Due 6/29/18 9 p.m ESTArticle and checklist is attached The selection of a research design is guided by the study’s purpose and research questions and hypotheses, and the design then links the resea
Interpersonal Violence and Mental Health Outcomes among
Asian American and Native Hawaiian/Other Pacific Islander
College Students
Olga G. Archambeau, M.A. 1
, B. Christopher Frueh, Ph.D. 1,2
, Aimee N. Deliramich, M.A. 1
,
Jon D. Elhai, Ph.D. 3
, Anouk L. Grubaugh, Ph.D. 4
, Steve Herman, Ph.D. 1
, and Bryan S. K.
Kim, Ph.D. 1
1 Department of Psychology, University of Hawaii, Hilo, HI
2 The Menninger Clinic, Houston, TX
3 Department of Psychology, University of Toledo, Toledo, OH
4 Veterans Affairs Medical Center and Department of Psychiatry, Medical University of South
Carolina, Charleston, SC
Abstract In a cross-sectional survey of college students (N = 614) we studied interpersonal violence
victimization, perpetration, and mental health outcomes in an ethnoracially diverse rural-based
sample of Asian Americans (27%), and Native Hawaiian/Other Pacific Islanders (25%), two
groups vastly underrepresented in trauma research. High rates of interpersonal violence (34%),
violence perpetration (13%), and probable psychiatric diagnoses (77%), including posttraumatic
stress disorder, were found. Exposure to physical violence, sexual violence, and life stress all were
predictive of psychopathology. Female participants were associated with higher likelihood of
sexual violence victimization compared to male participants, and Asian American status
(especially among males) was associated with lower likelihood of physical and sexual violence
compared with European Americans. These data enhance our understanding of interpersonal
violence and mental health outcomes among previously understudied minority groups.
Keywords interpersonal violence; posttraumatic stress disorder; anxiety; health disparities; rural; trauma
Empirical data on the mental and physical health of ethnoracial minorities in the United
States are broadly lacking (Freeman & Payne, 2000) and very few studies have examined
potential ethnoracial disparities in medical and psychiatric sequelae after exposure to
psychological trauma because most national studies have only very small subsamples of
certain minority groups (Pole, Gone, & Kulkarni, 2008). Due to wide variation in regional
representation in the U.S. population, some ethnoracial minorities, such as Asian Americans
and Native Hawaiians/Other Pacific Islanders, typically appear in insufficient numbers in
nationally-representative epidemiological surveys to permit meaningful conclusions. Few
studies have been designed to examine trauma exposure and its sequelae in Asian
Americans, Native Hawaiians, and other Pacific Islanders (Pole et al., 2008). This is a
Corresponding Author: B. Christopher Frueh, Ph.D., Professor of Psychology, University of Hawaii at Hilo, 200 West Kawili Street\
,
Hilo, Hawai'i, 96720, USA. Telephone: 808/933-3315; fax: 808/974-7737; [email protected]. NIH Public Access
Author Manuscript
Psychol Trauma . Author manuscript; available in PMC 2011 December 1.
Published in final edited form as:
Psychol Trauma . 2010 December 1; 2(4): 273±283. doi:10.1037/a0021262.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript concern because interpersonal violence has dramatic adverse effects on mental and physical
health (Breslau et al., 1998; Kilpatrick et al., 2003; Magruder et al., 2005). Lower
socioeconomic status is an identified risk factor for interpersonal violence (Breslau et al.,
1998), and ethnic minorities tend to be disproportionally of lower socioeconomic status,
potentially leaving them at higher risk for exposure to violence.
Rates of violent victimization for general population samples across the U.S. range from
20% to 70% of lifetime exposure to violent crimes and vary according to sampling methods
(Berman, et al., 1996; Fitzpatrick & Boldizar, 1993) and are high among adolescents (Ford,
Elhai, Connor, & Frueh, 2010). One of a few studies on the prevalence and correlates of
violence victimization among Native Hawaiians used a sample of adolescents from four
Hawaii public schools and found a 3.3% rate of past 6-month victimization (Hishinuma
Chang, Goebert, Else, Nishimura, Choi-Misailidis et al., 2005). However, lifetime
victimization rates were not reported. This same study found significant differences in
victimization rates by ethnicity, with lower rates for Chinese Americans, Filipino
Americans, Japanese Americans, and other Asian American adolescents as compared to
non-Chinese, non-Filipino, non-Japanese, and non-Asian American adolescents respectively.
Also, significantly higher rates of victimization were found for adolescents who were at
least part-European Americans relative to non-European American students. Another study
that examined data on sexual assault exposure in a community-based probability sample of
adults in Hawaii, reported similar findings with Asian Americans having significantly lower
prevalence rates for unwanted sexual experiences compared to European Americans. Native
Hawaiians/Other Pacific Islanders had a higher 12-month period prevalence, but lower
lifetime exposure to sexual assault than European Americans (Crisanti et al., in press).
Survivors of violent assaults frequently suffer from serious psychiatric conditions such as
post-traumatic stress disorder (PTSD; Berman, et al., 1996; Frueh, Grubaugh, Acierno,
Elhai, Cain, & Magruder, 2007; Magruder, Frueh, Knapp, Davis, Hamner, Martin et al.,
2005; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993), depression (Kilpatrick,
Ruggiero, Acierno, Saunders, Resnick, & Best, 2003), anxiety disorders (Dempsey, 2002;
Singer et al, 1995), and substance abuse (Kilpatrick, Acierno, Resnick, Saunders, Best, &
Schnurr, 2000; Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997). In general, victims of
violence have an increased risk of developing one or more psychiatric conditions compared
to those who have never been victimized (Boney-McCoy & Finkelhor, 1995, 1996).
Research has consistently shown that victims of violent crimes are more likely than non-
victims to develop PTSD-related symptoms (Resnick et al., 1993; Yoshihama & Horrocks,
2002; Kilpatrick, Ruggiero, et al., 2003). One study reported the rate of PTSD among crime
victims at 26% compared to 9% among non-victims (Resnick et al., 1993).
With regard to violence perpetration, both criminal records and other data indicate that
different ethnic and racial groups exhibit differential rates of involvement in the legal system
for violent assaults (Hawkins, Laub, Lauritsen, & Cothern, 2000; Jang, 2002; Malik, et al.,
1997; McNulty & Bellair, 2003; Snyder & Sigmund, 2006). Official criminal records for the
state of Hawaii suggest that Native Hawaiian offenders are clearly overrepresented in the
criminal justice system compared to Asian American groups, such as Chinese, Japanese, and
Korean. According to the data presented in Uniform Crime Reports, 25% of adults arrested
for aggravated assault in the state of Hawaii in 2004 were Native Hawaiians compared to
8% who were East Asian Americans (i.e. Japanese, Chinese, Korean). This is also true for
juvenile offenders. Twenty eight percent (28%) of juveniles arrested for aggravated assault
were Native Hawaiians, compared to 19% who were European Americans and 4% who were
East Asian Americans (Gao & Perrone, 2005). These results are partially supported by
studies that used self-report data in order to examine racial and ethnic differences in
perpetration of violence. A study conducted with a large sample of high school students in Archambeau et al. Page 2
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Hawaii found that adolescents of Native Hawaiian ancestry had a significantly higher rate of
self-reported arrest or serious trouble with the law than Japanese American adolescents
(Hishinuma, Johnson, Kim, Nishimura, Makini, Andrade, et al., 2005). Yet another study
conducted with a similar sample of high school students in Hawaii found that Japanese
American youth had a lower level of violence, deviant behaviors, and delinquency than
Filipino American, Native Hawaiian, and Samoan youth, with Samoan youth displaying the
highest rates of violence-related behaviors (Maeda, Hishinuma, Nishimura, Garcia-Santiago,
& Mark, 2006).
The purpose of the present study was to examine the prevalence of interpersonal violence
victimization and perpetration, as well as to replicate previous research findings of mental
health outcomes of physical and sexual violence in an ethnoracially diverse rural-based
sample of Asian Americans, and Native Hawaiian/Other Pacific Islanders, groups that are
vastly underrepresented in research on trauma exposure and its sequelae. Preliminary
evidence suggests that interpersonal violence rates in rural areas of Hawaii may be at least as
high as rates in urban areas of Hawaii or in the nation more broadly (Affonso, Shibuya, &
Frueh, 2007; Affonso et al., 2010; Perrone et al. 1998). In fact, while empirical data show
that there may be few rural/urban differences in trauma exposure (Elhai, Baugher,
Quevillon, Sauvageot, & Frueh, 2004), none of the extant studies have specifically
examined violence rates, correlates and consequences in this specific population. The
present study also evaluated the relationship between community violence, life stress,
psychiatric morbidity, and demographic risk factors such as ethnoracial status and family
income. We hypothesized that exposure to interpersonal violence would increase the risk of
developing PTSD, depression, and anxiety symptoms, as well as substance abuse/
dependence after controlling for relevant demographic variables.
Method
Study Overview The present study is a large cross-sectional survey that examined self-reported lifetime
exposure to interpersonal violence, mental health outcomes (i.e., PTSD, depression, anxiety,
and substance abuse), rates of violence perpetration, and other relevant variables among
college students in rural Hawaii. This study was conducted with full approval from the
university Institutional Review Board.
Participants Participants in this study consisted of 614 students enrolled in introductory psychology
classes at a university in Hawaii. Participants’ demographic information is presented in
Table 1. Thirty (30%) percent of participants endorsed their primary racial identity as
European American, 27% as Asian American/Non-Filipino, 25% as Native Hawaiian/Pacific
Islander, and 11% as Asian American/Filipino. Typically Asian Americans from different
countries of origin (e.g., Korea, China, Japan) sampled in U.S. studies are lumped together
as one ethnoracial group. We elected to follow this trend so that our results would be
comparable to other U.S. samples of Asian Americans. However, because Filipinos in
Hawaii may view themselves as more similar to other Pacific Islander groups than Asian
groups, we included them as a separate category so as to not risk having an Asian American
effect washed out. Our obtained results for several variables support this approach. Due to
small numbers, African Americans (2%), American Indians (0.2%), Hispanics (2.6%), and
those participants who endorsed “Other” category (2%) were excluded from statistical
analyses. Thus, the final sample consisted of Asian American/Non-Filipino, Native
Hawaiian/Pacific Islander, Filipino, and European American participants, with European
Americans used as a reference category. Archambeau et al. Page 3
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript The age of participants ranged from 18 to 53 years old (M=19.71; SD=4.0). Age distribution
was similar across all ethnoracial groups in this sample. Because participants were recruited
from introductory psychology classes, the study sample consisted of students from many
different majors, and only 6 % of participants were psychology majors. Forty two percent
(42%) of the participants reported having lived on the Big Island of Hawaii most or all of
their lives. It is difficult to precisely estimate the study participation rate. However, the
lower bound participation rate for this sample was 70.6% (614/870) and the actual
participation rate was probably much higher. This study was one of approximately ten
different studies being conducted at any given time and students were also provided other
non-research alternatives to fulfilling their requirement. Moreover, no participant elected to
not participate in the study after reviewing the informed consent or beginning the study.
Thus, there were no decliners or drop-outs.
Procedure Participants were recruited through the human subjects’ pool in the psychology department
of the university for course credit. Students had the option to complete other written
assignments in lieu of research study participation, which is standard practice with
undergraduate human subject pools. Study personnel conducted an informed consent process
with all potential participants prior to their participation in the study. The project was
explained to potential participants in a group administration format, and at the end of this
process, participants willing to complete the survey were asked to sign the informed consent
document. Participants were assured that their participation in the project was voluntary and
that they could withdraw without penalty at any time. The survey consisted of 17 pages and
took approximately 15–30 minutes to complete. Participants anonymously completed the
survey, placing the survey in an envelope separate from their informed consent document.
Measures The survey asked about participants’ demographics, victimization and perpetration history,
and symptoms of four psychiatric disorders (i.e., depression, anxiety, PTSD, and substance
abuse/dependence). The majority of instruments used in the study are standardized
questionnaires widely used in epidemiological research on violence and mental health
outcomes.
Demographics— Demographic questions covered a wide range of variables, including
gender, ethnicity, family income, class standing, and marital status.
Criminal victimization— Participants were asked about lifetime childhood and adult
exposure to physical and sexual assaults. Criminal victimization questions were adapted
from the Trauma Assessment for Adults: Self-Report Version (TAA; Resnick, 1996). The
TAA has been used widely to screen community and medical populations for trauma
exposure (Kilpatrick, et al., 2000; Resnick, 1996 ) and has demonstrated good psychometric
qualities (Gray, Elhai, Owen, & Monroe, 2009). History of childhood and adult physical
assault was assessed by 6 yes/no questions. Childhood physical assault was defined as: (1)
being a victim of a fight (being in a fight that involved pushing, shoving, punching or
slapping by someone without the intent to kill or seriously injure) before the age of 18, or
(2) being attacked by someone with a weapon and with the intent to kill or seriously injure
before the age of 18, or (3) being attacked without a weapon but with the intent to kill or
seriously injure before the age of 18. Adult physical assault was defined as: (1) being a
victim of a fight (being in a fight that involved pushing, shoving, punching or slapping by
someone without the intent to kill or seriously injure) after the age of 18, or (2) being
attacked by someone with a weapon and with the intent to kill or seriously injure after the
age of 18, or (3) being attacked without a weapon but with the intent to kill or seriously Archambeau et al. Page 4
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript injure after the age of 18. Childhood and adult sexual assault experiences were assessed by 7
yes/no questions. Childhood sexual assault was defined as: (1) having any sexual contact
before the age of 13 with someone who was at least five years older, or (2) being fondled,
raped, or sexually assaulted before the age of 13, or (3) having any sexual contact between
the ages of 13 and 18 with someone who was older than 18 and at least 3 years older than
the victim, or (4) being forced to have sexual contact by means of pressure, coercion,
threats, or physical force between the ages of 13 and 18, or (5) being fondled, raped, or
sexually assaulted between the ages of 13 and 18. Adult sexual assault was defined as (1)
being forced to have sexual contact by means of pressure, coercion, threats, or physical force
after the age of 18, or (2) being raped or sexually assaulted after the age of 18.
Participants who endorsed having any physical or sexual assault experiences were asked to
indicate whether they experienced fear, helplessness, or horror at the time of the event
(PTSD’s criterion A2). Only those participants endorsing criterion A2 were categorized as
having experienced physical or sexual assault; however, any participant who endorsed a
childhood sexual assault prior to the age 13 was classified as being a victim of a sexual
trauma regardless of whether or not the response involved fear, helplessness, or horror.
Stressful life experiences— Participants were asked five yes/no questions designed
specifically for this study pertaining to recent (past 6 months) stressful life experiences
which included questions about: personal divorce/separation, death of a family member,
significant financial problems, having been arrested, or being fired from a job. Participants
were classified as having experienced recent life stress if they answered yes to any of the
five life stress questions.
Violence perpetration— Violence perpetration was assessed by 4 yes/no questions
developed for the current study. Participants were asked to indicate whether or not they (1)
started a physical fight with someone else since they turned 18, (2) started a physical fight
with somebody of the opposite sex since they turned 18, (3) physically assaulted someone
else with the intention of killing or seriously injuring them, (4) have been arrested for assault
or any other type of violent behavior. Participants who endorsed at least 1 of the above
questions were classified as having a history of violence perpetration.
Posttraumatic stress disorder— PTSD was assessed by a brief (10-item) Trauma
Screening Questionnaire (TSQ) a screening instrument with (yes/no) responses based on
DSM-IV diagnostic criteria of PTSD symptoms experienced at least twice in the past week
(Brewin et al., 2002). The presence of PTSD was defined as an affirmative answer to any 6
out of 10 questions (Brewin, et al., 2002). Cronbach’s alpha for this sample was 0.85, which
is indicative of good internal consistency.
Anxiety— Anxiety symptoms were assessed using three (3) stem questions from the MINI
International Neuropsychiatric Interview - one question corresponding to generalized
anxiety disorder (GAD), panic or social anxiety, respectively. The questions were as
follows: (1) Have you worried excessively or been anxious about several things over the
past 6 months? If yes, are these worries present most days? (2) In the past 6 months, have
you on more than one occasion had spells or attacks when you suddenly felt anxious,
frightened, uncomfortable, or uneasy, even in situations where most people would not feel
this way? If yes, did the spells peak (and then start to come down) within 10 minutes? (3) In
the past 6 months, were you fearful or embarrassed being watched, being the focus of
attention, or fearful of being humiliated? This includes things like speaking in public, eating
in public or with others, writing while someone watches, or being in social situations .
Participants who endorsed symptoms consistent with any of the three anxiety disorders were
classified as having a probable anxiety disorder. Archambeau et al. Page 5
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Depression—Depression was assessed by the Center of Epidemiological Studies
Depression Scale which is comprised of 20 questions (Radloff, 1977, Knight, Williams,
McGee, & Olaman, 1997). Participants were asked to rate the frequency of their depressive
symptoms (rare or none of the time, some or little of the time, occasionally or moderate
amount of time, or most or all of the time) experienced during the past week. Participants
with a score 16 or higher were classified as having current depression (Radloff, 1977).
Cronbach’s alpha for this sample was 0.88.
Substance abuse and dependence (SA/D)— Substance abuse was assessed using five
(5) questions based on the DSM-IV-TR criteria for alcohol/substance abuse. Probable
alcohol/substance abuse was defined as an affirmative response to any one of the five
questions (Kilpatrick et. al., 2000). Alcohol/substance dependence was assessed using a 7-
item measure based on the DSM-IV-TR criteria for alcohol/substance dependence. Probable
alcohol/substance dependence was defined as an affirmative response to any three of the
seven questions (Kilpatrick et. al., 2000). Participants who endorsed the requisite number of
items for either alcohol/substance abuse or alcohol/substance dependence were classified as
having current substance abuse or dependence (SA/D) in this study.
Data Analysis Prevalence of victimization and perpetration and probable psychiatric diagnoses was
determined by calculating the percent of participants endorsing the corresponding item or
criteria. Gender differences in the prevalence of victimization and perpetration rates and the
rates of psychopathology were examined by means of chi-square analyses. Univariate
logistic regression analyses were performed in order to identify demographic risk factors
(i.e., gender, ethnicity, family income) associated with higher rates of violence victimization
and perpetration. Hierarchical logistic regression was used to test the hypothesis that lifetime
exposure to interpersonal violence victimization is predictive of psychopathology after
controlling for relevant demographic variables. The hierarchy consisted of 2 steps: 1)
demographics (gender, race, SES) entered in Step 1, 2) traumatic experiences (physical
violence, sexual violence, life stress) entered in Step 2. All analyses were conducted using
SPSS.
Results
Prevalence of Violence Victimization, Perpetration, and Probable Psychiatric Diagnoses Prevalence of violence victimization, perpetration, and probable psychiatric diagnoses is
presented in Table 2. Overall, 35% of respondents reported being a victim of violence.
Twenty four percent (24%) of participants reported being a victim of physical violence, and
21% of participants reported being a victim of sexual violence. In terms of gender
differences, significantly more women (28%) than men (6%) reported being a victim of
sexual violence ( χ2
=41.43, df= 1, p<0.0001).
In terms of violence perpetration, 13% of participants reported starting a physical fight with
someone else after the age of 18. Four percent (4%) of the total sample reported physically
assaulting someone else with the intention to kill or seriously injure with males reporting
significantly more assault perpetrations than females (7% vs. 2%; χ2
=8.28, df= 1, p<0.01). A
higher proportion of females reported starting a fight with somebody of the opposite sex
(12% vs. 2%; χ2
=17.30, df= 1, p<0.0001).
Overall, 78% of participants had symptoms that might be indicative of at least one
psychiatric diagnosis (PTSD, depression, anxiety, SA/D). Prevalence for the total sample
was 18.6% for PTSD symptoms, 58% for anxiety symptoms, 35% for SA/D, and 39% for Archambeau et al. Page 6
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript depression. Females had higher prevalence than males for depression (41% vs. 33%;
χ 2
=4.01, df= 1, p<0.05) and anxiety symptoms (63% vs. 49%; χ2
=10.27, df= 1, p<0.001).
Males had higher prevalence of substance abuse or dependence than females (41% vs. 31%;
χ 2
=5.00, df= 1, p<0.05).
Sociodemographic Risk Factors for Violence Victimization and Perpetration Univariate logistic regression analyses for physical and sexual victimization and
perpetration are presented in Table 3. Four logistic regression analyses were conducted to
determine which demographic risk factors (gender, race, family income) were predictors of
physical violence, sexual violence, violence perpetration, and violence perpetration towards
opposite sex. Three logistic regression models were statistically reliable in distinguishing the
dependent variable: physical violence ( −2 Log Likelihood=584.244; χ2
(7)=15.79, p<0.05);
sexual violence ( −2 Log Likelihood=484.750; χ2
(7)=54.22, p<0.001); and violence
perpetration towards opposite sex ( −2 Log Likelihood=259.460; χ2
(7)=26.20, p<0.001).
Regression coefficients are presented in Table 3. For physical violence victimization, the
only significant variable was Asian American (Non-Filipino) ethnicity (OR=0.50 vs.
European American). Asian American (Non-Filipino) participants were significantly less
likely than European Americans to endorse being a victim of physical violence. Female
gender was associated with a significantly higher likelihood of being a victim of sexual
violence (OR=7.37 vs. male); and non-Filipino Asian American ethnicity was associated
with a significantly lower likelihood of reporting sexual violence (OR=0.42 vs. European
Americans). With regard to violence perpetration there was only one statistically significant
relationship: Females were more likely to endorse using physical violence toward to
opposite sex (OR=9.42 vs. male).
Psychopathology Five hierarchical logistic regression analyses were conducted: one for each type of
psychopathology (PTSD, depression, anxiety, and substance abuse) and one for
psychopathology in general. All logistic regression models were statistically reliable in
distinguishing the dependent variables: PTSD ( −2 Log Likelihood=463.674; χ2
(10)=47.87,
p<0.001); anxiety ( −2 Log Likelihood=671.677; χ2
(10)=50.53, p<0.001); depression ( −2
Log Likelihood=676.414; χ2
(10)=37.53, p<0.001); substance abuse ( −2 Log
Likelihood=651.197; χ2
(10)=39.59, p<0.001); overall psychopathology ( −2 Log
Likelihood=479.519; χ2
(10)=66.65, p<0.001). Final regression model for PTSD correctly
classified 79.8% of the cases; final model for anxiety – 65.8% of the cases; for depression –
62.4% of the cases; for substance abuse – 66.8% of the cases; and overall psychopathology –
79.2% of the cases. Regression coefficients are presented in Table 4. Non-Filipino Asian
American ethnicity was significantly associated with a lower risk of anxiety and SA/D in the
final model (OR=0.62 and OR=0.47 vs. European Americans). Other variables significantly
associated with SA/D were female gender as a protective factor (OR=0.62 vs. male), family
income $20,000 to $39,000 (OR=0.54 vs. family income over $75,000), family income
$40,000 to $74,000 (OR=0.46 vs. family income over $75,000), and life stress (OR=1.59 vs.
none). Life stress was also associated with an increased risk of developing depression
(OR=1.82 vs. none) and anxiety (OR=1.97 vs. none) symptoms. Being a victim of physical
violence was a significant predictor for depression (OR=1.89 vs. none), PTSD (OR=2.97 vs.
none), and anxiety (OR=1.83 vs. none) symptoms. Being a victim of sexual violence was
associated with an increased risk of PTSD (OR=1.94 vs. none) and anxiety (OR=1.78 vs.
none) symptoms. Overall, the risk of developing any psychopathology was significantly
associated with physical violence (OR=2.96 vs. none), sexual violence (OR=3.57 vs. none),
and life stress (OR=3.18 vs. none). Archambeau et al. Page 7
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript DiscussionIn this study we examined the prevalence of interpersonal violence victimization,
perpetration, and mental health outcomes in an ethnoracially diverse rural-based sample of
Asian Americans, and Native Hawaiian/Other Pacific Islanders. These are groups that are
underrepresented in research on trauma exposure and its sequelae. Study findings indicate
that 34% of the total sample of college students in rural Hawaii endorsed interpersonal
violence victimization. Traumatic exposure was operationally defined not only as
encountering physical or sexual violence, but also experiencing an intense psychological
reaction such as fear, horror, or helplessness related to the event (i.e., DSM-IV A2 criteria
for trauma in the PTSD diagnosis). By adhering to this more rigorous definition of trauma
exposure, rates of interpersonal violence exposure may be somewhat lower in the present
sample relative to other studies (e.g., 20–70%). This also may account for some of the
unexpected findings, such as the failure to find gender differences in physical violence
victimization.
The hypothesis that lifetime exposure to interpersonal violence is predictive of psychiatric
symptoms was generally supported. Physical violence was significantly related to symptoms
of PTSD, depression, anxiety (broadly defined), and overall psychopathology. Sexual
violence was a significant predictor of PTSD, anxiety symptoms and overall
psychopathology. The results of this study replicated previous research findings on trauma
and violence sequelae, most of which have been conducted with predominantly European
American and African American samples, which found that exposure to interpersonal
violence increased the risk of psychiatric disorders such as PTSD, depression, and substance
abuse (e.g. Kilpatrick, et al., 2003; Magruder et al., 2005). Furthermore, stressful life events
also appeared to be significantly related to all psychopathology symptoms, except PTSD,
supporting previous research findings that have shown life stress (such as financial
problems, divorce/separation, death of a family member) to be a very strong predictor of
psychopathology, perhaps stronger than exposure to violence or other trauma (Gold, Marx,
Soler-Baillo, & Sloan, 2005; Long, Elhai, Schweinle, Gray, & Grubaugh, 2008). This
finding reinforces discussions that are currently taking place in the field regarding our
understanding of “trauma” and how we conceptualize the etiological events that may lead to
PTSD diagnoses (O’Donnell, Creamer, & Cooper, in press; Long et al., 2008), and has
implications for the disorder in future revisions of the DSM (Elhai, Grubaugh, Kashdan, &
Frueh, 2008; Rosen, Lilienfeld, Frueh, McHugh, & Spitzer, 2010).
Contrary to the findings of most studies conducted with the national samples (Catalano,
2006; Fitzpatrick & Boldizar, 1993; Gladstein et al. 1992; Malik et al., 1997; Slovak &
Singer, 2002), as well as other Hawaii samples (Hishinuma, Chang, et al., 2005; Mayeda,
2006), the present study found no significant gender differences in physical violence
victimization. However, gender differences in sexual victimization were consistent with
previous studies on this topic and showed that females have significantly higher rates than
males (Catalano, 2006; Tjaden & Toennes, 2000). The rates of violence perpetration towards
the opposite sex found in the present study were significantly higher by women than by men
(11.8% vs. 1.6%), which is also consistent with previous research findings and supports the
hypothesis that women tend to perpetrate more physical violence than men in the context of
intimate relationships (Malik, et al., 1997; Spencer & Bryant, 2000). This finding may help
explain why there were not gender differences in physical violence victimization. However,
the current data do not address severity or adverse outcomes of this violence. Thus, our
obtained data cannot address the important question of whether violence perpetrated or
received by one gender is different in severity or qualitative experience. Future research
should study this question. Archambeau et al. Page 8
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Regarding ethnoracial status, Asian American/Non-Filipino participants (especially males)
were much less likely than European Americans to endorse being a victim of physical and
sexual violence as well as to develop anxiety and substance abuse/dependence symptoms.
These results support previous research findings that Asian Americans report lower violence
victimization rates than other ethnoracial groups in Hawaii (Crisanti et al., in press;
Hishinuma, Chang, et al., 2005) and are less likely to report problematic alcohol or drug use
behaviors. Previous research studies have shown higher rates of violence perpetration
among Native Hawaiian and Filipino American respondents (Gao & Perrone, 2005;
Hishinuma, Johnson, et al., 2005; Maeda et al., 2006). However, this finding was not
replicated by the present study, which could be attributed to the nature of the present sample
(college students versus the general population). This is an encouraging finding in that it
indicates there are not the expected ethnoracial disparities in violence perpetration among
college students in this sample.
Limitations One of the major limitations of the present study is its cross-sectional survey design which
prevents us from making causal inferences regarding our study variables. Additionally, our
assessment of interpersonal violence exposure was based on self-report, which could yield
biased estimates. The assessment of psychopathology was also limited to self- report
measures which are less valid than a structured clinical interview administered by an
experienced clinician. In addition, anxiety symptoms were assessed using only the stem
questions from a structured clinical interview, and thus no conclusions about actual
psychiatric diagnoses of anxiety disorders could be made based on the information collected
from the participants. Another limitation of the study is the nature of the sample which was
limited to introductory psychology students, who are primarily single and in their first year
of college. Therefore, generalization of our results to other groups of Asian Americans and
Native Hawaiians/Other Pacific Islanders should be made with caution.
Conclusions The results of the present study provide valuable information about the prevalence of
various forms of interpersonal violence victimization and perpetration, as well as the
association between interpersonal violence and mental health outcomes among a rural-based
ethnoracially diverse sample (27% Asian American/Non-Filipino, 25% Native Hawaiian/
Other Pacific Islander) of college students. An important finding is the overall high
percentage of psychiatric symptoms, indicating a significant number of college students in
rural Hawaii might be suffering from various types of psychopathology, including PTSD,
depression, anxiety, and substance abuse problems. Findings also support the association
between interpersonal violence exposure and adverse psychiatric sequelae, and suggest
important disparities along gender and ethnoracial lines. Results of the present study may be
useful in informing violence prevention programs (e.g., Affonso, Shibuya, & Frueh, 2007;
Affonso et al., 2010) and guiding implementation of evidence-based mental health practices
(Frueh, Ford, Elhai, & Grubaugh, in press) that are appropriate for ethnoracially diverse
communities, including those living in rural Hawaii (e.g., Morland, Greene, Rosen, Mauldin,
& Frueh, 2009; Morland et al., in press).
Additional research with community samples, structured clinical interviews, and
longitudinal designs is needed to further explore interpersonal violence exposure and
psychopathology patterns. Risk and protective factors for violence victimization,
perpetration, and developing negative mental health outcomes should be further studied in
community samples to examine the patterns of victimization and how they are linked to
negative mental health outcomes in the general population of Asian Americans and Native
Hawaiian/Other Pacific Islanders living in the U.S. Efforts are also needed to better Archambeau et al. Page 9
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript understand the role of cultural (Kim, 2007), societal, and contextual factors (Frueh,
Grubaugh, Elhai, & Buckley, 2007) that influence posttraumatic reactions. Last, effort is
needed to better understand the finding that Asian Americans (especially males) report
significantly lower rates of physical and sexual violence than other enthnoracial groups. It
will be important to understand whether this is a reporting artifact, possibly related to
cultural factors, a “true” difference, or some combination of the two.
Acknowledgments This work was partially supported by grant MH074468 from the National Institute of Mental Health (NIMH), and
from the McNair Foundation. Elements of the current work were included in Ms. Archambeau’s master’s thesis.
References Affonso DD, Mayberry L, Shibuya JY, Archambeau OG, Correa M, Deliramich AN, Frueh BC.Cultural context of school communities in rural Hawaii to inform youth violence prevention.
Journal of School Health 2010;80:146–152. [PubMed: 20236417]
Affonso DD, Shibuya JY, Frueh BC. Talk story: Perspectives of children, parents, and community leaders on community violence in rural Hawaii. Public Health Nursing 2007;24:400–408. [PubMed:
17714224]
Berman SL, Kurtinez WM, Silverman WK, Serafini LT. The impact of exposure to crime and violence on urban youth. American Journal of Orthopsychiatry 1996;66:329–336. [PubMed: 8827256]
Boney-McCoy S, Finkelhor D. Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal prospective study. Journal
of Consulting and Clinical Psychology 1996;64:1406–1416. [PubMed: 8991327]
Boney-McCoy S, Finkelhor D. Psychosocial sequelae of violent victimization in a national youth sample. Journal of Consulting and Clinical Psychology 1995;63:726–736. [PubMed: 7593865]
Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives of General
Psychiatry 1998;55:626–632. [PubMed: 9672053]
Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, et al. Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry 2002;181:158–162. [PubMed:
12151288]
Catalano SM. Criminal victimization, 2005. National Crime Victimization Survey. Bureau of Justice Statistics Bulletin 2006 Semtember;:1–12.
Crisanti AS, Frueh BC, Gundaya D, Salvail FR, Triffleman E. Racial disparities in sexual assault among Asian Americans and Native Hawaiians/Other Pacific Islanders. Journal of Clinical
Psychiatry. in press.
Dempsey M. Negative coping as mediator in the relation between violence and outcomes: Inner-city African-American youth. American Journal of Orthopsychiatry 2002;72:102–109. [PubMed:
14964599]
Elhai JD, Baugher SN, Quevillon RP, Sauvageot J, Frueh BC. Psychiatric symptoms and health service utilization in rural and urban combat veterans with posttraumatic stress disorder. Journal of
Nervous and Mental Disease 2004;192:701–704. [PubMed: 15457114]
Elhai JD, Grubaugh AL, Kashdan TB, Frueh BC. Empirical examination of a proposed refinement to posttraumatic stress disorder's symptom criteria using the National Comorbidity Survey
Replication data. Journal of Clinical Psychiatry 2008;69:597–602. [PubMed: 18294026]
Fitzpatrick KM, Boldizar JP. The prevalence and consequences of exposure to-violence among African-American youth. Journal of the American Academy of Adolescent Psychiatry
1993;32:424–430.
Ford JD, Elhai JD, Connor DF, Frueh BC. 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 2010;46:545–552. [PubMed: 20472211] Archambeau et al. Page 10
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Freeman HP, Payne R. Racial injustice in health care. New England Journal of Medicine2000;342:1045. [PubMed: 10749970]
Frueh, BC.; Ford, JD.; Elhai, JD.; Grubaugh, AL. An overview of evidence-based practice in adult mental health. In: Sturmey, P.; Hersen, M., editors. Handbook of Evidence Based Practice in
Clinical Psychology, Volume II: Adult Disorders. New York: Wiley; in press
Frueh BC, Grubaugh AL, Acierno A, Elhai JD, Cain G, Magruder KM. Age differences on PTSD, psychiatric disorders, and healthcare service use among veterans in Veterans Affairs primary care
clinics. American Journal of Geriatric Psychiatry 2007;15:660–672. [PubMed: 17670996]
Frueh BC, Grubaugh AL, Elhai JD, Buckley TC. U.S. Department of Veterans Affairs disability policies for PTSD: Administrative trends and implications for treatment, rehabilitation, and
research. American Journal of Public Health 2007;97:2143–2145. [PubMed: 17971542]
Gao, G.; Perrone, P. Crime in Hawaii 2004: A review of Uniform Crime Reports. Honolulu: Crime Prevention and Justice Assistance Division, Sate of Hawaii; 2005 Dec.
Gladstein J, Rusonis EJ, Heald PP. A comparison of inner-city and upper-middle class youths' exposure to violence. Journal of Adolescent Health 1992;13:275–280. [PubMed: 1610842]
Gold SD, Marx BP, Soler-Baillo JM, Sloan DM. Is life stress more traumatic than traumatic stress? Journal of Anxiety Disorders 2005;19:687–698. [PubMed: 15927781]
Gray MJ, Elhai JD, Owen JR, Monroe JR. Psychometric properties of the Trauma Assessment for Adults. Depression and Anxiety 2009;26:190–195. [PubMed: 19031486]
Hishinuma ES, Chang JY, Goebert DA, Else IR, Nishimura ST, Choi-Misailidis S, et al. Prevalence of victims of violence among ethnically diverse Asian/Pacific islanders. Violence and Victims
2005;20:561–575. [PubMed: 16248491]
Hishinuma ES, Johnson RC, Kim SP, Nishimura ST, Makini GK, Andrade NN, et al. Prevalence and correlates of misconduct among ethnically diverse adolescents of native Hawaiian/part-Hawaiian
and non-Hawaiian ancestry. International Journal of Social Psychiatry 2005;51:242–258.
[PubMed: 16252792]
Kilpatrick DG, Acierno R, Resnick HS, Saunders BE, Best CL. A 2-year longitudinal analysis of the relationships between violent assault and substance use in women. Journal of Consulting and
Clinical Psychology 1997;65:834–847. [PubMed: 9337502]
Kilpatrick DG, Acierno R, Resnick HS, Saunders B, Best CL, Shnurr PP. Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical
Psychology 2000;68:19–30. [PubMed: 10710837]
Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best CL. Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: Results from the national
survey of adolescents. Journal of Consulting and Clinical Psychology 2003;71:692–700. [PubMed:
12924674]
Kim BSK. Adherence to Asian and European American cultural values and attitudes toward seeking professional psychological help among Asian American college students. Journal of Counseling
Psychology 2007;54:474–480.
Knight RG, Williams S, McGee R, Olaman S. Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life. Behaviour
Research and Therapy 1997;35:373–380. [PubMed: 9134792]
Long ME, Elhai JD, Schweinle A, Gray MJ, Grubaugh AL, Frueh BC. Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1
stressors. Journal of Anxiety Disorders 2008;22:1255–1263. [PubMed: 18281192]
Magruder KM, Frueh BC, Knapp RG, Davis L, Hamner MB, Martin RH, et al. Prevalence of posttraumatic stress disorder in VA primary care clinics. General Hospital Psychiatry
2005;27:169–179. [PubMed: 15882763]
Malik S, Sorenson SB, Aneshensel CS. Community and dating violence among adolescents: Perpetration and victimization. Journal of Adolescent Health 1997;21:291–302. [PubMed:
9358292]
Mayeda DT, Hishinuma ES, Nishimura ST, Garcia-Santiago O, Mark GY. Asian/Pacific islander youth violence prevention center: Interpersonal violence and deviant behaviors among youth in
Hawaii. Journal of Adolescent Health 2006;39:276el–276e-11. [PubMed: 16892499] Archambeau et al. Page 11
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript McNulty TL, Bellair PE. Explaining racial and ethnic differences in serious adolescents' violentbehavior. Criminology 2003;41:709–748.
Morland LA, Greene CJ, Rosen C, Foy D, Reilly P, Shore J, He Q, Frueh BC. Telemedicine anger management with a rural PTSD population: A randomized noninferiority trial. Journal of Clinical
Psychiatry. (in press).
Morland LA, Greene CJ, Rosen C, Mauldin PD, Frueh BC. Issues in the design of a randomized non- inferiority clinical trial of telemental health psychotherapy for rural combat veterans with PTSD.
Contemporary Clinical Trials 2009;30:513–522. [PubMed: 19576299]
O’Donnell, ML.; Creamer, M.; Cooper, J. Criterion A: Controversies and clinical implications. In: Rosen, GM.; Frueh, BC., editors. The clinician’s guide to posttraumatic stress disorder. New York:
Wiley; (in press)
Perrone, PA.; Allen, JJ.; Kunitake, MM.; Richmond, JB.; Yamashiro, RL. Crime and Justice in Hawaii: 1998 Household Survey Report. Honolulu: Department of Attorney General, State of
Hawaii; 1998 Dec.
Pole N, Gone J, Kulkarni M. Posttraumatic Stress Disorder among ethnoracial minorities in the United States. Clinical Psychology: Science and Practice 2008;15:35–61.
Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement 1977;1:385–401.
Resnick, HS. Psychometric review of Trauma Assessment for Adults (TAA). In: Stamm, BH., editor. Measurement of Stress, Trauma, and Adaptation. Lutherville, MD: Sirdan Press; 1996.
Resnick HS, Kilpatrick DG, Dansku BS, Saunders BE, Best CL. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of Consulting
and Clinical Psychology 1993;61:984–991. [PubMed: 8113499]
Rosen GM, Lilienfeld S, Frueh BC, McHugh P, Spitzer R. Reflections on PTSD’s future in DSM-V. British Journal of Psychiatry. 2010
Singer MI, Anglin TM, Song LY, Lunghofer L. Adolescents’ exposure to violence and associated symptoms of psychological trauma. The Journal of the American Medical Association
1995;273:477–482.
Slovak K, Singer MI. Children and violence: Findings and implications from a rural community. Child and Adolescent Social Work Journal 2002;19:35–56.
Spencer GA, Bryant SA. Dating violence: A comparison of rural, suburban, and urban teens. Journal of Adolescent Health 2000;27:302–305. [PubMed: 11044701]
Tjaden, P.; Thoennes, N. Full Report of the Prevalence, Incidence, and Consequences of Violence against Women. Washington, DC: US Department of Justice; 2000.
Yoshihama M, Horrocks J. Posttraumatic stress symptoms and victimization among Japanese American women. Journal of Consulting and Clinical Psychology 2002;70:205–215. [PubMed:
11860046] Archambeau et al. Page 12
Psychol Trauma. Author manuscript; available in PMC 2011 December 1.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 13 Table 1
Demographic Information Total SampleAsian
American
(Non-Filipino)Filipino
AmericanNHPIEuropean
AmericanN%N%N%N%N%Ethnicity:African American132.2American Indian10.2Asian American/Non-Filipino16527.3Asian American /Filipino6711.1European American17829.5Hispanic/Latino(a)162.6Native
Hawaiian/Pacific
Islander15024.8Other142.3Gender:Male20533.46438.81725.411476.56838.2Female40866.610161.25074.63523.511061.8Class Standing:First-year Students38763.210966.55379.19664.49553.4Sophomore13221.63521.3913.43221.54827.0Juniors6811.1127.346.01812.12413.5Seniors233.884.911.532.095.1Graduate Students20.300000021.1Marital Status:Single54889.715594.56394.013489.314884.1Married/Living
w/Partner579.384.946.01610.72413.6Divorced/Widowed61.010.6000042.3Family Income:
Psychol Trauma . Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 14 Total SampleAsian
American
(Non-Filipino)Filipino
AmericanNHPIEuropean
AmericanN%N%N%N%N%Less than 20,0007612.8127.446.22517.12816.320,000–39,99916627.94427.22031.25235.63721.540,000–74,99922838.36640.72843.85437.05934.375,000 and up12621.14024.71218.81510.34827.9
Psychol Trauma . Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 15 Table 2
Lifetime Prevalence of Violence Victimization, Violence Perpetration, and Psychiatric Diagnoses for Asian American/Non-Filipino,\
Native Hawaiian/
Pacific Islander (NHPI), Filipino, European American Participants, and the total sample MalesFemalesTotal SampleN%N%N%Total Sample:VictimizationPhysical Violence4019.510726.214724.0Sexual Violence125.911528.212720.7Overall Victimization4722.916941.421635.2PerpetrationStarting Fight3316.24611.37912.9Assault136.882.0213.6Fight w/Opposite Sex31.64611.8498.5PsychopathologyPTSD2914.98020.510918.6Depression6532.816441.322938.5Anxiety9648.725062.534658.0SA/D8240.612631.420834.5Asian American (Non-Filipino):VictimizationPhysical Violence23.12322.82515.2Sexual Violence34.71918.82213.3Overall Victimization46.23332.73722.4PerpetrationStarting Fight710.987.9159.1Assault11.644.353.2Fight w/Opposite Sex0077.374.5PsychopathologyPTSD710.91717.02414.6
Psychol Trauma . Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 16 MalesFemalesTotal SampleN%N%N%Depression1828.13333.75131.5Anxiety2742.95050.07747.2SA/D1929.72424.24326.4Filipino American:VictimizationPhysical Violence741.21428.02131.3Sexual Violence15.91326.01420.9Overall Victimization741.22244.02943.3PerpetrationStarting Fight211.8510.0710.4Assault16.20011.5Fight w/Opposite Sex00816.3812.3PsychopathologyPTSD318.81021.31320.6Depression743.82043.52743.5Anxiety952.93368.84264.6SA/D423.51735.42132.3NHPI:VictimizationPhysical Violence822.93127.23926.2Sexual Violence38.62925.43221.5Overall Victimization1028.64640.45637.6PerpetrationStarting Fight720.01513.22214.8Assault412.510.953.6Fight w/Opposite Sex13.21413.11510.9PsychopathologyPTSD1029.42624.13625.4Depression926.55347.36242.5
Psychol Trauma. Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 17 MalesFemalesTotal SampleN%N%N%Anxiety1957.67365.29263.4SA/D1748.63127.74832.7European American:VictimizationPhysical Violence1927.92926.44827.0Sexual Violence34.44238.24525.3Overall Victimization2029.45247.37240.4PerpetrationStarting Fight1217.91211.02413.6Assault69.721.984.7Fight w/Opposite Sex11.61110.4127.2PsychopathologyPTSD711.32423.33118.8Depression2639.45247.77844.6Anxiety3553.07467.910962.3SA/D3551.54440.47944.6
Psychol Trauma. Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 18 Table 3
Logistic Regression Results: Risk Factors for Violence Victimization and Perpetration Risk FactorBSEWORCI (95%) Physical Violence Victimization Female Gender0.290.231.571.330.85–2.09Asian American (Non-Filipino) a−0.690.286.090.50*0.29–0.87Filipino American a0.260.320.631.290.69–2.43Native Hawaiian/Pacific Islander a−0.090.260.130.910.55–1.52Family Income: less than $20,0000.360.360.971.430.70–2.92Family Income: $20,000 to $39,0000.380.311.511.450.80–2.65Family Income: $40,000 to $74,0000.040.300.021.040.58–1.86 Sexual Violence Victimization Female Gender2.000.3729.307.37***3.58–15.19Asian American (Non-Filipino) a−0.860.317.900.42**0.23–0.77Filipino American a−0.470.371.550.630.30–1.31Native Hawaiian/Pacific Islander a−0.520.293.220.600.34–1.05Family Income: less than $20,0000.260.400.421.300.59–2.84Family Income: $20,000 to $39,0000.080.350.051.080.55–2.15Family Income: $40,000 to $74,000−0.010.330.0010.990.52–1.90 Violence Perpetration Female Gender−0.450.282.610.640.37–1.10Asian American (Non-Filipino)a−0.490.351.900.620.31–1.23Filipino American a−0.230.460.240.800.32–1.98Native Hawaiian/Pacific Islander a0.160.330.231.180.61–2.26Family Income: less than $20,000−0.240.480.260.780.31–2.00Family Income: $20,000 to $39,000−0.450.401.280.640.29–1.40Family Income: $40,000 to $74,0000.080.350.051.080.55–2.13 Violence Perpetration Toward Opposite Sex Female Gender2.240.749.309.42**2.23–39.85
Psychol Trauma
. Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 19 Risk FactorBSEWORCI (95%)Asian American (Non-Filipino)a−0.450.500.800.640.24–1.71Filipino American a0.400.520.611.490.54–4.10Native Hawaiian/Pacific Islander a0.300.420.521.360.59–3.09Family Income: less than $20,0000.670.571.371.950.64–5.99Family Income: $20,000 to $39,000−0.060.540.010.940.32–2.73Family Income: $40,000 to $74,0000.010.510.001.010.37–2.75Note. W= Wald Statistic; OR= odds ratio; CI= confidence interval.a
European Americans as reference group*p<0.05;** p<0.01;*** p<0.001
Psychol Trauma . Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 20 Table 4
Hierarchical Logistic Regression Results: Risk Factors for PTSD, Anxiety, Depression, Substance Use and Overall Psychopathology Step Final Model Risk FactorBSEWORCI (95%)BSEWORCI (95%) PTSD Step1Female Gender0.270.251.111.310.79–2.150.040.280.021.040.60–1.78Asian American
(Non-Filipino) a−0.140.310.200.870.47–1.590.100.320.091.100.59–2.08Filipino
American a0.280.380.551.330.63–2.800.280.400.481.320.60–2.89Nat. Haw/Pacific
Islander a0.460.292.521.590.90–2.810.490.312.481.630.89–2.99Fam. Income:
less than $20,0000.700.403.082.010.92–4.380.480.431.261.610.70–3.71Fam. Income:
$20,000 to
$39,0000.180.350.261.200.60–2.390.030.370.011.030.50–2.12Fam. Income:
$40,000 to
$74,0000.230.330.471.250.66–2.400.170.350.241.180.60–2.33Step 2Physical violence1.090.2518.712 97 ***1.81–4.86Sexual violence0.670.285.601.94*1.12–3.37Life Stress0.430.252.921.540.94–2.54 Anxiety Step1Female Gender0.420.194.781.53*1.05–2.230.320.212.441.380.92–2.06Asian American
(Non-Filipino) a−0.610.237.130.55**0.35–0.85−0.480.244.190.62*0.39–0.98Filipino
American a0.110.320.131.120.60–2.080.080.330.051.080.57–2.04Nat. Haw/Pacific
Islander a−0.070.240.090.930.58–1.50−0.130.250.280.880.53–1.44
Psychol Trauma
. Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 21 Step Final Model Risk FactorBSEWORCI (95%)BSEWORCI (95%)Fam. Income:
less than $20,0000.210.330.411.230.65–2.34−0.030.340.010.970.49–1.89Fam. Income:
$20,000 to
$39,0000.300.271.251.350.80–2.260.140.280.261.150.67–1.97Fam. Income:
$40,000 to
$74,0000.060.250.061.060.66–1.720.010.250.001.010.61–1.65Step 2Physical violence0.610.246.321.83 *1.14–2.94Sexual violence0.580.274.671.78*1.06–3.00Life Stress0.680.1912.501. 97 ***1.35–2.87 Depression Step1Female Gender0.400.204.021.49*1.01–2.190.380.213.281.460.97–2.21Asian American
(Non-Filipino) a−0.540.235.320.58*0.37–0.92−0.450.243.450.640.40–1.03Filipino
American a0.050.310.021.050.57–1.91−0.050.320.020.960.51–1.78Nat. Haw/Pacific
Islander a−0.120.240.250.890.56–1.41−0.210.250.750.810.50–1.31Fam. Income:
less than $20,0000.260.320.651.290.69–2.410.050.330.021.050.55–2.00Fam. Income:
$20,000 to
$39,000−0.170.270.410.840.50–1.42−0.330.281.460.720.42–1.23 Step Final Model Risk FactorBSEWORCI (95%)BSEWORCI (95%)Fam. Income:
$40,000 to
$74,000−0.180.250.500.840.52–1.37−0.240.260.910.780.48–1.29Step 2
Psychol Trauma . Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 22 Step Final Model Risk FactorBSEWORCI (95%)BSEWORCI (95%)Physical violence0.640.228.191.89**1.22–2.92Sexual violence0.110.240.211.120.70–1.80Life Stress0.600.199.491.82**1.24–2.66 Substance Abuse/Dependence Step1Female Gender−0.370.203.550.690.47–1.02−0.470.214.970.63*0.42–0.95Asian American
(Non-Filipino) a−0.820.2411.590 44***0.27–0.71−0.760.259.470.47**0.29–0.76Filipino
American a−0.440.321.890.650.35–1.21−0.480.332.160.620.33–1.17Nat. Haw/Pacific
Islander a−0.410.242.770.670.41–1.08−0.460.253.350.630.39–1.03Fam. Income:
less than $20,000−0.410.331.570.660.35–1.26−0.590.343.080.550.29–1.07Fam. Income:
$20,000 to
$39,000−0.490.273.450.610.36–1.03−0.620.275.130.54 *0.32–0.92Fam. Income:
$40,000 to
$74,000−0.720.258.230.49 **0.30–0.80−0.790.269.380.46**0.28–0.75Step 2Physical violence0.300.231.781.360.87–2.12Sexual violence0.370.252.181.450.89–2.36Life Stress0.460.205.321.59*1.07–2.35 Overall Psychopathology Step1Female Gender0.050.230.061.060.67–1.67−0.140.250.320.870.54–1.41Asian American
(Non-Filipino) a−0.700.276.600.50*0.29–0.85−0.510.293.180.600.34–1.05Filipino
American a−0.120.390.090.890.42–1.89−0.190.410.220.830.37–1.84Nat. Haw/Pacific
Islander a0.040.310.011.040.57–1.90−0.090.330.070.920.48–1.75
Psychol Trauma
. Author manuscript; available in PMC 2011 December 1. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Archambeau et al.Page 23 Step Final Model Risk FactorBSEWORCI (95%)BSEWORCI (95%)Fam. Income:
less than $20,000−0.110.410.070.870.40–2.01−0.610.441.880.550.23–1.30Fam. Income:
$20,000 to
$39,000−0.250.320.590.780.42–1.47−0.550.342.580.580.30–1.13Fam. Income:
$40,000 to
$74,000−0.250.320.590.780.42–1.47−0.350.321.240.710.38–1.31Step 2Physical violence1.090.388.112.96 **1.40–6.24Sexual violence1.270.438.853.57**1.54–8.27Life Stress1.160.2522.103.18***1.96–5.14Note. W= Wald Statistic; OR= odds ratio; CI= commence interval.a
European Americans as reference group*p<0.05;** p<0.01;*** p<0.001
Psychol Trauma . Author manuscript; available in PMC 2011 December 1.
