Polyvictimization: Latent profiles and mental health outcomes in a clinical sample of adolescents

Polyvictimization Profiles and Variations in Youth Mental Health Symptoms: A Person-Centered Approach

Polyvictimization, exposure to multiple potentially traumatic events (PTEs), is prevalent and has profound mental health implications. Investigating the patterns and impact of co-occurring PTEs during childhood is essential to design and deliver tailored clinical services. This study included a diverse community sample of 326 youth (ages 7-16). Latent class analysis (LCA) of DSM-5 posttraumatic stress disorder (PTSD) criterion A events was conducted to identify PTE classes. Classes were further characterized using race-related, peer, and dating victimization, and psychopathology symptoms (PTSD, anxiety, depression). Three classes emerged: (1) low trauma, (2) interpersonal and community violence (IPV/CV), and (3) emotional abuse, neglect, and interpersonal violence in familial relationships (EA/N/IPVFam). Demographics, total PTEs, age at first exposure, race-related events, PTSD, anxiety, and depression symptoms varied across classes, indicating functional significance of identified profiles. Results underscore the importance of considering PTE profiles and person-centered approaches to understand and address trauma-related sequelae in youth.

Unethical Work Polyvictimisation, Employee Well-Being, and Work Stress

Unethical behaviours have a wide-ranging negative influence in the workplace, including adverse effects on individuals who witness or are subjected to such acts. While research has explored the effects of various misbehaviours on employee well-being, this study draws from ethical impact theory and utilizes data from a panel sample of business professionals to examine the relationship between unethical work polyvictimisation, encompassing varied misbehaviours, and aggregated individual well-being and work stress. Most of the hypotheses were supported, with results indicating that unethical work polyvictimisation was negatively related to two conceptualisations of well-being. Unethical work polyvictimisation was also positively related to work stress, which functioned as a mediator and was negatively related to well-being. The findings suggest that organisations should reduce incidences of polyvictimisation to improve employee well-being and decrease their work stress.

Dissociation As a Mechanism of Risk for Interpersonal Victimization Among Adolescent Girls

Childhood interpersonal violence exposure (IVE) is associated with repeated victimization in adolescence and adulthood. Research suggests dissociation, a psychological phenomenon characterized by alterations and disruptions to consciousness, memory, and perceptions of the environment, and out-of-body experiences, increases the risk of revictimization. Self-report data from a longitudinal study of 92 violence-exposed adolescent girls from a large, urban area were analyzed to assess whether dissociation predicts polyvictimization or exposure to multiple types of interpersonal violence across adolescence. Participants' mental and interpersonal health was assessed at four in-person laboratory visits scheduled across 3.5 years (i.e., T1-T4). IVE included direct or indirect victimization experienced at home, school, the neighborhood, or town, such as child maltreatment, domestic violence, peer victimization, dating aggression, and community violence. Polyvictimization was operationalized as a composite score of the different types of IVE endorsed by the participant or caregiver. A random-intercept cross-lagged panel model was used to test the bidirectional relationships between dissociation and polyvictimization longitudinally. Cross-lagged regressions were analyzed to determine whether dissociation and polyvictimization predicted subsequent dissociation symptoms and polyvictimization. Concurrent and previous dissociation significantly accounted for polyvictimization at T2, T3, and T4. Polyvictimization did not significantly predict future dissociation symptoms. The results from this study provide support for dissociation's unique contribution to polyvictimization among violence-exposed girls, making it an important target for clinical assessment and treatment.

Adverse Childhood Experiences among Adolescent Girls in Residential Treatment: Relationship with Trauma Symptoms, Substance Use, and Delinquency

Adverse childhood experiences (ACEs) are negative events during childhood or adolescence, including abuse and maltreatment. ACEs are associated with negative life outcomes, and the risk of such outcomes increases when polyvictimization (i.e., multiple types of ACEs) occurs. This study identified patterns in ACEs among girls in a residential treatment program (RTP) and examined how these patterns were associated with trauma symptoms, substance use, and delinquent behavior. Data were coded from psychological assessment records for girls ages 13 to 18 who entered the RTP between 2017 and 2021 (N = 256). Adolescents identified as 43.0% White, 20.9% Biracial/Multiethnic, 16.7% Black, 12.5% Hispanic/Latina, 4.2% Native American/Indigenous Peoples, and 2.7% Middle Eastern/North African descent. Participants reported an average of 5.08 adverse experiences (SD = 2.47). Four distinct classes were identified through latent class analysis: polyvictimization (endorsing all 10 ACEs), abuse and non-support (maltreatment and lack of parental support), household dysfunction (parental separation, incarceration, substance use), and low adversity (exposure to only parental separation). The polyvictimization class and the abuse and non-support class reported higher levels of trauma symptoms compared to the low adversity class. The polyvictimization class reported higher substance use compared to the low adversity class. The household dysfunction class reported higher substance use and higher delinquent behaviors compared to the low adversity class. These findings provide a deeper understanding of adolescent girls' experiences of ACEs and mental health and behavioral concerns when entering residential treatment, which helps to inform prevention, intervention, and policy.

Interpersonal violence moderates sustained-transient threat co-activation in the vmPFC and amygdala in a community sample of youth

The increased risk for psychopathology associated with interpersonal violence exposure (IPV, e.g., physical abuse, sexual assault) is partially mediated by neurobiological alterations in threat-related processes. Evidence supports parsing neural circuitry related to transient and sustained threat, as they appear to be separable processes with distinct neurobiological underpinnings. Although childhood is a sensitive period for neurodevelopment, most prior work has been conducted in adult samples. Further, it is unknown how IPV exposure may impact transient-sustained threat neural interactions. The current study tested the moderating role of IPV exposure on sustained vmPFC-transient amygdala co-activation during an fMRI task during which threat and neutral cues were predictably or unpredictably presented. Analyses were conducted in a sample of 212 community-recruited youth (M/SDage = 11.77/2.44 years old; 51.9% male; 56.1% White/Caucasian). IPV-exposed youth evidenced a positive sustained vmPFC-transient amygdala co-activation, while youth with no IPV exposure did not show this association. Consistent with theoretical models, effects were specific to unpredictable, negative trials and to exposure to IPV (i.e., unrelated to non-IPV traumatic experiences). Although preliminary, these findings provide novel insight into how childhood IPV exposure may alter neural circuity involved in specific facets of threat processing.

Rethinking Lifetime Abuse in Old Age

Research on abuse is often piecemeal and focused on specific forms, populations, and social situations. As a result, these studies tend to ignore the web of abuse resulting from the interactive effects of various forms of abuse over the life course, together referred to as "lifetime abuse." An examination of abuse from the point of view of older adults is likely to provide a lifetime perspective based on linking child abuse to elder abuse over the life course and an assessment of its consequences. Despite the growing awareness and resulting body of knowledge regarding this phenomenon, proposed theoretical formulations about it remain limited. The present article aimed to conceptualize the multifaceted phenomenon of lifetime abuse and to gain a deeper perspective of the topic by understanding its dimensions, meanings, and experiences in older age, based on a critical review of empirical studies. A model is suggested, which can be useful for future exploration and understanding of lifetime abuse. Based on a critical review of previous studies, we suggest a theoretical framework of lifetime abuse from the perspective of older adults, identifying three key domains: (a) perception of time and life review in old age; (b) cumulative and interactive abusive life events; and (c) resilience versus vulnerability over the life course. We propose a heuristic model to explore and understand lifetime abuse. We believe our proposed model is open to reflection and elaboration and is intended to raise questions that could enhance the need for our understanding of lifetime abuse in old age.

Operational Definitions of Poly-Victimization: A Scoping Review

Throughout the last two decades, research on poly-victimization (PV) has evolved from examinations of a core set of past-year victimization types in youth samples to investigations of a broad range of victimization types experienced during variable time intervals in diverse samples of varying ages. As the concept of PV expands, greater clarity regarding the definition and measurement of PV is needed to advance understanding of its risk and protective factors as well as its associated outcomes. This scoping review aimed to (a) identify approaches used to operationally define and measure PV across studies and (b) synthesize empirical findings concerning risk factors and outcomes associated with PV. A systematic search of peer-reviewed research published before 2022 across 12 databases yielded 98 studies that met inclusion criteria. Study characteristics including the research design, sample type, victimization timeframe, operational definition(s) of PV, measurement of PV, analytic methods, and key findings were synthesized across studies. Findings indicated that the majority of reviewed studies were cross-sectional investigations that utilized categorical measures of lifetime PV in samples of youth. Results also demonstrated that PV is robustly associated with a broad range of predictors, including mental health symptoms and diagnoses as well as family- and community-level factors. PV is also associated with numerous adverse outcomes including depression, anxiety, suicidality, substance use, and delinquency across diverse study types and populations. Future research that examines the conditional effects of PV is needed to identify subgroups of individuals at higher risk of adverse outcomes following PV and modifiable targets for interventions.

Patterns of Poly-Victimization Among Early Adolescents: A Latent Class and Two-Wave Latent Transition Analysis

Background

Poly-victimization involves more than just counting incidents; it varies in severity and type among adolescents and can change over time.

Objective

The aim is to identify latent classes of poly-victimization among children in early adolescence, investigate transition probabilities between these latent categories, and examine the influencing factors.

Methods

We used stratified cluster random sampling to select 2275 junior high students from five rural middle schools in Shantou and Jieyang, China, and surveyed them in two waves. Latent Class Analysis (LCA) and Latent Transition Analysis (LTA) identified latent classes of poly-victimization, and multi-factor logistic regression examined factors influencing the probability of students transitioning between these latent classes.

Results

LCA identified three categories of poly-victimization: low poly-victimization, group, and high child maltreatment and peer and sibling victimization. The probabilities of remaining in the high child maltreatment and peer and sibling victimization group, transitioning to the transition group, or shifting to the low poly-victimization group were 37.00%, 29.20%, and 33.80%, respectively. Most transition group members remained in the same group, with a conversion probability of 77.10%, followed by transitioning to the low poly-victimization group with a probability of 15.80%. Physically healthy children, compared to those with disabilities or illnesses, were less likely to switch from the low poly-victimization group to the transition group (OR=0.034) or the high child maltreatment and peer and sibling victimization group (OR=0.14). Non-left-behind children, compared to left-behind children, have a higher probability of switching from the high child maltreatment and peer and sibling victimization group to the low poly-victimization group (OR=6.905).

Conclusion

The high child maltreatment and peer and sibling victimization group had similar probabilities of transitioning into other categories. Physical illness or disability, as well as being left behind, are significant risk factors for children transitioning from the low-harm group to the high-harm group.

Violence against children and later substance use in low- and middle-income countries

BACKGROUND

Globally, one in two children experience violence; experiences which may lead to later risky behaviors such as substance use. In low- and middle-income countries (LMICs), however, the association between childhood violence and substance use remains underexplored.

OBJECTIVE

This study assessed the association between childhood violence and substance use among LMIC youth.

PARTICIPANTS

Data from the Violence Against Children and Youth Surveys (VACS) in eight LMICs (2017-2019) were analyzed, comprising 33,408 children and young adults (ages 13-24).

METHODS

Exposure variables included the experience of childhood violence (physical, sexual, emotional) and polyvictimization (experience of two or more types). Outcomes were current smoking and past-month alcohol and drug use. Multivariable logistic regressions with country-fixed effects were estimated. Stratified analyses were performed based on participant's sex and age, and effect modification analyses examined whether associations differ by the presence of peer support.

RESULTS

Childhood physical violence was the most prevalent type of violence (40.7 %), and about 10 % of the participants experienced polyvictimization. All types of violence increased the odds of smoking, binge drinking, and drug use, and polyvictimization elevated the risk substantially. Stronger associations were observed in young women with a history of childhood sexual violence (current smoking aOR: 1.5, 95 % CI: 1.2-1.9; binge-drinking aOR: 2.1, 95 % CI: 1.7-2.5; and drug-use aOR: 2.3, 95 % CI: 1.5-3.5) compared to young men. Additionally, the associations between childhood sexual violence and substance use were more pronounced among adolescents (current smoking aOR: 1.7, 95 % CI: 1.2-2.2; binge-drinking aOR: 2.3, 95 % CI: 1.8-2.9; and drug-use aOR: 2.4, 95 % CI: 1.5-3.9), relative to young adults. Lack of peer support significantly increased the likelihood of drug use.

CONCLUSION

Childhood violence prevention programs can reduce substance use in LMICs, and they should take into account the survivor's sex and age. Our findings suggest that peer support can mitigate risky behaviors among the survivors of childhood violence.

Toward a Contextually Sensitive Understanding of Polyvictimization: A Latent Class Analysis of Violence, Risks, and Protections Among South African Adolescents From Highly Deprived Settings

South African adolescents experience a high prevalence of violence victimization alongside the health and economic burdens of HIV/AIDS and poverty. Polyvictimization is a useful theory and framework that allows for a nuanced understanding of lived adolescent experience patterns. Polyvictimization examinations are further enriched by person-centered analytical approaches. This study used latent class analysis to differentiate a sample of South African adolescents from highly deprived communities by their polyvictimization profiles and contextual violence risk and protective factors. Adolescents were sampled twice (2010/2011; 2011/2012), and data reflected their lifetime (sexual abuse) or recent (all other forms of assessed abuse/violence) violence victimizations, as well as individual, household, and community characteristics. Model fit indices supported a seven-class model with adolescents in high, moderate, and low polyvictimization classes. Adolescents in the high polyvictimization classes experienced a heavy burden of poverty and multiple forms of violence across contexts and were distinguished by HIV/AIDS and disability. Adolescents in the low polyvictimization class experienced relatively little violence, despite living in violent communities, and low household and individual burdens of HIV/AIDS and disability. Findings emphasize the importance of considering adolescent violence through a contextually sensitive polyvictimization lens to understand the complex web of violence that adolescents experience. This work supports previous research in low-resource South African settings highlighting the interconnected nature of violence, poverty, disability, and HIV/AIDS. Future research should explore these complex violence patterns and their effects, while program and policy actions must target and prevent adolescent violence especially for those impacted by poverty, disability, and HIV/AIDS.

Machine Learning Techniques to Predict Mental Health Diagnoses: A Systematic Literature Review

Introduction

This study aims to investigate the potential of machine learning in predicting mental health conditions among college students by analyzing existing literature on mental health diagnoses using various machine learning algorithms.

Methods

The research employed a systematic literature review methodology to investigate the application of deep learning techniques in predicting mental health diagnoses among students from 2011 to 2024. The search strategy involved key terms, such as "deep learning," "mental health," and related terms, conducted on reputable repositories like IEEE, Xplore, ScienceDirect, SpringerLink, PLOS, and Elsevier. Papers published between January, 2011, and May, 2024, specifically focusing on deep learning models for mental health diagnoses, were considered. The selection process adhered to PRISMA guidelines and resulted in 30 relevant studies.

Results

The study highlights Convolutional Neural Networks (CNN), Random Forest (RF), Support Vector Machine (SVM), Deep Neural Networks, and Extreme Learning Machine (ELM) as prominent models for predicting mental health conditions. Among these, CNN demonstrated exceptional accuracy compared to other models in diagnosing bipolar disorder. However, challenges persist, including the need for more extensive and diverse datasets, consideration of heterogeneity in mental health condition, and inclusion of longitudinal data to capture temporal dynamics.

Conclusion

This study offers valuable insights into the potential and challenges of machine learning in predicting mental health conditions among college students. While deep learning models like CNN show promise, addressing data limitations and incorporating temporal dynamics are crucial for further advancements.

The association between youth violence and mental health outcomes in Colombia: A cross sectional analysis

BACKGROUND

Violence against children and youth poses public health risks regarding mental health symptoms and substance use. Less studied is the relationship between violence and mental health/substance abuse in the Latin American context. This study explored sex-stratified relationships between violence and mental health/substance use among Colombian youth.

METHODS

We analyzed the 2018 Colombian Violence Against Children and Youth Survey, which collected cross-sectional data from Colombian youth (13-24 years) (n = 2705). Exposure variables were (i) binary sexual, emotional, and physical victimization and (ii) poly-victimization. The outcomes were binary suicidal thoughts, self-harm, past-month psychological distress, binge drinking, smoking, and drug use. Sex-stratified, logistic regressions were adjusted for age, primary school, parental presence, relationship status, and witnessing community violence.

RESULTS

For females, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts, self-harm, and psychological distress and (ii) sexual violence was associated with suicidal thoughts and self-harm. For males, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts and psychological distress, but not self-harm and (ii) sexual violence exposure was associated with suicidal thoughts and self-harm. Physical violence was generally not associated with internalized mental health outcomes for females/males, when emotional and sexual violence were held constant. Poly-victimization was consistently and positively associated with internalized mental health symptoms among females, and to a lesser degree for males. Substance use outcomes for males or females were not associated with violence.

CONCLUSIONS

Findings highlight the internalized mental health burden of emotional and sexual violence.

Associations Between Distinct Trauma Classes and Mental Health Care Utilization in Norwegian Adolescents: A National Registry Study

Adolescents who experience potentially traumatic experiences (PTEs) have an increased risk of psychopathology. PTEs often co-occur and may form interrelated patterns of exposure. This study investigated underlying classes of PTE exposure among Norwegian adolescent participants in the youth@hordaland study, and whether such classes were associated with contact with child and adolescent mental health services (CAMHS) and psychiatric diagnoses. The data stem from the population-based youth@hordaland study conducted in 2012 which was linked to the Norwegian Patient Registry (NPR, n = 8845). Exposure to PTEs was assessed by adolescent self-report whereas psychiatric disorders (Axis 1) were derived from the NPR. Latent Class Analysis was used to identify distinct classes of PTE exposure-patterns in the data. Logistic regression analyses were performed to investigate associations between classes of PTEs and contact with CAMHS and psychiatric diagnoses. Three classes of PTE exposure were identified based on model fit indices and theoretical considerations. Compared with participants in the low trauma class (88% of participants), those in the Situational-(6%) and Interpersonal trauma class (6%) had higher odds-ratios (ORs) for contact with CAMHS (OR = 2.27 (95% CI [1.78, 2.87])) and (OR = 3.26 (95% CI [2.61, 4.04])) respectively, and for being diagnosed with a psychiatric disorder in CAMHS (ORs ranged from 2.19 - 10.4) after adjusting for sex and parental education. There were more participants diagnosed with ADHD within the Interpersonal trauma class compared to the Situational trauma class when adjusting for sex and parental education (OR = 2.22 (95% CI [1.17, 4.40])). Three relatively homogeneous PTE classes, consisting of distinct patterns of trauma exposure were associated with a higher odds of contact with CAMHS and of being diagnosed with a psychiatric disorder in CAMHS. The study highlights the co-occurrence of PTEs and their impact across the diagnostic spectrum.

Patterns of Trauma Among Youth Seeking Mental Health Services at a Community-Based Clinic: A Latent Class Analysis Approach

We examine the association between trauma patterns, gender identity, ethnicity, foster care involvement, and mental health needs in a sample of low-income youth. Our community sample included 2,175 clients aged 6 or older (Mage = 11.9), has a closely-even gender ratio (55% female and 45% male and others) and is ethnically diverse (37% Black, 31% Multiracial, 14% Latinx, 9% White, 10% Others). 61% of youth in this sample have involvement with the foster care system. Latent class analysis was used to identify trauma patterns, explore predictors of latent class membership, and estimate the cumulative mental health needs for each trauma class. Results revealed four trauma patterns (Low Trauma, Caregiving Disruption, Community Violence, and Multiple Trauma). Girls were more likely than boys to be in the high-trauma groups. Compared to Black youth, Latinx youth were more likely to be in the Multiple Trauma class, whereas White youth were less likely to be in the high trauma classes. Youth with past or current involvement with the foster care system were more likely than those without to be in the high-trauma classes. Mental health needs for youth in Low Trauma and Caregiving Disruption were comparable, but were highest for those in Community Violence. Contrary to expectation, the Multiple Trauma group did not have the highest-level mental health needs. Interventions for low-income youth can benefit from knowing which trauma patterns are associated with various levels of mental health needs. Newer models of care focusing on building healthy communities may be the way forward.

The longitudinal relationship between social support and victimization among latino teens

PURPOSE

This study examines the relationship between social support and victimization of Latino youth over time, utilizing the stress prevention and support deterioration models.

METHODS

To address the research questions we utilized data from Waves 1 and 2 (n = 574) of the Dating Violence among Latino Adolescents (DAVILA) study, a national bilingual phone survey of self-identified Latino youth and their caregiver. Cross-lagged panel modeling was used to assess the fit of the two theoretical models to observed patterns of covariance among the victimization and social support variables specified.

RESULTS

Results show that victimization at Wave 1 was positively and strongly related to victimization at Wave 2 and social support at Wave 1 was positively and moderately associated with social support at Wave 2. As hypothesized, higher levels of victimization at Wave 1 were significantly related to decreases in social support at Wave 2 (β = -.15). Wave 1 social support was not significantly related to victimization at Wave 2.

CONCLUSIONS

We did not find support for the stress prevention model but did find support for the support deterioration model. Teens who were victimized tended to have lower levels of subsequent social support, highlighting the need to equip peers, family, and significant others to adequately respond to victimization disclosures.

Pathways from Polyvictimization to Offline and Online Sexual Harassment Victimization Among South Korean Adolescents

This study aimed to investigate the association between polyvictimization and offline and online sexual harassment and whether the association might be mediated by internalizing problems, low school satisfaction, and dropping out of school. The analytic sample was derived from the Children and Youth Rights Survey in South Korea. It consisted of 6353 adolescents' responses to the sexual harassment question and a set of other questions in the middle and high school questionnaires. The findings showed a direct association between polyvictimization and offline and online sexual harassment. Adolescents who were polyvictimized were more likely to be victims of both forms of sexual harassment. Furthermore, polyvictimization was positively related to dropping out of school, which was positively associated with offline sexual harassment. The findings from the study have significant implications for future research and practice.

Mapping Individual, Relational, and Contextual Factors onto Posttraumatic Stress Symptoms and Resilience

Posttraumatic stress symptoms (PTSS) and resilience are two well-established outcomes following trauma exposure, but little work has examined the unique associations between these outcomes and factors across the social ecology. This theoretically grounded study assessed how individual, relational, and contextual social ecological factors relate to PTSS and resilience. Participants included 606 college students (18-25 years, M_age = 20.79, SD = 1.86; 82.51% Female; 56.60% White, 29.37% Black or African American, 5.78% Asian, 8.25% Other races) with exposure to at least one traumatic event. Two hierarchical linear regression models examined associations between individual (i.e., emotion dysregulation, anger severity), relational (i.e., family support, friend support), and contextual (i.e., community cohesion, community disorder) factors, and PTSS and resilience. At the individual level, higher emotion dysregulation was associated with higher PTSS and lower resilience; anger severity was not related to either outcome. At the relational level, more friend support was negatively associated with PTSS. Friend and family support were positively related to resilience. At the contextual level, community cohesion was positively associated with resilience, but not PTSS, and community disorder was unrelated to both outcomes. Findings demonstrate unique factors across the social ecology that differentially relate to PTSS and resilience. Variables at all three ecological levels were associated with resilience, whereas only individual and relational variables were related to PTSS. Replication with longitudinal data could inform treatments for trauma-exposed individuals that may mitigate PTSS and bolster resilience.

Relationship between polyvictimization and overweight among adolescents from São Paulo city, Brazil

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (OR_adj: 1.60, 95%CI: 1.01-2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship.

Parallel Process of Posttraumatic Stress and Externalizing Problems Among Youth at High Risk for Victimization

Research shows comorbidity between posttraumatic stress symptoms (PTSS) and externalizing problems among polyvictimized youth. However, the impact of polyvictimization on the longitudinal co-development of PTSS and distinct forms of externalizing problems remains unclear. Growth trajectory modeling was used to address this gap. At ages 8, 12, and 16, polyvictimization was measured using youth, caregiver, and official records; whereas youth self-reported PTSS and caregivers reported aggression and delinquency. Results demonstrate that changes in PTSS and each externalizing domain were independent. Further, polyvictimization and PTSS/aggression were only associated at concurrent time points. In contrast, polyvictimization and delinquency were generally associated at concurrent and distal time points, suggesting that polyvictimization may have a more enduring impact on youths' delinquent behaviors than other symptoms.

The Association Between Patterns of Trauma Exposure, Family Dysfunction, and Psychopathology Among Adolescent Females With Depressive Symptoms From Low-Income Contexts

Distinguishing profiles of trauma exposure among low-income adolescent females with depressive symptoms is important for understanding comorbidity, family relationships, and treatment. Specifically, child maltreatment is essential to examine in comparison to other traumas. Participants included 170 adolescent females (65.3% Black; 21.2% White; 13.5% other race; 14.1% Latina/x) with depressive symptoms and their primary caregiver from low-income families. Latent class analysis (LCA) identified three trauma classes. Probabilities of endorsing different subtypes of maltreatment (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse), number of subtypes of maltreatment, and non-maltreatment traumas (accident, experiencing or witnessing physical assault, death or injury of loved one, medical trauma) varied among groups. Higher levels of family dysfunction and traumatic stress symptoms were reported in both classes with maltreatment exposure as compared to the class with only non-maltreatment trauma exposure. Findings have implications for family-focused interventions for maltreated adolescent females with depressive symptoms from low-income contexts.

PTSD and depressive symptoms in Chinese adolescents exposed to multiple stressors from natural disasters, stressful life events, and maltreatment: A dose-response effect

Objectives

Little is known about the effects and the extent that childhood adversity has on post-traumatic stress disorder (PTSD) and depression.

Study design

A population-based, epidemiological study from the Wenchuan earthquake.

Methods

A total of 5,195 Wenchuan Earthquake adolescent survivors aged 11-18 years from nine high schools in southwest China completed questionnaires that assessed their PTSD and depression symptoms due to childhood maltreatment, stressful life events, and childhood earthquake exposure.

Results

The PTSD and depression prevalences were 7.1 and 32.4%. After controlling for age and gender, the multiple linear regressions revealed that stressful life events had the most significant direct effect on depression (β = 0.491), followed by childhood emotional abuse (β = 0.085), and earthquake exposure (β = 0.077). Similarly, stressful life events (β = 0.583) were found to have more significant direct effects on PSTD, followed by earthquake exposure (β = 0.140); however, childhood emotional abuse was not found to have an effect. The structural equation modeling (SEM) revealed that there were interactions between the three childhood adversities, with all three concurrently affecting both PTSD and depression.

Conclusion

These findings add weight to the supposition that psychological maltreatment, negative life events, and earthquake exposure contribute to PTSD and depression. In particular, the identification of subgroups that have a high prevalence of these childhood adversities could assist professionals to target populations that are at high risk of mental health problems.

The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland

PURPOSE

Childhood trauma (CT) exposure is common, with many young people affected by multiple co-occurring traumas.

METHODS

Participants were a representative sample of 11-19-year-olds (n = 1293), who participated in the largest ever representative survey of youth mental health in Northern Ireland (NI) - the NI Youth Wellbeing Prevalence Survey 2020. This study used latent class analysis (LCA) to identify typologies that were most representative of trauma experience and co-occurrence among young people living in NI. Demographic, parental and deprivation variables were then used within a multinomial logistic regression analysis to describe trauma class membership.

RESULTS

Over 35% (n = 478) of participants reported exposure to at least one CT, with over 50% (n = 259) of trauma-exposed young people reporting multiple trauma exposure. LCA results provided support for a three-class model; 'low-exposure', 'moderate-exposure: community-victimization' and 'high-exposure: sexual-trauma'. While none of the child, parental or familial covariates differentiated members of the 'moderate-exposure: community-victimization' from 'low-exposure', those in 'high-exposure: sexual-trauma' were over four and a half times more likely to belong to a family in receipt of income benefits and over ten times more likely to have experienced some form of out-of-home care.

CONCLUSIONS

This study highlights the presence of three distinct trauma classes in the NI adolescent population. In particular, this study identifies a small minority of young people who have experienced multiple CT's, including sexually based traumas, with these traumas most likely to have occurred in the context of out-of-home care and familial poverty.

The Latent Class Analysis of Adverse Childhood Experiences among Chinese Children and Early Adolescents in Rural Areas and Their Association with Depression and Suicidal Ideation

Exposure to adverse childhood experiences (ACEs) is a global public health concern that is detrimental to the psychological outcomes of Chinese children in rural areas due to the lack of public awareness of ACEs and mental health resources. The objective of this study was to identify the patterns of ACEs and the impact of ACE patterns on depression and suicidal ideation among 4683 students (mean age = 10.08 years, SD = 0.99; 48.17% female students) from 63 elementary schools in rural areas in Guizhou Province, China. Latent class analysis was conducted to identify the best class pattern. A three-step approach was undertaken to explore the association between the class patterns and demographic covariates and depression and suicidal thoughts. An overall three-class pattern of ACEs was identified, which was: (1) high ACEs, (2) high verbal abuse and emotional neglect and low household dysfunction, and (3) low ACEs. The results also showed that children in the high ACEs class tended to show higher depression rates and more frequent suicidal ideation across the three groups. Being female and younger and having a lower socioeconomic status were risk factors. Our study identified a class pattern that was not found in previous research, which is high verbal abuse and emotional neglect and low household dysfunction.

Polyvictimization and Psychosocial Outcomes Among Trauma-Exposed, Clinic-Referred Youth Involved in the Juvenile Justice System

Polyvictimization is a robust predictor of emotional and behavioral problems and is linked to involvement in juvenile justice and other public sector systems. This study extends prior research by employing person-centered methods for identifying polyvictimization patterns among trauma-exposed, clinic-referred, justice-involved youth (n = 689; ages 12-18 years) and how identified classes differ on psychosocial outcomes and demographic characteristics. Most participants had experienced multiple traumatic event (TE) types. Latent class analyses identified three classes: mixed trauma/bereavement exposure group (55.1%; Mean = 3.0 TE types); maltreatment polyvictimized group (29.3%; Mean = 5.7 TE types); and maltreatment plus extreme violence polyvictimized group (15.7%; Mean = 9.3 TE types). Polyvictimized youth were more likely to be female, in out-of-home placements, and experiencing negative psychosocial outcomes (e.g., Posttraumatic Stress Disorder). Hispanic/Latino youth were overrepresented in the extreme polyvictimized subgroup. Results underscore the need for cross-system coordination of trauma-informed, comprehensive services for clinic-referred, justice-involved youth.

What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example

BACKGROUND

Potentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted).

METHODS

Among individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes.

RESULTS

On average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample.

LIMITATIONS

Primary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection.

CONCLUSIONS

Although population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.

Assessing Polyvictimization in a Family Justice Center: Lessons Learned From a Demonstration Project

There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.

Clusters of Adversity Types Among U.S. Youth: Associations With Mental Health

INTRODUCTION

Childhood adversities are risk factors for subsequent mental health problems. Research commonly focuses on adverse childhood experiences, despite evidence that other exposures, such as neighborhood violence or peer victimization, co-occur with adverse childhood experiences and are associated with similar mental health outcomes. This study explored the clustering of these exposures and examined the associations with mental health.

METHODS

Data were a nationally representative sample of U.S. children aged 10-17 years (N=1,959), collected in 2013-2014. Latent class analysis was conducted on 22 types of childhood adversity. Regression models examined associations with mental health and substance use. These secondary analyses were conducted in 2021.

RESULTS

A total of 5 classes were identified: Low all (59% of the sample), Abuse (29%), High multiple adversities (5%), Peer adversity (4%), and Neighborhood violence (4%). All classes had poorer mental health and a higher prevalence of substance use than Low all, with particularly harmful levels in High multiple adversities. Neighborhood violence was not significantly different from High multiple adversities on mental health symptoms and showed a greater proportion of past-year substance use than all other classes except High multiple adversities. Peer adversity and Abuse classes did not differ significantly in any outcomes.

CONCLUSIONS

Findings highlight the particularly deleterious impact of neighborhood violence and highly co-occurring adversity types on mental health and substance use. It is important to extend our conceptualization of adverse childhood experiences to include peer adversity and neighborhood violence and shift from a siloed approach to examining all these exposures.

Psychometric Properties of the Parent-Report Version of the UCLA PTSD Reaction Index for DSM-5

The UCLA PTSD Reaction Index for DSM-5 (RI-5) is a developmentally appropriate and well recognized screening tool for the assessment of Post-Traumatic Stress Disorder (PTSD) in children and adolescents. The children/adolescent self-report version of the RI-5 has been thoroughly studied in very recent years, showing adequate psychometric properties. Despite such results, the utility of the parent/caregiver-report version, which also integrates the RI-5 system, remains to be explored. As such, the present study aimed to test the general psychometric properties of the parent/caregiver-report version of RI-5, based on a sample of 457 children and adolescents, aged between 7 and 17 years, exposed to at least one potentially traumatic experience, and their respective primary caregivers. The RI-5 total score and categories revealed good internal consistency reliability. The total number of traumas reported emerged as a significant predictor of the RI-5 total score. The RI-5 total score proved to be significantly correlated with more internalizing and externalizing problems, but correlation coefficients were below .70, serving as an indicator of discriminant validity. The four-factor structure of the RI-5 was supported through confirmatory factor analysis. In conclusion, the present study provided preliminary evidence supporting the utility of the parent/caregiver-report version of the RI-5 for research purposes and for clinical assessment and treatment, anchored on a multiple informant perspective of child psychopathology.

The associations between childhood maltreatment and pregnancy complications: A systematic review and meta-analysis

INTRODUCTION

Childhood maltreatment is associated with pregnancy complications. This study aimed to systematically review and quantitatively synthesize the strength of the associations between maternal histories of childhood maltreatment and the risk of preterm delivery, low birth weight, and gestational diabetes.

METHODS

Subject Headings and keywords for childhood maltreatment and the pregnancy outcomes were searched in MEDLINE (Ovid; 1946-Present), PsycINFO (Ovid; 1806-Present), and Web of Science Core Collection. Original studies or dissertations that reported quantitative associations between childhood maltreatment and any of the pregnancy outcomes of interest were included. Two independent reviewers selected the pertinent studies, assessed the risk of bias, and extracted data. Pooled effect sizes were calculated for the three outcomes.

RESULTS

Twenty-eight studies were reviewed and 22 were meta-analysed. Maternal childhood maltreatment was associated with preterm birth (OR = 1.27 95% CI: 1.06-1.52, p = 0.001), low birth weight (OR = 1.42 95% CI: 1.10-1.83, p = 0.001), and gestational diabetes (RR = 1.37 95% CI: 1.02-1.83, p = 0.030), however high levels of heterogeneity were found. Findings were insignificant for studies examining gestational age and birth weight as continuous variables.

DISCUSSION

Findings confirm that under certain conditions, childhood maltreatment is associated with pregnancy outcomes. Future research should prioritize mediation and moderation models to clarify the mechanisms underlying these relationships. Trauma-informed care is needed to tailor the appropriate care for expecting mothers.

Patterns of polyvictimization predict stimulant use, alcohol and marijuana problems in a large cohort of sexual minority and gender minority youth assigned male at birth

OBJECTIVE

Men who have sex with men (MSM) and gender minorities (GM) are more likely to have substance problems and experience various forms of victimization compared to their heterosexual and cisgender counterparts. Polyvictimization allows for the assessment of the combined impact of multiple forms of victimization on health. This study examines the effects of polyvictimization patterns on stimulant use, alcohol and marijuana problems among a large cohort study.

METHOD

The sample was collected between 2015 and 2019 (n = 1,202). Mean age was 22. The sample was racially diverse (34.4% Black, 29.0% Hispanic/Latinx, 25.8% white, 5.9% other racial identity), 92.4% of the sample were MSM and 7.6% of the sample were GM. Using latent class analysis five qualitatively different polyvictimization classes were identified. Associations between these classes and stimulant use, alcohol and marijuana problems were examined using negative binomial and logistic regressions.

RESULTS

Polyvictimization class significantly predicted alcohol problems and cannabis problems, at baseline as well as methamphetamine, and cocaine use at both time points. The polyvictimization profiles that were characterized by intimate partner violence (IPV), childhood sexual abuse (CSA), and high victimization across types were associated with substance outcomes at baseline. The polyvictimization class that was characterized by report of IPV was associated with cocaine use at 6 month follow-up. The polyvictimization class that was characterized by CSA was associated with methamphetamine use at 6 month follow-up.

CONCLUSIONS

Researchers should examine the effects of victimization experiences more holistically and develop substance interventions that take multiple forms of victimization experiences into account. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patterns of childhood adversity and their associations with internalizing and externalizing problems among at-risk boys and girls

BACKGROUND

Different types of childhood adversity often cluster and overlap, underlining the importance of studying likely patterns of adversity co-occurrences and their impact on child functioning. Further sex-specific investigations of adversity co-occurrences and their associations with child mental health are warranted.

OBJECTIVE

To investigate if different sex-specific patterns of childhood adversity exist among at risk-children living in Denmark and to explore if divergent constellations of adversity are differentially associated with externalizing and internalizing problems.

PARTICIPANTS AND SETTING

Participants (N = 2198) were a sample of children ages 1-17 who have been in contact with the Danish child protection system due to suspected child abuse. The study included existing data collected as a part of child case procedures.

METHOD

Latent class analysis was used to identify patterns of adversity co-occurrences among girls and boys, respectively. Inter-class differences on age and child mental health were assessed using ANOVAs.

RESULTS

Greater variation and complexity in adversity exposure was found among girls (5 classes) compared to boys (3 classes). The female classes differed on age (p < .001, η2 = 0.06), internalizing (p < .001, η2 = 0.05), and externalizing problems (p = .002, η2 = 0.02). The male classes differed on internalizing (p < .001, η2 = 0.02) and externalizing problems (p < .001, η2 = 0.04). Overall, classes characterized by multiple adversities displayed higher scores of mental health problems compared to less exposed classes.

CONCLUSIONS

Exposure to multiple adversities is common among at-risk children. Information on different sex-specific patterns of adversity co-occurrences can guide intervention planning for affected children.

Adverse childhood experiences (ACEs), excessive alcohol use and intimate partner violence (IPV) perpetration among Black men: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) have been linked to subsequent intimate partner violence (IPV) perpetration and alcohol use. Although higher rates of ACEs are found in racial/ethnic minority populations, there is a paucity of research examining ACEs patterns and risk for IPV perpetration and excessive alcohol use among Black men.

OBJECTIVE

To identify homogeneous subgroups based on ACEs among Black men using latent class analysis and assessing risk for later IPV perpetration and excessive alcohol consumption in adulthood.

METHODS

Using a sample of Black men (n = 2306) from Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), we conducted latent class analysis (LCA) to examine their ACEs patterns based on 10 domains. ACE classes were used in logistic regression models to predict IPV perpetration and unhealthy alcohol use.

RESULTS

LCA revealed three classes: (1) High Household Dysfunction & Physical Neglect; (2) Physical/Emotional Abuse; and (3) Low ACEs. Men in the High Household Dysfunction & Physical Abuse (OR = 3.95, p < 0.001), and Physical/Emotional Abuse (OR = 2.37, p < 0.001) classes had increased risk for IPV perpetration (ref: Low ACEs class) controlling for sociodemographic factors. No significant association was found between class membership and unhealthy alcohol use.

CONCLUSIONS

Our findings highlight the need for interventions aimed at addressing ACEs among Black boys as they increase risk for negative outcomes in adulthood. Future research should explore heterogeneity in ACEs among youth and risk of IPV and explore possible causal mechanisms in the development of IPV among adults who have experienced ACEs.

The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa

Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.

Longitudinal Relations among Adolescent Risk Behavior, Family Cohesion, Violence Exposure, and Mental Health in a National Sample

Violence is a public health concern linked with mental health problems among adolescents, and risk behavior increases the likelihood of violence exposure. Family cohesion may attenuate the negative effects of risk behavior. The purpose of this study was to examine family cohesion as a moderator in the relation between risk behavior (substance use and delinquency) and violence exposure, and to explore longitudinal associations among cohesion, violence exposure, and subsequent mental health outcomes (PTSD and depression). Data were drawn from the National Survey of Adolescents-Replication, a nationally representative sample of 3604 adolescents, with data collected via structured phone interviews at three waves spanning a two-year period. Hypotheses were tested using longitudinal structural equation modeling. Findings revealed that high family cohesion attenuated the relation between risk behavior and subsequent violence exposure. Wave 2 violence exposure was associated with more Wave 3 mental health problems, but high family cohesion was related to fewer subsequent symptoms. Follow-up analyses revealed that family cohesion moderated the relation between risk behavior and experiencing, but not witnessing, violence. Several demographic associations were observed. Although risk behavior increases exposure to violence, and in turn, mental health problems, family cohesion may serve as a protective factor, attenuating the link between risk behavior and subsequent negative consequences. This effect emerged even when accounting for demographic and socioeconomic covariates. Interventions with adolescents should target family relationships as a protective factor to reduce risk of violence exposure and mental health problems, particularly for adolescents who are engaging in high-risk behaviors.

Physical and Sexual Victimization Class Membership and Alcohol Misuse and Consequences among Sexual Minority and Heterosexual Female Youth

OBJECTIVE

Evidence demonstrates sexual orientation disparities in physical and sexual victimization and alcohol misuse and consequences among female youth; however, most extant research has used variable-centered approaches. The current study used latent class analysis (LCA), a person-centered approach, to: (1) model female youths' physical and sexual victimization; (2) examine sexual orientation disparities in physical and sexual victimization latent class membership; (3) and use physical and sexual victimization latent class membership to predict female youths' engagement in alcohol misuse and related consequences.

METHOD

Participants were 7,185 youth assigned female sex at birth (77.0% heterosexual, 12.8% bisexual, 2.3% gay or lesbian; 46.8% racial minority) in grades 9 - 12 who completed the 2017 Youth Risk Behavior Survey - a school-based, cross-sectional survey.

RESULTS

LCA uncovered four classes: (1) "Poly-Victimization Class," (2) "No Victimization Class," (3) "Past-Year Sexual Victimization Class," and (4) "Lifetime Rape Class." Sexual orientation emerged as a significant predictor of class membership. Latent classes 3 and 4 were uniquely associated with alcohol misuse and consequences (i.e., binge drinking, riding with a drinking driver, and drinking and driving) among female youth.

CONCLUSIONS

Our findings help to elucidate the patterns of physical and sexual victimization regarding timeline, tactic used, and context among female youth; sexual orientation disparities in latent class membership; and alcohol misuse correlates of class membership. Prevention efforts aimed at reducing physical and sexual victimization may ultimately reduce female youths' risk of binge drinking, riding with drinking drivers, and drinking and driving.

Prevalence of Child Maltreatment in Adults With Congenital Heart Disease and Its Relationship With Psychological Well-Being, Health Behavior, and Current Cardiac Function

Background: The prevalence of child maltreatment in adults with congenital heart disease (ACHD) has not been assessed so far. Child maltreatment is a major risk factor for unfavorable behavioral, mental, and physical health outcomes and has been associated with decreased quality of life. Given the increased survival time of ACHD, it is essential to assess factors that may worsen the quality of life and interact with classical cardiovascular risk factors and mental well-being. Methods: In a cross-sectional study, 196 ACHD (mean age 35.21 ± 11.24 y, 44,4% female, 55.6% male) completed a thorough psychiatric and cardiac evaluation. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and rates were compared to already existing data from the German general population. Further psychological measurements included the WHO Quality of Life Questionnaire, Hospital Anxiety and Depression Scale (HADS) and assessment of lifestyle factors (exercise, smoking, alcohol consumption, body mass index). To identify a relationship between current cardiac function and child maltreatment, we used logistic regression. Results: ACHD reported significantly higher rates of emotional neglect and emotional abuse and sexual abuse and lower rates of physical neglect when compared to the general German population. In addition, total CTQ-scores, emotional abuse, emotional neglect, physical abuse, and sexual abuse correlated with symptoms of depression, anxiety, and negatively correlated with QoL. Furthermore, CTQ scores contributed significantly in predicting higher New York Heart Association (NYHA) scores (p = 0.009). Conclusion: Child maltreatment is more common in ACHD and associated with decreased quality of life and depression and anxiety. Furthermore, we found evidence that self-reported child maltreatment is associated with decreased cardiac function. Given the longer survival time of patients with ACHD, identifying factors that may negatively influence the disease course is essential. The negative consequences of child maltreatment may be the subject of psychosocial interventions that have demonstrated efficacy in treating posttraumatic stress disorders.

Victimization Status of Female and Male College Students in Spain: Prevalence and Relation to Mental Distress

Despite the growing body of research concerning victimization and mental health among college populations around the world, there remains a need for additional studies that emphasize the role that victimization has on mental health. This study builds on previous research by analyzing the relationship between mental distress and victimization status in Spanish college students (n = 828, 490 women and 338 men). Using online surveys, we examined the prevalence rates of seven types of victimization (threats, insults, online slander, theft, physical abuse, sexual harassment, and sexual abuse) and three mental health disorders (stress, anxiety, and depression, as measured by the DASS-21 [Depression Anxiety Stress Scale-21]) among students at two universities in southeastern Spain. According to their victimization experiences during the 12 months prior to the interviews, participants were classified into three victimization status groups: nonvictims (42.3%), single-type victims (23.3%), and polyvictims (34.4%). Except for threat and physical abuse, women reported significantly higher rates than men for each type of victimization and were classified more often as polyvictims. MANCOVA showed significant associations between polyvictimization and all three indicators of mental distress after controlling for sex. Interestingly, there were no differences between single-type victims and nonvictims in their self-reported levels of anxiety, stress, and depression. Female students reported a higher prevalence of severe and extremely severe levels of anxiety and stress than did their male counterparts. This study highlights the fact that a nontrivial proportion of college students experience mental distress, reinforces the existing link between polyvictimization and mental health disorders, and stresses the importance of violence awareness and prevention activities targeting this population.

Interpersonal polyvictimization: Addressing the care planning needs of traumatized children and youth

BACKGROUND

Exposure to maltreatment has a detrimental impact on both physical and mental health. However, research on the relationship between polyvictimization and care planning needs is scarce.

OBJECTIVES

This study investigated the associations between interpersonal polyvictimization and care planning needs for children and youth, controlling for sex and age differences.

PARTICIPANTS AND SETTINGS

The sample included 18,701 children and youth (M_age = 12.33, SD_age = 3.53) between 4 and 18 years. Participants were recruited from over 58 mental health agencies, facilities, and schools in Ontario, Canada between November 2012 and February 2020.

METHODS

Multivariate binary logistic regression was used to investigate polyvictimization, sex and age groups, as predictors on care planning outcomes. Significant interaction effects were further examined using simple effects analyses.

RESULTS

Children and youth experiencing polyvictimization, compared to those who did not, were more likely to report attachment difficulties, lack of informal support, interpersonal conflict, substance use and harm to self or others. In addition, the relationship between polyvictimization and attachment and interpersonal conflict care planning was moderated by sex.

CONCLUSIONS

Findings emphasize the importance of focusing on interpersonal polyvictimization and sex differences when developing treatment plans for a variety of care planning needs. Mental health practitioners could utilize the study findings to guide their clinical practices and ensure effective services are provided to those seeking mental health care.

Adverse childhood experience patterns, major depressive disorder, and substance use disorder in older adults

OBJECTIVES

This article investigates distinct patterns of adverse childhood experiences (ACEs) in a representative sample of US older adults, and how the ACEs patterns relate to major depression and substance use disorder (SUD).

METHODS

Data came from the National Epidemiologic Survey on Alcohol and Related Conditions III. The study sample consisted of older adults aged 55 or older (N = 11,386). The dependent variable was past-year SUD measuring any DSM-5 diagnosis for alcohol, tobacco, cannabis, and other illicit drugs. The independent variables were the classes of ACEs identified using 11 types of early adversities. The mediating variable was past-year major depressive disorder. We conducted a latent class analysis (LCA) to identify latent classes of ACEs, estimated the relationships between the ACEs classes, major depressive disorder, and SUD, and tested mediation by major depression.

RESULTS

Results of the LCA identified four classes of ACEs: High Adversity (6%), Low Adversity (69%), Child Abuse (16%), and Parental Substance Use (8%). The three classes of High Adversity, Child Abuse, and Parental Substance Use showed significantly higher rates of SUD than the Low Adversity class. The High Adversity and Child Abuse classes were more likely to have major depression compared to the Low Adversity class. In addition, major depression mediated the association between ACEs and SUD for those two classes.

CONCLUSION

The findings provide evidence for a long-term impact of ACEs on mental health and SUD later in life and emphasize trauma-informed care principles in interventions for older adults with SUD.

Predictors of substance use in a clinical sample of youth seeking treatment for Trauma-related mental health problems

Child maltreatment and traumatic events are well established risk factors for adolescent substance use problems, but little is known about the unique contributions of etiological factors on trauma-exposed youths' pre-treatment substance use in clinical settings. This study examined associations between substance use and risk and protective factors measured across multiple ecological levels among a unique sample of youth seeking treatment for trauma-related mental health problems in child advocacy centers. Participants were adolescents (N = 135; 85% female; 60% white, 31% black) aged 13-17 years (M = 15.4) with ≥ 1 experience of child maltreatment or other interpersonal violence, current substance use, and ≥5 PTSD symptoms. Youth and caregivers completed validated questionnaires and clinical interviews at a pre-treatment assessment in a randomized controlled trial of a treatment for co-occurring traumatic stress and substance use. Negative binomial regression models identified different patterns of risk and protective factors for alcohol and cannabis. Clinical implications of these results are discussed, including the potential targets for integrated psychotherapies that address co-occurring substance use and traumatic stress in youth.

Victimization profiles in girls involved in the juvenile justice system: A latent class analysis

BACKGROUND

Previous research has demonstrated that youth involved in the juvenile justice system endorse diverse patterns of victimization. However, previous research investigating victimization profiles among youth involved in the juvenile justice system has primarily consisted of boys.

OBJECTIVE

This study investigated victimization profiles and correlates of victimization exposure, including posttraumatic stress symptoms and risk behaviors, in a sample of girls involved in the juvenile justice system.

PARTICIPANTS AND SETTING

Participants were 245 girls involved in the juvenile justice system (Mage = 15.57, SD = 1.13) participating in a dating violence prevention program. The sample was racially diverse, and 48 % self-identified as Hispanic/Latina.

METHOD

Prior to participating in the intervention, participants completed self-report measures of adversity and victimization exposure, posttraumatic stress symptoms, and risk behaviors.

RESULTS

Results of latent class analysis identified three distinct victimization profiles. The first class (n = 106) was characterized by low levels of victimization. The second class (n = 98) experienced predominantly emotional victimization (i.e., emotional dominant). The third class (n = 41) was characterized by exposure to polyvictimization (i.e., polyvictimization predominant). Girls categorized into the polyvictimization dominant class evidenced the greatest levels of posttraumatic stress symptoms, substance use, suicidal behaviors, and sexual risk behaviors.

CONCLUSIONS

Girls involved in the juvenile justice system report distinct patterns of victimization, which are differentially associated with posttraumatic stress symptoms and risk behaviors. The present study underscores the importance of implementing trauma-informed assessment and intervention practices within juvenile justice systems.

Exposure to Adverse Childhood Experiences (ACEs) and Stress among the Community-based Urban Pediatric Population in Korea

BACKGROUND

This study aimed to investigate the impact of exposure to adverse childhood experiences (ACEs) and stress among the community-based urban pediatric population in Korea.

METHODS

In 2017, the analysis was conducted on 3,937 children and adolescents in an urban area in Korea based on the impact of actual traumatic experience, addiction, and mental health. The respondents were excluded if they were missing data on the survey, resulting in a final sample size of 3,556. The collected data were analyzed by applying cross-sectional and correlation analyses.

RESULTS

Among the respondents in the study group (mean age = 13.77), 43.1% were boys (n = 1,532) and 56.9% were girls (n = 2,024). Overall, 23.5% (n = 835) reported at least one ACE and 1.8% (n = 63) reported experiencing four or more ACEs. Emotional abuse (13.2%) was the most commonly reported ACE, followed by abandonment (7.7%) and physical abuse (7.5%). Self-reported measures of stress were associated with the ACE scores.

CONCLUSION

This is the first study of self-reported ACEs from a community-based pediatric population in Korea. We found that the number of the students revealed more than one ACEs was similar to the data in the US community study with self-reporting among the community samples and exposure to adverse experiences is highly correlated with various stress responses.

Latent classes of childhood maltreatment in children and adolescents in foster care: associations with ICD-11 PTSD and complex PTSD

Background: Children and adolescents in foster care often experience many co-occurring subtypes of maltreatment. However, little is known about different combinations of maltreatment subtypes, referred to as maltreatment classes. Furthermore, the association between those maltreatment classes and ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) has not been investigated in children and adolescents. In previous studies, classes characterized by cumulative maltreatment were associated with severe psychopathological symptoms. So far, no study investigated ICD-11 PTSD and CPTSD. Objective: The first aim of this study was the detection of distinct maltreatment classes by examining frequently co-occurring maltreatment subtypes. The second aim was the examination of the association between those maltreatment classes and ICD-11 PTSD and CPTSD. Method: Participants were 147 children and adolescents currently living in foster care institutions in Lower Austria. Maltreatment history, ICD-11 PTSD and CPTSD were assessed using standardized self-report questionnaires. Latent class analysis was applied to examine maltreatment subtypes. χ2 difference testing was used to examine class associations with PTSD and CPTSD. Results: Three latent classes that comprised different subtypes of maltreatment were identified (limited maltreatment, n = 49; high neglect, n = 53; cumulative maltreatment, n = 45). Cumulative maltreatment was associated with higher symptom severity of PTSD and CPTSD than the limited maltreatment and the high neglect class, with effect sizes ranging from 0.62 to 0.93. Conclusions: The association of the cumulative maltreatment class with the highest symptom severity of PTSD and CPTSD highlights the detrimental effect of cumulative maltreatment. The detection of a high neglect class identifies children and adolescents, who are at high-risk of experiencing future maltreatment because of their previous experiences of neglect and the associated lack of protection. The examination of the association of distinct maltreatment classes with ICD-11 PTSD and CPTSD might provide implications for targeted prevention, assessment and treatment.

A Preliminary Examination of Negative Life Events and Sexual Assault Victimization as Predictors of Psychological Functioning in Female College Students: Does One Matter More Than the Other?

The present study examined negative life events (NLEs) and sexual assault victimization as predictors of positive and negative psychological functioning in a sample of 151 female college students. Results obtained from conducting regression analyses indicated several notable patterns. NLEs, compared with sexual assault victimization, were a stronger negative predictor of positive functioning based on indices related to subjective well-being (e.g., life satisfaction, positive affect). Alternatively, sexual assault victimization, compared with NLEs, was a stronger positive predictor of negative functioning based on indices related to posttraumatic stress disorder symptoms (e.g., anxiety) and related conditions (e.g., alcohol use). Furthermore, both NLEs and sexual assault victimization were found to be positive predictors of negative functioning based on indices related to suicide risk (e.g., depressive symptoms, suicidal behaviors). Overall, our findings indicate that both NLEs and sexual assault victimization represent important and distinct predictors of psychological functioning in female college students.

Patterns of childhood trauma and psychopathology among Chinese rural-to-urban migrant children

BACKGROUND

Exposure to childhood trauma can cause psychopathology and negative psychosocial outcomes across the lifespan. Rural-to-urban migrant children are commonly exposed to traumatic experiences (TEs). However, no study has comprehensively examined patterns of childhood trauma in Chinese culture. The current study aimed to examine patterns of childhood trauma exposure among Chinese rural-to-urban migrant children.

METHODS

A large-scale (N = 15,890) cross-sectional survey of rural-to-urban migrant workers' children in grades 4 to 9 was conducted in Beijing. Childhood TEs, including accidents and injuries, interpersonal violence, and vicarious trauma, as well as demographics and internalizing and externalizing behaviors, were measured.

RESULTS

Four patterns of childhood trauma were found: low trauma exposure (60.4%), vicarious trauma exposure (23.9%), domestic violence exposure (10.5%), and multiple trauma exposure (5.3%). Age, gender, parents' marital status, father's education level, family support and peer support differentiated the four TE patterns. Both internalizing and externalizing behaviors were more severe in patterns with more types of TEs.

CONCLUSIONS

Our findings provide a better understanding of childhood trauma in Chinese culture and the relationship between TEs and mental health. Clinicians and policy makers should tailor prevention and treatment programs according to different patterns of victimization.

Health effects of repeated victimization among school-aged adolescents in six major cities in China

BACKGROUND

Child victimization is a public health concern in China. Existing studies documented associations between victimization and negative health effects, while cumulative health effects of repeated victimization have attracted relatively little attention from scholars.

OBJECTIVE

To examine the health effects of various types of repeated victimization by using a large representative sample of school children in six major cities in China.

PARTICIPANTS AND SETTING

This study used data from a large representative sample of 18,452 Chinese adolescents aged 15-17 from six cities, Tianjin, Shenzhen, Shanghai, Xi'an, Wuhan, and Hong Kong.

METHODS

We carried out a two-stage data analysis in this study, including descriptive statistics to describe the prevalence of repeated victimization, and multiple analysis of variance (MANOVA) to examine the health consequences of repeated victimization.

RESULTS

27.54% of respondents experienced one-time victimization, and 44.26% suffered repeated victimizations, and those adolescents with repeated victimization reported significantly higher levels of depression and lower levels of self-esteem and overall health when compared to those with one-time victimization and those without victimization experience.

CONCLUSIONS

Experiences of repeated victimization can have much stronger associations with negative health outcomes when compared to experiences of one-time victimization. Promoting awareness of both the severity and repetition of victimization and designing integrative screening tool could be meaningful strategies to address the issue of child victimization in China.

Childhood polyvictimization and marijuana use trajectories

Despite public sentiment to the contrary, recreational marijuana use is deleterious to adolescent health and development. Prospective studies of marijuana use trajectories and their predictors are needed to differentiate risk profiles and inform intervention strategies. Using data on 15,960 participants in the National Longitudinal Study of Adolescent to Adult Health, variable-centered approaches were used to examine the impact of childhood polyvictimization on marijuana onset, marijuana use from age 15 to 24 years, and marijuana dependence symptoms. Zero-Inflated Poisson latent class growth analysis (ZIP-LCGA) was used to identify marijuana use subgroups, and their associations with childhood polyvictimization were tested via multinomial logit regression within ZIP-LCGA. Results showed that the overall probability and frequency of marijuana use increased throughout adolescence, peaked in early adulthood, and diminished gradually thereafter. Polyvictimization was associated with earlier onset and greater overall use, frequency of use, and dependence symptoms. ZIP-LCGA uncovered four subgroups, including non-users and three classes of users: adolescence-limited users, escalators, and chronic users. Polyvictimization distinguished non-users from all classes of marijuana users. The findings underscore the lasting developmental implications of significant childhood trauma. Children who experience polyvictimization represent a group that may benefit from selective interventions aimed at preventing early, frequent, chronic, and dependent marijuana use.

Polyvictimization and psychopathology among children and adolescents: A systematic review of studies using the Juvenile Victimization Questionnaire

BACKGROUND

Exposure to child abuse can lead to lasting mental health problems. Extant research has found that different types of child abuse tend to co-occur and overlap, which merits the investigation of the effects of exposure to multiple types of childhood mistreatment.

OBJECTIVE

The aim of this study was to systematically review the evidence on the associations between multiple different types of interpersonal victimization or polyvictimization, and indicators of psychopathology among children ages 0-17.

METHODS

The review included studies across all economic strata and research on nationally representative, community, and at-risk samples, using the same standardized assessment tool (i.e. the Juvenile Victimization Questionnaire or JVQ). The review was conducted using peer-reviewed evidence published up until August 2019 from Scopus, EMBASE, PsycINFO, Medline, CINAHL, and ERIC. Out of 4998 relevant references screened, 255 met the inclusion criteria, 22 of which aimed to address childhood polyvictimization and psychopathology.

RESULTS

A total of 21 of the 22 included studies identified a significant positive association between polyvictimization and various indicators of psychopathology comprising both externalizing (e.g. anger), internalizing problems (e.g. depression) and total psychological distress. A range of studies demonstrated that polyvictimization was a stronger risk factor for psychopathology than individual (sub)types of victimization. Based on the study findings, we provide a set of recommendations for future research on polyvictimization and psychopathology.

CONCLUSION

The present systematic review was the first to review the evidence on the associations between polyvictimization (as measured by the JVQ) and child and adolescent psychopathology in the global research literature. As a novel approach, the present review included both normative and high-risk samples. The results showed that polyvictimization is a substantial risk factor for mental health problems spanning both inner-directed and outer-directed mental health difficulties. However, the inconsistency in methods of defining and measuring polyvictimization severely undermines the scientific impact of this body of work. Additional well-designed, longitudinal studies that take account of the context-specific nature of polyvictimization are required to better establish the causal relationships between childhood polyvictimization and psychopathology so as to improve prevention and intervention efforts.

Identifying Psychological Pathways to Polyvictimization: Evidence from a Longitudinal Cohort Study of Twins from the United Kingdom

OBJECTIVES

Examine the extent to which cognitive/psychological characteristics predict later polyvictimization. We employ a twin-based design that allows us to test the social neurocriminology hypothesis that environmental factors influence brain-based characteristics and influence behaviors like victimization.

METHODS

Using data from the Environmental Risk Longitudinal Twin Study (N = 1986), we capitalize on the natural experiment embedded in a discordant-twin design that allows for the adjustment of family environments and genetic factors.

RESULTS

The findings indicate that self-control, as well as symptoms of conduct disorder and anxiety, are related to polyvictimization even after adjusting for family environments and partially adjusting for genetic influences. After fully adjusting for genetic factors, only self-control was a statistically significant predictor of polyvictimization.

CONCLUSION

The findings suggest polyvictimization is influenced by cognitive/psychological characteristics that individuals carry with them across contexts. Policies aimed at reducing victimization risks should consider interventions that address cognitive functioning and mental health.

Synergistic adversities and behavioral problems in traumatized children and adolescents

OBJECTIVE

This study investigated synergy of commonly co-occurring pairs of childhood traumas/adversities to determine: 1) if synergistic pairings differ by gender and/or age grouping; and 2) if some traumas/adversities were more synergistically reactive.

METHODS

A sample of 10,355 clinic-referred youth (1.5-18 years) from the National Child Traumatic Stress Network Core Data Set was divided by gender and categorized into salient age groups (1.5-5 years, 6-12 years, and 13-18 years). Attributable Proportion (AP), a biomedically relevant metric, was calculated to assess additive synergy for behavior problems on the CBCL.

RESULTS

Overall, only four pairs of adversities were synergistic. Three involved sexual abuse with physical abuse, parental loss, and domestic violence. When the sample was analyzed by Gender X Age group, however, a more complicated picture emerges. Twelve of the twenty-one possible pairings (57 %) show additive synergy in one or more categories. The mean AP accounted for approximately 40 % of outcome variance. Males had more synergistic pairings (16) than females (7). The average synergistic effect was higher for males (42 % of variance) than females (36 % of variance). The vast majority of synergy occurs in the 6-12 and 13-18 age groups. Sexual abuse was the most synergistically reactive trauma, pairing most frequently (16) followed by physical abuse (10) or neglect (9).

CONCLUSION

Sexual abuse was malignantly synergistic, frequently pairing with other adversities, followed by physical abuse, neglect, and domestic violence. The findings underscore that all ACEs are not equal in their contributions to commonly assessed outcomes. The findings also have considerable implications for prevention, intervention, and future research.