Prevalence and mental health correlates of witnessed parental and community violence in a national sample of adolescents.

A significant proportion of children and adolescents in the US have witnessed some form of serious violence in their families or communities. A national study conducted in 1995 with a representative sample of adolescents found that the prevalence of witnessed violence was 39.4% (incidents ranged from mugging to shooting; Kilpatrick, Saunders, and Smith, 2003b). Estimates of witnessed community violence are considerably higher in urban and/or minority samples, as well as when definitions for witnessed violence are broadened to include verbal threats and hearing about violence (e.g., Campbell & Schwarz, 1996; Jaycox et al., 2002; Hurt et al., 2001; Richters & Martinez, 1993). While limited data are available regarding witnessed domestic violence specifically, prior studies have reported prevalence estimates ranging from 20% to 37% (Hurt et al., 2001; McCloskey & Walker, 2000; O’Brien, John, Margolin, & Erel, 1994; Silvern et al., 1995). The high prevalence of children’s exposure to violence is particularly noteworthy in light of research that has established a link between witnessed domestic or community violence and multiple psychiatric problems, including internalizing problems, externalizing problems, social problems, and posttraumatic stress disorder (PTSD; see reviews by Kitzmann, Gaylord, Holt, & Kenny, 2003; Osofsky, 2003; Buka, Stichick, Birdthistle, and Earls, 2001; Edleson, 1999a). Up to this point, the literatures examining witnessed domestic and community violence exposure have generally evolved separately, and few studies have examined these stressful life events in the context of a single study. Witnessed violence frequently takes place in the context of other factors that contribute to adverse outcomes among children. Exposure to community and domestic violence has been associated with poverty and scarcity of resources (Cicchetti & Lynch, 1993; Fantuzzo et al., 1997). Community violence and interparental conflict also tend to co-occur with each other (Osofsky, Wewers, Hann, and Fick, 1993; Richters & Martinez, 1993) and with other traumatic events. Studies have demonstrated a significant overlap between witnessed violence and child maltreatment, including both physical and sexual abuse (see Appel & Holden, 1998; Edleson, 1999b; Lynch & Cicchetti, 1998). Despite evidence for the co-occurrence of domestic violence, community violence, and child maltreatment, limited research has attempted to examine the unique contributions of different types of violence exposure in the prediction of mental health problems. Furthermore, few studies have examined the effects of witnessed violence while controlling for co-occurring risk factors such as poverty and histories of direct victimization. A developmental psychopathology perspective emphasizes the importance of considering the influence of multiple events on children’s development (Rutter & Sroufe, 2000). Not only must multiple events be taken into account in understanding the complexity of children’s responses to stressful events, but these experiences must also be understood within the context of interacting systems (e.g., family, community, society). Therefore, to gain an informed understanding of children’s developmental trajectories, it is necessary to assess multiple events within both the immediate environment (e.g., direct victimization within the family) and the broader context (e.g., witnessed community violence). Because direct physical and sexual victimization in childhood has been repeatedly linked to negative mental health outcomes (Kendall-Tackett, Williams, and Finkelhor, 1993; Kolko, 1992; Margolin & Gordis, 2000), it is possible that the reported effects of witnessed violence are best accounted for by its overlap with direct victimization. However, limited research has examined whether witnessed violence makes independent contributions to subsequent adaptation. Findings from the few studies that exist have been mixed (Kilpatrick et al., 2003a; Lynch & Cicchetti, 1998; Maker, Kemm-elmeier, and Peterson, 1998; O’Keefe, 1995; Silvern et al., 1995). Methodological differences may account for the inconsistent pattern of findings (e.g., different definitions of witnessed violence, use of homogenous samples). Further studies using representative samples, behaviorally specific measures, and comprehensive assessments of victimization are necessary before conclusions can be drawn about the unique effects of witnessed violence. The current study The aims of this study were threefold: a) to describe the prevalence of various forms of witnessed violence; b) to examine witnessed community and domestic violence in relation to adolescents’ psychiatric symptomatology, independent of the contribution of direct victimization and other key risk factors; and c) to determine which characteristics of witnessed violence contribute to psychiatric outcomes. We hypothesized that witnessed community and parental violence would each be associated with increased risk of PTSD and depression, beyond variance accounted for by demographics and direct traumatic stress history. Although some studies have failed to demonstrate a relation between witnessed violence and mental health, it was expected that the use of stricter definitions of witnessed violence would allow for the detection of these relations.