Childhood Maltreatment and Adulthood Substance Use in Ukraine: The Role of Depression

Background and Purpose: The negative outcomes of early-life maltreatment affect the quality of life for people across the globe. Experiencing childhood maltreatment in Ukraine, a country with poorly developed professional support systems that has experienced significant political turmoil, war, and economic strains (Burlaka et al., 2018) may further exacerbate the feelings of depression and increase the risk of substance use. We hypothesized that (H1) Childhood maltreatment will be positively associated with increased early adulthood depressive symptoms; (H2) Childhood maltreatment will be positively associated with increased substance use during early adulthood; and (H3) Increased depression during early adulthood will mediate the relationship between childhood maltreatment and adulthood substance use.

Methods: We used a cross-sectional sample of 829 students (M_age= 18.97, 66% females) from 27 Ukrainian regions attending ten public universities.Participants answered questions from the Adverse Childhood Experiences Questionnaire (ACEs; Felitti et al., 1998), the Alabama Parenting Questionnaire (APQ; Frick, 1991), Center for Epidemiologic Studies Depression Scale Revised (CESD-R-10; Björgvinsson et al., 2013)questionnaire, and the World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST; Humeniuk et al., 2008) and questions about gender and age.We used the structural equation modeling and performed the estimations in Stata 14.2 statistical software package (StataCorp, 2015) to test the paths from APQ (Corporal Punishment) and ACE (Hitting, Insults and Molesting) to CESD (Depression) and ASSIST (Substance Use, direct paths and via Depression).

Results: Higher frequency of corporal punishment (β= 0.14, z = 2.49, p< 0.05), increased adversity (β= 0.18, z = 2.92, p< 0.01) during childhood, female gender (β= -0.11, z = -2.83, p< 0.01), and older age (β= 0.17, z = 4.39, p< 0.001) had direct significant effects on higher depression scores during early adulthood. Additionally, increased depression had a direct significant effect on increased lifetime involvement with psychoactive substances (β= 0.16, z = 3.17, p< 0.01). The direct relationships between childhood corporal punishment, increased adversity, and adulthood substance use were not statistically significant. Childhood adverse experiences had the strongest standardized indirect effect, mediated by depression on adulthood involvement in substance use (β= 0.028, z = 2.17, p< 0.05), followed by older age (β= 0.026, z = 2.50, p< 0.05) and female gender (β= -0.016, z = -2.07,p< 0.05). The model provided a good fit for the data: χ²(76, N= 822) = 116.15, p< 0.01, CFI = 0.98, TLI = 0.98, RMSEA = 0.04 and explained 96% of the total variance (Bentler & Raykov, 2000).

Conclusions and Implications: As expected, participants with early life maltreatment experiences were more likely to develop depression symptoms as young adults. Next, increased depressive symptomatology was associated with increased substance use. This finding suggests the need for prevention policies and programming that would specifically target child maltreatment. Future research needs to further explore the ways in which adulthood depression mediates the relationship between childhood trauma and adulthood substance use in Ukraine.