Tóm tắt: Tác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông

CỦA HỌC SINH TRUNG HỌC PHỔ THÔNG THE EFFECT OF EMOTIONAL ABUSE AND NEGLECT IN CHILDHOOD ON MENTAL HEALTH PROBLEMS AMONG HIGH SCHOOL STUDENTS Major: Children and Adolescent Clinical PsychTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thôngTác động của lạm dụng và bỏ bê về mặt cảm xúc thời thơ ấu lên các vấn đề sức khỏe tâm thần của học sinh trung học phổ thông

CỦA HỌC SINH TRUNG HỌC PHỔ THÔNG

(THE EFFECT OF EMOTIONAL ABUSE AND NEGLECT

IN CHILDHOOD ON MENTAL HEALTH PROBLEMS

AMONG HIGH SCHOOL STUDENTS)

Major: Children and Adolescent Clinical Psychology

Code: 9310401.01

SUMMARY OF DOCTORAL DISSERTATION

IN CLINICAL PSYCHOLOGY

HANOI – 2024

THE THESIS WAS COMPLETED AT UNIVERSITY OF EDUCATION, VIETNAM NATIONAL UNIVERSITY, HANOI

Supervisors: 1 GS TS Lars Lien

The thesis can be found at:

- Vietnam National Library

- Center of Information and Library, The National University, Hanoi

INTRODUCTION

In this study, we focus on emotional abuse and neglect Emotional abuse and neglect are two forms of emotional/psychological maltreatment Emotional maltreatment is defined as a child-care relationship characterized by harmful interaction patterns, not necessarily physical contact with the child (Glaser, 2002) The rate and prevalence of child emotional maltreatment have been estimated in many studies at the global level as well as the regional/ national level Emotional abuse and neglect have short-term and long-term consequences for the physical and mental health of the victims It is associated with a variety of negative physical and mental health outcomes that affect the individual throughout the lifespan and place a substantial burden on both victims and the population as a whole (Gama, Portugal, et al., 2021a; Leeb et al., 2011) Children who are emotionally abused and neglected face similar and sometimes worse mental health problems as children who are physically or sexually abused (Dye, 2020) (Dye, 2020; Spinazzola et al., 2014), yet these types of maltreatment is rarely addressed in prevention programs or in treating victims (Spinazzola et al., 2014) In Vietnam, previous research suggests that child abuse and neglect is a serious problem (Emery et al., 2014; H T Nguyen, 2006; Nguyen et al., 2010; Ruiz-Casares & Heymann, 2009; Tran et al., 2017; Tran et al., 2018) Up to the present, studies of child abuse and neglect and mental health problems such as depression and anxiety in Vietnam are few There are only four studies (H T Nguyen, 2006; Nguyen et al., 2010; Pham et al., 2021; Thai et al., 2020) focus on this topic, the findings of these studies demonstrated the relationships between psychological distress, anxiety, depression, and suicidal ideation and child maltreatment In addition,

we also focus on perceived social support and social capital in the relationship between childhood emotional maltreatment and mental heath problems

Statement of the problem

Child maltreatment and neglect are serious social issues that exist not only in Vietnam but also in many other countries around the world Emotional

abuse and neglect are the most reported types of maltreatment The consequences of child maltreatment can be severe, leading to physical and mental health problems that can last a lifetime Moreover, the social and occupational effects of maltreatment can eventually impede the economic and social development of a nation (WHO, 2020) Previous research suggests that emotional abuse may be the most harmful form of maltreatment, resulting in developmental consequences that are comparable to or worse than those of other forms of maltreatment (Hart et al., 1996; Hart, Brassard, Binggeli, & & Davidson, 2002) Emotional abuse may have the most ubiquitous negative mental health effects of any form of childhood maltreatment, according to evidence from both high- and low-income countries (Dye, 2020; Gama, Portugal, et al., 2021b; Pandey, Gupta, Upadhyay, Gupta, Shukla, Mishra, & & Kumari, 2020) In this study, we focus on anxiety and depression in adolescence period Besides, this study also focuses on perceived social support and social capital since the social system in which a child is reared can affect parenthood (Mestechkina et al., 2014) Previous studies have shown inconsistent results regarding the role of social support and social capital in the relationship between childhood emotional maltreatment and mental health problems

Objectives of the study : This mixed-methods study explores childhood emotional maltreatment experiences among Vietnamese adolescents, adapts an instrument for measuring social capital, and obtains generalized information about the effect of childhood emotional maltreatment and current mental health problems, as well as the moderating role of perceived social support and the mediating role of social capital in this relationship

Research questions

(1) What is the status of childhood emotional abuse and neglect experiences among Vietnamese high school students?

(2) How is the experience of childhood emotional abuse and/ or neglect related

to current mental health problems among high school students?

(3) How perceived social support and social capital influence the relationship between childhood emotional abuse and neglect and current mental health problems?

CHAPTER 1:THEORICAL FRAMEWORK

1.1 Definitions

1.1.1 Childhood emotional abuse and neglect

In our study, childhood emotional maltreatment includes any type of emotional (psychological) abuse and neglect experienced before the age of 18 years

a Emotional abuse (psychological abuse): All abuse is about power and control, and the abuser uses tactics to exert power and control over his or her victims Emotional abuse is any kind of non-physical abuse imposed from one person to another Victims of emotional abuse are subjected to repeated threats, manipulation, intimidation, and isolation that cause them

to feel anxiety, fear, self-blame, and worthlessness They can become convinced that no one else cares or wants them Frequently they stay in abusive situations because they believe they have nowhere else to go

b Emotional neglect (psychological abuse): Houtepen et al (2018) defined emotional neglect as caregivers' persistent disregard for children's emotional needs, including failure to provide comfort when a child becomes scared or distressed In other words, according to Ludwig and Rostain (2009), emotional neglect can be defined as a relationship pattern

in which an individual’s affectional needs are consistently disregarded, ignored, invalidated, or unappreciated by a significant other

c Mental health problems: WHO defined mental health “…is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world

we live in Mental health is a basic human right And it is crucial to personal,

community and socio-economic development”1 In this study, we focus on depressive and anxiety symptoms among adolescents “Depression is extreme sadness or despair that lasts more than days It interferes with the activities of daily life and can cause physical symptoms such as pain, weight loss or gain, sleeping pattern disruptions, or lack of energy” (Kazdin, 2000) Anxiety is “an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune The body often mobilizes itself to meet the perceived threat: Muscles become tense, breathing is faster, and the heart beats more rapidly Anxiety may be distinguished from fear both conceptually and physiologically, although the two terms are often used interchangeably Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat”

1.1.2 Perceived social support

Perceived social support is defined as an individual's perception of supportive behaviors from people in their social network (Tardy, 1985) Perceived social support refers to how individuals perceive friends, family members and others as sources available to provide material, psychological and overall support during times of need (Ioannou et al., 2019)

1.1.3 Social capital

In our study, we used the definition proposed by Villalonga-Olives and Kawachi (2017): “Social capital is defined as the resources –for example, the exchange of favors, the maintenance of group norms, the presence of trust, and the exercise of sanctions– available to members of social groups The social group can take different forms, such as a workplace, a voluntary

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organization, or a tightly-knit residential community The resources can be accessed by the individuals belonging to the group, or by the group as a whole”

1.2 Literature Review

1.2.1 Prevalence of children and adolescents being emotionally abused

and neglected by parents/ caregivers

Many studies on adverse childhood experiences, including childhood maltreatment (e.g child abuse and neglect), have been conducted Previous studies have shown the prevalence of children being emotionally abused and neglected by parents/ caregivers at the global level as well as the regional/ national level Children and adolescents not only experienced emotional abuse and neglect in single form but also co-occurrence across multiple types of maltreatment (Arata et al., 2005; Clemmons et al., 2003; Higgins et al., 2023; Villodas et al., 2021) Neglect accompanied by physical and emotional abuse was the most common form (Kim et al., 2017) In addition, studies also consider some sample characteristics/ demographics related to childhood emotional abuse and neglect experiences

1.2.2 Mental health problems among adolescents

According to the World Health Organisation (WHO), it is estimated that in 2021, approximately 14% of individuals aged 10 - 19 worldwide experience mental health conditions Adolescence is the period of transition from childhood to adulthood This typically ranges from 12 to 18 years of age (Jaworska & & MacQueen, 2015) Adolescence is characterized by significant physical, cognitive, social, and emotional transformations (Backes & & Bonnie, 2019; Best & & Ban, 2021; Jaworska & & MacQueen, 2015) This period of rapid change can have an impact on social and emotional well-being (Backes & & Bonnie, 2019; Best & & Ban, 2021) The fast growth throughout adolescence suggests that the adolescent years might be crucial or sensitive to later health and disease (Backes & & Bonnie, 2019; Viner et al., 2015) This study focuses on depression and anxiety among adolescents Depression is a

common mental health disorder among adolescents globally (Shorey et al., 2022; Zhou et al., 2023), and it is a significant risk factor for suicide, which ranks as the second or third most common cause of death for this age group (Windfuhr et al., 2008) Anxiety disorder is a prevalent mental health condition among adolescents (Altwaijri et al., 2023; Sacco et al., 2022; Xiaoli et al., 2014) In Vietnam, the prevalence of depression and anxiety disorders in adolescents has been statistically determined through many studies

1.2.3 Childhood emotional abuse/ neglect and mental health problems

Individuals who were abused and neglected emotionally as children experience feelings of hopelessness (Courtney et al., 2008; Hamilton et al., 2013), low self-esteem (Chen & Jiang, 2022; Malik & Kaiser, 2016; Mwakanyamale & Yizhen, 2019), poor body image (Kircaburun et al., 2020), low life satisfaction (de Vasconcelos et al., 2020), etc They are also more likely to develop mental health problems (Christ et al., 2019; Dye, 2020; Gama, Portugal, et al., 2021a; H T Nguyen, 2006; Nguyen et al., 2010; Taillieu et al., 2016) This study focuses on depression and anxiety Numerous studies have been conducted to examine the link between child maltreatment and depression and anxiety Several systematic reviews and meta-analysis studies have provided evidence of this association According to our systematic review (including 82 studies with 85,942 respondents aged 10 to 18), emotional maltreatment during childhood are substantially associated with depression and/or anxiety in most studies The relationship between these experiences and depression/anxiety is supported by both cross-sectional and longitudinal research Most of the studies were done in high-income countries (HIC) such as the United States, Korea, Canada, etc There was little data from low- and lower-middle-income countries In low-income countries, no longitudinal study has been conducted Some theories have been used to explain the mechanism underlying the relationship between childhood emotional abuse/ neglect and mental health problems: social learning theory

(Bandura, 1978; Dodge et al., 1990), learned helplessness theory (Abramson et al., 1978)

1.2.4 The moderating role of perceived social support in the relationship

between childhood emotional abuse and/or neglect and mental health problems

Childhood emotional abuse/ neglect was negatively associated with current perceived social support (Chen & Jiang, 2022; Grave et al., 2021) Individuals who were abused and neglected emotionally as children experience

a lack of social support (Chen & Jiang, 2022) Emotional abuse usually results

in unpleasant emotions of guilt or responsibility for the abuse, shame, ineffectiveness, and a sense of being worthless and unlikely to be understood

by others Overt caregiver messages get internalized and decrease self-esteem over time, individuals develop a view of themselves as essentially flawed, unlovable, and hence vulnerable to abandonment or rejection In the long term, these early experiences lead to anxiety and negative expectations about relationships, and these expectations raise the likelihood of interpersonal problems (Kapeleris & Paivio, 2011; Paivio & Pascual-Leone, 2010) Emotional neglect, as opposed to abuse, is characterized by caregivers' lack of engagement and mirroring Chronic caregiver inattention may also develop into a fear of asking for care and warmth from others in adult relationships, leading to feelings of loneliness and isolation (Kapeleris & Paivio, 2011) Social support is important for maintaining good physical and mental health (Cheng et al., 2014; Ozbay et al., 2007; Vandervoort, 1999) McLaughlin et al (2020) have presented a model of transdiagnostic mechanisms Accordingly, children who have experienced trauma often exhibit changes in social information processing, emotional processing, and accelerated biological aging These changes can lead to the development of internalizing and externalizing psychopathologies However, children with higher levels of social support, particularly from caregivers, are less likely to develop psychopathology following trauma exposure According to the stress-buffering

model, social support may mitigate the psychological impact of a stressful event by attenuating the stress appraisal response An individual may see a stressful event as less stressful if he/she perceives that others will provide resources needed to cope with the event (Cohen & Willis, 1985; Cohen, Gottlieb, & Underwood, 2001) However, previous studies have shown inconsistent results regarding the role of social support in the relationship between childhood emotional maltreatment and mental health problems 1.2.5 The mediatting role of social capital in the relationship between

child emotional abuse and/or neglect and mental health problems

A study conducted by Zolotor and & Runyan (2006) demonstrated that increasing social capital decreases the odds of neglectful parenting, psychologically harsh parenting Some studies have proven this idea Fujiwara

et al (2016)’s study indicated that women living in trusting neighborhoods were less likely to report infant physical abuse compared to those living in areas with low neighborhood trust According to the findings of Kim et al (2022), having a lower sense of connection to neighbors appears to be associated with a higher risk of physically harsh parenting behaviors Connectedness with neighbors may offer women a stronger sensation of being supported or monitored, which may lead to less harsh parenting behaviors Children and adolescents living in areas with less social capital in the community appear to be at greater risk of abuse and have more psychological

or behavioural problems (Runyan, 1998) A study conducted by Kim and Lee (2021) showed that social capital from siblings, teachers, neighbors, or online acquaintances mediated the pathways from parental violence to maladaptive behaviors In addition, children’s social capital from siblings mediated in the pathways from parental violence to aggressive behavior and depressive mood

On the other hand, Saluja et al (2003)’s study demonstrated that social capital did not modify the relationship between child maltreatment and either aggression or depression-anxiety Explaining this result, they said this might be related to the fact that many previous studies looked at social capital

ecologically, whereas this study uses individuals as the unit of analysis Another study conducted by Lu and Xiao (2019) found a significantly positive relationship between adolescents’ ACEs and current mental disorders, and the effect was partially mediated by family functioning and civic engagement, but not by social capital

1.3 Conceptual framework

1.3.1 Theories

This study generated hypotheses on the relationship between stressful events and mental health, examining social support and social capital as moderators These hypotheses were developed based on three main theories: (1) Social Learning theory (Bandura, 1978; Dodge et al., 1990), (2) Learned Helplessness theory (Abramson et al., 1978), and (3) Stress-Buffering model (W Cohen & T A Wills, 1985)

1.3.2 Hypotheses

Hypothesis 1 (H1): Childhood emotional maltreatment (emotional abuse and neglect) is positively associated with mental health problems (depression and anxiety) among Vietnamese adolescents

Hypothesis 2 (H2): Perceived social support moderates the relationship between childhood emotional maltreatment and mental health problems in adolescent period

Hypothesis 3 (H3): Social capital mediates the relationship between childhood emotional maltreatment and mental health problems in adolescent period

CHAPTER 2 : METHODOLOGY 2.1 Overview of research design

This study is a retrospective and cross-sectional study that uses exploratory sequential mixed methods designs

2.2 Study setting and sample

2.2.1 Settings characteristics

For the first qualitative sub-study, we collected data in Hue, Ho Chi Minh City, and Dong Nai For the first quantitative sub-study, we piloted

YSCS with 10 high school students in Hanoi, Hue, Bac Giang, Ho Chi Minh City, and Ninh Binh, then we collected quantitative data to adapt YSCS in Hue and Ninh Binh For the second quantitative sub-study, we collected data in Hue and Ha Nam

2.2.2 Sampling strategy

Convenience sampling was used as a recruitment strategy

2.2.3 Study sample

Table 1 Description of study sample

The qualitative sub-study Focus group : 17 high school students in

Hue, Ho Chi Minh City, and Dong Nai The first quantitative sub-study Piloted YSCS: 10 students in Ho Chi

Minh city, Hue and Dong Nai

1454 high school students in Hue and Ninh Binh

For EFA, N=730 For CFA, N=724 The second quantitative sub-study 757 high school students in Hue and Ha

Nam 2.2.1.1 Participants in the qualitative sub-study

Table 2 Characteristics of the study participants in the qualtitative sub-study

N

2.2.1.2 Participants in the first quatitative sub-study

In the first quantitative sub-study, a total of 1454 high students in Hue and Ninh Binh completed the questionnaire (Table 7) As shown in the following Table, in order to adapt the YSCS, the first sample (N=730) was used for analyzing EFA and the second sample (N=724) was used for analyzing CFA

Table 3 Characteristics of the study participants in the first quantitative

sub-study (Sample 1A) (N=730)