اثرات متقابل وضعیت تأهل و سوء استفاده فیزیکی بر روی آسیب شناسی روانی نوجوانان
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|35054||2002||12 صفحه PDF||سفارش دهید||5408 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Child Abuse & Neglect, Volume 26, Issue 3, March 2002, Pages 277–288
Objective: The purpose of this study was to explore the interactional effects of parental marital disruption and physical abuse on risk for adolescent psychopathology in a nonclinical sample with a randomly selected control group. Method: The sample was drawn from 99 community-based adolescents indicated as physically abused by Child Protective Services and 99 randomly selected controls. Nonabused adolescents whose parents were married, abused adolescents whose parents were married, nonabused adolescents with a parental marital disruption, and abused adolescents with a parental marital disruption were compared. Outcome was psychopathology as measured by psychiatric diagnosis based on a best-estimate procedure subsequent to semistructured diagnostic interviewing. Results: Interactional effects of marital disruption and abuse were found for risk for lifetime Attention Deficit Hyperactivity Disorder (ADHD), with parental marital disruption and having been physically abused combining to increase the risk 15 times for diagnosis of lifetime ADHD. Parental marital status alone was not a significant risk factor for adolescent psychopathology, but physical abuse was a significant risk factor for several diagnostic categories. Conclusions: Future divorce research should include abuse history as a possible confounding variable. Possible reasons for the findings are reviewed and clinical implications are discussed.
The impact of divorce on children has become a focus of increasing attention by mental health clinicians and researchers. With more than one million children having experienced a family divorce each year in the US since the mid-1970s (Shiono & Quinn, 1994), this surge in focused study is clearly merited. Although there is variation in individual children’s reactions, marital conflict, separation, and divorce are undoubtedly stressful events in the life of a child and his or her family Behrman and Quinn 1994, Cummings and Davies 1994 and Kasen et al 1996. Each year in the US approximately 1.5 million cases of child abuse are reported. Physical abuse of children and adolescents is reported to occur at a rate of 5.7 cases per 1000 children (Lewis, 1994). Physical abuse of adolescents accounts for 43% of substantiated cases of physical abuse of females and 28% of those of males in the US (US Department of Health and Human Services, 1994). The negative impact of abuse on children and adolescents has been well documented, with child abuse having been designated a “national emergency” by the US Advisory Board on Child Abuse and Neglect (1990). One of the many variables that mediates the impact of divorce on children and adolescents is the level of interparental conflict and family discord that existed before and continues subsequent to the divorce Amato 1994, Behrman and Quinn 1994 and Johnston 1994. The type and intensity of these conflicts have become a research focus (Cummings & Davies, 1994). Johnston (1994) concluded, that as a group, children in families where there have been high conflict divorces, and particularly boys, are significantly more likely to have more emotional and behavioral disturbance than on national norms. These conclusions are based on studies of families with histories of high levels of interparental conflict after the divorce, as defined by verbal and physical aggression, overt hostility, and distrust between the parents (Johnston, 1994). Cummings and Davies (1994) provided a comprehensive analysis of the effects of marital conflict on children. They emphasized the need to “link exposure to specific types of conflicts with specific responses in children and, in turn, relate specific response processes with clinically significant child outcomes” (p. 81). Review of the literature indicates, that although still in its initial stages, the inquiry into the effects of high level marital conflict and high conflict divorce on children has been limited to a focus on the conflict between the parents. Children have been viewed as witnesses to this conflict, and the subsequent impact on them has been described in the literature on marital conflict (Cummings & Davies, 1994), high conflict divorce (Johnston, 1994), and child witness to domestic violence (Pelcovitz & Kaplan, 1994). Harold and Conger’s (1997) recent work included a finding that marital conflict produces increased hostility toward an adolescent child. However, there have not been studies on children or adolescents as the direct victim of physical abuse in the context of high levels of interparental conflict. This is an important issue in light of the fact that research on domestic violence and its impact on children indicates that children in homes with interparental violence are significantly more likely to be victims of abuse themselves (Henning, Leitenberg, Coffey, Turner, & Bennett, 1996). Straus, Gelles, and Steinmetz (1980) found that in families where there was spouse abuse, there was a 129% greater chance of child abuse. Various forms of family violence often coexist (McCloskey, Figueredo, & Koss, 1995). Clinicians can provide anecdotal data to support the idea that child abuse is relatively common in “high conflict divorce” families. The authors have noted that families presenting for admission for clinical services to subspecialty programs for separation and/or divorce or child abuse and/or neglect could be served often by either program. Mental health clinicians, particularly those who work with children and adolescents, are increasingly confronted with the interactional effects of divorce and abuse. Moreover, the risk of child psychopathology is greater for children who have experienced two or more stressful life conditions (Rutter, 1979). However, there has been extremely limited mention of this interactional issue in the professional literature, and there is a paucity of research available to guide clinical interventions. Klosinski (1993) described parental separation and divorce as a potential source of increased risk for psychological child maltreatment. Peretti (1988) studied physically abusive divorced and nondivorced mothers and concluded, “Divorce is one of the most devastating emotional experiences a person may encounter, and the resulting negative emotional and psychological consequences might have far reaching effects on child-abusing behaviors” (p. 51). Bolton and MacEachron (1986) discussed a model for understanding the risk for child maltreatment in the recently divorced parent-child relationship. In addition to separation and/or divorce potentially putting children at increased risk for subsequent abuse, victimization before parental separation is an essential variable to consider when looking at children’s adjustment to divorce. Parenting behaviors, rather than marital status per se, has been shown to predict children’s adjustment to divorce Ellwood and Stolberg 1991 and Ellwood and Stolberg 1993. The relationship between physical abuse of adolescents and psychopathology has been documented recently (Kaplan et al., 1998). Clearly, child abuse merits attention as one possible manifestation of or sequelae to interparental high conflict that may mediate the impact of divorce on children. The current study adds to the existing literature on the impact of divorce on children in three important ways. First, it adds to the available cross-sectional research by using diagnoses of child and adolescent psychopathology as outcome measures with diagnoses based on results of structured diagnostic interviews. Most studies on the impact of divorce on children use broad outcome measures, including academic achievement or behavioral difficulties as measured by parent and/or teacher reports. The impact of divorce on children’s mental health has been inferred from these global measures of children’s adjustment. Children’s psychopathology as defined by psychiatric diagnoses, has rarely been used as an outcome measure. An exception is a study conducted by Ellwood and Stolberg (1993) in which structured interviews using the Child Assessment Schedule (Hodges, 1985) were used to diagnose children’s psychopathology as one of several outcome measures of adjustment to divorce. Recently, a large-scale longitudinal study by Kasen et al. (1996) included psychiatric diagnoses based on structured interviews as a postdivorce measure. The need to use psychiatric diagnoses as an outcome measure is indicated by the finding that children from divorced families are more likely to utilize outpatient mental health services than children from intact families Emery 1988 and Zill 1978. Second, for this study, we directed our attention to a sample of randomly selected adolescents in the community and compared them with regard to psychopathology and parental marital status to a sample of physically abused adolescents from consecutive county referrals to the New York State Central Register for child abuse cases that were indicated for physical abuse. By using community-based samples, many biases associated with clinically referred samples that are often used in this type of research have been avoided. Third, our study examines the incremental risk for psychopathology in children as a factor of having been physically abused and of having experienced parental divorce. The current study was designed to explore the following hypotheses: (1) parental marital disruption is a risk factor for adolescent psychopathology as measured by psychiatric diagnoses using structured interviews; (2) in families with marital disruption, physical abuse victimization contributes significantly to risk for adolescent psychopathology; and (3) in families with marital disruption and physical abuse of an adolescent, the severity of abuse will be greater than in intact abusive families.