1. Conclusions & Implications Table 1: Characteristics of Sample (N=156)
Stress as a mediator of the relationship between youth trauma and
physical health among behavioral health service-seeking adults
Frank J. Snyder, Ph.D. M.P.H.1, Bronwyn Hunter, Ph.D.2, Azure B. Thompson, Dr.P.H. 2, Samantha L. Matlin, Ph.D2,3, Jacob Kraemer Tebes, Ph.D.2
1Department of Health & Kinesiology, College of Health and Human Sciences, Purdue University, 2Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, 3Philadelphia Department of Behavioral Health and Intellectual disAbility Services
Introduction
Methods (continued)
Results (continued)
Conclusions & Implications
Exposure to traumatic contexts (e.g., abuse, family violence) in childhood and adolescence has been shown to negatively affect health later in life.[1, 2] Less is known, however, about how youth exposure to trauma is related to adulthood stress and physical health.[3]
The current study supports the literature that suggests a link between traumatic youth contexts and adult stress and physical health.
Among this service-seeking adult population, perceived stress completely mediated the effect of youth trauma on current physical health.
Behavioral health interventions seeking to improve physical health may consider strategies to reduce perceived stress among adults exposed to youth trauma. One such strategy may include arts-based interventions, which have demonstrated promise in improving health and well-being.[4]
Table 1: Characteristics of Sample (N=156)
Figure 1: Path Model
Variable M SD
Age
43.5
11.3 n %
Gender
Male 65
41.7
Female 91
58.3
Race/ethnicity
African American 98
62.8
Hispanic 45
28.9
Other 13
8.3
Education
< High school 59
38.8
High school 54
35.5
> High school 39
25.7
Median
Income (median)
$5,001–$10,000
19.6
Objectives
The purpose of this study was to test a mediation model whereby perceived stress mediated the effects of youth trauma on physical health among behavioral health service-seeking adults.
Methods x.
Data were collected as part of the Philadelphia Community Health Project, a collaborative study involving the Philadelphia Department of Behavioral Health and Intellectual disAbility Services and several behavioral health clinics in distressed Philadelphia neighborhoods. Study participants were 156 behavioral health service-seeking adults in recovery from addiction or mental illness. A total of 99 participants were also subsequently invited to join in the creation of public murals under the guidance of the City of Philadelphia Mural Arts Program in order to promote individual recovery and well-being and help revitalize Philadelphia neighborhoods.
Cross-sectional data were collected on demographic characteristics including race/ethnicity, income, age, gender, and education. Data were also collected on youth trauma (Specific Childhood and Lifetime Trauma), perceived stress during the last month (Perceived Stress Scale), and current somatization/physical health (Brief Symptom Inventory–18, Somatization subscale).
Note: Fit Indices: χ2(2)= (ns); CFI=1.00; TLI=1.00; RMSEA 0.001
Table 2: Standardized effects of stress as a mediator of the relationship between youth trauma and physical health
Results
Path analysis (Figure 1), controlling for demographic characteristics, revealed that perceived stress mediated the relationship between youth trauma exposure and current somatization/physical health among adults seeking behavioral health services (Table 2). More specifically, the mediation model demonstrated an indirect-only mediation effect, whereby a significant mediated effect existed, but there was no direct effect of youth trauma on adulthood physical health. That is, the effect of youth trauma on adulthood physical health was completely mediated by adult perceived stress.
Additional longitudinal research is needed.
Future research will examine the impact of arts-based activities on individual recovery, including the effect of the program on participants’ stress and physical health.
Measures will also include community interviews and systematic social observations to examine community-level effects.
Future Research
Standardized Coefficient (β)
95% CI
Stress
Child trauma
0.187*
(0.029–0.345)
Age
0.038
(-0.132–0.207)
Male
-0.112
(-0.271–0.046)
African American
-0.186*
(-0.346–-0.027)
Income
0.016
(-0.149–0.181)
Somatization/Physical health
Stress
0.566***
(0.462–0.669)
(-0.078–0.154)
-0.040
(-0.160–0.079)
-0.035
(-0.148–0.079)
-0.329*
(-0.443–-0.214)
-0.188*
(-0.304–-0.072)
References
[1] Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), [2] Wu, N. S., Schairer, L. C., Dellor, E., & Grella, C. (2010). Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addictive Behaviors, 35(1), [3] Min, M. O., Minnes, S., Kim, H., & Singer, L. T. (2013). Pathways linking childhood maltreatment and adult physical health. Child Abuse & Neglect, 37(6), [4] Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2),
Acknowlegements
We would like to extend our appreciation to the participating agencies, staff, and study participants. Funding has been provided by Robert Wood Johnson Foundation (LFP City of Philadelphia/RWJF), the Thomas Scattergood Foundation, the National Institute on Drug Abuse (T32 DA019426), and Purdue Research Foundation Summer Faculty Grant.
Note: *p < .05, **p < .01, ***p < .001