Poly-Victimization and Mental Health in Youth: Mediating Roles of Trauma and Sleep

Background: Adverse childhood experiences have been evidenced to trigger emotional and behavioral problems among youth and young adults (Chapman et al., 2004). Many studies have shown that foster youth have high levels of stress and negative mental health outcomes (Havlicek, Garcia, & Smith, 2013) and have often been exposed to multiple types of child maltreatment, termed poly-victimization (Edwards, Holden, Felitti, & Anda, 2003). However, there is a dearth of literature on mechanisms wherein traumatic stress and sleep play roles in mediating the relationship between poly-victimization and anxiety. Thus, this study tested whether poly-victimization was correlated with anxiety in young adults, and whether this relationship was mediated by their traumatic stress and sleep deprivation.

 

Methods: This cross-sectional study used data collected from a survey conducted September 2016 to March 2018. The total sample (N=143) consisted of 92 youth aged 18-24 who had been in foster care, and a comparison group of 51 youth who had never been in foster care. The study assessed traumatic stress, types of child maltreatment, mental health problems, and sleep. Maltreatment (physical abuse, sexual abuse, and neglect) was measured with the Child Trauma Questionnaire (Bernstein et al., 2003). A wearable actigraphy device (FitBit) objectively measured sleep hours across four consecutive nights.  Structural equation modeling (SEM) was conducted to test whether there was an association between poly-victimization and anxiety in the former foster youth and non-foster youth groups, controlling for sex and race. Path analysis was performed to examine whether the relationship between poly-victimization and anxiety would be mediated by traumatic stress and sleep hours.

 

Results: Descriptive statistics showed that exposure to two types of child maltreatment accounted for the largest percent of the poly-victimization (39.2% for non-foster youth; 47.8% for former foster youth). SEM results indicated that there was no direct relationship between poly-victimization and anxiety, yet traumatic stress and total sleep hours were found to fully mediate the relationship between poly-victimization and anxiety among the former foster youth (b=.65, p<.001). In particular, traumatic stress in the former foster youth was predictive of sleep hours (b = -.22, p <.001). For non-foster youth, it was noticeable that traumatic stress was not responsible for anxiety levels itself. The association of traumatic stress to anxiety levels for the non-foster youth was only significant when it was indirectly mediated by sleeping hours (b =. 28, p <.001).

 

Conclusion and Implications: Study results indicated that the negative effects of poly-victimization on anxiety could be mitigated if the traumatic stress and sleep deprivation in young adults with experiences of maltreatment were addressed. Specifically, different intervention approaches may be more effective in reducing anxiety levels in each group. For instance, former foster youth may need more intensive treatments for alleviating both traumatic stress and sleep deprivation, whereas treatment specifically targeting sleep can be more effective in mitigating anxiety of non-foster youth. Models such as CBT-Insomnia could play a significant role in not only improving sleep but reducing anxiety among traumatized youth regardless of whether they have experiences in the foster care system.