وابستگی به الکل و خشونت خانگی به عنوان عوارض بدرفتاری و اختلال سلوک در دوران کودکی
|کد مقاله||سال انتشار||تعداد صفحات مقاله انگلیسی||ترجمه فارسی|
|36067||1998||13 صفحه PDF||سفارش دهید|
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Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Child Abuse & Neglect, Volume 22, Issue 11, November 1998, Pages 1079–1091
Objectives: To examine in the Navajo population: (1) the importance of childhood abuse as a risk factor for conduct disorder; (2) the importance of each form of abuse and conduct disorder as risk factors for alcohol dependence; and (3) the relative importance of each form of abuse, conduct disorder, and alcohol dependence as risk factors for being a perpetrator and/or victim of domestic violence. Method: The study is based on a case-control design. Cases (204 men and 148 women) between the ages of 21 and 65 were interviewed in alcohol treatment program and matched to community controls. There were two groups of controls: alcohol dependent (374 men, 60 women) and nonalcohol dependent (157 men, 143 women). When adjusted for stratification by age, community of residence, and sex, the combined control groups comprise a representative sample of the Navajo male and female population 21–65 years of age. Results: The prevalence of physical and sexual abuse before age 15 is within limits observed in other populations. Each form of abuse is a risk factor for conduct disorder. Along with conduct disorder, physical abuse is a risk factor for alcohol dependence. Physical abuse and alcohol dependence are independent risk factors for being involved in domestic violence as both perpetrator and victim. There appears to have been no secular trend in the incidence of childhood abuse over the past several generations, but there is suggestive evidence that domestic violence has become more common. Conclusions: Physical abuse is a significant risk factor for alcohol dependence as well as for domestic violence independent of the effects of alcohol abuse. The effects of sexual abuse with regard to both domestic violence and alcohol dependence do not appear to be significant.
The causes, consequences, and secular trends of abuse of children have been of increasing interest in the past several decades. Much of that concern has manifested itself in American Indian communities as well. In this paper we use data from a study of alcohol use and abuse by Navajo Indians to examine one small piece of the problem: the degree to which abuse in childhood is a risk factor for alcohol dependence and domestic violence. The evidence from Native American communities, limited though it is, indicates that child abuse is not unknown (US Congress Office of Technology Assessment, 1990). For Navajo children, White and Cornely (1981) and Hauswald (1987) report a rate of 13.5 per 1,000. Drawing on a medical chart review and staff survey at the San Carlos (Apache) Indian Health Service Hospital, Fischler (1985) found a rate of 5.7 per 1,000. For Cheyenne River Sioux Reservation children, Wichlacz, Lane, and Kempe (1978) reported a rate of 26 per 1,000, derived from a register of suspected cases. In a study of an Alaskan village, one third (28 of 84) of the native children were considered to have severe problems of abuse, neglect, and homelessness related to poverty and demoralization in the village (Jones, 1969); and a study in an unidentified southwestern Indian community reported a history of childhood sexual abuse of 49% among women and 14% among men (Robin, Chester, Rasmussen, Jaranson, & Goldman, 1997). The reported age-specific incidence rate of abuse of children less than 18 years of age on the Navajo Reservation in 1992-95 varied between 3.3 and 4.3 per 1,000 (Northern Navajo Medical Center, 1996). Because these data come from the Navajo Criminal Justice System and represent reported cases, they are very likely much lower than the true incidence. Human service providers who work with Indian children and adolescents in the Albuquerque and Phoenix Indian Health Service (IHS) attributed abuse and neglect “to chaotic family situations and to other mental health problems such as alcoholism and depression” (Piasecki, Manson, Biernoff, Hiat, Taylor, & Bechtold, 1989; see also Lujan, DeBruyn, May, & Bird, 1989). Indeed, there are data to support the association of alcohol abuse by parents and other caretakers and the abuse of Indian children. Based on a case-control study in several Southwestern Indian communities DeBruyn, Lujan, and May (1992) claim that alcohol abuse is a necessary but not sufficient cause of abuse and neglect. They also observed that in addition to alcohol abuse, abuse of other substances by parents, “histories of divorce, death in the immediate family, single-parent households, alcohol abuse by grandparents, and deaths in the family associated with alcoholism” were all risk factors for abuse of children. And an early case-control study of neglected infants in one Navajo community indicated that neglected infants were especially likely to have mothers who were single, widowed, or divorced and who came from smaller families than did controls (Oakland & Kane, 1973). Although none of these is inconsistent with what is known from studies of nonIndian populations (e.g., Mullen, Martin, Anderson, Romans, & Herbison, 1996), virtually all studies in Indian communities have been of cases known to official agencies. Thus their reported severity as well as the significance of multi-problem families may be greater than would be found in community surveys. What is less clear than the risk factors for abuse are the long term sequelae. Studies in other populations indicate that there are a number of untoward consequences, including depression (Mullen, Martin, Anderson, Romans, & Herbison, 1996), a wide variety of other psychiatric as well as somatic complaints (McCauley et al., 1997), and violence (Widom, 1989). There is some disagreement about alcohol abuse, however. In a recent review of the literature and report of a retrospective cohort study of abused and nonabused children, Widom, Ireland, and Glynn (1995) have suggested that studies of clinical populations tend to show an association between the experience of childhood abuse and subsequent alcohol dependence, but that in community studies, including their own, no such association was observed. On the other hand, Mullen, Martin, Anderson, Romans, and Herbison (1996) found that sexual abuse, but not physical and emotional abuse, was a risk factor for heavy drinking among severely abused women. Holmes and Robins (1988) have found that severe parental discipline in childhood was a risk factor for subsequent alcohol abuse. McCauley and colleagues (1997) have shown that among women childhood physical and sexual abuse are risk factors for substance (including alcohol) misuse. The first two were community-based studies. The third was of women enrolled in practices of general internal medicine. And in a study of a southwestern Indian community, a history of childhood sexual abuse was found to be a risk factor for multiple psychiatric problems in adulthood, including alcohol dependence and abuse (Robin, Chester, Rasmussen, Jaranson, & Goldman, 1997). Finally, it is commonly agreed that there is a cycle of violence, that violence begets violence, and that people who were abused as children are more likely to become abusive as adults, but Straus (1995) has observed that, “For the most part, quantitative data demonstrating such an association are lacking.” His own study did not show an impressive association between the degree to which parents reported having experienced physical punishment as children and the degree to which the were violent towards their own children. According to these data, therefore, the link between having been abused as a child and being abusive as an adult has not been clearly demonstrated. Regarding being the recipient of violence, however, calculations from data published by McCauley and colleagues (1997) from women patients in general internal medicine practices indicate that of the 400 who had experienced some form of childhood abuse, 196 (49%) also experienced abuse in adulthood, whereas of 1,460 who did not experience childhood abuse, 203 (13.9%) experienced abuse in adulthood. This more than 3-fold difference suggests that abuse in childhood is a risk factor for being the victim of abuse in adulthood. The associations between abuse in childhood and being the giver or recipient of abuse in adulthood are complicated by the association between alcohol misuse and violence (Martin, 1993). Kantor and Straus (1995) found that 76% of cases of family violence did not involve the use of alcohol. They did find, however, that for people who drank a great deal or drank in binges, a much higher proportion of cases of family violence involved alcohol than among more moderate drinkers. Using a subset of data from Indian informants from the same national survey used by Kantor and Straus 1995 and Bachman 1992 found a similar relationship. Because there is evidence that abuse in childhood is associated with subsequent alcohol misuse, and because both abuse in childhood and alcohol misuse are thought to be associated with domestic violence, it is worth exploring further the associations among them. Moreover because many of the risk factors for conduct disorder are the same as those for childhood abuse, most notably unstable families, low socioeconomic status, and alcohol abuse by parents and other caretakers Offord et al 1986, McGaha and Leoni 1995, Salzinger et al 1991, Velleman 1992a and Velleman 1992b; and because the adult sequelae of childhood abuse and conduct disorder are also similar and in some studies include alcohol abuse and domestic violence, it is important to examine and if possible disentangle the associations between abuse and conduct disorder and their relative contributions to subsequent alcohol dependence and domestic violence. Elsewhere we have shown that conduct disorder before age 15 is a risk factor for alcohol dependence among Navajo Indian men and women (Kunitz et al., in press). In this paper we extend that analysis to consider: (1) the degree to which both physical and sexual abuse are risk factors for conduct disorder; and (2) the joint effects of abuse and conduct disorder before age 15 on subsequent alcohol dependence and domestic violence.