Child Abuse Victimization, Depression, and Substance Use Among Homeless Women: Application of General Strain Theory

Purpose: Although previous research has accrued evidence on the association between child abuse victimization and substance use among women, results regarding the association among homeless women have been inconsistent. General strain theory (GST) provides a theoretical framework to understand how child abuse victimization contributes to homeless women’s substance use by including mediators and moderators. The main purpose of this study was to determine if GST could explain the association between child abuse victimization and substance use among homeless women by including depressive symptoms as a mediator and positive social support as a moderator.

Methods: Participants in this study were 445 homeless women who were randomly sampled in temporary shelter settings in the Los Angeles County between June 2007 and March 2008. Substance use was assessed by measuring heavy drinking, marijuana use, and crack cocaine use during the previous 6 months. Child abuse victimization was assessed by asking women if they were physically or sexually abused before the age of 18. Depressive symptoms were measured by two items which asked if women had 2 years or more when they felt depressed most days and if women have felt depressed for 2 weeks or more in the past year and positive social support was measured by the number of relative network members who provided any support during the past 6 months. To test the mediating effects of a binary mediator, coefficients were rescaled using STATA 12.0.

Results: The results of multivariate logistic regressions indicated that depressive symptoms fully mediated the four relationships (physical child abuse victimization and heavy drinking, physical child abuse victimization and crack cocaine use, sexual child abuse victimization and heavy drinking, and sexual child abuse victimization and crack cocaine use). Bootstrapping results indicated that the mediating effects of depressive symptoms were statistically significant (p < .01). Two interaction variables (physical child abuse x positive social support [OR = 0.85 95% CI = 0.79, 0.93] and sexual child abuse x positive social support [OR = 0.80, 95% CI = 0.67, 0.95]) were significant in predicting heavy drinking among homeless women (p < .01).

Implications for practice or policy: Despite some limitations, the results of this study have practical implications for addressing substance use among homeless women. Current interventions mainly focus on ongoing strains or mental health. The results of this study indicated that child abuse victimization may play a key role in understanding current substance use (heavy drinking and crack cocaine) among homeless women. The results suggested that practitioners need to assess for a history of child abuse victimization among homeless women with substance use problems. In addition, practitioners may focus on addressing depressive symptoms as a strategy to reduce substance use (especially heavy drinking and crack cocaine use) among homeless women who have a history of child abuse during childhood. Moreover, increasing positive social support, especially from relatives, may attenuate the likelihood of heavy drinking among homeless women who have a history of child abuse victimization.