Cindy Sousa

The Effects of Child Abuse and Exposure to Domestic Violence on Adolescent Internalizing and Externalizing Behavior Problems

This study examines the effects of child abuse and domestic violence exposure in childhood on adolescent internalizing and externalizing behaviors. Data for this analysis are from the Lehigh Longitudinal Study, a prospective study of 457 youth addressing outcomes of family violence and resilience in individuals and families. Results show that child abuse, domestic violence, and both in combination (i.e., dual exposure) increase a child’s risk for internalizing and externalizing outcomes in adolescence. When accounting for risk factors associated with additional stressors in the family and surrounding environment, only those children with dual exposure had an elevated risk of the tested outcomes compared to non-exposed youth. However, while there were some observable differences in the prediction of outcomes for children with dual exposure compared to those with single exposure (i.e., abuse only or exposure to domestic violence only), these difference were not statistically significant. Analyses showed that the effects of exposure for boys and girls are statistically comparable.

Longitudinal Study on the Effects of Child Abuse and Children’s Exposure to Domestic Violence, Parent-Child Attachments, and Antisocial Behavior in Adolescence

This study examined the unique and combined effects of child abuse and children’s exposure to domestic violence on later attachment to parents and antisocial behavior during adolescence. Analyses also investigated whether the interaction of exposure and low attachment predicted youth outcomes. Findings suggest that, although youth dually exposed to abuse and domestic violence were less attached to parents in adolescence than those who were not exposed, for those who were abused only and those who were exposed only to domestic violence, the relationship between exposure types and youth outcomes did not differ by level of attachment to parents. However, stronger bonds of attachment to parents in adolescence did appear to predict a lower risk of antisocial behavior independent of exposure status. Preventing child abuse and children’s exposure to domestic violence could lessen the risk of antisocial behavior during adolescence, as could strengthening parent—child attachments in adolescence. However, strengthening attachments between parents and children after exposure may not be sufficient to counter the negative impact of earlier violence trauma in children.

Individual and Collective Dimensions of Resilience Within Political Violence

Research has documented a link between political violence and the functioning of individuals and communities. Yet, despite the hardships that political violence creates, evidence suggests remarkable fortitude and resilience within both individuals and communities. Individual characteristics that appear to build resilience against political violence include demographic factors such as gender and age, and internal resources, such as hope, optimism, determination, and religious convictions. Research has also documented the protective influence of individuals’ connection to community and their involvement in work, school, or political action. Additionally, research on political violence and resilience has increasingly focused on communities themselves as a unit of analysis. Community resilience, like individual resilience, is a process supported by various traits, capacities, and emotional orientations toward hardship. This review addresses various findings related to both individual and community resilience within political violence and offers recommendations for research, practice, and policy.

Conflict, health care and professional perseverance: A qualitative study in the West Bank

Abstract The past three decades have been a time of considerable global conflict, affecting over 50 countries and causing substantial impacts on civilian health. While many effects are direct results of violence, conflict also impinges on health through indirect means. The restricted mobility of health care staff and patients, targeting of health care workers, and stressful working conditions disrupt the ability of health care workers in conflict zones to function effectively. This paper explores the challenges experienced by health care workers in West Bank, Palestine, as well as their strategies of persistence. Research activities included participant observation and interviews with health care providers, which were then analysed for common themes. Results demonstrated that the Israeli military occupation of the West Bank considerably impacts civilians’ access to both urgent and preventive care. While attempting to deliver care, providers encountered disruptions, harassment and violence, which interrupted care and contributed to job stress. Professional perseverance was evident, but its influence was limited by enduring constraints. This study thus underscores the importance of accountability to international law regarding the rights of civilians to health care in conflict zones. Health professionals may play a particular role in advocating for just and dignified resolutions to conflicts.

Political violence, collective functioning and health: A review of the literature

Political violence is implicated in a range of mental health outcomes, including PTSD, depression, and anxiety. The social and political contexts of people’s lives, however, offer considerable protection from the mental health effects of political violence. In spite of the importance of people’s social and political environments for health, there is limited scholarship on how political violence compromises necessary social and political systems and inhibits individuals from participating in social and political life. Drawing on literature from multiple disciplines, including public health, anthropology, and psychology, this narrative review uses a multi-level, social ecological framework to enhance current knowledge about the ways that political violence affects health. Findings from over 50 studies were analysed and used to build a conceptual model demonstrating how political violence threatens three inter-related domains of functioning: individual functioning in relationship to their environment; community functioning and social fabric; and governmental functioning and delivery of services to populations. Results illustrate the need for multilevel frameworks that move beyond individual pathology towards more nuanced conceptualizations about how political violence affects health; findings contribute to the development of prevention programmes addressing political violence.

Dwelling within political violence: Palestinian women's narratives of home, mental health, and resilience.

Political violence is increasingly played out within everyday civilian environments, particularly family homes. Yet, within the literature on political violence and mental health, the role of threats to home remains under-explored. Using focus group data from 32 Palestinian women, this paper explores the implications of violations to the home within political violence. Threats to the privacy, control, and constancy of the family home - key dimensions of ontological security (Giddens, 1990) emerged as central themes in womens narratives. Surveillance, home invasions, and actual or threatened destruction of womens home environments provoked fear, anxiety, grief, humiliation, and helplessness, particularly as women struggled to protect their children. Women also described how they mobilized the home for economic, familial and cultural survival. Study findings illuminate the impact of threats to intimate environments on the well-being of women and their families living with chronic political violence, and underscore the importance of attention to violations of place and home in research on civilian experiences of and responses to political violence.

Political violence and mental health: Effects of neoliberalism and the role of international social work practice:

Healing from political violence is not solely an individual project, but a communal process involving reclaiming collective action, trust, and efficacy. This article uses a case study from two Palestinian refugee camps in the West Bank to examine how two trends central to neoliberalism, individualism, and the medicalization of inherently social and political problems, discount larger forces that affect risk and resilience, thereby undermining mental health recovery from political violence. Implications for international social work include utilizing ecosocial frameworks for research and practice, engaging in advocacy, and establishing agendas for mental health practice that emphasize individual and collective self-determination.

Direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms.

There is a great deal of evidence about the mental health implications of physical child abuse and environmental stressors, or hardships that people experience at the household and neighborhood level (e.g., neighborhood violence; economic hardship, substance abuse, or conflict among family members). Yet, studies often focus on either abuse or environmental stress, not both, or examine abuse and environmental stressors as a combined set of experiences. Less is known, therefore, about how child abuse and environmental stress might work as either distinct or interrelated risks to diminish mental health over time. In this longitudinal study, we used path analyses to examine the cumulative effects of physical child abuse and environmental stressors on adult depressive symptoms among a sample of children followed into adulthood (N = 356). The goal was to assess whether chronic physical child abuse remains an independent predictor of adult outcomes once we accounted for the cumulative effects of household and neighborhood stressors across the lifecourse. Cumulative measures of physical child abuse and environmental stress each independently predicted a higher likelihood of adult depressive symptoms (ß = .122, p < .01 and ß = .283, p < .001, respectively). After accounting for adolescent depressive symptoms, only cumulative environmental stressors independently predicted depressive symptoms (ß = .202, p < .001). Tests of the indirect effect of cumulative environmental stress on the relationship between cumulative physical abuse and adult depressive symptoms were marginally statistically significant. Results add to literature that examines child abuse, adversity, and lifecourse perspectives on health.

Gli effetti del maltrattamento infantile e dell’esposizione alla violenza domestica sui problemi comportamentali internalizzanti ed esternalizzanti in adolescenza

Questo studio esamina gli effetti del maltrattamento infantile e dell’esposizione alla violenza domestica in infanzia sui comportamenti internalizzanti ed esternalizzanti in adolescenza. I dati per queste analisi provengono dal Lehigh Longitudinal Study, uno studio prospettico su 457 giovani volto a valutare gli esiti della violenza familiare e la resilienza negli individui e nelle famiglie. I risultati mostrano che il maltrattamento infantile, la violenza domestica ed entrambi in combinazione (ossia doppia esposizione) aumentano il rischio per il bambino di esiti internalizzanti ed esternalizzanti in adolescenza. Una volta tenuto conto dei fattori di rischio associati con fattori stressanti aggiuntivi nella famiglia o nell’ambiente circostante, solo quei bambini con una doppia esposizione riportavano un rischio elevato di incorrere negli esiti studiati rispetto ai giovani non esposti. Tuttavia, sebbene vi fossero delle differenze osservabili nella predizione degli esiti per i bambini con una doppia esposizione rispetto a quelli con una singola esposizione (ossia, solo maltrattamento o solo esposizione alla violenza domestica) queste differenze non sono risultate statisticamente significative. Le analisi hanno mostrato che gli effetti dell’esposizione per i maschi e le femmine sono statisticamente comparabili.

The Co-Occurrence and Unique Mental Health Effects of Political Violence and Intimate Partner Violence

The global mental health ramifications of political violence and intimate partner violence (IPV) are well established. There also exists a growing body of evidence about the increased risks for IPV within situations of political violence. Yet, except for a few studies, there is little literature that simultaneously examines how political violence and IPV might result in unique risks for particular types of mental health sequela. Delineating possible divergent patterns between specific mental health conditions resulting from political violence and IPV takes on an increased urgency given that, although they are related, the two most commonly reported outcomes of these two types of violence—post-traumatic stress disorder (PTSD) and depression—not only require different types of treatment, but may in fact be generated or maintained by disparate paths. Using survey data from adult women in Palestine (n = 122), this study explores the relationships between IPV and political violence (both lifetime and past-month exposure) and tests their independent relationships to PTSD and depressive symptomology. After controlling for the other form of violence exposure, political violence was correlated with PTSD and not with depressive symptomology, while IPV was correlated with depressive symptomology and not with PTSD. Findings demonstrate that distinct forms of violence exposure might indeed be associated with specific mental health outcomes. Results illustrate the need to assess for both political violence and IPV when researching and designing interventions related to violence.