Violence exposure and mental health of adolescents in small towns: An exploratory study
Daniel W L Lai
ABSTRACT
This study explores the impact of violence exposure on the mental health of the adolescents in a rural small twon. A structured questionnaire was used to survey 347 adolescents. Violence experienced and witnessed by the adolescents at school, in the neighbourhood, and at home was measured. Mental health was represented by the psychiatric symptoms, depression level, and self-esteem. The level of violence perpetrated by the adolescents was also explored. Results of the multiple regression analysis show that adolescents who have been exposed to more violence, either as a victim or as a witness, report more psychiatric symptoms, higher levels of depression, and more problems of self-esteem. Being a witness of violence also contributes significantly to the variance of violence committed by the adolescents. The implications of the finding to violence prevention are discussed in the conclusion
A B R E G E
Cette etude examine l’impact de la violence par rapport at la sante mentaLe des adolescents d’une petite ville rurale. Un questionnaire structure fut utilise pour sonder 347 adolescents. La violence qu’eprouvent et que temoignent les adolescents a l’ecole, dans leurs quartiers, et au foyer, fut mesuree. La sant6 mentale est representee par les symptomes psychiatriques, le niveau de depression psychologique, et L’estime de soi. Le niveau de violence commise par l’adolescent fut aussi explore. Les resultats de l’analyse de regression multiple demontrent que les adolescents qui ont etc touches par plus de violence, soit en tant que victimes soit en tant que temoins, rapportent plus de symptomes psychiatriques, des niveaux plus eleves de depression psychologique, et plus de problames d’estime de soi. Le fait d’etre temoin d’actes violents contribue de facon significative at la variance de la violence commise par l’adolescent. Les implications des resultats en ce qui concerne la prevention sont discutees.
Exposure to violence is believed to have negative impacts on the mental health of adolescents. Significant association has been observed between the level of exposure to violence of the adolescents and psychological trauma.1 Similarly, adolescents who are exposed to violence often display more Post Traumatic Stress Disorder (PTSD) related symptoms than those who are not.2’3
In most circumstances, adolescents are exposed to violence either at school, at home, or in their neighbourhood. No matter where the violence occurs, research findings generally support that exposure to violence often creates a negative impact on the mental health of the adolescents.
Students who have been robbed, threatened, or beaten in school have lower selfesteem than their unvictimized counterparts.4 Chronic exposure to violence not only results in decreased cognitive performance and school achievement5 but also increases the level of depression6,7 anxiety,8 aggression,9 and self-destructive behaviours among the adolescents.10 Adolescents who are exposed to domestic violence at home often report decreased social competence levels,11 decreased self-esteem,12 increased physical aggression,13 and increased conduct problems.14 Children who are exposed to community violence also report more depressive symptoms.6,15
Most studies documenting violence exposure have focused on youth in urban or suburban settings. Research on the impact of violence exposure on the adolescents in small towns in Canada is unavailable. This may be due to the myth that small towns are relatively safer and violence very seldom occurs. This study attempts to explore the relationships between violence exposure and mental health of adolescents in a small town setting. Two research questions are expected to be answered. First, what is the extent of violence exposure among adolescents in a small town? Second, to what degree is violence exposure associated with mental health problems among adolescents residing in a small town?
METHODS
A cross-sectional survey design using a 30-minute, anonymous, self-administered questionnaire was employed in this study. The structured questionnaire consisted of questions measuring violence exposure, violence behaviours, mental health status, and demographics of the respondents.
Violence exposure was conceptualized as the frequency of violence experienced and witnessed by the adolescents. In this study, violence was operationalized by the nine types of specific intimidating or violent incidents including: 1) having things damaged, 2) having things stolen, 3) having things taken by force or threat of force, 4) being verbally put down or bullied, 5) being threatened with hurt, 6) being slapped/punched, or kicked, 7) getting beaten up or mugged, 8) being threatened with a weapon, and 9) being attacked or beaten up by a group. Along a four-point Likert scale ranging from “never” (0), once (1), twice (2), and “three times or more” (4), the respondents were asked to rank the frequency of each of these incidents that they had experienced over the past year at school, in the neighbourhood, and at home. Three separate scores of VICTSCH, VICTNEIG, and VICTHOME were computed to represent the total level of violence experienced by the adolescents at each of these three different settings. Along the same Likert scale, the adolescents were also asked to rank the frequency of the violence incidents they witnessed personally over the past year at school, in the neighbourhood, and at home, resulting in the scores of WITSCH, WITNEIG, and WITHOME.
Violence committed by the adolescents was measured by asking them to self-report, along a four-point Likert scale ranging from “never” (0), to “three times or more” (4), the frequency of committing the nine specific types of violence mentioned above in the previous year. A total score (TCOMMIT) representing the overall level of violence committed was computed.
Mental health of the respondents was measured by three standardized instruments. The psychological symptoms were measured by the 53-item Brief Symptom Inventory (BSI)16 which assesses nine primary symptom dimensions of somatization (SOM), obsessive-compulsiveness (OC), interpersonal sensitivity (IS), depression (DEP), anxiety (ANX), hostility (HOS), phobic anxiety (PHOB), paranoid ideation (PAR), and psychoticism (PSY), as well as a global index of Global Severity Index (GSI) which represents the overall psychiatric symptoms one has experienced. Depression level of the respondents was measured by the 27-item Children Depression Inventory (CDI).17 Self-esteem was measured by the Index of Self-Esteem (ISE).18 For all of these measures, higher scores represent a more serious concern with the mental health issue assessed. Demographic information collected in the questionnaire includes the respondents’ age, gender, grade level, and race/ethnicity.
The study sample consists of grade 7 to grade 12 adolescents in a small Northern Alberta town, population approximately 5,000. The respondents were from the only two high schools in the community. All the classes from grade 7 to grade 12 in one of the schools were included in the study; in the other, due to the large student population, some of the classes in each of the grades were selected. In selecting the classes, the author endeavoured to maintain an appropriate balance of students from both the academic and vocational streams.
RESULTS
A total of 347 students from grade 7 to grade 12 successfully completed the questionnaire. The demographics of the respondents are presented in Table I.
Table II shows that the majority of the adolescents in this study have been victims of violence of some sort within a 12-month period. At school, over two thirds of the adolescents have been verbally put down or bullied. Approximately 7 of 10 adolescents have had something stolen. At home, about half of the adolescents have been verbally put down or bullied, and almost half have been slapped, punched, or kicked. About 15% of them have been threatened with a weapon at home as well. In general, the adolescents have experienced violence most frequently at school, then at home, and then in the neighbourhood.
Again, as shown in Table II, the adolescents generally have witnessed more violence than they have been a victim. Nine of ten adolescents have seen someone being verbally put down or bullied at school and almost the same proportion of the respondents have seen someone being slapped, punched, or kicked. Verbal put down is also very common both at home and in their neighbourhood. At home, over 4 of 10 adolescents have witnessed someone being slapped, punched, or kicked; about 15% have seen someone being beaten up; and 13% have witnessed someone being threatened with a weapon.
Male adolescents have experienced more violence than their female counterparts both at school (8.6 vs 5.14; t=5.81, p
Table III shows the frequency of selfreported violence committed by the respondents. Almost 7 of 10 adolescents have committed at least one type of violence. About 80% of the adolescents have verbally put down or bullied someone. The male adolescents in this study commit more violence than their female counterparts (4.59 vs 3.55; t=4.04, p
To explore the association between mental health and violence exposure, both bivariate and multivariate analyses were used. Table IV shows the zero-order bivariate correlations between the mental health scores and total level of violence committed (TCOMMIT), and the variables measuring violence exposure. In general, the more an adolescent has been victimized, the more psychological symptoms and mental health concerns are recorded. This relationship exists no matter whether the victimization happens at school, in the neighbourhood, or at home. At the same time, the bivariate results show that the more violence an adolescent has been exposed to, either as a victim or as a witness, the more violence he or she will commit.
To further explore the predicting power of violence exposure on the mental health problems, a series stepwise multiple regression analysis was employed, using the GSI and the 9 subscales, CDI, ISE, and TCOMMIT as the dependent variables in separate analysis. The predicting variables are the six variables measuring violence experienced and witnessed by the adolescents at school, in the neighbourhood, and at home, and also the demographic factors of age, gender, race/ethnicity, and grade level of the respondents.
Results in Table V show the predictors of the different mental health scores. Two general observations are obtained. First, all but one of the violence exposure variables are significant in predicting the mental health scores, in a positive direction. This means, regardless of the setting, adolescents who have experienced or witnessed more violence have more psychiatric symptoms, higher levels of depression, and more self-esteem problems. Second, having witnessed violence is the most important predictor of amount of violence committed by the adolescents. The more violence one witnesses at school, in the neighbourhood, and at home, the more violence one commits.
DISCUSSION
Findings from this study are consistent with much previous research,46-911-15 Adolescents who are exposed to more violence have more mental health problems. To be specific, those who have witnessed and experienced more violence tend to report more psychiatric symptoms, higher levels of depression, and more self-esteem problems.
An interesting aspect of this study is that it reports the situation of the adolescents in a rural small town setting. The findings give further support to the fact that the impact of violence exposure is universal. The results show that no matter in which setting violence takes place, its impact on the mental health of adolescents is often negative.
Another interesting discovery of this study is that violence committed by adolescents is explained significantly by the level of violence they witness rather than the violence they experience. The impacts on the mental health of the adolescents are different depending on whether they are victims or witnesses of violence. Having experienced violence either at school, in the neighbourhood, or at home, has a significant effect in explaining all 10 measures of psychiatric symptoms, depression, and self-esteem problems. However, having witnessed violence either at school or in the neighbourhood is only significant in explaining 7 of the 12 mental health indicators in this study. Further research is suggested to examine the differential impacts of being a victim and being a witness of violence.
Consistent with previous research findings, violence occurrence at home has a negative impact on the adolescents, both psychologically and socially. However, further research on the context in which violence at home has taken place is needed. Details such as the conditions under which violence has occurred, the relationship between the victim and the perpetrator(s), and the meanings of violence as defined by different family members, would be useful to devise appropriate violence prevention strategies at home.
The frequency of violence experienced and witnessed by the adolescents at school is alarming. However, some of the schools still have difficulties in admitting the problem. Sometimes, school administrators and teachers may be led to believe that violence at school is only perpetrated by a small group of “problem students,” and do not recognize that much of the violence takes place when teachers and staff are not around to see it. From the prevention perspective, more wellorganized efforts to educate the students are needed. Recognizing and acknowledging the problem are the initial steps. Before any violence prevention strategies can be effective, it is important for the school authorities to understand more about the adolescent subculture, and to create an open and safe atmosphere to discuss the issue of violence with the students.
Due to the significant impact of violence exposure on the mental health of the adolescents, more support services and counselling to students who are affected by violence of any kind should be made available and accessible to this population group, both at school and in the community. The focus of the services should also be extended to include not only victims of violence but also adolescents who have witnessed violence. Parents or caregivers of the adolescents should be aware of the impact of violence exposure and detect the issues at an early stage. Open discussion of the issues of violence with the adolescents by the parents/caregivers should be encouraged as the first step to deal with the problems.
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Faculty of Health and Social Development, Okanagan University College, Kelowna, BC Correspondence and reprint requests: Daniel W.L. Lai, PhD, Faculty of Health and Social Development, Okanagan University College, 3333 College Way, Kelowna, BC, V1V 1V7, Tel: 250-762-5445 ext. 7135, Fax: 250-470-6004, E-mail: dlai@okanagan.bc.ca
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