Brief Treatment and Crisis Intervention Advance Access originally published online on August 3, 2007
Brief Treatment and Crisis Intervention 2007 7(3):194-205; doi:10.1093/brief-treatment/mhm010
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Predictors of Emotional Stress in Crime Victims: Implications for Treatment
From the School of Social Work, Florida Atlantic University
Contact author: Diane L. Green, Associate professor, 6016 Edgemere Court, Palm Beach Gardens, FL 33410. E-mail: dgreen{at}fau.edu.
The goal of the present study is to identify predictors of emotional stress that crime victims experience within 30 days of the crime event. A sample of 175 crime victims—86 violent and 89 nonviolent crime victims—were interviewed. Emotional stress, coping strategy, social support, and individual characteristics were assessed. Multiple regression analyses revealed that the model including individual characteristics, coping strategies, social support, and well-being accounted for more than 74% of the variance. However, only gender, type of crime experienced, coping strategy, and social support significantly predicted emotional stress among crime victims. These findings underscore the need to examine both the short-term and long-term impact of these factors in the recovery process for victims of crime.
KEY WORDS: emotional stress, coping, social support, victims
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Predictors of Emotional Stress |
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Approximately 1,390,695 violent crimes occurred nationwide in 2005 (Federal Bureau of Investigation, 2006). During 2005, there were an estimated 469.2 violent crimes per 100,000 inhabitants. The estimated volume of violent crime increased 2.3% from 2004–2005. U.S. citizens are more likely to be victims of violent crime than to be involved in a traffic accident (FBI, 2006). Therefore, it is crucial to examine and understand the emotional and psychological effects of crime on victims.
Victimization is a stressful event resulting in significant levels of psychological and/or emotional stress (Atkeson, Calhoun, Resick, & Ellis, 1982; Burnam et al. 1988; Cook, Smith, & Harrell, 1987; Frieze, Hymer, & Greenberg, 1987; Kilpatrick et al. 1985; Roberts & Green, 2007). Emotional stress has been identified as a central and dominant response of victims of crime (Cook, Smith, & Harrel 1987). It is a latent factor among victims of crime and its manifestation involves four indicators: depression, posttraumatic stress disorder (PTSD), anger, and anxiety. Exposure to such stress often carries a risk of depression, anxiety, anger, and posttraumatic stress.
Studies have consistently shown that the effects of crime are pervasive and deleterious to the victims' emotional health (Davis & Friedman, 1985; Green, Streeter, & Pomeroy, 2005; Kilpatrick et al. 1985; Lurigio & Resick, 1990; Norris & Kaniasty, 1994; Witrz & Harrel, 1987). Symptomology of anxiety, depression, somatization, hostility, and fear were prevalent in crime victims, with the violent crime victims demonstrating higher levels of emotional stress than the nonviolent victims (Norris & Kaniasty, 1991). Kilpatrick, Edmunds, and Seymour (1992) examined PTSD and depression in rape victims and in the general population. Findings indicated that 31% of the rape victims were found to have PTSD and only 5% of the women in the general population experienced PTSD symptoms. In addition, 30% of the rape victims experienced major depression while only 10% of the women in the general population experienced major depression.
Multiple factors including individual characteristics, type of crime experienced, social support, and coping strategies have been examined among victims of crimes (Green, Streeter, & Pomeroy, 2005). For instance, Norris and Kaniasty (1994) found that individual differences of victims prior to the crime event could not account for individual differences in the effects of crime. However, Rando (1993) suggested that factors such as degree of violence, suddenness, unexpectedness, and randomness of the violent crime coupled with the anger of the victim may place victims at risk for complicated grief. Shock, disbelief, numbness, changes in appetite or sleeping patterns, difficulty concentrating, confusion, anger, fear, and anxiety are all symptoms of complicated grief (Redmond, 1989).
Precrime situations vary for each victim. While the review of the literature indicates that demographic characteristics including gender, race, and age have little impact on emotional stress resulting from a crime event, little research has been done to examine the relationship of these variables to the coping process and ensuing levels of emotional stress. The evaluation of gender and coping is largely invisible in the stress and coping literature. Personality traits have become increasingly considered as having a major impact on coping; however, individual characteristics such as gender and ethnicity have not been fully examined (Kobasa & Puccetti, 1993). Given the theoretical framework of this study, coping is viewed as a process that varies from situation to situation (Folkman & Lazarus, 1980). From this basic framework, the social context of the victim is brought to the forefront of the analysis. Additionally, prior victimization has been consistently shown to increase the trauma following a new crime as long as the crime is not a common occurrence (e.g., chronically abusive family).
There remains confusion about the experience of victims and the severity and clinical significance of the recovery process reported by clinicians and victims. The sudden and unanticipated criminal act is a catalyst to the trauma and grief that are experienced. Psychological consequences of crime are not limited to a few days or weeks after the crime. Evidence is mounting that criminal victimization can be an extremely stressful event, leaving many victims with significant levels of psychological emotional stress (Atkeson et al. 1982; Green & Pomeroy, 2005; Kilpatrick et al. 1985; Roberts & Green, 2007). The presence of such emotional stress implies that many victims would benefit from professional mental health services (Norris, Kaniasty, & Scheer, 1990).
As a result of the foregoing research, there is currently a growing convergence of humane, scientific, and public policy concerns regarding the needs and consequences of crime on victims. A commitment to social justice is the hallmark of the social work profession. The field of victim services is growing and expanding, and social workers need to understand the implications of the psychological correlates of victims' coping and stress in order to provide effective interventions. Thus, the aim of this study was to examine whether a significant portion of variance in emotional stress among violent of crime could be attributed to: (a) differences in individual characteristics, (b) perceived and received social support, (c) coping strategy, and (d) well-being.
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Methodology |
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Subjects
A nonprobability purposive sampling strategy was used and participants were recruited in two ways: (a) they were recruited from a County Sheriff's Office, and (b) A smaller group was recruited from Juvenile Court; however, only adult victims were included in the study. The sampling strategy was chosen in compliance with the limitations imposed by the County Sheriff's Office. The researcher worked in partnership with the agencies in the recruitment of crime victims. Therefore, the sample population can be described as including only those victims who have reported the crime to a formal organization.
The subjects for this study were victims of violent and nonviolent crime. "Crime victims" included individuals encountering the crime event or an individual within the immediate family for those crimes resulting in death. Violent crime victims were those adult individuals (18 years or older) who had encountered the following crimes, as categorized from offense codes recorded in the incident report: homicide, assault, aggravated assault, sexual assault, aggravated sexual assault, elder abuse, manslaughter, intoxication manslaughter, aggravated robbery, family violence, and intoxication assault. Nonviolent crime victims were those adult individuals who experienced the following crimes: theft, robbery, burglary, and domestic disturbance. If victims reported multiple crime categories, they were placed in the more severe category, for purposes of analysis.
Interviewing Procedures
The County Sheriff's Office and Juvenile Court staff notified potential participants about the study who then went through a two-stage screening process. This process was to ensure that the victims were not in any immediate emotional crisis or emotionally vulnerable situation. The County Sheriff's Office and Juvenile Court then followed up and contacted the victims and assessed whether or they were in immediate crisis. Those victims in immediate crisis were not asked to participate in the study. Once identified as potential respondents by the Sheriff's Office and Juvenile Court, they were contacted via phone by the researcher.
Data Collection
A semistructured interview protocol was used which consisted of demographic information and standardized measurements. In an attempt to improve both the response and accuracy, a personal interview format was chosen. This time-consuming approach assured the accuracy of the completed questionnaires. Additionally, it was recommended that the instruments chosen for the study be administered by a clinician.
Forty of the victims requested phone interviews sue to safety concerns. Some individuals who had been victims of family violence or family disturbance needed to be accountable for their time either at work or at home. Therefore, phone interviews were conducted with them. Response cards were mailed to the participant and an interview was set. The response information was also given to the participant at the time of the interview. The participant was asked to write down the range of potential responses prior to the administration of each set of questions to ensure accurate response categories. No statistically significant differences were found between those interviewed by phone and those interviewed in person.
In an effort to maximize the methodological rigor of the study, the semistructured interview protocol included instruments that have demonstrated good validity and reliability. Data collection occurred within 4–6 weeks of the initial crime event. During the visit, each victim completed a set of questionnaires focusing on personal characteristics, coping strategies, levels of emotional stress, and well-being. On average, interviews were completed in one to one and one-half hours.
Independent Variables
Individual Characteristics.
Gender, ethnicity, age, relationship to offender, prior victimization (traumatic event history), marital status, employment, and the type of crime were assessed. The data for these variables were gathered in the questionnaire with categorical response categories.
Coping Strategies.
The Coping Inventory for Stressful Situations: Situation Specific Scale (Endler & Parker, 1990) was used to assess coping strategies. The Coping Inventory for Stressful Situations: Situation Specific Scale is a 21-item, self-report instrument that assesses three types of coping strategies: (a) problem-focused coping, (b) emotion-focused coping, and (c) avoidance-oriented coping. Scores for all items on each factor are summed for scale scores. Internal consistency for the problem-focused, emotion-focused, and avoidance-oriented coping scales was 0.88, 0.89, and 0.82, respectively. Test–retest reliability over a 6-week period was 0.72, 0.70, and 0.59 for these same scales.
Social Support.
Two aspects of social support were assessed: received social support and perceived social support. Received social support was assessed using a short-form 12-item scale developed by Kaniasty (1988) for use with victims of crime. The short-form scale (12 items) was based on the Inventory of Socially Supportive Behaviors (Barrera, Sandler, & Ramsay, 1981) by identifying the items with the highest factor loadings (Kaniasty, 1988). The scale evaluates emotional, tangible, and informational help. Alpha coefficients for the short-form scale have been reported to range from .58 to .80 and test–retest coefficients range from 0.46 to 0.65 over a 4-week period (Kaniasty & Norris, 1992).
Perceived social support was measured with a 12-item scale developed by Kanaisty (1988) for victims of crime. This scale was created using principal components analysis of 12 items from the Social Support Appraisal Scale (Vaux, 1986). These items were chosen to parallel the tangible, emotional, and informational subscales of the received social support measurement. The Social Support Appraisal Scale assesses perceived availability of social support from family and friends. The psychometric properties have been established with internal consistency coefficients ranging from 0.76 to 0.83 (Cohen & Hoberman, 1983; Cohen & Willis, 1985).
Well-Being.
Subjective well-being was measured utilizing the Mental, Physical, and Spiritual Well-being Scale developed by Vella-Broderick (1994). The Mental subscale has a test–retest reliability of 0.94, the Physical subscale has a test–retest reliability of 0.81, and the Spiritual subscale has a test–retest reliability of 0.97. Coefficient alphas are .75, .81, and .85 respectively.
Dependent Variables
Emotional stress was assessed by examining the score of each separate scale mentioned below as well as a combined score of all the scales resulting in a total "level of emotional stress" score.
Depression.
Depression was measured using the Center for Epidemiological Studies—Depressed Mood Scale (Radloff, 1996). The Center for Epidemiological Studies—Depressed Mood Scale has been normed on various ethnic backgrounds, ages, and gender. It has good internal consistency with a reported coefficient alpha of.85. It has fair test–retest reliability with correlations ranging from 0.51 to 0.67 over a 4-week period (Weissman, Sholomskas, Pottenger, Prusoff, & Locke, 1977).
Posttraumatic Stress.
The Impact of Events Scale (Zilberg, Weiss, & Horowitz, 1982) was used to assess PTSD symptoms. The Impact of Events Scale is a 15-item self-report scale that measures emotional reactions, specifically avoidance and intrusion following a traumatic event such as crime. Split-half reliability for the scale has been reported at 0.86. Internal consistency of the subscales has been reported ranging from 0.79 to 0.92, with the average for the avoidance component reported at 0.86 and the average for the intrusion component reported at 0.90 (Horowitz, Wilner, & Alvarez, 1979).
Anxiety.
Anxiety was assessed utilizing the State Trait Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970). Only the State anxiety scale was used and is defined as "an unpleasant emotional state characterized by consciously perceived feelings of tension and apprehension" (Spielberger, p. 29). Research on the State Trait Anxiety Inventory indicates good reliability and validity (Spielberger, 1983). Internal consistency has been reported at 0.80.
Anger.
The assessment of anger was accomplished through the utilization of the State-Trait Anger Expression Inventory (Spielberger, 1983). Only the State Anger scale was used. The alpha coefficients have been reported at .93. The State-Trait Anger Expression Inventory has demonstrated convergent construct validity, as evidenced by reported correlations of this scale ranging from 0.88 to 0.91 with other anger and personality scales (Spielberger, 1996).
Data Analysis
Multiple regression was used to address the research question examining what factors predict levels of emotional stress. Hierarchical regression was used to identify the optimal set of predictor variables for the constructs of emotional stress. Zero-order correlations between the predictor variables and the amount of variance in the dependent variable were computed to determine the relationship between all other variables and their significance to emotional stress. Partial correlations that are significant provide information on the proportion of variance explained by each predictor variable on emotional stress. The overall objectives of utilizing multiple regression to answer the research question were to assess: (a) whether or not a relationship exists among the variables under study, (b) the degree of accuracy of prediction, and (c) relative importance of the various independent variables in the variation in levels of emotional stress.
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Results |
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Demographic Characteristics
The sample from the study was composed of 175 victims of violent or nonviolent crime. There were 86 violent crime victims and 89 victims of nonviolent crime. Table 1 presents the demographic characteristics on the sample of victims. Approximately 67% (N = 115) were female. Although the majority of the victims were Caucasian (48%), the sample also included African-Americans (36%) and Hispanics (16%). Approximately one-half (n = 85) of victims interviewed were married. This is a reflection of the large number of family violence and family disturbance crimes that were reported. Thirty percentage (n = 52) of the participants had previously been a victim of crime. The type of crime victims interviewed was approximately equally distributed between violent (n = 86) and nonviolent crimes (n = 89).
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Regression Analyses
The research question asks if a significant portion of variance of emotional stress can be attributed to differences in individual characteristics (i.e., gender, ethnicity, type of crime), perceived and received social support, coping strategy (emotion-focused, problem-focused, and avoidance-oriented coping), and well-being (spiritual, physical, and mental well-being).
A correlation matrix was examined and no indication of multicollinearity between independent variables was found (multicollinearity issues are discussed in results of diagnostics). Therefore, two models were estimated regressing emotional stress on the independent variables. Model one included all the independent variables excluding individual characteristic variables. Variables in this first model included emotion-focused coping, problem-focused coping, avoidance-oriented coping, received social support, mental well-being, physical well-being, and spiritual well-being. Individual characteristic variables were entered in model two as a second block. The individual characteristics entered in block two included gender, ethnicity, prior victimization, age, employment, marital status, offender relation, and whether or not the crime was violent or nonviolent.
Significance Test of the Coefficient of Determination—R2.
The correlation (r = .85) is significant at the p < .000 level for the first model (see Table 2). Results indicate that the independent variables account for more than 70% of the variance in emotional stress (R2 = .720; adjusted R2 = .705). The correlation (r = .88) is significant at the p < .000 level for the final regression model. In the second model, results indicate that the independent variables account for more than 74% of the variance in emotional stress (R2 = .748; adjusted R2 = .748) (see Table 3).
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Significance Test of Individual Regression Coefficients.
In the first model, problem-focused coping and perceived support were significant predictors of emotional stress (See Table 2). Table 3 presents the results from model two. Overall, problem-focused coping strategies, perceived support, gender, and type of crime were significant predictors of emotional stress. The results of the regression analysis suggest that a structural equation model may differ by type of crime.
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Discussion |
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This study examined the predictors of emotional stress for violent and nonviolent victims of crime. Findings revealed that the problem-focused coping was the strongest predictor of emotional stress. Additionally, gender, type of crime, and perceived support were found to be significant predictors of emotional stress.
Research suggests that problem-focused coping is indicative of good mental health in the western world (Lazarus, 1991; Lazarus & Folkman, 1984). However, this study indicates that utilization of problem-focused coping after experiencing a crime event is predictive of higher levels of emotional stress. This finding raises the question of the goal-directed approach of many interventions for victims of crime. Numerous studies have examined emotional stress and coping focusing on gender differences. For example, Folkman and Lazarus (1980) studied 100 white men and women in a community and concluded:
The most puzzling gender difference was the finding that men used more problem-focused coping than women in situations that had to be accepted. Perhaps men persevere in problem-focused coping longer than women before deciding that nothing can be done; and even when nothing can be done, men may be disposed to think about the problem more than women. (p. 235.)
Additional studies that examine stress and coping focusing on gender offer a view that differs from the traditional perspective that women are deficient copers (Billing & Moos, 1981; Pearlin & Schooler, 1978). Perhaps, the basis for the perception that women are ineffective copers stems from the acceptance that emotion-focused coping results in higher emotional stress levels and that women typically employ emotion-focused coping more than problem-focused coping. The findings of the present study challenge this assumption and indicate the need for further research to understand effective coping strategies over time in situation-specific environments.
Furthermore, results from this study indicate that perceived social support was found to have a statistically significant inverse relationship with emotional stress. This is consistent with theoretical grounds that increasing social support would lower an individual's anger with the situation. Moreover, research over last three decades has found that psychological well-being and psychosocial functioning are significantly impacted by an individual’s social support system. Social support, real or perceived, either acts as a buffer against the effects of stress or, alternately, has a direct positive effect on the individual's overall functioning. A number of studies have found a negative relationship between perceived social support and a variety of psychological symptoms, including depressive and anxiety symptoms (Sandler & Barrera, 1984; Sarason, Shearin, Pierce, & Sarason, 1987).
In addition, this study contributes to our understanding of the predictors of emotional stress in the victim recovery process. Research had indicated the need for examination of the effects of individual characteristics on levels of emotional stress experienced by victims of crime. Examination of the regression analyses indicate that gender and whether the crime was violent or nonviolent had a significant relationship with levels of emotional stress experienced. These findings point out the importance of considering individual factors in formulating treatment approaches for clinical interventions in working with victims of crime.
The findings of this study indicate the need for further research examining both the short-term and long-term effects of factors related to emotional stress on the recovery process for victims of crime. Future research should involve longitudinal studies that would further our understanding of the intraindividual approach to coping. This approach "assumes that individuals have a repertoire of coping options available to them from which they can build what they believe to be the most effective strategy, depending on the situation" (Cox & Ferguson, 1991, p. 21). Longitudinal studies that consider different types of violent and nonviolent crime would also lead to a better understanding of the needs, therapeutic interventions, and services that would enhance the victim's recovery process. These studies would contribute the mental health field by increasing the understanding about the dynamics of the coping process. Interventions will then be better guided by incorporating the changes in coping strategies over time and their influence of well-being. Future research would also benefit by having specific research questions that would inform current policy and practice about the identification of formal and informal support systems and their influence on the stress and coping process for victims. Future research could also explore the effect of case management and participation in support groups as means to reduce levels of stress and increase levels of well-being.
The goal of the current research was to begin the process of understanding one of the most serious problems in our time, victimization, and its effects on victims of crime. Understanding these phenomena would enable us to attain a first step in finding more humane and effective ways to assist the thousands of crime victims in the country. This understanding would also guide us to develop effective interventions and services to assist this underserved and often overlooked population. An integral component of victim assistance is clearly the provision of information and social support. In view of the growing national interest in this area, issues relating to the provision of services to crime victims deserve special consideration.
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Limitations |
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The sampling strategy was a limitation of this study in that subjects were self-selected and consisted of only those who had reported the crime to authorities which restricts the generalizability of the findings. However, financial and practical constraints limited the ability to use random selection. The selection process was dependent upon those names provided by service providers. Effort was taken o recruit a diverse sample. A further limitation was the inability to assess the influence of personality traits on emotional stress. A growing number of studies indicate the extent to which situational factors influence the paths from coping to emotional stress. Victims proceeding through the criminal justice process may change their coping strategies throughout the process and those strategies which consistently lower emotional stress could be determined. Finally, contextual factors, such as use of criminal justice and victim assistance services, may have affected the findings.
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Implications for Practice |
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This study's stress and coping framework encompasses the major factors that should be considered in planning and evaluating intervention and treatment programs. The results provide practitioners with a new perspective on working with crime victims and suggest that emotion-focused coping leads to lower levels of subjective emotional stress. Coping strategies play a central role in current theories of stress and coping. An important implication of this study for clinical intervention is the guidance that these findings may provide practitioners in identifying those individuals most at risk for high levels of emotional stress. Social support has been shown to ameliorate psychological distress in various population and social support networks safeguard against harmful effects during a state of crisis. If victim's assistance workers can identify the use of noneffective coping, they may be able to intervene early and prevent or affect the manifestation of acute depression, anger, anxiety, and posttraumatic stress. Most coping skills training programs emphasize a problem-solving approach as an effective coping strategy. Emotion-focused coping strategies may be just as effective if not more effective in promoting lower levels of emotional stress. Emotion-focused coping can be used to facilitate behavioral coping. Therapeutic techniques should be developed to rebuild the victim's assumptions and to regain a sense of control. It also appears that victims need to rely on appropriate mechanisms of social support. Victim support groups might be appropriate interventions because they provide an opportunity for informal support while engaging in the problem-solving process. Practitioners could conceptualize coping strategies dynamically and focus on its overall ability to improve functioning of the victim. They should assess the extent to which their clients are vulnerable to experiencing manifestation of posttraumatic stress and depression and recognize the risks imposed by their vulnerability to each of these.
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Acknowledgments |
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Conflict of Interest: None declared.
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References |
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