Longitudinal Trajectories of Family Conflict and Associations with Downstream Youth Mental Health: Examining Maltreated Adolescents Who Remain with Families

Background/purpose: Child maltreatment (CM) is a social problem linked with youth depression and externalizing problems (mental health/MH). Approximately 75% of maltreated youth remain home/with their families. During adolescence, some mild-fluctuating family conflict is expected, but maltreated youth may face elevated/atypical conflict levels and in turn, worse MH. Since MH outcomes and family conflict during adolescence may be linked, this study sought to examine longitudinal associations between conflict trajectories and subsequent MH outcomes among maltreated youth. Our aims assessed: 1) emergent family conflict trajectories/classes across adolescence; 2) risk for elevated/atypical trajectories; and 3) relationship between classes and MH outcomes. We hypothesized that maltreated youth would experience elevated/atypical trajectories of family conflict, and that elevated/atypical conflict would predict worse MH outcomes.

Methods: Four timepoints (T1-T4) of a prospective study on CM were analyzed. Our sample included urban youth remaining with families following maltreatment (substantiation via case records; n=146) and comparison/non-maltreated youth/families from the same neighborhoods (n=142). Adolescents (T1 age=10.9, SD=1.1) reported on family conflict (Family Environment Scale/FES subscale), depressive (Child Depression Inventory/CDI), and externalizing symptoms (aggression and rule-breaking/delinquency subscales of Youth Self-Report/YSR) across all timepoints. Parents also reported on family conflict (FES). We took the manual three-step BCH approach using Mplus (v8.0) to extract heterogeneity in conflict from T1-T3 and ran multinomial logistic regression with maltreatment/comparison grouping predicting class membership – controlling for youth’s sex, ethnicity, and maternal education. We conducted pairwise comparisons of youth MH outcomes (T3-T4) using Bonferroni corrections (p<.008) and pseudo-class Wald χ² tests.

Results: A four-class solution of conflict trajectories emerged: high-decreasing, persistent-high, low-increasing, and persistent-low. Maltreated youth were more likely than comparison youth to belong to the high-decreasing relative to persistent-low (OR=3.965, p=.001) and low-increasing groups (OR=3.074, p=.035). The persistent-high group fared worse overall relative to persistent-low (b=.217, p=.002 and b=.175, p=.007, T3 and T4 respectively for depression; b=.286 and b=.243, both p<.001 for T3/4 aggression; b=.229 and b=.248, both p<.001 for T3/4 rule-breaking/delinquency). Post hoc analyses showed trends which may suggest the high-decreasing group experienced increases in average depressive and rule-breaking/delinquency symptoms from T3-T4, despite decreasing/lowering T2-T3 family conflict. Discrepancy between youth- and parent-report family conflict emerged, with parent-report conflict means for high-decreasing resembling more youth-report group's persistent-high means.

Conclusion/implications: Our hypotheses were partially supported: four family conflict trajectories emerged and largely tracked with MH outcomes. Persistent-high and low-increasing groups predicted worse MH relative to the persistent-low group. However, maltreated youth significantly differed in their class membership in only one way: more likely to belong in high-decreasing. Considered alongside our post hoc analyses, this finding suggests youth in the high-decreasing group may be disengaging from families and face greater MH risk downstream. Future social work science might consider replicating/extending these findings using a larger sample and rigorous methods (e.g., multisource/multimethod) to aid in identifying robust predictors of persistently-high-conflict families who show all-around risk for poorer youth MH outcomes. Our findings also encourage practitioners to identify/provide higher conflict families, comprehensive services (e.g., Multisystemic or Functional Family Therapy), particularly in light of the Family First Act of 2018.