Multi-type maltreatment in childhood and psychological adjustment in adolescence: questionnaire study among adolescents in Western Herzegovina Canton

Aim

To determine the prevalence and intercorrelation of different forms of childhood maltreatment and psychological problems in adolescents in Western Herzegovina Canton.

Method

A questionnaire study was conducted in March 2003 on a convenient sample of 458 third-grade high-school students (39% boys) aged between 15 and 20 (median age, 17). Data were collected using a sociodemographic questionnaire, Family Adaptability and Cohesion Evaluation Scales III, Child Maltreatment Questionnaire, Youth Self-Report, and Rosenberg Self-Esteem Scale. Sociodemographic and family characteristics and exposure to maltreatment were analyzed as possible predictors of exposure to a particular type of abuse and subsequent psychological adjustment problems.

Results

Out of 458 students, 77% were emotionally abused, 52% physically abused, 30% neglected, 20% witnessed family violence, and 13% of girls and 21% of boys were sexually abused before the age of 14. Significant association between the maltreatment by a mother, father, and other adults were found for emotional and physical abuse and for neglect and witnessing family violence (r = 0.413-0.541, P<0.001 for all). Significant correlation was found between all forms of abuse (r = 0.163-0.594, P<0.05), except between sexual abuse and witnessing family violence (r = 0.048, P = 0.351). Almost two-thirds of students were exposed to multi-type maltreatment in childhood. Family characteristics and maltreatment scores significantly predicted anxiety/depression (R = 0.456, R² = 0.076), withdrawal (R = 0.389, R² = 0.049), somatic complaints (R = 0.437, R² = 0.059), social problems (R = 0.417, R² = 0.063), attention deficit and hyperactivity disorder (R = 0.368, R² = 0.045), rule-breaking behavior (R = 0.393, R² = 0.045), aggression (R = 0.437, R² = 0.078) (P<0.001 for all), as well as self-esteem (R = 0.371, R² = 0.035, P = 0.003).

Conclusion

Most third-grade high-school students in Western Herzegovina Canton were exposed to multi-type maltreatment in childhood, regardless of the war experience. Emotional and physical abuse were most frequently combined forms of maltreatment. Sociodemographic and family characteristics and exposure to some forms of abuse were significant predictors of exposure to other forms of abuse. Exposure to maltreatment in childhood predicted difficulties in psychological adjustment in adolescence.The focus of research on child maltreatment has recently shifted from sexual and physical abuse and physical neglect to different types of psychological maltreatment, including witnessing family violence in childhood (1,2). A growing body of evidence shows that childhood maltreatment takes many different forms, and a significant proportion of maltreated children are exposed not only to repetitive episodes of a single type of maltreatment, but also to multiple forms of maltreatment (3). Individuals who were sexually and physically abused in childhood have lower self-esteem, higher depression level, more psychosexual problems, more trauma symptoms, asocial/antisocial behavior, and poor mental health (3). According to research among adults who were exposed to maltreatment in childhood, multi-type maltreatment is generally associated with greater psychological and emotional impairment than single-type maltreatment (3,4). Individuals who were exposed to a combined physical and psychological maltreatment in childhood have to cope with low self-esteem, dysfunctional sexual behavior, and problems with anger or aggression in adult age (5), as well as higher levels of depression (6). Witnessing family violence is a unique predictor of trauma symptoms and low self-esteem, because it often leads, together with multi-type maltreatment, to anxiety, depression, dissociation, sleeping problems, and sexual dysfunction (3).The role of dysfunctional family background as a cause of adjustment issues in adolescence or adulthood is another increasingly investigated problem. Poor family functioning has been reported as a risk factor for child maltreatment (particularly sexual abuse). The study by Higgins and McCabe (7) showed that family factors in childhood, either independently or in combination with child maltreatment, were associated with adjustment difficulties in adulthood and that family violence during childhood was likely to have negative effects on psychological adjustment in early adulthood. Besides family cohesion, adaptability, and interpersonal relationships, some other family variables have also been found to increase the risk of family maltreatment (7). These include low social status, parental conflicts, parental divorce, living with only one parent, living with a stepfather, long-term absence of one parent before the age of sixteen, parental alcoholism or drug abuse, chronic illness of a parent or other family members, and low parental education (7).The fact that different types of maltreatment often overlap must be taken into account when the adjustment problems associated with one particular type of maltreatment are considered. The same applies to family dysfunction. Furthermore, the impact of child maltreatment, including neglect, should be assessed within the context of the overall family environment. The aims of our study were to determine the prevalence and intercorrelation of different forms of maltreatment in childhood; establish the frequency of maltreatment by the mother, the father, or other adults; and evaluate possible predictors of maltreatment in childhood and consequent psychological adjustment problems in adolescence. The study was performed in Western Herzegovina Canton of Bosnia and Herzegovina because there is no knowledge about the prevalence and type of childhood maltreatment or its psychological consequences in adolescents in this area.