The Relationship Between Victimization Severity And Somatic Disorders In a Sample Of At-Risk Adolescents: Evaluating Dispositional Coping Styles As Mediating Mechanisms

Background and Purpose: The study examined the influence of childhood victimization (physical, sexual or emotional) severity on somatic and substance use disorders among adolescents assessed for substance abuse treatment. Research demonstrates that victimization is associated with both substance use (Perez, 2000) and somatic (Moore, J., 2001) disorders. However, previous studies have not focused on the effects of victimization on somatic disorders among adolescents assessed for suspicion of drug use. Since victimization is stressful and coping can influence the impact of stress (Compas, Connor-Smith, Saltzman, Thomsen and Wadsworth, 2001), this study examines whether dispositional coping styles can mediate the effects of victimization on somatic and substance use disorders. More specifically, the study focuses on the following research questions: 1) What is the effect of victimization severity on substance use and somatic disorders among adolescents, and 2) what is the mediating effect of dispositional coping styles on the link between victimization severity, substance use and somatic disorders?

Methods: This cross-sectional study used data from, 4989 adolescents ages 12 to 18, who participated in a comprehensive screening program for substance abuse at 106 sites funded by SAMHSA and CSAT grants. A standardized assessment, Global Appraisal of Individual Needs (GAIN-I Intake Version 5.4.0), was used to answer the research questions. Severity of victimization was measured using the General Victimization Scale (alpha=0.82), while dispositional coping styles were measured by the Personality Coping Style Scale (alpha=0.85). Interpersonal and environmental stressors were measured using the Personal Sources of Stress Index and Other Sources of Stress Index. The Substance Problem Scale-Life Time (alpha=0.90) and the Somatic Symptom Index (alpha=0.69) were used to measure substance use and somatic disorders respectively. The model was tested using a structural equation modeling (SEM) approach.

Results: The model demonstrated an adequate fit (χ2=.00, p=1.00; CFI=1.00, TLI=1.00, RMSEA=0.00). The estimates for both direct and indirect effects were found to be significant and positive. Results of the model indicated that severity of victimization had a direct effect on somatic (b=0.191, p<.05) and lifetime substance problems (b=0.146, p<.05) even after controlling for personal and environmental sources of stress. Victimization also had an indirect effect on somatic and substance problems through dispositional coping styles (b=0.353, p<.05). Coping styles, in turn, significantly affected somatic (b=0.343, p<.05) and substance problems (b=0.39, p<.05). The model explained 27% of the variance in somatic symptoms and 29% of the variance in substance problems.

Conclusion and Implications: The study provides evidence for an association between victimization severity, coping styles, substance use and somatic disorders among at-risk adolescents. These adolescents require collaborative efforts between substance abuse, mental health and child welfare practitioners. The knowledge will allow practitioners to target victimization and coping styles, create more effective service plans and improve treatment response among their clients with both substance use and somatic disorders. They may advocate for policies which address their unique needs (e.g. funding for positive coping skills training). The study contributes to the research literature by focusing on severity of victimization and dispositional coping as factors influencing substance use and somatic disorder symptoms.