THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL SYMPTOMS: UNDERSTANDING THE INTERPLAY OF AND SPECIFIC CHARACTERISTICS OF VIOLENT EVENTS

Sarah Hassan

A Dissertation

Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

August 2017

Committee:

Carolyn J. Tompsett, Advisor

David Jackson Graduate Faculty Representative

Eric F. Dubow

Dara Musher-Eizenman

© 2017

Sarah Hassan

All Rights Reserved iii

ABSTRACT

Carolyn J. Tompsett, Advisor

Violence exposure is a serious public health concern, with increased exposure to adverse events associated with an increased risk for , drug , , suicide attempts, poor self-rated health, and severe obesity in adulthood (Felitti et al., 1998). Specific characteristics of violence exposure may influence the severity of psychopathology (Higgins &

McCabe, 2000), including chronicity of violence, the nature of the victim’s relationship to the perpetrator, and recency of the event.The current study tests how specific characteristics of violence exposure moderate the mediational model of violence exposure leading to a disengagement coping style leading to psychological symptoms. Participants, ages 18 to 22, were recruited from Introductory courses, Facebook, and online support groups for victims of violence. A total of 368 valid online surveys were collected. The simple ediationalm model was non-significant for both voluntary disengagement coping strategies and involuntary disengagement reactions. In addition, relationship to the perpetrator, chronicity of violence, and recency of violence did not moderate the mediationalmodel. Implications for research are discussed.

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ACKNOWLEDGMENTS

I would like to thank several people who provided me with support and feedback on this dissertation. First and foremost, I would like to express my profound appreciation to my academic advisor, Dr. Carolyn Tompsett for her guidance, helpful edits, and thoughtful critiques with regards to this dissertation as well as several other projects. I will always appreciate the support, encouragement, and respect I received from her throughout my graduate school career. I would also like to extend special thanks to my committee members Drs. Eric Dubow, Dara

Musher-Eizenman, and David Jackson, for their thoughtful discussions, interest, and helpful feedback on this dissertation. Thank you to my lab mates: Kelly Amrhein, Sindhia Colburn,

Hannah Geis, Lynnel Goodman, and Lindsey Roberts who spent time reading drafts of this manuscript and providing helpful feedback; your efforts were much appreciated. Thank you to my friends who have supported me both personally and professionally throughout this journey and for always providing a listening ear. The support I have received from you over the years has meant so much to me. Finally, my deepest and most heartfelt appreciation goes to my family, for their love and unwavering support. I would not be where I am today without your continual encouragement and belief in me.

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TABLE OF CONTENTS

Page

CHAPTER I: INTRODUCTION…………………………………………………… ...... 1

Definitions and Rates of Violence Exposure …………………………………………. 2

Cumulative Violence…………………………………………………………………… 3

Characteristics of Violence Exposure and Psychological Distress ……………………. 4

Coping …………………………………………….………………………………… 9

Violence Exposure, Coping, and Psychological Distress ...... 11

Present Study ………………………………………………………………………… 14

CHAPTER II: METHODS..………………………………………………………………… 19

Participants ……………………………………………………………………………. 19

Measures..…………………………………………………………………………… 20

Procedure..…………………………………………………………………………… 24

CHAPTER III: RESULTS ...... ………………………. 26

Descriptive Statistics ……………………………………………………………….. 26

Correlations …………………………………………………………………………. 29

ANOVA ……………………… ...... ……………………………. 30

Main Analyses …………………………………………………...... 30

CHAPTER IV: DISCUSSION ……………………………...... 42

Characteristics of Violence and Trauma Related Symptoms ……………………….. 42

Involuntary Disengagement and Voluntary Disengagement

Coping as a Potential Mediator ………………………………………………………. 44

Interpersonal Trauma Characteristics and Moderated Mediational Analyses ……… 45 vi

Sample Characteristics ……………………………………………… ...... ….. 46

Violence Exposure, Demographic Variables, and Trauma Symptoms ...... 47

Strengths and Limitations ……………………………………………… ...... ….. 48

Conclusions and Future Directions ...... 50

REFERENCES……………………………………………………………………………… 52

APPENDIX A: DEMOGRAPHIC QUESTIONNAIRE …………………………………… 67

APPENDIX B: ADAPTED EXPOSURE TO VIOLENCE MEASURE

CORE ITEMS ……… ...... 68

APPENDIX C: FOLLOW-UP ITEMS ……………………………………………………… 70

APPENDIX D: ADAPTED CENTRAL RELATIONSHIP QUESTIONNAIRE ………… 71

APPENDIX E: ADAPTED THE RESPONSES TO

QUESTIONNAIRE – (SR)……………………………………………………… ...... …… 72

APPENDIX F: TRAUMA SYMPTOM CHECKLIST (TSC-40)………………..………… 78

APPENDIX G: HSRB APPROVAL ………………………………………………………… 80

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LIST OF FIGURES

Figure Page

1 Simple Mediational Model ...... 16

2 Mediational model moderated by recency of event at path a...... 16

3 Mediational model moderated by recency of event at path b...... 17

4 Mediational model moderated by relationship to the perpetrator at path a ...... 17

5 Mediational model moderated by chronicity of violence at path a...... 18 viii

LIST OF TABLES

Table Page

1 Descriptive and Correlations ...... 27

2 Frequencies of exposure to violence ...... 28

3 Final regression model examining moderation of the relationship between

relationship characteristics and trauma symptoms ...... 32

4 Final regression model examining moderation of the relationship between

relationship characteristics and voluntary disengagement coping ...... 33

5 Final regression model examining moderation of the relationship between

relationship characteristics and involuntary disengagement reactions ...... 34

6 Simple Mediation Model for voluntary disengagement coping ...... 35

7 Simple Mediation Model for involuntary disengagement reactions ...... 36

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 1

CHAPTER I: INTRODUCTION

Violence exposure can include maltreatment, victimization by peers and siblings, sexual victimization, indirect victimization such as witnessing community and family violence, as well as direct or indirect exposure to school violence (Finkelhor, Ormrod, & Turner, 2009). Exposure to violence is a major public concern due to its short- and long-term impact on young adults’ emotional, academic, psychological, and physical well-being. The link between violence exposure and maladaptive psychological outcomes has been well-documented within the literature. In a national prospective survey, childhood exposure to adverse events—including exposure to violence—increased the risk for alcoholism, drug abuse, depression, suicide attempts, poor self-rated health, and severe obesity in adulthood; as the number of adverse events increased, so too did the risk for negative outcomes (Felitti et al., 1998). Furthermore, these negative mental health effects are associated with both direct victimization and witnessing violence (Fowler, Tompsett, Braciszewski, Jacques-Tiura, & Baltes, 2009), as well as with both chronic and acute exposure to violence (Buka, Stichick, Birdthistle, & Earls, 2001).

While exposure to violence in general is detrimental to psychological health, specific characteristics of violence exposure may influence the severity of psychopathology (Higgins &

McCabe, 2000). Some characteristics of exposure that may influence the severity of psychopathology include the age at first violence exposure, chronicity of violence exposure, and the nature of the victim’s relationship to the perpetrator. For example, previous research has found that, when compared to youth with a single incident of non-caregiver related abuse, individuals exposed to multiple incidents of chronic, caregiver-related abuse exhibit a greater number of symptoms overall (Kisiel, Fehrenbach, Small, & Lyons, 2009).

An individual’s means of coping is an additional factor that may influence the relationship between violence exposure and psychopathology. Disengagement coping strategies THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 2 are directed away from the stressors and one’s and thoughts (e.g. avoidance, , and wishful thinking) (Compass et al., 2001). Youth exposed to chronic and/or family- perpetrated forms of violence, such as , may tend to rely on disengagement coping strategies because, in the short-term, disengagement is adaptive and “self-protective” given the inescapable nature of such violence (Bailey, Moran, & Pederson, 2007). Although disengagement coping strategies may provide short-term relief by preventing the individual from focusing on the distressing emotions associated with these stressful events, in the long-term, disengagement may prevent the individual from addressing emotions and memories associated with the violent event and recovering from the experience. The present study examined the relations between interpersonal violence exposure, the characteristics of violence exposure, coping strategies, and psychological symptoms among a sample of young adults. It was expected that coping strategies would differ based on the characteristics of violence exposure, which in turn would impact the severity of psychological symptoms. It was also expected that recency of violence exposure would predict severity of psychological symptoms such that individuals who utilized disengagement coping strategies with a more recent event would report fewer symptoms; however, those who continued to use disengagement strategies with older events would report more symptoms.

Definitions and Rates of Violence Exposure

According to the World Health Organization (WHO), violence is defined as “the intentional use of physical force or power, threatened or actual, against another person, or against a group, or community, that results in or has a high likelihood of resulting in , death, psychological harm, maldevelopment, or deprivation” (Dahlberg & Krug, 2002). Interpersonal violence may occur within a range of relationships (e.g., family, romantic, and peer relationships) and contexts THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 3

(e.g., community, school, and family). These violent experiences may be emotional, physical, or sexual. For instance, physical violence may consist of being slapped, hit, or punched with or without a weapon; sexual violence might include unwanted fondling, touching, or penetration; and emotional may include or threats. Direct violence exposure takes place when a person is victimized, whereas indirect violence exposure refers to someone witnessing instances of violence (Barbarin, Richter, & DeWet, 2001).

Many individuals in the United States are exposed to some form of interpersonal violence.

According to the National Survey of Children’s Exposure to Violence (NatSCEV), 60% of children and adolescents in the United States have experienced at least one form of victimization, either directly or indirectly, within the past year (Finkelhor, Turner, Shattuck, & Hamby, 2015;

Finkelhor, Ormrod, & Turner, 2009; Finkelhor, Turner, Ormrod, & Hamby, 2009). Similarly, the

Adverse Childhood Experiences Study (ACE) indicates that approximately 58% of men and women reported experiencing at least one instance of physical, sexual, or emotional abuse before the age of eighteen (Dube et al., 2003). It is important to note that while these represent national rates, the severity of abuse ranges dramatically within each of these categories. For example, abuse as defined in these studies can include anything from insults or verbal threats to forced sexual penetration.

Cumulative Violence

Polyvictimization is a term used to describe the experience of multiple types of violence by one individual (Finkelhor, Ormrod, & Turner, 2009). Individuals who experience violence in one domain often have an increased likelihood of experiencing violence in other domains (Finkelhor,

Ormrod, & Turner, 2007). For instance, someone who is exposed to more severe forms of violence, such as physical or sexual violence, is more likely to also experience verbal threats and THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 4 insults; the reverse, however, is not necessarily true. In addition, individuals who experience violence in one context, such as within the home, are more likely to also experience violence in

other contexts, such as within the neighborhood. One such explanation for this is that living in dangerous communities—with high rates of community violence and low —may place a great deal of stress on a family, which may result in coercive behaviors and abuse within the family including or physical abuse (Finkelhor, Ormrod, Turner, & Holt

2009). Although much of the research on youth violence has focused on a single type of violence, such as neighborhood violence or family violence (Boxer & Sloan, 2013), the amount of studies investigating the cumulative or interactive effects of exposure to violence at multiple

ecological levels has increased tremendously within the last decade (e.g. Boxer et al., 2013;

Dubow et al., 2010; Dubow et al., 2012; Margolin, Vickerman, Oliver, & Gordis, 2010; Mrug,

Loosier, & Windle, 2008).

Characteristics of Violence Exposure and Psychological Distress

Recent research has moved away from identifying negative mental health outcomes associated with violence exposure, and has instead focused efforts on understanding the mediating and moderating factors that shape how and when violence exposure might lead to heightened psychological distress. The association between violence exposure and psychological symptoms is well-established, with more lifetime victimization associated with more post- traumatic stress symptoms, , depression, and aggression (Babchishin & Romano, 2014;

Kennedy et al. 2009; Mazza & Reynolds, 1999; Mrug et al., 2008; Mrug & Windle, 2010;

Schwab-Stone et al., 1995; Ward et. al, 2006). However, not all individuals exposed to violence suffer negative psychological outcomes (Luthar, Cicchetti, & Becker, 2000). THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 5

Researchers have outlined various factors that might contribute to differential responses to violence exposure. Harvey (1996) described factors shaping response to violence exposure as occurring within individual, event-specific, and environmental domains. Individual variables include age of the victim, prior experiences, perpetrator’s relationship to the victim, and coping skills. Characteristics of the violent event include frequency, severity, and duration.

Environmental factors include the community, neighborhood, or other ecological contexts within

which the violent event occurred (Harvey, 1996). For example, someone who is victimized once

by a stranger is likely to respond differently than an individual who is frequently victimized by a

trusted loved one over the course of a number of years. Boxer and Sloan-Power (2013) proposed

a similar four-dimensional framework for understanding the impact of violence exposure on

psychological and behavioral outcomes. This framework includes (1) context, which is the

setting in which the violence occurs; (2) content, or the severity of the event; (3) channel, which

is the way in which the youth experiences the violence (for example, direct victimization versus

witnessing violence); and (4) chronicity, or frequency of exposure. A recent study conducted by

Sundermann & DePrince (2015) found that child maltreatment characteristics—including age of onset, cumulative perpetrators, and cumulative types of violence—taken together predict a significant proportion of variance in , anxiety, dissociation, and posttraumatic stress symptoms. Based on the factors described above, the current study seeks to more closely

examine the intersections between specific characteristics of violence exposure—specifically

relationship to the perpetrator, chronicity, and recency, and how they are related to both the use

of coping strategies and trauma symptom severity.

Perpetrator’s Relationship to Victim. An individual’s relationship to the perpetrator

has been one of the most frequently studied characteristics of violence exposure and has been THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 6 identified as a predictor of the severity of mental health symptoms (Beitcheman et al., 1992). The most distressing psychological effects occur when victims are harmed by a trusted person, such as their parent or a romantic partner (Feinauera, 1989). Physical, emotional, or or assault perpetrated by an emotionally close or trusted individual is considered “high trauma” (Freyd, 1994; 1996). When compared to similar violence perpetrated by a more emotionally distant individual or stranger, high results in poorer outcomes and is more closely associated with psychological and physical symptoms, including higher levels of depression, posttraumatic stress, dissociative symptoms, and physical health problems

(Goldsmith, Freyd, & DePrince, 2011; Lawyer, Ruggiero, Resnick, Kilpatrick, & Saunder, 2006;

Leahy, Pretty, & Tenenbaum, 2004; Martin et al., 2013).

Studies examining high-betrayal traumas have expanded to capture multiple forms of violence. However, most of these studies have not explicitly examined differential effects among violence types; youth who have experienced sexual violence have received more attention than youth who have experienced physical violence (Kiser et al., 2014). In addition, much of the research on perpetrator-victim relationships has focused on demographic variables (e.g., biological parent) rather than on the individual’s emotional or physical dependency on the perpetrator (e.g., emotional closeness; Kiser et al., 2014). However, both the emotional bond the victim feels with the perpetrator and the level of betrayal may be determining factors in increasing distress (Feinauera, 1989), and as such, it may be more important to examine the nature of the relationship than to focus solely on kinship descriptors (Lucenko, Gold, & Cott,

2000; Kendall-Tackett et al., 1993).

A number of mechanisms have been proposed to explain the association between closeness of the perpetrator and more severe psychopathology. According to attachment theory (Bowlby, THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 7

1973), children develop internal working models through a primary caregiver’s responsiveness.

Internal working models are defined as automatic cognitive representations of the self, the world, and others which are based in large part on one’s relationship with a primary caregiver (Bowlby,

1969; Bowlby, 1988; Pearlman & Curtois, 2005). Individuals who are victimized by a trusted person are more likely to develop negative views of themselves, others, and the world (Bradhsaw

& Garbarino, 2004). Youth who are harmed by individuals on whom they emotionally and physically rely may come to view the world as stressful and lonely, and they may learn to believe that they are not worthy of respect or comfort (Howell, 2011).

Emotional and physical dependence and victimization are “at odds with each other,” creating conflict within the individual (Martin et al., 2013). Individuals who are exposed to violence perpetrated by a loved one may be more prone to make negative self-appraisals and to engage in self- in order to maintain the relationship with someone on whom they also physically and emotionally depend. Individuals who make negative attributions “ascribe causes of the event to themselves (internal), across situations (global), and over time (stable)” (Steel et al., 2004).

These attributions are likely to influence both an individual’s short- and long-term reactions to violence. Individuals with early experiences of violence perpetrated by a loved one may come to view themselves as unworthy, incompetent, powerless, or bad, which likely lead to feelings of depression and anxiety (Wright, Crawford, & Del Castillo, 2009).

Chronicity. Chronic violence exposure creates a stressful, chaotic, and uncontrollable environment for children and adolescents. An early victimization experience does not inevitably lead to psychopathology; instead, it initiates a risk for psychopathology, which is amplified through repeated and frequent exposure (Sroufe, 2013). Children who live in environments characterized by chronic violence are likely to live in a state of pervasive and perceived THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 8 threat which can lead to greater harmful effects (Suglia et al. 2008). As a result, compared to children maltreated in only one developmental period, chronically maltreated children have more externalizing and internalizing problems (Jaffee & Maikovich-Fong, 2011).

Age of Onset. The current study was originally designed to also examine differential effects of violence based on age of onset, although as will be noted later, due to low base rates this variable could not be examined in the current sample. When compared to adults, children are more susceptible to negative outcomes associated with violence exposure due to their limited coping skills, dependence on primary caregivers, and their continued emotional, neurobiological, social, behavioral, and cognitive development (De Young, Kenardy, & Cobham, 2011).

Although direct victimization threatens all individuals’ of safety, younger children exposed to various forms of interpersonal violence, particularly chronic forms of violence, are especially vulnerable. Younger children are more dependent on others and have little control over their lives or bodies, and as such, are less able to report, move away, or otherwise protect themselves; as a result they are more susceptible to negative outcomes (van der Kolk, 2005; Carlson, Furby,

Armstrong, & Shlaes, 1997; Kaplow & Widom, 2007). In addition, exposure to violence early in life, especially chronic forms of violence, can lead to uncertainties about the reliability and predictability of the world and others, which bring about difficulties attuning to others’ emotions, social isolation, and interpersonal difficulties (Cook et al. 2005; Schimmenti, 2012).

Taken together, early, severe, and ongoing violence exposure—particularly if perpetrated by a close loved one—modifies early attachment, leads to impairments in development, increases posttraumatic stress symptoms, and distorts cognitive understanding of self, others, and the future (Briere, 2002). “Complex trauma” is a term often used to describe experiences of multiple

and/or chronic and prolonged, developmentally-adverse traumatic events, frequently of an THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 9 interpersonal nature and early-life onset (van der Kolk, 2005). These experiences are likely to have a negative impact on an individual’s self-esteem and sense of agency, as well as modify attributions and expectancies, leading to increased “negative self-image, loss of the expectation of being protected, and a constant fear of future victimization” (Schimmenti, 2012).

Coping

Coping is one factor that can intervene between a stressor(s) and symptom development

(Barbarin, 1993; Boxer & Sloan, 2013; Compas, Orosan, & Grant, 1993; Taylor & Stanton,

2007). Coping is defined as the cognitive, behavioral, and emotional strategies that individuals use to manage stressful or threatening situations (Dubow & Rubinlicht, 2011; Folkman &

Lazarus, 1985).

Models of Coping. Coping has been conceptualized in a number of different ways, with the most widely employed dimensions including: (1) problem vs. vs. avoidant-focused coping, (Lazarus & Folkman, 1984) (2) engagement (approach) vs. disengagement (avoidance)

coping (Roth & Cohen, 1986) and (3) The Response to Stress Model (Connor-Smith, Compas,

Wadsworth, Thomsen, and Saltzman, 2000). Problem-focused coping involves active attempts to

change or deal with a stressful situation and may include strategies such as seeking information,

generating possible solutions, and taking action to change a circumstance; emotion-focused

coping involves an acute and intense awareness of one’s emotional distress and tendency to

express those feelings (Lazarus & Folkman, 1984). Engagement coping strategies are directed

towards the source of the stress or one’s emotions or thoughts (e.g., seeking social support), and

disengagement or avoidant coping strategies are directed away from the stressors and one’s

emotions and thoughts (e.g., withdrawal; Compass et al., 2001). Cognitive strategies include

cognitive restructuring, wishful thinking, self-blame, and self-criticism, whereas behavioral THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 10 strategies involve either withdrawing from others or, alternatively, seeking social support

(Gutner, Rizvi, Monson, & Resick, 2006).

The Response to Stress Model is a comprehensive model of coping that differentiates between voluntary and involuntary responses to stress (Compass et al., 2001). Overall, this model measures three types of voluntary coping and two types of involuntary stress responses, yielding five total factors: primary control coping, secondary control coping, disengagement coping, involuntary engagement, and involuntary disengagement reactions. Voluntary coping includes conscious efforts to cope with a stressor such as problem solving and cognitive restructuring, whereas involuntary stress response includes conditioned reactions such as rumination or emotional numbing (Compass et al., 2001). Involuntary stress responses can be further broken down into involuntary engagement (rumination, arousal, intrusive thoughts) and involuntary disengagement reactions (cognitive interference, emotional numbing) (Compass et al., 2001).

Attempting to use problem solving or emotion regulation to influence events or conditions are primary control coping strategies, whereas efforts to adapt to the environment through acceptance or cognitive restructuring are secondary control coping strategies (Compass et al.,

2001). Disengagement coping includes avoidance, denial, and wishful thinking (Compass et al.,

2001). This model conceptually has numerous advantages over past models by distinguishing between (1) voluntary and involuntary responses (2) engagement and disengagement responses and (3) primary and secondary control strategies (Dubow & Rubinlicht, 2011).

Situational vs. Dispositional Coping. Coping style—or dispositional coping—refers to strategies that individuals generally use in response to a number of different stressful situations across time (Sandler, Wolchik, MacKinnon, Ayers, & Roosa, 1997; Boxer, Sloan-Power, &

Mercado, 2012). Some researchers have identified stable individual differences in coping THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 11 resources that improve the ability to manage stressful events, including optimism, self-esteem, social support, and personal control (Taylor & Stanton, 2007). However, the concept of stable coping styles is controversial (Scarpa, Haden, & Hurley, 2006), with some arguing that coping is

“constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person” (Lazarus &

Folkman, 1984, p. 141). According to this argument, coping strategies change with the demands of the situation. Situational coping refers to the potential for more dynamic application of coping strategies, suggesting that coping strategies might change from moment to moment, across different events, or over time (Boxer, Sloan-Power, Mercado, & Schappell, 2012).

The effectiveness of coping strategies for protecting against adverse effects of stress and trauma depends upon the goodness of fit between the type of stressor and the strategy; the controllability of the stressor is a critical component that influences the outcome of coping

(Boxer, Sloan-Power, & Mercado, 2012; Causey & Dubow, 1992; Dubow & Rubinlicht, 2011).

For example, problem-focused strategies may be far less successful under conditions of uncontrollable stressors, such as some forms of violence exposure, than they are when stressors are controllable, such as worrying about an upcoming deadline and thus working more. Studies investigating the influence of coping have typically focused on coping with a type of stressor

(e.g. academic stressor). People tend to utilize approach coping strategies if the stress or threat is controllable or escapable, whereas they tend to utilize avoidant coping if the stress is uncontrollable or inescapable (Olff et al., 2005; Folkman & Lazarus, 1980).

Violence Exposure, Coping, and Psychological Distress

Violence exposure is associated with increased use of disengagement or avoidant coping strategies, and these coping strategies are typically associated with more emotional distress (Bal, THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 12

Van Oost, De Bourdeaudhuij, & Crombez, 2003; Dempsey, 2002). However, there has been some suggestion that avoidant coping strategies may play an adaptive or protective role when a stressor is chronic, frequent, and uncontrollable (Boxer, Sloan-Power, Mercado, & Schappell,

2012). Disengagement coping strategies appear to be adaptive in the short-term by shielding individuals from overwhelming emotions, particularly when the nature of the stressor is outside of one’s control. However, in the long-term, these coping strategies may hinder processing of the

violence exposure, which is associated with increased emotional distress and symptoms (Bal,

Van Oost, De Bourdeaudhuij, & Crombez, 2003; Creamer, Burgess, & Pattison, 1992; Kliewer

et al., 1998). Thus, recency of the violence exposure is an additional factor that is important to examine because it likely impacts one’s utilization and effectiveness of coping stategies.

Relationship to the perpetrator, age of onset, and the chronicity of violence are all factors that may impact the utilization of coping strategies. However, few empirical studies have examined the relationship between coping and characteristics of interpersonal violence, with no known study using a sample of young adults to simultaneously examine multiple interpersonal violence characteristics and coping. Assessing coping and its differential association to various violence characteristics is an important pathway to better understanding the effects of violence exposure and can better inform treatment.

Age of Onset of Violence and Coping. Individuals exposed to violence at earlier ages

may not have the social, cognitive, or physical resources necessary to cope with violence

exposure (Keiley, Howe, Dodge, Bates, & Pettit, 2001). In addition, given that coping strategies

are still developing and are easily affected by a stressor. Therefore, disengagement coping

strategies are more likely to mediate the relationship between violence exposure and

psychological outcomes when violence exposure occurs at a younger age (Wadsworth, Raviv, THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 13

Compas, & Connor-Smith, 2005). For example, early and severe victimization experiences place an individual at risk for being overwhelmed by emotional distress related to memories of the event, leading to an increased reliance on the use of dissociation and other methods of disengagement coping (Briere, 2002). Children and adolescents may be forced to rely on cognitive and emotional methods of avoidance—such as numbing, dissociation, and disengagement—because they cannot physically escape from the violence (Carlson, Furby,

Armstrong, & Shlaes, 1997).

Chronicity of Violence and Coping. Youth who are exposed to chronic forms of violence soon discover that the stressful event will be repeated, and learn to remove themselves in any way possible (Terr, 1991). These youth may come to rely on cognitive means of disengagement, including denial, withdrawal, emotional numbing, and dissociation (Terr, 1991).

According to Wadsworth, Raviv, Compas, & Connor-Smith (2005), powerful stressors—such as

chronic violence—can shape coping strategies, which in turn may shape outcomes.

Relationship to the Perpetrator and Coping. Youth who are exposed to violence perpetrated by a trusted loved one are subjected to experiences that generate intense negative affect, fear, and powerlessness, with their environments often not facilitating the development of age-appropriate flexible coping strategies (Bailey, Moran, & Pederson, 2007). For example, --a form of avoidance coping--may occur specifically in the context of interpersonal violence that is perpetrated by someone with whom the victim shares a close relationship (Freyd, 1996). Overall, studies have demonstrated that when the perpetrators were known, victims coped more by using disengagement coping strategies, which led to more severe psychological symptoms over time (Gutner, Rizvi, Monson, & Resick, 2006; Merill, Guimond,

Thomsen, & Milner, 2003). THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 14

Present Study

The current study examines how specific characteristics of violence exposure —in particular the relationship of the perpetrator to the victim and chronicity—moderate the mediational model of violence exposure leading to a disengagement coping style leading to psychological symptoms. The current study also sought to understand how recency of violence impacted the utilization and effectiveness of disengagement coping. Due to the cross-sectional nature of the study, associations that support possible moderated mediation were examined, but conclusions about causality and formal mediation are not proposed. Much of the research investigating the nature of a perpetrator’s relationship to the victim and its association with disengagement coping and psychological symptoms has focused on sexual violence. In addition, studies examining the interplay between specific characteristics of violence exposure and coping have typically focused on one specific characteristic (e.g., relationship to the perpetrator). The present study will add to the literature by simultaneously examining cumulative violence and other characteristics that may influence mental health outcomes.

Statement of Hypotheses

Hypothesis 1. Specific characteristics of violence exposure—including variety of types of violence exposures, closeness of perpetrator, and greater chronicity—taken together will be associated with more severe psychological symptoms.

Hypothesis 2. Each characteristic of violence exposure will predict a unique proportion of variance in psychological symptoms.

Hypothesis 2a. It is expected that a higher number of different types of violence

exposure will be associated with more severe symptoms. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 15

Hypothesis 2b. It is expected that greater closeness to the perpetrator will be

associated with more severe symptoms.

Hypothesis 2c. It is expected that more frequent exposure to violence will be

associated with more severe symptoms.

Hypothesis 3. Each characteristic of violence exposure will predict a unique proportion of variance in both voluntary disengagement coping and involuntary disengagement reactions. Disengagement coping includes avoidance, denial, and wishful thinking (Compass et al., 2001). Involuntary disengagement reactions include emotional numbing, cognitive interference, escape, and inaction (Compass et al., 2001). It is expected that both voluntary disengagement coping and involuntary disengagement reactions will produce similar results given that the scales are correlated. However, the current study will be looking at both scales separately as they are two different constructs.

Hypothesis 3a. It is expected that exposure to more types of victimizations will be

associated with greater use of disengagement coping strategies.

Hypothesis 3b. It is expected that greater closeness to the perpetrator will be

associated with greater use of disengagement coping strategies.

Hypothesis 3c. It is expected that more frequent exposure to violence will be

associated with greater use of disengagement coping strategies.

Hypothesis 4.

Hypothesis 4. It is expected that disengagement strategies will mediate the relationship between violence exposure and psychological symptoms (see Figure 1 for illustration), such that violence exposure will lead to increased disengagement coping strategies which would be associated with more psychological symptoms. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 16

Figure 1. Simple Mediational Model

+ c

Violence a Disengagement b Psychological Exposure Symptoms + coping +

Hypothesis 5.

Hypothesis 5a. It is expected that within the mediational model, recency of violence exposure will moderate the relationship between violence and exposure and disengagement coping (see Figure 2 for illustration). A stronger relationship between violence exposure and disengagement coping was expected for those who report more recent violence exposure.

Figure 2. Mediational model moderated by recency of event at path a.

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Recency of violence exposure

Hypothesis 5b. It is expected that within the mediational model, recency of violence exposure will moderate the relationship between disengagement coping and psychological symptoms (see Figure 3 for illustration). A stronger relationship between disengagement coping and psychological symptoms was expected for those who report less recent violence exposure.

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 17

Figure 3. Mediational model moderated by recency of event at path b.

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Recency of Violence Exposure

Hypothesis 5c. It is expected that within the mediational model, closeness of

perpetrator will moderate the relationship between violence exposure and

disengagement coping (see Figure 4 for illustration). A stronger relationship

between violence exposure and disengagement coping was expected for those

who report higher perceived closeness to the perpetrator.

Figure 4. Mediational model moderated by relationship to the perpetrator at path a

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Closeness to perpetrator

Hypothesis 5d. It is expected that within the mediational model, frequency of

violence will moderate the relationship between violence exposure and

disengagement coping (see Figure 5 for illustration). A stronger relationship

between violence exposure and disengagement coping was expected for those

who report more frequent exposure to violence. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 18

Figure 5. Mediational model moderated by chronicity of violence at path a.

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Frequency of violence

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 19

CHAPTER II: METHODS

Participants

College students from a public university in a semi-rural county of northwest Ohio were recruited thorough emails and Introductory Psychology courses. The current study was listed on the SONA system, and participants were given credit in one of their psychology classes. In addition, young adults were also recruited from Facebook as well as national online support groups for victims of childhood maltreatment, domestic violence, and .

Recruitment emails were sent to administrators of the following online support groups: Pandora

Aquarium, Fort Refuge, After Silence, Adult Survivors of , Healing ,

Survivors Chat, and RAINN. With the permission of administrators, recruitment scripts were

posted on online discussion boards. Healing Minds, After Silence, and Adult Survivors of Child

Abuse did not return the researcher’s emails. Pandora Aquarium and Fort Refuge granted

permission to post the recruitment script on their online discussion board. Administrators from

Survivor Chat and RAINN granted permission for the researcher to post on their respective

social media sites. Each script provided a link for the survey. Recruitment scripts were also

posted on the researcher's Facebook timeline. Facebook friends of the researcher had the option

to share the post. The current study was advertised to participants between the ages of 18 to 22.

Participants were not included in the analyses if they did not meet the age criteria (18-

22), completed the entire survey in less than 60 seconds, did not complete the majority of the

survey (over 75%), or if the researcher felt that the participant was not answering accurately (e.g.

answer “4” for every item). A total of 368 valid surveys were collected, 95% were recruited through Introductory Psychology courses and 5% were recruited through Facebook and online support groups. The racial/ethnic breakdown of the sample is as follows: 82% Caucasian, 10% THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 20

African American, 4% Latino/a or Hispanic, 2% Multiracial, 1% Asian, and 1% ‘‘Other.’’ The sample was predominately female (78%), with mean age of 18.9 years (Range = 18–22; SD =

1.08). Less than 4% of the sample reported participating in any support groups related to violence (3.6% in one support group; 0.3% in two support groups). Approximately 1% of the sample reported military experience, but none of the respondents reported any active deployment across the lifetime. Respondents reported on how urban they considered their hometown: 56%

Suburban, 29% Rural, and 15% Urban.

Measures

Demographic Information. Participants completed a self-report form requesting their age, gender, family income, parents’ education, family structure, race, and ethnicity.

Demographic variables were used to describe the sample and included in preliminary analyses to determine if demographic variables need to be statistically controlled in the main analyses (see

Appendix A).

Violence Exposure. The current study used items from three different measures of violence exposure, in an effort to create a comprehensive measure of violence exposure addressing the various characteristics of interest. The Stressful Life Events Screening

Questionnaire (SLESQ; Goodman, Corcoran, Turner, Yuan, & Green, 1998) is a 13-item self- report measure used with non-clinical adult samples and assesses lifetime exposure to a number of traumatic events, including exposure to violence. The present study used seven items from this measure, assessing for physical and sexual violence, emotional abuse, and conventional crime.

Seven items from the Juvenile Victimization Questionnaire (JVQ; Finkelhor, Hamby, Ormrod, and Turner, 2005; Finkelhor, Ormrod, et al., 2005b) were also added. Two items assessed events involving exposure to family violence that did not include direct victimization (e.g., witnessing THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 21 domestic violence), three items assessed witnessing violence in the community, one item assessed being threatened, and one item assessed peer verbal aggression. Finally, two items from the Survey of Exposure to Community Violence (SECV; Richters & Saltzman, 1990) which address more severe violent experiences (e.g. seeing someone being killed or seriously wounded) were added to this measure. For each event, participants were asked to indicate whether they were ever exposed to the event (Yes or No) as well as to indicate whether the event occurred before and/or after the start of high school. This developmental milestone was used to reduce inaccuracy because it was expected that participants were unlikely to remember the exact age of victimization, especially if it occurred earlier in life. Participants had the option to endorse that the violent event occurred both before and after high school. In total, the questionnaire contained

16 items regarding different kinds of victimization including conventional crime, child maltreatment, sexual victimization, and indirect victimization (witnessing violence). Participants were asked to think about violent experiences that had occurred both in childhood/adolescence and in adulthood. The current study only included items related to witnessing violence (in real life) or direct victimization. When a participant indicated “Yes” to experiencing an item, they were prompted to respond to follow-up items regarding how often they had experienced that event, relationship to perpetrator, emotional closeness to the perpetrator, age of onset (before or after the start of high school), and recency of last event (details below). The study was administered online, and if a participant answered “No” to the item, they did not receive follow- up questions regarding that item. The number of different types of violence exposure that a participant endorsed was summed to create a lifetime polyvictimization score. Scores ranged from 0 to 16, with higher scores indicating exposure to more types of violence. See Appendix B for a list of core violent events and Appendices C and D for the follow-up items. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 22

Frequency. Frequency was conceptualized as how often the participant

experienced incidents of violence exposure. Responses range from one time to every day.

Higher scores indicate more frequent and repeated exposure. In cases where multiple

events were reported, the highest frequency for an event occurring after the start of high

school was used. If a participant did not endorse an event after the start of high school,

then the highest frequency for an event occurring before the start of high school was

used.

Perpetrator relationship. In order to understand the nature of the respondent’s

relationship to the perpetrator, the following 4 questions were added to each violence

item that a participant endorsed. These items were adapted from the Central Relationship

Questionnaire (Barber, 1998). “On a 1 (Not At All) to 7 (Extremely) scale please rate:

How close was this person to you? How intimate a relationship did you have with this

person? How much of an authority figure was this person for you? How important was

this person to you?” (see Appendix D). The mean was calculated for each item. Higher

scores indicate a closer relationship with the perpetrator. Scores range from 1 to 7. These

items were created for each perpetrator and for each violent event. In order to account for

multiple perpetrators of a single event or across multiple events, the highest score for

each participant is used for an event occurring after the start of high school. If a

participant did not endorse an event after high school, then the highest score (closeness to

perpetrator) for an event occurring before the start of high school was used.

Recency. Recency was conceptualized as how long ago the participant

experienced each incidents of violence exposure. Participants were asked how recent THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 23

each event last occurred. Responses range from a week ago to more than five years ago

(9-point-scale). The recency of the most recent event reported was used in analyses.

Coping. The Response to Stress Questionnaire (RSQ; Connor-Smith et al., 2000) is a 57- item self-report questionnaire that measures a range of voluntary coping and involuntary responses to stress. Participants were asked to pick the most stressful event endorsed from the violence questionnaire that occurred after the start of high school, and to identify the strategies they have used or are using to cope with that event. Only participants who endorse at least one violent event were included in the main analyses. Although the measure typically uses the word

“violence” in the instructions, the current study substituted the words “these events” in an effort to control for any misinterpretations on whether the event was in fact perceived as a violent event by the participant. Participants were asked to pick the most serious event that has happened since the start of high school from the violence questionnaire just completed and identify the strategies used or are using to cope with those events. Participants rate the degree to which each response was enacted on a 1 (Not at all) to 4 (A lot) scale. The measure assesses three types of coping and two types of involuntary stress responses. The RSQ comprises five factors, including primary control coping, secondary control coping, disengagement coping, involuntary engagement, and involuntary disengagement. Sample items include “I try not to feel anything” and “I try to believe that it never happened” (See Appendix E). The Response to Stress

Questionnaire has been used with children, adolescents, and adults. The author received permission from the Vanderbilt Stress and Coping Lab to adapt the questionnaire. For example, the author removed the option regarding seeking advice from a “stuffed animal” given that the sample comprises solely of young adults. Previous research using the Response to Stress

Questionnaire has found that internal consistencies for the five subscales demonstrate excellent THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 24 reliability, with alphas for the five subscales averaging between .80 and.87 (Connor-Smith, et al.,

2000). The current study uses the voluntary and involuntary disengagement scales. Subscale scores on the RSQ were computed as proportions of the total score for all responses (i.e., sum of scores on disengagement coping items/sum of all items) to control for overall responding biases as recommended by Connor-Smith et al. (2000). Both the voluntary and involuntary disengagement scales had good internal consistency, with respective Cronbach’s α =.81 and

Cronbach’s α =.86.

Trauma Symptoms. The Trauma Symptom Check-list 40 (TSC-40; Briere, 1996) is a

40-item self-report instrument that assesses symptoms in adults associated with childhood or adult traumatic experiences. It measures posttraumatic stress symptoms and other symptom clusters. The TSC-40 consists of six subscales: Anxiety, Depression, Dissociation, Sexual Abuse

Trauma Index, Sexual Problems, and Sleep Disturbance, as well as a total score. Each symptom item is rated according to its frequency of occurrence over the prior two months, using a four- point scale ranging from 0 (Never) to 3 (Often). Sample items include “Uncontrollable crying” and “Feeling tense all the time.” (See Appendix F). Studies using the TSC-40 have found that it demonstrates excellent reliability, with alphas for the full scale averaging between .89 and .91

(Briere, 1996). The total sum score was calculated with higher scores indicating high levels of trauma symptoms. The TSC-40 had excellent internal consistency in the current sample, with

Cronbach’s α =.95.

Procedure

The current study was listed on SONA, and participants were given credit in one of their psychology classes. In addition, participants were recruited from Facebook, national online support groups for victims of childhood maltreatment, domestic violence, and sexual assault, and THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 25 through student emails. Clicking on the study link allowed participants to view the informed consent form, which detailed the nature of study participation. If students decided to participate, they were first asked for their name and student ID number, which was used only to assign course credit. Participants recruited from Facebook, online support groups, and emails were asked to provide their email addresses after completing the survey to participate in a raffle for one of twenty-five $25 Amazon gift cards. Participants were then forwarded to a separate website for the online survey. After they completed the survey, participants were provided with a debriefing form including information for supportive services in the event that the participant experienced distress as a result of their participation. Students’ names were entered into an online database of students within SONA who have participated in research, and students received credit regardless of whether they completed the entire survey or only portions of it.

Non-psychology student participants were given the option of entering in the raffle. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 26

CHAPTER III: RESULTS

Descriptive Statistics

Means, range, and standard deviations were examined for polyvictimization scores, relationship closeness to the perpetrator, chronicity of violence, recency of event, involuntary disengagement reactions, voluntary disengagement coping, and trauma symptoms with regards to the overall sample (Table 1). Frequency of exposure to violence was assessed for all items (Table

2). Forty-four percent of participants reported exposure to no violent events, 18% reported events only occurring before the start of high school, 4% reported events occurring only after the start of high school, and 34% reported events occurring both before and after starting high school.

Given the low rate of respondents endorsing age of onset of victimization after the start of high school, age of onset was not included as a potential moderator. The most frequently endorsed item was “Did you ever get scared or feel really bad because people your age were calling you names, saying mean things to you, or saying they didn’t want you around?” (41%), followed by

“Has a parent, romantic partner, or family member repeatedly ridiculed you, put you down, ignored you, or told you were no good?” (30%), followed by “Other than experiences mentioned in earlier questions, has anyone ever touched private parts of your body, made you touch their body, or tried to make you to have sex against your wishes?” (21%). The current study found that of those who reported at least one type of victimization experience, 82% experienced two or more violent events and 35% reported five or more violent events. Of those who reported at least one violent event, 6% of the college sample was also in a support group and 70% of the support group samples were also in college. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 27 Table 1 Descriptive and Correlation of the Overall Sample

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

1. Polyvictimization 1 Score

2. Voluntary .103 1 Disengagement Coping 3. Involuntary .255** .184** 1 Disengagement Reactions 4. Relationship .352** .085 .182* 1 Closeness to the Perpetrator 5. Frequency of .425** .043 .205** .396** 1 Violence 6. Recency of Event .550** .056 .247** .331** .426** 1 7. Trauma Symptoms .284* .111 .117 .150* .194** .216** 1

8. Age .066 .174* .042 .027 .072 .172* .016 1 9. Income -.113* -.120 .008 -.078 -.031 .032 -.084 -.097 1 10. Mother’s -.086 .015 .079 .011 -.035 .131 .007 -.086 .254** 1 Educational Status 11. Father’s -.127* -.104 -.064 .003 -.026 .055 -.066 -.076 .338** .461** 1 Educational Status N 357 199 199 176 195 200 355 356 351 356 353 Mean 2.31 .16 .19 4.30 4.02 5.15 12.07 18.94 6.31 3.61 3.37

Standard Deviation 2.34 .03 .03 2.04 2.52 2.94 12.39 1.08 1.92 1.03 1.07

Range 0-16 .09-.24 .12-.28 1-7 0-8 1-9 0-120 18-22 1-10 1-5 1-5 Note. *p < .05, **p < .01 THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 28

Table 2 Frequencies of exposure to violence of overall sample

Item Lifetime Before the After the Frequency Start of Start of High School High School 1. Did a parent, caregiver or other person ever slap you, beat you, or20% 19% 2% otherwise attack or harm you? 2. Have you ever been kicked, beaten, slapped around or otherwise 8% 2% 6% physically harmed by a romantic partner, date, other family member, stranger, or someone else? 3. Sometimes groups of individuals or gangs attack people. Did a group 3% 2% 1% of individuals or a gang hit, jump, or attack you? 4. Did you see a parent get pushed, slapped, hit, punched, or beat up by 14% 12% 3% another parent, or their boyfriend or girlfriend? 5. Did you see a parent hit, beat, kick, or physically hurt your brothers 8% 7% 1% or sisters, not including a spanking on the bottom? 6. In real life, did you see anyone get attacked or hit on purpose using a 17% 11% 6% stick, rock, gun, knife, or something that would hurt? 7. Have you actually seen a seriously wounded person after an incidence 11% 5% 6% of violence? 8. Have you actually seen someone being killed by another person? 1% 0% 1% 9. Was physical force or a weapon ever used against you in a robbery or 2% 1% 1% mugging? 10. Other than the experiences already covered, has anyone ever7% 4% 3% threatened you with a weapon like a knife or gun? 11. Were you in any place in real life where you could see or hear people 14% 7% 7% being shot, bombs going off, or street riots? 12. Has anyone (parent, other family member, romantic partner, stranger 12% 5% 7% or someone else) ever physically forced you to have intercourse, or to have oral or anal sex againstyour wishes, or when you were helpless, such as being asleep or intoxicated? 13. Other than experiences mentioned in earlier questions, has anyone 21% 11% 9% ever touched private parts of your body, made you touch their body, or tried to make you to have sex against your wishes? 14. Has a parent, romantic partner, or family member repeatedly ridiculed 30% 20% 19% you, put you down, ignored you, or told you were no good? 15. Did you ever get scared or feel really bad because people your age 41% 33% 13% were calling you names, saying mean things to you, or saying they didn’t want you around? 16. Did someone threaten to hurt you when you thought they might really 20% 12% 10% do it? THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 29

Correlations Correlations between all variables of interest were examined with regards to the overall sample

(Table 1). Some correlations only included respondents who reported some history of exposure to violence, as measures of characteristics of violence exposure and disengagement coping were not administered to respondents without a history of violence. Higher polyvictimization scores (exposure to more types of violent events) were associated with higher rates of involuntary disengagement reactions as well as higher levels of trauma symptoms. Polyvictimization scores were also positively related to relationship closeness to the perpetrator, frequency of violence, and recency of the event, such that exposure to more types of violent events were associated with more perceived closeness to the perpetrator, more recent exposure to violence, and more frequent exposure to violence.

Polyvictimization scores were negatively related to income and father’s educational status, such that exposure to more types of violent events was associated with lower income and lower educational status for participants’ fathers. Voluntary and involuntary disengagement coping strategies had a weak, positive correlation at r = .18. Voluntary disengagement coping was also positively related to age, such that older participants reported increased use of voluntary disengagement strategies. Greater use of involuntary coping was associated with greater relationship closeness with perpetrator, higher frequency of violence, and more recent events. Perceived relationship closeness was also associated with trauma symptoms such that higher level of perceived closeness to the perpetrator was associated with more trauma symptoms. Chronicity of violence exposure was also associated with trauma symptoms, such that more chronic violence was associated with greater trauma symptoms. Respondents with more recent events reported more chronic exposure to violence as well as higher perceived closeness to the perpetrator. Higher perceived closeness to the perpetrator was also associated with more frequent exposure to violence. More recent events were found among older participants. Higher income was THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 30 associated with higher educational statuses for mother and father. Mother and father’s educational status were also positively associated with each other.

ANOVA

A series of one-way between subject analyses of variance (ANOVA) was used to determine whether any of the predictors or outcomes varied based on race or gender with regards to the overall sample. There was a significant association of gender with frequency of violence F (1, 193) = 7.33, p <

.01, with women reporting more frequent exposure to violence. Race was recoded into two groups: minority and Caucasians. There was a significant association of race on trauma symptoms F (1, 353) =

5.14, p < .05, with minorities reporting significantly higher levels of trauma symptoms compared to

Caucasians. Based on the information obtained from the ANOVAs as well as the correlations, age, gender, income, and race were included as covariates in remaining analyses.

Main Analyses

Only participants who endorsed exposure to at least to one violent event were included in the following analyses (N = 199). Skewness and kurtosis were examined for polyvictimization, relationship closeness to the perpetrator, chronicity of violence, recency of event, involuntary and voluntary disengagement coping, and trauma symptoms. The following variables were non-normally distributed: polyvictimization with a skewness of .482 (SE = .172) and kurtosis of -.586 (SE = .341), trauma symptoms with a skewness of .748 (SE = .172) and kurtosis of -.124 (SE = .343). Consequently, each variable was transformed for the main analyses: polyvictimization (Square Root) and trauma symptoms

(Square Root). Variables were no longer skewed after the transformation: [polyvictimization: skewness:

.034 (SE = .172) and trauma symptoms: skewness: -.145 (SE = .172)]. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 31

Hypothesis 1. Specific characteristics of violence exposure—including number of types of violence, closeness of perpetrator, and chronicity— will predict a significant proportion of the variance in psychological symptoms when examined together.

A linear regression was performed with number of types of violence exposure entered in Step 1 of the model, and closeness of perpetrator, chronicity, and covariates entered in Step 2 of the model. See

Table 3 for results.

There was a significant Model R2 which supports Hypothesis 1.

Hypothesis 2. Each characteristic of violence exposure will predict a unique proportion of

variance in psychological symptoms.

A linear regression was performed with number of types of violence exposure entered in Step 1

of the model, and closeness of perpetrator, chronicity, and covariates entered in Step 2 of the model. See

Table 3.

Hypothesis 2a. It is expected that a higher number of types of violence exposure will be

associated with more severe symptoms.

Polyvictimization was a significant predictor of trauma symptoms in the regression

model. Hypothesis 2a was supported; participants who reported exposure to more types of

violent events reported more trauma symptoms.

Hypothesis 2b. It is expected that greater closeness to the perpetrator will be associated

with more severe symptoms.

Relationship closeness was not a significant predictor of trauma symptoms in the final

model. Hypothesis 2b was not supported.

Hypothesis 2c. It is expected that more frequent exposure to violence will be associated

with more severe symptoms. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 32

Chronicity of violence exposure was not significant in the final model. Therefore,

Hypothesis 2c was not supported.

Table 3. Regression examining violence and violence characteristics predicting trauma symptoms

 F R2 R2

Step 1 16.42** .091 .085 Polyvictimization .302** Step 2 3.27** .126 .088 Polyvictimization .259** Relationship Closeness .088 Chronicity .043 Gender -.033 Age -.099 Race .140 Income .037

Note. ** p < .01.

Hypothesis 3. Each characteristic of violence exposure will predict a unique proportion of

variance in both voluntary disengagement coping and involuntary disengagement reactions. It was

expected that both voluntary disengagement coping and involuntary disengagement responses would

produce similar results given that the scales are correlated. However, the current study examined both

scales separately as they are two different constructs. A linear regression was performed with number of

types of violence exposure entered in Step 1 of the model, and closeness of perpetrator, chronicity, and

covariates entered in Step 2 of the model. See Tables 4 and 5.

Hypothesis 3a. It is expected that number of different types of violence exposure will be

associated with increased use of disengagement coping.

Polyvictimization was a significant in the final model for involuntary disengagement reactions

but not for voluntary disengagement coping; thus, Hypothesis 3a was partially supported. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 33

Hypothesis 3b. It is expected that greater closeness to the perpetrator will be associated with greater use of disengagement coping strategies.

Closeness to the perpetrator was not significant in the final model for voluntary disengagement coping or involuntary disengagement reactions. Therefore, Hypothesis 3b was not supported.

Hypothesis 3c. It is expected that more frequent exposure to violence will be associated with greater use of disengagement coping strategies.

Chronicity was not significant in the final model for voluntary disengagement coping or involuntary disengagement reactions. Therefore, Hypothesis 3c was not supported.

Table 4. Regression examining violence and violence characteristics predicting voluntary disengagement coping

 F R2 R2

Step 1 1.50 .009 .003 Polyvictimization .095 Step 2 1.60 .067 .025 Polyvictimization .093 Relationship Closeness .052 Chronicity -.053 Gender -.079 Age .139 Race -.119 Income -.141 Note. * p < .05; ** p < .01.

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 34

Table 5. Regression examining violence and violence characteristics predicting involuntary disengagement reaction

 F R2 R2

Step 1 16.01** .089 .084 Polyvictimization .299** Step 2 3.69** .141 .103 Polyvictimization .224** Relationship Closeness .069 Chronicity .136 Gender .084 Age .019 Race .111 .106 Note. ** p < .01.

Hypotheses 4 and 5. The researcher examined a hypothesized moderated mediation model using recommendations and the PROCESS SPSS macro developed by Preacher, Rucker, and Hayes (2007).

The PROCESS macro for SPSS was used to test whether voluntary disengagement coping and involuntary disengagement reactions mediated the effects of violence exposure on self-reported trauma symptoms while controlling for covariates (race, age, income, and gender). Two separate models were run for involuntary disengagement reactions and voluntary disengagement coping.

Results are reported in Table 6 and 7 respectively. See Figure 1.

Figure 1. Simple Mediational Model

c

Violence a Disengagement b Psychological Exposure coping Symptoms

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 35

Simple mediation model: Hypothesis 4 voluntary disengagement. The overall model accounted for significant variance in trauma symptoms, with R2 = .1188 and F(6, 186) = 4.18, p < .001. See table

7. As expected, polyvictimization was significantly positively associated with trauma symptoms.

Polyvictimization was not significantly associated with voluntary disengagement coping. Voluntary

disengagement coping was also not significantly associated with trauma symptoms. The indirect

association of polyvictimization on self-reported trauma symptoms through voluntary disengagement

coping was non-significant.

Table 6. Simple Mediation Model: voluntary disengagement

B SE 95% CIa

violence exposure → (C) trauma Symptoms 1.114 .268 .586, 1.642***

violence exposure → voluntary .006 .004 -.001, .013 disengagement coping voluntary disengagement coping → trauma 7.342 5.426 -3.362, 18.046 symptoms

violence exposure → (C’) → trauma .045 .053 -.012, .219 symptoms

Indirect Effects (Mediation Tests)

violence exposure to trauma symptoms via .045 .053 -.012, .219 voluntary disengagement coping

Note. C, direct association of violence exposure on trauma symptoms; C’, indirect association of violence exposure on trauma symptoms adjusted for the mediator. aBootstrapping based confidence intervals **p < .01; ***p < .001

Simple mediation model: Hypothesis 4 involuntary disengagement. The overall model accounted for significant variance in trauma symptoms, with R2 = .1110 and F(5, 187) = 3.87, p < .01.

See Table 6. As expected, polyvictimization was significantly positively associated with trauma symptoms. Polyvictimization was also significantly positively associated with involuntary THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 36 disengagement reactions. However, involuntary disengagement reactions were not significantly associated with trauma symptoms. The indirect association of polyvictimization on trauma symptoms through involuntary disengagement reactions was nonsignificant.

Table 7. Simple Mediation Model: Involuntary Disengagement

B SE 95% CIa

violence exposure → (C) trauma Symptoms 1.127 .277 .581, 1.673*** violence exposure → involuntary .017 .004 .008, .025*** disengagement

Involuntary disengagement → trauma 1.937 4.507 -6.955, 10.828 symptoms

violence exposure → (C’) → trauma .032 .088 -.1420, .2121 symptoms

Indirect Effects (Mediation Tests)

violence exposure to trauma symptoms via . 032 .088 -.1420, .2121 involuntary disengagement

Note. C, direct association of violence exposure on trauma symptoms; C’, indirect association of violence exposure on trauma symptoms adjusted for the mediator. aBootstrapping based confidence intervals **p < .01; ***p < .001

Hypothesis 5a.

Figure 2. Mediational model moderated by recency of event at path a

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Recency of Violence Exposure

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 37

Moderated mediation model: Hypothesis 5a voluntary disengagement. The moderated mediation model used the PROCESS macro to test the association between polyvictimization and voluntary disengagement coping, and whether recency of violence moderated path “a,” the association between polyvictimization and voluntary disengagement coping (Model 7 from Hayes, 2013). See

Figure 2. The overall model accounted for significant variance explained in trauma symptoms, with R2 =

.1179 and F (7,184) = 2.42, p < .001. The interaction term between polyvictimization and recency of

violence was not significant, indicating that the association of polyvictimization on voluntary

disengagement coping was not moderated by recency of violence (b = .002, SE = .001, p = .179, CI 95%

= -.001, .005).

Moderated mediation model: Hypothesis 5a involuntary disengagement. The moderated mediation model used the PROCESS macro to test the association between polyvictimization and involuntary disengagement reactions, and whether recency of violence moderated path “a,” the association between polyvictimization and involuntary disengagement (Model 7 from Hayes, 2013). See

Figure 2. The overall model accounted for significant variance explained in trauma symptoms, with R2 =

.1095 and F (7,184) = 3.89, p < .01. The interaction term between polyvictimization and recency of violence was not significant, indicating that the association of polyvictimization on involuntary disengagement was not moderated by recency of violence (b = -.001, SE = .002, p = .632, CI 95% = -

.004, .003).

Hypothesis 5b.

Figure 3. Mediational model moderated by recency of event at path b THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 38

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Recency of Violence Exposure

Moderated mediation model: Hypothesis 5b voluntary disengagement. The moderated mediation model used the PROCESS macro to test the association between polyvictimization and voluntary disengagement coping, and whether recency of violence moderated path “b,” the association between voluntary disengagement coping and trauma symptoms (Model 14 from Hayes, 2013). See

Figure 3. The overall model accounted for significant variance explained in trauma symptoms, with R2 =

.1288 and F (8,183) = 3.38, p < .01. The interaction term between voluntary disengagement coping and recency of violence was not significant, indicating that the association of voluntary disengagement coping on trauma symptoms was not moderated by recency of violence (b = -1.975, SE = 1.830, p =

.2820, CI 95% = -5.586, 1.636).

Moderated mediation model: Hypothesis 5b involuntary disengagement. The moderated mediation model used the PROCESS macro to test the association between polyvictimization and involuntary disengagement and whether recency of violence moderated path “b”, the association between involuntary disengagement and trauma symptoms (Model 14 from Hayes, 2013). See Figure 3.

The overall model accounted for significant variance explained in trauma symptoms, with R2 = .1165 and F (8,183) = 3.01, p < .01. The interaction term between involuntary disengagement and recency of violence was not significant, indicating that the association of involuntary disengagement on trauma symptoms was not moderated by recency of violence (b = .002, SE = .001, p = .1794, CI 95% = -.001,

.005). THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 39

Hypothesis 5c.

Figure 4. Mediational model with closeness to the perpetrator moderating path a

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Closeness to perpetrator

Moderated mediation model: Hypothesis 5c voluntary disengagement. The moderated mediation model used the PROCESS macro to test whether relationship to the perpetrator moderated path “a”, the association between polyvictimization and voluntary disengagement coping (Model 7 from

Hayes, 2013). See Figure 4. The overall model accounted for significant variance explained in trauma symptoms, with R2 = .0713 and F(7,162) = 3.92, p < .01. The interaction term between

polyvictimization and relationship to the perpetrator was not significant, indicating that the effect

polyvictimization on voluntary disengagement coping was not moderated by relationship to the

perpetrator (b = -.001, SE = .002, p = .7130, CI 95% = -.0045, .0031).

Moderated mediation model: Hypothesis 5c involuntary disengagement. The moderated mediation model used the PROCESS macro to test whether relationship to the perpetrator moderated path “a”, the association between polyvictimization and involuntary disengagement (Model 7 from

Hayes, 2013). See Figure 4. The overall model accounted for significant variance explained in trauma symptoms, with R2 = .1165 and F(8,183) = 3.02, p < .01. The interaction term between

polyvictimization and relationship to the perpetrator was not significant, indicating that the effect of

polyvictimization on involuntary disengagement was not moderated by relationship to the perpetrator (b

=-1.024, SE = 1.578, p = .5173, CI 95% = -4.138, 2.090). THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 40

Hypothesis 5d.

Figure 5. Mediational model with chronicity moderating path a

c

Violence a Disengagement b Psychological Exposure coping Symptoms

Frequency of violence

Moderated mediation model: Hypothesis 5d voluntary disengagement. The moderated mediation model used the PROCESS macro to test whether frequency of violence moderated path “a”, the association between polyvictimization and voluntary disengagement coping (Model 7 from Hayes,

2013). See Figure 5. The overall model accounted for significant variance explained in trauma symptoms, with R2 = .1165 and F(6,180) = 3.95, p < .01. The interaction term between

polyvictimization and frequency of violence was not significant, indicating that the association between

polyvictimization and voluntary disengagement was not moderated by frequency of violence (b = -.001,

SE = .002, p = .6208, CI 95% = -.004, .002).

Moderated mediation model: Hypothesis 5d involuntary disengagement. The moderated

mediation model used the PROCESS macro to test whether frequency of violence moderated path “a”,

the association between polyvictimization and involuntary disengagement (Model 7 from Hayes, 2013).

See Figure 4. The overall model accounted for significant variance explained in trauma symptoms, with

R2 = .1105 and F(6,180) = 3.73, p < .01. The interaction term between polyvictimization and frequency

of violence was not significant, indicating that the association between polyvictimization and THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 41 involuntary disengagement was not moderated by frequency of violence (b = .001, SE = .002, p = .6754,

CI 95% = -.003, .004).

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 42

CHAPTER IV: DISCUSSION

Violence exposure is a serious public health problem; individuals who are victimized, particularly when they are victimized repeatedly, demonstrate higher rates of post-traumatic stress symptoms, anxiety, depression, and aggression (Babchishin & Romano, 2014; Kennedy et al. 2009;

Mazza & Reynolds, 1999; Mrug et al., 2008; Mrug & Windle, 2010; Schwab-Stone et al., 1995; Ward et. al, 2006). Recent research has focused on understanding the factors that shape how and when violence exposure might lead to heightened psychological distress. Factors that shape responses to violence exposure may occur within individual, event-specific, and environmental domains, including but not limited to age of the victim, prior experiences, perpetrator’s relationship to the victim, and coping skills (Harvey, 1996). Thus, the current study sought to understand how specific characteristics of violence exposure —in particular the relationship of the perpetrator to the victim and chronicity of violence exposure—moderate the mediational model of violence exposure leading to a disengagement coping style, which in turn was expected to be associated with psychological symptoms. It was also expected that recency of violence would influence the relationship between disengagement and trauma symptoms, with higher use of disengagement strategies with less recent events being associated with heightened psychological symptoms.

Characteristics of Violence and Trauma Related Symptoms

Taken together, specific characteristics of violence exposure—including number of types of violence, closeness of the perpetrator to the victim, and chronicity—predicted overall trauma-related symptoms; however, when controlling for the other variables, only polyvictimization scores (number of types of violent events experienced) were a significant individual predictor of trauma-related symptoms.

This is consistent with previous literature that has found that as the number of types of violence experienced increases, so too does the risk for severe and complex psychiatric symptoms, signifying that THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 43 to a large degree, polyvictimization explains trauma-related symptoms (Agorastos, et. al 2014; Aho,

Proczkowska-Björklund, & Svedin, 2016). For example, previous literature has found that, compared to victims who experienced a single type of chronic violence, people who had even low polyvictimization scores had significantly higher levels of symptoms, demonstrating that, when compared to one type of ongoing victimization, additional types of victimizations are associated with more symptoms (Finkelhor,

Ormrod, & Turner, 2007). Moreover, other studies have found that abuse characteristics, as a group, predicted adult functioning; however, none of the individual abuse characteristics were significantly related to outcomes (Brand & Alexander, 2003). It is possible that polyvictimization shares enough variance with the other trauma related characteristics to render them non-significant when simultaneously modeled. In fact, the current study found that polyvictimization scores were positively related to relationship closeness, frequency of violence, and recency of the event, such that exposure to more types of violent events were associated with higher rates of perceived closeness to the perpetrator, more recent exposure to violence, and more frequent exposure to violence. Similar research has found that individuals who have experienced multiple victimizations have a significant probability of being victimized by an adult family member (Turner, Shattuck, Finkelhor, & Hamby, 2016), with the reverse also being true. When compared to those victimized by non-parental perpetrators, people who experienced child sexual abuse perpetrated by a close loved one are more likely to also experience other forms of violence (e.g. physical abuse; Aakvaag, Thoresen,Wentzel-Larsen, & Dyb, 2016).

Additionally, Hickman and colleagues (2013) found that after controlling for the influence of polyvictimization, frequency of violence exposure was not associated with psychological symptoms.

Overall, these results suggest that polyvictimization is closely tied to relationship to the perpetrator and chronicity of violence, but that polyvictimization appears to be the strongest predictor of outcomes above and beyond characteristics of interpersonal violence. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 44

Involuntary Disengagement and Voluntary Disengagement Coping as a Potential Mediator

Two separate mediational models were run for both voluntary disengagement coping strategies and involuntary disengagement reactions. Consistent with previous research, polyvictimization was significantly positively associated with psychological symptoms (Turner, Shattuck, Finkelhor, &

Hamby, 2016; Robboy & Anderson, 2011). Polyvictimization was also significantly associated with involuntary disengagement strategies. Involuntary stress responses are unavoidable reactions to interpersonal violence and have been found to mediate the relationship between violence exposure and symptomology (Epstein-Ngo, Maurizi, Bregman, & Ceballo, 2013). Although polyvictimization did predict involuntary disengagement stress reactions, involuntary disengagement did not predict trauma- related symptoms. Furthermore, the indirect association of polyvictimization on trauma symptoms through both voluntary and involuntary disengagement was nonsignificant. Some studies have found that involuntary stress responses mediated the relations between violence exposure (both direct and indirect) and psychological well-being (Epstein-Ngo, Maurizi, Bregman, & Ceballo, 2013).

Additionally, voluntary disengagement coping has been found to mediate the relation between a stressor and symptoms (Wadsworth & Berger, 2006). However, the pattern of relations between disengagement strategies and symptoms in the existing literature is inconsistent. The varying findings likely mirror differences in measurement and types of stressor (Wadsworth, Raviv, Santiago & Etter, 2011). For example, previous research has typically focused on one type of stressor (e.g. community violence; ) rather than looking at a range of different events. One known study has investigated the mediating effects of avoidant coping on polyvictimization and symptomatology and found that avoidant coping strategies partially mediated the relationship between lifetime interpersonal victimizations and psychological symptoms (Kirchner, et al., 2017). However, this study included venting feelings in their conceptualization of avoidance, which typically have been conceptualized under approach or THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 45 engagement coping domains, and conceptualized polyvictimization as including not only number of types of violence but how often they occurred, meaning high scores indicated a combination of more types of violence and more frequent violence within those types. Thus again, reflecting differences in measurement. It is possible that given the pervasive nature of polyvictimization, it is more difficult to employ disengagement strategies. For example, it is more challenging to deny experiences of victimization when they are occurring in multiple contexts of your life and you are constantly exposed to reminders of those violent experiences. For individuals who experience victimization across contexts, violence exposure may ultimately feel “inescapable” (Butcher, Holmes, Kretschmar, & Flannery, 2016).

The current study failed to find a simple mediation; as a result moderated mediational model was employed to test whether subgroup differences obscured true mediation.

Interpersonal Trauma Characteristics and Moderated Mediational Analyses

The association of polyvictimization with voluntary disengagement coping or involuntary disengagement reactions was not moderated by relationship to the perpetrator nor by frequency of violence. This finding is somewhat inconsistent with the previous literature, which has found that characteristics of abuse (e.g., frequency) can lead to higher rates of avoidant or disengagement coping strategies (Taft, Resick, Vogt, & Mechannic, 2007). However, much of the research examining the association between abuse-related characteristics (such as frequency of violence) and disengagement coping strategies have focused on one type of violence (e.g. sexual abuse Cantón-Cortés & Cantón,

2010, Rosenthal et al. 2005; community violence—Scarpa, Haden & Hurley, 2006). It is possible that when an individual has experienced multiple types of victimization within several contexts, specific characteristics of abuse incidents no longer matter. The current study found that of those who reported at least one type of victimization experience, 82% experienced two or more violent events and 35% reported five or more violent events. According to Finkelhor, Ormrod, Turner, & Holt, (2009), THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 46 individuals exposed to multiple types of violence are characterized as (a) residing in a dangerous community, (b) living in a dangerous family, (c) having a chaotic, multi-problem family environment, and/or (d) having emotional problems. It is possible that in those exposed to multiple types of victimizations, the number of types of victimization--rather than abuse related characteristics--really captures the complexity of victims’ experiences. For example, when exposed to multiple types of violence, relationship to the perpetrator may no longer matter, because multiple perpetrators are involved and include close loved ones, acquaintances, strangers, or all of the above. As such,

polyvictimization is a construct that describes the ubiquitous nature of a young adult’s experience with

violence rather than abused related characteristics. Overall, this study again confirmed that the number

of different types of violence experienced was the only significant predictor of trauma-related

symptoms.

Sample Characteristics

One other explanation for the non-significant findings has to do with the unique sample.

Although the current researcher attempted to collect data from various sources, the current analyses

consisted of a mostly college sample (approximately 95%). One meta-analysis found that responses of

college students were found to be more homogeneous than those of non-student subjects (Peterson,

2001). College students are likely to have more personal, financial, and social resources and experience

less distress than clinical or community samples. A meta-analysis focusing on sexual abuse found that

college student samples consistently generated smaller, more homogeneous effect sizes than did

community or clinical samples (Jumper, 1995). These findings suggest that it may be more challenging

to find significant moderation in college samples, particularly with regards to trauma, given the lack of subgroup differences. Duncan (2000) found a significant relationship between PTSD symptoms reported by college students during the second week of freshman year and college attendance in the 4th THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 47 year, with students with an abuse history and significant PTSD symptoms leaving college prematurely.

Thus, college student samples may experience less overall impairment compared to community and clinical samples due to the resources needed to obtain admission to college and to maintain enrollment

(Peterson, 2001). These personal, financial, and social resources likely impact one’s ability to cope with various stressors, including interpersonal violence.

Of those who reported at least one violent event, 70% of the support group samples were also in college, and 6% of the college sample was also in a support group. The participants who were not from the college sample were from an online support group for victims of various violent events. By its very nature, the purpose of support groups is to provide an outlet for emotional expression as well as provide relief from emotional distress. Individuals who are willing to seek out a support group and discuss their experiences have likely processed and coped with their previous exposure to violence at least to a certain extent. Thus, online support groups may be considered a form of engagement coping because they are focused on emotional expression and processing of the violent events.

Violence Exposure, Demographic Variables, and Trauma Symptoms

The current study found that women reported more frequent exposure to violence. This is predictable given that males typically report more severe forms of assault (assault with a weapon and/or group assault) whereas females more often report experiences of maltreatment, sexual victimization, and emotional , which tend to be more frequent in nature (Aho, Proczkowska-Björklund, & Svedin,

2016; Cyr, et. al., 2013; Finkelhor, Ormrod, & Turner, 2009; Olweus, 1993). In addition, the current sample included mostly college students with relatively low base rates of more severe forms of violence

(e.g., less than 5% reported physical force or a weapon ever used against them in a robbery or mugging), which again typically are experienced more by males. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 48

Findings from the current analyses also indicate that, compared to Caucasians, minorities report significantly higher levels of trauma-related symptoms. This is consistent with previous literature which revealed that, compared to Caucasians, both Hispanics and African Americans reported more PTSD symptoms (López, et al., 2016). Minorities are exposed to higher rates of , , and . Carter (2007) proposes a term called “race-based traumatic stress injury,” which involves actual or threat of emotional/physical pain that results from experiences of racism. Experiences of racism, regardless of its link to interpersonal violence, are associated with negative emotional reactions and symptom clusters that may mirror trauma-related symptoms (e.g., hypervigilance; avoidance of certain places). It is also possible that the interpersonal violence reported by minorities in the current sample was race-related (e.g., physical assault targeted at a specific racial group; Bryant-Davis &

Ocampo, 2005), which may lead to increased trauma-related symptoms given that it is linked to one’s personal identity.

Strengths and Limitations

The present study has a number of strengths. First, this study included multiple forms of violence rather than focusing on a specific type. This integrative approach is a strength given that individuals exposed to one type of violence (e.g., child abuse) are at increased risk for experiencing other forms of violence (e.g., witnessing domestic violence). In fact, a national study found that approximately one- third of adolescents had experienced multiple types of potentially traumatic victimization (Ford, Elhai,

Connor, & Frueh, 2010). Second, this study examined violence across the lifespan, whereas many previous studies have focused solely on violence within either childhood or adulthood. This study also looked at the victims’ perceived closeness to the perpetrator(s). Previous research has typically focused on kinship descriptors rather than understanding the nature of the relationship. Some literature suggested that the emotional bond the victim feels with the perpetrator and the associated level of betrayal would THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 49 be determining factors in increasing symptoms (Feinauera, 1989). Thus, it is important to examine the nature of the relationship (Lucenko, Gold, & Cott, 2000; Kendall-Tackett et al., 1993). Finally, the current study examined both involuntary disengagement and voluntary disengagement strategies.

Disengagement coping includes avoidance, denial, and wishful thinking, whereas involuntary disengagement includes responses such as emotional numbing and cognitive interference that are not intentional (Connor-Smith et al., 2000). This is a strength given that adjustment to stressful events includes cognitive, behavioral, emotional, and physiological responses. While most studies examine voluntary coping efforts, involuntary stress reactions are automatic and outside of one’s control, and may enable or limit an individual's ability to initiate voluntary coping responses (Connor-Smith, et. al,

2000). Thus both are beneficial to examine when investigating the association between violence exposure and trauma-related symptoms.

Despite these strengths, several limitations must be noted within the context of the present study.

First, measures used for all constructs were self-report questionnaires; therefore, responses may not be an accurate representation of individuals’ experiences. For example, it is possible that participants may be unwilling to endorse disengagement coping strategies or may be unaware of their coping strategies.

Nevertheless, the most accurate informant for potentially traumatic life events and perceived distress is the individual. Participants may be unaware of their own coping behaviors or symptoms they display or may be unwilling to disclose such things, particularly if they are avoidant. The present sample largely comprised Caucasian, female college students; thus, readers should exercise caution in generalizing study results to other populations. The study is cross-sectional, making it impossible to infer a causal association between variables. The study was also retrospective, and thus it is possible that participants inaccurately reported events and/or coping strategies used. Although the present study initially sought to examine age of the victimization as a moderator, the group who was only exposed to violence after THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 50 starting high school was too small to compare differences. Finally, although coping was standardized such that participants were asked to think of the most stressful event that occurred after the start of high school victimization, individuals with victimization experiences before the start of high school were also included in the main analyses to increase power. Given the amount of time since the event occurred

(minimum four years ago), participants who experienced a victimization only occurring before the start of high school may not have accurately remembered how they coped with that violent event. It is also possible that when answering the questionnaire, they may have been thinking about a different stressor that was recent but not violent (despite instructions to focus on most recent violent event). Therefore, it is difficult to make inferences about the relation between violence exposure and disengagement coping.

Conclusions and Future Directions

Polyvictimization scores were significantly associated with increased psychological symptoms.

Thus, identifying protective factors that buffer individuals from the deleterious effects of high rates of different victimizations has important implications. Polyvictimization scores did not appear to predict disengagement coping but did predict involuntary disengagement reactions. Disengagement coping and involuntary disengagement reactions did not appear to be linked to trauma-related symptoms, regardless of trauma-related characteristics (relationship to the perpetrator and chronicity) or recency of the event.

This finding suggests that other factors may play a role in the link between polyvictimization and symptom intensity. Participants may be unaware of their own coping behaviors or symptoms they display or may be unwilling to disclose such things, particularly if they are avoidant. As such, future research should utilize multiple methods and multiple informants when collecting research regarding trauma exposure and trauma symptoms. This will provide a more comprehensive picture of an individual’s experiences and behaviors. Research has generally shown that developmental level is an important factor to examine in understanding the link between violence exposure, disengagement THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 51 coping, and trauma symptoms. Thus, future research should also seek to examine the impact of developmental level on trauma-related symptoms within the context of disengagement strategies. In sum, it is clear that polyvictimization is a consistent predictor of trauma-related symptoms, and therefore, it is important to identify potential protective factors for young adults who have been exposed to multiple types of violence. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 52

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APPENDIX A: DEMOGRAPHICS QUESTIONNAIRE 1. Please select your gender: Male Female 2. Your age: 3. Please select which of the following best describes your ethnic background: African- Asian Caucasian/White American/Black Hispanic/Latino Mixed/Multi-Ethnic Other: 4. What is the approximate household income of the household you grew up in? Less than $10,000 to $15,000 to $24,999 $25,000 to $35,000 to $49,999 $10,000 $14,999 $34,999 $50,000 to $75,000 to $100,000 to $150,000 to $200,000 or more $74,999 $99,999 $149,999 $199,999 5. How many people were living in the household you grew up in? 6. Who was living in in the household you grew up in? (Check all the apply) a. _Mother b. _Father c. _Sister d. _Brother e. _Stepparent f. _Other Relative______7. What is the highest degree earned by your mother/guardian? Did not High Advanced degree Some graduate school College degree (e.g., master’s or college high school diploma doctorate) 8. What is the highest degree earned by your father/guardian? Did not High Advanced degree Some graduate school College degree (e.g., master’s or college high school diploma doctorate) 9. How would you describe your hometown? Urban Suburban Rural 10. About how far do you currently live from home (where your parents live or where you grew up)? Still living Less than 30 30-60 miles 60-100 miles More than 100 miles at home miles

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APPENDIX B:ADAPTED EXPOSURE TO VIOLENCE MEASURE-CORE ITEMS

The items listed below refer to events that may have taken place at any point in your entire life, including early childhood. This is a confidential survey. No one will know that these are your answers.

If an event or ongoing situation occurred more than once, please record all pertinent information about all events on the follow-up items. Do not include in your answers things you may have seen only on TV, radio, the news, or in the movies.

PHYSICAL VIOLENCE 1. When you were a child, did a parent, caregiver or other person ever slap you, beat you, or otherwise attack or harm you?a 2. As an adult, have you ever been kicked, beaten, slapped around or otherwise physically harmed by a romantic partner, date, family member, stranger, or someone else?a 3. Sometimes groups of individuals or gangs attack people. Did a group of individuals or a gang hit, jump, or attack you?b

INDIRECT VICTIMIZATION 4. Did you see a parent get pushed, slapped, hit, punched, or beat up by another parent, or their boyfriend or girlfriend?b 5. Did you see a parent hit, beat, kick, or physically hurt your brothers or sisters, not including a spanking on the bottom?b 6. In real life, did you see anyone get attacked or hit on purpose using a stick, rock, gun, knife, or something that would hurt?b 7. Have you actually seen a seriously wounded person after an incidence of violence? c 8. Have you actually seen someone being killed by another person?c

CRIME 9. Was physical force or a weapon ever used against you in a robbery or mugging?a 10. Other than the experiences already covered, has anyone ever threatened you with a weapon like a knife or gun?a 11. Were you in any place in real life where you could see or hear people being shot, bombs going off, or street riots?b

SEXUAL VIOLENCE 12. Has anyone (parent, other family member, romantic partner, stranger or someone else) ever physically forced you to have intercourse, or to have oral or anal sex against your wishes, or when you were helpless, such as being asleep or intoxicated?a 13. Other than experiences mentioned in earlier questions, has anyone ever touched private parts of your body, made you touch their body, or tried to make you to have sex against your wishes?a

EMOTIONAL ABUSE/THREATS 14. Has a parent, romantic partner, or family member repeatedly ridiculed you, put you down, ignored you, or told you were no good?a 15. Did you ever get scared or feel really bad because people your age were calling you names, saying mean things to you, or saying they didn’t want you around?b THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 69

16. Did someone threaten to hurt you when you thought they might really do it?b

a Items from Stressful Life Events Scale (a) b Items from Juvenile Victimization Questionnaire (b) c Items from Survey of Exposure to Community Violence (c)

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APPENDIX C: FOLLOW-UP ITEMS

Please note that participants will only receive the follow-up questions for items endorsed as “Yes” having experienced.

Sample: 1) When you were a child, did a parent, caregiver or other person ever slap you, beat you, or otherwise attack or harm you? X Yes No

a. How many times did this happen? (Check only one) (a) never (d) 3 or 4 times (g) more than 10 times (b) 1 time (e) 5 or 6 times (h) at least once a week (c) 2 times (f) 7 or 8 times (i) almost every day

b. Did this occur Before the Start of High School After the Start of High School

c. Who did this? (What was the person’s relationship to you?) (Check all that apply) 1 Brother, sister, or other child who lived with you (cousin, etc.) 2 Brother, sister, or other child who did not live with you (cousin, etc.) 3 Father (including step-father, foster father, or live-in boyfriend) 4 Mother (including step-mother, foster mother, or live-in girlfriend) 5 An adult relative who lived in your home (uncle, grandparent, etc.) 6 An adult relative who did not live with you 7 Your boyfriend, girlfriend, date, other romantic partner, or ex-boyfriend or ex-girlfriend 8 Someone else you know such as a friend, neighbor, teacher, or someone from school 9 Adult Stranger (a stranger is someone you don’t know) 10 Child Stranger (a stranger is someone you don’t know)

d. When was the last time this happened? (Check only one) (a) about a week ago (d) about 6 months ago (g) between 1 and 2 years ago (b) about a month ago (e) about 9 months ago (h) between 3 and 5 years ago (c) about 3 months ago (f) about a year ago (i) more than 5 years ago

*After completing ALL violence core items and ALL follow-up items, participants will be presented with this question:

“How many times have you yourself actually been the victim of any type of violence such as those described in this questionnaire?”

(a) never (d) 3 or 4 times (g) more than 10 times (b) 1 time (e) 5 or 6 times (h) at least once a week (c) 2 times (f) 7 or 8 times (i) almost every day

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APPENDIX D: ADAPTED CENTRAL RELATIONSHIP QUESTIONNAIRE

“On a 0 (Not At All) to 6 (Extremely) scale please rate:

1. How close was this person to you? 1 2 3 4 5 6 7 2. How intimate a relationship did you have, with this person? 1 2 3 4 5 6 7 3. How much of an authority figure was this person for you? 1 2 3 4 5 6 7 4. How important was this person to you?” 1 2 3 4 5 6 7 THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 72

APPENDIX E: ADAPTED THE RESPONSES TO STRESS QUESTIONNAIRE – (SR)

Below is a list of things that sometimes people do, think, or feel when they are dealing with stress. Everyone deals with problems in their own way – some people do a lot of the things on this list or have a bunch of feelings, other people just do or think a few of these things.

Please pick the MOST SERIOUS event that has happened to you SINCE you started high school from the questionnaire you just completed and identify the strategies you have used or are using to cope with those events. For each item below, circle one number from 1 (not at all) to 4 (a lot) that shows how much you do or feel these things when you are around this event like the things you indicated above. Please let us know about everything you do, think, and feel, even if you don’t think it helps make things better.

Please briefly describe the event(s) you are referring to including who did this, the first time the event occurred, and how many times it happened.

How much do you do this?

WHEN DEALING WITH THE STRESS OF THE EVENT DESCRIBED ABOVE: Not at all A little Some A lot

1. I try not to feel anything. 1 2 3 4

2. When dealing with these events, I feel sick to my stomach 1 2 3 4 or get headaches.

3. I try to think of different ways to change or fix the situation. 1 2 3 4 Write one plan you thought of: ______

______

4. When faced with the stress of these events, I don’t feel anything at all, 1 2 3 4 it's like I have no feelings.

5. I wish that I were stronger and less sensitive so that things would be different. 1 2 3 4

6. I keep remembering these events that happened or can’t stop thinking about 1 2 3 4 what might happen. 7. I let someone or something know how I feel. (remember to circle a number.) → 1 2 3 4 Check all you talked to:

 Parent  Friend  Brother/Sister  Pet  Clergy Member

 Teacher  God  Other Family Member  None of these THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 73

8. I decide I’m okay the way I am, even though I’m not perfect. 1 2 3 4

9. When I’m around other people I act like these events never happened. 1 2 3 4

10. I just have to get away from everything when I am dealing with the stress of these events. 1 2 3 4 11. I deal with the stress of these events by wishing it would just go away, 1 2 3 4 that everything would work itself out.

12. I get really jumpy when I am dealing with the stress of these events. 1 2 3 4 13. I realize that I just have to live with things the way they are. 1 2 3 4

14. When I am dealing with the stress of these events, I just can’t be near 1 2 3 4 anything that reminds me of the situation. 15. I try not to think about it, to forget all about it. 1 2 3 4

16. When I am dealing with the stress of these events, I really don’t know what I feel. 1 2 3 4

17. I ask other people or things for help or for ideas about how to make things better. (remember to circle a number.) → 1 2 3 4

Check all you talked to:

 Parent  Friend  Brother/Sister  Pet  Clergy Member

 Teacher  God  Other Family Member  None of these

18. When I am trying to sleep, I can’t stop thinking about the stressful aspects of 1 2 3 4

these events that happened or I have bad dreams about them.

19. I tell myself that I can get through this, or that I will be okay. 1 2 3 4

20. I let my feelings out. (remember to circle a number.) → 1 2 3 4

I do this by: (Check all that you did.)

 Writing in my journal/diary  Drawing/painting

 Complaining to let off steam  Being sarcastic/making fun

 Listening to music  Punching a pillow

 Exercising  Yelling

 Crying  None of these THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 74

21. I get help from other people or things when I’m trying to figure out how to deal with my feelings. (remember to circle a number.) → 1 2 3 4

Check all that you went to:

 Parent  Friend  Brother/Sister  Pet  Clergy Member

 Teacher  God  Other Family Member  None of these

22. I just can’t get myself to face the stress of these events. 1 2 3 4

23. I wish that someone would just come and take away the stressful aspects of these events. 1 2 3 4

24. I do something to try to fix the problems with these events. 1 2 3 4 Write one thing you did:______

______

25. Thoughts about these events just pop into my head. 1 2 3 4

26. When I am dealing with these events, I feel it in my body. (remember to circle a number.) → 1 2 3 4 Check all that happen:

 My heart races  My breathing speeds up  None of these

 I feel hot or sweaty  My muscles get tight

27. I try to stay away from people and things that make me feel upset or remind me of these events. 1 2 3 4

28. I don’t feel like myself when I am dealing with these events, it’s like I am far away from everything. 1 2 3 4

29. I just take things as they are; I go with the flow. 1 2 3 4

30. I think about happy things to take my off these events or how I’m feeling. 1 2 3 4 31. When something stressful happens related to these events, I can’t stop thinking 1 2 3 4 about how I am feeling.

32. I get sympathy, understanding, or support from someone. (remember to circle a number.) → 1 2 3 4 Check all you went to:

 Parent  Friend  Brother/Sister  Pet  Clergy Member

 Teacher  God  Other Family Member  None of these

33. When something stressful happens related to these events, I can’t always control what I do. (remember to circle a number.) → 1 2 3 4 THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 75

Check all that happen:

 I can’t stop eating  I can’t stop talking

 I do dangerous things  I have to keep fixing/checking things

 None of these

34. I tell myself that things could be worse. 1 2 3 4

35. My mind just goes blank when something stressful happens related to 1 2 3 4 these events, I can’t think at all.

36. I tell myself that it doesn’t matter, that it isn’t a big deal. 1 2 3 4

37. When I am faced with these events, right away I feel really: (remember to circle a number.) → 1 2 3 4

Check all that you feel:

 Angry  Sad  None of these

 Worried/anxious  Scared

38. It’s really hard for me to concentrate or pay attention when something stressful happens 1 2 3 4

related to these events.

39. I think about the things I’m learning from these events or the situation, or something good 1 2 3 4

that will come from it.

40. After something stressful happens related to these events, I can’t stop thinking 1 2 3 4

about what I did or said.

41. When these events happens, I say to myself, “This isn’t real.” 1 2 3 4

42. When I’m dealing with these events, I end up just lying around or sleeping a lot. 1 2 3 4

43. I keep my mind off these events by:

(remember to circle a number.) → 1 2 3 4

Check all that you do:

 Exercising  Seeing friends  Watching TV THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 76

 Playing video games  Doing a hobby  Listening to music  None of these

44. When something stressful happens related to these events, I get upset by things 1 2 3 4 that don’t usually bother me.

45. I do something to calm myself down when I’m dealing with the stress of these events.

(remember to circle a number.) → 1 2 3 4

Check all that you do:

 Take deep breaths  Pray  Walk

 Listen to music  Take a break  Meditate  None of these

46. I just freeze when I am dealing with these events, I can’t do anything. 1 2 3 4

47. When stressful things happen related to these events I sometimes act without thinking. 1 2 3 4

48. I keep my feelings under control when I have to, then let them out when they won’t make 1 2 3 4

things worse.

49. When something stressful happens related to these events, I can’t seem to get 1 2 3 4

around to doing things I’m supposed to do.

50. I tell myself that everything will be all right. 1 2 3 4

51. When something stressful happens related to these events, I can’t stop 1 2 3 4

thinking about why this is happening.

52. I think of ways to laugh about it so that it won’t seem so bad. 1 2 3 4

53. My thoughts start racing when I am faced with these events. 1 2 3 4 54. I imagine something really fun or exciting happening in my life. 1 2 3 4

55. When something stressful happens related to these events, I can get so upset 1 2 3 4

that I can’t remember what happened or what I did. THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 77

56. I try to believe that it never happened. 1 2 3 4

57. When I am dealing with the stress of these events, sometimes I can’t control what I do or say. 1 2 3 4 THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 78

APPENDIX F: TRAUMA SYMPTOM CHECKLIST (TSC-40)

How often have you experienced each of the following in the last two months? 0 = Never to 3 = Often 1. Headaches 0 1 2 3 2. (trouble getting to sleep) 0 1 2 3 3. Weight loss (without dieting) 0 1 2 3 4. Stomach problems 0 1 2 3 5. Sexual problems 0 1 2 3 6. Feeling isolated from others 0 1 2 3 7. "Flashbacks" (sudden, vivid, distracting memories) 0 1 2 3 8. Restless sleep 0 1 2 3 9. Low sex drive 0 1 2 3 10. Anxiety attacks 0 1 2 3 11. Sexual overactivity 0 1 2 3 12. Loneliness 0 1 2 3 13. 0 1 2 3 14. "Spacing out" (going away in your mind) 0 1 2 3 15. Sadness 0 1 2 3 16. Dizziness 0 1 2 3 17. Not feeling satisfied with your sex life 0 1 2 3 18. Trouble controlling your temper 0 1 2 3

19. Waking up early in the morning and can't get back to sleep 0 1 2 3

20. Uncontrollable crying 0 1 2 3 21. Fear of men 0 1 2 3 22. Not feeling rested in the morning 0 1 2 3 23. Having sex that you didn't enjoy 0 1 2 3 24. Trouble getting along with others 0 1 2 3 25. Memory problems 0 1 2 3 26. Desire to physically hurt yourself 0 1 2 3 27. Fear of women 0 1 2 3 THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 79

28. Waking up in the middle of the night 0 1 2 3 29. Bad thoughts or feelings during sex 0 1 2 3 30. Passing out 0 1 2 3 31. Feeling that things are "unreal” 0 1 2 3 32. Unnecessary or over-frequent washing 0 1 2 3 33. Feelings of inferiority 0 1 2 3 34. Feeling tense all the time 0 1 2 3 35. Being confused about your sexual feelings 0 1 2 3 36. Desire to physically hurt others 0 1 2 3 37. Feelings of guilt 0 1 2 3 38. Feelings that you are not always in your body 0 1 2 3 39. Having trouble breathing 0 1 2 3 40. Sexual feelings when you shouldn't have them 0 1 2 3

THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 80

APPENDIX G: HSRB APPROVAL

DATE: November 3, 2016

TO: Sarah Hassan, M.A. FROM: Bowling Green State University Human Subjects Review Board

PROJECT TITLE: [837415-5] Coping with Stressful Events and Emotional Well-Being SUBMISSION TYPE: Continuing Review/Progress Report

ACTION: APPROVED APPROVAL DATE: November 30, 2016 EXPIRATION DATE: December 1, 2017 REVIEW TYPE: Full Committee Review

REVIEW CATEGORY: Full Committee

Thank you for your submission of Continuing Review/Progress Report materials for this project. The Bowling Green State University Human Subjects Review Board has APPROVED your submission. This approval is based on an appropriate risk/benefit ratio and a project design wherein the risks have been minimized. All research must be conducted in accordance with this approved submission.

The final approved version of the consent document(s) is available as a published Board Document in the Review Details page. You must use the approved version of the consent document when obtaining consent from participants. Informed consent must continue throughout the project via a dialogue between the researcher and research participant. Federal regulations require that each participant receives a copy of the consent document.

Please note that you are responsible to conduct the study as approved by the HSRB. If you seek to make any changes in your project activities or procedures, those modifications must be approved by this committee prior to initiation. Please use the modification request form for this procedure.

You have been approved to enroll 500 participants. If you wish to enroll additional participants you must seek approval from the HSRB.

All UNANTICIPATED PROBLEMS involving risks to subjects or others and SERIOUS and UNEXPECTED adverse events must be reported promptly to this office. All NON-COMPLIANCE issues or COMPLAINTS regarding this project must also be reported promptly to this office.

This approval expires on December 1, 2017. You will receive a continuing review notice before your project expires. If you wish to continue your work after the expiration date, your documentation for continuing review must be received with sufficient time for review and continued approval before the expiration date.

Good luck with your work. If you have any questions, please contact the Office of Research Compliance at 419-372-7716 or [email protected]. Please include your project title and reference number in all correspondence regarding this project.

Generated on IRBNe THE LINK BETWEEN LIFETIME VICTIMIZATION AND PSYCHOLOGICAL 81

DATE: February 29, 2016

TO: Sarah Hassan, M.A. FROM: Bowling Green State University Human Subjects Review Board

PROJECT TITLE: [837415-2] Coping with Stressful Events and Emotional Well-Being SUBMISSION TYPE: Revision

ACTION: APPROVED APPROVAL DATE: February 29, 2016 EXPIRATION DATE: December 1, 2016 REVIEW TYPE: Expedited Review

REVIEW CATEGORY: Full Board review category

Thank you for your submission of Revision materials for this project. The Bowling Green State University Human Subjects Review Board has APPROVED your submission. This approval is based on an appropriate risk/benefit ratio and a project design wherein the risks have been minimized. All research must be conducted in accordance with this approved submission.

The final approved version of the consent document(s) is available as a published Board Document in the Review Details page. You must use the approved version of the consent document when obtaining consent from participants. Informed consent must continue throughout the project via a dialogue between the researcher and research participant. Federal regulations require that each participant receives a copy of the consent document.

Please note that you are responsible to conduct the study as approved by the HSRB. If you seek to make any changes in your project activities or procedures, those modifications must be approved by this committee prior to initiation. Please use the modification request form for this procedure.

You have been approved to enroll 500 participants. If you wish to enroll additional participants you must seek approval from the HSRB.

All UNANTICIPATED PROBLEMS involving risks to subjects or others and SERIOUS and UNEXPECTED adverse events must be reported promptly to this office. All -COMPLIANCE NON issues or COMPLAINTS regarding this project must also be reported promptly to this office.

This approval expires on December 1, 2016. You will receive a continuing review notice before your project expires. If you wish to continue your work after the expiration date, your documentation for continuing review must be received with sufficient time for review and continued approval before the expiration date.

Good luck with your work. If you have any questions, please contact the Office of Research Compliance at 419-372-7716 or [email protected]. Please include your project title and reference number in all correspondence regarding this project.