Childhood Polyvictimization and Associated Health Outcomes: A Systematic Scoping Review

Six of one, half a dozen of the other? Examining measurement properties of different potentially traumatic event polyvictimization operationalizations using a multiverse analysis framework

Numerous differences exist between and within research projects related to assessment and operationalization of potentially traumatic events (PTEs) for youth, especially when measuring polyvictimization. However, few studies have systematically examined how polyvictimization measurement differences influence PTE's relation to functioning. This study sought to address these knowledge gaps by conducting a secondary data multiverse replication (SDMR) to systematically (re)evaluate PTE polyvictimization measurement approaches. Participants included 3297 adolescents (Mage = 14.63; 50.59% female; 65.15% white) from the National Survey of Adolescents-Replication study who completed a structured interview on PTE exposure and emotional and behavioral health (i.e., posttraumatic stress and major depressive disorder, drug and alcohol use, and delinquency). Results indicated that PTE operationalizations using a count variable tended to demonstrate better model performance and prediction of youth at-risk of emotional and behavioral health challenges, compared to models using a binary (yes/no) PTE operationalization. Differences in model performance and prediction were less distinct between models examining multiple forms of a single type of PTE (e.g., maltreatment, community violence), compared to models examining multiple PTE types. These findings emphasize the importance of using multidimensional approaches to PTE operationalization and the need for more multiverse analyses to improve PTE evidence-based assessment.

Child maltreatment and behavioral health outcomes in child welfare: Exploring the roles of severity and polyvictimization

BACKGROUND

Child maltreatment and polyvictimization are known risk factors for long-term detrimental health and development outcomes, including behavioral health challenges. However, effects from specific types and combinations of maltreatments are unclear. This study examined the association between maltreatment or polyvictimization and behavioral health in a child welfare sample.

PARTICIPANTS AND SETTING

Medical records of children with child welfare involvement with at least one behavioral health condition (i.e., mental, behavioral or neurodevelopmental disorder, ICD-10 F01-F99) between 1/1/2018-12/31/2021 were extracted from a large, academic hospital system.

METHODS

Behavioral health complexity was categorized as non-chronic, non-complex chronic, or complex chronic using the Pediatric Medical Complexity Algorithm. Partial proportional logistic regression models adjusted for age, sex, race/ethnicity, caregiver type, and physical health complexity generated odds of behavioral health complexity by maltreatment type (physical abuse, sexual abuse, neglect) and maltreatment combinations.

RESULTS

The analytic sample included 3992 participants (mean age 7.6 (Standard Deviation, 5.0) 44 % female, 29 % white, 32 % black, 22 % Hispanic). Participants who experienced physical abuse (Odds Ratio [OR]: 1.79, 95 % Confidence Interval [CI]: 1.10-2.91), or neglect (OR: 1.69, 95 % CI: 1.38-2.07) were more likely to have increasing behavioral health complexity versus those without maltreatment. Participants with both physical abuse and neglect were over twice as likely (OR: 2.44, 95 % CI: 1.88-3.16) to have increasing behavioral health complexity versus those who did not experience maltreatment.

CONCLUSION

Results emphasize the differential impacts of maltreatment and polyvictimization exposures on behavioral health complexity among children with child welfare involvement that can guide risk assessment and clinical care.

Let it go, let it go: Stop measuring child maltreatment as a binary yes/no

Numerous methods are used in the measurement of child maltreatment (CM) exposure. As a science, it is necessary that the field of CM research evaluate its measurement approaches periodically to ensure that the common approaches are the best approaches. A prominent method for measuring CM in research as a predictor variable is to conceptualize CM as a two-level, yes/no binary variable (e.g., 0 = No CM exposure, 1 = CM exposure). While there is no consensus on what method is the best approach for measuring CM, empirical evidence suggests that the binary measurement approach to CM has significant limitations. The current paper sought to progress the field of CM and trauma research forward by reviewing several lines of research demonstrating why the use of a binary yes/no CM measurement approach is problematic. As evidence for why a binary measurement of CM should be halted, this paper reviews research on: why the characteristics or details of CM exposure matter, risk of CM "contamination," and CM's relation with environmental or systemic factors. The ethical and clinical implications of a CM binary measurement approach are also discussed. Several recommendations for the field are provided on how researchers can improve the measurement of CM and ensure accurate and replicable studies are being published.

Indirect victims of violence: Mental health and the close relatives of serious assault victims in England

An extensive body of evidence shows the impact of being the direct victim of a serious assault. However, much less is known about the impact on the family and close relatives of victims, who may be considered indirect victims. Based on analyses of the 2014 Adult Psychiatric Morbidity Survey, a face-to-face, cross-sectional probability-sample survey of 7519 adults aged 16 and over in England, this article estimates what proportion of the population was closely related to a victim of serious assault, and whether this experience was associated with a higher prevalence of feeling unsafe, depression and anxiety disorder, post-traumatic stress, self-harm, and suicidality. Descriptive and multivariable regression analyses were conducted, adjusting for complex survey design and potentially confounding factors. Results show that one in twenty adults (4.5%, n = 345) was closely related to a victim of serious assault (95% confidence interval (CI):4.0-5.2%). Close adult relatives of assault victims were more likely than the rest of the population to have been direct victims of violence and abuse themselves, to have experienced multiple other adversities, and to live in more deprived neighbourhoods. However, even when controlling for these experiences, relatives of victims had adjusted odds of feeling unsafe in the neighbourhood where they lived 2.36 times higher than the rest of the population (CI:1.26-4.44), and their odds of having a depressive or anxiety disorder were 1.37 times higher (0.99-1.90). These analyses indicate that relatives in England may already be vulnerable, with potential to also be further affected by the experiences of family members. To more fully account for the effects of violence in society, research with indirect victims of serious violence in the context of their own experiences of direct victimization and wider adversities is required. This could be factored into a broader remit for victim support services which includes support for victims' families.

Lifetime victimization experiences, depressiveness, suicidality, and feelings of loneliness in youth in care

BACKGROUND

Research has demonstrated the damaging effects of poly-victimization on the mental health of children and adolescents. However, few studies have been conducted in high-risk youth in care (Y-IC) samples.

OBJECTIVE

The study examines the frequency of lifetime victimization and the association of poly-victimization and victimization types on depressiveness, suicidality, and feelings of loneliness among Y-IC.

PARTICIPANTS AND SETTING

164 participants aged 14 and 21 years (M = 17.39, SD = 1.95), who live in family-based care or residential care.

METHODS

The Juvenile Victimization Questionnaire (JVQ) was used to assess lifetime victimization. The Patient Health Questionnaire (PHQ-9), and the Loneliness Scale-SOEP (LS-S) to measure depressiveness, suicidality, and loneliness. Hierarchical regression models were calculated.

RESULTS

Participants reported on average 12.66 (SD = 6.58) victimization experiences. The female and diverse gender groups reported higher rates of victimization, loneliness, depressiveness, and suicidality than the males. Participants in residential care reported more victimizations and stronger feelings of loneliness than those in family-based care. Poly-victimization was not associated with any of these internalizing symptoms but peer victimization was significantly associated with depressiveness (β = 0.23, p = .002) and loneliness (β = 0.22, p = .006), sexual victimization with depressiveness (β = 0.22, p = .004).

CONCLUSION

Y-IC show high levels of victimization and internalizing symptoms, with higher burden on girls and youth living in residential care. Findings underscore the relevance of social exclusion experiences among peers within Y-IC. Interventions should address multiple forms of victimization, with a special focus on sexual and peer victimization.

Lifetime Polyvictimization and Mental Health Outcomes in Women With vs Without Incarceration Histories: A Population-Based Latent Class Analysis

We use latent class analysis, a life course framework, and information on the type, frequency, and timing of trauma exposure to identify distinct polytrauma groups in a national sample of women (AddHealth). We compare the identified polytrauma groups and their associations with mental health in adulthood in women with and without incarceration histories. A unique group with polyvictimization (neglect, physical, sexual) exposure in childhood by a caregiver in women with incarceration histories was not identified in women without incarceration histories. We find evidence of distinct associations between polytrauma groups and mental health and possibly, criminal justice involvement, in adulthood.

Is lifetime abuse forgivable in old age?

Old age is characterized by reflection and a retrospective examination of the multiple meanings of various life experiences, including lifelong abuse. Forgiveness is found to have a salutary effect, especially for older adults. To understand the place and role of forgiveness in the reflective process during aging, we performed a secondary analysis of in-depth, semi-structured interviews (N = 78) with older women survivors of abuse. Inductive thematic analysis was based on concepts developed deductively from the literature review. The findings include three main themes: (1) The dimensions of forgiving: The victim as subject; (2) Being forgiven: Between lost forgiveness and hope; and (3) Self-forgiveness and the aging self. Despite the known salutary effect of forgiveness, we must consider that this is not a universally desirable process. We included the dimension of forgiveness in the study of abuse throughout the older person's life course and identified further complexities in addition to the "forgiveness"/"unforgiveness."

Polyvictimization and Adolescent Health and Well-Being in Ethiopia: The Mediating Role of Resilience

Interpersonal violence is a pervasive experience affecting one billion children and adolescents annually, resulting in adverse health and well-being outcomes. Evidence suggests that polyvictimization, the experience of multiple forms of violence, is associated with more harmful consequences for adolescents than experiencing individual types of violence, although data from low-and middle-income countries are limited. This study analyzed data on over 4100 adolescents from the Gender and Adolescence, Global Evidence Study in Ethiopia to examine the association between polyvictimization and adolescent mental and physical health and the mediating role of resilience using linear regression and path analysis. We hypothesized that adolescents experiencing polyvictimization would experience worse mental and physical health than those experiencing no types or individual types of victimization, and that resilience would mediate these relationships. Half of sampled girls and over half of boys experienced polyvictimization. Among both sexes, polyvictimization was associated with worse mental but not worse physical health. Resilience mediated the association between polyvictimization and mental health among girls only. Strengthening resilience among girls may be an effective avenue for mitigating polyvictimization's negative mental health effects, but additional research and programming for preventing and identifying polyvictimized adolescents and linking them to care is needed.

Exploring Collaborative Care Effects on the Mental and Physical Health of Patients With and Without Violent Victimization Histories

Collaborative care is a multicomponent intervention delivered by frontline social work, nursing, and physician providers to address patients' physical, emotional, and social needs. We argued that collaborative care may particularly benefit patients with a violent victimization history because it practices three principles of trauma-informed care: patient-provider collaboration, preventing repeat trauma in clinical and community settings, and delivering comprehensive mental and physical healthcare. We conducted an exploratory secondary data analysis of a collaborative care randomized clinical trial involving patients who presented with traumatic physical injury at a Level I trauma center in Washington state between 2006 and 2009. We used random-effect linear regression models to estimate how histories of multiple violent traumas moderated the effects of the collaborative care intervention on Short Form-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) T-scores over time. Collaborative care significantly improved follow-up MCS scores among patients who experienced three to four types of violent victimization in their lifetime. Additionally, intervention effects on MCS scores at the 3- and 6-month follow-up were clinically stronger for patients who reported three to four types of violent victimization (3-month = 7.5, 95% confidence level [CI] = 5.1 to 18.7; 6-month = 11.9, 95% CI = 5.1 to 18.7) than those without a history of violent victimization (3-month = 0.8, 95% CI = -5.1, 6.6; 6-month = 5.6, -2.4 to 13.5). We did not find that intervention effects on PCS scores differed between these groups at any wave. Collaborative care may be a promising approach to delivering trauma-informed mental healthcare to patients with histories of multiple types of violent victimization.

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.

Prevalence and Predictors of Poly-Victimization of Adolescents in England and Wales

This study examined the change in the prevalence of adolescent poly-victimization and individual and area predictors of poly-victimization in England and Wales. The national representative longitudinal Offending, Crime and Justice Survey (2003-2006) was analyzed with data from 2,066 adolescents, aged between 10 and 18 years (mean ± SD at Time 1 = 13.08 ± 2.01), using multilevel multinomial logit models. Findings revealed that the majority of the adolescents (41.6%, 48.5%, 54.6%, 61.6%, respectively) did not experience victimization between 2003 and 2006. However, 28.3%, 25.9%, 19.5%, and 14.5% of the adolescents experienced poly-victimization (experiencing more than or equal to two types of victimizations), with a decrease of 13.8% over the 4-year period. Furthermore, some adolescents were consistent poly-victims, meaning they were poly-victims in all years that they participated in the survey. In particular, 3.57% of the adolescents who participated in the four waves of the survey were poly-victims in all years; 7.41% of the adolescents who participated in three of the four waves of the survey were poly-victims in all years; and 25.79% of the adolescents who participated in two of the four waves of the survey were poly-victims in both years. Statistically significant predictors of poly-victimization included having parents who have been in trouble with the police, offending, participating in community-related activities, being a boy, not managing income well, and living in an urban or deprived area. Offending had the greatest impact on poly-victimization. Findings highlight that adolescent poly-victimization in England and Wales decreased between 2003 and 2006 but some adolescents were more likely to experience poly-victimization due to individual, familial, and area characteristics. The findings therefore indicate that a holistic approach is needed to reduce adolescent poly-victimization and suggest that targeting area deprivation should be the priority.

Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment

Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.