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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, 2 6 th September 2013. Background. Childhood maltreatment . Background.

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slide1

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

slide2

Background

  • Childhood maltreatment
slide3

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)
slide4

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)
slide5

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)
slide6

Background

2. Community violence exposure (CVE)

slide7

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
slide8

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
slide9

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)
slide13

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)
slide14

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 neighbourhooddeprivation
  • 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)
slide15

Outline

  • Part I: Characterizing levels of exposure
  • Part II: The impact of maltreatment and CVE
  • Part III:The influence of individual maltreatment types
slide16

Part I:

Characterizing levels of exposure

slide17

Part I: Levels of exposure

Childhood maltreatment

slide18

Part I: Levels of exposure

Childhood maltreatment: Any exposure*

KIDS COMPANY:

84%

COMPARISON:

56%

VS.

*Statistically significant difference = p < .01

slide19

Part I: Levels of exposure

Childhood maltreatment: Any exposure*

*All group differences statistically significant = p < .01

slide20

Part I: Levels of exposure

Childhood maltreatment: Severe-Extreme*

KIDS COMPANY:

38%

COMPARISON:

8%

VS.

*Statistically significant difference = p < .001

slide21

Part I: Levels of exposure

Childhood maltreatment: Severe-Extreme*

*All group differences statistically significant = p < .01

slide22

Part I: Levels of exposure

Community violence exposure

slide23

Part I: Levels of exposure

2. Community violence exposure: Any exposure*

KIDS COMPANY:

98%

COMPARISON:

95%

VS.

*Difference not significant

slide24

Part I: Levels of exposure

2. Community violence exposure: Any exposure*

n.s.

*Group differences for witnessing and victimization statistically significant = p< .01

slide25

Part I: Levels of exposure

2. Community violence exposure: Severe acts*

* All group differences statistically significant = p < .001

slide26

Part I: Levels of exposure

Single vs. Multi-type

slide27

Part I: Levels of exposure

3. Single vs. Multi-type: Childhood maltreatment

Participants with experience of maltreatment(68% of sample; N = 139)

slide28

Part I: Levels of exposure

3. Single vs. Multi-type: Community violence exposure

Participants with experience of community violence(92% of sample; N = 187)

slide30

Part I: Levels of exposure

Maltreatment

(68% of sample)

slide31

Part I: Levels of exposure

Maltreatment

(68% of sample)

No CVE

97%

CVE

slide32

Part I: Levels of exposure

Maltreatment

(68% of sample)

No CVE

97%

CVE

Maltreated youth typically experience a DOUBLE DISADVANTAGE

slide33

Part I: Levels of exposure

  • Summary
    • Alarming levels of exposure
    • Multi-type exposure ‘norm’
    • Maltreatment and CVE frequently co-occur
slide34

Part I: Levels of exposure

  • Summary
    • Alarming levels of exposure
    • Multi-type exposure ‘norm’
    • Maltreatment and CVE frequently co-occur
slide35

Part I: Levels of exposure

  • Summary
    • Alarming levels of exposure
    • Multi-type exposure ‘norm’
    • Maltreatment and CVE frequently co-occur
slide36

Part II:

The impact of maltreatment and CVE

slide37

Part II: Maltreatment & CVE impact

?

?

  • Aim
    • What are theirindependent effects?
    • What are theircombined effects?
slide38

Part II: Maltreatment & CVE impact

Independent effects: Childhood maltreatment

CHILDHOOD MALTREATMENT

*

*

*

INTERNALIZING

(Anxiety, depression)

EXTERNALIZING

(Conduct problems, ASB)

TRAUMA SYMPTOMS

(Anger, PTSD, dissociation)

* Effects statistically significant = p < .001

slide39

Part II: Maltreatment & CVE impact

Independent effects: Community violence exposure

COMMUNITY VIOLENCE EXPOSURE

*

*

INTERNALIZING

(Anxiety, depression)

EXTERNALIZING

(Conduct problems, ASB)

TRAUMA SYMPTOMS

(Anger, PTSD, dissociation)

* Effects statistically significant = p < .01

slide40

Part II: Maltreatment & CVE impact

2. Combined effects: Additive

slide41

Part II: Maltreatment & CVE impact

  • Summary
    • Both maltreatment and CVE have serious consequences for mental health
    • Children who experience both forms of adversity are at particularly high risk for mental health problems
slide42

Part II: Maltreatment & CVE impact

  • Summary
    • Both maltreatment and CVE have serious consequences for mental health
    • Youth who experience double disadvantage are at particularly high risk for mental health problems
slide43

Part III:

The influence of individual maltreatment types

slide44

Part III: Maltreatment types

Sexual Abuse

  • Aim

Physical Abuse

Physical Neglect

Emotional Neglect

Emotional Abuse

  • Similar or different effects?
slide45

Part III: Maltreatment types

  • Findings
    • All maltreatment types have negative effect*
      • Driven by what is common to all types

*(std. B = .14 – . 69; significant at least p < .05)

slide46

Part III: Maltreatment types

  • Findings
    • All maltreatment types have negative effect
      • Driven by what is common to all types

FEELING UNSAFE AND VULNERABLE?

slide47

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)

slide48

Part III: Maltreatment types

  • Findings

2. Emotional abuse

      • Unique predictive power, over and above all other types

FEELING UNLOVED AND UNSUPPORTED?

slide50

Key findings

  • Inner city youth are highly vulnerable to violence exposure
  • Maltreatment and CVE are key developmental risk factors
  • Emotional abuse unique predictive power
slide51

Implications

  • NEED TO TAKE ACTION!
    • Increase awareness
    • Invest in prevention
    • Improve access to effective interventions
slide52

Acknowledgments

  • Funding:
    • Kids Company charity
  • Collaborators:
    • DrEamon 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