Charlotte Cecil Molecules of Happiness: Why Love Matters for Vulnerable Children

Double Disadvantage: The impact of childhood maltreatment and community

violence exposure on adolescent mental health

Charlotte CecilMolecules of Happiness: Why Love Matters for Vulnerable Children

London, 26th September 2013

1. Childhood maltreatment

Background

• Maltreatment prevalence

Affects millions of children worldwide

Difficult to estimate true prevalence Many cases never come to light Existing estimates vary widely Community studies vs. official reports

UK: up to 1 in 5 experience severe maltreatment (NSPCC; Radford et al., 2011)

Background

• Maltreatment effects Childhood

Child fatality 1 in 10 injury-related child fatalities worldwide (WHO; Pinheiro et al., 2006)

Increased risk of mental health and adjustment difficulties Emotional, behavioural, interpersonal domains (Cicchetti & Toth, 2005)

Underpinned by biological changes in brain structure, function, and stress response (McCrory et al, 2010)

Background

• Maltreatment effects Childhood

Child fatality 1 in 10 injury-related child fatalities worldwide (WHO; Pinheiro et al., 2006)

Increased risk of mental health and adjustment difficulties Emotional, behavioural, interpersonal domains (Cicchetti & Toth, 2005)

Underpinned by biological changes in brain structure, function, and stress response (McCrory et al, 2010)

Adulthood Increased susceptibility to psychiatric and medical disorders

E.g. mood and personality disorders, obesity, diabetes, chronic pain (Oswald et al., 2010)

Decreased life opportunities E.g. education, employment, earnings (Currie & Widom, 2010)

Background

2. Community violence exposure (CVE)

Background

• Community Violence Exposure (CVE)

Characteristics Acts: Chasing, threatening, robbing, beating up, shooting, stabbing, murder Levels of exposure: Hearing about, witnessing, directly experiencing

Most chronic and prevalent form of violence exposure Rates of exposure remain constant across years (Fowler et al., 2009)

50%+ of urban youth affected (Buka et al, 2001)

4-70% witness stabbing/shooting 1-47% witness murder

CVE impact Mental health & behaviour (Margolin & Gordis, 2000)

PTSD, Aggression

Background



Most prevalent and chronic form of violence exposure 50%+ of urban youth affected (Buka et al, 2001)

Rates of exposure remain constant across years (Fowler et al., 2009)


PTSD, Aggression

Background



Most chronic and prevalent form of violence exposure Rates of exposure remain constant across years (Fowler et al., 2009)

50%+ of urban youth affected (Buka et al, 2001)


Background

FREQUENTLY CO-OCCUR

YET, EXAMINED SEPARATELY

• Sample 204 inner city youth from the community 16-24 year olds, males and females Multiple recruitment channels

50% Kids Company 50% Inner city London schools and internet websites

Matched for age, sex, ethnic background, IQ and neighbourhood deprivation

• Measures Developmental adversity (self-report)

Childhood maltreatment Current exposure to community violence

Mental health functioning (multi-rater reports)

Internalizing difficulties (anxiety, depression)

Externalizing difficulties (conduct problems, ASB)

Trauma symptoms (anger, PTSD, dissociation)

Kids-Co/UCL Project

• Sample 204 inner city youth from the community 16-24 year olds, males and females Multiple recruitment channels

50% Kids Company 50% Inner city London schools and internet websites

Matched for age, sex, ethnic background, IQ and neighbourhood deprivation

• Measures Developmental adversity (self-report)

Childhood maltreatment Current exposure to community violence

Mental health functioning (multi-rater reports)

Internalizing difficulties (anxiety, depression)

Externalizing difficulties (conduct problems, ASB)

Trauma symptoms (anger, PTSD, dissociation)

Kids-Co/UCL Project

• Part I: Characterizing levels of exposure

• Part II: The impact of maltreatment and CVE

• Part III: The influence of individual maltreatment types

Outline

Part I: Characterizing levels of exposure

Part I: Levels of exposure

Childhood maltreatment


*Statistically significant difference = p < .01

1. Childhood maltreatment: Any exposure*

KIDS COMPANY:

84%

COMPARISON:

56%VS.


*All group differences statistically significant = p < .01

Emotional abuse Physical abuse Sexual abuse Emotional neglect Physical neglect0

10

20

30

40

50

60

70

62

48

25

66

52

35

21

7

35

12

Kids Co (N = 98) Comparison (N = 106)

Perc

enta

ge (%

)

1. Childhood maltreatment: Any exposure*


1. Childhood maltreatment: Severe-Extreme*

KIDS COMPANY:

38%

COMPARISON:

8%VS.

*Statistically significant difference = p < .001


1. Childhood maltreatment: Severe-Extreme*

Emotional abuse Physical abuse Sexual abuse Emotional neglect Physical neglect0

5

10

15

20

25

30

25

21

10

1615

43


Perc

enta

ge (%

)

*All group differences statistically significant = p < .01


Community violence exposure


2. Community violence exposure: Any exposure*

KIDS COMPANY:

98%

COMPARISON:

95%VS.

*Difference not significant


2. Community violence exposure: Any exposure*

Hearing about Witnessing Victimization0

10

20

30

40

50

60

70

80

90

100

92

74 73

91

45

53


Perc

enta

ge (%

)

*Group differences for witnessing and victimization statistically significant = p < .01

n.s.


2. Community violence exposure: Severe acts*

* All group differences statistically significant = p < .001

Witnessed shooting/stabbing Witnessed killing Been shot/stabbed0

5

10

15

20

25

30

35

40

45

50

44

26

118 7

1


Perc

enta

ge (%

)


Single vs. Multi-type


3. Single vs. Multi-type: Childhood maltreatment

28%

24%

17%

20%

11%

1

2

1

3

45

Multi-type mal-treatment: 72%

Participants with experience of maltreatment (68% of sample; N = 139)


3. Single vs. Multi-type: Community violence exposure

17%

34%

49%

1

2

3

Multi-type CVE: 83%

Participants with experience of community violence (92% of sample; N = 187)


Degree of overlap


Maltreatment (68% of sample)


97%No CVE

CVE



97%

Maltreated youth typically experience a DOUBLE DISADVANTAGE

No CVE

CVE


• Summary

1. Alarming levels of exposure

2. Multi-type exposure ‘norm’

3. Maltreatment and CVE frequently co-occur


• Summary





• Summary





Part II: The impact of maltreatment and CVE

Part II: Maltreatment & CVE impact

• Aim What are their independent effects? What are their combined effects?

? ?


1. Independent effects: Childhood maltreatment

CHILDHOOD MALTREATMENT

TRAUMA SYMPTOMS(Anger, PTSD, dissociation)

INTERNALIZING(Anxiety, depression)

EXTERNALIZING

(Conduct problems, ASB)

* * *

* Effects statistically significant = p < .001


1. Independent effects: Community violence exposure

COMMUNITY VIOLENCE EXPOSURE

* Effects statistically significant = p < .01

**

TRAUMA SYMPTOMS(Anger, PTSD, dissociation)

INTERNALIZING(Anxiety, depression)

EXTERNALIZING

(Conduct problems, ASB)


2. Combined effects: Additive

CVE Maltreatment Double disadvantage0

1

2

3

4

5

6

7

8

9

10

Men

tal H

ealth

diff

icul

ties

• Summary1. Both maltreatment and CVE have serious consequences for

mental health

2. Children who experience both forms of adversity are at particularly high risk for mental health problems


• Summary1. Both maltreatment and CVE have serious consequences for

mental health

2. Youth who experience double disadvantage are at particularly high risk for mental health problems


Part III: The influence of individual

maltreatment types

• Aim

Part III: Maltreatment types

Emotional Abuse

Physical Abuse

Sexual Abuse

Physical Neglect

Emotional Neglect

Similar or different effects?

• Findings

1. All maltreatment types have negative effect*• Driven by what is common to all types


*(std. B = .14 – . 69; significant at least p < .05)

• Findings

1. All maltreatment types have negative effect• Driven by what is common to all types

FEELING UNSAFE AND VULNERABLE?


• Findings

2. Emotional abuse* • Unique predictive power, over and above all other types


*(std. B = .29 – . 76; significant at least p < .01, except externalizing difficulties)

• Findings

2. Emotional abuse • Unique predictive power, over and above all other types

FEELING UNLOVED AND UNSUPPORTED?


Conclusions

1. Inner city youth are highly vulnerable to violence exposure

2. Maltreatment and CVE are key developmental risk factors

3. Emotional abuse unique predictive power

Key findings

• NEED TO TAKE ACTION!

• Increase awareness

• Invest in prevention

• Improve access to effective interventions

Implications

• Funding:• Kids Company charity

• Collaborators:• Dr Eamon McCrory• Prof Essi Viding• Dr Ted Barker• Dr Jo Guiney

Thank you to all of the young people, teachers, key workers who have taken part in this research

Acknowledgments

Documents

Charlotte Cecil Molecules of Happiness: Why Love Matters for Vulnerable Children