The Effects of Cumulative Childhood Victimization, Intimate Partner Violence, and Homelessness On Adolescent Mothers' Depression

Background and Purpose: While researchers have studied individual types of violence exposure among youths, including physical abuse by a caregiver, witnessing intimate partner violence (IPV), and sexual abuse, attention has recently turned to examining cumulative violence. Among adolescents who are poor, female, and residing in urban areas, cumulative physical and sexual victimization is common. As these experiences accumulate throughout childhood, they are associated with negative outcomes including childbearing, IPV victimization, homelessness, and mental health problems. In exploring these relationships, researchers have typically taken an additive approach to cumulative victimization, using main effects models (e.g., two types of victimization as predictors of depression). We go beyond this typical approach by first identifying clusters of cumulative victimization, then examining the relationships between clusters and depression symptoms as mediated by IPV victimization and homelessness, within a sample of adolescent mothers. We address the following research questions: What are the associations between profiles of childhood cumulative victimization, IPV victimization, homelessness, and depression? 2) To what extent do IPV victimization and homelessness explain the relationship between patterns of cumulative victimization and depression?

Methods: Participants (N = 206) were recruited from three community sites that serve pregnant or parenting adolescents, and surveyed about their childhood experiences with physical abuse by a caregiver, witnessing IPV (both assessed using the Revised Conflict Tactics Scale [CTS 2]), and sexual victimization (Russell’s child sexual abuse framework); IPV victimization (CTS 2); homelessness history; and current depression symptoms (Center for Epidemiologic Studies Depression Scale). Using the three childhood victimization variables, we used Ward’s method of hierarchical agglomerative clustering followed by K-means cluster analysis to identify five cluster profiles: HiAll (high victimization across all three types), HiFV (high physical abuse by caregiver and witnessing IPV), HiWIPV (high witnessing IPV), HiSV (high sexual victimization), and LoAll (low victimization across all three). We used Mplus 6 to conduct path analysis and estimate the indirect, direct, and total effects.

Results: There were significant differences by cluster in IPV victimization, F(4, 204) = 12.22, p = .000, homelessness history, χ²(4, N = 206) = 18.09, p = .001, and depression, F(4, 202) = 9.37, p = .000. In general, HiAll and HiFV had significantly higher levels of IPV victimization, HiAll had a significantly higher rate of homelessness history, and LoAll had a significantly lower level of depression, in comparison to the other four clusters. Both HiAll and HiFV had significant indirect effects pathways to depression (b = 1.88, p = .002, 95% CI 1.45 to 4.49, and b = 1.48, p = .003, 95% CI 1.97 to 4.53, respectively), in comparison to LoAll.

Conclusions: In order to better understand how victimization shapes poor outcomes among high-risk adolescents, we must identify distinct profiles of cumulative victimization rather than simply counting forms of victimization. Among adolescent mothers who have experienced high levels of family violence, depression symptoms might be best understood as the result of a chain of risks linking cumulative victimization, IPV victimization, and homelessness history.