Coleman_2010.pdf
Prevalence and Impact of Childhood Maltreatment in Incarcerated Youth
Daniel Coleman and Lisa M. Stewart Portland State University
The prevalence of childhood maltreatment and the magnitude of the association of mal- treatment with internalizing mental health symptoms were examined in 398 incarcerated
youth. The prevalence of abuse greatly exceeded general population rates. The proportion of variance in mental health symptoms accounted for by maltreatment was small but developmentally significant. Sexual abuse is a markedly stronger predictor of internalizing
mental health problems in incarcerated youth than physical abuse. Consistent with a bio- psychological model of trauma, dissociation at the time of sexual abuse was the strongest nondemographic predictor of mental health symptoms. Physical abuse was associated with more internalizing mental health problems for children from families with mental
health problems and families with lower socioeconomic status. Implications for practice and research are discussed.
T he majority of incarcerated youth have experienced trauma, including childhood sexual abuse (CSA), child-
hood physical abuse (CPA), domestic violence, and street violence (Carrion & Steiner, 2000; Dembo et al., 1992; McMackin, Leisen, Sattler, Krinsley, & Riggs, 2002). Trauma
exposure is linked to both behavior disorders and emotional problems (Ford, 2002; Greenwald, 2002). For some youth, trauma exposure may be a pivotal developmental experience, leading to a cascade of events ending in mental health problems
and incarceration. Incarcerated youth are a vulnerable popula- tion, disproportionately from lower socioeconomic status (SES), and often experiencing family conflict, family substance abuse
(FSA), and family mental health (FMH) problems. This cluster of risk factors increases the likelihood of incarcerated youth developing serious mental health consequences following a trau-
matic event (McNally, 1999). The rates of mental health problems in incarcerated youth
exceed the number of disorders and severity of symptoms found
in youth treated in community mental health (Atkins et al., 1999). Few studies of incarcerated youth have provided effect size estimates of the association of trauma and mental health problems (Brown, Cohen, Johnson, & Smailes, 1999; Gover,
2004). In part due to small sample sizes, most studies of incar- cerated youth have tested simple main effects models of child and trauma characteristics predicting mental health outcomes.
To address these gaps, secondary analysis of an existing data set investigated the effects of physical and sexual abuse on the
anxiety, depression, and interpersonal sensitivity of incarcerated youth, controlling for other risk factors and examining interac-
tive effects. This data set, collected by Richard Dembo and col- leagues in the late 1980s (Dembo, 2002), continues to merit analysis. The data set includes complex assessment of childhood
maltreatment, the sample size is adequate to support relatively complex multivariate and interactive analyses, and the outcome measures include a range of mental health constructs. The theoretical and empirical foundation of this study is the
biopsychological model of trauma. Trauma response is not lim- ited to psychological consequences, but traumatic stress is rooted in changes in brain chemistry and biology (Bremner,
2005; DeBellis, Keshavan, Shifflett, & Iyengar, 2002). As van der Kolk (1994) stated, ‘‘the body keeps the score’’ of trauma (p. 253). Persistent posttraumatic symptoms are higher in those
who dissociate in response to the trauma (Birmes, Brunet, Carr- eras, Ducasse, & Charlet, 2003). Dissociation is a marker that the normal coping processes based in the language-dominant
neocortex are overwhelmed by a trauma, and responding to the trauma is left to more primitive parts of the brain. van der Kolk (2002) describes dissociation as the ‘‘speechless terror’’ of the trauma victim. The traumatic experience is burned into the pre-
linguistic subcortical parts of the brain, unmediated by con- scious thought. The nature of traumatic memory is paired with dysregulation of neurotransmitters tied to emotion and threat-
response (van der Kolk, 2002). Planning this secondary analysis balanced examination of
empirically based theory and the existing literature with the vari-
ables available in the data set. From the mental health variables collected in the study, depression and anxiety were selected as the two most common consequences of childhood maltreatment
Correspondence concerning this article should be addressed to Daniel
Coleman, School of Social Work, Portland State University, Portland,
OR 97207. Electronic mail may be sent to [email protected].
American Journal of Orthopsychiatry � 2010 American Orthopsychiatric Association 2010, Vol. 80, No. 3, 343–349 DOI: 10.1111/j.1939-0025.2010.01038.x
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(Paolucci, Genuis, & Violato, 2001; Springer, Sheridan, Kuo, & Carnes, 2007). Reflecting the biopsychological theoretical model
of trauma, interpersonal sensitivity was chosen as a measure of personality-level difficulties such as rejection sensitivity and instability of emotions associated with complex post-traumatic
reactions (van der Kolk, 2005). Another hypothesis based in a biopsychological model is the central role of dissociation. Within the sexually abused participants, we examined the associ- ation of demographic variables, dissociation, and other abuse
characteristics to posttraumatic symptoms.
Maltreatment and Incarcerated Youth
Prevalence
Exposure to at least one DSM criterion A stressor appears to be a common experience for Americans by early adulthood, with survey estimates ranging from 40% to over 90% (Costello,
Erkanli, Fairbank, & Angold, 2004; McNally, 1999). It is likely that incarcerated youth have experienced more traumatic experi- ences, and more intense traumas, than general population teens (Brosky & Lally, 2004; Coleman, 2005).
In a meta-analysis of prevalence studies, Bolen and Scannapi- eco (1999) estimated a general population sexual abuse victim- ization prevalence rate of 13% for boys and 30%–40% for girls.
CSA prevalence rates in incarcerated youth are generally twice the general population rate for males, but rates for incarcerated females are similar to general population estimates (Coleman,
2005; Dembo et al., 2000). Dembo et al. (2000) found that 38% of incarcerated youth
reported physical abuse. Incarcerated youth also experience physical traumas at high rates when they are incarcerated.
Woolf and Funk (1985) found such rates 4 to 8 times greater than those of nonincarcerated youth.
The Impact of Maltreatment on Mental Health Problems
There are differences in the mental health effects of the most prevalent trauma exposures. For example, posttraumatic stress disorder (PTSD) occurs at over twice the rate in sexual versus
nonsexual assaults (McNally, 1999). A large longitudinal study from childhood into young adulthood found child sexual abuse much more predictive of later mental health problems than physical abuse or neglect (Brown, Cohen, et al., 1999).
Meta-analyses of the effects of sexual abuse give estimates of main effects across numerous studies, often not controlled for other variables. In two meta-analyses, the meta-analytic correla-
tion of CSA to anxiety, depression or psychological distress ran- ged from .196 (R2 = .038) to .24 (R2 = .057; Paolucci et al., 2001; Weaver & Clum, 1995; Paolucci et al., 2001). In contrast,
Rind and Tromovitch (1997) conducted a meta-analysis of seven general population CSA prevalence studies and found meta-ana- lytic correlation coefficients for CSA and psychological distress
of .07 for men and .1 for women, accounting for 1% of the vari- ance or less. The proportion of variance in mental health symp- toms accounted for in the meta-analyses reviewed ranged from < 1% to nearly 6%, and for those that included clinical sam-
ples the range was approximately 4%–6%.
Briere and Elliott (2003) estimated the effect size of childhood abuse and interaction effects on PTSD symptoms in a nationally
representative sample of adults. For both anxiety and depres- sion, sexual and physical abuse together accounted for 8% of the variance, with the beta coefficients for sexual abuse approxi-
mately 2 times the size of physical abuse. An instructive risk factor–outcome benchmark is provided by
Briere and Elliott (2003): The meta-analytic correlation of smoking and lung cancer is .12 (R2 = .014). A benchmark from
developmental psychology is the meta-analytic correlation of mother’s psychopathology with child internalizing problems of .18 (R2 = .03), and of father’s psychopathology with child
internalizing problems of .14 (R2 = .02) (Connell & Goodman, 2002). Sulloway (1996) provides the following guidance on interpreting effect size: ‘‘Relatively small correlations constitute
surprisingly large effects, despite modest amounts of ‘variance explained’ and should not be dismissed as unimportant’’ (p. 372).
Specific to incarcerated youth, Brown, Henggeler, Brondino, and Pickrel (1999) found that sexually abused youth had higher rates of internalizing problems and those exposed to domestic violence had higher rates of externalizing problems. For psychi-
atric comorbidity, sexual abuse accounted for 8% of the vari- ance, second only to gender in strength. Trauma variables accounted for 2% of the variance in internalizing disorders, less
than expected. Gover (2004) estimated the effect of sexual abuse in a large national sample of incarcerated youth (n = 588). She found sexually abused youth experienced depression levels one
half of a standard deviation above those who did not report sex- ual abuse (R2 = .06). In summary, the studies specific to incar- cerated youth found effect sizes of CSA ranging from 6% to
8% of the variance in psychological distress. Fewer studies reported effect sizes for CPA, but the existing research indicates that CSA has a more powerful negative influence on mental health than CPA.
This study will examine the following research questions:
1. Controlling for other risk factors, what proportion of the variance in the mental health problems (anxiety, depres-
sion, and interpersonal sensitivity) of incarcerated youth are due to sexual and physical abuse (main effects)?
2. What is the influence on mental health of interactive effects of the independent variables?
3. In the sexually abused subsample, which demographic and abuse experience variables, including dissociation, are associated with higher mental health symptoms?
Method
Design
The data for this study were collected by Dembo and colleagues, with data collection finishing in the late 1980s (Dembo, 2002). A survey design was utilized with questionnaires
completed by interview with 398 participants at intake to a regional detention center in Florida. In addition to the original human subjects review, secondary analysis of this data was approved by the human subjects committee at Portland State
University.
344 COLEMAN AND STEWART
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Sample
Ninety-eight percent of eligible youth agreed to participate in the study. Of the 398 subjects in the sample, 285 (71.6%)
were male and 113 were female (28.4%). Two hundred and eighteen subjects were White (54%) and 169 (42%) were Afri- can American. The average age was 15.4 years (SD = 1.49). One third of the sample came from families supported by a
primary wage earner who worked in a low-skill occupation, and 21% of the families were primarily supported by public assistance.
Measures
Control variables. Construction of variables to measure substance abuse, SES, FMH, and FSA followed procedures
described by Dembo et al. (1992). FSA was measured by four items that tapped family use of drugs or alcohol, and family receipt of treatment for substance abuse. A summative scale was formed of these four items with marginal reliability (Cronbach’s
a = .63). FMH was measured by two items that tapped the presence of FMH problems, and mental health treatment. A summative scale was formed of these two items with very good
reliability (Cronbach’s a = .89). An ordinal scale of family SES was constructed based on parent’s occupation and parental edu- cation level. Youth substance abuse (YSA) was measured
through times of lifetime use of nine categories of substances. The nine items were factor analyzed by principal components analysis, extracting and saving a single factor that accounted for 55% of the variance.
Childhood physical abuse. Six items measuring the fre- quency of different kinds of child physical abuse (e.g., struck
with a hard object, shot with a gun) were factor analyzed by principal components analysis, extracting and saving a single factor that accounted for 63% of the variance.
Childhood sexual abuse. This was defined using the criteria and coding procedures outlined by Dembo et al.
(1992), which followed Finkelhor’s (1979) sexual abuse survey procedures. The interview elicited detailed information about the type of abuse, relationship to perpetrator(s), age of victim and perpetrator when the abuse occurred, and the victim’s
response to the sexual abuse. Fifty-five percent of the sample (221 youth) indicated a history of a sexual experience with an adult. Those who reported sex with an adult were coded
as yes for CSA if they met at least one of the following crite- ria: the perpetrator was a parent, the participant was younger than 13 at the time of the abuse, the age difference between
perpetrator and victim was 5 years or greater, force or threat was used, or the participant experienced dissociation in response to the abuse.
For the analysis of correlates of mental health symptoms in the sexually abused subsample, the following individual CSA variables were used: perpetrator was a parent, participant age when sex occurred, age and gender of perpetrator, force was
used, dissociation occurred at the time of the abuse, and the number of times participant had sex with an adult.
Youth mental health measures. The mental health- dependent variables examined in this study were the General
Severity Index (GSI), and the anxiety, depression, and interper- sonal sensitivity subscales of the Symptom Checklist 90 (SCL– 90), a widely used broad spectrum measure of mental health
symptoms with strong reliability and validity (Derogatis, 1983).
Analyses
The distributions of individual variables, bivariate combina- tions of variables, and multivariate models were examined for normality, equal variance, and linearity. The distributional
assumptions were judged to be adequately satisfied to proceed with the planned analyses. Multiple regression and semipartial squared correlation were
used to analyze the impact of sexual and physical abuse on men- tal health, controlling for family SES, ethnicity, gender, YSA, FSA, and FMH. Age had very narrow variability in this sample,
and had no bivariate associations with the dependent variables, so it was not included in the multivariate models. For the dependent variables, depression, anxiety, and interpersonal sen- sitivity, hierarchical regression models were constructed. At Step
1, the demographic, social, family, and abuse variables were entered into the regression simultaneously, At Step 2, the 12 the- oretically selected interaction terms (CSA and CPA · each of
the other main effects, CSA · CPA, and Gender · Ethnicity) were entered and a final model was arrived at by backwards removal of nonsignificant interaction terms. For the analysis of
correlates of mental health symptoms among the sexually abused participants, bivariate correlations were computed.
Results
Prevalence of Sexual and Physical Abuse
A total of 92 participants (23.1%) reported CSA, with girls (50 of 112) 3 times more likely than boys (42 of 284) to report CSA, v2(1) = 40.14, p < .000. CSA was not related to age or
ethnicity. CPA was reported by 169 respondents (42.5%), with boys 1.6 times more likely than girls, v2(2) = 7.928, p < .05. African Americans were 1.8 times less likely to report
CPA—29% of African Americans versus 71% of others— v2(2) = 22.73, p < .000. No significant relationship was found between CPA and the age of the youth.
Estimating the Effect Size of Maltreatment on the Mental Health of Incarcerated Youth
Table 1 shows the intercorrelations of the variables for the first two research questions. CPA was not associated with anxi- ety, depression, or interpersonal sensitivity. CSA was correlated
with all three mental health variables, with bivariate R2 ranging from .026 for interpersonal sensitivity to .053 for anxiety. In comparison, the strongest bivariate correlate of any one of the mental health variables was FMH problems with anxiety (bivar-
iate R2 of .11). Table 2 presents the results of the regression models. Family
SES and physical abuse did not reach statistical significance as a
CHILDHOOD MALTREATMENT IN INCARCERATED YOUTH 345
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main effect in any model. The main effects model for anxiety found four variables positively associated with anxiety. In decreasing strength, they were FMH, YSA, CSA, and FSA. The final interaction model accounted for 24% of the
variance in anxiety, with four interaction terms. The strongest
interaction term of Physical Abuse · FMH indicated that above and beyond the main effect association of FMH, those children with FMH problems and physical abuse experienced markedly higher anxiety. The next two strongest interaction terms had
negative associations (a protective effect): Children with CPA
Table 1. Inter correlations of Independent and Dependent Variables
1 2 3 4 5 6 7 8 9 10
1. CPA —
2. CSA .029 —
3. SES .091 ).050 —
4. FSA .077 .106* .040 —
5. FMH .138** .068 ).011 .259** —
6. Gender .002 ).295 ).034 .009 .043 —
7. White ).047 .095 .064 .194** .269** ).114* —
8. YSA .131* .203** .103* .237** .215** .010 .384** —
9. Anxiety .065 .228** ).023 .262** .328** ).112* .243** .283** —
10. Depression .069 .220** ).017 .246** .302** ).166** .261** .250** .821** —
11. Interpersonal sensitivity .029 .159** ).032 .235** .249** ).184** .155** .152** .760** .771**
Note. CPA = childhood physical abuse; CSA = childhood sexual abuse; SES = socioeconomic status (family); FSA = family substance abuse;
FMH = family mental health; YSA = youth substance abuse.
*p < .05. **p < .01.
Table 2. Multiple Regression Models of Anxiety (n = 365), Depression (n = 367), and Interpersonal Sensitivity (n = 367)
R2 Outcome Predictor
Step 1 Step 2
b sr2 b sr2
.21*** Anxiety CPA .008 — .14 —
CSA .14** .02 .13* .014
SES ).03 — ).04 —
FSA .13* .014 .05 —
FMH .22*** .042 .23*** .045
Gender ).05 — ).05 —
White .08 — .08 —
YSA .16** .02 .15** .016
.24*** CSA · FSA — — .13* .011
CPA · SES — — ).29* .008
CPA · FMH — — .47* .013
CPA · YSA — — ).33* .011
.17*** Depression CPA ).03 —
CSA .13* .013
SES ).03 —
FSA .12* .013
FMH .20*** .034
Gender ).11* .01
White .12* .012
YSA .10 —
.12*** Interpersonal
sensitivity
CPA ).01 —
CSA .08 —
SES ).02 —
FSA .16** .021
FMH .17** .025
Gender ).15** .019
White .03 —
YSA .07 —
Note. CPA = childhood physical abuse; CSA = childhood sexual abuse; SES = socioeconomic status (family); FSA = family substance abuse;
FMH = family mental health; YSA = youth substance abuse; sr2 = semipartial squared correlation.
*p < .05. **p < .01. ***p < .001.
346 COLEMAN AND STEWART
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who abused substances or from higher SES families had lower anxiety levels. The final significant interaction term (CSA · FSA) indicated that sexually abused children from substance- abusing families had additional risk for anxiety beyond the baseline risk of CSA or FSA by itself. Controlling for the other
variables in the model, CSA accounted for 1.4% of the variance in anxiety, and CSA · FSA accounted for 1%. The three significant physical abuse interaction terms each account for approximately 1% of the variance in anxiety.
The regression model for depression had no significant inter- action terms. Five main effect variables were significant, accounting for 19% of the variance in depression. Again, FMH
was the strongest variable, followed by CSA and ethnicity (White). Controlling for the other variables in the model, CSA accounted for 1.4% of the variance in depression.
The regression model for interpersonal sensitivity had three significant main effects and one significant interaction term, accounting for 15% of the variance in interpersonal sensitivity.
FMH was the strongest predictor followed by FSA. There was a modest effect that male participants had lower interpersonal sensitivity scores. In the interaction term model, a nonsignificant trend was evident that physically abused participants who also
abused substances (CPA · YSA) scored lower on interpersonal sensitivity. Neither CSA nor CPA had a significant association in the multivariate analysis.
The final analysis examined the impact of social, familial, and abuse variables on overall symptom severity in the subsample of sexually abused teens (n = 92). The SCL–90 GSI scale of gen-
eral psychiatric symptoms was used as the dependent variable in this analysis. The strongest predictor of higher symptoms was identifying as White (r = .36, p < .05). Dissociation at the time
of abuse was positively correlated with symptom severity (r = .32, p < .05). The age of the abuser was also correlated with higher symptom severity in youth (r = .26, p < .05). Lastly, there was a positive correlation with symptom severity if
the perpetrator of the abuse was a parent (r = .25, p < .05). There were 7 participants who reported sexual abuse by a par- ent (8% of those who reported sexual abuse).
Discussion
Incarcerated youth in this sample reported high rates of expo- sure to sexual and physical abuse, rates close to previous esti- mates. The participants reported sexual abuse at more than twice the general population prevalence. Convergent with prior
research on both general population and incarcerated youth, girls are more likely to report experiencing sexual abuse (Briere & Elliott, 2003; Dembo et al., 2000).
Physical abuse was slightly higher in this sample than reported by Dembo et al. (2000) in a similar sample of incarcer- ated youth, and more than twice general population prevalence
(Briere & Elliott, 2003). The differential prevalence of physical abuse among boys and girls in this sample conflicts with general population studies, which find similar rates of physical abuse in
both boys and girls (Briere & Elliott, 2003). CPA had no bivariate or main effects association with mental
health in the multivariate models. However, the interaction term analysis found several significant CPA interaction terms. Among
those kids who were physically abused, higher SES and substance
abuse were protective against anxiety, and FMH problems exacerbated anxiety. These findings underline the importance of
interaction term analyses: Main effects analyses would lead to the incorrect conclusion that CPA has no relationship to anxiety in this sample. In fact, children from low-income backgrounds,
or with mentally ill family members, are more likely to have mental health consequences of physical abuse. In addition, sub- stance abuse may mask physical abuse reactive mental health symptoms. In the anxiety model, each of these interaction terms
accounts for approximately 1% of the variance. Using the most liberal estimate of effect size (bivariate corre-
lations), CSA accounted for approximately 5% of the variance
in anxiety and depression, and 2.5% of the variance in interper- sonal sensitivity. In the more conservative estimates of the multivariate models, the strongest effect was found for CSA on
anxiety symptoms, with CSA accounting for 1.4% of the vari- ance and interaction terms explaining an additional 1.1% of variance (2.5% total). For depression, a more modest amount
of unique variance was explained by CSA (1.3%). CSA was the second strongest risk factor across the three
models, following FMH problems. The variable FMH problems likely taps into several influences, including: genetic predisposi-
tion, the influence of learned patterns of emotions and cognition, and adaptation to stressful, confusing or unempathic parental behaviors as a consequence of parental mental health symptoms.
The third strongest main effect across the models was FSA problems. Not only does FSA itself have a negative effect on youth mental health, but those who experienced CSA in the
context of FSA had significantly worse anxiety (CSA · FSA interaction term). These findings could reflect underlying genetic dispositions to anxiety in substance-abusing families, or reduced
protective factors of care and support for abused youth in sub- stance-abusing families. Strengths of the study include a large sample for a forensic or
clinical study, and detailed assessment of childhood maltreat-
ment. The study also includes a larger proportion of females than many juvenile justice studies, allowing more confidence about results across gender. Limitations include a cross-sec-
tional design and a sample limited to one geographic area in the United States. Only White and African American youth were well represented in this sample, so conclusions about ethnicity
are limited to those two groups. A measure specific to mental health consequences of trauma such as Briere’s (1995) Trauma Symptom Inventory may have better captured the variance in trauma-related mental health problems than the SCL–90. The
three outcome variables used are all internalizing mental health symptoms, leaving unmeasured behavioral disturbance. As externalizing symptoms might mask internalizing, a more com-
plete model could be constructed with data that include mea- sures of both internalizing and externalizing symptoms. As noted in the Introduction, the data set was collected in
1989, so factors subject to change over time such as trends in drugs of abuse may not represent current patterns. For this reason, a general underlying factor of drug and alcohol use was
analyzed rather than the use of individual substances. The juvenile justice system has also experienced change since these data were collected. Overall, the sample size and thorough measurement of maltreatment make this data set of enduring
interest.
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CSA stands out as a risk for internalizing mental health prob- lems, controlling for other family problems. Although physical
abuse and witnessing domestic or street violence is undoubtedly traumatic, the pseudointimacy and often confused emotional messages of sexual abuse make for a more profoundly disturb-
ing traumatic experience. This is consistent with previous research that has found sexual assault results in much higher rates of PTSD and slower rates of remission of symptoms than other types of assault (McNally, 1999). The association of
sexual abuse with depression and anxiety replicated results in earlier studies of incarcerated youth (Brown, Cohen, et al., 1999; Coleman, 2005). The effect sizes fell at the high end of the
meta-analytic estimates reviewed earlier. The magnitude of the effect shows that CSA is among the few strongest risk factors for mental health problems. The association of CSA and mental
health problems, on average, exceeds the correlation of smoking and lung cancer (Briere & Elliott, 2003) and is similar to the association of parental mental health problems with child men-
tal health problems (Connell & Goodman, 2002). As noted in the Introduction, apparently small effects are developmentally significant. The more severe consequences of sexual abuse than other
abuse experiences are consistent with neurobiological models of trauma adoption. The elevated levels of anxiety and depression likely reflect dysregulated neurochemical affective and danger
responses (van der Kolk, 2002). Among those who were sexually abused, the correlation of dissociation and mental health symp- toms also converges with neurobiological models. Dissociation
is a marker that normal coping resources are overwhelmed and the brain is engaging primitive danger responses. An older per- petrator and parent–child incest, the other significant correlates
of mental health symptoms in those who were sexually abused, are also trauma conditions likely to trigger the overwhelming fear and helplessness tied to dissociation.
Implications for Practice
This study joins a growing body of evidence that trauma rates
are disproportionately higher in incarcerated youth and that trauma exposure is associated with behavioral and mental health problems. There is more than sufficient evidence to
warrant close clinical attention to trauma in incarcerated youth. However, as with research on trauma in broader populations, not all traumatized individuals develop criminal behavior or serious mental health symptoms. Ford (2002) comments:
‘‘Traumatic victimization is unlikely to be the primary cause of Oppositional Defiant Disorder or Conduct Disorder’’ (p. 28). The role of maltreatment and other traumas should be recog-
nized as one risk factor alongside family-level variables such as parental mental health and substance problems, nested within structural economic and social factors such as poverty and lack
of opportunity. Taking this broad view of causes for mental health problems,
there is a need for clinicians working in corrections to be trained
to recognize and treat trauma, including an understanding of dissociation. Although exceeding the scope of this study, there is promising evidence for cognitive approaches (Ahrens & Rexford, 2002) and eye-movement desensitization reprocessing
(Soberman, Greenwald, & Rule, 2002).
Implications for Research
The previous section argued for recognizing the role of trauma, without overly weighting trauma in relation to other
developmental influences. However, there is a need for research to estimate the impact of maltreatment and other trauma on the development of criminal behavior. Clinical and forensic samples are biased in not including youth who experienced similar risk
factors but did not enter the corrections or mental health sys- tem. Studies are needed with national probability sampling, pos- sibly with oversampling of youth in the juvenile justice system,
or case–control studies drawing matched normal population samples to a forensic sample. It is possible that current research underestimates the effect of trauma, as it is largely conducted
on samples of youth already in the juvenile justice system. Out- side of the scope of this study, there is extensive need for the development and testing of assessment and treatment protocols
for traumatized youth in juvenile justice. It is interesting that sexually abused White youth showed
higher risk for internalizing mental health symptoms than sexu- ally abused youth of color (predominantly African Americans
in this sample). This may reflect protective cultural factors in the support received by youth of color, with high extended fam- ily support and strong ties to religious community (Abney &
Priest, 1995; Neville, 1997). Protective cultural factors warrant further quantitative and qualitative investigation.
Conclusion
Incarceration before adulthood is the result of a combination of genetic factors, social disadvantage, family conditions such as
mental illness and substance abuse, childhood maltreatment, and other traumas. The rates of childhood maltreatment are markedly higher in incarcerated youth, and these traumas are
associated with internalizing mental health problems. Consistent with previous research, CSA had more deleterious effects, but youth from families with mental health problems and lower
income backgrounds suffered stronger negative effects of CPA. Consistent with the empirically based bio-psychological model of trauma adoption, dissociation and sexual abuse characteris-
tics likely to trigger dissociation were associated with higher mental health symptoms. Professionals working in juvenile jus- tice can use these results, in conjunction with the broader litera- ture, to inform their understanding, assessment, and treatment
of incarcerated youth.
Keywords: adolescents; incarcerated youth; child abuse and neglect; juvenile delinquency; emotional disturbance; trauma;
victimization; social class
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