Exploring Gaps in Child Maltreatment Trends: A Narrative Review from the U.S. and Japan

ABSTRACT

Child maltreatment affects millions globally across all economic levels. Despite its prevalence, comparative research and internationally comparable data are limited due to varied definitions, methodologies, and reporting systems. This narrative review aims to compare child maltreatment trends in the U.S. and Japan, highlighting the roles of sociocultural factors. Through a literature review and analysis of national data since 1990, the study estimates maltreatment and fatality rates in both countries. Findings suggest an increase in Japan’s reported maltreatment cases, likely attributable to legislative changes and heightened public awareness, while the U.S. appears to show a decline, potentially linked to improved mental health services and socioeconomic advancements. In both nations, mothers are predominantly identified as perpetrators, with sociocultural factors influencing maltreatment types and rates. Japan faces challenges in accurately measuring maltreatment due to reporting inconsistencies and mental health stigma. Despite a higher victimization rate, Japan reports significantly fewer fatalities than the U.S., with the fatality rate in the U.S. being approximately 9 times higher than in Japan. This contrast underscores the critical role of healthcare access and mental health support. The review advocates for international efforts to standardize maltreatment definitions and reporting, suggesting the adoption of trauma-informed care and comprehensive healthcare access as effective strategies.

Child maltreatment is a global issue. Nearly half of the global child population experiences at least one form of trauma or adverse event each year.¹ Although poverty is one of the risk factors for child maltreatment, numerous children in economically advanced countries are victimized by maltreatment.^{2, 3} While there is a critical need for comparative research on child maltreatment across nations, challenges arise from the lack of universally accepted definitions and consistent methodologies.⁴ Despite these challenges, this narrative review endeavors to analyze and compare child maltreatment trends across economically advanced countries, especially the U.S. and Japan. These two countries provide a compelling contrast in aspects, including their social welfare systems and legal frameworks governing child protection. Both nations offer distinct approaches to handling social issues, which makes them ideal for a study focused on the impact of cultural and socio-economic factors. This comparative study demonstrates the value of cross-national analyses, even in contexts with differing definitions and reporting practices.

SEARCH STRATEGIES

A narrative review approach was employed, allowing for an extensive qualitative synthesis and discussion of the trends in child maltreatment across the U.S. and Japan. The literature search included both peer-reviewed articles and gray literature, such as reports and government documents. Primary databases searched included PubMed, PsycINFO, and Google Scholar. Specific search terms utilized were “child maltreatment,” “physical abuse,” “emotional abuse,” “sexual abuse,” “neglect,” “United States,” and “Japan.” These terms were strategically combined to capture comprehensive and relevant literature.

Governmental datasets were primarily utilized due to their comprehensive coverage and authoritative nature concerning child maltreatment in both nations. Priority was given to materials published in the last three decades, ensuring a comprehensive historical perspective. For Japan, the child maltreatment victimization rate for each year since 1990 was calculated using national datasets, based on the number of reported victims and the child populations aged 0–17.^{5, 6} The maltreatment fatality rate in Japan was also calculated using the same approach and datasets.^{5, 7} Similarly, the victimization and fatality rates in the U.S. were derived from national reports.^8,9,10,11,12

FINDINGS

The Definitions of Child Maltreatment and Its Victims

Child maltreatment in Japan encompasses neglect, physical abuse, emotional abuse (including witnessing domestic violence), and sexual abuse by caregivers.¹³ In the U.S., where each state is responsible for its own definitions, the categories closely mirror those of Japan, while several states incorporate witnessing domestic violence and parental substance abuse.^{12, 14}

In the U.S., when child protectve services, agencies responsible for child welfare, receive a child maltreatment report and this case meets the state’s definition of child maltreatment, a report is “screened in (i.e., an investigation is warranted).”^{15, 16} Once a report is screened in, an investigation determines whether the report is “unsubstantiated (i.e., the allegation or risk of maltreatment was not found),” “substantiated (i.e., allegation or risk of maltreatment was found or founded)” or “indicated (i.e., maltreatment was not substantiated under state law or policy, but it is suspected that a child may have been maltreated or at-risk of maltreatment).” A case being substantiated or indicated is defined as “a child maltreatment victim” by the National Child Abuse and Neglect Data System (NASCNDS).¹² Similarly, Japan annually reports the number of cases screened and intervened, paralleling the NASCANDS definition of “a child maltreatment victim.”

Child Maltreatment Victimization Rate

In 2022, over 219,000 children were reported victims of child maltreatment in Japan,⁶ whereas approximately 559,000 children were reported victims in the U.S.¹²Figure 1 illustrates the trend of the child maltreatment victimization rate per 1,000 children between 1990 and 2022. In Japan, the rate increased from 0.04 to 12.4, representing a staggering increase of 309%. Conversely, in the U.S., the rate dropped from 13.4 to 9.1, indicating a 32.1% decrease. In 1990, the rate in the U.S. was 335 times higher than in Japan. However, by 2022, the rate in the Japan has surpassed that of the U.S. by 1.36 times.

Fig. 1.

 Child maltreatment victims in the U.S. and Japan per 1,000 children. U.S. data represent unique counts (i.e., counting a child only once, no matter how many times reports are made about them). Japanese data represent duplicate counts (i.e., counting a child each time a new report is made).

Factors Influencing Victimization Rates

Japan has witnessed an exponential increase in victimization rates. Significant changes in social systems, such as improved infrastructure for reporting maltreatment and revisions to definitions and policies, may have played a role. For instance, the enactment of the Child Abuse and Prevention Act of 2000, which mandated the reporting of child maltreatment, resulted in a dramatic surge in reports. This indicates that professionals obligated to report maltreatment have significantly contributed to this increase.¹⁷ In 2013, the police department enhanced the intervention system for domestic violence, leading to an increase in the number of maltreatment reports filed with the police.¹⁷ The establishment of a 3-digit telephone number for reporting child maltreatment in 2015 led to an additional increase in reports.¹⁸ Raised public awareness of child maltreatment has further accelerated these reports.¹⁹

Despite these advancement, the support systems for victimized children and their families remain underdeveloped,²⁰ raising the risk of maltreatment recurrence. In addition, stigma surrounding mental illness in Japan persists.²¹ Such stigma may deter caregivers from seeking the mental health support they need, especially in challenging child-rearing situations. The COVID-19 pandemic may have exacerbated these issues, altering lifestyles, limiting social interactions, and straining social services. The pandemic has particularly impacted women, increasing their risk of mental health issues due to a rise in domestic violence, caregiving fatigue, and economic pressures.²² This environment, coupled with mental health stigma, may hinder caregivers from seeking essential support. Additionally, there has been an increase in child poverty rates in Japan,²³ which is associated with an increased occurrence in child maltreatment.²⁴ Divorce rates, single-parent families, and teen pregnancy are also on the rise in Japan,^25,26,27 linking economic hardship to increased victimization rates.

Furthermore, the current reporting scheme in Japan presents unique challenges in accurately capturing the extent of child maltreatment. Unlike U.S. data, which represent unique counts (i.e., counting a child only once, no matter how many time reports are made about them), Japanese data involve duplicate counts (i.e., counting a child each time a new report is made). This difference complicates the visibility of the actual number of victimized children. Moreover, a recent investigation in an urban area revealed that even “unsubstantiated” cases were included in the maltreatment counts by eight out of twelve child guidance centers, agencies responsible for child welfare.²⁸ This may have led to inflated figures and complicated efforts to understand the true scale of the issue. This lack of uniformity in reporting practices underscores the need for refined data collection methods to better inform policy and intervention strategies.

In contrast, the U.S. has exprienced considerable declines in victimization rates. Research findings support a genuine decline in sexual abuse victimization rates, despite existing concerns over inconsistent definitions of sexual abuse, varied screening procedures, and differing data collection methods across child protective agencies.²⁹ Additionally, while source data on physical abuse victimization rates present mixed findings, the overall trend indicates a gradual decrease in such incidents.³⁰ This declining trend can be attributable to various socio-cultural factors. For example, the decline has occurred alongside greater access to medications and mental health services for families in need.³¹ Economic advancements have potentially reduced poverty-related crime and victimization.³² A study also indicates that from 2001 to 2013, the reduction in adolescent births accounted for 7.5% of the decrease in child physical abuse cases, and 9.5% of the decline in sexual abuse cases. Additionally, a decrease in intimate partner violence was linked to 4.9% of the reduction in child physical abuse cases during the same timeframe.³³

Furthermore, the declining trends may be partly due to national initiatives aimed at promoting of trauma-informed care (TIC) to prevent and address trauma and adverse childhood experiences (ACEs). TIC is a framework recognizing and addressing the impacts of trauma on individuals’ behaviors and emotions, emphasizing the creation of a safe environment for both those being helped and the providers. Incorporating cultural sensitivity into TIC is crucial, as understanding and respecting the individual’s cultural background can significantly influence the effectiveness of support and recovery processes.³⁴ The enactment of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act in 2018 has established a task force dedicated to enhancing TIC and formulating national strategies. With a budget of $27.55 million, these strategies support the widespread adoption of TIC practices across various professional domains, including education, child welfare, and healthcare.³⁵

A notable example of national efforts is the ACEs Aware initiative launched by the California Office of the Surgeon General and the Department of Health Care Services in 2019, focusing on ACE screening to improve early detection and intervention in child maltreatment cases. The rising demand for TIC in medical education has also led to the formation of the National Collaborative on Trauma-Informed Health Care Education and Research. This body has initiated a campaign to integrate TIC into medical education, aiming to equip all medical students with the skills to identify and address trauma effectively, thereby improving early child maltreatment interventions.³⁶ These collective efforts, alongside welfare policy reforms and shifting societal attitudes towards violence, may have contributed to the observed decrease in child maltreatment rates.

Characteristics of Perpetrators

In Japan, a considerable portion of child maltreatment cases involves biological parents as perpetrators. Data shows that 55.2% of victims are maltreated by biological mothers, while 35.9% suffer at the hands of biological fathers. Maltreatment by non-biological fathers accounts for 3.4%, non-biological mothers for 0.4%, and the remaining 5.1% involves other perpetrators.³⁷ In the U.S., parents are involved in 89.0% of child maltreatment incidents, whether acting individually or collaboratively, without distinguishing between biological and non-biological relationships. A detailed analysis shows that mothers acting alone are responsible for 37.4% of cases, fathers alone for 24.5%, and both parents for 19.2%. Nonparental perpetrators include relatives, unmarried partners of a parent, friends, neighbors, foster parents, and child daycare providers.¹²

The approach to categorizing perpetrators differs between Japan and the U.S., making direct comparison challenging. However, both countries exhibit a pronounced trend of mothers being more frequently identified as perpetrators. Factors such as increasing divorce rates and the growing number of single-parent families, predominantly led by mothers, may influence this trend. In both Japan and the U.S., single mothers constitute the majority of single-parent families,^{5, 38} a status often associated with economic challenges.³⁹ This economic strain may inadvertently heighten the risk of child maltreatment, thus increasing the prevalence of mothers as perpetrators.

Historical trends further underscore this dynamic, showing an increase in the proportion of cases involving fathers in recent decades in both countries. More specifically, between 2012 and 2022 in Japan, the rate of cases maltreated by biological mothers decreased by 2.1%, while the incidence of cases maltreated by biological fathers increased by 6.9%.⁴⁰ Similarly in the U.S, the rates of children maltreated by mothers alone declined by 3.3%, whereas the rate of cases maltreated by fathers alone increased by 4.0% between 2014 and 2022.⁴¹ These patterns suggest societal shifts towards greater paternal involvement in child-rearing, potentially increasing the opportunity for maltreatment by fathers due to more frequent child-father interactions.

Understanding these trends is crucial for developing targeted prevention strategies. Recognizing the changing dynamics in family structures and roles can guide policymakers and practitioners in creating more effective interventions tailored to the specific needs and risks associated with different perpetrator profiles.

Types of Child Maltreatment

Figure 2 shows the victimization rate for each child maltreatment type in 2022. In Japan, 16.2% of victims experienced neglect, 23.6% experienced physical abuse, 59.1% experienced emotional abuse, and 1.1% experienced sexual abuse, totaling 100% in 2022.⁶ In the U.S., 76.2% of victims experienced neglect (including medical neglect), 17.0% experienced physical abuse, 6.8% experienced emotional abuse, 10.6% experienced sexual abuse, and 3.4% experienced other types of child maltreatment in FFY (Federal Fiscal Year) 2022. Because some victims experienced multiple types of maltreatment, the total percentage exceeds 100%, summing to 114.2%.¹²

Fig. 2.

 Victimization rates per maltreatment type in the U.S. and Japan in 2022. In U.S. data, if a child experiences more than one type of maltreatment, they are counted in each category, resulting in a total percentage exceeding 100%. In Japanese data, categories of other are not included, each child is counted for only one type of maltreatment per consultation, making the total percentage exactly at 100%.

Emotional abuse emerges as the predominant form of maltreatment in Japan, whereas neglect is the most common type in the U.S. Although emotional abuse could be the most widespread form of child abuse in general, it is often the least visible.⁴² The higher rates of emotional abuse in Japan may stem from the broadening of the definition of child maltreatment. After the amendment to the Child Abuse Prevention Act in 2004, which stipulated that witnessing domestic violence is emotional abuse,¹³ the number of emotional abuse reports soared. On the other hand, emotional abuse might be under-reported in the U.S. Regarding neglect, it strongly correlates with poverty while the link is less evident in physical abuse reports and absent in sexual abuse reports.² With the child poverty rate standing at 26.2% in the U.S. compared to Japan’s 14.8%,⁴³ the elevated rate of neglect in the U.S. may be attributable to this socioeconomic disparity.

Additionally, the sexual abuse victimization rate in the U.S. is more than 10 times higher than that in Japan. Children living with single parents or step-parents have higher risk of sexual abuse than children living with two married biological parents.⁴⁴ In the U.S., 23% of children reside in single-parent households, a stark contrast to Japan’s 7%. Furthermore, a mere 11% of American children live in extended-family homes, significantly lower than the global average of 38%.⁴⁵ This disparity suggests that children in the U.S. may experience a reduced level of supervision and protection in their living environments. Such conditions could potentially contribute to the higher incidence of sexual abuse observed in the U.S. compared to Japan. Furthermore, the lower sexual abuse rate in Japan may not accurately reflect the acual occurrence of sexual abuse. People, including mental health professionals, in Japan often believe that sexual abuse is unlikely to occur to young-aged children, which might deter the discovery of sexual abuse.²⁷

Child Maltreatment Fatality

In 2021, Japan reported 74 fatalities due to child maltreatment, equating to a rate of 0.3 deaths per 100,000 children aged 0–17.^{5, 7} In contrast, the U.S. reported 1,990 fatalities from child maltreatment in FFY 2022 for the same age range, resulting in a rate of 2.7 deaths per 100,000 children.¹² These data indicate that the rate of child maltreatment fatalities in the U.S. is approximately 9.0 times higher than in Japan.

Given the low incidence of child maltreatment fatalities, minor or potentially random discrepancies can remarkably impact the fatality ratio. Assuming the accuracy of the reported data, it is observed that in Japan, a majority of child maltreatment cases involve emotional abuse, which is less likely to result in fatalities than other forms of maltreatment. In contrast, the U.S. shows higher rates of neglect and physical abuse, potentially contributing to the greater number of fatalities.

Additionally, healthcare access may play a crucial role. In Japan, universal healthcare insurance covers all children, and regular health check-ups for infants and toddlers are generally offered for free or at low costs, with follow-ups to encourage all families to utilize the services. In contrast, in the U.S., 5.4% of children are uninsured and 22.7% are underinsured.⁴⁶ The lack of insurance may hinder parents from seeking necessary medical care for their children, leading to deaths from medical neglect.

A unique aspect of child maltreatment fatalities in Japan is the occurrence of combined filicide-suicide, where parents kill their children before committing suicide. The motivation behind filicide-suicide often stems from the parents’ feelings of guilt or shame, fearing to leave their children behind.⁴⁷ In 2021, of the 74 reported child maltreatment fatalities, 24 resulted from filicide-suicide, constituting 32.4% of the total.⁷ Unfortunately, comprehensive data on filicide-suicide rates in the U.S. are lacking, making direct comparison challenging.

CONCLUSIONS

This review highlights critical aspects of child maltreatment trends in the U.S. and Japan, shedding light on the influence of cultural and socioeconomic factors. A crucial observation from the sources indicates that victimization rates in Japan appear to be on the rise, while in the U.S., these rates seem to be trending downwards. This divergence can be attributed to legislative changes and enhanced reporting mechanisms in Japan, such as the Child Abuse and Prevention Act of 2000 and its amendment in 2004, which have significantly increased the visibility of child maltreatment, especially emotional abuse. Raised public awareness may also have played a role in this uptrend. However, challenges persist, particularly in accurately capturing the extent of maltreatment due to the current reporting scheme, which includes duplicate cases and inconsistent categorization. Moreover, the lack of adequate support resources for affected children and their families remains a pressing concern.

Conversely, the U.S. has seen a notable decrease in child maltreatment rates. This decline aligns with broader access to mental health services and socioeconomic improvements. Research highlights the role of reduced adolescent births and intimate partner violence in this downward trend. Furthermore, the U.S. has made significant strides in maltreatment prevention and response through the adoption of TIC, bolstered by national initiatives such as the SUPPORT for Patients and Communities Act of 2018. These efforts may have enhanced prevention, early detection, and intervention by reforming child welfare practices.

In both nations, mothers emerge as the most frequent perpetrators, reflecting broader societal trends such as rising single-parent households and economic strain. Additionally, the growing involvement of fathers in maltreatment cases aligns with societal shifts towards more engaged paternal roles. The disparities in the types of maltreatment, with emotional abuse predominating in Japan and neglect in the U.S., illuminate the nuanced impact of sociocultural differences and policy frameworks.

Child maltreatment fatalities and physical abuse victimization rates further reveal the stark contrasts between the two countries, with Japan reporting remarkably lower rates than the U.S. This difference may be attributed to Japan’s universal healthcare system, highlighting the need for comprehensive healthcare access and mental health support to prevent physical abuse and maltreatment fatalities.

This comparative analysis suggests a mutual benefit in leveraging each country’s strengths. Japan’s comprehensive healthcare access model and the U.S.’s emphasis on TIC provide viable pathways for reducing child maltreatment and improving support for affected families. Further, advancing educational efforts for professionals, parents, and the public about maltreatment and prevention strategies may be paramount. Culturally sensitive approaches that respect each country’s norms and values, while addressing maltreatment effectively, are essential for moving forward.

Given the global scope of child maltreatment, enhancing collaboration with existing international platforms could be a productive next step. This effort could focus on identifying gaps in current initiatives, standardizing definitions and reporting practices, and facilitating more effective data sharing. By pooling expertise, experiences, and resources, a more effective and unified response could be realized.

This review has several limitations. The focus on cultural aspects directly related to child maltreatment may not fully capture broader cultural influences that affect maltreatment trends in Japan and the U.S. Additionally, differences in how maltreatment data are collected and defined by each country can affect the comparability of findings. There is also a potential for biases in reporting practices, where changes in legislation or public awareness might influence reporting rates. Lastly, the reliance on published and gray literature means that some relevant studies or data may not have been included, which could limit the completeness of the analysis.

Ultimately, this comparative study underscores the complexity of child maltreatment, influenced by a mosaic of factors including policy, social awareness, and healthcare infrastructure. It advocates for intensified international collaboration to better understand and combat this pervasive issue. Embracing TIC and bolstering support systems for affected children and families emerge as crucial steps towards alleviating the impact of child maltreatment globally.