Jennifer Killpack and Dr. Christopher M. Layne, Clinical Psychology
Childhood physical and sexual abuse (CA) is associated with a greatly increased risk for problems in adulthood (Rumstein-McKean, & Hunsley, 2001). Prevalence rates of depression, posttraumatic stress disorder, interpersonal difficulties, and adult victimization are higher among women with a history of CA (Ornduff, Kelsey, & O’Leary, 2001). Social support is theorized to mediate the relationship between CA and adult psychosocial adjustment (Brewin, Andrews, & Valentine, 2000). Women who experienced both CA and adult sexual assault experience clinically significant levels of interpersonal problems unlike women who experienced adult assault but not CA, or women who had never been assaulted (Cloitre et al, 1997). Research studies have demonstrated that CA, interpersonal problems, social support, depression, and PTSD are interrelated, but no single unified model that incorporates all of these variables has been formulated to date.
Hypotheses
It is believed that CA will be significantly related to posttraumatic stress symptoms and depression symptoms. Also, the relationship between CA and posttraumatic stress and depression symptoms will be mediated by social support and interpersonal problems.
Methods
Women with a history of CA were self-referred for free treatment and assessment through newspaper advertisements. Following a phone screening, potential study participants were invited for a clinical assessment. Those who did not meet the criteria for the treatment study were referred elsewhere. CA was defined as childhood sexual and/or physical abuse that occurred under the age of 18. Four psychological measures were used to determine the levels of social support, interpersonal problems, posttraumatic stress symptoms, and depression symptoms.
Results
A structural equation model was used to test the study hypotheses (see figure 1). Although childhood sexual abuse variables were originally modeled, but were dropped in later models because they yielded poorer model fit. Exploratory factor analysis was performed on the social support and interpersonal problems measures to determine their dimensionality. The resulting model fit was adequate, X2(59) = 161.52, CFI = 0.93, RMSEA = 0.074 (90% CI 0.06-0.09), Hoelter Index= 155.
Discussion
The relationship between childhood physical abuse and adverse adult outcomes is consistent with prior research findings. The absence of a relationship between childhood sexual abuse and adverse adult outcomes is not consistent with prior research findings. This integrative model sheds light on the complex ways in which CA may be linked to adult-age psychosocial adjustment. It suggests that perceived social support and interpersonal problems may mediate this relationship. Interpersonal problem was a key to this model. The regression coefficients were much stronger than expected. It was stronger than social support, which was theorized to a strong mediator in the model. The role that interpersonal problems play in adulthood psychosocial adjustment should be noted. Future directions would include examining the role that interpersonal problems in adulthood may play in mediating the links between CA and difficulties in adulthood.
Figure 1 – A structural equation model showing the relationship between childhood physical abuse and PTSD and Depression, as mediated by social support and interpersonal problems.
References
- Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting & Clinical Psychology, 68(5), 748-766.
- Cloitre, M., Scarvalone, P., & Difede, J. (1997). Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women. Journal of Traumatic Stress, 10(3), 437-452.
- Ornduff, S. R., Kelsey, R. M., & O’Leary, K. (2001). Childhood physical abuse, personality and adult relationship violence: A model of vulnerability to victimization. American Journal of Orthopsychiatry, 71(3), 322-331.
- Rumstein-McKean, O., & Hunsley, J. (2001). Interpersonal and family functioning of female survivors of childhood sexual abuse. Clinical Psychology Review, 21(3), 471-490.