Individual-level factors related to better mental health outcomes following child maltreatment among adolescents

Child Abuse & Neglect 79 (2018) 192–202

Contents lists available at ScienceDirect

Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg

Research article

Individual-level factors related to better mental health outcomes following child maltreatment among adolescents

T

Kristene Cheunga, Tamara Taillieub, Sarah Turnerc, Janique Fortierd, ⁎ Jitender Sareene, Harriet L. MacMillanf, Michael H. Boyleg, Tracie O. Afifih, a

Department of Psychology, University of Manitoba, P233 Duff Roblin Building, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2, Canada Applied Health Sciences Program, University of Manitoba, S109-750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W5, Canada c Departments of Community Health Sciences and Psychiatry, University of Manitoba, PZ-489 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada d Department of Community Health Sciences, University of Manitoba, S109-750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W5, Canada e Departments of Community Health Sciences, Psychology, and Psychiatry, University of Manitoba, PZ430 PsycHealth Centre, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4, Canada f Departments of Psychiatry and Behavioural Neurosciences and Pediatrics, Offord Centre for Child Studies, McMaster University, MIP Building, Suite 201A, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada g Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, Ontario, L8N 3Z5, Canada h Departments of Community Health Sciences and Psychiatry, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W5, Canada b

AR TI CLE I NF O

AB S T R A CT

Keywords: Child maltreatment Mental health Mental disorders Wellbeing Coping

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,123; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above.

⁎

Corresponding author. E-mail addresses: [email protected] (K. Cheung), [email protected] (T. Taillieu), [email protected] (S. Turner), [email protected] (J. Fortier), [email protected] (J. Sareen), [email protected] (H.L. MacMillan), [email protected] (M.H. Boyle), Tracie.Afifi@umanitoba.ca (T.O. Afifi). https://doi.org/10.1016/j.chiabu.2018.02.007 Received 5 September 2017; Received in revised form 30 January 2018; Accepted 7 February 2018 0145-2134/ © 2018 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Child maltreatment is a strong determinant of poor physical and mental health outcomes (Afifi, Mota, MacMillan, Sareen, 2013; Afifi et al., 2014, Afifi et al., 2016a; Barnes & Josefowitz, 2014; Kendall-Tackett, 2002; Kessler et al., 2010; Noll & Shenk, 2010; Norman et al., 2012). Not all individuals who have experienced child maltreatment will experience adverse outcomes (Nanni, Uher, & Danese, 2014; Norman et al., 2012). This finding can be understood through the resiliency theory, which suggests that specific individual, social, and contextual variables, known as promotive factors, inhibit the development of adverse outcomes after being exposed to risk (Fergus & Zimmerman, 2005; Zimmerman & Brenner, 2010). There are two types of promotive factors: (a) assets, which are positive factors within the individual, and (b) resources, which are positive factors outside of the individual, such as parental relationships. Moreover, the protective factor model within the resiliency theory posits that the presence of promotive factors might decrease the association between risk exposure and adverse outcomes. Researchers in the field of childhood adversity are attempting to identify factors that promote resiliency following child maltreatment, which can have implications for prevention and intervention strategies. Afifi and MacMillan (2011) published a review on resilience following child maltreatment, which included a list of protective factors that have been identified in studies published up to 2010. This review demonstrated that most research on resilience following child maltreatment has emphasized the importance of individual-level protective factors (i.e., assets; Afifi & MacMillan, 2011). Some of the most common individual-level factors that have emerged include positive coping strategies (Afifi & MacMillan, 2011; Afifi et al., 2016b; Marriott, Hamilton- Giachritsis, & Harrop, 2014; Simpson, 2010), positive self-esteem (Afifi & MacMillan, 2011; Domhardt, Münzer, Fegert, & Goldbeck, 2015; Marriott et al., 2014; Simpson, 2010), an internal locus of control (Afifi & MacMillan, 2011; Domhardt et al., 2015; Marriott et al., 2014), and hope/optimism (Afifi & MacMillan, 2011; Domhardt et al., 2015; Simpson, 2010; Williams & Nelson-Gardell, 2012). Furthermore, there is preliminary evidence that physical exercise may be important for positive health outcomes among children who are at risk for experiencing, or have experienced, maltreatment (Afifi et al., 2016b; Morgan, 2010; Waechter & Wekerle, 2015). The research to date on the mental health outcomes of individuals with a history of child maltreatment has several limitations. First, most studies on individual-level factors have involved non-representative samples (Holmes, Yoon, Voith, Kobulsky, & Steigerwald, 2015; Williams & Nelson-Gardell, 2012). Second, most studies did not include a non-maltreatment comparison group, which precludes the examination of possible differences among individuals with and without a history of child maltreatment. Third, most studies have focused on a single type of child maltreatment. Fourth, most studies have defined mental health narrowly as the absence of mental disorders (Holmes et al., 2015; Marriott et al., 2014; Williams & Nelson-Gardell, 2012). Mental health is not only the absence of mental disorders, but according to the World Health Organization (2005), it includes the presence of positive functioning, a sense of well-being and the perceived ability to cope with life stress. Accordingly, a more comprehensive assessment of mental health in research should be multidimensional and include a measure of psychopathology, perceived mental health (Keyes, 2005) and thoughts about suicide. To address the current limitations in the child maltreatment literature identified above, the present study has three main objectives: 1) to determine the prevalence of child maltreatment types across specific mental health indicators (i.e., perceived mental health for the past 30 days, past-year mental disorders, and past-year suicidal ideation); 2) to estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) to examine the relationship between individual-level protective factors and overall mental health status of adolescents with and without a history of maltreatment. Based on a large body of literature supporting the association between child maltreatment and adverse outcomes, we hypothesized that adolescents with a history of any type of child maltreatment would have poorer mental health outcomes overall compared to adolescents without a history of child maltreatment. In line with the protective factor model and the resiliency theory, we also hypothesized that individuallevel factors would be associated with better mental health outcomes among adolescents with a child maltreatment history. 1. Material and methods 1.1. Data and sample The data were drawn from the National Comorbidity Survey of Adolescents (NCS-A) master file, which is a large, cross-sectional, nationally representative epidemiologic survey of adolescents aged 13 to 17 years from the United States (N = 10,148). The current study consists of a subset of the NCS-A sample, which includes adolescents who attended school at the time of data collection (n = 10,123). Data were collected between 2001 and 2004 (school sample response rate = 74.7%) through face-to-face interviews by trained interviewers using computer-assisted self-administered interviewing techniques (Kessler et al., 2009). Data were collected from a variety of Census regions (Northwest, Midwest, South, and West) and geographic settings (i.e., Census major metropolitan area, other urbanized county and rural county; Kessler et al., 2009; Kessler et al., 2012). Written informed consent from a parent and the adolescent was obtained before the administration of the interview (Kessler et al., 2009). The Human Subjects Committees of both Harvard Medical School and the University of Michigan approved the recruitment, consent, and data collection for the NCS-A (Kessler et al., 2009). The NCS-A is a publicly available dataset and has been used in recently published studies (e.g., Avenevoli, Swendsen, He, Burstein, & Merikangas, 2015; Cheung et al., 2017; Lee-Winn, Townsend, Reinblatt, & Mendelson, 2016; Marshall, 2016). 1.2. Primary measures 1.2.1. Child maltreatment The NCS-A measured child maltreatment by using questions adapted from the Conflict Tactics Scales (CTS; Straus, Hamby, Finkelhor, Moore, & Runyan, 1998). The CTS includes questions about physical abuse, emotional abuse, sexual abuse, physical 193

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Table 1 Mutually exclusive mental health categories based on current perceived mental health for the past 30 days, past-year mental disorder(s), and past-year suicidal ideation. Mental health indicators No past year suicidal ideation

Past year suicidal ideation

Perceived mental health for the past 30 days

No past year mental disorder

Past year mental disorder

No past year mental disorder

Past year mental disorder

Excellent/Very good Good Fair/Poor

Good mental health Moderate mental health Poor mental health

Moderate mental health Moderate mental health Poor mental health

Poor mental health Poor mental health Poor mental health

Poor mental health Poor mental health Poor mental health

neglect, and exposure to intimate partner violence (IPV). All types of maltreatment, aside from sexual abuse, were assessed in terms of frequency (never, not very often, sometimes, or often) while the respondent was growing up; sexual abuse was assessed as a yes/no variable (i.e., did this ever happen). The following classification criteria are consistent with previous publications (Afifi, Brownridge, Cox, & Sareen, 2006, Afifi, Boman, Fleisher, & Sareen, 2009). Individuals were categorized as having experienced physical abuse if their primary male or female caregiver did any of the following: 1) pushed, grabbed, shoved, or threw something at them sometimes or often; or 2) kicked, bit or hit with a fist, beat up, choked, burned or scalded, or threatened them with a knife or gun, not very often, sometimes, or often. Sexual abuse was assessed by asking respondents whether someone either had sexual intercourse with them or penetrated their body with a finger or object when they did not want them to do so, either by threatening them or by using force. Emotional abuse was assessed by asking respondents whether one of their primary caregivers sometimes or often: 1) insulted or swore; 2) shouted, yelled, or screamed; and/or 3) threatened to hit them. Physical neglect consisted of experiencing one of the following items either sometimes or often: 1) were made to do chores that were too difficult or dangerous for someone their age; 2) were left alone or unsupervised when they were too young to be alone; 3) went without things they needed like clothes, shoes, or school supplies because their parents or caregivers spent the money on themselves; 4) their parents or caregivers made them go hungry or did not prepare regular meals; and/or 5) their parent or caregivers ignored or failed to get them medical treatment when they were sick or hurt. Finally, to assess exposure to IPV, respondents were asked whether their parents/couple who raised them did any of the following things to each other either sometimes or often: 1) insulted or swore; 2) shouted, yelled, or screamed; or 3) threatened or hit. A respondent was classified as having a history of child maltreatment if they met the criteria for at least one of the above individual types of child maltreatment.

1.2.2. Mental health indicator The mental health indicator captures three different levels of mental health and well-being: 1) good mental health, 2) moderate mental health, and 3) poor mental health (see Table 1). The mental health indicator categories were generated with responses to the following items: the presence of past-year mental disorder(s); the presence of past-year suicidal ideation; and perceived mental health for the past 30 days. The use of a three-level mental health indicator has been supported by previous research (Gallagher, Lopez, & Preacher, 2009; Joshanloo, Wissing, Khumalo, & Lamers, 2013; Keyes et al., 2008; Lamers, Glas, Westerhof, & Bohlmeijer, 2012; Robitschek & Keyes, 2009) and it has also been used in recent studies (Afifi et al., 2016b; Cheung et al., 2017).

1.2.3. Past-year mental disorders Past-year mental disorders were diagnosed using a modified Composite International Diagnostic Interview (CIDI), a semi-structured research diagnostic interview (Kessler et al., 2012, Kessler et al., 2009). Respondents were classified as having a past-year mental disorder if they met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV; American Psychiatric Association, 2000) criteria for any of the following 23 types of mental disorders: attention deficit disorder, agoraphobia with panic disorder, agoraphobia without panic disorder, alcohol abuse, alcohol dependence, anorexia, any binge eating disorder, bipolar I disorder, bipolar II disorder, bulimia, conduct disorder, drug abuse, drug dependence, dysthymia, generalized anxiety disorder, hypomania, intermittent explosive disorder, major depressive disorder, oppositional defiant disorder, panic disorder, posttraumatic stress disorder, social phobia, or specific phobia.

1.2.4. Past-year suicidal ideation Past-year suicidal ideation was assessed by asking respondents whether they had ever seriously thought about killing themselves in the past 12 months (yes or no).

1.2.5. Perceived mental health for the past 30 days Respondents were asked to rate their mental health over the past 30 days on a 5-point ordinal scale ranging from poor to excellent. The 5-point scale was then collapsed into 3-levels; poor/fair, good, and very good/excellent. 194

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

1.3. Individual-level protective factors 1.3.1. Physical exercise Physical exercise was assessed by asking respondents how often they engage in vigorous physical exercise that lasts for 15 min or longer, and that causes their heart to beat fast (several times a week or more, about once a week, several times a month, about once a month, less than once a month, or never). The variable was collapsed into two levels: 1) several times a week or more, and 2) less than several times a week. Engaging in physical exercise in the summer and the winter was assessed separately. 1.3.2. Positive coping strategies Five items were used to assess positive coping strategies. Respondents were asked to rate their perceived ability to keep calm on a 4-point scale, which was collapsed into 2-levels: poor/fair, and good/excellent. Respondents were also asked to indicate how much they would do the following things to cope with stressful situations: 1) analyze a problem, 2) seek advice from others, 3) make a plan of action and follow it, and 4) keep a sense of humor. These items were rated on a 4-point scale ranging from not at all to a lot (collapsed into 2-levels: not at all/a little and some/a lot). 1.3.3. Positive self-esteem Self-esteem was measured by asking individuals how true the following statement was: “I am overall satisfied with myself,” ranging from not at all true to very true (collapsed into 2-levels; not at all true/not very true, and somewhat true/very true). 1.3.4. Locus of control Locus of control was measured using three items on a 4-point scale ranging from not at all true to very true (collapsed into 2-levels; not at all true/not very true, and somewhat true/very true). Respondents were provided with the following statements and were asked to indicate the degree to which each statement was true: 1) my life is determined by my own actions, 2) when I make plans, I almost always make them work, and 3) when I get what I want, it is usually because I worked hard for it. 1.4. Covariates The sociodemographic covariates included adolescent age (13–14 years, 15–17 years), sex (male and female), present/absent male head of the household, and history of family low socioeconomic status (SES). To assess the presence/absence of having a male head of the household, respondents were asked to identify who the male head of their household was (i.e., biological father, adoptive father, step father) for most of their childhood. Respondents who indicated that there was an adult male head of the household were classified as having a male head of their household present. Respondents who could not identify a male head of the household were classified as having an absent male head of the household. To assess family history of low SES, respondents were asked: “was there ever a time when [their] family received money from government assistance program like welfare, Aid to Families with Dependent Children, General Assistance, or Temporary Assistance for Needy Families.” Individuals who answered yes to this question were categorized as having a history of low family SES. 1.5. Statistical analysis Survey weights representing the probability of being selected and participating were applied to ensure that the sample was representative of adolescents in the United States in terms of sociodemographic (race, age, sex, parents' education; family income, number of siblings, etc.) and geographic factors (Census region and urbanicity; Kessler et al., 2009). Additional details regarding the design of the NCS-A and the sample representativeness can be found elsewhere (Kessler et al., 2012, Kessler et al., 2009). Taylor series linearization was used in estimating variance to account for the complex sampling design. First, the prevalence of sociodemographic covariates was presented by perceived mental health for the past 30 days, past-year mental disorder(s), and past-year suicidal ideation. Second, cross-tabulations and logistic regression were used to model the distribution of child maltreatment types by perceived mental health for the past 30 days, mental disorder(s), and suicidal ideation. Third, the same approaches were used for the distribution of child maltreatment types by the overall mental health indicator (i.e., good, moderate, poor mental health). Fourth, multinomial regression models were used to determine the association between individual-level protective factors and the overall mental health indicator. Fifth, interaction terms were examined to determine whether the relationships between individual-level factors moderated the relationship between child maltreatment and overall mental health outcomes. The models were developed separately for those classified with and without a child maltreatment history and adjusted for sociodemographic variables (i.e., age, sex, present/absent male head of household, and history of low family SES). Statistical significance was set at p < .01. 2. Results Table 1 shows how the three levels of the mental health indicator were categorized based on perceived mental health for the past 30 days, past-year mental disorder, and past-year suicidal ideation. Previous research demonstrated that 41.8%, 47.1%, and 11.2% of adolescents were classified as having good, moderate, and poor mental health, respectively (Cheung et al., 2017). Table 2 provides the distribution of sociodemographic covariates by perceived mental health for the past 30 days, past-year mental disorder(s), and past-year suicidal ideation among American adolescents in this survey. Most adolescents rated their mental health as excellent or very 195

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Table 2 Sociodemographic covariates by mental health indicators of perceived mental health for the past 30 days, past-year mental disorders, and past-year suicidal ideation in the American adolescent population. Covariates

Perceived mental health for the past 30 days

Past-year mental disorder

Past-year suicidal ideation

Excellent/Very good

Good

Poor/Fair

No

Yes

No

Yes

Sex Male % (n) Female % (n)

66.8 (2989)

26.8 (1234)

6.4 (290)

61.2 (2814)

38.8 (1722)

96.6 (4390)

3.4 (137)

61.3 (2871)

30.6 (1408)

8.1 (383)

53.9 (2583)

46.2 (2102)

92.8 (4364)

7.2 (314)

Age 13 to 14 % (n) 15 to 17 % (n)

67.0 (2535)

27.2 (1078)

5.8 (233)

61.4 (2461)

38.6 (1409)

95.4 (3702)

4.6 (162)

63.5 (3565)

28.5 (1621)

8.0 (448)

56.0 (3152)

44.0 (2502)

94.2 (5326)

5.8 (319)

Male head of household Present % (n) 65.6 (5784) Absent % (n) 57.7 (648)

27.5 (2493)

7.0 (624)

58.1 (5276)

41.9 (3661)

94.7 (8481)

5.3 (442)

33.2 (369)

9.2 (113)

53.8 (601)

46.2 (538)

94.1 (1071)

5.9 (66)

History of low family SES No % (n) 67.1 (5146) Yes % (n) 54.6 (895)

26.6 (2094)

6.3 (500)

60.7 (4734)

39.3 (3029)

95.0 (7367)

5.0 (386)

33.9 (541)

11.5 (185)

43.8 (729)

56.2 (901)

92.6 (1532)

7.4 (95)

28.1 (2874)

7.3 (744)

57.7 (5901)

42.3 (4221)

94.6 (9590)

5.4 (515)

Overall sample % (n)

64.6 (6457)

Note. Mental health indicators are not exclusive. SES = socioeconomic status.

good (64.6%). About two-fifths of male and one-half of female adolescents (38.8% and 46.2%, respectively) met diagnostic criteria for a past-year mental disorder and approximately 1 in 29 (3.4%) male adolescents and 1 in 14 (7.2%) female adolescents had past-year suicidal ideation. The percentage of adolescents who met criteria for a mental disorder and suicidal ideation was slightly higher in adolescents aged 15–17 years (44.0%, 5.8%, respectively) than those who were 13- to 14-years old (38.6%, 4.6%, respectively). Most adolescents rated their mental health as excellent/very good regardless of whether they had a present (65.6%) or absent (57.7%) male head of household, or whether they reported a history of low family SES (54.6%) or not (67.1%). The proportion of adolescents who had a past-year mental disorder and suicidal ideation was slightly higher in adolescents with an absent male head of the household (46.2%, 5.9%, respectively) than those who had a present male head of the household (41.9%, 5.3%, respectively). Similarly, there was a higher percentage of adolescents with a past-year mental disorder or suicidal ideation who had a family history of low SES (56.2%, 7.4%, respectively) compared to those who did not (39.3%, 5.0%, respectively). Table 3 displays the prevalence of child maltreatment types by perceived mental health for the past 30 days, past-year mental disorder(s), and past-year suicidal ideation. All child maltreatment types were associated with increased odds of poor/fair perceived mental health for the past 30 days (range of adjusted odds ratios (AORs), 2.6–4.4), increased odds of past-year mental disorder(s) (range of AORs, 2.0–4.6), and past-year suicidal ideation (range of AORs, 2.0–6.0). Table 4 presents the prevalence of child maltreatment types by an overall measure of mental health based on all three mental health indicators. The prevalence of adolescents who experienced the different types of maltreatment can be found in Cheung et al. (2017). The prevalence of good, moderate, and poor mental health among adolescents with a history of child maltreatment was 32.4%, 53.6%, and 14.0%, respectively. The prevalence of good, moderate, and poor mental health among adolescents without a history of child maltreatment was 54.9%, 40.5%, and 4.6%, respectively. All types of child maltreatment were associated with increased odds of having poor mental health (range of ORs, 3.2–9.5). The largest ORs were for sexual abuse and poor mental health. Experiencing more than one type of child maltreatment was also associated with increased odds of having poor mental health (range of ORs, 2.8–15.6). Table 5 displays the odds ratios for the association between individual-level factors and the overall mental health indicator among adolescents with and without a child maltreatment history. Being physically active several times a week or more in the winter; utilizing positive coping strategies; having an internal locus of control and having overall satisfaction with oneself were significantly associated with increased odds of better mental health outcomes among adolescents with (AORs ranging from 1.7 to 8.7) and without (AORs ranging from 1.9 to 38.2) a history of child maltreatment. Specifically, the following positive coping strategies were significantly associated with better mental health among adolescents with and without a history of child maltreatment: the perceived ability to 1) keep calm, and 2) analyze a problem. The perceived ability to seek advice from others, and make a plan of action were also significantly associated with better mental health among adolescents with a history of child maltreatment. The following locus of control items were significantly associated with better mental health outcomes among adolescents with and without a history of

196

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Table 3 Prevalence of child maltreatment by mental health indicators of perceived mental health for the past 30 days, past-year mental disorders, and past-year suicidal ideation in the American adolescent population. Mental health indicators Child maltreatment history

Perceived mental health for the past 30 days

Past-year mental disorder

Past-year suicidal ideation

Excellent/Very good

Good

Poor/Fair

No

Yes

No

Yes

Physical abuse Yes % No % OR (99% CI)

51.9 66.5 1.0

32.2 27.4 1.5 (1.2, 1.9)***

15.9 6.1 3.4 (2.4, 4.7)***

31.2 60.9 1.0

68.8 39.1 3.4 (2.4, 4.8)***

86.7 95.5 1.0

13.4 4.6 3.2 (2.3, 4.6)***

Emotional abuse Yes % No % OR (99% CI)

55.8 68.5 1.0

31.7 26.5 1.5 (1.2, 1.8)***

12.6 5.0 3.1 (2.1, 4.5)***

41.5 64.1 1.0

58.5 35.9 2.5 (2.0, 3.2)***

90.3 96.2 1.0

9.7 3.8 2.7 (1.9, 3.9)***

Sexual abuse Yes % No % OR (99% CI)

48.6 65.5 1.0

30.1 28.0 1.5 (1.0, 2.1)**

21.3 6.5 4.4 (2.8, 7.1)***

24.4 59.6 1.0

75.6 40.4 4.6 (2.8, 7.5)***

78.1 95.6 1.0

21.9 4.5 6.0 (3.6, 10.1)***

Physical neglect Yes % No % OR (99% CI)

53.2 68.5 1.0

34.5 26.0 1.7 (1.4, 2.1)***

12.4 5.5 2.9 (2.0, 4.2)***

44.9 62.1 1.0

55.1 37.9 2.0 (1.7, 2.4)***

91.6 95.6 1.0

8.4 4.4 2.0 (1.5, 2.7)***

Exposure to IPV Yes % No % OR (99% CI)

55.6 68.2 1.0

32.9 26.4 1.5 (1.2, 2.0)***

11.5 5.4 2.6 (1.7, 4.0)***

42.2 63.6 1.0

57.8 36.4 2.4 (1.9, 3.0)***

89.6 96.5 1.0

10.4 3.5 3.2 (2.1, 4.7)***

Number of types of child maltreatment Three types or more, % 48.1 Two types, % 58.2 One type, % 60.6 No maltreatment, % 73.6 OR (99% CI) Three types or more 1.0 Two types 1.0 One type 1.0

34.8 30.1 32.9 23.0

17.2 11.7 6.6 3.4

26.5 46.5 56.0 69.9

73.5 53.5 44.0 30.1

83.3 92.9 95.0 97.6

16.7 7.2 5.0 2.4

2.3 (1.8, 3.0)*** 1.7 (1.2, 2.2)*** 1.7 (1.3, 2.4)***

7.8 (3.9, 15.7)*** 4.4 (2.6, 7.5)*** 2.4 (1.3, 4.4)***

1.0 1.0 1.0

6.4 (4.8, 8.6)*** 2.7 (2.2, 3.3)*** 1.8 (1.4, 2.4)***

1.0 1.0 1.0

8.1 (4.6, 14.1)*** 3.1 (1.8, 5.5)*** 2.1 (1.4, 3.2)***

Any child maltreatment Yes % No % OR (99% CI)

32.5 23.0 1.8 (1.5, 2.2)***

10.5 3.4 4.0 (2.5, 6.5)***

46.9 69.9 1.0

53.1 30.1 2.6 (2.2, 3.1)***

91.9 97.6 1.0

8.1 2.4 3.6 (2.5, 5.2)***

57.1 73.6 1.0

IPV = intimate partner violence. ** Significantly different from reference category (p < .01). *** Significantly different from reference category (p ≤ .001).

maltreatment: the belief that 1) self-made plans always work out, and 2) success is due to hard work. Additionally, the belief that life is determined by one's own actions was significantly associated with better mental health among adolescents with a history of child maltreatment. Exposure to maltreatment influenced the association between self-esteem and mental health outcomes. Specifically, interaction terms demonstrated that the effect of overall satisfaction with oneself was significantly stronger among respondents without a history of child maltreatment compared to those with a history of child maltreatment. No other interaction terms were significant, which suggests that associations between the other individual-level factors and mental health outcomes were similar for both adolescents with and without a history of child maltreatment.

3. Discussion The current study identifies several novel findings about mental health and individual-level factors associated with better mental health for a representative sample of adolescents with and without a history of child maltreatment. First, we found that 32.4% of adolescents with a child maltreatment history had good mental health compared to 54.9% without a child maltreatment history. Moreover, 14.0% of adolescents with a child maltreatment history compared to 4.6% of adolescents without a child maltreatment history were classified as having poor mental health. Second, individual-level factors associated with better mental health outcomes included being physically active in the winter as well as the abilities to: keep calm, to analyze a problem, seek advice from others, make a plan of action, overall satisfaction with oneself and beliefs that self-made plans always work out, life is determined by one's own actions, and success is due to hard work. Third, including a comparison group of individuals without a history of child 197

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Table 4 Prevalence of child maltreatment by an overall measure of mental health based on all three mental health indictors in the American adolescent population. Mental health based on all three mental health indictors Child maltreatment history

Good

Moderate

Poor

Physical abuse Yes % No % OR (99% CI)

21.1 46.1 1.0

57.6 45.9 2.7 (2.0, 3.7)***

21.3 8.1 5.8 (3.9, 8.5)***

Emotional abuse Yes % No % OR (99% CI)

28.7 48.7 1.0

54.9 44.5 2.1 (1.7, 2.6)***

16.4 6.8 4.1 (3.1, 5.4)***

Sexual abuse Yes % No % OR (99% CI)

17.0 44.3 1.0

52.1 47.3 2.9 (1.4, 5.9)***

30.8 8.4 9.5 (4.5, 20.1)***

Physical neglect Yes % No % OR (99% CI)

30.6 47.1 1.0

53.8 45.3 1.8 (1.5, 2.2)***

15.6 7.6 3.2 (2.2, 4.5)***

Exposure to IPV Yes % No % OR (99% CI)

29.5 48.0 1.0

54.8 44.8 2.0 (1.5, 2.7)***

15.7 7.2 3.6 (2.4, 5.3)***

Number of types of child maltreatment Three types or more, % Two types, % One type, % No child maltreatment, % OR (99% CI) Three types or more Two types One type

16.9 32.3 38.4 54.5

52.2 50.7 51.1 40.2

28.9 17.1 10.5 5.3

1.0 1.0 1.0

4.3 (3.1, 6.0)*** 2.1 (1.6, 2.9)*** 1.8 (1.4, 2.3)***

15.6 (8.5, 28.7)*** 5.3 (3.2, 8.8)*** 2.8 (1.6, 4.6)***

Any child maltreatment Yes % No % OR (99% CI)

32.4 54.9 1.0

53.6 40.5 2.2 (1.9, 2.7)***

14.0 4.6 5.2 (3.6, 7.4)***

Notes. Good mental health (excellent/very good perceived mental health, no mental disorders, and no suicidal ideation); Moderate mental health (good perceived mental health, with or without mental disorders, and no suicidal ideation); Poor metal health (Poor/fair perceived mental health, with or without mental disorders, and with or without suicidal ideation). IPV = intimate partner violence. *** Significantly different from reference category (p ≤ .001).

maltreatment indicated that differences in the individual-level factors and better mental health outcomes existed among adolescents with and without a history of child maltreatment. In addition, the effect for being satisfied overall with oneself was significantly stronger among respondents without a history of child maltreatment compared to those with a history of child maltreatment. This finding fits with the resiliency theory, which would view being satisfied overall with oneself as an asset associated with better mental health outcomes among adolescents with a history of child maltreatment. Our findings indicate that a history of any form of child maltreatment results in significantly higher odds of adolescents having poorly perceived mental health for the past 30 days compared to those who did not experience child maltreatment, and this is consistent with previous research (Hillberg, Hamilton-Giachritsis, & Dixon, 2011; Martsolf, Draucker, & Chapman, 2004). The current study contributes to the literature by examining the perceived mental health of adolescents who have a history of child maltreatment, whereas other studies have focused on perceived mental health outcomes among adults with a history of child maltreatment (Hillberg et al., 2011; Martsolf et al., 2004). The current study also adds to our knowledge of the relationship between child maltreatment and mental health outcomes by analyzing this association using a nationally representative sample of adolescents. The results of this study support previous research on the relationship between child maltreatment and mental disorders (e.g., Afifi et al., 2011; Afifi et al., 2014; Afifi et al., 2016b; Kessler et al., 2010; Lindert et al., 2014) and suicidal behaviors (Afifi et al., 2016b, Afifi et al., 2014; Devries et al., 2014; Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013). The present study also demonstrated that all forms of child maltreatment significantly increased the odds of having overall poor mental health based on the three-level mental health indicator. This finding aligns with a previous study that examined the relationship between a history of child abuse (i.e., physical abuse, sexual abuse, and exposure to IPV) and overall mental health based on a similar three-level indicator among a representative adult sample (Afifi et al., 2016b). The current study involving adolescents is unique in that it included measures of physical neglect and emotional abuse in addition to physical abuse, sexual abuse, and exposure to IPV. Of note, the odds of having poor mental health overall in 198

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Table 5 Results from the multinomial multivariable analyses examining the relationship between individual-level factors and an overall measure of mental health based on all three mental health indictors among individuals with and without a child maltreatment history in the American adolescent population. No child maltreatment history, AOR (99% CI)a

Child maltreatment history, AOR (99% CI)a

Good mental health

Moderate mental health

Good mental health

Moderate mental health

Summer physical activity Less than several times a week Several times a week or more

1.0 1.3 (0.8, 2.2)

1.0 1.1 (0.7, 2.0)

1.0 1.7 (1.0, 2.8)**

1.0 1.4 (0.8, 2.4)

Winter physical activity Less than several times a week Several times a week or more

1.0 1.9 (1.1, 3.5)**

1.0 1.5 (0.8, 2.9)

1.0 1.9 (1.1, 3.2)**

1.0 1.3 (0.8, 2.2)

1.0 2.6 (1.3, 5.5)***

1.0 4.4 (3.0, 6.5)***

1.0 1.8 (1.2, 2.9)***

1.0 3.2 (1.1, 9.3)**

1.0 2.6 (1.6, 4.3)***

1.0 1.8 (1.1, 3.2)**

1.0 1.6 (0.7, 3.3)

1.0 1.7 (1.0, 2.9)**

1.0 1.6 (1.0, 2.5)**

1.0 1.5 (0.6, 3.5)

1.0 1.8 (1.1, 3.0)**

1.0 1.6 (1.1, 2.3)**

1.0 1.8 (0.8, 3.9)

1.0 1.5 (0.8, 2.7)

1.0 1.5 (0.7, 2.0)

1.0 7.2 (3.8, 13.4)***,b

1.0 8.7 (4.5, 17.0)***

1.0 3.7 (2.4, 5.7)***

1.0 1.5 (0.7, 3.5)

1.0 1.7 (1.1, 2.8)**

1.0 1.3 (0.8, 2.0)

1.0 1.9 (0.8, 4.4)

1.0 3.4 (2.0, 5.7)***

1.0 1.8 (1.0, 3.3)**

1.0 2.2 (0.9, 5.1)

1.0 2.6 (1.5, 4.4)***

1.0 1.5 (0.95, 2.2)

Positive coping strategies Ability to keep calm Fair/Poor 1.0 Excellent/Good 5.0 (2.1, 11.7)*** Ability to analyze a problem Not at all/A little 1.0 A lot/Some 4.4 (1.7, 11.4)*** Ability to seek advice from others Not at all/A little 1.0 A lot/Some 1.9 (0.8, 4.1) Ability to make a plan of action and follow it Not at all/A little 1.0 A lot/Some 2.2 (0.9, 5.1) Ability to keep sense of humor Not at all/A little 1.0 A lot/Some 2.4 (0.99, 5.7) Positive self-esteem Overall satisfaction with oneself Not at all/Not very Very true/Somewhat true

1.0 38.2 (10.4, 140.1)***,b

Locus of control Life is determined by own actions Not at all/Not very 1.0 Very true/Somewhat true 2.3 (0.97, 5.5) When I make plans I always make them work Not at all/Not very 1.0 Very true/Somewhat true 4.9 (2.2, 10.8)*** When I get what I want it is usually because I work hard Not at all/Not very 1.0 Very true/Somewhat true 4.2 (1.5, 11.6)***

Notes. Good mental health (excellent/very good perceived mental health, no mental conditions, and no suicidal ideation); Moderate mental health (good perceived mental health, with or without mental conditions, and no suicidal ideation); Poor metal health (poor/fair perceived mental health, with or without mental conditions, and with or without suicidal ideation). AOR = odds ratios adjusted for age, sex, present/absent male head of household, and history of low family socioeconomic status. a Poor well-being and functioning is the reference category with an odds of 1.0. b For significant interaction terms, effects were stronger for adolescents without a history of maltreatment. ** Significantly different from reference category (p ≤ .01). *** Significantly different from reference category (p ≤ .001).

relation to experiencing physical and sexual abuse in the current study were higher than those reported in the study by Afifi et al. (2016b). However, these studies are not directly comparable because they used different datasets. Our finding that physical exercise is significantly associated with better mental health outcomes among adolescents with and without a history of child maltreatment aligns with previous research (Afifi et al., 2016b; Morgan, 2010; Waechter & Wekerle, 2015). We also found that positive self-esteem, locus of control, and most forms of positive coping strategies were associated with better mental health outcomes among adolescents regardless of their child maltreatment history is consistent with previous research involving adults with a history of child abuse (Afifi & MacMillan, 2011; Afifi et al., 2016b; Domhardt et al., 2015; Marriott et al., 2014; Simpson, 2010). This finding also aligns with the protective factor model of the resiliency theory (Fergus & Zimmerman, 2005; Zimmerman & Brenner, 2010). Specifically, based on the protective factor model of the resiliency theory, the individual-level factors identified above can be viewed as promotive factors for overall positive mental health. The present study adds an examination of this association among a representative sample of adolescents as opposed to adults. Overall, the results of the current study demonstrate that several types of individual-level factors are associated with better mental health outcomes among adolescents. To increase our knowledge and understanding of the association between individual-levels factors and better mental health outcomes among adolescents, future studies should examine the association between these factors and specific types of maltreatment. 199

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

3.1. Limitations The current study has several limitations. First, the data are cross-sectional, which precludes any causal inferences. Second, the NCS-A data were only collected from adolescents attending school during data collection (Kessler et al., 2009). Given that adolescents who struggle with emotional, behavioral, and academic problems tend to have poorer school attendance (Kearney, 2008; Kent et al., 2011), the data are not generalizable to adolescents who do not attend school. Third, the child maltreatment questions used in the NCS-A only referred to the child's mother or father as the perpetrator; however, child maltreatment, especially sexual abuse, can be committed by a broad range of perpetrators. Fourth, the retrospective nature of the child maltreatment items may be susceptible to recall bias. Fifth, the present study only examined the following four different sociodemographic factors: adolescent age, sex, present/ absent male head of the household, and history of low family SES. It is possible that childhood factors that were not included in the analyses of the current study might have confounded the relationship between individual-level factors and better mental health outcomes; however, our ability to include additional sociodemographic factors was limited by the variables available in the NCS-A dataset. Sixth, the operationalization of child maltreatment was restricted to the CTS items used in the NCS-A, which might exclude some types of child maltreatment. Seventh, the statistical analyses for the current study required the use of a dichotomous measure of psychopathology; however, psychopathology could also be measured on a continuum. 3.2. Directions for future research and implications Future research on child maltreatment and factors associated with better mental health outcomes could address the number of limitations identified above. For example, future researchers could consider using informant reports (e.g., parents, teachers) of individual-level factors and mental health status of adolescents in addition to self-report measures. Using multiple sources as opposed to single sources of information might provide a more complete examination of the relationship between factors and mental health outcomes. As noted above, one area of research that requires further examination is physical exercise in relation to resilience after child maltreatment. It is well established that engaging in physical exercise is related to reduction in symptom severity among individuals with depression (Knapen, Vancampfort, Moriën, & Marchal, 2015; Rosenbaum, Tiedemann, Sherrington, Curtis, & Ward, 2014; Stanton & Happell, 2014), anxiety disorders, posttraumatic stress disorder, and obsessive-compulsive disorder (Asmundson et al., 2013). Physical exercise, especially aerobic and strength training, has even been recommended as a form of, or supplement to, treatment for individuals with depression and other mental disorders (Asmundson et al., 2013; Knapen et al., 2015; Rosenbaum et al., 2014; Stanton & Happell, 2014). Moreover, research on physical exercise with respect to mental health has found that engaging in physical exercise has physiological benefits, such as angiogenesis, neurogenesis, and overall enhanced cognitive functioning (Deslandes et al., 2009). Given these promising results about the impact of physical exercise on improving mental health outcomes, this should clearly be an area of focus for interventions aimed at improving the mental health of adolescents. Future research may shed light on the specific mechanisms by which physical exercise leads to these benefits. For example, it may be possible to determine the extent to which the benefits are related to one or more of the following: physiological impact, potential to enhance self-esteem and personal control, as well as the social aspects of physical exercise. The current study identifies several key components to be considered for inclusion in intervention programs for adolescents who have a history of child maltreatment. These include enhancement of global self-esteem, problem-solving skills, motivation, and personal control. In addition, treatment programs could also incorporate a year-round vigorous physical exercise component, and relaxation techniques (i.e., to increase one's perceived ability to keep calm during stressful situations). It would be important to systematically examine the extent to which these activities are included in current evidence-based interventions. Certain programs clearly include some of these components; for example, trauma-focused cognitive behavior therapy includes developing individualized relaxation skills to reduce stress and positive coping skills (Cohen, Mannarino, & Iyengar, 2011). Some school-based interventions (Norwood, Murray, Nolan, & Bowker, 2011; Olowokere & Okanlawon, 2014), and specific programs such as the Positive Action program (Guo et al., 2015), are effective in increasing self-esteem among adolescents. Overall, the results of this study clearly demonstrate that child maltreatment is associated with poorer mental health. Although prevention of child maltreatment should be a priority, resources still need to be offered to those who experience maltreatment with the aims of reducing subsequent maltreatment as well as impairment. Research focused on development and implementation of programs that help foster resilience among those who have experienced maltreatment in childhood should also be a priority. References Afifi, T. O., & MacMillan, H. L. (2011). Resilience following child maltreatment: A review of protective factors. Canadian Journal of Psychiatry, 56, 266–272. Afifi, T. O., Brownridge, D. A., Cox, B. J., & Sareen, J. (2006). Physical punishment, childhood abuse and psychiatric disorders. Child Abuse & Neglect, 30, 1093–1103. http://dx.doi.org/10.1016/j.chiabu.2006.04.006. Afifi, T. O., Boman, J., Fleisher, W., & Sareen, J. (2009). The relationship between child abuse, parental divorce, and lifetime mental disorders and suicidality in a nationally representative adult sample. Child Abuse & Neglect, 33, 139–147. http://dx.doi.org/10.1016/j.chiabu.2008.12.009. Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., MacMillan, H., ... Sareen, J. (2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45, 814–822. http://dx.doi.org/10.1016/j.jpsychires.20.11.08. Afifi, T. O., Mota, N., MacMillan, H. L., & Sareen, J. (2013). Harsh physical punishment in childhood and adult physical health. Pediatrics, 132, e330–e340. http://dx. doi.org/10.1542/peds.2012-4021. Afifi, T. O., MacMillan, H. L., Boyle, M. H., Taillieu, T., Cheung, K., & Sareen, J. (2014). Child abuse and mental disorders in Canada. Canadian Medical Association Journal, 186, E324–E332. http://dx.doi.org/10.1503/cmaj.131792.

200

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Afifi, T. O., MacMillan, H. L., Boyle, M. H., Cheung, K., Taillieu, T., Turner, S., ... Sareen, J. (2016a). Child abuse and physical health in Canada. Health Reports, 27, 10–18. Afifi, T. O., MacMillan, H. L., Taillieu, T., Boyle, M., Turner, S., Cheung, K., ... Sareen, J. (2016b). Individual and relationship-level factors related to better mental health outcomes following child abuse in a nationally representative Canadian sample. The Canadian Journal of Psychiatry, 61, 776–788. http://dx.doi.org/10. 1177/0706743716651832. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Asmundson, G. J., Fetzner, M. G., DeBoer, L. B., Powers, M. B., Otto, M. W., & Smits, J. A. (2013). Let’s get physical: A contemporary review of the anxiolytic effects of exercise for anxiety and its disorders. Depression and Anxiety, 30, 362–373. http://dx.doi.org/10.1002/da.2043. Avenevoli, S., Swendsen, J., He, J. P., Burstein, M., & Merikangas, K. R. (2015). Major depression in the national comorbidity survey–adolescent supplement: Prevalence, correlates, and treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 37–44. http://dx.doi.org/10.1016/j.jaac.2014.10.010. Barnes, R., & Josefowitz, N. (2014). Forensic assessment of adults reporting childhood sexualized assault: Risk, resilience, and impacts. Psychological Injury and Law, 7, 34–46. http://dx.doi.org/10.1007/s12207- 014-9184-0. Cheung, K., Taillieu, T., Turner, S., Fortier, J., Sareen, J., MacMillan, H. L., ... Afifi, T. O. (2017). Relationship and community factors related to better mental health following child maltreatment among adolescents. Child Abuse & Neglect, 70, 377–387. http://dx.doi.org/10.1016/j.chiabu.2017.06.026. Cohen, J. A., Mannarino, A. P., & Iyengar, S. (2011). Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: A randomized controlled trial. Archives of Pediatric Adolescent Medicine, 16, 16–21. Deslandes, A., Moraes, H., Ferreira, C., Veiga, H., Silveira, H., Mouta, R., ... Laks, J. (2009). Exercise and mental health: Many reasons to move. Neuropsychobiology, 59, 191–198. http://dx.doi.org/10.1159/000223730. Devries, K. M., Mak, J. Y., Child, J. C., Falder, G., Bacchus, L. J., Astbury, J., ... Watts, C. H. (2014). Childhood sexual abuse and suicidal behavior: A meta-analysis. Pediatrics, 133, e1331–e1344. http://dx.doi.org/10.1542/peds.2013-2166. Domhardt, M., Münzer, A., Fegert, J. M., & Goldbeck, L. (2015). Resilience in survivors of child sexual abuse: A systematic review of the literature. Trauma, Violence & Abuse, 16, 476–493. http://dx.doi.org/10.1177/1524838014557288. Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health, 26, 399–419. http://dx.doi.org/10.1146/annurev.publhealth.26.021304.144357. Gallagher, M. W., Lopez, S. J., & Preacher, K. J. (2009). The hierarchical structure of well- being. Journal of Personality, 77, 1025–1050. http://dx.doi.org/10.1111/j. 1467-6494.2009.00573.x. Guo, S., Wu, Q., Smokowski, P. R., Bacallao, M., Evans, C. B., & Cotter, K. L. (2015). A longitudinal evaluation of the positive action program in a low-income, racially diverse, rural county: Effects on self-esteem, school hassles, aggression, and internalizing symptoms. Journal of Youth and Adolescence, 44, 2337–2358. http://dx. doi.org/10.1007/s10964-015-0358-1. Hillberg, T., Hamilton-Giachritsis, C., & Dixon, L. (2011). Review of meta-analyses on the association between child sexual abuse and adult mental health difficulties: A systematic approach. Trauma, Violence, & Abuse, 12(1), 38–49. http://dx.doi.org/10.1177/1524838010386812. Holmes, M. R., Yoon, S., Voith, L. A., Kobulsky, J. M., & Steigerwald, S. (2015). Resilience in physically abused children: Protective factors for aggression. Behavioral Sciences, 5, 176–189. http://dx.doi.org/10.3390/bs5020176. Joshanloo, M., Wissing, M. P., Khumalo, I. P., & Lamers, S. M. (2013). Measurement invariance of the Mental Health Continuum-Short Form (MHC-SF) across three cultural groups. Personality and Individual Differences, 55, 755–759. http://dx.doi.org/10.1016/j.paid.2013.06.002. Kearney, C. A. (2008). School absenteeism and school refusal behavior in youth: A contemporary review. Clinical Psychology Review, 28, 451–471. Kendall-Tackett, K. (2002). The health effects of childhood abuse: Four pathways by which abuse can influence health. Child Abuse & Neglect, 26, 715–729. Kent, K. M., Pelham, W. E., Jr., Molina, B. S., Sibley, M. H., Waschbusch, D. A., Yu, J., ... Karch, K. M. (2011). The academic experience of male high school students with ADHD. Journal of Abnormal Child Psychology, 39, 451–462. Kessler, R. C., Avenevoli, S., Costello, E. J., Green, J. G., Gruber, M. J., Heeringa, S., ... Zaslavsky, A. M. (2009). Design and field procedures in the US national comorbidity survey replication adolescent supplement (NCS-A). International Journal of Methods in Psychiatric Research, 18, 69–83. Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., ... Williams, D. R. (2010). Childhood adversities and adult psychopathology in the WHO world mental health surveys. The British Journal of Psychiatry, 197, 378–385. http://dx.doi.org/10.1192/bjp.bp.110.080499. Kessler, R. C., Avenevoli, S., Costello, E. J., Georgiades, K., Green, J. G., Gruber, M. J., ... Sampson, N. A. (2012). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 69, 372–380. http://dx.doi. org/10.1001/archgenpsychiatry.2011.160. Keyes, C. L. M. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health complete state model of health. Journal of Consulting and Clinical Psychology, 73, 539–548. http://dx.doi.org/10.1037/0022-006X.73.3.539. Keyes, C. L., Wissing, M., Potgieter, J. P., Temane, M., Kruger, A., & Van Rooy, S. (2008). Evaluation of the mental health continuum–short form (MHC–SF) in setswana‐speaking South Africans. Clinical Psychology & Psychotherapy, 15, 181–192. http://dx.doi.org/10.1002/cpp.572. Knapen, J., Vancampfort, D., Moriën, Y., & Marchal, Y. (2015). Exercise therapy improves both mental and physical health in patients with major depression. Disability & Rehabilitation, 37, 1490–1495. http://dx.doi.org/10.3109/09638288.2014.972579. Lamers, S. M., Glas, C. A., Westerhof, G. J., & Bohlmeijer, E. T. (2012). Longitudinal evaluation of the mental health continuum-short form (MHC-SF). European Journal of Psychological Assessment, 28, 290–296. http://dx.doi.org/10.1027/1015-5759/a000109. Lee-Winn, A. E., Townsend, L., Reinblatt, S. P., & Mendelson, T. (2016). Associations of neuroticism and impulsivity with binge eating in a nationally representative sample of adolescents in the United States. Personality and Individual Differences, 90, 66–72. http://dx.doi.org/10.1016/j.paid.2015.10.042. Lindert, J., von Ehrenstein, O. S., Grashow, R., Gal, G., Braehler, E., & Weisskopf, M. G. (2014). Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: Systematic review and meta-analysis. International Journal of Public Health, 59, 359–372. http://dx.doi.org/10.1007/s00038-0130519-5. Marriott, C., Hamilton- Giachritsis, C., & Harrop, C. (2014). Factors promoting resilience following childhood sexual abuse: A structured, narrative review of the literature. Child Abuse Review, 23, 17–34. http://dx.doi.org/10.1002/car.4. Marshall, A. D. (2016). Developmental timing of trauma exposure relative to puberty and the nature of psychopathology among adolescent girls. Journal of the American Academy of Child & Adolescent Psychiatry, 55, 25–32. http://dx.doi.org/10.1016/j.jaac.2015.10.004. Martsolf, D. S., Draucker, C. B., & Chapman, T. R. (2004). The physical health of women in primary care who were maltreated as children. Journal of Emotional Abuse, 4(1), 39–59. http://dx.doi.org/10.1300/J135v04n01_03. Miller, A. B., Esposito-Smythers, C., Weismoore, J. T., & Renshaw, K. D. (2013). The relation between child maltreatment and adolescent suicidal behavior: A systematic review and critical examination of the literature. Clinical Child and Family Psychology Review, 16, 146–172. http://dx.doi.org/10.1007/s10567-0130131-5. Morgan, P. (2010). ‘Get up. Stand up.’ Riding to resilience on a surfboard. Child & Family Social Work, 15, 56–65. http://dx.doi.org/10.1111/j.1365-2206.209.00637.x. Nanni, V., Uher, R., & Danese, A. (2014). Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: A meta-analysis. American Journal of Psychiatry, 169, 141–151. http://dx.doi.org/10.1176/appi.ajp.21/11020335. Noll, J. G., & Shenk, C. E. (2010). Introduction to the special issue: The physical health consequences of childhood maltreatment-implications for public health. Journal of Pediatric Psychology, 35, 447–449. http://dx.doi.org/10.1093/jpepsy/jsq013. Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. Plos Medicine, 9, 1–31. http://dx.doi.org/10.1371/journal.pmed.1001349. Norwood, S. J., Murray, M., Nolan, A., & Bowker, A. (2011). Beautiful from the inside out: A school-based programme designed to increase self-esteem and positive body image among preadolescents. Canadian Journal of School Psychology, 26. http://dx.doi.org/10.1177/0829573511423632 263–228. Olowokere, A. E., & Okanlawon, F. A. (2014). The effects of a school-based psychosocial intervention on resilience and health outcomes among vulnerable children. The Journal of School Nursing, 30, 206–215. http://dx.doi.org/10.1177/1059840513501557.

201

Child Abuse & Neglect 79 (2018) 192–202

K. Cheung et al.

Robitschek, C., & Keyes, C. L. (2009). Keyes's model of mental health with personal growth initiative as a parsimonious predictor. Journal of Counseling Psychology, 56, 321–329. http://dx.doi.org/10.1037/a0013954. Rosenbaum, S., Tiedemann, A., Sherrington, C., Curtis, J., & Ward, P. B. (2014). Physical activity interventions for people with mental illness: A systematic review and meta-analysis. The Journal of Clinical Psychiatry, 75, 964–974. http://dx.doi.org/10.4088/JCP.13r08765. Simpson, C. L. (2010). Resilience in women sexually abused as children. Families in Society, 241–247. http://dx.doi.org/10.1606/1044-3894.4001. Stanton, R., & Happell, B. (2014). Exercise for mental illness: A systematic review of inpatient studies. International Journal of Mental Health Nursing, 23, 232–242. http://dx.doi.org/10.1111/inm.12045. Straus, M. A., Hamby, S. L., Finkelhor, D., Moore, D. W., & Runyan, D. (1998). Identification of child maltreatment with the parent-child conflict tactics scales: Development and psychometric data for a national sample of American parents. Child Abuse & Neglect, 22, 249–270. http://dx.doi.org/10.1016/S0145-2134(97) 00174-9. Waechter, R. L., & Wekerle, C. (2015). Promoting resilience among maltreated youth using meditation, yoga, tai chi and qigong: scoping review of the literature. Child & Adolescent Social Work Journal, 32, 17–31. http://dx.doi.org/10.1007/s10560-014-0356-2. Williams, J., & Nelson-Gardell, D. (2012). Predicting resilience in sexually abused adolescents. Child Abuse & Neglect, 36, 53–63. http://dx.doi.org/10.1016/j.chiabu. 21.07.00. World Health Organization (2005). Promoting mental health: Concepts, emerging evidence, practice. [Internet]. Geneva; 2005. Available from:http://www.who.int/ mental_health/evidence/MH_Promotion_Book.pdf. Zimmerman, M. A., & Brenner, A. B. (2010). Resilience in adolescence: Overcoming neighborhood disadvantage. In J. Reich, A. J. Zautra, & J. S. Hall (Eds.). Handbook of adult resilience (pp. 283–308). New York, NY: Guilford Press.

202