Wekerle Christine, Leung Eman, Wall Anne-Marie, MacMillan Harriet, Boyle Michael, Trocme Nico, Waechter Randall
Faculty of Education, Department of Psychology, Psychatry Program, University of Western Ontario, Ont., Canada.
Child Abuse Negl. 2009 Jan;33(1):45-58. doi: 10.1016/j.chiabu.2008.12.006. Epub 2009 Jan 22.
For child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse-teen dating violence link.
A random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales.
Over 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63-67%) and nearly half of males (44-49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings.
These results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others.
The present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths' conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare.
对于可能经历过多种形式虐待的儿童保护服务(CPS)系统中的青少年而言,当其他形式的虐待更为突出且更明显地超出公认的育儿社会规范时,情感虐待的独特影响可能会被忽视。本研究探讨童年期情感虐待对于理解青少年创伤后应激障碍(PTSD)症状及约会暴力的独特预测价值。此外,PTSD症状被视为情感虐待与青少年约会暴力之间联系的一个解释性桥梁。
从一个大型城市CPS服务区的活跃案件量中随机抽取402名青少年作为一项关于青少年健康行为的大型纵向研究的一部分。研究针对处于不同CPS状态的青少年中期人群。CPS青少年使用已发表的量表报告其一生的虐待经历、PTSD症状以及过去一年的约会经历。
超过85%的CPS青少年开始约会。对于正在约会的青少年而言,一定程度的约会暴力较为常见:超过一半的女性(63 - 67%)和近一半的男性(44 - 49%)经历过。在考虑其他形式虐待的情况下,情感虐待成为男性和女性PTSD症状及约会暴力的显著预测因素。PTSD症状是男性情感虐待 - 施暴及女性情感/身体虐待 - 受虐关系中的显著中介因素,表明研究结果存在性别差异模式。
这些结果表明:(1)CPS青少年是约会暴力及与PTSD相关干预的重点关注群体;(2)CPS青少年在青少年适应过程中持续受到童年期情感虐待的独特负面影响。所有CPS儿童都应接受情感虐待情况的评估,并针对情感虐待如何具体影响儿童与自己及他人建立关系的方式给予适当的干预关注。
本研究对以下方面具有实践意义:(1)青少年约会暴力问题;(2)童年期情感虐待的重要性;(3)针对CPS青少年PTSD症状的重要性。大量CPS青少年报告过早卷入暴力恋爱关系,需要得到支持以获得与未涉及CPS系统的同龄人相同的非强制性恋爱关系体验。约会、健康恋爱关系及约会暴力的话题可能需要成为常规个案工作的一部分,以支持青少年对健康亲密关系的概念化理解及相关技能的培养。此外,这些知识需要传达给寄养父母和集体家庭工作人员。关于童年期情感虐待的影响,CPS工作者需要意识到其对关系发展产生长期独特影响的可能性。情感虐待在性别方面具有独特性(即对女性而言,它与身体虐待相关),并且对PTSD症状和约会暴力具有独特的预测性。最后,与理论和生物心理社会证据一致,PTSD症状是理解虐待相关损害的关键因果因素。关注PTSD症状可能预防约会暴力;关注情感虐待经历可能预防PTSD症状。CPS青少年是研究中的重要群体,将他们纳入研究有助于为儿童福利领域基于证据的实践和政策提供更多证据。