July 6, 2012 — Using physical punishment, including spanking and smacking, to discipline children is linked to a significantly increased risk for mental illness in later life, new research shows. Results from a national United States epidemiologic survey reveal that harsh physical punishment, including pushing, grabbing, shoving, slapping, or hitting, is linked to mental health disorders even in the absence of more severe child maltreatment, such as physical, sexual, and emotional abuse as well as neglect or exposure to intimate partner violence.
The current findings, the investigators write, "indicate that harsh physical punishment in the absence of child maltreatment is associated with increased odds of having several lifetime Axis I and Axis II disorders." These include mood disorders, anxiety disorders, alcohol and drug dependence as well as several personality disorders.
With principal investigator Jitender Sareen, MD, FRCPC, University of Manitoba, Winnipeg, Canada, the study was published online July 2 in Pediatrics.
Still Common
The American Academy of Pediatrics strongly opposes striking a child for any reason, and the Canadian Paediatric Society recommends that physicians strongly discourage the use of physical punishment.
The right of a parent or caregiver to use physical punishment has been banned in 32 countries. However, it is still permitted in both Canada and the United States.
Despite these recommendations, the authors note that physical punishment is common.
The investigators point out that data from a nationally representative sample of adults in the United States revealed that almost one half (49%) reported a history of physical punishment in childhood. Further, a recent study of mothers in the Carolinas in the United States revealed that 46% reported slapping or spanking their children during the past year.
Although previous research has linked physical punishment, including spanking and smacking, with aggression, delinquency, and internalizing conditions in childhood and a range of Axis I mental disorders, the authors note that the current study is unique.
"To our knowledge, there have been no examinations of the link between physical punishment and a broad range of mental health disorders in a nationally representative sample controlling for several types of maltreatment.
"Previous studies have not considered the proportion of mental disorders in the general population that may be attributable to physical punishment alone without experiencing more severe forms of child maltreatment," they write.
For the current study, the investigators used data on 34,653 US adults who were participants in the National Epidemiologic survey on Alcohol and Related Conditions between 2004 and 2005.
The researchers found that the prevalence of harsh physical punishment alone, without more severe child maltreatment, was 5.9%. Girls were less likely than boys to experience physical punishment (59.4% vs 40.6%).
Compared with whites, black participants were more likely to experience harsh physical punishment. Asians, native Hawaiians, and other Pacific Islanders were the least likely to experience physical punishment.
Reducing Mental Illness
After adjusting for sociodemographic variables, physical punishment was associated with an increased likelihood of Axis I disorders, including major depression, dysthymia, mania, mood disorders, phobias, anxiety disorders, and drug and alcohol abuse or dependence (adjusted odds ratio [aOR], 1.36 - 2.46).
Physical punishment was also associated with increased odds of Axis II disorders, including several individual personality disorders (aOR, 1.63 - 2.46) and cluster A and B disorder diagnosis (aOR, 1.82 - 1.94).
Overall, the researcher found that from 2% to 7% of mental disorders were attributable to physical punishment.
They note that pediatricians and other healthcare providers who work with children and parents should be aware of the link between physical punishment and mental disorders.
"These findings inform the ongoing debate around the use of physical punishment and provide evidence that harsh physical punishment independent of child maltreatment is related to mental disorders," they write.
From a public health perspective, study authors conclude that reducing physical punishment may help decrease the prevalence of mental disorders in the general population.
Lastly, they note that the findings "are important in considering policy and programmatic approaches to protect children from inappropriate and potentially harmful discipline."
Pediatrics. Published online July 2, 2012. Full article
Poster Comment:
Physical discipline is likely the result of "parent" failure to preemptively (and repeatedly) instruct children to avoid the kind of behavior which brought on the spanking, usually due to lack of time as well as forethought.