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To date, no studies have investigated emotional abuse of adult Latina women by their mothers despite evidence that emotional maternal abuse may significantly contribute to the emotional abuse experienced by Latina women in their lifetime.
Cross-sectional data including 316 women was analyzed using mediation and logistic regression.
Overall, 7.1% of mothers and 24.1% of daughters abused drugs; and, 19.5% of daughters were emotionally abused by their mothers. Mother's attachment to her daughter mediated the association between mother's drug abuse and emotionally abusing her adult daughter (Indirect effect: 0.863).
Latina women can serve as perpetrators of emotional abuse of their adult children. Since drug-abusing daughters are more likely to be victims of emotional abuse by their mothers and drug-abusing mothers are more likely to abuse their daughters, drug-rehabilitation practitioners should incorporate a family abuse component into rehabilitation programs.
Emotional abuse is that which a person verbally attacks another person with disrespect or fury (e.g., criticism of others' appearance or personality, mockery, teasing, and swearing) that may generate psychological pain (1). Previous investigations have demonstrated that 25-33% of Latinas experience emotional abuse, which is much higher than the 4.6% reported in studies of nationally representative U.S. samples (2, 3, 4). Exposure to emotional abuse causes stress and negatively affects a woman's mental health (5, 6); nonetheless, most previous studies have only investigated emotional abuse of Latina women that is perpetrated by their husbands (7). To date, no studies have investigated maternal emotional abuse among adult Latinas by their mothers despite evidence that this may significantly contribute to the emotional abuse Latina women experience in their lifetime.
Emotional abuse among Latinos may be primed by the unique cultural characteristics and typical living arrangements (8). As the Latino community continues to grow and Latinas age, we expect the numbers of older mothers will drastically increase. From this perspective, many more adult daughters may be exposed to emotional abuse by their mothers. In 2050, the US Latino population aged 65 years and older is projected to reach 71 million, up from 37.4 million in 2010 (9).
As middle-aged persons age, they face potential increases in aging-related health and psychosocial conditions, which may increase their exposure to psychoactive prescription medications (10) and risk of non-medical use/abuse or dependence on drugs (11, 12). Across racial/ethnic groups, past-year substance use disorders (SUD) among 50-59 year olds are projected to increase from 1.9 million in 2002–06 to 3.1 million in 2020, and are expected to more than triple among 60-69 year olds from 0.6 million to 1.9 million during the same time-period (13). Among Latinos, the association between SUD and emotional abuse perpetrated by mothers with adult children is not clearly understood.
The issue of emotional abuse may characterize consequences of new tensions in Latino family relationships. A study focusing on the links between family relationships and emotional abuse in Latino families underscored the importance of the mother in her children's lives, including throughout adulthood (14). Compared to other aging populations, Latinos are twice as likely to live with family members and foreign born Latinos are especially dependent on their children (15); nonetheless, Latino parents are still expected to be an authority figure to their children (16). The Latino cultural value familismo posits that Latina women should be the main caregivers and nurturers for aging family members, and the value respeto influences a great deal of respect toward parents (17); accordingly, many Latina mothers, although expected to remain authority figures in the family, become dependent on their adult-daughters to support them financially and provide them with necessary resources including medical care. The stress that results from loss of independence and authority, and conflict between older family members who highly value familismo and respeto and younger, more U.S.-acculturated family members who may value individualism and autonomy (18), may cause mothers to emotionally abuse their daughters.
Our study seeks to expand the existent knowledge on emotional abuse and mother daughter attachment. Latina mother-daughter dyadic attachment often forges strong lifelong ties in which both dyad-members rely profoundly on one another for emotional, financial, and other support over the lifespan (19). De La Rosa, Dillon, Rojas, Schwartz, and Duan (20) demonstrated that closer attachment to the mother was associated with a daughter's lower engagement in sexual activity while under the influence of drugs, suggesting that daughter's attachment to her mother is protective against this sexual risk behavior.
There is a gap in the literature regarding the extent to which SUD increases emotional abuse among Latino mothers and adult daughters and the mediating role of attachment as a protective factor. Such information could provide public health clinicians with a better understanding of the effects of drug abuse on Latino family structures. Accordingly, such a study may inform the development of more appropriate drug rehabilitation programs for this population. Thus, our study specifically focuses on the emotional abuse perpetrated by mothers (mean age = 58.52 years) toward their adult-daughters (mean age = 32.48 years). Drugs included alcohol, illicit drugs, and non-medical use of prescription medication. The aims of our study are to examine:
Data were taken from the “Longitudinal Study of Drug Abuse & HIV Risk Among Latina Mother-Daughter Dyads” in Miami-Dade County, Florida. Data were collected between 2010 and 2011. The baseline study purposely attempted to recruit substance using and non-using participants via snowball sampling to ensure adequate range of variability in alcohol/drug use practices. Inclusion criteria comprised: (a) consenting to be interviewed; (b) being at least18 years old; (c) self-identifying as Latina; and, (d) living in Miami-Dade County, Florida. Exclusion criteria included enrollment in a drug treatment program during the 12 months prior to the interview. A detailed description of the sample selection criteria and sampling methods is provided elsewhere (20, 21).
Participants were administered a structured individual face-to-face interview that took 1-1.5 hours to complete. They received a $40.00 incentive for the interview. Interviews took place at locations convenient to participants (e.g., participants' homes or in public places). The study was approved by, and conducted in compliance with, the Institutional Review Board at a major public university in South Florida.
Exposure to emotional abuse during the past 30 days and throughout entire lifetime was assessed using a subsection of the Addition Severity Index (22). The first section asks participants to identify if they have had close, long lasting, personal relationships with a list of social actors. The second section asks participants to report the occurrence of significant periods of time when they have experienced serious problems getting along with these people. Participants were asked to respond “yes” or “no” to the following question: “Did any of these people (e.g., mother, father, partner, friends) mentioned in the last few questions abuse you emotionally, meaning, make you feel bad through harsh words; does not allow you to go out or meet with certain friends; and/or, break things in the house?” Those who answered “yes” were asked to identify who the perpetrator(s) was/were. This measurement has been previously used in studies on substance abuse and emotional abuse (23, 24).
We used the Drug Use Frequency measure (DUF; 25) to assess frequency of use of cannabis, cocaine, PCP, heroin, inhalants, and hallucinogens. DUF also assessed the frequency and use of each type of prescription drug (i.e., sedatives, hypnotics or tranquilizers, stimulants, or opioids) that was used for non-medical purposes using an 8-point Likert scale ranging from 1 (never uses) to 8 (uses every day). Past research indicates convergent validity of DUF scores that correlated closely with collateral reports of drug use frequency with self-reports in other drug and alcohol use measures (25). A participant was categorized as abusing illegal substances in the past 12 months if she fulfilled at least one of the following criteria: (a) three days or more per week of marijuana use, (b) two or more days per week of cocaine use, (c) one or more occasions of heroin use per week, (d) three or more occasions of ecstasy use per month, and/or (e) non-medical use of prescription drugs (use of a medication without prescription, or using prescription medication in greater amounts than prescribed or for a longer period of time than prescribed; adapted from (26).
Mother/daughter attachment was measured using a 25-item adapted version of the Inventory of Parent and Peer Attachment (IPPA) (27). The IPPA assesses self-perception of positive and negative affective and cognitive attachment with parents and peers including subscales of trust, communication, and alienation. Sample items include “I trust my daughter/mother” (trust scale) and “I can count on my daughter/mother when I need to get something off my chest” (communication scale). Agreement with each statement is rated via a 5-point Likert scale ranging from “almost never or never true” to “almost always or always true.” A confirmatory factor analysis of the IPPA scale revealed an adequate fit to the data of the overall IPPA score [χ2 (268) = 587.52, p < .0001; CFI = .91; RMSEA = .06] (Cronbach's alpha coefficients for the total scale score were 0.93 for the total sample, 0.93 for the daughter sample, and 0.92 for the mother sample). Additional information on the scale and its use in this sample can be found in a previous publication (20).
We described the socio-demographic characteristics of the sample using proportions for categorical variables and means with standard deviations (SD) for continuous variables. To determine significant associations for Aim 1, logistic regression analysis were performed. Significant associations were determined with p-values (< .05) and 95% confidence intervals (CIs). Analyses for Aims 2 and 3 were performed using the PROCESS computational tool model 4 (28) in SPSS v.21. PROCESS produces regression coefficients in unstandardized form. The scale of measurement of the variables in the model determined the scale of unstandardized coefficients. Each model included one exposure variable (e.g., mother drug abuse), one mediation variable (e.g., mother's attachment to her adult daughter) and one outcome variable (e.g., mother being a perpetrator of emotional abuse against her daughter). All models adjusted for substance use at sample configuration to control for oversampling of substance abusers. In the present study, 95% CIs were produced for the potential mediator, and were used to identify the presence of significant total and specific indirect (i.e., mediation) effects. We identified the presence of a significant estimate of indirect effects when zero was not included within the CIs.
The present study includes 299 of the women who were interviewed between 2010 and 2011. The mean age of the mothers and daughters were 58.5 ± 10 and 32.5 ± 9 years old, respectively. About one third of mothers were divorced (34.8%) whereas 39.7% of daughters were married/living with a partner or single (39.7%). More than half of the mothers were born in a Latin American country other than Cuba (51.8%). About half of the daughters were born in the United States (47.1%). More than half of the mothers and daughters were U.S. citizens. Among mothers, 36.6% reported their highest level of education as less than high school. Among daughters, the largest proportion (37.2%) reported additional training after high school as their highest level of education. Most of the mothers were unemployed (55.4%); whereas most of the daughters were employed (64.5%) (Table 1).
The prevalence of drug abuse during the past 12 months was 7.1% for mothers and 24.1% for daughters. The prevalence of mother against daughter emotional abuse was 19.5%. Mother's country of origin, employment status, marital status and age were not associated with being a perpetrator of emotional abuse against her adult daughter.
Mothers who abused drugs were more likely to perpetrate emotional abuse against their daughters (OR: 4.65; 95% CI: 1.05, 20.51) (Table 3). Daughter's drug abuse was associated with being more likely to suffer emotional abuse by her mother (OR: 3.11; 95% CI: 1.05, 9.27) (Table 2).
Mother's drug abuse had a significant negative effect on her attachment to her adult daughter (p=.010) (Path a on Figure 1.1) but was not associated with the daughter's attachment towards the mother (Path a on Figure 1.3). Daughter's drug abuse was not associated with the mother's nor the daughters' attachment to one another (Path a on Figures 1.2 and 1.4). Mother's attachment to her daughter had a significant negative effect on being a mother who perpetrates abuse against her daughter (Path b on Figures 1.1. and 1.3.). Daughter's attachment to her mother had a significant negative effect on having an emotionally abusive mother (Path b on Figures 1.2. and 1.4.) Mother's attachment to her daughter mediated the association between mother's drug abuse and emotionally abusing her adult daughter (Indirect effect: 0.863; SE: 0.449; p = .041; 95% CI: 0.21, 1.99) (Figure 1.3. The indirect effect of mother/daughter attachment was not significant on Figures 1.2, 1.3, and 1.4).
Our study addresses a significant research gap in the U.S. Latino population, a racial/ethnic group that continues to grow at a rapid rate (29). Our study is the first, to our knowledge, that examines emotional abuse of Latina women by their mothers in a group of U.S.- and foreign-born Latino mothers and daughters. What makes the present study especially unique is its focus on adult Latina daughters and mothers. Additionally, most previous studies on emotional abuse among adults have focused on male perpetrators and female victims based on the assumptions that males are the exclusive aggressors and females exclusively victims (30). Findings from our study, however, suggest that women with adult children also serve as perpetrators of emotional abuse.
Our findings regarding SUD for mothers are in line with a previous study, which found that 9.2% of Latino mothers reported drug abuse (31). In our study, Latina daughters who abused drugs or had a mother who abused drugs were more likely to be emotionally abused by their mother which is consistent with other studies that found Latino drug-abusers to be more likely to emotionally abuse family members (32, 33).
Researchers have found evidence that dyadic attachment between Latino adolescents and their parents could serve as a protective factor for low self-esteem, depression, and suicidal attempts (34, 35, 36, 37, 38). Our analyses further demonstrate the benefit of dyadic parent to adult child attachment by revealing that higher levels of attachment had a significant negative association with being a mother who perpetrates emotional abuse against her adult daughter. One potential explanation for this finding is that the cultural value of respeto reduces the likelihood of parent/adult-children conflict in traditional Latino families (38).
Proceeding from a mediation perspective, our results suggest that mother's drug abuse had a negative impact on her attachment to her daughter, which in turn increased her risk for emotionally abusing her daughter. However, differences between mediation and confounding factors cannot be established using cross-sectional data (39); we suggest the longitudinal investigations address this matter.
Future longitudinal studies should determine whether a Latina mother's experience of emotional abuse as a child or during early adulthood precludes acts of emotional abuse toward her daughter(s). It would also be worthwhile to investigate the impact of husband/father abuse of mothers and daughters on the attachment between mothers and daughters. Researchers should also consider investigating the extent to which negativism, a situation in which all communications between family members are negative, underlies reasons for drug abuse in Latinos (40)
Future longitudinal studies should follow this group of women to evaluate changes in emotional abuse during the acculturation process, specifically, the extent to which the stress due to cultural differences between mothers and daughters contributes to emotional abuse. These studies should focus on stress specific to Latino immigrants such as the erosion of traditional culturally protective values, such as familismo, respeto, and dignidad (familism, respect and dignity), during the acculturation process. Some research has indicated that acculturation discrepancies among parents and their children can negatively impact domains of family dynamics such as family communication and family cohesion (41). Similarly, higher levels of acculturation stress have been associated with decreased level of familismo (42). One evidence-based intervention that may offset both of these effects is Family Effectiveness Training (43) which targets acculturation-related problems as a systemic family issue.
Because acculturated Latinos are more likely to challenge their parents' authority (44), non-acculturated parents may feel exceptional stress due to this severe cultural barrier. In addition, acculturation should be considered as a factor in the substance use habits of Latina women in the U.S. Previous studies have indicated that acculturation with U.S. culture is associated with higher risk for substance abuse and hazardous drinking behaviors in Latino samples (45, 46). Accordingly, it may be worthwhile, in a future study, to investigate the role of acculturation on mother-daughter dyadic relationships in mothers and daughters who abuse substances. If acculturation plays a role in the relationship between mothers and daughters as well as in the development of substance abuse disorders in Latinas, then acculturation likely plays a role in the emotional abuse patterns of substance abusing mothers and daughters. Additional studies should take into account other domains of acculturation, such as cultural practices or cultural values (47). Future longitudinal research can provide insight into the causal pathways of drug addiction that account for Latina mother-daughter dyadic relationship and the influence of specific cultural values such as familism on such pathways.
Practice implications are indicated by two of our main findings. If drug-abusing daughters are more likely to be victims of emotional abuse by their mothers and drug-abusing mothers are more likely to abuse their daughters, then drug-rehabilitation practitioners should incorporate a family abuse component into drug-rehabilitation programs. It is recommended that the intake process includes a means to capture the quality of mother-daughter relationships. Mother-Adult Daughter Questionnaire (MAD) could be used as this tool measures the adult daughter's perception of connectedness, interdependence, and trust in hierarchy as it relates to her relationship with her mother (48). The information from this questionnaire would allow practitioners to be well informed in evaluating complex nuances and eliciting variations in the manner in which daughters experience their relationships with their mothers thus, allowing practitioners a means of recommending mother-daughter counseling or treatment.
In future work, we hope to conduct a similar study with a similar group of women to understand whether similar dynamics hold as women with adult daughters age. Egocentric social network studies could also examine group level dynamics and attributes among mothers and/or daughters that could influence substance abuse and emotional abuse. Future studies should assess if the pathways among our exposure, mediator, and outcome variables run in the opposite direction. To further expand our understanding of emotional abuse among Latinos, future work should incorporate psychometrically reliable and valid measures of emotional abuse that yield continuous scores for the different commonly accepted types of maltreatment (49) and should include complementary assessment tools, semi-structured comprehensive interviews, clinicians' observations, and behavioral functional analysis of violent acts (50). Based on the nature of the survey instrument utilized in our study, we were unable to determine whether the mothers who were abused by their children were abused by the daughter who participated in the study versus another daughter, another son, or any combination thereof. Future studies should consider questioning the mother and daughter about uni- and bi-directional emotional abuse to and from one another.
The results of our study should be interpreted in lieu of several limitations. Due to the study's cross-sectional design, we cannot imply causal relationships between variables. Our purposive sampling decreases the generalizability of our findings. Due to the nature of the study and the traditionally modest culture of Latina women, drug abuse may have been underreported resulting in recall bias. Although major cultural differences exist between different Latin American countries and regions, our relatively small sample size did not allow us to stratify analyses by countries or regions.
Our study is among the first to explore the role of drug abuse by Latina women on emotional abuse of adult Latina daughters by their mothers. Most previous research has focused on women's role as victim; women's role as a perpetrator of abuse has been understudied. The fact that mother's attachment to her daughter mediates the association between being a drug abuser and being a perpetrator of emotional abuse should be viewed as a potential target for population-based interventions and individual or familial therapeutic treatments.
We acknowledge Mr. Arnaldo Gonzales for his editing support.
Grant Support: This research is supported by the National Institute on Minority Health and Health Disparities (award #P20MD002288) and the National Institute of Nursing Research (award #R01NR012150). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities, the National Institute of Nursing Research, or the National Institutes of Health.