# Associations between perpetrator characteristics of child maltreatment, age of onset, and physical and mental health

## TL;DR

This study explores how the characteristics of CM perpetrators and the age at which maltreatment begins affect long-term physical and mental health outcomes.

## Contribution

The study introduces a novel analysis of perpetrator characteristics and their differential impact on physical and psychiatric multimorbidity in CM survivors.

## Key findings

- CM by parents and professionals increases physical multimorbidity in adulthood.
- CM by parents, relatives, and peers increases psychiatric multimorbidity in adulthood.
- Perpetrator groups show different frequencies across CM onset age groups.

## Abstract

Child maltreatment (CM) is a major health risk factor. However, perpetrator characteristics have been largely understudied in representative samples. Our aim is to describe perpetrator characteristics of CM and to identify risk constellation connecting onset of CM and perpetrator relations. Moreover, we look at differential effects of perpetrator relations on long term physical and mental health.

In a cross-sectional observational approach, a representative sample of the German population (N = 2515) was assessed regarding CM characteristics (ICAST-R), physical and mental health as well as sociodemographic information. We used social network analysis to describe co-occurrences of perpetrator groups and \documentclass[12pt]{minimal}
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\begin{document}$$\:{{\upchi\:}}^{2}$$\end{document} tests to test differences in relative frequencies of perpetrator relations in onset groups. Multivariate Analysis of Variance and follow-up analyses were used to identify differences in sociodemographic, CM characteristics as well as health outcomes between onset groups. A Poisson regression was calculated to scrutinize the effect of perpetrator relation on physical and mental health.

Perpetrator multiplicity and interconnectedness of perpetrator groups were high. Different frequencies of perpetrator groups across age of onset were observed for overall CM and CM subtypes. Participants who reported adolescent CM onset were younger than those with earlier CM onset. CM perpetrated by parents and by professionals in child related environments increased the risk of physical multimorbidity in adulthood. CM perpetrated by parents, relatives and others in the household, and peers and partners increased the risk of psychiatric multimorbidity in adulthood.

This study provides insights into the risk constellations of CM by examining perpetrator relation, multiplicity, and co-occurrence. We found group differences in onset as well as differential risks for physical and psychiatric multimorbidity by perpetrator relation. These findings highlight the need for future research and prevention strategies that more explicitly address perpetrator characteristics.

The online version contains supplementary material available at 10.1186/s13034-026-01049-w.