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1.
In the present study, we examined the role of cumulative childhood maltreatment experiences for several health related outcomes in adulthood, including symptoms of psychological distress as well as perceived social support and hardiness. The sample comprised adult survivors of sexual abuse (N = 278, 95.3% women, mean age at first abusive incident = 6.4 years). One-way ANOVAs revealed a statistically significant dose-response relation between cumulative childhood maltreatment scores and self-reported symptoms of posttraumatic stress (PTSS), anxiety, depression, eating disorders, dissociation, insomnia, nightmare related distress, physical pain, emotional pain, relational problems, self-harm behaviors as well as on a measure of symptom complexity. Cumulative childhood maltreatment was also associated with lower levels of work functioning. An inverse dose-response relation was found for perceived social support and hardiness. Using a Bonferroni corrected alpha level, cumulative childhood maltreatment remained significantly associated with all outcome measures with the exception of eating disorder symptoms after controlling for abuse-related independent variables in hierarchical regression analyses. Results add to previous literature by showing that dose-response relation between cumulative childhood adversities and adult symptom outcomes could also be identified in a sample characterized by high exposure to adversities, and lends support to the notion put forth by previous authors that cumulative childhood adversities seem to be related to the severity of adult health outcomes in a rule-governed way. 相似文献
2.
Laura E. Miller Åsa Källström Cater Kathryn H. Howell Sandra A. Graham-Bermann 《Child abuse & neglect》2014
Although excellent data exist on the overall prevalence of childhood exposure to intimate partner violence (IPV), there is less information available on the specific patterns of IPV exposure in childhood and how they influence adult mental health. The current study examines 703 Swedish adults who reported exposure to IPV in childhood. Participants were part of a large national study on violence exposure. They provided an extensive history of their exposure to IPV and maltreatment experiences during childhood via electronically administered questionnaires. Mean comparison and multivariate regression methods were employed to assess differences in violence severity by reported perpetration pattern (mother-only, father-only, bidirectional or other), the association between violence severity and environmental context, and the contribution of these characteristics to adult mental health outcomes. Overall, violence perpetrated in public and by fathers was more severe and was related to poorer mental health outcomes in adulthood for child witnesses. These findings provide important insight into possible clinical “flags” for identifying children at high risk for exposure to IPV and abuse in the home. 相似文献
3.
《Child abuse & neglect》2014,38(12):1985-1994
Children may be subjected to many forms of violence and a significant number will experience multiple victimizations. These children are at high risk for developing psychological and emotional difficulties that may last into adulthood. Despite the increased risk for psychopathology, a substantial percentage of young adults exhibit resilient functioning following a history of childhood violence. This study examines the role of social support, spirituality, and emotional intelligence in promoting resilience during emerging adulthood. Participants included 321 young adult American college students, age 18–24, who experienced childhood violence, including community violence, interpersonal aggression, child maltreatment, peer/sibling victimization, and/or sexual assault. Findings revealed that this sample was highly victimized, with an average of 9 violent experiences reported during childhood. Hierarchical multiple regression analyses indicated that after controlling for exposure to childhood victimization, other potentially traumatic events, and current depression and anxiety symptoms, higher resilience during emerging adulthood was associated with greater spirituality, greater emotional intelligence, and support from friends (but not from family). Findings suggest that the potency of protective factors outweighs that of adversity and psychopathology when predicting resilient functioning. By identifying variables that can enhance resilience, this study offers unique insight into how functioning may be improved by both individual and environmental factors. 相似文献
4.
Child maltreatment is a risk factor for detrimental effects on mental health that may extend to adulthood. This study aimed to examine the association between exposure to childhood maltreatment, socio-demographic factors, and students’ mental health status and self-esteem. A cross-sectional study enrolled a representative sample of 1270 students from Kuwait University. An anonymous self-administered questionnaire included students’ socio-demographic characteristics, history of exposure to childhood physical and/or emotional maltreatment, DASS-21 to assess mental health status, and Rosenberg self-esteem scale was used. Chi-square test and binary logistic regression models were applied. The study found that among participants, 49.6%(95% CI: 64.8%–52.4%), 63.0%(95% CI: 60.3%–65.7%), and 43.8%(95% CI: 41.1%–46.6%) reported having depression, anxiety, and stress respectively. Moreover, 22.5%(95% CI: 20.1%–24.8%) and 18.6%(95% CI:16.5%–20.9%) reported childhood physical and emotional maltreatment, respectively; while 12.7% reported both. Multivariate analysis revealed that experiencing childhood physical and emotional maltreatment were independent contributors to reporting depression and anxiety; while exposure to only emotional maltreatment contributed to reporting stress. Gender, GPA, childhood enrollment in private/public schools, number of close friends, were other contributors to mental health problems. Participants’ median score of self-esteem was 17/30, and only childhood emotional maltreatment was a significant predictor to low self-esteem after adjustment for other confounders. Mental health problems, and experiencing childhood physical and emotional maltreatment were prevalent relatively high among university students. Childhood corporal and emotional maltreatment were independent predictors to adolescents and young adults’ mental health problems. Experiencing childhood emotional maltreatment predicted low self-esteem. Further research to assess culture factors associated with childhood maltreatment is recommended. 相似文献
5.
The influence of adverse childhood experiences (ACEs), which often include childhood exposure to maltreatment and household dysfunction, on health risk behaviors during young adulthood has been widely documented. A vulnerability marker for the increased risky behaviors among young ACEs victims such as impulsivity remains to be explored. The present study investigated how different profiles of ACEs influence impulsivity in young adulthood. Respondents were young people (N = 336; ages 18–25) who were recruited from the community. Latent class analysis (LCA) was used to identify subpopulations of individuals based on varying exposure to 13 types of ACEs, including childhood maltreatment, household dysfunction, and community violence. Four distinct classes emerged: Low ACEs (56%), Household Dysfunction/Community Violence (14%), Emotional ACEs (14%), and High/Multiple ACEs (16%). Multiple regression analyses found that compared to those in the Low ACEs class, young adults in the Emotional ACEs and High/Multiple ACEs respectively, reported increased levels of negative urgency, controlling for sociodemographic characteristics and other impulsivity traits. This result suggests that childhood exposure to multiple ACEs at high levels is particularly related to impulsive self-control in the context of intense negative emotionality. 相似文献
6.
OBJECTIVES: This study had two primary objectives: First, to examine the nature and co-occurrence of various forms of child maltreatment (sexual, physical, emotional, and witnessing violence) reported by Latina college students, and second, to explore coexisting maltreatment types and acculturation status as possible contributors to long-term adjustment difficulties. METHOD: Participants were 112 Latina undergraduate students categorized by the number of childhood maltreatment types experienced (0, 1, or 2 or more) and acculturation level (1 to 5). The possible effects of co-occurring forms of maltreatment, in conjunction with acculturation status, were investigated with respect to participants' reported trauma symptomatology. Data were collected using self-report measures. RESULTS: Nearly three out of 10 participants (29%) experienced more than one type of child maltreatment and, as expected, these individuals reported greater trauma symptomatology than those reporting either a single type of maltreatment or no maltreatment at all. Those who reported multiple types also endured more severe maltreatment than did respondents who experienced a single type. Acculturation level was neither directly related to trauma symptoms nor did it moderate the lasting correlates of maltreatment among victims. Interestingly, those who experienced a single form of maltreatment reported no more trauma symptoms than did participants who reported no maltreatment history at all. CONCLUSION: This investigation documents a large degree of overlap among various forms of self-reported childhood maltreatment within a Latina college population. The results underscore the need to consider multiple forms of maltreatment, as well as severity, when making inferences regarding potential effects on later functioning. 相似文献
7.
BackgroundDespite global efforts to end violence against children in all settings, reports reveal that violence against children is still highly prevalent, especially in low-and middle- income countries. Violence in childhood is associated with a host of negative outcomes, and exposure in one setting can easily spill over to other contexts. For instance, exposure to family violence was not only related to mental health problems but also seems to be a risk factor for peer victimization.ObjectivesThe present study aimed to examine the prevalence of maltreatment within the family and adolescents’ mental health problems and their relation to peer victimization. We also aimed to gain new insights into the perceptions of adolescents concerning maltreatment within their families.MethodsData were collected from April to November 2017 in a representative sample of 702 students from 12 public secondary schools in Southwestern Uganda who responded to self-administered questionnaires.ResultsOverall, 95% of the students experienced at least one type of family violence in the past month. Students (81.3%) had endorsed some level of acceptance of violent discipline as a valid strategy in response to any misbehavior. Maltreatment within the family was related to peer victimization (β = .47) and this relation was mediated by mental health problems (0.002, 95%-CI: 0.001–0.004).ConclusionsThe results indicated a high prevalence of maltreatment within Ugandan families that was associated with peer victimization. This underscores the need to implement interventions aiming to reduce maltreatment and violence in order to protect children from potentially negative consequences. 相似文献
8.
OBJECTIVE: The purpose of this study is to assess the extent to which intimate partner violence and different forms of child maltreatment occur within and across childhood and adulthood for a high-risk group of women. METHOD: Low-income adult women were interviewed, retrospectively, regarding their experiences with intimate partner violence and child maltreatment in childhood and adulthood, and intra- and intergenerational relationships between multiple forms of family violence were identified. RESULTS: Analyses demonstrated weak to moderate associations between various forms of violence within generations. Only weak support was found for the transmission of violence hypothesis that maltreated children are more likely to grow up to maltreat their own children. Stronger support was found for the theory of learned helplessness, whereby children maltreated or witness to violence during childhood are more likely to be victimized as an adult. CONCLUSION: The results from this study suggest that interventions with children who are identified for one form of victimization should be assessed for other forms of victimization, and interventions should also address learned behaviors or beliefs associated with continued or future victimization. 相似文献
9.
Childhood violence exposure (CVE) in formative developmental years may have potent effects on severity and complexity of post-traumatic stress symptoms (PTSS) in adulthood, yet little research has examined the role of age of first exposure in the context of polyvictimization or gone beyond an examination of direct effects. The current study examines the specific associations between age of first exposure, total CVE, and posttraumatic stress symptoms in adulthood. Further, the conditional and indirect effects of age of first exposure on posttraumatic stress symptoms were examined. We hypothesized that age of first exposure to violence would be associated with higher total violence exposure across childhood, thereby predicting current posttraumatic stress symptom severity (i.e., indirect effect). We also postulated that age of first exposure would affect the relationship between total violence exposure and posttraumatic stress symptoms such that earlier exposure would exacerbate the effects of violence exposure (i.e., conditional effect). Participants included 269 violence-exposed adults recruited through MTurk; the mean age of first CVE was 6 years (SD = 3.29). Conditional process models indicated that age of first exposure was significantly associated with higher total childhood violence exposure, which in turn, was significantly associated with current posttraumatic stress symptoms in all domains. Further, a conditional effect of age of first exposure was present such that the relationship between total exposure to violence and symptoms of hyperarousal was stronger for those first exposed at earlier ages. Findings provide support suggesting the particular potency of early trauma on regulatory response systems. 相似文献
10.
BackgroundExtensive research has examined the relationship between exposure to family violence and its long-term mental health effects. Social support has been found to moderate this relationship, but there is a dearth of research on its mediating role.ObjectivesThe article presents the results of a study on the relationship between witnessing interparental violence and experiencing parental violence during childhood and adolescence on the one hand, and post-traumatic stress symptoms (PTSS) during young adulthood on the other. In addition, the article presents results on the role of social support as a mediator in this relationship.Method, participants, and settingA cross-sectional survey was conducted among 516 Israeli university and college students (90.7% female, and 9.3% male; M age = 24.9, SD = 2.7) using a retrospective, self-administered questionnaire.ResultsThe results revealed that exposure to each pattern of family violence (i.e., witnessing interparental violence and experiencing parental violence) predicted higher levels of PTSS. Furthermore, social support was found to partially mediate the relationship between exposure to family violence during childhood and adolescence and current PTSS as well as its four symptoms, i.e., depression, sleep disturbance, dissociation, and anxiety.ConclusionsThe results of the current study highlight the important role of social support in the association between adversities experienced early in life and young adulthood outcomes. The findings are interpreted on the basis of Conservation of Resources Theory (Hobfoll et al., 1990), which served as the conceptual framework for the study. The limitations of the study and implications for future research are discussed. 相似文献
11.
April Chiung-Tao Shen 《Child abuse & neglect》2009,33(3):148-160
ObjectivesThis study investigated the joint long-term impact of witnessing interparental violence and experiencing child physical maltreatment on young adults’ trauma symptoms and behavior problems. It also explored Chinese traditional beliefs as a possible contributor to young adults’ trauma and behavior.MethodsThis study used self-reporting measures to collect data from a national proportionate stratified sample of 1,924 college students in Taiwan. The sample was divided into four groups: no violence; interparental violence only; child physical maltreatment only and dual violence, to compare the combined effect of dual violence on long-term outcome with the no violence group and the one type of violence group.ResultsThe results indicated a significant association of interparental violence and child physical maltreatment, and 11.3% of participants reported witnessing partner violence between parents and experiencing physical maltreatment during childhood. Participants experiencing dual violence reported more trauma symptoms and behavior problems than did those experiencing only one form of violence or none at all. Exposure to both interparental violence and child physical maltreatment during childhood is a significant predictor of young adults’ trauma symptoms and behavior problems, after controlling for other potentially confounding risk factors. Cultural factors also play a significant role in predicting young adults’ trauma symptoms and internalizing behavior problems, after accounting for control variables and violence-related variables. Moreover, cultural factors interact significantly with dual violence experiences in predicting young adults’ externalizing behavior problems.ConclusionsThis study extended Western co-occurrence study findings with large Taiwanese community samples. The results demonstrated that dual violence experiences during childhood have long-term detrimental impact on young adults’ trauma symptoms and behavior problems. Cultural beliefs and their interaction with dual violence experiences play a significant role in young adults’ trauma symptoms and behavior problems as well.Practice implicationsThe present findings underscore the need for interventions for young adults exposed to childhood dual violence. Moreover, the findings highlight the need for culturally sensitive interventions to address the cultural factor impact on young adults’ trauma symptoms and behavior problems. 相似文献
12.
OBJECTIVE: This retrospective, cross-sectional study explored the hypothesis that multiple forms of child abuse and neglect (child multi-type maltreatment; CMM) would be associated with women's lower social support and higher stress in adulthood, and that this, in turn, would amplify their vulnerability to symptoms of depression and posttraumatic stress disorder (PTSD). METHOD: Participants were 100 women recruited from an inner-city gynecological treatment center for low-income women. Data were analyzed via structural equation modeling (SEM) with Lisrel 8.0. RESULTS: CMM was directly predictive of decreased social support and increased stress in adulthood. CMM was also directly predictive of PTSD symptoms, but not depression symptoms in adulthood. Social support partially mediated the relationship between CMM and adult PTSD symptoms, and stress fully mediated the relationship between CMM and adult symptoms of depression. CONCLUSIONS: Findings support both direct and mediational effects of social resources on adult depression and PTSD symptoms in women with histories of CMM, suggesting that resources are key factors in psychological adjustment of CMM victims. 相似文献
13.
Rodgers CS Lang AJ Laffaye C Satz LE Dresselhaus TR Stein MB 《Child abuse & neglect》2004,28(5):575-586
OBJECTIVE: This study examines the unique contribution of five types of maltreatment (sexual abuse, physical abuse, emotional abuse, physical neglect, emotional neglect) to adult health behaviors as well as the additive impact of exposure to different types of childhood maltreatment. METHOD: Two hundred and twenty-one women recruited from a VA primary care clinic completed questionnaires assessing exposure to childhood trauma and adult health behaviors. Regression models were used to test the relationship between childhood maltreatment and adult health behaviors. RESULTS: Sexual and physical abuse appear to predict a number of adverse outcomes; when other types of maltreatment are controlled, however, sexual abuse and physical abuse do not predict as many poor outcomes. In addition, sexual, physical, and emotional abuse and emotional neglect in childhood were all related to different adult health behaviors. The more types of childhood maltreatment participants were exposed to the more likely they were to have problems with substance use and risky sexual behaviors in adulthood. IMPLICATIONS: The results indicate that it is important to assess a broad maltreatment history rather than trying to relate specific types of abuse to particular adverse health behaviors or health outcomes. 相似文献
14.
BackgroundSon preference is an enduring phenomenon in China and may often be related to childhood adverse experiences. According to a life-course perspective, adverse experiences during a childhood period may have a long-term effect on mental health in later age. However, little is known about this relationship between parents’ son preference, childhood adverse experiences and adulthood mental health in China.ObjectiveThe study aims to evaluate the association of parents’ son preference and individual mental health in old age in China. The mediating role of childhood adverse experiences was also estimated.Participants and settingThe China Health and Retirement Longitudinal Study (CHARLS) 2015 combined with CHARLS life history survey was analyzed (N = 11,666).MethodsMental health was measured by a shortened modification of the Center for Epidemiologic Studies Depression scale including seven items, and higher scores indicated worse mental health status. A four-step mediating model was applied.ResultsRespondents growing in families with son preference had on average 0.75 (P < 0.001) points higher on the mental health scale than their counterparts, and the effects were consistent for both males and females. Childhood adverse experiences measured by physical maltreatment, emotional adverse experiences and witnesses of inter-parent violence mediated the relationship between parents’ son preference and individual adulthood mental health by 47.87%. For females, physical maltreatment and emotional adverse experiences explained the most parts of health effects of parents’ son preference, whereas witnesses of inter-parent violence was the most influential mediator for males.ConclusionParents’ son preference led to adverse childhood experiences, which influenced mental health in adulthood. 相似文献
15.
《Child abuse & neglect》2014,38(12):1955-1965
Evidence on the relationship of adolescent exposure to violence (AEV) with adult physical and mental health problems is limited, with studies often focusing on earlier childhood rather than adolescence, and also on short term rather than long term outcomes. Information specifically on the relationship of AEV to seeking help for mental health problems in adulthood from either formal sources such as mental health professionals or informal sources such as friends and clergy is even more difficult to find. The present study investigates how adolescent exposure to violence (AEV), in the form of parental physical abuse, witnessing parental violence, and exposure to violence in the neighborhood, are related to self-reported adult physical problems and seeking formal or informal assistance with mental health, controlling for more general adolescent violent victimization and for self-reports and parent reports of mental health problems in adolescence. This study adds to the literature on AEV and adult physical problems, and provides a rare look at the relationship of AEV to adult help-seeking for mental health problems. The results suggest that AEV is associated with mental health problems in adolescence for both females and males, that for females AEV is related to physical problems and to seeking help for mental health problems in adulthood, but for males the only significant relationship involves inconsistent reports of witnessing parental violence and adult physical problems. 相似文献
16.
Childhood maltreatment is a strong risk factor for subsequent violence, including violent behaviors in young adulthood and offspring maltreatment after becoming a parent. Little is known about the specific circumstances under which supportive relationships may help disrupt this cycle of violence throughout the life course. We conducted two complementary analyses to assess whether maternal social support in early childhood, and also paternal involvement in middle childhood, could prevent the intergenerational transmission of violence, using data from the Avon Longitudinal Study of Parents and Children (n = 11,384). We found that higher levels of maternal social support in the postpartum period reduced the odds of offspring maltreatment at ages 0–8 years (OR = 0.95, 95% CI 0.93–0.96). When classifying mothers according to their abuse history, this protective association of social support was observed among mothers with no history of childhood maltreatment and among those with only childhood maltreatment (and not postpartum intimate partner violence [IPV]), but not among mothers who reported IPV since the child’s birth. We then extended our analysis of these offspring forward in time and found that paternal involvement at ages 9–10 years was associated with a reduced risk of offspring self-reported violent perpetration at ages 18–20 years (OR = 0.85, 95% CI = 0.77–0.94). This protective association was generally apparent among all subgroups of children, including those with a history of childhood maltreatment. Together these results highlight the protective influence of supportive relationships against the intergenerational transmission of violence, depending on abuse history, context, and timing, with important implications for the prevention of childhood maltreatment and mitigation of its negative effects. 相似文献
17.
Childhood maltreatment is associated with elevated risk for depression across the human lifespan. Identifying the pathways through which childhood maltreatment relates to depressive symptoms may elucidate intervention targets that have the potential to reduce the lifelong negative health sequelae of maltreatment exposure. In this cross-sectional study, 271 women with early-stage breast cancer were assessed after their diagnosis but before the start of adjuvant treatment (chemotherapy, radiation, endocrine therapy). Participants completed measures of childhood maltreatment exposure, psychological resources (optimism, mastery, self-esteem, mindfulness), and depressive symptoms. Using multiple mediation analyses, we examined which psychological resources uniquely mediated the relationship between childhood maltreatment and depressive symptoms. Exposure to maltreatment during childhood was robustly associated with lower psychological resources and elevated depressive symptoms. Further, lower optimism and mindfulness mediated the association between childhood maltreatment and elevated depressive symptoms. These results support existing theory that childhood maltreatment is associated with lower psychological resources, which partially explains elevated depressive symptoms in a sample of women facing breast cancer diagnosis and treatment. These findings warrant replication in populations facing other major life events and highlight the need for additional studies examining childhood maltreatment as a moderator of treatment outcomes. 相似文献
18.
Women involved in the criminal justice system experience multiple forms of adversity over their lifetimes. These events may include childhood abuse, involvement in the child welfare system as children, intimate partner violence victimization during adulthood, and punitive interactions with the child welfare system as mothers. Community supervision (e.g. probation or parole) entails particular stressors, such as obtaining basic needs and employment. A majority of women under community supervision also experience depression and anxiety. The current study used the Stress Process Model to investigate associations between childhood and adulthood stressors (including childhood abuse, intimate partner violence and child welfare system involvement), recent stressful life events, and symptoms of depression and anxiety for mothers (n = 348) on probation and parole. All of the mothers had experienced some form of childhood and/or adulthood victimization. Structural equation modeling was conducted to examine how childhood abuse, adulthood victimization, and child welfare system involvement as a child and a mother were associated with recent stressful life events and symptoms of depression and anxiety. Results indicated multiple direct and indirect relationships from childhood and adulthood stressors to mental health symptoms as women navigated probation and parole. For example, adverse childhood experiences were associated with elevated anxiety and depression symptoms via higher levels of recent stressful life events and adverse adulthood experiences. These findings highlight relationships between childhood abuse and adulthood factors and the mental health of mothers involved in the criminal justice system, with implications for theory, practice, and research. 相似文献
19.
Predictors of psychological distress and positive resources among Palestinian adolescents: trauma, child, and mothering characteristics 总被引：1，自引：0，他引：1
OBJECTIVE: The aim was to examine how traumatic and stressful events, responses to violence, child characteristics, and mothering quality, as measured in middle childhood predict psychological distress and positive resources in adolescence. METHOD: The participants were 65 Palestinian adolescents (17+/-.85 years; 52% girls), who had been studied during the First Intifada (T1), during the Palestinian Authority rule (T2) and before the Second Al Aqsa Intifada (T3) in Gaza. Psychological distress was indicated by PTSD, and depressive symptoms and positive resources by resilient attitudes and satisfaction with quality of life, all measured at T3. The predictors that were measured at T1 were exposure to military violence, active coping with violence and children's intelligence, cognitive capacity, and neuroticism. Mothering quality and stressful life-events were measured at T2, the former reported by both the mother and the child, and the latter by the mother. RESULTS: Adolescents' PTSD symptoms were most likely if they had been exposed to high levels of traumatic and stressful experiences and had poor cognitive capacity and high neuroticism in middle childhood. Only high levels of childhood military violence and stressful life-events predicted high depressive symptoms and low satisfaction with quality of life in adolescence. CONCLUSIONS: Military violence in childhood forms risks for both increased psychological distress and decreased positive resources. However, child characteristics such as cognitive capacity and personality are important determinants of psychological vulnerability in military trauma. 相似文献
20.
Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for youth with PM were more severe than youth who experienced either PA or SA only. Co-occurring PM and PA was associated with the most severe trauma exposure profile and with severity of PTSD symptoms, even after adjusting for demographic and trauma characteristics. Youth exposed to SA only had a distinct trauma profile and greater PTSD symptom severity after adjusting for demographic and trauma characteristic variables. Study findings hold important implications for trauma screening, assessment, and intervention, as well as for traumatic stress research methods that extend beyond abuse-specific or cumulative-risk approaches. 相似文献