Poly-Victimization in a National Sample of Children and Youth

Background

Most studies of children's exposure to violence focus on separate, relatively narrow categories of victimization (such as sexual abuse, physical maltreatment, or bullying), paying less attention to exposure to multiple forms of victimization.

Purpose

This study documents children's lifetime exposure to multiple victimization types (i.e., “poly-victimization”) and examines the association between poly-victimization and extent of trauma symptomatology.

Methods

Analyses were based on telephone interviews conducted between January 2008 and May 2008 with a nationally representative sample of 4053 children aged 2–17 years and their caregivers.

Results

Exposure to multiple forms of victimization was common. Almost 66% of the sample was exposed to more than one type of victimization, 30% experienced five or more types, and 10% experienced 11 or more different forms of victimization in their lifetimes. Poly-victims comprise a substantial portion of the children who would be identified by screening for an individual victimization type, such as sexual assault or witnessing parental violence. Poly-victimization is more highly related to trauma symptoms than experiencing repeated victimizations of a single type and explains a large part of the associations between individual forms of victimization and symptom levels.

Conclusions

Studies focusing on single forms of victimization are likely to underestimate the full burden of victimization that children experience and to incorrectly specify the risk profiles of victims. Research, clinical practice, and intervention strategies are likely to improve with more comprehensive assessments of victimization exposure.

Introduction

Considerable research has documented1, 2, 3, 4, 5, 6 high levels of childhood exposure to abuse, violence, and crime, as well as its damaging physical and mental health consequences. Most of this substantial body of literature focuses on separate, relatively narrow categories of experiences. For example, investigators have documented linkages between psychological disorder and specific forms of maltreatment, such as child physical abuse7, 8 and child sexual abuse.9, 10, 11 Associations between mental health impairments and exposure to neighborhood violence,12, 13 peer bullying,14, 15 and witnessing parental violence16, 17 are also well established. In this literature, however, little attention has been paid to the possibility that children may often be exposed to multiple forms of victimization. Yet there is reason to suspect that children who suffer one type of victimization are also likely to experience other types.18, 19, 20

Focusing on only one or a few types of the large spectrum of victimizations that children experience has several important limitations. First, it is likely to substantially underestimate the full burden of victimization exposure and the full strength of the relationship between victimization and child mental health.²¹ Second, a narrow focus on specific types of victimization can lead to a serious overestimation of the impact of individual victimization experiences because outcomes may be related to other victimizations or their co-occurrence rather than individual victimization events.²² Third, this fragmented approach hampers the identification of the most highly victimized children, who are at greatest risk for serious mental health problems and who may be the most important targets for intervention. To the extent that such children are included in intervention efforts, the range and complexity of victimization exposures that characterize their risk are unlikely to be fully acknowledged and addressed.

It was hypothesized that a more complete assessment of the number of different victimization types to which children are exposed will reveal a group of youth who account for both a high proportion of the total victimization burden and a considerable part of the explained variance in distress symptoms. Building on earlier research,¹⁹ the current study employs the concept of “poly-victimization” to describe this highly victimized group of children in an effort to demonstrate the detrimental consequences of poly-victimization for child well-being.

The present study builds on previous research on this topic in several ways. Although earlier work¹⁹ by the authors demonstrated the effects of multiple contemporaneous (within the past year) victimizations on child mental health, evidence6, 23, 24 suggests that the effects of adversity often accumulate over time. Examining cumulative lifetime exposure to multiple victimizations across the entire developmental spectrum of childhood may provide more insight into this public health problem. Unlike studies that rely on adult recall of events from the distant past, this research assesses children themselves, focusing on the effects of cumulative victimization experiences over the child's life course. By utilizing a large, nationally representative sample of children and youth, and examining a broader array of victimizations than previous studies, this research represents the most comprehensive epidemiologic assessment of child victimization to date.