Dr Grainne McAnee (Bamford Centre), along with her PhD supervisory team, Professor Mark Shevlin, Professor Jamie Murphy and Dr James Houston, has published the first of a series of planned studies from her PhD thesis, in Child Abuse and Neglect. The title of the study is “Where are all the males? Gender-Specific Typologies of Childhood Adversity Based on a Large Community Sample.”
The title of Grainne’s thesis was, “The Development and Testing of a Population Based Model of Social Factors as Mediators of the Trauma Psychosis Association”. The study documented and extended the first phase in the development of the model at the centre of her thesis. This addressed the issue of child abuse, which is defined in the paper as, ‘all forms of physical and/emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity, in the context of a relationship of responsibility, trust or power’.
The study used a large general population dataset (n=34653) and analysis was done in two parts. Firstly, latent class analysis (LCA) was used to identify if there were distinct groups of people who had shared experiences of a range of adversities. The LCA was based on six categories which were created based on responses to 14 questions around childhood experiences. The six categories were neglect, childhood physical abuse, witnessing interpersonal violence, molestation, childhood sexual abuse and having a parent with mental health issues. Secondly, three binary logistic regression models were specified using hierarchical binary logistic regression. Class membership was dummy coded and used as the independent variable in the regression models. The dependent variable for each model, was in turn a diagnosis of anxiety, depression and finally, PTSD.
Critical to the study and a main focus of the findings, was that the data was stratified by gender and findings compared for the total data, males only and females only. Major findings were firstly that there were classes of people who grouped together in terms of their shared patterns of experiences of abuse and adversity. Secondly, that stratifying the data by gender produced classes of people that differed both quantitatively and qualitatively. For instance, the best model for males was represented by three groups of people. The best model for females was represented by four. More classes were required to explain the occurrence and co-occurrence of abuse for females, which reflected the total data. It seems the more complex patterns of abuse for females tend to be what is represented in the total data. Thirdly, the study showed that there were markedly different outcomes in relation to the mental health variables which were a diagnosis of anxiety, depression or PTSD. The results of the binary logistical regressions reflect that if the data is not stratified by gender, results that are particularly significant for males will not be seen. Results showed that for the sexual abuse class of males, odds ratios for anxiety, depression and PTSD were all higher than for females in the corresponding class. The male sexual abuse class were 2.1 times more likely to have a diagnosis of anxiety, 1.8 times more likely to have a diagnosis of depression and 1.5 times more likely to have a diagnosis of PTSD. For all female classes, the odd ratios were similar to the total sample. It appears that if data is not stratified by gender, inferences which are made are about the female data, and important information concerning males is not evident.
The study highlights that research to date using LCA to model population data may have been reporting findings based solely on the female data in the sample. Important findings for males who have been sexually abuse may have been missed. Combined with this is the importance of including family level contextual information to allow this work to continue to expand and develop in sophistication. Incorporating both these findings may advance our understanding of the complex and multifaceted relationship between abuse and adversity and clinical outcomes. This study shows that for boys who are sexually abused, the risk of depression, anxiety and PTSD is much greater and this needs to be the impetus to explore this issue further. The paper is available here.