Family Polyvictimization and Elevated Levels of Addiction and Psychopathology Among Parents in a Chinese Household Sample

Abstract

When studying the co-occurring victimization within a family, current literature often focuses on individual violence and fails to cover more than two forms of violence. This study fills the research gap by using families, instead of individuals, as units and investigating the prevalence of family polyvictimization. Family polyvictimization is defined as the co-occurrence of child victimization, intimate partner violence (IPV) between parents, and elder abuse within a family. This study analyzed a set of data from 7,466 households, with at least a child under 18 years of age, in six regions in China collected during 2009 and 2010. Descriptive analyses and ordinal logistic regressions were performed to explore the prevalence of family polyvictimization, as well as its associations with parents’ addictive behaviors and negative health factors. The lifetime prevalence and the past-year prevalence of family polyvictimization was 2.53% and 1.09%, respectively. Parents from a polyvictimized family were more likely to report addictive behaviors, and to show poorer mental health and more posttraumatic stress disorder (PTSD) and depressive symptoms than those who were less exposed to violence. Findings show the importance of the whole-family approach to screening multiple types of violence within a family when one type is detected, as well as the potential usefulness of identifying at-risk families among parents with addictive behaviors and poor mental health.

Keywords

child victimization intimate partner violence elder abuse health family

Introduction

The Concept of Family Polyvictimization

Different forms of violence often occur against different members within a single family (Cannon, Bonomi, Anderson, Rivara, & Thompson, 2010; Chan, 2011; Grossman & Lundy, 2003; Pritchard, 2007). The most established link between different forms of family violence connects parental intimate partner violence (IPV) and child maltreatment. The lifetime co-occurrence rates of IPV and child maltreatment in the family range from 6% to 55%, depending on the definitions of violence and samples used in the studies (e.g., Beeman, Hagemeister, & Edleson, 2001; Cannon et al., 2010; White & Smith, 2009). Similarly, other studies have found co-occurrence rates of IPV and elder abuse ranging from less than 1% to almost 71% (e.g., Grossman & Lundy, 2003; Zink & Fisher, 2007) and co-occurrence of child maltreatment and elder abuse ranging from 10% to 66% (e.g., Pritchard, 2007; Reay & Browne, 2001).

Despite the growing body of literature on co-occurrence of family violence, there is a lack of research on the co-occurrence of more than two forms of violence within a family (Chan, 2011). Recent research has demonstrated the importance of studying multiple forms of victimization among children (i.e., child polyvictimization; Finkelhor, Ormrod, & Turner, 2007; Finkelhor, Ormrod, Turner, & Hamby, 2005). Child polyvictimization usually refers to children’s exposure to multiple forms of victimization (such as physical maltreatment, peer bullying, and neighborhood violence), and has been demonstrated to have even more harmful and less reversible effects on victims than frequent exposure to a single type of victimization (Finkelhor et al., 2007; Finkelhor, Turner, Hamby, & Ormrod, 2010). For example, in Finkelhor et al.’s (2010) national study on polyvictimization, child polyvictims were more likely to have elevated levels of lifetime adversities and distress than other victims or non-victims. Those adversities included psychopathology such as depression and anxiety, as well as parental problems such as unemployment, substance abuse, and mental illness.

The concept of child polyvictimization leads one to recognize the importance of family polyvictimization, which is the experience of multiple forms of violence by different members within the same family. These types of violence may include child maltreatment by parents, IPV between parents, and elder abuse against grandparents.

Conceptual Pathways to Family Polyvictimization

Co-occurrence of multiple forms of violence can stem from various factors. Previous studies on the co-occurrence of two types of violence have found evidence that co-occurrence is associated with various individual characteristics such as older age (Jasinski & Dietz, 2003), female gender (Jasinski & Dietz, 2003), race and ethnicity—for example, being African American and Hispanic as compared with White (Jasinski & Dietz, 2003; Kelleher et al., 2006)—lower education levels (Salisbury, Henning, & Holdford, 2009; Slep & O’Leary, 2009), unemployment (Salisbury et al., 2009), and poor mental health (Casanueva, Martin, & Runyan, 2009), as well as addictive behaviors such as substance abuse (Dixon, Hamilton-Giachristsis, Browne, & Ostapuik, 2007; Hartley, 2002), alcohol abuse (Hartley, 2002), and frequent gambling (Afifi, Brownridge, MacMillan, & Sareen, 2010).

As pointed out by the World Health Organization (2005), viewing families as a whole may be helpful to the studying of violence because different forms of violence are likely to be associated with the same factors within a family. Identifying the common associated factors beneath the occurrence of multiple forms of family violence can be a very important step to help detect victimized families at an early stage. When studying the pathways to child polyvictimization, Finkelhor and colleagues (2010) have demonstrated that child polyvictims tend to come from “dangerous families” (p. 32) with extensive violence and conflicts, and/or disrupted families with adversities that lead to poor parental supervision and emotional deprivation. These conceptual pathways for child polyvictimization are equally possible for family polyvictimization. However, to the best of our knowledge, there are no studies using a family-oriented approach that examines the co-occurrence of more than two forms of violence within the same family.

When we apply the developed and tested conceptual model of child polyvictimization (Finkelhor et al., 2010) to family polyvictimization, family disruption and adversity may be even more stand out as the ground for the co-occurrence of family violence. In families with children, disruption can be the result of impaired parental functioning. Literature has revealed several causes of the impairment of parental functioning, three of which are domestic (family) violence, mental health disorders, and addictive problems (Whitaker, Orzol, & Kahn, 2006), which are often shown to be highly comorbid (Bailey, Webster, Baker, & Kavanagh, 2012; Ford, Elhai, Connor, & Frueh, 2010). In a study on maternal conditions and functioning (Kahn, Wilson, & Wise, 2005), it was shown that maternal depression, posttraumatic stress disorders (PTSD), smoking problem, and alcohol dependence together explained one forth to one half of the relationship between family disadvantages and child problematic behaviors. Other studies also reveal the hampering effects of paternal psychopathology and substance use on fathering (e.g., Eiden, Edwards, & Leonard, 2002; McMahon, Winkel, & Rounsaville, 2008). A more recent study (Stover, Urdahl, & Easton, 2012) has demonstrated that paternal depression and drug use are associated with hostile or neglectful parenting behaviors. In particular, Stover et al. have found a mediating effect of paternal depression on the association between drug use and negative parenting.

The Current Study

In this study, family polyvictimization is defined as the co-occurrence of child victimization, parental IPV, and elder abuse against different members in the same family. With reference to the past findings, parental psychopathology and addictive behaviors are believed to play a very significant role on lowering the quality of parenting, and the poor parental functioning may then contribute to the family disruption and dysfunction, which can lead to a heightened risk of family polyvictimization. Based on this assumption and the finding that polyvictimization was associated with more distress and trauma symptoms than the frequent exposure to any single form of victimization (Finkelhor et al., 2010), two hypotheses were made in this study:

Hypothesis 1: Family polyvictimization would be positively associated with parental addictive behaviors (frequent gambling, frequent smoking, alcohol dependence, and substance dependence), and the addictive problems would be greater among parents from polyvictimized families than those from other families (i.e., families experienced only one form of victimization and those did not experience any victimization).

Hypothesis 2: Family polyvictimization would be positively associated with parental psychopathology. To be specific, it would be associated with more symptoms of depression and PTSD and a poorer mental health, and the severity of psychopathological problems would be greater among parents from polyvictimized families.

Method

Sample

This study was conducted in six purposively selected geographic regions in China in 2009 and 2010. The six regions included urban and rural areas in Shanghai, Shenzhen, Tianjin, Wuhan, Xi’an, and Hong Kong. In each region except Hong Kong, a multi-stage stratified probability sampling procedure was used. To put it simply, administrative districts, neighborhoods, villages, and then communes were sampled in each region step-by-step with stratification. A total of 180 communes were selected across Shanghai, Shenzhen, Tianjin, Wuhan, and Xi’an. The official registers of households and temporary migrants were used as the sampling frame to select eligible households. In each eligible household, one parent or caregiver of any child aged 17 years or younger was randomly selected for the survey. If there were more than one eligible parent or caregiver, the one whose birthday (month and day) was the most recent would be invited.

Because Hong Kong is a special administrative region with different administrative systems from the Mainland China, a different sampling procedure was used. A total of 14,442 households were sampled from the official register maintained by the Census and Statistics Department in Hong Kong, and one of the eligible parents or caregivers was invited to participate.

All parent participants were provided with a structured questionnaire that guided their reports on demographic characteristics of family members, their experience of IPV and elder abuse within the family, and, to their best knowledge, the experiences of violence victimization of their child who was 2 to 14 years of age. Parent respondents also reported their own health-related factors, including PTSD, depression, and health-related quality of life. Children aged 15 to 17 years were invited to report their own experience of violence victimization with a guided questionnaire. If there were more than one eligible child, the most recent birthday method would be applied to select the participating child. No identifying information of the participants was recorded, and anonymity, privacy, and the right to refusal were ensured in all procedures. No incentives were given to any participant. This study was approved by the Ethics Committee of the University of Hong Kong as well as the local ethics committee boards in the research sites.

A total of 8,945 eligible households agreed to participate, with a response rate of 76.8%. In this study, we analyzed data from 7,466 households that had complete records of (a) parents’ self reports of IPV, elder abuse, addictive behaviors, health-related factors, and demographic background, plus (b) either parent-reported victimization of children 2 to 14 years of age or self-reported victimization of children aged 15 to 17 years. Tables 1 and 2 show basic demographic characteristics of the children and parents.

Table 1.

Demographic Characteristics of the Child Sample, China, 2009-2010.

	Total (N = 7,466)		Boys (n = 3,942)		Girls (n = 3,524)
Characteristics	N	%	n	%	n	%	χ²
City of residence							20.95*
Hong Kong	2,357	31.57	1,239	31.43	1,118	31.73
Mainland	5,109	68.43	2,703	68.57	2,406	68.27
Shanghai	972	13.02	462	11.72	510	14.47
Shenzhen	1,042	13.96	588	14.92	454	12.88
Tianjin	1,010	13.53	518	13.14	492	13.96
Wuhan	841	11.26	471	11.95	370	10.50
Xi’an	1,244	16.66	664	16.84	580	16.46
Residential area							0.56
Urban	5,443	72.90	2,861	72.58	2,582	73.27
Rural	1,695	22.70	903	22.91	792	22.47
Suburban	328	4.40	178	4.51	150	4.26
Child characteristics
Age (M, SD)	11.46	4.67	11.41	4.67	11.51	4.67	−0.87^a
Age (range)							0.06
2-9 years	2,410	32.28	1,279	32.45	1,131	32.09
10-14 years	2,284	30.59	1,216	30.85	1,068	30.31
15-17 years	2,772	37.13	1,447	36.70	1,325	37.60
Living with parent(s)							0.68
Yes	7,260	97.24	3,828	97.11	3,432	97.39
No	157	2.10	88	2.23	69	1.96
Missing	49	0.66	26	0.66	23	0.65

t-statistic from t test.

p < .01.

Table 2.

Demographic Characteristics of the Parent Respondents, China, 2009-2010, by Gender of the Child.

	Total (N = 7,466)		Boys (n = 3,942)		Girls (n = 3,524)
Parent Characteristics	n	%	n	%	n	%	χ²
Gender of respondent							5.86
Male (Father)	3,064	41.04	1,669	42.34	1,395	39.59
Female (Mother)	4,097	54.88	2,114	53.63	1,983	56.27
Missing	305	4.08	159	4.03	146	4.14
Marital status							4.87*
Married/cohabiting	7,004	93.81	3,714	94.22	3,290	93.36
Divorced/separated/widowed	337	4.51	158	4.01	179	5.08
Missing	125	1.68	70	1.77	55	1.56
Father’s education							1.05
Junior high school or below	3,490	46.75	1,858	47.13	1,632	37.46
Senior high school	2,362	31.64	1,257	31.89	1,105	31.36
College or above	1,209	16.19	624	15.83	585	16.60
Missing	405	5.42	203	5.15	202	5.73
Mother’s education							3.20
Junior high school or below	3,858	51.67	2,079	52.74	1,779	50.48
Senior high school	2,307	30.90	1,191	30.21	1,116	31.67
College or above	1,011	13.54	528	13.39	483	13.71
Missing	290	3.89	144	3.65	146	4.14
Family income							1.25
No income	221	2.96	119	3.02	102	2.89
Below median	556	7.45	301	7.64	255	7.24
Above median	6,091	81.58	3,210	81.43	2,881	81.75
Missing	598	8.01	312	7.91	286	8.12
Receiving social security	654	8.76	322	8.17	332	9.42	3.80*
Addictive behavior^a
Gambling	1,368	18.32	727	18.44	641	18.19	0.20
Smoking	3,310	44.33	1,752	44.44	1,558	44.21	0.15
Alcoholic dependence	1,691	22.65	881	22.35	810	22.99	0.25
Substance dependence	40	0.54	23	0.58	17	0.48	0.38

Addictive behavior of either parent.

p < .05.

Measures

In addition to basic demographic characteristics (e.g., gender, age, residential area, education attainment, employment status, and family income), the following information was assessed:

Child victimization

Children’s experiences of violence victimization were assessed with the Chinese version of the 34-item Juvenile Victimization Questionnaire (JVQ; Chan, Fong, Yan, Chow, & Ip, 2011; Finkelhor, Hamby, Ormrod, & Turner, 2005). The scale has five subscales that cover different aspects of violence: conventional crime, child maltreatment, peer and sibling victimization, sexual victimization, and witnessing of victimization or indirect victimization. All items were rated on a 3-point Likert-type scale (0 = no experience, 1 = experience within the past year, and 2 = experience before the past year), so that both the past-year prevalence and the lifetime prevalence could be recorded. Consistent with previous research, the five subscales demonstrated satisfactory to good internal consistencies (α = .63-.97)

Parental IPV

Parent respondents reported their experience of perpetration or victimization of IPV with their current partner using the Chinese version of the Revised Conflict Tactics Scale (CTS2; Chan, 2004; Straus, Hamby, Boney-McCoy, & Sugarman, 1996). A total of 33 items were used in four subscales: physical assault, psychological aggression, sexual violence, and injury. Items were rated on a 3-point Likert-type scale identical to that used to assess child victimization. The CTS2 showed satisfactory reliability in this study (α = .77-.87).

Elder abuse

The Chinese version of the CTS2 (Chan, 2004) was modified to assess elder abuse. Parent respondents reported if any elderly people (aged 60 years or above) living in the same household had been victimized by violence, including physical assault, psychological aggression, neglect, and injury. These subscales have shown good reliability in past research (Yan & Tang, 2004). The modified scale had 23 items rated on a 3-point scale, and it demonstrated satisfactory to good reliability in this study (α = .73-.90).

PTSD

The 48-item UCLA PTSD index was used to assess parent respondents’ experience of traumatic events in the past 4 weeks based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) PTSD diagnostic criteria (Rodriguez, Steinberg, & Pynoos, 1999). The scale was translated into Chinese using a back-translation procedure before it was incorporated into the structured questionnaire. Items were rated on a yes/no (1/0) scale. A total score was calculated by summing the 48-item scores, with higher scores indicating more severe PTSD symptoms. The translated PTSD index evidenced good reliability in this study (α = .94).

Depression

The Chinese version of the 21-item Beck Depression Inventory version II (BDI-II) was used to capture any depressive symptoms expressed by the parent respondents during the previous 2 weeks (Leung, 2001). A 4-point Likert-type scale from 0 to 3 was used. The item scores were summed to give a total score, with higher scores indicating more severe depressive symptoms. The internal consistency of the BDI-II in this study was good (α = .90).

Health-related quality of life

Parents reported their health-related quality of life in the past 4 weeks with the Chinese version of the 12-item Short Form Health Survey (SF-12v2; Lam, Tse, & Gandek, 2005). In line with the manual for the survey, item scores were weighted and summed to give two component scores: physical and mental. Both scores ranged from 0 to 100; higher scores indicate better health-related quality of life. In this study, the scale showed good internal consistency (α = .87).

Addictive behaviors

Parent respondents reported their addictive behaviors with four self-reported questions covering four kinds of behaviors: frequent gambling, frequent smoking, alcohol dependence, and substance dependence. Another set of four questions assessed the addictive behaviors of the respondent’s partner. All items were rated on a 2-point “yes/no” scale.

Statistical Analyses

Lifetime and past-year prevalence rates of child victimization, parental IPV, and elder abuse were first summarized. To estimate the co-occurrence rates of violence within a family, participating households were classified into four major groups: (a) no violence, (b) any one type of violence only, (c) any two types of violence, and (d) all three types of violence.

Distributions of addictive behaviors and the mean scores of health-related factors of the four groups of households were computed to give a preliminary picture of their relationships with the number of types of violence that a family experienced. A series of independent ordinal logistic regressions was then conducted to examine the associations between family polyvictimization and the addictive behaviors and health-related factors of parents. To be specific, the associations between the number of forms of family violence reported and the addictive behaviors and health-related factors among parents were explored. In the ordinal logistic regression analyses, the dependent variable (the number of types of violence that a family experienced) was ordered as “0” (no violence), “1” (one type of violence), and “2” (two to three types of violence, polyvictims). The individual regressions were adjusted for other independent variables. Missing data were handled with listwise deletion. Model goodness-of-fit was tested with the Hosmer and Lemeshow (H-L) test.

Results

Prevalence

Table 3 presents the lifetime and past-year prevalence of child victimization, parental IPV, and elder abuse among the 7,466 sampled households. Approximately 42.67% of the households reported child victimization, 31.80% reported psychological IPV between parents, 9.95% reported other types of parental IPV, and 16.45% reported elder abuse. Past-year prevalence rates were 34.72% for child victimization, 26.80% for psychological IPV between parents, 7.66% for other types of parental IPV, and 8.16% for elder abuse.

Table 3.

Prevalence of Child Victimization, Parental IPV, and Elder Abuse by Gender of the Child, China, 2009-2010.

	Lifetime Prevalence (%)				Past-Year Prevalence (%)
Violence	Total (N = 7,466)	Boys (n = 3,942)	Girls (n = 3,524)	p value	Total (N = 7,466)	Boys (n = 3,942)	Girls (n = 3,524)	p value
Child victimization
Conventional crime	27.94	29.10	26.65	.02	19.80	20.38	19.15	.19
Child maltreatment	14.89	15.55	14.16	.09	10.90	11.41	10.32	.14
Peer and sibling victimization	17.89	20.32	15.18	<.001	13.70	15.73	11.43	<.001
Sexual victimization	1.63	1.85	1.39	.12	1.46	1.65	1.25	.15
Witnessing and indirect victimization	17.57	18.06	17.03	.24	13.94	14.10	13.76	.68
Any one type	42.67	44.22	40.95	.002	34.72	35.98	33.31	.044
Parental IPV
Psychological	31.80	32.15	31.41	.50	26.80	27.33	26.21	.29
Physical	5.75	6.19	5.25	.08	4.49	4.87	4.05	.09
Sexual	4.19	4.26	4.11	.75	4.10	4.54	3.60	.06
Injury	2.21	2.18	2.24	.86	1.93	1.86	2.01	.65
Any one type, excluding psychological violence	9.55	10.07	8.97	.11	7.66	8.40	6.84	.12
Elder abuse
Psychological	15.10	15.75	14.36	.09	7.33	8.19	6.36	<.01
Physical	4.67	5.38	3.89	<.01	1.63	1.93	1.31	.03
Neglect	7.14	7.23	7.04	.75	3.24	3.60	2.84	.06
Injury	0.70	0.81	0.57	.21	0.33	0.41	0.26	.26
Any one type	16.45	17.12	15.69	.10	8.16	9.03	7.18	<.01

Note. IPV = intimate partner violence.

There exist gender differences in some forms of family violence. For example, families with a boy were more likely than those with a girl to report peer and sibling victimization against children, physical IPV between parents, as well as physical and psychological elder abuse against grandparents (all p < .05).

Table 4 shows data on family polyvictimization. Almost half (47.35%) of the households had never experienced any type of violence. About 39.16% reported having experienced only one type of violence, 10.96% reported two, and 2.53% reported all three types of violence, that is, polyvictimization. During the past year, 58.08% had experienced no violence, 34.34% had only one type, 6.49% had two, and 1.09% had polyvictimization.

Table 4.

Distribution of Families by Number of Types of Violence Experienced, China, 2009-2010 (N = 7,466).

	Percentage (%)
Violence	Lifetime	Past-Year
No violence	47.35	58.08
Any one type of violence	39.16	34.34
Child victimization only	30.36	27.76
Parental IPV^a only	2.53	2.94
Elder abuse only	6.27	3.65
Any two types of violence	10.96	6.49
Child victimization and parental IPV^a	3.31	3.15
Child victimization and elder abuse	6.47	2.73
Parental IPV^a and elder abuse	1.18	0.62
Three types of violence (child victimization, parental IPV, and elder abuse)	2.53	1.09

Note. IPV = intimate partner violence.

Any type of IPV excluding psychological violence.

Associations With Parental Psychopathology and Addictive Behaviors

Table 5 shows the distributions of parental addictive behaviors and the mean scores of the parental health-related factors among households exposed to different numbers of types of violence. The proportions of parents reporting frequent gambling, frequent smoking, alcohol dependence, and substance dependence were generally greater among polyvictimized households, followed by those exposed to only one type of violence. In contrast, the smallest proportions of parents showing addictive behaviors were found in the households with no experience of violence. In terms of parental health, polyvictimized households had the highest mean scores and thus the most severe PTSD and depressive symptoms, whereas non-victims had the lowest scores on these health indicators. Also, polyvictims had the lowest scores in health-related quality of life, indicating that parents in these families were more likely to report poorer physical and mental health.

Table 5.

Distribution of Parental Addictive Behavior and Mean Scores of Health Factors by Number of Violence.

	Lifetime Experience			Past-Year Experience
Variable	No Violence (n = 3,531)	Any One Type (n = 2,927)	Any Two Types or More (n = 1,008)	No Violence (n = 4,338)	Any One Type (n = 2,561)	Any Two Types or More (n = 567)
Addictive behavior
Gambling
Yes	14.64%	20.46%	28.70%	16.62%	20.69%	28.86%
No	85.36%	79.54%	71.30%	83.38%	79.31%	71.14%
Smoking
Yes	38.75%	49.08%	59.12%	40.05%	51.96%	60.74%
No	61.25%	50.92%	40.88%	59.95%	49.04%	39.26%
Alcohol dependence
Yes	19.06%	24.25%	35.16%	19.57%	25.87%	38.89%
No	80.94%	75.75%	64.84%	80.43%	74.13%	61.11%
Substance dependence
Yes	0.53%	0.42%	1.00%	0.42%	0.63%	1.30%
No	99.47%	99.58%	99.00%	99.58%	99.37%	98.70%
Health-related factors
PTSD (M, SD)	16.70, 7.49	17.05, 7.04	17.92, 6.46	16.69, 7.34	17.39, 6.99	18.38, 6.63
Depression (M, SD)	1.98, 4.18	3.47, 5.47	5.47, 6.72	2.19, 4.37	3.78, 5.74	6.37, 7.07
Health-related QoL
Physical health (M, SD)	50.64, 7.53	49.42, 8.23	48.91, 8.18	50.50, 7.66	49.34, 8.19	48.61, 8.01
Mental health (M, SD)	52.58, 7.82	51.64, 8.12	49.11, 8.22	52.58, 7.82	51.30, 8.06	47.92, 8.59

Note. PTSD = posttraumatic stress disorder; QoL = quality of life.

Tables 6 and 7 show the adjusted odds ratios (aOR) from the ordinal logistic regressions. Apart from substance dependence, which had prevalence rates that were too low to perform reliable regressions, all three remaining types of addictive behaviors were associated with significantly higher odds of the number of types of violence experienced within a household: gambling (aOR = 1.32, p < .05), smoking (aOR = 1.40, p < .001), and alcohol dependence (aOR = 1.30, p < .05; Table 6). In terms of parental health, parents with more severe PTSD (aOR = 1.01, p < .01) or depressive symptoms (aOR = 1.08, p < .001) were more likely to come from victimized families. Echoing with this finding, parental mental health was negatively associated with the number of types of violence experienced in the family (aOR = 0.98, p < .001).

Table 6.

Associations Between Number of Family Violence in Past Year, Demographic Characteristics, and Parental Addictive Behaviors.

	Number of Past-Year Violence
Variable ^a	aOR	95% CI
Residential area (rural or suburban)	1.17	[−0.02, 0.33]
Child characteristics
Boy	1.13	[−0.03, 0.27]
Age	0.99	[−0.03, 0.00]
Parent characteristics
Father respondent	0.94	[−0.21, 0.09]
Divorced/separated/widowed	0.93	[−0.41, 0.26]
Education
Junior high school or below	0.86	[−0.39, 0.08]
Senior high school	1.01	[−0.23, 0.25]
Receiving social security	1.02	[−0.27, 031]
Addictive behavior
Gambling	1.32*	[0.07, 0.49]
Smoking	1.40**	[0.16, 0.51]
Alcohol dependence	1.30*	[0.06, 0.47]
Substance dependence	NA^b

Note. aOR = adjusted odds ratio; CI = confidence interval.

The dependent variable (number of types of violence experienced) is ordered: 0 = no violence, 1 = any one type of violence, 2 = any two or more types of violence. All regression analyses were conducted separately with the adjustment of other independent variables. Reference categories are as follows: For residential area, city; for child gender, girl; for parent respondent’s gender, mother respondent; for marital status, married or cohabiting; for education, college or above; for receiving social security, no; for all addictive behavior, no; for living with grandparents, no.

The number of cases was too small to perform reliable statistical analysis.

p < .05. **p < .001.

Table 7.

Associations Between Number of Forms of Family Violence and Parents’ PTSD, Depression, and Health-Related QoL.

	Number of Past-Year Family Violence
Variable ^a	aOR	95% CI
PTSD	1.01*	[−0.02, 0.33]
Depression	1.08**	[0.07, 0.09]
Health-related QoL
Physical health	1.00	[−0.01, 0.00]
Mental health	0.98**	[−0.03, 0.01]

Note. PTSD = posttraumatic stress disorder; QoL = quality of life; aOR = adjusted odds ratio; CI = confidence interval.

The dependent variable (number of types of violence experienced) is ordered: 0 = no violence, 1 = any one type of violence, 2 = any two types of violence or more. All regression analyses were conducted separately with the adjustment of demographic variables listed in Table 6.

p < .01. **p < .001.

Overall, the current findings provided supportive evidence to the two hypotheses in this study that, when compared with any single form of victimization, family polyvictimization could be associated with higher risks of parental addictive behaviors and psychopathological problems.

Discussion

Using a large and diverse sample of households from six different geographical regions in China, this study provides reliable estimates of the prevalence of family polyvictimization. As one of the very first studies to explore the prevalence rates of experience of three types of violence within a family (family polyvictimization) with the use of the whole-family approach, this study found that 1 in every 40 families had experienced family polyvictimization over the lifetime, and 1 in around 83 families had been polyvictims in the past year. The prevalence of individual form of family violence was comparable with the findings in past research in the Chinese populations. For example, the past-year prevalence of child victimization was about 35%, which falls approximately midway in the range of 3% to 62% as reported in previous studies (Chan, 2011; Hong Kong Medical Coordinators on Child Abuse, 2003; Tang & Davis, 1996; Wong, Chen, Goggins, Tang, & Leung, 2009). As to the past-year prevalence of parental IPV, the current finding of 8% to 27% are also comparable with the past ones between 5% and 38% (Garcia-Moreno, Jansen, Watts, Ellsberg, & Heise, 2005; Tang & Lai, 2008).

This study provides evidence supporting that family polyvictimization is associated with parental addictive behaviors and psychopathological problems, and more importantly, the parental problem is more severe among polyvictimized families than those which are less exposed to violence. This may serve as a piece of preliminary evidence that family polyvictimization may be rooted from family disruption and dysfunction (Finkelhor et al., 2010), which are greatly associated with the parental problems and their ability to provide good parenting practices. Consistent with previous studies that explored the parental factors associated with the co-occurrence of child victimization and parental IPV (Afifi et al., 2010; Dixon et al., 2007), this study revealed that parents with addictive behaviors were more likely to come from a victimized family. One possible explanation is that the addictive parents are themselves the perpetrators of violence. Indeed, there is evidence that smoking and alcohol dependence are two common behaviors of abusive parents (Hartley, 2002), in particular, those who are also victims of IPV (Dixon et al., 2007), as well as the perpetrators of elder abuse (Bradshaw & Spencer, 2005). Researchers have suggested that addictive individuals might be more violent under the influence of alcohol or drugs, and some may use alcohol and drugs to rationalize their violent behaviors, forming a vicious cycle (Bradshaw & Spencer, 2005). Another equally possible explanation is that the addictive parents were actually the victims of IPV, as IPV victims have often been shown to have greater risk of smoking and alcohol abuse (Crane, Hawes, & Weinberger, 2013; Lemon, Verhoek-Oftedahl, & Donnelly, 2002).

In terms of health, parents from victimized families were more likely to have poorer health. In general, parents from polyvictimized families reported the most severe symptoms of PTSD and depression, as well as the poorest health-related quality of life, which is in line with the findings on child polyvictimization in literature (Finkelhor et al., 2010). This finding provides a piece of preliminary evidence supporting the idea that family polyvictimization may be associated with more negative health factors than any single type of victimization. The associations between the number of types of victimization and health factors were further supported by the results of the ordinal logistic regressions. The number of types of violence experienced in a family was positively associated with the severity levels of PTSD and depressive symptoms and, at the same time, negatively associated with parents’ mental health-related quality of life.

Study Limitations

Given the constraints on time and resources, several limitations were unavoidable in this study. For example, the household sample was confined to six cities in Mainland China. Thus, the findings may not be generalizable to the whole population. In addition, cross-sectional studies do not allow us to establish causal associations between family polyvictimization, addictive behaviors, and health. It remains unclear whether addictive behaviors and negative health factors precede family victimization or the other way around. As for the analysis procedures, the regression analysis only controlled for a handful of demographic factors. There may be other confounding factors of violence victimization, such as personality characteristics, marital relationship, and presence of community violence.

Conclusion

Using a large and diverse sample of households in China, this study extends our knowledge on violence by taking families, rather than individual family members, as units of violence victims, and exploring the association between family polyvictimization, parental addiction, and psychopathology which provides a ground for future studies on the pathways of family polyvictimization. Findings of this study have important implications for health professionals. With regard to the prevalence of family polyvictimization, child protection services and services for family violence may screen for as many types of violence and victimization as possible that their clients may experience. Also, the links between family victimization and parental addiction or poor health provide insight into the potential effectiveness of identifying at-risk families among parents who are addicted to alcohol or other substances, as well as the possibility of screening or detection of family violence in clinics or services that deal with addictive behaviors or mental health. Furthermore, the findings provide evidence that supports holistic, whole-family screening to identify at-risk families and facilitate the delivery of timely interventions for families as a whole.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This Optimus Study was initiated and funded by the UBS Optimus Foundation.

Author Biography

Ko Ling Chan specializes in research and practice with violence against women and children, intimate partner violence, pregnancy violence, child protection, and family problems. He has extensive experience in managing large-scale projects on family violence, and has published more than 80 refereed journal articles.

References

Afifi

T. O.

Brownridge

D. A.

MacMillan

Sareen

(2010). The relationship of gambling to intimate partner violence and child maltreatment in a nationally representative sample. Journal of Psychiatric Research, 44, 331-337.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Bailey

Webster

Baker

Kavanagh

D. J.

(2012). Exposure to dysfunctional parenting and trauma events and posttraumatic stress profiles among a treatment sample with coexisting depression and alcohol use problems. Drug and Alcohol Review, 31, 529-537.

Beeman

S. K.

Hagemeister

A. K.

Edleson

J. L.

(2001). Case assessment and service receipt in families experiencing both child maltreatment and woman battering. Journal of Interpersonal Violence, 16, 437-458.

Bradshaw

Spencer

(2005). The role of alcohol in elder abuse cases. In Pitchard

(Ed.), Elder abuse work: Best practices in Britain and Canada (pp. 332-353). London, England: Jessica Kingsley Press.

Cannon

E. A.

Bonomi

A. E.

Anderson

M. L.

Rivara

F. P.

Thompson

R. S.

(2010). Adult health and relationship outcomes among women with abuse experiences during childhood. Violence and Victims, 25, 291-305.

Casanueva

Martin

S. L.

Runyan

D. K.

(2009). Repeated reports for child maltreatment among intimate partner violence victims: Findings from the National Survey of Child and Adolescent Well-Being. Child Abuse & Neglect, 33, 84-93.

Chan

K. L.

(2004). Correlates of wife assault in Hong Kong Chinese families. Violence and Victims, 19, 189-201.

Chan

K. L.

(2011). Co-occurrence of intimate partner violence and child abuse in Hong Kong Chinese families. Journal of Interpersonal Violence, 26, 1322-1342.

10.

Chan

K. L.

Fong

D. Y. T.

Yan

Chow

C. B.

(2011). Validation of the Chinese Juvenile Victimization Questionnaire. Hong Kong Journal of Paediatrics, 16, 17-24.

11.

Crane

C. A.

Hawes

S. W.

Weinberger

A. H.

(2013). Intimate partner violence victimization and cigarette smoking: A meta-analytic review. Trauma, Violence & Abuse, 14, 204-315.

12.

Dixon

Hamilton-Giachristsis

Browne

Ostapuik

(2007). The co-occurrence of child and intimate partner maltreatment in the family: Characteristics of the violent perpetrators. Journal of Family Violence, 22, 675-689.

13.

Eiden

R. D.

Edwards

E. P.

Leonard

K. E.

(2002). Mother-infant and father-infant attachment among alcoholic families. Development and Psychopathology, 14, 253-278.

14.

Finkelhor

Hamby

S. L.

Ormrod

Turner

(2005). The Juvenile Victimization Questionnaire: Reliability, validity, and national norms. Child Abuse & Neglect, 29, 383-412.

15.

Finkelhor

Ormrod

Turner

(2007). Poly-victimization: A neglected component in child victimization. Child Abuse & Neglect, 31, 7-26.

16.

Finkelhor

Ormrod

Turner

Hamby

S. L.

(2005). The victimization of children and youth: A comprehensive, national survey. Child Maltreatment, 10, 5-25.

17.

Finkelhor

Turner

Hamby

Ormrod

(2010). Polyvictimization: Children’s exposure to multiple types of violence, crime, and abuse. Juvenile Justice Bulletin. Retrieved from http://www.unh.edu/ccrc/pdf/jvq/Polyvictimization%20OJJDP%20bulletin.pdf

18.

Ford

J. D.

Elhai

J. D.

Connor

D. F.

Frueh

B. C.

(2010). Poly-victimization and risk of posttraumatic, depressive, and substance use disorders and involvement in delinquency in a national sample of adolescents. Journal of Adolescent Health, 46, 545-552.

19.

Garcia-Moreno

Jansen

H. A. F. M.

Watts

Ellsberg

M. C.

Heise

(2005). WHO multi-country study on women’s health and domestic violence against women: Initial results on prevalence, health outcomes and women’s responses. Geneva, Switzerland: World Health Organization.

20.

Grossman

S. F.

Lundy

(2003). Use of domestic violence services across race and ethnicity by women aged 55 and older: The Illinois experience. Violence Against Women, 9, 1442-1452.

21.

Hartley

C. C.

(2002). The co-occurrence of child maltreatment and domestic violence: Examining both neglect and child physical abuse. Child Maltreatment, 7, 349-358.

22.

Hong Kong Medical Coordinators on Child Abuse. (2003). Management of child abuse in Hong Kong: Results of a territory-wide inter-hospital prospective surveillance study. Hong Kong Medical Journal, 9, 6-9.

23.

Jasinski

J. L.

Dietz

T. L.

(2003). Domestic violence and stalking among older adults: An assessment of risk markers. Journal of Elder Abuse & Neglect, 15, 3-18.

24.

Kahn

R. S.

Wilson

Wise

P. H.

(2005). Intergenerational health disparities: Socioeconomic status, women’s health conditions, and child behavior problems. Public Health Reports, 120, 399-408.

25.

Kelleher

Gardner

Coben

Barth

Edleson

Hazen

(2006). Co-occurring intimate partner violence and child maltreatment: Local policies/practices and relationships to child placement, family services and residence. Washington, DC: U.S. Department of Justice.

26.

Lam

C. L.

Tse

E. Y.

Gandek

(2005). Is the standard SF-12 Health Survey valid and equivalent for a Chinese population? Quality of Life Research, 14, 539-547.

27.

Lemon

S. C.

Verhoek-Oftedahl

Donnelly

E. F.

(2002). Preventive healthcare use, smoking, and alcohol use among Rhode Island women experiencing intimate partner violence. Journal of Women’s Health & Gender-Based Medicine, 11, 555-562.

28.

Leung

R. K. W.

(2001). A validation of the traditional Chinese (Hong Kong) versions of the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II). Hong Kong, China: University of Hong Kong.

29.

McMahon

T. J.

Winkel

J. D.

Rounsaville

B. J.

(2008). Drug use and responsible fathering: A comparative study of men enrolled in methadone maintenance treatment. Addiction, 103, 269-283.

30.

Pritchard

(2007). Identifying and working with older male victims of abuse in England. Journal of Elder Abuse & Neglect, 19, 109-127.

31.

Reay

A. M. C.

Browne

K. D.

(2001). Risk factor characteristics in carers who physically abuse or neglect their elderly dependants. Aging & Mental Health, 5, 56-62.

32.

Rodriguez

Steinberg

Pynoos

R. S.

(1999). UCLA PTSD Index for DSM-IV Instrument Information: Child version, parent version, adolescent version. Los Angeles: UCLA Trauma Psychiatry Service.

33.

Salisbury

E. J.

Henning

Holdford

(2009). Fathering by partner-abusive men: Attitudes on children’s exposure to interparental conflict and risk factors for child abuse. Child Maltreatment, 14, 232-242.

34.

Slep

A. M. S.

O’Leary

S. G.

(2009). Distinguishing risk profiles among parent-only, partner-only, and dually perpetrating physical aggressors. Journal of Family Psychology, 23, 705-716.

35.

Stover

C. S.

Urdahl

Easton

(2012). Depression as a mediator of the association between substance abuse and negative parenting of fathers. American Journal of Drug and Alcohol Abuse, 38, 344-349.

36.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283-316.

37.

Tang

C. S. K.

Davis

(1996). Child abuse in Hong Kong revisited after 15 years: Characteristics of victims and abusers. Child Abuse & Neglect, 20, 1213-1218.

38.

Tang

C. S. K.

Lai

B. P.

(2008). A review of empirical literature on the prevalence and risk markers of male-on-female intimate partner violence in contemporary China, 1987-2006. Aggression and Violent Behavior, 13, 10-28.

39.

Whitaker

R. C.

Orzol

S. M.

Kahn

R. S.

(2006). Maternal mental health, substance use, and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years. Archives of General Psychiatry, 63, 551-560.

40.

White

J. W.

Smith

P. H.

(2009). Covariation in the use of physical and sexual intimate partner aggression among adolescent and college-age men: A longitudinal analysis. Violence Against Women, 15, 24-43.

41.

Wong

W. C. W.

Chen

W. Q.

Goggins

W. B.

Tang

C. S. K.

Leung

P. W.

(2009). Individual, familial and community determinants of child physical abuse among high-school students in China. Social Science & Medicine, 68, 1819-1825.

42.

World Health Organization. (2005). World report on violence and health. Geneva, Switzerland: Author.

43.

Yan

E. C. W.

Tang

C. S. K.

(2004). Elder abuse by caregivers: A study of prevalence and risk factors in Hong Kong Chinese families. Journal of Family Violence, 19, 269-277.

44.

Zink

Fisher

B. S.

(2007). The prevalence and incidence of intimate partner and interpersonal mistreatment in older women in primary care offices. Journal of Elder Abuse & Neglect, 18, 83-105.