The moderating role of emotional stability in the relationship between exposure to violence and anxiety and depression

This study investigated the associations among exposure to violence, emotional stability, and psychological symptoms. The moderating role of emotional stability in the relationship between exposure to violence and anxiety and depression was examined in a sample of 482 high school students in Hong Kong. Results showed that both witnessing violence and low levels of emotional stability were positively associated with symptoms of anxiety and depression. Low levels of emotional stability exacerbated the relation between witnessing violence and symptoms of anxiety and depression; the opposite pattern was found among adolescents with high levels of emotional stability. This study sheds light on the role of emotional stability in ameliorating the detrimental effects of witnessing violence on symptoms of anxiety and depression among adolescents. Findings of this study also have implications for the development of emotionally healthy personalities.     

Risk Factors for Community Violence Exposure in Adolescence

Community violence is recognized a significant public health problem. However, only a paucity of research has examined risk factors for community violence exposure across domains relevant to adolescents or using longitudinal data. This study examined youth aggressive behavior in relation to community violence exposure among a community epidemiologically defined sample of 582 (45% female) urban adolescents. Internalizing behaviors, deviant peer affiliation, and parental monitoring were examined as moderators of the association between aggressive behavior and exposure to community violence. For males with aggressive behavior problems and deviant peer affiliation or low parental monitoring, co-occurring anxiety symptoms protected against subsequent witnessing community violence. In contrast, males with aggressive behavior problems and co-occurring depressive symptoms were at increased risk for witnessing community violence. Implications of the findings for preventive interventions and future research are discussed.     

Exposure to community violence and trauma symptoms in late adolescence: comparison of a college sample and a noncollege community sample

This paper presents a comparison for two samples (college and noncollege) of older, urban African-American adolescents of correlations between two measures of exposure to community violence (victim and witness) and four types of psychological trauma symptoms (anger, anxiety, depression, and dissociation). The central issue is the generalizability of previous findings about these relationships obtained from beginning college students of traditional age. The two samples did not differ in the magnitude of either the zero-order correlations or the multiple correlations between the two types of exposure to community violence and the four types of symptoms of trauma. The conclusion is that findings regarding the relationship of exposure to community violence with psychological symptoms of trauma obtained from college students may tentatively be generalized to older adolescents who are not in college.     

Intervening Processes Between Youths’ Exposure to Community Violence and Internalizing Symptoms Over Time: The Roles of Social Support and Coping

The roles of social support and coping as intervening processes between exposure to community violence and internalizing symptoms were examined longitudinally among a community sample of 667 middle school students in the inner city. After controlling for potential confounders (e.g., social desirability, victimization and witnessing of family violence, guardian's psychological symptomatology), internalizing symptoms at Year 2 were predicted by hypothesized changes over 1 year, such that increased community violence exposure, decreased guardian and peer support, and increased use of defensive and confrontational behavioral coping were related to more internalizing symptoms of anxiety, depression and PTSD, although some of these relations varied by gender. The relations between internalizing symptoms at Year 3 and increased changes in exposure to community violence over 2 years were moderated by social support and/or coping, such that decreased guardian support and increased use of defensive and confrontational coping were generally associated with more symptoms for boys exposed to community violence. Girls who witnessed increased community violence and who increased their use of defensive or confrontational coping experienced more internalizing symptoms. The findings underscore the importance of developmental and contextual considerations in the design and implementation of interventions.     

The association of ecological variables and psychological distress with exposure to community violence among adolescents

Ecological theory suggests that exposure to community violence should be related to individual, family, and community characteristics; traumatic stress theory suggests that exposure to community violence should be related to level of psychological distress. A correlational study of 468 older adolescents in New York City tested these hypotheses. Exposure was found to be moderately related to level of psychological distress, but was not related to family or neighborhood characteristics. It was concluded that the nature of exposure to community violence poses difficulties for interventions aimed at either prevention or amelioration of effects.     

Exposure to Verbal Parental Aggression and Sexual Activity Among Low Income African American Youth

The study examined whether witnessing verbal parental aggression (VPA) was related to sexual activity among mostly low income African American youth, and whether psychological symptoms mediated this relationship. Five hundred and sixty-three African American high school adolescents (ages 13–19) completed self-administered questionnaires, which assessed demographics, psychological problems (e.g., depression, anxiety, aggression and posttraumatic stress disorder symptoms), witnessing VPA, and sexual activity. Participants who witnessed high versus no VPA were 2 times more likely to report sexual activity. This relationship was mediated by aggression for males and females, and posttraumatic stress disorder symptoms for females only. Youth service providers should be trained to understand the prevalence of co-occurring problems such as exposure to VPA, aggression, PTSD symptoms, and sexual activity, with the goal of more effectively supporting the healthy development of African American youth.     

Child-to-parent violence and its association with exposure to marital violence and parent-to-child violence

The aims of this study were: (a) to examine the relationships between the exposure to different types of family violence (intraparental violence and parent-to-child aggression) and the perpetration of child-to-parent violence (CPV); (b) to analyze sex differences in the relationships specified. The sample comprised 1681 Spanish university students who reported the exposure to different types of family violence during their childhood. Both psychological and physical family violence were analyzed separately. Results showed that both witnessing marital psychological violence and parent-to-child psychological aggression are related to CPV. Furthermore, psychological and physical parent-to-child aggression as well as witnessing physical aggression between parents was associated with physical CPV. Multigroup analyses showed that the relationships among variables were not significantly different as a function of sex. This finding suggests that the relation between exposure to family violence and CPV is similar for men and women.     

Effects of Exposure to Community Violence on Internalizing Symptoms: Does Desensitization to Violence Occur in African American Youth?

The purpose of the current study was to examine the linear and curvilinear associations of exposure to community violence to internalizing symptoms in 251 African American adolescents (mean age = 12.86, SD = 1.28). Participants reported on exposure to community violence, anxiety symptoms, and depressive symptoms. Regression analyses were used to test the hypotheses and, consistent with predictions, the results indicated that the association between violence and depression was curvilinear; whereas the association to anxiety was linear and positive. The results highlight the importance of considering more complex models of the impact of exposure to community violence on psychological functioning in African American youth from economically- disadvantaged communities.     

Predictors of violence exposure among inner-city youth

Examined the ability of demographic variables and risk factors (parental substance use, number of people in the home, out-of-home placements, grades repeated, arrest history, and total life stress) to predict exposure to community violence among 342 high school students from inner-city Baltimore referred for mental health care in community centers or in the schools. Over 90% of the sample knew at least 1 victim of a violent act, 77% reported witnessing a violent act, and 47% reported past victimization by violence. Risk variables were more powerful regression predictors of violence exposure than demographic characteristics such as race, sex, or clinical setting. Even after controlling for demographic differences in violence exposure, risk factors as a group accounted for another 10% to 15% of variance. Life stress was the most consistent predictor of violence exposure for this sample, and life stress was the only variable to make a significant unique contribution to the prediction of all 4 violence criteria.     

Positive School Climate as a Moderator of Violence Exposure for Colombian Adolescents

In Colombia, many adolescents have experienced violence related to the decades‐long armed conflict in the country and have witnessed or been directly victimized by violence in their communities, often related to gang activity or drug trafficking. Exposure to violence, both political and community violence, has detrimental implications for adolescent development. This study used data from 1857 Colombian adolescents in an urban setting. We aim to understand the relations between exposure to violence and adolescent outcomes, both externalizing behaviors and developmental competence, and then to understand whether school climate (i.e., safety, connectedness, services) moderates these relations. Results demonstrate that armed conflict, community violence victimization, and witnessing community violence are positively associated with externalizing behaviors, but only armed conflict is negatively associated with developmental competence. School safety, connectedness, and services moderate the relation between community violence witnessing and externalizing behaviors. School services moderates the relation between community violence victimization and developmental competence. As students perceived more positive school climate, the effects of community violence exposure on outcomes were weakened. This study identifies potential levers for intervention regarding how schools can better support violence‐affected youth through enhancements to school safety, connectedness, and services.     

Patterns of Community Violence Exposure During Adolescence

This study examined cross-sectional and longitudinal patterns of community violence exposure and malleable predictors of these exposure patterns among a community sample of 543 urban African American early adolescents (45.3% female; mean age: 11.76). In each of grades 6, 7, and 8, latent class analyses revealed two patterns of community violence exposure: high exposure and low exposure. For the majority of participants, experiences with community violence were similar at each grade. Impulsive behavior and depressive symptoms distinguished adolescents in the high and low exposure classes in grade 6. Implications for interventions to prevent community violence exposure are discussed.     

Exploring Violence Exposure, Stress, Protective Factors and Behavioral Problems Among Inner-City Youth

This study examined relationships between violence exposure, other stressors, family support, and self-concept on self-reported behavioral problems among 320 urban adolescents (aged 11–18) referred for mental health treatment. Overall, participants reported high levels of violence exposure, with a median of six past encounters with violence as a witness, victim, or through the experiences of associates. All forms of violence exposure (witnessing, being a victim, knowing of victims) were correlated with internalizing and externalizing behavioral problems for males and females. Total violence exposure predicted behavioral problems among participants, even after controlling for the effects of other risk, demographic and protective factors. Family support and self-concept moderated the influence of life stress and cumulative risk on problem behavior outcomes, but these protective variables did not significantly moderate violence exposure.     

Predicting adolescent posttraumatic stress in the aftermath of war: Differential effects of coping strategies across trauma reminder,loss reminder,and family conflict domains

Background and Objectives: The vast majority of youth who lived through the Bosnian war were exposed to multiple traumatic events, including interpersonal violence, community destruction, and the loss of a loved one. This study examined factors that predict post-war psychological adjustment, specifically posttraumatic stress, in Bosnian adolescents. Design: Regression analyses evaluated theorized differential relations between three types of post-war stressors – exposure to trauma reminders, loss reminders, and intrafamilial conflict – specific coping strategies, and posttraumatic stress symptom dimensions. Methods: We examined 555 Bosnian adolescents, aged 15–19 years, to predict their long-term posttraumatic stress reactions in the aftermath of war. Results: Findings indicated that post-war exposure to trauma reminders, loss reminders, and family conflict, as well as engagement and disengagement coping strategies, predicted posttraumatic stress symptoms. Secondary control engagement coping responses to all three types of post-war stressors were inversely associated with posttraumatic stress symptoms, whereas primary control engagement coping responses to family conflict were inversely associated with hyperarousal symptoms. Disengagement responses to trauma reminders and family conflict were positively associated with re-experiencing symptoms. Conclusions: These findings shed light on ways in which trauma reminders, loss reminders, and family conflict may intersect with coping responses to influence adolescent postwar adjustment.     

Help-Seeking and Internal Obstacles to Receiving Support in the Wake of Community Violence Exposure: The Case of Arab and Jewish Adolescents in Israel

We examined help-seeking and internal obstacles to receiving psychosocial support in the wake of community violence exposure in a sample of 1,835 Arab and Jewish adolescents living in Israel. Paper and pencil surveys conducted in schools examined adolescents’ personal victimization and witnessing of community violence in the past year, and then queried adolescents about their help-seeking after violence exposure. Our findings indicated widespread exposure to community violence, particularly for the Arab respondents. Only one in three Arab and one in four Jewish adolescents reported seeking help from anyone to cope with such experiences following their violence exposure, and only rarely did adolescents seek help from a mental health professional (one in twenty for Jewish and one in nine for Arab adolescents). Adolescents across both samples indicated a variety of internal obstacles that might explain their lack of seeking help to cope with violence exposure, including cognitive minimization of the event, deliberately maintaining the secrecy of the event, wishing to maintain their autonomy, and failing to believe in the efficacy of seeking help from others. Such findings shed light on the difficult challenges to providing professional support to adolescents when they are exposed to community violence, and suggest that such challenges, while varying to a degree across cultures, are also prevalent across cultures.     

Adapting Cognitive-Behavioral Therapy for Depressed Adolescents Exposed to Interpersonal Trauma: A Case Study With Two Teens

A substantial body of evidence indicates that interpersonal trauma increases risk for adolescent and adult depression. Findings from 4 clinical trials for adolescent depression show poorer response to standard cognitive-behavioral therapy (CBT) among depressed adolescents with a trauma history than youth without such a history. This paper reports on the development of a modified CBT (mCBT) protocol that has been adapted for treating depressed adolescents who have been exposed to traumatic interpersonal events (physical/sexual abuse or witnessing domestic violence). First, we provide an empirical rationale for targeting executive function deficits and trauma-related cognitions in the mCBT protocol. Second, we present promising results from 2 community clinic cases.     

Factors Related to the Seeking and Contribution of Prenatal Care Among Ethnically Diverse Adolescents

This article describes an issue of importance to the field of medicine and nursing. We examined factors related to the seeking of prenatal care (PNC) and contribution of PNC on infant complications and psychological birth trauma among adolescents. Additionally, we addressed the confounding factors of violence and depression, common occurrences within this frequently overlooked age range. We collected data from a convenience sample of 260 ethnically diverse adolescents, ages 13–19, within 72 h of birth. We found that most adolescents did not receive the minimum number of PNC visits. Logistic regression models documented that none of the study variables influenced seeking PNC. However, we did find gestational age, as expected, and partner violence to affect the number of PNC visits obtained. Depressive symptoms significantly influenced infant complications, and psychological birth trauma, which was measured via objective and subjective indicators (appraisal). Our findings also revealed that PNC did not contribute to infant complications or birth trauma. Yet, despite obtaining the most PNC visits, Black adolescents appeared most at risk for infant complications, depression, and birth trauma. We believe that the clinical significance of these findings supports the need to better address the psychosocial dimension of care as part of routine PNC. We recommend increased assessments of violence and depression throughout pregnancy, especially for the Black adolescent with targeted education to aid in recognition of symptoms, consequences to maternal and infant health, and connections to psychological birth trauma.     

Effects of Gender,Ethnicity and Educational Status on Exposure to Community Violence and Psychological Distress in Adolescence

ABSTRACT

A study of 1,142 older adolescents living in the central city of a large urban area found a complex set of relationships among exposure to community violence, psychological distress, gender, ethnicity, and educational status. Although males and school dropouts had higher levels of exposure and females had higher levels of psychological distress, the relationshipbetween exposure to community violence and psychological distress did not differ by gender, ethnicity or educational status. The findings are interpreted in terms of the theory of protective and vulnerability processes. The authors conclude that the relationship between exposure to community violence and psychological distress is robust.     

Behavioral Inhibition and Risk for Posttraumatic Stress Symptoms in Latino Children Exposed to Violence

Latino children in urban contexts marked by poverty are at high risk of being exposed to violence and developing posttraumatic stress disorder (PTSD). Nonetheless, there is great variability in individual responses to violence exposure. This study examines risk for developing re-experiencing, avoidance, and arousal symptoms of PTSD as a function of individual differences in behavioral inhibition and exposure to community violence. Participants were 148 Latino students (M age =11.43 years, SD?=?0.69; 55 % girls) living in an area marked by poverty and crime. Children completed self-report measures of behavioral inhibition and posttraumatic stress symptoms during a baseline assessment. During a follow-up interview 6 months later, children completed self-report measures of exposure to community violence since the baseline assessment and posttraumatic stress symptoms. Structural equation models revealed that behavioral inhibition at baseline was positively associated with PTSD avoidance and arousal symptoms at follow-up, after controlling for symptoms at baseline. Furthermore, behavioral inhibition moderated the association between violence exposure and symptoms such that violence was more strongly associated with the development of PTSD avoidance symptoms as behavioral inhibition increased. Results suggest that individual differences in behavioral inhibition contribute to risk for specific PTSD symptoms and are important for understanding variation in responses to trauma exposure. By examining diathesis-­stress models within a disorder, we may be better able to elucidate the etiology of a disorder and translate this improved understanding into personalized intervention approaches that maximize effectiveness.     

Identity Distress Among Youth Exposed to Natural Disasters: Associations with Level of Exposure,Posttraumatic Stress,and Internalizing Problems

Identity distress involves intense or prolonged upset or worry about personal identity issues including long-term goals, career choice, friendships, sexual orientation and behavior, religion, values and beliefs, and group loyalties. Research suggests that trauma exposure and subsequent posttraumatic stress disorder (PTSD) symptoms may negatively affect identity development and psychological adjustment. However, little is known about their specific associations with identity distress and internalizing problems among disaster-exposed adolescents. This study aimed to examine these associations in a sample of 325 adolescents (60% female; 89% African American) who experienced a major natural disaster and its aftermath. The results indicated that identity distress was positively associated with age, hurricane exposure, PTSD symptoms, and internalizing problems. Linear regression analyses also showed that identity distress was uniquely associated with internalizing symptoms and that there was an indirect effect of hurricane exposure on identity distress via PTSD symptoms. PTSD symptoms moderated the link between identity distress and internalizing symptoms, with a significant positive slope found for youth with more PTSD symptoms. Findings were generally consistent with previous work and predictions, and they add to the extant knowledge about identity distress by providing data on the linkages among disaster exposure, posttraumatic stress, and internalizing problems in adolescents.