The influence of geographical and economic factors in estimates of childhood abuse and neglect using the Childhood Trauma Questionnaire: A worldwide meta-regression analysis

This multilevel meta-analysis examined the effects of geographical and economic factors on worldwide childhood maltreatment estimates measured by the Childhood Trauma Questionnaire (CTQ) short-form. The primary outcome extracted was continuous scores on the CTQ subscales - emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect - and total score. Geographical, economical and methodological variables were extracted for use as covariates in meta-regression models. A literature search identified 288 studies suitable for the CTQ total score analysis (N = 59,692) and 189 studies suitable for maltreatment subtype analysis (N = 44,832). We found that Europe and Asia were associated with lower CTQ estimates while South America presented the highest estimates among continents. Specifically, studies from China, Netherlands and United Kingdom presented the lowest maltreatment estimates. Furthermore, high-income countries presented lower CTQ physical neglect estimates in comparison to low- or middle-income countries, while per-capita gross domestic product of countries was negatively associated with childhood physical neglect estimates. Despite the influence of methodological covariates, these findings indicate that geographical and economic factors could influence variations of childhood maltreatment estimates around the world, particularly when assessed by a structured standardized questionnaire.