IPV victimisation and depression are each significant risk factors for adolescent females, with serious consequences that last into adulthood. While some recent literature has examined the prevalence of physical and sexual violence against adolescent females, this study focused on urban minority adolescents and also included an examination of emotional/verbal abuse and threats in these young women’s lives. The adolescent females in our study reported rates of physical IPV (29%) within the range of previous studies (6-46%) (CDC, 2008; Coker et al., 2000
; Foshee, 1996
; Roberts et al., 2005
; Silverman et al., 2001
; Watson et al., 2001
). Compared to findings from previous research, rates of emotional/verbal IPV in our sample were higher when examining our overall rate that included seldom occurrences (75%), but similar when comparing emotional/verbal abuse that occurred sometimes/often (22%) (Roberts et al., 2005
The multi-item measure used in the CADRI was sensitive to capturing a range of emotional/verbal IPV, and may have contributed to the higher rates of abuse reported here. It could also be that cultural factors affected the measurement or prevalence of IPV in this sample of African American and Hispanic adolescent females, but an assessment of cultural variables was beyond the scope of this study. These findings might also indicate that some urban, adolescent females are at especially high risk for being exposed to emotional/verbal partner abuse. Threatening behaviours are usually not assessed when examining IPV among adolescents, but our findings indicate this was a common burden for young females to experience in their relationships (43%), with 3% of our sample experiencing recurrent partner threats. While 30% of adolescents in this sample experienced physical abuse, only one participant had a pattern of exposure. Within each abuse subtype, the majority of this sample had limited exposure, which might indicate they had the ability and/or supportive resources to resist on-going partner abuse. Notably, 25% of the sample encountered all three types of abuse, suggesting a substantial portion of urban adolescent females are at a high level of risk for experiencing multiple forms of IPV.
As expected, each distinct form of abuse related to the participants’ risk of depression in bivariate relationships. The association of emotional/verbal abuse with depression, in bivariate, adjusted and joint models, calls attention to a strong relationship between this type of IPV and depression. Experiencing threatening behaviour was also associated with depression in bivariate and adjusted models. We also found a statistically significant bivariate relationship between physical IPV and depression, but not in the adjusted model. This may be due to the finding that only one participant experienced physical IPV on an on-going basis. Experiencing ongoing physical abuse has been associated with greater partner psychological control in comparison to one-time exposures (Follingstad et al., 1988
).While the relationship between physical abuse and depression was not statistically significant in the adjusted model, the overall measure of IPV (which included physical and non-physical abuse) was also significantly associated with depression.
The findings presented here regarding non-physical forms of abuse for adolescent females are similar to previous research with adult female samples. For example, Houry and colleagues (2006)
found that emotional and physical abuse were each significantly associated with depressive symptoms in African American adult females. Yoshihama, Horrocks and Kamano (2009)
found that emotional abuse, in conjunction with or separately from sexual or physical abuse, was significantly associated with negative mental health outcomes among Japanese adult women. Kramer, Lorenzon and Mueller (2004)
also found that emotional abuse was as strongly associated with health problems (e.g. depression) as physical abuse in a sample of predominately Caucasian woman.
Over half (54%) of the girls in this study reported depressive symptomatology above the cut-off of 15. This is higher than the nationally representative data from the YRBS 2007, in which 36% of adolescent girls were in the clinical range of depression, even in sub-samples of girls from similar urban areas (CDC, 2008
). It could be that the scale we used was more sensitive to detecting depression symptoms than the single item used in the YRBS. Cultural issues may have also influenced the measurement and prevalence of depression symptoms as well. It may also be that some African American and Hispanic female adolescents living in impoverished urban areas have relatively high levels of accumulated adversity without adequate protective factors. Therefore, these young women may have a higher than average risk for these symptoms.
The findings from this study should be considered in light of its methodological limitations. This study employed a cross-sectional design; thus, the temporality of the relationship between IPV and depression cannot be determined. Several studies have suggested that depressive symptoms may precede experience of physical or sexual intimate partner abuse for adolescents (Cleveland, Herrera, & Stuewig, 2003
; Foshee et al., 2004
; Lehrer et al., 2006
). Therefore, adolescent females with a history of depression may be more vulnerable to subsequent abuse than those without this history. In addition, those who experience physical and/or sexual violence in their adolescent relationships are more likely to report subsequent depression as adults (Ackard, Eisenberg, & Neumark-Sztainer, 2007
). Our results suggest this may include non-physical forms of abuse as well. In this cross-sectional study we were unable to examine causal relationships; therefore longitudinal studies are needed to explicate this important relationship over time.
In line with our theoretical perspective of cumulative adversity and the diatheses–stress model, different forms of IPV in this sample of African American and Hispanic adolescent females can be seen as a stress that can transform a potential for depression into actual symptoms. It has also been recognised, however, that diatheses may influence exposure to a stressor (Monroe & Simons, 1991
). More specifically, one may be more vulnerable to depression due to a variety of life circumstances and exposures, which also can influence the likelihood of experiencing adverse life events such as IPV. For example, a diathesis for depression may have been activated by prior stressful exposure. Subsequently, a depressed adolescent female may be more likely to encounter IPV, possibly due to maladaptive interpersonal skills or poor partner selection decisions. In turn, the additional stress of IPV may exacerbate pre-existing depressive symptomatology. From this perspective, adolescent females exposed to recurrent IPV would be more likely to incur deleterious effects such as depression.
The time-frame specified in the questions for the CES-DC was the past week, yet some participants may have experienced depressive symptoms outside of this timeframe. Depressive symptoms not captured by this instrument could be linked to their history of dating violence. Thus, our findings could potentially underestimate the relationship between IPV and depression. Further, even though the CADRI is a multidimensional instrument, it does not measure coercive control. Additionally, the restricted version we used did not measure sexual abuse. Both of these aspects of IPV are deserving of more study. IPV may have also been underestimated since participants were asked only about one partner within the past year. Also, our measure of IPV was limited to behaviours and we do not know the intent or meaning behind any of these acts. Given that the CADRI gathers information of a sensitive nature and we used an interview format, it is possible that respondents were hesitant to divulge information related to their abuse history through this method. Thus, the occurrence and/or frequency of abuse may be underestimated.
Implications for clinical practice
The results from this study can aid practitioners in assessment and intervention. Providers who identify depressive symptoms in urban minority adolescent females should assess for both physical and non-physical forms of IPV. Given the broad range of activities that constitute IPV, assessing physical and sexual abuse alone is not sufficient. Detailed assessments of relationship dynamics, including emotional/verbal abuse and threatening behaviours can also help to identify urban minority adolescent females who may be at risk for depression. Previous research also indicates that adolescent females exposed to IPV have a greater likelihood of experiencing more severe depressive symptoms if they do not have adequate support from family and friends (Holt & Espelage, 2005
; Roche, Runtz, & Hunter, 1999
). With social support, these adolescents are more likely to leave an abusive relationship (Champion, Shain, & Piper, 2004
). For practitioners, encouraging family support as well as greater access to community resources for adolescents in abusive relationships may be an important step in reducing the possibility of depressive symptomatology.
Depression is frequently under-recognised and under-treated among adolescents, and can be a target area for practitioners in assessment and intervention. Depressive symptoms among adolescents are often misdiagnosed as primarily conduct, attentional, or substance abuse disorders, or attributed to normal adolescent development (Saluja et al., 2004
; Smith & Blackwood, 2004
). Youth who experience depressive symptoms are also at risk for decreased school performance (Wong et al., 2003
), increased STI/HIV risk related behaviours (Brown et al., 2006
), and increased risk of suicide (Bhatia & Bhatia, 2007
). Early onset of depression is predictive of more severe depression and other adverse outcomes, including poorer health, higher healthcare service utilization, and increased work impairment during adulthood (Bhatia & Bhatia, 2007
; Fergusson, Boden, & Horwood, 2007
; Keenan-Miller, Hammen, & Brennan, 2007
). Likewise, IPV in adolescents is often missed by primary care and social service providers. Females who experience IPV in adolescence are more likely to face IPV in their adult relationships (Teitelman et al., 2008
As practitioners, the early detection to both multi-dimensional IPV and depression can help to identify at-risk youth in need of care and services. Provision of adequate protective factors can reduce the accumulation of further adversity and of long-term negative physical and mental health consequences (Hatch, 2005
). In particular, youth with a history of prior adversity and stressors may be at greater risk for both depression and exposure to IPV, requiring more extensive treatment and follow-up.