Adverse childhood experiences and intimate partner violence: testing psychosocial mediational pathways among couples
Introduction
Exposure in early life to adverse childhood experiences (ACEs), including physical, psychologic, and sexual abuse [1], is associated with an increased likelihood of intimate partner violence (IPV) in adulthood. Witnessing or experiencing violent events as a child has been hypothesized to lead to the intergenerational transfer of violence through imitating or tolerating similar behaviors in adult relationships [2]. By using a variety of measures of childhood abuse and partner violence, in previous studies authors have found significant associations between ACEs and IPV [3], [4], [5], [6]. Although there is a strong, consistent association between ACEs and IPV, relationships differ across types of childhood trauma and types of partner violence. In one study authors found child sexual abuse to be associated with female-to-male partner violence (FMPV) and male-to-female partner violence (MFPV), whereas physical abuse was associated with MFPV only [7]. Some evidence points to alcohol use, stressors, and antisocial personality disorder as potential mediators of associations between ACEs an adult IPV [4], [8], but research on these mechanisms is sparse.
Impulsivity, by itself or through increased alcohol abuse, may mediate the relationship between ACEs and IPV. Although neurobiologic mechanisms have not definitively been established, it is plausible that childhood abuse and trauma may result in greater levels of impulsivity in adulthood [9]. Numerous studies indicate that impulsivity is positively associated with IPV [10], [11]. ACEs are linked with increased risk of adult alcohol abuse [12]; in turn, problem drinkers are at greater risk for IPV, particularly among men [11], [13], [14].
Psychosocial factors such as depression and anxiety are also potential mediating factors linking ACEs and adult IPV. ACEs often lead to depression and anxiety [1], [15], with a graded relationship between number of ACEs and severity of adult depression [16]. Besides being a consequence of childhood maltreatment and/or family dysfunction, depression is a risk factor for both reciprocal [17] and unidirectional IPV [18], [19]. Ehrensaft et al [20] found that psychiatric disorders in adolescence predicted partner violence in early adulthood, whereas past-week depressive symptoms were associated with partner violence in a sample of adolescents [18]. In a study using the World Health Organization Mental Health Survey, investigators estimated the population-attributable risk for partner violence from premarital psychiatric conditions to be 17.2% [21].
Much of the current literature emphasizes the role of depression as a consequence of, rather than a risk factor for, IPV [22], [23], [24], [25], with this relationship varying by type of partner violence. For example, Caetano and Cunradi [26] found that FMPV, but not MFPV, was a risk factor for both partners’ depression. In contrast to previous studies’ emphasis on depression as a result of IPV, this analysis focuses on the importance of psychosocial factors in the pathway between ACEs and adult IPV. In this regard, the current study builds upon findings reported by Schafer et al. [13], in which pathways between childhood abuse and IPV were mediated by each partner’s impulsivity and alcohol problems.
In this study, partner-specific pathways between ACEs and MFPV and FMPV are tested to determine whether depression, anxiety, impulsivity, and problem drinking are mediators of these relationships and whether associations differ across partners. A structural equation model of these relationships was estimated using data from a sample of couples drawn from 50 medium-sized California cities. Depression, impulsivity, and anxiety were expected to be associated with both ACEs and MFPV and FMPV. We also hypothesized that indirect pathways between ACEs and IPV through psychosocial characteristics would be significant. No previous studies, to our knowledge, have used couple data on both MFPV and FMPV to determine whether depression, anxiety, and impulsivity are in the pathway between ACEs and MFPV and FMPV.
Section snippets
Data source and measures
Couples were sampled from 50 California cities with populations 50,000 to 500,000. Couples were recruited by telephone from a purchased sample of household addresses and telephone numbers. Eligible households included those with couples who were married or cohabiting, had lived together for at least 12 months at the time of the survey interview, were between 18 and 50 years of age, and were fluent in English or Spanish. Trained survey interviewers first spoke with the female partner in the
Results
Among couples included in this study's analysis, prevalence of MFPV was 7% and prevalence of FMPV was 10%. Correlations among male partner reports of model variables and IPV measures and their means and standard deviations are presented in Table 1. Male depression and anxiety were moderately correlated with one another, as were MFPV and FMPV. A parallel set of statistics for female reports of model variables and IPV measures is presented in Table 2. Similar to male correlations, the strongest
Discussion
This study expands Schafer et al.’s (2004) conceptual framework linking IPV with each partner’s adverse childhood experiences, impulsivity, and hazardous alcohol use to include important mediating variables such as depression and anxiety [13]. Although the authors of previous studies have shown the positive relationship between adverse childhood experiences and adult partner violence [5], [6] and the intergenerational transmission of violence and externalizing behaviors [39], [40], [41], the
Acknowledgments
This project was supported by Grant Number 1 R01AA017705-3 from the National Institute on Alcohol Abuse and Alcoholism; Carol Cunradi, Principal Investigator. The authors gratefully acknowledge Lillian Remer for her preparation and development of the data. The content is solely the responsibility of the authors and does not necessarily represent the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health.
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