Gender Specific Associations Between Parental Risk Factors and Trauma-Related Psychological Symptoms Among Adolescents Jamara A. Tuttle, MSW 1,2,Terry Sears, DrPH 1, Harolyn M.E. Belcher, M.D., M.H.S. 1,3,4 Kennedy Krieger Institute 1,Howard University 2,Johns Hopkins School of Medicine 3, Johns Hopkins Bloomberg School of Public Health 4

Abstract In 2004, United States’ child protective service agencies reported that 26.1% of the substantiated 872,00 cases of abuse occurred among youth ages 12 to 17 years old. This study was designed to examine the association among parental risk factors, psychological symptoms related to adverse childhood experiences and gender in adolescents. The Trauma Symptom Checklist for Child (Briere, 1996) was used to assess 182 adolescents treated at an urban-based mental health clinic. The majority of the study participants were female (61%) and African American (67%). The average age was 12.8 (+1.9). Regression analyses were conducted with and without gender stratification. Models were adjusted for race/ethnicity and age of admission to treatment. Maternal mental health disorders were associated with depressive (8.0, p<0.05) and overt dissociation symptoms (6.8, p<0.05) in female offspring. Parental mental health was associated with sexual concern-distress in female offspring (11.8, =0.05). Paternal incarceration was associated with increased anger (8.2, p<0.05) and maternal incarceration was associated with increased dissociation-fantasy symptoms (8.8, p<0.05) in male adolescent offspring. Data suggest that parental mental health is associated with psychological symptoms in female offspring and parental incarceration is associated with psychological symptoms in male offspring. These findings may assist mental health clinicians in the identification of gender-specific risk factors associated with adverse psychological symptoms.

Introduction In 2004, 26.1% of substantiated child abuse cases occurred among youth ages 12 to 17 years Adverse childhood experiences (ACE) including: physical abuse, sexual abuse, emotional abuse, and living with caregivers who have substance abuse and mental health disorders, history of incarceration, and/or domestic violence places the child at significant risk for cardiovascular disease, obesity, cirrhosis, mental health disorders, and substance abuse as adults Immediate effects of ACE may result in different mental health symptoms based on the age, gender, and frequency and severity of exposure.

Purpose To evaluate the association between parental risk factors and trauma-related psychological symptoms To determine if parent risk factor and trauma-related psychological symptom associations are different by gender

Method Data was collected on 182 children, ages 12 to 17 years, treated at an urban-based mental health center that focuses on addressing the needs of children with a history of ACE. The Trauma Symptom Checklist for Children (TSCC) was used to assess symptoms related to trauma exposure. The TSCC is a self-report of post traumatic stress and related psychological symptoms. Clinical Scales include: Anxiety, Depression, Anger, Posttraumatic Stress, Dissociation (> 65 Clinical) and Sexual Concerns (> 70 Clinical).

Table 1. Demographics N=182 Characteristicsn(%)Mean (S.D.) Gender (female)111 (61) Race (African American)122 (67) Age (years)12.8 (1.9) Physical Abuse44 (24) Sexual Abuse51 (28) Emotional Abuse13 (7) Neglect84 (46) Trauma Symptom Checklist for Children Anxiety47.2 (10.3) Depression46.9 (10.8) Anger49.0 (10.8) Post Traumatic Stress48.2 (10.3) Dissociation-Overt48.3 (9.5) Sexual Concerns-Problems50.6 (12.3) Sexual Concerns-Distress54.9 (18.7)

Table 2. Psychological Symptoms Associated with Parental Risk Factors and Youth’s Gender N=182 (adjusted for race/ethnicity & age at admission) Parental Risk Factorβ95% Confidence Intervalp Paternal Incarceration [Anger] to 7.6>0.05 Boys to Girls to 5.9>0.05 Maternal Incarceration [Dissociation-Fantasy] to 7.7>0.05 Boys to Girls to 4.0>0.05 Maternal Mental Health Disorders [Depressive Symptoms] to Boys to 7.0>0.05 Girls to Maternal Mental Health Disorders [Dissociation Overt] to Boys to 9.5>0.05 Girls to Parental Mental Health Disorders [Sexual Concern-Distress] to 13.7>0.05 Boys to 0.8>0.05 Girls to

Results Maternal mental health disorders were associated with depressive (8.0, 95% CI 1.7 to 14.2, p<0.05) and dissociation-overt symptoms (6.8, 95% CI 1.5 to12.1, p<0.05)among females. Parental mental health disorders had a trend association with sexual concerns-distress ( % CI to 23.7, p=0.052) in females. In adolescent males, paternal incarceration was associated with increased anger (8.2, 95% CI 1.7 to 14.7 p<0.05) and maternal incarceration was associated with increased dissociation-fantasy (8.9, 95% CI 1.5 to 16.2, p<0.05).

Conclusion Adolescent female trauma symptoms were associated with parental mental health disorders. Adolescent male trauma symptoms were associated with a history of parental incarceration.

Clinical Implication This preliminary study suggests that parental risk factors may be associated with gender specific patterns of trauma symptoms. Improved understanding of trauma response for each gender may assist in the development of effective gender- specific mental health interventions.