J Fam Viol (2011) 26:255261 DOI 10.

1007/s10896-011-9361-9

ORIGINAL ARTICLE

Childhood Maltreatment, Intimate Partner Violence, Work Interference and Womens Employment
Pamela C. Alexander

Published online: 25 February 2011 # Springer Science+Business Media, LLC 2011

Abstract This study examined the long-term effects of childhood maltreatment, intimate partner violence (IPV) and work interference on womens employment in a sample of 135 housed or homeless women. Work interference (defined as a partner s interference with or restraint of a womans working) was reported by 60% of women who had experienced IPV and was more common among nonHispanic White women. Abuse history of any type was not predictive of womens employment or receiving job training, but child sexual abuse history and lifetime IPV were predictive of non-Hispanic White womens not looking for a job. Receiving job training was negatively correlated with womens current mental health. The study suggests different but overlapping pathways to the outcome of underemployment for racial/ethnic minority and majority womennamely, macro level factors and individual vulnerability factors, respectively. The need for traumainformed services for unemployed and/or homeless women is highlighted. Keywords Intimate partner violence . Work interference . Childhood maltreatment . Employment Research suggests that abused womens experience of intimate partner violence (IPV) is associated with unstable employment (Staggs and Riger 2005; Staggs et al. 2007), with barriers to employment (Romero et al. 2003), and with increased reliance upon welfare benefits even in comparison to other low-income women (Tolman and Raphael 2000). Even from data collected during a booming
P. C. Alexander (*) 18 Brook Street, Sherborn, MA 01770, USA e-mail: pamela.carlson.alexander@gmail.com

economy, an experience of IPV offset 40% and 75% of the respective gains in employment during two waves of a longitudinal study of 598 women on welfare rolls (Tolman and Wang 2005). Not surprisingly, for many women, IPV also increases their risk of homelessness (Sormanti and Shibusawa 2008). There are several possible reasons why IPV may have this impact on womens employment. First, IPV may lead to disorders such as PTSD and depression that interfere with womens concentration, attention, problem-solving and other characteristics needed for optimal functioning at work (Kimerling et al. 2009). Second, many women have partners who actively interfere with their attempts to work (Tolman and Raphael 2000), by engaging in behaviors ranging from work disruption to work-related stalking (Swanberg et al. 2005). While much work interference is obviously related to IPV, it is distinct from physical violence (Brush 2002) and may have its own antecedents and effects. Finally, IPV may be masking the effects of childhood maltreatment history on womens employment. It is clear, for example, that childhood maltreatment is correlated both with IPV (Ehrensaft et al. 2003; Kwong et al. 2003) and with homelessness (Morrell-Bellai et al. 2000). Moreover, Bassuk et al. (2006) found that a history of childhood sexual abuse was a particularly strong predictor of IPV among homeless and extremely poor women. Childhood maltreatment has also been found to predict both psychiatric and nonpsychiatric employment disability, another proxy of underemployment (Sansone et al. 2005). However, in spite of incidental findings that rates of abuse in both childhood and adulthood are related to time spent on welfare (Salomon et al. 1996), few researchers have looked at the cumulative effects of childhood maltreatment and IPV on employment.

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The effects of childhood maltreatment on IPV and employment may vary by race/ethnicity. For example, in a combined sample of almost 500 women who were abused by partners, African American (but not White or Hispanic) womens unemployment was associated with their childhood experience of verbal and physical abuse by their fathers and with posttraumatic stress symptoms (Alexander 2009). In a subsample of 168 women, unemployment irrespective of race was correlated with dissociative symptoms, White womens unemployment was correlated with a childhood history of sexual abuse, and both African American and Hispanic womens unemployment was correlated with a history of abuse in multiple relationships in adulthood (another effect of childhood maltreatment). Therefore, it is important to consider race/ethnicity in any study of abuse and employment. Understanding the predictors of employment among poor and/or homeless women is essential. Not only is employment a desirable goal in and of itself, but it may also have a protective effect against both IPV and associated mental health problems (Riger and Staggs 2004; Rothman et al. 2007; Villarreal 2007). Therefore, the purpose of this study was to survey an ethnically diverse sample of housed or homeless women about their experiences of childhood maltreatment, IPV, employment, partner interference with their employment and mental health and physical health problems. Three main questions were explored: 1) What are the correlates of work interference (i.e., partner interference with womens employment)? 2) What are the impacts of childhood maltreatment, IPV and work interference on womens employment? 3) What are the impacts of childhood maltreatment, IPV and work interference on womens mental health and physical health? Racial/ethnic differences were also explored.

sample were housed in a shelter with the length of residence in the shelter ranging from less than 1 week to more than 1-1/2 years. Residing in a shelter was unrelated to age, education, employment status, and racial/ethnic background, but was more common among women with children, X2 (1)=6.79, p =.009. Measures Demographic Questions Women provided the following demographic information: their age; race/ethnicity; years of education; whether or not they were currently residing in a shelter and if so, for how long; their current employment status, including number of hours worked per week; their relationship to their current partner and length of relationship; and number of children under the age of 18. Questions Regarding History of Maltreatment in Childhood Women completed a detailed questionnaire developed by the author about their histories of physical abuse by each parent [When you were a child or teenager (i.e., before the age of 17), did your primary father/mother figure ever repeatedly slap you in the face, strike, beat or otherwise physically attack or harm you?], their history of sexual abuse [When you were a child or teenager (i. e., before the age of 17), did anyone ever actually touch private parts of your body or make you touch theirs against your wishes or when you were asleep, drugged or in some other way helpless?], and their history of witnessing IPV [When you were a child or teenager (i. e., before the age of 17), did you ever see or hear physical fights (such as pushing, grabbing, shoving, or hitting) between your parents and their partners?]. Follow-up questions in the questionnaire assessed the age at which abuse occurred, age and role of the perpetrator, nature of the abuse, frequency of occurrence, and, in the case of sexual abuse, the use of threat or force. Only sexual acts perpetrated by someone at least 5 years older than the individual or that involved threat or force were classified as sexual abuse. The Revised Conflict Tactics (CTS2; Straus et al. 1996) Physical Assault Scale (12 items) was used to assess partner-to-self violence during the previous 12 months and over the lifetime of the relationship. Items are measured on an 8-point Likert-type scale. The measure has good internal consistency and construct and discriminant validity (Straus et al. 1996). Lifetime prevalence was based upon the respondents acknowledgement of whether or not a given behavior had ever occurred. Moffitt et al. (1997) noted the superiority of these variety scores to frequency scores in that the former are less skewed and more reliable. Women also responded to the following

Method Participants The sample consisted of 135 housed or homeless women who were recruited from nine agencies providing services for homeless, abused and/or unemployed women. Their average age was 31.7 years (SD=10.6) with ages ranging from 18 to 68 years. Their average years of education was 11.5 years (SD=2.2) with education ranging from 2 to 18 years. Approximately 18.7% of the women were African American, 44.8% were non-Hispanic White, 28.3% were Hispanic, and 8.2% were of other racial/ ethnic backgrounds. Women had an average of 1.7 children (SD=1.2), with 16.3% of the women having no children and the rest having one to six children. With respect to current residence, 77% of the women in this

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question: When you were a teenager or an adult, did any previous intimate partner ever use physical violence toward you? The Work/School Abuse (W/SAS; Riger et al. 2000) Work Scale (12 items) was used to assess womens experience of partner restraint and interference with their attempts to work. Women responded with respect to their current relationship (current work interference) and with respect to their lifetime experience of work interference. The scale has good reliability and convergent validity (Riger et al. 2000). Cronbachs alpha for the overall scale was .87 in the current sample. The Brief Center for Epidemiological Studies Depression Scale (BCESD; Anderson et al. 1994; Radloff 1977) is a 10-item version of the CESD self-report scale assessing the frequency of depressive symptoms during the past week. Internal consistency, construct validity and concurrent validity are high, both for the original CESD and for the BCESD (Anderson et al. 1994; Radloff 1977). Cronbachs alpha in the current sample was .70. The 10-item Alcohol Use Disorders Identification Test (AUDIT; Allen et al. 1997) was used to measure recent alcohol dependency, misuse, and social and legal consequences related to excess alcohol use. Items are scored on a 4-point Likert-type scale. The AUDIT has good criterion validity and internal consistency, and has been used with a variety of samples (Allen et al. 1997). Clinical research also has shown the AUDIT to have good sensitivity and specificity in high-risk Hispanic and African American samples (Cherpitel and Bazargan 2003). Cronbachs alpha was .92 in this sample. The PTSD ChecklistCivilian Version (PCL-C; Weathers and Ford 1996) is a 17-item self-report checklist of current symptoms based on the DSM-IV criteria for PTSD. Test-retest reliability and internal consistency are good (Weathers and Ford 1996). Cronbachs alpha in the current sample was .95. The Physical Health Questionnaire (PHQ; Schat et al. 2005) is a 14-item self-report scale of somatic symptoms. Respondents answered items referring to the previous 2 weeks. The scale is internally consistent and construct validity is good (Schat et al. 2005). Cronbachs alpha in the current sample was .87. Procedures Women who were receiving services and/or housing at one of nine agencies in the Boston/Providence metropolitan area were invited to participate in this study by completing the questionnaires for this study in small groups. They provided informed consent, were assured of the confidentiality of their responses, and received $25 for participating.

Results Womens Demographics and Employment Only 21.1% of the women surveyed were currently employed; number of hours they worked averaged only 21.5 h (SD=10.36) per week. Whether women were employed was unrelated to demographic factors such as age, education, race/ethnicity, number of children or whether a woman was residing in a shelter. The number of hours worked for those who were employed also was unrelated to these variables, with the exception of age which was negatively correlated with the number of hours worked per week, r = .453, N =25, p =.023, and current experiences of work interference which were more common among women who worked longer hours, r =.451, N =26, p =.021. On the other hand, whether a woman reported that she was actively looking for a job (54.1% of the sample) or was currently receiving job training (34.4% of the sample) was significantly related to demographics. Younger women were more likely to be looking for a job, r = .216, N =107, p =.026; less educated women were more likely to be receiving job training, r = .174, N =131, p =.047; and women of minority race/ethnicity were significantly more likely to be looking for a job, r =.257, N =109, p =.007, and to be receiving job training, r =.256, N =131, p =.003. Womens Experience of IPV and Work Interference Approximately 51% of the sample was currently experiencing physical IPV and 78.2% of the sample had experienced IPV at some time in their life. Lifetime prevalence of physical IPV was unrelated to demographic characteristics such as age, education or racial/ethnic minority status. Approximately 20% of the women in the sample were currently experiencing some degree of work interference, and 49.6% of the sample had experienced such interference at some time in their life. (The following analyses refer to this lifetime prevalence of work interference.) With regard to demographics, an experience of work abuse at some point in time was modestly associated with more education, r =.171, N =134, p =.048, and with being non-Hispanic White, r =.226, N =134, p =.009. While an experience of work interference was clearly associated with an experience of physical abuse by a partner, r =.525, N =133, p <.001, the correlation was moderate rather than strong, suggesting the distinction between the two constructs. Nearly 60% of women who had experienced IPV at some time in their life had also experienced work interference while 92.5% of women who reported a past experience of work interference also reported having experienced IPV. Work interference was

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also more prevalent among women who had experienced IPV by multiple partners, r =.267, N =130, p =.002. A series of regression analyses was conducted to assess degree to which the lifetime prevalence of IPV and work interference were predicted by childhood maltreatment (physical abuse by ones father and by ones mother, child sexual abuse, and witnessing IPV between ones parents), controlling for the demographic variables of education and racial/ethnic minority status. For none of the following analyses were the demographic variables statistically significant. Childhood maltreatment, namely physical abuse by father, t =3.02, p =.003, and child sexual abuse, t =2.16, p =.033, significantly predicted a lifetime experience of IPV, Adjusted R2 =.167, F (6, 109)=4.84, p <.001. Childhood maltreatment, consisting of physical abuse by father, t =2.45, p =.016, and child sexual abuse, t =2.29, p =.024, also predicted a lifetime experience of work interference, Adjusted R2 =.129, F (6, 109)=3.83, p =.002. Womens Abuse History, Physical and Mental Health Problems, and Employment Logistic regression analyses were conducted to assess the effects of childhood maltreatment, IPV and work interference on indicators of employment, controlling for demographic variables where indicated. Neither a womans employment nor whether she was receiving job training was significantly predicted by her history of childhood maltreatment, IPV and work interference. On the other hand, whether a woman was currently looking for a job was predicted by her history of abuse. (See Table 1) Namely, controlling for age and racial/ ethnic minority status (both of which covaried with looking for a job), women with a history of child sexual abuse and non-Hispanic White women were less likely to report that

Table 1 Effect of abuse history on looking for a joball women (N =92)

Overall Model Variable Age Minority status Witnessed IPV CSA history Abuse by father Abuse by mother Work abuse IPV history NR2 .283 B (SE B) .04 (.02) 1.15 (.52)* .01 (.28) 1.52 (.57)** .22 (.70) .40 (.82) .14 (.09) .03 (.07) 2LL 103.67 Exp (B) .96 .32 1.00 4.60 1.25 .67 1.15 .97 Model X2, df 21.73, 8** 95% C. I. .921.00 1.148.66 .332.78 1.5214.40 .324.90 .133.34 .971.36 .841.12 % Cor. 69.6

NR2 Nagelkerke R squared, 2LL 2 log likelihood,% Cor. percentage correctly classified, Minority status Non-Hispanic White (0) or racial/ ethnic minority (1), CSA history child sexual abuse history, Work abuse lifetime prevalence of work abuse, IPV history lifetime prevalence of IPV. * p <.05. ** p <.01

they were currently looking for a job. In order to further explore the influence of racial/ethnic minority status in predicting whether a woman was looking for a job, this regression analysis was conducted separately for nonHispanic White women and for women of a racial/ethnic minority. The equation remained significant for White women only, X2 (7)=18.26, p =.011, with a history of child sexual abuse tending to be negatively correlated with looking for a job, B = 1.69, p =.10, with the lifetime prevalence of IPV also negatively associated with looking for a job, B = 1.69, p =.024, and with the lifetime prevalence of work interference positively associated with looking for a job, B =.33, p =.024. Further exploration of the work interference variable indicated that a current experience of work interference was negatively associated with a womans propensity for looking for a job, but a past experience of work interference was positively associated with job-seeking. Analyses were then conducted to assess the effect of a childhood maltreatment history, lifetime IPV history and lifetime work interference history on womens current physical and mental health symptoms. Neither physical health symptoms nor depression was correlated with the demographic variables of age, education, racial/ethnic minority status, the number of children, or whether or not a woman was residing in a shelter. On the other hand, alcohol abuse was significantly less prevalent among women residing in a shelter, r = .414, N =134, p <.001, and significantly more prevalent among non-Hispanic White women, r =.19, N =133, p <.03. Moreover, PTSD symptoms were also less prevalent among women residing in a shelter, r = .195, N=132, p = .025. Therefore, linear regression analyses of the impact of abuse history on these outcomes controlled for the respective demographic variables that covaried with the outcome. Physical health symptoms, Adjusted R2 =.343, F (6,90)=9.37, p <.001, were significantly predicted by a history of witnessing IPV, t =3.25, p =.002, and by a history of physical abuse by ones father, t =2.13, p =.036. Depression symptoms, Adjusted R2 =.202, F (6,107)=5.77, p <.001, were significantly predicted by a lifetime history of IPV, t =2.28, p =.025, and marginally by a history of physical abuse by ones father, t = 1.98, p = .05. PTSD symptoms, Adjusted R2 = .355, F (7,107)=9.98, p <.001, were significantly predicted by a history of child sexual abuse, t =3.34, p =.001, and by a lifetime history of IPV, t =2.64, p =.01. Current alcohol abuse, Adjusted R2 =.252, F (8,107)=5.84, p <.001, was predicted by not residing in a shelter, t = 3.80, p <.001, and by a history of physical abuse by ones father, t =3.16, p =.002. Finally, the impact of physical and mental health symptoms (depression, PTSD and alcohol abuse) on indicators of employment was assessed through a series of logistic regression analyses. Neither employment status nor whether a woman was currently looking for a job was

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predicted by physical or mental health symptoms. On the other hand, in a logistic regression analysis controlling for the demographic variables of education and racial/ethnic minority status, whether a woman was currently receiving job training was significantly predicted by physical and mental health symptoms, X2 (5)=22.66, p <.001. Namely, she was more likely to be receiving job training if she was less depressed, B = .09, p =.04, and not abusing alcohol, B = .10, p =.05. Given the nonsignificant relationship between abuse history and either employment or receiving job training, there was no evidence that mental health symptoms mediated the effects of abuse history on these indicators of employment. Similarly, given the nonsignificant relationship between physical or mental health symptoms and looking for a job, there was no evidence that the effects of a history of child sexual abuse on womens reports of looking for a job were mediated by physical or mental health symptoms.

Discussion Results of this study suggest that work interference by a partner is a common experience of at-risk women. Not surprisingly, a partners interference with a womans attempts to work is significantly more common among women experiencing IPV, suggesting that the direct restraint and interference with womens employment is an important, albeit sometimes under-recognized aspect of the abuse. Furthermore, the fact that 92.5% of women who reported having experienced work interference also experienced physical violence by their partner suggests that work interference is an important indicator of what may be otherwise hidden abuse. Therefore, an employer who notices that a womans partner appears to be interfering with her ability to get to work consistently and in a timely manner may want to inform or remind the woman about Employee Assistance programs or other available resources. Both IPV and work interference were predicted in part by childhood maltreatment and especially by physical abuse by ones father and child sexual abuse. The effect of childhood maltreatment on physical health and the mental health symptoms of depression, PTSD and alcohol abuse was highly significant, even when analyzed in conjunction with the impact of lifetime prevalence of IPV and work interference. This is an important finding, in that most analyses of IPV effects fail to consider childhood maltreatment which may have preceded the IPV. Abuse in both childhood and adulthood continues to exert its effects on womens physical and mental health. The constellation of childhood maltreatment, IPV and work interference was not predictive of employment, per se. Given that less than one-fourth of this sample was

employed and given the current economic downturn, there may have been a restriction of range. Other researchers have also failed to find a clear-cut relationship between abuse history and employment (Swanberg et al. 2005). For example, Tolman and Raphael (2000) concluded that abuse does not necessarily prevent employment so much as interfere with it. However, this study did identify a different way in which abuse history may interfere with employmentnamely, a history of child sexual abuse was associated with decreased levels of looking for a job even controlling for impact of IPV and work interference. Follow-up analyses suggested that the impact of a history of abuse on looking for a job was limited to non-Hispanic White women and that they were also likely to be hindered in their job search by a history of IPV. Although looking for a job was not predicted by physical or mental health symptoms, receiving job training was negatively predicted by womens depression and alcohol abuse. Given the importance of job skills for employment (Staggs et al. 2007) as well as the importance of looking for a job in order to get a job, the role of childhood maltreatment and mental health symptoms therefore must be addressed in any program attempting to increase womens employability. Results also argue for trauma-informed service delivery in order to avoid retraumatizing a population with a high rate of childhood abuse (Harris 1998; Hooper and Warwick 2006). In other words, social service providers and employment specialists need to be aware that many of the people they serve have histories of trauma that may complicate their employment and their relationships with employers, co-workers and the trainers themselves. Race/ethnicity appeared to affect womens employment and experience of work interference in several ways. First, work interference was significantly more common among non-Hispanic White women, a finding consistent with the results of others (Brush 2001; Honeycutt et al. 2001). On the other hand, women did not differ in their lifetime experience of IPV as a function of race/ethnicity. NonHispanic White women in this sample had experienced significantly more childhood abuse (namely, child sexual abuse and physical abuse by mothers), were significantly more likely to have experienced multiple abusive relationships in adulthood, and reported significantly more problems with alcohol abuse. While they did not differ from racial/ethnic minority women in their employment or number of hours worked, White women in this sample were significantly less likely to be actively looking for a job or receiving job training, even though they had a higher level of education. Follow-up analyses suggested that, in addition to a history of sexual abuse, a lifetime history of IPV also seemed to deter White women in this sample from looking for a job. These results are consistent with research

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findings that the effects of childhood abuse and neglect on revictimization are stronger among non-Hispanic Whites than among non-Whites and Hispanics (Widom et al. 2008), with significantly fewer differences among minority abused and neglected individuals and controls. Thus, social problems such as adulthood victimization, homelessness and underemployment are caused by both macro level or situational factors and by personal vulnerability (Morrell-Bellai et al. 2000; Widom et al. 2008). In this study, determinants of underemployment appeared to be different for women of majority and minority racial/ethnic backgrounds. Namely, the underemployment of minority women may have been more attributable to the macro level factors of less education, racial discrimination and neighborhood disadvantage (Benson et al. 2000). Alternatively, underemployment among White women was predicted by the individual vulnerability factors of childhood maltreatment, a history of IPV, work interference, multiple abusive relationships, alcohol abuse, and decreased motivation to seek a job or job training. Although all of the women in this sample had experienced some combination of macro level and personal factors, different sets of stressors may have led to the same set of outcomes (i.e., underemployment) for racial/ethnic majority and minority women. Findings of this study must be interpreted within the context of its limitations. First, this was a cross-sectional study, in which the time sequence between IPV, work interference, and employment was not assessed. Given the inconclusiveness of findings that employment may either elicit IPV and work interference or may conversely protect women from IPV (Riger and Staggs 2004), it is essential to conduct longitudinal research with an emphasis on identifying individual differences. In other words, for whom does IPV and work interference hinder employment, for whom does employment elicit abuse, and whom does employment protect from further abuse? A longitudinal design would also clarify under what circumstances womens mental health improves with employment, even in the face of continued IPV (Brush 2003), and under what circumstances womens mental health mediates the impact of IPV and work interference on their employment (Riger and Staggs 2004). Second, although the literature reviewed in this study argues that abusive men restrict their partners from working, Fox et al. (2002) noted that both a mans and a womans preference that his/her partner work more is also associated with an increased risk of IPV, perhaps because it is associated with his underemployment and the couples increased reliance upon the womans salary. Tauchen and Witte (2001) have similarly found that a mans unemployment increases his risk for abusive behavior. Furthermore, frequency of a couples arguments regarding money may increase a womans risk for IPV (Fox et al. 2002). This

study also did not assess the impact of a couples preferences regarding each other s employment and arguments regarding money on a womans violent behavior. Therefore, both partners views as to their own and each other s employment as well as each partner s abusive behavior toward the other should be assessed in order to evaluate the relationship between employment and IPV in all its complexity. In conclusion, this study highlights prevalence of partner interference with the employment of women who, for the most part, are also experiencing IPV. However, the relationships between these variables and other proxies of employment are complicated. In addition to the impact of IPV and work interference, womens reports of looking for a job are predicted by their history of child sexual abuse. Moreover, their reports of receiving job training are affected by their current mental health. Inclusion of race/ ethnicity as a variable also suggests very different life experiences and stressors for majority and minority women. Therefore, it is essential that both future research and social service programs for abused and/or homeless women attend to how womens search for employment is impacted by individual differences resulting from demographic and structural factors and from the long-lasting effects of childhood maltreatment.
Acknowledgements This research was supported by the Harold Benenson Memorial Research Fund at the Wellesley Centers for Women. The author wishes to thank Janet Fender, who is the Director of the Domestic Violence Unit at the Massachusetts Department of Transitional Assistance.

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