Is Poly-Victimization a Factor in Predicting Harmful Behaviors and Outcome Recommendations Among Youth Presenting At a Pediatric Psychiatric Intake Response Center (PIRC)?

Introduction: In nationally representative samples, poly-victimization (multiple types of victimization) is not only prevalent at about 1 out of 4 children, but is associated with increased mental health symptoms, predictive of a spectrum of mental health disorders, and follows children into adulthood. Furthermore, many programs that address childhood victimization focus on one victimization type rather than the interaction/accumulation of victimization as a consideration in therapy for youth. Because most studies on poly-victimization focus on youth in general, this study seeks to focus the population to youth who present to a psychiatric intake center and examine poly-victimization’s role in regards to outcome recommendations, harmful behaviors (suicide, self-harm and violent behaviors), and symptom presentation.

Methods: This study employed a systematic chart review of patients presenting to a PIRC aged up to 19 years old (n = 260) in 2010-2011. Distribution of males and females were about equal (females = 49.62%), mean age was about 13, and majority of patients were Caucasian/White (79.69%). The exposure of interest was presence of poly-victimization (more than one type of victimization) as ordinal and categorical measures. Other exposure variables include age, race/ethnicity, insurance status (as a proxy for SES), gender, history of mental health issues, and family structure type. The outcomes of interest were outcome recommendations (inpatient, outpatient or partial), harmful behaviors, and presence of PTSD or depression symptoms. Mantel-Haenszel Chi-Square analyses and logistic regression models were performed.

Results: About 24.23% of youth sampled have experienced more than one type of victimization. M-H chi-square analyses show a statistically significant positive trend association between inpatient recommendation and poly-victimization (P = .0099). Furthermore, M-H chi-square analyses show a statistically significant positive trend between all types of harmful behaviors and poly-victimization (suicidal history P = .0005; homicidal/violent history P = .0056; self-harm history P = .0005). A logistic regression modeling inpatient outcome showed poly-victimization as a significant modifier of the relationship between different types of victimization and inpatient recommendation. Similar models will be performed examining harmful behaviors and symptom presentation.

Conclusion: Poly-victimization is prevalent in youth who present to a PIRC that triages care and may have a greater impact on outcome determination, harmful behavior, and symptom presentation than singular types of victimization. This may have important implications in planning and design of programs that focus on continuity of care for youth who are released from inpatient or receive outpatient or partial hospitalization outcome recommendations from their providers and are seeking behavioral therapy.