Child maltreatment and quality of life: a study of adolescents in residential care

Abstract

BackgroundChildhood maltreatment is an important risk factor for mental and physical health problems. Adolescents living in residential youth care (RYC) have experienced a high rate of childhood maltreatment and are a high-risk group for psychiatric disorders. Quality of life (QoL) is a subjective, multidimensional concept that goes beyond medical diagnoses. There is a lack of research regarding the associations between childhood maltreatment and QoL. In the present study, we compare self-reported QoL between adolescents in RYC in Norway with and without maltreatment histories, and adolescents from the general population. We also study the impact of number of types of adversities on QoL.MethodsAdolescents aged 12–23 years living in RYC in Norway were invited to participate in the study; 400 participated, yielding a response rate of 67 %. Maltreatment histories were assessed through interviews with trained research assistants, and completed by 335 adolescents. Previous exposure to maltreatment was reported by 237 adolescents. The Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents (KINDL-R) was used. Nonexposed peers in RYC (n = 98) and a sample of adolescents from the general population (n = 1017) were used for comparison. General linear model analyses (ANCOVA) were conducted with five KINDL-R life domains as dependent variables. Linear regression was used to study the effect of number of types of adversities.ResultsExposed adolescents in RYC reported poorer QoL than peers in control groups. Compared with nonexposed peers in RYC, the 95 % confidence intervals for mean score differences on the KINDL-R subdomains (0–100 scale) were 1.9–11.4 (Physical Well-being), 2.2–11.1 (Emotional Well-being), −0.7–10.0 (Self-esteem), and 1.8–10.9 (Friends). Compared with the general population sample, the 95 % confidence intervals for mean score differences were 9.7–17.6 (Physical Well-being), 7.9–15.3 (Emotional Well-being), 3.6–12.5 (Self-esteem), and 5.3–12.8 (Friends). Number of types of adversities was associated with a poorer QoL score on all subdomains (Physical- and Emotional Well-being, Self-esteem, Friends, and School).ConclusionsChildhood maltreatment was associated with a poorer QoL score. We suggest the use of QoL and maltreatment measures for all children and adolescents in RYC.

Quality of life among adolescents living in residential youth care: do domain-specific self-esteem and psychopathology contribute?

“…Even when the same specific self-esteem domain is evaluated as important for QoL in different populations, the reasons for this could be different. A large portion of the adolescents had experienced sexual abuse as we have shown in previous reports on this sample [28,54]. Patients with a history of child sexual abuse and post-traumatic stress disorder report aversive emotional responses, negative cognitions, and dissociative states triggered by viewing their own body in a mirror [55].…”

Childhood maltreatment, psychopathology and well-being: The mediator role of global self-esteem, attachment difficulties and substance use

“…In two previous studies on the same study population of adolescents in RYC, an association between experienced childhood maltreatment (witnessing violence, victim of family violence, victim of sexual abuse, household dysfunction) and both a broad spectrum of psychiatric disorders and a poor QoL was found (Greger et al, , 2016. In this study we want to explore underlying mechanisms by studying global self-esteem, attachment difficulties and substance use as possible mediating factors of the associations between childhood maltreatment and psychopathology, and between childhood maltreatment and well-being.…”

Children placed in alternate care in Norway: A review of mental health needs and current official measures to meet them

“…Regarding the subjective experience of quality of life (QoL), as measured by KINDL‐R (Ravens‐Sieberer & Bullinger, ), our results showed that adolescents in RYC report lower subjective quality of life in the areas of physical and emotional well‐being, self‐esteem and relationship with friends compared with young people in the general population (Jozefiak & Kayed, ). In addition, poor QoL was associated with experienced childhood maltreatment (Greger, Myhre, Lydersen, & Jozefiak, ). The adolescents' self‐esteem domains − social acceptance and physical appearance − added substantially to the explained variance in QoL among adolescents living in RYC, over and beyond the levels of psychopathology (Jozefiak et al, ).…”

“…Further research is needed to gain more knowledge about how to best combine screening instruments to adequately capture dimensions of psychopathology that are especially relevant for this high‐risk group of children. Although the early identification and assessment of healthcare needs is of major importance for these children and adolescents, more emphasis should also be given to systematic identification of maltreatment, as this is associated with mental disorders (Gover, ; Greger et al, ; Kaplan et al, ; Lehmann et al, ; McLaughlin et al, ; Mills et al, ), poor QoL (Greger et al, ) and poor physical health in a long‐term perspective (Rich‐Edwards et al, ; Springer, Sheridan, Kuo, & Carnes, ; Thurston et al, ). There are several standardised instruments available for assessing maltreatment history and trauma‐related symptoms, for example the Childhood Trauma Questionnaire (Bernstein & Fink, ; Bernstein et al, ), validated in Nordic samples.…”