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Child Abuse & Neglect, Vol. 21, No. 2, pp. 211-226, 1997 Copyright © 1997 ElsevierScience Ltd Printed in the USA. All rights reserved 0145-2134/97 $17.00 + .00
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SPOTLIGHT ON PRACTICE
SOCIAL SUPPORT AND COPING STRATEGIES AS MEDIATORS OF ADULT ADJUSTMENT FOLLOWING CHILDHOOD M A L T R E A T M E N T MARSHA G.
RUNTZ
Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
JOHN R.
SCHALLOW
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
Abstract--Structural equation modelling (SEM) was used to examine whether coping efforts and social support mediate the long-term sequelae of child maltreatment. The hypothesized SEM fit the data well and indicated that the association between previous childhood sexual and physical maltreatment and current psychological adjustment appeared to be strongly mediated by social support and coping strategies. In this sample of 302 female and male university students, most of whom reported at least one episode of childhood maltreatment, perceived social support and ways of coping with earlier maltreatment appeared essential to an understanding of the relationship between childhood maltreatment and later adjustment. Copyright © 1997 Elsevier Science Ltd Key Words--Sexual abuse, Physical abuse, Coping, Social support.
INTRODUCTION R E V I E W S O F T H E vast array o f studies e x a m i n i n g the l o n g - t e r m sequelae o f b o t h c h i l d h o o d s e x u a l a b u s e ( B e i t c h m a n et al., 1992; F i n k e l h o r , 1990; N e u m a n n , 1994; N e u m a n n , H o u s k a m p , Pollock, & Briere, 1996; Stein, G o l d i n g , Siegel, B u r n a m , & S o r e n s o n , 1988) a n d p h y s i c a l a b u s e ( M o e l l e r , B a c h m a n n , & MoeUer, 1993; R o c k l i n & Lavett, 1987; Swett, Surrey, & C o h e n , 1990) list n u m e r o u s p s y c h o l o g i c a l , b e h a v i o r a l , a n d social difficulties in adults that r a n g e f r o m d e p r e s s i o n a n d p o o r s e l f - e s t e e m to s u b s t a n c e abuse a n d p e r s o n a l i t y disorders. Y e t This research was partially supported by a doctoral fellowship to the first author from the Social Science and Humanities Research Council of Canada. An earlier paper based on this data was presented at the 1992 meeting of the Canadian Psychological Association in Quebec City, Canada. The SEM was presented at the 1996 meeting of the American Psychological Association in Toronto. Received for publication July 21, 1994; final revision received July 16, 1996; accepted August 1, 1996. Reprint requests should be addressed to Marsha Runtz, Ph.D., Department of Psychology, P.O. Box 3050, University of Victoria, Victoria, British Columbia, Canada, V8W 3P5. 211
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there is no evidence for any consistent set of symptoms that could be viewed as a "post-child abuse syndrome" and certainly not all survivors of childhood abuse demonstrate significant impairment later in life. One unfortunate side-effect of the rapid expansion of research into the long-term sequelae of child maltreatment has been the apparent creation of an image of the former victim of child abuse as an individual who is invariably damaged both psychologically and socially. In actuality, there is a great deal of variability among former child abuse victims with regard to the type and extent of their subsequent difficulties in functioning (Browne & Finkelhor, 1986; Farber & Egeland, 1987; Finkelhor, 1990; Herman, Russell, & Trocki, 1986; Wolfe, Wolfe, & Best, 1988). What previous studies have suggested is that individuals with a history of child abuse are not a homogeneous group, and that many may demonstrate healthy adjustment years after the abuse (Farber & Egeland, 1987; Herman et al., 1986). Sexual and physical abuse experiences occur within the broader context of the individual's life and individual factors and other life circumstances influence the presentation of symptoms and behavior problems in adulthood. Studies basing their conclusions regarding the "effects" of child abuse simply on correlations between childhood experiences and symptoms measured in adulthood may be oversimplifying this apparent relationship by not taking into account other important variables that might influence later adjustment. Recognizing that child abuse experiences are not all alike, some writers have begun to examine the influences that contribute to differences in individuals' adjustment following victimization. Not surprisingly, factors related to aspects of the abusive situation itself such as severity, use of force, relationship to the offender, and victim age all appear to predict adjustment in former victims of child sexual abuse (Browne & Finkelhor, 1986; Spaccarelli, 1994; Wyatt & Newcomb, 1990). Similarly, greater severity of child physical abuse appears to be associated with poorer adjustment in adulthood (Briere & Runtz, 1988). With regard to situational factors during childhood, parental warmth (Wind & Silvern, 1994), social support (Testa, Miller, Downs, & Panek, 1992), family functioning (Koverola, Proulx, Battle, & Hanna, 1996; Nash, Hulsey, Sexton, Harralson, & Lambert, 1993), and support and belief from the nonoffending parent (Everson, Hunter, Runyan, Edelsohn, & Coulter, 1989; Spaccarelli & Kim, 1995) appear to be important determinants of the longterm impact of child sexual abuse. Similarly, among children who have been physically abused or neglected, the presence of a supportive adult during childhood seems to serve as a protective factor (Werner & Smith, 1982; Zimrin, 1986). Some individual differences in the cognitive processing of the abusive experience, such as causal attributions (Gold, 1986; Wyatt & Mickey, 1987), feelings of stigma and self-blame (Coffey, Leitenberg, Henning, Turner, & Bennett, 1996; Wyatt & Newcomb, 1990), and the search to find meaning (Roth & Newman, 1993; Silver, Boon, & Stones, 1983) also influence recovery from childhood sexual maltreatment. Some of these studies have even suggested that cognitive, social, and environmental factors may be more important than the characteristics of the abuse itself in predicting the adjustment of former victims of childhood abuse. The cognitive and behavioral factors that are of particular interest in the current study are the interrelated variables of coping strategies and social support.
Coping with Victimization and Other Stressful Life Events Burt and Katz (1988) view coping as "efforts made in response to stimuli experienced as threatening or stressful--efforts aimed both at reducing the anxiety that those stimuli create and at reducing the interference of the stimuli with one's capacity to function" (p. 345). Their method of assessing coping strategies of rape victims incorporated Lazarus and Folkman's (1984) theory of coping, Horowitz's (1976) formulation of post-traumatic stress responses,
Social support and coping strategies as mediators
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and the rape outcome research of Burgess and Holmstrom (1979). They chose to focus on five dimensions of coping (i.e., avoidance, nervousness and anxiety-related behaviors, selfdestructive behaviors, cognitive approaches, and expressive responses) that are related to problem-focused and emotion-focused coping and to various defense mechanisms. All five of these coping strategies were found to be associated with higher levels of symptomatology and lower levels of self-esteem in sexually assaulted women. Whether these negative relationships between coping strategies and adjustment can be seen as fulfilling Burt and Katz's (1988) definition provided earlier, it should be noted that their sample consisted of women in an acute stage of dealing with the relatively recent trauma of their rape experiences. In studies of coping with general life stress, some coping strategies have been found to be more effective than others. Active problem-solving tends to be more effective than some of the emotion-focused strategies such as avoidance and denial (Billings & Moos, 1981), yet emotion-focused coping can be adaptive in some situations. For example, Suls and Fletcher (1985) found emotion-focused coping to be helpful initially, yet it became less effective over time. Burt and Katz (1988), on the other hand, found that expressive coping after sexual assault tended to increase over time and was therefore an indication of long-term recovery. This apparent discrepancy may be explained by the fact that emotion-focused coping can involve both potentially positive (e.g., emotional expression) and negative behaviors (e.g., self-blame). When these factors are examined separately among former victims of child sexual abuse, it is apparent that internal attributions of blame are maladaptive (Gold, 1986; Wyatt & Newcomb, 1990) while emotional expressiveness is adaptive (Silver et al., 1983). As might be expected, nonexpressive coping is associated with greater anxiety and depression in former victims of sexual abuse (Gold, Milan, Mayall, & Johnson, 1994). The coping strategies of adults who were physically abused as children have not been previously examined.
Social Support and Life Stress In addition to coping strategies, social support appears to be an important mediator of the effects of life stress in general (Heller, Swindel, & Dusenbury, 1986; Kessler, Price, & Wortman, 1985; Pearlin, Lieberman, Menaghan, & Mullan, 1981). It has also been shown to be an important factor in the adjustment of sexually abused children (Conte & Schuerman, 1987 ), adults sexually victimized as children (Gold, 1986; Gold et al., 1994; Testa et al., 1992; Wyatt & Mickey, 1987), adult victims of sexual assault (Kimerling & Calhoun, 1994), and child victims of neglect, poverty, and violence (Mrazek & Mrazek, 1987; Werner & Smith, 1982; Zimrin, 1986). Social support and coping also appear to have an interactive effect on adjustment and well-being (Heller et al., 1986). This is not surprising as the effective use of a social support system can also be viewed as a coping strategy. Since many measures of coping include aspects of social support such as sharing feelings with friends or talking to others about one's problems, there may also be some conceptual overlap in these two constructs that could partially account for similarities in their functions. Spaccarelli's (1994) transactional model of the relationship between various risk and protective factors and later adjustment in victims of child sexual abuse appears to accommodate both coping strategies and social support in a single theory. The model incorporates victim's cognitive appraisals (e.g., negative self-evaluations), coping responses (e.g., seeking emotional support from others), as well as developmental (e.g., victim age) and environmental factors (e.g., family support) that may either moderate or mediate the effects of abuse on mental health (Spaccarelli & Kim, 1995). For sexually abused girls, parental support but not cognitive appraisals or coping strategies were predictive of resilience (Spaccarelli & Kim, 1995). While child-parent relationships are likely to be highly important to young children, during adulthood support from peers and current ways of coping may take on increased significance with regard to adjustment.
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In summary, the stress and trauma literature suggest that intervening variables such as coping strategies and social support may be relevant to the study of the current functioning of former victims of child sexual and physical abuse. Since the effectiveness of any coping style is thought to be specific to the context in which it is employed (Lazarus & Folkman, 1984), coping strategies that are effective with rape or other types of trauma in adulthood may differ from those that are most effective when dealing with child maltreatment. The present study used Burt and Katz's (1987) conceptualization of coping with trauma to determine the relative efficacy of coping strategies and social support in influencing the potentially negative longterm sequelae of child physical and sexual maltreatment. The approach taken is consistent with Alexander's (1992) call for researchers working in the child abuse area to use "more complex models, hypotheses, and research designs" (p. 166). A structural equation model is presented that examines coping and social support as mediators of the relationship between child maltreatment and adjustment in adulthood; moreover, the moderating effects of gender on these relationships are examined.
Hypothesized Structural Equation Model The structural equation model (SEM) that was tested is presented in the path diagram in Figure 1. Latent variables of child sexual and child physical maltreatment, subsuming measures of the frequency and severity of abusive experiences, were hypothesized to have both direct causal pathways and indirect mediated causal pathways to a psychological adjustment latent variable measured by self-rep.vrts of self-esteem and psychological symptoms. Mediating and moderating variables were examined in the manner suggested by Baron and Kenny (1986).
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Figure 1. Path diagram of the final model of the mediation of child abuse and psychological adjustment by social support and coping strategies. (Parameters marked with an asterisk are significant a t p
