Child Attributions Mediate Relationships Between Violence Exposure and PTSD Symptomology

Background: Violence and trauma exposure have been increasingly investigated as contributing to a range of negative outcomes in child physical, emotional, social, and psychological functioning, particularly among youth who are racial/ethnic minorities (Andrews et al., 2015).  However, there are a variety of risk and protective factors that influence the effect of trauma on the individual child.  Attributions refer to inferences made about the cause of an event, situation, or action (Collins, Koeske, Russell & Michalopoulos, 2013), with internal, stable, and global attributions most likely to lead to negative psychological outcomes. However, there have been relatively few research studies that have evaluated children's attributions of violence and trauma.  Based on attribution theory, we hypothesized that personal negative attributions would more strongly mediate the relationship between traumatic experiences and PTSD symptomatology for children who had direct victimization (IPV-Self) versus those who heard about or witnessed violence and victimization (IPV-Other).

Methods:  Data were drawn from an on-going clinical intervention with families at risk for child maltreatment and/or neglect residing in West Baltimore. Children (N=120) self-reported on the validated Children's Attributions and Perceptions Scale (CAPS) sub-scales (Feeling Different From Peers, Personal Attributions for Negative Events, Perceived Credibility, and Interpersonal Trust), UCLA PTSD Scale, and Traumatic Events Screening Inventory. The main analytic approach was a mediation analysis that quantified the role that the four CAPS attribution subscales have on the relationship between traumas (IPV-self vs. IPV-other) on PTSD symptoms, after adjusting for child age and within family clustering.  For the mediation analysis we ran Stata 14.1 and the package sgmediation, which performs the regression calculations and the conducts a Sobel-Goodman test of the mediator, and then used bootstrap estimation to calculate confidence intervals for the standard errors. 

Results:  Participating youth were most often male (53.9%), African-American (92.3%), and had a mean age of 8.35 years (SD = 2.12).  For each of the IPV variables (Self and Other) the CAPS subscales had a statistically significant mediating effect on PTSD, with the exception of the Lack of Trust sub-scale. The indirect path though the mediator (Feeling Different) accounts for 43.10% of the total variance in the relationship between IPV-Self and PTSD.  For three of the four CAPS subscales, the relationship between the IPV-Self variable had a higher percent of total effect for the mediating variables.  Only with Lack of Trust had a stronger mediating effect on the IPV-Other variable compared with the IPV-Self variable (33.41% vs 36.74%, respectively).

Conclusions: Findings underscore the importance of systematically assessing child attributions in clinical work with violence-exposed youth. Targeting attributions within treatment modalities may reduce child distress and post-traumatic stress symptomatology.

Collins, K. S., Koeske, G. F., Russell, E. B., Michalopoulos, L. M. (2013). Children's attributions of community violence exposure and trauma symptomology. Journal of Child and Adolescent Trauma, 6, 201-216.

Andrews, A. R., Jobe-Shield, L., Lopez, C. M., Metgzer, I. W., de Arellano, M. A., Saunders, B., & Kilpatrick, D. G.  (2015).  Polyvictimization, income, and ethnic differences in trauma-related mental health during adolescence. Social psychiatry and psychiatric epidemiology, 50(8), 1223-1234.