Vardarbības izraisītie veselības traucējumi bērniem un jauniešiem Latvijā. Promocijas darba kopsavilkums

The Doctoral Thesis was carried out at Rīga Stradiņš University. Defence: at the public session of the Doctoral Council of Medicine on 26 September 2017 at 15.00 in Hippocrates Lecture Theatre, 16 Dzirciema Street, Rīga Stradiņš University.Introduction. The goal No. 16.1 of the UN Sustainable Development Goals aims to significantly reduce all forms of violence. Children belong to the most vulnerable part of society and must be particularly protected from violence and its adverse effects. To identify and successfully solve the problem of violence, it is necessary to identify the extent of the problem, as well as to understand its impact on children’s health and well-being in the long term. Violence is a multifactorial phenomenon, therefore, the influence of beliefs and values of family, local community, culture and social values must be considered when researching, interpreting the results and addressing the problem of violence. The aim of the thesis was to assess the prevalence of violence and its forms in the population of children and young adults of Latvia, and its relationship between the risk factors associated with family, health and its disorders, as well as to find out expert opinions on how the child victims perceive the violence, the consequences of violence, coping mechanisms and rehabilitation. Material and methods. In the quantitative part of the research data from representative cross-sectional study on the adverse childhood experiences of young adults in Latvia were used. Based on the WHO recommendations, the study tool used was a questionnaire from the Adverse Childhood Experiences (ACE) Study. Overall, 1223 cases were analysed. The frequency distribution, cross tabulation and Chi-Square Test (χ²) were used for statistical data processing. The relationships were calculated by odds ratio, stratified odds ration based on Mantel- Haenszel’s method, Spearman’s rank correlation coefficient and multiple logistic regression. In order to find out the experiences of experts dealing with child victims of violence in the qualitative part of the study, in-depth semi-structured expert interviews were conducted with psychologists and doctors-psychotherapists working with child victims of violence. Overall, 14 experts were interviewed. The method used for the interview data processing was thematic analysis. Results. Most often young adults in childhood have experienced emotional violence (31.5%), physical (27.0%) and emotional (23.8%) neglect, but less frequently they have suffered from physical (16.4%) and sexual (10.3%) violence. Women have experienced violence more often than men. Children whose families had the following risk factors: low socio-economic status, parents’ divorce, father’s violence against mother, psycho-emotional health problems and alcohol abuse, had higher odds for experiencing one or more forms of violence, as compared to the children from families without the above mentioned risk factors. Multivariate regression analysis suggested that the young adults who had experienced some form of violence (except sexual abuse) in childhood, had a 1.2–2.2 times (depending on the form of violence) higher odds for poor health self-assessment, compared to young adults who had not witnesed violence in their childhood. Physical and emotional violence experienced during childhood increased the odds ratio of excessive alcohol use in adolescence by 1.4 and 1.2 times. Young adults who had experienced physical and emotional violence, and emotional neglect during childhood, had a 2.6, 2.3 and 2.1 times respectively higher odds of developing mental health problems during adolescence, compared to young adults without such experience. Violence (except sexual violence) experienced during childhood increased the odds of suicide attempts in adolescence by 2.0–4.0 times, compared to young adults without violence experience. Following the interpretation of the interviews, the question section on the victims’ experience of violence and the understanding of the concept of violence, highlighted three topics: the conceptual diversity of the notion of violence, characteristics of the experience of child violence, and child’s openness on the experienced violence. The section on the impact of violence on child’s health, outlined two topics: effects on the physical and psycho-emotional health, and the factors that influence health effects. The section dealing with the way in which the child victims of violence overcome the caused disorders, and what is the role of institutions in this process, outlined three topics: characterization of strategies for overcoming disorders, dealing with the child victim of violence, systemic requirements of rehabilitation. Conclusions. Violence against children is a pressing issue of public health in Latvia. Children from dysfunctional families have higher odds to experience violence. Violence experienced in childhood is associated with increased odds for a bad health self-assessment, excessive alcohol consumption, development of psycho-emotional health problems, and suicide attempts in young adult age. The key topics in the analysis of the expert interviews were conceptualization of the notion of violence, characteristics of the experience of violence, effects of violence and coping mechanisms, as well as the child victim’s needs in rehabilitation process