Multiplicity of Child Maltreatment and Biopsychosocial Outcomes in Young Adulthood

Abstract

This study examined the moderating role of resiliency characteristics in the relationship between multiplicity of child maltreatment and biopsychosocial outcomes (i.e., psychological, physical, and interpersonal distress) in young adulthood. Participants included 765 college women who completed surveys. Structural equation modeling showed that resiliency characteristics moderated the relationship between multiplicity of child maltreatment and psychological distress; at high levels of resiliency characteristics, there was a nonsignificant relationship between multiplicity of child maltreatment and psychological distress. There was no evidence of moderation for physical or interpersonal distress. However, for both interpersonal and physical distress, the main effects of multiplicity of child maltreatment were positively related to each form of distress, and the main effect of resiliency characteristics was negatively related to each form of distress. These findings underscore the importance of promoting resiliency characteristics among survivors of multiplicity of child maltreatment to promote optimal functioning.

Keywords

childhood maltreatment multiplicity of child maltreatment resiliency characteristics young adulthood psychological physical interpersonal violence abuse biopsychosocial

Emerging adulthood, generally between the ages of 18 and 25, is a distinct period between adolescence and adulthood when individuals begin to develop a new identity and establish their independence. This time is characterized by developmental stress, where new challenges (e.g., college and living independently) are accompanied by new vulnerabilities (Arnett, 2000; Banyard & Cantor, 2004). Research has documented that adverse early childhood experiences can influence adjustment in emerging adulthood, resulting in poor mental (van Vugt, Lanctôt, Paquette, Collin-Vézina, & Lemieux, 2014) and physical (Anda et al., 2006) health outcomes. One type of adverse experience in childhood is maltreatment, which we operationalize to include physical, psychological, and sexual abuse and witnessing intimate partner violence between parents or caregivers (Afifi & MacMillan, 2011).

Experiences of child maltreatment can lead to a number of negative consequences in childhood (Arata, Langhinrichsen-Rohling, Bowers, & O’Brien, 2007) as well as long-term consequences in emerging adulthood (Anda et al., 2006; van Vugt et al., 2014). These consequences are biopsychosocial in nature, transcending multiple domains of functioning (operationalized to include interpersonal and psychological functioning and physical health). There is a growing body of research documenting that most victims of childhood maltreatment experience multiple forms of victimization (i.e., multiplicity of child maltreatment) and that negative biopsychosocial outcomes increase in severity with more forms of victimization experienced (Chartier, Walker, & Naimark, 2010; Finkelhor, Ormrod, Turner, & Hamby, 2005).

Adverse mental health outcomes frequently correlated with a history of child maltreatment in emerging adulthood include depression, anxiety, and somatization (Kaplow & Spatz Widom, 2007; Mersky & Topitzes, 2009; Springer, Sheridan, Kuo, & Carnes, 2007). Among young adults, histories of child maltreatment are also correlated with higher rates of physical health symptoms, chronic medical conditions, increased utilization of health care services, and perceptions of poor physical health (Chartier et al., 2010; Springer et al., 2007; Thompson, Arias, Basile, & Desai, 2002). Interpersonal outcomes such as difficulty establishing intimate relationships, decreased marital or relationship satisfaction, nonassertiveness, being distant, and self-sacrificing are also correlates of child maltreatment among young adults (Davis, Petretic-Jackson, & Ting, 2001; Paradis & Boucher, 2010).

Although multiplicity of child maltreatment places an individual at risk of experiencing a number of adverse biopsychosocial outcomes, not all individuals with maltreatment experiences demonstrate negative outcomes. This has led researchers to examine resiliency characteristics, resilience, and related constructs. Although no consensus in the field has been reached to date about the definition of resilience and related terms, some research focuses more on resilience as a fluid, multidimensional process (Bolger & Patterson, 2003; Cicchetti, 2013; Connor & Davidson, 2003; Herrman et al., 2011; Klika & Herrenkohl, 2013; Luthar, Cicchetti, & Becker, 2000; Walsh, Dawson, & Mattingly, 2010). However, for the purpose of this study, we are conceptualizing resiliency characteristics as psychological characteristics of individuals, which are undoubtedly related to larger resilience processes. Throughout the article, we use resiliency characteristics to refer to personal characteristics and resilience or resiliency to refer to a process.

According to Masten (2001), resiliency characteristics are not uncommon, as qualities of an individual can moderate the impact of adversity. In this study, which focused on a critical point of transition (i.e., emergent adulthood), we were guided by variable-focused approaches to understanding resiliency characteristics, specifically characteristics of an individual known to promote biopsychosocial well-being in the face of trauma or adversity (Masten, 2001). Resiliency characteristics have been operationalized to include hardiness (e.g., ability to cope with change, unexpected events, and stress), persistence (e.g., ability to achieve goals despite obstacles), commitment to finding meaningful purpose in life, believing one can influence one’s surroundings and event outcomes, and believing one can learn and grow from both positive and negative life experiences (Bonanno, 2004; Campbell-Sills & Stein, 2007).

To date, few studies have examined the buffering role of resiliency characteristics in the relationship between child maltreatment and biopsychosocial outcomes in emergent adulthood. In a study of college students, which included young adult survivors of childhood emotional neglect, Campbell-Sills, Cohan, and Stein (2006) found that individuals who utilized task-oriented coping demonstrated higher levels of resiliency characteristics (as measured by the Connor Davidson Resilience Scale [CD-RISC]; Connor & Davidson, 2003) and reported fewer psychiatric symptoms than those who employed emotion-oriented coping. Further in this same study (Campbell-Sills, Cohan, & Stein, 2006) and another study by the same research team (Campbell-Sills & Stein, 2007), the researchers found that resiliency characteristics (as measured by the CD-RISC) moderated the relationship between childhood maltreatment and psychological distress in undergraduate students. Specifically, at low levels of resiliency characteristics, there was a strong and positive relationship between childhood maltreatment and psychological distress, whereas at high levels of resiliency characteristics, there was a weak relationship (Campbell-Sills et al., 2006) or no relationship (Campbell-Sills & Stein, 2007) between childhood maltreatment and psychological distress.

Less research has focused on resiliency characteristics in the relationship between child maltreatment and physical health. In one study, Heckman and Clay (2005) found that hardiness, as measured by the Dispositional Resilience Scale (Bartone, Ursano, Wright, & Ingraham, 1989), was negatively related to physical health problems in middle-age community women with and without histories of childhood physical and/or sexual abuse. However, hardiness did not moderate the impact of childhood abuse on physical health. Based on our literature search, we were unable to locate any studies that have examined resiliency characteristics in the relationship between child maltreatment and physical health in emerging adulthood.

Similarly, little research to date has examined how resiliency characteristics might moderate the relationship between child maltreatment and interpersonal functioning. Connor et al. (1999) suggested that the presence of certain individual qualities reflective of greater resiliency characteristics may mitigate an individual’s feelings of helplessness in situations of stress or trauma. Specifically, these individual characteristics may facilitate increased self-efficacy, decreased self-blame, engagement in more active coping, and less social withdrawal or poor self-care (e.g., Connor et al., 1999). Such resiliency characteristics may allow individuals to more readily activate their social support network in times of stress; this could serve as a buffering factor against development of interpersonal problems subsequent to a trauma.

We were able to locate only two published studies examining the relationships among child maltreatment, resiliency characteristics, and interpersonal functioning. Wright, Fopma-Loy, and Fischer (2006) found that among a sample of community women with childhood sexual abuse histories, interpersonal functioning (i.e., marital satisfaction) was unrelated to measures of resiliency characteristics, which included problem solving and seeking social support. Lamoureux, Palmieri, Jackson, and Hobfall (2012) found among a sample of primarily low-income, young, urban women that childhood sexual abuse was negatively related to resiliency characteristics (operationalized to include self-esteem and self-efficacy) but that resiliency characteristics were unrelated to interpersonal distress in the presence of psychological distress symptoms. It is important to point out that Lamoureux et al. (2012) did not directly study the moderating role of resiliency characteristics on interpersonal distress. Based our literature search, we were unable to locate any studies that have examined resiliency characteristics as moderators between child maltreatment and interpersonal functioning in emerging adulthood.

Although there is growing recognition of the need to better understand the role of resiliency characteristics in the relationship between childhood maltreatment and biopsychosocial outcomes, there have been limitations to the few published studies. Specifically, the majority of studies tend to either examine one outcome, most commonly psychological functioning, or one form of child maltreatment (e.g., sexual abuse), rather than multiplicity of child maltreatment and its outcomes. More research is required to further delineate the biopsychosocial outcomes associated with multiplicity of child maltreatment, given that most victims of childhood maltreatment experience multiple forms of victimization, and outcomes become more severe with more forms of victimization experienced (Chartier et al., 2010; Finkelhor, Ormrod, & Turner, 2007).

This type of research is especially needed during emergent adulthood, as individuals within this age-group are already at a heightened risk for a number of negative experiences (e.g., sexual victimization, suicide), and child maltreatment further increases the likelihood of these experiences (Arnett, 2000; Duke, Pettingell, McMorris, & Borowsky, 2010; Hahm, Lee, Ozonoff, & Wert, 2010; Zarrett & Eccles, 2006). Given that the majority of resiliency research has focused on children and adolescents (e.g., Yates, Egeland, & Sroufe, 2003), we seek to add to this body of literature by exploring resiliency characteristics in the emerging adult population. Also, examining resiliency characteristics among college students is particularly important, given that college-age individuals may not seek treatment as readily as other populations (Bonanno, 2004; Campbell-Sills et al., 2006).

This study tested resiliency characteristics as moderators of multiplicity of child maltreatment and biopsychosocial outcomes in a sample of young, college women. We hypothesized that resiliency characteristics would moderate the relationship between multiplicity of child maltreatment and psychological, physical, and interpersonal distress. Specifically, we hypothesized that the relationship between multiplicity of child maltreatment and biopsychosocial outcomes would be stronger at lower levels of resiliency characteristics than higher levels of resiliency characteristics. Put another way, at high levels of resiliency characteristics, biopsychosocial distress scores would be low regardless of the number of maltreatment types experienced.

Method

Participants

Participants were 765 college women from a medium-sized, Midwestern university. Women were 18–25 years of age (mean age = 18.74, SD = 1.01) and mostly first-year students (70.2%). The racial classification of the sample is as follows: 87.8% White, 4.7% Black, 4.5% Asian, and 3.0% multiracial or another racial identification. The majority of the sample (83.6%) came from families with annual incomes equal to or above US$50,000, and 77.4% were raised in two-parent homes.

Procedure

These data come from a larger, longitudinal study assessing the impact of sexual assault during college (Probst, Edwards, Tansill, & Gidycz, in preparation); the analyses presented herein utilize only the initial survey data. Women were recruited through introductory and other lower level psychology courses and received course credit for their participation. In order to avoid a selection bias, we did not mention anything about abuse or trauma in the recruitment message; the study was advertised as “A Study of Women’s Social Experiences.” Anyone who met the study criteria (i.e., identified as a female and 18 years of age or older) could sign up for the study.

Upon arrival, to the lab participants were provided informed consent. The survey session was administered by a female graduate student in groups of approximately 10–15 women. After completing the surveys, women were provided with debriefing and referral information. Prior approval was obtained from the university’s institutional review board.

Measures

Demographics

A brief measure was included to collect demographics that were examined in their relation to the outcome variables. These variables included age (continuous), family income (ordinal), race (non-White [0] or White [1]), and family household (non-two-parent [0] or two-parent [1]).

Resiliency characteristics

The 25-item CD-RISC (Connor & Davidson, 2003) measured resiliency characteristics. Items (e.g., “having to cope with stress can make me stronger,” “tend to bounce back after illness or hardship,” “thinks of self as strong person,” “can handle unpleasant feelings”) examined how individuals felt in the last month and were rated on a 5-point scale, ranging from 0 (not true at all) to 4 (true nearly all the time). The items were summed to create a composite score ranging from 0 to 100, with higher scores indicative of the presence of greater resiliency characteristics. Although other measures of resiliency characteristics exist (e.g., Dispositional Resilience Scale; Bartone et al., 1989; Wagnild & Young, 1993), the CD-RISC is the first to become well-validated, widely used in the scientific community, and generalizable across a variety of cultures and populations (Di Fabio & Palazzeschi, 2012; Ozlem, 2010; Yu et al., 2011; Yu & Zhang, 2007). The CD-RISC has established psychometric properties (Connor & Davidson, 2003) and in the current study, Cronbach’s α = .94.

Multiplicity of child maltreatment

Four separate measures, described subsequently, were used to create an index of multiplicity of maltreatment. These measures assessed childhood experiences of sexual abuse, physical abuse, verbal abuse, and witnessing intimate partner violence. On each of these four measures, participants received a score of 0 (indicating no experience with that specific form of child maltreatment) or 1 (indicating any exposure to that specific form of child maltreatment). These scores were then summed to create a multiplicity of child maltreatment score ranging from 0 to 4, indicating the number of types of child maltreatment participants experienced.

Childhood sexual abuse

The Childhood Sexual Victimization Questionnaire (Finkelhor, 1979) is a self-report measure consisting of 8, behaviorally specific items and was used to assess childhood sexual abuse. Participants answered yes or no to indicate whether they had certain sexual experiences before the age of 14, ranging from noncontact sexual abuse to completed rape. An experience was classified as childhood sexual abuse if (1) there was an age discrepancy of more than 5 years between the child and the other person; and/or (2) some form of coercion was used to gain the child’s participation (e.g., use of power or authority, physical force, gifts, and threats); and/or (3) the other person was a caregiver or authority figure (e.g., parent, uncle, and grandparent). Risin and Koss (1987) found the concurrent validity of the instrument to be adequate.

Physical and verbal childhood abuse

The violence and psychological aggression subscales of the Parent -Child Conflict Tactics Scales assessed childhood physical abuse and verbal abuse, respectively (Straus, 1979; Straus, Hamby, Finklehor, Moore, & Runyan, 1998). Participants answered questions regarding experiences that occurred before the age of 18 with a caregiver. The violence subscale, which assessed childhood physical abuse, included 9 items ranging in severity (e.g., “pushed, grabbed, or shoved me;” “kicked, bit, or hit me with a fist;” “threatened me with a knife or a gun”). Participants who answered affirmatively to one or more of these 9 items were considered to be victims of childhood physical abuse. The psychological aggression subscale, which assessed childhood verbal abuse, included 6 items. However, 3 items classified by Straus and colleagues as moderate (e.g., “stomped out of the room or house or yard”) were excluded, given they are generally endorsed by the majority of participants and not likely reflective of abuse (Edwards, Desai, Gidycz, & VanWynsberghe, 2009). Thus, only the 3 items (e.g., “threatened to hit or throw something at me”) classified as severe were used to identify participants as victims of childhood verbal abuse. Participants who answered affirmatively to one or more of these 3 items were considered to be victims of childhood verbal abuse.

Childhood witnessing intimate partner violence between parents or caregivers

Witnessing intimate partner violence in childhood was operationalized to include witnessing physical violence occurring between parents or caregivers before the age of 18, and the violence subscale of the Conflict Tactics Scales (Straus 1979) was used to measure this construct. The items (e.g., “pushed, grabbed, or shoved the other person”) on the violence subscale for witnessing intimate partner violence were identical to the items measuring childhood physical abuse, except they measured witnessing violence between parents or caregivers. Participants who answered affirmatively to one or more of these 9 items were considered to have witnessed intimate partner violence during childhood.

Biopsychosocial functioning

Three measures, discussed subsequently, assessed psychological, physical, and interpersonal distress and were the dependent variables in the moderated regression analyses.

Psychological distress

Global psychological distress was assessed using the 53-item Brief Symptom Inventory (BSI; Derogatis & Melisaratos, 1983). The BSI assesses psychological symptoms across multiple domains, including anxiety (e.g., “feeling fearful”), depression (e.g., “feeling blue”), somatization (e.g., “faintness or dizziness”), obsession-compulsion (e.g., “difficulty making decisions”), hostility (e.g., “feeling easily annoyed or irritated”), interpersonal sensitivity (e.g., “feeling inferior to others”), phobic anxiety (e.g., “feeling afraid in open spaces”), paranoid ideation (e.g., “feeling that most people can’t be trusted”), and psychoticism (e.g., “the idea that someone else can control your thoughts”). Participants rated how often they experienced each symptom in the previous 7 days on a 5-point scale ranging from 0 (not at all) to 4 (extremely). The nine symptom domains are summed to create a measure of current psychological distress; higher scores are indicative of greater psychological distress. The BSI possesses strong psychometric properties (Derogatis & Melisaratos, 1983), and the Cronbach’s α was .95 for the current sample.

Physical health distress

The 33-item Cohen and Hoberman Inventory of Physical Symptoms (CHIPS; Cohen & Hoberman, 1983) assessed participants’ physical symptoms during the past 2 weeks. The CHIPS contains items that were selected to exclude psychosomatic symptoms but include common physical symptoms (e.g., “How much were you bothered by back pain?”; “How much were you bothered by numbness or tingling in parts of your body?”). Each item is rated on a scale ranging from 0 (not at all) to 4 (extreme bother). Items are summed and higher scores are indicative of greater physical health distress. The CHIPS has established psychometric properties (Cohen & Hoberman, 1983), and in the current sample, the Cronbach’s α was .89.

Interpersonal distress

The 32-item Inventory of Interpersonal Problems—Short Circumplex Form (IIP-SCF; Soldz, Budman, Demby, & Merry, 1995) was utilized to assess overall interpersonal difficulties across all relationships. Participants responded to items that assessed domineering (“I try to control people too much”), vindictive (“I want to get revenge against people”), cold (“I keep other people at a distance too much”), socially avoidant (“It is hard for me to join in groups”), nonassertive (“It is hard for me to be firm when I need to be”), exploitable (“I am too easily persuaded by other people”), overly nurturant (“I try to please other people too much”), and intrusive (“I open up to people too much”) interpersonal patterns on a 5-point scale ranging from 0 (not at all) to 4 (extremely). Consistent with the original measure instructions, there is no specific time frame provided to participants. A composite score was generated and higher scores are indicative of greater overall interpersonal distress. The IIP-SCF has demonstrated good psychometric properties (Soldz et al., 1995), and in the current study, the Cronbach’s α was .92.

Data Analysis Plan

First, we computed means and standard deviations and bivariate correlations among all study variables. Next, we tested the moderation hypotheses using structural equation modeling. The model included the main effects of multiplicity of child maltreatment and resiliency characteristics (both mean centered; Aiken & West, 1991), and the product of multiplicity of child maltreatment and resiliency characteristics regressed onto each of the three biopsychosocial outcome variables. Demographic variables that demonstrated significant bivariate relationships with the outcome variables were included in the model. Missing data were handled using full information maximum likelihood method, which is the ideal method in structural equation modeling (Enders & Bandalos, 2001). We allowed error terms for the biopsychosocial outcome variables to correlate with one another, given that they were all correlated at the bivariate level and to avoid drawing causal paths between these variables. Although the biopsychosocial outcome variables were positively skewed, log and square root transformations did not affect any of the inferential data analyses (i.e., correlations or moderated regression analyses). Thus, the biopsychosocial variables were not transformed in the models.

The fit of the model was tested using AMOS 21. The goodness-of-fit χ² statistic was used to provide a test of the hypothesized model; a nonsignificant χ² statistic is desirable because it indicates no significant difference between the model and the data. Several goodness-of-fit indices were used to examine the fit of the model to the data, including the comparative fit index (CFI), Tucker–Lewis index (TLI), and root mean square error of approximation (RMSEA). For the CFI and TLI, values close to 0.95 and higher are evidence of an appropriate fit; for the RMSEA, values close to 0.06 and lower are evidence of an appropriate fit (Hu & Bentler, 1999; Loehlin, 2004).

Significant interaction terms were further explored utilizing the MODPROBE macro developed by Hayes and Matthes (2009). This macro conducts simple slope analyses, which are the conditional effects of multiplicity of child maltreatment on biopsychosocial outcome variables at different values of resiliency characteristics (i.e., mean and ±1 standard deviation). Moreover, MODPROBE conducts the Johnson–Newman method, which produces the values of resiliency characteristics at which the conditional effect of multiplicity of child maltreatment transitions between significant and nonsignificant.

Results

Descriptive and Basic Inferential Statistics

Means and standard deviations and bivariate correlations among all study variables are displayed in Table 1. Within the sample, 33.6% of participants reported no child maltreatment, 26.5% one type of child maltreatment, 24.5% two types, 13.2% three types, and 2.2% all four types of child maltreatment. Put another way, 66.4% of participants reported experiencing one or more types of childhood maltreatment and among those, 63.2% experienced multiplicity of child maltreatment. Of the entire sample, 39.9% experienced multiple types of maltreatment. At the bivariate level, multiplicity of child maltreatment was positively related to all biopsychosocial outcome variables, and resiliency characteristics were negatively related to all biopsychosocial outcome variables.

Table 1.

Means and Standard Deviations for and Correlations Among All Study Variables.

	M	SD	Range	1	2	3	4	5
1. Multiplicity of child maltreatment	1.24	1.08	0–4	—	−.10**	.23**	.30**	.17**
2. Resiliency characteristics	70.29	15.38	0–100		—	−.41***	−.24***	−.36***
3. Psychological distress	22.34	20.04	0–112			—	.59***	.54***
4. Physical distress	23.44	15.38	0–101				—	.37***
5. Interpersonal distress	33.69	19.06	0–99					—

Note. Means, standard deviations, and ranges for multiplicity of child maltreatment and resiliency characteristics are uncentered. However, in all inferential analyses, including bivariate correlations, these variables are centered. Also, correlations for all demographic variable and outcome variable were examined. Age was positively associated with interpersonal distress, growing up in a two-parent household was negatively associated with interpersonal and physical distress, and family income was negatively associated with physical health distress.

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

Moderation Analyses

The model was a good fit to the data as demonstrated by the goodness-of-fit indices, χ²(df = 4, N = 765) = 1.28, p = .865; CFI = 1.00; TLI = 1.01; RMSEA = 0.001 (see Figure 1). Although the resiliency characteristics and multiplicity of child maltreatment product term were significantly related to psychological distress, the product term was unrelated to interpersonal or physical distress. Further examination of the significant interaction using MODPROBE demonstrated that the relationship between multiplicity of child maltreatment and psychological distress becomes significantly weaker as resiliency characteristics increased. Moreover, the Johnson–Newman technique demonstrated that at resiliency characteristic values a little greater than 1 standard deviation above the mean, the relationship between multiplicity of child maltreatment and psychological distress became nonsignificant. In other words, at high levels of resiliency characteristics, psychological distress scores were low regardless of multiplicity of child maltreatment status. See Figure 1 for the plot of this interaction.

Figure 1.

Model testing hypothesized relationships. Note. Dotted lines represent nonsignificant paths; all other lines are reflective of significant coefficients. All coefficients are standardized.

Figure 2.

Plot of interaction term for psychological distress model.

Although moderation was not supported for physical or interpersonal distress, the main effects of multiplicity of child maltreatment and resiliency characteristics were significantly related to these types of distress. Specifically, higher levels of physical and interpersonal distress were related to lower levels of resiliency characteristics and higher counts of multiplicity of child maltreatment. Increasing age also related to more pronounced interpersonal distress and higher family income related to lower psychological distress, although no other demographic covariates were significant in the presence of child maltreatment and resiliency characteristics.

Discussion

This study examined resiliency characteristics as a moderator of multiplicity of child maltreatment and biopsychosocial outcomes in college women. At the descriptive level, 66% of participants reported experiencing childhood maltreatment, and among those, 63% experienced multiplicity of child maltreatment. These findings are consistent with the notion that individuals who experience one form of child maltreatment are likely to experience other forms of maltreatment as well (Finkelhor et al., 2007; Richmond, Elliott, Pierce, Aspelmeier, & Alexander, 2009).

Consistent with hypotheses and previous research (e.g., Campbell-Sills et al., 2006; Campbell-Sills & Stein, 2007), resiliency characteristics moderated the relationship between multiplicity of child maltreatment and psychological distress. Specifically, at high levels of resiliency characteristics, individuals who were maltreated were indistinguishable from those who were not. It may be that people with more resiliency characteristics, as measured by the CD-RISC (Connor & Davidson, 2003), have better “tolerance of negative affect, and strengthening effects of stress” (Connor & Davidson, 2003, p. 80), which allows them to better adjust to and cope with higher levels of stress. Decreased feelings of helplessness subsequent to the trauma may also facilitate greater self-efficacy, decreased self-blame, and engagement in more active coping, curtailing the development of negative psychological outcomes.

Contrary to the hypotheses, resiliency characteristics did not moderate the relationship between multiplicity of child maltreatment and interpersonal and physical distress. It is important to keep in mind, however, that the main effect of resiliency characteristics was significant such that those characteristics were negatively related to interpersonal and physical distress. Thus, resiliency characteristics indeed reduce the likelihood of physical and interpersonal distress, but unlike psychological distress, at higher levels of resiliency characteristics, multiplicity of child maltreatment is still exerting a significant influence on these forms of distress.

There are a few possibilities as to why resiliency characteristics were not a significant moderator in the analyses of interpersonal and physical distress. First, our measure of resiliency characteristics is primarily a measure of psychological characteristics and may not adequately capture resiliency characteristics that are more of a social or biological nature. Second, because college is a time of new challenges, including changes in the nature of interpersonal relationships and attachment bonds between young adults and their parents, there may be a number of other contributors to interpersonal distress that were not measured in this study. Further, chronic stress from exposure to childhood abuse may hinder the normal course of development, therefore lessening the potential buffering impact of resiliency characteristics on physical health symptoms. Indeed, research has found that exposure to adverse environments during childhood can affect brain development and neurobiological systems (Cicchetti & Curtis, 2006).

Although the chronic stress hypothesis may not be particularly relevant to our young sample, as they have not experienced decades of chronic emotional stress, it is possible that if maltreatment began early in childhood, they may have experienced a decade or more of subsequent biopsychosocial symptoms. The development of physical health effects appears to take time from the point of abuse, and later in life, we might expect to see more discrepant physical health outcomes where resiliency characteristics may play more of a role. Furthermore, it may be that some of the women with multiplicity of child maltreatment histories in our sample reported physical health problems (e.g., sexually transmitted infections and headaches from head injury) that resulted directly from the abuse, which we would not expect resiliency characteristics to necessarily eradicate. This is not to minimize the importance of resiliency characteristics in survivors coping with physical health ailments as reported in health psychology literature (e.g., Yi, Vitaliano, Smith, Yi, & Weinger, 2008) or our finding that resiliency characteristics demonstrated significant main effects with physical and interpersonal functioning.

Despite the contributions of these data, several limitations should be noted. We used a convenience sample of college students, which limits the generalizability of the study’s findings. Further, college students may possess more resiliency characteristics than noncollege young adults. For example, Boden, Horwood, and Fergusson (2007) found that individuals reporting child maltreatment (i.e., child physical or sexual abuse) were less likely to graduate high school or attend college. Therefore, participants in our sample may possess more resiliency characteristics than community or clinical samples of young adults. However, there is research demonstrating that college students, in general, report more elevated levels of psychological and interpersonal distress than the general population (e.g., Zarrett & Eccles, 2006). Also, given that our sample was derived from a larger study examining sexual assault (Probst et al., 2014), which research suggests is much more common among women than men (Black et al., 2011), the current analyses focused only on women. Theoretically, similar relationships would likely exist between childhood maltreatment, resiliency characteristics, and biopsychosocial outcomes for women and men. Nevertheless, future research would benefit from including noncollege young adults, along with samples that are more diverse demographically in terms of gender, race, ethnicity, and so forth.

Additional limitations to the study include its cross-sectional design and assessment of resiliency characteristics. Future research would benefit from longitudinal studies that will allow for clarification of temporal sequencing and causal relationships, as well as fluctuations in resiliency characteristics across time. Some literature suggests that cross-sectional studies tend to document higher levels of resiliency or resiliency characteristics compared to studies examining resiliency or resiliency characteristics over time (Mersky & Topitzes, 2009), suggesting that the levels of resiliency characteristics reported here may be inflated. Our measure of resiliency characteristics also only assessed the construct as characteristics of an individual rather than a dynamic process that would require assessment of functioning across multiple domains (e.g., education and behaviors) over time. A limitation associated with using this variable-focused approach to examining resiliency characteristics is that it may not identify patterns among individuals (Masten, 2001). Further, the lack of a common definition of resilience (and related terms) within the literature has led to differing means of measurement, rates, and understanding of this important construct across studies making findings varied (e.g., Walsh et al., 2010). Indeed, some developmental researchers (e.g., see Rutter, 2007) object to defining resilience as a personal characteristic (i.e., resiliency characteristics), and it is possible that if we measured resilience as a process, the results of the current study may have differed.

There are other measurement issues that are limitations to our study. We did not include a measure of social desirability in our survey, and the time frames on some of our measures were inconsistent (e.g., psychological distress in the past week and physical distress during the past 2 weeks). Although this likely had little impact on the results, future research could use more consistent time frames across symptom measures and control for social desirability. Further, retrospective reports of child maltreatment may be influenced by recall biases, and participants’ current mood states may influence perceptions of resiliency characteristics. Thus, future research would benefit from the inclusion of longitudinal, prospective methodologies beginning early in life prior to the onset of child maltreatment and following individuals throughout the young adult years.

It is also important to consider the study results in light of our measurement of multiplicity of child maltreatment. Traditional measures of multiplicity of child maltreatment, and related constructs (e.g., polyvictimization), generally include a broader spectrum of childhood maltreatment experiences (e.g., community violence, and robbery; Finkelhor et al., 2005, 2007). Future researchers should further explore how resiliency factors moderate the diverse range of victimization experiences that individuals may encounter. Although there is debate in the field about how to best measure experiences of victimization (e.g., number of types experienced, frequency, severity, etc.), some research suggests that the number of types of maltreatment experienced is a more robust predictor than any single type of maltreatment alone, regardless of type or severity (Finkelhor et al., 2005). The way in which we conceptualized multiplicity of child maltreatment did not take severity and frequency into account. Clearly, the field would benefit from increased discussion and empirical examinations into the best way to measure multiplicity of child maltreatment.

The results of this study have some important implications for young women who enter college having experienced multiplicity of child maltreatment. First, our data suggest that a number of women will enter college with a history of multiplicity of child maltreatment and that such a history is associated with psychological, physical, and interpersonal distress. Given that resiliency characteristics moderated the relationship between psychological distress and multiplicity of child maltreatment, it is important that educators and health care providers work collaboratively to foster the development of resiliency characteristics (e.g., self-efficacy, social ties and connections, social and problem-solving skills, distress tolerance, and active coping strategies) in young women who have experienced multiplicity of child maltreatment. Programming that focuses on the development of resiliency characteristics has the potential to bolster students’ ability to effectively cope with future stressors or traumatic situations leading to the mitigation of negative psychological consequences.

In addition to focusing on the development of resiliency characteristics in young women with abuse histories, more generally, schools and colleges should focus on the development of resiliency characteristics in all female students. The establishment of programming in schools and colleges, which for some students may be environments that are more stable, protective, and encouraging of their well-being than their family homes, may be beneficial in bolstering resiliency characteristics. Although a moderating effect was not found for multiplicity of child maltreatment and physical and interpersonal distress, there was a noted main effect for resiliency on these two outcomes. This suggests that education and trainings on college campuses that may foster the development and sustainability of resiliency characteristics have the potential to benefit the functioning of female students across interpersonal and physical domains as well as mitigate psychological distress.

Consistent with our findings and based on related literature (Benight & Bandura, 2004; Haskett, Nears, Sabourin Ward, & McPherson, 2006), programming focused on developing resiliency characteristics would likely be beneficial in promoting resiliency characteristics and healthy functioning in college students. Research is still needed to directly test the effectiveness of these types of interventions on fostering resiliency characteristics specifically among female survivors of multiplicity of child maltreatment, as well as general undergraduate populations and to identify the critical dimensions of resiliency characteristics. Increased understanding of the specific components of resiliency most salient in promoting well-being in psychological functioning may be useful in developing intervention programs and policies for female college student survivors of multiplicity of child maltreatment across different developmental periods. Finally, the data presented in the current study are a reminder to those committed to the study and prevention of multiplicity of child maltreatment of the strength, courage, and resiliency that survivors demonstrate in the face of such adversities, and the importance of focusing on such strengths in research, clinical work, policy, and advocacy efforts.

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

Funding for this project was provided by the Ohio University Counsel on Research Student Enhancement.

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