Prevalence and demographic correlates of childhood maltreatment in an adult community sample☆
Introduction
Numerous studies have examined the community epidemiology of childhood maltreatment and its negative sequelae in adulthood. Reported prevalence estimates of maltreatment vary widely from study to study (e.g., 3% to 36% for sexual abuse, Finkelhor, 1994a), but are generally quite high. In a recent review of studies examining the prevalence of sexual abuse, Gorey and Leslie (1997) reported a 22.3% prevalence of sexual abuse among women and an 8.5% prevalence among men using an aggregate of 25 samples. The province-wide Ontario Health Supplement reported similarly high prevalences of physical abuse—21.1% among women and 31.2% among men (MacMillan et al., 1997).
The experience of childhood abuse and neglect is often accompanied by wide-ranging mental and physical health consequences for adult survivors. Studies have linked childhood maltreatment to such varied psychological phenomena as suicidality, depression, dissociation, anxiety, and substance abuse (Dhaliwal, Gauzas, Antonowicz, & Ross, 1996; Dube et al., 2003; Johnson et al., 2002; Malinosky-Rummell & Hansen, 1993; Mullen, Martin, Anderson, Romans, & Herbison, 1996). Additional studies have linked childhood maltreatment to a variety of adverse health outcomes, including infectious diseases, pain disorders, cancer, and heart disease (Felitti et al., 1998, Imbierowicz & Egle, 2003; Walker et al., 1999, Walker et al., 1999). Maltreatment has also been linked to greater numbers of physician diagnoses and higher health care costs among adult survivors (Walker et al., 1999, Walker et al., 1999; Walker et al., 1999, Walker et al., 1999). In sum, much research indicates that childhood maltreatment is a disturbingly common phenomenon with numerous problematic aftereffects.
One way of decreasing the impact of childhood maltreatment upon adult survivors is to develop prevention programs that address trauma-specific issues and outcomes. For example, the Skills Training in Affect and Interpersonal Regulation/ Prolonged Exposure program aims to prevent revictimization among sexual abuse survivors (Cloitre, 1998). A first step towards the development of such preventive interventions is to determine the number of persons at risk so that appropriate levels of resources can be devoted to such efforts. The development of successful preventive interventions also depends in part on knowing the demographic characteristics of potential intervention participants. Such knowledge can be used to target interventions to groups or communities most likely to have persons at risk and to identify points of access to these targeted groups (e.g., churches, community organizations) (Mrazek & Haggerty, 1994). Knowledge regarding the background of potential participants can also be used to match the needs and expectations of participants by suggesting preventive intervention content (e.g., addressing culture-specific attributions regarding abuse), format (e.g., highly structured vs. unstructured), and delivery (e.g., by paraprofessional members of the same demographic group vs. by mental or physical health professionals). Given the importance of information on the prevalence and correlates of maltreatment to the development of successful interventions, such information for all types of maltreatment is needed.
Despite this need for information on all types of childhood maltreatment, relatively little is known about the prevalence and correlates of emotional abuse and neglect. For example, a recent review of risk factors for childhood emotional maltreatment (Black, Slep, & Heyman, 2001) revealed only one study addressing demographic correlates of this form of maltreatment in a community sample. Most of the literature on childhood maltreatment focuses overwhelmingly on sexual abuse and, secondarily, on physical abuse and neglect. This focus on sexual and physical trauma may be due to the fact that these types of trauma are most often the focus of child protection agency reports (Zellman & Faller, 1996) and thus may have the greatest direct impact on government resources. Nonetheless, emotional abuse and neglect may also have significant long-term physical and psychological consequences, including many of the difficulties previously listed (Felitti et al., 1998, Imbierowicz & Egle, 2003, Johnson et al., 2002, Mullen et al., 1996; Walker et al., 1999, Walker et al., 1999). Thus, information on the prevalence and correlates of emotional maltreatment seems especially needed.
Along with the lack of information on emotional maltreatment, there is also a paucity of information on the prevalence and correlates of exposure to multiple forms of abuse and neglect. Most large-scale epidemiological studies have reported on only one or a few types of maltreatment, usually sexual and physical (e.g., Brown, Cohen, Johnson, & Salzinger, 1998; Finkelhor, Hotaling, Lewis, & Smith, 1990; MacMillan et al., 1997, Vogeltanz et al., 1999). Moreover, we found only one study that examined demographic predictors of exposure to multiple maltreatment types in a community sample (i.e., MacMillan et al., 1997). Since there are some data indicating that having been the victim of more than one form of maltreatment increases risk for adverse physical and mental health outcomes (Felitti et al., 1998; Moeller, Bachmann, & Moeller, 1993; Mullen et al., 1996), it seems important to obtain additional information on individuals who have experienced multiple types of maltreatment along with information on the scope and nature of multi-type maltreatment.
To provide such information, we examined the prevalence and demographic correlates of childhood abuse and neglect in a large community sample, using a retrospective, self-report methodology with a standardized, reliable instrument. We examined five types of childhood maltreatment, covering a broad range of traumatic experience: emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse. We chose potential demographic correlates on both practical and theoretical bases. First, we sought to examine variables that are relatively objective and easily obtainable, in order to maximize the utility of our findings for research and clinical purposes (e.g., identifying at-risk populations to target interventions aimed at preventing negative sequelae of childhood maltreatment). Second, we sought to examine variables that, theoretically, could help describe the occurrence of underinvestigated forms of childhood maltreatment (i.e., emotional abuse and neglect) and the experience of multiple maltreatment types (i.e., co-occurring maltreatment). Belsky (1980) provides some direction for such investigations. He suggests that individual differences in perpetrators and child victims, as well as broader forces of community and culture, all can contribute to the occurrence of child maltreatment. In a recent review of etiological theories in child maltreatment (Azar, Povilaitis, Lauretti, & Pouquette, 1998), this wide-ranging perspective was quite evident; numerous factors at the level of the individual, community, and culture have been used to explain maltreatment. Of these, several appear to cut across trauma types, including cultural values (e.g., legitimacy of physical punishment), socioeconomic status/stress (e.g., due to poverty), and power differentials (e.g., based on sex or the notion of children as property). Consequently, we examined demographic indices of these factors, using race as an index of culture, respondents’ educational level as an index of socioeconomic status, and sex as an index of power differential. Information is provided on (1) the prevalence of each maltreatment type, (2) the prevalence of co-occurring maltreatment, and (3) demographic correlates of each maltreatment type and of co-occurring maltreatment.
Section snippets
Respondents
Respondents were 1,007 residents of the metropolitan Memphis, Tennessee area between the ages of 18 and 65 years in 1997. Respondents were asked to participate in a study of criminal victimization and traumatic stress. For the purposes of the current study, only data from persons indicating an ethnic/racial identity of Black or White were used; this encompassed 97.5% of respondents, and is representative of the demographics of the sampled population. Demographic information for this subsample (N
Prevalence of childhood maltreatment
Table 1 displays the demographic characteristics of the sample. The prevalence of childhood maltreatment is displayed for the entire sample and for men and women separately in Table 2; the prevalence is displayed for individual maltreatment types and for co-occurring maltreatment. Statistically significant differences in prevalence between the sexes are also noted in Table 2. Approximately one third (35.1%) of the sample met criteria for at least one form of childhood maltreatment; 13.5% met
Discussion
This study reports on the prevalence, co-occurrence, and demographic correlates of childhood maltreatment in a community sample. It expands on previous work most notably by examining a full range of childhood traumas: emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse. Consequently, we were able to report not only on the prevalence of each form of maltreatment but also on the prevalence of co-occurring types of maltreatment, including those that have been
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Supported in part by a VA Merit Review Grant and a grant (MH64122) from the National Institutes of Mental Health to M.B.S.
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Present address: Department of Psychology, California State University, San Bernardino, San Bernardino, CA, USA.