Examining the independent protective effect of subjective well-being on severe psychological distress among Canadian adults with a history of child maltreatment

Abstract

The purpose of this study was to examine the independent protective effect of subjective well-being on severe psychological distress among adult Canadians with a history of child maltreatment. Data for this study were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). A sample of 8126 respondents aged 20–69 years old who experienced at least one child maltreatment event was analyzed using binary logistic regression with severe psychological distress as the outcome variable. Of the 8126 respondents with a history of child maltreatment, 3.9% experienced severe psychological distress within the past month. Results from the multivariate logistic regression revealed that emotional and psychological well-being each had a significant effect on severe psychological distress. For each unit increase in emotional well-being, the odds of a respondent having severe psychological distress were predicted to decrease by a factor of 28% and for each unit increase in psychological well-being, the odds of a respondent having severe psychological distress were predicted to decrease by a factor of 10%, net the effect of demographic, socioeconomic, and health factors. Other factors associated with psychological distress included: younger age, poor self-perceived physical health, and chronic condition. Having post-secondary education, having a higher income, and being non-White predicted lower odds of severe psychological distress. Although, child maltreatment is associated with stressful life events later in adulthood, subjective well-being could serve as a protective factor against severe psychological distress among adults who experienced maltreatment when they were children.

Introduction

Child maltreatment is a public health concern that has preoccupied the attention of researchers and policy makers in the field of social work and public health. Child maltreatment has been defined as “any physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity” (WHO Consultation on Child Abuse Prevention, 1999, as cited in Runyan, Wattam, Ikeda, Hassan, & Ramiro, 2002, p. 59). Although the literature has focused on physical abuse, sexual abuse, emotional abuse (also referred to as psychological abuse), and neglect, scholars have also recently considered exposure to intimate partner violence (IPV) as a form of child maltreatment (see e.g., Miller, Howell, & Graham-Bermann, 2012). Recent estimates from Ontario, Canada show that exposure to IPV represented close to half (48%) of all substantiated child maltreatment investigations conducted by child protection services (CPS) workers in 2013 (Fallon et al., 2015).

Various studies have documented the long-term health consequences of child maltreatment. Many of these studies have found a history of child maltreatment to be associated with poor academic performance (Leiter, 2007, Shonk and Cicchetti, 2001), attention deficit-hyperactivity disorder (ADHD; Fuller-Thomson, Mehta, & Valeo, 2014), health behaviours such as alcohol use, smoking, and obesity (Anne Lown et al., 2011, Min et al., 2013, Norman et al., 2012, Rohde et al., 2008, Shin and Miller, 2012, Taha et al., 2014), and chronic conditions such as diabetes, lung cancer, and cardiovascular disease (Brown et al., 2010, Fuller-Thomson et al., 2010, Goodwin and Stein, 2004). Maltreated individuals have also been found to be at increased risk of experiencing poor physical health (Wegman & Stetler, 2009), as well as mental health problems, such as troubled sleep, major depressive disorder, general anxiety disorder, and suicide-related behaviours (Baiden et al., 2015, Maniglio, 2010, Nanni et al., 2014, Norman et al., 2012, Reiser et al., 2014).

Others have also observed severe psychological distress (SPD) among individuals with a history of maltreatment (see e.g., McPhie, Weiss, & Wekerle, 2014). SPD presents a significant burden to individuals, their families, and society. It can lead to functional impairment, increased absenteeism, loss of productivity, interpersonal and family conflict (Hilton et al., 2009, Norén et al., 2007), poor quality of life (Atkins, Naismith, Luscombe, & Hickie, 2013), suicide-related behaviours (Williams & Hasking, 2010), as well as substance use and poor mental health (Geisner et al., 2004, Leung et al., 2012).

It should be mentioned that the majority of studies that examined individuals who have experienced child maltreatment relied on self-assessment. For instance, Baiden et al. (2015) assessed troubled sleep based on self-report, Fuller-Thomson et al. (2014) assessed ADHD based on self-report, Goodwin and Stein (2004) assessed diabetes by means of self-report, and Reiser et al. (2014) assessed suicidal behaviours based on self-report. Other studies assessed health and mental health problems using standardized questionnaires. For example, McPhie et al. (2014) assessed psychological distress using the Global Severity Index (GSI) of the Brief Symptom Inventory (BSI). In addition, Shonk and Cicchetti (2001) assessed academic performance using a number of standardized instruments including the Teacher's Checklist of Children's Peer Relationships and Social Skills, the Teacher's Rating Scale of Child's Classroom Orientation, and the Child Behavior Checklist – Teacher's Report Form (CBCL-TRF). Also, Brown et al. (2010) assessed lung cancer using discharge records. Irrespective of the method of assessment, the literature has consistently found that child maltreatment experiences are associated with long-term, adverse effects on health and mental health in adulthood.

According to the 2002 Canadian Mental Health and Well-Being Survey, 3.7% of men and 5.9% of women aged 15 years and over reported having symptoms that met the criteria for a major depressive episode within the previous 12 months (Government of Canada, 2006). Three out of four (75.5%) of these individuals reported that their mental health interfered with their daily lives (Government of Canada, 2006). Lim, Jacobs, Ohinmaa, Schopflocher, and Dewa (2008) estimated the economic burden of SPD and mental illness in Canada in 2003 to be 51 billion dollars in direct and indirect costs. However, the extant literature has shown that through social support, self and social acceptance, and personal growth, some individuals who experienced trauma and stressful life events are able to develop certain protective factors against various life stressors and mental health problems (Howell and Buro, 2015, Marum et al., 2014). Subjective well-being (SWB) is one of such protective factors that scholars have identified as a buffer for the adverse effects of trauma and stressful life events on health and mental health problems.

The effect of SWB on health and mental health has been receiving increasing research attention (see e.g., Argyle, 2001, Marum et al., 2014, Seligman, 2012). Subjective well-being is often defined as consisting of the sum of affective and cognitive components and typically consists of people's emotional responses and an overall assessment of life satisfaction (Deiner, Suh, Lucas, & Smith, 1999). Some researchers have found that SWB improves with age (Argyle, 2001, Deiner et al., 1999). However, using data on individuals from 72 countries across the world from the General Social Survey of the United States, the Eurobarometer Surveys, and the World Value Survey, Blanchflower and Oswald (2008) found that SWB follows a U-shaped distribution over the life course. Controlling for gender, marital status, level of education, and annual income, they found that a typical individual's SWB is high early in life, reaches its lowest level in middle age (typically mid to late forties), and then rises again late in adulthood. One explanation offered was that, mental distress tends to reach its peak in middle age. Middle age is also the period in life where individuals come to the realization that many of the life goals and aspirations they had in their youth may not have be attained (Blanchflower & Oswald, 2008).

An impressive body of literature has found SWB to be an important concept in understanding various health related qualities of life (see e.g., Keyes, 2002, Keyes et al., 2012, Keyes and Simoes, 2012, Lyubomirsky and Layous, 2013, Oishi et al., 2010, Seligman, 2012). Meta-analyses and systematic reviews have also found similar results (see e.g., Pressman and Cohen, 2005, Sin and Lyubomirsky, 2009). A comprehensive meta-analysis performed by Lyubomirsky, King, and Diener (2005) on the benefits of SWB found that individuals with higher SWB are more likely to report better health, both physically and mentally. All these studies vary in complexity with respect to the methodological design and population examined. However, to the best of our knowledge, there is no study in Canada that has examined the contributory effect of SWB on SPD among adults with a history of maltreatment.

Although previous literature has consistently found many negative and long-term effects of child maltreatment on an individual's functioning (e.g., Norman et al., 2012), not all individuals who experience child maltreatment experience negative outcomes. Some individuals are resilient (Grych et al., 2015, Hurd and Zimmerman, 2010, Masten, 2001). Masten, Best, and Garmezy (1990) defined resilience as “the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances” (p. 425). Similarly, Fergus and Zimmerman (2005) defined resilience as “the process of overcoming the negative effects of risk exposure, coping successfully with traumatic experiences, and avoiding the negative trajectories associated with risks” (p. 399). In regard to interpersonal violence, Grych et al. (2015) identified a framework, the Resilience Portfolio Model, to explain resilience for victims of violence. The model proposes that an individual's resilience portfolio, which consists of their resources (e.g., supportive relationships and environmental factors) and assets (i.e., regulatory, interpersonal, and meaning-making strengths), predicts their response to experiences of violence. Examining resilience among individuals who have experienced child maltreatment is particularly important, as it will help in identifying specific protective factors to promote resilience among individuals who have experienced child maltreatment and decrease their likelihood of experiencing negative life outcomes later in adulthood (Grych et al., 2015).

The extant literature has identified an association between SWB, which is a measure of an individual's assets and strengths, and better physical and mental health. In line with the Resilience Portfolio Model, SWB may act as a protective factor against the negative and long-term effects of child maltreatment. To examine the protective role of SWB, the present study builds on past research by examining the independent protective effect of SWB on SPD among adult Canadians with a history of child maltreatment. In line with the Resilience Portfolio Model, it was hypothesized that controlling for demographic, socioeconomic, and health factors, there would be a significant inverse association between SWB and SPD.