Research articleConditional and indirect effects of age of first exposure on PTSD symptoms
Section snippets
The Importance of Assessing Polyvictimization
The long-term effects of CVE are particularly potent for polyvictims, suggesting the need for comprehensive assessments of CVE. Much recent theoretical and empirical work has demonstrated that children's risk for exposure is frequently “bundled” (e.g., Finkelhor et al., 2011, Finkelhor et al., 2007a, Finkelhor et al., 2007b, Hamby & Grych, 2013). That is, exposure to multiple types of violence is common and assessing only a single type of exposure is likely to result in an incomplete
Explanations for the Potency of Early Victimization
There are several theories that have been put forward to explain the particular potency of early exposure to violence. Some researchers have hypothesized that early exposure to violence overwhelms children's coping capacities, resulting in long-term decrements in this domain and increasing vulnerability to stress (Contractor et al., 2013, Kaplow et al., 2005). There is also evidence to suggest that early exposure to violence may alter children's cognitive and attentional bias to threatening
The Current Study
In sum, there is ample evidence to suggest the timing of CVE may provide key insights into symptom presentation and severity that are not best understood in terms of direct effects. The primary objective of the current study is therefore to provide a more detailed investigation of the effects of age of first CVE on symptoms of posttraumatic stress in a high-risk sample. Studies of the relationship between age of exposure and posttraumatic stress symptoms have made an important contribution to
Data Analysis Plan
In order to evaluate the study hypotheses, four conditional PROCESS models (Hayes, 2013) were conducted – one model for each PTSD symptom domain. All models controlled for age and sex as covariates and were bootstrapped (10,000). Violence exposure and age of first exposure were centered prior to the analysis. A graphical depiction of the model can be found in Fig. 1. Hypotheses regarding conditional and indirect effects were modeled simultaneously (see Fig. 1). For interactions that were
Results
Overall, the sample was highly exposed, reporting an average of 8 violent event types across childhood (SD = 5.39). The number of events within each domain (community crime, maltreatment, peer/sibling violence, sexual violence, and witnessed violence) is detailed in Table 1. On average, the age of first exposure across all types of violence was six years of age (M = 6.25, SD = 3.29). The average age of first exposure within each domain, however, reflected differences in the onset of violence across
Discussion
The goals of the current study were to address three critical gaps in the literature on the relationship between age of first exposure to CVE and posttraumatic stress symptoms. First, there is a need to assess broad experiences of childhood exposure to violence (CVE), consistent with recent theoretical and empirical work underscoring the importance of assessing diverse exposures to violence and the assessment of polyvictimization (Hamby & Grych, 2013). There is also a need to examine the
Limitations and Future Directions
The current study advances inquiry in childhood polyvictimization and symptom presentation forward in important ways, but it has a number of limitations that are important to consider. Although the variables assessed in our process models were temporally constrained (i.e., age of first exposure preceded other exposures, which preceded current symptoms) the data are cross-sectional, which limits its ability to draw causal conclusions. For these reasons, it is critical that future prospective
Clinical Implications
Given the early age onset of poly-victimization, the current study emphasizes the value of assessing multiple types of victimization in child victims in clinical settings. As evidence-based interventions become increasing “modularized” and can flexibly address diverse symptom presentation, clinicians might consider the unique clinical need of those exposed to violence at young ages. For example, those with early exposure may require additional support managing symptoms of hyperarousal,
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