The influence of childhood sexual abuse, physical abuse, family environment, and gender on the psychological adjustment of adolescents

Abstract

Objective: The primary aim of the current study was to examine the contributions of sexual abuse, physical abuse, family cohesion, and conflict in predicting the psychological functioning of adolescents. Additional analyses were conducted to determine whether adolescent victims of child sexual abuse and physical abuse perceive their family environments as more conflictual and less cohesive than nonabused adolescents.

Method: Participants were 131 male and female adolescents, ages 16 years to 18 years, receiving services at a residential vocational training program. Participants completed well established psychological assessment tools to assess abuse history, family environment characteristics, and current adjustment.

Results: Physically abused adolescent females perceived their family environments as more conflictual and less cohesive than females without physical abuse, and sexually abused females perceived their family environments as more conflictual and less cohesive than females without sexual abuse. Physically abused adolescent males reported more conflict than males without physical abuse, but did not differ with regard to cohesion. Adolescent males with and without a sexual abuse history did not differ on the family dimensions. Multiple regression analyses revealed that both conflict and cohesion, in addition to a history of sexual and physical abuse, predicted depression and distress. Separate analyses by gender revealed these variables differentially impact adjustment in male and female adolescents. Results of a power analysis indicated sufficient power to detect these differences.

Conclusions: Findings indicate that in addition to child sexual abuse and physical abuse, family conflict and cohesion are risk factors for the development of psychological distress and depression in adolescence. Implications for treatment and directions for future research are discussed.

Résumé

Objectif: Le but principal de cette étude fut d’examiner comment les agressions sexuelles, les mauvais traitements physiques, la cohésion familiale et les conflits prédisent le fonctionnement psychologique des adolescents. D’autres analyses ont été faites pour déterminer si l’adolescent victime d’agressions sexuelles et physiques perçoit son milieu familial comme étant rempli de conflit et moins cohésif, comparé à la perception qu’ont les adolescents non victimes.

Méthode: Cent trente-et-un adolescents et adolescentes âgés de 16 à 18 ans inscrits dans un programme résidentiel de formation les préparant à un métier ont participé à l’étude. Leur anamnèse, les caractéristiques de leur milieu familial et leur adaptation courante ont fait l’objet d’une évaluation au moyen de tests psychologiques fiables.

Résultats: Les adolescentes victimes de mauvais traitements physiques considàrent davantage que leur milieu familial est rempli de conflits et moins cohésif comparé aux adolescentes non victimes. De même pour les adolescentes victimes d’agressions sexuelles. Les adolescents victimes de mauvais traitements physiques rapportent un plus grand nombre de conflits familiaux que les adolescents non victimes, cependant, au niveau de la cohésion familiale, on note aucune différence entre les deux groupes, ni aucune différence au niveau des divers aspects du milieu familial. Des analyses de régression multiple indiquent que le conflit et la cohésion, en plus des abus physiques et sexuels, prédisent la dépression et la détresse. Des analyses différenciées selon le sexe indiquent que ces variables ont des conséquences différentes sur l’adaptation des garçons et des filles. Une analyse de la compétence des tests rassure qu’ils ont été capables de capter ces différences.

Conclusions: Les constats indiquent que non seulement les mauvais traitements physiques et sexuels sont des facteurs de risque par rapport à la détresse psychologique et la dépression chez les adolescents des deux sexes, mais aussi les conflits familiaux et la cohésion.

Resumen

Objetivo: El principal objetivo del presente estudio fue examinar las contribuciones del abuso sexual, abuso fı́sico, cohesión familiar, y conflicto para predecir el funcionamiento psicológico en adolescentes. Se realizaron análisis adicionales para determinar si las vı́ctimas adolescentes de abuso sexual en la niñez y abuso fı́sico percibı́an sus ambientes familiares como más conflictivos y con menos cohesión que los adolescentes no abusados.

Método: Los participantes fueron 131 varones y hembras adolescentes, edades 16–18 años, que eran atendidos en un programa de entrenamiento residencial vocacional. Los participantes completaron instrumentos de evaluación psicológica reconocidos para evaluar la historia de abuso, las caracterı́sticas del ambiente familiar y su ajuste actual.

Resultados: Las adolescentes fı́sicamente abusadas hembras percibı́an sus ambientes familiares como más conflictivos y con menos cohesión que las hembras sin abuso fı́sico, y las hembras sexualmente abusadas percibı́an sus ambientes familiares como más conflictivos y con menos cohesión que las hembras sin abuso sexual. Los varones adolescentes fı́sicamente abusados reportaron más conflicto que los varones sin abuso fı́sico, pero no diferı́an en relación a la cohesión. Los adolescentes varones con y sin una historia de abuso sexual no diferı́an sobre las dimensiones familiares. Los análisis de regresión múltiple revelaron que tanto el conflicto y la cohesión, además de la historia de abuso sexual y fı́sico predecı́an depresión y tensión. Análisis separados por género revelaron que estas variables influı́an diferencialmente el ajuste en los adolescentes varones y hembras. Los resultados de un análisis de poder indicaron suficiente poder para detectar estas diferencias.

Conclusiones: Los resultados indicaron que además del abuso sexual en la niñez y el abuso fı́sico, el conflicto familiar y la cohesión son factores de riesgo para el desarrollo de tensión psicológica y depresión en la adolescencia. Se discuten las implicaciones para el tratamiento y las direcciones para investigaciones futuras.

Introduction

With nearly three million cases of child abuse and neglect reported in the US each year, child maltreatment has emerged as an urgent national problem (American Humane Association, 1994). Results of investigations conducted in recent decades point to a number of immediate and long-term problems associated with child abuse (e.g., Briere and Runtz 1988, Browne and Finkelhor 1986, Polusny and Follette 1995). To date, however, relatively few studies have examined the effects of child sexual and/or physical abuse within the adolescent population. The unique emotional, social, and physical development occurring during this period suggest that child abuse may differentially affect the psychological functioning of this age cohort as compared to others Hussey and Singer 1993, Williamson et al 1991.

Existing research documenting abuse-related sequelae within the adolescent population has focused primarily on child sexual abuse. Findings have generally demonstrated that adolescents with a sexual abuse history exhibit a wide range of emotional and behavioral problems (Briere & Runtz, 1988). Most notably, investigators have consistently found that adolescent survivors of child sexual abuse report greater depression and general psychological distress, more conduct problems and aggression, lower self-esteem, and more substance abuse problems Brown et al 1999, Fergusson et al 1996, Garnefski and Arends 1998, Garnefski and Diekstra 1997, Harrison et al 1989, Kendall-Tackett et al 1993, Luster and Small 1997. While the results of such investigations are largely consistent, the heavy reliance on inpatient and treatment samples within this literature limits the generalizability of findings (e.g., Cohen et al 1996, Harrison et al 1989, Hart et al 1989).

In comparison to child sexual abuse, fewer studies have examined the effects of childhood physical abuse on adolescent functioning. Those studies available have indicated that adolescents physically abused in childhood show greater overall adjustment difficulties, poorer social competence, decreased language ability, and poorer overall school performance than nonabused adolescents (Flisher, Kramer, Hoven, & Greenwald, 1997). Physically abused adolescents are also more likely to have a variety of psychiatric conditions, including major depression, conduct disorder, and generalized anxiety disorder as compared to nonphysically abused individuals Briere and Runtz 1988, Flisher et al 1997, Kaplan and Pelcovitz 1982, Kolko et al 1988, Malinosky-Rummell and Hansen 1993.

It is apparent that survivors of physical and sexual abuse often display a wide range of psychological and behavioral problems. Despite these findings, no one type of abuse is associated with a specific pattern of symptomatology. Some studies from the adult literature indicate that sexual and physical abuse result in similar psychological outcomes Margo and McLees 1991, Mullen et al 1996, Wind and Silvern 1992. Other work, however, highlights the differences in symptom expression on the basis of exposure to sexual or physical abuse Cohen et al 1996, Hart et al 1989, Luster and Small 1997. Given the conflicting findings, it is unclear what the unique contribution of physical and sexual abuse may be in predicting later adjustment. A complete understanding of the relationship between abuse and psychopathology may not be adequately achieved until types of abuse are considered together.

To further clarify the relationship between the occurrence of abuse and subsequent psychological symptomatology, researchers have expanded their analyses to include contextual variables that may influence psychological functioning. Specifically, numerous investigators have examined the influence of family environment on the development of psychopathology (for review see Draucker 1996, Hulsey et al 1992). While investigators have only recently begun to unravel the specific relationships between childhood family environment, sexual abuse, and psychological functioning (Hulsey et al., 1992), results of this line of inquiry have consistently shown that survivors of sexual abuse often perceive their family as having high levels of conflict and low levels of cohesion Benedict and Zautra 1993, Jackson et al 1990, Ray et al 1991. Moreover, it has been demonstrated that these dimensions of family environment are robust predictors of psychological functioning among individuals with a sexual abuse history. Specifically, it has been shown that family conflict is uniquely predictive of psychosocial adjustment (Edwards & Alexander, 1992), anxiety (Yama, Tovey, & Fogas, 1993), and depression (Yama, Tovey, & Fogas, 1993). In addition, family cohesion is predictive of social isolation (Harter, Alexander, & Neimeyer, 1988), depression, self-esteem, social adjustment (Ray & Jackson, 1997), and general psychological adjustment (Fromuth, 1986) independent of a sexual abuse history. These relationships, however, are predominantly based on investigations that have utilized child and adult samples of women.

Only a few studies have examined the relationship between family functioning and adjustment with adolescent populations. Feiring, Taska, and Lewis (1998) investigated psychological distress at the time of abuse discovery in a sample of 87 children and 67 adolescents, and indicated that low levels of parental support were significantly related to elevated psychological distress. Likewise, maternal support was significantly related to depression in a sample of 50 treatment-seeking adolescent female sexual abuse survivors (Morrison & Clavenna-Valleroy, 1998) and to binge drinking among a large community sample of male and female adolescents with a sexual abuse history (Luster & Small, 1997). In contrast to these findings, Hussy and Singer (1993) revealed that depression and self-esteem, and perceived family cohesion and adaptability, did not differ as a function of sexual abuse status in psychiatrically hospitalized adolescents. It is likely, however, that these null findings may be an artifact of the nature of the inpatient sample. Finally, one longitudinal investigation has shown that child sexual abuse and family environment increase the likelihood that an adolescent will experience depression as well as other psychiatric disorders (Fergusson et al., 1996). Notably, family environment was operationalized as a composite score of family stability, parent-child relationships, and parental adjustment in this investigation. In light of the evidence linking family environment to families in which sexual abuse has occurred, it seems likely that this relationship may extend to other forms of maltreatment, specifically physical abuse. However, investigations of the relationship between physical abuse in childhood and family environment have not yet been conducted.

Examinations of the effects of abuse has also included gender as a factor that may influence outcome. Gender differences in symptom expression on the basis of exposure to sexual and physical abuse were revealed in an investigation conducted by Chandy, Blum, and Resnick (1996). Results indicated that male adolescent victims of sexual abuse experienced more difficulties in school, marijuana use, delinquent behavior, and sexual risk taking behavior as compared to female victims who reported higher levels of disordered eating, suicidal ideation and behavior, and a greater frequency of alcohol consumption. Conversely, Garnefski and Arends (1998) revealed that sexual abuse was equally related to emotional and behavioral problems and suicidal ideation in adolescent males and females, but that aggressive and delinquent behavior was more prevalent in males. These conflicting findings hinder our understanding of possible gender-related effects on the sequelae of sexual abuse. It is likewise possible that the findings of existing research-based samples on both male and female participants may be confounded by the influence of gender.

Thus far, studies examining the impact of child abuse on the psychological adjustment of adolescents are limited. Despite what appears to be an abundance of literature indicating a relationship between family characteristics, the occurrence of childhood sexual abuse, and subsequent adjustment, few studies have demonstrated this relationship in the adolescent population. Notably, no investigators have explored the relationship between a history of physical abuse and specific family environment characteristics. As such, no studies have yet concurrently examined the effects the different types of abuse, as well as family functioning, on adolescent adjustment, nor considered these factors in conjunction with gender issues. As indicated by the literature review, it appears as though psychological functioning in adolescents may be best accounted for by models that include both contextual variables and multiple types of abuse.

The purpose of the current study was to examine the influence of family environment, gender, and childhood victimization (sexual and physical) on the psychological adjustment of adolescents. The hypotheses of this study were based on the premise that specific family environment characteristics, often related to childhood sexual abuse and physical abuse, would play a role in the development of psychological problems. Specifically, it was hypothesized that family environments characterized by low cohesion and high conflict would add significant unique variance in predicting adolescent depression and distress, in addition to the variance accounted for by child sexual abuse and physical abuse. Given previous findings in the literature regarding gender differences in depression and distress, exploratory hierarchical regressions were also planned to consider these relationships separately for males and females. In addition, preliminary analyses were conducted to examine the family functioning of sexually and physically abused adolescents. It was hypothesized that adolescents who experienced childhood abuse, defined as either sexual abuse or physical abuse, would report having family environments characterized by high conflict and low cohesion relative to nonabused adolescents. Gender differences in these relationships were also examined.