Post-traumatic Stress Disorder among child perpetrators and victims of violence from the Northern Uganda civil war: Findings from the WAYS study

War experiences are known risk factors for post-traumatic stress disorder (PTSD) and other poor psychosocial outcomes. This study aimed to assess the extent to which perpetrating violence (operationalised as intentional and unintentional killing or mutilation) and being a victim of violence (operationalised as being a victim of violence, e. g., witnessing violence, injuries, torture) predict PTSD and other psychosocial outcomes independently in war-affected youth of Northern Uganda. Data on war experiences, PTSD, psychosocial problems, and socio-demographic characteristics were collected from the youth formerly abducted by the Ugandan Lord’s Resistance Army (LRA) at baseline (mean age = 22.39 years; SD = 10.47) and at follow-up (mean age = 23.52 years; SD = 9.28) using self-report questionnaires. On average, the participants spent 3.13 years in captivity (SD = 2.99) and were abducted at 14.14 years of age (SD = 4.21). Regression models were fitted to predict PTSD and psychosocial outcomes from perpetrating violence controlling for being a victim of violence and demographic characteristics. Thirty-seven percent (n = 168) reported killing or being responsible for killing while in rebel captivity. After adjusting for being a victim of violence, perpetrating violence remained a statistically significant predictor of PTSD and poor psychosocial outcomes such as depression, anxiety, somatic complaints, psychotic symptoms, and conduct problems. Among war-affected youth returning from LRA captivity, perpetrating violence may just be as toxic a risk factor for PTSD and other psychosocial outcomes as being a victim of violence. Mental health workers should consider both the effects of being a victim of violence and perpetrating violence in treatment planning.     

Exposure to Community Violence: Defining the Problem and Understanding the Consequences

Exposure to community violence has emerged as a major risk factor for the development of emotional and behavioral problems in children and adolescents. In the past decade, there has been a proliferation of research within the fields of medicine, sociology, and psychology documenting the rates and consequences of exposure to community violence. This interdisciplinary growth has led to a great deal of variability within the field of exposure to community violence, making it difficult to glean general conclusions regarding rates and impact of exposure. This review advances the current understanding of exposure to community violence by integrating findings across disciplines as well as reviewing the few studies that have provided initial explanatory information regarding mediators and moderators of the relationship between exposure to community violence and its associated outcomes.     

Prospective Risk Factors for Adolescent PTSD: Sources of Differential Exposure and Differential Vulnerability

There are two types of risk factors for developing PTSD: factors that increase the likelihood of experiencing a potentially traumatizing event and factors that increase the likelihood of developing symptoms following such events. Using prospective data over a two-year period from a large, diverse sample of urban adolescents (n?=?1242, Mean age?=?13.5), the current study differentiates these two sources of risk for developing PTSD in response to violence exposure. Five domains of potential risk and protective factors were examined: community context (e.g., neighborhood poverty), family risk (e.g., family conflict), behavioral maladjustment (e.g., internalizing symptoms), cognitive vulnerabilities (e.g., low IQ), and interpersonal problems (e.g., low social support). Time 1 interpersonal violence history, externalizing behaviors, and association with deviant peers were the best predictors of subsequent violence, but did not further increase the likelihood of PTSD in response to violence. Race/ethnicity, thought disorder symptoms, and social problems were distinctly predictive of the development of PTSD following violence exposure. Among youth exposed to violence, Time 1 risk factors did not predict specific event features associated with elevated PTSD rates (e.g., parent as perpetrator), nor did interactions between Time 1 factors and event features add significantly to the prediction of PTSD diagnosis. Findings highlight areas for refinement in adolescent PTSD symptom measures and conceptualization, and provide direction for more targeted prevention and intervention efforts.     

Community Violence and Youth: Affect, Behavior, Substance Use, and Academics

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health, 2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.     

Aggressive and Prosocial Behavior: Community Violence, Cognitive, and Behavioral Predictors Among Urban African American Youth

We use longitudinal multilevel modeling to test how exposure to community violence and cognitive and behavioral factors contribute to the development of aggressive and prosocial behaviors. Specifically, we examine predictors of self-, peer-, and teacher-reported aggressive and prosocial behavior among 266 urban, African American early adolescents. We examine lagged, within-person, between-person, and protective effects across 2 years. In general, results suggest that higher levels of violence exposure and aggressive beliefs are associated with more aggressive and less prosocial peer-reported behavior, whereas greater self-efficacy to resolve conflict peacefully is associated with less aggression across reporters and more teacher-reported prosocial behavior. Greater knowledge and violence prevention skills are associated with fewer aggressive and more prosocial teacher-reported behaviors. Results also suggest that greater self-efficacy and lower impulsivity have protective effects for youth reporting higher levels of exposure to community violence, in terms of teacher-reported aggressive behavior and peer-reported prosocial behavior. Differences among reporters and models are discussed, as well as implications for intervention.     

Exposure to violence and neighborhood affiliation among inner-city youth.

Examined the prediction of exposure to violence by neighborhood affiliation in a sample of 167 inner-city adolescents (107 girls, 60 boys) age 14 to 19 years. Measures of exposure to violence, emotional and behavioral problems, and demographic information as well as a new neighborhood affiliation measure developed specifically for adolescents were administered. Adolescents reported fairly high rates of exposure to violence, supporting other recent research. Boys reported experiencing and witnessing significantly more violence than girls. In multiple regression analyses, higher neighborhood affiliation predicted greater exposure to violence at a trend level (p = .06), even when age, sex, length of residence in one's neighborhood, and concurrent emotional and behavioral problems were controlled. These findings suggest that greater affiliation or attachment to one's neighborhood may be an important risk factor for inner-city youth that should be investigated in larger samples.     

Exposure to Parental Cigarette Smoking and Child Problem Behaviors: A Longitudinal Study

This study examined exposure to environmental tobacco smoke (ETS), a major public health problem. ETS has been found to be associated with an increased risk of adverse health effects in children. This study utilizes data from a community-based, longitudinal investigation examining the relation between children’s exposure to ETS and later internalizing symptoms and externalizing behaviors. Interviews were administered to a representative community sample of participants from two New York State counties in 1983, with subsequent interviews in 1985–1986, 1992, 1997, and 2002–2003 (when the participants’ mean age was 32). Data was collected on various personality and behavioral characteristics of the participants, and on internalizing symptoms and externalizing behaviors demonstrated by their children. Results indicated that children’s exposure to ETS was associated with an increased risk for both internalizing symptoms and externalizing behaviors. This relationship was maintained despite control on a number of parental psychosocial risk factors (e.g., demographic variables, personality and behavioral attributes) that have been found to be associated with both parental cigarette smoking and behavior problems among children. These data, which indicate an association between exposure to ETS and internalizing symptoms and externalizing behaviors among children, support public health policies to further restrict children’s exposure to ETS.     

Gender Differences in the Relations among Patriarchal Beliefs,Parenting, and Teen Relationship Violence in Mexican Adolescents

Teen relationship violence is a global phenomenon associated with adverse outcomes. As in other countries, teen relationship violence is of concern in Mexico. However, few studies have examined the risk and protective factors of teen relationship violence among Mexican adolescents. This study examined whether patriarchal beliefs and exposure to authoritarian parenting among Mexican adolescents are associated with perpetration and victimization of physical and verbal-emotional teen relationship violence. Two hundred and four students (15–18 years old) from Monterrey, Mexico, completed questionnaires. Hierarchical regression analyses controlling for age revealed that among girls, authoritarian parenting was associated with physical and verbal-emotional victimization and verbal-emotional violence perpetration. Among boys, higher endorsement of patriarchal beliefs was associated with lower reports of physical perpetration and physical victimization.     

Pathways to Adolescent Substance Use Among Sexually Abused Girls

This study examined the link between childhood sexual abuse and adolescent substance use among girls, and evaluated depressive self-concept and behavioral under-control (BUC) as pathways to substance use for sexually abused girls. Participants (n = 150) were drawn from a longitudinal study of the impact of domestic violence on the lives of women and children. Structural equation modeling revealed that girls childhood sexual abuse was associated prospectively with their later substance use. This relationship persisted when age, co-occurring forms of child abuse (physical, exposure to domestic violence), childhood depression and aggression, family income, maternal substance use, and parenting practices were controlled. Behavioral under-control mediated the relationship between childhood sexual abuse and later substance use, but depressive self-concept did not. Implications, limitations, and directions for future research are discussed.     

That Could Be Me (or Not): Senseless Violence and the Role of Deservingness,Victim Ethnicity,Person Identification,and Position Identification1

Building on just‐world theory, the current study examined variables contributing to the labeling of violent incidents as senseless. In a 2 × 2 (Blame Opportunities x Victim Ethnicity) design, Dutch participants (N= 78) were provided with a written hypothetical situation depicting a violent incident. Consistent with predictions, the violence was evaluated to be less deserved and more senseless (and the desired penalty for the offender was stronger) when participants had no opportunity to blame the victim than when they did have an opportunity to blame the victim. Likewise, an act of violence committed against a victim belonging to an ethnic minority (allochthonous victim) was perceived to be more deserved and less senseless (and the desired penalty for the offender was smaller) than a similar violent act directed against a native (autochthonous) victim. Findings designate that the just‐world theory offers a promising approach to investigate factors determining the labeling of violent incidents as senseless by outside, uninvolved observers.     

Exposure to Violence, Perceived Peer Relationships, and Corresponding Psychological Sequelae

As children’s exposure to violence (EV) has become more evident, concern for the implications that violence has on children has risen. Consequently, researchers have explored the relationship between exposure and outcomes, as well as potential mediators and moderators. In this study, we (a) examined EV in a sample of children from the Midwestern United States; (b) replicated previous findings that identify a direct relationship between EV and psychological sequelae; and (c) explored the possibility that loneliness mediates the exposure–outcomes relationship. Children (11–14 years) in our sample were exposed to elevated levels of violence in their neighborhoods. Furthermore, children who were directly victimized demonstrated greater levels of behavioral difficulties than children who were not. Although loneliness was not a significant mediator, our findings have laid the groundwork for future research regarding the influence of peer relationships on EV and outcomes.     

Intrafamilial physical victimization and externalizing behavior problems: Who remain the ‘forgotten’ children?

Over the past few decades, researchers have documented positive associations between direct child maltreatment and exposure to interpersonal violence (including intimate partner violence, community violence, school violence, and media violence) and children's externalizing behavior problems. However, current family violence literature largely ignores the effects of child abuse on other children in the family. A handful of studies have focused on exposure to child abuse and documented the behavioral effects on siblings, and these studies lend support for broadening scholarship focused on this type of family violence. This article presents empirical research and theories that focus on the relationships between child physical abuse and exposure to intimate partner violence and children's externalizing behavior problems. Using this literature as a foundation, an argument is made for the need to focus on children's exposure to child physical abuse. This article presents information from the few studies that have focused on children who were exposed to the physical abuse of a sibling and offers theoretical frameworks, including social learning theory and psychological proximity, as a foundation for future research. The article concludes with a discussion of services that may be necessary for children who have been exposed to the physical abuse of a sibling, including services focused on safety and mental health.     

The Effects of Children's Exposure to Domestic Violence: A Meta-Analysis and Critique

A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Z _r = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.     

Exposure to community violence and social support as predictors of anxiety and social and emotional behavior among African American children

We examined the effects of exposure to violence and social support on self-reported state and trait anxiety and parental rated problem behaviors among school-aged African-American children in low and high violence areas. Ninety-seven (97) fourth through sixth graders and their parents were interviewed about exposure to community violence, social support, and state and trait anxiety. Results indicate that trait anxiety was correlated positively with exposure to violence and negatively with social support. State anxiety was correlated negatively with family social support. Problem behaviors were correlated negatively with family support and income. Hierarchial multiple regression analyses indicated that children's reports of their exposure to community violence continued to explain significant variability in trait anxiety, and problem behavior after controlling for both income and social support measures. Social support from peers, family and teachers played differential roles in predicting problem behaviors among children from high and lower violence areas. These findings suggest that in planning intervention programs for children exposed to violence, greater attention to empowering parents to support their children, to fostering peer group support, and to bolstering teacher support may be useful, but attention to the underlying socio-political causes of violence exposure is essential.     

Learning difficulties,social intelligence,and self-concept: connections to bully-victim problems

Learning skills, social intelligence, and self-concept were related to each other and to bully-victim problems among fifth-grade children (79 boys and 62 girls, aged 11-12 years). In addition to exploring connections between single variables, a person-oriented approach was applied in order to analyze children's value patterns with respect to learning skills, self-concept, and social intelligence, and how these value patterns are related to bully-victim problems. Social intelligence was found to be positively correlated with learning skills, but negatively related to victimization. Bullying was positively correlated with self-concept scores. However, this was true only of boys. According to cross-tabulations, there were significantly more bullies among children with learning difficulties (LD) than would have been expected by chance. Victimization, on the other hand, was not related to LD. LD children's proposed victim status was in some degree supported by cluster analysis: a group of LD children emerged, who not only scored high on bullying, but also tended to be victimized by others. In addition, two groups of bullies appeared: one whose members could be interpreted as socially unskilled and another as socially skilled. This finding is in line with recent theoretical reasoning, which calls into question the idea of bullies as a unified group, lacking in social skills.     

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3–5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (β = .037, p < .001) and internalizing (β = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (β = .071, p < .01) and internalizing (β = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.     

News Coverage of Intimate Partner Violence: Impact on Prosocial Responses

Intimate partner violence (IPV) is a pervasive and widespread problem in the United States, yet the issue is not well understood among the general public. Media portrayals of IPV have a significant influence on public perceptions, including public support for IPV victims and willingness to engage in helping behaviors. In the current study, we tested a path model examining the influence of contextual information about the victim and perpetrator described in a news article on feelings of sympathy for the victim of the described IPV incident, affective perspective taking, and prosocial responses that include: (a) support for public health initiatives to help victims of IPV, (b) preferences for prosocial information seeking, and (c) behavioral intentions toward engaging in protective actions to help victims of IPV. The model demonstrated acceptable fit and provided support for all 6 hypotheses. Results showed that sympathy does not have a direct impact on individuals' prosocial responses to help victims of IPV, but instead has an indirect effect through affective perspective taking. Implications for framing IPV in ways that promote a prosocial, public health–oriented response are discussed.     

Inconsistent Condom Use and History of Trauma Among Vietnamese Female Sex Workers in a Chinese Border Region

Previous studies have indicated a potential association between trauma, such as physical violence, emotional violence and sexual violence, and high-risk sexual behavior. Female sex workers (FSWs) were interviewed to elicit history of traumatic events and sexual behaviors. Among 187 participants, 79 (42.2 %) inconsistently used condoms with clients in the past 30 days. Experiencing community violence (OR: 0.4; 95 % CI: 0.2, 0.8) was found to be significantly protective for inconsistent condom use. In this study, experiencing community violence was found to be protective for inconsistent condom use among FSWs, but none of the other trauma subgroups had significant associations with inconsistent condom use. Reasons for unprotected sex among FSW may be more related to economic or other contextual factors.     

Parental Loss and Family Violence as Correlates of Suicide and Violence Risk

Seventy-nine psychiatric inpatients were administered a battery of psychometric instruments that obtained information about early parental loss, exposure to family violence, and behavioral problems in themselves and in their first-degree relatives. These variables were correlated with suicide and violence risk measures. Suicide risk significantly correlated with all family variables whereas violence risk correlated with behavioral problems both in oneself and in one's first-degree relatives. Moreover, suicidal and/or violent patients had experienced maternal loss significantly more frequently than the nonsuicidal/nonviolent patients. In the suicidal/violent group, age of patient at death of parents was significantly lower than in the nonsuicidal/nonviolent group. Finally, family violence was significantly correlated with behavioral problems in self and in first-degree relatives. Findings are interpreted according to the authors' theoretical model of aggression regulation.     

Children of Probationers in the Child Welfare System and Their Families

This study describes changes over a 36-month period in the lives of children of probationers who were subjects of reports of maltreatment. Data on a nationally representative sample of reported victims of maltreatment were used to examine probationer-parents’ contact with the criminal justice system, and concurrent changes in their children’s households, risk exposure, and emotional and behavioral problems. Results show that 36 months after coming in contact with the child welfare system, about 40% of probationer’s children no longer lived with their probationer-parents. During the same period, children’s exposure to risk (i.e., parental substance abuse, mental illness, and domestic violence) dropped markedly; however, there was an upward trend in the prevalence of child emotional and behavioral problems. These problems ultimately declined among very young children, but persisted among elementary school age children. Further prospective studies are needed to better understand the confluence of factors affecting the outcomes of probationers’ children.