The Impact of Trauma Exposure on Mental Health and Behavioral Problems in Adolescent Girls in Child Welfare: Moderating Effect of Resiliency

Background and Purpose: Exposure to traumatic experiences and the resulting emotional dysregulation, loss of safety, and maladaptive coping lead to mental health and behavioral problems in adolescence and adulthood. Adolescents involved in the child welfare system by definition have histories of child maltreatment, and research has focused on their abuse-related traumas. Yet, little is known about the other types of traumas that girls in the child welfare system experience, and the protective factors that may help to reduce their negative effects. To better understand the types of traumas experienced and identify potential protective factors in this population, the following questions were examined: 1) How do the rates of child-welfare specific traumas (e.g., abuse, neglect, and family separation) compare with community-level and disaster-related traumas among adolescent girls in the child welfare system? And 2) to what extent does resiliency lessen the impact of trauma on mental health and behavioral problems?

 

Methods: This study included 207 adolescent girls, ages 12-19, (mean = 14.9, SD=1.7) involved in child welfare who were referred to a trauma-focused intervention. The majority were African American (74%), and the remainder were White (26%). Data from face-to-face interviews were used to measure the following variables:  1) Trauma Exposure (types and number) measured by UCLA PTSD Index (14 items); 2) Resiliency-14 items (Wagnild, 2011); 3) PTSD-17 items (Foa, 2001); 4) Depression-27 items (Kovacs, 2003; 27 items); 5) Frequency of Perpetration (18 items) and Revictimization (Farrell, 2000; 18 items); 5) Substance Use (8 items, ever used); 6) School Problems-5 items; and 7) Control Variables: age, ethnicity, number of placements, medication and service use. Data analyses included descriptive statistics, correlations, MANCOVA and regression.

Results: The mean number of traumas endorsed was 6.6 (SD=2.5). The most common traumas were “someone close experiencing:” illness/injuries (84.5%), death (84%), or an accident (62%). Childhood separation and abuse-related traumas were endorsed by 40%-60% of the girls, followed by community-level violence (35%-49%), and natural disasters (37%).  Girls exposed to more types of traumas experienced more symptoms of PTSD (r=.39, p<.001), depression (r=.26, p<.001), used more substances (r=.39, p<.001), had more problems in school (r=.23, p<.01), and reported higher frequencies of revictimization (r=.39, p<.001) and perpetration towards others (r=.31, p<.001). A MANCOVA (Wilk’s λ= .74) indicated that the number of traumas was significantly associated with the combined dependent variables. Post-hoc regression analyses indicated that resiliency significantly moderated the relationship between total number of traumas experienced and: PTSD, depression, perpetration, and revictimization, but not for substance use or school problems. At higher levels of resiliency, the relationships between trauma exposure and mental health problems, and trauma exposure and perpetration/revictimization weakened.

Conclusions and Implications: Girls in child welfare experience a variety of traumatic events, and the most common are related to injuries/illness and death. The cumulative effects of trauma are associated with mental health and behavioral problems, yet resiliency reduces the negative impact of trauma on PTSD, depression, revictimization, and perpetration. Interventions that target exposure to diverse traumatic events are suggested to strengthen resiliency-related skills and beliefs in this population.