The linkages among childhood maltreatment, adolescent mental health, and self-compassion in child welfare adolescents

Objectives

Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion – a concept of positive acceptance of self. While not applied previously to a child welfare sample, self-compassion may be of value in understanding impairment among maltreatment victims. This may be most pertinent in adolescence and young adulthood, when self-identity is a focal developmental process.

Methods

The present sample was drawn from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study, which followed randomly selected adolescents receiving child protection services across two years within an urban catchment area. Child maltreatment was assessed at baseline using the Childhood Trauma Questionnaire ( [Bernstein et al., 1994] and [Bernstein et al., 2003] ). Mental health, substance and alcohol use problems, suicide attempt, and self-compassion were assessed at the two-year follow-up point. There were 117 youths, aged 16–20 years (45.3% males) who completed the self-compassion scale (Neff, 2003). Bivariate correlations were computed between adolescent self-compassion and each form of self-reported maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect). Finally, hierarchical, stepwise regression was used to examine unique contributions of child maltreatment subtypes in predicting adolescent self-compassion, as well as maltreatment-related impairment.

Results

Higher childhood emotional abuse, emotional neglect, and physical abuse were associated with lower self-compassion. Controlling for age and gender, emotional abuse was significantly associated with reduced self-compassion, even when the effects of emotional neglect and physical abuse were taken into account. Youths with low self-compassion were more likely to have psychological distress, problem alcohol use, and report a serious suicide attempt, as compared with those with high self-compassion. A number of maltreatment-related areas of impairment, identified by screening instruments, were significantly associated with lower self-compassion.

Conclusion

Self-compassion may be a fruitful aspect of research to pursue in an effort to better understand the impact of childhood emotional abuse on adolescent functioning, particularly considering the under-researched group of those receiving child protective services.     

The maltreatment of adolescents

Official reports of maltreatment involving adolescent victims were compared to those involving younger children in a representative sample of protective services' reports drawn from New York State in 1985. Specific case characteristics, including age, gender, ethnicity of the victim, and source of report, are described and their relation to case substantiation is examined. Analyses revealed that adolescents represent a substantial proportion of all victims of official child maltreatment reports. The impact of age on substantiation varied as a function of the type of maltreatment, where for adolescents sexual abuse reports were more likely to be substantiated, while neglect and physical abuse reports were less likely to be substantiated. Reports involving adolescents were significantly more likely to involve a female victim. Significant gender differences in substantiation rate were found only for sexual abuse reports involving adolescents. White children were also found to be under-represented in this sample, while blacks were over-represented relative to their numbers in the population. The impact of minority status on substantiation was significant for neglect and physical abuse reports involving children. The majority of adolescent reports came from mandated sources, which had a significantly higher substantiation rate than reports from non-mandated sources.     

Reflective function mediates the relationship between emotional maltreatment and borderline pathology in adolescents: A preliminary investigation

Deficits in mentalizing, particularly within the context of attachment relationships i.e., reflective function (RF), are posited to result from childhood maltreatment and to influence the development of borderline personality disorder (BPD). Whilst a mentalization-based model of BPD provides a theoretical explanation, direct empirical support for this model, in linking childhood maltreatment to borderline pathology remains limited. This study examined the interrrelationships between childhood maltreatment, RF, and borderline pathology in a mixed adolescent sample, consisting of adolescents with BPD (n = 26) and a group of non-clinical adolescents (n = 25). With the aim of directly testing the mentalization-based model of BPD, we additionally investigated the influence of each form of childhood maltreatment within this developmental pathway. Self-report data supported the hypothesized indirect effect of childhood maltreatment on elevated borderline pathology through lowered RF in adolescents. Both emotional abuse and emotional neglect were found to indirectly influence borderline pathology through adolescent RF, however, only emotional abuse indirectly influenced borderline pathology through RF, after all other maltreatment types were controlled for. Findings support the promotion of mentalization, within attachment-related contexts, as an intervention target for adolescents with borderline pathology and as a potential target of prevention for at-risk children and adolescents with histories of childhood maltreatment, especially emotional abuse. Future research should delineate other underlying mechanisms, independent of RF, which may also link the influence of childhood maltreatment, and in particular, emotional abuse, to BPD.     

Childhood history of abuse and child abuse potential in adolescent mothers: a longitudinal study

OBJECTIVES: The purpose of this research was to determine whether adolescent mothers of newborns are at higher risk for child abuse than adult mothers of newborns and to examine whether adolescent mothers with memories of child maltreatment have a higher risk for child abuse. METHOD: Two groups (adolescents and adults) of pregnant mothers were followed for 20 months beginning between the 5th and the 7th month of pregnancy until the child was 18 months old. Adolescent (N = 24) and adult (N = 24) mothers were matched on sociodemographic variables. During pregnancy, memories of child maltreatment were evaluated. When child was 1, 6, 12, and 18 months old, risk for child abuse was evaluated. RESULTS: Adolescent and adult mothers showed no differences in memories of childhood physical or emotional abuse. Nevertheless, adolescent mothers showed higher child abuse potential and depression scores than adult mothers. Mothers with memories of severe physical punishment showed higher child abuse potential scores and mothers with memories of physical punishment producing physical damage showed higher child abuse potential and depression scores. A statistically significant age of the mother by physical punishment producing physical damage interaction was found for depression. CONCLUSIONS: The results of this longitudinal study indicated that the potential for abuse was significantly greater in adolescent mothers than in adult mothers, and in mothers who had been victims of physical abuse than in those who had not. It also appeared that, among adolescent mothers, those who had been victims of childhood physical abuse constitute a higher risk group for child physical abuse.     

The predictive impact of domestic violence on three types of child maltreatment

OBJECTIVE: This exploratory study investigated the co-occurrence of domestic violence and three types of child maltreatment: physical child abuse, psychological child abuse, and child neglect. METHOD: A sample of 2544 at-risk mothers with first-born children participated in a home-visiting child abuse prevention program. A longitudinal design using multiple data collection methods investigated the effect of domestic violence during the first 6 months of child rearing on confirmed physical child abuse, psychological child abuse, and child neglect up to the child's first 5 years. RESULTS: Logistic regressions revealed significant relationships between domestic violence and physical child abuse, psychological child abuse, and child neglect. These effects were significant beyond the significant effects of known risks of maltreatment, as measured by the Kempe Family Stress Inventory (KFSI). Domestic violence occurred in 59 (38%) of the 155 cases of confirmed maltreatment. Domestic violence preceded child maltreatment in 46 (78%) of the 59 cases of co-occurrence, as indicated by independent home observations and child protective service records. CONCLUSIONS: The findings indicate that domestic violence during the first 6 months of child rearing is significantly related to all three types of child maltreatment up to the child's fifth year. Domestic violence and risks factors measured on the KFSI continue to contribute to all three types of maltreatment up to the child's fifth year. Prevention programs would be wise to provide services to at-risk families until the child is at least 5 years old. Addressing concurrent problems during treatment may enhance intervention.     

Differential correlates of multi-type maltreatment among urban youth

OBJECTIVE: The aim of this study was to examine the differential effects of multi-types of maltreatment in an adolescent sample. Different combinations of maltreatment (emotional, sexual, physical, neglect) were examined in relation to both negative affect and externalizing symptoms in male and female youth. METHOD: One thousand four hundred fifty-two middle and high school youth were recruited from urban schools and a mandated early warning truancy program. Youth completed an anonymous survey that included measures of child maltreatment, depression, suicide proneness, hopelessness, delinquency, hostility, substance use, and promiscuity. Respondents were categorized into groups of different combinations of maltreatment by their reports of sexual abuse, physical abuse, neglect (emotional and physical), and emotional abuse. RESULTS: Nearly two-thirds of boys and girls reported some form of maltreatment, and multi-type maltreatment was common (e.g., 13% reported experiencing both physical and sexual abuse and neglect). Individuals with maltreatment histories were more depressed (F=52.78, p<.0001), suicide prone (F=24.29, p<.001), and hopeless (F=32.07, p<.0001) than non-abused individuals. Maltreated adolescents were also more hostile (F=35.03, p<.0001), and they engaged in more delinquent behavior (F=26.76, p<.0001), promiscuity (F=8.54, p<.0001), and drug and alcohol use (F=9.61, p<.0001). Individuals experiencing multi-type maltreatment were the most symptomatic, particularly youth with histories of physical abuse, sexual abuse, and neglect. In general, gender differences in effects were not observed. CONCLUSIONS: The results highlight the importance of studying combined types of maltreatment, as well as understanding the particularly deleterious effects of neglect and emotional abuse. The results are generally consistent with an additive model of maltreatment effects.     

Cumulative stress and substantiated maltreatment: the importance of caregiver vulnerability and adult partner violence

OBJECTIVE: Our goal is to assess the effect of caregiver vulnerabilities, singly and in combination, on the substantiation of child abuse (physical, sexual) and neglect, while controlling for relevant background variables. We test the moderator role of adult partner violence in qualifying the relationship between caregiver vulnerabilities and maltreatment substantiation. METHOD: Secondary analyses of the 1998 Canadian Incidence Study of Reported Child Maltreatment (CIS) are used to predict child protective service investigation substantiation versus non-substantiation from a range of caregiver vulnerability factors. Involvement in partner violence was examined as a moderator in the relation between caregiver vulnerabilities and maltreatment substantiation. The CIS is an epidemiological survey of first-reported cases to child protective services, using a random sample of child welfare agencies across Canada. Child welfare workers completed a research form on the child, primary caregiver, family, perpetrator, severity and type of maltreatment, as well as services and court outcomes. All maltreatment classifications were assigned according to the Canadian legal definition of child abuse and neglect. Hierarchical logistic regression analyses were used, with stepped entry of: (1) demographic factors, socioeconomic disadvantage, and caregiver's own history of maltreatment; (2) caregiver vulnerability factors; (3) involvement in partner violence; (4) the interaction between caregiver vulnerability and partner violence. RESULTS: Caregiver substance abuse was found to be the single most potent kind of caregiver vulnerability in predicting maltreatment substantiation. When the total number of vulnerabilities was used as the predictor, prediction across all types of maltreatment increased, especially for substantiated neglect. Analyses also showed that the presence of partner violence in the home exacerbated the effect of caregiver vulnerability on substantiation. CONCLUSIONS: The total number of caregiver vulnerabilities was the best predictor of the substantiation of child abuse and neglect. This relationship was moderated by the existence of partner violence: high caregiver vulnerability and high partner violence increased the likelihood of substantiation versus non-substantiation. These results suggest that caregiver issues should be considered in tandem with partner relationships. Among child welfare cases, caregiver vulnerability and partner violence are critical targets for child maltreatment prevention and early child protective services intervention.     

Childhood maltreatment and Chinese adolescents’ bullying and defending: The mediating role of moral disengagement

In the present study, we tested the mediating role of moral disengagement in the effect of childhood maltreatment on bullying and defending. We also examined whether the mediating effect of moral disengagement differed between girls and boys, early and middle adolescents, as well as only and non-only children. Five hundred and fifty-two Chinese adolescents participated in this study. The results indicated that the prevalence rates of physical abuse, physical neglect, emotional abuse, and emotional neglect were 4.0%, 40.0%, 10.5%, and 27.9%, respectively. Path analysis showed that moral disengagement partially mediated the relation between childhood maltreatment and bullying, but did not mediate the relation between childhood maltreatment and defending. Moreover, multi-group analyses indicated that no significant path in the final model differed by gender. However, early adolescents exposed to high levels of childhood maltreatment were more likely to engage in bullying and less likely to engage in defending than middle adolescents, and early adolescents with high levels of moral disengagement were more likely to engage in bullying than middle adolescents. Compared to non-only children, only children exposed to high levels of childhood maltreatment were more likely to score higher on moral disengagement and less likely to engage in defending.     

Childhood abuse and neglect and adult intimate relationships: a prospective study

OBJECTIVE: The present study extends prior research on childhood maltreatment and social functioning by examining the impact of early childhood physical abuse, sexual abuse, and neglect on rates of involvement in adult intimate relationships and relationship functioning. METHOD: Substantiated cases of child abuse and neglect from 1967 to 1971 were matched on gender, age, race, and approximate family class with non-abused and non-neglected children and followed prospectively into adulthood. Between 1989 and 1995, 1,196 participants (676 abused and neglected and 520 controls) were administered a 2-hour in-person interview, including a psychiatric assessment and a variety of standardized rating scales. RESULTS: Male and female abuse and neglect victims reported higher rates of cohabitation, walking out, and divorce than controls. Abused and neglected females were also less likely than female controls to have positive perceptions of current romantic partners and to be sexually faithful. CONCLUSIONS: Although previous research on childhood maltreatment and adult intimate relationships has emphasized outcomes for female victims of childhood sexual abuse, present findings suggest that other forms of early maltreatment (physical abuse and neglect) also have a negative effect on both males' and females' ability to establish and maintain healthy intimate relationships in adulthood.     

Association between maltreatment and polydrug use among adolescents

Different studies have related sexual and physical abuse during childhood and adolescence to the development of substance abuse disorders. Nevertheless, we are not aware of the role that other more common maltreatment types, such as neglect, will play among the most risky pattern of consumption: the polydrug use. A clinical sample of 655 adolescents, divided into two groups: polydrug users and non-polydrug users, were assessed on their pattern of drug consumption, history of childhood maltreatment, current psychopathology and their family history of alcoholism. Polydrug users had a greater prevalence of all types of maltreatment, although the most associated to this group were sexual abuse and emotional neglect. Other relevant variables to adolescent consumption were: the diagnosis of depressive disorder, the presence of anxiety traits and the family history of alcohol dependence. Polydrug users have higher risks of having had problems during infancy and adolescence, such as maltreatment and other psychopathological conditions, with the addition of family history of alcoholism. Accordingly, practitioners should take into account that those variables may influence polydrug abuse because it is the most risky pattern for subsequent dependence of substances, and they should always be considered during treatment.     

The relation of emotional maltreatment to early adolescent competence: Developmental processes in a prospective study

ObjectivesThis investigation examined developmental pathways between childhood emotional maltreatment and adaptational outcomes in early adolescence. This study utilized a developmental psychopathology perspective in adopting a multidimensional approach to the assessment of different forms of emotional maltreatment and later adjustment outcomes. Specifically, emotional abuse (i.e., verbal criticism, hostility) and emotional neglect (i.e., psychological unavailability) were compared using a process-level analytic approach to examine if and how different forms of emotional maltreatment would contribute to adolescent adjustment via aggression and social withdrawal in middle childhood.MethodsThe current study sample is drawn from a longitudinal, prospective study of a high-risk community sample (N = 196), incorporating a multi-method and multi-informant design. Multiple mediator models were tested via bootstrapping regression techniques.ResultsBivariate correlations revealed that both emotional neglect and emotional abuse were associated with increased aggression and social withdrawal in middle childhood, and lower ratings of socioemotional competence in early adolescence. However, the mediational model, which controlled for child gender and concurrent physical and sexual maltreatment, was only significant for the contribution of emotional abuse to lower adolescent competence via social withdrawal in middle childhood. Post hoc analyses revealed that this association was only significant for boys.ConclusionsWhile social withdrawal in middle childhood significantly explained the observed relation between emotional abuse and decreased competence in adolescence, this process did not emerge as salient in understanding the relation between emotional neglect and adolescent adaptation. Furthermore, these developmental processes appeared to vary by gender. The results are in need of replication and extension to other outcome domains, but represent an important contribution to the empirical study of specific forms of emotional maltreatment.Practice implicationsEmotional maltreatment is generally overlooked and unrecognized as compared to physical or sexual forms of maltreatment. This study adds to the accumulating empirical evidence that the effects of emotional maltreatment are disabling, enduring, and should be carefully assessed by clinicians. Furthermore, this assessment should specify the particular form of emotional maltreatment that has occurred, as the results of the study indicate that developmental processes and adjustment outcomes may vary according the type of emotional maltreatment (i.e., emotional abuse, emotional neglect) that is experienced. Finally, clinicians must recognize that a single maltreatment type may vary in its impact on subsequent adjustment, as significant gender differences emerged in the current study that point to the role of individual differences that warrant further investigation.     

Effects of academic performance on the relationship between child maltreatment and deviant behavior: A national study in Taiwan

BackgroundChild maltreatment has been found to significantly increase the risk of deviant behavior. Academic performance has been shown to have an indirect effect on the relationship between child maltreatment and deviant behavior. However, not all adolescents who have been maltreated engage in deviant behavior, so the relationship between child maltreatment and deviant behavior has remained unclear.ObjectiveThe aim of this research was to examine the potential mediating and/or moderating effects of academic performance on the relationship between child maltreatment and deviant behavior.Participants and settingThe data in this study were from a nationwide study examining the consequences of childhood maltreatment in Taiwan. The database consisted of data from 2321 adolescents.MethodsA secondary data analysis was conducted. Self-report data were obtained on childhood maltreatment experiences, academic performance, and deviant behaviors. Path analyses and a generalized linear model were used to examine the effects of academic performance on the relationship between child maltreatment and deviant behavior.ResultsMost participants were male (61.4%), with a mean age of 15.9 years. The mean scores of self-rated academic performance and deviant behavior were 2.86 and 8.2, respectively. A total of 83% participants reported having experienced childhood maltreatment. In this study, academic performance was found to have a moderating rather than a mediating effect on the relationship between child maltreatment and deviant behavior. Among adolescents who had been maltreated during childhood, those who self-rated poorer academic performance were more likely to have a higher deviant behavior score than those who self-rated better academic performance.ConclusionsGood academic performance can be a buffer that reduces the risk of deviant behavior among individuals with a history of childhood maltreatment. Healthcare professionals and educators can tailor early prevention and intervention educational programs targeted toward adolescents with experience of childhood abuse or poor academic performance to prevent the incidence of deviant behavior and thus break the cycle of violence.     

Childhood adversity and behavioral health outcomes for youth: An investigation using state administrative data

This study aimed to measure the relative contribution of adverse experiences to adolescent behavioral health problems using administrative data. Specifically, we sought to understand the predictive value of adverse experiences on the presence of mental health and substance abuse problems for youth receiving publicly funded social and health services. Medicaid claims and other service records were analyzed for 125,123 youth age 12–17 and their biological parents. Measures from administrative records reflected presence of parental domestic violence, mental illness, substance abuse, criminal justice involvement, child abuse and/or neglect, homelessness, and death of a biological parent. Mental health and substance abuse status of adolescents were analyzed as functions of adverse experiences and other youth characteristics using logistic regression. In multivariate analyses, all predictors except parental domestic violence were statistically significant for substance abuse; parental death, parental mental illness, child abuse or neglect and homelessness were statistically significant for mental illness. Odds ratios for child abuse/neglect were particularly high in both models. The ability to identify risks during childhood using administrative data suggests the potential to target prevention and early intervention efforts for children with specific family risk factors who are at increased risk for developing behavioral health problems during adolescence. This study illustrates the utility of administrative data in understanding adverse experiences on children and the advantages and disadvantages of this approach.     

The maltreated adolescent: patterns of physical abuse

Although adolescents are severely and chronically physically abused, relatively little attention has been directed towards understanding this phenomenon. This study explored the family characteristics and the behavioral-emotional reactions of 77 adolescents who were physically maltreated. The youths were selected at a number of sites including a runaway shelter, a hospital-based child abuse team, and a protective service unit. Six different patterns of adolescent reaction to abuse were identified: acting-out, depression, generalized anxiety, extreme adolescent adjustment, emotional-thought disturbance, and helplessness-dependency. Abuse toward these youth had been ongoing for an average of nearly five years. As there were no differences in family characteristics and emotional-behavioral reactions between subjects who were abused only during adolescence (including single-incident abuse) and subjects for whom family violence was evident from childhood on, the utility of a developmentally specific system of abuse categorization is questioned. It is suggested that it is the pattern of parent and child interaction rather than the course of the maltreatment that is related to the emotional and behavioral dysfunction of the adolescent victim.     

Adaptation and psychometric properties of the ISPCAN Child Abuse Screening Tool for use in trials (ICAST-Trial) among South African adolescents and their primary caregivers

Child abuse prevention research has been hampered by a lack of validated multi-dimensional non-proprietary instruments, sensitive enough to measure change in abuse victimization or behavior. This study aimed to adapt the ICAST child abuse self-report measure (parent and child) for use in intervention studies and to investigate the psychometric properties of this substantially modified tool in a South African sample. First, cross-cultural and sensitivity adaptation of the original ICAST tools resulted in two preliminary measures (ICAST-Trial adolescents: 27 items, ICAST-Trial caregivers: 19 items). Second, ICAST-Trial data from a cluster randomized trial of a parenting intervention for families with adolescents (N = 1104, 552 caregiver-adolescent dyads) was analyzed. Confirmatory factor analysis established the hypothesized 6-factor (adolescents) and 4-factor (caregivers) structure. Removal of two items for adolescents and five for caregivers resulted in adequate model fit. Concurrent criterion validity analysis confirmed hypothesized relationships between child abuse and adolescent and caregiver mental health, adolescent behavior, discipline techniques and caregiver childhood abuse history. The resulting ICAST-Trial measures have 25 (adolescent) and 14 (caregiver) items respectively and measure physical, emotional and contact sexual abuse, neglect (both versions), and witnessing intimate partner violence and sexual harassment (adolescent version). The study established that both tools are sensitive to measuring change over time in response to a parenting intervention. The ICAST-Trial should have utility for evaluating the effectiveness of child abuse prevention efforts in similar socioeconomic contexts. Further research is needed to replicate these findings and examine cultural appropriateness, barriers for disclosure, and willingness to engage in child abuse research.     

The mitigating effects of maternal social support and paternal involvement on the intergenerational transmission of violence

Childhood maltreatment is a strong risk factor for subsequent violence, including violent behaviors in young adulthood and offspring maltreatment after becoming a parent. Little is known about the specific circumstances under which supportive relationships may help disrupt this cycle of violence throughout the life course. We conducted two complementary analyses to assess whether maternal social support in early childhood, and also paternal involvement in middle childhood, could prevent the intergenerational transmission of violence, using data from the Avon Longitudinal Study of Parents and Children (n = 11,384). We found that higher levels of maternal social support in the postpartum period reduced the odds of offspring maltreatment at ages 0–8 years (OR = 0.95, 95% CI 0.93–0.96). When classifying mothers according to their abuse history, this protective association of social support was observed among mothers with no history of childhood maltreatment and among those with only childhood maltreatment (and not postpartum intimate partner violence [IPV]), but not among mothers who reported IPV since the child’s birth. We then extended our analysis of these offspring forward in time and found that paternal involvement at ages 9–10 years was associated with a reduced risk of offspring self-reported violent perpetration at ages 18–20 years (OR = 0.85, 95% CI = 0.77–0.94). This protective association was generally apparent among all subgroups of children, including those with a history of childhood maltreatment. Together these results highlight the protective influence of supportive relationships against the intergenerational transmission of violence, depending on abuse history, context, and timing, with important implications for the prevention of childhood maltreatment and mitigation of its negative effects.     

Longitudinal examination of peer and partner influences on gender-specific pathways from child abuse to adult crime

Research provides increasing evidence of the association of child abuse with adult antisocial behavior. However, less is known about the developmental pathways that underlie this association. Building on the life course model of antisocial behavior, the present study examined possible developmental pathways linking various forms of child abuse (physical, emotional, sexual) to adult antisocial behavior. These pathways include child and adolescent antisocial behavior, as well as adulthood measures of partner risk taking, warmth, and antisocial peer influences. Data are from the Lehigh Longitudinal Study, a prospective longitudinal study examining long-term developmental outcomes subsequent to child maltreatment. Participant families in the Lehigh Longitudinal Study were followed from preschool age into adulthood. Analyses of gender differences addressed the consistency of path coefficients across genders. Results for 297 adult participants followed from early childhood showed that, for both genders, physical and emotional child abuse predicted adult crime indirectly through child and adolescent antisocial behavior, as well as adult partner and antisocial peer influences. However, for females, having an antisocial partner predicted an affiliation with antisocial peers, and that in turn predicted adult crime. For males, having an antisocial partner was associated with less partner warmth, which in turn predicted an affiliation with antisocial peers, itself a proximal predictor of adult crime. Sexual abuse also predicted adolescent antisocial behavior, but only for males, supporting what some have called “a delayed-onset pathway” for females, whereby the exposure to early risks produce much later developmental outcomes.     

Associations between types of maltreatment and substance use during adolescence

OBJECTIVE: The aim of this study was to investigate associations between four categories of maltreatment and substance use among adolescents. METHOD: All 10th through 12th graders n = 2,187) at six public high schools in a rural Oregon county filled out an anonymous survey that included questions about their experience of emotional, sexual, and physical abuse and their use of a variety of substances. Substance use was subsequently categorized as: (1) tobacco use, (2) alcohol use, and (3) illicit drug use. Experience of maltreatment was subsequently categorized as: (1) no type of maltreatment, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, and (5) sexual and physical abuse. RESULTS: Results showed that all four categories of maltreatment were associated with increased levels of all three categories of substance use. Statistical comparisons of the magnitude effects of different types of maltreatment on substance use indicated a linear trend with the effects of emotional abuse being significantly lower than those of physical or sexual abuse, and the effects of the combination of physical and sexual abuse being significantly higher than the other types. CONCLUSION: Results suggested that all types of maltreatment, including emotional abuse, are related to significantly higher levels of substance use and should be considered serious risk factors for substance use during adolescence. Results also indicated that the strength of association between maltreatment and substance use varies by type of maltreatment. Youth who have experienced both physical and sexual abuse are at especially high risk of substance use.     

Child maltreatment as a risk factor for opioid dependence: Comparison of family characteristics and type and severity of child maltreatment with a matched control group

ObjectiveTo examine the prevalence, characteristics and risk factors for child maltreatment among opioid-dependent persons compared to a community sample of similar social disadvantage.MethodThe study employed a case-control design. Cases had a history of opioid pharmacotherapy. Controls were frequency matched to cases with regard to age, sex and unemployment and were restricted to those with a lifetime opioid use of less than five times. The interview covered child maltreatment, family environment, drug use and psychiatric history.ResultsThis study found a high prevalence of child maltreatment among both cases and controls. Despite the elevated prevalence among controls, opioid-dependent males had a higher prevalence of physical and emotional abuse; female cases had a higher prevalence and greater severity of sexual abuse. The prevalence of neglect was similar for both groups. Early parental separation was more prevalent among female cases compared to female controls; otherwise the prevalence of the risk factors was comparable for both groups. The risk factors significantly associated with child maltreatment were also similar for both cases and controls.ConclusionsGiven the documented association between child maltreatment and adult mental disorder, child maltreatment may be an important antecedent of current psychological distress in persons presenting to treatment for opioid dependence. Apart from a possible association between early parental separation and sexual abuse among female cases, the increased prevalence of child maltreatment associated with opioid dependence did not appear to be related to differences in early childhood risk factors considered in this paper. Other risk factors may be more pertinent for those with opioid dependence.Practice implicationsThe high prevalence of child maltreatment among the opioid-dependent sample has implications for the assessment and treatment of clients presenting with opioid dependence. Assessment of child maltreatment history could help inform the development of individual treatment plans to better address those factors contributing to the development and maintenance of opioid dependence. Specifically, management of co-morbid mental disorder associated with child maltreatment could be the focus of relapse prevention programmes and also have a positive influence on treatment retention.     

Gender-specific outcomes for sexually abused adolescents

This study examined the gender differences in outcomes related to school performance, suicidal involvement, disordered eating behaviors, sexual risk taking, substance use, and delinquent behaviors of male (n = 370) and female teenagers (n = 2,681) who self-reported a history of sexual abuse. It was found that female adolescents, by and large, engaged in internalizing behaviors and males in externalizing behaviors. Male adolescents were found to be at higher risk than females in poor school performance, delinquent activities, and sexual risk taking. Female adolescents, on the other hand, showed higher risk for suicidal ideation and behavior as well as disordered eating. Females showed more frequent use of alcohol. However, male adolescents exhibited more extreme use of alcohol and more frequent and extreme use of marijuana. Among index female adolescents, protective factors against adverse correlates included a higher emotional attachment to family, being religious or spiritual, presence of both parents at home, and a perception of overall health. Factors that augmented adverse correlates for them included a stressful school environment due to perceived high levels of substance use in and around school, worry of sexual abuse, maternal alcohol consumption, and physical abuse. For male adolescents, maternal education and parental concern appeared to be protective factors.