Mental health correlates of victimization classes among homeless youth

Literature reports high rates of street victimization among homeless youth and recognizes psychiatric symptoms associated with such victimization. Few studies have investigated the existence of victimization classes that differ in type and frequency of victimization and how youth in such classes differ in psychiatric profiles. We used latent class analysis (LCA) to examine whether classes of homeless youth, based on both type and frequency of victimization experiences, differ in rates of meeting diagnostic criteria for major depressive episodes and posttraumatic stress disorder (PTSD) in a sample of homeless youth (N = 601) from three regions of the United States. Results suggest youth who experience high levels of direct and indirect victimization (high-victimization class) share similarly high rates of depressive episodes and PTSD as youth who experience primarily indirect victimization only (witness class). Rates of meeting criteria for depressive episodes and PTSD were nearly two and three times greater, respectively, among the high victimization and witness classes compared to youth who never or rarely experienced victimization. Findings suggest the need for screening and intervention for homeless youth who report direct and indirect victimization and youth who report indirect victimization only, while prevention efforts may be more relevant for youth who report limited victimization experience.     

Defensive functioning of homeless youth in relation to experiences of child maltreatment and cumulative victimization

OBJECTIVE: To determine the relationship between use of defense mechanisms and experiences of child maltreatment and cumulative victimization among homeless youth. METHOD: Twenty-five homeless youth were individually interviewed regarding their victimization experiences and coping strategies. Use of defense mechanisms was assessed using the Defense Mechanism Rating Scale. RESULTS: Relationships were demonstrated between use of defenses and specific as well as cumulative victimization experiences. All levels of defenses became more pervasive in response to victimization, but this was not a predictor of overall immature defensive functioning. CONCLUSIONS: Clinical and program interventions to engage homeless youth need to incorporate an understanding of the relationship between defenses and victimization in order to be effective in maximizing upon the strengths of this population.     

Screening homeless youth for histories of abuse: prevalence, enduring effects, and interest in treatment

Objectives

To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse.

Methods

Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in a structured assessment of histories of abuse, tobacco use and substance abuse.

Results

Sixty-four homeless youth in Salt Lake City, Utah completed the study, 43 males and 21 females. Eighty-four percent screened positive for childhood physical and/or sexual abuse occurring before the age of 18; 42% screened positive for both physical and sexual abuse; 72% reported still being affected by their abuse. Among all abuse victims, 44% were interested in treatment for their abuse history and 62% of homeless youth who reported still being affected by their abuse were interested in treatment. Individuals were more likely to be interested in treatment if they were female, had not completed high school or had been previously asked about family dysfunction. Many victims who declined treatment offered spontaneous insight into their decision. Interest in treatment was similar to interest in treatment for other behaviors such as smoking and substance abuse.

Conclusions

Histories of abuse are common among homeless youth. A majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse. Our finding that homeless youth continue to be impacted by their abuse and are interested in treatment should prompt more screening for histories of abuse.     

Attitudes toward family obligation among adolescents in contemporary urban and rural China

A sense of obligation to support, assist, and respect the family was examined among approximately 700 urban and rural 10th- (M = 16.6 years) and 12th- (M = 18.9 years) grade students in the People's Republic of China. Urban male adolescents reported a weaker sense of family obligation than did rural male adolescents and both urban and rural female adolescents. Only children did not differ from those with siblings in terms of their attitudes toward family support and respect. A sense of family obligation was generally associated with more positive family relationships and a higher level of academic motivation among Chinese adolescents. Discussion focuses on how the shift to a market economy may influence adolescents' identification with the family in contemporary China.     

Perpetrators of early physical and sexual abuse among homeless and runaway adolescents

OBJECTIVE: To examine abuse specific variables among homeless and runaway adolescents and to look at perpetrators of childhood abuse. METHOD: A total of 372 homeless and runaway adolescents were interviewed using a systematic sampling strategy in metropolitan Seattle. Young people were interviewed on the streets and in shelters by outreach workers in youth service agencies. RESULTS: Approximately one-half of these young people reported being physically abused and almost one-third experienced sexual abuse. Females experienced significantly higher rates of sexual abuse compared to males, and sexual minority youth experienced significantly higher rates of physical and sexual abuse compared to heterosexual youth. Average duration of physical and sexual abuse was 5 and 2 years, respectively. Both types of abuse were rated as extremely violent by more than half of those who were abused. The average number of different perpetrators of physical and sexual abuse was four and three, respectively. Biological parents were the majority of perpetrators for physical abuse whereas nonfamily members most often perpetrated sexual abuse. Average age of perpetrators was late 20s to early 30s and the majority of perpetrators were male for both types of abuse.CONCLUSIONS: The pattern of exploitation and victimization within the family may have serious and cumulative developmental consequences for these youth as they enter the street environment. Early intervention programs are needed to break the cycle of exploitation and abuse that adolescents experience within the family. Without intervention, many of these youth may be at risk of future exploitation and re-victimization out on the street.     

Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth

OBJECTIVE: To examine family risk factors associated with dissociative symptoms among homeless and runaway youth. METHOD: Three hundred and twenty-eight homeless and runaway youth were interviewed using a systematic sampling strategy in metropolitan Seattle. Homeless young people were interviewed on the streets and in shelters by outreach workers in youth service agencies. RESULTS: The current study revealed widespread prevalence of dissociative symptoms among these young people. Multivariate analyses revealed that sexual abuse, physical abuse, and family mental health problems were all positively associated with dissociative symptoms. No gender differences were found for any of the models. CONCLUSIONS: Dissociative behavior is widespread among these youth and may pose a serious mental health concern. Some young people experience numerous stressors, and with few resources and little support available, many may invoke maladaptive strategies such as dissociative behavior to handle such situations, which may in turn be detrimental to their mental health. Unless youth are provided with programs and intervention, the cycle of abuse that they have experienced at home is likely to continue on the street.     

Depressive symptoms and co-occurring depressive symptoms, substance abuse, and conduct problems among runaway and homeless adolescents

This study examines factors that contribute to depressive symptoms and to co-occurring depression, substance abuse, and conduct problems among 602 runaway and homeless adolescents. The respondents were interviewed in shelters, drop-in centers, and directly on the streets in four Midwestern states (Missouri, Iowa, Nebraska, and Kansas). Results indicate that although family-of-origin factors contribute to depressive symptoms and comorbidity among runaway and homeless adolescents, experiences and behaviors when the adolescents are on their own also have powerful effects. The authors discuss the findings from a life-course perspective focusing on mechanisms through which street experiences accentuate or amplify already high levels of psychological distress and behavioral problems among this population of young people.     

Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents

OBJECTIVE: To examine the relationship between childhood experiences of sexual abuse, sexual coercion during adolescence, and the acquisition of sexually transmitted infections (STIs) in a population of homeless adolescents. METHOD: Homeless adolescent females (N = 216) from a northwestern United States city were recruited by street outreach workers for a longitudinal study of STI epidemiology. Baseline data on childhood abuse and recent history of sexual coercion were used to predict physiologically confirmed STI acquisition over the subsequent 6 months. RESULTS: About 38% of all girls reported a history of childhood sexual abuse (CSA). Girls with a history of CSA were more likely to report recent sexual coercion. In turn, sexual coercion in the last three months was significantly associated with a higher number of sexual partners (but not with a greater frequency of intercourse or with lower rates of condom use). Number of sexual partners significantly predicted the future acquisition of an STI within 6 months. CONCLUSIONS: Interventions to reduce risky sexual behaviors in homeless adolescent females may need to consider the impact of CSA, particularly on the number of sexual partners during adolescence. However, it also should be noted that engagement in intercourse often results from coercion and is not voluntary in this population.     

Longitudinal associations among youth depressive symptoms, peer victimization, and low peer acceptance: an interpersonal process perspective

A longitudinal investigation was conducted to explicate the network of associations between depressive symptoms and peer difficulties among 486 fourth through sixth graders (M = 9.93 years). Parent and teacher reports of depressive symptoms; peer, self, and teacher reports of victimization; and peer reports of peer acceptance were obtained. A systematic examination of nested structural equation models provided support for a symptoms-driven model whereby depressive symptoms contributed to peer difficulties; no evidence was found for interpersonal risk or transactional models. Analyses further revealed that victimization mediated the association between prior depressive symptoms and subsequent peer acceptance. Results extend knowledge about the temporal ordering of depressive symptoms and peer difficulties and elucidate one process through which depressive symptoms disrupt peer relationships.     

Bullying victimization and depression among left-behind children in rural China: Roles of self-compassion and hope

BackgroundBullying victimization among school-aged children is an important public health issue that may affect their well-being and mental health. However, few studies have been conducted on left-behind children in rural China, who are defined as the children who stay in rural areas for more than six months and have one or both parents migrating to urban areas for work. The mechanisms through which bullying victimization will influence depression have disproportionally adopted a psychopathological perspective, and the protective factors are understudied.ObjectiveThis study aims at investigating the factors that might contribute to breaking up the vicious circle between bullying victimization and developmental problems, focusing on the protective role of self-compassion and hope in the association between bullying victimization and depression.MethodsUsing questionnaires, data were collected from a sample of 1091 school-aged left-behind children from west and central China.ResultsCompared with rural children living with their parents, left-behind children reported a higher level of bullying victimization. Bullying victimization was positively associated with depression through decreased self-compassion and hope, and self- compassion played a more crucial role than hope in the linkage between bullying victimization and depression.ConclusionsOur study's findings suggest that it is necessary to incorporate self-compassion and hope in mental health prevention and intervention programs targeting left-behind children with bullying victimization experiences.     

The role of Internet use and parental mediation on cyberbullying victimization among Spanish children from rural public schools

Cyberbullying victimization research on individual and familial correlates is scarce in Spain. By building upon previous studies, this research examines the role of Internet usage and parental mediation in online victimization. Spanish children from rural public schools (10–12 years; n?=?1068) completed a self-report questionnaire which measured being cyberbullied, Internet use and parental mediation strategies. Logistic regression analyses examined the association among cyberbullying victimization, online activities, intensity and purposes of online communication, and restricting, evaluating and co-using parental mediation. The results show that Internet use, specifically online communication, increases the likelihood of cyberbullying victimization. Conversely, monitoring software installed on the computer, joint creation of rules regarding the time spent online and personal information shared help lessen the likelihood of online victimization. The results are examined in the light of previous research, while implications for practice and future research are considered.     

Incidence,type and intensity of abuse in street children in India

ObjectiveThe aims of this cross-sectional survey were to examine the prevalence, type and intensity of abuse in street children in Jaipur city, India.MethodBased on purposive random sampling, 200 street children, inclusive of equal number of boys and girls, were selected from the streets of Jaipur city, India, and administered an in-depth interview schedule which included five areas of abuse, namely, “general abuse,” “health abuse,” “verbal abuse,” “physical abuse,” and “psychological abuse.” Data was interpreted using percentages, t-test and correlations.ResultsStreet children reported experiences of abuse in all the five areas under study. Larger numbers of children (61.8%) scored in the “moderate” category of abuse while 36.6% children indicated abuse in “severe” and “very severe” categories on the intensity of abuse. Highest mean scores were obtained on the “verbal” and “psychological” area of abuse. Gender differences were significant in health and overall abuse, indicating boys to be significantly more abused than girls. There were significant positive correlations of abuse with increasing “age” and “income” of street children; and the occurrence of “multi-type” maltreatment and neglect in street children was clearly present.ConclusionDifferent forms of abuse are prevalent in street children in India. This area of study needs attention both by the researchers and the social workers.Practice implicationschildren who are identified in severe and very severe categories of abuse should be worked with in a follow up study with the help of governmental and nongovernmental agencies working in the field for child welfare.     

Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities

To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score (p < 0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score (p < 0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support.     

Relative contributions of parent substance use and childhood maltreatment to chronic homelessness,depression, and substance abuse problems among homeless women: mediating roles of self-esteem and abuse in adulthood

OBJECTIVE: This study, using latent variable methodology, explores simultaneously the relative effects of childhood abuse and early parental substance abuse on later chronic homelessness, depression, and substance abuse problems in a sample of homeless women. We also examine whether self-esteem and recent violence can serve as mediators between the childhood predictors and the dysfunctional outcomes.METHOD: The sample consists of 581 homeless women residing in shelters or sober living centers in Los Angeles (54% African-American, 23% Latina, 22% White, mean age=33.5 years). Multiple-indicator latent variables served as predictors and outcomes in structural models. Childhood abuse was indicated by sexual, physical, and verbal abuse.RESULTS: Childhood abuse directly predicted later physical abuse, chronic homelessness, depression, and less self-esteem. Parent substance use directly predicted later substance use problems among the women. Recent physical abuse predicted chronic homelessness, depression, and substance use problems. Greater self-esteem predicted less depression and fewer substance use problems. Childhood abuse also had significant indirect effects on depression, chronic homelessness, and drug and alcohol problems mediated through later physical abuse and self-esteem.CONCLUSIONS: Although there was a strong relationship between childhood abuse and parent drug use, childhood abuse was the more pervasive and devastating predictor of dysfunctional outcomes. Childhood abuse predicted a wider range of problems including lower self-esteem, more victimization, more depression, and chronic homelessness, and indirectly predicted drug and alcohol problems. The mediating roles of recent physical abuse and self-esteem suggest salient leverage points for change through empowerment training and self-esteem enhancement in homeless women.     

Violence among family members of children and adolescents evaluated for sexual abuse

OBJECTIVES: The two aims of this study were to: (1). describe the prevalence and characteristics of domestic adult and child physical violence in the homes of children and adolescents evaluated in a specialized sexual abuse clinic and (2). describe parent or caretaker responses to domestic adult and child violence and child sexual abuse, including tendencies to report or seek medical care. METHOD: A consecutive sample of 164 subjects (ages 7-19) were interviewed in a sexual abuse clinic regarding in-home violent or abusive experiences among family members that had occurred at any time during their childhood. RESULTS: Fifty-two percent of these children and teenagers reported spousal violence in their home. Fifty-eight percent of child sexual offenders who were in-home males also physically abused their adult female partner. Half of in-home males who were physically violent to children also sexually abused them. In 86% of homes with partner violence, the children were also physically assaulted. There was no difference in sexual abuse disclosure rates or patterns for children living with or without adult violence. CONCLUSIONS: Sexually abused children should be questioned about physical abuse and the presence of violence among adults in their home. Safety plans for sexually abused children should incorporate screening for family violence and safety plans for parents and siblings of child victims, when appropriate.     

Association of autistic traits in adulthood with childhood abuse,interpersonal victimization,and posttraumatic stress

Persons with autistic traits may be at elevated risk for interpersonal victimization across the life course. Children with high levels of autistic traits may be targeted for abuse, and deficits in social awareness may increase risk of interpersonal victimization. Additionally, persons with autistic traits may be at elevated risk of posttraumatic stress disorder (PTSD) symptoms subsequent to trauma. We examined retrospectively reported prevalence of childhood abuse, trauma victimization and PTSD symptoms by autistic traits among adult women in a population-based longitudinal cohort, the Nurses’ Health Study II (N = 1,077). Autistic traits were measured by the 65-item Social Responsiveness Scale. We estimated odds ratios (OR) for childhood sexual and physical/emotional abuse and PTSD symptoms by quintiles of autistic traits. We examined possible mediation of PTSD risk by abuse and trauma type. Women in the highest versus lowest quintile of autistic traits were more likely to have been sexually abused (40.1% versus 26.7%), physically/emotionally abused (23.9% versus 14.3%), mugged (17.1% versus 10.1%), pressured into sexual contact (25.4% versus 15.6%) and have high PTSD symptoms (10.7% versus 4.5%). Odds of PTSD were elevated in women in the top three quintiles of autistic traits compared with the reference group (OR range = 1.4 to 1.9). Childhood abuse exposure partly accounted for elevated risk of PTSD in women with autistic traits. We identify for the first time an association between autistic traits, childhood abuse, trauma victimization, and PTSD. Levels of autistic traits that are highly prevalent in the general population are associated with abuse, trauma and PTSD.     

School enrollment among urban non-slum,slum and rural children in Kenya: Is the urban advantage eroding?

For long now, the urban child has been considered to be more likely than his/her rural counterpart in being able to realize the dream of fully participating in school. This observation has mainly been attributed to what is commonly known as the “urban advantage”. This “urban advantage” is associated with increased access to facilities such as schools in urban areas. Recent work documenting population health in urban and rural areas has however begun to suggest that some sections of the urban population do not benefit from the “urban advantage”. For example, a child in the slums of Nairobi is more likely to suffer from diarrhea than a child in rural Kenya. In addition, a child from the richest household in the slums is more likely to suffer from diarrhea than a child from the poorest family in rural Kenya. This paper explores patterns of school enrollment comparing urban slum, urban non-slum and rural children. The paper uses data from the Kenya Demographic and Health Survey (KDHS) for 1993, 1998 and 2003. A contrast with school enrollment in Nairobi slums is done using the KDHS-type Nairobi Cross Sectional Slum Survey for 2000. Data from focus group discussions collected in the slums of Nairobi provide the context for discussion. The results suggest that school enrollment is higher in urban non-slum than in urban slum areas, and is higher in slums than in rural areas at younger ages. However, this is only true up to age 9 for females and 11 for males, from which school enrollment for slum children declines and the rate of decline is faster than among their rural counterparts. The corresponding ages at which the enrollment among the rural children begins to visibly decline are 13 years for males and 14 years for females. Factors contributing to these results point to the poor quality of primary schools in slums, limited access to secondary school for slum children, increased vulnerability to coercion into sexual activity and other ills that hinder school participation, disabling environment at home and increased child labor.     

The relationship between parental involvement and adequate yearly progress among urban,suburban, and rural schools

Using national data from the 2007–08 School and Staffing Survey, we compared the relationships between parental involvement and school outcomes related to adequate yearly progress (AYP) in urban, suburban, and rural schools. Parent-initiated parental involvement demonstrated significantly positive relationships with both making AYP and staying off the category of schools in need of mandatory improvement across urban, suburban, and rural schools, whereas school-initiated parental involvement demonstrated significantly negative relationships with both outcomes across urban and suburban schools. We tested school website as a way of communication with parents. Frequency of updates of school website was significantly positive across both outcomes but for urban schools only. We also tested school support for involvement of parents with limited English proficiency (LEP). Provision of translators to parents with LEP was not statistically significant. Provision of translated materials to parents with LEP was significantly positive only on making AYP only for urban schools.