Child maltreatment and resilience in adulthood: a protocol for a systematic review and meta-analysis

ABSTRACT

Background: Although child maltreatment (CM) has been linked to health problems and poor psychosocial functioning, not all individuals exposed to CM develop or experience negative consequences later in life. This suggests that some individuals show resilience after being exposed to CM. However, conclusions have been limited by inconsistent findings across different CM subtypes and resilience domains.

Objective: To develop a protocol for conducting a systematic review and meta-analysis to quantify associations between CM (overall and its subtypes) and resilience (global and its multiple domains) in adulthood, and to examine moderators and mediators of these associations.

Method: PubMed, PsycINFO, Embase, Scopus, and Web of Science will be searched to identify relevant studies on the association between CM (exposure) and resilience (outcome) in adults (≥ 18 years). Data will be screened and extracted by at least two independent reviewers. The methodological quality of the included studies will be independently assessed with a modified version of the Newcastle–Ottawa Scale (NOS). If deemed viable, a meta-analysis will be conducted using a random effects model. Heterogeneity of evidence will be estimated with the I² statistic, and publication bias will be assessed. The effects of potential moderators (e.g. timing and severity of CM, age, sex, family cohesion, socio-economic status, country/region) will be analysed using meta-regression and subgroup analyses, and meta-analytical structural equation modelling will be employed to synthesise indirect mediation effects. Candidate moderators and mediators (e.g. genetic factors, brain functioning, attachment style, personality traits, physical activity, and social support) will be also examined qualitatively.

Conclusions: This protocol will facilitate a systematic review and meta-analysis that has the potential to enhance our knowledge about the association between CM exposure in early life and resilience in adulthood. Understanding associations and underlying mechanisms between CM and resilience is potentially important in informing prevention and interventions to sustain health and improve outcomes among adults with a history of CM.

PROSPERO registration: CRD42023394120.

HIGHLIGHTS

• In this study protocol, we propose to quantitatively summarise the existing literature on the relationship between child maltreatment and resilience with regard to mental health consequences and psychosocial functioning later in life.

• This preregistered systematic review and meta-analysis will establish the procedures to investigate associations between an overall classification of child maltreatment and its different associated subtypes, and a global/trait classification of resilience and its different domains in adults.

• This protocol will further determine the analytical approach to explore and summarise effect moderators and mediators of the association between child maltreatment and resilience in adulthood.

• The resulting synthesis, that will be based on this protocol, could enhance our understanding of the strength of the association between child maltreatment and resilience and inform prevention strategies and clinical interventions to improve health and psychosocial functioning in adult survivors.

Antecedentes: Aunque el maltrato infantil (MI) se ha relacionado con problemas de salud y un pobre funcionamiento psicosocial, no todas las personas expuestas al MI desarrollan o experimentan consecuencias negativas a lo largo de su vida. Esto sugiere que algunos individuos muestran resiliencia después de haber estado expuestos al MI.

Objetivo: Desarrollar un protocolo para realizar una revisión sistemática y un meta-análisis para cuantificar las asociaciones entre el MI (total y sus subtipos) y resiliencia (global y sus múltiples dominios) en la edad adulta y examinar los moderadores y mediadores de estas asociaciones.

Método: Se buscará en PubMed, PsycINFO, Embase, Scopus y Web of Science para identificar estudios relevantes sobre la asociación entre MI (exposición) y resiliencia (resultado) en adultos (≥ 18 años). Los datos serán examinados y extraídos de forma independiente por al menos dos revisores. La calidad metodológica de los estudios incluidos se evaluará de forma independiente con una versión modificada de la escala Newcastle-Ottawa (NOS). Si es viable, se realizará un meta-análisis utilizando el modelo de efectos aleatorios. Se estimará la heterogeneidad de la evidencia con el estadístico I² y se evaluará el sesgo de publicación. Los efectos de potenciales moderadores (p. ej., comienzo, duración y severidad del MI, edad, sexo, cohesión familiar, estatus socioeconómico y país/región) se analizarán mediante meta-regresiones y análisis de subgrupos, y se emplearán modelos meta-analíticos de ecuaciones estructurales para sintetizar los efectos indirectos de mediación. Los posibles moderadores y mediadores (p. ej., factores genéticos, funcionamiento cerebral, estilo de apego, rasgos de personalidad, actividad física y apoyo social) también serán examinados cualitativamente.

Conclusiones: Este protocolo de revisión sistemática y meta-análisis tiene el potencial de incrementar el conocimiento sobre la asociación entre la exposición al MI en la edad temprana y la resiliencia en la adultez. Comprender las asociaciones y los mecanismos subyacentes entre el MI y la resiliencia tiene potencial importancia para informar programas preventivos y de intervención que promuevan una mejora en la salud y el funcionamiento en adultos con antecedentes de MI.

Registro en PROSPERO: CRD42023394120.

背景：尽管儿童虐待 (CM) 与健康问题和心理社会功能不良有关，但并非所有接触过 CM 的人都会在以后的生活中出现或经历负面后果。这表明一些人在接触 CM 后表现出心理韧性。 然而，由于不同 CM 亚型和心理韧性领域的不一致的发现，结论受到限制。

目的：制定一项系统综述和元分析方案，以量化成年期 CM（整体及其亚型）和心理韧性（整体及其多个领域）之间的关联，并考查这些关联的调节者和中介者。

方法：将检索 PubMed、PsycINFO、Embase、Scopus 和 Web of Science，以确定有关 CM 与成人心理韧性之间关系的相关研究。数据将由至少两名独立评审员筛选和提取。纳入研究的方法学质量将使用纽卡斯尔-渥太华量表的修改版本进行独立评估。如果认为可行，将使用随机效应模型进行元分析。将使用 I2 统计量估计证据的异质性，并评估发表偏倚。将使用元回归和亚组分析来分析潜在调节因素（例如 CM 的时间/严重程度、年龄、性别、家庭凝聚力、社会经济地位、国家/地区）的影响，并使用元分析结构方程模型用于综合间接中介效应。候选调节因素和中介因素（例如遗传因素、大脑功能、依恋风格、人格特征、身体活动和社会支持）也将进行定性考查。

结论：本方案将促进有可能增强我们对早期生活中 CM 暴露与成年心理韧性之间关系了解的系统综述和元分析。了解 CM 和心理韧性之间的关联和潜在机制对于为有 CM 病史的成人提供预防和干预措施以维持健康和改善预后具有潜在重要意义。

KEYWORDS:

• Childhood trauma
• neglect
• bullying
• traumatic stress
• adaptive coping
• mental health
• psychological well-being
• resilient functioning
• social support
• adults

PALABRAS CLAVE:

• Trauma infantil
• negligencia
• acoso escolar
• estrés traumático
• afrontamiento adaptativo
• salud mental
• funcionamiento resiliente
• bienestar psicológico
• apoyo social
• adultos

关键词:

• 童年期创伤；忽视； 霸凌；创伤性应激；适应性应对；心理健康韧性功能；心理幸福感；社会支持；成人

Acknowledgments

NEF-O thanks the support of the European Union Horizon 2020 research and innovation program (EU.3.1.3. Treating and managing disease: Grant No. 945151), and DAAD (Deutscher Akademischer Austauschdienst) (ID-57681229 – Ref. No. 91629413). The work by JSW was made possible through funding by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the Early Investigators Programme from funding received from the South African National Treasury. The content hereof is the sole responsibility of the authors and does not necessarily represent the official view of the SAMRC. EV thanks the support of the Spanish Ministry of Science, Innovation and Universities (PI15/00283; PI18/00805; PI21/00787) integrated into the Plan Nacional de I + D + I and co-financed by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER); CIBERSAM; the Comissionat per a Universitats i Recerca del DIUE de la Generalitat de Catalunya to the Bipolar Disorders Group (2021 SGR 1358) and the project SLT006/17/00357, from PERIS 2016-2020 (Departament de Salut), CERCA Programme/Generalitat de Catalunya, also thanks the support of European Union Horizon 2020 research and innovation program (EU.3.1.3. Treating and managing disease: Grant No. 945151). For SS, this work was supported in part by the SAMRC. The funders had no role in the study design or writing of the protocol.

Disclosure statement

EV has received grants and served as a consultant, advisor, or CME speaker for the following entities: AB-Biotics, AbbVie, Angelini, Biogen, Boehringer-Ingelheim, Celon Pharma, Dainippon Sumitomo Pharma, Ferrer, Gedeon Richter, GH Research, Glaxo-Smith Kline, Janssen, Lundbeck, Novartis, Orion Corporation, Organon, Otsuka, Sage, Sanofi-Aventis, Sunovion, Takeda, and Viatris, outside the submitted work. SS has received educational grants and travel support from Lundbeck and Cipla. The other authors report no financial relationships with commercial interests.

Additional information

Funding

This project is funded in part by DAAD (Deutscher Akademischer Austauschdienst) (ID-57681229-Ref. No. 91629413) (scholarship to NEF-O). Open access publication funding enabled and organised by CIBERSAM.