A History of Childhood Maltreatment and Intimate Partner Violence Victimization Among Native American Adults.

632353 research-article2016

JIVXXX10.1177/0886260516632353Journal of Interpersonal ViolenceKong et al.

Article

A History of Childhood Maltreatment and Intimate Partner Violence Victimization Among Native American Adults

Journal of Interpersonal Violence 1–23 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260516632353 jiv.sagepub.com

Jooyoung Kong, MSW,1 Soonhee Roh, MSW, PhD,2 Scott D. Easton, PhD,1 Yeon-Shim Lee, PhD,3 and Michael J. Lawler, MSW, PhD2

Abstract This study examined the association between childhood maltreatment and intimate partner violence (IPV) victimization among Native American adults. Based on Riggs’s theoretical model of the long-term effects of childhood abuse, we also examined the mediating roles of insecure attachment patterns and depressive symptoms. The current study was a secondary data analysis using the 2013 General Well-Being Among Native Americans dataset (N = 479). Structural equation modeling was used to examine the hypothesized relationships among key constructs. Consistent with existing literature of revictimization, our findings showed that the experience of childhood maltreatment was positively associated with IPV victimization. Mediation analyses indicated that depression was a significant mediator in the association between childhood maltreatment and IPV victimization. In addition, all the paths linking childhood maltreatment, fearful attachment, depressive symptoms, and IPV victimization were statistically significant, 1Boston

College, Chestnut Hill, MA, USA of South Dakota, Sioux Falls, USA 3San Francisco State University, CA, USA 2University

Corresponding Author: Jooyoung Kong, School of Social Work, Boston College, Chestnut Hill, MA, USA. Email: [email protected]

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although the overall mediation effect was not significant. The results of this study suggest that Riggs’s model can serve as a useful theoretical framework for understanding the long-term effects of childhood maltreatment among Native American adults. Practitioners in the area of IPV should include maltreatment history and current attachment patterns in client assessments, which could help address conflict and violence within intimate relationships. Keywords childhood maltreatment, adult attachment, depressive symptoms, intimate partner violence Research on Native Americans has consistently documented that historical discrimination and trauma, such as the experience of colonization, racism, and out-of-home placements, have disrupted the cultural and familial structures and bonds among this population (Campbell & Evans-Campbell, 2011; Willmon-Haque & BigFoot, 2008). In addition to issues such as poverty, substance abuse, and mental health problems, childhood maltreatment, and the resulting disruptions to families and tribes, is emerging as a serious concern among Native American communities (National Child Welfare Resource Center for Tribes, 2011; Whitekiller-Drywater, 2014). Though the Indian Child Welfare Act (1978) was intended to provide additional protections for Native American children and families in need of child welfare services due to maltreatment, these families continue to be disproportionately at greater risk than other cultural groups for poor outcomes in safety, permanency, and well-being (i.e., health, mental health, and education; Lawler, LaPlante, Giger, & Norris, 2012; WhitekillerDrywater, 2014). Despite the disparate outcomes relative to Native American children and families receiving child welfare services, few studies have investigated the long-term effects of childhood maltreatment among Native Americans (DeBruyn, Chino, Serna, & Fullerton-Gleason, 2001). For example, the relationship between a history of childhood adversity and the quality of intimate relationships in adulthood has rarely been examined among Native Americans. However, this is an important issue for social work scholars and practitioners because research has established that earlier traumatic experiences may lead to other traumatic events or poly-victimization across a lifetime (Finkelhor, Ormrod, & Turner, 2007). Furthermore, improving our understanding of these linkages can foster timely interventions designed to prevent future violence and promote the well-being of adult survivors of child maltreatment.


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Thus, this study examined the link between a history of childhood maltreatment and intimate partner violence (IPV) victimization among a large sample of Native American adults (N = 479). We relied on Riggs’s (2010) theoretical model of adult attachment to investigate the pathways through which the history of childhood maltreatment affects IPV victimization in adulthood. More specifically, we examined the role of two correlates of childhood maltreatment—insecure attachment and depressive symptoms—in mediating the association between childhood maltreatment and IPV victimization.

Childhood Maltreatment and IPV Victimization Parental childhood maltreatment is an emerging, serious concern among Native American families (Child Trends Data Bank, 2014). In 2012, the incidence of maltreatment among American Indian and Alaskan Native children was recorded at a rate of 12.4 per thousand children (Child Trends Data Bank, 2014). This rate exceeds the rates for Caucasian, Hispanic, and Asian children that were, respectively, 10.3, 8.4, and 1.7 per thousand children. The high incidence rate for Native American children is alarming for several reasons, including the fact that childhood maltreatment can lead to subsequent trauma exposure across the lifespan (Finkelhor et al., 2007; Renner, Cavanaugh, & Easton, 2015). An extensive body of research targeting the general population indicates that adults with a history of childhood maltreatment are at high risk for IPV victimization (Widom, Czaja, & Dutton, 2008, 2014). Fritz, Slep, and O’Leary (2012) found that exposure to family violence during childhood increased the risk of physical victimization in intimate relationships in the future. Iverson, McLaughlin, Adair, and Monson (2014) found that exposure to childhood physical abuse and interparental violence were associated with greater physical, sexual, and emotional IPV victimization.

Theoretical Considerations: Riggs’s Model of Adult Attachment Grounded in adult attachment theory, Riggs (2010) developed a theoretical model explaining the mechanisms through which parental abuse during childhood can affect the survivor’s intimate relationships in adulthood. Bowlby (1979) argued that early attachment experiences serve as a foundation for a child’s future social relations and stated that “there is a strong causal relationship between an individual’s experiences with his parents and his later capacity to make affectional bonds” (p. 135). A secure attachment relationship can be established through warm, consistent, and responsive care


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provided by a primary caregiver (Davila & Levy, 2006). With a well-established base, children can develop mental representations of the social world and internal working models of themselves and others; these tasks are accomplished by perceiving oneself as worthy of love/care and others as supportive of/responsive to their needs (Zhang & Labouvie-Vief, 2004). Conversely, the lack of consistent, sensitive caregiving can lead to an insecure attachment, thereby reinforcing internal working models of the self as unworthy of love and others as unavailable and untrustworthy (Berlin, Cassidy, & Appleyard, 2008). Insecure attachment can be viewed in terms of three dimensions: preoccupied (anxious), dismissing (avoidant), and fearful (mixture of anxious and avoidant; Bartholomew & Horowitz, 1991). Preoccupied persons strive for self-worth by seeking to gain the acceptance of others, whereas dismissing persons tend to avoid close relationships to protect themselves from rejection or disappointment. People with a fearful attachment simultaneously seek approval from others to boost their selfworth but avoid close relationships due to the fear of rejection (Bartholomew & Horowitz, 1991). Attachment scholars argue that parental abuse during childhood can cause disruptions in the victim’s attachment system and negatively affect their internal working models across the lifespan (Crittenden & Ainsworth, 1989). Studies suggest that adults with a history of childhood maltreatment are likely to exhibit a fearful or disorganized attachment style (Bacon & Richardson, 2001; Rapoza & Baker, 2008). Childhood maltreatment is also linked with low self-esteem/self-worth (Coates, Dinger, Donovan, & Phares, 2013), lack of trust (Schofield & Beek, 2005), impaired social functioning (Alink, Cicchetti, Kim, & Rogosch, 2012), and poor interpersonal relationships (Prather & Golden, 2009). A primary assumption of Riggs’s (2010) model is that emotional abuse by parents may lead the child victim to develop an insecure attachment and negative internal working models of the self and others. A history of abuse can impede a survivor’s emotional regulation and social competence and increases his or her use of maladaptive coping strategies (e.g., emotionfocused, avoidant, or compulsive responses to stress). These strategies can significantly disrupt social functioning and interpersonal relationships for survivors. Thus, the direct and indirect effects of childhood emotional abuse can result in an insecure attachment in adulthood, which then leads to mental health problems. This chain of effects eventually serves as a risk factor for undermining intimate partner relationships in adulthood. We believe that Riggs’s adult attachment model is highly relevant in understanding the Native American population. Historically, parent–child relationships among Native Americans have been disrupted due to cultural


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assimilation policies including the education of children in off-reservation boarding schools and their placement in foster and adoptive homes (Christensen & Manson, 2001). Research has pointed out that the weakened familial and cultural ties have resulted in a number of social problems, including substance abuse, mental health concerns (i.e., depression, anxiety), and financial deprivation (Whitekiller-Drywater, 2014).

Mediating Associations Insecure attachment and IPV victimization. Among the general population, research has established that adult insecure attachment is associated with IPV victimization. Henderson and colleagues (2005) found that preoccupied attachment predicted greater psychological and physical abuse by a partner and that gender did not moderate those associations. The authors’ interpretation was that because of the need for love and support from others, preoccupied individuals may tolerate and sustain abusive relationship. Gay, Harding, Jackson, Burns, and Baker (2013) found that the experience of childhood emotional abuse was associated with preoccupied and dismissing attachment in adulthood, which, in turn, increased IPV victimization. Henderson, Bartholomew, and Dutton (1997) found that fearful attachment was associated with greater exposure to the physical abuse and longer duration in abusive relationships, whereas preoccupied attachment was associated with a greater risk for returning to abusive partners. Based on a review of the existing literature, we hypothesized that insecure attachment will be directly and indirectly associated with IPV victimization. Psychological distress and IPV victimization. Psychological distress is often cited in the literature as a potential consequence of childhood maltreatment and IPV victimization (Duran et al., 2009). In studies that examined the longterm effects of childhood maltreatment, psychological distress was also considered to mediate the association between childhood maltreatment and intimate relationship functioning (Norman et al., 2012). For example, DiLillo, Lewis, and Loreto-Colgan (2007) found that psychological distress was a significant correlate of childhood maltreatment, which led to relationship problems, such as fear of intimacy, negative reactions to sexual activity, and physical aggression among dating couples. This is possibly because psychological distress involves maladaptive coping strategies (e.g., rejection, disengagement) that may invoke relational dysfunction (Calvete, Corral, & Estévez, 2007). For those who are in a relationship with a violent partner, psychological distress may influence the victims less prone to withdraw from the relationship (Lang, Stein, Kennedy, & Foy, 2004). Those who are more


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depressed may adopt passive coping strategies (e.g., denial, disengagement) that can lead them to remain in the abusive relationship. This hypothesis is particularly important in studying Native Americans. Scholars have argued that historical oppression and trauma have undermined resiliency among this population (e.g., mental health concerns; Olson & Wahab, 2006) and could lead to future victimization. Insecure adult attachment and psychological distress. In addition to exerting mediational effects between childhood maltreatment and IPV, insecure adult attachment and psychological distress have been highly correlated in several studies (Bifulco, Moran, Ball, & Bernazzani, 2002; Wei, Mallinckrodt, Larson, & Zakalik, 2005). There is a great deal of evidence that insecure adult attachment is associated with psychological distress. For example, researchers have found that a high percentage of individuals with insecure attachment styles use either emotional reactivity or emotional cutoff, both of which can lead to depressed or anxious mood (Wei, Vogel, Ku, & Zakalik, 2005). Other studies also showed that high levels of insecure attachment increase feelings of depressive symptoms through self-criticism, emotional dysregulation, or maladaptive coping styles (Cantazaro & Wei, 2010; Monti & Rudolph, 2014). Based on theoretical considerations and a review of literature, we anticipate that the experience of childhood maltreatment is linked to insecure attachment in adulthood, which can lead to IPV victimization. We also speculate that psychological distress, the correlates of childhood maltreatment and insecure attachment, could increase the occurrence of IPV. Thus, the current study aims to (a) examine the association between childhood maltreatment and IPV victimization among Native American adults, and (b) investigate the mediating effects of adult insecure attachment and depressive symptoms on that relationship. We focused on victimization in current marital or dating relationships and evaluated the following four hypotheses: Hypothesis 1: A history of childhood maltreatment will be positively associated with IPV victimization in adulthood. Hypothesis 2: The three types of insecure attachment styles (preoccupied, dismissing, and fearful attachments) will mediate the link between childhood maltreatment and IPV victimization. Hypothesis 3: Depressive symptoms will mediate the link between childhood maltreatment and IPV victimization. Hypothesis 4: Insecure attachment and depressive symptoms will sequentially mediate the link between child maltreatment and IPV victimization.


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Method Sample and Data Collection The current study was a secondary data analysis using data from the 2013 General Well-Being Among Native American Study, a study designed to explore cancer screening literacy among Native Americans in the Midwest (for more information, please see Roh, 2015). After receiving approval by University of South Dakota Institutional Review Board, data were collected from Native American women (aged 18 years or older) and men (aged 40 years or older) in rural areas of South Dakota. Some cancer screening tests are unique to men (e.g., prostate cancer) and women (e.g., cervical cancer). The different minimum age eligibility criteria for men and women in the study reflected guidelines established by national health organizations. Data collection occurred between September 2013 and May 2014. To ensure a large sample with a wide age range, participants were recruited through several different localities, including Native American churches (whose members were predominantly Native Americans), other religious organizations and churches, senior centers and housing facilities, an annual Indian art market, and three powwows. Data were collected with a self-administered survey consisting of more than 200 items. Prior to collecting data, the lead researcher explained the purpose and procedures of the study, the kinds of questions that would be asked, and issues related to the confidentiality of data and participants’ benefits and risks. Interested, eligible participants then provided informed written consent. Trained interviewers were available for participants who had questions or needed assistance; only two participants required such assistance. The questionnaire took approximately 30 min to complete; participants received compensation of US$10 for their time. A total of 489 Native American adults participated in the study. After excluding 10 cases in which the participant failed to complete the study questionnaire, the final sample consisted of 479 Native American adults.

Study Sample The average age of participants was 47.4 years (SD = 13.54). Female participants were (44.6 years), on average, younger than male participants (51.6 years). Supplementary analyses, however, showed that there were no significant differences in the socio-demographic variables based on gender. Among the sample, 60% were female, 32% were married, and 64% reported that their health status was good or excellent (29.3% fair, 5.1% poor). On average, the


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respondents completed 13.2 years of education, which was higher than the average educational level of most Native Americans. According to the 2010 Census data, only 13% of the population obtained a bachelor’s degree or higher (U.S. Census Bureau, 2010). This may be attributable to several reasons including recruitment techniques that resulted in a non-probability sample. The respondents also reported having a monthly household income of “US$1,000 to US$1,499.” Approximately 60% of the sample (n = 290) reported having been born in reservation areas. One third of the respondents identified their spiritual or religious affiliation as traditional tribal spirituality; others reported Protestant or Catholic (23.8%) and Native American church (22.8%). More than half of the sample (56.3%) reported that they could speak or understand their Native language. The majority of the sample (87.2%) reported that they were enrolled as a member of a Dakota, Nakota, and Lakota tribe. Bivariate analysis showed that there were no significant differences on IPV victimization and insecure attachment in regard to the enrollment.

Measures IPV victimization. IPV victimization was assessed by a modified version of the Conflict Tactics Scale (CTS; Straus, Gelles, & Steinmetz, 1980), a wellestablished and commonly used measure for IPV (Straus & Douglas, 2004). Initially, we estimated a second-order factor structure to measure the unobservable latent construct: IPV victimization. A second-order factor indicates a broader construct that encompasses the primary factors (Schumacker & Lomax, 2010). In this case, the 20 items of the CTS were grouped into four factors—psychological aggression, physical assault, sexual coercion, and injury—and these factors were then loaded on IPV victimization. For simplicity, we calculated the mean scores of the four factors and used them as observed items for the latent variable of IPV victimization in the final model. Respondents were asked how many times they experienced psychological aggression or physical assault from their current spouse (or boyfriend, girlfriend) in the past year. Response choices for each item were based on a 7-point Likert-type scale ranging from never (0) to more than 20 times (6). The psychological aggression was the mean score of six items including, for example, (a) shouted or yelled at you, (b) destroyed something belonging to you, and (c) threatened to hit or throw something at you. Cronbach’s alpha coefficient for this scale was .92. The physical assault was the mean score of eight items including (a) threw something at you that could hurt, (b) pushed or shoved you, (c) grabbed or slapped you. Cronbach’s alpha coefficient for this scale was .94. The sexual coercion was the mean score of two items: (a)


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insisted on sex when you did not want to and (b) used threats or force to make you have sex. Cronbach’s alpha coefficient for this scale was .77. Injury was the mean score of four items: (a) you had a sprain, bruise, or small cut because of a fight with your spouse; (b) you felt physical pain that still hurt the next day because of a fight with your partner; (c) you went to a doctor because of a fight with your partner; and (d) you had a broken bone from a fight with your partner. Cronbach’s alpha coefficient for this scale was .92. Childhood maltreatment. A history of childhood maltreatment was measured by four items from the Adverse Childhood Experiences scale (Center for Disease Control and Prevention, 2014). Two items assessed whether participants experienced verbal and physical abuse during childhood: Did a parent or other adult in the household often or very often (a) swear at you, insult you, put you down, or humiliate you? Or act in a way that made you afraid that you might be physically hurt? (b) push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured?

Two other items assessed emotional and physical neglect: Did you often feel that (a) no one in your family loved you or thought you were important or special? Or your family didn’t look out for each other, feel close to each other, or support each other? (b) you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? Or your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

For each item, participants indicated whether or not they experienced the abuse/neglect (1 = yes; 0 = no). The responses of the four items were summed to produce a total score (range = 0-4) with higher scores indicating greater exposure to childhood maltreatment. Cronbach’s alpha coefficient for this scale was .74. Preoccupied attachment. Insecure attachment consisted of three dimensions: preoccupied, dismissing, and fearful attachment styles, which were measured by items from the Relationship Questionnaire (Bartholomew & Horowitz, 1991). Preoccupied attachment was measured by a single item: I want to be completely emotionally intimate with others, but I often find that others are reluctant to get as close as I would like. I am uncomfortable being without close relationships, but I sometimes worry that others don’t value me as much as I value them.


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Response choices were based on a 7-point Likert-type scale ranging from strongly disagree (1) to strongly agree (7). Dismissing attachment. Dismissing attachment was measured by a single item: “I am comfortable without close emotional relationships. It is very important to me to feel independent and self-sufficient, and I prefer not to depend on others or have others depend on me.” Response choices were based on a 7-point Likert-type scale ranging from strongly disagree (1) to strongly agree (7). Fearful attachment. Fearful attachment was measured by a single item: I am uncomfortable getting close to others. I want emotionally close relationships, but I find it difficult to trust others completely, or to depend on them. I worry that I will be hurt if I allow myself to become too close to others.

Response choices were based on a 7-point Likert-type scale ranging from strongly disagree (1) to strongly agree (7). Depressive symptoms. Depressive symptoms were measured by the nine-item version of the Patient Health Questionnaire (PHQ-9), a well-validated scale to screen, diagnose, and measure the severity of depressive symptoms (Kroenke, Spitzer, & William, 2001). We estimated a measurement model; the unobservable latent concept of depressive symptom was modeled as a common factor underlying the nine individual items. The items asked respondents how often they have been bothered by specific symptoms in the past two weeks (e.g., little interest or pleasure in doing things; feeling down, depressed, or hopeless; feeling tired or having little energy; poor appetite or overeating). Response choices for each item were based on a 4-point Likerttype scale: not at all (0), several days (1), more than half the days (2), and nearly every day (3). Cronbach’s alpha coefficient for this scale was .91. Socio-demographic characteristics. We controlled for socio-demographic characteristics, including gender, age, and educational attainment. Gender was entered as a dummy-coded variable with males serving as the reference category. Age and educational attainment were entered as continuous variables.

Analytic Procedures The analysis was conducted in LISREL 8.8 using a structural equation modeling (SEM) approach to test the hypothesized model as indicated by Figure 1.


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Figure 1. Conceptual model.

Note. IPV = intimate partner violence.

SEM tests theoretical models and estimates complex relationships among one or more independent/dependent variables (Schumacker & Lomax, 2010). The models were estimated using the asymptotic covariance matrix of polychoric correlations. The significance test of indirect effects was conducted by using the Sobel test (Preacher & Hayes, 2008). Complete data were provided by 90.2% (n = 432) of the study sample; educational attainment had the most missing cases at 2.9% (n = 14) of respondents. In terms of model testing, Satorra–Bentler Scaled χ2 statistics, the root mean square error of approximation (RMSEA) ≤ .06, comparative fit index (CFI) ≥ .95, and non-normal fit index (NNFI) ≥ .95 were used to evaluate the model fit (Morse, Weinhardt, Griffeth, & Ziebell, 2014). The initial model was re-specified by adding several error covariances based on values of the modification indices (MI) and expected parameter change (EPC). Figure 2 specifies error covariances of the final model. Given that there were 210 distinct unknown parameters and 56 free parameters to be estimated, the final model was over-identified with 154 degrees of freedom.

Results Table 1 presents descriptive statistics for the variables used in the analysis. Overall, the mean frequency with which respondents experienced psychological aggression in the past year was “once” (M = 1.29, SD = 1.61). The


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Figure 2. Final model.

Note. Significant standardized estimates and error covariances are shown. IPV = intimate partner violence. *p < .05. **p < .01. ***p < .001.

experience of physical assault occurred less than “one time” with a mean value of .63 (SD = 1.27). The experience of sexual coercion and injury occurred less than “one time” (M = 0.43, SD = 1.11; M = 0.46, SD = 1.15, respectively). On average, respondents experienced one type of abuse or neglect (M = 1.15, SD = 1.32) and reported “disagree” with having preoccupied (M = 3.68, SD = 1.62) and fearful attachment styles (M = 3.90, SD = 1.75) and “neutral/mixed” agreement with having a dismissing attachment (M = 4.56, SD = 1.55). Overall, the respondents experienced depressive symptoms for “several days” over the last 2 weeks with mean values ranging from 0.25 to 0.85 (SD = 0.79~0.95). The findings of the SEM model are summarized in Table 2 with unstandardized and standardized estimates and goodness-of-fit statistics. In addition, Figure 2 presents significant standardized path coefficients and corresponding significance levels. The first hypothesis was supported in that there was a direct positive association between childhood maltreatment and IPV in adulthood. A 1 standard deviation (SD) increase in the frequency of childhood maltreatment corresponded with a 0.16 SD increase in IPV (p < .01). The second hypothesis that the three types of insecure attachment styles (preoccupied, dismissing, and fearful attachments) will mediate the link between childhood maltreatment and IPV victimization was not supported.


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Kong et al. Table 1. Descriptive Statistics (N = 479). Variables Intimate partner violence Psychological aggression Physical assault Sexual coercion Injury Childhood maltreatment Preoccupied attachment Dismissing attachment Fearful attachment Depressive symptom Little interest or pleasure in doing things Feeling down, depressed, or hopeless Trouble falling or staying asleep, or sleeping too much Feeling tired or having little energy Poor appetite or overeating Feeling bad about yourself—or that you are a failure or have let yourself or your family down Trouble concentrating on things, such as reading the new newspaper or watching television Moving or speaking so slowly that other people could have noticed Thoughts that you would be better off dead or of hurting yourself in some way Socio-demographic characteristics Female Age Educational attainment

M (SD) or n (%)

Range

1.29 (1.61) 0.56 (1.15) 0.43 (1.11) 0.46 (1.15) 1.15 (1.32) 3.68 (1.62) 4.56 (1.55) 3.90 (1.75)

0~6 0~4 1~7

0.64 (0.95) 0.58 (0.87) 0.81 (0.99)

0~3

0.85 (0.95) 0.74 (0.95) 0.57 (0.87)

0.46 (0.77)

0.39 (0.79)

0.25 (0.79)

286 (60%) 47.39 (13.54) 13.2 (2.95)

— 18~95 1~22

Note. Higher mean scores signify higher values of the variables listed.

Childhood maltreatment was positively associated with only one of the insecure attachment patterns (i.e., fearful attachment); a 1 SD increase in the frequency of childhood maltreatment was associated with a 0.15 SD increase in fearful attachment (p < .01). Also, none of the insecure attachment patterns were significantly associated with IPV. The results supported the third hypothesis that depressive symptoms will mediate the link between childhood maltreatment and IPV victimization. A 1 SD increase in the frequency of childhood maltreatment was associated with


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Table 2. Unstandardized and Standardized Estimates and Goodness-of-Fit Indices (N = 479).

Factor loadings (λy) η4: Depressive symptom y1: Little interest or pleasure in doing thingsa y2: Feeling down, depressed, or hopeless y3: Trouble falling or staying asleep, or sleeping too much y4: Feeling tired or having little energy y5: Poor appetite or overeating y6: Feeling bad about yourself y7: Trouble concentrating on things y8: Moving or speaking so slowly that other people could have noticed y9: Thoughts that you would be better off dead or of hurting yourself in some way Factor loadings (λy) η5: IPV x1: Psychological aggressiona x2: Physical assault x3: Sexual coercion x4: Injury Parameter estimates γ(1, 1): Maltreatment → Preoccupied attachment γ(2, 1): Maltreatment → Dismissing attachment γ(3, 1): Maltreatment → Fearful attachment γ(4, 1): Maltreatment → Depressive symptom γ(5, 1): Maltreatment → IPV β(4, 1): Preoccupied attachment → Depressive symptom β(4, 2): Dismissing attachment → Depressive symptom β(4, 3): Fearful attachment → Depressive symptom β(5, 1): Preoccupied attachment → IPV β(5, 2): Dismissing attachment → IPV β(5, 3): Fearful attachment → IPV β(5, 4): Depressive symptom → IPV Goodness-of-fit indices χ2 (df) RMSEA (90% CI) CFI NNFI

Unstandardized (SE)

Standardized

1 1.15 (.05)*** 1.10 (.05)***

0.75 0.86 0.82

0.95 (.05)*** 1.06 (.05)*** 1.13 (.06)*** 1.16 (.05)*** 1.15 (.06)***

0.72 0.79 0.85 0.87 0.86

1.16 (.06)***

0.87

1 1.05 (.03)*** 0.64 (.05)*** 0.79 (.05)***

1.00 1.10 0.64 0.78

0.06 (.05) −0.01 (.05) 0.15 (.05)** 0.14 (.04)** 0.16 (.06)** 0.14 (.04)*** −0.05 (.04) 0.16 (.04)*** 0.05 (.06) −0.01 (.05) 0.04 (.07) 0.18 (.09)*

0.06 −0.01 0.15 0.19 0.16 0.19 −0.07 0.21 0.05 −0.01 0.04 0.14

350.62 (154)*** .05 (.05-.06) .98 .98

Note. Standard errors are shown in parentheses. IPV = Intimate partner violence; RMSEA = root mean square error of approximation; CFI = comparative fit index; NNFI = non-normal fit index. aReference group (path loading was set as 1 for model identification). *p < .05. **p < .01. ***p < .001.


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a 0.19 SD increase in depressive symptoms (p < .01), and a 1 SD increase in depressive symptoms was associated with a 0.14 SD increase in IPV (p < .05). The mediation effect of depressive symptoms between childhood maltreatment and IPV was statistically significant (b = 2.00, SE = 1.26, p < .05). Last, the fourth hypothesis—insecure attachment and depressive symptoms will sequentially mediate the link between child maltreatment and IPV victimization—was supported. A 1 SD increase in the frequency of childhood maltreatment was associated with a 0.15 SD increase in fearful attachment (p < .01), and a 1 SD increase in fearful attachment was associated with a 0.21 SD increase in depressive symptoms (p < .05). In addition, a 1 SD increase in depressive symptoms was associated with a 0.14 SD increase in IPV (p < .05). However, the mediation path that involves child maltreatment, fearful attachment, depressive symptoms, and IPV was not statistically significant. Overall, this model yielded acceptable model fit (Satorra–Bentler Scaled χ2 = 350.62, df = 154, p < .001; RMSEA = .05; CFI = .98; NNFI = .98). An insignificant result of the Satorra–Bentler Scaled χ2 would indicate a good model fit. However, the χ2 statistic is sensitive to sample size and thus it is nearly always significant when large samples are involved (Jöreskog & Sörbom, 1993).

Discussion The primary purpose of this study was to examine the link between a history of childhood maltreatment and IPV victimization among Native American adults. Based on Riggs’s (2010) theoretical model, we also investigated the mediating roles of insecure attachment and depressive symptoms in terms of maintaining the long-term linkage. As expected, there was a significant association between a history of childhood maltreatment and IPV victimization. This is consistent with previous studies that found that people who experience childhood victimization are at greater risk for subsequent victimization and relational aggression in adulthood (DiLillo et al., 2007). This important result provides empirical evidence that the argument of poly-victimization— that victims of violence during childhood are more likely to be exposed to victimization experiences across a lifetime—also holds for Native Americans (Finkelhor, Ormrod, Turner, & Holt, 2009). Within the context of collective trauma and systematic oppression experienced by Native Americans throughout U.S. history, this result highlights the vulnerability of Native Americans who are experiencing cumulative disadvantages or “extended” poly-victimization. The finding also raises a special concern for social work researchers and practitioners who are trying to eliminate problems within Native American families and communities. Downloaded from jiv.sagepub.com at University of Otago Library on February 25, 2016

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The current study did not find support for insecure attachment as a mediator between childhood maltreatment and IPV victimization; none of the three insecure attachment patterns were directly associated with IPV victimization. In addition, among the insecure attachment patterns, fearful attachment was the only significant correlate of childhood maltreatment, which was consistent with the findings of previous studies (Godbout, Dutton, Lussier, & Sabourin, 2009). Adults with fearful attachment patterns perceive themselves as unworthy and unlovable and others as non-trustworthy and non-responsive to their needs (Berlin et al., 2008; Zhang & Labouvie-Vief, 2004). Researchers have pointed out that traumatic, frightening, and abusive treatment from parents could distort the child’s ability to obtain a sense of safety. These distortions undermine a child’s resolution of fear and anxiety, which frequently results in the development of negative beliefs/images about the self and others (Cassidy & Mohr, 2001). Adults with preoccupied or dismissing attachment may have not received highly reactive and consistent care, but they at least developed an organized strategy to seek security from parents (Cassidy & Mohr, 2001). Consistent with previous literature, the findings of this study support the view that earlier adverse experiences can continue to affect survivors of childhood maltreatment by distorting basic beliefs and perceptions about the world. It is likely that these beliefs were internalized and reinforced across a lifetime, which may lead to relationship challenges in adulthood for the survivor. Attachment researchers argue that it is a difficult—but not impossible—task for individuals to alter their attachment patterns (Bowlby, 1988; Wei, Mallinckrodt, et al., 2005). To solve intimate relationship conflict, an assessment of one’s belief systems of self and others (and an examination of how the beliefs influence intimate partner interactions) will be important. It is also noteworthy that depressive symptoms mediated the relationship between childhood maltreatment and IPV victimization. First, depressive symptoms were a significant correlate of childhood maltreatment, consistent with previous studies that indicated that adult survivors of childhood maltreatment are more likely to experience greater levels of depression (Sugaya et al., 2012). In turn, depressive symptoms were positively associated with IPV victimization. Several studies have attempted to identify factors related to revictimization, and psychological distress has been one of the predictors leading to IPV victimization (Lang et al., 2004). Our findings support these previous studies among Native American adults. The results imply that adult survivors’ depressive symptoms can be understood as unresolved issues from earlier adverse experience. These issues should be properly addressed to minimize its negative impact on survivors’ lives. Although we did not find a significant mediation effect, all the paths linking childhood maltreatment, fearful attachment, depressive symptoms, and


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IPV victimization were statistically significant. These results suggest that Riggs’s (2010) model can enhance our understanding of the long-term effects of childhood maltreatment on IPV among Native American adults. Based on the theoretical considerations, future research can extend our findings and examine the long-term effects of childhood family violence on contemporary adult relationship functioning among Native Americans. These studies could investigate, for example, how specific types of insecure attachment (e.g., fearful attachment) and manifestations of depression (e.g., hopelessness, feelings of worthlessness/inappropriate guilt) could mediate associations between childhood maltreatment and IPV. It is also possible that certain types of childhood maltreatment may be stronger predictors of fearful attachment and IPV victimization. This vital research will help identify timely and appropriate intervention points and inform efforts to design more targeted treatment programs aimed at containing the negative impact of childhood adverse experiences.

Limitations Several limitations of the current study should be noted. First, the cross-sectional research design limits our ability to make causal conclusions about the findings. Future research should incorporate longitudinal designs to provide more rigorous support for the associations among variables. In addition, the use of convenience sampling to recruit Native American adults in a Midwestern state limits the generalizability of the findings. The fact that data were collected from well-established organizations within the Native American community (e.g., religious organizations and churches, senior centers, three powwows) could have resulted in a systematic selection bias. For example, participants in the study might have had fewer emotional or psychological problems than non-participants considering their levels of engagement in the social settings. We also could not examine tribal differences on any of the variables because data on tribal membership were not collected. Future studies with more representative samples of Native American adults across different tribes and rural/urban contexts will enhance our understanding of IPV with this population. In terms of measurement issues, all the data were based on self-report and susceptible to the effect of social desirability.

Implications Despite these limitations, this study provides important implications for theory and practice. First, this study suggests that Riggs’s (2010) model of adult attachment can serve as a useful theoretical framework to understand the long-term


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sequelae of childhood maltreatment among Native American adults. The theory incorporates important concepts known to affect Native American families, such as mental health problems and family functioning. Taken together, adult attachment theory offers a practical means to better understand the causes and pathways to IPV victimization among this population. Beyond improved understanding, the theory can also help guide the development and testing of focused and practical interventions aimed at preventing IPV victimization. Practitioners in the area of IPV should include maltreatment history and current attachment patterns in their assessments with clients. Intervention plans can be enhanced and customized by reviewing the client’s internal working models of self and others and altering distorted, negative beliefs. Treatment should also focus on the resolution of past trauma to better deal with current violence between intimate partners (Cassidy & Mohr, 2001). In addition, the effort to reduce depressed moods of adult survivors of childhood maltreatment may also help address conflict and violence within intimate relationships. To provide holistic and systematic interventions, practitioners need to understand the complex nature of depression among these clients as their symptoms may involve historical, familial, and interpersonal sources of stress and trauma. To live a life as Native American in this country has not been easy considering the history of oppression and violence against the population. Several health measures indicate that Native Americans experience troubling social problems that threaten to undermine family functioning (National Child Welfare Resource Center for Tribes, 2011; Whitekiller-Drywater, 2014). This study extends our knowledge of Native Americans by showing that childhood maltreatment, as one of the major social problems, can threaten the quality of adult intimate relationships. More research will be needed to fully understand the mechanisms through which early life problems pose risks for healthy relationships during adulthood, thereby creating opportunities for timely, appropriate interventions for the population. Acknowledgment Dr. Roh (lead researcher) acknowledges Dr. Robin Miskimins for her mentoring on a Seed Grant at the School of Health Sciences of the University of South Dakota.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study received funding through the


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University of South Dakota Seed Grants at the School of Health Sciences (S.R.) and the Institute on Aging at Boston College (S.D.E.).

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Riggs, S. A. (2010). Childhood emotional abuse and the attachment system across the life cycle: What theory and research tell us. Journal of Aggression, Maltreatment & Trauma, 19, 5-51. doi:10.1080/10926770903475968 Roh, S. (2015). Correlates of receipt of colorectal cancer screening among American Indians in the Northern Plains. Manuscript under review. Schofield, G., & Beek, M. (2005). Providing a secure base: Parenting children in long-term foster family care. Attachment & Human Development, 7, 3-25. Schumacker, R. E., & Lomax, R. G. (2010). A beginner’s guide to structural equation modeling. New York, NY: Routledge. Straus, M. A., & Douglas, E. M. (2004). A short form of the revised Conflict Tactics Scales, and typologies for severity and mutuality. Violence and Victims, 19, 507-520. Straus, M. A., Gelles, R. J., & Steinmetz, S. K. (1980). Behind closed doors: Violence in the American family. Beverly Hills, CA: SAGE. Sugaya, L., Hasin, D. S., Olfson, M., Lin, K., Grant, B. F., & Blanco, C. (2012). Child physical abuse and adult mental health: A national study. Journal of Traumatic Stress, 25, 1-9. doi:10.1002/jts.21719 U.S. Census Bureau. (2010). American Indian and Alaska Native Heritage Month: November 2011. Retrieved from https://www.census.gov/newsroom/releases/ archives/facts_for_features_special_editions/cb11-ff22.html Wei, M., Mallinckrodt, B., Larson, L. M., & Zakalik, R. A. (2005). Adult attachment, depressive symptoms, and validation from self versus others. Journal of Counseling Psychology, 52, 368-377. doi:10.1037/0022-0167.52.3.368 Wei, M., Vogel, D. L., Ku, T.-Y., & Zakalik, R. A. (2005). Adult attachment, affect regulation, negative mood, and interpersonal problems: The mediating roles of emotional reactivity and emotional cutoff. Journal of Counseling Psychology, 52, 14-24. Whitekiller-Drywater, V. (2014). Family group conferencing: An indigenous practice approach to compliance with the Indian Child Welfare Act. Journal of Public Child Welfare, 8, 260-278. Widom, C. S., Czaja, S. J., & Dutton, M. A. (2008). Childhood victimization and lifetime revictimization. Child Abuse & Neglect, 32, 785-796. Widom, C. S., Czaja, S. J., & Dutton, M. A. (2014). Child abuse and neglect and intimate partner violence victimization and perpetration: A prospective investigation. Child Abuse & Neglect, 38, 650-663. doi:10.1016/j.chiabu.2013.11.004 Willmon-Haque, S., & BigFoot, D. S. (2008). Violence and the effects of trauma on American Indian and Alaska Native populations. Journal of Emotional Abuse, 8, 51-66. doi:10.1080/10926790801982410 Zhang, F., & Labouvie-Vief, G. (2004). Stability and fluctuation in adult attachment style over a 6-year period. Attachment & Human Development, 6, 419-437.

Author Biographies Jooyoung Kong, MSW, is a doctoral candidate at Boston College School of Social Work. Her research interests include late-life intergenerational relationships, longterm care issues and policies, and long-term effects of childhood trauma.


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Soonhee Roh, MSW, PhD, LMSW, is an assistant professor at University of South Dakota’s Department of Social Work in Sioux Falls. She is the lead researcher in the current study. Her areas of research interest include health disparities, American Indian well-being, positive adaptation in aging, mental health, as well as for access and behavioral service utilization issues among ethnic and racial minorities. Scott D. Easton, PhD, ACSW, LMSW, is an assistant professor in the Department of Mental Health at the Boston College School of Social Work. His research interests include risk and protective factors for mental health among adults with histories of adverse childhood experiences (especially sexual abuse), trauma processing models, and masculinity and men’s health. Yeon-Shim Lee, PhD, ACSW, is an associate professor at San Francisco State University School of Social Work. She has published extensively on racial and ethnic health/mental health disparities, family violence (elder abuse and intimate partner abuse), intergenerational transmission of violence, substance use, acculturation, and health interventions. Michael J. Lawler, MSW, PhD, is dean and professor, School of Health Sciences, University of South Dakota. His research interests include health disparities, child well-being, child welfare, transfer of learning, and forensic psychology.


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