Maltreatment Clusters Among Youth in Outpatient Substance Abuse Treatment: Co-Occurring Patterns of Psychiatric Symptoms and Sexual Risk Behaviors

Abstract

The purpose of the current study was to describe the use of a brief maltreatment assessment instrument to classify adolescents receiving alcohol or other drug (AOD) treatment services based on the extensiveness and severity of prior maltreatment. This goal is significant because maltreatment reduces the effectiveness of AOD treatment and is associated significantly with co-occurring patterns of psychiatric symptoms and sexual risk behaviors. Structured interviews were administered to 300 adolescent treatment clients (202 males, 98 females; M=16.22 years; SD=1.13 years) to assess childhood maltreatment experiences, past year psychiatric symptoms, and sexual risk behaviors during the past 180 days. Cluster analysis classified adolescents into unique groups via self-reported sexual abuse, physical punishment, and parental neglect/negative home environment. Significant between-cluster differences in psychiatric symptoms and sexual risk behaviors were documented using MANOVA and chi-square analyses. More severe maltreatment profiles were associated with higher scores for psychiatric symptoms and unprotected intercourse. Significant heterogeneity and distinct types within this treatment sample of adolescents supports the adaptation of selected prevention efforts to promote HIV/STI risk reduction.

Psychiatric Symptom Typology in a Sample of Youth Receiving Substance Abuse Treatment Services: Associations with Self-Reported Child Maltreatment and Sexual Risk Behaviors

“…The LPA also enhanced our current understanding of multiple determinants of adolescent psychiatric symptoms and vulnerability to health risk behaviors [69]. Previous research has suggested linkages between maltreatment histories and sexual risk behavior [23], however little has been done to examine these links in relation to cooccurring psychiatric symptoms, such as substance abuse and dependence symptoms. Elkington, Bauermeister and Zimmerman [76] recently reported that substance use mediated relations between psychological distress and sexual risk behavior and suggested two plausible explanations.…”

“…However, unexplained variability in relations between adverse rearing environments and the development of psychopathology among youth, including substance abuse, is recognized as a significant prevention and clinical research challenge [20][21][22]. Youth with substance use problems often report past maltreatment experiences, broad ranges of problem behaviors, and meet diagnostic criteria for psychiatric disorders [11,23]. Yet, it remains unclear what types of childhood maltreatment experiences are associated with specific psychiatric disorders or maladaptive health risk behaviors, including sexual risk behavior.…”

Sexually Transmitted Infections in a Sample of At-Risk Youth: Roles of Mental Health and Trauma Histories

“…Furthermore, much of the studies of substance abuse relied on self-report, whereas youth in our study were receiving some form of intervention. Among youth in substance abuse treatment, one study found that more severe maltreatment profiles were associated with having unprotected sex at higher rates than less severe maltreatment profiles (Tubman et al, 2011). Youth who are in treatment for substance use/abuse may be less likely to be engaging in sexual risk behaviors than youth who are using substances but are receiving no services.…”

“…Among populations of foster care, maltreated, and/or runaway youth, those who experience (most often sexual) abuse (Ahrens, Katon, McCarty, Richardson, & Courtney, 2012), abuse substances (Clatts, Goldsamt, Yi, & Gwadz, 2005; Hudson & Nandy, 2012), or engage in delinquent activity (Mason et al, 2010; Tolou-Shams, Brown, Gordon, & Fernandez, 2007) are often shown to be more likely to engage in sexual risk behaviors. Similarly, among youth treated for substance abuse, child maltreatment has also been a consistent predictive factor of sexual risk behavior (Oshri, Tubman, & Jaccard, 2011; Tubman, Oshri, Taylor, & Morris, 2011). While it is clear that behavioral problems can overlap, the subset of youth who may be particularly prone to sexual risk behavior is less clear.…”

Sex Differences and HIV Risk Behaviors: The Interaction between the Experience of Multiple Types of Abuse and Self-Restraint on HIV Risk Behaviors

“…Research has consistently shown that females tend to report more instances of childhood sexual and emotional abuse than males, whereas males report more cases of childhood physical abuse than females (Jones et al, 2010; Tubman, Oshri, Taylor, & Morris, 2011; Zurbriggen et al, 2010). In one adolescent study, externalizing symptoms, such as risky sexual behaviors and substance use, were associated with sexual abuse in females but with physical abuse in males; negative affect symptoms, such as depression, were also associated with sexual abuse in females but not in males (Arata et al, 2007).…”