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The association between emotional abuse in childhood and healthcare utilization in adulthood among sami and non-sami: the SAMINOR 2 questionnaire survey

Abstract

Background

Emotional abuse in childhood is the most common type of childhood abuse worldwide and is associated with a variety of somatic and mental health issues. However, globally and in indigenous contexts, research on the associations between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood is sparse.

Aim

The main aim of this study was to investigate the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood in Sami and non-Sami populations, and to examine whether this association differs between the two ethnic groups.

Method

This study used cross-sectional data from the SAMINOR 2 Questionnaire Survey - a population-based study on health and living conditions in areas with Sami and non-Sami populations in Middle and Northern Norway. In total, 11 600 individuals participated in SAMINOR 2. Logistic regression was used to present the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization.

Results

Emotional abuse in childhood was significantly associated with somatic specialist healthcare utilization in adulthood (fully adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.15–1.49), with no differences observed between ethnic groups. Emotional abuse in childhood was also associated with mental specialist healthcare utilization (fully adjusted OR 3.99, 95% CI 3.09–5.14), however this association was weaker among Sami (crude OR 2.38, 95% CI 1.37–4.13) compared with non-Sami (crude OR 5.40, 95% Cl 4.07–7.15) participants.

Conclusions

Emotional abuse in childhood is associated with somatic and mental specialist healthcare utilization in adulthood, with a stronger association to mental healthcare utilization. The association between emotional abuse in childhood and mental specialist healthcare utilization was weaker among Sami than non-Sami participants. Future studies should investigate the reason for this ethnic difference. Our results highlight the need to strengthen efforts to prevent childhood abuse and develop strategies to reduce its societal and personal burden.

Peer Review reports

Introduction

According to the World Health Organization [1], around 1 billion (approximately half of) children aged 2–17 years have been impacted by various forms of childhood abuse, including physical, sexual, and emotional abuse [2]. Prior studies have primarily focused on merged categories of violence and abuse or on sexual and physical abuse alone, with less attention to the specific impacts of emotional abuse [3, 4]. The limited existing research has demonstrated an association between emotional abuse in childhood and somatic and mental health outcomes [3, 5,6,7,8]. The wide definition of emotional abuse in childhood includes isolated incidents, as well as patterns of non-verbal, hostile behaviours or attitudes toward children, which can cause them to experience fear, guilt, powerlessness, humiliation, or a sense of not being wanted [8]. Emotional abuse in childhood is highly prevalent [5, 9]. According to a meta-analysis by Stoltenborgh et al. [9], the prevalence was 36% for emotional abuse, 22.6% for physical abuse and 12.7% for sexual abuse during childhood, respectively.

The adverse impacts that emotional abuse in childhood have on health equal those that result from physical and sexual abuse [8, 10]. A comprehensive review and meta-analysis [8] examined the long-term consequences of physical and emotional abuse in childhood, on both somatic and mental health outcomes. The results revealed that emotional abuse was strongly associated with a range of psychological disorders, including symptoms of depression, anxiety disorders, and post-traumatic stress disorder (PTSD). Emotional abuse showed the strongest connection to these mental health conditions, while the association with somatic health was more inconsistent [8]. A Norwegian study suggested a strong association between abuse in childhood, including emotional abuse, and adult mental health issues [11]. Although several risk factors for emotional abuse exist [1], the direction of association remains somewhat unclear. Some studies report equal risk of psychological maltreatment between boys and girls [12], however a Norwegian report from 2014 describe a higher prevalence among women regarding psychological abuse from parents or guardians in childhood [13]. Regarding overall violence, there seem to be declining prevalence in younger age cohorts, indicating that older age cohorts are associated with higher risk of reporting childhood violence [13]. Low socioeconomic status in families has been associated with an increased risk of emotional abuse in childhood [14], as well as being a minority [15], although the direct correlation is not clear.

Although the long-term negative impacts of emotional violence in childhood on health in adulthood have been acknowledged, little is known about the long-term impacts of emotional violence in childhood on healthcare utilization globally or in an indigenous context. Research on childhood abuse in indigenous populations is based on limited data. However, some research has indicated that childhood violence is more common among indigenous than non-indigenous populations [16,17,18,19]. This has been linked to the cultural experience the indigenous populations have had to endure, such as harsh assimilation policies, colonization, and discrimination [16, 20, 21]. A study exploring healthcare utilization for specific diseases, like arthritis, suggested that indigenous people from Canada, New Zealand, and the United States utilize specialist healthcare less than non-indigenous people, but they are more likely to be hospitalized than their non-indigenous counterparts [22]. A Canadian study showed that indigenous people utilize primary and specialist healthcare less frequently, but they are hospitalized more frequently than the non-indigenous population [23]. The Sami are the indigenous inhabitants of Norway, Sweden, Finland, and Russia’s Kola Peninsula. In Norway, the Sami live primarily in the northern region, where they constitute the majority in some areas and the minority in others. The culture, language, and traditions of the Sami are distinct from those of the majority population. A population-based study from Norway showed that the Sami population reported a higher prevalence of emotional abuse in childhood than non-Sami from the same geographical area [16]. Emotional abuse was found to be strongly associated with chronic pain and mental health problems in adulthood [6, 7].

The few studies that have examined healthcare utilization among indigenous people from Norway indicated a similar level of healthcare utilization between Sami and non-Sami. Gaski and colleagues [24] compared specialist healthcare spending in Sami-majority and Sami-minority in neighbouring municipalities and found no significant differences, whereas another study examining healthcare use among the youth population found equal frequency of GP and mental healthcare use, but Sami youth having a higher odds for using school healthcare service [25]. One population-based master thesis suggested that primary healthcare utilization was similar between Sami and non-Sami adults [26].

Knowledge gap

There is a lack of research examining the associations between exposure to abuse in childhood and somatic and mental specialist healthcare utilization in adulthood among Sami and non-Sami, and this is especially true regarding outcomes related to emotional abuse in childhood. To our knowledge, this is the first population-based study examining the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood in an area with Sami and non-Sami populations in Norway. Our aim was to investigate the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood, and to examine whether this association differed between Sami and non-Sami populations.

Materials and methods

The SAMINOR study

The SAMINOR study is the first population-based study on health and living conditions in areas with Sami and non-Sami populations in Norway [27, 28]. It consists of two surveys; SAMINOR 1 (2003–2004) and the SAMINOR 2 Questionnaire Survey (2012), in addition to a SAMINOR 2 clinical examination (2014). This study used the SAMINOR 2 Questionnaire Survey (hereafter SAMINOR 2). The details of SAMINOR 2 are available elsewhere [27]. Participants from 25 municipalities or smaller districts within municipalities in Central and Northern Norway were invited to SAMINOR 2 (Fig. 1), selected based on the distribution of the Sami population [27].

Fig. 1
figure 1

Study area for SAMINOR 2 questionnaire study

The map of the study area is used with permission from the centre for Sami Health Research (CSHR) at UiT the Arctic University of Norway. It is designed by Marita Melhus at CSHR, based on a raw map of Norway from the Norwegian Mapping Authority.

Study sample

The present study used a cross-sectional design and included questionnaire data from SAMINOR 2, in which 44 669 men and women aged 18–69 years were invited to participate. In total, 11 600 individuals completed the questionnaire and consented to participate (27% response rate). Observations with missing values were excluded.

Variables

Exposure variable

The exposure variable was emotional abuse in childhood. The SAMINOR 2 questionnaire included the NorVold Abuse Questionnaire (NorAQ), a validated questionnaire to measure childhood abuse [29, 30]. One question in the NorAQ was used to measure emotional abuse in childhood: “Have you experienced that someone systematically and over time has tried to repress or humiliate you?” Participants who responded “yes, as a child” were classified as “having experienced emotional abuse in childhood”, while participants who responded “no” were categorized as “not having experienced emotional abuse in childhood”. Participants who responded, “yes, as a child and adult” and “yes, as an adult” were excluded. We have no information on who carried out the violence.

Outcome variables

Outcome variables were somatic and mental specialist healthcare utilization. Somatic specialist healthcare utilization in adulthood was measured by the following question: “In the last 12 months, have you been examined or treated for physical problems at any of the following?” Response options were: “hospital”, “specialist medical centre”, “private practice specialist”, and “none of the above”. Somatic specialist healthcare utilization among participants who responded “none of the above” was classified as non-use; all other responses were classified as “somatic specialist healthcare utilization in adulthood”.

Mental specialist healthcare utilization was measured by the following question: “In the last 12 months, have you been examined or treated for psychological problems at any of the following?” Response options were: “hospital”, “specialist medical centre”, “private practice specialist”, and “none of the above”. Mental specialist healthcare utilization among participants who responded “none of the above” was classified as “non-use”; all other responses were classified as “mental specialist healthcare utilization in adulthood”.

Possible interaction term

As differences in the prevalence of emotional abuse in childhood have been found between Sami and non-Sami in Norway [16], and as the two ethnic groups have different cultures, languages, and religions that may affect the associations under investigation, we decided to examine whether ethnicity could be an interaction term. The question, “What ethnicity do you consider yourself?” was used to determine ethnicity. Participants who responded “Sami” were categorized as Sami, while participants who responded “Norwegian” were categorized as non-Sami. Participants who responded “Kven” or “other” were excluded from the analyses. Thus, the variable ethnicity had two values: “Sami” and “non-Sami”.

Possible confounders

Age and gender: Data on age and gender were collected from the national registry Statistics Norway (SSB). Due to a low number of young adult participants in SAMINOR 2, we merged the age groups 18–29 and 30–39 to ensure anonymity, which was a requirement in the original master thesis. Age is presented in categories as 18–39, 40–49, or 50–69 years. Gender is presented as male and female.

Educational level: Educational level was included as a proxy for socioeconomic status. Educational level was determined from the question: “How many years of schooling have you completed?”, which is a frequently used measure of education [31]. For the dataset on somatic specialist healthcare utilization, the responses were categorized into primary school (≤ 9 years), upper secondary school (10–12 years), higher university or college (14–15 years), and university (≥ 16 years). Due to the small number of participants, in the dataset on mental specialist healthcare utilization, educational level was categorized as 0–12 years and ≥ 13 years to ensure anonymity.

Statistical analysis

IBM SPSS Statistics for Windows version 28 (IBM Corp. in Armonk, NY) was used to perform all analyses. As all variables were categorical, descriptive statistics including frequency and cross-tabulation with percentages were used to describe sample characteristics. Due to the dichotomous nature of the outcome variable, logistic regression was used to estimate the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood. The results are presented as odds ratios (ORs) and corresponding confidence intervals (CIs), and the estimates were considered statistically significant if they met p < .05 level. We examined possible interactions between ethnicity and somatic and mental specialist healthcare utilization in adulthood by adding an interaction term between ethnicity and childhood abuse in the regression model, and conducted stratified analyses where applicable. If no interaction was evident, we included ethnicity as a confounder in the model.

Ethics

The questionnaire used in SAMINOR 2 has previously been approved by The Regional Committee of Research Ethics (REC) (ID 2011/1840) and the Norwegian Centre for Research Data (NSD). All participants gave informed consent to participate when returning the questionnaire. The present analysis was submitted for approval to both the REC (ID 374,706) and the NSD (ID 331,086), both of which concluded that approval was not required. The present study also obtained approval from the Ethics expert committee for Sami Health Research (ID 13/21) - an expert committee selected by the Sami Parliament that must consider any research on Sami health.

Results

Participant characteristics

Analyses of the association between emotional abuse in childhood and somatic specialist healthcare utilization in adulthood included 8681 participants: 19% (n = 1689) Sami and 81% (n = 6692) non-Sami. Analyses of the association between emotional abuse in childhood and mental specialist healthcare utilization in adulthood included 8459 participants: 20% (n = 1658) Sami and 80% (n = 6801) non-Sami.

Among all (n = 8681), 58% reported somatic specialist healthcare utilization in the last 12 months. Among all (n = 8459), 3.3% reported mental specialist healthcare utilization in the last 12 months. See Table 1 for background characteristics of the participants. In the whole sample, 13% of the participants reported emotional abuse in childhood. In Table 2, the number of participants reporting on emotional abuse in childhood and healthcare use is outlined, by ethnicity.

Table 1 Participant characteristics by ethnicity. The SAMINOR 2 questionnaire survey
Table 2 N (%) of participants reporting exposure to emotional abuse in childhood and the use of somatic and mental healthcare the past 12 months, by ethnicity

The association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood

Emotional abuse in childhood was significantly associated with somatic specialist healthcare utilization in adulthood (crude OR 1.23, 95% CI 1.08–1.40). The significant association remained after partially adjusting the model for age and after fully adjusting the model for age, gender, ethnicity, and educational level (Table 3).

Emotional abuse in childhood was also significantly associated with the mental specialist healthcare utilization in adulthood (crude OR 4.45, 95% CI 3.46–5.71). The significant association remained after partially adjusting the model for age and after fully adjusting for age, gender, and educational level (Table 3).

Table 3 Association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood. The SAMINOR 2 Questionnaire Survey

Interaction between mental specialist healthcare utilization in adulthood and ethnicity

There was a significant interaction between mental specialist healthcare utilization in adulthood and ethnicity. Therefore, we repeated the analysis and stratified by ethnicity. As few Sami participants reported using mental specialist healthcare in the stratified analyses (N = 21), only a univariate analysis was conducted. Participants who reported Sami ethnicity had a lower OR for mental specialist healthcare utilization (crude OR 2.38, 95% CI 1.37–4.13) compared to participants reported non-Sami ethnicity (crude OR 5.40, 95% CI 4.07–7.15). We found no significant interaction of ethnicity on somatic healthcare utilization, and therefore included ethnicity as a possible confounder in this model.

Discussion

Main findings

This study aimed to investigate the association between emotional abuse in childhood and somatic and mental specialist healthcare utilization in adulthood in Sami and non-Sami populations. The results demonstrate that emotional abuse in childhood is significantly associated with increased somatic and mental specialist healthcare utilization in adulthood. These significant associations were present also after adjusting for age, gender and educational level. For those who reported emotional abuse in childhood, the odds for reporting mental specialist heathcare were almost four-fold compared to the odds of reporting somatic specialist healthcare. Moreover, the association between emotional abuse in childhood and mental specialist healthcare utilization was weaker among Sami (OR 2.38) than non-Sami participants (OR 5.40). To the best of our knowledge, this is the first population-based study in either a global or indigenous context to investigate the specific impact of emotional abuse in childhood on somatic and mental specialist healthcare utilization in adulthood.

Association between emotional abuse and healthcare utilization

Our findings are consistent with research that investigated how additional childhood stress affects healthcare utilization in adulthood [32], as well as studies that explored the distinct impacts of sexual and physical childhood abuse on healthcare utilization in adulthood (visits to general practitioners, emergency departments, and hospital admission). A retrospective cohort study [32] investigated how additional childhood stress, including exposure to abuse (sexual, physical, and emotional) and neglect, and growing up in environments affected by issues such domestic abuse, substance misuse, or mental illness, impacts healthcare utilization in adulthood (visits to general practitioners, emergency department visits, and hospital overnight stays). The OR for emergency department visits (OR 1.34) and overnight hospital stays (OR 1.32) are consistent with our study’s findings regarding the association between emotional abuse in childhood and somatic specialist healthcare utilization (OR 1.30). A population-based study examining how sexual and physical abuse in childhood could affect healthcare utilization in adulthood including both primary and secondary healthcare, found significant associations between sexual and physical abuse and emergency department visits, with an OR of 1.84 and 1.74, respectively [33]. Considering that emotional violence is the most frequently reported type of childhood abuse [5, 9], it is noteworthy that our findings are similar to those from other studies that have looked at other types of childhood violence and use of healthcare services. While these studies measured healthcare use in various ways and sometimes included visits to specialists without separating mental from somatic healthcare, our study indicates that making this separation is important due to the distinct difference in associations between somatic and mental specialist healthcare.

Emotional abuse in childhood and mental specialist healthcare utilization vs. emotional abuse in childhood and somatic specialist healthcare utilization

Our results showed a stronger association between emotional abuse in childhood and mental specialist healthcare utilization compared to somatic specialist healthcare utilization in adulthood. This finding is not unexpected, as a systematic review showed similar results when examining the association with health outcomes [8], with stronger associations between emotional abuse in childhood and psychological disorders compared to somatic diseases. Additionally, emotional abuse in childhood has consistently been linked to various psychological symptoms and disorders, including depression, anxiety, and post-traumatic stress disorder [8, 11, 34,35,36]. The relationship between emotional violence in childhood and somatic health outcomes is also possibly linked to its impact on neurophysiological development, affecting pathways through neurological, hormonal and chronic inflammation systems that are especially vulnerable during critical sensitive periods of childhood [37,38,39]. Although there are fewer studies investigating the relationship between childhood abuse and somatic illnesses, some studies have found that adverse experiences in childhood may be a risk factor for somatic diseases in adulthood, such as cardiovascular disease and diabetes mellitus [40, 41]. Taken together, childhood emotional abuse appears to have stronger impact on mental specialist health care utilization than somatic healthcare utilization. However, it is important to consider that only a small number of participants who reported emotional abuse in childhood also reported mental specialist healthcare utilization (3.3% of participants). Therefore, our findings should be considered preliminary.

Similarities and differences between Sami and non-sami populations

The association between exposure to emotional abuse in childhood and somatic specialist healthcare utilization was the same in both ethnic groups. Compared to other indigenous populations, who tend to have less primary and specialist healthcare utilization and higher hospital admission rates [23], studies have indicated that both the youth and the adult population among Sami and non-Sami in Norway have comparable healthcare utilization [24, 25, 42]. Moreover, an additional study indicated that expenditure on somatic and mental specialist healthcare is comparable in both Sami-majority and Sami-minority municipalities in the same geographical area where the SAMINOR 2 study was conducted [24]. An argument could be made that this is a result of similarities in socioeconomic status between Sami and non-Sami populations in Norway compared to other indigenous populations that tend to have lower socioeconomic status than the majority population in their country, which in turn may restrict their access to healthcare [43]. Additionally, it is possible that the combination of geographical factors, with Sami and non-Sami populations residing in the same geographical regions of Norway, and Norway’s universal healthcare system, may ensure equitable access to healthcare services [44, 45].

Despite equal access and few differences in socioeconomic status among Sami, we found a weaker association between emotional abuse in childhood and mental specialist healthcare utilization among Sami than non-Sami participants. It might be that the Sami face specific challenges in accessing mental healthcare, including cultural and language barriers, limited knowledge about Sami culture among mental healthcare workers, and potential deficiencies in addressing their unique needs [46]. Moreover, the Sami population has been subject to forced assimilations, prejudice, and discrimination from the majority population. As a result, Sami people might lack trust in mental health professionals and be more hesitant to seek help for their mental health issues than non-Sami people. Another possible explanation may be a stronger stigma associated with mental health problems among Sami than non-Sami [47]. The phenomenon of stigma surrounding mental health disorders is prevalent across different societies and can act as a barrier to seeking appropriate help [48, 49]. In conclusion, this absence of cultural and language competence among mental healthcare professionals, the stigma of mental health problems, and the historical trauma of the Sami population, might weaken the association between emotional abuse in childhood and mental specialist healthcare utilization in adulthood among Sami compared to non-Sami populations. Finally, the weaker association between emotional abuse in childhood and mental specialist healthcare utilization in adulthood in Sami participants might be influenced by few participants and lack of statistical power. Analyses stratified by ethnicity resulted in small numbers across the different groups, and we were unable to control for potential confounding variables. Hence, it is crucial to interpret our findings with caution.

In our population, 13% of participants reported being exposed to emotional abuse in childhood. We did not examine the prevalence among Sami and non-Sami specifically. However, Table 2 indicates that more Sami than non-Sami participants report emotional abuse in childhood, which corresponds to other research on indigenous populations [16,17,18,19]. There might be several possible explanations for this trend, but harsh assimilation policies, colonization and discrimination appear to be the main hypotheses [21, 50]. However, a discussion on prevalence and of possible causes for any ethnic difference in prevalence is deemed beyond the scope of this paper.

Strengths and limitations

The large sample size is one of the strengths of this study, as it provides a unique opportunity to examine the impact of emotional abuse in childhood on somatic and mental specialist healthcare utilization in adulthood separately. In addition, SAMINOR 2 data were collected in municipalities with Sami and non-Sami populations [27], enabling the examination of ethnic differences within the same regions. However, the low response rate (27%) may pose a threat to generalizability and introduce non-response bias, and unfortunately, we do not have any information on non-participants. Research has indicated that non-participants in population-based studies tend to be younger and have lower levels of education [51], which may have affected our results. Although we do not have any data on non-participants, the proportion of healthcare utilization we observed corresponds to Norway’s national report on health services, suggesting that the healthcare utilization in our study is representative of the Norwegian population [52].

One major limitation is that emotional violence was defined by one question only. Several questions might have shown a broader picture on this issue and hence given a different result. The use of questions from the NorAQ, a validated questionnaire to measure childhood abuse, is considered a strength of this study [27, 29, 30]. However, the NorAQ questions have not yet been validated in Sami and non-Sami populations in Norway. Due to cultural and linguistic differences, misinterpretations of NorAQ questions cannot be ruled out. Therefore, the results need to be interpreted with caution.

Recall bias might have interfered the results as respondents who struggle with mental and physical health might recall adverse events like childhood abuse in a more negative way [53], and hence amplify the association between childhood abuse and adult health care utilization. On the other hand, studies suggest that it is more common to under-report childhood abuse in adulthood [54], hence weakening the association between childhood abuse and adult health care utilization. Both types of bias might have disrupted the results. Another source of bias is the large age-span between the respondents (18–69 years). Hence the memories and the interpretation of memories might differ throughout the lifespan.

There is no general agreement in the literature on the use of the term “violence” or “abuse”. The term “abuse” is often linked to non-physical behaviours perpetrated by parents/caregivers. In this study the term “abuse” is used, however, it should be noted that we do not have information on perpetrators in this study.

Lastly, the cross-sectional nature of this study does not allow us to determine any causal link between emotional abuse in childhood and specialist healthcare utilization in adulthood. However, as emotional abuse in childhood occurred prior to the reported healthcare utilization in adulthood, we can speculate on the direction of the association.

Conclusion

In conclusion, our study indicates that emotional abuse experienced in childhood could impact both mental and somatic specialist healthcare utilization in adulthood. This association was stronger for mental specialist healthcare utilization than somatic specialist healthcare utilization. The association between emotional abuse in childhood and mental specialist healthcare utilization was less pronounced among Sami than non-Sami participants, although these results should be interpreted as preliminary due to the few Sami participants reporting emotional abuse in childhood and mental specialist healthcare use. Further research is needed to better understand the reasons for these associations as well as the ethnic differences.

Data availability

The data that support the findings of this study were used under license for the current study and are therefore not publicly available. Data are available from the SAMINOR Study upon reasonable request (www.saminor.no), but restrictions apply to the availability of these data, due to Norwegian privacy regulations.

Abbreviations

CI:

Confidence interval

NorAQ:

NorVold Abuse Questionnaire

NSD:

Norwegian Centre for Research Data

OR:

Odds Ratio

REC:

The Regional Committee of Research Ethics

SAMINOR 2:

SAMINOR 2 Questionnaire survey

SSB:

Statistics Norway

References

  1. World Health Organization. Violence against children. Fact Sheet. 2022 2911.

  2. World Health Organization. Global status report on preventing violence against children 2020: executive summary. Licence: CC BY-NC-SA 3.0 IGO. 2020.

  3. Annor FB, Gilbert LK, Davila EP, Massetti GM, Kress H, Onotu D, et al. Emotional violence in childhood and health conditions, risk-taking behaviors, and violence perpetration among young adults in Nigeria. Child Abuse Negl. 2020;106:104510.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sedlak AJ, Mettenburg J, Basena M, Peta I, McPherson K, Greene A, et al. Fourth national incidence study of child abuse and neglect (NIS-4). Volume 9. Washington, DC: US Department of Health and Human Services; 2010. p. 2010.

    Google Scholar 

  5. WHO. Child maltreatment: World Health Organization. 2020 [ https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

  6. Eriksen AM, Hansen KL, Schei B, Sørlie T, Stigum H, Bjertness E, et al. Childhood violence and mental health among indigenous Sami and non-sami populations in Norway: a SAMINOR 2 questionnaire study. Int J Circumpolar Health. 2018;77(1):1508320.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Eriksen AM, Schei B, Hansen KL, Sørlie T, Fleten N, Javo C. Childhood violence and adult chronic pain among indigenous Sami and non-sami populations in Norway: a SAMINOR 2 questionnaire study. Int J Circumpolar Health. 2016;75(1):32798.

    Article  PubMed  Google Scholar 

  8. Norman, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med. 2012;9(11):e1001349.

    Article  PubMed  Google Scholar 

  9. Stoltenborgh M, Bakermans-Kranenburg MJ, Alink LR, van IJzendoorn MH. The prevalence of child maltreatment across the globe: review of a series of meta‐analyses. Child Abuse Rev. 2015;24(1):37–50.

    Article  Google Scholar 

  10. Gama CMF, Portugal LCL, Gonçalves RM, de Souza Junior S, Vilete LMP, Mendlowicz MV, et al. The invisible scars of emotional abuse: a common and highly harmful form of childhood maltreatment. BMC Psychiatry. 2021;21(1):1–14.

    Article  Google Scholar 

  11. Thoresen S, Myhre M, Wentzel-Larsen T, Aakvaag HF, Hjemdal OK. Violence against children, later victimisation, and mental health: a cross-sectional study of the general Norwegian population. Eur J Psychotraumatology. 2015;6(1):26259.

    Article  Google Scholar 

  12. Iwaniec D, Larkin E, Higgins S. Research Review: risk and resilience in cases of emotional abuse. Child Family Social work. 2006;11(1):73–82.

    Article  Google Scholar 

  13. Thoresen S, Hjemdal OK. Vold Og Voldtekt i Norge: en nasjonal forekomststudie av vold i et livsløpsperspektiv [Prevalence of violence in a lifespan perspective in Norway]. Oslo: Nasjonalt kunnskapssenter om vold og traumatisk stress; 2014.

    Google Scholar 

  14. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American journal of preventive medicine; 2019.

  15. Baier D, Hong JS, Kliem S, Bergmann MC. Consequences of bullying on adolescents’ Mental Health in Germany: comparing Face-to-face bullying and cyberbullying. J Child Fam stud. 2019;28(9):2347–57.

    Article  Google Scholar 

  16. Eriksen AM, Hansen KL, Javo C, Schei B. Emotional, physical and sexual violence among Sami and non-sami populations in Norway: the SAMINOR 2 questionnaire study. Scand J Public Health. 2015;43(6):588–96.

    Article  PubMed  Google Scholar 

  17. Curtis T, Larsen FB, Helweg-Larsen K, Bjerregaard P. Violence, sexual abuse and health in Greenland. Int J Circumpolar Health. 2002;61(2):110–22.

    Article  PubMed  Google Scholar 

  18. Toombs E, Lund J, Mushquash CJ. Adverse childhood experiences (ACEs) are increasing in indigenous populations in Canada: now what? Can Psychol = Psychologie Canadienne. 2022;63(364,2A):576–88.

    Article  Google Scholar 

  19. Spillane NS, Schick MR, Kirk-Provencher KT, Nalven T, Goldstein SC, Crawford MC, et al. Trauma and substance use among indigenous peoples of the United States and Canada: a scoping review. Trauma Violence Abuse. 2023;24(5):3297–312.

    Article  PubMed  Google Scholar 

  20. Brzozowski J-A, Taylor-Butts A, Johnson S. Victimization and offending among the Aboriginal population in Canada. Canadian Centre for Justice Statistics Ottawa; 2006.

  21. Anderson I, Robson B, Connolly M, Al-Yaman F, Bjertness E, King A, et al. Indigenous and tribal peoples’ health (the Lancet-Lowitja Institute Global Collaboration): a population study. Lancet (London England). 2016;388(10040):131–57.

    Article  PubMed  Google Scholar 

  22. Loyola-Sanchez A, Hurd K, Barnabe C, editors. Healthcare utilization for arthritis by indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic review. Seminars in arthritis and rheumatism. Elsevier; 2017.

  23. Nader F, Kolahdooz F, Sharma S. Assessing health care access and use among indigenous peoples in Alberta: a systematic review. J Health Care Poor Underserved. 2017;28(4):1286–303.

    Article  PubMed  Google Scholar 

  24. Gaski M, Melhus M, Deraas T, Førde OH. Use of health care in the main area of Sami habitation in Norway–catching up with national expenditure rates. Rural Remote Health. 2011;11(2):83–93.

    Google Scholar 

  25. Turi AL, Bals M, Skre IB, Kvernmo S. Health service use in indigenous Sami and non-indigenous youth in North Norway: a population based survey. BMC Public Health. 2009;9(1):1–10.

    Article  Google Scholar 

  26. Hansen S. Are there differences in health care utilization in areas with both Sami and non-sami populations in Norway? The SAMINOR 1 study. UiT Norges arktiske universitet; 2015.

  27. Brustad M, Hansen KL, Broderstad AR, Hansen S, Melhus M. A population-based study on health and living conditions in areas with mixed Sami and Norwegian settlements–the SAMINOR 2 questionnaire study. Int J Circumpolar Health. 2014;73(1):23147.

    Article  PubMed  Google Scholar 

  28. Lund E, Melhus M, Hansen KL, Nystad T, Broderstad AR, Selmer R, et al. Population based study of health and living conditions in areas with both Sami and Norwegian populations-the SAMINOR study. Int J Circumpolar Health. 2007;66(2):113–28.

    Article  PubMed  Google Scholar 

  29. Swahnberg K. NorVold abuse questionnaire for men (m-NorAQ): validation of new measures of emotional, physical, and sexual abuse and abuse in health care in male patients. Gend Med. 2011;8(2):69–79.

    Article  PubMed  Google Scholar 

  30. Swahnberg IK, Wijma B. The NorVold abuse questionnaire (NorAQ) validation of new measures of emotional, physical, and sexual abuse, and abuse in the health care system among women. Eur J Public Health. 2003;13(4):361–6.

    Article  PubMed  Google Scholar 

  31. Khalatbari-Soltani S, Maccora J, Blyth FM, Joannès C, Kelly-Irving M. Measuring education in the context of health inequalities. Int J Epidemiol. 2022;51(3):701–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bellis M, Hughes K, Hardcastle K, Ashton K, Ford K, Quigg Z, et al. The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study. J Health Serv Res Policy. 2017;22(3):168–77.

    Article  PubMed Central  Google Scholar 

  33. Chartier MJ, Walker JR, Naimark B. Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse Negl. 2010;34(6):454–64.

    Article  PubMed  Google Scholar 

  34. Blackburn-Munro G. Hypothalamo-pituitary-adrenal axis dysfunction as a contributory factor to chronic pain and depression. Curr Pain Headache Rep. 2004;8(2):116–24.

    Article  PubMed  Google Scholar 

  35. Misiak B, Łoniewski I, Marlicz W, Frydecka D, Szulc A, Rudzki L, et al. The HPA axis dysregulation in severe mental illness: can we shift the blame to gut microbiota? Prog Neuropsychopharmacol Biol Psychiatry. 2020;102:109951.

    Article  CAS  PubMed  Google Scholar 

  36. Shea A, Walsh C, MacMillan H, Steiner M. Child maltreatment and HPA axis dysregulation: relationship to major depressive disorder and post traumatic stress disorder in females. Psychoneuroendocrinology. 2005;30(2):162–78.

    Article  CAS  PubMed  Google Scholar 

  37. Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, et al. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009;163(12):1135–43.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ehlert U. Enduring psychobiological effects of childhood adversity. Psychoneuroendocrinology. 2013;38(9):1850–7.

    Article  PubMed  Google Scholar 

  39. Kelly-Irving M, Mabile L, Grosclaude P, Lang T, Delpierre C. The embodiment of adverse childhood experiences and cancer development: potential biological mechanisms and pathways across the life course. Int J Public Health. 2013;58(1):3–11.

    Article  PubMed  Google Scholar 

  40. Bengtsson J, Elsenburg LK, Andersen GS, Larsen ML, Rieckmann A, Rod NH. Childhood adversity and cardiovascular disease in early adulthood: a Danish cohort study. Eur Heart J. 2023;44(7):586–93.

    Article  PubMed  Google Scholar 

  41. Souama C, Lamers F, Milaneschi Y, Vinkers CH, Defina S, Garvert L, et al. Depression, cardiometabolic disease, and their co-occurrence after childhood maltreatment: an individual participant data meta-analysis including over 200,000 participants. BMC Med. 2023;21(1):93.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hansen KL, Melhus M, Lund E. Ethnicity, self-reported health, discrimination and socio-economic status: a study of Sami and non-sami Norwegian populations. Int J Circumpolar Health. 2010;69(2):111–28.

    Article  PubMed  Google Scholar 

  43. Norum J, Nieder C. Socioeconomic characteristics and health outcomes in Sami speaking municipalities and a control group in northern Norway. Int J Circumpolar Health. 2012;71(1):19127.

    Article  PubMed  Google Scholar 

  44. Norum J, Nieder C. Sami-speaking municipalities and a control group’s access to somatic specialist health care (SHC): a retrospective study on general practitioners’ referrals. Int J Circumpolar Health. 2012;71(1):17346.

    Article  PubMed  Google Scholar 

  45. Norum J, Bjerke FE, Nybrodahl I, Olsen A. Admission and stay in psychiatric hospitals in northern Norway among Sami and a control group. A registry-based study. Nord J Psychiatry. 2012;66(6):422–7.

    Article  PubMed  Google Scholar 

  46. Sørlie T, Nergård J-I. Treatment satisfaction and recovery in Saami and Norwegian patients following psychiatric hospital treatment: a comparative study. Transcult Psychiatry. 2005;42(2):295–316.

    Article  PubMed  Google Scholar 

  47. Bongo BA. Samer snakker ikke om helse og sykdom. Samisk forståelseshorisont og kommunikasjon om helse og sykdom. En kvalitativ undersøkelse i samisk kultur. 2012.

  48. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11–27.

    Article  CAS  PubMed  Google Scholar 

  49. Singh A, Mattoo SK, Grover S. Stigma associated with mental illness: conceptual issues and focus on stigma perceived by the patients with schizophrenia and their caregivers. Indian J Social Psychiatry. 2016;32(2):134.

    Article  Google Scholar 

  50. Kirmayer LJ, Brass G. Addressing global health disparities among indigenous peoples. Lancet (London England). 2016;388(10040):105–6.

    Article  PubMed  Google Scholar 

  51. Langhammer A, Krokstad S, Romundstad P, Heggland J, Holmen J. The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms. BMC Med Res Methodol. 2012;12(1):1–14.

    Article  Google Scholar 

  52. Norwegian Directorate of Health. SAMDATA Spesialisthelsetjenesten 2014. Norwegian Directorate of Health; 2014.

  53. Jeronimus BF, Riese H, Sanderman R, Ormel J. Mutual reinforcement between Neuroticism and Life experiences: a Five-Wave, 16-Year study to test reciprocal causation. J Pers Soc Psychol. 2014;107(4):751–64.

    Article  PubMed  Google Scholar 

  54. McKinney CM, Harris TR, Caetano R. Reliability of self-reported childhood physical abuse by adults and factors predictive of inconsistent reporting. Violence Vict. 2009;24(5):653–68.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank the participants in the study for providing data for the analyses.

Funding

The SAMINOR 2 questionnaire study receive funding from, the Norwegian Ministry of Health and Care Services, the Northern Norway Regional Health Authority, the Regional Research Fund for Northern Norway, the Sami National Centre for Mental health, the Finmark Hospital Trust, The Sami Parliament, Finnmark county Council, Troms County Counsil, and Nordland County Council. This particular project, based on a master thesis, has not received any additional funding.

Open access funding provided by UiT The Arctic University of Norway (incl University Hospital of North Norway)

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Contributions

All authors contributed to designing the study, interpreting results, and revising the manuscript. FAO conducted the data analyses and wrote the manuscript with the assistance of ADN and AE. ADN and AE worked with the reviews. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Anja M. Davis Norbye.

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Ethics approval

The study was conducted in accordance with the Declaration of Helsinki. The questionnaire used in SAMINOR 2 has previously been approved by The Regional Committee of Research Ethics (REC) (ID 2011/1840) and the Norwegian Centre for Research Data (NSD). All participants gave informed consent to participate when returning the questionnaire. The present analysis was submitted for approval to both the REC (ID 374706) and the NSD (ID 331086), both of which concluded that approval was not required. The present study also obtained approval from the Ethics expert committee for Sami Health Research (ID 13/21) - an expert committee selected by the Sami Parliament that must consider any research on Sami health.

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The authors declare no competing interests.

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Osman, F.A., Eriksen, A.M. & Norbye, A.M.D. The association between emotional abuse in childhood and healthcare utilization in adulthood among sami and non-sami: the SAMINOR 2 questionnaire survey. BMC Health Serv Res 24, 754 (2024). https://doi.org/10.1186/s12913-024-11211-9

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