Elsevier

The Lancet

Volume 380, Issue 9845, 8–14 September 2012, Pages 899-907
The Lancet

Articles
Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies

https://doi.org/10.1016/S0140-6736(12)60692-8Get rights and content

Summary

Background

Globally, at least 93 million children have moderate or severe disability. Children with disabilities are thought to have a substantially greater risk of being victims of violence than are their non-disabled peers. Establishment of reliable estimates of the scale of the problem is an essential first step in the development of effective prevention programmes. We therefore undertook a systematic review and meta-analysis to synthesise evidence for the prevalence and risk of violence against children with disabilities.

Methods

For this systematic review and meta-analysis, we searched 12 electronic databases to identify cross-sectional, case-control, or cohort studies reported between Jan 1, 1990, and Aug 17, 2010, with estimates of prevalence of violence against children (aged ≤18 years) with disabilities or their risk of being victims of violence compared with children without disabilities.

Findings

17 studies were selected from 10 663 references. Reports of 16 studies provided data suitable for meta-analysis of prevalence and 11 for risk. Pooled prevalence estimates were 26·7% (95% CI 13·8–42·1) for combined violence measures, 20·4% (13·4–28·5) for physical violence, and 13·7% (9·2–18·9) for sexual violence. Odds ratios for pooled risk estimates were 3·68 (2·56–5·29) for combined violence measures, 3·56 (2·80–4·52) for physical violence, and 2·88 (2·24–3·69) for sexual violence. Huge heterogeneity was identified across most estimates (I2>75%). Variations were not consistently explained with meta-regression analysis of the characteristics of the studies.

Interpretation

The results of this systematic review confirm that children with disabilities are more likely to be victims of violence than are their peers who are not disabled. However, the continued scarcity of robust evidence, due to a lack of well designed research studies, poor standards of measurement of disability and violence, and insufficient assessment of whether violence precedes the development of disability, leaves gaps in knowledge that need to be addressed.

Funding

WHO Department of Violence and Injury Prevention and Disability.

Introduction

Violence against children is a huge and serious problem worldwide.1 An estimated 53 000 children aged 0–17 years were murdered in 2002 and about 150 million girls and 73 million boys were thought to have been sexually abused.1 However, little is known about the magnitude of violence against children with disabilities. Worldwide, an estimated 5% of children (about 93 million) aged 0–14 years have moderate or severe disability, with estimates ranging from 2·9% in high-income countries to 4·4–6·4% in low-income and middle-income countries.2 The results of a review3 of the extent of violence in adults with disabilities showed that they are at increased risk of being victims of violence compared with those without disabilities; adults with mental illness are particularly vulnerable. Children with disabilities are also thought to be at greater risk of violence than are those without. The reasons for this difference include societal stigma and discrimination, negative traditional beliefs and ignorance within communities,4 lack of social support for carers,5 type of impairment (eg, communication difficulties), and heightened vulnerability as a result of the need for increased care, including medical attention.6

Reliable estimates of the extent of the problem are essential for the development of effective population-level public health programmes to prevent children with disabilities from becoming victims of violence, and improve their health and quality of life. The conclusion drawn from the findings of a previous systematic review of population-based studies was that the association between childhood disability and abuse was weak.7 However, this study was not based on a quantitative synthesis of the evidence and the results of individual studies continue to draw attention to the increased risk of becoming a victim of violence for a child with a disability.8 We undertook a systematic review and meta-analysis to identify the characteristics and coverage of research into the prevalence and risk of violence perpetrated against children (aged ≤18 years) with disabilities; assess the quality of this research; and undertake a quantitative synthesis of the evidence, with a view to identifying knowledge gaps and research priorities.

Section snippets

Search strategy and selection criteria

We searched Medline, PsycINFO, CINAHL, International Bibliography of the Social Sciences, ASSIA, ERIC, Sociological Abstracts, Cochrane Library, Embase, National Criminal Justice Reference System Abstracts Database, Social Care Online, and Social Sciences Citation Index to identify studies reported between Jan 1, 1990, and Aug 17, 2010. A search strategy was developed for each database using a combination of free text and controlled vocabulary terms (appendix p 1). We used search terms from two

Results

17 studies were selected for inclusion (figure 1; appendix p 2): 15 cross-sectional and two cohort. Prevalence of violence in children with disabilities only was reported in six studies,5, 23, 25, 28, 30, 31 prevalence in both children with and without disabilities in ten,16, 17, 18, 19, 20, 22, 24, 26, 27, 29 and risk of violence in individuals who were disabled compared with those who were not in one.21 The type of perpetrator was not stated in 12 studies;16–21,23,25,26,28,30,31 violence

Discussion

Findings from this systematic review and meta-analysis show that violence is an important problem for children with disabilities, confirm the variable quality of studies, and show wide variation in the prevalence and risk of violence between studies. Our review is the first to provide pooled estimates of the prevalence and risk of violence perpetrated against children with disabilities. We have also investigated characteristics of studies that might affect these estimates. The pooled risk

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