dren born in 1984 (excluding persons who had refused to
participate in national research or were imprisoned). Partici-
pation in the study was entirely voluntary and the study was
approved by the Danish Data Protection Agency. To increase
the number of participants who had experienced childhood
abuse and neglect, children who had been in child protection
where over-sampled by stratifying the number of “child pro-
tection cases” versus “non child protection cases” (1/3:2/3).
A child protection case was defined as a case where the
council (according to the files of local social workers) had
provided support for the child and the family or placement
with a foster family due to concerns about the well-being and
development of the child.
The data was collected using a structured interview,
which were conducted as a telephone interview or as a resi-
dential interview when a telephone interview could not be
obtained. The average duration of the interview was esti-
mated at 43 minutes. The response format was pre-coded but
with an option for respondents to add additional comments
as necessary. The interview did not define abuse and neglect
per se
but asked respondents if they had experienced specific
incidences which are characterised as abusive or neglectful.
A letter sent prior to the data collection informed each par-
ticipant about the nature of the research, the possibility of
being interviewed in the home, and the procedures securing
confidentiality. Persons, who did not respond to the letter,
where contacted by telephone if possible, and then eventu-
ally contacted at their home address. A minimum of six con-
tact attempts (conducted during different times at the day as
well as on working days and during the weekend) was made
to each non-responding participant. At least three of these
attempts were made at the home address.
The interviewers where carefully trained by The Danish
National Centre for Social Research prior to the data collec-
tion. The training included detailed oral information and
standardized written instructions regarding the purpose and
content of the study. Moreover, test trials were conducted to
familiarize the interviewers with the questionnaire and the
coding procedure. The study included several sensitive ques-
tions regarding sexual abuse and violence. Hence, partici-
pants, who were interviewed in their home, answered these
questions using computer assisted personal interviewing,
whereby respondents could enter their answers directly on to
a laptop computer. This method has been validated in similar
studies [10]. Moreover, all participants were given the op-
portunity to speak to an experienced psychologist, via a tele-
phone help line, after completing the interview.
Participants
A total of 2980 interviews were achieved with a response
rate of 63%. The most common reasons for non participation
were refusal to take part in the study (21%), lack of contact
(13%), and illness or disability (2%). To adjust for the over-
sampling of child protection cases the data have been
weighted so that findings are representative of the total Dan-
ish population of young people aged 24 years.
The demographic characteristics of the total sample
(weighted), the non child protection cases, and the child pro-
tection cases are summarized in Table
1.
Measures
Physical Neglect.
Retrospective reports on neglect by
parents or guardians were obtained utilizing seven single-
items that describes different experiences of physical neglect
(aged <12; please see Table
2).
The items asked whether
respondents had experienced seven types of physical neglect
and scores were rated on a two-point (yes/no) format.
Emotional Abuse.
Retrospective reports on emotional
abuse by parents or guardians were obtained utilizing single-
items that describes different experiences of emotional abuse
(aged <12; please see Table
3).
The items asked whether
respondents had experienced six types of emotional abuse
and scores were rated on a two-point (yes/no) format.
Physical Abuse.
Retrospective reports on physical abuse
by parents or guardians was obtained utilizing single-items
that describe different experiences of serious violent treat-
ment (aged <12; please see Table
4).
The items asked
whether respondents had experienced seven different types
of abuse and scores were rated on a two-point (yes/no) for-
mat.
Sexual Abuse.
Retrospective reports on sexual abuse by
parents or guardians were obtained utilizing single-items that
describe experiences of serious sexual abuse (aged <24;
please see Table
5).
The four types of abuse were rated on a
two-point (yes/no) format.
RESULTS
Physical Neglect
A total of 3.0% of the sample experienced some form of
physical neglect from their parents or guardians under the
age of 12. When the sample was split by gender 2.6 % of all
males and 3.4 % of all females reported experiencing physi-
cal neglect. The most prevalent experience reported was be-
ing responsible for their own care whilst sick (total = 5.9 %).
The most prevalent experience reported by males (6.2 %)
and females (5.7 %) remained consistent with that reported
by the full sample. When the sample was split by child pro-
tection status a total of 2.1% of the non-protection cases and
16.0% of child protection cases reported experiencing some
form of physical neglect at the hands of their parents or
guardians. The most prevalent of which, for the non-
protection cases, was again being responsible for own care
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Clinical Practice & Epidemiology in Mental Health, 2013, Volume 9
Christoffersen et al.
Table 1. Demographic Characteristics of Child Non-Protection Cases and Child Protection Cases
Total Sample Weighted
N
= 2980 (Percent Values)
Gender
Male
Female
No. of Children
0
1
2
=>3
Education
< 11yrs
> 11yrs
Still in education
Other
Marital Status
Married / Cohabiting
Single
Note.
All values are weighted.
Child Non-Protection Case
N
= 2128 (Percent Values)
Child Protection Case
N
= 852 (Percent Values)
52.2
47.8
52.0
48.0
55.5
44.5
91.2
6.6
1.8
0.3
91.8
6.2
1.6
0.3
81.6
12.9
4.8
0.6
11.7
87.0
0.5
0.8
10.2
88.6
0.5
0.7
34.4
62.3
0.6
2.6
46.0
54.0
46.1
53.9
44.7
55.2
Table 2. Experience of Physical Neglect from Parents or Guardians by Gender and Child Protection Status
Total
Total (N)
Weighted (N)
Aged <12 you were expected to wash own clothes (%)
Aged <12 you had to attend school in dirty clothes because
there were no clean ones available (%)
Aged <12 you were occasionally starved due to lack of food
or no one available to prepare meals (%)
Aged <12 you were responsible for own care when sick (%)
Aged <12 had to call a doctor for yourself when ill (%)
Often had to care for yourself due to parental alcohol or drug
problems (%)
Were often abandoned in the home for several days (%)
Total (%)
2980
2980
2.9
1.5
1.2
5.9
0.6
3.9
1.3
3.0
Male
1579
1555
1.7
1.6
1.0
6.2
0.5
2.9
1.4
2.6
Female
1401
1425
4.2
1.4
1.4
5.7
0.6
4.9
1.1
3.4
Child Non-Protection Case
2128
2794
2.4
1.1
0.7
5.5
0.5
2.9
0.9
2.1
Child Protection Case
852
186
10.8
8.0
8.8
13.1
2.1
19.0
6.8
16.0
Note: All percentage values are weighted; Total = Positive endorsement of at least two items; Categories were not mutually exclusive.
Table 3. Experience of Emotional Abuse from Parents or Guardians by Gender and Child Protection Status
Total
Total (N)
Weighted (N)
Addressed in humiliating (e.g. being called lazy, stupid, or
useless) manner by parents/guardians (%)
2980
2980
13.1
Male
1579
1555
12.6
Female
1401
1425
13.7
Child Non-Protection Case
2128
2794
12.0
Child Protection Case
852
186
30.6
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Table 3. contd….
Total
Humiliated or degraded in public by parents/guardians (%)
Threatened about getting thrown out of the home by par-
ents/guardians (%)
Threatened about violent punishment by parents/guardians (%)
Parents/guardians have through their behaviour shown that you
were unwanted, unloved, and worthless (%)
Parents/guardians have critized or bullied you constantly (%)
Total (%)
5.4
13.6
3.0
4.9
2.9
5.2
Male
4.4
15.3
3.1
4.1
2.0
4.4
Female
6.4
11.7
2.9
5.8
3.9
6.1
Child Non-Protection Case
4.7
12.3
2.4
3.9
2.3
4.2
Child Protection Case
16.4
33.3
12.0
19.8
12.3
19.6
Note.
All percentage values are weighted; Total = Positive endorsement of at least three items; Categories were not mutually exclusive.
Table 4. Experience of Physical Abuse from Parents / Guardians by Sex and Child Protection Status
Total
Total (N)
Weighted (N)
Beaten with an object, such as a whip or coat hanger? (%)
Threatened with a weapon, such as a knife or a gun? (%)
Had objects thrown at you? (%)
Grabbed round the neck and chocked? (%)
Been left with burn or bite marks? (%)
Had injuries such as broken bones, stab wounds, brain
haemorrhage, or burns which were treated by a doctor? (%)
Been hit, kicked or exposed to violence which has resulted
in bruising, bleeding, or other physical injuries? (%)
Total (%)
2980
2980
2.6
0.4
2.7
0.5
0.2
0.3
2.2
5.4
Male
1579
1555
3.2
0.4
3.2
0.3
0.1
0.2
2.3
6.3
Female
1401
1425
2.1
0.5
2.2
0.6
0.3
0.4
2.2
4.5
Child Non-Protection Case
2128
2794
2.1
0.3
2.1
0.3
0.1
0.2
1.6
4.5
Child Protection Case
852
186
11.4
2.5
12.0
2.5
1.9
2.2
12.0
19.7
Experience of physical abuse from parents / guardians by sex and child protection status
Note. All percentage values are weighted; Total = Positive endorsement of at least one item; Categories were not mutually exclusive.
Table 5. Experiences of Sexual Abuse by Sex and Child Protection Status
Total
Total (N)
Weighted (N)
Experienced sexual touching or someone exposing their
private parts /sex organs to you (%)
Experienced attempted intercourse (%)
Experienced forced / completed intercourse (%)
Experienced other types of sexual behaviour (%)
Total (%)
2980
2980
2.6
2.6
1.9
0.8
3.4
Male
1579
1555
0.5
0.4
0.2
0.2
0.7
Female
1401
1425
4.8
5.0
3.8
1.4
6.4
Child Non-Protection Case
2128
2794
2.1
2.2
1.6
0.6
2.9
Child Protection Case
852
186
9.5
9.2
6.5
3.8
11.6
Experiences of sexual abuse by sex and child protection status
Note. All percentage values are weighted; Total = Positive endorsement of at least one item; Categories were not mutually exclusive; Values pertain to experiences occurring under
the age of 24.
when sick (5.5 %). However, this differed for the child pro-
tection cases, the most prevalent experience reported was
‘often had to care for yourself due to parental alcohol or
drugs problems’ (19.0%). For further details of the seven
physical neglect experiences please see Table
2.
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Emotional Abuse
A total of 5.2% of the sample experienced some form of
emotional abuse from their parents or guardians under the
age of 12. When the sample was split by gender 4.4% of all
males and 6.1% of all females reported experiencing emo-
tional abuse. When the sample was split by child protection
status a total of 4.2% of non child protection cases reported
experiencing some form of emotional abuse at the hands of
their parents or guardians. Of those individuals highlighted
as a child protection case a total of 19.6% reported experi-
encing some form of emotional abuse. The most prevalent of
emotional abuse experiences across all categories was being
threatened about getting thrown out of the home by parents
or guardians (Total = 13.6%; Males = 15.3%; Females =
11.7%; Child non-protection case = 12.3%; Child protection
case = 33.3%). For further details of the six emotional abuse
experiences please see Table
3.
Physical Abuse
A total of 5.4% of the sample experienced some form of
physical abuse from their parents or guardians under the age
of 12. When the sample was split by gender 6.3% of all
males and 4.5% of all females reported experiencing physi-
cal abuse. The most prevalent experience reported was hav-
ing an object throw at them (2.7%) and being hit with an
object, such as a whip or coat hanger (2.6%). The most
prevalent experience reported by males remained consistent
with that reported by the full sample (having an object throw
at them and being hit with an object; both 3.2%). The most
prevalent experiences reported by females was having ob-
jects thrown at them (2.2%) and being hit, kicked, or ex-
posed to violence resulting in injury (2.2%). When the sam-
ple was split by child protection status a total of 4.5% of non
child protection cases reported experiencing some form of
physical abuse at the hands of their parents or guardians. The
most prevalent of which was again consistent with that re-
ported by the full sample and by males (having an object
throw at them and being hit with an object; both 2.1%). Of
those individuals highlighted as a child protection case a
total of 19.7% reported experiencing some form of physical
abuse. The most prevalent of which was having an object
thrown at them (12.0%). For further details of the seven
physical abuse experiences please see Table
4.
Childhood Sexual Abuse
Four questions enquired about types of childhood sexual
abuse experiences occurring under the age of 24. In total,
3.4% of the sample (Males = 0.7% & Females = 6.4%; Non-
child protection = 2.9% & Child protection = 11.6%) experi-
enced sexual abuse under the age of 24. In the total sample,
the most prevalent experiences reported were having experi-
enced sexual touching or someone exposing their private
parts or sex organs and attempted intercourse (both 2.6%).
When split by gender the most prevalent experience for
males was having sexual touching or someone exposing their
private parts or sex organs (0.5%). For females the most
prevalent experience was attempted intercourse (5.0%).
When split by child protection status the most prevalent ex-
perience for non child protection cases was attempted inter-
course (2.2%). For child protection cases the most prevalent
experience was having sexual touching or someone exposing
their private parts or sex organs (9.5%). For further details of
the specific types of sexual abuse across gender and child
protection status please see Table
5.
DISCUSSION
The current study aimed to conduct a detailed assessment
of the prevalence of childhood maltreatment in Denmark
while also assessing whether childhood abuse varies as a
function of gender or child protection status. Participants
were asked questions regarding specific experiences of four
types of maltreatment; physical neglect, emotional abuse,
physical abuse and sexual abuse. In total, 3.0% of the sample
experienced physical neglect, 5.2% experienced emotional
abuse, 5.4% experienced physical abuse, and 3.4% experi-
enced sexual abuse from parents or guardians. It is notable
that much of the preceding literature in relation to childhood
abuse has focused on childhood sexual abuse [10]. However,
in addition to sexual abuse, a UK based prevalence study
conducted by May-Chahal and Cawson [10] also addressed
the prevalence of physical abuse, neglect, and emotional
abuse. They concluded that the prevalence of serious physi-
cal abuse was 7%, compared to the 5.4% prevalence of
physical abuse in the current study. These estimates lie cen-
trally to the range of estimates reported from both UK (15%)
[17] and US (2.3%) [18] studies in relation to levels of se-
vere physical violence against children. In relation to the
prevalence of neglect, the May-Chahal and Cawson [10]
study reported a UK prevalence of 6% compared to the Dan-
ish prevalence of 3.0%. With regards to the prevalence of
emotional abuse, the UK prevalence was reported at 6%
compared to the Danish prevalence of 5.2%. The specific
items in relation to neglect and emotional abuse are similar
across both the current study and the May-Cahal & Cawson
[10] study. This is notable given that May-Chahal and Caw-
son [10] stated that “There have been no prevalence studies
using a comprehensive set of behavioural items to measure
emotional abuse or neglect and no two studies measure the
same items.” (p. 981).
With regards to sexual abuse, the May-Cahal and Caw-
son [10] UK study reported a total prevalence of 10% com-
pared to the total prevalence of 3.4% reported for the current
study. However, it is important to note that there are vast
differences between these two studies in relation to the items
which pertain to the experiences of sexual abuse. For exam-
ple, the May-Cahal and Cawson [10] study assessed sexual
abuse under the age of 16 in relation to whether or not such
was contact or non-contact sexual abuse and in relation to
who was the perpetrator of the abuse (i.e., parent/carer; other
relative; other known people; or stranger/person just met).
The current study asked a number of questions pertaining to
specific types of sexual abuse experiences (cf. Table
5).
In-
terestingly, the May-Cahal and Cawson [10] study reported
that when asked about the experiences of contact sexual
abuse under the age of 16, by parents or carers, the reported
prevalence was 1%. The prevalence of non-contact sexual
abuse was less than 1%. Notably, albeit that the sexual abuse
experiences questions were asked in relation to events occur-
ring under the age of 24, the current study also asked one
direct, yet broad question in relation to the experience of
sexual abuse under the age of 13. This question, thus experi-
ence of sexual abuse under the age of 13 was endorsed by
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Child Maltreatment in Denmark
Clinical Practice & Epidemiology in Mental Health, 2013, Volume 9
155
1% of the total sample. More recently, Elklit and Petersen
[7] conducted a study assessing the prevalence of 19 trau-
matic experiences in adolescents aged 14 and 15 years across
four countries; Denmark (N=390), Iceland (N=206), Lithua-
nia (N=183), and the Faeroe Islands (N=687). The total sam-
ple consisted of 1466 students. Three of the 19 experiences
were sexual abuse, physical abuse, and severe childhood
neglect. Results concluded that although these events were
among the least prevalent of the traumatic experiences,
physical abuse was experienced by 5% of the sample, sexual
abuse was experienced by 4% of the sample, and severe
childhood neglect was experienced by 4% of the sample.
When broken down by individual countries, the prevalence
of these traumas for Denmark alone was reported as: physi-
cal abuse 3.6%, severe childhood neglect 3.1%, and sexual
abuse 1.5%. The current results report higher rates of physi-
cal abuse (5.4%) and sexual abuse (3.4%) in Denmark but
similar rates for neglect (3.0%). However, as noted in the
introduction, methodological and sample age variations can
significantly alter the reported prevalence rates and thus hin-
der comparison between studies, even when the population
of interest belongs to the same country.
GENDER
Gender differences in the prevalence of childhood sexual
abuse has been of particular interest to researchers. Indeed,
studies of sexual abuse by gender have been conducted in the
UK and the US. A UK based study estimated that 5% of girls
compared to 2% of boys experienced sexual abuse which
included penetration or coerced masturbation [19]. Notably,
US based studies report higher prevalence rates of sexual
abuse compared to the UK prevalence rates. Indeed, two
meta-analytic studies have been conducted. The first con-
cluded that the prevalence of sexual abuse as experienced by
females ranged from 12-17% as compared to the 5-8% of
males experiencing sexual abuse [20]. The second concluded
that the prevalence of sexual abuse as experienced by fe-
males ranged from 8-30% as compared to the 2-16% of
males experiencing sexual abuse. Finkelhor [13] conducted a
review in which he reported that non US studies estimate
that approximately 20% of females compared to 10% of
males experience sexual abuse. Elklit and Petersen [7] re-
ported that sexual abuse had been experienced by 1.3% of
females compared to 0.25% of male Danish adolescents. The
current study, using more specified behavioural items, re-
ported a higher prevalence of sexual abuse in both females
(6.4%) and males (0.7%). However, it is important to note
that sexual abuse often goes unreported particularly with
regard to male victims. Indeed, a review regarding the sexual
abuse of male children and adolescents reported that there is
a high level of secrecy surrounding the sexual abuse of boys
[21].
The current study concluded that a higher percentage of
females reported experiencing all types of abuse with the
exception of physical abuse. Indeed, these results support
those of previous studies. For example, MacMillan
et al.
[22]
examined the Ontario Health Survey and concluded that
physical abuse was reported more often by males compared
to females. Likewise, May-Chahal and Cawson [10] reported
more males compared to females had experienced ‘violent
treatment from anyone’ or ‘serious physical abuse from a
parent / carer’. With regards to emotional abuse and physical
neglect, the May-Chahal and Cawson [10] study supported
the current findings as they also reported that females more
often report emotional abuse and physical neglect (defined as
absence of physical care) than males.
Child Protection Status
The current study revealed that a higher percentage of
children defined as a child protection case (i.e., a case where
the council, according to the files of local social workers,
had provided support for the child and the family or had or-
ganised the childs placement with a foster family due to con-
cerns about the well-being and the development of the child),
reported experiencing all four types of childhood abuse
compared to those not defined as a child protection case.
However, it is important to note that these cases may have
been referred for support because of the experience of child-
hood maltreatment and have not necessarily experienced
maltreatment as a function of being in care. However, this
finding is not particularly surprising given that children and
adolescents who are in care are often regarded as those indi-
viduals in society who are the most vulnerable [23]. Notably,
however a child protection case within the current study is
not necessarily a child who is placed in care away from the
home. This highlights issues with the definition of a child
protection case, further highlighting issues with making
comparisons between studies.
Strengths and Limitations
The current study is a nationally representative study of
24 year olds in Denmark. Furthermore, the current study
enquires about specific abuse experiences rather than simply
enquiring whether or not an individual experienced a broadly
defined type of abuse. Moreover, we surveyed the individu-
als who potentially experienced the abuse rather than survey-
ing parents about whether or not they perpetrated abuse. The
current study is however not without limitation. First, the
study achieved a response rate of 63%. Generally, this is
regarded as typical for population survey data; nevertheless
it raises questions in relation to how those who participated
differed from those who choose not to participate. In particu-
lar, it is possible that those who choose not to participate
were more likely to have experienced maltreatment. Ulti-
mately, this may result in a reduction of the true rate of mal-
treatment within the Danish population. This is however, a
relatively common and often hard to avoid methodological
limitation of many studies attempting to assess the true
prevalence of childhood maltreatment. Second, the physical
neglect, emotional abuse, and physical abuse items were
asked in relation to specific experiences which occurred un-
der the age of 12, whereas the sexual abuse items were asked
in relation to experiences which occurred under the age of
24. Although this potentially inflated the prevalence of sex-
ual abuse experiences, we did enquire about sexual abuse
aged 12 or under, using a single direct question. This re-
sulted in a prevalence of sexual abuse of 1%. We can specu-
late that the higher prevalence of sexual abuse is related to
the additional time-frame however we must also consider
that the literature on sexual abuse reports that estimates of
prevalence based on Yes/No reports of any sexual abuse
experience, often results in underestimates of prevalence
compared to an approach that enquires about specific sexual
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Clinical Practice & Epidemiology in Mental Health, 2013, Volume 9
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Accepted: August 21, 2013
abuse experiences. Additionally, the current questioning
format focused on experiences which occurred at the hands
of parents or guardians. Thus, ignores potential abuse which
may have been perpetrated by other family members or ac-
quaintances. This may be particularly relevant for sexual
abuse given that we queried about experiences up to the age
of 24 rather than under the age of 12 as with other abuse
types (Fergusson et al., 1996). Both of these points may di-
lute the true prevalence of abuse and thus may also hinder
comparisons with alternative studies. However, difficulties
in comparing with other studies are a widely acknowledged
limitation within this field (as previously discussed) and not
solely a limitation of the current study.
Conclusion and Implications for Future Research
In conclusion, childhood abuse is prevalent within soci-
ety. However, there are a number of methodological difficul-
ties with hinder the revelation of true prevalence rates. Stud-
ies, such as the current, help to highlight not only the esti-
mated prevalence but help to highlight that several methodo-
logical issues need to be considered in future research. For
example, future research would profit from employing stan-
dardised definitions of abuse. In addition, research in this
area should primarily be conducted using representative
samples employing standardised methodological procedures.
By doing so, researchers would be able to make comparisons
between studies and across countries and thus gain a clearer
picture of the true prevalence of childhood abuse. One fur-
ther consideration relates to the fact that abuse types rarely
occur in a stand-alone fashion. Indeed, there may be consid-
erable overlap between abuse experiences, in other words,
children who are physically abused may also experience
emotional abuse. Thus, future research, and a future line of
enquiry for the current researchers, may attempt to uncover
whether or not homogeneous groups of abuse victims exist.
CONFLICT OF INTEREST
The authors confirm that this article content has no con-
flicts of interest.
ACKNOWLEDGEMENTS
We thank the Danish National Research Foundation for
generous research support.
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Received: July 22, 2013
© Christoffersen
et al.;
Licensee
Bentham Open.
Revised: August 20, 2013
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