Childhood Polyvictimization and Associated Health Outcomes: A Systematic Scoping Review

Abstract

Background: Polyvictimization, the experience of multiple types of victimization, is associated with detrimental health outcomes. Despite extensive research on the health consequences of polyvictimization, one challenge in understanding this literature lies in the varied operationalized definitions of polyvictimization and health outcomes. This scoping review provides the volume of the current literature on this topic, documents the varied constructs of polyvictimization and associated health outcomes, identifies knowledge gaps, and guides future research directions. Method: A systematic search of English-language original articles that presented quantitative associations of childhood polyvictimization and health outcomes was performed through six-database searches, a gray literature search, and citation mining from June 2020 to January 2021. The varied constructs of polyvictimization, health outcomes, and other study characteristics were extracted. Results: A total of 96 studies were included. Two ways of creating continuous variables (30.21%) and four ways of constructing categorical variables (72.92%) were identified for operationalizing polyvictimization. The majority of health outcomes were mental, behavioral, or social (96.88%), while slightly more than 10% of studies examined physical health (11.46%) or general health conditions (10.42%), respectively. More than half of studies used U.S. samples (56.25%). Conclusions: The varied constructs of polyvictimization suggests that there is a need to establish a valid polyvictimization construct that is consistently agreed upon in the research community. Findings summarize the specific health outcomes that can be targeted for further investigation and prevention efforts. Findings also suggest that the study of resilience and coping education for childhood polyvictims is sorely needed.

Keywords

child abuse mental health and violence violence exposure

Polyvictimization is an important and fairly recent public health concept, with the term first used by Finkelhor et al. in 2007 to differentiate between experiences of one single type of victimization exposure—such as sexual violence or physical violence—and the experience of multiple types of victimization, or polyvictimization (Finkelhor et al. 2007a). Individuals who experience polyvictimization, as compared to those who experience one victimization type, are at greater risk for negative mental health outcomes (Cyr et al., 2017), including trauma-related symptomatology (Finkelhor et al., 2007a, 2007b). In addition, polyvictimization allows for an exploration of victimization profiles, including how certain victimization types tend to cluster together, and how exposure to one victimization type can increase the odds of exposure to different types of victimization (Finkelhor et al., 2007a; Fleckman et al., 2016). Understanding polyvictimization is essential in crafting more effective violence prevention strategies that address complex victimization experiences and target multiple health outcomes.

Among polyvictimization studies, the majority of the literature focuses on childhood experiences of polyvictimization (Ramsey-Klawsnik, 2017) given the harmful effects of child maltreatment and childhood violence exposure on related health outcomes (Cyr et al., 2014; Ford & Delker, 2018; Richmond et al., 2009; Schwab-Reese et al., 2018). A large volume of literature documents a variety of associated negative health outcomes of childhood polyvictimization, including: lower self-esteem; depression, anxiety disorders, psychosis, post-traumatic stress disorder (PTSD), and other mental health symptoms; risky behaviors, self injury, and suicide attempts; substance misuse; attention and cognitive difficulties; aggressive behaviors; delinquency and criminal activities; severe obesity; somatic complaints and physical health diagnoses; and poor perception of health (Curran et al., 2016; Cyr et al., 2014; 2017; Dierkhising et al., 2019; Fleckman et al., 2016; Hellström, 2019; Källström et al., 2017; Kennedy, 2017; Kerig, 2018; La Flair et al., 2013; Moeller et al., 1993; Samms-Vaughan & Lambert, 2017). Clearly, polyvictimization can have a wide array of negative associations with mental, behavioral, social, and physical health symptoms.

Discrepancies in the Literature

While mounting research has emerged over the last decade focusing on the impact of polyvictimization, one limitation of the existing literature is the variance in conceptual and operationalized definitions. A major variation is how “multiple” victimizations is defined. At the conceptual level, while most literature defines the term as multiple types of victimization (Chan et al., 2019; Finkelhor et al., 2007a; Ford & Delker, 2018; Grasso et al., 2016; Hooven et al., 2012; Kallstrom et al., 2017; Mitchell et al., 2020; Nguyen et al., 2019), the term has also been applied with slight variations. As a few examples from recent research, Hellström (2019) defined the term as exposure to violence in different settings (e.g., school, home, and community); Miller-Graff et al. (2019) used the term as varied types of violence by different perpetrators; Kennedy (2017) noted the term as cumulative forms of direct and indirect interpersonal violence. These varied conceptual definitions across studies show that the notion has been slightly differently applied to each violence context.

At the level of operationalized definitions, polyvictimization has been differently applied in research studies. La Flair et al. (2013) defined polyvictimization as experiencing more than one form of childhood abuse and neglect among four types of violence: sexual abuse, physical abuse, witness to domestic violence, and neglect by a parent or caregiver. On the other hand, Dierkhising et al. (2019) defined polyvictimization as high exposure (mean = 2.8 to 4.8) as opposed to low exposure (mean = 1.3 to 1.8) among 17 traumatic stressors. While some polyvictimization literature includes exposure only related to interpersonal violence (Carbonaro, 2019; La Flair et al., 2013; Miller-Graff et al., 2015), this study by Dierkhising et al. (2019) included multiple forms of maltreatment, victimization, and traumatic experiences that were not necessarily interpersonal violence (e.g., illness/medical trauma, serious injury/accident, natural disaster, or war). As such, the operationalized definitions of polyvictimization across studies have been wide-ranging.

Literature Reviews of Childhood Polyvictimization and Health Outcomes

To date, there has been no prior systematic review that synthesized both aspects of childhood polyvictimization and its related health outcomes. There have been a few systematic reviews on polyvictimization focused on prevalence of these experiences among certain clinical subgroups, including a study regarding polyvictimization among children with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder with samples from Spain, Hong-Kong, Norway, France, and the U.S. (Hellström, 2019). Additionally, there was a systematic review of poly-traumatization typologies with samples from Ireland, Australia, and the U.S. (Contractor et al., 2018). Further, there have been a few review papers that addressed the evidence, contexts, and information about older adults affected by polyvictimization (Ramsey-Klawsnik, 2017) and the factors associated with physical and sexual child abuse and polyvictimization in Africa (Meinck et al., 2015). A systematic review and meta-analysis reported the prevalence of polyvictimization among children and adolescents in low- and lower-middle income countries (Le et al., 2018), which provided a supplemental table that summarized associated health and well-being outcomes. However, out of the 30 studies reviewed by Le et al. (2018), a majority reported the associations between specific, individual forms of victimization and health outcomes, not multiple types of victimization and its associated health outcomes. As such, a deeper understanding of the impact of childhood polyvictimization on health outcomes is imperative across different country settings. Indeed, the prevalence and patterns of polyvictimization differ across countries and regions, as one recent meta-analysis reveals that the prevalence of polyvictimization in low-middle income countries was on average 38.1% (Le et al., 2018) whereas that of the U.S. was 10% (Turner et al., 2010) and that of China was 14% (Chan, 2013; Johnco et al., 2019). However, there is no previous systematic synthesis on this topic that includes all geographic areas regardless of health conditions. Thus, the purpose of this paper is to offer a scoping review of these general associations that are not limited by a country setting or clinical subgroups.

Study Purpose

Scoping reviews are performed to clarify concepts, determine the scope of a body of literature, identify knowledge evidences and gaps, and confirm the relevance of inclusion criteria and potential questions for systematic reviews as precursors to future review projects (Munn et al., 2018). The methodology, structure, and values of scoping reviews are well-documented (Arksey & O’Malley, 2005; Colquhoun et al., 2014; Levac et al., 2010; Munn et al., 2018; Peters et al., 2015). Following these guidelines, we performed a systematic scoping review to: (1) clearly indicate the volume of available studies on the topic of childhood (ages 0–19) polyvictimization and associated health outcomes. The polyvictimization was experienced during the childhood (developmental period) but the health outcomes assessed were not limited to childhood. (both published and unpublished literature), (2) determine the coverage of the body of literature on the topic, especially documenting the varied constructs of polyvictimization and health outcomes, (3) identify and analyze knowledge evidences and gaps, and (4) pose more specific research questions that can be valuably addressed by future systematic reviews. A systematic review and meta-analysis of these associations were considered, but with inconsistent definitions of polyvictimization, broad scope of health outcomes, and samples of varied regional aspects, it was inherently challenging to yield an accurate synthesis that can be used as a firm knowledge base to offer clinical implications and guide practice, program, policy, and research. Thus, this scoping review will help future systematic reviews to be more precise, answer clinically meaningful questions with less risk of bias of the emerging evidences, provide directions to future research priorities and evidence to inform practice, programs, and policy, and make sense of the landscape of the emerging evidences (Colquhoun et al., 2014; Munn et al., 2018).

Methods

Scoping Review Team

The study team consisted of four reviewers, a method expert, and three content experts. The reviewers searched, screened, and coded the literature, and the method and content experts ensured the review’s scientific credibility and content relevance in the violence literature field.

Population, Intervention, Comparison, and Outcomes

The Population, Intervention, Comparison, and Outcomes (PICO) elements used in the study were the following. (1) Population: 0–19 years old (the age range exposed to polyvictimization); (2) Intervention: not applicable (included studies were observational or retrospective); (3) Comparison group: those who have not experienced polyvictimization (e.g., those who experienced only one single-type victimization or no victimization experience in childhood); (4) Outcome: health outcomes. The age 19 was used following the definition by WHO and similar sources (Canêo & Neirotti, 2017; UNICEF, n.d.; WHO, n.d.). A number of childhood polyvictimization studies included age 18 (e.g., Butcher et al., 2016; Davis et al., 2020; Jativa & Angeles Cerezo, 2014; Kirchner et al., 2020; Kretschmar et al., 2017; Le et al., 2018; Sabri et al., 2012; Soler et al., 2013) and age 19 (Carbonaro, 2019; Juan et al., 2019; Kamndaya et al., 2017).

Search Strategy and Selection of the Literature

The literature search was conducted between June 8, 2020 and June 16, 2020. Six databases were searched using Georgia State University library system in Web Scale Discovery Service: Web of Science, PubMed, Embase, Medline with Full Text, APA Psycinfo, and ProQuest Central. Of these, Web of Science, APA Psycinfo, and ProQuest Central were additionally used to search for unpublished articles, conference proceedings, and dissertations. In addition, gray literature was searched through relevant organization websites such as Office of Juvenile Justice and Delinquency Prevention, American Institute for Foreign Study, and Substance Abuse and Mental Health Services Administration between May 29 and June 7, 2020.

The search terms were determined after consulting the method and content experts and two university librarians. The same search terms were used for all six databases: [(“poly-victimization” or “poly victimization” or “multi-domain victimization” or “polyvictimization”) AND (child or children or young person or adolescent or teenager or youth or young people) AND (health outcomes or health consequences or health implications or health impact)]. We only included studies that met the following eligibility criteria: (1) was an original article about childhood polyvictimization experience; (2) presented health outcomes (e.g., mental distress, PTSD, suicidal risks, depression, or substance abuse); (3) evaluated quantitative associations between childhood polyvictimization and health outcomes; (4) was written in English. We did not limit the years of publication as the concept of polyvictimization was recent (Finkelhor et al., 2007a). Studies were included regardless of the country/region of focus. As we reviewed studies, we established post-hoc exclusion criteria: (1) included traumatic events or life adversities that were beyond interpersonal violence victimization (e.g., poverty, parent lost job, no good friends, accidents, natural disasters, not living with mother, parental impairment, family member in jail, family substance use, or police arrest/detention) as part of the polyvictimization experience—in this sense, the experiences included in the study were distinguished from adverse childhood experiences (ACEs; i.e., potentially traumatic events that occur in childhood), which are a broader concept that includes life adversities and potentially traumatic experiences experienced in childhood besides experiencing violence, abuse, or neglect or witnessing violence (CDC, 2021); (2) did not meet the temporality of the timings of polyvictimization and health outcomes—health outcomes were assessed earlier in the life trajectory than polyvictimization occurred, or both victimization and health outcome measures were lifetime, thus temporality could not be established; (3) health outcomes were delinquency or criminal behaviors that were distant from direct health outcomes.

Two steps of screening process were involved to include eligible studies for this review, and then backward reference searching was made. First, abstract screening was performed. Duplicate articles were merged using Zotero (a reference management software), and Abstrakr (an abstract screening tool) was used for the abstract screening process. Abstracts were double screened by two reviewers based on Eligibility Criteria 1, 2, and 4, and discrepancies were resolved by the first author. Then, full text articles were retrieved except for conference abstracts or unavailable studies. Second, full-text screening was conducted. Three reviewers divided the studies and screened articles following the eligibility and post-hoc criteria. Then, the first author double-screened all articles. Discrepancies were resolved through discussions. An Excel spreadsheet was used for this process. Next, citation mining was conducted. The reference list of the included studies from full text screening was examined based on the title, abstract, and full text. Titles and abstracts were assessed by the first author, full-text was double-screened by the reviewer team, and then discrepancies were resolved through discussions.

Data Extraction

Following the aims of the study, we coded the operationalized definition of polyvictimization, documenting how victimization profiles were compared and what victimization types were included in each study, as well as the investigated health outcomes. The victimization classification method was not part of our study focus, but, based on the extracted data, we summarized general methodological approaches that studies have taken to operationally define polyvictimization in the studies (e.g., continuous vs. categorical). At the same time, we documented whether studies recorded victimization perpetrator types, frequency, and/or severity, as some definitions of polyvictimization noted victimization by multiple perpetrators or increased total exposure (frequency and severity) of victimization and accounting for the number and type of perpetrators, frequency of victimizations, and severity of victimizations may contribute to understanding the impact of victimizations. Finally, we extracted information such as author names, year of publication, country that the sample(s) were drawn from, sample size, and female percent in sample.

Results

Study Selection

Out of the six databases, a total of 389 studies were identified (Web of Science: 181, PubMed: 76, Embase: 69, Medline with Full Text: 28, APA Psycinfo: 33, and ProQuest Central: 2), of which 165 studies were duplicates. After duplicates were merged, 224 studies were double-screened. Abstract screening revealed that 139 abstracts were eligible, and 131 studies were located for full text screening. After the second double-screening process, 54 studies were eligible to be included. Citation mining added an additional 40 studies. The active gray literature search added two relevant reports/articles to the final set. Thus, the final set of included studies were 96 (Figure 1).

Figure 1.

Flow chart following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Study Characteristics

In the following sections, we summarize our review results including: polyvictimization construct; associated health outcomes; victimization perpetrator, frequency, and severity characteristics; countries samples were drawn from; female percent among study samples; and publication year.

Polyvictimization Construct

Victimization Types

Regarding the types of victimization included in the polyvictimization construct (Supplementary Appendix A), both specific domain and individual items of victimization differed widely. To iterate, the number and the types of victimization included in polyvictimization constructs varied extensively from using two victimization types with three individual items (Shevlin et al., 2015) to three victimization types with 14 items (Natukunda et al., 2019), 36 individual victimization items grouped into six broader types (Álvarez-Lister et al., 2014), 44 victimization items of 10 types (Michel-Smith, 2019), and to 75 items of 10 different types of victimization (Riedl et al., 2019). At times, direct violence exposure was classified as one type (Voith et al., 2014), while, at other times, direct violence exposure was often further classified into more detailed victimization types, such as sexual violence, physical violence, or conventional crime (e.g., Aho et al., 2016; Kirchner et al., 2020; Turner et al., 2017). As such, studies vastly differed in terms of what victimization items and types were included in the construct. However, as not every study documented the number of individual question items, our review did not summarize such information but documented the victimization domain/type investigated in the studies (Supplementary Appendix A).

Continuous Versus Categorical Variable

When it comes to the polyvictimization construct, 30.21% of included studies coded polyvictimization as a continuous variable; however, the majority of studies (72.92%) coded it as a categorical variable. Two common approaches were found for the construction of continuous polyvictimization variables, and four were noted for the construction of categorical polyvictimization variables. For continuous polyvictimization variables, the first common approach was a summary measure of the total number of individual victimization items experienced. For example, studies using this approach counts sexual harassment, non-penetrative sexual assault, and rape as unique items (not as one sexual violence domain). Whether the range of possible victimization types was 0–14, 0–36, or 0–75, the polyvictimization construct was a continuous variable that summed the number of different individual victimization items that respondents were exposed to among the items examined (e.g., Guerra et al., 2016; Turner et al., 2010, 2013a, 2013). A second common approach was to create the polyvictimization variable using the number of different domains of victimization experienced. For example, domains include any sexual violence, any non-sexual physical violence, and any verbal violence. In this case, the cumulative victimization domain/type had a lower range such as 0–3, 0–4, or 0–5 (e.g., Boxer & Terranova, 2008; Edwards et al., 2014; Edwards et al., 2003; Horn et al., 2018; Kennedy, 2017; Nguyen et al., 2019a).

In terms of categorical polyvictimization variables, one approach (14.58%) compared victimization profiles distinguished by different mixtures of violence types. Examples include no maltreatment, emotional abuse only, or physical abuse, sexual abuse, and neglect (Arata et al., 2007) or neglect only, physical abuse only, or physical abuse and neglect (Hahm et al., 2010) by mixture of different types.

A second approach to the categorical variable (7.29%) was to define polyvictimization as experiencing more than one type of violence (e.g., Charak et al., 2015; Hickman et al., 2013; Itani et al., 2018; Kamndaya et al., 2017; Natukunda et al., 2019; Sabri et al., 2012; Shevlin et al., 2015; Updegrove & Muftic, 2019). These studies compared the polyvictimization group with those who experienced none or one type of violence. In these studies, the group who experienced “more than one type of violence” was not further classified as those exposed to, for example, three types of violence or four types of violence victimization.

Third, a number of studies (29.17%) classified “more than one type of violence exposure” further and defined polyvictimization by different numbers/scores of victimizations experienced as an ordinal variable. The most basic structure is to group victimization profiles solely by the number of victimization types experienced, for example, no abuse, one, two, and three types of abuse experienced (Moeller et al., 1993; Raskauskas, 2010) or one, two, and three or more maltreatment types experienced (Richardson et al., 2008), defining beyond two or more types of violence exposure. However, in many cases, studies also applied cut-off points to define polyvictimization. That is, depending on the age group or the number of victimization items examined, the cut-off points for polyvictimization differed, for example, four or more victimization types experienced (Chan et al., 2017; Riedl et al., 2019), five or more victimizations experienced (Ellonen & Salmi, 2011; Turner et al., 2019), seven or more screeners endorsed (Turner et al., 2012), nine or more forms of victimization experienced (Soler et al., 2012), more than 10 forms of victimization experienced (Le et al., 2016), 14 or more items endorsed (Michel-Smith, 2019), or 37 or more episodes reported (Kirchner et al., 2020). At times, cut-off points were set at the top 10–13 percent of the victimized group (Aho et al., 2016; Finkelhor et al., 2011, 2011b; Jackson-Hollis et al., 2017; Mitchell et al., 2020).

Additionally, as part of the third approach to the categorical variable scheme, some studies defined polyvictimization even further, distinguishing low, mid, and high polyvictimization groups (de Azeredo et al., 2019; Fernández-Artamendi et al., 2020; Finkelhor et al., 2007a; Margolin et al., 2010; Segura et al., 2016). For example, de Azeredo et al. (2019) distinguished low levels of polyvictimization (scores of five to 10) and high levels of polyvictimization (scores greater than 10) using different cumulative scores of victimization, and Fernández-Artamendi et al. (2020) distinguished low, mid, and high polyvictimization levels according to the number of forms of victimization experienced and the age group: low polyvictimization (one to six forms of victimization (<14 years), one to eight forms of victimization (≥14 years)), mid polyvictimization (seven to 20 forms of victimization (<14 years), nine to 20 forms of victimization (≥14 years old)), and high polyvictimization (≥21 forms of victimization).

Still in the third approach in the categorical methods, chronic conditions, severity, and frequency status were also sometimes considered in addition to types of victimization. When the chronic condition of victimization was considered, one classification schema classified victimizations as no victimization, victimization in one stage of development (out of three stages: 0–5, 6–12, and 13–18 years old), victimization in more than one stage of development, victimization of multiple types in one stage of development, and victimization of multiple types in more than one stage of development (Mitchell et al., 2020). Further, when severity/frequency characteristics were considered, the classification could be made as no, low (low levels of one to five child maltreatment types), moderate (moderate/severe levels of one to three child maltreatment types), and severe (moderate/severe levels of four to five child maltreatment types) levels of victimization (Dovran et al., 2019). However, with all these different variations, these examples speak to one scheme that defines polyvictimization with the number of victimization experiences endorsed as an ordinal variable.

Lastly, analytical schemes (21.88%) such as latent class analysis or cluster analysis were used to identify victimization groups. Latent class analysis was the most commonly used as an analytical method to distinguish different victimization profiles (e.g., Aebi et al., 2015; Beck et al., 2014; Berzenski & Yates, 2011; Butcher et al., 2016; Cecil et al., 2014; Charak et al., 2016; Curran et al., 2016; Davis et al., 2019; Grasso et al., 2013, 2016; Kretschmar et al., 2017; Obsuth et al., 2018; Pears et al., 2008; Turner et al., 2016). In addition, cluster analysis was also used to define which victimization types are clustering to one another (e.g., Álvarez-Lister et al., 2014; Higgins, 2004; Holt et al., 2007; Holt & Espelage, 2003). At times, studies with longitudinal victimization characteristics examined changes over time; Turner et al. (2017) classified these as stable low, decreasing, increasing, and stable high polyvictimization groups, and Davis et al. (2020) separated groups as sustained polyvictimization, moderate/decreasing victimization, and low victimization.

Associated Health Outcomes

Supplementary Appendix A shows a wide range of associated health outcomes with polyvictimization. Among the 96 studies, 93 studies (96.88%) investigated mental, behavioral, and/or social health aspects, 11 studies (11.46%) examined physical health conditions, and 12 studies (10.42%) analyzed general health, such as quality of life, life satisfaction, overall health status, daily functioning, well-being, or coping capacity (these classifications are not mutually exclusive as some studies investigated more than one category of health outcomes).

Other Characteristics

Victimization Perpetrator, Frequency, and Severity

Twenty-one studies incorporated the victimization characteristics of perpetrator, frequency, and/or severity as part of the polyvictimization construct, while a majority of the included studies did not incorporate such aspects in the polyvictimization construct. The number of studies that incorporated one or a combination of these characteristics is summarized (Figure 2), and the studies that incorporated these aspects are identified (Supplementary Appendix A).

Figure 2.

Number of studies that did and did not report victimization perpetrator, frequency, and severity.

Country of Sample Recruitment

More than half of the studies (56.25%) had samples drawn from the U.S., 10 studies (10.42%) from Spain, five studies (5.21%) from Canada, four studies (4.17%) from Sweden, and three studies (3.13%) from England. One to two studies (1.04–2.08%) have been conducted on this topic with samples from other parts of the world (i.e., Austria, Brazil, China, Denmark, Hong-Kong, Australia, Belgium, Cambodia, Chile, Finland, Haiti, India, Kenya, Netherlands, Nigeria, Norway, South Africa, Switzerland, Taiwan, UAE, Uganda, and Vietnam) (Figure 3).

Figure 3.

Number of country of sample recruitment among the included studies (n = 96).

Female/Male Percent in Samples

87 studies reported what percent of their sample was female or male. While eight studies had female only samples and one study had a male only sample, generally, female percent was evenly distributed across different samples with a majority of sample being females (55.17%) or males (44.83%). Female percent is documented (Supplementary Appendix A).

Publication Years

Despite the fact that the term “polyvictimization” itself was first used in 2007 in the field of violence (Finkelhor et al., 2007a), while most studies (86.46%) were published after 2007, the concept of multiple types of violence exposure was used prior to 2007 as in seven studies (7.29%) and in 2007 in six studies (6.25%) included in our review (Supplementary Appendix A).

Discussion

Our review aimed to identify the volume of available studies on the topic of childhood polyvictimization and its associated health outcomes through the end of childhood (age 19), including both published and unpublished literature. Specifically, in this study, our goals were to document the varied constructs of childhood polyvictimization and associated health outcomes, identify and analyze knowledge evidences and gaps, and pose more specific research questions that can be addressed in future systematic reviews. Table 1 summarizes key findings.

Table 1.

Critical Findings.

96 studies about health outcomes of childhood polyvictimization were included.

Operationalized definitions for polyvictimization were varied across studies, as were the health outcomes examined.

The majority of studies were from the United States (56.25%), examined polyvictimization as a categorical construct (72.92%), and measured mental, behavioral, or social outcomes (96.88%).

More childhood polyvictimization research that focus on coping and resilience is needed to strengthen positive resilience and coping strategies for individuals with childhood polyvictimization to mitigate its negative health consequences.

There is a need to establish a valid polyvictimization construct that is consistently agreed upon in the research community.

This review indicated the significant volume (96 studies) of currently available published and unpublished studies on childhood polyvictimization and its associated health outcomes and documented the varied constructs currently in play in the scientific literature focused on these associations. By examining these constructs, the review identified general patterns in operationally defining polyvictimization, consisting of varied approaches for constructing continuous (two identified) and categorical variables (four identified). These findings offer a valuable addition and summary of the current literature that can be referenced by future researchers as they make decisions for operationalizing polyvictimization. It is currently challenging to specifically summarize patterns of the types/number of victimizations which constitute polyvictimization given that they vary significantly from study to study. More research is warranted to assist researchers in the best approach for such classifications. These variations illuminate the importance of developing an agreed upon unbiased standard measurement of polyvictimization that can answer clinically meaningful questions across studies and contexts in evidence synthesis.

More specifically, a consensus on a polyvictimization construct amongst clinical and research experts, as well as the development of an instrument that would allow for unbiased standard measurement of polyvictimization, are warranted. While the existing literature on polyvictimization can inform these next steps, more research is also needed to examine what specific victimization types have sufficient strength of evidence and better understand the victimization thresholds that define polyvictimization. One way to achieve this goal would be developing a commonly agreed hypothesized measurement model based on theory and previous analytic research and testing validity and reliability of the construct by using statistical methods such as confirmatory factor analysis on different populations. A consistent and comprehensive body of measures that could include various approaches to delivery (e.g., clinical interview, self-report, record review, and multi-informant interview) and allow for the flexibility of the various types of study methods in this field of study would be beneficial to future research, clinical practice, and program evaluation. At the same time, an approach to instrument development that ensures a sound theoretical framework and practical approach to efficient and cost-effective assessment for clinical intervention programs for polyvictimized patient groups must be prioritized (Davis, 1996).

In terms of health outcomes, the majority of studies (93 studies, 96.88%) analyzed mental, behavioral, or social health outcomes while fewer studies investigated physical (11 studies, 11.46%) or general (10 studies, 10.42%) health outcomes. It may be that childhood polyvictimization has more direct relationships with mental, behavioral, and social health outcomes as they are highly impactful on the short-term outcomes of focus in childhood (school, peer, and relational success). It may be that physical and general health outcomes are there but not regularly assessed, or it may be that the mental, behavioral, and social health outcomes serve as mechanisms for more long-term health outcomes. Regardless, it is difficult to fully understand the true associations until there is an established operational definition of polyvictimization and more consistency among the health outcomes of study. Further, even when a consensus definition of polyvictimization is established, it is likely that victimization characteristics and other demographic or individual level factors may moderate or mediate the extent of health outcomes children experience. Thus, while this review clearly highlights the need of standard instrument development of polyvictimization, more longitudinal studies that follow youth transitioning from childhood to adulthood and that ensure a comprehensive approach to measuring health and well-being as well as potential mechanistic drivers of these associations are warranted to better explicate outcomes associated with childhood polyvictimization. There are existing datasets that would allow for such investigations (e.g., the National Longitudinal Study of Adolescent to Adult Health or the Longitudinal Studies of Child Abuse and Neglect) and this is an imperative next research step for this field of study.

As to knowledge evidences and gaps, the list of victimization types, polyvictimization construct schemes, and associated health outcomes are identified (Supplementary Appendix A); based on this list, future studies can navigate which investigations are further necessary for increasing our understanding of the impact of specific victimization types, strengthening current construct schemes, exploring additional analytic schemes, or analyzing certain health outcomes. In particular, more studies are needed that investigate coping strategies and resilience. It was surprising to note that despite all the studies focused on negative health outcomes of polyvictimization, there was only one study that investigated coping strategies as health outcomes (Kirchner et al., 2020). Thus, it is evident that childhood polyvictimization studies that focus on coping and resilience are much needed to understand how to best strengthen mental stamina for individuals who experienced violence victimization in childhood. In addition, given that most of the studies used samples from the U.S., more studies in different regional contexts should be also encouraged, especially for global settings where prevalence of polyvictimization may be higher (Le et al., 2018).

Moreover, this review offers insights for future systematic reviews and measurement of cumulative adverse childhood experiences. First, future systematic reviews can be conducted with narrower focus, which investigate specific types of victimization, different ways to define polyvictimization, particular health outcomes, or within certain countries with greater depth and specificity. In addition, as our review did not include violence perpetration or delinquency as health outcomes, future reviews can explore the associations between childhood polyvictimization and juvenile/criminal justice system involvement or delinquent behaviors. Furthermore, as childhood polyvictimization is part of cumulative adverse childhood experiences, these varied constructs of polyvictimization can offer a framework as to how to measure cumulative adverse childhood experiences, as well as delineate how the compounding experiences of polyvictimization and other adverse childhood experiences might affect deleterious health outcomes. As the types/number of victimizations, schemes constructing polyvictimization, and health outcome measurements ranged broadly, a meta-analysis may still be a challenge. Key recommendations from the current study for future research, practice, and policy are listed in Table 2.

Table 2.

Implications for Practice, Policy, and Research.

More research is needed on:
Polyvictimization in diverse contexts, outside of the United States.
The impact of polyvictimization on physical and general health outcomes.
The impact of perpetrator type, frequency, and severity of victimizations on health outcomes.
Coping mechanisms and resiliency as health outcomes.
The mitigating effects of resiliency, coping mechanisms, and protective factors on health outcomes.

It is important that research on polyvictimization use scientifically valid and more consistent methodology. In particular, future research should make an effort to:
Build consensus on the conceptual and operational definition of polyvictimization.
Use a widely accepted construct of polyvictimization.
Use a longitudinal design to follow children through the transition into adulthood.
Conduct narrower and more in-depth systematic reviews based on particular victimization type, polyvictimization construct scheme, health outcome, or countryspecific context.

Because research on polyvictimization is so diverse, it is important that practice and policy decisions are made on the basis of studies that are the best fit for the context and intended outcome.

Strengths and Limitations

Our review should be interpreted based on its strengths and limitations. Among many strengths, this review was conducted with a strong team of reviewers and experts both in methods and content. Additionally, it undertook the most rigorous approach, including double-screening, double-coding, searching for gray literature, and citation mining. Importantly, through citation mining, our team located seven additional studies dated prior to 2007 and six additional studies dated in 2007. Without the citation mining, based on the initial literature search alone, this review would have resulted in 54 studies, which is about a half of our final set of studies. This suggests the importance of citation mining in following the most rigorous systematic review approach to yield a complete and comprehensive set of eligible studies. Further, this was the first study that presented the varied construct of polyvictimization, which is a much-needed topic that has not been addressed in childhood violence research. Additionally, including samples from all countries and all years broadened the scope of the literature and advanced comprehensiveness of the review.

Nonetheless, this review has several limitations. First, this review was not able to comment on the robustness or rigor of the included studies. Next, although rigorous, human errors may have occurred in screening or coding studies. Lastly, as our review included studies with only English language, geographical and cultural diversity could have been limited.

Conclusions

To our knowledge, this is the first review of both published and unpublished studies that explores childhood polyvictimization and its associated health outcomes. This review covers the scope of the current literature, documents the varied constructs of polyvictimization and associated health outcomes, and highlights existing evidences and gaps. It is important to increase understanding of how polyvictimization can best be structured to improve the validity of research on this topic as well as what health outcomes should be prioritized when investigating, designing, and implementing secondary prevention interventions. Relatedly, examining approaches to strengthen positive resilience and coping strategies for individuals with childhood polyvictimization in order to reduce detrimental health consequences across the lifespan is an area of great need. This review can help direct future research to narrow the research gap and build consensus on this emerging and important topic of childhood polyvictimization.

Supplemental Material

sj-pdf-1-tva-10.1177_15248380211073847 – Supplemental Material for Childhood Polyvictimization and Associated Health Outcomes: A Systematic Scoping Review

Supplemental Material, sj-pdf-1-tva-10.1177_15248380211073847 for Childhood Polyvictimization and Associated Health Outcomes: A Systematic Scoping Review by NaeHyung Lee, Terri Deocampo Pigott, Ashley Watson, Katherine Reuben, Kathryn O’Hara, Greta Massetti, Xiangming Fang and Shannon Self-Brown in Trauma, Violence, & Abuse

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

NaeHyung Lee

Katherine Reuben

Supplemental Material

Supplement material for this article is available in online.

Author Biographies

NaeHyung Lee, Ph.D., conducts research on adverse childhood experiences both in the United States and international contexts. Her research interests include health impacts of violence and other life adversities experienced particularly among children and youth as well as effective strategies to prevent adverse childhood experiences and mitigate their effects.

Terri Pigott, Ph.D., is a Professor in the School of Public Health and the College of Education and Human Development at Georgia State University. Dr. Pigott’s research focuses on meta-analysis methods, including strategies for missing data in meta-analysis, power in meta-analysis, and outcome reporting bias.

Ashley Watson, M.P.H., is a doctoral student in the Department of Health Policy & Behavioral Sciences in the School of Public Health at Georgia State University. Her main research focus is child maltreatment prevention, especially the identification of risk and protective factors of both caregivers and victims. Additionally, she is interested in research focused on health disparities, gender differences and women’s health.

Katherine Reuben, B.S., is a graduate student in the School of Public Health at Georgia State University. Her research addresses child maltreatment and commercial sexual exploitation. She is particularly interested in understanding and preventing interpersonal violence towards groups that are vulnerable but under-researched in this context, such as individuals with developmental disabilities and survivors with complex dissociative disorders.

Kathryn O’Hara, B.S., is a master’s student in the School of Public Health at Georgia State University. Her research interests include child maltreatment prevention, especially the implementation of parenting programs both universally and among targeted populations. She is also interested in implementation and intervention science.

Greta Massetti, Ph.D. is Adjunct Faculty in the School of Public Health at Georgia State University. Her research addresses the prevalence, contexts, and health consequences of violence against children and youth globally. Dr. Massetti is a Senior Scientist in the Centers for Disease Control and Prevention’s Division of Violence Prevention, where she leads global efforts to improve the availability of data on violence against children and youth and to use data to inform evidence-based strategies to prevent violence.

Xiangming Fang, Ph.D., is an Associate Professor of Health Economics in the School of Public Health at Georgia State University. The primary focus of his research has been to quantify the economic burden of violence against children to the society. He has also conducted research on the impacts of violence against children on medical services and children’s human capital accumulation.

Shannon Self-Brown, Ph.D., is a Professor in the School of Public Health at Georgia State University. Dr. Self-Brown’s publications have focused on the impact of youth violence, trauma, and disaster exposure on youth mental health, as well as the implementation of evidence-based behavioral parenting programs and mental health practices for traumatized youth.

References

Aebi

Linhart

Thun-Hohenstein

Bessler

Steinhausen

H.-C.

Plattner

(2015). Detained male adolescent offender’s emotional, physical and sexual maltreatment profiles and their associations to psychiatric disorders and criminal behaviors. Journal of Abnormal Child Psychology, 43(5), 999–1009. https://doi.org/10.1007/s10802-014-9961-y

Aho

Proczkowska-Björklund

, & Svedin

C. G.

(2016). Victimization, polyvictimization, and health in Swedish adolescents. Adolescent Health, Medicine and Therapeutics, 7, 89-99. https://doi.org/10.2147/AHMT.S109587.

Álvarez-Lister

M. S.

Pereda

Abad

Guilera

(2014). Polyvictimization and its relationship to symptoms of psychopathology in a southern European sample of adolescent outpatients. Child Abuse & Neglect, 38(4), 747–756. https://doi.org/10.1016/j.chiabu.2013.09.005

Arata

C. M.

Langhinrichsen-Rohling

Bowers

O’Brien

(2007). Differential correlates of multi-type maltreatment among urban youth. Child Abuse & Neglect, 31(4), 393–415. https://doi.org/10.1016/j.chiabu.2006.09.006

Arksey

O’Malley

(2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616

Beck

Palic

Andersen

T. E.

Roenholt

(2014). Childhood abuse types and physical health at the age of 24: Testing health risk behaviors and psychological distress as mediators. Journal of Aggression, Maltreatment and Trauma, 23(4), 400–413. https://doi.org/10.1080/10926771.2014.892047

Berzenski

S. R.

Yates

T. M.

(2011). Classes and consequences of multiple maltreatment: A person-centered analysis. Child Maltreatment, 16(4), 250–261. https://doi.org/10.1177/1077559511428353

Boxer

Terranova

A. M.

(2008). Effects of multiple maltreatment experiences among psychiatrically hospitalized youth. Child Abuse & Neglect, 32(6), 637–647. https://doi.org/10.1016/j.chiabu.2008.02.003

Butcher

Holmes

M. R.

Kretschmar

J. M.

Flannery

D. J.

(2016). Polyvictimization across social contexts: Home, school, and neighborhood violence exposure. Criminal Justice and Behavior, 43(12), 1726–1740. https://doi.org/10.1177/0093854816662679

10.

Canêo

L. F.

Neirotti

(2017). The importance of the proper definition of adulthood: What is and what is not included in a scientific publication. Brazilian Journal of Cardiovascular Surgery, 32(1), 60. https://doi.org/10.21470/1678-9741-2016-0049

11.

Carbonaro

R. S.

(2019). Childhood polyvictimization and the life course: Associations with depression and crime. Violence and Victims, 34(5), 770–785. https://doi.org/10.1891/0886-6708.VV-D-18-00099

12.

CDC (2021). Preventing adverse childhood experiences. https://www.cdc.gov/violenceprevention/aces/fastfact.html

13.

Cecil

C. A. M.

Viding

Barker

E. D.

Guiney

McCrory

E. J.

(2014). Double disadvantage: The influence of childhood maltreatment and community violence exposure on adolescent mental health. Journal of Child Psychology and Psychiatry, 55(7), 839–848. https://doi.org/10.1111/jcpp.12213

14.

Chan

K. L.

(2013). Victimization and poly-victimization among school-aged Chinese adolescents: Prevalence and associations with health. Preventive Medicine, 56(3–4), 207–210. https://doi.org/10.1016/j.ypmed.2012.12.018

15.

Chan

K. L.

Chen

(2019). Prevalence and correlates of the co-occurrence of family violence: A meta-analysis on family polyvictimization. Trauma, Violence & Abuse, 22(2), Article 1524838019841601. https://doi.org/10.1177/1524838019841601

16.

Chan

K. L.

Chen

, & Ip

(2017). Can family structure and social support reduce the impact of child victimization on health-related quality of life? Child Abuse & Neglect, 72, 66-74. https://doi.org/10.1016/j.chiabu.2017.07.014.

17.

Charak

Byllesby

B. M.

Roley

M. E.

, Claycomb

M. A.

Durham

T. A.

Ross

Armour

, & Elhai

J. D.

(2016). Latent classes of childhood poly-victimization and associations with suicidal behavior among adult trauma victims: Moderating role of anger. Child Abuse & Neglect, 62, 19-28. https://doi.org/10.1016/j.chiabu.2016.10.010.

18.

Charak

Koot

H. M.

Dvorak

R. D.

Elklit

Elhai

J. D.

(2015). Unique versus cumulative effects of physical and sexual assault on patterns of adolescent substance use. Psychiatry Research, 230(3), 763–769. https://doi.org/10.1016/j.psychres.2015.11.014

19.

Colquhoun

H. L.

Levac

O’Brien

K. K.

Straus

Tricco

A. C.

Perrier

Kastner

Moher

(2014). Scoping reviews: Time for clarity in definition, methods, and reporting. Journal of Clinical Epidemiology, 67(12), 1291–1294. https://doi.org/10.1016/j.jclinepi.2014.03.013

20.

Contractor

A. A.

Caldas

Fletcher

Shea

M. T.

Armour

(2018). Empirically derived lifespan polytraumatization typologies: A systematic review. Journal of Clinical Psychology, 74(7), 1137–1159. https://doi.org/10.1002/jclp.22586

21.

Curran

Adamson

Stringer

Rosato

Leavey

(2016). Severity of mental illness as a result of multiple childhood adversities: US national epidemiologic survey. Social Psychiatry and Psychiatric Epidemiology, 51(5), 647–657. https://doi.org/10.1007/s00127-016-1198-3

22.

Cyr

Chamberland

Clément

M.-È.

Wemmers

J.-A.

Collin-Vézina

Lessard

Gagné

M.-H.

Damant

(2017). The impact of lifetime victimization and polyvictimization on adolescents in québec: Mental health symptoms and gender differences. Violence and Victims, 32(1), 3–21. https://doi.org/10.1891/0886-6708.VV-D-14-00020

23.

Cyr

Clément

M.-È.

Chamberland

(2014). Lifetime prevalence of multiple victimizations and its impact on children’s mental health. Journal of Interpersonal Violence, 29(4), 616–634. https://doi.org/10.1177/0886260513505220

24.

Davis

A. E.

(1996). Instrument development: Getting started. The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses, 28(3), 204–207. https://doi.org/10.1097/01376517-199606000-00009

25.

Davis

J. P.

Christie

N. C.

Dworkin

E. R.

Prindle

Dumas

T. M.

DiGuiseppi

Helton

J. J.

Ring

(2020). Influences of victimization and comorbid conditions on latency to illicit drug use among adolescents and young adults. Drug and Alcohol Dependence, 206(2), Article 107721. https://doi.org/10.1016/j.drugalcdep.2019.107721

26.

Davis

J. P.

Dworkin

E. R.

Helton

Prindle

Patel

Dumas

T. M.

, & Miller

(2019). Extending poly-victimization theory: Differential effects of adolescents’ experiences of victimization on substance use disorder diagnoses upon treatment entry. Child Abuse & Neglect, 89, 165-177. https://doi.org/10.1016/j.chiabu.2019.01.009.

27.

de Azeredo

L. A.

Viola

T. W.

Rothmann

L. M.

Trentin

Arteche

A. X.

Kristensen

C. H.

Buchweitz

Grassi-Oliveira

(2019). Hair cortisol levels and mental health problems in children and adolescents exposed to victimization. Stress: The International Journal on the Biology of Stress, 23(5), 546–555. https://doi.org/10.1080/10253890.2019.1690448

28.

Dierkhising

C. B.

Ford

J. D.

Branson

Grasso

D. J.

, & Lee

(2019). Developmental timing of polyvictimization: Continuity, change, and association with adverse outcomes in adolescence. Child Abuse & Neglect, 87, 40-50. https://doi.org/10.1016/j.chiabu.2018.07.022.

29.

Dovran

Winje

Arefjord

Tobiassen

Stokke

Skogen

J. C.

Øverland

(2019). Associations between adverse childhood experiences and adversities later in life Survey data from a high-risk Norwegian sample. Child Abuse & Neglect, 98(12), 104234. https://doi.org/10.1016/j.chiabu.2019.104234

30.

Edwards

V. J.

Holden

G. W.

Felitti

V. J.

Anda

R. F.

(2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the adverse childhood experiences study. American Journal of Psychiatry, 160(8), 1453–1460. https://doi.org/10.1176/appi.ajp.160.8.1453

31.

Edwards

K. M.

Probst

D. R.

Rodenhizer-Staempfli

K. A.

Gidycz

C. A.

Tansill

E. C.

(2014). Multiplicity of child maltreatment and biopsychosocial outcomes in young adulthood: The moderating role of resiliency characteristics among female survivors. Child Maltreatment, 19(3–4), 188–198. https://doi.org/10.1177/1077559514543354

32.

Ellonen

Salmi

(2011). Poly-victimization as a life condition: Correlates of poly-victimization among Finnish children. Journal of Scandinavian Studies in Criminology and Crime Prevention, 12(1), 20–44. https://doi.org/10.1080/14043858.2011.561621

33.

Fernández-Artamendi

Águila-Otero

F Del Valle

, & Bravo

(2020). Victimization and substance use among adolescents in residential child care. Child Abuse & Neglect, 104, 104484. https://doi.org/10.1016/j.chiabu.2020.104484.

34.

Finkelhor

Ormrod

R. K.

Turner

H. A.

(2007a). Poly-victimization: A neglected component in child victimization. Child Abuse & Neglect, 31(1), 7–26. https://doi.org/10.1016/j.chiabu.2006.06.008

35.

Finkelhor

Ormrod

R. K.

Turner

H. A.

(2007b). Polyvictimization and trauma in a national longitudinal cohort. Development and Psychopathology, 19(1), 149–166. https://doi.org/10.1017/S0954579407070083

36.

Finkelhor

Shattuck

Turner

H. A.

Ormrod

Hamby

S. L.

(2011a). Polyvictimization in developmental context. Journal of Child & Adolescent Trauma, 4(4), 291–300. https://doi.org/10.1080/19361521.2011.610432

37.

Finkelhor

Turner

Hamby

, & Ormrod

(2011b). Polyvictimization: Children’s exposure to multiple types of violence, crime, and abuse. Justice: Office of Juvenile Justice and Delinquency Prevention, U.S. Department of. https://www.ojp.gov/pdffiles1/ojjdp/235504.pdf.

38.

Fleckman

J. M.

Drury

S. S.

Taylor

C. A.

Theall

K. P.

(2016). Role of direct and indirect violence exposure on externalizing behavior in children. Journal of Urban Health, 93(3), 479–492. https://doi.org/10.1007/s11524-016-0052-y

39.

Ford

J. D.

Delker

B. C.

(2018). Polyvictimization in childhood and its adverse impacts across the lifespan: Introduction to the special issue. Journal of Trauma & Dissociation, 19(3), 275–288. https://doi.org/10.1080/15299732.2018.1440479

40.

Grasso

D. J.

Petitclerc

Henry

D. B.

McCarthy

K. J.

Wakschlag

L. S.

Briggs-Gowan

M. J.

(2016). Examining patterns of exposure to family violence in preschool children: A latent class approach. Journal of Traumatic Stress, 29(6), 491–499. https://doi.org/10.1002/jts.22147

41.

Grasso

D. J.

Saunders

B. E.

Williams

L. M.

Hanson

Smith

D. W.

Fitzgerald

M. M.

(2013). Patterns of multiple victimization among maltreated children in Navy families. Journal of Traumatic Stress, 26(5), 597–604. https://doi.org/10.1002/jts.21853

42.

Guerra

Pereda

Guilera

, & Abad

(2016). Internalizing symptoms and polyvictimization in a clinical sample of adolescents: The roles of social support and non-productive coping strategies. Child Abuse & Neglect, 54, 57-65. https://doi.org/10.1016/j.chiabu.2016.03.004.

43.

Hahm

H. C.

Lee

Ozonoff

Van Wert

M. J.

(2010). The impact of multiple types of child maltreatment on subsequent risk behaviors among women during the transition from adolescence to young adulthood. Journal of Youth and Adolescence, 39(5), 528–540. https://doi.org/10.1007/s10964-009-9490-0

44.

Hellström

(2019). A systematic review of polyvictimization among children with attention deficit hyperactivity or autism spectrum disorder. International Journal of Environmental Research and Public Health, 16(13), 2280. https://doi.org/10.3390/ijerph16132280

45.

Hickman

L. J.

Jaycox

L. H.

Setodji

C. M.

Kofner

Schultz

Barnes-Proby

Harris

(2013). How much does “how much” matter? Assessing the relationship between children’s lifetime exposure to violence and trauma symptoms, behavior problems, and parenting stress. Journal of Interpersonal Violence, 28(6), 1338–1362. https://doi.org/10.1177/0886260512468239

46.

Higgins

D. J.

(2004). The importance of degree versus type of maltreatment: A cluster analysis of child abuse types. The Journal of Psychology, 138(4), 303–324. https://doi.org/10.3200/JRLP.138.4.303-324

47.

Holt

M. K.

Espelage

D. L.

(2003). A cluster analytic investigation of victimization among high school students: Are profiles differentially associated with psychological symptoms and school belonging? Journal of Applied School Psychology, 19(2), 81–98. https://doi.org/10.1300/J008v19n02_06

48.

Holt

M. K.

Finkelhor

Kantor

G. K.

(2007). Multiple victimization experiences of urban elementary school students: Associations with psychosocial functioning and academic performance. Child Abuse & Neglect, 31(5), 503–515. https://doi.org/10.1016/j.chiabu.2006.12.006

49.

Hooven

Nurius

P. S.

Logan-Greene

Thompson

E. A.

(2012). Childhood violence exposure: Cumulative and specific effects on adult mental health. Journal of Family Violence, 27(6), 511–522. https://doi.org/10.1007/s10896-012-9438-0

50.

Horn

S. R.

Roos

L. E.

Beauchamp

K. G.

Flannery

J. E.

Fisher

P. A.

(2018). Polyvictimization and externalizing symptoms in foster care children: The moderating role of executive function. Journal of Trauma & Dissociation, 19(3), 307–324. https://doi.org/10.1080/15299732.2018.1441353

51.

Itani

Fischer

Kraemer

(2018). Gender moderates the association between polyvictimization and suicidal ideation among adolescents in the United Arab Emirates. International Journal of Adolescence and Youth, 23(3), 347–356. https://doi.org/10.1080/02673843.2017.1377089

52.

Jackson-Hollis

Joseph

, & Browne

(2017). The impact of extrafamilial victimization and poly-victimization on the psychological well-being of English young people. Child Abuse & Neglect, 67, 349-361. https://doi.org/10.1016/j.chiabu.2017.03.004.

53.

Játiva

Cerezo

M. A.

(2014). The mediating role of self-compassion in the relationship between victimization and psychological maladjustment in a sample of adolescents. Child Abuse & Neglect, 38(7), 1180–1190. https://doi.org/10.1016/j.chiabu.2014.04.005

54.

Johnco

Salloum

McBride

N. M.

Cepeda

Guttfreund

Novoa

J. C.

Storch

E. A.

(2019). Child trauma exposure and subsequent emotional functioning in El Salvador. Traumatology, 26(1), 19–28). https://doi.org/10.1037/trm0000193

55.

Juan

Edmeades

Petroni

Kapungu

Gordon

Ligiero

(2019). Associations between mental distress, poly-victimisation, and gender attitudes among adolescent girls in Cambodia and Haiti: An analysis of violence against children surveys. Journal of Child & Adolescent Mental Health, 31(3), 201–213. https://doi.org/10.2989/17280583.2019.1678476

56.

Kallstrom

Å.

Hellfeldt

Howell

K. H.

Miller-Graff

L. E.

Graham-Bermann

S. A.

(2017). Young adults victimized as children or adolescents: Relationships between perpetrator patterns, poly-victimization, and mental health problems. Journal of Interpersonal Violence, 35(11–12), 2335–2357. https://doi.org/10.1177/0886260517701452

57.

Kamndaya

Pisa

P. T.

Chersich

M. F.

Decker

M. R.

Olumide

Acharya

Cheng

Brahmbhatt

Delany-Moretlwe

(2017). Intersections between polyvictimisation and mental health among adolescents in five urban disadvantaged settings: The role of gender. BMC Public Health, 17(Suppl 3), 525. https://doi.org/10.1186/s12889-017-4348-y

58.

Kennedy

S. C.

(2017). The relationship between childhood polyvictimization and subsequent mental health and substance misuse outcomes for incarcerated women (2016-58391-156; Issues 11-A(E)). [Doctoral dissertation. Florida State University. EBSCOhost]. https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=psyh&AN=2016-58391-156&site=ehost-live&scope=site&custid=gsu1

59.

Kerig

P. K.

(2018). Polyvictimization and girls’ involvement in the juvenile justice system: Investigating gender-differentiated patterns of risk, recidivism, and resilience. Journal of Interpersonal Violence, 33(5), 789–809. https://doi.org/10.1177/0886260517744843

60.

Kirchner

Magallon-Neri

Forns

Munoz

Segura

Soler

Planellas

(2020). Facing interpersonal violence: Identifying the coping profile of poly-victimized resilient adolescents. Journal of Interpersonal Violence, 35(9–10), 1934–1957. https://doi.org/10.1177/0886260517700617

61.

Kretschmar

J. M.

Tossone

Butcher

Flannery

D. J.

(2017). Patterns of poly-victimization in a sample of at-risk youth. Journal of Child & Adolescent Trauma, 10(4), 363–375. https://doi.org/10.1007/s40653-016-0109-9

62.

La Flair

L. N.

Reboussin

B. A.

Storr

C. L.

Letourneau

Green

K. M.

Mojtabai

Pacek

L. R.

Alvanzo

A. A. H.

Cullen

Crum

R. M.

(2013). Childhood abuse and neglect and transitions in stages of alcohol involvement among women: A latent transition analysis approach. Drug and Alcohol Dependence, 132(3), 491–498. https://doi.org/10.1016/j.drugalcdep.2013.03.012

63.

M. T. H.

Holton

Nguyen

H. T.

Wolfe

Fisher

(2016). Poly-victimisation and health risk behaviours, symptoms of mental health problems and suicidal thoughts and plans among adolescents in Vietnam. International Journal of Mental Health Systems, 10(1), 66. https://doi.org/10.1186/s13033-016-0099-x

64.

M. T. H.

Holton

Romero

Fisher

(2018). Polyvictimization among children and adolescents in low- and lower-middle-income countries: A systematic review and meta-analysis. Trauma, Violence & Abuse, 19(3), 323–342. https://doi.org/10.1177/1524838016659489

65.

Levac

Colquhoun

O’Brien

K. K.

(2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1), 69. https://doi.org/10.1186/1748-5908-5-69

66.

Margolin

Vickerman

K. A.

Oliver

P. H.

Gordis

E. B.

(2010). Violence exposure in multiple interpersonal domains: Cumulative and differential effects. Journal of Adolescent Health, 47(2), 198–205. https://doi.org/10.1016/j.jadohealth.2010.01.020

67.

Meinck

Cluver

L. D.

Boyes

M. E.

Mhlongo

E. L.

(2015). Risk and protective factors for physical and sexual abuse of children and adolescents in Africa: A review and implications for practice. Trauma Violence & Abuse, 16(1), 81–107. https://doi.org/10.1177/1524838014523336

68.

Michel-Smith

(2019). Poly-victimization: A broad assessment of childhood victimization and its implications for juvenile justice and child well-being. (Doctoral dissertation). Retrieved from APA PsycInfo. https://scholars.unh.edu/dissertation/2420/

69.

Miller-Graff

Cater

Å. K.

Howell

K. H.

Graham-Bermann

S. A.

(2015). Victimization in childhood: General and specific associations with physical health problems in young adulthood. Journal of Psychosomatic Research, 79(4), 265–271. https://doi.org/10.1016/j.jpsychores.2015.07.001

70.

Miller-Graff

Howell

K. H.

Scheid

C. R.

Schaefer

(2019). “Violence is everywhere”: Childhood polyvictimization, perceptions of the prevalence of victimization, and posttraumatic stress symptoms. Violence and Victims, 34(2), 376–393. https://doi.org/10.1891/0886-6708.VV-D-17-00144

71.

Mitchell

K. J.

Moschella

E. A.

Hamby

Banyard

(2020). Developmental stage of onset, poly-victimization, and persistence of childhood victimization: Impact on adult well-being in a rural community-based study. Child Maltreatment, 25(1), 20–31. https://doi.org/10.1177/1077559519859080

72.

Moeller

T. P.

Bachmann

G. A.

Moeller

J. R.

(1993). The combined effects of physical, sexual, and emotional abuse during childhood: Long-term health consequences for women. Child Abuse & Neglect, 17(5), 623–640. https://doi.org/10.1016/0145-2134(93)90084-I

73.

Munn

Peters

M. D. J.

Stern

Tufanaru

McArthur

Aromataris

(2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), 143. https://doi.org/10.1186/s12874-018-0611-x

74.

Natukunda

H. P. M.

Mubiri

Cluver

L. D.

Ddumba-Nyanzi

Bukenya

Walakira

E. J.

(2019). Which factors are associated with adolescent reports of experiencing various forms of abuse at the family level in post-conflict northern uganda?. Journal of Interpersonal Violence, 36(21–22), NP12067–NP1209. https://doi.org/10.1177/0886260519888526

75.

Nguyen

K. H.

Kegler

S. R.

Chiang

, & Kress

(2019). Effects of poly-victimization before age 18 on health outcomes in young kenyan adults: Violence against children survey. Violence and Victims, 34(2), 229-242. https://doi.org/10.1891/0886-6708.VV-D-17-00182.

76.

Obsuth

Mueller Johnson

Murray

A. L.

Ribeaud

Eisner

(2018). Violent poly-victimization: The longitudinal patterns of physical and emotional victimization throughout adolescence (11–17 years). Journal of Research on Adolescence: The Official Journal of the Society for Research on Adolescence, 28(4), 786–806. https://doi.org/10.1111/jora.12365

77.

Pears

K. C.

Kim

H. K.

Fisher

P. A.

(2008). Psychosocial and cognitive functioning of children with specific profiles of maltreatment. Child Abuse & Neglect, 32(10), 958–971. https://doi.org/10.1016/j.chiabu.2007.12.009

78.

Peters

M. D. J.

Godfrey

C. M.

Khalil

McInerney

Parker

Soares

C. B.

(2015). Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare, 13(3), 141–146. https://doi.org/10.1097/XEB.0000000000000050

79.

Ramsey-Klawsnik

(2017). Older adults affected by polyvictimization: A review of early research. Journal of Elder Abuse & Neglect, 29(5), 299–312. https://doi.org/10.1080/08946566.2017.1388019

80.

Raskauskas

(2010). Multiple peer victimization among elementary school students: Relations with social-emotional problems. Social Psychology of Education, 13(4), 523–539. https://doi.org/10.1007/s11218-010-9124-0

81.

Richardson

Henry

Black-pond

Sloane

(2008). Multiple types of maltreatment: Behavioral and developmental impact on children in the child welfare system. Journal of Child & Adolescent Trauma, 1(4), 317–330. https://doi.org/10.1080/19361520802505735

82.

Richmond

J. M.

Elliott

A. N.

Pierce

T. W.

Aspelmeier

J. E.

Alexander

A. A.

(2009). Polyvictimization, childhood victimization, and psychological distress in college women. Child Maltreatment, 14(2), 127–147. https://doi.org/10.1177/1077559508326357

83.

Riedl

Beck

Exenberger

Daniels

Dejaco

Unterberger

, & Lampe

(2019). Violence from childhood to adulthood: The influence of child victimization and domestic violence on physical health in later life. Journal of Psychosomatic Research, 116, 68-74. https://doi.org/10.1016/j.jpsychores.2018.11.019.

84.

Sabri

Coohey

Campbell

(2012). Multiple victimization experiences, resources, and co-occurring mental health problems among substance-using adolescents. Violence and Victims, 27(5), 744–763. https://doi.org/10.1891/0886-6708.27.5.744

85.

Samms-Vaughan

Lambert

(2017). The impact of polyvictimisation on children in LMICs: The case of Jamaica. Psychology, Health & Medicine, 22(Suppl 1), 67–80. https://doi.org/10.1080/13548506.2016.1274411

86.

Schwab-Reese

L. M.

Currie

Mishra

A. A.

Peek-Asa

(2018). A comparison of violence victimization and polyvictimization experiences among sexual minority and heterosexual adolescents and young adults. Journal of Interpersonal Violence, 36(11–12), NP5874–NP5891. https://doi.org/10.1177/0886260518808853

87.

Segura

Pereda

Guilera

, & Abad

(2016). Poly-victimization and psychopathology among Spanish adolescents in residential care. Child Abuse & Neglect, 55, 40-51. https://doi.org/10.1016/j.chiabu.2016.03.009.

88.

Shevlin

McElroy

Murphy

(2015). Loneliness mediates the relationship between childhood trauma and adult psychopathology: Evidence from the adult psychiatric morbidity survey. Social Psychiatry and Psychiatric Epidemiology, 50(4), 591–601. https://doi.org/10.1007/s00127-014-0951-8

89.

Soler

Kirchner

Paretilla

Forns

(2013). Impact of poly-victimization on mental health: The mediator and/or moderator role of self-esteem. Journal of Interpersonal Violence, 28(13), 2695–2712. https://doi.org/10.1177/0886260513487989

90.

Soler

Paretilla

Kirchner

Forns

(2012). Effects of poly-victimization on self-esteem and post-traumatic stress symptoms in Spanish adolescents. European Child & Adolescent Psychiatry, 21(11), 645–653. https://doi.org/10.1007/s00787-012-0301-x

91.

Turner

H. A.

Finkelhor

Hamby

S. L.

, & Shattuck

(2013a). Family structure, victimization, and child mental health in a nationally representative sample. Social Science & Medicine, 87, 39-51. https://doi.org/10.1016/j.socscimed.2013.02.034.

92.

Turner

H. A.

Finkelhor

Ormrod

(2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38(3), 323–330. https://doi.org/10.1016/j.amepre.2009.11.012

93.

Turner

H. A.

Finkelhor

Shattuck

Hamby

(2012). Recent victimization exposure and suicidal ideation in adolescents. Archives of Pediatrics & Adolescent Medicine, 166(12), 1149–1154. https://doi.org/10.1001/archpediatrics.2012.1549

94.

Turner

H. A.

Shattuck

Hamby

Finkelhor

(2013b). Community disorder, victimization exposure, and mental health in a national sample of youth. Journal of Health and Social Behavior, 54(2), 258–275. https://doi.org/10.1177/0022146513479384

95.

Turner

H. A.

Shattuck

Finkelhor

Hamby

(2016). Polyvictimization and youth violence exposure across contexts. Journal of Adolescent Health, 58(2), 208–214. https://doi.org/10.1016/j.jadohealth.2015.09.021

96.

Turner

H. A.

Shattuck

Finkelhor

Hamby

(2017). Effects of poly-victimization on adolescent social support, self-concept, and psychological distress. Journal of Interpersonal Violence, 32(5), 755–780. https://doi.org/10.1177/0886260515586376

97.

Turner

H. A.

Mitchell

K. J.

Jones

L. M.

Hamby

Wade

R. J.

Beseler

C. L.

(2019). Gun violence exposure and posttraumatic symptoms among children and youth. Journal of Traumatic Stress, 32(6), 881–889. https://doi.org/10.1002/jts.22466

98.

UNICEF (n.d.). Frequently asked questions on the convention on the rights of the child. https://www.unicef.org/child-rights-convention/frequently-asked-questions

99.

Updegrove

A. H.

Muftic

L. R.

(2019). Childhood polyvictimization, adult violent victimization, and trauma symptomatology: An exploratory study of prostitution diversion program participants. Journal of Family Violence, 34(8), 733–743. https://doi.org/10.1007/s10896-018-0015-z

100.

Voith

L. A.

Gromoske

A. N.

Holmes

M. R.

(2014). Effects of cumulative violence exposure on children’s trauma and depression symptoms: A social ecological examination using fixed effects regression. Journal of Child and Adolescent Trauma, 7(4), 207–216. https://doi.org/10.1007/s40653-014-0026-8

101.

WHO (n.d.). Adolescent health. https://www.who.int/westernpacific/health-topics/adolescent-health

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