The moderating role of resiliency on the negative effects of childhood abuse for adolescent girls involved in child welfare

Highlights

• High resiliency mitigated the negative effects of abuse on PTSD and depression.

• High resiliency mitigated the negative effects of sexual abuse on revictimization.

• Resiliency may be a protective factor for girls with histories of child abuse.

Abstract

Child abuse is associated with a number of negative psychosocial outcomes, including mental health problems, substance abuse, and interpersonal violence. Yet some children thrive or “adapt well” despite experiencing abuse; researchers are increasingly interested in the protective factors and mechanisms that may prevent negative outcomes. The purpose of this study was to explore the role of resiliency characteristics in the relationship between childhood abuse and the negative outcomes of depression, posttraumatic stress disorder (PTSD), substance abuse, and revictimization in adolescent girls involved in child welfare. Participants were 237 adolescent girls ages 12–19 years (M = 14.9, SD = 1.6), and who were youths of color (75%) and white (25%). Data were collected through surveys assessing histories of physical, sexual, and emotional child abuse; symptoms of posttraumatic stress and depression; lifetime substance use; and experiences of physical, verbal, and relational revictimization in the last three months. All forms of childhood abuse were significantly associated with symptoms of depression and PTSD as well as revictimization and substance use. Higher levels of resiliency were associated with fewer depression and PTSD symptoms and experiencing less revictimization. Resiliency significantly moderated the relationship between sexual abuse and depression, PTSD, and revictimization. Resiliency also moderated the relationship between emotional abuse and depression. No significant interactions emerged in the relationship between physical abuse and any of the mental health and behavioral problems. This study suggests that resiliency may serve as a protective factor in the relationship between abuse (sexual and emotional) and depression, PTSD, and revictimization during adolescence.

Introduction

Childhood abuse may be the most severe environmental threat to normal healthy development for children (Cicchetti, 2013); unfortunately childhood abuse and neglect are common in the United States. Recent prevalence rates indicate that one in eight children under 18 years of age has experienced at least one form of neglect or physical, sexual, or emotional abuse (Wildeman et al., 2014). Childhood abuse has been associated with a number of serious mental health outcomes, including posttraumatic stress and depression (Brewin et al., 2000, Gilbert et al., 2009, McMillen et al., 2005), and adolescent females are at increased risk for negative outcomes compared to males (Auslander et al., 2002, Edmond et al., 2002). Child abuse is also associated with a number of negative behavioral outcomes such as heightened risk for substance use and abuse across the lifespan (Cicchetti, 2013, Dube et al., 2003, Kilpatrick et al., 2003) and multiple types of revictimization (Desai et al., 2002, Irwin, 1999, Schaaf and McCanne, 1998, Widom et al., 2008).

Recent research on survivors of child abuse has focused on resiliency characteristics, defined as psychological attributes of an individual which may protect against negative consequences (Edwards et al., 2014, Wingo et al., 2014). Despite considerable evidence linking negative mental health and behavioral outcomes with a history of childhood abuse, negative consequences are not inevitable. Previous studies have shown that many adults with histories of childhood abuse report positive outcomes in multiple domains of functioning (Collishaw et al., 2007, DuMont et al., 2007, McGloin and Widom, 2001). A growing body of research has examined factors and mechanisms that may have a protective effect against the negative outcomes associated with childhood abuse (Cicchetti, 2013, Haskett et al., 2006, Ong et al., 2006, Windle et al., 2011).

In spite of this growing demand to understand what protects children in the face of extreme stress, there has been little consensus on the conceptualization of resilience. The term is often used to describe survivors of hardship who cope successfully and achieve positive outcomes in spite of significant challenges (Zolkoski & Bullock, 2012); however, in addition to being conceptualized as an outcome, resilience can also be considered as a trait, a process, or the adaptive capacity of multiple systems in an individual's life (Masten, 2011, Southwick et al., 2014). For this study, resilience was defined as intrapersonal characteristics such as perseverance and self-reliance that allow an individual to adapt to adversity (Wagnild & Young, 1993). Within a socio-ecological model, resiliency characteristics are therefore considered to be a protective factor for child welfare-involved adolescent girls. In this perspective, the “emotional stamina” associated with resiliency characteristics develops over time and can be strengthened; individuals with high levels of resiliency characteristics are able to flexibly draw upon a range of problem-solving strategies in the face of difficult circumstances (Wagnild, 2011, Wagnild and Young, 1993).

Resiliency characteristics in adolescents have been associated with positive behavioral and mental health outcomes. In the general population, higher resiliency levels in adolescents have been significantly associated with lower levels of anxiety, depression, and stress; and resilient adolescents have been found to be less likely to engage in risky behaviors such as substance use (Ali et al., 2010, Hjemdal et al., 2011, Veselska et al., 2009). In an at-risk homeless population of adolescents, those considered resilient were better able to avoid life-threatening behaviors and felt more hopeful and less lonely compared to those with lower levels of resiliency (Rew, Taylor-Seehafer, Thomas, & Yockey, 2001).

Resiliency has also been found to moderate the negative impact of child abuse on mental health and behavior, although the majority of studies rely on retrospective reports of abuse histories from adult samples. In studies with young adult college students, resiliency characteristics moderated the relationship between childhood abuse and psychological distress; at high levels of resiliency, psychological distress was low regardless of the number of types or severity of childhood abuse (Campbell-Sills et al., 2006, Edwards et al., 2014). Results from other studies demonstrated that resiliency characteristics mitigated the effects of childhood abuse on depression in an urban adult population in the United States (Wingo et al., 2010) and in a community-based sample of adults in Germany (Schulz et al., 2014).

Research on the role of resiliency as a moderator of the relationship between childhood abuse and mental health and behavioral outcomes in adolescence has been limited, particularly among child welfare-involved youth. In one of the few studies of adolescents, resiliency was found to moderate the relationship between abuse (emotional, physical, and sexual) and PTSD re-experiencing symptoms (Zahradnik et al., 2010); however, the sample was limited to native Canadian high school students. Prior studies with child welfare-involved youth have often conceptualized behavioral and mental health outcomes as indicators of resiliency (e.g. Edmond, Auslander, Elze, & Bowland, 2006) rather than testing resiliency characteristics as a protective factor. To develop effective interventions that help children thrive after adversity, researchers recommend identifying the unique characteristics of each specific population of interest and the factors associated with healthy outcomes for that group (Zolkoski & Bullock, 2012). National and regional studies demonstrate that adolescent girls with child welfare histories are particularly vulnerable to mental health and behavioral problems (Edmond et al., 2002, Stahmer et al., 2005); however, there are no studies examining the role of resiliency characteristics as a protective factor. This indicates a particularly strong and urgent need for research that will contribute to interventions tailored to meet the unique needs and build on the unique strengths of this highly vulnerable group of adolescents.

The current study addressed this knowledge gap by examining the role of resiliency, as defined by intrapersonal characteristics, on the relationship between childhood abuse and behavioral and mental health outcomes in a sample of child welfare-involved adolescent females. The study explored the following questions: 1) Does resiliency vary according to demographics (age, race, or living situation)? 2) Is there an association between child abuse (physical, sexual, and emotional abuse) and mental health and behavioral problems such as depression, posttraumatic stress disorder (PTSD), substance abuse, and revictimization? And if so, 3) does resiliency moderate the relationship between child abuse (physical, sexual, and emotional abuse) and negative mental health and behavioral problems? Study findings will develop our understanding of potentially modifiable intrapersonal characteristics that may play a role in mitigating the harmful effects of abuse in childhood.