Child maltreatment severity and adult trauma symptoms: Does perceived social support play a buffering role?☆
Introduction
Child maltreatment (i.e., sexual, physical, and emotional abuse; physical and emotional neglect) has long been recognized as a traumatic event capable of producing long-term psychological distress, including post-traumatic stress symptoms. However, there is substantial variability in the degree of long-term psychological difficulties reported by adult survivors. Recent research has focused on factors that may explain this variation. One such factor is the nature and severity of the maltreatment itself. Several studies of sexual abuse survivors suggest that abuse characteristics indicative of increased severity (e.g., more invasive, frequent, or enduring acts) contribute to increased long-term difficulties, including trauma symptoms (Risser et al., 2006, Steel et al., 2004, Trickett et al., 2001). In fact, in one population-based study of adult women, abuse involving penetration was found to be the single best predictor of PTSD (Kilpatrick et al., 1989). Although maltreatment types other than CSA have been less often studied, abuse severity of these types also appears to play a role in adjustment following maltreatment. For example, child physical abuse (CPA) resulting in greater physical injury has been linked to increased psychotic symptoms among adults (Schenkel, Spaulding, DiLillo, & Silverstein, 2005), while increased severity of emotional abuse, as rated by trained interviewers, is associated with more severe levels of depression (Bifulco, Moran, Baines, Bunn, & Stanford, 2002). Together, these findings suggest the importance of considering maltreatment severity – rather than simply dichotomizing samples into victims and nonvictims – when examining these experiences as risk factors for adult psychological symptoms.
Social support is another factor that may contribute to the variability in long-term impairment among adult victims of child maltreatment. Social support has been theorized to shield trauma-exposed individuals from the development of posttraumatic symptoms (Brewin et al., 2000, Guay et al., 2006). According to the stress buffering model, social support may mitigate the psychological impact of a stressful event by attenuating the stress appraisal response (Cohen & Wills, 1985). That is, an individual may deem an event less stressful if he or she perceives that others will provide resources needed to cope with the event. Social support following the stressful event may also facilitate cognitive and emotional processing, allowing victims to reappraise the event in a more adaptive manner (Thoits, 1986, Williams and Joseph, 1999). Meta-analytic findings show that a lack of social support is the single strongest predictor of the development of traumatic stress symptoms among military and civilian populations exposed to psychological trauma (ES = 0.40; Brewin et al., 2000). While the studies included in this meta-analysis examined varying types of social support (e.g., perceived social support, structural support, functional support), researchers (Cohen and Wills, 1985, Sarason et al., 2001) have found that perceived social support, in particular, best moderates psychological distress. In other words, the perception of one's ability to access social support, if needed, is likely more valuable than the actual support received immediately following a stressful event.
A number of studies support the notion that perceived social support lessens the long-term impact of maltreatment. For example, perceived social support may protect against feelings of loss among adult female victims of CSA attending college (Murthi & Espealage, 2005). Similarly, greater perceived social support from a spouse may increase resilience to difficulties in various domains of functioning among both female and male survivors of CSA, CPA, and neglect (Dumont, Widom, & Czaja, 2007). Among women seeking treatment at an outpatient clinic for psychological difficulties related to CSA, treatment focused on increasing the perception of available social support as a means of improving self-esteem also attenuated symptoms of post-traumatic stress disorder (Hyman, Gold, & Cott, 2003).
Despite these findings, there may be limits to the protective function conveyed by social support, particularly in cases of severe child maltreatment. Specifically, victims of severe maltreatment may perceive that the resources provided by family and friends will not provide sufficient benefit to aid in coping with intense post-traumatic reactions associated with severe victimization (e.g., fear, anger, avoidance). Findings from two prior studies support the possibility. In a study of undergraduate students (Scarpa, Haden, & Hurley, 2006), perceived social support from friends served as a buffer between community violence victimization (i.e., violence experienced within one's home, school, or surrounding neighborhood) and PTSD symptoms only when individuals had experienced fewer incidents of violence. In a second study, which examined adolescents and young adults transitioning out of the child welfare system, the effect of perceived social support in buffering relations between child maltreatment and depression diminished as the number of types of maltreatment experienced increased (Salazar, Keller, & Courtney, 2011). These studies suggest an attenuated benefit of social support with increasing trauma severity.
In sum, considerable evidence indicates that more severe child maltreatment is associated with increased psychological difficulties, including trauma symptoms, among adult victims (Bifulco et al., 2002, Risser et al., 2006, Schenkel et al., 2005). Further, theory and accumulating evidence indicate that perceived social support may buffer against the negative psychological consequences of child maltreatment (Dumont et al., 2007, Hyman et al., 2003, Murthi and Espealage, 2005). However, as indicated by recent empirical findings, the buffering effect of social support may vary depending on the severity and complexity of victimization experienced (Salazar et al., 2011, Scarpa et al., 2006).
Building on this work, a major goal of the present study was to examine the moderating effect of perceived social support on associations between maltreatment severity and adult trauma symptoms. In doing so, we extended the current literature by considering the severity of multiple abuse types and gender in this process. Although most studies have focused on female victims of sexual abuse, physical abuse, emotional abuse, and neglect have also been linked to long-term trauma symptoms and are reported as often by men as by women (U.S. Department of Health and Human Services, 2008). Moreover, men generally seek less social support, perceive lower levels of social support, and experience less psychological benefit from social support than do women (Cutrona, 1996, Flaherty and Richman, 1989, Turner, 1994, Walen and Lachman, 2000). Thus, it is possible that perceived social support plays a lesser role in buffering against maltreatment-related trauma symptoms among men.
Consistent with the above literature, we hypothesized that: (1) more severe child maltreatment of any type would independently predict increased trauma symptoms in both men and women; (2) increased perceived social support from both family and friends would predict decreased trauma symptoms in men and women; (3) an interaction would occur, such that associations between child maltreatment severity and trauma symptoms would diminish for both men and women as social support from family or friends increased; (4) as the severity of child maltreatment increased, the buffering effect of social support would be attenuated, and; (5) the buffering effect of perceived social support would be less likely among men than among women.
Section snippets
Participants
Participants for this study were 372 spouses recruited from a public database of marriage license records in a Midwestern county as part of a larger prospective study on the associations between child maltreatment history and adult interpersonal functioning. To qualify for the study, individuals had to be 19 years of age or older (the age of majority in the state where data collection took place) and be married for less than one year at the time of initial recruitment. Participants in the
Descriptive characteristics of the sample
Data analyses began with an assessment of descriptive data. Using dichotomous cutoff scores employed by Bernstein and Fink, 1998, (201) (54.0%) participants reported experiences that met the criteria for one or more forms of child maltreatment on the CTQ. Twenty-nine (15.6%) women and 9 (4.8%) men met criteria for sexual abuse, 29 (15.6%) women and 50 (26.9%) men met criteria for physical abuse, 61 (32.8%) women and 46 (24.7%) men met criteria for emotional abuse, 34 (18.3%) women and 40
Discussion
The primary aim of this study was to examine the unique and interactive impact of child maltreatment severity and perceived social support on adult trauma symptoms. We expected that increased maltreatment severity and decreased social support would individually and jointly predict greater trauma symptoms. Consistent with these predictions, greater severity of several maltreatment types (sexual abuse, emotional abuse, emotional neglect, and physical neglect) was associated with greater trauma
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2022, Child Abuse and NeglectCitation Excerpt :Conversely, lack of social support was associated with higher levels of stress as well as depressive and posttraumatic stress symptoms during and after the postpartum period (Herbell & Zauszniewski, 2019; Salazar et al., 2011; Lagdon et al., 2021; Vranceanu et al., 2007; Brewin et al., 2000; Glazier et al., 2004), especially for those mothers with a history of CM (Racine et al., 2018, 2020; Razurel et al., 2013; Schwab-Reese et al., 2017; Vranceanu et al., 2007; Wajid et al., 2019). Thereby, the amount of (subjectively) perceived support is the more relevant predictor for lower stress and better health than the actual received amount of support in demanding situations (Evans et al., 2013; Mercer & Ferketich, 1988; Prati & Pietrantoni, 2010). However, especially women with a history of CM report on average a substantial lack of social support (Racine et al., 2018; Schury et al., 2017; Sperry & Widom, 2013; Vranceanu et al., 2007) along with a higher risk for (intimate) relationship difficulties, less reliable social relationships, poor social networks, and social isolation (Berlin et al., 2011; Bosquet Enlow et al., 2018; Cloitre et al., 2008; Widom et al., 2014).
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This research was supported by NIMH grant K01 MH066365 awarded to David DiLillo, Ph.D.