Childhood abuse, whether physical or sexual, is a major public health issue. The most recent United States data from Child Protective Services (CPS) show that in 2013 there were 3.5 million referrals of child maltreatment involving 6.4 million children. Out of these cases, 18% were for physical abuse and 9% were for sexual abuse. However, researchers argue that CPS data grossly underestimate the prevalence of childhood abuse as most childhood abuse goes unreported. Indeed, to date, the true prevalence of childhood abuse remains unknown as research has been hampered by inconsistent definitions of abuse and wide variation in methodologies including measures for its identification and modes of administration of these measures. Although a health care visit presents an opportunity to identify a childhood abuse history, health care providers frequently fail to ask about it. The reasons doctors give for not asking about abuse include lack of training, not knowing how to ask, and lack of familiarity with practical methods for screening that can be used in primary care settings. There is little to no research on effective means for identifying childhood abuse histories, especially in the adolescent and young adult population, or on how different modes of administration of screens to identify childhood abuse compare to each other. The net result is that most childhood physical and sexual abuse is never identified and many victims do not get the needed services to help them heal. When unaddressed, childhood abuse has negative impacts on victims’ health and wellbeing over the life course. Prior studies of adults show that when compared with non-victims of abuse, victims tend to perceive their health as poorer and utilize more health care services including emergency room and urgent outpatient care. These studies also suggest that adult victims use less routine and preventive care than non-victims. Only two studies, conducted among widely different adolescent populations, have examined how adolescent victims perceive their health. Similarly, limited evidence examining perception of health is available for young adults. These studies found that victims perceive their health as poorer than non-victims. There have been no adolescent-specific studies of how victimization impacts adolescents’ utilization of health care. One study includes participants ages 15 to 98 years and only two studies focusing on this issue in samples primarily of young adults attending college have been published. These studies found that victims utilize more health care than non-victims. Therefore, we lack a sufficient body of evidence to come to clear conclusions of how childhood abuse affects self-perceived health in adolescents and young adults. The general lack of evidence about both how childhood abuse impacts perception of health and utilization of health care in adolescents and young adults indicates a need for further study. Given that little is known about how to best identify an abuse history in adolescents and young adults and the impact of abuse on perception of health and utilization of health care, this dissertation pursued three aims: (1) to review the literature comparing modes of administration of screens to identify adolescent and young adult victims of childhood physical and sexual abuse; (2) to investigate how different modes of administration of screens to identify adolescent and young adult victims of childhood physical abuse within a primary care health setting compare to each other, and; (3) to examine the association of a history of childhood abuse (defined as none, physical only, and sexual with or without physical) with perceived health status and the health care utilization patterns among adolescents and young adults. For aim 1, a comprehensive literature review was conducted via PubMed of studies, published between January 1st, 1994 and December 31st, 2014 that compared modes of administration of screens to identify a history of childhood physical and sexual abuse in adolescents and young adults. Only one study was found. This study compared paper and pencil questionnaire, computer assisted survey, and face to face structured interview in the identification of childhood physical and sexual abuse among young adults in a college setting. No significant difference in the proportion of childhood physical abuse or childhood sexual abuse was identified by mode of administration. The identification through this search of only one study – which was conducted among college students, with no studies done among adolescents – shows a significant gap in our knowledge regarding this issue. Given that understanding how to identify childhood abuse is a critical issue, this gap is disturbing and underscores the need for studies of identification of childhood abuse to be a research priority. For aim 2, a sample of participants, ages 12-24 years, receiving health services at the Mount Sinai Adolescent Health Center in New York City were randomized to one of four modes of administration to identify a history of childhood physical abuse. The four modes of administration of screens to identify childhood abuse were paper and pencil screen, Audio Computer Assisted Self Interview screen (ACASI), face to face structured screen and face to face unstructured interview. The full sample also completed measures to assess demographic characteristics and to screen for depression symptoms. Of the sample, 44.5% of the participants disclosed childhood physical abuse. There was a statistically significant difference in the proportion of childhood physical abuse identified according to mode of administration: face to face unstructured interview identified the highest proportion of childhood physical abuse victims, followed by face to face structured screen. After adjusting for age, gender, race/ethnicity, depression, living arrangement and last grade completed, the odds of identifying physical abuse was 1.6 (95%CI: 1.0, 2.7) and 4.5 (95%CI: 2.6, 7.8) greater for face to face structured screen and for face to face unstructured interview, respectively as compared to paper and pencil screen. ACASI and paper and pencil were similar to each other but inferior to the face to face methods. For aim 3, in addition to what was measured for aim 2, the sample completed measures on a history of childhood sexual abuse and perceived health and health care utilization. The sample was then categorized into three groups: no abuse, physical abuse only, and sexual abuse with or without physical abuse. The association of childhood abuse status with perceived health and health care utilization were examined. There was no statistical significant association between a history of childhood abuse status and perceived health. However, the odds of reporting a fair/poor perception of health among those reporting childhood abuse were at least 40% lower regardless of whether the abuse was physical (OR: 0.60; 95%CI: 0.3,1.2) or sexual (OR: 0.50; 95%CI: 0.2,1.1). No significant association was found between childhood abuse status and health care utilization. However, the odds of victims reporting using urgent care only versus routine care only were at least 10% lower regardless of whether the abuse was physical (OR: 0.50; 95%CI: 0.3, 1.1) or sexual (OR: 0.90; 95%CI: 0.4,1.9). The odds of reporting using both urgent and routine care versus routine care only was similar between victims and non-victims for physical abuse (OR: 1.0; 95%CI: 0.6, 1.5) and was 30% higher for victims of sexual abuse (OR: 1.3; 95%CI: 0.8, 2.2). The findings from the three aims examined identified significant gaps in our knowledge on childhood abuse among adolescents and young adults suggesting an urgent need for further research. While much research has focused on the impact of childhood abuse on health and well-being, aim 1 reveals that little is known about which mode of administration of screens to identify childhood abuse is most effective in the identification of childhood abuse in adolescent and young adults. Furthermore, we know even less about what modes of administration of screens might be practical in primary care settings, or what must be done to improve the level of screening for childhood abuse by physicians and other health care providers. Although the findings from aim 2 suggest that face to face modes of administration are most effective in screening for childhood physical abuse in primary care settings, further studies are needed to support these findings. In addition, there is a need for studies that examine what are the best methods to use to identify childhood sexual abuse in primary care settings. The findings from aim 3 suggest that adolescents and young adults with a history of childhood physical and sexual abuse, receiving health care at the Mount Sinai Adolescent Health Center, do not perceive their health as worse than non-victims nor do they appear to utilize health care differently from non-victims. These findings contrast with results from prior studies of perceived health status and health care utilization among adolescents and young adult childhood abuse victims. Understanding how abuse impacts both the perception of health and health care utilization will be crucial in the development of interventions to identify and support adolescent and young adult victims of childhood physical and sexual abuse.

This study sought to explore and describe the recollections of young adults who were exposed to domestic violence within the family structure during childhood, so as to develop an understanding of the systems and structures needed to develop effective services to child victims of domestic violence. It is envisaged that services to these children could aid as an important preventative strategy, in that newly acquired behaviour and thinking patterns could assist them to defer from engaging in violent relationships, thereby, breaking the cycle of violence. The research study was conducted by means of a qualitative research approach and made use of the phenomenological, contextual, explorative and descriptive research designs. The purposive sampling technique was used and semi-structured interviews were employed to obtain the data. Tesch’s (cited in Creswell, 2009:186) proposed eight steps for data analysis were employed. Data verification focused on credibility/authenticity, transformability, dependability and conformability. It is envisaged that the findings and conclusions of this study could inform the planning of services to children exposed to domestic violence. / Social Work / M.A. (S.S.)

Explores why revictimization occurs in women who were sexually abused as children. Examines variables such as nature and severity of childhood abuse, attachment, and self-esteem to identify predictors of repeated abuse. A correlational-regression approach was used to test the hypothesis that lower positive attachment to parental figures, mediated by low self-esteem, will be associated with revictimization in adulthood. Approximately 150 women (Age = 18 to 54; M = 27) from various communities across Southern California participated in the study. Results did not support the hypothesis. Though self-esteem was correlated with both attachment and revictimization individually, there was no mediational effect of self-esteem between parental attachment and revictimization.

An understanding of factors that contribute to Complex Post Traumatic Stress Disorder (CPTSD) is of considerable importance to inform the prevention and treatment of the disorder. Moreover, gaining a better understanding of the factors that contribute to the etiology of CPTSD is of interest since most research to date focuses on the etiology of PTSD. Therefore, the purpose of the current study is to test the hypothesized prediction between childhood exposure to violence, childhood attachment, current interpersonal factors, and CPTSD symptoms. Using data from a community clinic and shelter serving victims of domestic violence and sexual assault, a partial least squares path analysis approach was employed to test the model’s strength in predicting contributing factors of CPTSD. Results support the proposed model, however, an alternative and more parsimonious model was found to be superior and revealed relationships between interpersonal variables and CPTSD. Specifically, women who reported child abuse and poor attachment with either parent, a perceived lack of current emotional and tangible support, and recent intimate partner violence (IPV) also reported symptoms of CPTSD. However, other variables, such as adult attachment avoidance and anxiety did not influence IPV or CPTSD as expected. Ultimately, the current findings lend support for Herman’s (1992) original conceptualization of CPTSD symptoms observed in survivors of prolonged and repeated trauma. Implications of these findings are discussed and results highlight the importance of assessing the contextual factors (e.g., social support, family environment) when a victim of prolonged trauma comes for treatment. Lastly, treatment implications and specific points of intervention are presented.

Thesis (M.A.) - Carleton University, 2002. / Includes bibliographical references (p. 60-71). Also available in electronic format on the Internet.

The purpose of this study was to explore the effects of participants' abused or nonabused status as it interacted with their age and gender in producing different patterns of Hand Test responses as a function of the age or gender of the card. Participants, 61 young adults (M age = 23) and 60 older adults (M age = 73), were presented with the original Hand Test cards, as well as four alternate versions (e.g., young male, young female, older male, and older female). Expected effects varying by age, gender, and abuse status were not found. Results indicated main effects for participant abuse status, which were largely consistent with previous Hand Test research. Significant interaction effects were also found for participant age by participant abuse status (p < .05), as well as participant age by participant gender by participant abuse status (p < .05). An interaction effect was also found for Hand Test version by participant abuse status (p < .05), Hand Test version by participant age by participant abuse status (p < .05), as well as Hand Test version by participant gender by participant abuse status (p < .05). These results suggest that the alternate forms of the cards may pull for certain responses among abused participants that would not have been identified otherwise via the standard version of the Hand Test, clinical interviews, or other projective and self-report measures of personality. Overall, the variations in Hand Test stimuli interact with participants' abuse status, and warrant the use of alternate versions of the Hand Test as a viable projective measure.

This exploratory study examined the effects of ritualistic child abuse, with its attendant sexual abuse, on a Single adult survivor. It sought to investigate the impact of such severe psychological, emotional, and sexual trauma on her function in a variety of social roles, such as wife, mother, employee, friend, parishioner, and therapy client, roles which are particularly salient to the practice of marital and family therapy and which offer potential resources for healing. The study employed in-depth interviewing of an adult female who was ritually abused during childhood and adolescence by family members. Her husband, son, friends, minister, and therapist were also interviewed in order to provide understanding of their perspectives about the survivor's recovery process and to determine their involvement. This researcher, also a survivor of similar abuses, utilized direct exposure to the survivor's therapeutic process through participant observation and examined her artistic creations, completed during the recovery period, in efforts to explore creativity as a further resource for healing. This report has attempted to describe aspects of a complex phenomenon, ritualistic child abuse, by capturing the candid recollections of the subject and outlining the interpersonal relationships that formed her recovery context. This researcher has shared a brief analysis of the results, suggestions of questions for further research, and personal reflections. / Ph. D.

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Vocational disruption for survivors of interpersonal trauma has been noted by both practitioners and researchers. While limited empirical support exists, a firm theoretical framework and a full range of outcomes have not been explored. Guided by the framework of social cognitive career theory (SCCT), a promising framework recommended in the previous literature, the aim of the current study was to explore the function of contextual barriers and supports as predictors of career decision self-efficacy (CDSE). Due to the lack of consistency in previous research and absent theoretical specification of the particular mode of intervening variables, both mediation and moderation were explored using multiple regression. The results indicate the relationship between background factors (i.e., childhood maltreatment) and CDSE was fully mediated by an indirect pathway via personal factors (i.e., trauma-related symptoms) and learning experiences (i.e., anxious and avoidant attachment with a career-related mentor) in the prediction of CDSE. The results also indicate that personal factors (i.e., trauma-related symptoms) function as a moderator between background factors (i.e., childhood maltreatment) and learning experiences as anxious attachment with a career-related mentor. Finally, learning experiences as anxious attachment with a career-related mentor moderated the relationship between personal factors (i.e., trauma-related symptoms) and CDSE. Overall, within the SCCT model, the proposed predictors help explain differences in CDSE as related to childhood maltreatment through mediation and moderation. Theoretical and practical implications of the results are discussed.

Previous research indicates that those with a history of abuse have an increased risk to experience subsequent traumatic events. This study utilized a convenience sample of undergraduate students to examine the reaction of those with a history of abuse to subsequent traumatic experiences. In addition, the study assessed the level of posttraumatic growth an individual experiences following childhood abuse. The level of posttraumatic growth was examined to determine if the growth allowed for participants to better handle successive traumas. Those with a history of abuse experienced higher levels of symptomology following a successive traumatic event. Results did not support the hypothesis that among those with a history of abuse, lower levels of posttraumatic growth would predict higher levels of symptoms following a later trauma. Implications and limitations of the study, as well as directions for future research are discussed.