Previous studies have highlighted numerous relationships between violence exposure and negative outcomes within low income, inner-city areas. The current study adds to this literature by examining associations between violence exposure and mental health outcomes from a developmental contextual perspective. In order to increase knowledge about the consequences of violence exposure, the study looked at multiple domains as rated by multiple informants across two time points, factoring in other possible explanatory variables including general life stress, and exploring potential mediated relationships. Data were drawn from a sample of predominantly African American elementary school aged children and their parents who lived in a low socioeconomic (SES) inner-city area of Philadelphia. An assessment utilizing a semi-structured interview for PTSD resulted in diagnosis for 7% of the sample. Of those who identified a Criterion A trauma (N = 53), 15% were diagnosed. However, when assessing PTSD symptomatology by checklist, 34% received an “approximate diagnosis” by meeting criteria for all three major symptom clusters, with 49% of the children who identified a Criterion A trauma meeting “diagnosis”. Regression analyses indicated that both child-reported life stress and violence exposure uniquely predicted child-reported internalizing symptomatology including PTSD and depression, but that a large proportion of the variance accounted for in these variables was shared by violence and life stress. Similar results emerged when the relationship between parent reported violence and parent reported externalizing problems. Mediational analyses utilizing a composite outcome created from violence and life stress scores indicated that self-esteem partially mediated the relationship between Violence/Stress and PTSD symptomatology and that PTSD partially mediated the relationship between Violence/Stress and depression. Substantial amounts of variance were accounted for between the Violence/Stress – PTSD relationship when self-esteem and previous emotional distress were accounted for (44%). Additionally, substantial amounts of variance were accounted for between the Violence/Stress – depression relationship when PTSD symptomatology and previous emotional distress were accounted for (44%). Future studies should continue to longitudinally evaluate multiple contributors of mental health status across different populations and geographical environments where violence is prevalent. Clinical and policy implications are discussed.
"The route through childhood is shaped by many forces, and it differs for each of us. Our biological inheritance, the temperament with which we are born, the care we receive, our family relationships, the place where we grow up, the schools we attend, the culture in which we participate, and the historical period in which we live — all these affect the paths we take through childhood and condition the remainder of our lives."