Do county mental health, physical health, and care provider availability predict child maltreatment report rates?

Hyunil Kim, Chien Jen Chiang, Eun Jee Song, Liliane Windsor

Research output: Contribution to journalArticlepeer-review


Background: Research on community-level relationships between mental/physical health and child maltreatment is sparse. Objective: We examined how rates of mental distress, physical distress, mental health professionals, and primary care physicians were related to child maltreatment report rates at the county level. Participants and setting: U.S. counties from 2014 to 2017. Methods: Within-between random effects models estimated both within-effects (i.e., longitudinal changes) and between-effects (i.e., inter-county differences) of mental distress rates, physical distress rates, mental health professional rates, and primary care physician rates and their associations with overall and age-specific maltreatment report rates, while adjusting for potential confounders. Results: Longitudinal increases of mental distress rates marginally significantly (p < .10) increased overall maltreatment report rates (β = 0.50) and significantly (p < .05) increased age 0–5 maltreatment report rates (β = 0.84). Conversely, longitudinal increases of mental health professional rates significantly decreased overall (β = −0.38), age 0–5 (β = −0.59), and age 6–11 (β = −0.31) maltreatment report rates and marginally significantly decreased age 12–17 maltreatment report rates (β = −0.13). Between-effects of metal distress rates and mental health professional rates were mostly not significant. Neither within-effects nor between-effects of physical distress rates and primary care physician rates were significant. Conclusions: Our findings suggest that community mental distress is a risk factor for child maltreatment reports and that community availability of mental health professionals is a protective factor. Community-based strategies to address mental distress and human resource approaches to supply sufficient mental health professionals in communities may help reduce maltreatment report rates in communities. Further research is required to confirm our findings and to better understand underlying mechanisms.

Original languageEnglish (US)
Article number105880
JournalChild Abuse and Neglect
StatePublished - Dec 2022


  • Child abuse
  • Child maltreatment
  • Mental health
  • Physical health
  • Provider availability
  • Within-between random effects

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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