儿童身体虐待是一个全球关注的问题。保守估计,这种虐待的全球患病率为25%,它的后果和对社会的成本随着事件的频率和严重程度的增加而升级。关于降低身体虐待累犯率的育儿计划的证据综合,到目前为止,无法建立有效性。过去的评论中数据的缺乏和不一致的纳入标准使得荟萃分析通常是不可能的或缺乏信息。当前的系统评价更新了以前的评价,并通过汇集来自明确定义的育儿干预试验范围的试验水平数据,克服了他们遇到的一些方法学问题,旨在防止有证实或怀疑身体虐待史的父母再次虐待儿童。通过9个在线数据库寻求随机对照试验和严格的非随机设计,两个审判登记处,几个票据交换所,并与专家联系。本综述共纳入14项可变质量研究,其中4项结果支持荟萃分析.总的来说,这篇综述提供了支持基于社会学习理论的育儿行为计划在减少儿童身体虐待累犯的硬标记方面的有效性的证据。荟萃分析发现,对于接受育儿计划的虐待父母,累犯风险的绝对风险降低要低11个百分点(RD=-0.11,95%CI[-0.22,-0.004],p=0.043,I2=28.9%)。然而,以风险比计算时,合并效应大小无统计学意义(0.76,95%CI[0.54,1.07],I2=38.4%)。政策制定者和从业者应该意识到,这种干预方法得到了有希望的证据的支持,这些证据表明儿童身体虐待的硬标记略有减少,尽管这些研究结果的方法学稳健性应该在未来的研究中进一步探索。
Child physical abuse is an issue of global concern. Conservative estimates set global prevalence of this type of maltreatment at 25%, its consequences and cost to society escalating with increasing frequency and severity of episodes. Syntheses of the evidence on parenting programs for reducing rates of physical abuse recidivism have, to date, not been able to establish effectiveness. Paucity of data and inconsistent inclusion criteria in past reviews made meta-analysis often impossible or uninformative. The current systematic
review updates prior reviews and overcomes some of the methodological issues they encountered by pooling trial-level data from a well-defined scope of trials of parenting interventions aimed at preventing the re-abuse of children by parents with substantiated or suspected physical abuse history. Randomized controlled trials and rigorous non-randomized designs were sought via nine online databases, two trial registries, several clearinghouses and contact with experts. A total of fourteen studies of variable quality were included in this
review, four of which had outcomes that enabled meta-analysis. Overall, this
review presents evidence supporting the effectiveness of parenting behavioral programs based on social learning theory for reducing hard markers of child physical abuse recidivism. Meta-analysis found that the absolute risk reduction in risk of recidivism was 11 percentage points less for maltreating parents who undergo parenting programs (RD = -0.11, 95% CI [-0.22, -0.004], p = 0.043, I 2 = 28.9%). However, the pooled effect size was not statistically significant when calculated as a risk ratio (0.76, 95% CI [0.54, 1.07], I 2 = 38.4%). Policy makers and practitioners should be made aware that this intervention method is backed by promising evidence featuring modest yet significant reductions in hard markers of child physical abuse, even though the methodological robustness of these findings should be further explored in future research.