relationships between childhood exposure to violence, posttraumatic stress, resilience, and alcohol

210 Pages·2011·0.67 MB·English

RELATIONSHIPS BETWEEN CHILDHOOD EXPOSURE TO VIOLENCE,
POSTTRAUMATIC STRESS, RESILIENCE, AND ALCOHOL MISUSE IN
MI’KMAQ ADOLESCENTS

by

Marc Zahradnik

Submitted in partial fulfilment of the requirements
for the degree of Doctor of Philosophy

at

Dalhousie University
Halifax, Nova Scotia
May 2011

© Copyright by Marc Zahradnik, 2011
DALHOUSIE UNIVERSITY
DEPARTMENT OF PSYCHOLOGY

The undersigned hereby certify that they have read and recommend to the Faculty of
Graduate Studies for acceptance a thesis entitled “RELATIONSHIPS BETWEEN
CHILDHOOD EXPOSURE TO VIOLENCE, POSTTRAUMATIC STRESS,
RESILIENCE, AND ALCOHOL MISUSE IN MI’KMAQ ADOLESCENTS” by Marc
Zahradnik in partial fulfilment of the requirements for the degree of Doctor of
Philosophy.

Dated: May 17th, 2011

External Examiner: _________________________________
Research Supervisor: _________________________________
Examining Committee: _________________________________
_________________________________

Departmental Representative: _________________________________

ii
DALHOUSIE UNIVERSITY

DATE: May 17th, 2011
AUTHOR: Marc Zahradnik
TITLE: RELATIONSHIPS BETWEEN CHILDHOOD EXPOSURE TO
VIOLENCE, POSTTRAUMATIC STRESS, RESILIENCE, AND
ALCOHOL MISUSE IN MI’KMAQ ADOLESCENTS

DEPARTMENT OR SCHOOL: Department of Psychology
DEGREE: PhD CONVOCATION: October YEAR: 2011
Permission is herewith granted to Dalhousie University to circulate and to have copied
for non-commercial purposes, at its discretion, the above title upon the request of
individuals or institutions. I understand that my thesis will be electronically available to
the public.

The author reserves other publication rights, and neither the thesis nor extensive extracts
from it may be printed or otherwise reproduced without the author’s written permission.

The author attests that permission has been obtained for the use of any copyrighted
material appearing in the thesis (other than the brief excerpts requiring only proper
acknowledgement in scholarly writing), and that all such use is clearly acknowledged.
_______________________________
Signature of Author

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TABLE OF CONTENTS

LIST OF TABLES ........................................................................................................... viii

LIST OF FIGURES ........................................................................................................... ix

ABSTRACT ........................................................................................................................ x

LIST OF ABBREVIATIONS AND SYMBOLS USED ................................................. xxi

ACKNOWLEDGEMENTS ............................................................................................. xiii

CHAPTER 1. INTRODUCTION ....................................................................................... 1

Childhood Exposure to Violence ............................................................................... 1
Emotional Abuse ............................................................................................... 3
Witnessing Domestic Violence ......................................................................... 5
Physical Abuse .................................................................................................. 7
Sexual Abuse .................................................................................................. 10
Adolescent Alcohol Use .......................................................................................... 13
Normative and Problematic Use in Adolescence ............................................ 13
Reasons for Adolescent Alcohol Use ............................................................. 15
Negative Reinforcement Theories for Alcohol Use ........................................ 17
Stress Responses ...................................................................................................... 19
Posttraumatic Stress Disorder (PTSD) ............................................................ 19
Functional Relationship between PTSD and Alcohol Use ............................. 21
Functional Relationship between Depression and Alcohol Use ..................... 24
First Nations Context ............................................................................................... 25
General Methodology .............................................................................................. 28
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CHAPTER 2. PROLOGUE TO POSTTRAUMATIC STRESS HYPERAROUSAL
SYMPTOMS MEDIATE THE RELATIONSHIP BETWEEN CHILDHOOD
EXPOSURE TO VIOLENCE AND SUBSEQUENT ALCOHOL MISUSE IN
MI’KMAQ YOUTH ......................................................................................................... 30

CHAPTER 3. STUDY 1. POSTTRAUMATIC STRESS HYPERAROUSAL
SYMPTOMS MEDIATE THE RELATIONSHIP BETWEEN CHILDHOOD
EXPOSURE TO VIOLENCE AND SUBSEQUENT ALCOHOL MISUSE IN
MI’KMAQ YOUTH ......................................................................................................... 33

Abstract .................................................................................................................... 33
Introduction .............................................................................................................. 34
Method ..................................................................................................................... 38
Participants and Procedures ............................................................................ 38

Measures ......................................................................................................... 39

Data Analysis .................................................................................................. 41

Results .................................................................................................................... 412
Discussion ................................................................................................................ 43
CHAPTER 4. PROLOGUE TO RESILIENCE MODERATES THE RELATIONSHIP
BETWEEN EXPOSURE TO VIOLENCE AND POSTTRAUMATIC STRESS
REEXPERIENCING IN MI’KMAQ YOUTH ................................................................. 54

CHAPTER 5.STUDY 2. RESILIENCE MODERATES THE RELATIONSHIP
BETWEEN EXPOSURE TO VIOLENCE AND POSTTRAUMATIC STRESS
REEXPERIENCING IN MI’KMAQ YOUTH ................................................................. 56

Abstract .................................................................................................................... 56
Introduction .............................................................................................................. 57
Method ..................................................................................................................... 60
Procedures ....................................................................................................... 60

Participants ...................................................................................................... 61

Measures ......................................................................................................... 61
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Data Analysis .................................................................................................. 64

Results ...................................................................................................................... 65
Principal Components Analysis of the CYRM ............................................... 65

Bivariate Relationships and Descriptive Statistics ......................................... 67

Moderating Analyses with Global Constructs ................................................ 67

Moderating Analyses with Subscales ............................................................. 67

Discussion ................................................................................................................ 69
CHAPTER 6. PROLOGUE TO KNOWLEDGE TRANSLATION IN A
COMMUNITY-BASED STUDY OF THE RELATIONS AMONG VIOLENCE
EXPOSURE, POSTTRAUMATIC STRESS, AND ALCOHOL MISUSE IN
MI’KMAQ YOUTH ......................................................................................................... 78

CHAPTER 7. STUDY 3. KNOWLEDGE TRANSLATION IN A COMMUNITY-
BASED STUDY OF THE RELATIONS AMONG VIOLENCE EXPOSURE,
POSTTRAUMATIC STRESS, AND ALCOHOL MISUSE IN MI’KMAQ YOUTH .... 79

Abstract .................................................................................................................... 79
Introduction .............................................................................................................. 80
Community Consent ................................................................................................ 83
Sharing of Results .................................................................................................... 88
Tangible Benefits and Documented Results ............................................................ 91
Future Directions and Lessons Learned ................................................................. 100
CHAPTER 8. DISCUSSION .......................................................................................... 105

Summary and Integration of Main Novel Findings ............................................... 105
Strengths, Limitations, and Future Directions ....................................................... 108
Clinical Implications .............................................................................................. 114
Conclusion ............................................................................................................. 121
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REFERENCES ............................................................................................................... 123

APPENDIX A. Demographics and Substance Use Questions ....................................... 155

APPENDIX B. Childhood Experience of Violence Questionnaire ................................ 158

APPENDIX C. Child Post-traumatic Stress Symptom Scale ......................................... 178

APPENDIX D. Centre of Epidemiological Studies Depression Scale ........................... 181

APPENDIX E. Rutgers Alcohol Problem Index ............................................................ 183

APPENDIX F. Differences Between EV and No EV on Measures of Depressive
Symptoms, PTS Symptom Clusters, and Alcohol Misuse ............................................. 185

APPENDIX G. Child and Youth Resilience Measure ................................................... 186

APPENDIX H. Exploratory Principal Component Analysis of the Child and Youth
Resilience Measure ......................................................................................................... 188

APPENDIX I. Tables for Moderating Analyses Using Total PTS, PTS Avoidance,
PTS Numbing, and PTS Hyperarousal as Dependent Variables .................................... 190

APPENDIX J. Copyright Permissions ............................................................................ 194

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LIST OF TABLES
Table 3.1. Bivariate Correlations Among Variables and Means and Standard
Deviations ........................................................................................................................ 50

Table 3.2. Model Fit Indices for Path Models Testing the Indirecct Effects of
Exposure to Violence on Alcohol Misuse Through PTS Symptoms .............................(cid:17)(cid:17) 52

Table 3.3. Bootstrap Analyses for Indirect Effects of PTS Symptoms between
Exposure to Violence and Alcohol Misuse ....................................................................... 53

Table 5.1. Correlations Among Variables ........................................................................ 75

Table 5.2. Moderating Effects of Various Aspects of Resilience on the Relationship
between Exposure to Violence and the Posttraumatic Stress Symptom of
Reexperiencing ................................................................................................................. 76

Table 7.1. PTSD Screening Workshop Knolwedge Test Scores at Pretest and
Postest ...........................................................................................................................(cid:17)(cid:17)(cid:17)103

Table 7.2. Trauma Focussed-Cognitve Behavioural Therapy Web Workshop
Knowledge Test Scores at Pretest and Postest ..............................................................(cid:17)(cid:17) 104

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LIST OF FIGURES
Figure 3.1. The path model involving PTS hyperarousal as a mediator
in explaining the link between violence exposure and alcohol misuse (Study 1) ............ 51

Figure 5.1. Slopes for the differential effect of exposure to violence on PTS
reexperiencing at low and high levels of resilience (Study 2) ......................................... 77

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ABSTRACT
This research was conducted in partnership with a Nova Scotain Mi’kmaq (First Nation)
community that was interested in learning more about how exposure to violence (EV)
might be related to youth alcohol use. There are many consequences of childhood
exposure to violence (EV), but two of the more notable consequences of EV are
posttraumatic stress (PTS) symptoms and excessive or problematic alcohol misuse. Given
the strong relationship in the literature between each of the PTS symptom clusters and
alcohol problems, it was hypothesized that these symptom clusters would mediate the
relationship between EV and alcohol misuse. Study 1 demonstrated that PTS
hyperarousal symptoms, but none of the other PTS symptoms, fully mediated the
relationship between EV and alcohol misuse, even after controlling for depressive
symptoms, age and gender. The literature on EV also demonstrates that despite its
numerous potential negative consequences, some youth continue to thrive. This thriving
in the face of hardship is called resilience. Study 2 employed a direct measure of
resilience (Child and Youth Resilience Measure; Ungar et al, 2008) to examine which if
any aspects of resilience can successfully buffer youth from experiencing negative mental
health consequences after EV. Study 2 demonstrated that all three aspects of resilience
(i.e., individual, family, and community) moderated the relationship between EV and
PTS reexperiencing symptoms. More specifically, at higher levels of resilience, the
positive relationship between EV and PTS reexperiencing symptoms was dampened.
Study 3 documented the collaborative-research process from beginning (i.e., research
question formation) to end (i.e., implementation of action-based recommendations). It
highlighted how the research questions outlined in Studies 1 and 2 were relevant to both
the specific community in question, as well as some Aboriginal communities more
broadly. It also highlighted how the first author participated in a research process that is
described by the Canadian Institutes of Health Research (CIHR) as Integrated Knowledge
Translation (KT). And finally, it identified via qualitative and quantitative methods how
the research process as a whole has helped equip the community with more tools to tackle
the problems that its members have identified as important for study and change.
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