PowerPoint

Report
Double Disadvantage:
The impact of childhood maltreatment and community
violence exposure on adolescent mental health
Charlotte Cecil
Molecules of Happiness: Why Love Matters for Vulnerable Children
London, 26th September 2013
Background
1. Childhood maltreatment
Background
• Maltreatment prevalence
 Affects millions of children worldwide
 Difficult to estimate true prevalence
 Many cases never come to light
 Existing estimates vary widely
 Community studies vs. official reports
 UK: up to 1 in 5 experience severe maltreatment (NSPCC; Radford et al., 2011)
Background
• Maltreatment effects
 Childhood
 Child fatality

1 in 10 injury-related child fatalities worldwide (WHO; Pinheiro et al., 2006)
 Increased risk of mental health and adjustment difficulties


Emotional, behavioural, interpersonal domains (Cicchetti & Toth, 2005)
Underpinned by biological changes in brain structure, function, and stress response (McCrory et al, 2010)
Background
• Maltreatment effects
 Childhood
 Child fatality

1 in 10 injury-related child fatalities worldwide (WHO; Pinheiro et al., 2006)
 Increased risk of mental health and adjustment difficulties


Emotional, behavioural, interpersonal domains (Cicchetti & Toth, 2005)
Underpinned by biological changes in brain structure, function, and stress response (McCrory et al, 2010)
 Adulthood
 Increased susceptibility to psychiatric and medical disorders

E.g. mood and personality disorders, obesity, diabetes, chronic pain (Oswald et al., 2010)
 Decreased life opportunities

E.g. education, employment, earnings (Currie & Widom, 2010)
Background
2. Community violence exposure (CVE)
Background
• Community Violence Exposure (CVE)
 Characteristics
 Acts: Chasing, threatening, robbing, beating up, shooting, stabbing, murder
 Levels of exposure: Hearing about, witnessing, directly experiencing
 Most chronic and prevalent form of violence exposure
 Rates of exposure remain constant across years (Fowler et al., 2009)
 50%+ of urban youth affected (Buka et al, 2001)
 4-70% witness stabbing/shooting
 1-47% witness murder
 CVE impact
 Mental health & behaviour (Margolin & Gordis, 2000)
 PTSD, Aggression
Background
• Community Violence Exposure (CVE)
 Characteristics
 Acts: Chasing, threatening, robbing, beating up, shooting, stabbing, murder
 Levels of exposure: Hearing about, witnessing, directly experiencing
 Most prevalent and chronic form of violence exposure
 50%+ of urban youth affected (Buka et al, 2001)
 Rates of exposure remain constant across years (Fowler et al., 2009)
 CVE impact
 Mental health & behaviour (Margolin & Gordis, 2000)
 PTSD, Aggression
Background
• Community Violence Exposure (CVE)
 Characteristics
 Acts: Chasing, threatening, robbing, beating up, shooting, stabbing, murder
 Levels of exposure: Hearing about, witnessing, directly experiencing
 Most chronic and prevalent form of violence exposure
 Rates of exposure remain constant across years (Fowler et al., 2009)
 50%+ of urban youth affected (Buka et al, 2001)
 CVE impact
 Mental health & behaviour (Margolin & Gordis, 2000)
FREQUENTLY CO-OCCUR
YET, EXAMINED SEPARATELY
Kids-Co/UCL Project
• Sample
 204 inner city youth from the community
 16-24 year olds, males and females
 Multiple recruitment channels
 50% Kids Company
 50% Inner city London schools and internet websites

Matched for age, sex, ethnic background, IQ and neighbourhood deprivation
• Measures
 Developmental adversity (self-report)
 Childhood maltreatment
 Current exposure to community violence
 Mental health functioning (multi-rater reports)
 Internalizing difficulties (anxiety, depression)
 Externalizing difficulties (conduct problems, ASB)
 Trauma symptoms (anger, PTSD, dissociation)
Kids-Co/UCL Project
• Sample
 204 inner city youth from the community
 16-24 year olds, males and females
 Multiple recruitment channels
 50% Kids Company
 50% Inner city London schools and internet websites

Matched for age, sex, ethnic background, IQ and neighbourhood deprivation
• Measures
 Developmental adversity (self-report)
 Childhood maltreatment
 Current exposure to community violence
 Mental health functioning (multi-rater reports)
 Internalizing difficulties (anxiety, depression)
 Externalizing difficulties (conduct problems, ASB)
 Trauma symptoms (anger, PTSD, dissociation)
Outline
• Part I: Characterizing levels of exposure
• Part II: The impact of maltreatment and CVE
• Part III: The influence of individual maltreatment types
Part I:
Characterizing levels of exposure
Part I: Levels of exposure
Childhood maltreatment
Part I: Levels of exposure
1. Childhood maltreatment: Any exposure*
KIDS COMPANY:
84%
COMPARISON:
VS.
*Statistically significant difference = p < .01
56%
Part I: Levels of exposure
1. Childhood maltreatment: Any exposure*
70
Percentage (%)
60
66
62
50
52
48
40
30
35
35
25
20
21
10
12
7
0
Emotional abuse
Physical abuse
Kids Co (N = 98)
Sexual abuse
Emotional neglect
Comparison (N = 106)
*All group differences statistically significant = p < .01
Physical neglect
Part I: Levels of exposure
1. Childhood maltreatment: Severe-Extreme*
KIDS COMPANY:
38%
COMPARISON:
VS.
*Statistically significant difference = p < .001
8%
Part I: Levels of exposure
1. Childhood maltreatment: Severe-Extreme*
30
25
Percentage (%)
25
20
21
15
16
15
10
10
5
4
0
Emotional abuse
3
Physical abuse
Kids Co (N = 98)
Sexual
abuse
Emotional neglect
Comparison (N = 106)
*All group differences statistically significant = p < .01
Physical neglect
Part I: Levels of exposure
Community violence exposure
Part I: Levels of exposure
2. Community violence exposure: Any exposure*
KIDS COMPANY:
98%
*Difference not significant
COMPARISON:
VS.
95%
Part I: Levels of exposure
2. Community violence exposure: Any exposure*
n.s.
100
90
92
91
80
Percentage (%)
70
74
73
60
50
53
40
45
30
20
10
0
Hearing about
Witnessing
Kids Co (N = 98)
Victimization
Comparison (N = 106)
*Group differences for witnessing and victimization statistically significant = p < .01
Part I: Levels of exposure
2. Community violence exposure: Severe acts*
50
45
Percentage (%)
40
44
35
30
25
26
20
15
10
5
11
8
7
0
Witnessed shooting/stabbing
Witnessed killing
Kids Co (N = 98)
Comparison (N = 106)
* All group differences statistically significant = p < .001
1
Been shot/stabbed
Part I: Levels of exposure
Single vs. Multi-type
Part I: Levels of exposure
3. Single vs. Multi-type: Childhood maltreatment
1
11%
20%
5
4
Multi-type
maltreatment: 72%
1
28%
3
17%
2
24%
Participants with experience of maltreatment (68% of sample; N = 139)
Part I: Levels of exposure
3. Single vs. Multi-type: Community violence exposure
49%
3
1
Multi-type CVE:
83%
17%
2
34%
Participants with experience of community violence (92% of sample; N = 187)
Part I: Levels of exposure
Degree of overlap
Part I: Levels of exposure
Maltreatment
(68% of sample)
Part I: Levels of exposure
Maltreatment
(68% of sample)
97%
No CVE
CVE
Part I: Levels of exposure
Maltreatment
(68% of sample)
97%
No CVE
CVE
Maltreated youth typically experience a
DOUBLE DISADVANTAGE
Part I: Levels of exposure
• Summary
1. Alarming levels of exposure
2. Multi-type exposure ‘norm’
3. Maltreatment and CVE frequently co-occur
Part I: Levels of exposure
• Summary
1. Alarming levels of exposure
2. Multi-type exposure ‘norm’
3. Maltreatment and CVE frequently co-occur
Part I: Levels of exposure
• Summary
1. Alarming levels of exposure
2. Multi-type exposure ‘norm’
3. Maltreatment and CVE frequently co-occur
Part II:
The impact of maltreatment and CVE
Part II: Maltreatment & CVE impact
?
• Aim
 What are their independent effects?
 What are their combined effects?
?
Part II: Maltreatment & CVE impact
1. Independent effects: Childhood maltreatment
CHILDHOOD
MALTREATMENT
*
*
*
INTERNALIZING
EXTERNALIZING
TRAUMA SYMPTOMS
(Anxiety, depression)
(Conduct problems, ASB)
(Anger, PTSD, dissociation)
* Effects statistically significant = p < .001
Part II: Maltreatment & CVE impact
1. Independent effects: Community violence exposure
COMMUNITY
VIOLENCE
EXPOSURE
*
*
INTERNALIZING
EXTERNALIZING
TRAUMA SYMPTOMS
(Anxiety, depression)
(Conduct problems, ASB)
(Anger, PTSD, dissociation)
* Effects statistically significant = p < .01
Part II: Maltreatment & CVE impact
2. Combined effects: Additive
10
9
Mental Health difficulties
8
7
6
5
4
3
2
1
0
CVE
Maltreatment
Double disadvantage
Part II: Maltreatment & CVE impact
• Summary
1. Both maltreatment and CVE have serious consequences for
mental health
2. Children who experience both forms of adversity are at
particularly high risk for mental health problems
Part II: Maltreatment & CVE impact
• Summary
1. Both maltreatment and CVE have serious consequences for
mental health
2. Youth who experience double disadvantage are at particularly
high risk for mental health problems
Part III:
The influence of individual
maltreatment types
Part III: Maltreatment types
Sexual
Abuse
• Aim
Physical
Abuse
Physical
Neglect
Emotional
Abuse
Emotional
Neglect
Similar or different effects?
Part III: Maltreatment types
• Findings
1. All maltreatment types have negative effect*
•
Driven by what is common to all types
*(std. B = .14 – . 69; significant at least p < .05)
Part III: Maltreatment types
• Findings
1. All maltreatment types have negative effect
•
Driven by what is common to all types
FEELING UNSAFE AND VULNERABLE?
Part III: Maltreatment types
• Findings
2. Emotional abuse*
•
Unique predictive power, over and above all other types
*(std. B = .29 – . 76; significant at least p < .01, except externalizing difficulties)
Part III: Maltreatment types
• Findings
2. Emotional abuse
•
Unique predictive power, over and above all other types
FEELING UNLOVED AND UNSUPPORTED?
Conclusions
Key findings
1. Inner city youth are highly vulnerable to violence exposure
2. Maltreatment and CVE are key developmental risk factors
3. Emotional abuse unique predictive power
Implications
• NEED TO TAKE ACTION!
• Increase awareness
• Invest in prevention
• Improve access to effective interventions
Acknowledgments
• Funding:
• Kids Company charity
• Collaborators:
•
•
•
•
Dr Eamon McCrory
Prof Essi Viding
Dr Ted Barker
Dr Jo Guiney
Thank you to all of the young people, teachers, key workers who
have taken part in this research

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