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Objective To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. Methods A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. Findings The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven--home-visiting, parent education, abusive head trauma prevention and multi-component interventions--show promise in preventing actual child maltreatment. Three of them--home visiting, parent education and child sexual abuse prevention --appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. Conclusion Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries. Objectif Faire la synthese des preuves recemment fournies par des revues systematiques et completes sur l'efficacite d'interventions universelles et selectives pour prevenir la maltraitance des enfants, evaluer la qualite methodologique de ces revues et des etudes d'evaluation des resultats sur lesquelles elles reposent et cartographier la distribution geographique des preuves. Methodes Une revue systematique de revues a ete realisee. La qualite des revues examinees a ete evaluee a l'aide d'un outil d'evaluation des revues systematiques multiples (AMSTAR) et celle des evaluations de resultats au moyen d'indicateurs de la validite interne et de la validite de construction des mesures de resultat. Resultats La revue s'est concentree sur sept types principaux d'interventions: visites a domicile, education des parents, prevention des abus sexuels chez l'enfant, prevention des traumatismes craniens dus a la maltraitance, interventions pluricomposantes, interventions s'appuyant sur les medias et groupes de soutien et d'entraide. Quatre sur sept de ces interventions--visites domicile, education des parents, prevention des traumatismes cranien dus a la maltraitance--semblent prometteuses pour prevenir la maltraitance proprement dite. Trois d'entre elles--visites domicile, education des parents et prevention des abus sexuels chez l'enfant--apparaissent efficaces dans la reduction des facteurs de risque de maltraitance infantile, en depit du caractere provisoire de ces conclusions compte tenu des defauts methodologiques des revues et des etudes d'evaluation des resultats sur lesquelles elles se fondent. Une analyse de la distribution geographique des preuves montre que les evaluations des resultats des interventions pour prevenir la maltraitance des enfants sont extremement rares dans les pays a revenu faible et moyen et ne constituent que 0,6 % de l'ensemble de la base factuelle. Conclusion Les preuves attestant l'efficacite de quatre des sept principaux types d'interventions pour prevenir la maltraitance des enfants sont prometteuses, meme si ces preuves sont affaiblies par les probtemes methodologiques et la rarete des evaluations des resultats d'interventions dans les pays a revenu faible et moyen. Objetivo Sintetizar las pruebas recientes aportadas por revisiones sistematicas e integrales de la eficacia de las intervenciones universales o selectivas para prevenir el maltrato infantil, evaluar la calidad metodolegica de las revisiones y de los estudios de evaluacien de los resultados incluidos en elias, y elaborar un mapa de la distribucien geografica de los datos. Metodos Se realize una revisien sistematica de las revisiones. La calidad de las revisiones sistematicas se valoro con un instrumento de evaluacion de multiples revisiones sistematicas (AMSTAR), y la calidad de los estudios de evaluacien de los resultados incluidos en elias con indicadores de la validez interna y la validez conceptual de las medidas de los resultados. Resultados La revision se centre en siete tipos principales de intervenciones: visitas a domicilio, educacien de los padres, prevencien del abuso sexual infantil, prevencion de los traumatismos craneales por maltrato, intervenciones con multiples componentes, intervenciones basadas en los medios de comunicacien, y grupos de apoyo y entreayuda. Cuatro de las siete (visitas a domicilio, educacien de los padres, prevencien de los traumatismos craneales por maltrato e intervenciones con multiples componentes) fueron prometedoras para evitar que se produzca el maltrato infantil. Tres (visitas a domicilio, educacien de los padres y prevencion del abuso sexual infantil) parecen ser eficaces para reducir los factores de riesgo de maltrato infantil, aunque estas conclusiones son provisionales, teniendo en cuenta las deficiencias metodologicas de las revisiones y de los estudios en los que se basan. El analisis de la distribucion geografica de los datos revela que los estudios sobre los resultados de las intervenciones de prevencien del maltrato son extremadamente raros en los paises de bajos y medianos ingresos (0,6% de la totalidad de dichos estudios). Conclusien Las pruebas sobre la eficacia de cuatro de los siete tipos de intervenciones principales para prevenir el maltrato infantil son prometedoras, aunque seven debilitadas por los problemas metodolegicos y la escasez de estudios de evaluacien de los resultados procedentes de los paises de bajos y medianos ingresos., Introduction Child maltreatment prevention is poised to become a global health priority due to four main factors. First, retrospective and prospective studies have established that child maltreatment has strong, long-lasting [...]

Objectives. We sought to determine the fractions of psychiatric disorders and suicide ideation and attempts in a general population sample attributable to childhood physical abuse, sexual abuse, and witnessing domestic violence. Methods. Data were obtained from the US National Comorbidity Survey Replication. Population attributable fractions were calculated to determine the proportion of psychiatric disorders and suicide ideation and attempts attributable to adverse childhood experiences. The analysis was stratified by gender. Results. The estimated attributable fractions for psychiatric disorders attributable to having experienced any adverse childhood event ranged from 22% to 32% among women and 20% to 24% among men. Having experienced any adverse event accounted for a substantial proportion of suicide ideation and attempts among women (16% and 50%, respectively) and men (21% and 33%, respectively). Substantial proportions of poor mental health outcomes were also attributable to increasing number of adverse events. Conclusions. The estimated proportions of poor mental health outcomes attributed to childhood adversity were medium to large for men and women. Prevention efforts that reduce exposure to adverse childhood events could substantially reduce the prevalence of psychopathology and suicidal behavior in the general population. (doi:10.2105/AJPH.2007.120253)

Injuries and violence are a significant and growing cause of child death and disability, as well as having other health consequences including mental health, behavioural and reproductive health problems. Every [...]