The effect of maltreatment and trauma on health risk behaviors among adolescents involved with the child welfare system : the role of psychological symptoms

Childhood maltreatment, including abuse and neglect, remains a pressing social problem in the United States, with retrospective studies finding that up to 40% of adults report having experienced some type of maltreatment during their youth (Finkelhor, Turner, Shattuck, & Hamby, 2013). The consequences of maltreatment are widespread and long lasting, and can include post-traumatic stress disorder, depression, anxiety, aggression, delinquency, substance abuse, and suicidality (Gilbert et al., 2009). Although the effects of various individual forms of maltreatment and of a composite “adverse childhood experience” (ACE) score on rates of individual health risk behaviors in adolescence and adulthood have been documented, the pathway whereby childhood maltreatment leads to later engagement in risk behavior is still not well understood (Anda et al., 2007; White & Widom, 2007), and relatively little is known about the psychological factors that link childhood maltreatment to engagement in health risk behaviors. This study used a subsample of adolescents from the second National Study of Child and Adolescent Well-Being (NSCAW II), a longitudinal study of youth involved with the child welfare system, to examine: 1) the effects of child maltreatment and trauma symptoms reported at baseline on engagement in health risk behaviors measured 36 months later, and 2) whether depressive symptoms and future expectations, measured 18 months after baseline, mediate the effects of maltreatment on health risk behaviors. Using structural equation modeling, this study found that both maltreatment and trauma symptoms were risk factors for later adverse outcomes, but that maltreatment was more consistently and strongly associated with behavioral outcomes (i.e. substance use and sexual behavior) while trauma symptoms were more consistently associated with psychological outcomes (i.e. depressive symptoms and future expectations). Results overall did not support the hypothesis that the psychological constructs examined mediated the effects of maltreatment and trauma on later health risk behaviors. Findings also identified early substance use as a critical risk factor for youth exposed to maltreatment, as substance use at baseline mediated the effects of maltreatment not only on later substance use but also on sexual risk behavior, as well as increasing risk for subsequent depression.