Factors associated with the recurrence of violence against children and adolescents. Mato Grosso-Brazil, 2013 to 2019

Silva, Silvana Maria da; Andrade, Amanda Cristina de Sousa; Melanda, Francine Nesello; Oliveira, Ligia Regina de

doi:10.1590/1413-81232024297.02912024

Abstract

This study examined factors associated with the recurrence of interpersonal violence against children and adolescents in Mato Grosso state, considering cases recorded in the Notifiable Diseases Information System, from 2013 to 2019. Associations between variables were estimated by logistic regression and stratified by age group (children and adolescents). The frequency of recurrent violence against children was 49.0% and, against adolescents, 42.9%. For both, recurrent violence was positively associated with occurrence at home, psychological or emotional violence, aggressors’ being more than two, their being relatives and threats being the means of aggression. Neglect or abandonment and male or both-sex aggressors were positively associated with recurrent violence against children. Against adolescents, poor education, sexual violence and intimate-partner aggressors were positively associated with recurrent violence, while other aggressors and firearms or physical force were negatively associated. The findings offer significant contributions to knowledge of factors associated with recurrent violence, which is still little studied in the national and international literature. This is essential in order to inform strategies to reduce the recurrence of violence and protect children and adolescents.

Key words:
Violence; Child; Adolescent; Recurrence

Introduction

Violence is a public health problem and ranks second among causes of mortality in the 0 to 19 year-old age group, and the trend has been upward in recent years¹1 Brasil. Ministério dos Direitos Humanos (MDH). Secretaria Nacional de Proteção dos Direitos da Criança e Adolescente. Letalidade infanto-juvenil: dados da violência e políticas públicas existentes. Brasília: MDH; 2018.^,²2 Fundo das Nações Unidas para a Infância (Unicef). As crianças têm direito à segurança onde quer que estejam [Internet]. 2020. [acessado 2021 jan 3]. Disponível em: https://www.unicef.org/end-violence
https://www.unicef.org/end-violence... . In 2012, there were 95,000 homicide victims in this age group, with the largest number concentrated in Latin America and the Caribbean³3 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Revisão sistemática de estudos sobre registros de violência contra crianças e adolescentes no Brasil. Cien Saude Colet 2019; 24(2):487-496..

The problem of violence, although not new in our society, is still a very delicate subject, especially when it involves children and adolescents. Violence causes individual, collective and economic losses, at a worldwide cost of US$7 trillion per year from violence against children alone²2 Fundo das Nações Unidas para a Infância (Unicef). As crianças têm direito à segurança onde quer que estejam [Internet]. 2020. [acessado 2021 jan 3]. Disponível em: https://www.unicef.org/end-violence
https://www.unicef.org/end-violence... .

Cases of violence against children and youth are multi-causal and are thus not directly related only to race, class, religion or culture. Social vulnerability, however, is associated with greater risk of violence in childhood⁴4 Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Geneva: WHO; 2002.. Children are among the groups most vulnerable to violence, because of the stage of their development and their dependence on care and protection from adults⁵5 World Health Organization (WHO). World report on child injury prevention. Geneva: WHO; 2008..

In Brazil, the Child and Adolescent Statute (Estatuto da Criança e do Adolescente, ECA) enacted in the 1990s constituted a major advance in the fight against child violence, by establishing that it is health personnel’s duty to report cases of abuse⁶6 Brasil. Presidência da República. Lei nº 8.069, de 13 de julho de 1990, que institui o Estatuto da Criança e do Adolescente. Diário Oficial da União 1990; 16 jul.. Moreover, in 2011 the Ministry of Health set up a Violence and Accident Surveillance System (Sistema de Vigilância de Violências e Acidentes, VIVA) to inform public health policies and contribute to preventing violence and promoting a culture of peace by means of data reported by health services⁷7 Brasil. Ministério da Saúde (MS). Viva: vigilância de violências e acidentes: 2013 e 2014. Brasília: Ministério da Saúde; 2017.. It has been suggested that commonly the cases reported are the most severe, resulting from prior violence⁸8 Farias MS, Souza CS, Carneseca EC, Passos ADC, Vieira EM. Caracterização das notificações de violência em crianças no município de Ribeirão Preto, São Paulo, no período 2006-2008. Epidemiol Serv Saude 2016; 25(4):799-806..

Recurrent violence has multiple, significant adverse effects on children and adolescents⁹9 Carnochan S, Rizik-Baer D, Austin MJ. Preventing the recurrence of maltreatment. J Evid Based Social Work 2013; 10(3):161-178., leaving immeasurable, invisible marks and directly impacting their health and quality of life¹⁰10 Piovezan LNC, Diniz LO, Calmeto MN, Fontella RB, Ferreira RSB, Vidal CEL. Análise das fichas de notificação de violência emitidas por serviços de saúde da região de Barbacena. Rev Med Minas Gerais 2018; 28(Supl. 5):e-S280502.

11 Sinimbu RB, Mascarenhas MDM, Silva MMA, Carvalho MGO, Santos MR, Freitas MG. Characterization of victims of domestic violence, sexual and/or other violence in Brazil - 2014. Rev Saude Foco 2016; 1(1):1-14.^-¹²12 Mascarenhas MDM, Malta DC, Silva MMA, Lima CM, Carvalho MGO, Oliveira VLA. Violência contra a criança: revelando o perfil dos atendimentos em serviços de emergência, Brasil, 2006 e 2007. Cad Saude Publica 2010; 26(2):347-357..

Recurrent violence exposes the child to chronicity of the event, jeopardising their growth and development and increasing their likelihood of death¹³13 Hamilton LHA, Jaffe PG, Campbell M. Assessing children's risk for homicide in the context of domestic violence. J Fam Violence 2013; 28(2):179-189.^,¹⁴14 Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção de maus tratos infantis. Cien Saude Colet 2019; 24(11):3997- 4008.. Recurrent violence against adolescents is associated with greater transgression of social norms, lower resilience and impaired self-esteem¹⁵15 McGee ZT, Baker SR. Impact of violence on problem behavior among adolescents: risk factors among an urban sample. J Contemp Crim Justice 2002; 18(1):74-93.^,¹⁶16 Yule K, Houston J, Grych J. Resilience in children exposed to violence: a meta-analysis of protective factors across ecological contexts. Clin Child Fam Psychol Rev 2019; 22(3):406-431..

Certain factors have been identified as associated with the recurrence of violence against children and adolescents¹⁷17 Kim K, Choi J, Jang H, Lee HJ, Jang H. Predictive model for intra-familial child maltreatment re-reports and recurrence in South Korea: analysis of national child protection services case records. Child Abuse Negl 2022; 125:105487.

18 Horikawa H, Suguimoto SP, Musumari PM, Techasrivichien T, Ono-Kihara M, Kihara M. Development of a prediction model for child maltreatment recurrence in Japan: a historical cohort study using data from a Child Guidance Center. Child Abuse Negl 2016; 59:55-65.

19 White OG, Hindley N, Jones DP. Risk factors for child maltreatment recurrence: an updated systematic review. Med Sci Law 2015; 55(4):259-277.

20 Ng QX, Yong BZJ, Ho CYX, Lim DY, Yeo WS. Early life sexual abuse is associated with increased suicide attempts: an update meta-analysis. J Psychiatr Res 2018; 99:129-141.

21 Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682.

22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809.^-²³23 Platt VB, Coelho ESB, Bolsonia C, Honickya M, Bordina GP, Camargo MAV. Sexual violence against children in the state of Santa Catarina, Brazil: characteristics and factors related to repetitive violence. Rev Paul Pediatr 2023; 41:e2022069. A systematic review of cohort studies found that neglect, younger age, cases involving multiple types of abuse and factors in the family environment, such as poverty and mental health problems, were associated with more frequent recurrence¹⁹19 White OG, Hindley N, Jones DP. Risk factors for child maltreatment recurrence: an updated systematic review. Med Sci Law 2015; 55(4):259-277.. Studies in Brazil to investigate the recurrence of violence against children and adolescents have examined cross-sections by type of violence²³23 Platt VB, Coelho ESB, Bolsonia C, Honickya M, Bordina GP, Camargo MAV. Sexual violence against children in the state of Santa Catarina, Brazil: characteristics and factors related to repetitive violence. Rev Paul Pediatr 2023; 41:e2022069 or specific group (children only²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809. or adolescents only²¹21 Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682.).

Accordingly, it is important to know the characteristics and risk factors associated with recurrent violence in children and adolescents in order to support measures and decision-making by professionals and managers to reduce these recurrences. This study examined factors associated with the recurrence of interpersonal violence against children and adolescents in Mato Grosso state, from 2013 to 2019.

Method

This study used data from notifications of violence against children and adolescents in Mato Grosso from 2013 to 2019. Children and adolescents were considered to be, respectively, 0 to 9 and 10 to 19 years old, as defined by the World Health Organisation²⁴24 World Health Organization (WHO). Adolescent health [Internet]. 2019. [cited 2023 jun 11]. Available from: http://www.who.int/topics/adolescent_health/en/
http://www.who.int/topics/adolescent_hea... . The data were provided by the Mato Grosso State Health Department and extracted from the Interpersonal and Self-Inflicted Violence Surveillance (VIVA-Sinan) component of the Violence and Accident Surveillance System (Sistema de Vigilância de Violências e Acidentes, VIVA), in turn part of Brazil’s Notifiable Diseases Information System. Since 2011 it has been mandatory for all public and private health establishments in Brazil to report violence against children and adolescents²⁵25 Brasil. Ministério da Saúde (MS). Viva: instrutivo notificação de violência interpessoal e autoprovocada. Brasília: MS; 2016.. Records of cases of self-harm were excluded from this study.

Data on the dependent variable, recurrent violence, were obtained from the question as to whether or not the violence reported had occurred at other times (No; Yes; Unknown). Thus, all comparisons in this study were made between the group exposed to recurrent violence (‘Yes’ category of the variable ‘Occurred at other times’) and the non-recurrent, single-instance violence group (‘No’ category). Cases with data Unknown were excluded from the analysis (n = 1,018).

The independent variables analysed were divided into blocks in the following order: (1) victim characteristics: sex (female; male), race/skin colour (black/brown; indigenous; white/yellow), education (illiterate/lower secondary education; upper secondary/higher education), marital status (married/stable union; no partner), disability/disorder (Yes, No). Physical, intellectual, vision and hearing impairments, mental disorders, behavioural disorders and other disabilities and disorders were considered; (2) characteristics of the violence: time of occurrence (by day - morning/afternoon; at night - night/early morning); place where the violence occurred (residence; bar or similar; school/sports venue; public place; other locations - others, commerce/services, industries/construction); (3) type of violence: physical (Yes; No), psychological/emotional (Yes; No), sexual (Yes; No), neglect/abandonment (Yes; No); (4) characteristics of the likely aggressor: sex (female; male; both), age group of the aggressor - age group of the likely aggressor (child - 0 to 9 years; adolescent - 10 to 19 years; young adult - 20 to 24 years; adult - 25 to 59 years old; older adult - 60 years old or more), number of people involved (one; two or more), alcohol consumed by likely aggressor (Yes; No), relation to the victim (relative - father, mother, stepfather, stepmother, sibling and child; friends/acquaintances - friends/acquaintances, caregivers, employer/boss; others - persons unknown, police, institutional, others); and (5) means of aggression: physical force (Yes; No); strangulation (Yes; No), blunt force (Yes; No), sharp object (Yes; No), hot object/substance (Yes; No), poison (Yes; No), firearm (Yes; No), threat (Yes; No), means other than previously specified (Yes; No). The variables type of violence and relation to the victim allowed multiple responses. The variables education and marital status were considered for adolescents only.

The stratification variable was age group in years: 0 to 9 - children and 10 to 19 - adolescents.

The data were treated by descriptive analysis using absolute and relative frequencies. Frequency of recurrent violence against children and adolescents was calculated by independent variable. Associations between recurrent violence against children and adolescents and the independent variables were ascertained by univariate and multiple analyses. Odds ratios (ORs) were estimated, with respective confidence intervals (95%CI), using logistic regression models. In all analyses, the group exposed to recurrent violence was compared with the group not exposed to recurrent violence.

Variables with p-value of less than 0.20 in the univariate analysis were included in the multiple model. The multiple model was fitted by hierarchical entry of independent variables, which were organised into blocks in the following order: (1) characteristics of victim; (2) characteristics of violence; (3) type of violence, (4) characteristics of probable aggressor; and (5) characteristics of means of aggression.

For each hierarchical level, a model was fitted by excluding the variables with the highest p-values. The model was then re-estimated after each exclusion, and so on until all variables at the same level remained significant at 5%. The variables at more distal levels remained as adjustment factors for hierarchically lower levels. In the final model, a 5% level of significance was used to determine the variables associated with recurrent violence. All analyses were stratified by age group (children and adolescents). The analyses were carried out using STATA software, version 12.

The project was approved, on 16 June 2020, by the research ethics committee of the Universidade Federal de Mato Grosso, on Application for Ethics Appraisal Certificate (Certificado de Apresentação para Apreciação Ética, CAAE) No. 30260420.9.0000.8124 and Opinion No. 4.091. 189.

Results

From 2013 to 2019, 5,742 cases of interpersonal violence against children and adolescents were recorded in Mato Grosso state, 1,018 (18.3%) of which were excluded because the ‘Occurred at other times’ field was left blank. Of the 4,553 cases for which this variable was recorded, 44.7% (2,037) reported recurrent violence, which was more frequent among children (49.0%) than adolescents (42.9%).

In the total of reported cases of interpersonal violence analysed (n = 4,553), most of the children and adolescents were female and of black or brown race/colour; violence occurred most often in the residence, aggressors were mainly male and the aggression was most commonly by physical force or threats. The most frequent types of violence against children were sexual (61.5%), physical (45.4%), psychological or emotional (37.3%) and neglect or abandonment (10.0%); the aggressor was a friend or acquaintance (58.7%) or relative (43.7%). Against adolescents, violence was mostly physical (60.7%), sexual (48.6%), psychological or emotional (33.3%) and the aggressor was a friend or acquaintance (35.4%) (Tables 1, 2 and 3).

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Table 1
Frequency distribution (number and %) of notified cases of violence and recurrent violence against children and adolescents and associations with characteristics of victim, violence and type of violence. Mato Grosso, 2013 to 2019.

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Table 2
Frequency distribution (number and %) of notified cases of violence and recurrent violence against children and adolescents and associations with characteristics of probable aggressor. Mato Grosso, 2013 to 2019.

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Table 3
Frequency distribution (number and %) of notified cases of violence and recurrent violence against children and adolescents and associations with means of aggression. Mato Grosso, 2013 to 2019.

Female adolescents with little education (illiterate or lower secondary education) and married or in a stable union faced higher odds or recurring violence. The home was the place where violence was most likely to recur against both children (OR = 2.43; 95%CI: 1.62-3.64) and adolescents (OR = 2.44; 95%CI: 1.94-3.06), while odds were lowest for teenagers in public places and bars or similar places. By type of violence, psychological or emotional and sexual violence associated positively with recurrence against children and adolescents, while physical violence and neglect associated negatively with recurrence against adolescents (Table 1).

Recurrent violence was associated with aggressor characteristics (Table 2) as follows: there were higher odds of the aggressors’ being either of both sexes or males. By aggressor age group, recurrent violence was more likely to be committed against children by older adults than by other age groups (OR = 3.85; 95%CI: 1.75-8.45), although other age groups, such as adults and young adults, proved to be important. Higher odds of recurrence against adolescents were seen only in adults (OR = 2.36; 95% CI: 1.02-5.44). There were higher odds that recurrent violence against children would be committed by two or more aggressors (OR = 1.40; 95%CI: 1.06-1.86) and if the aggressor used alcohol (OR = 1.42; 95%CI:1.05-1.91). For adolescents, two or more aggressors (OR = 0.70; 95%CI: 0.59-0.83) and aggressors’ having used alcohol (OR = 0.72; 95%CI: 0. 61-0.85) returned lower odds of recurrent violence. As regards the aggressor’s kinship, both children and adolescents were at greater likelihood of recurrent violence when the aggressor was relative and lesser likelihood when they had other relationships. For adolescents, the odds of recurrent violence were greater when the aggressor was an intimate partner (OR = 2.42; 95%CI: 2.02-2.89).

Recurrent violence against children was positively associated with threats (OR = 3.50; 95%CI: 2.68-4.58), followed by strangulation (OR = 2.96; 95%CI: 1.06-8.27) and physical force (OR = 1.65; 95%CI: 1.31-2.07), while against adolescents, higher odds were found for threats (OR = 1.75; 95%CI: 1.50-2.05) and other means (OR = 1.53; 95%CI: 1.20-1.99). On the other hand, negative associations with recurrent violence were found for firearms (against both groups), other means (against children) and physical force and sharp objects (against adolescents) (Table 3).

In the adjusted analysis (Table 4), children were more likely to suffer recurrent violence if it occurred at home, if the type of violence was psychological/emotional or neglect/abandonment, when the aggressors were family members, male or of both sexes, if more than two aggressors were involved and the means of aggression was physical force or threat. Adolescents were more likely to suffer recurrent violence if they had little education (illiterate or lower secondary education), if the violence occurred at home, if the type of violence was psychological or emotional or sexual, if more than two aggressors were involved, if the aggressors were family members or intimate partners and threats were the means of aggression. The lowest odds of recurrent violence against adolescents were when the relationship with the aggressor was “Other” and the means of aggression was a firearm or physical force.

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Table 4
Multiple models of associations with recurrent violence against children and adolescents. Mato Grosso, 2013 to 2019.

Discussion

Although there are studies that describe the characteristics of occurrences of violence against children and adolescents in Brazil, there are as yet few records in the Brazilian and international literature that address recurrent violence in these populations²¹21 Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682.^,²³23 Platt VB, Coelho ESB, Bolsonia C, Honickya M, Bordina GP, Camargo MAV. Sexual violence against children in the state of Santa Catarina, Brazil: characteristics and factors related to repetitive violence. Rev Paul Pediatr 2023; 41:e2022069^,²⁶26 Tener D. The secret of intrafamilial child sexual abuse: who keeps it and how? J Child Sex Abus 2018; 27(1):1-21.

27 Hillis S, Mercy J, Amobi A, Kress H. Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics 2016; 137(3):e20154079.

28 Trindade LC, Linhares SM, Vanrell JP, Godoy D, Martins JC, Barbas SM. Sexual violence against children and vulnerability. Rev Assoc Med Bras 2014; 60(1):70-74.^-²⁹29 Baptista RS, Franca IS, Costa CM, Brito VR. Caracterização do abuso sexual em crianças e adolescentes notificado em um Programa Sentinela. Acta Paul Enferm 2008; 21(4):602-608..

This study revealed that the frequency of recurrent violence in children (49.0%) and adolescents (42.9%) was higher than in notification data for adolescents in Brazil from 2011 to 2017 (39.9%)³⁰30 Pereira VOM, Pinto IV, Mascarenhas MDM, Shimizu HE, Ramalho WM, Fagg CW. Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017. Rev Bras Epidemiol 2020; 23(Supl. 1):e200004. and for children in Espírito Santo state from 2011 to 2018 (32.5%)²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809. and in other Brazilian municipalities in different periods⁸8 Farias MS, Souza CS, Carneseca EC, Passos ADC, Vieira EM. Caracterização das notificações de violência em crianças no município de Ribeirão Preto, São Paulo, no período 2006-2008. Epidemiol Serv Saude 2016; 25(4):799-806.^,³¹31 Oliveira NF, Moraes CL, Junger WL, Reichenheim ME. Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016. Epidemiol Serv Saude 2020; 29(1):e2018438.

32 Souto DF, Zanin L, Ambrosano MB, Flório FM. Violência contra crianças e adolescentes: perfil e tendências decorrentes da Lei nº 13.010. Rev Bras Enferm 2018; 71(Supl. 3):1237-1246.^-³³33 Von Hohendorff J, Patias ND. Violência sexual contra crianças e adolescentes: identificação, consequências e indicações de manejo. Barbaroi 2017; 49:239-257.. Frequencies of recurrent violence against children and adolescents also varied in other countries: 5.9% in South Korea¹⁷17 Kim K, Choi J, Jang H, Lee HJ, Jang H. Predictive model for intra-familial child maltreatment re-reports and recurrence in South Korea: analysis of national child protection services case records. Child Abuse Negl 2022; 125:105487., 24.7% in Japan¹⁸18 Horikawa H, Suguimoto SP, Musumari PM, Techasrivichien T, Ono-Kihara M, Kihara M. Development of a prediction model for child maltreatment recurrence in Japan: a historical cohort study using data from a Child Guidance Center. Child Abuse Negl 2016; 59:55-65. and around 20% in different studies in the United States¹⁹19 White OG, Hindley N, Jones DP. Risk factors for child maltreatment recurrence: an updated systematic review. Med Sci Law 2015; 55(4):259-277.. There is thus no consensus in the literature as to the prevalence of recurrent violence; this can be accounted for by methodological differences between studies or by the as yet small number of studies that address the issue. Likewise, the difficulty in obtaining information, whether due to failure to record properly or the involvement of a person responsible, generally father and mother, in communicating the event can result in differences in results between studies²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809.^,³⁴34 Medeiros KB. Resistências de crianças e adolescentes vítimas de violência doméstica e a escola na rede de proteção [tese]. Itatiba: Universidade São Francisco; 2018..

The high frequency of recurrent violence revealed by this study indicated this population’s social vulnerability, as well as the urgent need for measures to protect children and adolescents. Violence is a phenomenon that, given its magnitude and the vulnerability of those affected, transcends social spheres and makes children and adolescents with little education and in unfavourable social conditions, more prone to recurrent violence²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809.^,³⁴34 Medeiros KB. Resistências de crianças e adolescentes vítimas de violência doméstica e a escola na rede de proteção [tese]. Itatiba: Universidade São Francisco; 2018..

The findings warrant concern as to why it takes so long for violence against children and adolescents to be recognised or revealed, as the home is the main setting for the violence and the perpetrator, close to the victim. In cases of recurrent violence, the aggressors against children and adolescents were a family member (father, mother, stepfather, stepmother, sibling or child) and, against adolescents, as well (intimate partner: former spouse, spouse and boyfriend). This finding is similar to other that of studies in the literature⁸8 Farias MS, Souza CS, Carneseca EC, Passos ADC, Vieira EM. Caracterização das notificações de violência em crianças no município de Ribeirão Preto, São Paulo, no período 2006-2008. Epidemiol Serv Saude 2016; 25(4):799-806.^,²¹21 Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682.^-²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809. demonstrating that children and adolescents live daily with their aggressors, those who are responsible for protecting them. They also indicate a need to expand social protection networks, so as to break the cycle of violence and offer protection and care for children and adolescents.

For both children and adolescents, violent acts were repeated more often when there were two or more aggressors. The perpetrators of violence were mostly male, although males and females also participated jointly against children. This profile has been found in other studies examining recurrent violence against children²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809. and adolescents²¹21 Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682.. The fact that violence is more often recurrent against females may explain the greater prevalence of male aggressors, in view of aspects of culture reflected in gender-based violence from an early age, revealing the domination of women in macho culture and the naturalisation of acts of violence from early childhood²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809.. On the other hand, participation by both sexes as aggressors suggests parents’ participating as a way of “educating” and “disciplining”, resulting from adult-centric power-based relationships²²22 Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809.^,³²32 Souto DF, Zanin L, Ambrosano MB, Flório FM. Violência contra crianças e adolescentes: perfil e tendências decorrentes da Lei nº 13.010. Rev Bras Enferm 2018; 71(Supl. 3):1237-1246..

Note the positive association of recurrence with psychological violence against children and adolescents, neglect or abandonment of children and sexual violence against adolescents. Two previous studies that evaluated reports of violence in Brazil found positive associations between recurrence and psychological and sexual violence against children³⁵35 Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet 2015; 20(3):655-665. and adolescents³⁰30 Pereira VOM, Pinto IV, Mascarenhas MDM, Shimizu HE, Ramalho WM, Fagg CW. Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017. Rev Bras Epidemiol 2020; 23(Supl. 1):e200004.. Santos et al. (2018)³⁶36 Santos MJ, Mascarenhas MDM, Rodrigues MP, Monteiro RA. Caracterização da violência sexual contra crianças e adolescentes na escola - Brasil, 2010-2014. Epidemiol Serv Saude 2018; 27(2):e2017059. reported a higher proportion of recurrent sexual violence against adolescents, as found in this study. Studies have shown that neglect is one of the main types of violence practiced against children⁸8 Farias MS, Souza CS, Carneseca EC, Passos ADC, Vieira EM. Caracterização das notificações de violência em crianças no município de Ribeirão Preto, São Paulo, no período 2006-2008. Epidemiol Serv Saude 2016; 25(4):799-806.^,¹⁹19 White OG, Hindley N, Jones DP. Risk factors for child maltreatment recurrence: an updated systematic review. Med Sci Law 2015; 55(4):259-277.^,³²32 Souto DF, Zanin L, Ambrosano MB, Flório FM. Violência contra crianças e adolescentes: perfil e tendências decorrentes da Lei nº 13.010. Rev Bras Enferm 2018; 71(Supl. 3):1237-1246.^,³³33 Von Hohendorff J, Patias ND. Violência sexual contra crianças e adolescentes: identificação, consequências e indicações de manejo. Barbaroi 2017; 49:239-257.^,³⁷37 Sousa RP, Oliveira FB, Bezerra MLO, Leite ES, Maciel EJS. Caracterização dos maus-tratos contra a criança: análise das notificações compulsórias na Paraíba. Rev Espac Saude 2015; 16(4):20-28. and its association with recurrence may relate to children’s greater vulnerability to abuse, given their physical and emotional inability to react.

The most common means of attack were physical force against children and threats against children and adolescents, both of which were associated with repeated violence. This finding is similar to those of studies in Brazil using data from notifications of violence against adolescents from 2011 to 2017³⁰30 Pereira VOM, Pinto IV, Mascarenhas MDM, Shimizu HE, Ramalho WM, Fagg CW. Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017. Rev Bras Epidemiol 2020; 23(Supl. 1):e200004. and against children in 2012³⁸38 Assis SG, Avanci JQ, Pesce RP, Pires T de O, Gomes DL. Notificações de violência doméstica, sexual e outras violências contra crianças no Brasil. Cien Saude Colet 2012; 17(9):2305-2317., where the means most used were physical force and threats.

It is must be stressed that, given the complexity of the issue, the study findings may not reveal the real scenario of recurrent violence against children and adolescents, because of the many obstacles to the notification process, particularly in situations of violence, and more specifically non-fatal violence, involving these groups. Violence is still a taboo, framed by sociocultural constructions reflected in all societies. It is thus a complex social challenge to be met in all its various manifestations. In that context, this study can contribute to knowledge production, while at the same time exposing a problem sometimes invisible to those close to or providing care for children and adolescents.

The study findings show that violence occurs mainly in the family environment and that aggressors are people close to the victim. These facts represent the domestic sphere of the problem of violence against children and adolescents and, accordingly, the urgent need to implement strategies to combat such violence, given that this dimension has deep roots intertwined with sociocultural constructions that need to be reworked into a society conscious of all the harm done by violence at the individual, family and social levels. The literature also emphasises that, when violence occurs in the private space of the home, this gives rise to underreporting, protection of aggressors and silence from victims¹⁴14 Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção de maus tratos infantis. Cien Saude Colet 2019; 24(11):3997- 4008.^,³⁵35 Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet 2015; 20(3):655-665.^,³⁹39 Fornari LF, Sakata-So KN, Egry EY, Fonseca RMGS. As perspectivas de gênero e geração nas narrativas de mulheres abusadas sexualmente na infância. Rev Lat Am Enferm 2018; 26:e3078..

In this connection, underreporting of cases of violence and/or recurrent violence in the study group can be considered one limitation of this study, given that most cases occurred within the family, hindering access to disclosure or with victims possibly denying accusations for fear of being taken out of the family or of what may happen to them after reporting the event¹⁴14 Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção de maus tratos infantis. Cien Saude Colet 2019; 24(11):3997- 4008.^,²³23 Platt VB, Coelho ESB, Bolsonia C, Honickya M, Bordina GP, Camargo MAV. Sexual violence against children in the state of Santa Catarina, Brazil: characteristics and factors related to repetitive violence. Rev Paul Pediatr 2023; 41:e2022069^,³⁵35 Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet 2015; 20(3):655-665.^,³⁹39 Fornari LF, Sakata-So KN, Egry EY, Fonseca RMGS. As perspectivas de gênero e geração nas narrativas de mulheres abusadas sexualmente na infância. Rev Lat Am Enferm 2018; 26:e3078.. Moreover, single-instance violence may be even more underreported, in that more recurrent violence may arouse in the victim the need to seek help. It is thus possible that the frequency of recurrent violence, in proportion to all cases of violence, may have been overestimated.

Another limitation relates to the comparison groups, because the group exposed to repeated violence was compared to victims of single-instance violence and not to children and adolescents who suffered no violence. It was also difficult to compare the study findings with those of other studies, because the literature on recurrent violence is still scarce and because it targets specific groups, such as women and/or children²¹21 Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682..

Violence and, above all, recurrent episodes may be related to the naturalisation of violence, which accommodates violent acts against the more fragile, such as children and adolescents. In view of this, it is essential to give visibility to violence and confront it as a problem that can be avoided through more assertive and effective public policies. It is essential that, in addition to its being the duty of the state, the various forms of social organisation strive to assure the rights of children and adolescents.

In this regard, it is important to establish protection networks for victims in situations of violence and to expand the participation and integration of active subjects of at least the public security, public health, education and culture sectors. Care networks for victims of violence must be strengthened and also extend their care to the care personnel involved, who need preparation and proper conditions in which to perform their role in combating violence, without overwork or fear of threats and impotence when diagnosing and referring victims.

By profiling victims, acts of violence, aggressors and factors associated with the recurrence of violence, important contributions can be made to understanding violence against children and adolescents and local policies to prevent and control these problems can be properly directed.

Acknowledgements

To the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for the Master’s scholarship.

References

¹
Brasil. Ministério dos Direitos Humanos (MDH). Secretaria Nacional de Proteção dos Direitos da Criança e Adolescente. Letalidade infanto-juvenil: dados da violência e políticas públicas existentes. Brasília: MDH; 2018.
²
Fundo das Nações Unidas para a Infância (Unicef). As crianças têm direito à segurança onde quer que estejam [Internet]. 2020. [acessado 2021 jan 3]. Disponível em: https://www.unicef.org/end-violence
» https://www.unicef.org/end-violence
³
Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Revisão sistemática de estudos sobre registros de violência contra crianças e adolescentes no Brasil. Cien Saude Colet 2019; 24(2):487-496.
⁴
Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Geneva: WHO; 2002.
⁵
World Health Organization (WHO). World report on child injury prevention. Geneva: WHO; 2008.
⁶
Brasil. Presidência da República. Lei nº 8.069, de 13 de julho de 1990, que institui o Estatuto da Criança e do Adolescente. Diário Oficial da União 1990; 16 jul.
⁷
Brasil. Ministério da Saúde (MS). Viva: vigilância de violências e acidentes: 2013 e 2014. Brasília: Ministério da Saúde; 2017.
⁸
Farias MS, Souza CS, Carneseca EC, Passos ADC, Vieira EM. Caracterização das notificações de violência em crianças no município de Ribeirão Preto, São Paulo, no período 2006-2008. Epidemiol Serv Saude 2016; 25(4):799-806.
⁹
Carnochan S, Rizik-Baer D, Austin MJ. Preventing the recurrence of maltreatment. J Evid Based Social Work 2013; 10(3):161-178.
¹⁰
Piovezan LNC, Diniz LO, Calmeto MN, Fontella RB, Ferreira RSB, Vidal CEL. Análise das fichas de notificação de violência emitidas por serviços de saúde da região de Barbacena. Rev Med Minas Gerais 2018; 28(Supl. 5):e-S280502.
¹¹
Sinimbu RB, Mascarenhas MDM, Silva MMA, Carvalho MGO, Santos MR, Freitas MG. Characterization of victims of domestic violence, sexual and/or other violence in Brazil - 2014. Rev Saude Foco 2016; 1(1):1-14.
¹²
Mascarenhas MDM, Malta DC, Silva MMA, Lima CM, Carvalho MGO, Oliveira VLA. Violência contra a criança: revelando o perfil dos atendimentos em serviços de emergência, Brasil, 2006 e 2007. Cad Saude Publica 2010; 26(2):347-357.
¹³
Hamilton LHA, Jaffe PG, Campbell M. Assessing children's risk for homicide in the context of domestic violence. J Fam Violence 2013; 28(2):179-189.
¹⁴
Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção de maus tratos infantis. Cien Saude Colet 2019; 24(11):3997- 4008.
¹⁵
McGee ZT, Baker SR. Impact of violence on problem behavior among adolescents: risk factors among an urban sample. J Contemp Crim Justice 2002; 18(1):74-93.
¹⁶
Yule K, Houston J, Grych J. Resilience in children exposed to violence: a meta-analysis of protective factors across ecological contexts. Clin Child Fam Psychol Rev 2019; 22(3):406-431.
¹⁷
Kim K, Choi J, Jang H, Lee HJ, Jang H. Predictive model for intra-familial child maltreatment re-reports and recurrence in South Korea: analysis of national child protection services case records. Child Abuse Negl 2022; 125:105487.
¹⁸
Horikawa H, Suguimoto SP, Musumari PM, Techasrivichien T, Ono-Kihara M, Kihara M. Development of a prediction model for child maltreatment recurrence in Japan: a historical cohort study using data from a Child Guidance Center. Child Abuse Negl 2016; 59:55-65.
¹⁹
White OG, Hindley N, Jones DP. Risk factors for child maltreatment recurrence: an updated systematic review. Med Sci Law 2015; 55(4):259-277.
²⁰
Ng QX, Yong BZJ, Ho CYX, Lim DY, Yeo WS. Early life sexual abuse is associated with increased suicide attempts: an update meta-analysis. J Psychiatr Res 2018; 99:129-141.
²¹
Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682.
²²
Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809.
²³
Platt VB, Coelho ESB, Bolsonia C, Honickya M, Bordina GP, Camargo MAV. Sexual violence against children in the state of Santa Catarina, Brazil: characteristics and factors related to repetitive violence. Rev Paul Pediatr 2023; 41:e2022069
²⁴
World Health Organization (WHO). Adolescent health [Internet]. 2019. [cited 2023 jun 11]. Available from: http://www.who.int/topics/adolescent_health/en/
» http://www.who.int/topics/adolescent_health/en
²⁵
Brasil. Ministério da Saúde (MS). Viva: instrutivo notificação de violência interpessoal e autoprovocada. Brasília: MS; 2016.
²⁶
Tener D. The secret of intrafamilial child sexual abuse: who keeps it and how? J Child Sex Abus 2018; 27(1):1-21.
²⁷
Hillis S, Mercy J, Amobi A, Kress H. Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics 2016; 137(3):e20154079.
²⁸
Trindade LC, Linhares SM, Vanrell JP, Godoy D, Martins JC, Barbas SM. Sexual violence against children and vulnerability. Rev Assoc Med Bras 2014; 60(1):70-74.
²⁹
Baptista RS, Franca IS, Costa CM, Brito VR. Caracterização do abuso sexual em crianças e adolescentes notificado em um Programa Sentinela. Acta Paul Enferm 2008; 21(4):602-608.
³⁰
Pereira VOM, Pinto IV, Mascarenhas MDM, Shimizu HE, Ramalho WM, Fagg CW. Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017. Rev Bras Epidemiol 2020; 23(Supl. 1):e200004.
³¹
Oliveira NF, Moraes CL, Junger WL, Reichenheim ME. Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016. Epidemiol Serv Saude 2020; 29(1):e2018438.
³²
Souto DF, Zanin L, Ambrosano MB, Flório FM. Violência contra crianças e adolescentes: perfil e tendências decorrentes da Lei nº 13.010. Rev Bras Enferm 2018; 71(Supl. 3):1237-1246.
³³
Von Hohendorff J, Patias ND. Violência sexual contra crianças e adolescentes: identificação, consequências e indicações de manejo. Barbaroi 2017; 49:239-257.
³⁴
Medeiros KB. Resistências de crianças e adolescentes vítimas de violência doméstica e a escola na rede de proteção [tese]. Itatiba: Universidade São Francisco; 2018.
³⁵
Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet 2015; 20(3):655-665.
³⁶
Santos MJ, Mascarenhas MDM, Rodrigues MP, Monteiro RA. Caracterização da violência sexual contra crianças e adolescentes na escola - Brasil, 2010-2014. Epidemiol Serv Saude 2018; 27(2):e2017059.
³⁷
Sousa RP, Oliveira FB, Bezerra MLO, Leite ES, Maciel EJS. Caracterização dos maus-tratos contra a criança: análise das notificações compulsórias na Paraíba. Rev Espac Saude 2015; 16(4):20-28.
³⁸
Assis SG, Avanci JQ, Pesce RP, Pires T de O, Gomes DL. Notificações de violência doméstica, sexual e outras violências contra crianças no Brasil. Cien Saude Colet 2012; 17(9):2305-2317.
³⁹
Fornari LF, Sakata-So KN, Egry EY, Fonseca RMGS. As perspectivas de gênero e geração nas narrativas de mulheres abusadas sexualmente na infância. Rev Lat Am Enferm 2018; 26:e3078.

Publication Dates

Publication in this collection
01 July 2024
Date of issue
July 2024

History

Received
05 Apr 2023
Accepted
01 Feb 2024
Published
22 Feb 2024

Este é um artigo publicado em acesso aberto sob uma licença Creative Commons

[1] ¹
Brasil. Ministério dos Direitos Humanos (MDH). Secretaria Nacional de Proteção dos Direitos da Criança e Adolescente. Letalidade infanto-juvenil: dados da violência e políticas públicas existentes. Brasília: MDH; 2018.

[2] ²
Fundo das Nações Unidas para a Infância (Unicef). As crianças têm direito à segurança onde quer que estejam [Internet]. 2020. [acessado 2021 jan 3]. Disponível em: https://www.unicef.org/end-violence
» https://www.unicef.org/end-violence

[3] ³
Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Revisão sistemática de estudos sobre registros de violência contra crianças e adolescentes no Brasil. Cien Saude Colet 2019; 24(2):487-496.

[4] ⁴
Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Geneva: WHO; 2002.

[5] ⁵
World Health Organization (WHO). World report on child injury prevention. Geneva: WHO; 2008.

[6] ⁶
Brasil. Presidência da República. Lei nº 8.069, de 13 de julho de 1990, que institui o Estatuto da Criança e do Adolescente. Diário Oficial da União 1990; 16 jul.

[7] ⁷
Brasil. Ministério da Saúde (MS). Viva: vigilância de violências e acidentes: 2013 e 2014. Brasília: Ministério da Saúde; 2017.

[8] ⁸
Farias MS, Souza CS, Carneseca EC, Passos ADC, Vieira EM. Caracterização das notificações de violência em crianças no município de Ribeirão Preto, São Paulo, no período 2006-2008. Epidemiol Serv Saude 2016; 25(4):799-806.

[9] ⁹
Carnochan S, Rizik-Baer D, Austin MJ. Preventing the recurrence of maltreatment. J Evid Based Social Work 2013; 10(3):161-178.

[10] ¹⁰
Piovezan LNC, Diniz LO, Calmeto MN, Fontella RB, Ferreira RSB, Vidal CEL. Análise das fichas de notificação de violência emitidas por serviços de saúde da região de Barbacena. Rev Med Minas Gerais 2018; 28(Supl. 5):e-S280502.

[11] ¹¹
Sinimbu RB, Mascarenhas MDM, Silva MMA, Carvalho MGO, Santos MR, Freitas MG. Characterization of victims of domestic violence, sexual and/or other violence in Brazil - 2014. Rev Saude Foco 2016; 1(1):1-14.

[12] ¹²
Mascarenhas MDM, Malta DC, Silva MMA, Lima CM, Carvalho MGO, Oliveira VLA. Violência contra a criança: revelando o perfil dos atendimentos em serviços de emergência, Brasil, 2006 e 2007. Cad Saude Publica 2010; 26(2):347-357.

[13] ¹³
Hamilton LHA, Jaffe PG, Campbell M. Assessing children's risk for homicide in the context of domestic violence. J Fam Violence 2013; 28(2):179-189.

[14] ¹⁴
Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção de maus tratos infantis. Cien Saude Colet 2019; 24(11):3997- 4008.

[15] ¹⁵
McGee ZT, Baker SR. Impact of violence on problem behavior among adolescents: risk factors among an urban sample. J Contemp Crim Justice 2002; 18(1):74-93.

[16] ¹⁶
Yule K, Houston J, Grych J. Resilience in children exposed to violence: a meta-analysis of protective factors across ecological contexts. Clin Child Fam Psychol Rev 2019; 22(3):406-431.

[17] ¹⁷
Kim K, Choi J, Jang H, Lee HJ, Jang H. Predictive model for intra-familial child maltreatment re-reports and recurrence in South Korea: analysis of national child protection services case records. Child Abuse Negl 2022; 125:105487.

[18] ¹⁸
Horikawa H, Suguimoto SP, Musumari PM, Techasrivichien T, Ono-Kihara M, Kihara M. Development of a prediction model for child maltreatment recurrence in Japan: a historical cohort study using data from a Child Guidance Center. Child Abuse Negl 2016; 59:55-65.

[19] ¹⁹
White OG, Hindley N, Jones DP. Risk factors for child maltreatment recurrence: an updated systematic review. Med Sci Law 2015; 55(4):259-277.

[20] ²⁰
Ng QX, Yong BZJ, Ho CYX, Lim DY, Yeo WS. Early life sexual abuse is associated with increased suicide attempts: an update meta-analysis. J Psychiatr Res 2018; 99:129-141.

[21] ²¹
Leite FMC, Pinto IBA, Luis MA, Iltchenco Filho JH, Laignier MR, Lopes-Júnior LC. Violência recorrente contra adolescentes: uma análise das notificações. Rev Latino-Am Enferm 2022; 30 (Esp.):e3682.

[22] ²²
Pedroso MRO, Leite FMC. Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo. Epidemiol Serv Saude 2021; 30(3):e2020809.

[23] ²³
Platt VB, Coelho ESB, Bolsonia C, Honickya M, Bordina GP, Camargo MAV. Sexual violence against children in the state of Santa Catarina, Brazil: characteristics and factors related to repetitive violence. Rev Paul Pediatr 2023; 41:e2022069

[24] ²⁴
World Health Organization (WHO). Adolescent health [Internet]. 2019. [cited 2023 jun 11]. Available from: http://www.who.int/topics/adolescent_health/en/
» http://www.who.int/topics/adolescent_health/en

[25] ²⁵
Brasil. Ministério da Saúde (MS). Viva: instrutivo notificação de violência interpessoal e autoprovocada. Brasília: MS; 2016.

[26] ²⁶
Tener D. The secret of intrafamilial child sexual abuse: who keeps it and how? J Child Sex Abus 2018; 27(1):1-21.

[27] ²⁷
Hillis S, Mercy J, Amobi A, Kress H. Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics 2016; 137(3):e20154079.

[28] ²⁸
Trindade LC, Linhares SM, Vanrell JP, Godoy D, Martins JC, Barbas SM. Sexual violence against children and vulnerability. Rev Assoc Med Bras 2014; 60(1):70-74.

[29] ²⁹
Baptista RS, Franca IS, Costa CM, Brito VR. Caracterização do abuso sexual em crianças e adolescentes notificado em um Programa Sentinela. Acta Paul Enferm 2008; 21(4):602-608.

[30] ³⁰
Pereira VOM, Pinto IV, Mascarenhas MDM, Shimizu HE, Ramalho WM, Fagg CW. Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017. Rev Bras Epidemiol 2020; 23(Supl. 1):e200004.

[31] ³¹
Oliveira NF, Moraes CL, Junger WL, Reichenheim ME. Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016. Epidemiol Serv Saude 2020; 29(1):e2018438.

[32] ³²
Souto DF, Zanin L, Ambrosano MB, Flório FM. Violência contra crianças e adolescentes: perfil e tendências decorrentes da Lei nº 13.010. Rev Bras Enferm 2018; 71(Supl. 3):1237-1246.

[33] ³³
Von Hohendorff J, Patias ND. Violência sexual contra crianças e adolescentes: identificação, consequências e indicações de manejo. Barbaroi 2017; 49:239-257.

[34] ³⁴
Medeiros KB. Resistências de crianças e adolescentes vítimas de violência doméstica e a escola na rede de proteção [tese]. Itatiba: Universidade São Francisco; 2018.

[35] ³⁵
Rates SMM, Melo EM, Mascarenhas MDM, Malta DC. Violence against children: an analysis of mandatory reporting of violence, Brazil 2011. Cien Saude Colet 2015; 20(3):655-665.

[36] ³⁶
Santos MJ, Mascarenhas MDM, Rodrigues MP, Monteiro RA. Caracterização da violência sexual contra crianças e adolescentes na escola - Brasil, 2010-2014. Epidemiol Serv Saude 2018; 27(2):e2017059.

[37] ³⁷
Sousa RP, Oliveira FB, Bezerra MLO, Leite ES, Maciel EJS. Caracterização dos maus-tratos contra a criança: análise das notificações compulsórias na Paraíba. Rev Espac Saude 2015; 16(4):20-28.

[38] ³⁸
Assis SG, Avanci JQ, Pesce RP, Pires T de O, Gomes DL. Notificações de violência doméstica, sexual e outras violências contra crianças no Brasil. Cien Saude Colet 2012; 17(9):2305-2317.

[39] ³⁹
Fornari LF, Sakata-So KN, Egry EY, Fonseca RMGS. As perspectivas de gênero e geração nas narrativas de mulheres abusadas sexualmente na infância. Rev Lat Am Enferm 2018; 26:e3078.

Variables	Children (n = 1,360)			Adolescents (n = 3,193)
	n (%)	Recurrent violenceª		n (%)	Recurrent violenceª
	n (%)	n (%)	OR (95%CI)	n (%)	n (%)	OR (95%CI)
Characteristics of victim
Sex
Female	925 (68.0)	468 (50.6)	1.21 (0.97-1.53)	2,418 (75.7)	1,163 (48.1)	2.54 (2.13-3.04)
Male	435 (32.0)	199 (45.7)	1.00	775 (27.3)	207 (26.7)	1.00
Race or skin colour
Black or brown	891 (67.6)	456 (51.2)	1.26 (0.99-1.60)	2,272 (73.0)	961 (42.3)	0.93 (0.79-1.09)
Indigenous	34 (2.6)	16 (47.0)	1.07 (0.53-2.16)	57 (1.8)	30 (52.6)	1.41 (0.82-2.42)
White or yellow	393 (29.8)	178 (45.3)	1.00	786 (25.2)	346 (44.0)	1.00
Schooling
Illiterate/lower secondary	-	-	-	1,186 (43.8)	725 (47.7)	1.53 (1.31-1.79)
Upper secondary/higher education	-	-	-	1,520 (56.2)	442 (37.3)	1.00
Marital status
Married/stable union	-	-	-	330 (11.6)	165 (50.0)	1.38 (1.10- 1.74)
Single		-	-	2,513 (88.4)	1,053(41.9)	1.00
Disability/disorder	-
Yes	45 (3.6)	28 (62.2)	1.76 (0.95-3.26)	134 (4.4)	69 (51.5)	1.41 (0.99-1.99)
No	1,215 (96.4)	586 (48.2)	1.00	2,881 (95.6)	1,237 (42.9)	1.00
Characteristics of violence
Time of occurrence¹
Day	461 (62.1)	199(43.2)	1.09 (0.81-1.48)	979 (43.3)	398 (40.6)	1.17 (0.99-1.39)
Night	281 (37.9)	115(40.9)	1.00	1,276 (56.6)	470 (36.8)	1.00
Place of occurrence
Home	1,031 (78.2)	563 (54.6)	2.43 (1.62-3.64)	1,864 (60.0)	1,027 (55.1)	2.44 (1.94-3.06)
Bar or similar	74 (5.6)	7 (50.0)	2.02 (0.66-6.18)	157 (5.1)	22 (21.1)	0.53 (0.31-0.89)
School/sports venue	14 (1.1)	27 (36.5)	1.16 (0.63-2.13)	104 (3.3)	47 (29.9)	0.85 (0.57-1.26)
Public place	82 (6.2)	20 (24.4)	65 (0.34-1.23)	578 (18.6)	109 (18.9)	0.46 (0.34-0.62)
Outros locais²2 Fundo das Nações Unidas para a Infância (Unicef). As crianças têm direito à segurança onde quer que estejam [Internet]. 2020. [acessado 2021 jan 3]. Disponível em: https://www.unicef.org/end-violence https://www.unicef.org/end-violence...	118 (8.9)	39 (33.0)	1.00	401 (12.9)	134 (33.4)	1.00
Type of violence
Physical
Yes	602 (45.4)	293 (48.7)	0.97 (0.78-10.21)	1,909 (60.7)	705 (36.9)	0.53 (0.46-0.62)
No	723 (54.6)	356 (49.2)	1.00	1,238 (39.3)	645 (52.1)	1.00
Psychological/emotional
Yes	491 (37.3)	311 (63.3)	2.49 (1.98-3.13)	1,035 (33.3)	555 (53.6)	1.89 (1.62-2.20)
No	826 (62.7)	338 (40.9)	1.00	2,076 (66.7)	787 (37.9)	1.00
Sexual
Yes	814 (61.5)	434 (53.3)	1.45 (1.16-1.82)	1,523 (48.6)	809 (53.1)	2.22 (1.92-2.56)
No	510 (38.5)	224 (43.9)	1.00	1,610 (51.4)	544 (33.8)	1.00
Neglect/abandonment
Yes	133 (10.0)	94 (70.7)	2.73 (1.84-4.02)	87 (2.8)	66 (75.9)	4.33 (2.64-7.12)
No	1,187 (89.9)	557 (46.9)	1.00	3,022 (97.2)	1,270 (42.0)	1.00

Characteristics of probable aggressor	Children (n = 1,360)			Adolescents (n = 3,193)
	n (%)	Recurrent violence ª		n (%)	Recurrent violence ª
	n (%)	n (%)	OR (95%CI)	n (%)	n (%)	OR (95%CI)
Aggressor sex
Female	221 (17.5)	94 (42.5)	1.00	313 (10.1)	99 (31.6)	1.00
Male	976 (77.5)	513 (52.5)	1.50 (1.11-2.01)	2,706 (87.6)	1,218 (45.0)	1.76 (1.37-2.71)
Both	63 (5.0)	46 (73.0)	3.65 (1.97-6.77)	69 (2.2)	33 (47.8)	1.98 (1.16-3.36)
Aggressor age group
0 to 9 years	108 (11.1)	35 (32.4)	1.00	27 (1.2)	8 (29.6)	1.00
10 to 19 years	138 (14.2)	61 (44.2)	1.65 (0.97-2.79)	579 (26.0)	259 (44.7)	1.92 (0.82-4.46)
20 to 24 years	97 (10.0)	49 (50.5)	2.12 (1.20-3.75)	498 (22.4)	191 (38.3)	1.47 (0.63-3.44)
25 to 59 years	592 (60.9)	337 (56.9)	2.75 (1.78-4.25)	1,081 (48.5)	539 (49.8)	2.36 (1.02-5.44)
60 years or more	37 (3.8)	24 (64.8)	3.85 (1.75-8.45)	42 (1,9)	22 (52.4)	2.61 (0.93-7.27)
Number of aggressors
One	1,020 (80,8)	501 (49.1)	1.00	2,323 (75.7)	1,053 (45.3)	1.00
Two or more	243 (19.2)	140 (57.6)	1.40 (1.06-1.86)	746 (24.3)	275 (36.8)	0.70 (0.59-0.83)
Alcohol consumed
Yes	225 (22.5)	127 (56.4)	1.42 (1.05-1.91)	869 (35.5)	339 (39.0)	0.72 (0.61-0.85)
No	776 (77.5)	370 (47.7)	1.00	1,647 (65.5)	772 (46.9)	1.00
Relation to victim¹
Relative
Yes	594 (43.7)	346 (58.2)	1.93 (1.56-2.40)	621 (19.4)	424 (68.3)	3.70 (3.07-4.46)
No	766 (56.3)	321 (41.9)	1.00	2,572 (80.6)	946 (36.8)	1.00
Friend/acquaintance
Yes	798 (58.7)	286 (50.9)	1.13 (0.91-1.41)	1,131 (35.4)	441 (39.0)	0.78 (0.67-0.90)
No	562 (41.3)	381 (47.7)	1.00	2,062 (64.6)	929 (45.0)	1.00
Intimate partner
Yes	32 (2.4)	18 (56.2)	1.34 (0.66-2.73)	635 (19.9)	383 (60.3)	2.42 (2.02-2.89)
No	1,328 (97.6)	649 (48.9)	1.00	2,558 (80.1)	987 (38.6)	1.00
Other
Yes	159 (11.7)	53 (33.3)	0.48 (0.34-0.68)	790 (24.7)	158 (20.0)	0.24 (0.20-0.30)
No	1,201 (88.3)	614 (51.1)	1.00	2,403 (75.3)	1,212 (50.4)	1.00

Means of aggression	Children (n = 1,360)			Adolescents (n = 3,193)
	n (%)	Recurrent violence ª		n (%)	Recurrent violence ª
	n (%)	n (%)	OR (95%CI)	n (%)	n (%)	OR (95%CI)
Physical force
Yes	479 (37.2)	273 (57.0)	1.65 (1.31-2.07)	1,515 (49.2)	610 (40.2)	0.80 (0.69-0.92)
No	809 (62.8)	360 (44.5)	1.0	1,565 (50.8)	714 (45.6)	1.0
Strangulation
Yes	19 (1.5)	14 (73.7)	2.96 (1.06-8.27)	143 (4.7)	64 (44.7)	1.07 (0.77-1.51)
No	1,262 (98.5)	613 (48.6)	1.00	2,918 (95.3)	1,251 (42.9)	1.00
Blunt force
Yes	47 (3.7)	19 (40.4)	0.69 (0.38-1.26)	133 (4.3)	63 (47.4)	1.20 (0.84-1.70)
No	1,232 (96.3)	608 (49.3)	1.00	2,926 (95.7)	1,252 (42.8)	1.00
Sharp object
Yes	41 (3.2)	14 (34.1)	0.52 (0.27-1.01)	344 (11.2)	105 (30.5)	0.54 (0.42-0.69)
No	1,239 (96.8)	614 (49.5)	1.00	2,725 (88.8)	1,214 (44.5)	1.00
Hot object/substance
Yes	20 (1.6)	7 (35.0)	0.55 (0.21-1.39)	12 (0.4)	4 (33.3)	0.66 (0.19-2.20)
No	1,266 (98.4)	624 (49.3)	1.00	3,051 (99.6)	1,312 (43.0)	1.00
Poisoning
Yes	9 (0.7)	1 (11.1)	0.12 (0.16-1.03)	29 (0.9)	9 (31.0)	0.60 (0.26-1.30)
No	1,276 (99.3)	629 (49.3)	1.00	3,032 (99.1)	1,310 (43.2)	1.00
Firearm
Yes	21 (1.6)	3 (14.3)	0.16 (0.50-0.60)	294 (9.6)	39 (13.3)	0.18 (0.12-0.25)
No	1,257 (98.4)	624 (49.6)	1.00	2,775 (90.4)	1,277 (46.0)	1.00
Threat
Yes	342 (26.8)	244 (71.3)	3.50 (2.68-4.58)	836 (27.3)	445 (53.2)	1.75 (1.50-2.05)
No	933 (73.2)	388 (41.6)	1.00	2,227 (72.7)	877 (39.4)	1.00
Other means¹1 Brasil. Ministério dos Direitos Humanos (MDH). Secretaria Nacional de Proteção dos Direitos da Criança e Adolescente. Letalidade infanto-juvenil: dados da violência e políticas públicas existentes. Brasília: MDH; 2018.
Yes	255 (20.7)	99 (38.8)	0.62 (0.48-0.82)	263 (8.9)	139 (52.8)	1.53 (1.20-1.99)
No	977 (79.3)	493 (50.4)	1.00	2,679 (91.1)	1,129 (42.1)	1.00

Variable	Children	Adolescents
Variable	OR (95%CI)ª	OR (95%CI)ª

Sex
Female	1.12 (0.84-1.49)	1.10 (0.83-1.45)
Male	1.00	1.00
Schooling
Illiterate/lower secondary	-	1.25 (1.03-1.51)
Upper secondary/higher education	-	1.00
Characteristics of violence
Place of occurrence
Home	2.29 (1.42-3.70)	1.66 (1.24-2.22)
Bar/similar	1.19 (0.56-2.47)	1.03 (0.61-1.72)
School/sports venue	2.12 (0.60-7.47)	1.13 (0.61-2.11)
Public place	0.80 (0.40-1.62)	0.91 (0.62-1.31)
Other places¹1 Brasil. Ministério dos Direitos Humanos (MDH). Secretaria Nacional de Proteção dos Direitos da Criança e Adolescente. Letalidade infanto-juvenil: dados da violência e políticas públicas existentes. Brasília: MDH; 2018.
Type of violence
Psychological/emotional
Yes	1.68 (1.27-2.20)	1.68 (1.36-2.07)
No	1.00	1.00
Sexual
Yes	-	2.14 (1.69-2.72)
No	-	1.00
Neglect/abandonment
Yes	1.92 (1.15-3.20)	-
No	1.00	-
Characteristics of probable aggressor
Sex do Aggressor
Male	1.60 (1.11-2.28)	-
Both	2.48 (1.13-5.43)	-
Female	1.00	-
Number of aggressors
Two or more	1.48 (1.02-2.14)	1.41 (1.12-1.78)
One	1.00	1.00
Relation to victim¹
Relative
Yes	1.36 (1.03-1.79)	2.97 (1.12-1.78)
No	1.00	1.00
Intimate partner
Yes	-	3.12 (2.40-4.05)
No	-	1.00
Others
Yes	-	0.49 (0.37-0.65)
No	-	1.00
Means of aggression
Physical force
Yes	1.36 (1.04-1.78)	0.80 (0.65-0.99)
No	1.00	1.00
Firearm
Yes	-	0.46 (0.29-0.74)
No	-	1.00
Threat
Yes	2.37 (1.74-3.23)	1.31 (1.04-1.64)
No	1.00	1.00

Saúde Pública

Saúde Pública

Factors associated with the recurrence of violence against children and adolescents. Mato Grosso-Brazil, 2013 to 2019

Abstract

Introduction

Method

Results

Discussion

Acknowledgements

References

Publication Dates

History