Childhood maltreatment is associated with a range of mental and physical health consequences. These consequences are apparent in childhood and often continue for many years into adulthood. Individuals who have been sexually or physically abused are more likely to experience serious health problems compared to their non-abused counterparts [1, 2]. Within the research literature there is a general consensus regarding the categorisation of types of childhood maltreatment. The Fourth US National Incidence Study of Child Abuse and Neglect (NIS-4) [3] identified four types of childhood maltreatment; physical abuse, sexual abuse, emotional abuse, and neglect. The current study will assess the prevalence of all four. Physical abuse is defined as an inflicted act causing physical injury to the child or exposing the child to risk of physical injury. Sexual abuse refers to sexually motivated behaviours between the child and an older person involving the child or sexual exploitation of the child, often involving bodily contact, but not necessarily. Emotional abuse is defined as caregiver behaviours that convey to the children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another's needs. Finally, neglect is defined as failing to give the child the care needed according to the child's age and development, for instance having too much responsibility, failure to provide safe health care, unsafe household conditions, inadequate clothing and nutrition, and a lack of supervision [3, 4].

The existence of childhood maltreatment is a major concern worldwide. Information with regards to the number of children who are maltreated is predominantly based on the number of cases which are reported to the authorities or on studies which have focused on single types of maltreatment. However, it is estimated that only a limited number of all cases of maltreatment are reported to the authorities [5]. More precise knowledge about the prevalence of childhood maltreatment can be achieved by conducting studies which utilize large-scale nationally representative samples. To date, only a limited number of nationally representative studies in relation to childhood maltreatment have been conducted. However, these studies have generally focused on specific types of maltreatment [6-12]. Furthermore, the reported prevalence rates often differ dramatically. For example, studies have reported the prevalence of physical abuse ranging from 4.5% to 47% [6, 8]. In relation to sexual abuse, studies have reported prevalence rates which range from 3% to 36% [13]. This could reflect sample specific social and cultural differences. However, it is also likely to reflect the use of different methodological procedures.

The varying prevalence rates of childhood maltreatment reported across epidemiological studies may be attributed to methodological differences. For example, studies using convenience samples have on occasion reported higher rates of maltreatment, which may be attributable to sample specific variations. In addition, the use of retrospective studies has several limitations. One such limitation being, the temporal proximity between the occurrence of the event and the event recall. For example, studies employing retrospective self-reports about maltreatment, which occurred decades ago, may not be as precise as studies using self-reports from adolescents where the events occurred more recently and thus may be easier to recall.

A further issue affecting prevalence rates refers to how maltreatment is defined. Indeed, the majority of the extant research has employed broad categories of maltreatment, albeit some studies have asked questions in relation to specific events. Unfortunately however, these questions have often been ambiguous with regards to whether or not they are actually assessing maltreatment per se. May-Chahal and Cawson [10] for instance, found that 16% of their participants qualified for the formal definition of sexual abuse (contact and non-contact abuse), but that only 6% considered themselves as abused. Furthermore, even studies enquiring about specific types of maltreatment often use different definitions of events. For example, although sexual abuse is often categorised as both contact and non-contact sexual abuse, there is still no clear cut definition as to what actually constitutes sexual abuse. This trend is also apparent in the definition of other types of childhood maltreatment. For example, physical abuse is often defined very broadly, i.e., being hit by the hand of anyone. However, some studies do attempt to differentiate between mild and severe physical abuse [6, 8]. Even vaguer definitions exist across studies in relation to emotional abuse and neglect. Precise definitions of what constitutes particular types of abuse would be advantageous from both a research and clinical perspective. The former as it would facilitate more precise estimates of prevalence and the latter as it has been reported that when asking about an individual’s abuse history, specific well-defined types of maltreatment, promote recognition rather than recall and thus reduces the subjective interpretations of whether a certain event was abuse or not [14].

A final issue relates to anonymity in data collecting methodologies. For example, in an interview situation, the interviewee may not wish to disclose the abuse due to social taboos and potential feelings of embarrassment and shame. A number of alternative interviewing procedures help to overcome the potential of underreporting, for example, telephone interviewing and Computer Assisted Personal Interviewing if the interview is conducted face to face [10]. However, it is also important to note that variations in reported prevalence rates may not be solely attributable to methodological differences. Indeed, a recent cross-national study of maltreatment in four nations (Denmark, Iceland, Lithuania, Faeroe Islands), each employing the same methodological procedures, reported rather different prevalence rates [7]. For example, severe childhood neglect was reported as five times higher in the Faeroe Islands compared to Lithuania. Thus, the Elklit and Petersen study indicated that cultural differences may exist over and above the differences which can be attributed to methodological variation. Indeed, culture specific norms may influence whether or not you regard yourself as having been abused.

Child maltreatment has devastating consequences for both males and females, however important gender differences exist. Females are reported as experiencing sexual abuse to a far greater extent than males. Furthermore, females seem to be victimized more often in family-related events whereas males are more often victimized in activities outside the family [7]. Studies have also reported that gender affects post-abuse adjustment and symptoms. Sexual abuse has been associated with gynaecological problems, headaches, arthritis, and breast cancer for women and thyroid disease for men [2]. Furthermore, Banyard, Williams, and Siegel [15], when comparing females and males who had experienced sexual abuse, found that females had more mental health symptoms than males. Unfortunately, there are only a limited number of gender studies, employing non-clinical samples, available in the extant literature. It is however, important to note that gender based estimates of abuse may be biased in that males may underreport sexual abuse and the consequences thereof, thus artificially increasing the gender differences [16].

The majority of studies tend to focus on specific types of maltreatment, generally either sexual abuse or physical abuse. Only a limited number of studies have assessed emotional abuse and neglect. Notably, fewer studies assess various types of maltreatment using nationally representative samples. Thus, given that all types of maltreatment have long-term consequences there is a need for more precise large-scale epidemiological studies gathering information on heterogeneous maltreatment types.

Childhood maltreatment has been highlighted as having profound aversive consequences on both physical and psychological health. These aversive consequences are apparent in childhood but persist for many years to come leading to adulthood illness and significant psychological distress, e.g., PTSD. Indeed, most studies focus on only one specific type of abuse, despite research which has emphasized that the target and effectiveness of interventions may vary depending on the type of maltreatment [2]. The current study aimed to conduct a detailed assessment of the prevalence of childhood maltreatment in Denmark. Using a similar approach as May-Chahal and Cawson [10], the present study asked participants questions regarding specific experiences of four types of maltreatment; physical abuse, sexual abuse, emotional abuse and physical neglect, a method less flawed by subjective interpretations of whether maltreatment has occurred or not. The current study also aims to assess whether the prevalence of childhood maltreatment varies as a function of gender or child care status.

The current study aimed to conduct a detailed assessment of the prevalence of childhood maltreatment in Denmark while also assessing whether childhood abuse varies as a function of gender or child protection status. Participants were asked questions regarding specific experiences of four types of maltreatment; physical neglect, emotional abuse, physical abuse and sexual abuse. In total, 3.0% of the sample experienced physical neglect, 5.2% experienced emotional abuse, 5.4% experienced physical abuse, and 3.4% experienced sexual abuse from parents or guardians. It is notable that much of the preceding literature in relation to childhood abuse has focused on childhood sexual abuse [10]. However, in addition to sexual abuse, a UK based prevalence study conducted by May-Chahal and Cawson [10] also addressed the prevalence of physical abuse, neglect, and emotional abuse. They concluded that the prevalence of serious physical abuse was 7%, compared to the 5.4% prevalence of physical abuse in the current study. These estimates lie centrally to the range of estimates reported from both UK (15%) [17] and US (2.3%) [18] studies in relation to levels of severe physical violence against children. In relation to the prevalence of neglect, the May-Chahal and Cawson [10] study reported a UK prevalence of 6% compared to the Danish prevalence of 3.0%. With regards to the prevalence of emotional abuse, the UK prevalence was reported at 6% compared to the Danish prevalence of 5.2%. The specific items in relation to neglect and emotional abuse are similar across both the current study and the May-Cahal & Cawson [10] study. This is notable given that May-Chahal and Cawson [10] stated that “There have been no prevalence studies using a comprehensive set of behavioural items to measure emotional abuse or neglect and no two studies measure the same items.” (p. 981).

With regards to sexual abuse, the May-Cahal and Cawson [10] UK study reported a total prevalence of 10% compared to the total prevalence of 3.4% reported for the current study. However, it is important to note that there are vast differences between these two studies in relation to the items which pertain to the experiences of sexual abuse. For example, the May-Cahal and Cawson [10] study assessed sexual abuse under the age of 16 in relation to whether or not such was contact or non-contact sexual abuse and in relation to who was the perpetrator of the abuse (i.e., parent/carer; other relative; other known people; or stranger/person just met). The current study asked a number of questions pertaining to specific types of sexual abuse experiences (cf. Table 5). Interestingly, the May-Cahal and Cawson [10] study reported that when asked about the experiences of contact sexual abuse under the age of 16, by parents or carers, the reported prevalence was 1%. The prevalence of non-contact sexual abuse was less than 1%. Notably, albeit that the sexual abuse experiences questions were asked in relation to events occurring under the age of 24, the current study also asked one direct, yet broad question in relation to the experience of sexual abuse under the age of 13. This question, thus experience of sexual abuse under the age of 13 was endorsed by 1% of the total sample. More recently, Elklit and Petersen [7] conducted a study assessing the prevalence of 19 traumatic experiences in adolescents aged 14 and 15 years across four countries; Denmark (N=390), Iceland (N=206), Lithuania (N=183), and the Faeroe Islands (N=687). The total sample consisted of 1466 students. Three of the 19 experiences were sexual abuse, physical abuse, and severe childhood neglect. Results concluded that although these events were among the least prevalent of the traumatic experiences, physical abuse was experienced by 5% of the sample, sexual abuse was experienced by 4% of the sample, and severe childhood neglect was experienced by 4% of the sample. When broken down by individual countries, the prevalence of these traumas for Denmark alone was reported as: physical abuse 3.6%, severe childhood neglect 3.1%, and sexual abuse 1.5%. The current results report higher rates of physical abuse (5.4%) and sexual abuse (3.4%) in Denmark but similar rates for neglect (3.0%). However, as noted in the introduction, methodological and sample age variations can significantly alter the reported prevalence rates and thus hinder comparison between studies, even when the population of interest belongs to the same country.

Gender differences in the prevalence of childhood sexual abuse has been of particular interest to researchers. Indeed, studies of sexual abuse by gender have been conducted in the UK and the US. A UK based study estimated that 5% of girls compared to 2% of boys experienced sexual abuse which included penetration or coerced masturbation [19]. Notably, US based studies report higher prevalence rates of sexual abuse compared to the UK prevalence rates. Indeed, two meta-analytic studies have been conducted. The first concluded that the prevalence of sexual abuse as experienced by females ranged from 12-17% as compared to the 5-8% of males experiencing sexual abuse [20]. The second concluded that the prevalence of sexual abuse as experienced by females ranged from 8-30% as compared to the 2-16% of males experiencing sexual abuse. Finkelhor [13] conducted a review in which he reported that non US studies estimate that approximately 20% of females compared to 10% of males experience sexual abuse. Elklit and Petersen [7] reported that sexual abuse had been experienced by 1.3% of females compared to 0.25% of male Danish adolescents. The current study, using more specified behavioural items, reported a higher prevalence of sexual abuse in both females (6.4%) and males (0.7%). However, it is important to note that sexual abuse often goes unreported particularly with regard to male victims. Indeed, a review regarding the sexual abuse of male children and adolescents reported that there is a high level of secrecy surrounding the sexual abuse of boys [21].

The current study concluded that a higher percentage of females reported experiencing all types of abuse with the exception of physical abuse. Indeed, these results support those of previous studies. For example, MacMillan et al. [22] examined the Ontario Health Survey and concluded that physical abuse was reported more often by males compared to females. Likewise, May-Chahal and Cawson [10] reported more males compared to females had experienced ‘violent treatment from anyone’ or ‘serious physical abuse from a parent / carer’. With regards to emotional abuse and physical neglect, the May-Chahal and Cawson [10] study supported the current findings as they also reported that females more often report emotional abuse and physical neglect (defined as absence of physical care) than males.

The authors confirm that this article content has no conflicts of interest.