THE RELATIONSHIP BETWEEN CUMULATIVE ADVERSITIES
, EXPOSU
RE TO
VIOLENCE, GENDER AND MENTAL HEALTH: A STUDY OF THE WORKPLACE IN
.
GAUTENG
PROVINCE, SOUTH AFRICA
MIKAT~KO MABUNDA
2011
Pag=-THE RELATIONSHIP BETWEEN CUMULATIVE ADVERSITIES, EXPOSURE TO VIOLENCE, GEl\DER AND MENTAL tJEALTH: A STUDY OF THE WORKPLACE IN
GAUTENG PROVINCE, SOUTH AFRICA
111111111111 1111111111 IIIII 11111111111111111111 11111111 060038876
North-West University Mafikeng Campus Library
Mikateko Mabunda 23367008
Dissertation (article format) submitted in partial fulfilment of the requirements for the degree in Masters of Social Science in Research Psychology at the North-West University (Mafikeng Campus)
Supervisor: Professor E.S. Idemudia
TABLE
O
F C
O
NTENTS
DEDICATIO
N
ACKNOWLEDGEMENT
SUMMARY
PREFAC
E
LETTER OF
C
ONSENT
INSTRUCTION
TO AUTHORS
MANUSCRIPT
TITLE
PAG
E
ABSTRACT
INT
ROD
UCTI
O
N
AND STATEMENT OF
PROBL
EM
TH
EORETICA
L BACKGROUN
D
HYPOTH
ESES
METHODOLOGY
DesignSample and Characteristics
Instruments and Psychometric properties
CAS
GHQ-28CEDV
ProcedureRESULTS
DISCUSSIO
N
CONCL
USIONS
RECOMMENDATIO
NS
ACKNOWLEDGEMENT
DECLARATIONS
REFERENCES
3 l r , p;4
5 7 9 10 1115
16 17 1925
27 28 28 2829
29
3032
333
4
3841
42
43
44
45
DEDICATION
Th
i
s study
is dedicated
in
lo
v
ing memory
to my
lat
e
parents
Nkanyezi Alson and
Ntombizodwa
Lydia Mabunda
And
ACKNOWLEDGEMENTS
Jehovah you are my shield and comforter. You are the source of my strength and wisdom. You are the best gift my mother ever gave me.
J
sometimes fail to do your will but you always bless me. Obrigado51
• To Prof. E.S. Idemudia thank you for demanding nothing less than perfection. Thank you for listening and caring. May our Almighty grant you more life of great quality. May He expand your territory from the North to the South and from the East to the West. I will always remember to "focus''. Obilu sir.
• To my family, Douglas, Renee, Tsakani, Nyeleti, Mandla and Nyiko. You guys and your families are the best part of me. I thank God for you every day that I breathe. I really could not have done this without your support.
• North-West University, thank you for awarding me a bursary to further my studies • To Nyambeni Matamela thank you for always taking my anxiety filled calls
• To Margareth Mosela Mafongozi, where do I start to say thank you? Should it be for keeping me healthy while I studied throughout the long nights? Or for assisting me with collecting data? Or for always encouraging me to stand whenever 1 was exhausted. I am yet to meet a person as strong and courageous as you my friend. Thank you for sharing your goodness with me.
• To Dr.
L.M. Moga
ladi and Dr.M.L.A Modisane.
Thank you for always understanding and for giving me the time to travel to Mafikeng for my studies. You alwayssupported my work and studies and for that I pray that God blesses you.
• To Themba Mdaka. I am so proud to be associated with a person of your calibre. You have a mandate from God to take care of His folk and you are doing exactly that. May He bless your family and increase every aspect of your life.
•
To
my
cousin Han
y
ani Makumbani. Thanks
for
the SPSS programme. You know
where it
landed
me on that fateful Sunday afternoon.
•
To friends and family who helped collect data
, I thank
you from the bottom of my
heart.
•
Special mention of the following people who assisted me
in
this journey: Mohau
Modise
,
Veronica Mohai
,
Mr.
Oupa
Molepo and Mr. Abe Mashabela.
•
To the Far East Rand
Hospital
employees
, thank
you for understanding and for
a
s
sisting me with information. I also want to
thank
you for understanding when
1
wa
s
at school and away from work.
•
To all the institutions who assisted me with collecting data and pro
v
iding me with
information I
thank
you.
SUMMARY
Cumulative adversity is a complex subject to study as it involves many facets with vast differences in approach. Ln an attempt t•o understand the relationship between cumulative adversities, exposure to violence and mental health in workplace settings in Gauteng Province, the study was anchored on three hypotheses and thereby investigated (I) whether there will be a relationship between cumulative adversities and mental health, (2) whether there will b.e a relationship between exposure to violence during childhood and poor mental health and (3) whether there will be a significant differenc.e between gender, cumulative adversities, exposure to violence and mental health. The study utilised a questinnnaire with three sections-A, B and C. Section A contained demographic items, Section B contained the cumulative adversity scales and ·the Child Exposure to Domestic Violence scale measuring direct and indirect exposur.e to violence in childhood and Section C contained the General Health Questionnaire 28 scale measuring mental health with four subscales-somatic complaints, anxiety and insomnia, social dysfiunction, and depression. Psychometric properties of the scales used are valid and reliable. Five hundred workers participated in the study using a cross-section design and were randomly selected from three hospitals in Gauteng Province, South Africa. Participants were 18 years or older with age ranging between I 8-65 years. Males wene 251 (50.2%) and females were 249 (49.8%). Mean age of employees was 33.8 years (SO
=
11.0). The first two hypotheses were tested with a hierarchical multiple regression and the third hypothesis with a t-test. Results from the study showed that cumulative adversities (family, childhood, personal) and exposure to violence (direct and indirect witnessing of violence in childhood) jointly and significantly predicted poor mental health of workers in the model,R
2=
0.35, F (5, 440)=
47.49, p<OOOI. The variables, familycumulative adversity, personal cumulative adversity, childhood adversity, indirect exposure to violence and direct exposure to violence explained 59% of the total variance on poor mental health. Of the variables, the main significant predictors of mental health were: personal cumulative adversity (b = .35, t ( 445) = 7.56,
p
< .0 I), indirect exposure to domestic violence (b = -.123, t (445) = -2.18, p < .05) and direct exposure to violence(b=
.3 7, t ( 445= 6.25, p < .01 ). In addition, the Durbin-Watson result ( 1.58) is less than 2 and therefore shows that the assumption of independent error is met for this model. Results for hypothesis three showed significant main effects for gender on two of the cumulative adversity measurements with males scoring higher in family cumulative adversity, t=
(498) =3.64, p<.OOOl and Personal cumulative adversity, t = (498) = 2.37, p<.Ol. Males had higher mean scores than females on family adversity (X-bar 4.87 versus X-bar 3.73) and Personal adversity (X-bar 3.11 versus X-bar 2.52). In addition, there was also a significant main effect for direct exposure to violence, t = (498) = 3.00, p<.003 with males scoring higher than females (X-bar 16.9 versus X-bar 14.5). There were no significant results for gender, childhood cumulative adversity, indirect exposure to violence and the four subscales of mental health-somatic complaints, anxiety, social dysfunctions and depression. It was noted in conclusion that the study contributed to the body of knowledge by showing that cumulative adversities and child exposure to domestic violence can predict mental health and that men and women react differently on cumulative adversities and exposure to violence in childhood. Workplace programmes which promote positive health can improve the mentaJ wellness of employees; therefore, several preventive recommendations were made in line with the findings of the study.PREFACE
Article format
For the purpose of this thesis, which is the requirements for the degree of Masters in Research Psychology the article format as described by General Regulation A. 7.5.1.b of the
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The target journal for submission of the current manuscript is Journal of Social Sciences (JSS). For the purpose of examination tables will be included in the text.
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·'The relationship between cumulative adversities. exposure to violence and mental health: A study of the workplace in Gauteng Province, South Africa" may be. submitted for purposes of
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LETTER
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I, the undersigned, hereby give consent that Mikateko Mabunda may submit the manuscript entitled "THE RELA TiqNSHIP BETWEEN CUMULATIVE ADVERSITIES, EXPOSURE TO VIOLENCE, GENDER AND MENTAL HEALTH: A STUDY OF THE WORKPLACE
IN
GAUTENG PROVINCE, SOUTH AFRICA .. for the purpose of a thesis in fulfilment for the Masters of Research degree in PsychologyJOURNAL OF SOCI
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MANUSCRIPT
THE RELATIONSHIP BETWEEN CUMULATIVE ADVERSITIES, EXPOSURE TO VIOLENCE, GENDER AND MENTAL HEALTH: A STUDY OF THE WORKPLACE IN
GAUTENG PROVINCE, SOUTH AFRICA
THE
RELATIONSHIP BETWEEN
CUMULATIVE ADVERSITIES, EXPOSURE
TO
V
IO
LENCE
,
GENDER AND
ME
N
TAL I:IEALTH:
A STUDY
OF
THE WORKPLACE IN
GAUTENG PROVNCE, SOUTH AFR
ICA
Mikateko Mabunda*,
Erhabor
S. Idemudia
Facult
y
of Human and Social Sciences, North West University (Mafikeng Campus),
South
Africa
Correspondence to:
Mikateko Mabunda
Prof
.
E.S.
Id
emudia
Departmen
t of
Psychology
(lpelegeng
Child and Family Center)
North West
U
ni
versity
(Mafikeng Campus)
Private Ba
g
X
2046
Mmbatho
2735
South Africa
Mikateko.mabunda
@
yahoo.com
erhabor.idemudia
@
nwu.ac.
za
Tel:+ 27-18-389-2425
Fax:
+
27-18-389-2424
16 1 rare
ABSTRACT
This study investigated
(l)whether there wiq be a relationship
between
cumulative adversities
and the quality of mental
health
,
(2) whether there will be a
relationship
between exposure to
violence
during
childhood and poor
mental
health and (3) whether there will be a significant
difference between gender
,
cumulative adversities
,
and exposure to violence and mental
health.
Data
were collected from five hundred participants that were randomly selected
from
three different
hospitals
in
Gauteng Province.
Age of participants
ranged
between 18-65
years. Males were 251 (50
.
2%) and females were 249 (49.8%)
.
Mean
age of employees was
33.8 years (SO= 11.03). Results showed
that
cumulative adversities (Family, childhood
,
personal) and exposure to violence (direct and indirect witnessing of violence
in
childhood)
jointly and significantly predicted poor mental health of workers. The variables
,
family
cumulative adversity
,
personal
c~mulative adversity,indirect
exposure and
direct exposure
explained 59% of
the
total variance on poor mental health. The
Durbin-
Watson result ( 1.58)
i
s
less than 2 and therefore shows that the assumption of
i
ndependent error is met for this
model.
Results
for hypothesis three showed significant
main
effects for gender on two of the
cumulative adversity measurements; family adversity and personal adversity. In addition,
there was also a significant
main
effect for direct exposure
to
violence. There were no
significant results for childhood cumulative adversity
,
indirect exposure and
the
four
subsca
l
es o
f
mental
health-somatic
complaints, anxiety
,
social
dysfunctions
and depression.
Workplace programmes which promote positive health can improve the mental wellness of
e
mployees; hence several preventive
recommendations
were made in line with the findings of
the study.
Keywords: Cumulative adver
s
ities
/
Gender
/
Exposure to
v
iolence/Mental-health/W orkplace
/
Gauteng
Provinc
e/
South Africa.
Introduction
&St
a
te
m
e
nt of pr
o
bl
e
m
:
Being psychologically healthy is as important as indeed the working environment and the job itself (Farrell, 2011). The impact of mental health problems in the workplace has serious consequences not only for the individual but also for the productivity of the enterprise (Baumann & Muijen, 2010; World Health Organization, 2010). Mentall health can be defined as a state of well-being in whjcb an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community (http://www.who.int/mediacentre/factsheets/fs220/len/). According to Baumann and M uijen (20 I 0), employee performances, rates of illness, absenteeism, accidents and staff turnover are highly affected by employees· mental health status.
The workplace environment demands an overall wellness of an individual to enable them to function to their fullest capacity. Psychological problems may hinder p~roductivity as it would affect optimal functioning. According to Statistics South Africa (200 I )1, a high percentage of all disability is due to ··emotional .. and intellectual disability. B~radshaw (2003) have described neuro-psychiatric disorders as the second highest proportion of burd~n of disease after HIVAfDS in Vv'estem Cape alone. Unfortunately, understanding mental health in work settings is hardly in estigated.
Based on this statement it is then safe to assume that employees who atre in optimal physical and psychological health are more likely to come to work and perform well. However, stressors causing poor mental health can be accumulated from childhood and into adulthood. These cumulative adversities (CAs) may have ramifications for mental health in a workplace. Studying the temporal dimension of exposure to violence and cumulative adversity can bring social research closer to understanding the extent of their consequences on mental health. 18 1
r
ageThis will be of benefit for both the organizations and
their
most
valued
asset, which
is
their
human resource, the employees.
Cumulative adversity (CA)
is
defined as expos
u
re to
potentially
traumatic events along
life
(Shmotkin
&Litwin,
2009).
These events
have
been
linked
with
adulthood mental health
problems in
several
studies
such as Lamont (2010)
,
who
stated that childhood
adversity
,
such
as exposure
to child abuse and neglect, can lead to
a
wide range of adverse consequences that
can
last
a lifetime.
Sometimes,
the
effects
remain largely hidden on
l
y to emerge
at key times
in
later life
(McQueen,
I
tzin
,
Kennedy, Sinason
,
&Maxted
,
2009)
,
such
as with the demands
of the
working
environment.
It
is important to
note
that cumulative adversity may occur directly to
the
individual and also
through indirect witnessing the adversities of a
loved
one. Both of
these
experiences
are said
to have
both
immediate and long-term consequences
for
health and
general wellbeing
(
Olesen
,
Macdonald
,
Raphael
&Bunerworth
,
201
0). A
parent's physical illness
,
for instance
,
may be
a cause
of mental anguish to a child. According to Hayes
,
Gray, and Edwards
(2008)
and Saunders
,
Naidoo, and Griffiths
,
(2007) this offers an
explanation for
the
common
co-occurrence of
many of these
adversities
and children's mental health. Adverse life
events
or
stres
s
ors
that
occur
to
a child'
s
parent
or
within their
familial
context
have been
connected
to
health,
behavioural
and
social
difficulties during childhood,
and
poorer outcomes later in life
(Olesen
,
et al, 2010).The adverse consequences
caused by parental adversities may
stem
from the fact that
distressed parents may not have
the strength
to
spend
quality time with their
children.
This
may lead to difficulties
in
engaging with
the child
and
nurturing the
child
'
s psychological
development, which
in tum
may render the child vulnerable to more adversity and later life mental challenges. These children are also more likely to experience depression and substance abuse as adults (Pirkola, lsometsa, Aro, Kestila, Hamalainen, Veijola, Kivuruusu, & Lonnqvist, 2005). Parental and familial stressors are consistently linked to poorer developmental, academic and health outcomes during childhood and later adulthood (Olesen,eta/, 20 I 0).
A study conducted by McLaughlin, Green, Gruber, Sampson, Zaslavsky, and Kessler, (20 1 0),
found that exposure to CAs involving maladaptive family functioning, e.g. parental mental illness, substance use disorder, criminality, family violence, physical and sexual abuse, and
neglect were significantly associated with persistence of mood and anxiety disorders and that these associations remained statistically significant. throughout the life course. According to Afifi, .Enns, Cox, Asmundson, Stein, and Sareen (2008) and McLaughlin, eta/., (201 0) this associations render individuals with a history of CAs especially vulnerable to mental
disorders triggered by adult stressors.
Other studies, such as Shmotkin and Litwin's (2009), have reported that cumulative adverse
events also have
an
influence on physical health. Scott, Von Korff, Angermeyer, Benjet, Bruffaerts, de Girolamo, Haro, Lepine, Ormel, Posada-Villa, Tachimori and Kessler, (2011)examined cross-sectional community data in adults from I 0 countries. History of childhood adverse experiences was shown to increase risk for all six of the medical disorder groups and
adults with experience of three or more adverse childhood experiences were found to have the greatest risk of an adult medical disorder. Cumulative adversity creates a vulnerability to
poor mental health which affects physical health.
In
Scott· set
a/.,
(2011) study anonset, before age 21, of an anxiety disorder or depression increased adult medical disorder risk for the six categories presented in the study.
Although cumulative adverse consequences are particularly apparent for mental health problems (Rodgers, Blewitt, Jacomb & Rosenman, 201 0), in some instances it might be the severity of adversity that may actually cause poor mental health. Respondents with higher cumulative adversity, in Schilling, Aseltine, and Gore's (2008) research, had disproportionately poorer mental health because of the severity of the adversities they were exposed to, and not the cumulative number of different types of adv~rsities experienced.
According to Seery, Holman, Silver and Cohen (2010), exposure to adverse life events typically predicts subsequent negative effects on mental health a~d well-being, such that more adversity predicts worse outcomes. These negative life events have been implicated in the development of alcohol dependence (Lloyd & Turner, 2008). Findings from the study suggest that high levels of lifetime exposure to adversity are implicated causally in the onset of alcohol dependence.
Cumulative adversity is a complex subject to study as it involves many facets with vast differences. Firstly most studies use self reported cumulative adversity exposure which varies amongst individuals (Schilling, Aseltine & Gore, 2007). Secondly accuracy is not certain as accuracy involves comparability of measures across countries and some of these studies do not comply (e.g. not much research includes third world countries as
in
Africa). Thirdly adverse experiences may also foster subsequent resilience, with resulting advantages for mental health and well-being instead of the opposite (Seery, eta!., 201 0). ln a multiyear longitudinal study of a national sample, people with a history of some lifetime adversityreported better mental health and well-being outcomes than those with lack of adversity history. Cumulative adversity may, in fa_ct, play a preparatory role for future adversity. Individuals with that experience may be able to handle life challenges as they would tell themselves '·this too shall pass'·. Gender and racial differences also need to be investigated.
Exposure to violence is very prominent in South Africa (RSA). According to a national report by the South African Police Services (2009) indicated that during years 2008/2009, a total of
2 098 229 (approximately 2,1 million) serious crime cases were registered in RSA, with
violent crimes being dominant. This is a serious public health concern that compromises the
society by affecting people's behaviour and psychological well-being. Violence is a form of
CA that can have negative implications for transitions to adulthood especially since trajectories established during early ad~lthood have profound implications for the quality of later life as indicated by Piquero, Brame, and Moffitt (2005). This exposure can have
significant effects on child development and the fonnation of intimate relationships
throughout childhood and adulthood (Muscari, 20 l 0). Results in a study conducted by Foster
and Brooks-Gunn (20 II) indicate the pervasive detrimental effects of violence exposure on
internalizing (e.g. depressive/anxiety symptoms), externalizing problems (e.g. aggressive behaviours), and social and educational outcomes across childhood and adolescence. Recent research also finds consistent links between community violence exposure and asthma in
children, including wheezing among preschoolers (Stemthal, Jun, Earls, & Wright, 201 0),
showing that not only does it have an impact on mental health but it also has physical health
consequences. Exposure in this study is conceptualized as including both direct (i.e., experiencing physical victimization) and indirect exposure (i.e., witnessing others' victimization).
The impact of exposure to violence on physical health is evidenced in the biomedical researches (e.g. Lanius & Vermetten, 2009) which, increasingly, recognize that childhood events, specifically abuse and emotional trauma, have profound and enduring effects on the neurologulatory systems mediating medical illness as well as on behaviour from childhood into adult life. For an example, Buse (2011) states that fibromyalgia is one of the medical co-morbidities resulting from adverse childhood experiences. Other medical conditions are migraine, chronic pain disorders and an increased risk for cardiovascular events. Poor physical health will subsequently lead to distress causing further poor mental health.
Mental health remains an invisible problem in Africa (Gordon, 2011 ). Mental health is defined as a state of well-being in which the individual realizes his or her own abilities, can cope with ~he normal stresses of life, can work productively and fruitfully, and is able to
make
a
contribution to his or her community(http://www.who.int/mediacentre/factsheets/fs220/enl). The implication of the above WHO definition is that being mentally healthy does not only mean the absence of mental illness but also the individual"s ability to develop and maintain a balance of all aspects of life. According to the WHO (201 0) report, mental health includes emotions, cognition, social functioning and coherence. Social functioning involves relations with others and the society which means that an individuars social setting is important to their mental health. Therefore exposure to violence whether at home or in the community from childhood will undoubtedly have a negative effect on the mental health of an individual. These forms of stressors may accumulate into adulthood with consequences for poor mental health and therefore affect productivity in the work place.
The current
s
tud
y
i
s
focused
o
n
life co
u
rse
events
to contextualize
ex
p
os
ur
e
to
vio
le
nc
e
and
CAs
thr
ough
the
tr
ansition
to
adult
h
ood
to eva
l
uate the
s
tr
e
n
gth of
their Iong-tenn
effects on
mental health
i
n
ad
ul
thood.
The
a
im
was
to empirically
in
vestigate w
h
ether cum
u
lative
adve
r
sit
i
es wi
ll
affect
poor
m
e
nt
al
health.
Th
e study also see
k
s
to
find out whet
h
er
if being
exposed
to
vio
l
ence will also
impact mental
health
and
h
ow
ma
les and
females
react to
cumulative adversities
a
nd
ex
p
osu
r
e
to
vio
l
ence. Understanding
t
hese factors wi
ll
help
put in
place programmes that would
h
elp
pre
ven
t or
mana
ge
workers wellbeing in a work place and
in part
i
cular
recogni
ze ge
nde
r
difference i
n
wor
k
plac
e sett
in
gs.
These
programme
s
will
in
add
ition h
e
lp
boost
healthc
are a
nd th
e
r
efo
re
reduce government
costs o
n m
e
dical
expenses.
Ear
l
y
di
agnosis
and treatment
of
these
a
d
ve
r
s
itie
s
in the
ear
l
y stages of
l
ife
wi
ll
substantially
reduce
econo
m
ic and
personal
costs of
thes
e
illnesses.
Th
e
or
e
ti
ca
l b
ac
k
g
r
o
und
Chronic childhood adversity
h
as
l
ong bee
n theori
ze
d to be
an aetiological facto
r
in
the
development
of
p
syc
hopatho
logy (
B
en jet,
B
o
rg
es,
&
Medina-Mora
,
20
I
0)
.
Accord
in
g to
Richard
s (20
II)
,
individuals
from
violent
homes m
ay
likely exhib
i
t
a
ttitud
es
and
behaviours
that reflect
th
e
ir
c
hildh
oo
d
ex
peri
e
n
ces
of witnessing domestic
v
i
ole
n
ce.
These attit
u
de
s
and
behaviours from
seve
re trauma
in
c
hildh
oo
d
,
including
sexua
l
and
physical
abuse.
may
persist
as a
s
tres
so
r into
adu
lth
ood.
In
a
work place
se
tting
,
these
externalize
d
behavioural
pro
b
lems
ma
y
l
ead
to
ot
her
psychopathologica
l
problems that
may in tum affect
productivity
an
d
workp
l
ace wellness. A
nd
vul
ner
a
b
il
i
ty
to current
a
nd
future
s
tre
sses
may be heightened
by these past
traumas.
Social
learning theory
i
s
one
of
the
mo
st co
mmon
theories
u
sefu
l in
providing an interpretive
framework for
und
e
r
s
tanding
h
ow
exposure
to lif
e
course events
imp
act
people's
li
ves.
Th
e
theory
suggests
that individual
s
learn
behaviours
in
childhood through observation of
parents
or guardians
,
and
replicate those behaviours in their
own
li
ves (Akers
&Sellers
,
2009
;
Bandura
,
1973
;
Lewis
&Fremouw,
2001).
The implication here is that adults
who
have been
ex
p
osed
to
violence
might themselves tum out to be perpetrators breeding
b
roader
grounds
for
further mental health
problems emanating from
behaviours learned in
childhood.
Social Stress theory
best
explains the
direct links
of CAs and
poor mental health
as it
stipu
l
ates that
multiple
adverse exposures
of perceived
stressors
arisi
n
g
from
a constellation
of contextual stressors
,
chronic
s
train.
and acute
s
tr
e
ssor
s
contribute to poor
mental
health
outcome
s
(Rutter
,
2005
;
Thomp
s
on
,
Mazza
,
Herting
,
Randell
,
&Eggert
,
2005
)
. For example,
in their
s
tudy of early expo
s
ure to
violence,
domestic
violence
,
attachment representations,
and marital adjustme
n
t, Godbouta, Dutton, L
u
ssie
r
and Sabourina (2009) fo
un
d t
h
at
previo
u
s
psycholo&rical parental
victimi
z
ation was
the
strongest predictor of anxious attachment
,
and
witne
s
sing
p
sy
chological
dome
s
tic
v
iolence
during
childh
o
od was
the
strongest pred
i
ctor of
a
v
oidant attachment in adulthood. McLaughlin
,
Green
,
Gruber
,
Sampson
,
Za
s
lavsky
,
and
Kessler (201 0) also showed
that
CAs a
r
e positively
and significantly associated wit
h
impairment
and
that
they greatly
predict disorder-related impairment,
highlighting the
ongoing clinical significance of CA
s
throughout the lif
e
-cou
r
se
.
The Life Course
perspective i
s
another
useful
way of
understanding
the
relationship between
CA
s,
through looking
at
t
he
environment,
and the
subsequent
mental health. Thi
s
view
looks
at
how
chrono
l
ogical age
,
relationships
,
common
life trans
i
tions
,
and social change shape
people
's
live
s (
therefore
mental health
)
from
birth
to
death
(Hutchison
,
2007).
According
to
this
theoretical mode
l
,
to tmderstand
a
person·
s
l
ife.
we
have
to investigate t
h
e
s
equence
of
significant events, experiences. and transitions m a person~s life from cruldhood. As
stipulated in the literature of the current study, significant occurrence that involves a
relatively abrupt change may lead to the emergence of numerous problems later in the life
which may produce serious and long-lasting effects on mental health. Hareven (2000) says
that an impact on life can occur when a significant occurrence or transition occurs
simultaneously with a crisis or is followed by a crisis, when the transition involves family
conflict over the needs and wants of individuals and the greater good of the family unit, when
the transition is followed by unforeseen negative consequences and lastly when it requires
exceptional social adjustments.
While a vast amount of research has provided support for the association of individual
childhood adversities with the development of psychopathology in later life, much of the
research has focused on specific or a limited number of adversities and/or a specific or limited
number of health outcomes. This is mostly due to the underlying theories of the different
studies which have driven the types of childhood adversities studied (these generally fall into
the categories of family pathology, abuse and neglect, interpersonal loss and socio-economic
disadvantage). Complicating the interpretation of research findings is the fact that childhood
adversities are highly co-morbid (Benjet et al., 2009) as are psychiatric disorders, thus it is
likely that studies of individual adversities and individual disorders may inflate associations
or fail to recognize alternative indirect pathways to psychopathology.
