title: Direct and indirect forms of childhood maltreatment and nonsuicidal self-injury among clinically-referred children and youth.
abstract: Although exposure to direct forms of childhood maltreatment is among the most widely studied risk factors for nonsuicidal self-injury (NSSI), research on NSSI has largely overlooked the role of exposure to indirect forms of child maltreatment (i.e., witnessing domestic violence). To address this gap in the literature, the present study examined associations among both direct and indirect forms of child maltreatment and NSSI among clinically-referred children and youth.
  
  
  
  Data was collected using the interRAI Child and Youth Mental Health Assessment (ChYMH) at ten mental health agencies. The ChYMH is a comprehensive standardized clinical assessment tool completed by trained assessors using multiple sources. The study included a convenience sample of 747 children and youth (68% male) between ages 8-18 with complex mental health histories referred for inpatient or outpatient care in Ontario, Canada.
  
  
  
  Univariate chi-square analyses indicated positive associations with NSSI and both direct (i.e., physical, sexual) and indirect child maltreatment (i.e., witnessing domestic violence). In a binary multivariate logistic regression analysis controlling for participant age and sex, only exposure to indirect child maltreatment emerged as multivariate predictor of NSSI.
  
  
  
  The sample was limited to only 10 mental health agencies and only consenting parents/guardians referred to mental health services suggesting the study may not be generalizable to all clinical samples.
  
  
  
  The present study provides evidence that witnessing domestic violence in childhood is an important risk factor for NSSI. Clinical relevance includes implications for clinicians to develop targeted intervention and prevention strategies for NSSI for children who have witnessed domestic violence.
authors.affiliation: Faculty of Education, Western University, 1137 Western Road, Canada, N6G 1G7. Electronic address: jarmient@uwo.ca.
authors.forename: Jenna
authors.initials: J
authors.lastname: Armiento
authors.affiliation: Faculty of Education, Western University, 1137 Western Road, Canada, N6G 1G7.
authors.forename: Chloe A
authors.initials: CA
authors.lastname: Hamza
authors.affiliation: Faculty of Education, Western University, 1137 Western Road, Canada, N6G 1G7.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Stewart
authors.affiliation: Faculty of Education, Western University, 1137 Western Road, Canada, N6G 1G7.
authors.forename: Alan
authors.initials: A
authors.lastname: Leschied
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D017579:Domestic Violence / Q000523:psychology; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008603:Mental Health; D008605:Mental Health Services; D009864:Ontario; D012017:Referral and Consultation; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*
keywords: Childhood maltreatment; Nonsuicidal self-injury; Physical maltreatment; Self-harm; Sexual maltreatment; Witnessing domestic violence