Abus, maltraitance et négligence: (1)épidémiologie et retentissements psychiques, somatiques et sociaux

In 2006, the WHO recognized child abuse as a major public health problem for children as well as other chronic conditions. All forms of abuse concern nearly 1-5% of children in high-income countries, with frequent association between them. Global underestimation of these maltreatment behaviors was underlined by crosschecking data from retrospective survey carried into adulthood and official ones. In France, the number of children abuse stabilized in the last years, with a decrease of sexual abuse and an increase of severe neglect and emotional abuse reported. In recent years, observational epidemiology studies have drawn the different risk factors associated with maltreatment context (individual, environmental and familial), and assessed psychological, somatic and social long-term consequences for child. In psychiatric field, association with anxiety disorders, depressive disorders and maladaptative behavior in adolescent is strong, especially among girls with addictions. Suicide remains the leading cause of death in this population. Beyond the highest prevalence, these disorders are often more severe, resistant and recurring. Associations with somatic disorders such as obesity, or diabetes have been identified but are less clear for painful complaints such as digestive complaints or headaches. Cohort on socio-economic outcome and medical needs stress a long-range impact, beyond childhood, on these outcomes. Work on early brain development highlights the mechanisms involved in the repercussions of these injuries on the emotional and cognitive development. Vulnerability to later psychopathology would be partly modulated by genetic polymorphisms and interactions with the environment that constitute risk or protective factors, through epigenetic modification involving structures regulating stress such as the amygdala and the hypothalamic-pituitary system.