A Path Analysis Investigating the Relations Among Family Violence, Behavioral Health, and Trauma Among Chinese Adolescents

Background and Purpose: Exposure to family violence, including intimate partner violence (IPV) and child abuse, has numerous deleterious effects on adolescents’ behavioral health and trauma symptomology. The pathways by which family violence influences behavioral health and trauma symptoms are less well understood, particularly among adolescents in non-Western contexts. To address this gap, the current study used a large, national representative sample of adolescents in China to explore the effects of exposure to family violence on adolescents’ behavioral health (i.e., substance misuse and gambling behavior) and trauma symptoms.

Methods: A three-stage stratified random sampling method was used to obtain a representative sample from adolescents in five major cities in China. Cross-sectional, self-report data were collected from 16,254 adolescents (14-18 years of age, 47.7% female) using a self-administered survey. Adolescents were assessed regarding the frequency of a variety types of child abuse (e.g., corporal punishment and verbal abuse), IPV between their parents (e.g., physical violence and verbal abuse), substance misuse, and gambling participation. Adolescents’ trauma symptoms were assessed using the UCLA-PTSD-Index. Multivariate path analysis was used to examine the direct and mediational relations among adolescents’ family violence exposure, substance misuse and gambling engagement, and trauma symptoms.

Results: More than half of the adolescents reported having experienced at least one type of child abuse (57.0%) and witnessed at least one type of IPV between their parents (50.3%). Further, nearly 20% of adolescents reported lifetime substance misuse: 16.0% reported problem drinking, 19.2% reported cigarette smoking, and 0.7% reported illicit drug use. Additionally, 17.9% of the adolescents reported having engaged in gambling behavior.

Path analysis revealed that both child abuse (β = 0.16) and exposure to IPV (β = 0.11) were significantly associated with a greater severity of trauma symptoms. Further, child abuse was significantly related to more problem drinking (OR = 1.21), cigarette smoking (OR = 1.15), illicit drug use (OR = 1.21), and gambling engagement (OR = 1.14); while exposure to IPV was significantly related to more problem drinking (OR = 1.10) and cigarette smoking (OR = 1.11). Additionally, problem dinking (β = 0.05) and gambling engagement (β = 0.04) were significantly related to greater trauma symptoms. Finally, substance misuse and gambling engagement significantly mediated the association between child abuse and adolescents’ trauma symptoms, and the association between exposure to IPV and adolescents’ trauma symptoms. Model fit the data adequately [χ2 (1) = 4.29, p = 0.04; RMSEA = 0.014; CFI = 1.00; TLI = 0.99].

Conclusions and Implications: Given the prevalence rates and negative effects of family violence exposure among adolescents in China, policy and services are in an urgent need to protect children in their homes and prevent those who have experienced family violence from developing behavioral and mental health problems. Importantly, findings indicate the mediational role of substance misuse and gambling engagement in linking the relation between family violence exposure and adolescents’ trauma symptoms. This suggests that family violence awareness and interventions could be a meaningful intervention strategy to address behavioral health problems among Chinese youth.