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    The association of parental or caregiver alcohol use with child maltreatment: A systematic review and meta-analysis of longitudinal studies
    (John Wiley and Sons Ltd on behalf of Society for the Study of Addiction, 2025-04-29) Leung JYY; Parker K; Lin E-Y; Huckle T
    Background and Aims: Caregiver alcohol use is a risk factor for child maltreatment, but a previous meta-analysis was limited to physical abuse only. We aimed to quantify the association of parental or caregiver alcohol use with child maltreatment and assess if this differs by incidence or recurrence of maltreatment and level of caregiver alcohol use. Methods: We undertook a systematic review and meta-analysis of longitudinal studies according to a registered protocol on PROSPERO (CRD42020211585). We searched the databases MEDLINE, PubMed, Scopus, PsycINFO, CINAHL and the Cochrane Library in November 2024. We included studies that reported the association of interest. We excluded studies that only assessed prenatal alcohol use or caregiver substance use, and studies that did not adjust for socio-economic position. Two reviewers independently screened the retrieved articles for relevance, extracted data from the included studies and assessed the methodological quality of studies using criteria adapted from the Newcastle-Ottawa scale. We performed meta-analyses using inverse variance weighting and random effects models. Results: We included seven studies on child maltreatment incidence and five on recurrence. All were cohort studies in high-income countries: three in Australia, one in Denmark, one in New Zealand, two in South Korea, one in the United Kingdom and four in the United States. The sample size ranged from 501 to 84 245 (median 4782). Caregiver alcohol-related diagnoses were associated with higher child maltreatment incidence [odds ratio (OR) = 2.32, 95% confidence interval (CI) = 1.10–4.89] and recurrence (OR = 1.92, 95% CI = 1.13–3.28) compared with caregivers without alcohol-related diagnoses. An association of any caregiver drinking with child maltreatment incidence could not be ruled out (OR = 1.22, 95% CI = 0.72–2.08). The review was limited by high heterogeneity and variable reporting of alcohol use and child maltreatment; however, we obtained similar results after sensitivity analysis and adjustment for reporting bias. Conclusions: Caregiver alcohol use may be an important risk factor for child maltreatment, adding to the growing body of evidence on alcohol's harm to others and calling for stronger actions to reduce alcohol harm.
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    Developmental and epileptic encephalopathy: Personal utility of a genetic diagnosis for families
    (Wiley Periodicals LLC on behalf of International League Against Epilepsy, 2021-03) Jeffrey JS; Leathem J; King C; Mefford HC; Ross K; Sadleir LG
    Objectives Identifying genetic pathogenic variants improves clinical outcomes for children with developmental and epileptic encephalopathy (DEE) by directing therapy and enabling accurate reproductive and prognostic information for families. We aimed to explore the additional personal utility of receiving a genetic diagnosis for families. Methods Semi-structured interviews were conducted with fifteen families of children with a DEE who had received a genetic diagnosis. The interviews stimulated discussion focusing on the impact of receiving a genetic diagnosis for the family. Interview transcripts were analyzed using the six-step systematic process of interpretative phenomenological analysis (IPA). Results Three key themes were identified: “Importance of the label,” “Relief to end the diagnostic journey,” and “Factors that influence personal utility.” Families reported that receiving a genetic label improved their knowledge about the likely trajectory of the DEE, increased their hope for the future, and helped them communicate with others. The relief of finally having an answer for the cause of their child's DEE alleviated parental guilt and self-blame as well as helped families to process their grief and move forward. Delay in receipt of a genetic diagnosis diluted its psychological impact. Significance To date, the factors associated with the personal utility of a genetic diagnosis for DEEs have been under appreciated. This study demonstrates that identifying a genetic diagnosis for a child's DEE can be a psychological turning point for families. A genetic result has the potential to set these families on an adaptive path toward better quality of life through increased understanding, social connection, and support. Early access to genetic testing is important as it not only increases clinical utility, but also increases personal utility with early mitigation of family stress, trauma, and negative experiences.