Koc EM et al.
ORIGINAL
ARTICLE
Esra Meltem Koc1
Figen Sahin Dagli2
Fatma Nur Aksakal3
Hilal Aksoy4
Rabia Kahveci5
Duygu Ayhan Baser6
Catherine Meads7
Adem Ozkara5
1
Katip Celebi University Faculty of
Medicine, Departments of Family
Medicine, Izmir, Turkey
²Gazi University Faculty of Medicine,
Departments of Pediatrics, Ankara,
Turkey
3
Gazi University Faculty of Medicine,
Departments of Public Health, Ankara,
Turkey
4
Ministry of Health, Ankara, Turkey
5
Ankara Numune Training and Research
Hospital, Departments of Family
Medicine, Ankara, Turkey
6
Kocaeli Public Health Directorate,
Kocaeli, Turkey
7
Anglia Ruskin University, Faculty of
Health, Social Care and Education,
United Kingdom
Corresponding Author:
Esra Meltem Koç
Izmir Katip Celebi University Faculty of
Medicine, Departments of Family Medicine,
Izmir, Turkey
Tel:+90 505 488 70 18
E-mail: meltemnuzumlali@yahoo.com
Received: 04.12.2017
Acceptance: 18.03.2018
DOI: 10.18521/ktd..382958
Konuralp Medical Journal
e-ISSN1309–3878
konuralptipdergi@duzce.edu.tr
konuralptipdergisi@gmail.com
www.konuralptipdergi.duzce.edu.tr
Exploring Prevalence of Child Abuse: Use of ICASTRetrospective Instrument with the First Year Medical
Students in a University
ABSTRACT
Objective: This study determined the prevalence of child abuse in first year
medical students in a Turkish university using the ICAST-R, as well as the
relationships between sociodemographic data and abuse.
Methods: First-year medical students in a Turkish university have been surveyed
between 15th-30th June 2012, using ISPCAN Child Abuse Screening ToolRetrospective Version (ICAST-R) and a questionnaire to collect
sociodemographic data. Data analysis was performed with SPSS 15.0.
Results: This study was included 192 students, 56.8% female and 43.2% male.
Physical, emotional and sexual abuses were found in 14.6%; 32.3%; and 8.9% of
participants, respectively. No significant relation between gender and emotional
abuse was found (p= 0.775), whereas both physical and sexual abuse were more
common in males (p= 0.04; p= 0.018 respectively). There was a statistically
significant relation between emotional abuse and parental separation (p= 0,014).
Conclusions: Abuse is not rare among the medical student participants, and
several preventable factors could worsen it. The findings have implications on
how medical students are taught about these issues.
Keywords: Child, Abuse, Prevalence, Medical Students, Turkey, ICAST
Çocuk İstismarı Prevalansının Araştırılması: Bir
Üniversitedeki
Tıp
Fakültesi
Birinci
Sınıf
Öğrencilerinde ICAST-R Ölçeğinin Kullanımı
ÖZET
Amaç: Bu çalışma ICAST-R kullanılarak Türkiye‟deki bir üniversitenin tıp
fakültesi birinci sınıf öğrencilerinin çocukluk dönemi istismar prevalansının yanı
sıra istismar ile sosyodemografik veriler arasındaki ilişkinin belirlenmesini
amaçlamaktadır.
Gereç ve Yöntem: Tıp fakültesi birinci sınıf öğrencilerine 15-30 Haziran 2012
tarihleri arasında ISPCAN Child Abuse Screening Tool-Retrospective Version
(ICAST-R) ve sosyodemografik verileri toplamak için anket uygulandı. Veri
analizi SPSS 15.0 ile gerçekleştirildi.
Bulgular: Çalışmaya %56.8‟sı kadın ve %43.2‟si erkek olan 192 öğrenci
katılmıştır. Fiziksel, duygusal ve cinsel istismar sıklığı sırasıyla % 14.6; % 32.3;
ve % 8.9 bulunmuştur. Fiziksel ve cinsel istismar erkeklerde daha sık olmasına
(sırasıyla; p=0.04; p=0.018) rağmen cinsiyet ile duygusal istismar arasında
anlamlı ilişki saptanmamıştır (p=0.775). Ebeveynlerin ayrı olması ile duygusal
istismar arasında istatistiksel olarak anlamlı ilişkj saptanmıştır(p= 0,014).
Sonuç: Tıp fakültesi öğrencilerinde istismar nadir değildir ve birkaç önlenebilir
faktör durumu daha da kötüleştirebilir.
Anahtar Kelimeler: Çocuk, İstismar, Prevalans, Tıp Öğrencisi, Türkiye, ICAST
Konuralp Tıp Dergisi 2018;10(1):7-12
7
Koc EM et al.
INTRODUCTION
According
to
the
World
Health
Organization, 40 million children throughout the
world, aged 15 and below, are neglected or abused
every year(1). International studies show that
approximately 20% of females and 5-10% of males
undergo emotional abuse in their childhood and 2550% of all children, regardless of gender, undergo
physical abuse(1). Furthermore, many more
children are exposed to both emotional abuse and
neglect(1). Child maltreatment is defined as “all
forms of physical and/or emotional ill-treatment,
sexual abuse, neglect or negligent treatment or
commercial or other exploitation, resulting in actual
or potential harm to the child‟s health, survival,
development or dignity in the context of a
relationship of responsibility, trust or power”(1).
Turkey has recently put regulations in place
to prevent and manage child abuse and neglect
cases. There is a limited number of local Turkish
studies investigating the frequency of this issue(26), but no study has yet explored the issue deeply
with an internationally recognized, reliable and
valid questionnaire.
The International Society for the Prevention
of Child Abuse and Neglect (ISPCAN) developed
the ISPCAN Child Abuse Screening Tool (ICAST)
as a result of The World Report on Children and
Violence which was produced at the request of the
UN Secretary General and the UN General
Assembly(R). Three new instruments - ICASTParent(P), ICAST-Retrospective(R) and ICASTChild(C) - were designed to assess the incidence
and prevalence of child abuse and neglect(7).
The primary aim of this study is to pilot-test
the instrument “ICAST-Retrospective (R) for
young medical students” in a Turkish context to
determine the frequency of childhood abuse in this
group. The secondary aim of this study is to
determine the social risk factors associated with the
abuse in this particular group.
MATERIAL AND METHODS
Study Methodology: This cross-sectional
study was performed in the Department of
Pediatrics at a university. All of the first year
medical students were included to the study. A
sociodemographic questionnaire developed by the
research team and ICAST-R were applied to the
students for collecting the data during the lesson.
ICAST-R was developed through focused group
discussions with international child maltreatment
experts from 28 countries, and then subjected to a
Delphi study in two waves to determine the
perceived importance and translatability of items.
The resultant questionnaire was translated into six
languages and field tested in seven countries with
convenient samples of young adults aged 18–26
years (N = 842). The aim of the Delphi study was to
sample for diversity. The data of the study wasn‟t
sufficient for estimating prevalence or making
comparisons between countries(8).
During the data acquisition process, all the
participants were asked to fill in the questionnaire
under observation, after reading and signing the
consent form.
Setting: The study was performed with first
year medical students in a university between 15th30th June 2012, on a voluntary basis.
Participants: Medical students were chosen
as a convenient sample because of their ease of
accessibility. All the participants were clearly
informed about the aim of the study and the content
of the questionnaire. Personal identity information
was not collected from the participants. During the
data acquisition process, all the participants were
asked to fill in the questionnaire under observation,
after reading and signing the consent form.
Tools: Sociodemographic Questionnaire:
This questionnaire consisted of questions with the
aim of obtaining information about the
demographic characteristics of the participants.
ICAST-R: This is a questionnaire that was
developed by ISPCAN and aims to evaluate
whether the participants experienced physical,
emotional, or sexual abuse in their childhood before
the age of 18. The instrument includes 15 primary
questions about physical, sexual and emotional
abusive events. There were three choices to all
questions: “yes”, ”no”, and “cannot remember.”
Supplementary questions about the context of child
abuse including frequency, duration, and
perpetrator were asked under each main question.
The choices were “once or twice”, “between 3 and
10 times,” or “more than 10 times” for frequency;
“before 5 years,” “between age 5 and 9,” “between
age 10 and 13,” or “between age 14 and 17” for
duration, and both adult and peers for perpetrators.
The questionnaire was developed using the Delphi
method and field tests were performed in 7
countries. After these tests, researchers decided that
the questionnaire proves effective when translated
and it can competently reflect the childhood abuse
and neglect across many cultures8.
The original questionnaire form was
independently translated from English into Turkish
by two translators. The resultant two translations
were examined by a small group to work out
differences between two versions and ended up
with a first version of translated tool. This version
was back-translated into English by one translator.
Discrepancies between the original English and
back-translated version were examined. All
ambiguities were identified and clarified. The final
translation was externally reviewed by two experts.
Data analysis: SPSS 15.0 for Windows
application was used for the statistical analysis.
Frequencies, percentages, median (min., max.) and
mean± standard deviation were presented as
descriptive statistics. Chi-square test was performed
to compare the data. p<0.05 was accepted to be
statistically significant.
Konuralp Tıp Dergisi 2018;10(1):7-12
8
Koc EM et al.
Ethics: The ethical approval for the study
was taken from Ethics Committee of Gazi
University Faculty of Medicine.
RESULTS
There were 258 students as the first year
medical students. Fifty four students didn‟t want to
participate. Twelve students didn‟t complete the
questionnaire. Finally, 192 students (74.4% of the
targeted) were included in the study.
Demographic properties: One hundred
nine of the 192 participants were female (56.8%),
whereas 83 were male (43.2%). The mean age of
the participants was 19.41±1.33. Sociodemographic
data is summarized in Table 1. Of all the
participants 160 (83.3%) were non-smokers, 27
(14.1%) were active smokers, and 3 (1.6%) were
ex-smokers.
Table I. Demographic Properties
Age (Mean±SD)
Number of person in the family
(Mean±SD)
Number of siblings(Mean±SD)
Income level
Low income
Medium income
High income
Place of residence
Flat
Self-contained house
Squatter‟s house
19.41± 1.33
4.76±1.37
1.97± 1.24
7(%3.8)
98(%53.5)
78(%42.6)
151(%79.5)
38(%2)
1(%0.5)
Education levels of parents: 28 of fathers
(14.6%) had an education level of primary school
or less, 164 of fathers (85.4%) had an education
level of high school or more, while 59 of mothers
(30.7%) had an education level of primary school
or less and 133 of mothers (69.3%) had an
education level of high school or more.
One hundred and eighty had parents who
lived together (93.8%), while the parents of 10
participants (5.2%) were separated due to reason
such as death, divorce, etc.
ICAST Results: 14.6% (28) of participants
had stated that he/she had experienced physical
abuse, 32.3% (62) had suffered emotional abuse,
and 8.9% (17) had been victims of sexual abuse in
their childhood. 8.3% (9) of the females and
23.5%(19) of the males stated that he/she had
undergone physical abuse while 31.8% (34) of the
females and 33.7% (28) of the males had stated that
he/she had suffered emotional abuse. Additionally,
4.6% (5) of the females and 14.5% (12) of the
males reported having been sexually abused in their
childhood.
The relations between sociodemographic
characteristics and abuse types are given in Table 2.
Although there was a statistically significant
relation between male gender and both physical and
sexual abuse (p=0.04; p=0.018 respectively), there
was no relation between gender and emotional
abuse (p=0.775). Furthermore, parent separation
had a statistically significant relation with
emotional abuse (p=0.014), but not with physical or
sexual abuse (p=0.607; p=0.211 respectively).
Table 2. Relations (p values) Between the Abuse
Types and Sociodemographic Characteristics of the
Participants (Statistically significant values are
marked as underlined.)
Gender
Smoking
Parents separation
Mothers‟
education level
Fathers‟ education
level
Family income
level
Physical
abuse
0.040
0.001
0.014
0.225
Emotional
abuse
0.775
0.104
0.607
0.718
Sexual
abuse
0.018
0.610
0.211
0.643
0.821
0.706
0.023
0.059
0.944
0.588
The most common type of physical abuse
was hitting or punching at 71.4% (n=20), the most
common type of emotional abuse were verbal
insults at 80.6% (n=50), the most common type of
sexual abuse was genital touching against the
victim‟s will 47% (n=8) (Table 3). According to
the statements of the attendants, mothers and male
teachers were most commonly responsible for
physical abuse. Male teachers were also reported as
being responsible for emotional abuse while peers
or younger girlfriends were accountable for sexual
abuse.
DISCUSSION
Main findings: This study showed that there
was a statistically significant relation between male
gender and both physical and sexual abuse. Mothers
and male teachers were most commonly responsible
for physical abuse and parent separation has a
statistically significant relation with emotional
abuse.
Strengths and limitations: The present
study has several limitations. First, as the
questionnaire involves questions exploring abuse
and neglect, it may have been hard for the
participants to answer such questions about their
private life, and this might have lead to
underreporting and underestimation of actual abuse.
This is a general limitation that can be seen in most
of the studies and we tried to overcome this
limitation by asking the participants to fill the
questionnaire without revealing their identity.
Second, 66 people did not want to participate and
this population might have avoided to answer the
questions due to any psychological effect of their
experiences in the past.
As the percentage of those who avoided to
participate is only 20.9%, we think that our data
losses are acceptable. Third, the findings reflect
only one center with a limited number of
participants and might not be generalizable to other
settings.
Konuralp Tıp Dergisi 2018;10(1):7-12
9
Koc EM et al.
Table 3. Distribution According to Types of Abuse
Physical Abuse (n=28)
To be hit/punched
To be kicked
To be beaten with an object like stick, cane, whip or belt
To be shaken
To be stabbed or cut you with a knife
Emotional Abuse (N=62)
To be insulted
Not to be loved
Wanted to be died or not to be borned
Threatened to be hurt or killed
Threatened to be abandoned by the people in the family
Sexual Abuse (N=17)
To be exposed toones‟ genitals without will
To be forced to pose nude in front of any person or for photo., video or webcam
To be touched to private parts
To be forced to touch ones‟ private parts
To be forced to have any sexual intercourse
*:Participants ticked more than one option.
On the other hand, our study group actually
involves lots of students from different cities who
came to Ankara, therefore it may give an idea about
the frequency of abuse and neglect in childhood.
Despite above common limitations of such studies,
the major strength of this study is that it is the first
study about prevalence of child abuse in Turkey,
which used ICAST-R, an internationally recognized
tool and it has given us the opportunity to see and
discuss child abuse and risk factors in our country.
Comparison with existing literature:
There is no universal reliable prevalence of abuse
and neglect because of the lack of data in low and
middle income countries. There is no reliable data
for our country either, mostly due to deficient
records and lack of academic studies. Studies
published to date about this issue were performed
with different questionnaires. The ICAST
questionnaires are internationally recognized and
have already been used in epidemiological studies
from several settings, either as ICASTRetrospective(R), ICAST-Parent(P) or ICASTChild(C)(8-12).
Lee and Kim(9) performed a study using the
retrospective version of ICAST to determine the
prevalence of childhood maltreatment in South
Korea and the associations between perceptions of
abuse experienced during childhood and recent
interpersonal problems and depression. In the study,
539 young persons aged 18–24 years from various
universities, work places, and clinical settings
participated. Şimşek and his colleagues (13)
performed a study using the ICAST-R to determine
the prevalence of childhood maltreatment at
medical faculty in Turkey. That study was
conducted with 173 first-year students.
Number
(%)*
20
9
7
4
4
10.4
4.6
3.6
2.1
2.1
50
8
11
11
7
26
4.2
5.7
5.7
3.6
7
6
8
4
2
3.6
3.1
4.2
2.1
1
The participants may have had difficulty in
remembering abuse and/or neglect experienced
during their childhood. To lower the probability of
forgetting the abuse experienced in the childhood
period, the minimum age of the ICAST-R
instrument which is 18 years old was targeted,
therefore the study was performed with the
university students who are in the first year of
medical school. The mean age was 19.41±1.33 in
our study; 18,8 in the study of Şimşek et al.(13),
20.1 in the study of Lee et al.(9) and 20.3 in the
study of Dunne et al.(8) Also 109 of the 192
participants were female (56.8%), 83 were
male(43.2%) in our study whereas 434 of the 842
participants were females (51.5%) and 407 of them
were males (48.3%) in the study by Dunne et al(8).
Twenty eight of 189 medical school students
(14.8%) in our study stated that they had been
physically abused. Physical abuse prevalence was
found to be 23.1% in the study of Şimşek et al.(13),
42.2% in the study of Lee et al.(9) and 52% in the
study of Dunne et al(8).These studies yielded
higher physical abuse prevalence probably because
of intersociety differences about perception of child
abuse as an item of discipline. In our study, the
most common physical abuse type was “hit/
punched”(10.4%). Lee et al.(9) and Dunne et al.(8)
also found that “hit/punch”, “beat with a stick or
belt” are the most common physical abuse types.
According to the study of Dunne et al.(8) the most
common answer in Russia, Egypt, Kyrgyzstan was
“hit/punched” (48.3%;49.4%;15.8%);“beaten with
an object” in Malaysia and Colombia
(39.2%;433%); but in India both of these types
were seen equally with the percentage of 33.1.
In cases of physical abuse, fathers were
found to be the first person to blame. According to
the study of Dunne et al.(8), fathers are most likely
Konuralp Tıp Dergisi 2018;10(1):7-12
10
Koc EM et al.
and mothers are second most likely to be
responsible for physical abuse; however, Lee et
al.(9) found that those with the greatest
responsibility were males from school followed by
the victim‟s father. This difference may also be
explained by cultural differences. It was thought
that beating is perceived as a normal disciplinary
method in schools in South Korea as compared to
our country.
We have found emotional abuse prevalence
as 32.3%; similarly Lee et al.(9) found as 36.3%. In
the study of Şimşek et al.(13) emotional abuse
prevalance was 40.5%. Dunne et al.(8) found that
53% of the participants had either been harshly
insulted or threatened with violence before age 18.
The most common type of emotional abuse was
“insulted or criticized” in our study(31.2%).
Likewise, Lee et al.(9) and Dunne et al.(8) (Russia
54.2%; Egypt 59.6%; Lebonan 45.8%; India 46.8%;
Malaysia 41.6%; Colombia 63.3%; Kyrgyzstan
39.6%;) found that most common emotional abuse
types was “insulted or criticized”. While Dunne et
al.(8) found that fathers and mothers and Lee et
al.(9) found that boyfriends at school and fathers
are the primary and secondary responsible parties
for emotional abuse, respectively. In contrast, our
study found that male teachers are primary
contributors of emotional abuse.
Sexual abuse is a taboo in most of the
populations and, thus, discussions on this topic are
often avoided. For this reason, its accurate
frequency is widely unknown. Studies performed in
our country about sexual abuse frequency yielded
similar results with percentages between 10.7 and
26 (3-5). We have found in our study that sexual
abuse frequency is 8.3%; 4.6% of female and
14.5% of male students stated that they had been
sexually abused. The reason of the low frequency in
female students compared with the males might be
that female students are more sensitive about this
issue and it is hard for them to share their
experience or sexually abused women are much
less likely to achieve sufficient educational
qualifications in order to get to medical school . In
the study of Şimşek et al.(13), prevalance of sexual
abuse was found %11. Dunne et al.(8) found
determined that 242 respondents reported
experiencing at least one unwanted sexual act
(29%). In our study the most common two answers
were “Someone touched child‟s genital” and
“someone exposed their genitals” respectively
(4.1% and 3.6%). Similarly Dunne et al.(8) found
that “someone touched child‟s genitals” and
“someone exposed their genitals” were the two
most common types of sexual abuse (17.8% and
16.9%) The most common answer given by the
participants in Russia, Lebonan, Colombia was
“someone exposed their genitals” (respectively
15%;14,2%;28,3%) and in Egypt, India, Malaysia,
Kyrgyzstan was
“someone touched child‟s
genitals” (respectively 28.1%;25%;18.4%;13.9%;).
According to the study of Lee et al.(9) females
reported „someone exposed genitals‟ the most and
„someone touched genitals‟ was reported most for
males. Dunne et al.(8) had found that the abuser is
mostly an old foreign male and Lee et al.(9) had
found that it is a unknown person. We have found
in our study that the most common abuser is a
person out of the family. But it must be kept in
mind that the abuse might have been covered in
cases of in-family sexual abuse, which, in turn,
affects the study results.
Previous studies performed in Turkey
showed that 13,9-87% of the children had
experienced physical abuse (6,14,15). These studies
yielded results with higher prevalence than our
study, most likely due to variations in questioning
techniques used. Moreover, there could have been a
change in the society in the recent 25 years after
publication of the study performed by Bilir et al.(6);
however, the prevalence was still high in a study
contributed by UNICEF in 2010(15). The physical
violence prevalence is thought to be high because
types of behavior that do not cause injury like
“throwing slippers” were also included in this
study.
Broken families because of death, divorce or
different study place constitute a significant risk in
child abuse(16). Furthermore, Zeren et al.(17)
found in their study with 150 university students
that the children whose mother were divorced,
undergone mostly emotional type of abuse. Like, in
our study we found a statistically significant
relation between emotional abuse and parent
separation.
CONCLUSION
There are many studies and arrangements on
especially medical field about child abuse and
neglect that have been put into practice recently. It
is an issue with undefined parts because of the
difficulty in diagnosis and deficiencies in statistical
and epidemiological data. To our knowledge there
are no studies performed on medical students about
the incidence of their childhood abuse and neglect.
This study may be important in this aspect as well.
As the long term negative effects of childhood
abuse on personal relations and psychological
health is very well known, it is of interest how these
future physicians who were abused in their
childhood will act in their professional lives about
the care of the patients and building empathetic
relations. Further national studies need to be
performed with an internationally accepted tool
regarding examined validity and reliability, like
ICAST-R, in order to determine the frequency in
Turkey. Our pilot study will guide the future
national studies and help raise efficiency in study
process.
Competing interests: The authors declare
no conflict of interest.
Konuralp Tıp Dergisi 2018;10(1):7-12
11
Koc EM et al.
REFERENCES
1. World report on violence and health, World Health Organization, Geneva,2002.
2. Altıparmak S. Çocuk istismarı ve ihmalinin çocuk bedeni üzerine etkileri. Çocuk Dergisi 2008;8:9-13.
3. Zoroglu SS, Tuzun U, Sar V, ve ark. Çocukluk dönemi istismar ve ihmalinin olası sonuçları. Anadolu
Psikiyatr. Derg. 2001;2:69-78.
4. Alikasifoglu M, Erginoz E, Ercan O, et al. Sexual abuse among female high school students in Istanbul,
Turkey. Child Abuse Negl. 2006;30:247-255.
5. Eskin M, Kaynak Demir H, Demir S. Same-sex sexual orientation, childhood sexual abuse, and suicidal
behavior in university students in Turkey. Arch Sex Behav 2005;34:185-195.
6. Bilir S, Arı Dönmez NB, Güneysu S. 4-12 yaşları arasında 16.000 çocukta örselenme durumları ile ilgili bir
inceleme. Çocuk İstismarı ve İhmali, Ankara, ILO,1990;45-54.
7. Runyana DK, Dunneb MP, Zolotor AJ. Introduction to the development of the ISPCAN child abuse
screening tools. Child Abuse Negl. 2009;33:842–845.
8. Dunne MP, Zolotor A, Runyan DK, et al. ISPCAN Child Abuse Screening Tools Retrospective version
(ICAST-R): Delphi study and field testing in seven countries. Child Abuse Negl. 2009;33: 815–825.
9. Lee Y, Kim S. Childhood maltreatment in South Korea: retrospective study. Child Abuse Negl. 2011; 35:
1037-1044.
10. Zolotor AJ, Runyan DK, Dunne MP, et al. ISPCAN Child Abuse Screening Tool Children's Version
(ICAST-C): Instrument development and multi-national pilot testing. Child Abuse Negl. 2009;33:833-41.
11. Runyan DK, Dunne MP, Zolotor AJ, et al. The development and piloting of the ISPCAN Child Abuse
Screening Tool-Parent version (ICAST-P). Child Abuse Negl. 2009;33:826-832.
12. Al-Eissa MA, AlBuhairan FS, Qayad M, et al. Determining child maltreatment incidence in Saudi Arabia
using the ICAST-CH: A pilot study. Child Abuse Negl. 2015;42; 174-182
13. Simsek E, Güney S A, Baysal S U. A retrospective study with ICAST-R (ISPCAN child abuse screening
tools-retrospective) questionnaire for determination of child abuse in first year medical students in Turkish
population. Child Abuse & Neglect 2017;69:125-133.
14. Ayvaz M, Aksoy MC. Çocuk istismarı ve ihmali: ortopedik yönleri. Hacettepe Tip Dergisi 2004;35:27-33.
15. Türkiye‟de Çocuk İstismarı ve Aile İçi Şiddet Araştırması Özet Raporu, 2010 (Summary Report of Child
abuse and Domestic Violence Research in Turkey 2010)
16. Bahar G, Savas HA, Bahar A. Çocuk istismarı ve ihmali: bir gözden geçirme. Fırat Saglik Hizmetleri
Dergisi 2009;12:51-65.
17. Zeren C, Yengil E, Çelikel A, et al. Üniversite öğrencilerinde çocukluk çağı istismarı sıklığı (Frequency of
childhood abuse in university students). Dicle Med J 2012;39(4):536-541.
Konuralp Tıp Dergisi 2018;10(1):7-12
12