Abstract
Child maltreatment is associated with internalizing and externalizing problems in adolescents, as well as psychiatric hospitalizations, which represent severe mental health difficulties and substantial burden on individuals and the health care system. These negative outcomes are especially prevalent in youth in foster care. Not all youth exposed to maltreatment, however, demonstrate poor mental health outcomes. Additional factors, such as maltreatment chronicity and coping style, may help explain why some (but not all) youth develop major psychiatric problems. The purpose of the present study was to examine how maltreatment chronicity and coping style were associated with internalizing, externalizing, and psychiatric hospitalizations, and whether coping style moderated the relation between maltreatment chronicity and mental health in a sample of foster adolescents. Participants were 283 adolescents ages 12–19 residing in foster care. Youth reported on maltreatment, coping, and mental health; caregivers reported on mental health. Psychiatric hospitalizations were obtained from medical records. Youth who experienced more maltreatment had higher caregiver- and self-reported internalizing, and more psychiatric hospitalizations. Youth who approached problems directly had lower caregiver-reported internalizing and externalizing, while youth who dealt with stressors alone had higher self-reported internalizing and externalizing, and more psychiatric hospitalizations. Youth who avoided facing their problems had less psychiatric hospitalizations. Further, a significant interaction revealed that youth with more maltreatment who avoided problems had less psychiatric hospitalizations, suggesting that avoiding problems may be more protective for youth with the most chronic abuse and neglect. Findings highlight the importance of examining both maltreatment and coping.
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Aiken, L. S., West, S. G., & Reno, R. R. (1991). Multiple regression: Testing and interpreting interactions. Sage.
Bal, S., Van Oost, P., De Bourdeaudhuij, I., & Crombez, G. (2003). Avoidant coping as a.mediator between self-reported sexual abuse and stress-related symptoms in adolescents. Child Abuse & Neglect, 27, 883–897. https://doi.org/10.1016/S0145-2134(03)00137-6.
Beck, A. T. (2002). Cognitive models of depression. Clinical Advances in Cognitive Psychotherapy: Theory and Application, 14, 29–61.
Bilotta, E., Giacomantonio, M., Leone, L., Mancini, F., & Coriale, G. (2016). Being alexithymic: Necessity or convenience. Negative emotionality × avoidant coping interactions and alexithymia. Psychology and Psychotherapy: Theory, Research and Practice, 89, 261–275. https://doi.org/10.1111/papt.12079.
Bolger, K. E., & Patterson, C. J. (2001). Developmental pathways from child maltreatment to peer rejection. Child Development, 72, 549–568. https://doi.org/10.1111/1467-8624.00296.
Boxer, P., & Terranova, A. M. (2008). Effects of multiple maltreatment experiences among psychiatrically hospitalized youth. Child Abuse & Neglect, 32, 637–647. https://doi.org/10.1016/j.chiabu.2008.02.003.
Brown, S., Fite, P. J., Stone, K., & Bortolato, M. (2016). Accounting for the associations between child maltreatment and internalizing problems: The role of alexithymia. Child Abuse & Neglect, 52, 20–28. https://doi.org/10.1016/j.chiabu.2015.12.008.
Caples, H. S., & Barrera, M. (2006). Conflict, support and coping as mediators of the relation between degrading caregiving and adolescent adjustment. Journal of Youth and Adolescence, 35, 603–615. https://doi.org/10.1007/s10964-006-9057-2.
Chaffin, M., Wherry, J. N., & Dykman, R. (1997). School age children's coping with sexual abuse: Abuse stresses and symptoms associated with four coping strategies. Child Abuse & Neglect, 21, 227–240. https://doi.org/10.1016/S0145-2134(96)00148-2.
Clarke, A. T. (2006). Coping with interpersonal stress and psychosocial health among children and adolescents: A meta-analysis. Journal of Youth and Adolescence, 35, 11–24. https://doi.org/10.1007/s10964-005-9001-x.
Cohen, Y., Spirito, A., Sterling, C., Donaldson, D., Seifer, R., Plummer, B., & Ferrer, K. (1996). Physical and sexual abuse and their relation to psychiatric disorder and suicidal behavior among adolescents who are psychiatrically hospitalized. Child Psychology & Psychiatry & Allied Disciplines, 37, 989–993. https://doi.org/10.1111/j.1469-7610.1996.tb01495.x.
Compas, B.E., Jaser, S.S., Bettis, A.H., Watson, K.H., Gruhn, M.A., Dunbar, J.P., Williams, E. & Thigpen, J.C. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological Bulletin, 143, 939–991. https://doi.org/10.1037/bul0000110
Elzy, M., Clark, C., Dollard, N., & Hummer, V. (2013). Adolescent girls’ use of avoidant and approach coping as moderators between trauma exposure and trauma symptoms. Journal of Family Violence, 28, 763–770. https://doi.org/10.1007/s10896-013-9546-5.
English, D. J. & LONGSCAN investigators. (1997). Modified maltreatment classification system (MMCS). Retrieved from http://www.iprc.unc.edu/longscan. Accessed 21 June 2014.
English, D. J., Graham, J. C., Litrownik, A. J., Everson, M., & Bangdiwala, S. I. (2005). Defining maltreatment chronicity: Are there differences in child outcomes. Child Abuse & Neglect, 29, 575–595. https://doi.org/10.1016/j.chiabu.2004.08.009.
Éthier, L. S., Lemelin, J. P., & Lacharité, C. (2004). A longitudinal study of the effects of chronic maltreatment on children’s behavioral and emotional problems. Child Abuse & Neglect, 28, 1265–1278. https://doi.org/10.1016/j.chiabu.2004.07.006.
Finkelhor, D., Turner, H., Hamby Sewanee, S., & Ormrod, R. (2011). Polyvictimization: Children’s exposure to multiple types of violence, crime, and abuse. Free Inquiry in Creative Sociology, 39, 24–34.
Gabrielli, J., Jackson, Y., Tunno, A. M., & Hambrick, E. P. (2017). The blind men and the elephant: Identification of a latent maltreatment construct for youth in foster care. Child Abuse and Neglect, 67, 98–108. https://doi.org/10.1016/j.chiabu.2017.02.020.
Garcia, C. (2010). Conceptualization and measurement of coping during adolescence: A review of the literature. Journal of Nursing Scholarship, 42, 166–185. https://doi.org/10.1111/j.1547-5069.2009.01327.x.
Gravetter, F., & Wallnau, L. (2014). Essentials of statistics for the behavioral sciences (8th ed.). Belmont: Wadsworth.
Gusler, S., & Jackson, Y. (2017). The role of poly-victimization in predicting differences in foster youths’ appraisals. Child Abuse & Neglect, 69, 223–231. https://doi.org/10.1016/j.chiabu.2017.04.020.
Gutierrez, L. M. (1994). Beyond coping: An empowerment perspective on stressful life events. Journal of Sociology and Social Welfare, 21, 201–220.
Gyllenberg, D., Sourander, A., Niemelä, S., Helenius, H., Sillanmäki, L., Piha, J., Kumpulainen, K., Tamminen, T., Moilanen, I., & Almqvist, F. (2010). Childhood predictors of later psychiatric hospital treatment: Findings from the Finnish 1981 birth cohort study. European Child & Adolescent Psychiatry, 19, 823–833. https://doi.org/10.1007/s00787-010-0129-1.
Hahm, H. C., Lee, Y., Ozonoff, A., & Van Wert, M. J. (2010). The impact of multiple types of child maltreatment on subsequent risk behaviors among women during the transition from adolescence to young adulthood. Journal of Youth and Adolescence, 39, 528–540. https://doi.org/10.1007/s10964-009-9490-0.
Hébert, M., Langevin, R., & Oussaïd, E. (2018). Cumulative childhood trauma, emotion regulation, dissociation, and behavior problems in school-aged sexual abuse victims. Journal of Affective Disorders, 225, 306–312. https://doi.org/10.1016/j.jad.2017.08.044.
Higgins, D. J., & McCabe, M. P. (2000). Multi-type maltreatment and the long-term adjustment of adults. Child Abuse Review, 9, 6–18 https://doi.org/10.1002/(SICI)1099-0852(200001/02)9:1<6::AID-CAR579>3.0.CO;2-W. Accessed 21 June 2014.
Hobfoll, S. E., Dunahoo, C. L., Ben-Porath, Y., & Monnier, J. (1994). Gender and coping: The dual-axis model of coping. American Journal of Community Psychology, 22, 49–81. https://doi.org/10.1007/BF02506817.
Jackson, Y., Gabrielli, J., Tunno, A. M., & Hambrick, E. P. (2012). Strategies for longitudinal research with youth in foster care: A demonstration of methods, barriers, and innovations. Child and Youth Services Review, 34, 1208–1213. https://doi.org/10.1016/j.childyouth.2012.02.007.
Jones, A. M., & Morris, T. L. (2012). Psychological adjustment of children in foster care: Review and implications for best practice. Journal of Public Child Welfare, 6, 129–148. https://doi.org/10.1080/15548732.2011.617272.
Kendall, P. C., Cummings, C. M., Villabø, M. A., Narayanan, M. K., Treadwell, K., Birmaher, B., Compton, S., Piacentini, J., Sherrill, J., Walkup, J., Gosch, E., Keeton, C., Ginsburg, G., Suveg, C., & Albano, A. M. (2016). Mediators of change in the child/adolescent anxiety multimodal treatment study. Journal of Consulting and Clinical Psychology, 84, 1–14. https://doi.org/10.1037/a0039773.
Linehan, M. (2015). DBT skills training manual (Second ed.). New York, NY: Guilford Press.
Little, T. D., Lopez, D. F., & Wanner, B. (2001). Children’s action-control behaviors (coping): A longitudinal validation of the behavioral inventory of strategic control. Anxiety, Stress, & Coping, 14, 315–336. https://doi.org/10.1080/10615800108248360.
Lopez, D. F., & Little, T. D. (1996). Children’s action-control beliefs and emotional regulation in the social domain. Developmental Psychology, 32, 299–312. https://doi.org/10.1037/0012-1649.32.2.299.
Luke, N., & Banerjee, R. (2013). Differentiated associations between childhood maltreatment experiences and social understanding: A meta-analysis and systematic review. Developmental Review, 33, 1–28. https://doi.org/10.1016/j.dr.2012.10.001.
Luthar, S. S., Lyman, E. L., & Crossman, E. J. (2014). Resilience and positive psychology. In M. Lewis & K. Rudolph (Eds.), Handbook of developmental psychopathology (pp. 125–140). New York: Springer. https://doi.org/10.1007/978-1-4614-9608-3_7.
Masten, A. S., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22, 491–495. https://doi.org/10.1017/S0954579410000222.
Mathew, A., & Nanoo, S. (2013). Psychosocial stressors and patterns of coping in adolescent suicide attempters. Indian Journal of Psychological Medicine, 35, 39–46. https://doi.org/10.4103/0253-7176.112200.
Maughan, A., & Cicchetti, D. (2002). Impact of child maltreatment and interadult violence on children's emotion regulation abilities and socioemotional adjustment. Child Development, 73, 1525–1542. https://doi.org/10.1111/1467-8624.00488.
McGuire, A., Cho, B., Huffhines, L., Gusler, S., Brown, S., & Jackson, Y. (2018). The relation between dimensions of maltreatment, placement instability, and mental health among youth in foster care. Child Abuse & Neglect, 86, 10–21. https://doi.org/10.1016/j.chiabu.2018.08.012.
Miller Smedema, S., Catalano, D., & Ebener, D. J. (2010). The relationship of coping, self worth, and subjective well-being: A structural equation model. Rehabilitation Counseling Bulletin, 53, 131–142. https://doi.org/10.1177/0034355209358272.
Miller, G. E., Chen, E., & Parker, K. J. (2011). Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving towards a model of behavioral and biological mechanisms. Psychological Bulletin, 137, 959–997. https://doi.org/10.1037/a0024768.
Mueller, J., & Buehner, M. (2006). Two facets of non-expression of emotions: Relationship between dimensions of alexithymia and the repressive coping style. Personality and Individual Differences, 41, 1337–1347. https://doi.org/10.1016/j.paid.2006.04.023.
Narayan, A., Cicchetti, D., & Rogosch, F. A. (2015). Interrelations of maternal expressed emotion, maltreatment, and separation/divorce and links to family conflict and children’s externalizing behavior. Journal of Abnormal Child Psychology, 43, 217–228. https://doi.org/10.1007/s10802-014-9911-8.
Reynolds, C. R. & Kamphaus, R. W. (2004). BASC-2: Behavior assessment system for children.
Shapiro, D. N., Kaplow, J. B., Amaya‐Jackson, L., & Dodge, K. A. (2012). Behavioral markers of coping and psychiatric symptoms among sexually abused children. Journal of Traumatic Stress, 25, 157–163. https://doi.org/10.1002/jts.21674
Tremblay, C., Hébert, M., & Piché, C. (1999). Coping strategies and social support as mediators of consequences in child sexual abuse victims. Child Abuse & Neglect, 23, 929–945. https://doi.org/10.1016/S0145-2134(99)00056-3.
Vanlede, M., Little, T. D., & Card, N. A. (2006). Action-control beliefs and behaviors as predictors of change in adjustment across the transition to middle school. Anxiety, Stress, and Coping, 19, 111–127. https://doi.org/10.1080/10615800600632896.
Weis, R., & Smenner, L. (2007). Construct validity of the behavior assessment system for children (BASC) self-report of personality: Evidence from adolescents referred to residential treatment. Journal of Psychoeducational Assessment, 25, 111–126. https://doi.org/10.1177/0734282906293762.
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This research was supported by funding from the National Institutes of Mental Health, R01 Grant MH079252–03 awarded to Yo Jackson, as well as funding from the National Institutes of Mental Health, T32 Grant 2T32MH019927–26 awarded to Lindsay Huffhines.
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Huffhines, L., Jackson, Y. & Stone, K.J. Internalizing, Externalizing Problems and Psychiatric Hospitalizations: Examination of Maltreatment Chronicity and Coping Style in Adolescents in Foster Care. Journ Child Adol Trauma 13, 429–441 (2020). https://doi.org/10.1007/s40653-020-00305-1
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DOI: https://doi.org/10.1007/s40653-020-00305-1