Searching for Social Support Moderates the Relationship Between Polyvictimization and Externalizing Symptoms: A Brief Report

Abstract

Externalizing disorders emerge most readily during adolescence, especially in traumatized population. In this context, it is necessary to determine the factors influencing these disorders. The aim of this study was to evaluate the role of polyvictimization in developing externalizing symptoms while considering the possible effects of active coping related to the search for social support. The participants were 78 adolescents (M = 14.18, SD = 1.63) cared for in child and adolescent protection public services in Chile. The results of multiple regression analysis indicated that polyvictimization was a good predictor of externalizing symptoms, but searching for social support acted as a moderator in that relationship. The results show that searching for social support acts as a protective factor and decreases the adverse influence of polyvictimization over externalizing symptoms. Prevention and intervention programs should consider improvements in the coping strategies of poly-victims with externalizing problems.

Keywords

adolescence polyvictimization externalizing social support coping

The externalizing symptoms are a group of behavior problems directed over the external environment, which include a wide range of behavioral manifestations such as impulsivity, antisocial behavior, oppositionist behaviors, drug use, and aggression (Achenbach & Rescorla, 2001). In Chile, the National Service for Children and Adolescents (Servicio Nacional de Menores [SENAME]) is the state agency responsible for providing support to adolescents with behavioral and emotional problems. A study of the psychiatric service of University of Chile (Clínica Psiquiátrica de la Universidad de Chile, 2004) shows high rates of externalizing symptoms among adolescents treated by SENAME: 41.6% of them were diagnosed with behavioral disorders, 24.1% were diagnosed with oppositional defiance disorder, and 17.6% with alcohol dependence. In addition, 15.8% abused drugs and 11.1% were diagnosed with drug dependence. However, there is little research examining which intervention policies are most effective with this population (Ministerio de Salud & SENAME, 2007). This lack of information is alarming because these externalizing symptoms are related to academic failure (Hinshaw, 1992), poorer mental health during adolescence (Tackett, Herzhoff, Harden, Page-Gould, & Josephs, 2014), and antisocial behavior in adulthood (Moffitt, 1993).

Internationally, there is evidence that externalizing symptoms arise from the interactions among factors such as inadequate parental styles (Reitz, Dekovic, & Meijer, 2006), biological factors (Carr, 2006), low frustration tolerance (Ormel et al., 2010), and negative involvement with peers (Buist & Vermande, 2014). The externalizing symptoms, like antisocial behavior, are also prevalent in children who have been physically maltreated or sexually abused (Jaffee, Caspi, Moffitt, Polo-Tomas, & Taylor, 2007).

The risk of externalizing disorders is likely to be higher among young people exposed to repeated experiences of multiple types of victimization or “polyvictimization” (Finkelhor, Ormrod, & Turner, 2007). Polyvictimization is a concept that helps target a group of children who suffer from different types of victimization during their lifetime (Finkelhor, Ormrod, & Turner, 2009).

The available studies show that polyvictimization has a strong relationship with externalizing behaviors (Álvarez-Lister, Pereda, Abad, Gilera, & GReVIA, 2014; Boxer & Terranova, 2008; Cudmore, Cuevas, & Sabina, 2017; Ford, Connor, & Hawke, 2009; Ford, Wasser, & Connor, 2011; Pereda, Abad, & Guilera, 2017), but currently, little is known about the mechanisms that explain this relationship (Cyr, Clément, & Chamberland, 2014). Cyr et al. (2014) indicated that gender and age are important factors to explain anger symptoms in poly-victims, but we need more knowledge of the mechanisms that explains the effects of polyvictimization to develop intervention programs (Manly, Oshri, Lynch, Herzog, & Wortel, 2013).

Although research with poly-victims is scarce, there is abundant evidence that having social support prevents psychopathology in victims of specific events such as peer violence or sexual abuse (Evans, Steel, & DiLillo, 2013; Holt, & Espelage, 2007; Murthi & Espelage, 2005). In addition, and according to Frydenberg and Lewis (2000), there is evidence that active coping (wherein the individual mobilizes his own resources toward finding solutions and searches for social support) is more effective than avoidant coping (where the individual evades or refuses the problem) in the prevention of symptoms in victims (Bal, Crombez, De Bourdeaudhuij, & Van Oost, 2009; Bal, Van Oost, De Bourdeaudhuij, & Crombez, 2003; O’Leary, 2009). It is reasonable to ask if these protective factors are applicable to poly-victims.

The objective of this brief report was to evaluate if active coping—referring to the search for social support—moderates the relationship between polyvictimization and externalizing symptoms in a clinical sample of Chilean adolescents. We expect that the search for social support will be a protective factor, weakening the relationship between polyvictimization and externalizing symptomatology.

Method

Participants

The participants were 78 Chilean adolescents (61.5% of female) between 12 and 18 years of age (M = 14.18 SD = 1.63). All participants were treated for more than 3 months by SENAME: 3.8% by normative crises, 11.5% to have abused other children, 8.9% for having been victims of sexual exploitation, 25.5% for having been victims of physical or sexual abuse, and 50.3% for severe family conflicts (e.g., neglect, witnessing violence between parents). We only included adolescents from whom we had reliable details about their history of victimization and externalizing symptomatology. All participants were from low socioeconomic status, and 85.9% attend to school regularly.

Measures

Questionnaire about the history of victimization of adolescents

The psychologists treating the participants answered 11 questions evaluating whether each treated adolescent had been exposed to neglect, physical abuse, psychological abuse, and sexual abuse in different contexts (e.g., “During the life of the youth, has she or he been the victim of sexual abuse by a family member who was living in the same home?”). The answers ranged from 0 = never to 4 = very often. Polyvictimization scores were obtained from the sum of all responses. The total possible scores ranged between 0 and 44 (higher scores indicate more polivictimization throughout the victim’s life). An exploratory factor analysis of the principal axes showed that all items loaded onto one factor (factor loads over .32), which explained 42.79% of the variance. Cronbach’s alpha was .85.

Questionnaire about the externalizing symptomatology of adolescents

The psychologists of the treated adolescents answered three questions evaluating the frequency of externalizing symptomatology in the adolescents (alcohol and drug use, and criminal acts). The answers ranged from 0 = never to 4 = very often. The total score was obtained from the sum of the three items (possible scores from 0 to 12; higher scores indicate more symptomatology). An exploratory factor analysis of the principal axes showed that all items loaded onto one factor (factor loads over .41), which explained 65.84% of the variance. Cronbach’s alpha was .73.

Adolescent Coping Scale (ACS)

In this study, we used only the items related to the scale (Frydenberg & Lewis, 2000) that referenced coping in relationship with others, which brought together 17 items related to searching for social support. The response format was a 5-point Likert-type scale with 1 = never and 5 = very often. The total score was computed after adjusting and integrating partial scores (possible scores range from 17 to 105 points; higher scores indicate more searching for social support). Cronbach’s alpha was .85.

Procedure

Prior to its implementation, the project was approved by a university ethics committee and by the directors of 11 specialized centers for the care for victims. Legal guardians and adolescents gave their informed consent for participation in the study. To avoid exposing adolescents to stressful instruments, their own therapists responded to the scales for polyvictimization and externalizing symptoms using the information available in the clinical records (Guerra & Pereda, 2015). In addition, the therapists administered the coping scale to the adolescents. Descriptive and correlational analyses were performed. The proposed model was tested using a hierarchical multiple regression analysis. First, we evaluated the direct effects of polyvictimization and the search for social support on externalizing symptoms. Then, we evaluated the effects of the interactions between polyvictimization and searching for social support. We made the analysis controlling sex and age because a previous study suggested that these factors predict the symptomatology (Cyr et al., 2014).

Results

The adolescents’ scores ranged between 0 and 36 points on the scale for polyvictimization (M = 8.51, SD = 7.05), between 0 and 6 points on the scale for externalizing (M = 1.18, SD = 1.81), and between 24 and 90 on the scale for searching for social support (M = 52.10, SD = 15.94). Polyvictimization was related to externalizing symptomatology (r = .25, p < .05), but not to the search for social support (r = −.03, p > .05). The search for social support was not related to the symptomatology (r = −.20, p > .05).

As Table 1 shows, the initial regression analysis indicated that age (β = .27, p < .05) and polyvictimization (β = .24, p < .05) had an effect on externalizing symptoms, explaining 18% of its variance. However, the inclusion of an interaction between polyvictimization and the search for social support (in Step 2) nullified the direct effects of polyvictimization over the symptoms. The effect of this interaction was significant (β = -.23, p < .05) and generated a larger increase (5%) in the amount of explained variance in the externalizing symptoms, according to Cohen’s (1992) standards. Thus, the hypothesis of a moderating role of the search for social support was supported.

Table 1.

Regression Coefficients Associated With Externalizing Symptoms (n = 78).

	B	β	95% CI
Step 1
Female gender	−.42	−.12	[−1.22, 0.37]
Age	.30*	.27*	[0.06, 0.54]
Polyvictimization	.43*	.24*	[0.05, 0.82]
Searching social support	−.28	−.15	[−0.67, 0.11]
R²	.18*
Step 2
Female gender	−.53	−.14	[−1.31, 0.25]
Age	.31*	.28*	[0.08, 0.55]
Polyvictimization	.35	.19	[−0.03, 0.73]
Searching social support	−.31	−.17	[−0.69, 0.07]
Polyvictimization × Searching Social Support	−.40*	−.23*	[−0.78, −0.03]
R²	.23*

Note. B = unstandardized beta weight; β = standardized beta weight; CI = confidence interval.

p < .05.

For further understanding of these results, we graphed interactions (see Figure 1), such that the high or low searching social support corresponds to scores that are 1 SD above or below the mean (Cohen, Cohen, West, & Aiken, 2003). In adolescents with a high level of active search for social support, there was no relationship between polyvictimization and externalizing symptoms (β = −.32, p > .05). In contrast, in those with a low degree of searching for social support, the relationship was significant (β = .55, p < .05).

Figure 1.

Interaction between polyvictimization and the seeking of social support on externalizing symptoms.

Discussion

Our objective was to evaluate the possible moderating effect of active searching for social support in the relationship between externalizing symptoms and polyvictimization. The results show that the polyvictimization is an important predictor of externalizing symptoms, as has been suggested by previous studies (Álvarez-Lister et al., 2014; Boxer & Terranova, 2008; Ford et al., 2009; Ford et al., 2011). However, it was noted that this relationship was moderated by the degree of searching for social support. Thus, as indicated by studies with victims of specific traumatic events, the adolescents who actively coped with their stressful situations (Bal et al., 2003; Bal et al., 2009; O’Leary, 2009) and mobilized their social network (Evans et al., 2013; Holt & Espelage, 2007; Murthi & Espelage, 2005) showed lower externalizing symptoms.

In this study, polyvictimization was associated with externalization only in adolescents with low search for social support, but not in those who were actively seeking to mobilize their support network. The evidence that the search for support is a protective factor, even for this serious form of victimization, expands the possibilities for intervention (Manly et al., 2013). It seems important that intervention programs with poly-victims who present externalizing problems should encourage the strengthening of their social support networks alongside their own personal coping strategies as proposed by trauma-focused cognitive behavior therapy (Cohen, Mannarino, Kliethermes, & Murray, 2012). For example, it could be useful in therapy to help adolescents to recognize their support network and improve their social skills to ask for help if required. According to that, therapists should include figures that would provide containment and support to adolescents in their intervention programs with poly-victims.

Research about externalizing symptoms in poly-victims is still scarce (Cyr et al., 2014; Manly et al., 2013); therefore, these results allow for better understanding of the process of the development of externalizing symptoms in that population. This is particularly relevant in Chile because there are not enough empirical data about factors to consider in interventions with this population (Ministerio de Salud & SENAME, 2007). In addition, most studies on the matter have been conducted in Europe or the United States. We need more research in the Latin American context, because, as it is known, there are various cultural and socioeconomic differences with respect to developed countries.

However, we must be clear that this is a preliminary report with limitations. First, we used new instruments to evaluate polyvictimization and externalizing that was answered by therapists. Although we only included adolescents for whom we had details about their history, the information could be incomplete. Furthermore, although in this study the instruments showed good psychometric properties, it is necessary to conduct more profound studies about its validity and reliability. Second, it is not possible to generalize our conclusions because we work with a too small clinical sample. Future studies with larger samples should deepen these results, and including other factors may also help to explain the relationships between polyvictimization and externalizing behaviors (e.g., comparing a clinical sample with an overall sample or by controlling the effect of treatment).

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) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Cristóbal Guerra is a clinical psychologist at a center for the treatment of victims, a researcher at the NGO Paicabi, and a professor in the psychological department at Santo Tomas University.

Claudia Ocaranza is a clinical psychologist with extensive experience in caring for children and adolescents in Public Services in Chile. She currently works in the private social services system.

Kchatriani Weinberger is a psychologist who studied and worked in Chile. At present, she is living and working in Australia.

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