Gender Differences in the Effects of Community Violence on Mental Health Outcomes in a Sample of Low-Income Youth Receiving Psychiatric Care

Previous research suggests that community violence impacts mental health outcomes, but much of this research has not (a) distinguished between different types of community violence, (b) examined gender differences, and (c) focused on youth living in urban poverty. The current study addresses these questions. Participants were 306 youth (23 % girls) and one parent/guardian receiving outpatient psychiatric services for disruptive behavior disorders in a large urban city. Youth and parents reported on youth’s experience of different types of community violence (being a direct victim, hearing reports, and witnessing violence), and whether violence was directed toward a stranger or familiar. Outcomes included youth externalizing, internalizing, and posttraumatic stress symptoms assessed via parent and youth reports. Being a direct victim of violence accords risk for all mental health outcomes similarly for both boys and girls. However, gender differences emerged with respect to indirect violence, such that girls who hear reports of violence against people they know are at increased risk for all assessed mental health outcomes, and girls who witness violence against familiars are at increased risk for externalizing mental health symptoms in particular. There are gender differences in violence-related mental health etiology, with implications for intervention assessment and design.     

Exposure to maternal vs. paternal partner violence,PTSD, and aggression in adolescent girls and boys

Adolescents who witness interparental violence (IPV) are at increased risk for perpetrating aggressive acts. They are also at risk for post‐traumatic stress disorder (PTSD). In this study, we examined the relation between exposure to maternal vs. paternal physical IPV and adolescent girls' and boys' aggressive behavior toward mothers, fathers, friends, and romantic partners. We also assessed the influence of PTSD (as assessed by the Diagnostic Interview for Children and Adolescents‐IV (DICA‐IV)) on the relation between exposure to IPV and aggressive behavior. Participants were 63 girls and 49 boys, ages 13–18, consecutively admitted to a youth correctional facility or assessment facility designated to serve aggressive and delinquent youth. Structural equation modeling was used to estimate unique relations between exposure to maternal vs. paternal IPV and youth aggression in relationships. Girls who observed their mothers' aggressive behavior toward partners were significantly more aggressive toward friends. Similarly, boys who witnessed their fathers' aggression were significantly more aggressive toward friends. Adolescent girls and boys who observed aggression by mothers toward partners reported significantly higher levels of aggression toward their romantic partners. Approximately one third of our sample met PTSD criteria; the relation between exposure to parental IPV and aggression was stronger for individuals who met criteria for PTSD. The implications of understanding the relations between parents' and their daughters' and sons' use of aggression are discussed within the context of providing support for families in breaking intergenerational patterns of violence and aggression. Aggr. Behav. 32:385–395, 2006. © 2006 Wiley‐Liss, Inc.     

Linkages between violence-associated attitudes and psychological,physical, and sexual dating abuse perpetration and victimization among male and female adolescents

Attitudes about violence and sex in dating relationships were related to psychological, physical, and sexual teen dating abuse perpetration and victimization. Data from Wave 4 of the national, randomly selected, Growing up with Media cohort (n = 876 adolescents aged 14-19 years), collected in 2011, were analyzed. Dating youth perceived more peer pressure to have sex and were more accepting of sex in brief or nonmarital relationships than pre-dating youth. Boys had higher levels of rape-supportive attitudes than girls. Among dating youth, the relative odds of involvement in teen dating abuse as a perpetrator or a victim were generally associated with greater acceptance of relationship violence, perceived peer pressure to have sex, and acceptance of sex in brief and/or nonmarital relationships. Rape-supportive attitudes were not significantly associated with any type of teen dating abuse involvement. Programs aimed at preventing dating abuse might benefit from targeting attitudes associated with sexual activity as well as relationship violence.     

Trajectories of externalizing problems among war-affected youth in Sierra Leone: Results from a longitudinal study

Mental health problems are linked to violence exposures such as witnessing or participating in war-related activities. Of particular concern is whether such exposure perpetuates risk of violent behavior. Externalizing problems have received limited attention in research on war-affected youth. Three waves of data (2002–2008) from a prospective longitudinal study in Sierra Leone were used to examine externalizing trajectories in 529 war-affected youth (average age 14.9 at baseline; 25% female). Of four groups, the largest represented a trajectory designated as ‘stable,’ with relatively low levels of externalizing at baseline declining slightly across the time points. Compared to the stable group, the probability of being classified in the ‘deteriorators’ group was greater among those who reported having injured/killed another person during the war and with a history of family abuse and neglect reported at T3. Membership in the ‘improvers’ group was more likely for those with higher family support and was also associated with reporting injuring/killing others during the war. A minority indicated sustained, heightened symptom levels, which was also associated with family abuse and neglect following the war. Our findings demonstrate that both traumatic war experiences and post-war experiences play vital roles in shaping adolescents' trajectories of externalizing over time.     

Childhood Exposure to Community and Domestic Violence: Prevalence,Risk Factors and Posttraumatic Outcomes in a South African Student Sample

The effects of exposure to direct and vicarious community and domestic violence on the posttraumatic adjustment of 323 South African students were examined. Data were collected using self-administered questionnaires, with the relationship between exposure to violence and posttraumatic outcomes being explored using binomial logistic regression analyses. Two hundred and sixty-two participants (81 %) reported that they had been exposed to some form of interpersonal violence during childhood. An analysis of risk factors for exposure to violence indicated that males were more than twice as likely as females to have experienced victimization by a community member. Direct exposure to domestic violence was the only form of violence which was found to be associated with Posttraumatic Stress Disorder (PTSD). Among participants who had experienced direct domestic violence, clinically significant levels of PTSD were significantly predicted by both gender (being female) and by abuse chronicity.     

Prolonged Stress,PTSD, and Depression Among School Aggressors and Victims

Exposure rates to school aggression as an aggressor, victim, aggressive victim, or a bystander is high, with large numbers of school-aged children reporting being subjected to verbal or physical violence. We hypothesized that all 3 clusters of the DSM–IV designation of posttraumatic stress disorder (PTSD; Criterion B: Intrusive recall, Criterion C: Avoidance, and Criterion D: Hypervigilance) would be experienced by pure victims, pure aggressors, and aggressive victims. We also anticipated that PTSD symptoms would lead to depression, primarily for victims. Questionnaires were given to 1,398 students, yielding 1,116 valid questionnaires (80% response rate). Respondents were enrolled in the general education system, from 9 different schools in Israel. Following calibration of the research instruments using exploratory and confirmatory factor analyses, a series of structural equation and reflection models were examined. The path through some of the symptoms of PTSD and depression was apparent only for victims. For the victims, the indirect model through avoidance predicted depression only for relational victimization. No clear linkage was found among aggression, PTSD, and depression for aggressors. For aggressors, physical aggression was linked with the 3 clusters of PTSD symptoms, but not with depression.     

A combination of combat experience,early abduction,and severe traumatization fuels appetitive aggression and violence among abductees of rebel war in Northern Uganda

Individuals who perpetrate violence may likely perceive violence as appealing and infliction of violence to derive pleasure is termed as appetitive aggression. Individuals who were abducted as children into an armed group often experience a higher number of traumatic event types, that is traumatic load and are usually socialized in a violence-endorsing environment. This study aims to investigate the interaction between age at initial abduction with that of traumatic load, and their influence on appetitive aggression along with perpetration of violent acts by former members of an armed rebel group of both sexes. Semi-structured interviews were conducted among a target group of formerly abducted rebel-war survivors (including participants with and without combat experience) from Northern Uganda. Participants included 596 women and 570 men with N = 1,166 (M_age = 32.58, SD_age = 9.76, range: 18–80 years). We conducted robust linear regression models to investigate the influence of age at initial abduction, traumatic load, combat experience, and biological sex on appetitive aggression as well as their perpetrated violent acts. Our study shows, appetitive aggression and the number of perpetrated violent acts were specifically increased in individuals who were abducted young, experienced several traumatic events in their lifetime, and with previous combat experience. For perpetrated violence men showed increased levels whereas for appetitive aggression the association was independent of biological sex. Therefore, early abducted individuals with a higher traumatic load, who have combat experience, need to be given special intervention to prevent any further violence.     

Troubled or Traumatized Youth? The Relations Between Psychopathy,Violence Exposure,Posttraumatic Stress Disorder,and Antisocial Behavior Among Juvenile Offenders

The current study examined how psychopathy, exposure to violence, and posttraumatic stress disorder (PTSD) are associated with antisocial behavior among 1,354 serious delinquent adolescents from the Pathways to Desistance study. Results showed that psychopathy, violence exposure, and PTSD are independently linked to self-reported involvement of delinquency, even after controlling for respondents’ demographic characteristics. However, the effect of PTSD on antisocial behavior was small. Differential associations were observed between the 2 factors of psychopathy, interpersonal/affective and social deviance, and PTSD symptoms. Specifically, the effect of social deviance characteristics on delinquency was above and beyond that of interpersonal/affective features. In addition, exposure to violence as a victim or witness were uniquely associated with increased delinquent behavior. Findings clarified the relations among psychopathy, violence exposure, PTSD, and antisocial behavior, and highlighted the differential links between psychopathy factors and delinquency.     

Psychopathy and behavioral correlates of victim injury in serious juvenile offenders

The study examines delinquent behavior and psychopathy and assesses their relationship to victim injury in a population of 168 incarcerated juvenile delinquent males with lengthy histories of criminal and violent behavior. A series of multiple regressions found that 17% of the variance associated with level of victim injury was accounted for by a model that included the three-factor model of the Psychopathy Checklist: Youth Version [Forth, Kosson, and Hare, 2003], criminal versatility, and age of onset of criminal offending. Notably, anger and DSM-IV symptoms of conduct disorder were not related to level of victim injury. The results of this study support an escalation hypothesis where individuals with earlier onset to criminal behavior and greater criminal versatility escalate to more severe violence. The current results demonstrate the importance of integrating established theories of juvenile delinquency when explaining severe violence in youth.     

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.     

Before they're victims: Rethinking youth‐targeted relationship abuse prevention in Australia

Intimate partner abuse (or relationship abuse) against women is recognised as a major public health issue. A number of relationship abuse prevention programs targeted at youth have been developed in Australia. These programs are generally aimed at changing attitudes, and take the stance that girls should not be viewed as being responsible for protecting themselves against violence. In this paper it is argued that the current, dominant focus on physical violence, over other forms of relationship abuse, limits the potential effectiveness of programs that might otherwise help young people to resist the development of abusive dynamics. It is also argued that programs that presume a victim status for girls and a perpetrator status for boys are both inconsistent with contemporary evidence and unlikely to empower young people at risk of chronic perpetration and/or victimisation to avoid such outcomes. A dyadic slippery slope model of chronic relationship abuse is proposed and new directions for prevention research in this area are suggested.     

The social structure of violence in childhood and approval of violence as an adult

Data from a national sample survey conducted for the Commission on the Causes and Prevention of Violence are used to investigate the relationship of three aspects of exposure to violence in childhood (observing violence, being a victim of violence, and committing violence) with approval of violence as an adult. Those who experienced violence as a child tended to favor the use of violence to achieve personal and political ends. However, there was no correlation between childhood violence experience and approval of the use of violence to settle conflicts between nations. It is concluded that the amount of violence experienced in childhood by members of a society is one of the factors contributing to the development and maintenance of cultural norms supporting the use of violence in face-to-face situations.     

Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans’ involvement in wartime atrocities

Background and Objectives: Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence.

Design and Methods: This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans.

Results: Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation.

Conclusions: These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.     

The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans

This study examined (a) the relationships between posttraumatic stress disorder (PTSD) symptom clusters and marital intimacy among Israeli war veterans and (b) the role of self-disclosure and verbal violence in mediating the effects of PTSD avoidance and hyperarousal symptoms on marital intimacy. The sample consisted of 219 participants divided into 2 groups: ex-prisoners of war (ex-POWs; N = 125) and a comparison group of veterans who fought in the same war but were not held in captivity (N = 94). Ex-POWs displayed higher levels of PTSD symptoms and verbal violence and lower levels of self-disclosure than did controls. Although ex-POWs and controls did not differ in level of marital intimacy, they did, however, present a different pattern of relationships between PTSD clusters and intimacy. In ex-POWs, self-disclosure mediated the relations between PTSD avoidance and marital intimacy. Verbal aggression was also found via indirect effect of hyperarousal on marital intimacy. The results point to the importance of self-disclosure and verbal violence as interpersonal mechanisms for the relations between posttraumatic symptoms on marital intimacy of ex-POWs.     

The Relationship of Adverse Childhood Experiences to PTSD,Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults

Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation‐based Native Americans. In 2011, data were collected from Native American (N = 288; 15–24 years of age) tribal members from a remote plains reservation using an anonymous web‐based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post‐traumatic stress disorder (PTSD) symptoms, depression symptoms, poly‐drug use, and suicide attempt. Seventy‐eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly‐drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation‐based populations must be developed, tested and evaluated longitudinally.     

Does war beget child aggression? Military violence,gender, age and aggressive behavior in two Palestinian samples

We examined, first, the relations between children's exposure to military violence and their aggressive behavior and the role of age and gender in that relation in two Palestinian samples. Second, we tested parenting practices as a moderator of the relation between exposure to military violence and aggressive behavior, and third, whether exposure to military violence of different nature (direct victimization versus witnessing) has specific associations with different forms of aggression (reactive, proactive and aggression-enjoyment). Study I was conducted in a relatively calm military-political atmosphere in Palestine-Gaza, and included 640 children, aged 6-16 years whose parents (N=622) and teachers (N=457) provided reports. Older children (> or =12 years) provided self-reports (N=211). Study II included 225 Palestinian children aged 10-14-year, who participated during a high-violence period of the Al Aqsa Intifada characterized by air raids, killing and destruction. Results showed that witnessing severe military violence was associated with children's aggressive and antisocial behavior (parent-reported) in study I, and with proactive, reactive and aggression-enjoyment (child-reported) in the study II. As hypothesized, good and supporting parenting practices could moderate the link between exposure to military violence and aggressive behavior. Aggr.     

Posttraumatic Stress Disorder and Associated Functional Impairments During Pregnancy: Some Consequences of Violence Against Women

Despite the high prevalence of violence in the lives of women of reproductive age, and the adverse consequences posed to pregnant women suffering from PTSD, few studies have examined violence-related trauma and PTSD among pregnant women. A structured research interview was administered to a convenience sample of 85 prenatal care women to collect information regarding their experiences of violence victimization, PTSD symptoms related to violence-related traumatic events, and whether these symptoms impaired various aspects of the women's daily functioning. Results indicated that 69% of the women experienced a violent traumatic event, with the majority of events occurring before the current pregnancy and being perpetrated by the women's intimate partners. The traumatized women evidenced high levels of PTSD symptoms during pregnancy, with 58% of the women meeting criteria for a PTSD diagnosis. Moreover, many of the women with PTSD symptoms reported that the symptoms adversely affected aspects of their daily functioning.     

Relationships between Past Trauma Exposures and PTSD among Survivors of Intimate Partner Violence

This study examined child abuse and community violence exposure as potential risk factors in the development of posttraumatic stress disorder (PTSD) symptoms following exposure to intimate partner violence (IPV). In a community sample of 51 primarily low-income women who had experienced IPV, childhood exposure to child abuse made a unique contribution to PTSD symptom severity from subsequent IPV. Community violence also accounted for variance in PTSD symptom severity, but in the opposite direction, with individuals exposed to community violence reporting lower levels of PTSD symptoms from IPV. These findings suggest the need for further research to identify which factors related to community violence exposure might inoculate individuals against the development of PTSD following IPV exposure.     

Implementation of an empirically based drug and violence prevention and intervention program in public school settings

Describes the implementation of a collaborative preventive intervention project (Healthy Schools) designed to reduce levels of bullying and related antisocial behaviors in children attending two urban middle schools serving primarily African American students. These schools have high rates of juvenile violence, as reflected by suspensions and expulsions for behavioral problems. Using a quasi-experimental design, empirically based drug and violence prevention programs, Bullying Prevention and Project ALERT, are being implemented at each middle school. In addition, an intensive evidence-based intervention, multisystemic therapy, is being used to target students at high risk of expulsion and court referral. Hence, the proposed project integrates both universal approaches to prevention and a model that focuses on indicated cases. Targeted outcomes, by which the effectiveness of this comprehensive school-based program will be measured, are reduced youth violence, reduced drug use, and improved psychosocial functioning of participating youth.