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CHILD
et al. / ADVERSE OUTCOMES
/ AUGUST 2002
180
METHOD
181
Exposure to Violence
We determined the level of violence witnessed by
the child through both child and caregiver reports.
The childs report of witnessed violence was measured by the Things Ive Seen and Heard survey,
administered at the age 8 interview (Richters & Martinez, 1990). Things Ive Seen and Heard assesses exposure to violence throughout a childs lifetime. A child
was considered to have witnessed minimal levels of
violence if she or he did not endorse any of the following items: (a) seeing a person arrested more than
once, (b) seeing someone beaten up more than once,
(c) ever having heard grownups in the home yell at
one another, (d) ever having seen grownups in the
home hit each other, (e) ever having seen someone
get stabbed, (f) ever having seen someone get shot,
(g) ever having seen a dead body (not in the context
of a funeral or wake), (h) ever having seen someone
pull a gun on someone, (i) ever having seen someone
shot in the childs own home, and ( j) ever having seen
someone pull a knife on someone. If the child
endorsed any of the first four items but none of the
items (e) through ( j), she or he was considered to
have witnessed a moderate level of violence. If the
child endorsed any of the last six items, she or he was
considered to have witnessed a high level of violence.
Caregiver report measures of violence witnessed by
the child were assessed using items from the age 8
administration of the Child Life Events survey. This
project-developed survey is based on an existing survey (Sarason, Johnson, & Siegel, 1978) and was
designed to track events that occurred in the past year
that may have had an impact on the childs psychological well-being. A child was considered to have witnessed a high level of violence if the caregiver
reported that the child observed any of the following
events in the home or neighborhood environment:
someone getting threatened with a weapon, someone
being stabbed, someone being killed or murdered, or
someone getting kicked, hit, or otherwise physically
harmed. If the parent reported that the child was
exposed to loud arguments but not to any of the other
indicators, the child was considered to have been witness to a moderate level of violence. For cases in which
parents did not endorse any of the above-listed indicators of violence, the child was considered to have been
exposed to a minimal level of violence.
Control Variables
To reduce the chances of finding a spurious association, as well as to show the adjusted effects of victimization and violence exposure on adverse outcomes,
we controlled for the following variables in our study:
182
TABLE 1:
Level of victimization
None
Moderate
High
Child self-report of witnessing violence
Minimal
Moderate
High
Caregiver report of childs witnessing violence
Minimal
Moderate
High
117
24
24
70.9
14.5
14.5
38
77
52
22.8
46.1
31.1
90
52
25
53.9
31.1
15.0
NOTE: The total N for some variables does not add to 167 due to
missing data.
7
6.65
6
183
4
3
2
3
Low Caregiver Depression
2.22
1
0
Minimal/Moderate
High
FIGURE 1:
184
TABLE 2:
Least-Square Means for Predictors From Multivariable Regression Analyses for Each Outcome (N = 167)
Outcomes
Predictor
Victimization
None
Moderate
Severe
p
Caregiver report of witnessed violence
Minimal
Moderate
Severe
p
Child report of witnessed violence
Minimal
Moderate
Severe
p
Caregiver Report:
a
Aggression
Caregiver Report:
a
Depression
Child Report:
b
Depression
Child Report:
b
Anger
Child Report:
b
Anxiety
8.56
11.83
12.10
.0189
3.49
6.32
5.23
.0014
6.28
7.90
5.45
.1921
5.56
8.01
4.09
.0910
7.54
8.11
6.56
.6367
9.12
12.23
11.14
.1686
4.51
5.50
5.02
.0041
7.08
5.90
6.65
.3057
6.00
5.88
5.78
.4483
8.74
5.75
7.71
.0451
12.84
9.59
10.09
.0443
5.98
3.79
5.26
.0372
4.52
6.50
8.61
< .001
3.67
6.01
7.98
.0029
4.67
7.23
10.29
< .001
NOTE: Least square means estimates are Type III sum of squares and control for caregiver depression, child sex, maternal education, caregiver age, father figure in home, child health status, caregiver social support, and significant life events.
a. Measured by the Child Behavior Checklist.
b. Measured by the Trauma Symptom Checklist for Children.
DISCUSSION
Although there has been previous research on negative mental health effects subsequent to child abuse,
childrens exposure to household violence, and childrens exposure to neighborhood violence, few studies have used longitudinal data and adjusted for
potentially confounding variables. The purpose of
this investigation was to examine the association of
experiencing physical abuse and/or witnessing violence in the household or neighborhood environment with mental health outcomes among children.
We build on prior research by adjusting for a strict set
of control variables and using data collected at multiple time points.
The children in our sample experienced high levels of violence at a young age. More than one fourth
(29%) had either come to the attention of the State
Division of Social Services as being possible victims of
child abuse or had experienced physical aggression at
the hands of caregivers, that is, they were shoved,
slapped, pushed, or grabbed. (Physical aggression to
children by caregivers was assessed through caregiver
report.) Violence witnessed by children in the home
and neighborhood was assessed through both caregiver and child report. Nearly half (46%) of the children reported seeing an arrest, an assault, or loud
arguments. According to the child self-report measure of witnessed violence, more than three quarters
(77.2%) of the children had been exposed to
moderate-high levels of violence, whereas the caregiver report indicated that 46% of children had been
exposed to moderate-high levels of violence. This discrepancy may be due to several factors. First, the Child
Life Events survey, which was administered to caregivers, inquires about events in the past year. In contrast, the child self-report Things Ive Seen and Heard
survey inquires about the childs entire lifetime. Second, the highly personal nature of the questions may
have resulted in underreporting by caregivers. However, even the findings from the more conservative
assessment reflect an above-average level of witnessed
violence. According to caregivers reports, 15% of
children had seen someone severely assaulted or
threatened with a weapon, and 31% were exposed to
loud arguments.
Our findings confirm that children are negatively
affected by exposure to violence, both personal victimization and what they see around them. When we
ran multivariate statistical models that tested the
effect of each predictor variable (victimization, child
self-report of witnessed violence, caregiver report of
witnessed violence) on all five mental health outcome
variables (child self-report of depression, anger, and
anxiety; caregiver report of childs depression and
aggression), all three were significantly associated
with negative mental health outcomes. The series of
multivariable statistical tests, which were adjusted for
potentially confounding variables, examined the
effects of victimization and witnessing violence on
CHILD MALTREATMENT / AUGUST 2002
each mental health outcome separately. Victimization was significantly associated with increased depression and aggression among children. Although the
caregivers report of witnessed violence was related to
significant increases in depression and anxiety, the
child self-report of witnessed violence was related to
significant increases in all five mental health
outcomes.
As compared to children who had not experienced
any victimization, those who had been physically
abused exhibited more severe adverse behavioral and
emotional outcomes. The mean scores for aggression,
depression, anxiety, and anger among nonvictimized
children were comparable to the scores of children in
the general population. In contrast, the scores of
those children who had been victimized were higher
than average (Achenbach, 1991; Briere, 1996). Similarly, those children who reported witnessing severe
violence also had high anxiety and depression scores
relative to the general population and to those who
reported witnessing a minimal or moderate amount
of violence. Strangely, systematic linear increases in
the magnitude of negative mental health outcomes
were not apparent for additional models. This is
partly due to the fact that in some cases, even those
children who experienced the lowest degree of violence had above-average levels of negative mental
health outcomes.
LIMITATIONS
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