Female Caregivers Surviving Violence Exposure and Extreme Urban Poverty: The Role of Attributions and Post Traumatic Stress

Background: Traumatic experiences have long been associated with adverse effects on psychological functioning, physical health, and well-being. Estimates suggest nearly 12 percent of adults exposed to trauma will develop Post Traumatic Stress Disorder (PTSD), with females disproportionately impacted (Shalev et al, 2019). However, the association between violence exposure, event centrality and PSTD is understudied. This study aimed to delineate the role of violence exposure on trauma symptoms in a sample of low-income, urban caregivers. Building on previous research, both direct and indirect effects were hypothesized: 1) violence exposure, depressive symptoms, and event centrality will be associated with trauma symptoms; 2) there will be an indirect effect of depressive symptoms on the relationship between violence exposure and trauma symptoms; and 3) there will be an indirect effect of event centrality on the relationship between violence exposures and trauma symptoms.

Methods: Data were drawn from a study of families at risk for child maltreatment in a large East Coast metropolitan city in the United States. Socio-demographic variables and established measures of depressive symptoms, PTSD, violence exposures and event centrality were collected via self-report questionnaire by trained study staff. Path analysis using Mplus statistical software v7 tested study hypotheses after controlling for key socio-demographics (age, income).

Results: Participants (n = 215; Mean age = 36 years) were predominantly female (98.0%), African American (94%), unemployed (79%), and impoverished with an annual family income under $12,000. Participants reported a high level of traumatic experiences, with an average of 11.13 lifetime violent events (SD = 4.57). The majority presented with clinically significant levels of depressive symptomology (CESD Mean=21.15) and PTSD (PCL-C Mean=42.21). Significant positive associations were found among number of violent events, event centrality, depressive symptoms, and PTSD symptoms. Statistically significant indirect effects of the centrality of events and depressive symptoms on the relationship between trauma experiences and trauma symptoms were also observed.

Implications: The direct effect of centrality of events supports the importance of how individuals understand and incorporate traumatic events into their life story and personal narrative as a predictor of PTSD symptoms. Findings suggest that female caregivers residing in poverty both report high rates of traumatic events and are more likely to incorporate those events into their life story and personal narrative making them more vulnerable to both depression and PTSD. Therapeutic techniques that incorporate life stories, such as narrative therapy, are critical in addressing trauma symptomatology in this population.

Shalev, A.Y., Gevonden, M., Ratanatharathorn, A., Laska, E., van der Mei, W.F....& van Zuiden, M. (2019). Estimating the risk of PTSD in recent trauma survivors: Results of the International Consortium to Predict PTSD (ICPP). World Psychiatry, 18, 77-87.