Co-occurring forms of child maltreatment and adult adjustment reported by Latina college students
Introduction
A large body of research has examined the prevalence, characteristics, and potential consequences of various forms of child maltreatment, including sexual abuse, physical abuse, psychological abuse, neglect, and traumatic exposure to violence between parents. Historically, however, this literature has been segmented, with researchers tending to focus their efforts on a particular form of maltreatment to the exclusion of others. For example, most studies examining the long-term correlates of child sexual abuse have done so without considering concomitant forms of maltreatment experienced by children who are sexually victimized. Likewise, investigations of the lasting impact of childhood physical abuse have rarely assessed additional types of maltreatment.
Recently, an emerging area of research has begun to explore and document a co-existence between different forms of family violence and child maltreatment. As a whole, this work suggests that children who experience one type of maltreatment are at an increased risk of other forms as well. In an early examination of this phenomenon, Hughes, Parkinson, and Vargo (1989) found that 48% of 84 children residing in a battered women’s shelter had not only been exposed to spousal abuse, but were also physically abused by a parent. This overlap between exposure to domestic violence and child physical abuse has been found consistently across a number of subsequent studies, with overall rates of co-occurrence estimated at 40% (see Appel & Holden, 1998 for a review). Other researchers have found the co-existence of physical and sexual abuse in a sample of female inpatient adolescents to be 71% (Westen, Ludolph, Misle, Ruffins, & Block, 1990). Similarly, Claussen and Crittenden (1991) noted that 91% of 175 children reported to child protective services for physical abuse or neglect were ultimately found to have experienced both physical and psychological abuse.
The range of abuse types considered has recently been broadened by Higgins and McCabe (2000) who examined the co-occurrence of childhood sexual abuse, physical abuse, psychological abuse, neglect, and exposure to family violence reported by a community sample of 175 Australian men and women. Nearly half (43%) of all participants reported experiencing more than one type of childhood maltreatment, while 15.4%, 11.4%, 9.7%, and 6.9% of the total sample were classified as having experienced two, three, four, and five types of maltreatment, respectively. Similarly, in a study utilizing a large community sample of females in the US (N=668), it was found that 53% of participants reported experiencing at least one form of child maltreatment (i.e., physical, sexual or emotional abuse) and 45% of the sample had endured two or all three types of abuse (Moeller, Bachman, & Moeller, 1993).
Given the accumulating evidence of a co-occurrence of maltreatment types, it seems important to assess whether these experiences are related to increased symptomatology among victims. Initial studies with children suggest that those who are multiply victimized may be at risk of greater short-term symptomatology in comparison to youth who have not been abused or who have experienced a single form of maltreatment. Hughes et al. (1989) used the term “double whammy” to describe their findings that physically abused children who had also witnessed parental violence showed greater internalizing and externalizing difficulties than did participants who experienced no maltreatment or those who had only witnessed parental violence. Other researchers have concluded that physical neglect, in conjunction with physical and verbal abuse, is particularly detrimental with regard to children’s future outlook, whereas a combination of physical neglect, verbal, and sexual abuse was associated with decreased life enjoyment (Ney, Fung, & Wickett, 1994).
The adult literature has also linked multiple childhood victimizations to long-term negative outcomes. For instance, women who report being physically and sexually abused as children may show more symptoms of PTSD, report increased sexual dysfunction, and experience more traumatic events in adulthood (e.g., sexual or physical assault, burglaries, serious injuries, or illnesses) than those with a history of a single type of child maltreatment or no maltreatment at all (Schaff & McCanne, 1998, Wind & Silvern, 1992). Other research has found that adults reporting three to five forms of child maltreatment had significantly higher levels of trauma-related symptoms and self-depreciation than those who experienced one or two types of maltreatment (Higgins & McCabe, 2000). Finally, the cumulative impact of child maltreatment may not be limited to psychological outcomes. Specifically, the likelihood of victims being hospitalized for illnesses and surgeries, and perceiving themselves as having physical difficulties, has been found to increase with the number of child maltreatment types reported (Moeller et al., 1993).
To date, knowledge about the co-occurrence and cumulative impact of multiple forms of child maltreatment has been derived from studies involving almost long-term exclusively non-Hispanic Caucasian samples. This limitation is indicative of a broader trend revealed by a recent content analysis of the child maltreatment literature, which found that ethnic and cultural factors are often ignored in research on child abuse and neglect (Behl, Crouch, May, Valente, & Conyngham, 2001). This failure to consider important demographic factors such as ethnicity highlights the need to incorporate diverse populations into the growing literature on co-occurring maltreatment types. Recent census figures showing a sharply increasing Hispanic population in the US (United States Census Bureau, 2001) underscores a particular need for the investigation of multiple forms of maltreatment within this burgeoning segment of society. Thus far, however, research with Latinos has mirrored the broader child maltreatment literature in its tendency to address single types of maltreatment, without considering the prevalence or possible combined effects of concurrent forms. For example, several studies have focused specifically on the occurrence and sequelae of childhood sexual abuse among Latinos (Arroyo, Simpson, & Aragon, 1997; Huston, Parra, Prihoda, & Foulds, 1995; Mennan, 1994; Sanders-Phillips, Moisan, Wadlington, Morgan, & English, 1995), while other literature has examined physical abuse (Roosa, Reinholtz, & Angelini, 1999; Schechter et al., 2000), or characteristics of psychological abuse (Champion, 1999).
Ethnic diversity is an important topic of investigation in child maltreatment research, in part, because factors associated with ethnicity may play a role in moderating the long-term impact of abuse. Ethnically based variables such as religiosity, social and family support, coping strategies, and treatment seeking, have the potential to help or hinder long-term adjustment to maltreatment. For instance, religion may help to provide a protective environment and encourage a perception of community support (Sorenson & Siegel, 1992, Sue & Sue, 1999) that may decrease psychological effects for Latinas who have experienced childhood maltreatment, especially sexual abuse. Conversely, it has been suggested that some religious beliefs may heighten victim-blaming responses, which may lower reporting rates and help-seeking by Latina victims, thereby contributing to deleterious psychological effects (Ramos Lira, Koss, & Russo, 1999). Further, Latino cultures tend to hold more traditional values than the US dominant culture (Lefley, Scott, Llabre, & Hicks, 1993), including an emphasis on the role of the family. An environment of familial support may encourage reporting and, in turn, help prevent long-term negative effects for victims of child maltreatment. In contrast, the traditional family values noted in many Latino populations may decrease reporting rates and victim support, as failure to protect an abusing relative could be considered a dishonor to the family (Ramos Lira et al., 1999).
Child maltreatment research with Latinos has typically focused on between-group comparisons among Latino and non-Hispanic Caucasian samples, with some investigations finding few ethnic differences in adjustment following abuse (Mannarino, Cohen, & Gregor, 1989; Mennan, 1994) and others reporting that children and adults of Hispanic descent may suffer more serious symptomatology following abuse (Morrow & Sorrell, 1989, Sanders-Phillips et al., 1995; Stein, Golding, Siegel, Burnam, & Sorenson, 1988). However, this grouping together of individuals from particular cultural backgrounds to compare one ethnic group to another precludes a more thorough analysis of within group ethnically-based factors that may play a role in adjustment to childhood maltreatment (Fontes, 1995). One such factor is acculturation, or the degree to which Latinos identify with Anglo-American culture as opposed to their culture of origin. As with other factors related to ethnicity, investigations examining the effects of acculturation on various aspects of adult adjustment have yielded mixed results. For example, one study found no relationship between acculturation and depressive symptomatology among Latinos (Cuéllar & Roberts, 1997), while another revealed that acculturative stress may increase levels of depression among Hispanics (Rogler, Cortes, & Malgady, 1991). To date, however, no studies have looked specifically at the potential impact of acculturation on outcomes for adult survivors of child maltreatment. A within-group examination of acculturation status can shed light on the role that affiliation with Anglo versus Latino culture may play in moderating the long-term correlates of childhood maltreatment.
The purpose of the present study is to add to the scant child maltreatment literature focusing on Latino populations by examining the nature and co-occurrence of multiple forms of childhood maltreatment in a sample of Latina college students. More specifically, childhood histories of sexual abuse, physical abuse, emotional abuse, and exposure to parental violence are examined in conjunction with acculturation status, as possible contributors to long-term difficulties in psychological functioning. Based on previous findings with non-Hispanic Caucasian samples, it is expected that those who recall experiencing multiple forms of maltreatment during childhood will report greater adult symptomatology in comparison to those who endured either a single form of maltreatment or no maltreatment at all. Additionally, it is predicted that acculturation status will moderate the relationship between the number of maltreatment types and participants’ trauma symptomatology.
Section snippets
Participants
Participants were recruited by research assistants from undergraduate psychology classes at a private, urban university in south central Texas. This university serves primarily female students and thus the present study was limited to female participants. Approximately 150 students were invited to take part in the study and 112 agreed to participate. All participants were females of Mexican American descent who received class credit for their participation. The mean age of participants was
Data analytic strategy
As noted, a primary objective of the investigation was to examine the potential impact of the number of maltreatment types and acculturation status on adult trauma symptomatology. This necessitated dichotomizing each form of child maltreatment (i.e., abuse either did or did not occur) and creating a summary score reflecting the total number of abuse types experienced by each participant. This score, in conjunction with acculturation level, served as grouping variables for conducting ANOVAs to
Discussion
The present investigation extends findings from studies of “multi-type” abuse with non-Hispanic, Caucasian samples (Briere & Runtz, 1990, Higgins & McCabe, 2000, Moeller et al., 1993, Ney et al., 1994) by suggesting that Latina college students may also commonly experience multiple forms of maltreatment during childhood. In the present study, 29% of participants reported being subjected to two or more forms of maltreatment as children. Furthermore, as predicted, those who endured multiple forms
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