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 Watch, read, and summarize, by providing at least 3-4 sentences, the materials listed below: 

 After completing the readings, make sure to provide something to substantiate the readings–something that allows you to take what you learn and move beyond by applying theories, providing examples through different forms of media, etc. 

To prevent mass shootings, don’t bother with motive; do a forensic ACEs investigation

SOCIAL SCIENCE AND PUBLIC POLICY

From Suicide and Strain to Mass Murder

Dinur Blum1 & Christian Gonzalez Jaworski1

# Springer Science+Business Media New York 2016

Abstract Mass media explanations and criminological pro- files of mass shootings focus on the perpetrator’s individual psychological traits in their search for motive and meaning behind such horrific events. We consider the broader social context to better understand mass shootings. We focus on three recent high profile mass shootings in the United States – Aurora, CO, Newtown, CT, and Santa Barbara, CA as examples of people responding to various experienced strains with violence, and conclude with some ideas to help prevent such occurrences from happening again.

Keywords Mass shooting . Violence .Murder . Criminology

B Humanity… All of my suffering on this world has been at the hands of humanity, particularly women. It has made me realize just how brutal and twisted human- ity is as a species. All I ever wanted was to fit in and live a happy life amongst humanity, but I was cast out and rejected, forced to endure an existence of loneliness and insignificance, all because the females of the human species were incapable of seeing the value in me.^

This is the story of how I, Elliot Rodger, came to be. This is the story of my entire life. It is a dark story of sadness, anger, and hatred. It is a story of a war against cruel injustice…This tragedy did not have to happen. I

didn’t want things to turn out this way, but humanity forced my hand, and this story will explain why.^ (Rodger 2014: 1)

This article examines three recent, high-profile mass shoot- ings in the United States and offers social explanations as the potential causes of these shootings. Criminologists Jack Levin and Eric Madfis define a mass murder or mass shooting as Bthe antisocial non-state-sponsored killing of multiple victims during a single episode at one or more closely related locations^ (2009: 1227). The mass shootings have been se- lected here because of the volume of news attention each has received. We focus on these shootings because they are atyp- ical of most mass murders in the United States and because of the media attention they receive (in no small part due to them being unusual events). According to criminologist Grant Duwe (2007), the most common type of mass shooting in the United States is among intimates, in which a person experiences a stress (such as losing their job), and copes with the strain by killing family members and themselves. In the mass shootings that get more media attention, the mass media focus on individual psychological explanations, explaining that these shootings are the result of crazy people, but not offering further explanations as to how purported mental ill- ness causes these violent episodes. We write hope to supple- ment the psychological explanations that are offered through the news media after mass shootings like these occur.

A more complete understanding of mass shootings has to take all factors into account and this can only be achieved by a comprehensive view of the social context of mass violence. Furthermore, our solutions in preventing mass shootings all revolve around changes in the social lives of potentially alien- ated young men. Since so many of the young men who com- mit violence share similar social characteristics and situations,

* Dinur Blum [email protected]

1 Department of Sociology, University of California, Riverside, 1206 Watkins Hall, 900 University Ave, Riverside, CA 92521, USA

DOI 10.1007/s12115-016-0035-3

Published online: 6 June 2016

Soc (2016) 53:408–413

it is important to understand the whole picture which includes social factors, especially if we are to find potential solutions to stopping mass shootings.

Why Focus on Social Explanations?

After the Jonestown mass suicide in 1978, sociologist Albert Black (1990) explained that residents of Jonestown died Bfor very different reasons and that two types of suicide occurred simultaneously: altruistic and fatalistic^ (1990: 285). In doing so, Black showed howmass suicide can be viewed as a social, rather than individual, phenomenon. While we do not focus on suicide in this paper, we believe Emile Durkheim gives us a good starting point by addressing an issue consid- ered to be individualistic and dealing with death by looking at mass shootings.

Durkheim (1997); orig. 1897; 1951) argued that communi- ty is the main preventer of egoistic suicide, which occurs when a person is isolated from the community in which he or she lives and is not well-integrated to the community. When a society no longer had a general sense of strong collective beliefs, the uncertainty produced would inspire indulgence in immoral acts, including suicide. Durkheim (1997) de- scribed some factors that lower the chances of egoistic suicide occurring. Among these factors was the idea of being married. With all other factors being the same, unmarried people would kill themselves about twice as much as married people. This can be understood as the marital relationship providing strong social ties for people, not to mention a form of social control in the form of spousal supervision and support, with single peo- ple not having these ties. It is important to continue this dis- cussion in the context of mass shootings, especially as the social root of many incidents can be examined with the hope of finding social solutions.

Criminologists Levin and Madfis (2009) build on Durkheim’s ideas of egoism and anomie by exploring the role of strain, meaning unpleasant life experiences, in school shootings. They argue that the combination of chronic strain, uncontrolled strain, and acute strain form a mindset for shooters that suggests that strain is persistent, never-ending, and catastrophic. This mindset lends itself to planning and committing mass murder in order to mitigate strain in the shooter’s mind Chronic strain is the range of negative experi- ences or disappointing events in social relationships at home, school, or work or in the neighborhood. These difficulties lead to anger, frustration, disappointment, depression, fear, and ul- timately, crime (1229–1230). Strain is chronic when it persists and intensifies over a long period of time. Uncontrolled strains are strains that are not mitigated by the presence of conven- tional and pro-social relationships. In this sense, uncontrolled strain and chronic strain are closely related to egoism and anomie, given the lack of positive relationships. The last type

of strain, acute strain, is a loss perceived to be catastrophic in the mind of the killer, which serves as a catalyst or precipitant. Levin and Madfiss argue that the chronic-acute distinction with strain is similar to illness. Just as a chronic illness is not necessarily felt constantly, the prolonged illness takes its toll on a person, while acute illness is felt more sharply, even if for a shorter duration of time. Similarly, chronic strain may not be constantly felt, but its presence is enough to take a toll on a person, while an acute strain is more pronounced and related to a specific event or events.

Case Study: Aurora, Colorado

After midnight on July 20th, 2012, in a quiet suburb of Denver, a man dressed in body armor and a gas mask walked into a crowded movie theater and sprayed gunfire inside, mur- dering twelve people and injuring fifty eight others. The crowd had gathered to watch the newest Batman film (The Dark Knight Rises).

Witnesses to the shooting said that a man appeared at the front of the theater about 20 min into the movie with a rifle, handgun, and gas mask. He threw a canister that released some kind of gas, after which a hissing sound ensued, and he subsequently opened fire on the crowd packed into the early-morning screening of the film. In less than thirty minutes, seventy people had been shot or wounded, making it one of the worst mass shootings in American history. (CNN.com, 7/20/12).

Immediately after the Aurora attack, the focus of the media focused on the man who had done such a horrific act. The suspected perpetrator had surrendered without a fight soon after the shooting and questions about his motives quickly began to circulate among the police, the victims, and national experts. Initial reports said that the suspect, James Holmes, had dyed his hair a bright orange and had described himself as Bthe Joker,^ a reference to the homicidal psychopath of previous Batman films (CNN.com, 7/20/12). Questions that were asked included speculation as to Holmes’ motives, the circumstances that would lead such a man, who was well educated, intelligent, and from the upper middle class with a good family, to seemingly senselessly and indiscriminately kill people. Was he mentally ill?

The British Broadcasting Corporation (BBC) reported that James Holmes had no romantic attachments, but was involved in a video game group. However, outside of this group, there was no mention of Holmes having close friends. A former classmate, Breanna Hath, said, BThere were no real girls he was involved with. It seemed he was really into a video game group that hung out together^ (BBC 7/30/12). A former lab colleague, Billy Kromka, said Holmes had been one of the quieter people, and had spent much of his time immersed in his computer, often participating in role-playing online

Soc (2016) 53:408–413 409

games.^ (BBC 7/30/12) It was also reported that Holmes, then a graduate student, received low scores on his comprehensive exams shortly before his suspected shootings and that after these exams he withdrew from school. This withdrawal would remove some of his social ties, as he no longer saw his co- workers or classmates, and also meant a sudden role exit and a shift in identity, as he was no longer a graduate student.

The Union-Tribune also reported that Holmes did not have an online presence besides his computer gaming group. By not being involved with social media, he reduced his ability to connect with coworkers, classmates, or other people outside of a game setting. The emphasis is not on Holmes’ gaming group or choice of game. Rather, our emphasis is on Holmes’ social isolation in both the outside and virtual worlds. Holmes had no connection to his victims, nor did he travel far when he picked the cinema as his killing site. Once he entered the theater, Holmes and his victims shared the same social and physical space.

Case Study: Newtown, CT

On December 14, 2012, Adam Lanza, 20 years old at the time, killed his mother at their home, then drove to Sandy Hook Elementary School in Newtown, Connecticut, close by. Upon reaching the school, he shot open an entrance, as the doors were locked (http://www.cnn.com/interactive/2012/12/us/sandy- hook-timeline/). Once Lanza was inside the school, he shot and killed 20 children, ages six and seven, as well as six adults. Lanza ultimately committed suicide by shooting himself in the head as first responders arrived at the school. Reports emerged that Lanza had been Bwracked by anxiety^ when he was in eighth grade (Griffin and Kovner 2013), and that he Bhad been found to have a type of autism, was faring poorly [in school], and [had been] bullied in high school.^ (Kleinfield et al. 2013). Other reports suggested that Lanza had been abused while a student at Sandy Hook (Huffington Post 2013). Similar to Holmes in Aurora, the focus immediately following this shooting was on the possible mental illness of the shooter. The large public debate sparked by this shooting centered on gun control, but no systematic public debate focused on what could have served as a catalyst for Lanza’s shooting.

Lanza was described as Bsmart but acutely shy, and was not known to have close friends^, and that Bhe was getting picked on and bullied and was starting to shut down.^ (Kleinfield et al. 2013). The only victim Lanza personally knew was his mother. This raises the question of why would he go to an elementary school and kill children, especially ones he did not know. Given that he was bullied at the school, we argue Lanza chose Sandy Hook as the site for his killing spree as a way of exacting revenge against a place where he was harassed, even

if he had no connection to the people he killed there. He was getting revenge against a site rather than a specific person or persons.

Case Study: Santa Barbara, CA

OnMay 23, 2014, 22-year-old Elliot Rodger went on a killing spree near the University of California, Santa Barbara. News reports described Rodger as mentally ill, and explained that Rodger:

[F]atally stabbed three men in his residence, shot two women to death in front of a sorority house, shot a man to death inside a deli, exchanged gunfire twice with police and injured 13 people as he drove from block to block…and ended the Friday night rampage near the University of California, Santa Barbara, apparently by fatally shooting himself in the head while sitting behind the wheel of his wrecked BMW. Inside the car, police found three handguns – all legally purchased – and more than 400 rounds of unused ammunition, Brown said at a Saturday evening press conference. (Ellis and Sidner 2014, cnn.com)

Unlike the previous shooters described, Rodger had left clues about his crime before the fact, making various YouTube videos and writing a 140-page manifesto detailing his anger. Rodger’s shooting spree left six people dead and 13 wounded. Similar to Lanza’s case in Connecticut, public sen- timent and focus centered on the availability of firearms and the possibility of mental illness playing a role in the shooting.

Rodger described himself as having a lonely life, calling his videos on YouTube a BLonely Vlog (Video Blog)^, and describing life as being Bunfair .̂ Rodger’s mother described him as a Bhigh-functioning autistic child^ (Nagourney et al. 2014). By framing him as autistic, the onus of explaining and understanding Rodger’s spree is placed squarely on him as an individual, rather than examining any social factors that may have pushed him towards feeling strain and using violence to alleviate this strain. Rodger was described as being withdrawn and shy, as well as being lonely and introverted even from a young age. Similar to Lanza, Rodger experienced bullying while in high school, which forced him to change schools multiple times. Rodger was described as withdrawing from schoolwork and spending time playing World of Warcraft alone, and not connecting with students his age, but instead with a special education assistant, with whom he discussed the game. Rodger had previous contact with the police (Rucker and Costa 2014). In Rodger’s case, contact with the police occurred after his mother saw his videos on YouTube and subsequently called mental health officials, who in turn had sheriff’s deputies check on Rodger (Rucker and Costa 2014).

410 Soc (2016) 53:408–413

What Do these Cases Have in Common?

In each of these cases, much of the media attention has fo- cused on individual aspects and characteristics of the shooters, but no broader social context was offered or analyzed in an attempt to explain the shootings. Typically, shooters are pre- sented as suffering from a mental disorder, independent of any social conditions that may have influenced them. This framing places the onus of understanding why mass shootings happen at the level of the individual shooter, and leaves broader social implications ignored. If sociologists, criminologists, and po- lice are ever to understand the totality of these horrible crimes, then the social world in which the killers lived in must be examined. By focusing exclusively on the individual shooter’s psychological factors, an important part–a broader societal context or influence–is neglected.

In addition to looking at individual psychological factors, examining social factors can help offer insight as to why mass shootings happen, as well as avenues to prevent them. While we may never be able to totally predict and eliminate mass shootings, we believe incorporating the broader social context will lend insight into social factors that go into these events. Given this awareness, interventions may be possible to reduce the likelihood of mass murders. One factor we see in common with the mass shooters in this paper is the lack of community integration, and instead, the prevalence of social isolation. Given that only one of the shooters had a close friendship, we can see that the shooters were not well-integrated into their communities.

Given that the only community mentioned with respect to James Holmes was an online gaming group – and one that did not meet in person – there was no sense of social control or of obligation to a bigger group to which Holmes belonged. Based on news reports, Holmes had few friends, if any, and a former classmate of his said Holmes Bwas obsessed with computer games and was always playing role playing games. He did not have much of a life apart from that and doing his work. James seemed like he wanted to be in the game and be one of the characters.^ (Gye, Keneally, and Bates; dailymail.co.uk).

Similar to Holmes, Lanza Bhad spent most of his time in the basement of the home, primarily playing a warfare video game, BCall of Duty ,̂ which is often adversarial rather than social. (Kleinfield et al. 2013), as had Rodger (albeit a differ- ent game). We do not blame video games for these violent outbursts. Rather, we examine social isolation as a key factor in understanding mass shootings. By spending most of their time alone playing games, Lanza and Rodger were isolated from other people. Unlike Holmes, there are no reports about Lanza or Rodger belonging to gaming groups, so there is no knowledge if they joined one as a way of being included and integrated and having a sense of community.

We are left to reconcile whether individual-level strain is a catalyst for strain at the societal level or whether general soci- etal strain leads to individual-level strain. Ultimately, this dis- tinction may not be especially useful. Rather, it is the presence of strain that an individual internalizes – this strain can be either from the societal level, from the individual level, or have both levels felt in tandem – and that fuels negative emotions and the desire to act on them with violence, either against oneself (i.e. suicide) or by inflicting pain and harm onto others.

Many of the characteristics of these mass shootings fit with what Durkheim said. In each case, the shooters were unmar- ried, and Holmes reportedly had broken up with his girlfriend days before the shooting spree in Aurora, Colorado (Gye et al. 2012; dailymail.co.uk). Rodger was perpetually single, so while he did not have a breakup that acted as a catalyst, his persistent status as single had the same effect as Holmes’ breakup. Given each of their professional situations – Holmes had just failed his comprehensive exams and with- drew from graduate school; Rodger had changed high schools multiple times and had withdrawn from college. Both men faced sudden, unexpected changes which they may not have known how to deal with, not the least of which was the loss of a support network at work, compounded with losing or not having a support network in the form of a significant other in their personal lives.

From what has been discussed in the media, Holmes, Lanza, and Rodger had few, if any, communal ties. Holmes had his gaming group (which Rodger and Lanza did not have), were intelligent, and came from financially-stable families. However, given their few social ties, combined with the stress of not doing well in school (for Holmes and Rodger specifi- cally) and subsequent withdrawal, Holmes and Rodger may have felt isolated and lost, and felt that violence, including shooting, was a viable response to these stresses.

The Implications of a Social Perspective

This article does not seek to diminish psychological findings or diagnoses. Indeed, feelings of isolation likely have both social and psychological roots. We seek to explain social causes of mass shootings, not justify these acts of violence. We write this in an attempt to focus on factors that are typi- cally underreported or otherwise ignored in analyses and me- dia portrayals of mass shootings.

By focusing exclusively on psychological explanations, the mass media end up stigmatizing mental illness by conflating mental illness with violent behavior. This is problematic on several fronts. Mental illness is stigmatized even without the reported link to violence, and indeed, most cases of mental illness have nothing to do with violence. Further, by only offering individual-level explanations, the mass media ignore the social world in which shooters like the ones in this paper

Soc (2016) 53:408–413 411

live, and make it seem like they are in a separate world from others. We hope that by emphasizing social factors, we can show that even unsocial behavior like these shootings have social causes, and given that, we can address these causes to reduce the likeliness of these mass shootings occurring in the future.

Given this spate of violence, one possible intervention to consider is the implementation of support networks in schools and jobs.While co-workers can be a support network in and of themselves, having both formal and informal mechanisms may provide some much-needed social support, and a way to alleviate feelings of social isolation. Ideas for formal mech- anisms include workplaces hiring counselors for people to vent to during their employment as well as after – having someone in place who can advise workers with respect to stresses of the workplace, as well as during transitional pe- riods when workers are either leaving their workplace for a new one or when they are preparing to retire. Informal mech- anisms could include people working as teams and meeting regularly for both work-related goals but also to see how ev- eryone is doing –informal social control. Levin and Madfis (2009) argue:

By the time a youngster has murderous intentions, it is usually too late to intervene. But years earlier, a sensitive teacher, a perceptive guidance counselor, or even a con- cerned parent might have made all the difference. If strains are counteracted early on, then the cumulative impact of isolation, catastrophic losses, and planning lose their efficacy in regard to producing a massacre (2009: 1241).

The main idea behind the mechanisms we, as well as Levin and Madfiss, offer is to reduce feelings of isolation and in- crease feelings of belonging and of community. Such inter- ventions might not prevent all future mass shootings, but may reduce the likelihood of these horrific acts happening and save lives in the future.

A large part of any solution to the problem of mass shoot- ings would be that professionals should focus less on psycho- logical labeling of the individual and more on the social con- text of potential perpetrators. By solely viewing the individ- ual’s psychological characteristics, mental health workers and other professionals may be missing an important piece in preventing crime. Since we are arguing that these social forces play such an important role in mass shootings, it would make sense that our potential solutions would emphasize social fac- tors. Reintegrating potentially alienated young men into pos- itive social environments before they commit mass murder would be an important first step. We hope that by viewing social problems of isolated young men, psychological profes- sionals can add a necessary aspect in treating what we consid- er to be, at least in part, a social problem.

We do not discuss the role of firearms here. Certainly, we believe that the availability of firearms contributes tomass shoot- ings. However, we do not believe that the availability of guns is a primary force in explaining thesemass shootings. Aside fromnot wishing to engage in a political argument about whether or not firearms should be easily purchased and owned, we frankly be- lieve that this is tangential to our argument. Given that we ex- amine the role of strain and violence as a response to it, merely reducing the number of guns available changes the response to strain while not dealing with the underlying stressors.

Further Reading

Agnew, R. 2006. Pressured Into Crime: An Overview of General Strain Theory. Los Angeles:Roxbury Publishing.

Black, Jr., Albert. 1990. BJonestown – Two Faces of Suicide: A Durkheimian Analysis.^ Suicide & Life-Threatening Behavior. 20(4): 285–306.

Blum, Dinur and Christian Jaworski 2014. (forthcoming) BFrom Egoistic andAnomic Suicide to Egoistic andAnomicHomicide: Explaining the Aurora, COMass Shooting Using Durkheim, Merton and Agnew.^ In Gun Violence in American Society: Crime, Justice and Public Policy, edited by Lisa Eargle. Lanham, MD: University Press of America.

British Broadcasting Corporation 2012. BProfile: Aurora shooting suspect James Holmes.^ July 30, 2012.

CNN 2012. BSandy Hook Shooting: What Happened?^ http://www.cnn. com/interactive/2012/12/us/sandy-hook-timeline/.

DeLuca, Matthew 2013. BChilling Navy Yard Surveillance Video Shows Shooter Stalking Hallways.^ NBC News. Sept. 25, 2013. http:// usnews.nbcnews.com/_news/2013/09/25/20694290-chilling-navy- yard-surveillance-video-shows-shooter-stalking-hallways

Durkheim, Emile. 1997 (orig. 1897; 1951). Suicide: A Study in Sociology. Translated by John A. Spaulding and George Simpson. New York: Free Press

Duwe, G. 2007. Mass Murder in the United States: A History. North Carolina:McFarland & Company, Inc. Publishers.

Ellis, Ralph and Sara Sidner. 2014. BDeadly California rampage: Chilling video, but no match for reality.^ CNN.com. May 27, 2014.

Griffin, Alaine and Josh Kovner 2013. BAdam Lanza’s Medical Records Reveal Growing Anxiety.^ Hartford Courant. June 30, 2013.

Gye, Hugo, Meghan Keneally, and Daniel Bates 2012. BDark Knight Gunman Faced Eviction and ‘Broke Up With Girlfriend’ Just Before Killing Spree.^ Dailymail.co.uk. July 24, 2012.

Holmes, R. M., & Holmes, S. T. 2001.Mass Murder in the United States. New Jersey:Prentice Hall.

Huffington Post 2013. BAdam Lanza, Newtown Killer, Was Abused at Sandy Hook Elementary By Classmates: Family Member.^ http:// www.huffingtonpost.com/2013/04/16/adam-lanza-abused-sandy- hook_n_3086468.html.

Kalish, R., & Kimmel, M. 2010. Suicide by mass murder: Masculinity, aggrieved entitlement, and rampage school shootings. Health Sociology Review, 19(4), 451–464.

Kleinfield, N.R., Ray Rivera, and Serge F. Kovaleski. 2013. BNewtown Killer’s Obsessions, in Chilling Detail.^ New York Times. March 28, 2013.

Levin, J., & Madfis, E. 2009. Mass Murder at School and Cumulative Strain: A Sequential Model. American Behavioral Scientist, 52(9), 1227–1245.

Lilly, J. R., Cullen, F. T., & Ball, R. A. 2002. Criminological Theory: Context and Consequences (Third ed., ). Thousand Oaks:Sage.

412 Soc (2016) 53:408–413

Merton, Robert K. 1964. BAnomie, anomia, and social interac- tion: Contexts of deviant behavior. BIn M.B. Clinard (Ed.), Anomie and deviant behavior (pp. 213–242). New York: Free Press.

Nagourney, Adam, Michael Cieply, Alan Feuer, and Ian Lovett 2014. BBefore Brief, Deadly Spree, Trouble Since Age 8.^ New York Times. June 1, 2014.

Passas, N., & Agnew, R. (Eds.) 1997. The Future of Anomie Theory. Boston:Northeastern University.

Pearson, Michael 2012. BGunman Turns ‘Batman’ Screening Into Real- Life Horror Film.^ Cnn.com. July 20, 2012.

Rodger, Elliot 2014. My Twisted World: The Story of Elliot Rodger. Rowe, P., &Wilkens, J. 2012. Quiet, unassuming San Diegan accused of

mass murder. San Diego Union-Tribune. July, 20, 2012. Rucker, Philip and Robert Costa 2014. BIn Elliot Rodger, authorities in

Calif. saw warning signs but didn’t see a tipping point.^Washington Post. May 25, 2014.

Shear, Michael D. and Michael S. Schmidt 2013. BGunman and 12 Victims Killed in Shooting at D.C. Navy Yard.̂ New York Times. Sept. 16, 2013.

Dinur Blum is a doctoral candidate in Sociology at the University of California, Riverside. In addition to his work on mass shootings, Dinur’s research interests include work on the sociology of sport, media and culture, and criminology. He is working on research examining the messages intercollegiate student-athletes receive in order to better under- stand how they devote their time, energy, and attention to academics and athletics.

Christian Gonzalez Jaworski is a graduate student in Sociology at the University of California Riverside. He holds a BA in Sociology from the University of Oklahoma. His research interests include deviance, social theory, political economy and social movements.

Soc (2016) 53:408–413 413

  • From Suicide and Strain to Mass Murder
    • Abstract
    • Why Focus on Social Explanations?
    • Case Study: Aurora, Colorado
    • Case Study: Newtown, CT
    • Case Study: Santa Barbara, CA
    • What Do these Cases Have in Common?
    • The Implications of a Social Perspective
    • Further Reading

,

Prevalence and Impact of Childhood Maltreatment in Incarcerated Youth

Daniel Coleman and Lisa M. Stewart Portland State University

The prevalence of childhood maltreatment and the magnitude of the association of mal- treatment with internalizing mental health symptoms were examined in 398 incarcerated

youth. The prevalence of abuse greatly exceeded general population rates. The proportion of variance in mental health symptoms accounted for by maltreatment was small but developmentally significant. Sexual abuse is a markedly stronger predictor of internalizing

mental health problems in incarcerated youth than physical abuse. Consistent with a bio- psychological model of trauma, dissociation at the time of sexual abuse was the strongest nondemographic predictor of mental health symptoms. Physical abuse was associated with more internalizing mental health problems for children from families with mental

health problems and families with lower socioeconomic status. Implications for practice and research are discussed.

T he majority of incarcerated youth have experienced trauma, including childhood sexual abuse (CSA), child-

hood physical abuse (CPA), domestic violence, and street violence (Carrion & Steiner, 2000; Dembo et al., 1992; McMackin, Leisen, Sattler, Krinsley, & Riggs, 2002). Trauma

exposure is linked to both behavior disorders and emotional problems (Ford, 2002; Greenwald, 2002). For some youth, trauma exposure may be a pivotal developmental experience, leading to a cascade of events ending in mental health problems

and incarceration. Incarcerated youth are a vulnerable popula- tion, disproportionately from lower socioeconomic status (SES), and often experiencing family conflict, family substance abuse

(FSA), and family mental health (FMH) problems. This cluster of risk factors increases the likelihood of incarcerated youth developing serious mental health consequences following a trau-

matic event (McNally, 1999). The rates of mental health problems in incarcerated youth

exceed the number of disorders and severity of symptoms found

in youth treated in community mental health (Atkins et al., 1999). Few studies of incarcerated youth have provided effect size estimates of the association of trauma and mental health problems (Brown, Cohen, Johnson, & Smailes, 1999; Gover,

2004). In part due to small sample sizes, most studies of incar- cerated youth have tested simple main effects models of child and trauma characteristics predicting mental health outcomes.

To address these gaps, secondary analysis of an existing data set investigated the effects of physical and sexual abuse on the

anxiety, depression, and interpersonal sensitivity of incarcerated youth, controlling for other risk factors and examining interac-

tive effects. This data set, collected by Richard Dembo and col- leagues in the late 1980s (Dembo, 2002), continues to merit analysis. The data set includes complex assessment of childhood

maltreatment, the sample size is adequate to support relatively complex multivariate and interactive analyses, and the outcome measures include a range of mental health constructs. The theoretical and empirical foundation of this study is the

biopsychological model of trauma. Trauma response is not lim- ited to psychological consequences, but traumatic stress is rooted in changes in brain chemistry and biology (Bremner,

2005; DeBellis, Keshavan, Shifflett, & Iyengar, 2002). As van der Kolk (1994) stated, ‘‘the body keeps the score’’ of trauma (p. 253). Persistent posttraumatic symptoms are higher in those

who dissociate in response to the trauma (Birmes, Brunet, Carr- eras, Ducasse, & Charlet, 2003). Dissociation is a marker that the normal coping processes based in the language-dominant

neocortex are overwhelmed by a trauma, and responding to the trauma is left to more primitive parts of the brain. van der Kolk (2002) describes dissociation as the ‘‘speechless terror’’ of the trauma victim. The traumatic experience is burned into the pre-

linguistic subcortical parts of the brain, unmediated by con- scious thought. The nature of traumatic memory is paired with dysregulation of neurotransmitters tied to emotion and threat-

response (van der Kolk, 2002). Planning this secondary analysis balanced examination of

empirically based theory and the existing literature with the vari-

ables available in the data set. From the mental health variables collected in the study, depression and anxiety were selected as the two most common consequences of childhood maltreatment

Correspondence concerning this article should be addressed to Daniel

Coleman, School of Social Work, Portland State University, Portland,

OR 97207. Electronic mail may be sent to [email protected].

American Journal of Orthopsychiatry � 2010 American Orthopsychiatric Association 2010, Vol. 80, No. 3, 343–349 DOI: 10.1111/j.1939-0025.2010.01038.x

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of trauma, interpersonal sensitivity was chosen as a measure of personality-level difficulties such as rejection sensitivity and instability of emotions associated with complex post-traumatic

reactions (van der Kolk, 2005). Another hypothesis based in a biopsychological model is the central role of dissociation. Within the sexually abused participants, we examined the associ- ation of demographic variables, dissociation, and other abuse

characteristics to posttraumatic symptoms.

Maltreatment and Incarcerated Youth

Prevalence

Exposure to at least one DSM criterion A stressor appears to be a common experience for Americans by early adulthood, with survey estimates ranging from 40% to over 90% (Costello,

Erkanli, Fairbank, & Angold, 2004; McNally, 1999). It is likely that incarcerated youth have experienced more traumatic experi- ences, and more intense traumas, than general population teens (Brosky & Lally, 2004; Coleman, 2005).

In a meta-analysis of prevalence studies, Bolen and Scannapi- eco (1999) estimated a general population sexual abuse victim- ization prevalence rate of 13% for boys and 30%–40% for girls.

CSA prevalence rates in incarcerated youth are generally twice the general population rate for males, but rates for incarcerated females are similar to general population estimates (Coleman,

2005; Dembo et al., 2000). Dembo et al. (2000) found that 38% of incarcerated youth

reported physical abuse. Incarcerated youth also experience physical traumas at high rates when they are incarcerated.

Woolf and Funk (1985) found such rates 4 to 8 times greater than those of nonincarcerated youth.

The Impact of Maltreatment on Mental Health Problems

There are differences in the mental health effects of the most prevalent trauma exposures. For example, posttraumatic stress disorder (PTSD) occurs at over twice the rate in sexual versus

nonsexual assaults (McNally, 1999). A large longitudinal study from childhood into young adulthood found child sexual abuse much more predictive of later mental health problems than physical abuse or neglect (Brown, Cohen, et al., 1999).

Meta-analyses of the effects of sexual abuse give estimates of main effects across numerous studies, often not controlled for other variables. In two meta-analyses, the meta-analytic correla-

tion of CSA to anxiety, depression or psychological distress ran- ged from .196 (R2 = .038) to .24 (R2 = .057; Paolucci et al., 2001; Weaver & Clum, 1995; Paolucci et al., 2001). In contrast,

Rind and Tromovitch (1997) conducted a meta-analysis of seven general population CSA prevalence studies and found meta-ana- lytic correlation coefficients for CSA and psychological distress

of .07 for men and .1 for women, accounting for 1% of the vari- ance or less. The proportion of variance in mental health symp- toms accounted for in the meta-analyses reviewed ranged from < 1% to nearly 6%, and for those that included clinical sam-

ples the range was approximately 4%–6%.

Briere and Elliott (2003) estimated the effect size of childhood abuse and interaction effects on PTSD symptoms in a nationally

representative sample of adults. For both anxiety and depres- sion, sexual and physical abuse together accounted for 8% of the variance, with the beta coefficients for sexual abuse approxi-

mately 2 times the size of physical abuse. An instructive risk factor–outcome benchmark is provided by

Briere and Elliott (2003): The meta-analytic correlation of smoking and lung cancer is .12 (R2 = .014). A benchmark from

developmental psychology is the meta-analytic correlation of mother’s psychopathology with child internalizing problems of .18 (R2 = .03), and of father’s psychopathology with child

internalizing problems of .14 (R2 = .02) (Connell & Goodman, 2002). Sulloway (1996) provides the following guidance on interpreting effect size: ‘‘Relatively small correlations constitute

surprisingly large effects, despite modest amounts of ‘variance explained’ and should not be dismissed as unimportant’’ (p. 372).

Specific to incarcerated youth, Brown, Henggeler, Brondino, and Pickrel (1999) found that sexually abused youth had higher rates of internalizing problems and those exposed to domestic violence had higher rates of externalizing problems. For psychi-

atric comorbidity, sexual abuse accounted for 8% of the vari- ance, second only to gender in strength. Trauma variables accounted for 2% of the variance in internalizing disorders, less

than expected. Gover (2004) estimated the effect of sexual abuse in a large national sample of incarcerated youth (n = 588). She found sexually abused youth experienced depression levels one

half of a standard deviation above those who did not report sex- ual abuse (R2 = .06). In summary, the studies specific to incar- cerated youth found effect sizes of CSA ranging from 6% to

8% of the variance in psychological distress. Fewer studies reported effect sizes for CPA, but the existing research indicates that CSA has a more powerful negative influence on mental health than CPA.

This study will examine the following research questions:

1. Controlling for other risk factors, what proportion of the variance in the mental health problems (anxiety, depres-

sion, and interpersonal sensitivity) of incarcerated youth are due to sexual and physical abuse (main effects)?

2. What is the influence on mental health of interactive effects of the independent variables?

3. In the sexually abused subsample, which demographic and abuse experience variables, including dissociation, are associated with higher mental health symptoms?

Method

Design

The data for this study were collected by Dembo and colleagues, with data collection finishing in the late 1980s (Dembo, 2002). A survey design was utilized with questionnaires

completed by interview with 398 participants at intake to a regional detention center in Florida. In addition to the original human subjects review, secondary analysis of this data was approved by the human subjects committee at Portland State

University.

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Sample

Ninety-eight percent of eligible youth agreed to participate in the study. Of the 398 subjects in the sample, 285 (71.6%)

were male and 113 were female (28.4%). Two hundred and eighteen subjects were White (54%) and 169 (42%) were Afri- can American. The average age was 15.4 years (SD = 1.49). One third of the sample came from families supported by a

primary wage earner who worked in a low-skill occupation, and 21% of the families were primarily supported by public assistance.

Measures

Control variables. Construction of variables to measure substance abuse, SES, FMH, and FSA followed procedures

described by Dembo et al. (1992). FSA was measured by four items that tapped family use of drugs or alcohol, and family receipt of treatment for substance abuse. A summative scale was formed of these four items with marginal reliability (Cronbach’s

a = .63). FMH was measured by two items that tapped the presence of FMH problems, and mental health treatment. A summative scale was formed of these two items with very good

reliability (Cronbach’s a = .89). An ordinal scale of family SES was constructed based on parent’s occupation and parental edu- cation level. Youth substance abuse (YSA) was measured

through times of lifetime use of nine categories of substances. The nine items were factor analyzed by principal components analysis, extracting and saving a single factor that accounted for 55% of the variance.

Childhood physical abuse. Six items measuring the fre- quency of different kinds of child physical abuse (e.g., struck

with a hard object, shot with a gun) were factor analyzed by principal components analysis, extracting and saving a single factor that accounted for 63% of the variance.

Childhood sexual abuse. This was defined using the criteria and coding procedures outlined by Dembo et al.

(1992), which followed Finkelhor’s (1979) sexual abuse survey procedures. The interview elicited detailed information about the type of abuse, relationship to perpetrator(s), age of victim and perpetrator when the abuse occurred, and the victim’s

response to the sexual abuse. Fifty-five percent of the sample (221 youth) indicated a history of a sexual experience with an adult. Those who reported sex with an adult were coded

as yes for CSA if they met at least one of the following crite- ria: the perpetrator was a parent, the participant was younger than 13 at the time of the abuse, the age difference between

perpetrator and victim was 5 years or greater, force or threat was used, or the participant experienced dissociation in response to the abuse.

For the analysis of correlates of mental health symptoms in the sexually abused subsample, the following individual CSA variables were used: perpetrator was a parent, participant age when sex occurred, age and gender of perpetrator, force was

used, dissociation occurred at the time of the abuse, and the number of times participant had sex with an adult.

Youth mental health measures. The mental health- dependent variables examined in this study were the General

Severity Index (GSI), and the anxiety, depression, and interper- sonal sensitivity subscales of the Symptom Checklist 90 (SCL– 90), a widely used broad spectrum measure of mental health

symptoms with strong reliability and validity (Derogatis, 1983).

Analyses

The distributions of individual variables, bivariate combina- tions of variables, and multivariate models were examined for normality, equal variance, and linearity. The distributional

assumptions were judged to be adequately satisfied to proceed with the planned analyses. Multiple regression and semipartial squared correlation were

used to analyze the impact of sexual and physical abuse on men- tal health, controlling for family SES, ethnicity, gender, YSA, FSA, and FMH. Age had very narrow variability in this sample,

and had no bivariate associations with the dependent variables, so it was not included in the multivariate models. For the dependent variables, depression, anxiety, and interpersonal sen- sitivity, hierarchical regression models were constructed. At Step

1, the demographic, social, family, and abuse variables were entered into the regression simultaneously, At Step 2, the 12 the- oretically selected interaction terms (CSA and CPA · each of

the other main effects, CSA · CPA, and Gender · Ethnicity) were entered and a final model was arrived at by backwards removal of nonsignificant interaction terms. For the analysis of

correlates of mental health symptoms among the sexually abused participants, bivariate correlations were computed.

Results

Prevalence of Sexual and Physical Abuse

A total of 92 participants (23.1%) reported CSA, with girls (50 of 112) 3 times more likely than boys (42 of 284) to report CSA, v2(1) = 40.14, p < .000. CSA was not related to age or

ethnicity. CPA was reported by 169 respondents (42.5%), with boys 1.6 times more likely than girls, v2(2) = 7.928, p < .05. African Americans were 1.8 times less likely to report

CPA—29% of African Americans versus 71% of others— v2(2) = 22.73, p < .000. No significant relationship was found between CPA and the age of the youth.

Estimating the Effect Size of Maltreatment on the Mental Health of Incarcerated Youth

Table 1 shows the intercorrelations of the variables for the first two research questions. CPA was not associated with anxi- ety, depression, or interpersonal sensitivity. CSA was correlated

with all three mental health variables, with bivariate R2 ranging from .026 for interpersonal sensitivity to .053 for anxiety. In comparison, the strongest bivariate correlate of any one of the mental health variables was FMH problems with anxiety (bivar-

iate R2 of .11). Table 2 presents the results of the regression models. Family

SES and physical abuse did not reach statistical significance as a

CHILDHOOD MALTREATMENT IN INCARCERATED YOUTH 345

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main effect in any model. The main effects model for anxiety found four variables positively associated with anxiety. In decreasing strength, they were FMH, YSA, CSA, and FSA. The final interaction model accounted for 24% of the

variance in anxiety, with four interaction terms. The strongest

interaction term of Physical Abuse · FMH indicated that above and beyond the main effect association of FMH, those children with FMH problems and physical abuse experienced markedly higher anxiety. The next two strongest interaction terms had

negative associations (a protective effect): Children with CPA

Table 1. Inter correlations of Independent and Dependent Variables

1 2 3 4 5 6 7 8 9 10

1. CPA —

2. CSA .029 —

3. SES .091 ).050 —

4. FSA .077 .106* .040 —

5. FMH .138** .068 ).011 .259** —

6. Gender .002 ).295 ).034 .009 .043 —

7. White ).047 .095 .064 .194** .269** ).114* —

8. YSA .131* .203** .103* .237** .215** .010 .384** —

9. Anxiety .065 .228** ).023 .262** .328** ).112* .243** .283** —

10. Depression .069 .220** ).017 .246** .302** ).166** .261** .250** .821** —

11. Interpersonal sensitivity .029 .159** ).032 .235** .249** ).184** .155** .152** .760** .771**

Note. CPA = childhood physical abuse; CSA = childhood sexual abuse; SES = socioeconomic status (family); FSA = family substance abuse;

FMH = family mental health; YSA = youth substance abuse.

*p < .05. **p < .01.

Table 2. Multiple Regression Models of Anxiety (n = 365), Depression (n = 367), and Interpersonal Sensitivity (n = 367)

R2 Outcome Predictor

Step 1 Step 2

b sr2 b sr2

.21*** Anxiety CPA .008 — .14 —

CSA .14** .02 .13* .014

SES ).03 — ).04 —

FSA .13* .014 .05 —

FMH .22*** .042 .23*** .045

Gender ).05 — ).05 —

White .08 — .08 —

YSA .16** .02 .15** .016

.24*** CSA · FSA — — .13* .011

CPA · SES — — ).29* .008

CPA · FMH — — .47* .013

CPA · YSA — — ).33* .011

.17*** Depression CPA ).03 —

CSA .13* .013

SES ).03 —

FSA .12* .013

FMH .20*** .034

Gender ).11* .01

White .12* .012

YSA .10 —

.12*** Interpersonal

sensitivity

CPA ).01 —

CSA .08 —

SES ).02 —

FSA .16** .021

FMH .17** .025

Gender ).15** .019

White .03 —

YSA .07 —

Note. CPA = childhood physical abuse; CSA = childhood sexual abuse; SES = socioeconomic status (family); FSA = family substance abuse;

FMH = family mental health; YSA = youth substance abuse; sr2 = semipartial squared correlation.

*p < .05. **p < .01. ***p < .001.

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who abused substances or from higher SES families had lower anxiety levels. The final significant interaction term (CSA · FSA) indicated that sexually abused children from substance- abusing families had additional risk for anxiety beyond the baseline risk of CSA or FSA by itself. Controlling for the other

variables in the model, CSA accounted for 1.4% of the variance in anxiety, and CSA · FSA accounted for 1%. The three significant physical abuse interaction terms each account for approximately 1% of the variance in anxiety.

The regression model for depression had no significant inter- action terms. Five main effect variables were significant, accounting for 19% of the variance in depression. Again, FMH

was the strongest variable, followed by CSA and ethnicity (White). Controlling for the other variables in the model, CSA accounted for 1.4% of the variance in depression.

The regression model for interpersonal sensitivity had three significant main effects and one significant interaction term, accounting for 15% of the variance in interpersonal sensitivity.

FMH was the strongest predictor followed by FSA. There was a modest effect that male participants had lower interpersonal sensitivity scores. In the interaction term model, a nonsignificant trend was evident that physically abused participants who also

abused substances (CPA · YSA) scored lower on interpersonal sensitivity. Neither CSA nor CPA had a significant association in the multivariate analysis.

The final analysis examined the impact of social, familial, and abuse variables on overall symptom severity in the subsample of sexually abused teens (n = 92). The SCL–90 GSI scale of gen-

eral psychiatric symptoms was used as the dependent variable in this analysis. The strongest predictor of higher symptoms was identifying as White (r = .36, p < .05). Dissociation at the time

of abuse was positively correlated with symptom severity (r = .32, p < .05). The age of the abuser was also correlated with higher symptom severity in youth (r = .26, p < .05). Lastly, there was a positive correlation with symptom severity if

the perpetrator of the abuse was a parent (r = .25, p < .05). There were 7 participants who reported sexual abuse by a par- ent (8% of those who reported sexual abuse).

Discussion

Incarcerated youth in this sample reported high rates of expo- sure to sexual and physical abuse, rates close to previous esti- mates. The participants reported sexual abuse at more than twice the general population prevalence. Convergent with prior

research on both general population and incarcerated youth, girls are more likely to report experiencing sexual abuse (Briere & Elliott, 2003; Dembo et al., 2000).

Physical abuse was slightly higher in this sample than reported by Dembo et al. (2000) in a similar sample of incarcer- ated youth, and more than twice general population prevalence

(Briere & Elliott, 2003). The differential prevalence of physical abuse among boys and girls in this sample conflicts with general population studies, which find similar rates of physical abuse in

both boys and girls (Briere & Elliott, 2003). CPA had no bivariate or main effects association with mental

health in the multivariate models. However, the interaction term analysis found several significant CPA interaction terms. Among

those kids who were physically abused, higher SES and substance

abuse were protective against anxiety, and FMH problems exacerbated anxiety. These findings underline the importance of

interaction term analyses: Main effects analyses would lead to the incorrect conclusion that CPA has no relationship to anxiety in this sample. In fact, children from low-income backgrounds,

or with mentally ill family members, are more likely to have mental health consequences of physical abuse. In addition, sub- stance abuse may mask physical abuse reactive mental health symptoms. In the anxiety model, each of these interaction terms

accounts for approximately 1% of the variance. Using the most liberal estimate of effect size (bivariate corre-

lations), CSA accounted for approximately 5% of the variance

in anxiety and depression, and 2.5% of the variance in interper- sonal sensitivity. In the more conservative estimates of the multivariate models, the strongest effect was found for CSA on

anxiety symptoms, with CSA accounting for 1.4% of the vari- ance and interaction terms explaining an additional 1.1% of variance (2.5% total). For depression, a more modest amount

of unique variance was explained by CSA (1.3%). CSA was the second strongest risk factor across the three

models, following FMH problems. The variable FMH problems likely taps into several influences, including: genetic predisposi-

tion, the influence of learned patterns of emotions and cognition, and adaptation to stressful, confusing or unempathic parental behaviors as a consequence of parental mental health symptoms.

The third strongest main effect across the models was FSA problems. Not only does FSA itself have a negative effect on youth mental health, but those who experienced CSA in the

context of FSA had significantly worse anxiety (CSA · FSA interaction term). These findings could reflect underlying genetic dispositions to anxiety in substance-abusing families, or reduced

protective factors of care and support for abused youth in sub- stance-abusing families. Strengths of the study include a large sample for a forensic or

clinical study, and detailed assessment of childhood maltreat-

ment. The study also includes a larger proportion of females than many juvenile justice studies, allowing more confidence about results across gender. Limitations include a cross-sec-

tional design and a sample limited to one geographic area in the United States. Only White and African American youth were well represented in this sample, so conclusions about ethnicity

are limited to those two groups. A measure specific to mental health consequences of trauma such as Briere’s (1995) Trauma Symptom Inventory may have better captured the variance in trauma-related mental health problems than the SCL–90. The

three outcome variables used are all internalizing mental health symptoms, leaving unmeasured behavioral disturbance. As externalizing symptoms might mask internalizing, a more com-

plete model could be constructed with data that include mea- sures of both internalizing and externalizing symptoms. As noted in the Introduction, the data set was collected in

1989, so factors subject to change over time such as trends in drugs of abuse may not represent current patterns. For this reason, a general underlying factor of drug and alcohol use was

analyzed rather than the use of individual substances. The juvenile justice system has also experienced change since these data were collected. Overall, the sample size and thorough measurement of maltreatment make this data set of enduring

interest.

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CSA stands out as a risk for internalizing mental health prob- lems, controlling for other family problems. Although physical

abuse and witnessing domestic or street violence is undoubtedly traumatic, the pseudointimacy and often confused emotional messages of sexual abuse make for a more profoundly disturb-

ing traumatic experience. This is consistent with previous research that has found sexual assault results in much higher rates of PTSD and slower rates of remission of symptoms than other types of assault (McNally, 1999). The association of

sexual abuse with depression and anxiety replicated results in earlier studies of incarcerated youth (Brown, Cohen, et al., 1999; Coleman, 2005). The effect sizes fell at the high end of the

meta-analytic estimates reviewed earlier. The magnitude of the effect shows that CSA is among the few strongest risk factors for mental health problems. The association of CSA and mental

health problems, on average, exceeds the correlation of smoking and lung cancer (Briere & Elliott, 2003) and is similar to the association of parental mental health problems with child men-

tal health problems (Connell & Goodman, 2002). As noted in the Introduction, apparently small effects are developmentally significant. The more severe consequences of sexual abuse than other

abuse experiences are consistent with neurobiological models of trauma adoption. The elevated levels of anxiety and depression likely reflect dysregulated neurochemical affective and danger

responses (van der Kolk, 2002). Among those who were sexually abused, the correlation of dissociation and mental health symp- toms also converges with neurobiological models. Dissociation

is a marker that normal coping resources are overwhelmed and the brain is engaging primitive danger responses. An older per- petrator and parent–child incest, the other significant correlates

of mental health symptoms in those who were sexually abused, are also trauma conditions likely to trigger the overwhelming fear and helplessness tied to dissociation.

Implications for Practice

This study joins a growing body of evidence that trauma rates

are disproportionately higher in incarcerated youth and that trauma exposure is associated with behavioral and mental health problems. There is more than sufficient evidence to

warrant close clinical attention to trauma in incarcerated youth. However, as with research on trauma in broader populations, not all traumatized individuals develop criminal behavior or serious mental health symptoms. Ford (2002) comments:

‘‘Traumatic victimization is unlikely to be the primary cause of Oppositional Defiant Disorder or Conduct Disorder’’ (p. 28). The role of maltreatment and other traumas should be recog-

nized as one risk factor alongside family-level variables such as parental mental health and substance problems, nested within structural economic and social factors such as poverty and lack

of opportunity. Taking this broad view of causes for mental health problems,

there is a need for clinicians working in corrections to be trained

to recognize and treat trauma, including an understanding of dissociation. Although exceeding the scope of this study, there is promising evidence for cognitive approaches (Ahrens & Rexford, 2002) and eye-movement desensitization reprocessing

(Soberman, Greenwald, & Rule, 2002).

Implications for Research

The previous section argued for recognizing the role of trauma, without overly weighting trauma in relation to other

developmental influences. However, there is a need for research to estimate the impact of maltreatment and other trauma on the development of criminal behavior. Clinical and forensic samples are biased in not including youth who experienced similar risk

factors but did not enter the corrections or mental health sys- tem. Studies are needed with national probability sampling, pos- sibly with oversampling of youth in the juvenile justice system,

or case–control studies drawing matched normal population samples to a forensic sample. It is possible that current research underestimates the effect of trauma, as it is largely conducted

on samples of youth already in the juvenile justice system. Out- side of the scope of this study, there is extensive need for the development and testing of assessment and treatment protocols

for traumatized youth in juvenile justice. It is interesting that sexually abused White youth showed

higher risk for internalizing mental health symptoms than sexu- ally abused youth of color (predominantly African Americans

in this sample). This may reflect protective cultural factors in the support received by youth of color, with high extended fam- ily support and strong ties to religious community (Abney &

Priest, 1995; Neville, 1997). Protective cultural factors warrant further quantitative and qualitative investigation.

Conclusion

Incarceration before adulthood is the result of a combination of genetic factors, social disadvantage, family conditions such as

mental illness and substance abuse, childhood maltreatment, and other traumas. The rates of childhood maltreatment are markedly higher in incarcerated youth, and these traumas are

associated with internalizing mental health problems. Consistent with previous research, CSA had more deleterious effects, but youth from families with mental health problems and lower

income backgrounds suffered stronger negative effects of CPA. Consistent with the empirically based bio-psychological model of trauma adoption, dissociation and sexual abuse characteris-

tics likely to trigger dissociation were associated with higher mental health symptoms. Professionals working in juvenile jus- tice can use these results, in conjunction with the broader litera- ture, to inform their understanding, assessment, and treatment

of incarcerated youth.

Keywords: adolescents; incarcerated youth; child abuse and neglect; juvenile delinquency; emotional disturbance; trauma;

victimization; social class

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CHILDHOOD MALTREATMENT IN INCARCERATED YOUTH 349

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