(WITHDRAWN) Associations between Psychosocial Functioning and Physical Health in Youth with Maltreatment Experiences

Background and Purpose: Childhood maltreatment often results in long-term untoward outcomes, although some individuals demonstrate better psychosocial functioning or resilience. Maltreatment is linked with poor physical health outcomes, yet there is little research examining whether positive functioning may buffer the effects of maltreatment on physical health outcomes. The aims of this study were to: 1) Identify heterogeneity of psychosocial functioning using a latent profile analysis (LPA). Functioning was measured by both fewer problematic symptoms (depression, PTSD, anxiety, externalizing behavior, and substance abuse disorder) and the presence of the protective factor of social support; and 2) Explore the relationship between emergent classes of psychosocial functioning and physical health (self-reported illnesses, symptoms, and health status as well as measured overweight/obesity).

Methods: Participants were from a longitudinal study of youth with child welfare-documented maltreatment (n=219; mean age 18.3 years; range 15-23 years). Youth physical health was measured by the presence of health symptoms over the last 30 days (including colds and pain), presence of illnesses over the past year (including respiratory, gastrointestinal, ear, nose, and throat, urinary, and skin infections), a subjective rating of health status, and measured BMI. LPA utilized continuous measures of psychosocial functioning to determine emergent classes. Mean differences or odds ratios were assessed for each health variable between classes.

Results: The three resulting classes were labeled: 1) high support/lower symptoms (60.7%); 2) lower support/higher internalizing symptoms (29.2%); and 3) lower support/higher externalizing/substance abuse symptoms (10%). The lower support/higher externalizing/substance abuse symptoms class had similar internalizing behaviors as the lower support/higher internalizing symptoms class. Youth in the lower support/high externalizing/substance abuse symptoms class had worse subjective health status, more colds and pain symptoms in the past month, and more gastrointestinal illnesses in the past year than the high support/lower symptoms class, and a greater number of overall illnesses, respiratory problems, and gastrointestinal illnesses the last year than the lower support/higher internalizing symptoms class. Participants in lower support/higher internalizing symptoms class had higher a frequency of pain, higher probability of being overweight, and worse self-reported health status than participants in high support/lower symptoms class.

Conclusions and Implications: This study identified that the majority of the sample had positive psychosocial functioning and better self-perceived health status. We found two classes with poorer psychosocial functioning, with differences in physical health outcomes. Those youth with the highest substance abuse and externalizing symptoms had, in general, the highest rates of self-reported symptoms and illnesses, and may need more support in treating their physical as well as mental health. Overall, functioning class was related to certain health problems which often have a stress component. The lower support/higher internalizing symptoms had a higher probability of overweight status than the high support/lower symptoms class while the lower support/high externalizing/substance abuse symptoms did not, which may be related to lower food consumption in adolescents with substance abuse issues. The association of physical problems with functioning level may help explain how some maltreated youth grow up with better physical health whereas others have numerous physical problems.