PTSD Symptoms Mediate the Relationship Between Sexual Abuse and Substance Use Risk in Juvenile Justice

Abstract

Juvenile justice–involved youth face disproportionate rates of sexual abuse, which increases the risk of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs), both of which are associated with poor long-term outcomes. The present study tested two mediation and moderation models, controlling for age, race, and history of physical abuse, with gender as a moderator, to determine whether PTSD symptoms serve as a risk factor and/or mechanism in the relationship between sexual abuse and substance use. Data were examined for 197 juvenile justice–involved youth (mean age = 15.45, 68.9% non-White, 78.4% male) that completed court-ordered psychological assessments. Results indicated that PTSD symptoms significantly mediated the relationship between sexual abuse and drug (β = 3.44, confidence interval [CI] [0.26, 7.41]; test for indirect effect z = 2.41, p = .02) and alcohol use (β = 1.42, CI [0.20, 3.46]; test for indirect effect z = 2.23, p = .03). PTSD symptoms and gender were not significant moderators. Overall, PTSD symptoms mediate the relationship between sexual abuse and SUDs in juvenile justice–involved youth, which suggests viability of targeting PTSD symptoms as a modifiable risk factor to reduce the effects of sexual abuse on substance use in this high-risk population.

Keywords

sexual abuse substance use PTSD youth juvenile justice

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Abram

K. M.

Teplin

L. A.

Charles

D. R.

Longworth

S. L.

McClelland

G. M.

Dulcan

M. K.

(2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry, 61, 403–410. doi:10.1001/archpsyc.61.4.403

Achenbach

T. M.

Rescorla

(2001). ASEBA school-age forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders : DSM-5(5th ed.). Arlington, VA: American Psychiatric Association.

Asscher

J. J.

Van der Put

C. E.

Stams

G. J. J. M.

(2015). Gender differences in the impact of abuse and neglect victimization on adolescent offending behavior. Journal of Family Violence, 30, 215–225. doi:10.1007/s10896-014-9668-4

Baglivio

M. T.

Epps

Swartz

Huq

M. S.

Sheer

Hardt

N. S.

(2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Office of Juvenile Justice and Delinquency Prevention Journal of Juvenile Justice, 3, 1–14. Retrieved from http://www.journalofjuvjustice.org/JOJJ0302/%20article01.htm

Child Trends Data Bank. (2015). Indicators on children and youth. Juvenile Detention, 1–17. Retrieved from http://www.childtrends.org/wp-content/uploads/2012/05/88_Juvenile_Detention.pdf

Conrad

S. M.

Tolou-Shams

Rizzo

Placella

Brown

L. K.

(2014). Gender differences in recidivism rates for juvenile justice youth: The impact of sexual abuse. Law and Human Behavior, 38, 305–314. doi:10.1037/lhb0000062

Danielson

Macdonald

Amstadter

A. B.

Hanson

de Arellano

M. A.

Saunders

B. E.

Kilpatrick

D. G.

(2010). Risky behaviors and depression in conjunction with—or in the absence of—lifetime history of PTSD among sexually abused adolescents. Child Maltreatment, 15, 101–107.

10.

Danielson

McCart

M. R.

de Arellano

M. A.

Macdonald

Doherty

L. S.

Resnick

H. S.

(2012). Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: Findings from an open trial. Child Maltreatment, 15, 261–268.

11.

Dierkhising

C. B.

S. J.

Woods-Jaeger

Briggs

E. C.

Lee

Pynoos

R. S.

(2013). Trauma histories among justice-involved youth: Findings from the National Child Traumatic Stress Network. European Journal of Psychotraumatology, 4, 1–12. doi:10.3402/ejpt.v4i0.20274

12.

Ebesutani

Bernstein

Martinez

J. I.

Chorpita

B. F.

Weisz

J. R.

(2011). The youth self report: Applicability and validity across younger and older youths. Journal of Clinical Child & Adolescent Psychology, 40, 338–346.

13.

Fazel

Doll

Långström

(2008). Mental disorders among adolescents in juvenile detention and correctional facilities: A systematic review and metaregression analysis of 25 surveys. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1010–1019.

14.

Finkelhor

Cross

T. P.

Cantor

E. N.

(2005). How the justice system responds to juvenile victims: A comprehensive model of case flow. Trauma, Violence, & Abuse, 6, 83–102. doi:10.1177/1524838005275090

15.

Ford

J. D.

Chang

Levine

Zhang

(2013). Randomized clinical trial comparing affect regulation and supportive group therapies for victimization-related PTSD with incarcerated women. Behavior Therapy, 44, 262–276. doi:10.1016/j.beth.2012.10.003

16.

Ford

J. D.

Elhai

J. D.

Connor

D. F.

Frueh

B. C.

(2010). Poly-victimization and risk of posttraumatic, depressive, and substance use disorders and involvement in delinquency in a national sample of adolescents. Journal of Adolescent Health, 46, 545–552.

17.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press. Hershberger

Zapolski

, & Aalsma

M. C.

(2016). Social support as a buffer between discrimination and cigarette use in juvenile offenders. Addictive behaviors, 59, 7–11.

18.

Hershberger

Zapolski

Aalsma

M. C.

(2016). Social support as a buffer between discrimination and cigarette use in juvenile offenders. Addictive behaviors, 59, 7–11.

19.

Kendler

K. S.

Prescott

C. A.

Myers

Neale

M. C.

(2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry, 60, 929–937.

20.

Kerig

P. K.

Becker

S. P.

(2010). From internalizing to externalizing: Theoretical models of the processes linking PTSD to juvenile delinquency. In Egan

S. J.

(Ed.), Posttraumatic stress disorder (PTSD): Causes, symptoms and treatment (pp. 33–78). Hauppauge, NY: Nova Science.

21.

Khantzian

E. J.

(1987). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. In: Allen

D. F.

(eds) The cocaine crisis (pp. 65–74). Boston, MA: Springer.

22.

Kilpatrick

D. G.

Ruggiero

K. J.

Acierno

Saunders

B. E.

Resnick

H. S.

Best

C. L.

(2003). Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: Results from the National Survey of Adolescents. Journal of Consulting & Clinical Psychology, 71, 602–700. doi:10.1037/0022-006X.71.4.692

23.

Kingston

Raghavan

(2009). The relationship of sexual abuse, early initiation of substance use, and adolescent trauma to PTSD. Journal of Traumatic Stress, 22, 65–68. doi:10.1002/jts.20381

24.

Matulis

Resick

P. A.

Rosner

Steil

(2014). Developmentally adapted cognitive processing therapy for adolescents suffering from posttraumatic stress disorder after childhood sexual or physical abuse: A pilot study. Clinical Child and Family Psychology Review, 17, 173–190. doi:10.1007/s10567-013-0156-9

25.

Moss

H. B.

Chen

C. M.

H. Y.

(2014). Early adolescent patterns of alcohol, cigarettes, and marijuana polysubstance use and young adult substance use outcomes in a nationally representative sample. Drug and Alcohol Dependence, 136, 51–62.

26.

Miller

F. G.

Lazowski

L. E.

(2001). The Adolescent Substance Abuse Subtle Screening Inventory-A2 (SASSI-A2) manual. Springville, IN: SASSI Institute.

27.

Miller

F. G.

Renn

W. R.

Lazowski

L. E.

(2001). Adolescent SASSI-A2 user’s guide. Bloomington, IN: Baugh Enterprises.

28.

Mullers

E. S.

Dowling

(2008). Mental health consequences of child sexual abuse. British Journal of Nursing, 17, 1428–1433. doi:10.12968/bjon.2008.17.22.31871

29.

Najavits

L. M.

(2002). Seeking safety: A treatment manual for PTSD and substance abuse. New York, NY: Guilford Press.

30.

Najavits

L. M.

Gallop

R. J.

Weiss

R. D.

(2006). Seeking safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. The Journal of Behavioral Health Services & Research, 33, 453–463.

31.

Norr

A. M.

Albanese

B. J.

Boffa

J. W.

Short

N. A.

Schmidt

N. B.

(2016). The relationship between gender and PTSD symptoms: Anxiety sensitivity as a mechanism. Personality and Individual Differences, 90, 210–213. doi:10.1016/j.paid.2015.11.014

32.

Perera-Diltz

D. M.

Perry

J. C.

(2011). Screening for adolescent substance-related disorders using the SASSI-A2: Implications for nonreporting youth. Journal of Addictions & Offender Counseling, 31, 66–79.

33.

Rosenberg

H. J.

Vance

J. E.

Rosenberg

S. D.

Wolford

G. L.

Ashley

S. W.

Howard

M. L.

(2014). Trauma exposure, psychiatric disorders, and resiliency in juvenile-justice-involved youth. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 430.

34.

Ruffolo

M. C.

Sarri

Goodkind

(2004). Study of delinquent, diverted, and high-risk adolescent girls: Implications for mental health intervention. Social Work Research, 28, 237–245. doi:10.1093/swr/28.4.237

35.

Saar

M. S.

Epstein

Rosenthal

Vafa

(2015). The sexual abuse to prison pipeline: The girls’ story. Georgetown Law Center on Poverty & Inequality, 1–43. Retrieved from http://rights4girls.org/wp-content/uploads/r4g/2015/02/2015_COP_sexual-abuse_layout_web-1.pdf

36.

Smith

D. K.

Leve

L. D.

Chamberlain

(2006). Adolescent girls’ offending and health-risking sexual behavior: The predictive role of trauma. Child Maltreatment, 11, 346–353. doi:10.1177/1077559506291950

37.

Stein

L. A. R.

Lebeau-Craven

Martin

Colby

S. M.

Barnett

N. P.

Golembeske

Penn

J. V.

(2005). Use of the adolescent SASSI in a juvenile correctional setting. Assessment, 12, 384–394. doi:10.1177/1073191105279433

38.

Substance Abuse and Mental Health Services Administration. (2016). Criminal and juvenile justice: Overview. Retrieved from https://www.samhsa.gov/criminal-juvenile-justice

39.

Teplin

L. A.

Abram

K. M.

McClelland

G. M.

Dulcan

M. K.

Mericle

A. A.

(2002). Psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry, 59, 1133–1143.

40.

Teplin

L. A.

Elkington

K. S.

McClelland

G. M.

Abram

K. M.

Mericle

A. A.

Washburn

J. J.

(2005). Major mental disorders, substance use disorders, comorbidity, and HIV-AIDS risk behaviors in juvenile detainees. Psychiatric Services, 56, 823–828.

41.

Townsend

(2013). Prevalence and consequences of child sexual abuse compared with other childhood experiences. Darkness to Light, 1–19. Retrieved from www.d2l.org

42.

Vreugdenhil

van den Brink

Ferdinand

Wouters

Doreleijers

(2006). The ability of YSR scales to predict DSM/DISC–C psychiatric disorders among incarcerated male adolescents. European Child & Adolescent Psychiatry, 15, 88–96.

43.

Widom

C. S.

Maxfield

M. G.

(2001). An update on the “cycle of violence.” National Institute of Justice Research in Brief, 1–8. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/184894.pdf

44.

Widom

C. S.

White

H. R.

(1997). Problem behaviors in abused and neglected children grown up: Prevalence and co-occurrence of substance abuse, crime, and violence. Criminal Behavior & Mental Health, 7, 287–310. doi:10.1002/cbm.191

45.

Wolitzky-Taylor

Bobova

Zinbarg

R. E.

Mineka

Craske

M. G.

(2012). Longitudinal investigation of the impact of anxiety and mood disorders in adolescence on subsequent substance use disorder onset and vice versa. Addictive Behaviors, 37(8), 982–985. doi:10.1016/j.addbeh.2012.03.026

PTSD Symptoms Mediate the Relationship Between Sexual Abuse and Substance Use Risk in Juvenile Justice–Involved Youth

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