| Homeless youth report disproportionately high rates of childhood sexual abuse (CSA). Associations between CSA and poor psychosocial and health outcomes in adolescence and adulthood are well established (e.g., Arriola, Louden, Doldren, & Fortenberry, 2005; Briere & Elliot, 2003; Senn, Carey, Vanable, Coury-Doniger, & Urban, 2007). In particular, CSA is associated with later sexual risk behaviours (Fergusson, Horwood, & Lynskey, 1997; Senn, Carey, Vanable, Coury-Doniger, & Urban, 2006) and substance use (Grayson & Nolen-Hoeksema, 2005; Swanston et al., 2003). However, the mechanisms by which CSA leads to such outcomes are poorly understood. The self-trauma model (Briere, 1996b; 2002) highlights the importance of both affect dysregulation and posttraumatic stress symptoms (PTSS) as psychological sequelae of CSA and points to these factors as contributory to poor mental health outcomes. However, these mediators have not been explored in the relationship between CSA and maladaptive health behaviours among vulnerable populations such as homeless adolescents. The present study examined affect dysregulation and PTSS as common mediators of the relationship between CSA and health risk behaviours in a sample of 230 homeless adolescents. Using structural equation modeling, two mediational models were compared. Both models were deemed to be good fits to the data. Affect dysregulation and PTSS mediated the relationship between CSA and substance abuse but not sexual risk behaviours; CSA was independently associated with sexual risk behaviours. Additional exploratory analyses found that a model using only affect dysregulation as a mediator was the best fit to the data. These findings suggest that substance abuse among homeless youth with a history of CSA may play a role in coping with trauma when internal resources are low. Clinical implications for interventions with homeless youth are discussed. |
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