مواجهه نوجوان با خشونت و مشکلات بهداشت جسمی و روانی بزرگسالان

Evidence on the relationship of adolescent exposure to violence (AEV) with adult physical and mental health problems is limited, with studies often focusing on earlier childhood rather than adolescence, and also on short term rather than long term outcomes. Information specifically on the relationship of AEV to seeking help for mental health problems in adulthood from either formal sources such as mental health professionals or informal sources such as friends and clergy is even more difficult to find. The present study investigates how adolescent exposure to violence (AEV), in the form of parental physical abuse, witnessing parental violence, and exposure to violence in the neighborhood, are related to self-reported adult physical problems and seeking formal or informal assistance with mental health, controlling for more general adolescent violent victimization and for self-reports and parent reports of mental health problems in adolescence. This study adds to the literature on AEV and adult physical problems, and provides a rare look at the relationship of AEV to adult help-seeking for mental health problems. The results suggest that AEV is associated with mental health problems in adolescence for both females and males, that for females AEV is related to physical problems and to seeking help for mental health problems in adulthood, but for males the only significant relationship involves inconsistent reports of witnessing parental violence and adult physical problems.

There is an extensive literature on the relationship of childhood and adolescent exposure to violence on subsequent mental health problems (see for example the reviews by Acosta et al., 2001, Buka et al., 2001, Gewirtz and Edleson, 2007, Kendall-Tackett, 2013, Lynch, 2003, Ruback and Thompson, 2001 and Widom, 2014), and a much more limited literature on the relationship of childhood and adolescent exposure to violence on subsequent physical health problems (see for example the reviews in Kendall-Tackett, 2013, Ruback and Thompson, 2001 and Widom, 2014; and see also Bonomi et al., 2008, Springer, 2009 and Springer et al., 2007). Several limitations, however, affect nearly all of this research. First, this research often relies on samples that are small in size and/or limited to clinical samples of individuals who have experienced certain types of exposure to violence, or to predominantly urban, minority ethnicity, lower socioeconomic status samples, without comparison samples (Gewirtz and Edleson, 2007, Heyman and Slep, 2002, Lynch, 2003 and Margolin and Gordis, 2000). In particular, studies involving national probability samples representative of the general population are rare (Rebellon & Van Gundy, 2005); an important exception is the National Study of Children's Exposure to Violence (NATSCEV; see Finkelhor et al., 2009a and Finkelhor et al., 2009b). Second, studies of adolescents, as opposed to younger children, are particularly rare, and many studies make no distinction between adolescent and earlier childhood exposure to violence (Menard, Weiss, Franzese, & Covey, 2014; for exceptions to this general pattern, see Ireland et al., 2002 and Thornberry et al., 2001). Kitzmann, Gaylord, Holt, and Kenny (2003) conducted a meta-analysis of 118 studies on child exposure to domestic violence and found that only 10 utilized adolescent samples. Third, some studies have failed to distinguish between directly experiencing violence (as a perpetrator or a victim) from broader exposure to violence such as witnessing violence in the family or awareness of violence in the neighborhood (Acosta et al., 2001 and Gewirtz and Edleson, 2007). Fourth, several reviews of the literature have indicated the rarity of and the need for longitudinal studies (e.g., see also Gewirtz and Edleson, 2007 and Widom, 2014). Kitzmann et al. (2003) found that only 6% (7 studies) of the 118 studies they reviewed utilized longitudinal data sets. Even in existing longitudinal studies, individuals are often followed only into adolescence (e.g., Ehrensaft et al., 2003) or young adulthood (e.g., Yates, Dodds, Sroufe, & Egeland, 2003), neglecting longer term consequences of adolescent and childhood exposure to violence (Gewirtz and Edleson, 2007, Margolin and Gordis, 2000 and Margolin and Gordis, 2004). The present study examines the relationship of adolescent exposure to violence (hereafter AEV) to three adult outcomes: professional mental health service utilization, more general seeking assistance with mental health problems (which may include informal as well as professional sources of mental health assistance), and physical health, more specifically functional limitation. AEV is used here, as in Covey, Menard, and Franzese (2013), Eitle and Turner (2002), Finkelhor, Turner, Ormrod, and Hamby (2009), Finkelhor, Turner, Ormrod, Hamby, and Kracke (2009), and Menard et al. (2014), as a general term encompassing direct physical abuse, witnessing parental violence, and perceptions of neighborhood violence, as different and specific forms of the broader concept of exposure to violence. (An even broader term used in the literature is “maltreatment” which encompasses not only physical abuse or exposure to violence, but also neglect). Weaknesses in past research are addressed, first by examining a national probability sample (as opposed to a local or clinical sample) of over 1,000 total respondents. Second, we distinguish among direct victimization (physical abuse) and more general exposure to violence (witnessing parental violence and neighborhood violence). Third, we measure exposure to violence in adolescence and mental and physical health outcomes in middle adulthood, adding to our knowledge of both of these otherwise underrepresented age ranges. Fourth, we not only examine bivariate correlations but also include the different measures of AEV in the same analyses and consider their separate relationships to adult mental and physical health problems. Fifth, we control for prior violent victimization other than physical abuse, to allow for the possibility that violent victimization in general may be a risk factor for subsequent mental and physical health problems. We control as well for other potential confounding influences, including gender (by analyzing the data separately for females and males), ethnicity, urban–suburban–rural residence, and socioeconomic status. Separate analysis for females is necessary because past research suggests that they respond differently, with males more likely than females to engage in externalizing behaviors such as aggression and females more likely than males to engage in internalizing behaviors such as depression in response to exposure to violence (Gewirtz and Edleson, 2007, Herrenkohl et al., 2008 and Widom, 1989).