The moderating role of perceived social support in the relationship between childhood emotional abuse and/or neglect and mental health problems .... The mediatting role of social capitalTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông (the effect of emotional abuse and neglect in childhood on mental health problems among high school students) doctoral dissertation in psychology
Context and Background
Adverse childhood experiences (ACEs) are traumatic events that children and adolescents under 18 years of age have experienced (Crouch et al., 2019), such experiences include child abuse, neglect (child maltreatment), substance abuse, and mental illness in the family, as well as having a family member incarcerated or experiencing violence towards a parent These experiences can have a profound impact on a person's physical and mental health, often persisting well into adulthood (Center for Substance Abuse Treatment, 2014) Therefore, the social and occupational outcomes can ultimately slow a country's economic and social development (WHO, 2020) Among those types of ACES, child maltreatment has existed in various forms in every society since the early days of history There is now a large body of evidence that identifies five main maltreatment forms: physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect (Gama et al., 2021a; Gonzalez & McCall, 2017; H T Nguyen, 2006) In this study, we focus on emotional abuse and neglect Emotional abuse and neglect are two forms of emotional/psychological maltreatment Emotional maltreatment is defined as a child-care relationship characterized by harmful interaction patterns, not necessarily physical contact with the child (Glaser, 2002)
The rate and prevalence of child emotional maltreatment have been estimated in many studies at the global level as well as the regional/ national level
At the global level, these studies used meta-analyses and systematic reviews to gather data from accessible sources specified for each nation World Health Organization (2020) estimated that over one billion children aged 2–17 experienced some form of abuse A systematic review and meta-analysis study conducted by Lee and Kim (2022) showed that emotional abuse of 47 % in North America, 18 % in Europe, 35 % in Asia, and 88 % in Africa According to the World Bank national income, the rate was 77 % in low-income countries, 31 % in middle-income countries, and 33 % in high-income countries At the regional/ national level, studies of the prevalence of child emotional maltreatment have been conducted in many countries (Mathews et al., 2020) More importantly, some previous studies have found that the prevalence rate of emotional maltreatment is higher than that of other types of maltreatment (Myers, 2021; Shah et al., 2021; Stoltenborgh et al.,
2015) In Vietnam, according to a study conducted by Nguyen et al (2010), the prevalence of emotional neglect was 29.9% Emery et al (2014) determined the prevalence of child maltreatment in a randomly selected and representative cluster sample of 269 Hanoi families Extreme child maltreatment was reported by 21% of these families, and emotional neglect was reported by 12% According to Tran et al
Child abuse is a significant concern, with almost half of students aged 12 to 17 reporting at least one instance in the past year Emotional abuse is the most prevalent form, affecting over 30% of this population However, prevalence rates vary across studies due to differences in methodology and location, highlighting the need for more research to provide a more accurate understanding of this issue.
Emotional abuse and neglect have short-term and long-term consequences for the physical and mental health of the victims It is associated with a variety of negative physical and mental health outcomes that affect the individual throughout the lifespan and place a substantial burden on both victims and the population as a whole (Gama et al., 2021a; Leeb et al., 2011) Children who are emotionally abused and neglected face similar and sometimes more severe mental health problems as children who are physically or sexually abused (Dye, 2020) (Dye, 2020; Spinazzola et al., 2014), yet these types of maltreatment is rarely addressed in prevention programs or in treating victims (Spinazzola et al., 2014) Especially, most of the studies were done in high-income countries and there was little data from low- and lower-middle-income countries (Ngoc, Lien, et al., 2022) In Vietnam, previous research suggests that child abuse and neglect is a serious problem (Emery et al., 2014; H T Nguyen, 2006; Nguyen et al., 2010; Ruiz-Casares & Heymann, 2009; Tran et al., 2017; Tran et al., 2018) Up to the present, studies of child abuse and neglect and mental health problems such as depression and anxiety in Vietnamese adolescents are few There are only six studies (Lê, 2021; Nguyễn et al., 2023; H T Nguyen, 2006; Nguyen et al., 2010; Pham et al., 2021; Thai et al., 2020) focused on this topic The findings of these studies have found significant relationships between child maltreatment, and psychological distress, anxiety, depression, aggressive behavior, and suicidal ideation
Research on child abuse and neglect is crucial for both academic and clinical purposes, as it provides insights for intervention and prevention Cultural variations in defining and understanding maltreatment, including the acceptance of corporal punishment, highlight the need for culturally sensitive research Studies on child abuse and neglect can benefit victims and families by raising awareness, reducing stigma, and providing support to those at risk Additionally, research can reduce long-term economic costs associated with abuse-related consequences, such as mental health services and juvenile crime Furthermore, recognizing child maltreatment as a human rights issue, research provides evidence to improve policies and legal documents, supporting nations in achieving the Sustainable Development Goals, particularly Target 16.2 aimed at ending abuse and exploitation of children.
(2016), “child abuse refers to any act that results in harm to the body, emotion, psychology, honor, or human dignity of such child through violence against the child, child exploitation, sexual abuse, neglect and abandonment, and other forms of causing harm to the child Child neglect and abandonment refers to the child parent’s or the child caregiver’s failure to perform or inadequate performance of their duties to take care of the child” The law had definition of child abuse, child abandonment, and child sexual abuse, but it did not clearly define emotional abuse and neglect
In addition, we also focus on perceived social support and social capital in the relationship between childhood emotional maltreatment and mental heath problems There are several reasons why we focus on these variables
While the family provides the first context for infants and very young children, the wider environment, including friendships and school, takes on a larger role as children mature (Bronfenbrenner & Morris, 1998; Parcel et al., 2010) Social support includes emotional support, belonging in a social community, being valued, practical help, and information and guidance The term social support includes many aspects, and can be integrated into the broader term social capital – a term that includes components of social networks and social support (Drageset, 2021) Yamaguchi (2013) defines social capital in health and behavior research as “the sum of durable, trustworthy, reciprocal, and resource-rich network connections that are used as an asset to empower a society and its members” Social capital and social support play an important role in the normal development of children and adolescents Safe and supportive families, safe and friendly schools, and positive and supportive peers are critical to assisting young people in reaching their full potential and attaining the greatest health possible during the transition to adulthood (Viner et al., 2012; Yamaguchi, 2013) Previous studies have shown that increasing social capital decreases the odds of neglectful parenting, psychologically harsh parenting (Fujiwara et al., 2016; Zolotor & & Runyan, 2006) Child maltreatment tends to occur in families who experience a combination of several risk factors, and a lack of social support is one of them (Seagull, 1987)
Social capital focuses on the resources and benefits derived from social connections and networks, while social support pertains to the assistance and backing individuals receive from their social networks in times of need Social capital is broader and encompasses various aspects of social interactions/ social network, while social support is specific to providing help and support in challenging circumstances (Drageset, 2021; Yamaguchi, 2013)
Social support has been extensively studied in relation to childhood maltreatment and its long-term effects on mental health Theoretical models, such as the stress-buffering and social support deterioration models, explain how social support can mitigate the negative impact of maltreatment While some studies have shown inconsistent results, others have found that social support significantly mediates and moderates the relationship between childhood emotional maltreatment and mental health problems, reducing psychological distress and the perceived need for mental health care.
2022) Some other studies showed that social support does not have a statistically significant mediating or moderating role in this relationship (Schuck & & Widom,
2003) Until now, in Vietnam, the number of studies on social support and social capital in the relationship between childhood emotional maltreatment and mental health problems is still limited
Besides, the environment in which children and adolescents develop is associated with how they perceive themselves in relation to others (Marici et al.,
2013) Studies have shown cultural and/ or regional differences in social support and social capital index (Beugelsdijk & Van Schaik, 2004; Kim et al., 2008; Taylor et al., 2004) For instance, previous study has shown reliable cultural differences in people’s willingness to use social support for dealing with stressors Asians and Asian Americans are more reluctant to explicitly ask for support from close others than are European Americans because they are more concerned about the potentially negative relational consequences of such behaviors Asians and Asian Americans are more likely to use and benefit from forms of support that do not involve explicit disclosure of personal stressful events and feelings of distress (Kim et al., 2008) In Vietnamese culture, the extended family plays a much more important role in individuals’ lives, and there is much more multigenerational interaction A typical Vietnamese household may include parents, children, daughters-in-law, grandparents, grandchildren, and unmarried siblings The community also plays a larger role in peoples’ lives, and often they are considered one large extended family (Hunt, 2005) The study is particularly significant in the context of Vietnam, which is characterized by a collectivistic culture (Hofstede,
2020) As a result, this study may add to our knowledge of this problem in nations with collectivist cultures.
Statement of the problem
Child maltreatment and neglect are serious social issues that exist not only in Vietnam but also in many other countries around the world Emotional abuse and neglect are the most reported types of maltreatment The consequences of child maltreatment can be severe, leading to physical and mental health problems that can last a lifetime Moreover, the social and occupational effects of maltreatment can eventually impede the economic and social development of a nation (WHO, 2020)
Previous research indicates that emotional abuse is the most harmful form of maltreatment, resulting in developmental consequences that are comparable to or worse than those of other forms of maltreatment (Hart et al., 1996; Hart et al.,
2002) Dye (2020) discovered, for example, that individuals who reported emotional abuse had higher scores for depression, anxiety, tension, and neuroticism than those who reported only physical, only sexual, or both physical and sexual abuse According to a study by Pandey, Gupta, Upadhyay, Gupta, Shukla, Mishra and Kumari (2020), all forms of maltreatment were associated with poor mental health, with emotional abuse having the strongest and most pervasive effect Gama et al (2021) reported that emotional abuse was the form of maltreatment associated with the highest rates of revictimization and severity of PTSD symptoms Emotional abuse may have the most ubiquitous negative mental health effects of any form of childhood maltreatment, according to evidence from both high- and low-income countries (Dye, 2020; Gama et al., 2021b; Pandey, Gupta, Upadhyay, Gupta, Shukla, Mishra, & & Kumari, 2020) In this study, we focus on anxiety and depression in adolescence period
Besides, this study also focuses on perceived social support and social capital since the social system in which a child is reared can affect parenthood (Mestechkina et al., 2014) Previous studies have shown inconsistent results regarding the role of social support and social capital in the relationship between childhood emotional maltreatment and mental health problems Based on (1) Social Learning theory (Bandura, 1978; Dodge et al., 1990), (2) Learned Helplessness theory (Abramson et al., 1978), and (3) Stress-Buffering model (W Cohen & T A Wills, 1985), we created research questions for my study
In sum, we decided to focus on “The effect of emotional abuse and neglect in childhood on mental health problems among high school students” The findings of this study can aid in the development of effective policies and interventions aimed at promoting adolescent mental health in Vietnam
This study investigates the prevalence of childhood emotional maltreatment among Vietnamese adolescents and examines the relationship between emotional maltreatment, current mental health, perceived social support, and social capital The research utilizes a mixed-methods approach, adapting a tool for measuring social capital to understand how social support moderates and social capital mediates the impact of childhood emotional maltreatment on mental health.
This study uses an exploratory sequential design to first qualitatively investigate Vietnamese adolescents' understanding of emotional abuse and neglect through focus groups The qualitative findings will then inform the development of a quantitative measurement tool, which will be tested on a larger sample of high school students This research aims to provide valuable insights for developing interventions to support victims of emotional maltreatment and improve their mental health.
Research questions
(1) What is the status of childhood emotional abuse and neglect experiences among Vietnamese high school students?
(2) How is the experience of childhood emotional abuse and neglect related to current mental health problems among high school students?
(3) How perceived social support and social capital influence the relationship between childhood emotional abuse and neglect and current mental health problems?
Significance of the study
The study has both theoretical and practical implications, which should be taken into consideration :
This study provides a significant contribution to the theoretical understanding of childhood emotional abuse and neglect, as well as the potential association between these adverse childhood experiences and the current mental health challenges faced by adolescents Therefore, this study will help to enhance our general understanding of adverse childhood experiences, particularly childhood emotional maltreatment, and to promote the prevention of these problems By shedding light on the potential association between these adverse childhood experiences and current mental health problems in adolescents, this study provides valuable insights for clinicians, researchers, and educators Furthermore, the lack of knowledge surrounding this complex problem and its consequences has often led to stigma and misunderstanding The results of this study may help to address misconceptions/ misunderstanding and stigma that have often been associated with these experiences Therefore, by enhancing our understanding of these adverse experiences, this study has the potential to promote positive outcomes for children and adolescents who have experienced emotional maltreatment
This study makes a significant contribution to the current knowledge on social support and social capital among Vietnamese adolescents It sheds light on how social support and social capital are linked to childhood emotional maltreatment and mental health problems This study is particularly valuable as there is limited research on moderating factors in Vietnamese context Previous studies have shown cultural differences in social support and social capital, and have also suggested that these factors may be protective factors for victims of childhood emotional maltreatment This study is particularly significant in the context of Vietnam, which is characterized by a collectivistic culture The findings of this study can aid in the development of effective policies and interventions aimed at promoting adolescent mental health in Vietnam and other collectivistic cultures
Social capital and support act as protective factors against mental health issues in adolescents who have experienced emotional abuse and neglect This study suggests that interventions and preventive measures focusing on social support and capital can promote the well-being of these children The findings are particularly relevant for mental health, psychology, social work, and child protection practitioners, providing a framework to address the needs of vulnerable children.
THEORETICAL FRAMEWORK
Definitions
1.1.1 Childhood emotional abuse and neglect
Child abuse and neglect are defined differently across countries and cultures (Nguyen Phuong Hong Ngoc, Narmada Devkota, & Tam, 2022) Cultural differences in beliefs and values in child rearing have a large influence on the definition of child abuse and neglect (Hong & Hong, 1991; Laxmi, 2016) The definition has also changed several times as perceptions have shifted from treating children as property to recognizing that children have rights of their own (Crosson- Tower, 2010)
The perception of a child's social value in different cultures is summarized by Agathonos‐Georgopoulou (1992) as follows:
“1 Children may be valued as labour This does not only apply to simple or developing societies but also to the so-called advanced industrial societies where children may work for low pay, at tedious jobs and often at risk of their health
2 Children may also be valued as an insurance for one’s old age In countries where there is little or no provision of retirement pensions, the duty of support to parents is considered as vital
3 As a mark of adulthood, parenthood may be seen as an inevitable and necessary guarantee of status in society
4 Children may be valued for fulfilling the emotional needs of the parent-for self-perpetuation, for love, for power
5 Children may be valued as the nation’s future.”
This perception varies from country to country and is influenced by cultural norms and traditional practices of different cultures (Kempe, 2013) In Vietnam, in legal documents, the definition of child abuse and neglect is also stated in several legal documents:
“5 Child abuse refers to any act that results in harm to the body, emotion, psychology, honor, or human dignity of such child through violence against the child, child exploitation, sexual abuse, neglect and abandonment, and other forms of causing harm to the child
6 Violence against the child refers to acts of maltreating, persecuting or beating a child; taking physical abuse or causing harm to the child’s health; reviling or offending honor or dignity of the child; segregating, driving the child away and other deliberate acts that cause physical and mental harm to the child
7 Child exploitation refers to the act of forcing the child to work against the law on labor, perform or produce pornographic products; organizing or supporting for tourist activities for the purpose of child sexual abuse; offering, adopting, or supplying the child for prostitution and other acts of using the child for profiteering purpose
8 Child sexual abuse refers to the act of using violence, threatening to use violence, forcing, persuading, or seducing a child to engage in sexual acts The child sexual abuse includes rape, aggravated rape, sexual intercourse or molestation with children and use of children for prostitution or pornography in any form
9 Child neglect and abandonment refers to the child parent’s or the child caregiver’s failure to perform or inadequate performance of their duties to take care of the child.”
Law on Children (Law No 102/2016/QH13)
“The person who commits one of the following acts will be fined from VND 5,000,000 to VND 10,000,000:
- Infringing upon the body, causing harm to the health of children;
- Forced to fast, abstain from drinking, do not give or limit personal hygiene; forced to live in a toxic, dangerous environment or other forms of ill- treatment of children;
- Causing mental harm, insulting dignity and honor, cursing, threatening, humiliating, isolating, distracting, affecting the development of children;
- Using punitive measures to teach children to hurt and suffer physically and mentally;
- Frequently threatening children with images, sounds, animals, and objects that frighten and hurt children
In addition to being fined, the person who commits the act must also bear the costs of medical examination and treatment for children.”
(Clause 2, Article 27 of Decree 144/2013/ND-CP) The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” According to CDC, “child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher)” Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm (Gonzalez & McCall, 2017)
This study defines childhood emotional maltreatment as any form of emotional (psychological) abuse or neglect experienced before the age of 18 It's important to note that there is no universal definition for psychological or emotional maltreatment, including emotional abuse and neglect, which are often used interchangeably.
All abuse is about power and control, and the abuser uses tactics to exert power and control over his or her victims Emotional abuse is any kind of non- physical abuse imposed from one person to another Victims of emotional abuse are subjected to repeated threats, manipulation, intimidation, and isolation that cause them to feel anxiety, fear, self-blame, and worthlessness They can become convinced that no one else cares or wants them Frequently they stay in abusive situations because they believe they have nowhere else to go In contrast to physical violence, emotional violence is not easily identified because it is not readily evident (Moglia, 2015), particularly in children Therefore, child emotional abuse is a type of maltreatment that can be difficult for clinicians to detect and assess (Kimber & MacMillan, 2017) Child emotional abuse can also be defined as the failure of a caregiver to provide an appropriate and supportive environment and includes acts that have an adverse effect on the emotional health and development of a child Such acts include restricting a child’s movements, denigration, ridicule, threats and intimidation, discrimination, rejection, and other non-physical forms of hostile treatment (WHO, 2002) b Emotional neglect (psychological abuse)
Neglect refers to the failure of a parent to provide for the development of the child – where the parent can do so – in one or more of the following areas: health, education, emotional development, nutrition, shelter, and safe living conditions Neglect is thus distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver (WHO, 2002) Houtepen et al (2018) defined emotional neglect as caregivers' persistent disregard for children's emotional needs, including failure to provide comfort when a child becomes scared or distressed In other words, according to Ludwig and Rostain (2009), emotional neglect can be defined as a relationship pattern in which an individual’s affectional needs are consistently disregarded, ignored, invalidated, or unappreciated by a significant other People in neglectful families are emotionally disconnected from one another, behaving as if they were living on different planets Parents may have trouble understanding their children’s needs for love, affection, closeness, and support, or they may feel too overwhelmed or powerless to meet these needs on a consistent basis (Ludwig & Rostain, 2009) For example, Hopper et al (2018) listed types of emotional abuse and neglect:
Table 1 Types of child emotional abuse and neglect (Hopper et al., 2018)
Types of emotional neglect Types of emotional abuse
A caregiver is not physically present o Forced to be physically absent due to work, military service, hospitalization, or incarceration o Choosing to be absent due to substance or alcohol abuse or prioritizing another family
Caregiver is emotionally absent due to dissociation, severe depression, chronic mental illness, or developmental delays
Extreme family stress due to poverty, lack of social support, or dangerous neighborhood interferes with caregiver’s emotional availability
Caregivers ignore child’s bids for attention or shuns child
Caregiver abandons the child for periods of time with no indication of when he or she will return or imposes extended periods of isolation from others
Caregivers call the child derogatory names or ridicules or belittles the child
Caregiver blames the child for family problems or abuse of the child
Caregivers display an ongoing pattern of negativity or hostility toward the child
Caregivers make excessive and/or inappropriate demands of the child
A child is exposed to extreme or unpredictable caregiver behaviors due to the caregiver’s mental illness, substance, or alcohol abuse, and/or violent/aggressive behavior
Caregivers use fear, intimidation, humiliation, threats, or bullying to discipline the child or pressure the child to keep secrets
A caregiver demonstrates a pattern of boundary violations, excessive monitoring, or overcontrol that is inappropriate considering the child’s age
Children should not be burdened with excessive responsibilities, such as consistently caring for younger siblings or fulfilling the emotional needs of their caregivers, as this can lead to role reversal and an inappropriate level of burden.
A caregiver undermines a child’s significant relationships
Caregivers do not allow the child to engage in age-appropriate socialization
A child is exposed to relationship conflict between caregivers 1.1.1 Mental health problems
Mental health, as defined by WHO, is a fundamental aspect of overall well-being that empowers individuals to manage life's challenges, achieve their full potential, contribute to society, and thrive It is essential for personal, community, and socio-economic progress, enabling individuals to make informed decisions, foster meaningful relationships, and shape their world.
Literature Review
1.2.1 Prevalence of children and adolescents being emotionally abused and neglected by parents/ caregivers
Many studies on adverse childhood experiences, including childhood maltreatment (e.g child abuse and neglect), have been conducted There are acts of abuse and neglect that are more easily observable, such as physical abuse and neglect, but on the other hand, emotional maltreatment seems “invisible”, this type of child maltreatment are more difficult to identify than sexual abuse, physical maltreatment Emotional maltreatment, also known as psychological maltreatment, refers to a pattern of non-physical interactions, which potentially harm the victim’s health and development Emotional maltreatment can also be divided into two categories: emotional abuse and emotional neglect (Egeland, 2009; Glaser, 2002; Taillieu et al., 2016) In this study, we focus on childhood emotional abuse and neglect by parents/ caregivers Egeland (2009) defines emotional abuse as an act of commission that involves verbal hostility, taunting, belittling, and rejection Emotional neglect, on the other hand, is an act of omission: the inability to meet the child's emotional needs Emotionally neglectful parents are emotionally unavailable, detached, avoidant, and unresponsive to their child's wants or desires (Egeland,
Previous studies have shown the prevalence of children being emotionally abused and neglected by parents/ caregivers at the global level as well as the regional/ national level
At global level, these studies used meta-analyses and systematic reviews to gather data from accessible sources specified for each nation World Health Organization (2020) estimated that over one billion children aged 2–17 experienced some form of abuse Unicef (2017) estimated nearly 3 in 4 children or 300 million aged 2 – 4 years regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers According to a systematic review conducted by Moody (2018), studies of emotional abuse were less commonly found in comparison with other type of child maltreatment Prevalence rates amongst girls (28.4%) in North America were twice that for boys (13.7%) although there were twice as many study samples for girls found Prevalence rates in Europe were approximately half those reported in North America for both genders (boys: 6.2%, girls: 12.9%) and based on a smaller number of studies (boys n = 5, girls n = 8) In Asia, where there were more study samples involved median prevalence rates were higher for boys (33.2%) than for girls (26.9%) Another systematic review and meta-analysis study conducted by Lee and Kim (2022) showed that emotional abuse of 47 % in North America, 18 % in Europe, 35 % in Asia, and 88 % in Africa According to the World Bank national income, the rate was 77 % in low-income countries, 31 % in middle-income countries, and 33 % in high-income countries Especially, some previous studies have found that the prevalence rate of emotional maltreatment is higher than that of other types of maltreatment (Stoltenborgh et al., 2015) Meta-analyses on the global prevalence of emotional abuse showed the overall estimated prevalence was 363/1,000 for studies using self- report measures of child emotional abuse (Stoltenborgh et al., 2012) According to another meta-analysis study of Stoltenborgh et al (2013), the overall estimated prevalence was 184/1,000 for emotional neglect Stoltenborgh et al (2015) concluded that the overall estimated prevalence rates for self-report studies (assessing maltreatment ever during childhood) were 363/1000 for emotional abuse, and 184/1000 for emotional neglect The overall estimated prevalence rates for studies using informants (assessing the 1-year prevalence of maltreatment) were three per one thousand for emotional abuse
At regional/ national level, studies of the prevalence of child emotional maltreatment have been conducted in many countries (Mathews et al., 2020) For example, in Ecuador, emotional maltreatment was reported by 53 % of participants (university student (males = 1579; females = 1554)) mostly through insults by same- sex peers and parents (Jiménez-Borja et al., 2020) In the United Arab Emirates, based on a survey colleted from 518 adolescents, the mean age of study participants was 14.3 years Emotional abuse was the most frequent form of maltreatment (33.9%), physical abuse (12.6%) and neglect (12.1%) followed (Shah et al., 2021)
In China, a study conducted by Chen and Jiang (2022) showed that the prevalence of psychological abuse in Chinese adolescents was 25.66%, based on data which were obtained from 417 Chinese adolescents aged 15–18 years old In South Afica, 48.4% of participants reported childhood maltreatment, the most common type being emotional abuse (26.7%) (n = 1290 university students) (Myers et al., 2021)
In Zambia, Merrill et al (2020) conducted a study to investigate experiences of violence victimization among adolescents and young adults living with HIV, aged 15-24 years The study found that psychological abuse was the most common form of violence (70.4% lifetime, 65.3% past-year), followed by physical violence (50.8% lifetime, 44.7% past-year) and forced sex (10.4% lifetime, 4.7% past-year)
In India, a study was conducted by Pandey et al (2020), they collected data on 132 adolescents (12-18 years old; 114 males, 18 females) who had a history of child work The study found that a large proportion of the sample reported experiencing childhood abuse or neglect (83.36%) Further, 47.7% of the participants experienced emotional abuse, with 74.6% experiencing it outside of the family and 12.9% experiencing it within the family, etc
Research in Vietnam highlights the alarming prevalence of child maltreatment A 2010 study by Nguyen, Dunne, and Le found that 47.5% of children experienced physical abuse and 29.3% experienced neglect In 2014, Emery et al surveyed a representative sample of Hanoi families and found that 21% reported severe abuse and 12% reported neglect in the past year, demonstrating the ongoing challenge of child maltreatment in the country.
(2017) indicated that 49.9% (N51 students aged 12 to 17 years) reported at least
1 event of child maltreatment in the past year Emotional abuse was most frequently reported (31.8%), followed by physical abuse, neglect, and witnessing parental conflict According to Tran et al (2018), while the prevalence estimates of sexual abuse and neglect were unchanged over 10 years, the prevalence of physical abuse and emotional abuse declined In the Hanoi sample comparison, only the prevalence of emotional abuse declined, and this reduction was smaller for younger adolescents than for the older group
Table 3 Prevalence of childhood emotional abuse and neglect by parents/ caregivers
Country Sample Prevalence (%) Measurements Note
Emotional abuse Emotional neglect Meinck et al (2016)
35.5% for lifetime emotional abuse (12.1% incidence)
Five items from the UNICEF Measures for National-level Monitoring of OVC
Older children, girls, children in rural area were more likely to report emotional abuse Họuser et al (2011)
Germany 4455 persons resident in different places in Germany
Only persons at least 14 years old with adequate comprehension of written German were included
Severe emotional abuse in childhood and/or adolescence was reported by 1.6%
Severe emotional neglect was reported by 6.6%
458 third-grade high-school students (39% boys) aged between 15 and 20 (median age, 17)
A self-report, pre-tested and semi-structured questionnaire in the Hindi language (national
Country Sample Prevalence (%) Measurements Note
Emotional abuse Emotional neglect spoken language) was used for the purpose of the study It was modified from various standard questionnaires
(78.4% of the original cohort) from the 1993 Pelotas Cohort
The adverse childhood experiences assessed were: physical abuse, sexual abuse, emotional neglect, physical neglect, domestic violence, parental separation and parental death These ACEs were selected for inclusion in our analysis based on the ACE Study (Felitti et al., 1998) (Nourazar et al.,
11.7% (prevalence rates of severe and very severe psychological abuse) 27.7% (prevalence rates of moderate psychological abuse)
(prevalence rates of severe and very severe neglect) 27.7%
(prevalence rates of moderate psychological
Child abuse self-report scale
Country Sample Prevalence (%) Measurements Note
Emotional abuse Emotional neglect neglect) Yamamoto et al
Threat, putting to shame by the father or the mother were reported to have occurred at least several times a year by 26.1%, 14.3%
The participant was asked whether he/she had experienced any categories of maltreatment from the father or the mother, before the age of 16 These were (1) emotional neglect, e.g saying
“you are not my child”; (2) threat, e.g., not giving meals and disrupting participants’ cherished pets or toys; (3) putting to shame, e.g., scolding cruelly and making fun of the child in front of others Each maltreatment was rated for its frequency from both parents separately on a 5-point scale: never (1); once in the lifetime (2); several times a year (3); several times a month (4); and several times a week (5)
The prevalence rates of at least one form of psychological
Moreover, the rates of at least one
International Society for the Prevention of Child Abuse and Neglect Child Abuse
Living separately from parents posed children to
Country Sample Prevalence (%) Measurements Note
Emotional abuse Emotional neglect abuse both in the past year and lifetime were more than 97% form of neglect were about 58 per cent during the past year and 78 per cent over lifetime
Screening Tool for Children significant risks of neglect and psychological abuse Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse Children with more years of schooling experienced less neglect and psychological abuse
Overall, 48.4% of participants reported childhood maltreatment, the most common type
Selected items from the Composite International Diagnostic Interview, and the
Country Sample Prevalence (%) Measurements Note
Emotional abuse Emotional neglect being emotional abuse (26.7%)
Questionnaire were used to measure four types of maltreatment prior to the age of 17 Emotional abuse was measured by three items assessing the frequency with which caretakers insulted, said hurtful things, or emotionally abused participants van Berkel et al
Netherlands 785 people Emotional neglect was the most prevalent type of maltreatment, followed by physical neglect, emotional abuse, physical abuse, and finally sexual abuse
Prevalence data were based on cases reported to ‘Safe at Home’ organizations (former
This study collected data from 785 professionals working with children (sentinels) who reported suspected cases of child maltreatment they observed over a three-month period These sentinels, representing various child protective services (CPS) agencies, completed a form for each case they identified.
43.3 % 44.5 % Childhood emotional abuse and neglect were assessed with the 10-item Adverse
Country Sample Prevalence (%) Measurements Note
Questionnaire, which was developed by the Centers for Disease Control and Prevention, US
Vietnam 2591adolescents The prevalence estimates of at least one type of physical and emotional maltreatment,neglect and sexual abuse were 47.5%, 39.5%, 29.3% and 19.7% respectively
Questions measuring four forms of childmaltreatment were developed Mostly, these were modified from various sets of questionnaires previously used internat ionally and demonstrated to have goodinternal consistency
Children and adolescents not only experienced emotional abuse and neglect in single form but also co-occurrence across multiple types of maltreatment (Arata et al., 2005; Clemmons et al., 2003; Higgins et al., 2023; Villodas et al., 2021) Neglect accompanied by physical and emotional abuse was the most common form (Kim et al., 2017)
Conceptual framework
This study investigated the link between stressful events and mental health, focusing on social support and social capital as potential mitigating factors The research drew upon three key theoretical frameworks: Social Learning theory, Learned Helplessness theory, and the Stress-Buffering model, providing a foundation for the proposed hypotheses.
Childhood emotional maltreatment has been found to be associated with various mental health problems (Ngoc, Lien, et al., 2022) Previous results showed that CEA was positively related to adolescent depression and anxiety even after controlling for other types of childhood maltreatment (Li et al., 2022) According to the social learning theory, children who have been subjected to maltreatment learn to interact with others in the same way they have been treated Exposure to violence during childhood may lead to a perception of violence as a permissible behavior Consequently, abused children may resort to violent or aggressive behavior when faced with conflict or when attempting to demonstrate power This can result in difficulties with interpersonal relationships and social support, which, in turn, may lead to social exclusion and contribute to internalizing problems such as depression and anxiety
Childhood emotional abuse can lead to learned helplessness, characterized by passive and withdrawn behavior, contributing to internalizing problems like depression and anxiety This vulnerability is exacerbated by a lack of social interaction and support, which are crucial for well-being Social support and social capital act as stress buffers, mitigating the negative impact of emotional abuse on mental health Therefore, we propose that social support and social capital positively influence the relationship between emotional abuse experiences and the development of depression and anxiety in adolescence.
As mentioned above, the study’s hypotheses were formulated based on the stress-buffering model S Cohen and T A Wills (1985b) proposed the stress- buffering hypothesis/ stress-buffering model to explain why social support and network characteristics can help improve mental health outcomes for people experiencing stress According to the stress-buffering model, social support may mitigate the psychological impact of a stressful event by attenuating the stress appraisal response An individual may see a stressful event as less stressful if he/she perceives that others will provide resources needed to cope with the event (Cohen et al., 2001; S Cohen & T A Wills, 1985a) Children who have been abused or neglected are exposed not only to abusive or neglectful situations, but also to additional stressors such as separation from their parents, foster care placement, and various forms of revictimization later in life (Cannon et al., 2010; Fereidooni et al., 2023; Widom et al., 2008) A history of abuse and neglect, as well as these stressors, may increase the risk of mental health problems in adulthood According to the stress-buffering hypothesis, strong levels of social support protect individuals from stress-related mental problems As a result, we hypothesized that social support and social capital are protective factors for mental health disorders (such as depression and anxiety) later in life among victims of abuse and neglect
Hypothesis 1 (H1): Childhood emotional maltreatment (emotional abuse and neglect) is positively associated with mental health problems (depression and anxiety) among Vietnamese adolescents
H1.1: Childhood emotional maltreatment is positively associated with depression symptoms among Vietnamese adolescents
H1.2: Childhood emotional maltreatment is positively associated with anxiety symptoms among Vietnamese adolescents
Figure 9 Hypothesis 1.2 Hypothesis 2 (H2): Perceived social support moderates the relationship between childhood emotional maltreatment and mental health problems in adolescent period, such that the higher the level of perceived social support, the smaller the size of the effect of emotional maltreatment on depression and anxiety
H2.1: The higher the level of perceived social support, the smaller the size of the effect of childhood emotional maltreatment on depression
H2.2: The higher the level of perceived social support, the smaller the size of the effect of childhood emotional abuse/ neglect on depression
Childhood emotional maltreatment Depression symptoms
Childhood emotional maltreatment Anxiety symptoms
Childhood emotional maltreatment Depression symptoms
Hypothesis 3 (H3): Social capital mediates the relationship between childhood emotional maltreatment and mental health problems in adolescent period
- H3.1: Social capital mediates the relationship between childhood emotional maltreatment and depression in adolescent period
- H3.2: Social capital mediates the relationship between childhood emotional abuse/ neglect and anxiety in adolescent period
Childhood emotional maltreatment Depression symptoms
Childhood emotional maltreatment Anxiety symptoms
Childhood emotional maltreatment symptoms Anxiety
METHODOLOGY
Overview of research design
This study is a retrospective and cross-sectional study that uses exploratory sequential mixed methods designs
This study employs an exploratory sequential design, starting with qualitative data collection and analysis to gain a nuanced understanding of emotional maltreatment These insights inform the selection of relevant measurements for the subsequent quantitative phase, enabling a comprehensive analysis of the topic.
Figure 14 Exploratory sequential mixed methods research design
2.1.1 Phase 1: The qualitative sub-study
Focus group discussion is frequently used as a qualitative approach to gain an in-depth understanding of social issues (O Nyumba et al., 2018) Focus group methodology has many advantages: (1) People are generally more comfortable discussing sensitive problems when they are placed with those with similar backgrounds, (2) Focus groups allow participants to react to and build on the responses of other participants Therefore, participants can uncover, expand and build further opinions and thoughts (Shoaf & & Shoaf, 2006), (3) Focus groups are
(choose measurement and adapt scale)
Interpret results especially useful as a complement to other methods of data collection for providing in-depth information in a relatively short period of time (Gundumogula, 2020), the focus group methodology is a valuable tool for diving into and understanding people's thoughts, opinions, and the reasons behind them on topics that are important to them It allows for gathering rich and detailed information about people's feelings, thoughts, understandings, perceptions, and impressions in their own words, without pressuring them to make decisions or reach a consensus The method also provides insight into the similarities and differences of understandings held by participants (Liamputtong, 2011), (4) Given that participants are aware of being observed by the moderator, it is comparatively easier to ensure their full engagement even during periods of non-discussion This results in a high level of contribution to the research from the participants The moderator can be assured that each participant is giving their undivided attention to the subject matter throughout the session (Sagoe, 2012)
This study explored Vietnamese high school students' perceptions of emotional maltreatment through focus groups in Hue, Ho Chi Minh City, and Dong Nai The qualitative data analysis informed the development of the Youth Social Capital Scale (YSCS), which was piloted with ten students across various Vietnamese cities.
2.1.2 Phase 2: The first quantitative sub-study
This study adapted existing scales for Vietnamese samples, except for the YSCS scale To ensure consistency across all scales, we adapted the YSCS scale for use with Vietnamese participants.
According to Borsa et al (2012), psychological measurement tools are adapted in six steps: (1) forward translation: translation from the source language to the target language; (2) total translation synthesis; (3) general assessment of experts and specialists; 4) tool evaluation with overall objective; (5) backward translation; and (6) pilot study Having adapted YSCS to the Vietnamese culture, we piloted Vietnamese version of this scale to a sample of high school students (including a sample for examing EFA (Ns0) and a sample for examing CFA (Nr4)) to evaluate its psychometric characteristics, including Cronbach's alpha and the number of factors These stages are presented in the following process flowchart:
Figure 15 Procedures for cross-cultural adaptation of psychological instruments
(Borsa et al., 2012) First, we received permission from Jenny Onyx and Paul Bullen (authors of the scale) to translate, adapt and use their final scale The YSCS was translated using the forward and backward process
(1) Forward translation by two Vietnamese with a solid understanding of the English language, independent translation
(2) Synthesize the Vietnamese translation and hold a group discussion between the researcher and the two interpreters to compare the differences between the two forward translations and the available Vietnamese translation
(3) Backward translation by two native English-speaking Vietnamese, independent translation
(4) Synthesis of English translations, group discussion among researchers and two interpreters to compare distinctions between the two reverse translations
(5) The researcher conferred with a workers/ researcher in the fields of psychology and education among Vietnamese speakers who are fluent in English and modified the questionnaire in terms of semantics
To ensure content validity, the study involved eight researchers or experts with a minimum of a master's degree in psychology, social work, or psychiatry These experts had experience working with children and adolescents or in hospital or school settings.
(7) Administer surveys to 10 high school students in Hanoi, Hue, Bac Giang, Ho Chi Minh City, and Ninh Binh
(8) Send an email with the revised questionnaire to the original author Jenny Onyx
We asked Jenny Onyx for adjustments in the Vietnamese version of YSCS after piloting it with ten high school students and eight experts, and then created the final scale
2.1.3 Phase 3: The second quantitative sub-study
The measurement for phase 3 was selected based on the results of the qualitative sub-scale Next, we collected data on high school students in Hue and Ha Nam (Nu7) based on the final questionnaire with adapted scales This data was used to answer all this study’s questions
According to the statistic from MOET 4 , in 2022, Vietnam (includes Red River Delta, Northern Mountainous, Northern Centre and Central Coastal, Central Highlands, South Eastern and Mekong River Delta) has 2.781.613 high school students in total
For the first qualitative sub-study, we collected data in Hue, Ho Chi Minh City, and Dong Nai We did an online and offline focus group with 17 students Hanoi – capital of Vietnam, located in Northern Vietnam on the western bank of the Red River, Ho Chi Minh city is a city in Southern Vietnam, Dong Nai is in southeastern Vietnam, Ninh Binh is located to the south of the Northern Delta, between the Red and Ma rivers Bac Giang is located in the Red River Delta, and Hue is in the North Central Coast region of Vietnam, located near the center of Vietnam
A pilot study of the YSCS was conducted with 10 high school students in five Vietnamese provinces, followed by data collection in Hue and Ninh Binh to adapt the instrument Subsequent quantitative data was collected from two public high schools in Hue and two in Ha Nam, a province in the Red River Delta area of Northern Vietnam This data collection targeted a total of 697,581 high school students in the Red River Delta area, with 28 high schools in Ha Nam and 40 in Hue.
Convenience sampling was used as a recruitment strategy
4 https://moet.gov.vn/content/tintuc/Lists/News/Attachments/8820/to-gap-tkgd-2022.pdf
Table 5 Description of study sample
Sub-study Sample size and location
The qualitative sub-study Focus group : 17 high school students in
Hue, Ho Chi Minh City, and Dong Nai The first quantitative sub-study Piloted YSCS: 10 students in Hanoi, Hue,
Bac Giang, Ho Chi Minh City, and Ninh Binh
1454 high school students in Hue and Ninh Binh
For EFA, Ns0 ; For CFA, Nr4 The second quantitative sub-study 757 high school students in Hue and Ha Nam
2.2.1.1 Participants in the qualitative sub-study
Table 6 Characteristics of the study participants in the qualitative sub-study
2.2.1.2 Participants in the first quatitative sub-study
This sub-study involved 1454 high school students from Hue and Ninh Binh who completed a questionnaire To adapt the YSCS, these students were randomly divided into two groups: Sample 1A for Exploratory Factor Analysis (EFA) and Sample 1B for Confirmatory Factor Analysis (CFA), using the EFA results as a guide.
Table 7 Characteristics of the study participants in the first quantitative sub- study (Sample 1A) (Ns0)
Hue (urban/ semi urban-rural) 684 93.7 320 95.0 362 92.6
High 69 9.5 27 8.0 41 10.5 a Results from Independent sample T-test, b Results from Chi-square
Table 8 Characteristics of the study participants in the first quantitative sub- study (Sample 1B) (Nr4)
Hue (urban/ semi urban- rural)
High 70 9.7 27 8.2 43 11.0 a Results from Independent sample T-test, b Results from Chi-square
2.2.1.3 Participants in the second quatitative sub-study
A total of 757 students from four high schools in Ha Nam and Hue participated in the study, with an average age of 16.99 years (SD = 0.83) The sample comprised 362 boys and 387 girls, and the majority (98.8%) identified as Kinh, the dominant ethnic group in Vietnam.
Table 9 Sample characteristics in the second quantitative sub-study (Nu7) n %
My father/mother passed away 32 4.3
Recruitment procedues
A private/public school was chosen conveniently for the study A letter explaining the study objectives was sent to the school principals for approval After receiving their approval, we began the process of recruitment and research in the chosen school We met with the school administration and sent information about the study to parents/caregivers We designed a consent form and sent it to the students The consent form explained that the study required participation, and we offered a small gift to students/parents who completed the questionnaire.
Study methods
This study aimed to investigate the connection between childhood emotional abuse/neglect and depression/anxiety in adolescents, and how social support and social capital might influence this relationship To achieve this, we conducted comprehensive searches on Google Scholar, PubMed, and PsycInfo starting December 20th, 2020, using specific keywords to ensure a thorough and relevant review Our rigorous search criteria aim to provide a reliable and comprehensive overview of the current research literature on this topic (Table 10).
Table 10 Search terms and keywords used
General keywords Specific keywords adverse childhood experience, childhood trauma, child maltreatment, child abuse emotional maltreatment, psychological maltreatment, emotional abuse, psychological abuse, emotional neglect, psychological neglect mixed anxiety and depression, internalizing problems, internalizing disorder, internalizing psychological disorders, mood disorder, emotional problems, psychological problems, emotional disorder, mental disorder depressive disorders, disruptive mood dysregulation disorder, major depressive disorder, major depressive episode, depression, depress*, depressed, dysthymic disorder, dysthymia, dysthymic, persistent depressive disorder, anxiety, generalized anxiety disorder, panic disorder, phobic disorders, agoraphobia, social phobia, specific phobia, social and specific phobias, separation anxiety disorder
Social support peer support, family support
This qualitative sub-study employed a focus group to understand participants' perspectives on emotional abuse and neglect The research aimed to analyze qualitative findings, identify a suitable measurement for quantitative data collection, and pilot and validate the Youth Self-Report (YSCS).
To ensure the focus group questions were relevant and effective, they were developed collaboratively with supervisors and piloted with high school students This process refined the questions, ensuring they were easily understood and yielded rich information The interview guide explored five key areas: defining child maltreatment within their cultural context, understanding emotional abuse and neglect, identifying indicators of emotional abuse and neglect, and examining the influence of culture on childhood experiences and parenting practices.
2.4.3.1 The first quantitative sub-study
- Purpose: To culturally adapt and validate YSCS for Vietnamese high school students
Demographics: assess the participants’ characteristics like age, gender, and parental socio economic status
Youth Social Capital scale (YSCS) (Onyx et al., 2005): The YSCS was developed to measure social capital among youth aged between 12 - 20 years old The self-administered instrument consists of 34 items, which are categorized in seven factors: Participation in community (8 items), Youth social agency 6 items), Trust and safety (2 items), Neighborhood connections (4 items), Family and Friends
(5 items), Friends (3 items) and Moral principles (6 items) All items are answered on a 4-point Likert scale A total score is calculated by summing the results for all items, the higher the score the higher the social capital
2.4.3.2 The second quantitative sub-study
- Purpose: To have quantitative data on the childhood emotional maltreatment and mental health, as well as social capital and social support among high school students Based on this data, the preavalence of childhood maltreatment and other problems was identified and the relationship between these variable was explored
Demographics: assess the participants’ characteristics like age, gender, religion, ethnic group and parental socio economic status
Adverse Childhood Experience International Questionnaire (ACE-IQ) (WHO, 2018): This questionnaire asks how often adolescents experienced 13 domains of adversity while growing up Questions cover family dysfunction; physical, sexual, and emotional abuse and neglect by parents or caregivers; peer violence; witnessing community violence; and exposure to collective violence Among those sub-scales, we used items related to emotional abuse and neglect by parents/ caregivers Following the WHO questionnaire, all items in the Emotional abuse sub-scale (“Did a parent, guardian or other household member yell, scream or swear at you, insult or humiliate you?, and “Did a parent, guardian or other household member threaten to, or actually, abandon you or throw you out of the house?”) use a 4-point Likert scale (1=Many times, 2=A few times, 3=Once, 4 Never), except the Emotional neglect sub-scale (“Did your parents/guardians understand your problems and worries?”, and “Did your parents/guardians really know what you were doing with your free time when you were not at school or work?”) which was answered on a 5-point Likert scale (1 = Never, 2 = Rarely, 3 Sometimes, 4 = Most of the time, 5 = Always) We reversed the scores of all items, (except the Emotional neglect items) so the higher the score, the more severe the abuse and neglect Individuals who select “a few times” or “many times” are identified as victims of emotional abuse by their parents or caregivers, while those who select “never” or “rarely” are identified as victims of emotional neglect by their parents or caregivers We also used items related to the family environment in this study (1 = Yes, 2 = No) Each item includes an option “88=refused” in case the participant chooses not to answer it
The ACE-IQ, a tool for measuring emotional abuse and neglect, has been validated in numerous studies involving adolescents (Ho et al., 2019; Kazeem, 2015; Kidman et al., 2019) This study utilizes the Vietnamese version of the ACE-IQ, adapted by Trang (2020), demonstrating the tool's applicability across cultural contexts.
IQ among adolescents in Vietnam showed good reliability
Depression, Anxiety and Stress Scale - 21 Items (DASS-21) (Lovibond & Lovibond, 1995): The DASS-21 was utilized to evaluate the stress, anxiety, and depression levels of the students Prior research on adolescents has commonly employed the DASS-21 to detect indications of anxiety, depression, and stress The evidence they have provided supports the excellent reliability and strong internal consistency of the instrument for use with adolescents (Nguyễn Danh Lâm et al., 2022; Silva et al., 2016) The scale is comprised of 21 autobiographical items formatted as a 4-point Likert scale 0 - Not true for me at all; 1 - Partially or occasionally true for you; 2 - True for you most of the time or most of the time; 3 - Always or most of the time true for you) Each of the three DASS-21 scales contains
7 items, divided into subscales with similar content The depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/ involvement, anhedonia, and inertia The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect The stress scale is sensitive to levels of chronic non-specific arousal It assesses difficulty relaxing, nervous arousal, and being easily upset/ agitated, irritable/ over-reactive and impatient For each scale (Depression, Anxiety & Stress) sum the scores for identified items Before interpreting the scores, the summed numbers in each sub-scale need to be multiplied by 2 Recommended cut-off scores for conventional severity labels:
Table 11 Cut-off score of DASS-21
The Multidimensional Scale of Perceived Social Support (MSPSS) measures an individual's perceived support from family, friends, and significant others This study utilized eight items, four each for family and friends, rated on a six-point Likert scale A higher total score indicates greater perceived social support The MSPSS is widely used with adolescents and has demonstrated strong reliability and internal consistency in this population, as evidenced by multiple studies.
Youth Social Capital scale (YSCS) – Vietnamese version: The YSCS was created to assess social capital in adolescents aged 12 to 20 years It has been used in various studies (Koutra et al., 2017; Koutra et al., 2012; Viapude et al., 2016) The self-administered instrument consists of 31 items, which are categorized in four factors: Participation in community (8 items), Acceptance and trust (14 items), Neighbour Connections (3 items), Openess and safety (6 items) All items are answered on a 4-point Likert scale A total score is calculated by summing the results for all items, the higher the score the higher the social capital
The table below presents information on the Vietnamese adaptations of the psychometric characteristics of the instruments used in this study
Table 12 The psychometric properties of all scales in this study
Measurement Author(s) Sample Psychometric characteristic
All items: α=0.84 757 students from four high schools in Ha Nam and Hue
All items (child abuse and neglect): α=0.84
Le et al (2017) 1,387 high school students
Cronbach's Alpha was 0.84, 0.74, and 0.76 for the Depression, Anxiety, and Stress subscale Convergent validity was confirmed with moderate correlation coefficients (-0.47 to -0.66) between its factor scores and the ADHP-V mental health related domains
757 students from four high schools in Ha Nam and Hue
Cronbach's Alpha was 0.84, 0.74, and 0.76 for the Depression, Anxiety, and Stress subscale
Internal consistency was high for Family
757 students from four high schools in Ha Nam and Hue
All items: α=0.89 Family support: α=0.84 Peer support: α=0.87
Measurement Author(s) Sample Psychometric characteristic
African American, and 17 (15%) multiracial or other race/ethnicity
Vietnamese American (n = 372) and European American adolescents (n = 304)
Good internal consistency for T1 family support (α=0.88 for Vietnamese Americans and 0.91 for European Americans), T1 peer support (α=0.86 for Vietnamese Americans and 0.91 for European Americans), T2 peer support (α=0.87 for Vietnamese Americans and 0.90 for European Americans), and T2 family support (α = 0.88 for Vietnamese Americans and
Measurement Author(s) Sample Psychometric characteristic
Sample Psychometric characteristic 0.87 for European
None 730 high school students in Hue and Ninh Binh
EFA results: KMO=0.92, sig Barlett’s Test< 0.01 All items: α=0.91 Acceptance and trust (14 items, α =0.873)
724 high school students in Hue and Ninh Binh
CFA results: the model fit indices are acceptable (RMSEA = 0.05) and slightly less than the good fit values (CFI = 0.87, TLI
All items: α=0.903 Participation in community
(8 items, α =0.855) Acceptance and trust (14 items, α =0.873)
Measurement Author(s) Sample Psychometric characteristic
Sample Psychometric characteristic items, α =0.710) Openess and safety (6 items, α =0.635)
757 students from four high schools in Ha Nam and Hue
All items: α=0.894 Participation in community (8 items, α
2.4.4.1 Qualitative data analysis and intepretation
Ethical considerations
The study was approved by the Institutional Review Board (IRB) at the VNU University of Education, Vietnam National University, Hanoi.
RESULTS
Childhood emotional abuse and neglect experiences among Vietnamese high
Children and adolescents’ perceptions of abuse and neglect also influence whether they are identified and reported as victims Previous research has shown that children and adolescents may not report or delay reporting abuse because they are unaware that the maltreatment is happening in the first place (Owaidah et al.,
To gain insight into Vietnamese adolescents' understanding of emotional abuse and neglect, we conducted focus groups with high school students in Hue, Dong Nai, and Ho Chi Minh City This sub-study provided supplementary data for our quantitative research, offering valuable perspectives on the perception and observation of emotional maltreatment within the Vietnamese context.
Regarding emotional abuse of children, most students reported that this type of abuse is characterized by disrespectful acts and violent behavior that can harm children and force them to fulfill their parents' needs The students provided examples of emotional abuse that clearly showcase this defining characteristic First, it is evident that emotional abusive behavior is characterized by disrespect, as stated by the students:
“The abused children is akin to treating them as tools, without caring and respecting their rights…” (A male student, 10th grade, Ho Chi Minh city)
“I believe abusing children means grown-ups bossing around, making children do things they don't want, not thinking of their opinions.” (female student, 10th grade, Dong Nai)
“If it's about abusing and neglecting children's emotions, firstly, in a mental sense, there are many people who think that children don't know anything, like they don't respect children ” (A female student, 10th grade, Dong Nai)
“And it's like trying to forcefully change a child's thoughts, saying the child has to be like this, this is right, that is wrong, and it's frankly disappointing Forcing a mindset on the child that if they don't conform, if they don't do what others say, then they are wrong, it is their faults.” (A female student, 10th grade, Ho Chi Minh city)
However, in relation to the nature of violence as behaviour that inflicts harm upon the victim, students engaged in focus groups and provided the following reflections on emotional abuse:
“Emotional abuse is controlling by taking advantage of personal emotions to criticize oneself, blame, or manipulate the victim, causing them to feel ashamed and lowering their self-confidence.” (A female student, 12th grade, Hue)
“ criticizing or causing the child to feel insecure” (A female student, 12th grade, Hue)
Second, emotional abuse serves a purpose beyond that of harmful violence; it also satisfies the parents’ needs
“ when parents express their frustration by directing it towards their children, through actions such as shouting, scolding, or even physically harming them, without considering their children's emotions in order to appease their own anger.” (A female student in the 12th grade, Hue)
“Emotional abuse includes behaviours such as scolding or shaming children in the presence of others, blaming, offering criticism, and isolating them from their peers The intention behind this behaviour is to prevent the development of bad habits by putting the children into “safe zone” as dictated by those enforcers.” (A female student, 12th grade, Hue)
“In contrast, parents frequently impose their desired actions and models on their children, leading to the children's withdrawal and distancing from their parents I believe that each one has his or her own strengths, so it is important to promote mutual respect among children and encourage them to embrace their own abilities and grow together, rather than forcing them to conform to a predetermined expectation of parents” (A female student, 12th grade, Hue)
Parents sometimes confuse their love for their children with their own ambitions for success, leading them to use their authority to push their children into fulfilling their expectations.
Qualitative data indicated specific emotional abuse behaviors such as verbal coercion, shaming, blaming, criticizing, shouting, and scolding Most of these behaviors are active behaviors taken by the parents, with or without intent to harm
In terms of emotional neglect, results from qualitative research showed that adolescents reported the following characteristics of emotional neglect behavior: Parents who fail to give their children attention, do not listen to and respect their children’s thoughts and feelings, and do not meet their children’s emotional needs Emotional neglect behavior also leads to feelings of separation and lack of attachment in the relationship between parents and children
“ neglect occurs when parents hear their children’s cry for help, or that they want help by showing their needs to talk about their feelings or seeking advice, and just respond with, 'This is nothing, This is all normal, This will pass soon” That's neglect: disregarding a child's thoughts and emotions” (Female student, tenth grade, Ho Chi Minh City)
Parents often fail to acknowledge their children's thoughts and feelings, dismissing their opinions as insignificant due to their age, emphasizing academics over critical thinking, or prioritizing academic success over emotional and social well-being, leaving children feeling unheard and misunderstood.
“ it's an unwillingness to listen and having biases that children know nothing, therefore, their words aren't appreciated.” (Female student in 12th grade, Dong Nai)
Emotional neglect can be either passive or active Parents may deliberately and actively ignore or deny their children's feelings and thoughts, or may be unwilling to listen when their children need help or share their emotions
“Neglect is not worrying about a child's emotions, not caring about their needs or feelings, only thinking of the parents' own emotions ” (Female student in 12th grade, Dong Nai)
Relationship between variables
3.2.1 Childhood emotional abuse and neglect and anxiety/ depression symptoms
Results showed that students who have experienced emotional maltreatment are 2.13 times more likely to have mild anxiety or higher (95% CI: 1.59–2.86) and 2.50 times more likely to have depression at a mild or higher level (95% CI: 1.86– 3.35) compared to students who have not experienced emotional maltreatment (p