孤独症谱系障碍儿童遭受家长躯体情感暴力现状及相关因素

崔立华; 杜文冉; 李会敏; 董静怡

doi:10.16835/j.cnki.1000-9817.2023.02.009

孤独症谱系障碍儿童遭受家长躯体情感暴力现状及相关因素

doi: 10.16835/j.cnki.1000-9817.2023.02.009

1.
华北理工大学公共卫生学院河北省煤矿卫生与安全重点实验室，河北唐山 063210
2.
唐山市妇幼保健院儿童保健科
3.
唐山市玉田县医院急诊科

基金项目:

河北省重点研发计划项目 22377781D

河北省卫生健康委医学科学研究重点课题计划 20180734

详细信息

作者简介:
崔立华(1980-)，女，河北唐山人，在读博士，讲师，主要研究方向为儿童慢性病防控

通讯作者:
杜文冉，E-mail：duhailang1029@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G78 R179 B844.1 R748
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出版历程
- 收稿日期: 2022-07-22
- 修回日期: 2022-10-27
- 网络出版日期: 2023-03-02
- 刊出日期: 2023-02-25

Prevalence and relevant factors of physical and emotional abuse by parents among children with autism spectrum disorder

1.
Laboratory of Coal Mine Health and Safety of Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan(063210), Hebei Province, China

摘要

摘要: 目的了解孤独症谱系障碍(ASD)儿童遭受家长躯体情感暴力现状及其相关因素，为制定儿童暴力伤害的干预方案提供科学依据。方法 2021年3—10月选择唐山市3所特教机构的221名ASD儿童，同时方便选取市区和农村各2所幼儿园的395名非ASD儿童进行线上及现场问卷调查。使用自行设计的暴力行为调查表、儿童孤独症评定量表(CARS)和9项患者健康问卷抑郁量表(PHQ-9)收集调查对象遭受暴力、孤独症严重程度、养育人抑郁状况及其他影响因素。采用χ²检验、Fisher精确检验法、Logistic回归分析暴力的相关因素。结果最近1年内，81.9%的ASD儿童和72.9%的非ASD儿童遭受过暴力，ASD儿童躯体、情感暴力报告率分别为74.2%和73.8%，非ASD儿童分别为58.7%和65.8%，两组儿童躯体、情感及总暴力报告率差异均有统计学意义(P值均 < 0.05)。多因素Logistic回归分析结果显示，男童(OR=1.70，95%CI=1.12~2.60)、家庭人均年收入 < 1万元(OR=2.43，95%CI=1.45~4.08)、养育人抑郁程度重(OR_轻度=11.01，95%CI=5.38~22.49；OR_{中度及以上}=69.97，95%CI=24.25~201.93)是儿童遭受总暴力的影响因素；ASD疾病(OR=1.96，95%CI=1.32~2.92)、年龄大(OR=1.19，95%CI=1.01~1.41)及养育人抑郁程度重(OR_轻度=7.83，95%CI=3.67~16.74；OR_{中度及以上}=14.37，95%CI=6.17~33.46)是儿童遭受躯体暴力的影响因素；男童(OR=1.62，95%CI=1.11~2.36)、母亲从事体力劳动工作(OR=1.68，95%CI=1.09~2.59)、养育人抑郁程度重(OR_轻度=7.69，95%CI=3.74~15.81；OR_{中度及以上}=25.37，95%CI=10.80~59.63)是儿童遭受情感暴力的影响因素(P值均 < 0.05)。结论 ASD儿童遭受家长暴力报告率高，应加强ASD家庭心理健康和社会支持。
- 孤独性障碍 /
- 暴力 /
- 精神卫生 /
- 回归分析 /
- 儿童, 学龄前
Abstract: Objective To explore the prevalence and relevant factors of physical and emotional abuse by parents among children with autism spectrum disorder (ASD), so as to provide basis for intervention program of children abuse. Methods A total of 221 ASD children from 3 special education institutions in Tangshan were investigated from March to October in 2021, 395 non-ASD children from two kindergartens in urban and rural areas were selected by convenient sampling. Parents of these children were invited for online and on-site questionnaire survey. The self-designed violence questionnaire, Childhood Autism Rating Scale and Patient Health Questionnaire-9 were used to assess violence, severity of autism, depression of parents. Chi-square test, Fisher's exact probability method and Logistic regression were used to analyze the influencing factors of violence. Results About 81.9% of children with ASD and 72.9% of non-ASD children experienced violence(P < 0.05). The reported rates of physical and emotional violence in ASD children were 74.2% and 73.8% respectively, which in non-ASD children were 58.7% and 65.8% respectively. There were significant differences in the 3 types of violence rate between the two groups (P < 0.05). Multivariate Logistic regression analysis showed that boys (OR=1.70, 95%CI=1.12-2.60), annual per capita income < 10 000 yuan(OR=2.43, 95%CI=1.45-4.08), and parental depression (OR_mild=11.01, 95%CI=5.38-22.49; OR_moderate =69.97, 95%CI=24.25-201.93) were the risk factors for child violence exposure; ASD disease (OR=1.96, 95%CI=1.32-2.92), older age (OR=1.19, 95%CI=1.01-1.41) and parental depression(OR_mild=7.83, 95%CI=3.67-16.74; OR_moderate=14.37, 95%CI=6.17-33.46) were risk factors for physical violence; boys (OR=1.62, 95%CI=1.11-2.36), mothers who work in manual labor (OR=1.68, 95%CI=1.09-2.59) and parental depression (OR_mild=7.69, 95%CI=3.74-15.81; OR_moderate=25.37, 95%CI=10.80-59.63) were risk factors for emotional violence(P < 0.05). Conclusion The reported rate of parental violence against children with ASD is high. Mental health promotion and social support for families with ASD should be strengthened.
- Autistic disorder /
- Violence /
- Mental health /
- Regression analysis /
- Child, preschool
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 遭受各项暴力的报告率ASD儿童与对照组儿童间比较

Table 1. Comparison on reported rates of various types of violence between the children with ASD and control group

暴力类别	项目	ASD组(n=221)	对照组(n=395)	χ²值	P值
非接触性体罚	将孩子独自关在小屋里，使其感到非常害怕	30(13.6)	41(10.4)	1.42	0.23
	罚站	62(28.1)	87(22.0)	2.81	0.09
	罚跪	3(1.4)	0	2.95	0.09
	在吃饭时间不让孩子吃饭	4(1.8)	6(1.5)	0.00	1.00
轻度躯体暴力	非常用力地推搡/摇晃孩子	34(15.4)	55(13.9)	0.25	0.62
	非常用力地掐、拧、捏、抓孩子	48(21.7)	54(13.7)	6.64	0.01
	非常用力地徒手拍打孩子的屁股	120(54.3)	183(46.3)	3.60	0.06
	非常用力地徒手拍打孩子的手、脚、胳膊、腿或背	31(14.0)	34(8.6)	4.41	0.04
	非常用力地用物品如棍子、扫帚、皮带等打孩子的屁股	12(5.4)	11(2.8)	2.76	0.10
重度躯体暴力	非常用力地用拳头打、脚踹或踢孩子	20(9.0)	20(5.1)	3.71	0.05
	非常用力地徒手拍打孩子的脸或头等部位	2(1.0)	0		0.13^a
情感暴力	对孩子发怒，大声训斥	161(72.9)	251(63.5)	5.54	0.02
	羞辱孩子，试图使孩子感到自己坏、笨或毫无价值	25(11.3)	16(4.1)	12.03	< 0.01
	对孩子说过希望其不存在	14(6.3)	21(5.3)	0.27	0.60
	孩子在家里目睹过家人的殴打	14(6.3)	17(4.3)	1.22	0.27
	威胁孩子要将其赶出家门	27(12.2)	33(8.4)	2.41	0.12
	威胁过孩子要严重伤害他	4(1.8)	6(1.5)	0.00	1.00
注：()内数字为报告率/%；a为Fisher精确检验法。

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表 2 不同组间ASD儿童遭受暴力报告率比较

Table 2. Comparison on reported rates of violence in different groups among ASD children

组别	选项	人数	报告人数	χ²值	P值	组别	选项	人数	报告人数	χ²值	P值
性别	女	50	41(82.0)	<0.01	0.98		高中或中专	42	34(81.0)
	男	171	140(81.9)				大专及以上	104	83(79.8)
儿童年龄/岁	2	96	77(80.2)	3.00	0.39	父亲职业类型	脑力劳动	40	40(75.0)	1.57	0.21
	3	67	55(82.1)				体力劳动	181	151(83.4)
	4	30	23(76.7)			母亲职业类型	脑力劳动	28	22(78.6)	0.24	0.62
	5	28	26(92.9)				体力劳动	193	159(82.4)
是否独生子女	是	117	93(79.5)	0.98	0.32	养育人抑郁状况	无	13	8(61.5)	13.26	<0.01
	否	104	88(84.6)				轻度	129	99(76.7)
ASD严重程度	非典型	109	90(82.6)	1.47	0.48		中度及以上	79	74(93.7)
	轻中度	66	56(84.8)			居住地	城区	119	98(82.4)	0.04	0.85
	重度	46	35(76.1)				农村	102	83(81.4)
父亲年龄/岁	24~	58	43(74.1)	3.23	0.20	家庭人均年收入/万元	<1	72	65(90.3)	6.05	0.01
	30~	95	80(84.2)				1~3	65	53(81.5)
	35~51	68	58(85.3)				>3	84	63(75.0)
母亲年龄/岁	23~	85	63(74.1)	6.45	0.04	家庭收入减少	是	81	67(82.7)	0.06	0.81
	30~	90	80(88.9)				否	140	114(81.4)
	35~44	46	38(82.6)			家庭类型	大家庭	81	64(79.0)	0.72	0.70
父亲文化程度	初中及以下	79	68(86.1)	2.83	0.24		核心家庭	115	96(83.5)
	高中或中专	51	38(74.5)				组合家庭	25	21(84.0)
	大专及以上	91	75(82.4)			主要教养人	父母	174	140(80.5)	1.15	0.28
母亲文化程度	初中及以下	75	64(85.3)	0.93	0.63		其他	47	41(87.2)
注：()内数字为报告率/%。

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表 3 儿童遭受各类暴力影响因素的Logistic回归分析(n=616)

Table 3. Logistic analysis of influencing factors of violence suffered by children(n=616)

因变量	自变量	选项	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
总暴力	儿童性别	男	0.53	0.22	6.06	0.01	1.70(1.12~2.60)
	家庭人均年收入	< 1万元	0.89	0.26	11.39	< 0.01	2.43(1.45~4.08)
	养育人抑郁程度	轻度	2.40	0.37	43.23	< 0.01	11.01(5.38~22.49)
		中度及以上	4.25	0.54	61.72	< 0.01	69.97(24.25~201.93)
躯体暴力	ASD组		0.67	0.20	10.99	< 0.01	1.96(1.32~2.92)
	儿童年龄		0.18	0.09	4.33	0.04	1.19(1.01~1.41)
	养育人抑郁程度	轻度	2.06	0.39	28.24	< 0.01	7.83(3.67~16.74)
		中度及以上	2.67	0.43	38.17	< 0.01	14.37(6.17~33.46)
情感暴力	儿童性别	男	0.48	0.19	6.34	0.01	1.62(1.11~2.36)
	母亲职业类型	体力劳动	0.52	0.22	5.61	0.02	1.68(1.09~2.59)
	养育人抑郁程度	轻度	2.04	0.37	30.75	< 0.01	7.69(3.74~15.81)
		中度及以上	3.23	0.44	55.02	< 0.01	25.37(10.80~59.63)

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