Original article
Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents

https://doi.org/10.1016/j.jadohealth.2009.11.212Get rights and content

Abstract

Purpose

Adolescents exposed to multiple forms of psychological trauma (“poly-victimization,” Finkelhor et al. Child Abuse Negl 2007;31:7–26) may be at high risk for psychiatric and behavioral problems. This study empirically identifies trauma profiles in a national sample of adolescents to ascertain correlates of poly-victimization.

Methods

Latent Class analyses and logistic regression analyses were used with data from the National Survey of Adolescents to identify trauma profiles and each profile's risk of posttraumatic stress disorder, major depressive disorder, substance use disorders, and delinquency involvement and deviant peer group relationships. Poly-victimization classes were also compared to classes with trauma exposure of lesser complexity.

Results

Six mutually exclusive trauma profiles (latent classes) were identified. Four classes were characterized by high likelihood of poly-victimization, including abuse victims (8%), physical assault victims (9%), and community violence victims (15.5%). Poly-victimization class members, especially abuse and assault victims, were more likely than do youth traumatized by witnessing violence or exposure to disaster/accident trauma to have psychiatric diagnosis and (independent of psychiatric diagnoses or demographics) to be involved in delinquency with delinquent peers.

Conclusions

Poly-victimization is prevalent among adolescents and places youth at high risk for psychiatric impairment and for delinquency. Moreover, poly-victimized youths' risk of delinquency cannot be fully accounted for by posttraumatic stress disorder, depression, or substance use problems, suggesting that adolescent healthcare providers should consider poly-victimization as a risk for behavioral and legal problems even when PTSD, depression, or addiction symptoms are not clinically significant.

Section snippets

Procedure

Data were acquired from the National Survey of Adolescents (NSA) [30], an IRB-approved computer assisted telephone interview. Provisions were made for adolescent confidentiality and for mandated reporting and clinical follow-up when physical or sexual assault were disclosed [31], [32].

Sample

The NSA [30], [32] is a cross-sectional household probability sample of adolescents aged 12–17 years that was representative of the 1995 United States population. Of 5,367 households identified, more than 90% (n =

Latent class analysis of trauma history profiles

The Lo-Mendell-Rubin adjusted likelihood ratio test [34] was used to compare each model with K classes against a model with K – 1 classes [35]. Results showed no significant information was added after a six-class solution, Lo-Mendell-Rubin 2LLdiff(20) = 188.60, p = .002. A six-class solution fit the data, Pearson χ2(16,776,838) = 11,863.15, p > .05, Entropy = .68. Class membership prediction ranged from .72 (Class 3) to .87 (Class 1). Each class had a distinct trauma history profile (Figure 1

Discussion

Mutually exclusive subgroups of adolescents were identified based on distinctive latent class profiles of victimization, with approximately one-third reporting histories consistent with poly-victimization. Adolescents in the poly-victimization subgroups not only were more likely than nontraumatized adolescents to meet criteria for psychiatric disorders, but had double the risk of depression, triple the risk of PTSD, three to five times increased risk of SUDs, and five to eight times increased

Conclusion

Despite these limitations, the study's representative sample of adolescents and validated structured interview measures provide a basis for generalizing the findings to a wide range of adolescents and types of traumatic stressor exposure and to three well-documented and clinically significant health problems associated with victimization among adolescents (PTSD, depression, substance use problems)—as well as to involvement in (or association with peers involved in) juvenile delinquency. The

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