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Physical punishment and lifelong outcomes in low‑ and middle‑income countries: a systematic review and multilevel meta-analysis

Nature Human Behaviour volume 9, pages 1365–1379 (2025)Cite this article

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Abstract

Research from high-income countries has found negative outcomes associated with physical punishment. Yet, the extent to which such research evidence generalizes to children in low- and middle-income countries (LMICs) is largely unknown. The objective of the current pre-registered study (PROSPERO: CRD42022347346) was to conduct a meta-analysis of the associations between childhood physical punishment and individual outcomes in LMICs. We identified eligible articles by searching for keywords related to physical punishment in six languages across 11 databases, with search periods from April to August 2021 and June to July 2024. This process yielded 5,072 unique records, of which 189 studies, comprising 1,490 unique effect sizes and representing 92 LMICs, met our inclusion criteria. Findings from random-effects multilevel meta-analyses indicated that physical punishment was associated with detrimental outcomes, including mental health problems, worse parent–child relationships, substance use, impaired social–emotional development, negative academic outcomes and heightened externalizing behaviour problems, among others. Despite some variation by contextual and study-level characteristics, all subgroup estimates were consistent in direction. Sensitivity checks indicated that these findings were not typical of other non-violent methods of discipline but were specific to physical punishment and psychological aggression. The analysis confirmed that physical punishment is associated with detrimental outcomes for individuals in LMICs. Additional research is needed to inform the design, implementation, and evaluation of policies and interventions to prevent the physical punishment of children and adolescents worldwide.

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Fig. 1: PRISMA flowchart.
Fig. 2: Number of effect sizes per country.
Fig. 3: Summary results of the meta-analyses by outcome domain and overall.
Fig. 4: Effect sizes for the associations of six forms of discipline with child outcomes.
Fig. 5: Funnel plot.

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Data availability

We compiled the data for this study on the basis of the studies identified in our systematic literature review. Our data are available via our projects’ Open Science Framework repository at https://osf.io/kysc8/?view_only=671a44c0b0e240049cdc0346fe5250a0 (ref. 238). In the systematic review, we searched the following databases: APA PsycInfo, PubMed, EMBASE, ERIC, Sociological Abstracts, EconLit, Global Health, CINAHL Plus with Full Text, Academic Search Premier, Bibliography of Asian Studies, and Education Source.

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Acknowledgements

We thank all authors who provided data for the systematic review and meta-analysis, six Harvard librarians who supported the search strategy, and research assistants who supported study screening. J.C. was supported by the National Academy of Education/Spencer Dissertation Fellowship, a fellowship from the American Psychological Foundation, and the Patrice L. Engle Dissertation Grant in Global Early Child Development from the Society for Research in Child Development (SRCD) to conduct this project. E.T.G. was supported by grant P2CHD042849 awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (PI: Gershoff). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the paper.

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Authors and Affiliations

  1. Department of Applied Psychology, New York University, New York, NY, USA

    Jorge Cuartas

  2. Centro de Estudios sobre Seguridad y Drogas (CESED), Universidad de los Andes, Bogotá, Colombia

    Jorge Cuartas

  3. Harvard Graduate School of Education, Cambridge, MA, USA

    Jorge Cuartas & Dana C. McCoy

  4. Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA

    Elizabeth T. Gershoff

  5. Population Research Center, The University of Texas at Austin, Austin, TX, USA

    Elizabeth T. Gershoff

  6. School of Education, University of California at Irvine, Irvine, CA, USA

    Drew H. Bailey

  7. Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia

    Maria Alejandra Gutiérrez

  8. Echocardiographic Core Laboratory, Yale University, New Haven, CT, USA

    Maria Alejandra Gutiérrez

Authors
  1. Jorge Cuartas
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  2. Elizabeth T. Gershoff
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  3. Drew H. Bailey
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  4. Maria Alejandra Gutiérrez
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  5. Dana C. McCoy
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Contributions

J.C. conceptualized the original study, defined the search strategy, preregistered the study, conducted data extraction and verified the underlying data, designed the methodology, conducted formal statistical analysis, wrote the original draft, and provided critical review and editing. E.T.G. conceptualized the original study, designed the methodology, wrote the original draft, and provided critical review and editing. D.H.B. designed the methodology, conducted formal statistical analysis, and provided critical review and editing. M.A.G. conducted data extraction, verified the underlying data, and provided critical review and editing. D.C.M. designed the methodology and provided critical review and editing. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Jorge Cuartas.

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Cuartas, J., Gershoff, E.T., Bailey, D.H. et al. Physical punishment and lifelong outcomes in low‑ and middle‑income countries: a systematic review and multilevel meta-analysis. Nat Hum Behav 9, 1365–1379 (2025). https://doi.org/10.1038/s41562-025-02164-y

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