Main forms of child abuse include physical, emotional, and sexual harassment, and neglect (5,6). The signs of physical abuse are usually visible. Emotional abuse may take many forms, such as ignoring, belittling, or intimidation. It negatively affects the development, distorts the positive self-image of the child, leaves long-term consequences, and may lead to risky or aggressive behavior in adolescence or adulthood (5). Abuse is defined as a permanent type of behavior that “erodes and corrodes” the child’s integrity (7). In the strict sense, the term does not include occasional spanking, or “losing patience” with the child. Fit mothers react inadequately in 10% of total time spent with the child, as opposed to unfit mothers who do so in 80%-90% of the time (7).

Long-term negative family conditions are predictive of aggressive behavior, anxiety, depression, delinquency, and social problems in adolescence or adult life (8), for example adolescent pregnancy (9,10), risky sexual behavior and drug addiction (11-13), emotional vulnerability (14), lower verbal intelligence quotient (15), alcoholism, suicidal behavior, and job abandonment (11,16-18). According to the US Department of Health and Human Services, the prevalence of abuse in the USA for the year 2000 was about 12.3/1000 children (19). More than 60% of children were neglected, 20% were physically, 10% sexually, and 7% emotionally abused. The highest percentage of victims were infants and children up to 3 years of age, more often girls than boys, and more than 80% of abusers were parents (19).

According to a retrospective study from the United States that involved 1000 adults, about 30% of women and more than 40% men reported to have experienced some form of abuse in childhood; 5% reported to have been sexually and as many as 19% physically abused (20). In Thailand, as many as 77% of sixth graders in the elementary school were physically punished by whipping or lashing with a belt, and 95% were emotionally harassed by being yelled at or humiliated in various ways (21). In Croatia, the number of abused children has increased by 74% over the last 10 years, and the prevalence of sexual child abuse has tripled (22). According to the Croatian Ministry of Internal Affairs, 13698 cases of child abuse were recorded in the period between 1991 and 1995, and only 10% of the abused children were physically examined and treated in health care institutions (22).

A study among Croatian elementary school children in 2004 showed that 35% were victims of various forms of abuse and school violence, 19% were passive victims, 8% provocative victims, and 8% were bullies (23). In Sisačko-moslavačka County, 10%-20% of high school pupils experienced some form of harassment in childhood (24).

According to the 2001 census, Slavonski Brod and its surroundings had 124349 inhabitants and was the sixth largest town in Croatia. Before the war 1991-1995, it was a prosperous industrial and agro-industrial center with developed social services, but during the war it suffered considerable infrastructural damage and hosted many refugees from adjacent Bosnia, part of which took permanent residence. Post-war recession took its toll and nowadays Slavonski Brod has become one of the most impoverished towns in Croatia (25). Such socio-economic situation opens the possibility for increased violence and child abuse. The aim of this study was to determine the frequency of adolescent abuse in Slavonski Brod.

Table 1 Characteristics of high school pupils in the first and fourth-grade and their parents’ education level

Table 2 Family parental structure as reported by the pupils*

The investigation was approved by Ethical Committee of the Slavonski Brod General Hospital and endorsed by school authorities.

The questions were yes/no type and multichoice, or with Likert-type answers where appropriate. If the Likert-type answers were unsuitable or insufficient for the analysis, as was the case with physical punishment, the responses were recorded into yes/no format.

Table 3 Pupils’ perception of life at home and parental love and attention*

Table 4 Pupils’ perception of parental love with respect to parental family structure

Table 5 Pupils who were ever punished for disobedience and type of punishment

As many as 80% reported they had never been physically punished (Table 6). First-grade pupils reported having been physically punished significantly more often than fourth-grade pupils (Table 6).

Table 6 The frequency of physical punishment as reported by pupils

Severe physical punishment resulting in bruises or other forms of injuries was acknowledged by 96 (4.5%) of pupils, more often by those from rural (62, 2.9%) than from town families (34, 1.6%).

Linear regression analysis also showed significant association between the paternal and maternal level of education (R²=0.24, P<0.001). Paternal level of education was not associated with emotional or physical abuse (B=0.05, P=0.488 and B=0.06, P=0.260, respectively). Maternal level of education was significantly associated with their spouses’ level of education and also with physical abuse (R²=0.24, P<0.001). Mothers with higher education had spouses with higher education (B=0.15, P=0.006), and in such families physical abuse was less likely to occur (B=0.52, P=0.001). Emotional abuse was not associated with maternal educational level of (B=0.05, P=0.569).

Our study showed that fourth-grade high school pupils were less satisfied with life at home and parental love and attention they received than first-grade pupils. This may be the result of the normal process of maturation and individuation during adolescence or of adolescents’ interpreting some parental actions as the lack of love and understanding (4). Dissatisfaction with family life and the amount of parental attention was most often reported by fourth-grade pupils living in rural areas. Insufficient communication with parents may have been interpreted by older adolescents as the lack of parental attention. This could explain the dissatisfaction and feeling of being insufficiently loved that many pupils from formally integral families shared. Positive perception of parental care was shown to be associated with reduced psychiatric and somatic symptoms in adult life (26).

In our study, dissatisfaction with parental love and attention was reported by one-fifth of pupils, particularly those from incomplete or disrupted families. Also, one-fifth of the pupils whose parents were divorced felt insufficiently loved or unloved. Fourth-grade pupils expressed such feelings more often than first-grade pupils, possibly because their period of deprivation lasted longer. Parental divorce is a stressful experience for the child who may develop guilt feelings, insecurity, and low self-esteem, and feel unprotected or unloved. The feeling of rejection is associated with depression of the divorced mother and concurrent conflict with the father (27). Furthermore, adolescents from divorced families are likely to develop state anger (28). Parental divorce is also associated with lower quality of father-child relationships, yet with positive outcomes for mother-child relationships, social support, independence, and reduced anxiety in personal relationships (29). Children in fatherless families experience more interaction with mothers, and boys show more feminine but not less masculine characteristics of gender role behavior (30). Father-adolescent conflicts are also more strongly related to adolescent depression than mother-adolescent conflicts (31). Stressful experience related to parental divorce has been reported to increase risk of cancer in later life (32). In our study, pupils living with stepmother/stepfather missed parental love and attention more often than pupils who had either both parents or a single parent. Stepparent may disregard or even dislike the stepchild or impose strict discipline, causing the adolescent feel unloved and not understood (33). Research by Garnefski and Diekstra (33) in the Netherlands showed that adolescents from divorced families who lived with a stepmother/stepfather had considerably lower self-esteem than those who lived with both parents. They were more anxious and lonesome, experienced depressive moods, and had suicidal thoughts and attempts. Boys who lived with a stepmother/stepfather had more emotional problems in comparison with those who lived with only one parent. On the other hand, girls who lived with a single parent had more emotional problems than girls who lived with a stepmother/stepfather (33).

In our study, 6.3% of pupils had lost one of the parents. Such losses affect basic feelings of security and increase the attachment to the remaining parent, who him/herself is grieving and sometimes finds it hard to adjust to new conditions. His or her upbringing skills may suffer. Thus, single parents may encounter difficulties with disciplining, guiding, and supporting the child.

In our study, emotional abuse was associated with the female sex, younger age, and alcoholism in the family. Emotional abuse by adults decreases self-respect and elicits guilt feelings in children (34,35). Abused children often think nobody loves them and become aggressive or self-destructive (18,34,35).

Prevalence of emotional abuse has not been sufficiently documented. Data obtained in different studies are not fully comparable because emotional abuse has not been unambiguously defined and is evaluated on the basis of different indicators. According to the assessment of the American Humanitarian Association for the period 1987-1997, 11% of (reported) abused children were mistreated emotionally (2). In our survey, 80%-85% of pupils reported having been yelled at, scorned, intimidated, humiliated, or exposed to other forms of emotional abuse by their parents. A study of abuse and harassment among university students in Croatia showed that, by the age of fourteen, about a quarter of pupils experienced emotional abuse (36). A roughly equal percentage witnessed emotional abuse in the family.

Intimidation is a form of emotional abuse that causes fear or panic, for example threats to physical integrity, threats with abandonment or suicide and harsh disciplinary methods, such as tethering, confinement to dark room, etc. In our study, intimidation was reported to a lesser degree. However, it is possible that pupils provided biased answers because of shame or intent suppression.

Physical abuse in a wider sense means inflicting injury. Prevalence of neglect and physical abuse is increasing. MacMillian et al (37) reported that as many as 25% of the questioned persons experienced physical abuse in childhood. Edwards et al (38) found that almost a half of abused children experienced one form of abuse and over a third, two or more forms (emotional and/or physical). Children are exposed to physical abuse most frequently between 4 and 8 years of age, but many parents are reported to beat children at the younger or older age (22,39). According to the US National Clearinghouse on Child Abuse and Neglect (19), over three-quarters of reported deaths of children younger than 4 years were attributable to physical abuse. In most cases, the perpetrators were the parents, more often young than old ones, and more often fathers than mothers. Physically abused children were likely to develop depressive symptoms and suicidal behavior (40).

In our study, around 15% of pupils reported that they had been or were physically punished by the parents, which is less than in the previous studies in Croatia (36,39). This difference may reflect the situation in Slavonski Brod County and be attributed to a relatively favorable educational level of the parents' population and to traditional values that persisted in spite of worsened socioeconomic condition. On the other hand, their responses could be biased. Cole et al (31) in a study of family subsystems pointed out that adolescents’ reports need not be fully reliable.

In our study, physical punishment for disobedience was more often inflicted by mothers with elementary education from the rural area and by fathers with college degree from the urban area. This pattern reflects the educational structure of the parental sample as a whole and not a specific causative relationship. Physical punishment resulting in bruises or serious injuries was associated with higher educational level of the perpetrators (college degree), but the data are too scarce for a reliable conclusion.

According to our results, physical abuse was also associated with younger age, alcoholism in the family, lack of parental love, and emotional abuse. Improper parental behavior toward the children is often a result of alcoholism or other addiction, mental illness, poverty, or unemployment (41,42). Parental abuse of alcohol predisposes adolescents and young adults for introjective depression and aggressive defenses (43). In our study, the number of children reporting physical abuse and alcohol consumption in the family was small, but more frequent among older pupils who were obviously more able to recognize behavioral influences of alcohol. This finding could be attributed to an insufficient insight of young adolescents into manifestations of alcoholism, or neglect, or perhaps to conscious concealment of data. Yet, physical abuse was significantly associated with alcoholism in the family. Alcohol consumption was more frequently reported in parents with low education level from the rural area and those with college education from the town.

The limitations of our study are associated with typical limitations of questionnaire-based studies among adolescent population. Cole et al (31) point out that adolescents’ self-reports need not be fully reliable. Response biases that could have influenced our results cannot be excluded. Also, we cannot say if the adolescent population in Slavonski Brod was representative of the adolescent population of Croatia, so the results of our study may have a limited generalizability. It should be noted, however, that the recent unfavorable socio-economic conditions in a population that had seen “better days” did not take its toll in the form of high rates of child abuse.

In conclusion, we found that a considerable proportion of high school pupils in Slavonski Brod and the area were essentially content with life at home and parental care they received. Their parents were relatively well educated. Unfavorable family conditions, such as parental divorce, stepparent, or parental alcoholism resulted more often in pupils’ discontent. Disobedience was usually punished verbally or by aggressive behavior of the parents, and less often physically. Frequent physical punishment and alcoholism in the family were not prominent findings in our study, which may reflect a positive state of the population. On the other hand, it may be attributed to a concealment of embarrassing information by the pupils. Further investigations should address more explicitly the questions of sexual abuse and include adolescent population from different areas in Croatia.

The authors appreciate the help and cooperation of the school authorities and teachers.