Methods: We conducted a longitudinal study with a purposive sample of caregiver child dyads (n = 215) referred for services because of difficulty meeting basic needs. Participants had physical custody (> 6 months) of at least one child ages 5 to 11 years, at least two risk factors for abuse/neglect, and no child protection system involvement at intake. Caregivers were predominantly female (98.0%), African American (94%) and unemployed (79%). On average, caregivers were 36 years old (SD = 11.41), had 11 years of education (SD = 1.37), and annual incomes of $11,737.00 (SD = $11,453). We measured dissociative symptoms (Trauma Symptom Checklist; Briere, 1996), violence/victimization exposure (Traumatic Events Screening Inventory; Ford et al, 2000), and caregiver depression (Center for Epidemiological Studies Depression Scale; Radloff, 1977) at three timepoints. Path analysis using Mplus tested the moderating effect of depressive symptoms on the relationship between violence/victimization exposure and child dissociation over time. Paired-sample t-tests tested pre/post-intervention changes in child dissociation.
Results: Baseline child dissociation scores were high (M=52.24; SD=10.42). Child characteristics, gender (b=3.97, p=.02, 95%CI:0.53,7.42), age (b=1.35, p=.001, 95%CI:0.58,2.14), and violence/victimization exposure (b=0.89, p=.001, 95%CI:0.38,1.42), were predictive of child dissociation. Caregiver functioning (physical, social, emotional) and depression were not statistically significant predictors. A moderate-large effect size was observed (R2=.25, p<.001). A statistically significant moderating effect of caregiver depression (b=-0.06, p=.01, 95%CI:-0.11,-0.01) suggested the relationship between child violence/victimization exposure and dissociation weakens when higher levels of caregiver depression are present. Additionally, higher dissociation scores at T1 were predictive of higher T3 scores (b=0.29, p=.02, 95%CI:0.05,0,51). A large effect size was observed (R2=.29, p=.01). Child dissociative symptoms decreased post-intervention (M=2.87, SD=11.25, 95%CI:0.69-5.04, p=.01).
Conclusions/Implications: Children reported high dissociative symptoms. Data suggest girls, older children and those exposed to more violence/victimization were at greater risk of experiencing dissociation. Caregiver depression impacted dissociation differentially based on violence/victimization exposure suggesting a complex intergenerational relationship. Practice implications align with existing evidence supporting the need for family-based interventions to improve children’s mental health and decrease dissociation symptoms. Policies should reflect this by financially supporting family-based interventions that include caregivers and address their symptoms in a family context. Future research should focus on identifying and examining child dissociation which is often misdiagnosed.