Gender Differences in the Longitudinal Impact of Exposure to Violence on Mental Health in Urban Youth

Cross-lagged relationships between exposure to intimate partner violence, depressive symptoms and suicidal thoughts among adolescent and young married women

BACKGROUND

High rates of depression and suicidal ideation are found in women experiencing intimate partner violence (IPV), but their temporal relationship is unclear. This study explores the bidirectional causality between IPV victimization, depressive symptoms, and suicidal thoughts among adolescent and young married women in India.

METHODS

Data sourced from the UDAYA longitudinal survey in India, comprising 3,965 women aged 15-22. Employing Pearson's correlation coefficient, we analyzed the relationship between variables. Additionally, a two-wave cross-lagged autoregressive panel model explored the bidirectional link between IPV, depressive symptoms, and suicidal ideation.

RESULTS

Approximately 25 % and 45 % of the participants reported some form of partner violence at baseline and at follow-up after three years, respectively. Exposure to IPV at baseline was significantly associated with depressive symptoms at follow-up [β = 0.10, p < 0.001], and the association between depressive symptoms at baseline and IPV at follow-up was statistically not significant [β = -0.02, 95 % CI: -0.06-0.02]. Similarly, exposure to IPV at baseline was significantly associated with suicidal thoughts at follow-up [β = 0.24, p < 0.001], and the association between suicidal thoughts at baseline and IPV at follow-up was statistically not significant [β = 0.003, 95 % CI: -0.001-006].

CONCLUSIONS

The findings suggest that exposure to IPV is consistently and strongly associated with depressive symptoms and suicidal thoughts in adolescent and young married women. However, the reciprocal relationships did not hold true in this study, implying that reducing IPV during adolescence could potentially minimize the prevalence of depressive symptoms and suicidal thoughts during young adulthood.

Labor market discrimination and suicidal ideation: A longitudinal study of Korean women

This study investigates the impact of gender discrimination in the labor market on suicidal ideation among Korean women, taking into consideration women's multiple social locations and their discriminatory experiences across various aspects of employment. Analysis using waves 4 to 8 data of the Korean Longitudinal Survey of Women and Family, with response rates ranging from 68.3% to 78.2%, indicates that gender discrimination in hiring, dismissal, promotion, job allocation, training, wage, and sexual harassment is strongly associated with suicidal thoughts among women. This relationship remains significant even after controlling for stress, depression, and other forms of discrimination. Subgroup analysis further highlights that women with lower income levels are particularly susceptible to the adverse effects of gender discrimination. The findings underscore the importance of policy intervention to mitigate labor market discrimination against women as a crucial step in preventing suicides among Korean women.

The link between exposure to violence and psychological distress among middle-aged Muslims in Israel: the role of gender

Introduction

To date, it is still unclear if exposure to violence affects psychological distress in middle-aged adults and if the effects are gender specific. This age group is of special interest as it is at the onset of the aging process and is often overlooked or understudied in scholarly research. Specifically, targeted research on middle-aged Muslims living in Israel, a unique population exposed to increasing violence, is lacking.

Methods

We examined the relationship between exposure to violence and psychological distress in a cohort of 363 middle-aged adults (223 women) from three Muslim villages in northern Israel, collecting data on violence exposure (Screen for Adolescent Violence Exposure (SAVE) questionnaire), psychological distress (Kessler 6 Psychological Distress questionnaire), and other demographic characteristics including education level and socioeconomic status. We used this data to answer two questions: (1) is exposure to violence a predictor of psychological distress in middle-aged Muslims, and (2) does the relationship between exposure and distress differ between men and women?

Results

We revealed a positive link between exposure to violence and psychological distress (β = 0.145, p = 0.017) when controlling for gender, age, education level, and socioeconomic level.

Discussion

Despite previous evidence of gender-based differences in this interplay in younger cohorts, we did not find a significant interaction between gender and the violence exposure-psychological distress interplay. Our findings are some of the first to focus on middle-aged individuals and show that both men and women exhibit connections between exposure to violence and psychological distress when considering covariates. This research provides insights that can be used when planning community-wide interventions and treatment schemes to support healthy aging.

Exposure to maternal experiences of IPV in early childhood and sleep health in adolescence

BACKGROUND

Half of US women will experience intimate partner violence (IPV), and nearly all children in families experiencing such violence will be exposed. The negative effects of IPV exposure on children's mental and physical health are well-documented; however, less is known about effects on children's sleep health, a key marker of well-being.

OBJECTIVE

This study examines the associations of early childhood exposure to maternal experiences of IPV with sleep health in adolescence, focusing on multiple dimensions of sleep health and differences by child sex.

PARTICIPANTS AND SETTING

We rely on data from the Future of Families and Child Wellbeing Study, a population-based study following 5000 children in large US cities, from birth to age 15. Analyses are based on 2687 adolescents interviewed at the year-15 follow-up.

METHODS

Early childhood exposure to IPV is based on mothers' reports of her experiences of IPV from the child's birth to age 5. Adolescent sleep health is measured using 6 items approximating the BEARS sleep problem scale, at age 15. We estimate multivariate linear regression models to examine associations of early childhood IPV exposure with adolescent sleep health and stratify models by child sex.

RESULTS

Early childhood IPV exposure is associated with worse overall sleep health (β = 0.08; p < 0.001) and multiple dimensions of poor sleep health in adolescence. Associations are notably stronger among girls than boys.

CONCLUSIONS

The strong and lasting associations of early childhood exposure to IPV with adolescents' sleep health, particularly among girls, has important consequences for addressing adolescent health disparities.

History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence

BACKGROUND

Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized. Our objective was to determine if risk of hospital reencounter-violent reinjury and all-cause-was associated with preexisting MI at time of index injury among female victims of violence.

METHODS

All females (15-100 + years) presenting to a level I trauma center with violent injury (2002-2019) surviving to discharge were included (N = 1,056). Exposure was presence of preexisting MI. The primary outcome was hospital reencounters for violent reinjury and all-cause within one year (through 2020). The secondary outcome was the development of a new MI within one year of index injury. Odds of reencounter and development of new MI for those with and without preexisting MI were compared with multivariable logistic regression, stratified for interaction when appropriate.

RESULTS

There were 404 women (38%) with preexisting MI at time of index injury. Approximately 11% of patients with preexisting MI experienced violent reinjury compared to 5% of those without within 1 year ( p < 0.001). Specifically, those with MI in the absence of concomitant substance use had more than three times the odds of violent reinjury (adjusted Odds Ratio, 3.52 (1.57, 7.93); p = 0.002). Of those with preexisting MI, 64% had at least one reencounter for any reason compared to 46% of those without ( p < 0.001 ) . Odds of all-cause reencounter for those with preexisting MI were nearly twice of those without (adjusted Odds Ratio, 1.81 [1.36, 2.42]; p < 0.0001).

CONCLUSION

Among female victims of violence, preexisting MI is associated with a significantly increased risk of hospital reencounter and violent reinjury within the first year after index injury. Recognition of this vulnerable population and improved efforts at addressing MI in trauma patients is critical to ongoing prevention efforts to reduce violent reinjury.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.

“How Am I Supposed to Act?”: Adapting Bronfenbrenner’s Ecological Systems Theory to Understand the Developmental Impacts of Multiple Forms of Violence

Experiences of and exposures to violence impact older adolescents and young adults in a myriad of ways. While typically conceptualized as interpersonal, other forms of violence, namely, structural and symbolic, can be harmful to development for this population. This study utilized qualitative methodologies, including ethnographic field notes and interviews, to capture the ways in which 12 young persons aged 16 to 20 from Philadelphia experience and conceptualize multiple forms of violence across neighborhood contexts. In total, 85 interviews and over 100 hours of field observations were conducted and analyzed using thematic analysis. Findings from this study demonstrate that multiple forms of violence are experienced and impact how young adults make meaning of their life experiences. Importantly, our study explores how these forms of violence occur in tandem across contexts. Whereby, aspects of young adult development and well-being are shaped by violence across the micro, meso, and macro systems with which they interact. Implications of this work include adapting Bronfenbrenner’s Ecological Systems Theory to include multiple forms of violence so that practitioners and researchers can better understand how forms of violence are enacted and the associated impacts on young adults.

Exploring Substance Misuse Behaviors Among Black Girls in Detention: Intersections of Trauma, Sex, and Age

High risk substance misuse, trauma and gang involvement are prevalent in adolescents and often occur with youth involved with the youth punishment system. Evidence suggests that system involvement is related to trauma histories, substance misuse, as well as gang involvement. This study investigated the associations between individual and peer factors and their relationship to problem drug and alcohol use among Black girls involved with the youth punishment system. Data were collected from 188 Black girls in detention at baseline, as well as 3 and 6 month follow up periods. Measures assessed were abuse history, trauma history, sex while using drugs and alcohol, age, government assistance, and drug use. Significant findings from the multiple regression analyses indicated that younger girls were more likely to have a higher prevalence of having a drug problem than older girls at baseline. Having sex while on drugs and alcohol at the 3 month follow up period was correlated with drug use. These findings highlight how individual and peer factors can influence problem substance misuse, their behavior and peer relationships among Black girls in detention.

Indirect Associations between Middle-Childhood Externalizing Behaviors and Adolescent Substance Use through Late-Childhood Exposure to Violence

Longitudinal research to understand individual risk factors in childhood associated with exposure to violence and substance use is needed to inform prevention efforts. The present study tested indirect associations between age 8.5 externalizing behaviors and age 16 substance use through age 9.5 violence victimization and witnessing. Participants were 650 racially diverse (48.6% European American, 28.1% African American, 13.3% multiracial, and 10.0% other), predominantly socioeconomically disadvantaged youth (49% female). Externalizing behaviors were associated with higher levels of violence victimization and witnessing. The indirect path from externalizing behaviors to substance use was significant through victimization but not witnessing violence. Interventions aimed at reducing early externalizing behaviors may reduce risk for violence victimization, which may, in turn, reduce risk for adolescent substance use.

Racial discrimination and other adverse childhood experiences as risk factors for internalizing mental health concerns among Black youth

Adverse childhood experiences (ACEs) have been consistently linked to a reduction in healthy psychological adjustment among youth. Emergent evidence suggests that there are culturally specific ACEs, such as racial discrimination, that are particularly harmful to the mental health of Black youth. However, the psychological impact of racial discrimination on the mental health of Black youth relative to other ACEs remains underexplored. The present study aimed to address this gap by examining the extent to which racial discrimination was associated with other ACEs and elucidating the unique associations between children's experiences of racial discrimination and internalizing problems (i.e., depression, anxiety), after controlling for other ACEs. Data consisted of a subsample of Black children from the National Survey of Children's Health (N = 8,672; M_age  = 9.8 years; 51.1% male). Bivariate analyses illustrated that racial discrimination was positively associated with the co-occurrence of all other ACEs measured within the current study. Multivariable analyses using generalized linear mixed models revealed that racial discrimination was significantly associated with youth diagnoses of depression, adjusted odds ratio (aOR) = 1.35, 95% CI [1.23, 1.49], and anxiety, aOR = 1.39, 95% CI [1.31, 1.47], after controlling for other ACEs and sociodemographic covariates. The findings demonstrate that racial discrimination is comparably associated with youth internalizing problems relative to ACEs conventionally examined within the childhood trauma literature. The importance of these results, including how this knowledge can be leveraged to inform clinical practice and policy to promote the positive mental health of Black youth, are also discussed.

Stressful Life Events and Their Unique Associations with Psychosocial Outcomes: a Gendered Analysis Among High School Adolescents

INTRODUCTION

There is substantial evidence linking stressful life events (SLEs) in childhood to poor mental health later in life, but few studies explore how various types of SLEs differentially impact mental health. The purpose of this study is to assess associations between SLEs and psychosocial outcomes in a diverse adolescent population in the USA and to examine whether and how these relationships are gendered.

METHODS

The sample comprises 181 high school students ages 13-21 years in Harrisonburg, Virginia. This study analyzed associations between 12 SLEs and eight psychosocial outcomes using ordinary least-squares and logistic regressions. Relationships were estimated for the full sample and for males and females, separately.

RESULTS

For boys, having ever been forced to leave one's family was associated with declines in resilience (B = - 4.646; 95% CI (- 8.79, - 0.50)) and increases in externalizing symptoms (B = 0.392; 95% CI (0.15, 0.63)). Furthermore, boys who experienced a drastic change in their family reported lower levels of school belonging (B = - 9.272; 95% CI (- 17.45, - 1.09)). For girls, having ever been forced to leave one's family was associated with decreases in depressive (B = - 0.961; 95% CI (- 1.88, - 0.05)) and anxiety symptomology (B = - 0.868; 95% CI (- 1.68, - 0.06)). Overall, students who experienced a life-threatening emergency exhibited greater depressive (B = 0.445; 95% CI (0.15, 0.74)) and anxiety symptoms (B = 0.287; 95% CI (0.05, 0.52)), and depressive symptomology was also associated with having ever been physically hurt by someone (B = 0.224; 95% CI (0.01, 0.44)).

CONCLUSIONS

Findings provide insights into how exposures might engender different mental health processes and outcomes, and how these processes may manifest differently across gender.

Rating Scales for Behavioral Health Screening System Within Pediatric Primary Care

Barriers to conducting standardized behavioral health screening within pediatric primary care settings include engaging youth and families, limited time available for this activity, and difficulties related to obtaining behavioral health consultation and treatment from specialists. Child and adolescent psychiatrists may assist pediatric primary care practices with engaging youth and families around screening by assisting with identifying rating scales that have good psychometric characteristics across multiple languages and are validated in diverse samples and available within the public domain. Additionally, they may partner with pediatric primary care professionals to assist with optimizing screening workflows and linkage to specialized services.

Exposure to community violence and depressive symptoms: Examining community, family, and peer effects among public housing youth

Exposure to community violence is an epidemic problem that causes debilitating effects on youth mental health. However, the relationships between violence exposure and youth mental health remain unclear when examining co-occurring socioecological risk and protective factors. The purpose of this study is to clarify the observed gaps in knowledge by utilizing structural equation modeling (SEM) to examine the mediating role of community violence exposure on the relationship between perceived neighborhood risk factors, parental behaviors, and peers on depressive symptoms in a sample of urban youth in low-income public housing communities (n = 320). Results indicate that community violence exposure and exposure to delinquent peers mediates the effects of perceived neighborhood risk and parenting behaviors on depressive symptoms. These findings suggest that while interventions that limit exposure to community violence and delinquent peers could reduce depressive symptoms, interventions that reduce community violence are essential to improve youth mental health.

Childhood Trauma History and Negative Social Experiences in College

While there is literature documenting the association between childhood trauma and later sexual assault or interpersonal violence victimization, less is known about risk of less severe, but still negative, victimization experiences such as sexual harassment, hazing, and bullying in college. The goal of this study was to explore the association between self-reported childhood trauma (both personally experienced and witnessed) and negative social experiences in college-age adults (e.g., sexual harassment, hazing, and bullying), and the role that internalizing difficulties (i.e., depression and stress) plays in this association. A sample of 620 college-aged adults (ages 18-25) was recruited. Structural Equation Modeling (SEM) was used to investigate two models concerning direct and indirect childhood trauma experience. The models demonstrated significant positive relations between experiences of childhood trauma (both direct and indirect) and negative social experiences. Internalizing difficulties (i.e., depression and stress) mediated the relation between indirect childhood trauma and negative social experiences, but it did not significantly mediate the relation between direct childhood trauma and negative social experiences. These findings help to inform prevention efforts and have important implications for both school and community based mental health providers.

Mindfulness and Posttraumatic Stress Disorder Symptom Severity in Urban African-American High School Students

OBJECTIVES

The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population.

METHOD

Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness.

RESULTS

Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03].

IMPLICATIONS

This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.

Mild Traumatic Brain Injury as a Predictor of Classes of Youth Internalizing and Externalizing Psychopathology

Mild traumatic brain injury (mTBI), is a developing public health problem. Evidence suggests that youth who suffer a mTBI experience worse outcomes than similar adults. However, the structure of long-term symptoms associated with mTBI is not well understood. The current study aims to determine if classes of youth psychopathology can be predicted by mTBI status. The current study analyzed a large sample of children and adolescents from the Project on Human Development in Chicago Neighborhoods (n = 2978) to examine trajectories of psychopathologies. Using data from the Achenbach Childhood Behavior Checklist, latent classes of internalizing and externalizing psychopathology were identified. Multinomial logistic regression models were used to examine if mTBI predicted class membership, while controlling for a number of variables associated with psychopathology. The results of the current study suggest that mTBI may be an important transdiagnostic risk factor associated with developmental patterns of internalizing and externalizing psychopathology.

Community violence exposure and cortisol awakening responses in adolescents who are overweight/obese

BACKGROUND

Community violence exposure has been identified as a salient environmental stressor associated with dysregulated cortisol awakening response (CAR), which may act to exacerbate hypothalamic-pituitary-adrenal (HPA) axis dysregulation observed in adolescents who are overweight/obese.

PURPOSE

To perform an exploratory cross-sectional analysis examining the association between community violence exposure and CAR in adolescents who are overweight/obese.

METHODS

One-hundred adolescents (ages: 13-19 years; 65% female; average BMI percentile: 93.80 ± 4.13) were included in this analysis. Community violence exposure was measured using the Survey of Children's Exposure to Community Violence. Salivary cortisol collected across three days at awakening and 30 min post-awakening was used to calculate CAR area under the curve (AUC).

RESULTS

Community violence exposure was associated with a lower CAR AUC when controlling for baseline cortisol, sex, BMI, pubertal development, race and perceived stress (β = -0.04 ± 0.02; p = 0.04).

CONCLUSION

Findings from this study identified cross-sectional association between community violence and HPA dysregulation in adolescents who were overweight/obese. If long-term exposure to community violence does indeed accelerate HPA dysregulation in adolescents at increased weight status, policymakers and interventionists should consider implementing programs that limit adolescent violence exposure.

Facing Interpersonal Violence: Identifying the Coping Profile of Poly-Victimized Resilient Adolescents

Coping strategies are factors that mediate the relationship between interpersonal victimizations and psychological maladjustment. The objectives are as follows: (a) to establish the coping profile of adolescents according to the number of reported interpersonal victimizations; (b) to identify the most victimized adolescents (poly-victims), detecting those with psychological symptoms (nonresilient poly-victims) and those without psychological symptoms (resilient poly-victims), and then to examine any differences in coping strategies between the two groups; (c) to determine the accumulative effect of victimizations on mental health; and (d) to test the mediating role of both approach and avoidance coping between lifetime interpersonal victimizations and symptoms. Participants were 918 community Spanish adolescents (62.7% girls) aged between 14 and 18 years. Measures used were Youth Self-Report, Juvenile Victimization Questionnaire, and Adolescent Coping Orientation for Problem Experiences. The following results were reported: (a) The most victimized adolescents used to a greater degree avoidance coping strategies than nonvictimized adolescents. (b) Resilient poly-victimized adolescents were more likely to seek family support and tended to use more positive reappraisal than nonresilient poly-victimized adolescents. (c) A clear cumulative effect of victimizations on mental health was observed: 45% of the most victimized adolescents (poly-victims) reached clinical range on Youth Self-Report in front of 2% of nonvictimized adolescents. (d) Avoidance coping and more specifically Escaping and Venting feelings strategies played a mediating role between interpersonal victimizations and psychological symptoms. Approach coping had no mediating role, except for Positive reappraisal in girls. In conclusion, the possibility of identifying the coping profile of victimized adolescents may have clinical implications in terms of both prevention and intervention.

The role of relationship proximity to witnessed community violence and youth outcomes

AIMS

This study examines whether the relational proximity to the victim or perpetrator of witnessed community violence is associated with youth symptoms.

METHODS

Data come from the Longitudinal Studies of Child Abuse and Neglect, a national high-risk sample. The sample included 12-year-old youth (N = 720) who had witnessed violence in their lifetimes. Ordinary least squares (OLS) regressions tested whether relationship proximity differentiated youth functioning (social competency, withdrawal, anxiety/depression, delinquency, and aggression), and whether gender moderated these effects.

RESULTS

Witnessing violence toward a parent was associated with greater withdrawal, delinquency, and aggression symptoms. Witnessing violence perpetrated by a stranger was associated with lower social competency, higher anxiety/depression, and higher delinquency. Two perpetrator associations differed by gender.

CONCLUSION

Findings suggest important differences in outcomes based on relational proximity to victims and perpetrators. The particularly widespread associations between witnessing violence against a parent and youth functioning underscore the importance of targeting interventions toward youth with parent victims.

Indirect violence exposure and mental health symptoms among an urban public-school population: Prevalence and correlates

Available literature identifies the need for a deeper understanding of the role of gender, age and socioeconomic status in children's exposure to violence and associations with mental health (MH) outcomes. The 1548 participants for this study were enrolled from 28 public charter schools and 9 community-based settings; youth were administered a screener that assessed exposure to traumatic events and symptoms of post-traumatic stress disorder (PTSD) and depression. Respondents reported extremely high levels of exposure to indirect violence: 41.7% witnessed shooting/stabbing/beating; 18.3% witnessed murder; and 53.8% experienced the murder of someone close. Frequency of adverse MH outcomes was high: 21.2% screened positive for depression; 45.7% for lifetime PTSD; and 26.9% for current PTSD. More males than females reported witnessing shooting/stabbing/beating (p = .04); females more often reported experiencing the murder of someone close (p = .001). Indirect violence exposure generally increased with age. Youth attending schools with ≥90% free/reduced lunch participation (FRLP) showed significantly higher levels of violence exposure compared to youth in schools with <90% FRLP. Females endorsed significantly higher levels of depression (21.4% vs. 9.7%), and lifetime (53.9% vs. 34.9%) and current (32.5% vs. 19.6%) PTSD, compared with males (p < .0001, all comparisons). Female sex (aOR = 2.6), FRLP (aOR = 1.4 for ≥90% vs. <90%) and the number of different indirect violence exposures (aORs from 1.3 to 10.4), were significantly associated with a positive screen for any adverse MH outcome. Our data add important insights into gender heterogeneity of viewed violence, mental health symptoms, and their association-all of which are critical to guiding effective intervention efforts.

Arab youth involvement in violence: A socio-ecological gendered perspective

BACKGROUND

Previous research has extensively used a socio-ecological perspective to find the correlates of youth involvement in violence. However, little is known about the extent to which ecological factors correlated with youth violence are affected by gender, especially in non-Western cultures.

OBJECTIVE

The role of gender in the association between individual, family, and contextual factors and Arab youth involvement in several types of violence (severe physical, moderate physical, and verbal and indirect violence) was explored using a socio-ecological perspective.

PARTICIPANTS AND SETTING

The study was based on a large random sample of 3,178 Arab students, aged 11-18, from Israel.

METHODS

Information was collected from the adolescents through a structured, anonymous self-report questionnaire which they completed in the classroom under the guidance of a research assistant. Confidentiality and anonymity were ensured for all participants.

RESULTS

Gender was found to moderate the association between impulsivity and parental support and all types of violence except verbal violence. No interaction effect was found in the association between affiliation with delinquent peers and exposure to community violence and Arab youth involvement in violence.

CONCLUSIONS

The results emphasize the importance of exploring gender differences with respect to risk and protective factors for violence. This knowledge is an important step in the design and implementation of gender-specific intervention strategies to deal with youth violence.

Violence Exposure, Drug Use and HIV/AIDS Risk Taking Behaviors: The Role of Gender

OBJECTIVE

To examine gender differences among African American young adults in their exposure to violence (ETV) before age 18 and community violence as an adult, and the relationship of these exposures to drug use and HIV risk taking behaviors (HIVRTB).

METHOD

We detail these experiences in 440 self-identified African Americans, ages 18 to 25, from socio-economically disadvantaged wards in Washington, DC. Factor analysis was used to identify the types of violence experienced before age 18 and as adults. Regression was used to identify which types of violence had the greatest impact on subsequent drug use and HIVRTB.

RESULTS

We found gender differences in the types of violence experienced and their effects on drug use and HIVRTB. For women, the strongest ETV factors were direct personal violence, and exposure to drug sales or physical violence as adults. For men, the strongest factors were feeling unsafe in different situations as adults and exposure to violence among adults before age 18.

CONCLUSIONS

We identified the specific kinds of violence that are most likely to impact drug use and risky sexual behaviors that can leave one vulnerable to HIV and how these differ between women and men exposed to both childhood violence and community violence as an adult. Our findings point toward the need for trauma-informed programs that are tailored to gender.

Parallel-process trajectories of exposure to violence and psychological distress among justice-involved youth

BACKGROUND

Researchers have raised awareness of high levels of violence exposure among justice-involved adolescents and its association with psychological distress, yet the relationship between the violence and psychological distress has rarely been studied longitudinally.

AIM

This study aimed to gain understanding of the relationship between long-term exposure to violence and the development of psychological distress among justice-involved adolescents.

METHODS

We examined exposure to violence and emergent psychological distress among adolescents using latent growth model analyses with a sample of 1,336 young people-male and female-who completed 10 follow-up interviews over 7 years as part of the Pathways to Desistance study. We tested four models: (a) changes in exposure to violence over time, (b) changes in psychological distress over time, (c) the contemporaneous, parallel processes of changes in exposure to violence and psychological distress over time, and (d) differences in the evolution of violence exposure and psychological distress across sex and race/ethnicity.

RESULTS

For the sample as a whole, exposure to violence decreased over time, as did psychological distress, but their relationship to each other was consistent. There were individual differences, however, and the subgroup of young African Americans did not experience the reduction in exposure to violence reported by the young Whites and Hispanics.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Trajectories of exposure to violence and related psychological distress did not escalate over time as expected. In light of these findings, more research is needed on the heterogeneity of violence exposure and its negative psychological impacts.

Youth Adversities Amplify the Association between Adult Stressors and Chronic Inflammation in a Domain Specific Manner: Nuancing the Early Life Sensitivity Model

There is strong evidence that chronic, systemic inflammation hastens onset of the diseases of old age that ultimately lead to death. Importantly, several studies suggest that childhood adversity predicts chronic inflammation. Unfortunately, this research has been plagued by retrospective reports of childhood adversity, an absence of controls for adult stressors, and a failure to investigate various competing models of the link between childhood adversity and chronic inflammation. The present study was designed to address these limitations. Using 18 years of data collected from 413 African Americans (58% female) included in the Family and Community Health Study, hierarchical regression analyses provided support for a nuanced early life sensitivity explanation for the link between early adversity and adult chronic inflammation. Controlling for health risk behaviors and adult SES, late childhood (ages 10-12) adversity amplified the association between adult adversity (age 29) and chronic inflammation. This interaction operated in a domain-specific fashion. Harsh parenting amplified the relation between intimate partner hostility and inflammation, whereas early discrimination amplified the relation between adult discrimination and inflammation. These findings suggest that individuals may be primed to respond physiologically to adverse adult circumstances that resemble those experienced earlier in life.

The moderating effect of parental support: internalizing symptoms of emerging adults exposed to community violence

Evidence suggests parental support mitigates the association between community violence exposure and internalizing symptoms in adolescents. This study investigates this moderation of parental support for emerging adults and compares it with that for adolescents. Data were drawn from the Pathways to Desistence Study using community violence, parental support, and their interaction to predict internalizing symptoms in a series of regression models for adolescents and emerging adults. Results suggest that exposure to community violence during adolescence and emerging adulthood had a significant association with internalizing symptoms. Mother support during adolescence moderated this relationship. Emerging adulthood was marked by an increase in parental support; however, this support did not moderate the relationship between community violence and internalizing symptoms. Interventions, programs, and policies that leverage the parental support of emerging adults may be a useful strategy to mitigate the negative impacts of community violence.

Sexual Violence Victimization Among Youth Presenting to an Urban Emergency Department: The Role of Violence Exposure in Predicting Risk

Sexual violence (SV) is a widespread public health problem among adolescents and emerging adults with significant short- and long-term consequences. Young people living in urban, disadvantaged communities with high rates of violence may be especially at risk for SV victimization. Understanding interconnections between different forms of violence is critical to reducing SV risk among youth. Participants were youth ( N = 599) ages 14 to 24 years ( M = 20.05, SD = 2.42) presenting to an urban emergency department with a Level 1 trauma designation as part of a prospective cohort study and followed-up for 24 months. We used logistic regression to examine the probability of reporting SV during the 24-month follow-up based on baseline reports of community and peer violence exposure, accounting for previous SV victimization, substance use, and sociodemographic characteristics. Among youth presenting to an urban emergency department, 22% of youth not seeking care for a sexual assault reported any lifetime SV (forced and/or substance-induced sexual intercourse) at baseline. During the 24-month follow-up, 12% reported SV victimization. We found high community violence exposure (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.01, 8.68]) and peer violence exposure (OR = 1.58, 95% CI [1.19, 2.08]) were associated with increased odds of reporting SV during follow-up in addition to previous SV victimization (OR = 2.71, 95% CI [1.45, 5.09]). Sex, age, parent education, and alcohol or other drug use at baseline were not associated with odds of SV during follow-up. Investigating interconnections between SV victimization and other forms of violence across socioecological levels provides an opportunity to advance SV research and identify promising avenues for prevention based on other violence prevention research. Future strategies for SV prevention that incorporate community and peer components as well as SV-specific content may help reduce SV victimization among youth living in urban, disadvantaged communities.

The Mediating Role of Trauma Symptoms in the Association between Past and Future Teen Dating Violence Victimization

We examined whether the frequency of recent physical and sexual teen dating violence (TDV) victimization is positively associated with trauma symptom clusters (re-experiencing, avoidance, and hyperarousal), and whether these symptom clusters, in turn, are positively associated with the frequency of later TDV victimization. Participants were recruited primarily from truancy courts, and the sample consisted of 108 (47% female) 14-to-17-year-olds. Participants completed three assessments, spaced three months apart. Results indicated that the frequency of recent TDV victimization related positively to all three trauma symptom clusters. Re-experiencing symptoms mediated the relation between recent TDV victimization and TDV victimization six months later, even after controlling for exposure to community and interparental violence and demographic variables. The findings suggest that the trauma symptom clusters may differentially contribute to risk of future TDV victimization. Further research examining the cognitive and emotional processes involved in re-experiencing trauma symptoms will likely enhance our understanding of risk factors for TDV re-victimization.

Community Violence and Associated Psychological Problems Among Adolescents in the General Population

Based on a populational survey conducted among 1400 adolescents aged between 12 and 17 years old, the aim of this study is to assess the relationships between their community violence experiences and their psychological health (anger, depressive symptoms, and post-traumatic stress disorder symptoms). One MANOVA confirms that both boys and girls who report at least one incident of physical community violence present more psychological difficulties, especially anger. Subsequent MANOVAs show that anger intensity varies depending on whether the youth was a direct victim or a witness only, as well as on the diversity of the types of violent manifestations and on acquaintance with the perpetrator, whereas the presence of injuries has no significant effect. This study highlights the importance of considering the context of the community violence incident, to clearly understand its relationships with the youth's psychological difficulties.

Family Instability and Exposure to Violence in the Early Life Course

Family instability has been linked with a host of outcomes across the early life course. This study extends this literature by connecting instability with violence in the community by examining the associations among family structure, family structure change, and secondary exposure to violence during adolescence across diverse segments of the population. Using longitudinal data from the Project on Human Development in Chicago Neighborhoods study, we found that living with a single parent and experiencing family structure changes were associated with secondary exposure to violence. Multiple group models suggest that partner change translated into more exposure for boys than girls. Findings also suggest that family instability may lead to more secondary exposure to violence for African American youth.

Polyvictimization in childhood and its adverse impacts across the lifespan: Introduction to the special issue

Although much empirical work has focused on the adverse impact of specific types of childhood victimization (e.g., sexual, physical, or emotional abuse), researchers and clinicians increasingly are recognizing the prevalence of polyvictimization, or exposure to multiple types of victimization. Polyvictimization during formative developmental periods may have detrimental and potentially lifelong biopsychosocial impacts over and above the effects of exposure to specific types of adversity. In this guest editorial, we summarize the key questions and findings for six empirical studies on polyvictimization included in this Special Issue of the Journal of Trauma & Dissociation. These empirical studies further our understanding of the nature, consequences, and assessment of polyvictimization. We conclude with recommendations for continued scientific research and clinical inquiry on polyvictimization.

Service usage typologies in a clinical sample of trauma-exposed adolescents: A latent class analysis

OBJECTIVE

The purpose of this study is to describe typologies of service utilization among trauma-exposed, treatment-seeking adolescents and to examine associations between trauma history, trauma-related symptoms, demographics, and service utilization.

METHOD

Latent class analysis was used to derive a service utilization typologies based on 10 service variables using a sample of 3,081 trauma-exposed adolescents ages 12 to 16 from the National Child Traumatic Stress Network Core Dataset. Services used 30 days prior to the initial assessment from 5 sectors were examined (health care, mental health, school, social services, and juvenile justice).

RESULTS

A 5-class model was selected based on statistical fit indices and substantive evaluation of classes: (a) High intensity/multisystem, 9.5%; (b) Justice-involved, 7.2%; (c) Low intensity/multisystem, 19.9%; (d) Social service and mental health, 19.9%; and (e) Low service usage/reference, 43.5%. The classes could be differentiated based on cumulative trauma, maltreatment history, PTSD, externalizing and internalizing symptoms, and age, gender, race/ethnicity and place of residence.

CONCLUSIONS

This study provides new evidence about patterns of service utilization by trauma exposed, treatment seeking adolescents. Most of these adolescents appear to be involved with at least 2 service systems prior to seeking trauma treatment. Higher cumulative exposure to multiple types of trauma was associated with greater service utilization intensity and complexity, but trauma symptomatology was not. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Exposure to violence and mental health of adolescents: South African Health and Well-being Study

BACKGROUND

Material and social environmental stressors affect mental health in adolescence. Protective factors such as social support from family and friends may help to buffer the effects of adversity.

AIMS

The association of violence exposure and emotional disorders was examined in Cape Town adolescents.

METHOD

A total of 1034 Grade 8 high school students participated from seven government co-educational schools in Cape Town, South Africa. Exposure to violence in the past 12 months and post-traumatic stress disorder (PTSD) symptoms were measured by the Harvard Trauma Questionnaire, depressive and anxiety symptoms by the Short Moods and Feelings Questionnaire and the Self-Rating Anxiety Scale.

RESULTS

Exposure to violence was associated with high scores on depressive (odds ratio (OR)=6.23, 95% CI 4.2-9.2), anxiety (OR=5.40, 95% CI 2.4-12.4) and PTSD symptoms (OR=8.93, 95% CI 2.9-27.2) and increased risk of self-harm (OR=5.72, 95% CI 1.2-25.9) adjusting for gender and social support.

CONCLUSIONS

We found that high exposure to violence was associated with high levels of emotional disorders in adolescents that was not buffered by social support. There is an urgent need for interventions to reduce exposure to violence in young people in this setting.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Youth violence and mental health: repeating exposures

Purpose

The purpose of this paper is to discover and describe salient repeating and less common features of the recent medical literature about youth violence as it relates to mental health. How the relationship between youth violence and mental health is commonly conceptualized, investigated, and reported is summarized. Negative cases, unique approaches, and concepts are discussed.

Design/methodology/approach

An Ovid Medline literature search was conducted with the search parameters of “adolescent and violence” and “psychiatry or psychology or mental health.” In total, 66 articles met inclusion criteria and were analyzed using grounded theory procedures and techniques.

Findings

In all, 49 articles were reports of original research, 14 were literature reviews, and three were editorials. The articles included discussions of youth violence and mental health among young people in 49 countries. Most original research used cross-sectional designs that tested and supported the core hypothesis that greater exposure to violence is associated with more mental health issues. The relationship is robust even though characterizations of “exposure to violence” and “mental health” were highly variable. Meta-analytic and intervention studies were rare.

Originality/value

The core feature of the last decade of medical research has been the repeated testing and confirmation that a relationship between exposure to violence and mental health exists. Future youth violence research should move beyond continuing to test this hypothesis with cross-sectional study designs.

Community trauma as a predictor of sexual risk, marijuana use, and psychosocial outcomes among detained African-American female adolescents

Social determinants contribute to health disparities. Previous research has indicated that community trauma is associated with negative health outcomes. This study examined the impact of community trauma on sexual risk, marijuana use and mental health among African-American female adolescents in a juvenile detention center. One hundred and eighty-eight African-American female adolescents, aged 13-17 years, were recruited from a short-term detention facility and completed assessments on community trauma, sexual risk behavior, marijuana use, symptoms of posttraumatic stress disorder and psychosocial HIV/STD risk factors. Findings indicate that community trauma was associated with unprotected sex, having a sex partner with a correctional/juvenile justice history, sexual sensation seeking, marijuana use, affiliation with deviant peers and posttraumatic stress disorder symptoms at baseline and longitudinally. Findings reinforce the impact of community-level factors and co-occurring health issues, particularly in high-risk environments and among vulnerable populations. Structural and community-level interventions and policy-level changes may help improve access to resources and improve adolescents' overall health and standard of living in at-risk communities.

Trauma and homelessness in youth: Psychopathology and intervention

Youth runaway behavior and homelessness (RHY) in the U.S. is increasingly common, with prevalence estimated at 1-1.7 million youth. RHY have multiple, overlapping problems often including poor physical and mental health, frequent street victimization, and histories of physical and sexual abuse. Further, current street victimization interacts with childhood abuse to produce complex, unique presentations of traumatic symptoms and related disorders in runaway and homeless youth. This review paper explores (1) the role of childhood trauma in the genesis of runaway and homeless behavior, and (2) how childhood trauma interacts with street victimization to create vulnerability to psychopathology. In response to the trauma needs of RHY, we conducted a systematic review of the state of the current literature on trauma-informed interventions for RHY. We conclude that the field currently lacks empirically validated trauma interventions in RHY. However, theoretically plausible frameworks do exist and could be the basis for future research and intervention development.

Peritraumatic reactions in relation to trauma exposure and symptoms of posttraumatic stress in high school students

Background: Exposure to traumatic events is clearly associated with a diversity of subsequent mental health problems, with posttraumatic stress disorder (PTSD) as the most prevalent disorder. Epidemiologically, trauma exposure rates are more prevalent than PTSD, indicating that most trauma victims do not develop PTSD. More knowledge is needed to understand the development of the different posttraumatic pathways including the significance of pretraumatic, peritraumatic and posttraumatic risk factors. Objective: To study peritraumatic reactions in relation to trauma exposure and symptoms of posttraumatic stress and to enhance our understanding of peritraumatic reactions as mediators between trauma and later symptomatology. Method: The study was composed of a representative community sample of 5332 second year high school students (mean age 17.3 years) who completed the Juvenile Victimization Questionnaire (SAQ/JVQ), Trauma Symptom Checklist for Children (TSCC) and answered questions about peritraumatic reactions. Mediation effects of peritraumatic reactions on the trauma exposure relationship to symptoms was tested using the PROCESS macro for SPSS. Results: Traumatic events are common (84.1%) and are accompanied in three-quarters of the students with at least one form of peritraumatic reaction. Peritraumatic reactions, especially peritraumatic dissociative reactions, mediate the relationship between trauma exposure and symptoms, and gender moderates the effect of peritraumatic dissociation. This moderating effect was found to be larger for boys than for girls, indicating gender differences in response to trauma. Conclusions: The results indicate the need to screen for peritraumatic reactions as early as possible after a traumatic event in order to identify those at risk for PTSD.

Adolescent Exposure to Violence and Adult Violent Victimization and Offending

Research on the effects of child abuse and of childhood and adolescent exposure to domestic violence or community violence has generally, with some exceptions, found them to be related to subsequent negative behavioral outcomes, such as crime, delinquency, and substance abuse. This study uses longitudinal self-report data from the National Youth Survey Family Study to investigate how being physically abused by parents, witnessing violence between parents, and exposure to violence in the neighborhood are related to violent victimization and offending in middle adulthood, controlling for prior involvement in the outcome behaviors in adolescence. Physical abuse and witnessing parental violence appear to have little direct impact on adult violent offending and victimization net of the impact of adolescent violent victimization more generally; but adolescent exposure to neighborhood violence does appear to be predictive of adult violent victimization and offending for female respondents.

Exposure to Violence and Virologic and Immunological Outcomes Among Youth With Perinatal HIV in the Pediatric HIV/AIDS Cohort Study

PURPOSE

Exposure to violence in childhood has been linked to adverse health outcomes. Little is known about the prevalence and relationship of youth and caregiver violence exposure to clinical outcomes among youth with perinatal human immunodeficiency virus (HIV) infection (PHIV). We evaluated associations of youth and caregiver violence exposure with unsuppressed viral load (VL) (HIV RNA > 400 copies/mL) and CD4% <25% among 8- to 15-year-old participants with PHIV in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol.

METHODS

Annual clinical examination, record abstraction, and interview data were collected, including youth report of recent exposure to violence and caregivers' self-report of being assaulted/abused in adulthood. Multivariable logistic regression methods were used to calculate adjusted odds ratios for unsuppressed VL and CD4% <25%, controlling for sociodemographic characteristics.

RESULTS

Among 268 youth with PHIV (53% girls, mean age 12.8 years, 21% white, 42% with household income <$20,000/year), 34% reported past year violence exposure; 30% had a caregiver who reported being assaulted in adulthood. One quarter of youth (24%) had unsuppressed VL and 22% had CD4% <25%. Youth who were exposed to violence in the past year versus those who were not had elevated odds of unsuppressed VL. Youth with indirect exposure to violence in the past year versus those without had elevated odds of unsuppressed VL and CD4% <25% in adjusted models.

CONCLUSIONS

Youth with PHIV report a high prevalence of recent violence exposure, which was associated with poor virologic and immunologic outcomes. Reducing violence and providing support to youth with violence exposure and PHIV may improve health outcomes.

Adolescent Gender Differences in Residential Versus Outpatient Mental Health Treatment: A Meta-Analysis

Level-of-care decisions for adolescents in need of mental health services have been found to be inconsistent. This study sought to establish a research base for more objective and reliable level-of-care decisions related to gender differences in clinical characteristics of male and female patients aged 12–19 years receiving mental health treatment in a residential setting or outpatient mental health services. A meta-analytic approach was used to analyze 20 studies and 49 independent effect sizes across six constructs: internalizing, externalizing, psychosocial stressors, risk to self and others, total pathology, and substance use. The results indicated that male participants had higher levels of externalizing at the outpatient level, and female participants had higher levels of all remaining constructs at both levels of care. This indicated that female patients often presented to both levels of care with greater psychopathology.

Violence Exposure and Early Substance Use in High-Risk Adolescents

This study examines the relationship between violence exposure and early substance use as mediated by trauma symptoms. The Assessment of Liability and Exposure to Substance Use and Antisocial Behavior Scale was used to assess violence exposure at age 10 and substance use by age 12. Mediation analysis indicated direct relationships between violence exposure and tobacco/illegal drug use and indirect relationships between violence exposure and girls' substance use through trauma symptoms. Practitioners should consider violence exposure as a risk factor for early substance use in high-risk youths and potential gender differences in trauma symptom pathways to early substance use.

Predicting violent behavior: The role of violence exposure and future educational aspirations during adolescence

Few researchers have explored future educational aspirations as a promotive factor against exposure to community violence in relation to adolescents' violent behavior over time. The present study examined the direct and indirect effect of exposure to community violence prior to 9th grade on attitudes about violence and violent behavior in 12th grade, and violent behavior at age 22 via 9th grade future educational aspirations in a sample of urban African American youth (n = 681; 49% male). Multi-group SEM was used to test the moderating effect of gender. Exposure to violence was associated with lower future educational aspirations. For boys, attitudes about violence directly predicted violent behavior at age 22. For boys, future educational aspirations indirectly predicted less violent behavior at age 22. Implications of the findings and suggestions for future research are discussed.

Incident-level analysis of 703 retrospective self-reports of ordinary violence recalled by 334 Swedes aged 6 to 45 years

There is wide variation in how exposure to violence is conceptualized. Perceptions of ordinary violence are linked to people's actual experiences, which may be direct, indirect, observed, or vicarious, and all through filters of gender, class, community, and culture. Event-recall interviews were conducted among a convenience sample of Swedish males (n = 132) and females (n = 202) aged 6 to 45 years. Respondents spontaneously recalled 703 events (averaging 2.3 events for males, 2.1 for females). For men, 93% of events were male(s)-on-male(s), 2% female-on-female, and 2% male(s)-on-female(s). For women, 42% of events were male(s)-on-male(s), 19% female(s)-on-female(s), 24% male(s)-on-females, and 10% female(s)-on-male(s). Interviewee's roles differed. Of males, 17% were aggressors, 40% victims, and 43% observers. Of females, 12% were aggressors, 30% victims, and 58% observers. For males, there was a significant increase in degree of seriousness of events from junior-, to high school, to college. For females, events became more serious as interviewees progressed from aggressor to victim to observer. For males, violent events between strangers were significantly more serious than all other combinations of acquaintanceship. Most recently recalled events were the most serious for males (no effect for females). Participation in sports was linked to seriousness of events recalled by females, events being described as more serious by females who participated in sports, this effect being stronger for those females who participated in contact/collision and self-defense sports. The significant correlation between trauma and seriousness is nearly twice as strong for females which might be taken as an indication of stronger moral pathos.

The parent ratings of traumatized children with or without PTSD

Two clinical and 2 structured clinical interviews were used to identify children with posttraumatic stress disorder (PTSD), traumatized children without PTSD, and nontraumatized controls. Parents evaluated child conduct by marking the Conners' Parent Rating Scale-48 (CPRS-48; Conners, 1989). Data analysis indicated that the CPRS-48 Total scores and the Anxiety and Psychosomatic subscales scores of the PTSD group significantly exceeded the scores of the comparison groups. Children with PTSD and traumatized children without PTSD did not significantly differ on the Hyperactivity Index. The Hyperactivity Index scores of traumatized children without PTSD and nontraumatized controls were not significantly different. Nonsignificant differences were observed between groups on the CPRS-48 Impulsivity-Hyperactivity, Conduct Problems, and Learning subscales. Overall, PTSD was marked by higher internalizing scores and trauma exposure without PTSD was not associated with increased psychological morbidity.

The effects of violence exposure on the development of impulse control and future orientation across adolescence and early adulthood: Time-specific and generalized effects in a sample of juvenile offenders

Impulse control and future orientation increase across adolescence, but little is known about how contextual factors shape the development of these capacities. The present study investigates how stress exposure, operationalized as exposure to violence, alters the developmental pattern of impulse control and future orientation across adolescence and early adulthood. In a sample of 1,354 serious juvenile offenders, higher exposure to violence was associated with lower levels of future orientation at age 15 and suppressed development of future orientation from ages 15 to 25. Increases in witnessing violence or victimization were linked to declines in impulse control 1 year later, but only during adolescence. Thus, beyond previous experiences of exposure to violence, witnessing violence and victimization during adolescence conveys unique risk for suppressed development of self-regulation.

Adolescent exposure to violence and adult physical and mental health problems

Evidence on the relationship of adolescent exposure to violence (AEV) with adult physical and mental health problems is limited, with studies often focusing on earlier childhood rather than adolescence, and also on short term rather than long term outcomes. Information specifically on the relationship of AEV to seeking help for mental health problems in adulthood from either formal sources such as mental health professionals or informal sources such as friends and clergy is even more difficult to find. The present study investigates how adolescent exposure to violence (AEV), in the form of parental physical abuse, witnessing parental violence, and exposure to violence in the neighborhood, are related to self-reported adult physical problems and seeking formal or informal assistance with mental health, controlling for more general adolescent violent victimization and for self-reports and parent reports of mental health problems in adolescence. This study adds to the literature on AEV and adult physical problems, and provides a rare look at the relationship of AEV to adult help-seeking for mental health problems. The results suggest that AEV is associated with mental health problems in adolescence for both females and males, that for females AEV is related to physical problems and to seeking help for mental health problems in adulthood, but for males the only significant relationship involves inconsistent reports of witnessing parental violence and adult physical problems.

Gender-specific research on mental illness in the emergency department: current knowledge and future directions

Mental illness is a growing, and largely unaddressed, problem for the population and for emergency department (ED) patients in particular. Extensive literature outlines sex and gender differences in mental illness' epidemiology and risk and protective factors. Few studies, however, examined sex and gender differences in screening, diagnosis, and management of mental illness in the ED setting. Our consensus group used the nominal group technique to outline major gaps in knowledge and research priorities for these areas, including the influence of violence and other risk factors on the course of mental illness for ED patients. Our consensus group urges the pursuit of this research in general and conscious use of a gender lens when conducting, analyzing, and authoring future ED-based investigations of mental illness.

Family obligation values as a protective and vulnerability factor among low-income adolescent girls

Adolescents' beliefs about family obligation often reflect cultural variations in their family context, and thus are important for understanding development among diverse youth. In this study, we test hypotheses about the role of family obligation values in risk behavior and mental health in a sample of 194 low-income adolescent girls (mean age = 15.2; 58% Latina, 28% African-American/Black). We hypothesized that family obligation values can be both a protective and vulnerability factor, depending on the type of outcome and the presence of other risk factors. Across the sample, higher family obligation values tended to occur with indicators of positive family functioning (e.g., more frequent communication, less maternal hostility) based on mother and adolescent reports. As hypothesized, family obligation values moderated the relationship between established risk factors and adjustment in distinct ways, such that high family obligation values decreased risk in some domains (i.e., a protective factor) but increased risk in other domains (i.e., a vulnerability factor). Specifically, high family obligation values diminished the relationship between peer norms for risky behavior (sex and substance use) and individual engagement in those behaviors. At the same time, high family obligation values magnified the relationship between exposure to negative life events and poor mental health (PTSD and depressive symptoms). The results suggest that family obligation is an important but complex aspect of development among diverse adolescent girls.

The shrinking world of girls at puberty: violence and gender-divergent access to the public sphere among adolescents in South Africa

Participatory mapping was undertaken with single-sex groups of grade 5 and grade 8-9 children in KwaZulu-Natal. Relative to grade 5 students, wide gender divergence in access to the public sphere was found at grade 8-9. With puberty, girls' worlds shrink, while boys' expand. At grade 5, female-defined community areas were equal or larger in size than those of males. Community area mapped by urban grade 8-9 girls, however, was only one-third that of male classmates and two-fifths that of grade 5 girls. Conversely, community area mapped by grade 8-9 boys was twice that of grade 5 boys. Similar differences emerged in the rural site. No female group rated a single community space as more than 'somewhat safe'. Although curtailed spatial access is intended to protect girls, grade 8-9 girls reported most places in their small navigable areas as very unsafe. Expanded geographies of grade 8-9 boys contained a mix of safe and unsafe places. Reducing girls' access to the public sphere does not increase their perceived safety, but may instead limit their access to opportunities for human development. The findings emphasise the need for better violence prevention programming for very young adolescents.

Gender differences in the effects of community violence on mental health outcomes in a sample of low-income youth receiving psychiatric care

Previous research suggests that community violence impacts mental health outcomes, but much of this research has not (a) distinguished between different types of community violence, (b) examined gender differences, and (c) focused on youth living in urban poverty. The current study addresses these questions. Participants were 306 youth (23 % girls) and one parent/guardian receiving outpatient psychiatric services for disruptive behavior disorders in a large urban city. Youth and parents reported on youth's experience of different types of community violence (being a direct victim, hearing reports, and witnessing violence), and whether violence was directed toward a stranger or familiar. Outcomes included youth externalizing, internalizing, and posttraumatic stress symptoms assessed via parent and youth reports. Being a direct victim of violence accords risk for all mental health outcomes similarly for both boys and girls. However, gender differences emerged with respect to indirect violence, such that girls who hear reports of violence against people they know are at increased risk for all assessed mental health outcomes, and girls who witness violence against familiars are at increased risk for externalizing mental health symptoms in particular. There are gender differences in violence-related mental health etiology, with implications for intervention assessment and design.