Child and Adolescent Victimization and Mental Health Associations: A Hospital-Based Cross-Sectional Study in Mexico

Abstract

Child and adolescent victimization is a significant public health concern with profound effects on development and mental health. However, evidence from Mexico remains limited, particularly in hospital settings. The objective of this study was to estimate the prevalence of past-year and lifetime victimization among children and adolescents with chronic diseases and to examine its association with mental health outcomes. In this cross-sectional study, children and adolescents aged 6–17 years attending a tertiary care center in Mexico City between February 2022 and January 2024 completed the Juvenile Victimization Questionnaire (JVQ), and their parents completed the Child Behavior Checklist (CBCL/6–18). Associations between victimization and psychopathology were examined using regression models adjusted for demographic and family characteristics. Of 496 participants (mean age = 11.2 years; 57.3% female), 65.3% reported at least one victimization in the past year. Risk factors for experiencing ≥3 victimizations included residence in highly impoverished states (OR: 2.96, 95% CI [1.06, 8.20]), maternal adolescent pregnancy (OR: 3.81, [1.06, 13.6]), and parental non-cohabitation (OR: 1.59, [1.00, 2.53]). CBCL scores in the clinical range were identified in 52.2% of participants. A consistent gradient was observed, with higher total CBCL scores corresponding to a greater number of past-year and lifetime victimization types experienced. Victimization among Mexican children and adolescents living with chronic diseases is highly prevalent and strongly associated with psychopathology. Hospitals may play a critical role in addressing this issue, underscoring the need for systematic screening and interprofessional, family-centered interventions within pediatric care.

Keywords

violence exposure child maltreatment adverse childhood experiences mental health and violence

Introduction

Childhood adversity (CA) encompasses a broad range of negative experiences occurring throughout childhood and adolescence, including victimization. Contemporary conceptualizations identify victimization as a distinct dimension of CA, alongside threat, deprivation, and family dysfunction. Exposure to CA is among the strongest predictors of mental health problems (Green et al., 2010). Notably, recent evidence suggests that victimization may be particularly detrimental, showing stronger associations with both internalizing and externalizing symptoms during adolescence than other forms of adversity (Chow et al., 2025).

The negative effects of violence on child development are well-documented (McCrory et al., 2022; Orellana et al., 2024). Nevertheless, the World Health Organization reports alarmingly high rates of child victimization worldwide. Victimization encompasses maltreatment by caregivers, conventional crime, community violence, cyberviolence, exposure to parental violence, and violence from peers or siblings (Green et al., 2010). These experiences are associated with a wide range of adverse outcomes, including physical and mental health problems, social and behavioral difficulties, and poorer cognitive, academic, and long-term socioeconomic outcomes (Majer et al., 2010; Nanni et al., 2012; Shaffer et al., 2009; Yu et al., 2025). In Mexico, national survey data indicate that 38.2% of children and 15.5% of adolescents experienced physically violent discipline during the previous month, while 3.9% of adolescents reported physical aggression during the previous year and 2.7% reported a lifetime history of sexual abuse (Instituto Nacional de Salud Pública, 2024). Risk factors for victimization include individual child and parental characteristics, as well as broader family and community determinants (Austin et al., 2020; Hunter & Flores, 2021; Red por los Derechos de la Infancia en México, 2023).

Finkelhor and colleagues introduced the term polyvictimization to describe children who experience multiple forms of victimization, emphasizing the cumulative impact of these exposures on well-being and mental health (Finkelhor et al., 2007; Turner et al., 2006). This concept highlights that victimization contributes substantially to mental health risk, alongside other forms of CA.

The cumulative risk model of adversity posits that health risks increase as the number of adversities experienced by children accumulates (Hardi et al., 2025). In line with this framework, the American Academy of Pediatrics has recommended that pediatricians screen for risk factors associated with toxic stress, including victimization (Austin et al., 2024).

Beyond victimization, chronic and complex conditions may also constitute significant sources of adversity during childhood, imposing substantial psychological, logistical, and financial burdens on patients and their families (Jakubowski et al., 2023). These challenges may be particularly pronounced in households experiencing material deprivation. The co-occurrence of violence exposure, chronic illness, and socioeconomic precarity during critical developmental periods may have profound and synergistic effects on the mental health and cognitive development of children and adolescents.

In Mexico, interpersonal violence is the leading cause of death among the pediatric population between 1 and 19 years old (Castilla-Peon et al., 2024), suggesting that a substantial proportion of young people are exposed to violence and related victimization. Understanding the magnitude of this phenomenon is essential for developing effective and sustainable strategies to address it.

Recent meta-analytic evidence indicates that victimization is associated with psychopathology (Baldwin et al., 2024). However, most of this evidence derives from high-income countries and community-based samples. Data from middle-income settings, particularly in Latin America, remain limited, and studies conducted in clinical populations—where children may face compounded vulnerabilities due to chronic illness and socioeconomic adversity—are scarce. Healthcare-based studies are particularly relevant in Mexico, where many children receiving care for chronic and complex conditions may experience multiple and interacting sources of adversity.

Given the high burden of interpersonal violence in Mexico and the potential for healthcare settings to serve as key points for identification and intervention, examining victimization and its mental health correlates in this context represents an important and underexplored contribution to the literature. This study aimed to estimate the prevalence of different forms of victimization among children and adolescents receiving care at a tertiary pediatric center in Mexico and to examine their association with mental health outcomes.

Methods

This cross-sectional study was conducted among children and adolescents aged 6 to 17 years attending the Hospital Infantil de México Federico Gómez (HIMFG). HIMFG is a tertiary-level public pediatric referral center in Mexico City that provides specialized care for children with complex health conditions who lack health insurance.

A convenience sample of outpatients was recruited between February 14, 2022, and January 1, 2024. Inclusion criteria were hospital patients aged 6–17 years who attended outpatient care, were able to complete the questionnaire, and had caregivers who provided consent. Patients with cognitive impairment that prevented completion of the questionnaire were excluded. Demographic information was collected by a trained social worker and a psychologist, who also administered the Juvenile Victimization Questionnaire and the Child Behavior Checklist for ages 6–18 (CBCL/6–18). A total of 496 participants consented to participate and were included in the analyses.

Measures

Juvenile Victimization Questionnaire

The Juvenile Victimization Questionnaire—Self-Report, Spanish Version (JVQ; Hamby et al., 2004) is a self-administered instrument designed to capture a broad spectrum of childhood and adolescent victimization experiences. It includes 34 core items covering major offenses against children and adolescents, organized into five domains: conventional crime, child maltreatment, peer and sibling victimization, sexual victimization, and witnessing or indirect victimization. In addition, the questionnaire includes two supplementary items assessing exposure to internet-based aggression. The items are described elsewhere (Finkelhor et al., 2013). Reported internal consistency for the full scale is acceptable (Cronbach’s alpha of .80). Polyvictimization was defined as seven or more positive items for the past year and 10 or more for lifetime exposure, as proposed by Finkelhor et al. 2013.

Child Behavior Checklist

The Child Behavior Checklist for ages 6–18 (CBCL/6–18; Achenbach & Rescorla, 2000), Spanish (Mexico) version, was administered to parents to assess emotional and behavioral problems in children. The CBCL is part of the Achenbach System of Empirically Based Assessment (ASEBA). The instrument consists of 113 items rated on a three-point Likert scale (0 = not true, 1 = somewhat or sometimes true, 2 = very true or often true) that refer to the child’s behavior during the preceding 6 months. Clinical-range scores were defined as T-scores ≥65 for six syndrome scales (affective, anxiety, somatic, attention-deficit/hyperactivity, oppositional defiant, and conduct problems) according to the ASEBA. These scales can be further summarized into broadband scales: internalizing, externalizing, and total problems. The Spanish (Mexico) version has reported high internal consistency, with Cronbach’s α values of .90 for internalizing problems, .94 for externalizing problems, and .97 for total problems (Albores-Gallo et al., 2007). All forms and scoring materials were obtained under license from ASEBA (www.aseba.org), and the instrument is not reproduced here in accordance with copyright restrictions.

Statistical Analysis

Descriptive statistics were calculated for demographic characteristics and victimization exposures. Bivariate comparisons were conducted using Fisher’s exact test for categorical variables and mean differences with corresponding 95% confidence intervals (CIs) for continuous variables. Linear regression models were used to examine the association between the number of reported victimization types (JVQ) and CBCL scores (total, internalizing, and externalizing). Logistic regression models were used to estimate the associations between the number of reported past-year victimization types and CBCL clinical classifications, with results expressed as odds ratios (ORs) and 95% CIs. Demographic characteristics associated with CBCL scores in bivariate analyses (i.e., sex, age category, and parental cohabitation status) were included as adjustment covariates in all multivariable models. Each victimization category was examined in a separate logistic regression model. Victimization experiences were grouped (1, 2, 3–5, 6–8, and ≥9) to ensure at least 10 outcome events within each category for logistic regression analysis and to reflect increasing cumulative exposure. Primary multivariable analyses were conducted using all 496 participants. A sensitivity analysis was subsequently performed after excluding the 14 participants whose mothers had incomplete primary school education, given the very small size of this subgroup and the unexpectedly lower CBCL scores observed among these participants relative to the remainder of the sample. No evidence of problematic multicollinearity was identified (variance inflation factors < 2), and no heteroscedasticity was detected in linear regression models. All analyses were performed using Stata Statistical Software, Release 13 (StataCorp LP, College Station, TX, USA).

Ethical Considerations

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and was approved by the Institutional Review Board of the Hospital Infantil de México Federico Gómez (HIM-2022-007). Informed consent was obtained from at least one parent or legal guardian, and all participating children and adolescents provided assent.

Results

A total of 496 participants were included in the study, with a mean age of 11.2 ± 2.7 years, and 57.3% (n = 284) were female. Medical diagnoses were varied, with the most frequent being dermatological conditions (13.7%), allergies (12.9%), heart disease (12.0%), and cancer (8.0%). Most patients resided in Mexico City or the neighboring State of Mexico (84.3%). The mother was the primary caregiver in 97.2% of cases, and the median maternal age at the time of pregnancy was 26 years (IQR: 21–31). Participants had a median of one sibling (IQR: 0–2), and 46.8% lived in households where parents did not cohabit (Table 1).

Table 1.

Demographic Characteristics of Participating Children and Adolescents (N = 496).

Variable	n (%)
Female sex	284 (57.3%)
Age group
6–9 years	150 (30.2%)
10–13 years	226 (45.6%)
14–17 years	120 (24.2%)
Diagnosis (n = 474)
Dermatologic	65 (13.7%)
Allergy	61 (12.9%)
Heart disease	57 (12.0%)
Cancer	38 (8.0%)
Kidney disease	35 (7.4%)
Rheumatic disease	218 (44.3%)
Residency
Mexico City	192 (38.7%)
State of Mexico	226 (45.6%)
State with poverty rate ≥ 54%^a	18 (3.6%)
Others	60 (12.1%)
Primary caregiver
Mother	482 (97.2%)
Father	8 (1.6%)
Maternal grandmother	6 (1.2%)
Secondary caregiver (n = 492)
Sibling	220 (44.4%)
None	127 (25.8%)
Father	83 (16.9%)
Other	56 (11.3%)
Mother’s age group at pregnancy (n = 475)
14–17 years	35 (7.4%)
18–21 years	88 (18.5%)
22–34 years	292 (61.5%)
≥35 years	60 (12.6%)
Mother’s educational level (n = 482)
Incomplete primary school	14 (2.9%)
Complete primary school	50 (10.4%)
Secondary school	161 (33.4%)
Medium-high school or higher	257 (63.3%)
Father’s educational level (n = 343)
Incomplete primary school	10 (2.9%)
Complete primary school	37 (10.8%)
Complete secondary school	143 (41.7%)
Complete medium-high school or higher	153 (44.6%)
Remunerated labor
Mother	252/487 (51.8%)
Father	330/337 (97.9%)
Number of siblings (median, IQR)	1 (0-2)
Parents not cohabiting	224 (46.8%)

Oaxaca, Guerrero, and Chiapas.

Victimization Prevalence

Overall, 65.3% of participants reported at least one victimization episode during the previous year. The median number of past-year victimization types reported was one (range: 0–18), whereas the median lifetime number of victimization types was two (range: 0–21), as measured by the JVQ (Table 2). Several demographic characteristics were associated with reporting three or more past-year victimizations. These included residing in one of the three Mexican states with the highest poverty rates (Oaxaca, Guerrero, or Chiapas; OR: 2.96, 95% CI [1.06, 8.2]), being born to a teenage mother (OR: 3.81, [1.06, 13.6]), and parental non-cohabitation (OR: 1.59, [1.00, 2.53]).

Table 2.

CBCL Scales, Clinical-Range Classifications, and JVQ Results Among Participants (N = 496).

Outcome	n (%)/mean (SD)
CBCL T-scores, mean (SD)
Internalizing	58.8 (11.6)
Externalizing	53.5 (10.5)
CBCL total	56.0 (11.8)
CBCL clinical classification, n (%)
Affective problems (depression)	159 (32.1%)
Anxiety problems	150 (30.2%)
Somatic problems	140 (28.2%)
Attention-deficit/hyperactivity problems	87 (17.5%)
Oppositional defiant problems	69 (13.9%)
Conduct problems	66 (13.3%)
No clinical-range problems	237 (47.8%)
Past-year Victimizations^a, n (%)
None	172 (34.7%)
1 type	114 (23.0%)
2 types	74 (14.9%)
3–5 types	82 (16.5%)
6–8 types	38 (7.7%)
≥9 types	21 (4.2%)
≥ 7 (Past-year polyvictimization)	42 (8.5%)
Lifetime Victimizations^b, n (%)
None	93 (18.8%)
1 type	91 (18.4%)
2 types	76 (15.3%)
3 types	52 (10.5%)
4–6 types	95 (19.2%)
7–9 types	43 (8.7%)
≥10 (Lifetime polyvictimization)	46 (9.3%)

Note. CBCL = Child Behavior Checklist JVQ = Juvenile Victimization Questionnaire.

Positive items in JVQ for the past year.

Positive items in JVQ for lifetime.

Mental Health Outcomes

A CBCL score in the clinical range was identified in 259 participants (52.2%). The most frequent CBCL clinical categories were affective problems (32.1%) and anxiety problems (30.2%; Table 2). Parental non-cohabitation was associated with higher total CBCL scores (mean difference: 4.7, 95% CI [2.7, 6.8]). Participants whose mothers had an incomplete primary education (n = 14) had significantly lower total CBCL scores than the rest of the sample (mean difference: −11.3, [−17.7, −4.8]; Supplemental Table 1).

Associations between Victimization and CBCL

Lifetime and past-year victimization patterns are presented in Table 3. Mean CBCL scores increased progressively as the number of reported past-year victimization types increased. After adjustment for sex, age group, and parental cohabitation status, this dose-response pattern persisted (Figure 1).

Table 3.

Lifetime and Past-Year Prevalence of Victimization Experiences, by Sex.

Victimization type	Lifetime victimization	Past-year victimization
Victimization type	All victims%(N = 496)	All victims%(N = 496)	Male%(N = 212)	Female%(N = 284)	p ^a
Assault
Any physical assault^b	38.5	25.8	27.4	24.7	0.53
Assault with a weapon	5.7	4.0	2.8	4.9	0.26
Assault without a weapon	16.4	10.5	12.3	9.2	0.30
Attempted assault	8.7	5.9	9.4	3.2	0.01
Attempted kidnapping	6.9	3.5	2.8	3.9	0.63
Bias attack	12.5	6.9	6.6	7.0	1.00
Threatened assault	11.9	6.9	6.4	7.0	1.00
Any property victimization^c	43.6	28.0	30.2	26.4	0.37
Bullying
Peer victimization^d	34.7	22.4	22.6	22.2	0.91
Physical intimidation	9.9	7.2	7.6	7.0	0.86
Relational aggression	23.4	13.3	12.3	14.1	0.59
Internet harassment (≥10 years)^e	6.1	4.3	2.8	5.3	0.60
Sexual abuse
Any sexual victimization	8.9	4.2	2.4	5.6	0.11
Sexual harassment	3.8	2.2	0.9	3.2	0.13
Maltreatment by a caregiver
Any maltreatment^f	19.0	12.5	9.4	14.8	0.08
Physical abuse	7.1	4.0	2.8	4.9	0.26
Emotional abuse	13.9	9.7	7.6	11.3	0.20
Neglect	1.2	1.2	2.4	0.4	0.09
Custodial interference or family abduction	4.8	2.0	1.4	2.5	0.53
Witnessing violence
Any witness of violence^g	51.4	32.1	34.0	30.6	0.44
Witnessed family assault^h	17.3	8.1	6.1	9.5	0.19
Witnessed assault in the communityⁱ	46.0	28.6	30.7	27.1	0.42
Exposure to shooting	27.0	17.7	16.5	18.7	0.56
Witnessed a murder	2.0	1.2	0.9	1.4	1.00
Someone close was murdered	13.3	4.8	3.8	5.6	0.40
Household theft	9.9	5.7	2.8	7.8	0.02

Note. Item numbers correspond to the study by Finkelhor et al. (Finkelhor et al., 2013). Values in bold highlight p-values < .05.

Male vs. female past-year victimization, Fisher's exact test.

Any affirmative response to C4-C6, C8, C9, M1, P1-P3, P6.

C1-C3.

P1-P6.

Int1-Int2.

M1-M4, S1-S4 if perpetrated by a family member.

W1-W4.

W1-W2.

W3-W4.

Past-year polyvictimization was associated with every CBCL clinical category. Regarding specific victimization types, sexual victimization showed the strongest associations with several CBCL clinical categories, including affective problems (OR: 6.44, 95% CI [2.27, 18.25]), anxiety problems (OR: 3.17, [1.21, 8.31]), somatic problems (OR: 3.22, [1.25, 8.34]), and attention problems (OR: 4.76, [1.71, 13.26]). A history of physical assault (OR: 3.90, [2.25, 6.77]) and any child maltreatment (OR: 3.12, [1.57, 6.20]) were significantly associated with oppositional defiant disorder, whereas witnessing domestic violence showed the strongest association with behavioral disorders (OR: 3.55, [1.59, 7.91]). All adjusted ORs for the association between specific past-year victimization types and CBCL clinical classification are presented in Table 4 and Figure 2. Sensitivity analyses excluding participants whose mothers had incomplete primary education yielded effect estimates whose direction, magnitude, and statistical significance were largely unchanged (Supplemental Table 2).

Table 4.

Adjusted Odds Ratios for Associations Between Past-Year Victimization and CBCL Clinical-Range Classifications (N = 496).^a

Past-year victimization type	Affective n = 159	Anxiety n = 150	Somatic n = 140	Attention n = 87	ODD n = 69	Conduct n = 66
Any physical assault (n = 128)	2.34 (1.52–3.63)*	1.52 (0.98–2.38)	1.21 (0.77–1.92)	2.37 (1.42–3.93)*	3.90 (2.25–6.77)*	2.55 (1.45–4.47)*
Any property victimization (n = 139)	1.80 (1.18–2.76)*	1.41 (0.92–2.18)	1.37 (0.89–2.13)	2.17 (1.31–3.58)*	2.00 (1.16–3.45)*	1.28 (0.72–2.27)
Bias attack (n = 34)	1.77 (0.83–3.74)	1.35 (0.62–2.93)	1.12 (0.51–2.48)	1.40 (0.59–3.30)	3.33 (1.47–7.52)*	2.63 (1.12–6.16)*
Any peer victimization (n = 111)	2.16 (1.37–3.42)*	1.51 (0.95–2.42)	1.31 (0.82–2.11)	1.94 (1.14–3.30)*	2.86 (1.62–5.04)*	2.44 (1.37–4.35)*
Relational victimization (n = 66)	1.85 (1.06–3.23)*	1.21 (0.68–2.17)	0.93 (0.51–1.70)	1.48 (0.77–2.83)	2.28 (1.16–4.47)*	1.25 (0.59–2.66)
Any internet harassment (n = 21)	2.32 (0.90–5.97)	1.40 (0.54–3.64)	2.83 (1.11–7.22)*	1.96 (0.69–5.55)	1.99 (0.69–6.03)	2.74 (0.89–8.44)
Any sexual victimization (n = 21)	6.44 (2.27–18.25)*	3.17 (1.21–8.31)*	3.22 (1.25–8.34)*	4.76 (1.71–13.26)*	2.86 (0.91–9.00)	2.72 (0.80–9.31)
Any maltreatment (n = 62)	2.06 (1.14–3.70)*	1.55 (0.85–2.81)	1.24 (0.67–2.29)	2.04 (1.05–3.96)*	3.12 (1.57–6.20)*	2.53 (1.12–5.20)*
Any witnessing of violence (n = 159)	1.56 (1.02–2.38)*	1.56 (1.02–2.38)*	1.65 (1.07–2.53)*	1.73 (1.05–2.89)*	2.27 (1.31–3.93)*	2.27 (1.29–3.40)*
Witnessing domestic violence (n = 40)	1.36 (0.67–2.78)	1.34 (0.64–2.77)	1.34 (0.65–2.76)	2.18 (1.01–4.74)*	3.06 (1.38–6.79)*	3.55 (1.59–7.91)*
Witnessing community violence (n = 142)	1.62 (1.05–2.51)*	1.55 (1.01–2.40)*	1.69 (1.09–2.62)*	1.38 (0.81–2.33)	2.14 (1.23–3.74)*	1.79 (1.01–3.19)*
Household theft (n = 28)	2.66 (1.17–6.06)*	1.72 (0.76–3.95)	2.57 (1.14–5.79)*	2.20 (0.88–5.47)	1.44 (0.50–4.14)	2.54 (0.92–6.97)
Someone close murdered (n = 24)	1.64 (0.67–4.02)	2.33 (0.96–5.67)	2.36 (0.98–5.68)	1.50 (0.52–4.30)	1.68 (0.53–5.31)	1.19 (0.33–4.26)

Note. ODD = Oppositional defiant problems.

Odds ratios (95% confidence intervals) from logistic regression models adjusted for sex, age category, and parental cohabitation status

Statistically significant values (p < .05) are indicated by an asterisk and shown in bold.

Discussion

Our data demonstrate a high prevalence of victimization among children and adolescents attending a tertiary pediatric care center and show a consistent gradient between the number of victimization types reported and mental health outcomes. This graded association supports a dose–response relationship between victimization burden and psychopathology. The high proportion of children in the clinical range (52.2%) underscores the substantial mental health burden in this population. The particularly strong association with oppositional defiant problems may reflect the behavioral expression of chronic stress and environmental instability associated with repeated victimization.

Victimization

When compared with U.S. population-based data from 2015, the rates observed in our sample were notably higher for bias attacks (6.9% vs. 0.9%), attempted kidnappings (3.5% vs. 0.3%), and witnessing community violence (28.4% vs. 18.4%). These findings, however, are consistent with those reported in another Mexican sample (Méndez-López & Pereda, 2019), suggesting that children and adolescents in Mexico may be exposed to higher levels of interpersonal violence than those reported in some high-income countries.

In our sample, residence in highly impoverished states, being born to a mother with an adolescent pregnancy, and parental non-cohabitation were associated with a greater likelihood of experiencing multiple victimization events. These findings are consistent with previous research linking family instability and broader social disadvantage to increased exposure to victimization and other adverse experiences (Turner et al., 2006). Socioeconomic status could not be meaningfully analyzed due to very limited variability in this characteristic: nearly all participants belonged to the low socioeconomic category, consistent with the population served by the hospital.

Although gender differences in victimization—including peer assault, relational aggression, bullying, polyvictimization, and sexual victimization— have been reported in studies from Chile (Pinto-Cortez et al., 2021, 2022) and Mexico (Frías & Finkelhor, 2017), we did not observe significant gender differences in our sample, except for attempted assault and household theft.

Mental Health

Among the sociodemographic factors examined, parental non-cohabitation was the only one associated with poorer mental health outcomes and was therefore included as an adjustment variable in the multivariable analyses. Unexpectedly, participants whose mothers had incomplete primary school education exhibited significantly lower CBCL scores than the remainder of the sample. Given the well-established association between low parental educational attainment and increased psychosocial vulnerability, this finding was not anticipated. Because the CBCL relies on caregiver report, differences in symptom recognition, interpretation, or reporting cannot be excluded. Nevertheless, this finding should be interpreted cautiously given the very small number of participants in this subgroup (n = 14). Furthermore, the estimated associations in our study were materially unchanged after excluding these cases, supporting the robustness of the main analyses.

Polyvictimization and Mental Health Outcomes

Our findings are consistent with data from the Mexican National Health and Nutrition Survey (ENSANUT), which have documented significant associations between clinically relevant depressive symptoms, which affect 11.7% of Mexican adolescents, and several forms of victimization, including past-year physical victimization (OR: 4.68, 95% CI [3.83, 5.71]), lifetime sexual abuse (OR: 11.9, [9.76, 14.56]), and child maltreatment (OR: 1.29, [1.09, 1.53]). These estimates were calculated by the authors using publicly available ENSANUT data (Instituto Nacional de Salud Pública, 2024).

Supporting the cumulative risk model of adversity, a systematic review by Haahr Pedersen et al. documented consistent associations between polyvictimization and at least one indicator of psychopathology across diverse settings. Depression has been the most frequently reported problem, followed by anger/aggression and anxiety (Haahr-Pedersen et al., 2020; Turner et al., 2006). Similarly, affective problems were the most frequent CBCL clinical problem in our study, while the strongest association with victimization was observed for oppositional defiant problems, in agreement with the findings reported by Ortega et al. 2024.

The cumulative model of adversity also converges with the allostatic load model, which proposes that repeated or chronic stressors can disrupt physiological systems—including cardiovascular, metabolic, and immune pathways—thereby influencing the onset and progression of disease (McEwen et al., 2007). This framework is particularly relevant in our sample, which consists of children with chronic health conditions, in whom biological vulnerability and psychosocial stressors may interact synergistically.

Interpretation of the associations between victimization exposure and psychopathology requires consideration of the potential bidirectional relationship between these phenomena. With respect to peer victimization, a systematic review of longitudinal studies found that pre-existing internalizing symptoms predict subsequent peer victimization and, conversely, that peer victimization predicts later internalizing symptoms (r = .18 and r = .19, respectively; Christina et al., 2021). Similarly, a path analysis of nationally representative data found that depressive symptoms, anxiety, and peer victimization influence one another over time (Forbes et al., 2019). However, previous psychopathology does not fully explain the association between peer victimization and adverse mental health outcomes, suggesting that the relationship is at least partly bidirectional (Rijlaarsdam et al., 2021). In contrast, for violent or sexual victimization, the available evidence more consistently supports victimization as a contributing causal factor in the development of psychopathology (Pitkänen et al., 2026). Further longitudinal studies are needed to examine how cumulative exposure to multiple forms of victimization influences the development of mental health problems over time.

This study has several limitations. First, the cross-sectional design precludes causal inferences regarding the relationship between victimization and mental health outcomes. Second, the non-random sampling strategy—restricted to children and adolescents whose caregivers consented to participate during outpatient visits—may introduce selection bias and limit the generalizability of our findings. Given the number of regression models estimated, results should be interpreted with caution due to the potential for type I error. However, analyses were hypothesis-driven and focused on clinically distinct victimization categories, reducing the likelihood that findings are due to chance alone. Some associations showed wide confidence intervals, suggesting limited statistical precision for less frequent victimization categories.

Despite these constraints, this study provides valuable insights from a hospital setting, an area that has received limited attention in the literature on child and adolescent victimization in Mexico. The use of validated instruments and the focus on a tertiary referral center—where children with complex medical and psychosocial needs are concentrated—strengthen the relevance of our results.

Our study’s findings are particularly relevant in resource-limited healthcare settings, where chronic and often serious medical conditions may contribute to the accumulation of adversities experienced by children and their families. Chronic illness is frequently associated with psychological, logistical, and financial stress, potentially increasing both exposure and vulnerability to victimization.

Despite the high prevalence of victimization observed in our study and in national surveys, only a small proportion of cases are identified within healthcare systems. In 2024, the Mexican Ministry of Health reported 20,435 injuries related to family violence and 11,947 related to non-family violence among children and adolescents aged 1 to 17 years (Red por los Derechos de la Infancia en México, 2023). However, in a country with 35.5 million individuals in this age group, these figures represent only a fraction of the overall burden of victimization. Most cases remain undetected, and even when identified, healthcare professionals frequently report feeling insufficiently prepared to address the complex psychological and social consequences of victimization (Wilson & Lee, 2021).

Healthcare institutions are legally required to report suspected cases of child abuse, and mandatory reporting remains an essential component of child protection. However, reporting alone may be insufficient to address the broader psychosocial needs of affected children and families. Alternative models of care have therefore been proposed. For example, Eaves et al. described the A-TEAM framework, which promotes an aware, transparent, empathetic, and non-judgmental approach coordinated by an interprofessional team. Such models emphasize early identification, supportive screening, referral, and the development of therapeutic alliances among families, healthcare providers, and community institutions. These approaches may be particularly relevant in middle-income settings, where the social determinants of violence require comprehensive and context-sensitive responses (Eaves et al., 2023).

Conclusion

In summary, this study provides novel evidence of the high prevalence and mental health burden associated with child and adolescent victimization in a clinical population in Mexico. The findings reinforce the urgent need for systematic identification strategies within pediatric healthcare settings and support the development of family-centered, interprofessional responses to victimization. Preventing and addressing violence in childhood is an important public health priority, with potential implications for mental health, educational outcomes, and long-term social well-being.

Supplemental Material

sj-docx-1-jiv-10.1177_08862605261467511 – Supplemental material for Child and Adolescent Victimization and Mental Health Associations: A Hospital-Based Cross-Sectional Study in Mexico

Supplemental material, sj-docx-1-jiv-10.1177_08862605261467511 for Child and Adolescent Victimization and Mental Health Associations: A Hospital-Based Cross-Sectional Study in Mexico by Maria F. Castilla-Peon, Daniela Rodríguez-Zapata, Diana E. Moncivais-Esteban, Daniela de la Rosa-Zamboni and Nadia González-García in Journal of Interpersonal Violence

Footnotes

ORCID iDs

Maria F. Castilla-Peon

Nadia González-García

Ethical Considerations

Ethical approval for this study was obtained from the Institutional Review Board of the Hospital Infantil de México Federico Gómez (protocol number HIM-2022-007).

Consent to Participate

Written informed consent was provided by at least one parent or legal guardian, and assent was obtained from all participating children.

Funding

The authors disclosed receipt of the following financial support for the research and/or authorship of this article: This work did not receive external funding. Institutional support was provided by the Hospital Infantil de México Federico Gómez.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article.

Data Availability Statement

De-identified data and analytic materials are available from the corresponding author upon reasonable request.

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Maria F. Castilla-Peon, MD, MSc is a pediatrician and endocrinologist focused on epidemiological research on the social determinants of health. As a master’s in science, she is a Lecturer in Medical Statistics for postgraduate students. She has served as Associate Editor of Boletín Médico del Hospital Infantil de México. She is currently a researcher at the Hospital Psiquiátrico Infantil Dr. Juan N. Navarro.

Daniela Rodríguez-Zapata, BSc is a psychologist with a master’s degree in Brief Therapy. She is certified in the Battelle Developmental Inventory and has delivered talks and workshops on emotion management, conflict resolution, and assertiveness. Her experience includes patient care in public mental health services and serving as the state manager of the Child Development Strategy in Baja California Sur.

Diana E. Moncivais-Esteban, MD is a physician who completed her social service in research at the Hospital Infantil de México Federico Gómez, where she contributed to this study. She is currently pursuing a specialty in pediatrics. Her interests include child health and clinical and biomedical research aimed at improving the diagnosis and treatment of pediatric diseases.

Daniela de la Rosa-Zamboni, MD, MSc is an infectious diseases physician specializing in hospital epidemiology. As Subdirector of Comprehensive Patient Care at the Hospital Infantil de México Federico Gómez, she co-developed an institutional program for early detection and prevention of child maltreatment. She has served as President of the Mexican Association for the Study and Control of Healthcare-Associated Infections (AMR) and currently leads Mexico’s national AMR programs at the National Centre for the Prevention and Control of Diseases.

Nadia González-García, MD, PhD is a neuroscientist in cognitive sciences whose research focuses on child and adolescent mental health, particularly the effects of early adversity on brain development and the mechanisms underlying resilience to abuse and violence. She co-developed an institutional program for early detection and prevention of child maltreatment.

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