Trajectories of psychopathology and risky behaviors associated with childhood abuse and neglect in low-income urban African American girls

Abstract

The current study examined patterns of psychopathology, drug and alcohol use, and sexual behavior associated with childhood abuse and neglect in a high-risk sample of low-income African American girls seeking mental health treatment. Participants (N = 177) were African American girls recruited from mental health clinics serving low-income communities in Chicago, IL and followed over six waves of data collection (T1–T6) reflecting early (mean age 14) to late (mean age 17) adolescence. Child abuse and neglect history was determined from adolescent and caregiver reports. Latent curve modeling examined patterns of internalizing and externalizing psychopathology, drug and alcohol use, sexual experience, and risky sexual behavior reported by girls and associations with reported child abuse and neglect. Overall, these trajectories indicated a decrease in internalizing and externalizing symptoms, stability of drug and alcohol use, and an increase in sexual experience and risky sexual behaviors over time. Child abuse and neglect was associated with increased internalizing symptoms and sexual experience at baseline and with externalizing symptoms and risky sexual behavior both at baseline and the final point. Child abuse and neglect was not significantly associated with alcohol or drug use. This study adds to the literature on the long-term consequences of child abuse and neglect by demonstrating patterns of psychopathology and risky behavior that persist over time in a high-risk group of girls with self or parent reported histories of abuse and neglect. Interventions that address externalizing problems and health risk behaviors may be of particular importance for this population.

Introduction

Child abuse and neglect is a major public health and social welfare problem, affecting approximately one in twenty-five children ages zero to eighteen in the United States (Sedlak et al., 2010). In 2012, approximately 3.8 million children were referred to child protection service agencies for suspected abuse and neglect; 678,810 unique children were determined to be victims of abuse or neglect; and an estimated 1,640 children died from abuse or neglect (U.S. Department of Health and Human Services, 2012). Furthermore, the total cost of child abuse and neglect in the United States in a single year is estimated at $124 billion (Fang, Brown, Florence, & Mercy, 2012). Increasing evidence indicates that the negative consequences of childhood abuse and neglect extend across multiple domains of functioning and developmental time points (Currie and Widom, 2010, Johnson et al., 1999, Jonson-Reid et al., 2004, Lansford et al., 2002, Perez and Widom, 1994, Widom, 1999). Among these consequences, child abuse and neglect has been found to increase risk of psychopathology, substance use problems, risky sexual behavior, and criminal behavior in childhood and adulthood (Gilbert et al., 2009). Moreover, individuals with childhood abuse and neglect histories are more likely to use mental health and social services in adulthood (Yanos, Czaja, & Widom, 2010).

Although it is known that childhood abuse and neglect can have long-term consequences across multiple developmental domains, few studies have taken a longitudinal approach to examine developmental patterns in outcomes. In particular, no existing studies have examined the effects of childhood abuse and neglect on trajectories of behavioral outcomes over time. By contrast, the approach taken in the current analysis acknowledges change in developmental outcomes from early to late adolescence, an approach with the potential to capture complexity missed in analyses that examine behaviors at only one point in time.

In addition, some evidence suggests that the consequences of abuse and neglect can be more severe and long-lasting in minority children (Cohen, Deblinger, Mannarino, & de Arellano, 2001). However, minority populations remain under represented in the research, and therefore less is known about the consequences of childhood adversities, such as abuse and neglect, for minority youth growing up in low-income urban communities (Mersky et al., 2013, Widom et al., 2013). To our knowledge, no existing studies have focused specifically on longitudinal patterns associated with child abuse and neglect in low-income African American girls.

Guided by a developmental psychopathology framework (Cicchetti and Toth, 1995, Sroufe, 1983), the current study examined trajectories of psychopathology and risky behaviors (internalizing and externalizing psychopathology, alcohol and drug use, and sexual risk) associated with self- or caregiver-reported child abuse and neglect in a sample of low-income, urban African American girls who sought mental health treatment. The following review summarizes current research on the consequences of abuse and neglect in these three domains, emphasizing longitudinal studies and results for women and African Americans (“Black” is used when that term was used by the study authors).

Child abuse and neglect are linked to a variety of mental health problems, including antisocial behavior, depression, anxiety, and suicidality. Child abuse and neglect is a well-known predictor of externalizing problems, such as aggression and delinquency, which can result in juvenile justice involvement. Several large prospective investigations have documented a relationship between childhood abuse and neglect and juvenile delinquency (Lansford et al., 2007, Maxfield and Widom, 1996, Smith and Thornberry, 1995, Stouthamer-Loeber et al., 2001, Widom, 1989). The relationship between child abuse and neglect and antisocial behavior may be stronger among females than males (Herrera and McCloskey, 2001, Loeber and Stouthamer-Loeber, 1998, Maxfield and Widom, 1996). It is estimated that 70% of girls in the juvenile justice system have a history of sexual or physical abuse, versus 20% of females in the general population (Meichenbaum, 2006). Although there are likely a variety of pathways, physical and sexual abuse have been identified as important precursors of delinquent behavior in girls (Herrera and McCloskey, 2003, Lansford et al., 2007). A few studies report race or ethnic differences in the extent to which maltreated children are at increased risk for being arrested for a violent crime compared to non-maltreated children (Maxfield and Widom, 1996, Zingraff et al., 1993). Widom, Czaja, Wilson, Allwood, and Chauhan (2013) found that neglected Black children were twice as likely to be arrested for a violent crime relative to Black controls.

Child abuse and neglect is also associated with an increased risk of depression (Kim and Cicchetti, 2006, Kim and Cicchetti, 2010). Approximately a quarter of maltreated children meet criteria for major depression by their mid-20s (Fergusson et al., 2008b, Widom et al., 2007a). In addition, physical and sexual abuse history have been found to increase risk of suicide attempts (Fergusson, Boden, & Horwood, 2008b). Child abuse and neglect is also associated with an increased risk of anxiety disorders including generalized anxiety disorder, panic disorder, phobias, and post-traumatic stress disorder (Heim et al., 2010, Norman et al., 2012). These associations remain after controlling for family and individual characteristics correlated with abuse and neglect (Gilbert et al., 2009). In a prospective study, Widom et al. (2013) found that Black neglected children, in particular, showed increases in risk for anxiety and dysthymia. Another study found that PTSD risk following exposure to a traumatic event, such as childhood abuse and neglect, was significantly higher for Black adults (Roberts, Gilman, Breslau, & Koenen, 2012).

Studies have consistently found associations between child abuse and neglect and increased risk of alcohol problems in adolescence and adulthood. These effects are moderate and persist in most, but not all, studies after adjustment for family characteristics and parental alcohol use (Gilbert et al., 2009). Some researchers have reported a more consistent relationship between abuse and neglect and later alcohol problems among females than males (Simpson and Miller, 2002, Widom et al., 2007b). There is also evidence of an association between abuse and neglect and increased risk for drug use (Chauhan and Widom, 2012, Hadland et al., 2012, Widom et al., 2006). However, this evidence is mixed and inconsistent (Fergusson et al., 2008a, Hussey et al., 2006, Lansford et al., 2002, Thornberry et al., 2011, Widom et al., 2006). Prospective studies have found this relationship to be only borderline significant (Chauhan and Widom, 2012, Norman et al., 2012) or limited to women (Widom et al., 2006). Childhood physical abuse has been linked with alcohol problems in Black women (Caetano, Field, & Nelson, 2003), but neglect was not associated with alcohol problems among Black individuals in a prospective study (Widom et al., 2013).

Individuals who have experienced childhood abuse and neglect have been found to have heightened rates of sexually transmitted infections (STIs) and risky sexual behavior (Williams et al., 2010, Wilson and Widom, 2008, Wilson and Widom, 2009). Childhood sexual abuse, in particular, has been linked to an increased risk of teenage pregnancy, earlier onset of sexual activity, greater numbers of sexual partners, increased rates of abortion, and increased risk of sex trading in adolescence and adulthood (Boden et al., 2009, Kalichman et al., 2004, Senn et al., 2007, Young et al., 2011). One prospective study has also linked childhood physical abuse, sexual abuse, and neglect to risky sexual behaviors and STIs in adulthood (Wilson and Widom, 2008, Wilson and Widom, 2009, Wilson and Widom, 2011). Some evidence suggests that cultural, race, or ethnic differences may influence the relationship between childhood abuse and neglect and sexual risk behaviors (Wilson & Widom, 2009). Wyatt et al. (2002) found that general trauma history was associated with HIV-positive status in African American, European, and Hispanic women, but childhood sexual abuse was only associated with being HIV positive for African American women. Some have suggested that cultural norms within the African American community influence how victims and their families respond to and cope with child abuse and neglect which may, in turn, affect risk of engaging in risky sexual behavior (Sumner et al., 2010).

The current study examined longitudinal patterns of psychopathology (internalizing and externalizing), drug and alcohol use, sexual experience, and risky sexual behavior associated with self- or caregiver-reported childhood abuse and neglect in a high-risk sample of low-income African American girls seeking mental health treatment. Although prospective studies have examined pathways from childhood abuse and neglect to outcomes measured later in time, this study is unique in assessing how child abuse and neglect relates to trajectories of behavioral risks measured over multiple points in time during adolescence. We hypothesized that girls with histories of child abuse or neglect would be at increased risk for internalizing and externalizing psychopathology, drug and alcohol use, sexual experience, and risky sexual behavior (i.e., multiple partners and inconsistent condom use). We expected this pattern to persist over six points in time, spanning early adolescence (mean age 14) to late adolescence (mean age 17). We also hypothesized that child abuse and neglect would be associated with a more rapid increase in psychopathology and risk behaviors over time.