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Child Abuse and Women’s Mental
Health:
Moderating Processes
Dr. Adeline Lee
DPscyh(Clin)
Presentation outline
 Background
 Research Questions & Aims
 Project 1-Women Survivors
 Design & Participants
 Measures
 Statistical Analyses
 Results
 Implications/Summary
 Limitations
 Conclusion
Background
 Women exposed to childhood maltreatment have a
higher risk of developing Mental Illnesses.
 PTSD, Depression and Anxiety
 Hospital admissions (suicide & self-injury)
 Adverse childhood ecology:
 Attachment with parents/caregiver
 Physiological vulnerabilities
 Current lack of standard definition
Background cont’
 This Study’s Definition
 Child sexual abuse (CSA): adult involving child in any
sexual activity
 Physical child abuse (PCA): adult physically injures a child
intentionally
 Emotional child abuse (ECA): no adequate affection and
attention
 Child neglect (CNeg): unmet basic needs
 Witnessing family violence (WFV) : witnessing or being
aware of violence
 Multi-form abuse
Background cont’
 CSA, PCA & ECA independently associated
with  mental illnesses
 Multi-form abuse
 CSA, PCA and ECA: 23 fold increase risk of
PTSD1
  inpatient admission
  risk of BPD and adult self harm
1Schneider,
R., Baumrind, N., & Kimerling, R. (2007). Exposure to child abuse and risk for mental health problems in
women. Violence & Victims, 22(5), 620-631.
Background cont’
 However it is unclear whether:
 Different forms of maltreatment is related to
specific psychiatric illnesses in adulthood
 The moderating interaction between different
types of abuse when exploring women’s
mental health
 Lack of studies on ECA, CNeg and WFV
Research Qs & Aims
RQ: What is the relationship b/t forms of
child abuse and severity in symptoms of
depression, anxiety and PTSD?
 extent to which all five types of child abuse (PCA,
ECA, CSA, CNeg and WFV) simultaneously predict
depression, anxiety and post-traumatic stress
symptoms
RQ: What are the moderating interactions
between the five different abuse types on
the depression, anxiety and PTSD?
Design & Participants
 Cross sectional survey of 108 women who have
experienced any form of childhood abuse
 Exclusion criteria: Non-English speakers & women
deemed too unwell to participate by clinicians
 Recruitment
 - By referral from GP and other health practitioners
 - By advertisement/flyers in hospitals, medical
community health centres and universities
 - By open advertisement in general media
Measures
 Childhood Maltreatment History
 Comprehensive Childhood Maltreatment
Scale – Adult version (CCMS-A)
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


Child sexual abuse (CSA)
Physical child abuse (PCA)
Emotional childhood abuse (ECA)
Childhood neglect (CNeg)
Witnessing family violence (WFV)
Measures cont’
 Symptom severity of mental illnesses
 Beck Depression inventory 2nd Ed (BDI-II)
 Beck Anxiety Inventory (BAI)
 Post traumatic Stress Checklist- civilian version
(PCL-C)
 Formal mental illness diagnoses
 MINI International Neuropsychiatric Interview (MINI)
 Help seeking behavior and experience
 What helped
Statistical Analyses
 Descriptive analyses such as percentages and
means
 Hierarchical multiple linear regression analyses
predict severity of depression, anxiety and
PTSD and to assess for additional contributions
of moderator-interactions among abuse types
 To understand the moderating relationship
between abuse types on mental health, plots
and post-hoc probing of significant interactions
between abuse types was conducted
5/24/2017
Monash Alfred Psychriatry Reseacrh
Centre
Results
 Results from 108 women survivors
 Mean age = 40.7 years (range 20-59 years)
 The majority of women:
 single/never married (42.1%)
 live alone / with unrelated other (35.5%)
 completed university degree (43.9%)
 part-time employed (28%)
 household yearly income over $12001
(86.8%)
Results CCMS-A
Frequency (%) of women endorsing abuse type
and CCMS-A mean (SD) N=107
Child Abuse Type
Frequency (%)*
105 (98.1)
Mean CCMS-A Score (SD)
13.81 (7.3)
Physical Child Abuse
98 (91.6)
5.66 (5.7)
Witnessing Family
Violence
101 (94.4)
4.60 (2.4)
Child Neglect
83 (77.6)
5.1 (5.3)
Child Sexual Abuse
67 (62.6)
10.92 (14.5)
Emotional Child Abuse
Total Score
40.01 (20.71)
*Participants reporting their caregivers at least ‘occasionally’ engaged in the
behaviours within the CA subscales are classified as having experienced the
corresponding CA types
Results BAI, BDI-II & PCL-C
BAI Severity Category
BDI-II Severity Category
Severe
16, 15% Minimal
31, 29%
Moderate
32, 29%
Severe
25, 23%
Minimal
40, 38%
Moderate
25, 23%
Mild, 17
16%
Mild
28, 26%
Total Mean Score 15.0
SD=9.9
PCL-C Severity Category
No
PTSD
54,
50%
Probab
le
PTSD
53,
50%
Total Mean Score 43.0
SD=16
Total Mean Score 15.0
SD=9.9
Results
BDI-II HMR (Interactions)
Adj. R2
Step 1 CCMS-A Scales
.13**

R2 Change
.18**
WFV
-.21*
CNeg
.30**
CSA
.24*
Step 2 CCMS-A Scales
.20
.14
WFV
-.28**
CNeg
.37**
CSA
.25**
PCAxWFV
-.51**
ECAxWFV
.31*
Results
BDI-II Significant Interactions Plots
35
30
25
20
WFV=+1SD
15
30
10
25
5
0
PCA=-1SD PCA=+1SD
BDI
BDI
WFV=-1SD
20
WFV=-1SD
15
WFV=+1SD
10
5
0
ECA=-1SD ECA=+1SD
Results
BAI HMR (Interactions)
Adj. R2
Step 1 CCMS-A Scales
.06*

R2 Change
.11*
WFV
-.24*
CNeg
.22*
Step 2 CCMS-A Scales
WFV
.05
.08
-.27*
Results
PCL-C HMR (Interactions)
Adj. R2
Step 1 CCMS-A Scales
.12*
R2 Change
.13*
CNeg
Step 2 CCMS-A Scales

.28**
.15
.11
WFV
-.24*
CNeg
.34**
PCAxWFV
-.50**
ECAxWFV
.33*
Socio demographic Age was significantly correlated to PCL-C, therefore was entered
in step of the PCL-C model. Age was only significant in the first step.
Results
PLC-C Significant Interactions Plots
70
60
50
WFV=+1SD
30
20
60
10
50
0
PCA=-1SD
PCA=+1SD
40
PCL-C
PCL-C
WFV=-1SD
40
WFV=-1SD
30
WFV=+1SD
20
10
0
ECA=-1SD
ECA=+1SD
Implications / Summary
 High prevalence of depression, anxiety and
post-traumatic stress in women survivors of
child abuse
 Presence of multiple/co-occurring abuse
types
 Impact of child neglect on depression and
trauma after controlling for other child abuse
types
Implications / Summary
 Interaction between child abuse types WFV
and PCA
 Higher levels of physical child abuse were found to be
associated with higher levels of depression and posttraumatic stress only when family violence was
witnessed infrequently.
 Normalization of violence
 Lowers internalization
 Victims supporting each other
Implications / Summary
 Interaction between child abuse types WFV
and ECA
 When family violence was frequently witnessed,
higher levels of ECA were associated with higher
levels of post-traumatic stress
 Dose response theory
 PCA and ECA are likely to co-occur with WFV
 Experience of physical abuse and emotional
abuse are different or may have different
mechanisms
Implications / Summary
 Clinical complexity as depression, anxiety and
PTSD are highly comorbid disorders for child
abuse survivors and have diagnostic symptoms
in common
 Victims may not report their abuse experiences
when presenting for assistance
 Consider comprehensive trauma assessment to
more effectively identify, support and engage
with survivors
Limitations
 Cross-sectional not causal
 Despite fulfilling power calculations will benefit
from larger sample size to further explore
interactions
 Retrospective assessment
 Generalizability as only focused on child abuse
survivors
Conclusion
 Complex relationship found between child abuse
and depression, anxiety and PTSD
 Future research to consider all forms of child
abuse and account for interactions when
assessing mental health outcomes
 Utilizing standardized assessment
 behavioral questions
 collects frequency and severity of abuse
 differentiates types of perpetrators
 Longitudinal studies
References
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Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation and
treatment. California: Sage Publication.
Carlin, A. S., Kemper, K., Ward, N. G., Sowell, H., & et al. (1994). The Effect of Differences in
Objective and Subjective Definitions of Childhood Physical Abuse on Estimates of Its Incidence
and Relationship to Psychopathology. Child Abuse & Neglect, 18(5), 393-399.
Foa, E. B. (2000). Psychosocial treatment of posttraumatic stress disorder. Journal of Clinical
Psychiatry, 61(Suppl 5), 43-48.
Higgins, D., McCabe, M., & Ricciardelli, L. (2003). Child maltreatment, family characteristics and
adult adjustment mediating and moderating processes. Journal of Aggression, Maltreatment &
Trauma, 6(2), 61-86.
Green, J., McLaughlin, K., Berglund, P., BGruber, M., Sampson, N., Zaslavsky, A., & Kessler, R.
(2010). Childhood adversities and adult psychiatric disorder in the national comorbidity survey
replication i associations with first onset of dsm-iv disorders. Archives of General Psychiatry,
67(2), 113-123.
McLaughlin, K. A., Green, J. G. P., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R.
C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity
survey replication ii: Associations with persistence of dsm-iv disorders. Archives of General
Psychiatry February, 67(2), 124-132.
Miller, S., Wolff, M., & Scott, S. T. (2000). Eating Disorders, Child Maltreatment, and PostTraumatic Stress in Women. Family Violence & Sexual Assault Bulletin, 16(4), 17-22.
Schneider, R., Baumrind, N., & Kimerling, R. (2007). Exposure to child abuse and risk for mental
health problems in women. Violence & Victims, 22(5), 620-631.
Wilkinson, P., & Goodyear, I. (2011). Childhood adversity and allostatic overload of the
hypothalamic–pituitary–adrenal axis: A vulnerability model for depressive disorders.
Development and psychopathology, 23(4), 1017-1037.
Acknowledgments
This research was supported by the
Australian Postgraduate Award and Mental
Health Postgraduate Scholarship Scheme,
both from the Australian Government
awarded to Dr. Adeline Lee
Thank You
Questions…
Author contact email:
[email protected]