Study participants span three generations, sexually abused and comparison females comprising the original sample recruited for participation in the longitudinal study, the caregivers (usually the mother) of these females, and the offspring of these females. Henceforth the caregivers of the original sample will be referred to as the first generation (G1), the original sexually abused and comparison female participants of the longitudinal study will be referred to as the second generation (G2), and the offspring of these original participants will be referred to as the third generation (G3).
Original sample (G2)
Sexually abused females (N
= 84) were referred by child protective service (CPS) agencies in the greater Washington, D.C., metropolitan area. Eligibility criteria included: (a) age 6 to 16; (b) participation within 6 months of disclosure; (c) substantiated contact sexual abuse including genital contact and/or penetration; (d) perpetration by a family member (parent, grandparent, older sibling, uncle); and (e) participation of a nonabusing caregiver who was usually the biological mother (i.e., constituting the G1 sample) to inform on participants' functioning, family environment, demographics, and provide some limited information regarding her own developmental history. CPS records indicated that the median age at onset of abuse was 7.8 years, the median duration was 24 months; 70% experienced vaginal and/or anal penetration, and 60% of perpetrators were the primary father figure (biological fathers, stepfathers, or mothers' live-in boyfriends). The information on the perpetrators, the average age of onset, and the average duration is similar to comparable information reported in national surveys of protective services caseloads in years proximal to obtaining the sample via data reported in the National Incidence Study conducted by the National Center on Child Abuse and Neglect (1988)
The comparison sample (N = 82) was recruited via advertisements in community newspapers and posters in welfare, daycare, and community facilities in the same neighborhoods in which the abused participants lived. Comparison families contacted study personnel and were screened for eligibility, which included having no prior contact with protective service agencies and being demographically similar to a same-aged abused participant. Of the comparison families, 70% resided in the same zip code district, 20% in adjacent districts, and 10% in comparable, nearby districts. Comparison females were similar to the abused females in terms of racial/ethnic group, age, predisclosure socioeconomic status, family constellation (one or two parent families), and other nonsexual traumas.
Of the sample, 49% were Caucasian, 46% African American, 4% Hispanic, and 1% Asian American. The study design flow is depicted in . At the initial assessment (Time 1; T1), females ranged in age from 5.91 to 16.89 (M
= 11.11, SD
= 3.02) and reported low to middle socioeconomic status (Hollingshead, 1975
). Five follow-up assessments were conducted (Times 2 through 6; T2–T6). Ages at follow-up assessments were as follows: T2 6.92 to 18.20 (M
= 12.22, SD
= 2.96); T3 7.78 to 20.22 (M
= 13.42, SD
= 3.00); T4 10.63 to 25.91 (M
= 18.05, SD
= 3.42); T5 13.25 to 26.67 (M
= 19.85, SD
= 3.24); T6 18.12 to 32.14 (M
= 24.89, SD
Multigeneration Study Flow of the Original Sample (G2) and Their Offspring (G3)
At some point after entry into the study, 13 comparison females revealed that they had experienced some form of childhood sexual abuse and were dropped from the study (see ). At T4, 20 new comparison females were recruited (utilizing the original recruitment methods) to fortify the sample for longitudinal follow-up. More than 96% of the total sample were retained and reassessed at T5 and T6 follow-up assessments. By the conclusion of T6, 70 females reported having had at least one child.
Offspring sample (G3)
At the conclusion of the T6 assessment there were 135 known offspring; 78 offspring of abused mothers (OA), and 57 offspring of comparison mothers (OC). These offspring ranged in age from 5 months to 11 years 10 months with the mean age being similar across groups (OA M = 4.60, SD = 3.35, OC M = 3.56, SD = 2.57; p = n.s.) and were 53.66% minority (mostly African American with 3% Hispanic and 1% Asian). There were significantly more minority offspring in the OC sample (66.12%) than the OA sample (43.23%) F(1, 133) = 5.61, p < .05. Neither the average number of children per family nor gender differed significantly across the OA and OC groups (see ). The G3 sample included 76 only-children, 18 sibling pairs, 5 sibling trios, 2 families with four siblings, and 0 multiples. Of the 135 known offspring, 123 (91%) were assessed as part of the T6 protocol. Hence, G3 outcome information was not available for 12 offspring—6 were unable to be scheduled (3 OA, 3 OC), 3 had fathers who expressed their wishes that their children not participate (all 3 OA), and 3 were deceased (all 3 OA). Of the deceased, 2 died from complications of prematurity and one drowned in a bathtub as a result of maternal neglect.
Percentage of Occurrence (± SE) for Variables Assessed Across the Three Generations Arrayed By the Original (G2) Abused and Comparison Groupings
Assessments were completed in two 3-hr sessions by female-trained female clinical interviewers. In general, the bulk of assessments were focused on the original G2 sample of abused and comparison females. These assessments were comprehensive and spanned biological, psychological, and social domains. For purposes of the present investigation, we focus on a subset of constructs assessed during the final three assessments of this longitudinal study (T4–T6), reporting only on those constructs hypothesized to constitute significant risk factors associated with deleterious outcome for offspring. Caregivers of these original participants (G1) functioned mainly as informants of their daughters' functioning, but also provided limited self-reports of their own functioning and retrospective reports of their past histories. Offspring of the original sample (G3) were assessed as part of the T6 protocol and varied considerably with respect to age and developmental stage thus resulting in variable assessment tools and variable Ns for offspring outcomes.
G1 caregivers provided consent for G2 participants who were younger than the age of 18; those 18 and older signed for themselves, and those younger than 18 also provided assent. G2 mothers provided consent for G3 participants. All participants were awarded monetary compensation at a rate put forth by the National Institutes of Health Normal Volunteer Office. The study received approval from the University Institutional Review Board and obtained a Federal Certificate of Confidentiality.
Maintaining and engaging the G2 sample over the course of this longitudinal study was a significant challenge. Several strategies were employed including (a) frequent mailings (birthday and holiday cards, quarterly newsletters) and certified letters to maintain current addresses, (b) home visits to those whose telephone service was interrupted or unlisted, (c) address tracking software, and (d) obtaining information for two additional contact persons (family members, friends) who would likely have knowledge of participants' whereabouts. In addition, by communicating the importance of scientific knowledge gained from this type of longitudinal research, the research staff was able to foster considerable participant fulfillment as many participants viewed the study as a chance to contribute to something bigger than themselves and took tremendous pride in doing so. Finally, the research staff was inordinately cohesive, dedicated, consistent, and diligent.
Because of space constraints, measurement instruments are not discussed in detail as they are either widely used assessment tools or have been detailed in the referenced manuscripts.
Original sample (G2) assessments
Traumatic victimization histories were assessed via the Comprehensive Trauma Interview (Noll, Horowitz, et al., 2003
). Analyses included up to four of the most recent victimizations that occurred subsequent to study entry
and were subjectively rated by participants as being “very” or “extremely” upsetting as anchored to their identified “most upsetting” traumatic experience. Sexual victimizations
were sexual assaults or rapes involving bodily contact (e.g. genital fondling) by peers defined as individuals within 4 years of age of victims younger than 18, or any incident for victims older than 18. Nonpeer (i.e., individuals 4 or more years older than victims younger than 18) sexual victimizations occurring subsequent to their referring abuse were included for sexually abused participants. Physical victimizations
were contact (e.g., leaving marks or requiring medical attention) peer or nonpeer assaults. To increase reliability of responding, only victimizations reported at least twice during consecutive interviews, or those occurring during the time period preceding T6, were included.
was assessed via the Domestic Conflict Inventory (Margolin, 1981
), which assesses a host of violent acts (e.g., physically threatened, hit, or beaten) perpetrated by an intimate partner. Domestic violence was defined as the most recent occurrence of having experienced three or more of these acts at the hands of an intimate partner. Dropout
was defined via self-reports of having not completed high school and not being currently enrolled in high school or GED classes by the conclusion of the T6 assessment.
For the remaining constructs, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV
) diagnostic threshold or clinical cutoff scores (according to published norms) were used to define each occurrence. If multiple occurrences were observed, the most recent occurrence was included in present analyses. Posttraumatic Stress Disorder (PTSD)
was assessed via the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-IV
) PTSD criteria inventory (Davidson, Kudler, & Smith, 1989
) which was modified to be DSM-IV
compliant and concerned the traumatic event identified by the participant as the “worst” or “most upsetting.” Depression
was assessed via the Childhood Depression Inventory (Kovacs, 1981
) until age 18 and the Beck Depression Inventory (Beck, Steer, & Brown, 1986
) for adults aged 19 and older. Dissociation
was assessed via the Dissociative Experience Scale (Berstein & Putnam, 1986
). Current and lifetime reports of psychiatric diagnoses were assessed via the Scheduled Clinical Interview for DSM Diagnoses (SCID; First, Spitzer, & Williams, 1995
). For the present analyses, Psychiatric Diagnosis
was defined as having reached DSM-IV
criteria for at least one of the following disorders: anorexia nervosa/bulimia, attention deficit/hyperactivity disorder, oppositional defiant disorder, bipolar disorder, major depression, obsessive compulsive disorder, generalized anxiety disorder, panic disorder, or social phobia. The SCID was also used to assess Alcohol Dependence
and Substance Dependence
, each of which quantified separately for analyses. Being a Regular Smoker
was assessed via direct queries regarding smoking behaviors and was defined as daily consumption of cigarettes. If mothers reported multiple periods of regular smoking, the most recent occurrence was included in present analyses. Obesity
was assessed in adulthood via standardized height and weight assessments and was defined per Centers for Disease Control (CDC) guidelines as body mass index (BMI) ≥ 30.
Offspring sample (G3) assessments Born to a teenage mother
was assessed for all 135 known offspring, was calculated as the G3 date of birth minus the respective G2 date of birth, and was defined as being born to a mother who was 18 years 11 months old or younger. This variable was calculated for all 135 known offspring. The remaining G3 outcome variables were assessed at the T6 assessment session and, unless otherwise noted, were available for 123 offspring. G2 mothers reported on the intendedness of each pregnancy with Unintended
being defined by combining five items from an intensive labor and birth semistructured interview and questionnaire (α = .78). Two items concerned being unmarried or not cohabitating with the index G3 biological father at either conception and at the time of the birth. Three additional questions concerned the extent to which mothers were reluctant to get pregnant and assessed ambivalent feelings with regard to becoming pregnant and giving birth to the index G3 child. For purposes of the present analyses, a G3 participant was considered unintended if scores on this scale were 2 standard deviations above the sample mean. Born preterm
was gleaned from hospital labor and delivery records obtained via a release signed by each G2 and was defined as gestational age of fewer than 37 weeks. Involved in Child Protective Services (CPS)
was defined as G2 reports of her children having been neglected, physically abused, or sexually abused, and having been assigned a caseworker in participants'local jurisdiction as a result. Cognitive deficit
= 86) was defined as scoring 1.5 standard deviations below the population mean according to norms on one of two cognitive assessments: (a) the Bayley Scales of Infant Development 2nd edition (mental scales only; Bayley, 1993
) for ages 11 to 42 months, or (b) the Peabody Picture Vocabulary Tests–Revised (PPVT-R; Dunn & Dunn, 1981
) scores for ages 43 months and older. The reduced N
reflects those who were available for assessment and within the restricted developmental range as per Bayley and PPVT-R protocol instructions.
Caregiver sample (G1) assessments
Data were available for 128 caregivers. As noted earlier, these assessments were limited. For purposes of the present analyses, only caregiver self-reports of sexual abuse were included. G1 history of childhood sexual abuse was gleaned from a maternal developmental history questionnaire assessed at T1 using an intensive interview format and probing sensitive details of child abuse histories. Given that these were retrospective in nature, reports of G1 childhood sexual abuse were not cross-verified with CPS reports.
Analyses and Results
Percentages associated with the occurrence of each variable assessed are included in . Group mean comparisons were conducted via ANCOVA models with age and minority status covaried and Bonferroni alpha corrections imposed using SPSS (v. 13.0). Results indicated that significantly more caregivers (G1) of abused females retrospectively reported being sexually abused in childhood. Abused G2 females were more likely than comparison G2 females to have experienced at least one physical victimization, reached clinical cutoff for adult depression, be diagnosed with at least one psychiatric disorder, report a substance dependence, report an alcohol dependence, be a high-school dropout, be the victim of domestic violence, and be obese. G3 offspring born to abused mothers (OA) were more likely than offspring born to comparison mothers (OC) to have been born to a teen mother, have been born premature, and have been involved in child protective services. Intraclass correlations for G3 variables ranged from .02 to .13 with none reaching significance thus indicating negligible effects of sibling inclusion. However, a variable quantifying sibling number (0, 1, 2, or 3) was included in all models as an additional covariate to provide further assurance that the inclusion of siblings did not inflate results.
Because of fluctuations in sample size and multiple forms and patterns of missing data, neither multivariate comparisons among variables nor multivariate predictions of offspring outcomes were performed on these data. Instead, we opted to present a descriptive account of the number of risk factors operating in the lives of each offspring individually and to place these risk factors in developmental context for both the G2 and G3 participants. The resulting “lifeline” plots depicted in and (OA and OC, respectively) represent the lifeline of each G3 participant superimposed in the life span of his or her G2 mother. In these plots, the age of the G2 mother is arrayed horizontally on the x-axis and the age of G3 offspring is arrayed vertically on y-axis. By way of example, the oldest child in the OA sample (see the topmost lifeline in ) is an 11-year, 10-month-old non-minority girl who was born when her mother was approximately 17 years old and was last assessed when her mother was approximately 28 years old. The lifeline of this G3 offspring is superimposed on the life span of her G2 mother, and symbols representing the various risk factors are plotted with respect to age of the G2 mother at the occurrence of each. The resulting lifeline plots represent the cumulative risks to G3 offspring associated with (a) the experiences of the two previous generations and (b) the deleterious outcomes observed for these offspring. Thus, risk factors for the G3 sample can fall both directly on their lifelines as well as in the lives of their mother or grandmother prior to their birth. and contain the lifeline plots for the two groups of offspring, offspring born to abused mothers (OA) and offspring born to comparison mothers (OC). Plots were produced for all 135 known offspring; however, as noted above, G3 outcome assessments were not obtained for 12 offspring, and several assessments were conducted only for offspring within a restricted range of development (e.g., cognitive assessments). Those not assessed or assessed with only limited information are identified with (*) symbols in the plots. Results indicated that, on average, the OA sample experienced more risk-factors than the OC sample with age, minority status, gender, and sibling number covaried (OA M = 6.23, SD = 3.14; OC M = 3.88, SD = 2.11; F(1, 129) = 5.89; p < .05).
Third-generation lifelines with transgenerational risk-factors plotted for G3 offspring born to G2 mothers who were sexually abused in childhood (OA)
Third-generation lifelines with transgenerational risk-factors plotted for the comparison group of G3 offspring (OC)
The final analysis was an attempt to place risk factors in developmental context for G3 offspring. For example, it would be logical to assert that domestic violence occurring in the life of a child would be more damaging to a child and have a more lasting impact on that child's future development than domestic violence occurring earlier in the life of the mother before the child was born. To this end, we conducted a weighted analyses where risks that occurred in the lifetime of the G3 offspring, falling on the child's lifeline, were weighted twice (2×) those falling prior to the birth of offspring. Because of substantial crowding of risk factors occurring on or about the time of the birth of G3 offspring, three variables were considered to have fallen on the G3 lifeline although they are depicted just prior each birth and include (a) being born to a teen mother (teen pregnancy), (b) prematurity, and (c) unintendedness. These three variables were assumed to constitute substantial risk to children and were thus weighted 2×. Although selecting a 2× magnitude for all risk factors lying on G3 lifelines is slightly arbitrary, and differential weighting may have been more appropriate for some risks (e.g., the impact of child protective service involvement is likely more deleterious than other risks), we sought to take a parsimonious approach to weighting in the absence of definitive empirical support for a differential weighting scheme. With age, minority status, gender, and sibling number covaried, results of the weighted analysis indicated a significantly higher weighted average for the OA sample (M = 9.21, SD = 4.17) as compared with the OC sample (M = 5.77, SD = 3.41; F(1, 129) = 8.67; p < .01).