The Impact of Caregiver Depression, Exposure to Violence/Victimization, and a Trauma Informed Prevention Intervention on Child Dissociation in Urban African American Families Surviving Poverty

Background/Purpose: Dissociation in children following exposure to violence/victimization is a serious public health concern associated with adverse developmental outcomes. Child dissociation is estimated to impact 19 to 73% of children with clinical estimates between 24 and 44%. Measurement of severity and frequency may be influenced by reporter and child self-reported data are scarce as are interventions to mitigate children’s dissociative symptoms. Furthermore, risk factors for child dissociation are not well delineated. We posed the following question to address these gaps in trauma science literature using data collected from families at risk for child maltreatment and/or neglect living in an East Coast metropolitan city: (1) What level of dissociation do children experience? (2) What is the relationship between child dissociation, exposure to violence/victimization and caregiver depression? and (3) Does a trauma responsive prevention intervention reduce children’s dissociation?

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.