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Exposure to violence, depression, and hostility in a sample of inner city high school youth
Journal of Adolescence 1999, 22, 21]32 Article No. jado.1998.0198, available online at http://www.idealibrary.com on
Exposure to violence, depression, and hostility in a sample of inner city high school youth ANNE MOSES This study examines the prevalence of violence in a non-randomly selected population of 337 inner city school students, the relationship between exposure to violence and symptoms of depression and hostility, and demographic differences in exposure to and effects of traumatic violence. Students responded to an anonymous survey asking them to enumerate how many times they had experienced each of six types of traumatic violence. Sixty-two per cent of students were exposed to an average of 3.41 of the six types of violence listed. Exposure to most types of violence were highly intercorrelated. Males experienced more exposure to violence than females. Exposure to violence was predictive of hostility for both gender groups, and predictive of depression for females. Implications of exposure to traumatic violence on adolescent development are q 1999 The Association for Professionals in Services for Adolescents discussed.
Introduction Violence is becoming a regular feature in the lives of inner city youth, and young men are the predominant victims of such violence in neighborhoods where gang- and drug-related crime is common (Garbarino et al., 1991). Firearm homicide is the second leading cause of death for all 15- to 19-year-olds (Fingerhut et al., 1993). African]American males aged 15 to 24 were more than seven times more likely to be murdered than Whites (Fingerhut and Kleinman, 1990). Even adolescents who do not experience homocide are exposed to other types of violence. Interviews with a random sample of 387 9th and 10th grade boys from inner city Washington DC found that 27% had been attacked by a person with a weapon, and 12% had been badly beaten by a non-household member (Brounstein et al., 1989). A study of teenagers from six urban and suburban schools found that three-quarters of students had experienced, witnessed or been threatened by physical violence during the past year, and one-half of all students had actually witnessed firearm violence (Singer, 1994). In a study of violence in a Chicago urban housing project, interviews with ten mothers identified shooting as the major safety concern for their children and found that many of their children had witnessed firearm violence against family members, and that all of the children 5 years and under had experienced direct contact with shootings (Dubrow and Garbarino, 1989). Problems endemic to the inner city}the drug trade, poverty}have led to this rise in violence (Weisman, 1993). In addition, gangs and gang membership in cities has grown, increasing the chances that urban youth will be exposed to violence (Weisman, 1993; Burton et al., 1994). But what are the mental health consequences of exposure to such violence? How do children exposed to constant violence respond? And what are the ramifications on child and adolescent development? Reprint requests and correspondence should be addressed to A. Moses, Ph.D., The SPHERE Institute, 30 Alta Rd., Palo Alto, CA 94305, U.S.A. 0140-1971/99/010021+ 12 $30.00/0
q 1999 The Association for Professionals in Services for Adolescents
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Background and significance It is generally accepted that severe stress can have a harmful impact on adolescent emotional adjustment and has been associated with the development of various forms of psychological distress. Because they have not yet negotiated the transition to adulthood and have not fully developed cognitive and coping abilities by which to adapt to stress, adolescents are at particular risk for stress-related emotional problems. Research has suggested that depression and hostility may be two responses to stress-inducing traumatic violence. In a sample of 3735 9th through 12th grade adolescents from inner city and suburban public high schools, Singer (1994) examined the extent to which adolescents were exposed to violence, either as victims or as witnesses, and how such exposure is related to aggressive behaviors and trauma symptoms such as depression and anger. The study found alarming rates of adolescent exposure to violence, particularly among inner city youth, one-half of whom had witnessed at least one shooting in the past year. In addition, exposure to violence was significantly associated with depression and anger. Witnessing violence in the home and being female were the most highly predictive variables of distress symptoms. Other studies have specifically considered the connection between exposure to violence and depression in children and adolescents. In an examination of the relationship between exposure to violence and depression among 54 5th and 6th graders, Martinez and Richters (1993) found that experiencing violence against the self and witnessing violence against people familiar to the students were significantly associated with depressive symptomatology. No correlation was found between depression and witnessing violence against strangers. In a study of 225 Black adolescents living in or around a Georgia housing project, DuRant et al. (1995) found depression to be associated with exposure to violence. In particular, intrafamilial violence was highly correlated with depression, hopelessness, and lack of purpose in life. Other research has suggested that there is an association between depression and adolescent aggression (Malmquist, 1991). DuRant (1994) found that previous exposure to violence and victimization were the strongest predictors of adolescents’ own violent behaviors. In a study of violent and aggressive adolescents, Cairns et al. (1988) found that rates of suicide were 13.2 per 1000 teens as compared with 0.5 to 3 suicides per 1000 teens in the general population. While these studies did not measure hostility levels per se, to the extent that violent behavior reflects levels of hostility, they are applicable. To the extent that exposure to violence is stressful, it makes sense that the degree to which adolescents are exposed to violence should be correlated with emotional distress symptoms such as depression or hostility. How emotional distress is manifest, however, may differ according to individual personal and circumstantial characteristics. It is widely accepted that personal characteristics such as gender influence risk-taking behaviors, exposure to violence, and the manner in which individuals respond to traumatic stress. Rates of depression in normative adolescent populations indicate that females are more likely than males to suffer depression (Nolen-Hoeksema, 1991). Prior study has found that while males are more likely to experience exposure to violence, females are more likely to manifest symptoms of depression (Singer, 1994). Therefore, in order to establish a full picture of the divergent trajectories in response to exposure to violence, demographic characteristics such as gender must also be entertained.
Exposure to violence, depression, and hostility
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The manner in which adolescents meet challenge during a developmental transition not only influences their adjustment during that particular period, but also determines the available resources in subsequent transitional periods (Rice et al., 1993). Because it is a time of such tremendous psychosocial change, dangers to ego development as a result of traumatic stress during adolescence can be profound; exposure to traumatic violence can foster impaired identity formation, as adolescents struggling with role confusion suffer low self-esteem as a result of failure to master experience; views of the world may be negatively skewed as they fail to experience a sense of continuity and sameness; identity may be skewed towards criminality and violence as what they perceive as markers of adulthood (Eth and Pynoos, 1985; Weisman, 1993). Prior study has established associations between exposure to violence and both depression and anger in groups of adolescent youth (Durant et al., 1994, 1995; Singer, 1994). Although these studies have paved the way for further research, the connection between exposure to violence, depression, and hostility have not yet been fully explored. Most studies have examined traumatic violence as it occurs within only one realm of the adolescent’s world: at home, in the community, or in the school. In addition, most studies have considered exposure to violence only within the past year. This study proposes to examine: first, the prevalence of traumatic violence in a population of inner city high school students; second, the effects of such exposure on students’ levels of depression and hostility; and third, the contribution of gender, ethnicity, and age to adolescent symptomatology. Many types of traumatic violence (both witness and personal exposure) will be considered across the span of their lives and in different realms of their lives. At the outset, the study was guided by three goals: first, to describe the types and amounts of violence to which a non-randomized sample of urban adolescents are exposed; second, to examine the relationship between exposure to violence and symptoms of depression and hostility; and third, to examine demographic differences in violence exposure, gender differences in the effects of violence, and what specific types of violence are related to symptomotology.
Method Sample Participants were students at a New York City public high school located in upper Manhattan. It should be noted that New York City schools are not districted, meaning that high school placement is not based on residence but on a complicated system that combines some element of choice and lottery. The high school in which the study was conducted was located in a middle income neighborhood, while students who attend the school commuted from predominantly low socio-economic neighborhoods. Classes that participated were chosen by the assistant principal who identified English teachers she felt might be interested and/or willing to cooperate. Teachers themselves chose which classes would participate in the study. The sampling pool consisted of all students in classes that were chosen for participation, grades 9]12, at the target high school. Although students were informed that participation in the study was completely voluntary, all students who were present chose to participate. Because school policy
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forbade return to classes more than once, only those students who were present in class on the days surveys were completed actually participated in the study. Fourteen classes completed surveys. A total of 465 students were registered to attend these classes. Of these registered students, 337 were actually present on days when surveys were administered. Coincidentally, this attendance rate (71%) mirrors the attendance rate for the school itself, and for New York City public schools as a whole. The subjects ranged in age from 14- to 19-years-old. Most of the sample was Black (44.5%) or Hispanic (50.9%). The remaining students were Asian (0.9%) or of multiethnic origins (3.4%). Thirty-eight per cent of the students sampled were male, while the majority (62%) were female.
Variables and instrumentation A questionnaire was designed for use as a self-report method of data collection. Demographic information collected included gender, ethnicity, and age. Information about participants’ socio-economic status was not polled since school statistics have consistently found that all students came from the lowest socio-economic rung. Exposure to violence was measured by providing students with a list of six violent events: have you ever witnessed the shooting or stabbing of a family member, friend, or stranger (reported as violence against family, friends, and strangers); have you ever been raped; have you ever been shot or stabbed; have you ever been beaten up/jumped. Students were asked to indicate how many times in their lives they had experienced each event (response options were not provided; students were asked to provide an actual number, zero if they had never experienced a particular event). Students were instructed to not report vague frequencies (such as ‘‘hundreds of times’’), rather a real number. Depression and hostility were measured by subscales from the SCL-90-R (Derogatis, 1974). Students were presented with a list of symptoms and were asked to respond how often in the last week they had experienced each on a five-point Likert scale ranging from 0 (‘‘not at all’’) to 4 (‘‘extremely’’). The depression scale contained 12 items and responses were tallied to yield a continuous score ranging from 0 to 48. Hostility was measured by tallying responses to the six items comprising the hostility subscale, yielding a continuous score from 0 to 24. For this sample, the depression subscale had an internal reliability of 0.88 (Chronbach’s alpha). Reliability for the six-item hostility scale in this sample was also strong (Chronbach’s alpha = 0.84). At the end of the survey, students were provided with space to write comments.
Procedures Permission slips were disseminated to parents of the 465 registered students. Only 337 of the registered students participated in the study; these were all the students who were present the day they were surveyed and returned signed permission slips (all of the students who were present had signed permission slips). Once permission slips were collected, the researcher attended the scheduled class, explained that surveys were to be completed anonymously, assured of confidentiality, and handed out surveys. Students completed surveys over the 40-minute class period. The researcher was on hand to answer any questions about how to complete surveys. Although the teachers were also present, all questions were referred to the researcher and no teacher participated at all in survey administration.
Exposure to violence, depression, and hostility
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Table 1 Frequencies and means for exposure to violence, overall and by subgroups Variable
n (and %) exposed to violence
Mean for subset exposed to violence
Mean for sample
S.D.
Mean for male
S.D.
Mean for female
S.D.
Violence against family Violence against friends Violence against strangers Shot/stabbed Rape Beaten up/jumped Total exposures to violence
60 (18.29%)
1.35
0.25
0.62
0.23
0.51
0.26
0.68
96 (29.27%)
2.09
0.61
1.37
0.79
1.58
0.50
1.21
142 (43.29%)
1.84
0.80
1.94
1.27
2.88
0.52
0.88
25 (7.62%) 25 (7.62%) 71 (21.65%) 204 (62.19%)
1.08 1.16 1.53 3.41
0.08 0.12 0.33 2.18
0.30 0.59 1.01 3.62
0.12 0.02 0.53 2.89
0.37 0.12 1.43 4.83
0.06 0.18 0.21 1.74
0.24 0.74 0.61 2.51
Results Exposure to violence Students in the sample were indeed exposed to violence. Just under two-thirds of the sample (62.19%) witnessed a lifetime average of 3.41 of the types of violence listed, although almost 38% witnessed none of the events listed. Table 1 presents the types of exposure to violence surveyed by the questionnaire, and the mean scores for both the entire sample and the subset of students who experienced each type of violence (also broken down by gender). Table 2 provides an intercorrelational matrix, indicating that except for the experience of rape, most of the types of violence listed were highly correlated with each other. Males reported significantly more exposure to violence than females. t-Tests indicated that males and females in the sample reported exposure to roughly equal amounts of violence against family members; however, males were exposed to greater amounts of violence against friends ( t = 1.86, df = 324, p = 0.026) and strangers ( t = 3.46, df = 321, p = 0.001), and were more likely to have been shot/stabbed ( t = 1.75, df = 324, p = 0.0001) or beaten up/jumped ( t = 2.81, df = 324, p = 0.0001). Females reported a higher incidence of rape ( t = 2.47, df = 324, p = 0.0001) (see Table 1 for means by gender). Other demographic differences with regard to exposure to violence are worth noting. Black students were more likely than Hispanic students to have witnessed violence against family members ( t = 3.01, df = 310, p = 0.0001) and to have been raped ( t = 1.01, df = 309, p = 0.051). Correlation was used to examine the association between age and exposure to violence, and determined that in this sample older students had witnessed increased violence against friends ( r = 131, p = 0.004) and strangers ( r = 157, p = 0.018).
Distress symptoms Mean depression and hostility scores were compared to those for a ‘‘normative’’ population of White, middle class, midwestern high school students. Depression and hostility scores
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Table 2
Exposure to violence intercorrelation matrix Violence against family
Violence against friends
Violence against strangers
Shot/stabbed
Raped
0.17** 0.15**
0.01
Beaten up/jumped
Violence against family Violence against friends
0.28***
Violence against strangers
0.12*
0.48***
0.25*** 0.02
0.30*** 0.05
0.15**
0.21***
Shot/stabbed Raped Beaten up jumped
0.17** y0.01 0.26***
*p F 0.05; **p F 0.01; ***p F 0.001.
for this sample were 12.19 (S.D. 10.13) and 7.0 (S.D. 6.25), respectively, as compared with 9.6 (S.D. 8.28) and 5.28 (S.D. 4.86) (Derogatis, 1974). Female students ( t = 5.07, df = 321, p F 0.001) and Hispanic students ( t = 1.34, df = 307, p F 0.033) had significantly higher depression scores. Correlation found that older students were also more likely to have elevated depression ( r = 0.213, p F 0.001) and hostility ( r = 0.152, p F 0.006) scores. Analysis of variance was used to test for interactive effects of gender and ethnicity on all types of exposure to violence, depression, and hostility. No significant interactive effects were noted.
Exposure to violence and distress symptoms Correlation was used to determine whether exposure to violence variables (a continuous measure of the number of times a participant was exposed to each type of violence listed) were significantly correlated with continuous measures of depression and hostility. Students’ depression scores were only associated with having witnessed violence against family members and having been raped. In contrast, scores on the hostility inventory were positively correlated with all exposure to violence variables, except having witnessed violence against strangers (see Table 3 for Pearson correlation coefficients). Simple correlations were run separately for males and females to determine the gender-specific correlation between types of exposure to violence and distress symptoms. For females, no specific type of exposure to violence was uniquely correlated with depression, although the total number of exposures to the types of violence listed was. (Although this was the same correlation coefficient for males, its lack of significance was likely due to the larger female sample.) For males, only witnessing violence against family
Exposure to violence, depression, and hostility
Table 3
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Exposure to violence and distress symptoms
Variable Violence against family Violence against friends Violence against strangers Shot/stabbed Raped Beaten up/jumped
Depression
Hostility
0.112* 0.091 0.007 0.069 0.212*** 0.024
0.207*** 0.204*** 0.097 0.228*** 0.172*** 0.140**
*p F 0.05; **p F 0.01; ***p F 0.001.
members was positively correlated with depression scores. With regard to hostility, findings for both gender groups were essentially the same (see Table 4). Because few interactive effects existed between gender and ethnicity, separate multiple regression analyses were conducted for each gender group to determine whether different variables explained depression for males and for females. Due to the high intercorrelation between exposure to violence variables, exposure to violence variables were collapsed into one category that summed exposure to all types of violence. For males, only increased age predicted more depression, and exposure to violence predicted hostility, mirroring the simple correlations conducted for each gender group. Likewise for females, increased age and exposure to violence predicted both depression and hostility (see Tables 5 and 6).
Discussion Students in the sample were exposed to an inordinate amount of violence, with over 60% of students having experienced an average of 3.41 acts of violence in their lives. Witnessing and experiencing violence was an extremely common event: almost half the sample had seen strangers shot or stabbed, just under 30% had seen friends shot or stabbed, and 18% had seen family members shot or stabbed. In addition, the reported incidence of rape was particularly high, and even more alarming is that this occurrence may have actually been under-reported. While almost 14% of female students cited at Table 4
Correlation between exposure to violence and distress symptoms, by gender
Variable
Violence against family Violence against friends Violence against strangers Shot/stabbed Raped Beaten up/jumped Total exposures to violence
Males
Females
Depression
Hostility
Depression
Hostility
0.20* 0.15 0.08 0.12 0.04 0.07 0.14
0.26** 0.28*** 0.17 0.38*** 0.01 0.25* 0.33***
0.08 0.12 0.06 0.09 0.03 0.08 0.14*
0.26** 0.28*** 0.17 0.14* 0.05 0.08 0.22**
*p F 0.05; **p F 0.01; ***p F 0.001
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Table 5
A. Moses
Multiple regression analysis of depression by gender (male n s 120, female n s 195)
Variable
Males
Age Ethnicity (Hispanic) Exposure to violence
Females
Beta
t
p
Beta
t
p
0.229 0.124
2.527 1.389
0.013 0.167
0.217 0.113
3.14 1.626
0.001 0.105
0.058
0.641
0.522
0.150
2.166
0.031
Males: Adj. R 2 = 0.08, F (3,117) = 3.36, p = 0.021; Females: Adj. R 2 = 0.08, F (3,192) = 5.49, p = 0.001.
least one rape in their lifetime, this figure may not have reflected sexual abuse in the home, sexual molestation that did not result in intercourse, or date rape. In fact, several female students did not indicate a history of rape on the quantitative portion of the survey, but went on to describe sexually abusive situations on the back page. For the 62% of youth who witnessed violence, all types of exposure except the experience of rape were highly correlated with each other. Although it is not surprising that exposure to violence against friends, strangers, and oneself have high intercorrelations, their association with exposure to violence against family members is not as predictable, and is cause for speculation as to the causal direction of these associations. It is possible that witnessing violence against the family renders youth susceptible to later delinquent behavior that places them in risky violence-prone situations. Further research should explore the ages at which students become exposed to each type of violence in order to further examine this issue. Increased exposure to violence was linked to increased symptoms of psychological distress, yet increased exposure to violence against family members was the only type of violence linked to higher depression among students in the sample, while hostility scores were correlated with exposure to all types of violence except violence against strangers. Why was exposure to violence more predictive of hostility than depression? Only one study to date has considered the difference between witnessing violence against strangers vs. violence against ‘‘familiar’’ persons (i.e. friends and family members), and similarly found no relationship between distress and exposure to violence against Table 6
Multiple regression analysis of hostility by gender (male n s 121, female n s 195)
Variable
Age Ethnicity (Hispanic) Exposure to violence
Males
Females
Beta
t
p
Beta
t
p
0.086 0.139
0.970 1.593
0.334 0.114
0.151 0.044
2.168 0.629
0.031 0.530
0.280
3.138
0.002
0.218
3.137
0.002
Males: Adj. R 2 = 0.11, F (3,118) = 4.84, p = 0.003; Females: Adj. R 2 = 0.07, F (3,192) = 4.86, p = 0.003.
Exposure to violence, depression, and hostility
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strangers (Martinez and Richters, 1993). A number of students wrote comments on their surveys indicating that exposure to violence made little emotional impact; that they were, in fact, indifferent to violence unless it was directed at themselves, family, or friends. Why is this the case? One explanation supports previous research suggesting that youth exposed to extreme violence may take on an aggressive identity, perhaps symbolically, to avoid victimization, or to attribute meaning to their world as one in which violence is the norm and a warrior-like attitude is a necessary tool of survival (Garbarino et al., 1991). Or, the obverse could be true, and delinquent, hostile adolescents could be more likely to place themselves in situations where they are exposed to increased violence. An alternative and unsettling explanation is that students have, as they suggest, habituated to their environments and become densensitized to violence: unless it directly affects their world, it no longer has an impact. Although this coping ability might be considered adaptive in the short run, as a means to stave off anxiety and distress, consider the implications on adolescent emotional development. Is it healthy for our children to grow up without empathy for those who suffer? What positive implications can this lack of empathy possibly have? Implications of these findings are important for adolescent development and behavior. Reactions to severe forms of psychological distress will differ according to the age and developmental level attained by the child (Eth and Pynoos, 1985). Although students’ level of coping were not measured, for many students, anger, either in identification with aggressor or turned against the self, may be a viable way to cope with trauma, despite the fact that this manner of coping can impede healthy emotional development. Furthermore, as a reaction to violence, anger in service of defense has even broader consequences, for while a young child may imagine revenge against the perpetrators of violence, a teen is more likely to exact it.
Gender As demonstrated by other research (Singer, 1994), males were more likely to suffer exposure to violence, but females were more likely than males to suffer greater distress symptoms following such exposure. Although males had increased overall exposure to violence, for females cumulative exposure to violence was correlated with higher levels of depression, whereas for males it was not. With regard to hostility, exposure to violence was equally correlated with exposure to violence for both males and females. Why these discrepancies? What is it about adolescence that renders boys and girls vulnerable to different types of experiences? It is possible that witnessing and experiencing violence is particularly problematic for teenage boys as an impediment to their sense of competence as a male. For teenage boys living in climates of inner city poverty, where competence is already impeded by economic limitations to employment and success, this sense of competence may already be fragile and susceptible to further damage. While teenage girls experience less exposure to violence, they appear to be more sensitive to the emotional effects of violence than are teenage males. One explanation may be the experience of rape. Almost 14% of the females sampled had been raped at least once (and as previously noted, this figure is likely too low). In terms of female development, the experience of rape alone would likely undermine resolution of issues of competence, sexuality, and identity formation. Prior research has indicated that adult
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females who were raped experience high levels of anger and depression (Rothbaum et al., 1992). It is not surprising, then, that the experience of rape combined with exposure to many other types of violence might predict higher depression indices for females in this sample. Another explanation may be provided by examining gender differences and the emergence of psychological disorders during adolescence. Prior to adolescence, boys demonstrate more adjustment reactions, antisocial disorders, learning disorders, anxiety disorders, and affective disorders than do girls (Eme, 1979), yet following the transition to adolescence females suffer a higher incidence of affective and anxiety disorders (NolenHoeksema, 1991). It should also be noted that greater expression of psychological distress among females may not necessarily mean males are suffering less psychological distress. Males, while more likely to suffer increased exposure to violence, may also be more likely to deny affect and therefore admit to less psychological distress.
Limitations of the study The study has notable limitations to generalizability and validity. First is selection criteria: the sample was not randomly chosen, and therefore does not necessarily mirror the school population, nor the New York City public high school population of students. Rules of participation also limited generalizability. Because school policy forbade returning to classes to survey on more than one day, only those students who were present on the days surveys were completely actually participated in the study. Attaining such a limited sample has important implications. Because students who were more likely to be truant were less likely to participant, the reported incidence of violence is probably less frequent in the sample than it is in the population. Consequently, if results of this study are accurate in indicating that increased exposure to violence is related to increased symptoms of distress, it is also likely that the population the sample hopes to represent may also suffer greater symptoms of depression and hostility. The last limitation is caused by problems in survey construction. Surveys relied on recollection, and as such cannot be considered truly reliable sources of information. Self-report recollection of lifetime accounts of exposure to violence may be particularly problematic. Furthermore, because questions about sexual abuse, physical abuse, and domestic violence could not be directly asked, important information about exposure to violence is missing. It seems that certain variables may, in some cases, have acted as proxies for this information. Reported incidents of rape may have reflected some sexual abuse. Witnessing violence against family members may have tapped incidents of domestic violence. Still, it seems that exposure to violence was not comprehensively measured, and, if anything, the fact that questions directly assessing exposures to sexual, physical, and domestic abuse were omitted caused frequency of exposure to violence to be under-reported. It is possible that high distress symptomatology among students who had fewer reported incidents of violence might be explained by exclusion of these questions.
Conclusions This study demonstrated that in a non-representative sample of New York City high school youth, exposure to violence was significantly related to a higher incidence of
Exposure to violence, depression, and hostility
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depression and hostility. Exposure to each of the types of violence listed were highly intercorrelated. While male and female students had equal exposure to violence against family members and themselves, male students had greater exposure to violence against friends and strangers. Despite these differences, female students demonstrated increased symptoms of depression and hostility. Older students were also more likely to indicate higher symptoms of distress. Although it is difficult to say what the long-term results of these symptoms may be, students themselves, in focus groups and written responses, suggested that seeing and experiencing chronic violence in their communities made them depressed, angry, and often violent themselves. This study did not investigate the behavioral consequences of exposure to violence, so all we have is the students’ own descriptions. It is difficult to say what the long-term results of depression and hostility will be, but it is an unlikely coincidence that while rates of violent crime for adults around the country are down, the same rates for teenagers are significantly on the rise. Children and adolescents in the inner city face the challenges of normal development in abnormal circumstances. Understanding how dangerous environments affect the transition from childhood to adolescence to adulthood is a matter of great importance for clinicians who work with inner city youth, in order to help these adolescents make sense of the events in their lives and thereby feel a sense of mastery over their environments. Although this will not completely counterbalance the effects of exposure to trauma, it is the first step in removing the obstacles to healthy psychological development.
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Fingerhut, L. A. and Kleinman, J. C. (1990). International and interstate comparisons of homicide among young males. Journal of the American Medical Association, 263, 3292]3295. Fingerhut, L., Ingram, D. and Feldman, J. (1993). Firearm and non-firearm homicide among persons 15 through 19 years of age. Journal of the American Medical Association, 267, 3048]3053. Garbarino, J., Kostleny, K. and Dubrow, N. F. (1991). What children can tell us about living in danger. American Psychologist, 46, 376]383. Malmquist, C. P. (1991). Depression and extreme violence in adolescence. In Thinking Clearly About Psychology, Cicchetti, D. and Grove, W. M. (Eds). Minneapolis, MN: University of Minnesota Press. Martinez, P. and Richters, J.E. (1993). The NIMH community violence project: children’s distress symptoms associated with violence exposure. Psychiatry, 56, 22]35. Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569]582. Rice, K. G., Herman, M. A. and Petersen, A. C. (1993). Coping with challenge in adolescence: a conceptual model and psyco-educational intervention. Journal of Adolescence, 16, 235]251. Rothbaum, B. O., Foa, B., Riggs, D. S., Murdock, T. and Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455]475. Singer, M. I. (1994). The Mental Health Consequences of Adolescents’ Exposure to Violence. Cleveland, OH: Center for Practice Innovations, Case Western Reserve University. Weisman, G. K. (1993). Adolescent PTSD and developmental consequences of crack dealing. American Journal of Orthopsychiatry, 63, 553]561.
Exposure to violence, depression, and hostility in a sample of inner city high school youth ANNE MOSES This study examines the prevalence of violence in a non-randomly selected population of 337 inner city school students, the relationship between exposure to violence and symptoms of depression and hostility, and demographic differences in exposure to and effects of traumatic violence. Students responded to an anonymous survey asking them to enumerate how many times they had experienced each of six types of traumatic violence. Sixty-two per cent of students were exposed to an average of 3.41 of the six types of violence listed. Exposure to most types of violence were highly intercorrelated. Males experienced more exposure to violence than females. Exposure to violence was predictive of hostility for both gender groups, and predictive of depression for females. Implications of exposure to traumatic violence on adolescent development are q 1999 The Association for Professionals in Services for Adolescents discussed.
Introduction Violence is becoming a regular feature in the lives of inner city youth, and young men are the predominant victims of such violence in neighborhoods where gang- and drug-related crime is common (Garbarino et al., 1991). Firearm homicide is the second leading cause of death for all 15- to 19-year-olds (Fingerhut et al., 1993). African]American males aged 15 to 24 were more than seven times more likely to be murdered than Whites (Fingerhut and Kleinman, 1990). Even adolescents who do not experience homocide are exposed to other types of violence. Interviews with a random sample of 387 9th and 10th grade boys from inner city Washington DC found that 27% had been attacked by a person with a weapon, and 12% had been badly beaten by a non-household member (Brounstein et al., 1989). A study of teenagers from six urban and suburban schools found that three-quarters of students had experienced, witnessed or been threatened by physical violence during the past year, and one-half of all students had actually witnessed firearm violence (Singer, 1994). In a study of violence in a Chicago urban housing project, interviews with ten mothers identified shooting as the major safety concern for their children and found that many of their children had witnessed firearm violence against family members, and that all of the children 5 years and under had experienced direct contact with shootings (Dubrow and Garbarino, 1989). Problems endemic to the inner city}the drug trade, poverty}have led to this rise in violence (Weisman, 1993). In addition, gangs and gang membership in cities has grown, increasing the chances that urban youth will be exposed to violence (Weisman, 1993; Burton et al., 1994). But what are the mental health consequences of exposure to such violence? How do children exposed to constant violence respond? And what are the ramifications on child and adolescent development? Reprint requests and correspondence should be addressed to A. Moses, Ph.D., The SPHERE Institute, 30 Alta Rd., Palo Alto, CA 94305, U.S.A. 0140-1971/99/010021+ 12 $30.00/0
q 1999 The Association for Professionals in Services for Adolescents
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Background and significance It is generally accepted that severe stress can have a harmful impact on adolescent emotional adjustment and has been associated with the development of various forms of psychological distress. Because they have not yet negotiated the transition to adulthood and have not fully developed cognitive and coping abilities by which to adapt to stress, adolescents are at particular risk for stress-related emotional problems. Research has suggested that depression and hostility may be two responses to stress-inducing traumatic violence. In a sample of 3735 9th through 12th grade adolescents from inner city and suburban public high schools, Singer (1994) examined the extent to which adolescents were exposed to violence, either as victims or as witnesses, and how such exposure is related to aggressive behaviors and trauma symptoms such as depression and anger. The study found alarming rates of adolescent exposure to violence, particularly among inner city youth, one-half of whom had witnessed at least one shooting in the past year. In addition, exposure to violence was significantly associated with depression and anger. Witnessing violence in the home and being female were the most highly predictive variables of distress symptoms. Other studies have specifically considered the connection between exposure to violence and depression in children and adolescents. In an examination of the relationship between exposure to violence and depression among 54 5th and 6th graders, Martinez and Richters (1993) found that experiencing violence against the self and witnessing violence against people familiar to the students were significantly associated with depressive symptomatology. No correlation was found between depression and witnessing violence against strangers. In a study of 225 Black adolescents living in or around a Georgia housing project, DuRant et al. (1995) found depression to be associated with exposure to violence. In particular, intrafamilial violence was highly correlated with depression, hopelessness, and lack of purpose in life. Other research has suggested that there is an association between depression and adolescent aggression (Malmquist, 1991). DuRant (1994) found that previous exposure to violence and victimization were the strongest predictors of adolescents’ own violent behaviors. In a study of violent and aggressive adolescents, Cairns et al. (1988) found that rates of suicide were 13.2 per 1000 teens as compared with 0.5 to 3 suicides per 1000 teens in the general population. While these studies did not measure hostility levels per se, to the extent that violent behavior reflects levels of hostility, they are applicable. To the extent that exposure to violence is stressful, it makes sense that the degree to which adolescents are exposed to violence should be correlated with emotional distress symptoms such as depression or hostility. How emotional distress is manifest, however, may differ according to individual personal and circumstantial characteristics. It is widely accepted that personal characteristics such as gender influence risk-taking behaviors, exposure to violence, and the manner in which individuals respond to traumatic stress. Rates of depression in normative adolescent populations indicate that females are more likely than males to suffer depression (Nolen-Hoeksema, 1991). Prior study has found that while males are more likely to experience exposure to violence, females are more likely to manifest symptoms of depression (Singer, 1994). Therefore, in order to establish a full picture of the divergent trajectories in response to exposure to violence, demographic characteristics such as gender must also be entertained.
Exposure to violence, depression, and hostility
23
The manner in which adolescents meet challenge during a developmental transition not only influences their adjustment during that particular period, but also determines the available resources in subsequent transitional periods (Rice et al., 1993). Because it is a time of such tremendous psychosocial change, dangers to ego development as a result of traumatic stress during adolescence can be profound; exposure to traumatic violence can foster impaired identity formation, as adolescents struggling with role confusion suffer low self-esteem as a result of failure to master experience; views of the world may be negatively skewed as they fail to experience a sense of continuity and sameness; identity may be skewed towards criminality and violence as what they perceive as markers of adulthood (Eth and Pynoos, 1985; Weisman, 1993). Prior study has established associations between exposure to violence and both depression and anger in groups of adolescent youth (Durant et al., 1994, 1995; Singer, 1994). Although these studies have paved the way for further research, the connection between exposure to violence, depression, and hostility have not yet been fully explored. Most studies have examined traumatic violence as it occurs within only one realm of the adolescent’s world: at home, in the community, or in the school. In addition, most studies have considered exposure to violence only within the past year. This study proposes to examine: first, the prevalence of traumatic violence in a population of inner city high school students; second, the effects of such exposure on students’ levels of depression and hostility; and third, the contribution of gender, ethnicity, and age to adolescent symptomatology. Many types of traumatic violence (both witness and personal exposure) will be considered across the span of their lives and in different realms of their lives. At the outset, the study was guided by three goals: first, to describe the types and amounts of violence to which a non-randomized sample of urban adolescents are exposed; second, to examine the relationship between exposure to violence and symptoms of depression and hostility; and third, to examine demographic differences in violence exposure, gender differences in the effects of violence, and what specific types of violence are related to symptomotology.
Method Sample Participants were students at a New York City public high school located in upper Manhattan. It should be noted that New York City schools are not districted, meaning that high school placement is not based on residence but on a complicated system that combines some element of choice and lottery. The high school in which the study was conducted was located in a middle income neighborhood, while students who attend the school commuted from predominantly low socio-economic neighborhoods. Classes that participated were chosen by the assistant principal who identified English teachers she felt might be interested and/or willing to cooperate. Teachers themselves chose which classes would participate in the study. The sampling pool consisted of all students in classes that were chosen for participation, grades 9]12, at the target high school. Although students were informed that participation in the study was completely voluntary, all students who were present chose to participate. Because school policy
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forbade return to classes more than once, only those students who were present in class on the days surveys were completed actually participated in the study. Fourteen classes completed surveys. A total of 465 students were registered to attend these classes. Of these registered students, 337 were actually present on days when surveys were administered. Coincidentally, this attendance rate (71%) mirrors the attendance rate for the school itself, and for New York City public schools as a whole. The subjects ranged in age from 14- to 19-years-old. Most of the sample was Black (44.5%) or Hispanic (50.9%). The remaining students were Asian (0.9%) or of multiethnic origins (3.4%). Thirty-eight per cent of the students sampled were male, while the majority (62%) were female.
Variables and instrumentation A questionnaire was designed for use as a self-report method of data collection. Demographic information collected included gender, ethnicity, and age. Information about participants’ socio-economic status was not polled since school statistics have consistently found that all students came from the lowest socio-economic rung. Exposure to violence was measured by providing students with a list of six violent events: have you ever witnessed the shooting or stabbing of a family member, friend, or stranger (reported as violence against family, friends, and strangers); have you ever been raped; have you ever been shot or stabbed; have you ever been beaten up/jumped. Students were asked to indicate how many times in their lives they had experienced each event (response options were not provided; students were asked to provide an actual number, zero if they had never experienced a particular event). Students were instructed to not report vague frequencies (such as ‘‘hundreds of times’’), rather a real number. Depression and hostility were measured by subscales from the SCL-90-R (Derogatis, 1974). Students were presented with a list of symptoms and were asked to respond how often in the last week they had experienced each on a five-point Likert scale ranging from 0 (‘‘not at all’’) to 4 (‘‘extremely’’). The depression scale contained 12 items and responses were tallied to yield a continuous score ranging from 0 to 48. Hostility was measured by tallying responses to the six items comprising the hostility subscale, yielding a continuous score from 0 to 24. For this sample, the depression subscale had an internal reliability of 0.88 (Chronbach’s alpha). Reliability for the six-item hostility scale in this sample was also strong (Chronbach’s alpha = 0.84). At the end of the survey, students were provided with space to write comments.
Procedures Permission slips were disseminated to parents of the 465 registered students. Only 337 of the registered students participated in the study; these were all the students who were present the day they were surveyed and returned signed permission slips (all of the students who were present had signed permission slips). Once permission slips were collected, the researcher attended the scheduled class, explained that surveys were to be completed anonymously, assured of confidentiality, and handed out surveys. Students completed surveys over the 40-minute class period. The researcher was on hand to answer any questions about how to complete surveys. Although the teachers were also present, all questions were referred to the researcher and no teacher participated at all in survey administration.
Exposure to violence, depression, and hostility
25
Table 1 Frequencies and means for exposure to violence, overall and by subgroups Variable
n (and %) exposed to violence
Mean for subset exposed to violence
Mean for sample
S.D.
Mean for male
S.D.
Mean for female
S.D.
Violence against family Violence against friends Violence against strangers Shot/stabbed Rape Beaten up/jumped Total exposures to violence
60 (18.29%)
1.35
0.25
0.62
0.23
0.51
0.26
0.68
96 (29.27%)
2.09
0.61
1.37
0.79
1.58
0.50
1.21
142 (43.29%)
1.84
0.80
1.94
1.27
2.88
0.52
0.88
25 (7.62%) 25 (7.62%) 71 (21.65%) 204 (62.19%)
1.08 1.16 1.53 3.41
0.08 0.12 0.33 2.18
0.30 0.59 1.01 3.62
0.12 0.02 0.53 2.89
0.37 0.12 1.43 4.83
0.06 0.18 0.21 1.74
0.24 0.74 0.61 2.51
Results Exposure to violence Students in the sample were indeed exposed to violence. Just under two-thirds of the sample (62.19%) witnessed a lifetime average of 3.41 of the types of violence listed, although almost 38% witnessed none of the events listed. Table 1 presents the types of exposure to violence surveyed by the questionnaire, and the mean scores for both the entire sample and the subset of students who experienced each type of violence (also broken down by gender). Table 2 provides an intercorrelational matrix, indicating that except for the experience of rape, most of the types of violence listed were highly correlated with each other. Males reported significantly more exposure to violence than females. t-Tests indicated that males and females in the sample reported exposure to roughly equal amounts of violence against family members; however, males were exposed to greater amounts of violence against friends ( t = 1.86, df = 324, p = 0.026) and strangers ( t = 3.46, df = 321, p = 0.001), and were more likely to have been shot/stabbed ( t = 1.75, df = 324, p = 0.0001) or beaten up/jumped ( t = 2.81, df = 324, p = 0.0001). Females reported a higher incidence of rape ( t = 2.47, df = 324, p = 0.0001) (see Table 1 for means by gender). Other demographic differences with regard to exposure to violence are worth noting. Black students were more likely than Hispanic students to have witnessed violence against family members ( t = 3.01, df = 310, p = 0.0001) and to have been raped ( t = 1.01, df = 309, p = 0.051). Correlation was used to examine the association between age and exposure to violence, and determined that in this sample older students had witnessed increased violence against friends ( r = 131, p = 0.004) and strangers ( r = 157, p = 0.018).
Distress symptoms Mean depression and hostility scores were compared to those for a ‘‘normative’’ population of White, middle class, midwestern high school students. Depression and hostility scores
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Table 2
Exposure to violence intercorrelation matrix Violence against family
Violence against friends
Violence against strangers
Shot/stabbed
Raped
0.17** 0.15**
0.01
Beaten up/jumped
Violence against family Violence against friends
0.28***
Violence against strangers
0.12*
0.48***
0.25*** 0.02
0.30*** 0.05
0.15**
0.21***
Shot/stabbed Raped Beaten up jumped
0.17** y0.01 0.26***
*p F 0.05; **p F 0.01; ***p F 0.001.
for this sample were 12.19 (S.D. 10.13) and 7.0 (S.D. 6.25), respectively, as compared with 9.6 (S.D. 8.28) and 5.28 (S.D. 4.86) (Derogatis, 1974). Female students ( t = 5.07, df = 321, p F 0.001) and Hispanic students ( t = 1.34, df = 307, p F 0.033) had significantly higher depression scores. Correlation found that older students were also more likely to have elevated depression ( r = 0.213, p F 0.001) and hostility ( r = 0.152, p F 0.006) scores. Analysis of variance was used to test for interactive effects of gender and ethnicity on all types of exposure to violence, depression, and hostility. No significant interactive effects were noted.
Exposure to violence and distress symptoms Correlation was used to determine whether exposure to violence variables (a continuous measure of the number of times a participant was exposed to each type of violence listed) were significantly correlated with continuous measures of depression and hostility. Students’ depression scores were only associated with having witnessed violence against family members and having been raped. In contrast, scores on the hostility inventory were positively correlated with all exposure to violence variables, except having witnessed violence against strangers (see Table 3 for Pearson correlation coefficients). Simple correlations were run separately for males and females to determine the gender-specific correlation between types of exposure to violence and distress symptoms. For females, no specific type of exposure to violence was uniquely correlated with depression, although the total number of exposures to the types of violence listed was. (Although this was the same correlation coefficient for males, its lack of significance was likely due to the larger female sample.) For males, only witnessing violence against family
Exposure to violence, depression, and hostility
Table 3
27
Exposure to violence and distress symptoms
Variable Violence against family Violence against friends Violence against strangers Shot/stabbed Raped Beaten up/jumped
Depression
Hostility
0.112* 0.091 0.007 0.069 0.212*** 0.024
0.207*** 0.204*** 0.097 0.228*** 0.172*** 0.140**
*p F 0.05; **p F 0.01; ***p F 0.001.
members was positively correlated with depression scores. With regard to hostility, findings for both gender groups were essentially the same (see Table 4). Because few interactive effects existed between gender and ethnicity, separate multiple regression analyses were conducted for each gender group to determine whether different variables explained depression for males and for females. Due to the high intercorrelation between exposure to violence variables, exposure to violence variables were collapsed into one category that summed exposure to all types of violence. For males, only increased age predicted more depression, and exposure to violence predicted hostility, mirroring the simple correlations conducted for each gender group. Likewise for females, increased age and exposure to violence predicted both depression and hostility (see Tables 5 and 6).
Discussion Students in the sample were exposed to an inordinate amount of violence, with over 60% of students having experienced an average of 3.41 acts of violence in their lives. Witnessing and experiencing violence was an extremely common event: almost half the sample had seen strangers shot or stabbed, just under 30% had seen friends shot or stabbed, and 18% had seen family members shot or stabbed. In addition, the reported incidence of rape was particularly high, and even more alarming is that this occurrence may have actually been under-reported. While almost 14% of female students cited at Table 4
Correlation between exposure to violence and distress symptoms, by gender
Variable
Violence against family Violence against friends Violence against strangers Shot/stabbed Raped Beaten up/jumped Total exposures to violence
Males
Females
Depression
Hostility
Depression
Hostility
0.20* 0.15 0.08 0.12 0.04 0.07 0.14
0.26** 0.28*** 0.17 0.38*** 0.01 0.25* 0.33***
0.08 0.12 0.06 0.09 0.03 0.08 0.14*
0.26** 0.28*** 0.17 0.14* 0.05 0.08 0.22**
*p F 0.05; **p F 0.01; ***p F 0.001
28
Table 5
A. Moses
Multiple regression analysis of depression by gender (male n s 120, female n s 195)
Variable
Males
Age Ethnicity (Hispanic) Exposure to violence
Females
Beta
t
p
Beta
t
p
0.229 0.124
2.527 1.389
0.013 0.167
0.217 0.113
3.14 1.626
0.001 0.105
0.058
0.641
0.522
0.150
2.166
0.031
Males: Adj. R 2 = 0.08, F (3,117) = 3.36, p = 0.021; Females: Adj. R 2 = 0.08, F (3,192) = 5.49, p = 0.001.
least one rape in their lifetime, this figure may not have reflected sexual abuse in the home, sexual molestation that did not result in intercourse, or date rape. In fact, several female students did not indicate a history of rape on the quantitative portion of the survey, but went on to describe sexually abusive situations on the back page. For the 62% of youth who witnessed violence, all types of exposure except the experience of rape were highly correlated with each other. Although it is not surprising that exposure to violence against friends, strangers, and oneself have high intercorrelations, their association with exposure to violence against family members is not as predictable, and is cause for speculation as to the causal direction of these associations. It is possible that witnessing violence against the family renders youth susceptible to later delinquent behavior that places them in risky violence-prone situations. Further research should explore the ages at which students become exposed to each type of violence in order to further examine this issue. Increased exposure to violence was linked to increased symptoms of psychological distress, yet increased exposure to violence against family members was the only type of violence linked to higher depression among students in the sample, while hostility scores were correlated with exposure to all types of violence except violence against strangers. Why was exposure to violence more predictive of hostility than depression? Only one study to date has considered the difference between witnessing violence against strangers vs. violence against ‘‘familiar’’ persons (i.e. friends and family members), and similarly found no relationship between distress and exposure to violence against Table 6
Multiple regression analysis of hostility by gender (male n s 121, female n s 195)
Variable
Age Ethnicity (Hispanic) Exposure to violence
Males
Females
Beta
t
p
Beta
t
p
0.086 0.139
0.970 1.593
0.334 0.114
0.151 0.044
2.168 0.629
0.031 0.530
0.280
3.138
0.002
0.218
3.137
0.002
Males: Adj. R 2 = 0.11, F (3,118) = 4.84, p = 0.003; Females: Adj. R 2 = 0.07, F (3,192) = 4.86, p = 0.003.
Exposure to violence, depression, and hostility
29
strangers (Martinez and Richters, 1993). A number of students wrote comments on their surveys indicating that exposure to violence made little emotional impact; that they were, in fact, indifferent to violence unless it was directed at themselves, family, or friends. Why is this the case? One explanation supports previous research suggesting that youth exposed to extreme violence may take on an aggressive identity, perhaps symbolically, to avoid victimization, or to attribute meaning to their world as one in which violence is the norm and a warrior-like attitude is a necessary tool of survival (Garbarino et al., 1991). Or, the obverse could be true, and delinquent, hostile adolescents could be more likely to place themselves in situations where they are exposed to increased violence. An alternative and unsettling explanation is that students have, as they suggest, habituated to their environments and become densensitized to violence: unless it directly affects their world, it no longer has an impact. Although this coping ability might be considered adaptive in the short run, as a means to stave off anxiety and distress, consider the implications on adolescent emotional development. Is it healthy for our children to grow up without empathy for those who suffer? What positive implications can this lack of empathy possibly have? Implications of these findings are important for adolescent development and behavior. Reactions to severe forms of psychological distress will differ according to the age and developmental level attained by the child (Eth and Pynoos, 1985). Although students’ level of coping were not measured, for many students, anger, either in identification with aggressor or turned against the self, may be a viable way to cope with trauma, despite the fact that this manner of coping can impede healthy emotional development. Furthermore, as a reaction to violence, anger in service of defense has even broader consequences, for while a young child may imagine revenge against the perpetrators of violence, a teen is more likely to exact it.
Gender As demonstrated by other research (Singer, 1994), males were more likely to suffer exposure to violence, but females were more likely than males to suffer greater distress symptoms following such exposure. Although males had increased overall exposure to violence, for females cumulative exposure to violence was correlated with higher levels of depression, whereas for males it was not. With regard to hostility, exposure to violence was equally correlated with exposure to violence for both males and females. Why these discrepancies? What is it about adolescence that renders boys and girls vulnerable to different types of experiences? It is possible that witnessing and experiencing violence is particularly problematic for teenage boys as an impediment to their sense of competence as a male. For teenage boys living in climates of inner city poverty, where competence is already impeded by economic limitations to employment and success, this sense of competence may already be fragile and susceptible to further damage. While teenage girls experience less exposure to violence, they appear to be more sensitive to the emotional effects of violence than are teenage males. One explanation may be the experience of rape. Almost 14% of the females sampled had been raped at least once (and as previously noted, this figure is likely too low). In terms of female development, the experience of rape alone would likely undermine resolution of issues of competence, sexuality, and identity formation. Prior research has indicated that adult
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females who were raped experience high levels of anger and depression (Rothbaum et al., 1992). It is not surprising, then, that the experience of rape combined with exposure to many other types of violence might predict higher depression indices for females in this sample. Another explanation may be provided by examining gender differences and the emergence of psychological disorders during adolescence. Prior to adolescence, boys demonstrate more adjustment reactions, antisocial disorders, learning disorders, anxiety disorders, and affective disorders than do girls (Eme, 1979), yet following the transition to adolescence females suffer a higher incidence of affective and anxiety disorders (NolenHoeksema, 1991). It should also be noted that greater expression of psychological distress among females may not necessarily mean males are suffering less psychological distress. Males, while more likely to suffer increased exposure to violence, may also be more likely to deny affect and therefore admit to less psychological distress.
Limitations of the study The study has notable limitations to generalizability and validity. First is selection criteria: the sample was not randomly chosen, and therefore does not necessarily mirror the school population, nor the New York City public high school population of students. Rules of participation also limited generalizability. Because school policy forbade returning to classes to survey on more than one day, only those students who were present on the days surveys were completely actually participated in the study. Attaining such a limited sample has important implications. Because students who were more likely to be truant were less likely to participant, the reported incidence of violence is probably less frequent in the sample than it is in the population. Consequently, if results of this study are accurate in indicating that increased exposure to violence is related to increased symptoms of distress, it is also likely that the population the sample hopes to represent may also suffer greater symptoms of depression and hostility. The last limitation is caused by problems in survey construction. Surveys relied on recollection, and as such cannot be considered truly reliable sources of information. Self-report recollection of lifetime accounts of exposure to violence may be particularly problematic. Furthermore, because questions about sexual abuse, physical abuse, and domestic violence could not be directly asked, important information about exposure to violence is missing. It seems that certain variables may, in some cases, have acted as proxies for this information. Reported incidents of rape may have reflected some sexual abuse. Witnessing violence against family members may have tapped incidents of domestic violence. Still, it seems that exposure to violence was not comprehensively measured, and, if anything, the fact that questions directly assessing exposures to sexual, physical, and domestic abuse were omitted caused frequency of exposure to violence to be under-reported. It is possible that high distress symptomatology among students who had fewer reported incidents of violence might be explained by exclusion of these questions.
Conclusions This study demonstrated that in a non-representative sample of New York City high school youth, exposure to violence was significantly related to a higher incidence of
Exposure to violence, depression, and hostility
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depression and hostility. Exposure to each of the types of violence listed were highly intercorrelated. While male and female students had equal exposure to violence against family members and themselves, male students had greater exposure to violence against friends and strangers. Despite these differences, female students demonstrated increased symptoms of depression and hostility. Older students were also more likely to indicate higher symptoms of distress. Although it is difficult to say what the long-term results of these symptoms may be, students themselves, in focus groups and written responses, suggested that seeing and experiencing chronic violence in their communities made them depressed, angry, and often violent themselves. This study did not investigate the behavioral consequences of exposure to violence, so all we have is the students’ own descriptions. It is difficult to say what the long-term results of depression and hostility will be, but it is an unlikely coincidence that while rates of violent crime for adults around the country are down, the same rates for teenagers are significantly on the rise. Children and adolescents in the inner city face the challenges of normal development in abnormal circumstances. Understanding how dangerous environments affect the transition from childhood to adolescence to adulthood is a matter of great importance for clinicians who work with inner city youth, in order to help these adolescents make sense of the events in their lives and thereby feel a sense of mastery over their environments. Although this will not completely counterbalance the effects of exposure to trauma, it is the first step in removing the obstacles to healthy psychological development.
References Achenbach, L. Y. and Edelbrock, C. (1979). The child behavior profile II: boys aged 12]16 and girls aged 6]11 and 12]16. Journal of Consulting and Clinical Psychology, 87, 49]74. Berkovitz, I. H. (1981). Feelings of powerlessness and the role of violent actions in adolescents. Adolescent Psychiatry, 9, 477]492. Brounstein, P., Hatry, H., Altsculer, D. and Blair, L. (1989). Patterns of substance abuse and delinquency among inner city adolescents. Report to the National Institute of Justice. Washington, DC: The Urban Institute. Burton, D., Foy, D., Bwanausi, C., Johnson, J. and Moore, L. (1994). The relationship between traumatic exposure, family dysfunction, and post-traumatic stress symptoms in male juvenile offenders. Journal of Traumatic Stress, 7(1), 83]93. Cairns, R. B., Peterson, G. and Neckman, H. J. (1988). Suicidal behavior in aggressive adolescents. Journal of Consulting and Clinical Psychology, 17, 298]309. Derogatis, L. (1979) The Symptom Checklist, 90, revised. Dubrow, N. F. and Garbarino, J. (1989). Living in the war zone: mothers and their young children in a public housing development. Child Welfare, 68(1), 3]20. DuRant, R. H., Cadenhead, C., Pendergrast, R. A., Slavens, G. and Linder, C. W. (1994). Factors associated with the use of violence among urban black adolescents. American Journal of Public Health, 84, 612]617. DuRant, R. H., Getts, A., Cadenhead, C., Emans, S. J. and Woods, E. R. (1995). Exposure to violence and victimization, depression, hopelessness, and purpose in life among adolescents living in and around public housing. Developmental and Behavioral Pediatrics, 16, 233]238. Eme, R. F. (1979). Sex differences in childhood psychopathology: a review. Psychological Bulletin, 86, 574]595. Eth, S. and Pynoos, R. S. (1985). Developmental perspective on psychic trauma in childhood. In Trauma and its Wake, Figley, C. R. (Ed.). New York: Brunner/Mazel.
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