ارتباط بین بدرفتاری در دوران کودکی، سلامت روان نوجوانان و خود دلسوزی در نوجوانان رفاه کودکان

Abstract Objectives Childhood maltreatment is a robust risk factor for poor physical and mental health. Child welfare youths represent a high-risk group, given the greater likelihood of severe or multiple types of maltreatment. This study examined the relationship between childhood maltreatment and self-compassion – a concept of positive acceptance of self. While not applied previously to a child welfare sample, self-compassion may be of value in understanding impairment among maltreatment victims. This may be most pertinent in adolescence and young adulthood, when self-identity is a focal developmental process.

Introduction In child maltreatment, the child is wronged, for no reason, and left to deal with the aftermath of a harsh relationship encounter(s). Maltreatment, which tends to cluster with other adverse events (e.g., parental dysfunction, intimate partner violence, loss), is a robust risk factor for victim mental health and substance abuse problems across the lifespan (Gilbert et al., 2009 and McLaughlin et al., 2010). One study found that adverse childhood events accounted for 31–65% population attributable risk for mental health disorders (mood, anxiety, behavioral, substance abuse) in ages 4–12 years. In adolescence (13–19 years), it was between 24% and about 41%. Childhood adversity accounted for 17–41% of mental illness in young adulthood (Kessler et al., 2010). This suggests a higher mental health and substance use problem risk for maltreatment victims. While maltreatment levels are generally under-recognized, and there is overlap among subtypes (e.g., physical, sexual, and emotional abuse and neglect), emotional maltreatment is likely the most under-considered form in prevalence estimation and impact. Hart and Brassard (1987) argued that psychological or emotional maltreatment is the core threat to victim's mental health. Although definition of child emotional maltreatment varies by context, it reflects caregiver's failure to provide a developmentally appropriate and supportive environment, including such acts as denigration (emotional abuse) and lack of affection (emotional neglect) (e.g., Garbarino et al., 1986, Glaser, 2002, Hart et al., 2002, Trickett et al., 2009 and World Health Organization, 2006). Exposure to intimate partner violence is not routinely recognized as emotional maltreatment, although it can be considered an indicator (Gilbert et al., 2009). Emotional maltreatment is difficult to document by the child protective services (CPS), as it may not be identifiable as an event, or have clearly identifiable causal links to the victim's impaired functioning (Trocmé et al., 2005). Legal and medical definitions to guide CPS thresholds for intervention vary across states and regions (Hamarman, Pope, & Czaja, 2002). Although emotional maltreatment (not including exposure to domestic violence) represents a minority category among substantiated CPS cases, about one third to half of reported case had a sign of emotional harm (e.g., NaIS, 2011, Public Health Agency of Canada, 2010 and Trickett et al., 2009). Researchers have approached operationalizing emotional maltreatment in a variety of ways (e.g., Cicchetti et al., 2010, Egeland, 2009 and Hart and Brassard, 1987). For example, self-report measures, such as the Childhood Trauma Questionnaire (CTQ), a well-validated and common tool, taps both emotional abuse and emotional neglect, in addition to three other subtypes of child maltreatment (Bernstein et al., 2003). However, in the child welfare and clinical domains, the unique contribution of emotional maltreatment has been under-attended relative to other forms of maltreatment (for example, see special issue in this journal, Yates & Wekerle, 2009). Given that the phenomenology of maltreatment involves an attack on or disrespect of the child's personhood, the victim's self-identity processes seems germane to consider (Glaser, 2002 and Hart and Brassard, 1987). Maltreated adolescents may engage in self-harming (Jacobson and Gould, 2007 and Laye-Gindhu and Schonert-Reichl, 2005) or aggressive behaviors (Gordis, Feres, Olezeski, Rabkin, & Trickett, 2009) in an attempt to regulate (i.e., decrease or distract from) the experience of negative emotions, which may arise from maltreatment memories or environmental cues. Emotional maltreatment, in particular, has been linked to suicidal behaviors (Cicchetti et al., 2010) and relationship violence (e.g., Berzenski and Yates, 2010, Wekerle et al., 2009b and Zurbriggen et al., 2010). However, not all maltreated children and youth develop dysfunctional features of the self-system. To understand factors that differentiate youth who develop an overall healthy self-system from those who do not, aspects that may be protective need to be considered. Resilience is the process in which capacity of the individual to achieve positive and healthful outcomes despite the adversity (e.g., Cicchetti and Curtis, 2006, Ungar, 2007, Ungar, 2008 and Wekerle et al., in press). One candidate construct for resilience is self-compassion (Gilbert and Procter, 2006 and Neff and McGehee, 2010), as it may represent an affective-cognitive stance that is facilitative of an adaptive response to personal adversity. Self-compassion is an orientation towards seeing the world, and the self, realistically, but kindly, and in a contextualized manner supportive of greater well-being (Neff, 2003, Neff and McGehee, 2010 and Vettese et al., 2011). It reflects a warm, accepting (not over-personalized) approach that is based on kindness, humaneness (“common humanity”), and deliberate and reflective cognitive approach that emphasizes the present, here-and-now experience (“mindfulness”). Youths involved with child protective services (CPS) Maltreated youths receiving CPS services are likely to have primary caregivers as perpetrators, experience multiple forms of maltreatment, multiple caregivers and residential placements, as well as being faced with decreasing levels of child welfare support as they age out of care, complicating adolescent outcomes (e.g., Courtney et al., 2010). For example, frequent caregiver and school changes have been linked with higher trauma symptom and externalizing behavior scores (Raviv, Taussig, Culhane, & Garrido, 2010). Substance problems are noted in studies on maltreated adolescents (e.g., Shin, Edwards, Heeren, & Amodeo, 2009; for a review, see Tonmyr, Thornton, Draca, & Wekerle, 2010), adolescents in foster care (Vaughn, Ollie, McMillen, Scott, & Munson, 2007), and adolescents in CPS across various care categories (Wekerle, Leung, Goldstein, Thornton, & Tonmyr, 2009). The National Survey of Child and Adolescent Well-Being, a large-scale US study of children involved in the child welfare system, found that nearly 50% of school-age children exhibited clinical levels of mental health symptoms (Burns et al., 2004). Maltreatment links with mid-childhood suicidal thinking (Cicchetti et al., 2010) and adolescent suicidality (Enns et al., 2006 and Rhodes et al., 2011). One population study has placed the risk of suicide at four to six times higher with child welfare-involved youths, as compared to the general youth population (Vinnerljung, Sundell, Lofholm, & Humlesjo, 2006). CPS-involved adolescents seem an important sub-population to consider the impact of emotional maltreatment, self-development (including self-compassion), and mental health and substance use outcomes. The purpose of this study was to examine the applicability of the construct of self-compassion, as one element in resilient functioning, in CPS-involved adolescents. It is hypothesized that self-compassion would be inversely associated with maltreatment and, in particular, with emotional maltreatment. Self-compassion would be inversely related to health risk behaviors, such that maltreated youths with higher self-compassion scores would report fewer indices of maltreatment-related impairment (e.g., mood, anxiety, suicidality, and substance abuse; Gilbert et al., 2009). To our knowledge, this is the first study of a child welfare population to consider the utility of self-compassion and its association with mental health and substance use problems.

Conclusion This preliminary study encourages further study of self-compassion as it may apply to emotional abuse in particular, and maltreated youth and child welfare samples more generally. Given the early nature of the use of self-compassion, however, there needs to be further research on the psychometric properties of the measurement of this construct. Further investigation to test the validity of SCS in various adolescent populations would promote more studies, including child welfare youth and other samples where maltreatment backgrounds are noteworthy, such as those with corrections, addiction treatment, and self-harm presentations. Self-compassion may be an amenable target that would support the resilience of maltreated youths and may provide a useful complementary approach to current conceptual models informing child welfare practice. Work that supports maltreated youths to obtain greater measures of felt stability and self-compassion is encouraged.