The prevalence of child maltreatment among Chinese primary and middle school students: a systematic review and meta-analysis

The purpose of this study was to provide an estimate of the prevalence of child maltreatment among Chinese primary and middle school students. An attempt was also made to explore the causes of heterogeneity by analyzing stratified variables and other potentially related factors included in the study.

Literature retrieval has been carried out in the databases, including Pubmed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and China Biology Medicine disc (CBMdisc), for relevant published studies up to October 2019. The Cochran’s chi-squared test (Cochran’s Q), I² test and subgroup analysis were performed to evaluate the heterogeneity. Funnel plots were used to detect publication bias. Trim-and-fill method was performed to identify possible asymmetry and assess the robustness of the conclusions.

A total of 1433 studies were obtained after retrieval. Finally, 19 eligible studies were included in meta-analysis after detailed exclusion. The pooled prevalence of child physical abuse (CPA), child emotional abuse (CEA), child sexual abuse (CSA), child physical neglect (CPN) and child emotional neglect (CEN) were 0.20 (95% CI 0.13, 0.27), 0.30 (95% CI 0.20, 0.39), 0.12 (95% CI 0.09, 0.15), 0.47 (95% CI 0.35, 0.58) and 0.44 (95% CI 0.28, 0.59), respectively. In subgroup analyses, a higher prevalence of CEN was reported in rural areas. Meanwhile, the prevalence of CPN and CEN in non-only child group was higher than that observed in only child group. Compared with children without mental symptoms, children with mental symptoms have a higher incidence of all categories of child maltreatment. In terms of assessment tools, studies using Childhood Trauma Questionnaire as an assessment tool reported lower prevalence of CPA, CEA. Childhood Trauma Questionnaire In addition, the prevalence of CPN, CEN in studies conducted in northern China was significantly higher than that estimated in southern and central China. For CSA, eight additional studies required trimming according to the trim-and-fill analysis, and the pooled estimate was 0.042 after filling. For CPA, CEA, CPN and CEN, there were no indications of publication with the trim and fill method (data unchanged).

Our findings indicated that primary and middle school students had a relatively high prevalence of maltreatment. Because of the visible heterogeneity of the studies included, more large samples, high-quality and prospective studies are needed in the future to acquire the accurate prevalence of child maltreatment in China. Certainly, future research needs to focus not only on the estimate of prevalence of child maltreatment, but also on risk factors and intervention strategies for child maltreatment.