J Youth Adolescence

DOI 10.1007/s10964-016-0570-7

EMPIRICAL RESEARCH

A Three-Step Latent Class Analysis to Identify How Different

Patterns of Teen Dating Violence and Psychosocial Factors
Influence Mental Health
1
Hye Jeong Choi ●
Rebecca Weston2 Jeff R. Temple3
●

Received: 17 June 2016 / Accepted: 7 September 2016

© Springer Science+Business Media New York 2016

Abstract Although multiple forms (i.e., physical, threa-
tening, psychological, sexual, and relational abuse) and
patterns (i.e., perpetration and victimization) of violence can
co-occur, most existing research examines these experi-
ences individually. Thus, the purpose of this study is to
the homogenous subgroups of teen dating violence and
targeting adolescent teen dating violence accordingly.
Keywords Teen dating violence 3-Step latent class
●

investigate: (1) homogenous subgroups based on victimi- analysis Mental health Acceptance of couple violence
● ●

zation and perpetration of multiple forms of teen dating

violence; (2) predictors of membership in these subgroups;
and (3) mental health consequences associated with mem-
bership in each subgroup. Nine hundred eighteen adoles-
cents in the 9th or 10th grade at seven public high schools in
Texas participated in the survey (56 % female, White: 30 %,
Hispanic: 32 %, African American: 29 %, others: 9 %).
A three-step latent class analysis was employed. Five latent
teen dating violence classes were identified: (1) non-
violence; (2) emotional/verbal abuse; (3) forced sexual
contact; (4) psychological + physical violence; and (5)
psychological abuse. Females, African Americans, and
youth who had higher acceptance of couple violence scores
and whose parents had less education were more likely to
members of dating violence classes compared with the
nonviolence class. Adolescents who experienced multiple
types of dating violence reported greater mental health
concerns. Prevention programs may benefit by identifying
* Hye Jeong Choi
hjchoi0810@gmail.com
1
Department of Health Sciences, University of Missouri, 501 Clark
Hall, Columbia, MO 65211, USA
2
Department of Psychology, University of Texas at San Antonio,
San Antonio, TX 78249, USA
3
Department of Obstetrics/Gynecology, University of Texas at
Medical Branch, Galveston, TX 77555, USA
Introduction
Each year, approximately 10 % of adolescents experience
severe physical or sexual abuse (Kann et al. 2014), with
higher rates observed in regional and at-risk samples
(Zweig et al. 2013). It is estimated that approximately
400,000 youth in the US are victims of severe teen dating
violence annually (Wolitzky-Taylor et al. 2008). Although
mutuality (O’Leary et al. 2008; Swahn et al. 2010) and
different types of violent acts (Ybarra et al. 2016) play an
important role in teen dating violence, most existing stu-
dies are restricted by focusing on one or two type(s) of
abuse or by considering only perpetration or victimization.
Although recent studies have started to examine both teen
dating violence experiences (e.g., perpetration and victi-
mization) or multiple forms of abuse (Choi and Temple
2016; Ybarra et al. 2016), less is known about how mul-
tiple types and experiences of teen dating violence are
related with mental health and other individual and con-
textual factors. The purpose of this study is to simulta-
neously investigate how different forms (e.g., physical,
psychological) and experiences of teen dating violence
(e.g., perpetration and victimization) are related to psy-
chosocial factors and mental health.

Heterogeneous Patterns of Teen Dating Violence and
Psychosocial Factors
Teen dating violence can refer to threatening behavior, or
abuse against a current or former dating partner that is
physical, psychological, relational, or sexual in nature
(Saltzman et al. 2002). Physical violence occurs when a
youth deliberately and physically hurts his/her partner
(e.g., hitting, pushing, shoving, chocking); sexual violence
includes any abusive sexual contact against a partner’s will,
such as forced sex or kissing; threatening behaviors include
verbal and/or nonverbal communication intended to make a
partner feel fearful (Saltzman et al. 2002); psychological
abuse includes humiliating, insulting, ridiculing, alienating,
and blaming a partner (Wolfe et al. 2001); and relational
violence is defined as acts intended to deliberately hurt or
manipulate a dating partner’s social relationships (Linder
et al. 2002). Wolfe et al. (2001) demonstrated that these five
abuse were interrelated with one another, yet distinguishable.
In addition, teen dating violence has different types of
experience such as victimization only, perpetration only or
both victimization and perpetration (O’Leary et al. 2008).
Despite their differences and all possible combinations types
and experiences (e.g., physical victimization, physical victi-
mization, and psychological perpetration), these abusive acts
often co-occur (Haynie et al. 2013) and should not be con-
sidered in isolation. Studies conducted with nationally
representative samples showed that almost one-third of
adolescents reported both psychological victimization and
perpetration, 14 % of youth reported psychological victimi-
zation and physical victimization or perpetration (Ybarra
et al. 2016), and nearly all perpetrators of physical violence
also perpetrate psychological abuse (Haynie et al. 2013).
Although these different types of teen dating violence
often share predictors, developmental course, and con-
sequences (Wolfe et al. 2001), few studies have investigated
all types of teen dating violence simultaneously, and even
fewer have considered sexual and threatening behaviors
(Schiff and Zeira 2005). Instead, teen dating violence is
often defined as physical and psychological (Earnest and
Brady 2016) or physical and sexual (Buttar et al. 2013) in
nature. Complicating matters is the fact that teen dating
violence is often reciprocal and mutual (Swahn et al. 2010),
with different types of abuse co-occurring (Haynie et al.
2013; Ybarra et al. 2016).
Teen Dating Violence and Psychosocial Factors
Several theoretical models—from sociocultural to individual
behavior theories—have been proposed to account for the
relationship between psychosocial risk and protection factors
and teen dating violence. For example, social learning theory
(Bandura 1973) suggests that youth learn a specific behavior
J Youth Adolescence
(e.g., violence) by observing positive outcomes from others’
use of this behavior (e.g., interparental violence). Children
exposed to interparental violence may adopt attitudes that
are accepting of violence—for instance, as a way to resolve
conflict and a normal part of intimate relationships. Indeed,
recent empirical studies indicate that acceptance of violence
mediates the link between witnessing interparental violence
and teen dating violence victimization (Karlsson et al. 2016)
and perpetration (Temple et al. 2013). The developmental
system model (Capaldi et al. 2005) suggests that interactions
among individual (e.g., psychopathology), relational (e.g.,
couple satisfaction), and contextual (e.g., age, gender, eth-
nicity) factors are important in predicting teen dating vio-
lence. For example, Novak and Furman (2016) found that
externalizing symptoms and a negative relationship with
one’s partner were significantly related to victimization and
perpetration.
Different types or patterns of teen dating violence may
have different socio-psychological characteristics. Although
research is not conclusive, several studies have found dif-
ferences in victimization and perpetration or type of violent
acts by gender, ethnicity, and parental education. With
respect to gender, adolescent females generally report per-
petrating physical violence more often than males (Wolfe
et al. 2003; Foshee and Matthew 2007; Foshee et al. 2009),
whereas males report more perpetration of sexual abuse
(Molidor and Tolman 1998) and more victimization of
physical violence (Novak and Furman 2016; Williams and
Frieze 2005). Notably, females are more often victims of
injurious and severe physical and sexual abuse (Molidor
et al. 2000). With respect to ethnicity, African American
youth are more likely to be involved in physical (Carver
et al. 2003; Halpern et al. 2001), psychological, and
physical/psychological (Haynie et al. 2013) abuse compared
to other ethnicities. Finally, low-income youth, as deter-
mined by parental education or other means, are generally
more likely to be involved in teen dating violence (Foshee
et al. 2009). While additional research is warranted, it is
clear that gender, ethnicity, and parental education/socio-
economic status (SES) may be differently associated with
the type of and experiences with abuse. In addition, atti-
tudes accepting of violence have been shown to predict teen
dating violence (Temple et al. 2013; Williams et al. 2008;
Kinsfogel and Grych 2004; Josephson and Proulx 2008).
Generally, male-to-female violence has been positively
related to physical teen dating violence perpetration and
threatening behaviors (Lichter and McCloskey 2004), psy-
chological perpetration (Josephson and Proulx 2008), and
physical and sexual victimization (O’Keefe and Treister
1998). Acceptance of female-to-male violence (by both
males and females) has been shown to be positively asso-
ciated with physical teen dating violence perpetration
(Josephson and Proulx 2008).
J Youth Adolescence
Teen Dating Violence and Mental Health: Depressive
Symptoms, Anxiety, and Hostility
The association between mental health and teen dating
violence varies by the type and direction (perpetration vs.
victimization) of the violence (Haynie et al. 2013; Bonomi
et al. 2012). Victimization has been linked to anxiety,
depressive symptoms, and hostility (Holt and Espelage
2005; Exner-Cortens et al. 2013; Ackard et al. 2007;
Williams et al. 2008; Brown et al. 2009; Lehrer et al. 2006)
with victims of physical, sexual, or psychological abuse
reporting poorer psychological functioning relative to non-
victims (Brown et al. 2009; Howard and Wang 2005;
Ackard et al. 2007). Hostility, on the other hand, is
positively linked to perpetration (Temple et al. 2016).
Further, experiencing multiple acts of violence relative to
experiencing psychological, physical, or sexual abuse in
isolation may lead to more severe depressive and anxiety
symptoms. For instance, Exner-Cortens et al. (2013) and
colleagues found that victims of psychological and physical
abuse evidenced symptoms of depression whereas victims
of “only” psychological abuse did not evidence depression.
Current Study
The first purpose of this study is to identify homogenous
subgroups in teen dating violence by using more compre-
hensive definitions and indicators based on the literature
(Wolfe et al. 2001). We ask Research Question 1: Are there
distinct latent classes (e.g., subgroups) of teen dating vio-
lence based on experience and types of abusive acts?
Indeed, it is likely that gender, ethnicity, SES (level of
parental education as a proxy), and attitudes about violence
play important roles in how teen dating violence develops
over time (Temple et al. 2013; Ackard et al. 2007; Halpern
et al. 2001; Howard and Wang 2003). Given the hetero-
geneous patterns of violence (e.g., different experiences and
types), and that latent classes may have different char-
acteristics in terms of gender, ethnicity, parental education,
and acceptance of dating violence, we also ask Research
Question 2: Are memberships in latent violence classes
associated with gender, ethnicity, level of parental educa-
tion, and acceptance of couple violence? Because youth’s
patterns of teen dating violence (e.g., perpetration and vic-
timization; types of abuse) can influence their well-being,
we ask Research Question 3: Do distinct classes of teen
dating violence have differential effects on depressive
symptoms, anxiety, and hostility?
Furthermore, gender, ethnicity, parental education, and
attitudes about violence can differently influence mental
health depending on the patterns of teen dating violence
(e.g., perpetration and victimization; types of abuse).
For instance, female victims of physical and sexual dating
violence had significantly higher odds of having symptoms
of depression compared to non-victims and male victims
(Ackard et al. 2007). Although several studies have exam-
ined the associations between teen dating violence,
including patterns (Haynie et al. 2013; Bonomi et al. 2012),
individuals, relational, and contextual factors (Temple et al.
2013; Lehrer et al. 2006; Howard and Wang 2003; Williams
et al. 2008), and health outcomes (Exner-Cortens et al.
2013; Ackard et al. 2007; Howard and Wang 2003; Call-
ahan et al. 2003; Brown et al. 2009), less is known about
how gender, ethnicity, parental education, and acceptance
of dating violence influences anxiety, depressive symptoms,
and hostility symptoms within different patterns of teen
dating violence. Thus, we asked Research Question 4:
Depending on latent classes based on patterns of teen dating
violence, do risk and protective factors differently influence
mental health (e.g., depressive symptoms, anxiety, and
hostility)?
Methods
Participants and Procedure
A total of 1042 adolescents in the 9th or 10th grade at seven
public high schools in Texas completed surveys at Wave 1
and Wave 2 (retention rate: 92 %). At baseline, we recruited
participants in state mandated classes (response rate: 62 %)
and received parental consent and student assent prior to
administering surveys. The study was approved by IRB at
the last author’s institution. Although 1042 students
participated in the study, only those who endorsed the item,
“I have begun dating, going out with someone, or had a
boyfriend/girlfriend” at baseline were included in current
analyses (N = 918). Slightly more than half were female
(56 %) and average age was 15.1 years old. Participants
self-identified their racial/ethnic background as Hispanic
(32 %), White (30 %), African-American (29 %), and other
(9 %). Parental consent and student assent were obtained.
Project managers administered the pen-and-paper survey
at schools, and participants received gift cards as
compensation.
Measures
Lifetime dating violence (Wave 1)
The 50-item Conflict in Adolescent Dating Relationships
Inventory (Wolfe et al. 2001) was used to measure lifetime
teen dating violence (TDV) perpetration (25 items) and
victimization (25 items). Based on theory and empirical
studies (Wolfe et al. 2001), ten subscales were created;

sexual victimization (four items, e.g., “He/she touched me
sexually when I did not want him/her to,”) and perpetration
(four items, e.g., “I touched him/her sexually when he/she
did not want me to,”), relational victimization (three items,
e.g., “He/she said things to my friends about me to turn
them against me,”) and perpetration (three items), emo-
tional/verbal victimization (ten items, e.g., “He/she ridiculed
or made fun of me in front of others,”) and perpetration (ten
items), threatening behavior victimization (four items, e.g.,
“He/she destroyed or threatened to destroy something I
valued,”) and perpetration (four items), and physical abuse
victimization (four items; e.g., “He/she kicked, hit, or pun-
ched me,”) and perpetration (four items). Each subscale was
dichotomized so that any positive response meant any
experience within each subscale. Because of the common-
ness of emotional/verbal abuse and our desire to avoid
over-representing adolescents involved in psychological
TDV (Follingstad 2007), participants had to endorse
four or more (of ten) of these items to be considered as
victims/perpetrators of psychological abuse. Indeed,
most participants (80 %) reported at least one instance of
emotional/verbal abuse.
Demographic information (Wave 1)
Gender (Female = 1) and ethnicity were dummy-coded. Three
dummy variables were created for ethnicity (i.e., Hispanic = 1
vs. other ethnicities = 0, White = 1 vs. other ethnicities = 0,
and African-American = 1 vs. other ethnicities = 0). Partici-
pants reported the highest level of their parent education by
responding on a scale of 1–4, with 1 = less than high school
graduation, 2 = high school graduation, 3 = some college or
training after high school, and 4 = college graduation. The
mean for parental education was 2.86 (SD = 1.08).
Acceptance of couple violence (Wave 1)
To assess acceptance of couple violence, six items were
adapted from Foshee et al. (1992). Acceptance of male-to-
female (three items) and female-to-male violence (three
items) were measured separately. Adolescents reported the
degree to which they accepted male-female violence (e.g.,
“a boy angry enough to hit his girlfriend must love her very
much”; Cronbach’s α = .71, M = 1.24, SD = 0.45) on a 4-
point scale (1 = strongly disagree, 4 = strongly agree), with
a higher score indicating greater acceptance. The same scale
was used to measure acceptance of female-male violence;
Cronbach’s α = .77, M = 1.57, SD = 0.68.
Depressive symptoms (Wave 2)
Eight items were adapted from The Center for Epidemio-
logic Studies Short Depression Scale (Andersen et al. 1994;
10 items were used, and in this study we removed two items
J Youth Adolescence
to increase internal consistency). Youth reported their
past week depressive symptoms scores by answering the
following items on a 4-point scale (1 = less than 1 day and
4 = 5–7 days): “I had trouble keeping my mind on what I
was doing”; “I felt depressed”; “I felt fearful”; “My sleep was
restless”; “I was happy” (reverse coded); “I felt lonely”;
“I could not ‘get going’ ”; “I was bothered by things
that usually don’t bother me” (internal consistency = .80,
M = 1.81, SD = 0.59).
Anxiety (Wave 2)
Five items were used from the Screen for Child Anxiety-
Related Emotional Disorders (Birmaher et al. 1997), in
which adolescents responded to the following on a 3-point
scale (1 = not true and 3 = very true): “I am nervous”; “I
worry about being as good as other kids”; “I worry about
things working out for me”; “I am a worrier”; “People
tell me that I worry too much” (internal consistency = .85,
M = 1.90, SD = 0.47).
Hostility (Wave 2)
A subscale of the Symptom Checklist-90 (SCL-90;
Derogatis 1983) was used to measure hostility. Participants
reported their hostility scores by answering the following
items on a 4-point scale (1 = never and 4 = most of the
time): In general, how often do you (1) “have temper out-
bursts you can’t control?” (2) “have urges to beat, injure, or
harm someone?” (3) “have urges to break or smash things?”
(4) “get into frequent arguments?” (5) “feel easily annoyed
or irritated?” and (6) “shout or throw things?” (internal
consistency = .83, M = 1.89, SD = 0.63).
Analytical Plan
A 3-step latent class analysis (LCA; Asparouhov and
Muthén 2014) was employed to identify meaningful sub-
groups of adolescents with similar TDV patterns and to
examine the associations between these subgroups and
distal outcomes and predictors. LCA is used to identify
homogenous subgroups based on participants’ patterns of
response to indicators (e.g., physical victimization, psy-
chological perpetration). The 3-step LCA approach has
several advantages over 1-step LCA, including not having
to re-calculate estimations of LCA when including
co-variates or distal outcomes while also taking account
of a classification uncertainty rate (Asparouhov and Muthén
2014). To identify the optimal number of latent classes, the
Bayesian information criterion (BIC), the adjusted
Lo–Mendell–Rubin likelihood ratio test (LMR; Lo et al.
2001), and theoretical interpretation were employed.
Monte Carlo simulation studies showed that LRT and BIC
J Youth Adolescence

are good indicators to select the optimal number of classes outcomes (e.g., depressive symptoms) among classes, a
(Nylund et al. 2007; Yang 2006; Tofighi and Enders 2008). Wald test was employed (Asparouhov and Muthén 2014). A
A smaller BIC indicates a better fit of the model, while LMR manual 3-step estimation procedure with all auxiliary vari-
offers a p-value in terms of a model comparison between the ables was employed because it allowed us to examine the
k-1 and k classes. That is, when the p-value is less than .05, it moderator role of latent class in linear regression to predict
indicates that the k-class model is statistically better than the outcomes (Asparouhov and Muthén 2014). The full infor-
k-1 class model. Except for indicators of LCA, other vari- mation maximum likelihood estimation method (Graham
ables such as gender, ethnicity, parental education, and et al. 2003) was employed to handle missing data.
acceptance of couple violence are understood as auxiliary
variables in the 3-step LCA approach (Asparouhov and
Muthén 2014). Mplus 7.11 (Muthén and Muthén 1998– Results
2012) was employed to examine the models, and R3STEP
command was used for membership prediction of a latent The type of TDV most frequently perpetrated or experi-
class model. To compare the mean of the difference in distal enced was emotional/verbal abuse, followed by physical
abuse, threatening behavior, sexual abuse, and relational
Table 1 Number of adolescents experiencing dating violence in five abuse (see Table 1). Youth were more likely to report vic-
domains timization by sexual or relational abuse compared with
Role Domain n (%) perpetration of those categories, whereas they reported
similar percentages of victimization and perpetration of
Perpetration Sexual abuse 121 (11.1) emotional/verbal, physical abuse, and threatening behavior.
Relational abuse 86 (7.9)
Emotional/verbal abuse 463 (42.5)
Research Question 1: Latent Class Analysis
Threatening behavior 144 (13.2)
Physical abuse 216 (19.8)
A five-class model provided the best fit with good con-
Victimization Sexual abuse 222 (20.4)
vergence (see Table 1). Based on fit criteria, we identified
Relational abuse 195 (17.9)
five meaningful classes (see Fig. 1). Classes were: (1)
Emotional/verbal abuse 458 (42.0)
nonviolence (NV, n = 374, 40.7 %); (2) emotional and
Threatening behavior 161 (14.8)
verbal abuse (EV, n = 281, 30.6 %); (3) forced sexual
Physical abuse 216 (19.8) contact (FSC, n = 107, 11.7 %); (4) psychological +

Fig. 1 Response patterns for latent classes. EV emotional/verbal abuse class, FSC forced sexual contact, PPV psychological + physical abuse
violence class, PA psychological abuse class
 J Youth Adolescence

Table 2 Model fit index

Model Loglikelihood AIC BIC Adjust BIC LRT

1-Class solution −4554.51 9129.02 9177.24 9145.48 N/A

2-Class solution −3940.75 7923.50 8024.77 7958.07 1227.52***
3-Class solution −3825.59 7715.17 7869.48 7767.86 230.33***
4-Class solution −3761.57 7609.15 7816.50 7679.90 128.03***
5-Class solution −3722.14 7552.28 7812.68 7641.18 78.87***
6-Class solution −3691.05 7512.10 7825.54 7619.11 62.18***
Note LRT: adjusted Lo–Mendell–Rubin likelihood ratio test after six classes, the model did not converge
***p < .001

physical violence (PPV, n = 80, 8.7 %); and (5) psycholo-
gical abuse (PA, n = 76, 8.3 %). Youth in the nonviolence
class did not experience any type of TDV. Youth in the
emotional/verbal abuse class had high item-response
probabilities on emotional/verbal victimization (.76) and
perpetration (.78). Youth in the forced sexual contact class
had high item-response probability on sexual abuse victi-
mization (.83). Youth in the psychological + physical vio-
lence class had high item-response probabilities on
emotional/verbal victimization (.93) and perpetration (.96),
threatening behavior victimization (.60) and perpetration
(.75), and physical victimization (.74) and perpetration
(.90). Finally, youth in the psychological abuse class had
high item-response probabilities on emotional/verbal victi-
mization (.92) and perpetration (.88) and threatening
behavior victimization (.70), and relational victimization
(1.00), and physical victimization (.69) (Table 2).
Research Question 2: Latent Class Analysis with
Psychosocial Factors
Gender, ethnicity, parental education, acceptance of female-
to-male violence, and acceptance of male-to-female vio-
lence were included as covariates in the five-class model
(Table 3). The nonviolence class was considered as a
reference class. Except for the forced sexual contact class,
the proportions of female youth were significantly greater
than in the no violence class across the three TDV classes
(e.g., psychological abuse class). African-Americans were
more likely to be members of the emotional/verbal abuse
and psychological + physical violence classes. Youth who
had less educated parents were more likely to be members
of the psychological abuse class compared with the non-
violence class. While acceptance of male-to-female vio-
lence did not significantly predict class membership,
acceptance of female-to-male violence significantly differed
between youth in the forced sexual contact class and youth
in the nonviolence class, between youth in psychological +
physical violence class and those in the nonviolence class,
and between youth in the psychological abuse class and
those in the nonviolence class, respectively. That is, the
more accepting youth were of female-to-male violence, the
more likely they were to be members of forced sexual
contact, psychological + physical violence, or psychological
abuse classes compared to the nonviolence class.
Research Question 3: Distal Outcomes of Classes
Anxiety, depressive symptoms, and hostility were included
in the model as distal outcomes of classes to compare their
outcomes’ scores among classes (see Fig. 2). Youth in the
emotional/verbal abuse and psychological abuse classes had
significantly greater scores in anxiety compared with the
nonviolence and forced sexual contact classes. Youth in the
emotional/verbal abuse, psychological + physical violence,
and psychological abuse classes had significantly higher
scores in depressive symptoms and hostility than those in
nonviolence and forced sexual contact classes.
Research Question 4: The Role of Latent Class as a
Moderator between Psychosocial Factors and Distal
Outcomes
To examine the moderator role of these five latent classes,
gender, ethnicity, parental education, and acceptance of
male-to-female/female-to-male violence were included in
the LCA with a distal outcome model (see Table 4).
Because the mental health of youth in the nonviolence class
was least crucial in this study, interpretation of this class
was not considered in the paper.
Anxiety
Female youth in the emotional/verbal abuse class were more
likely to evidence severe anxiety symptoms than male
youth of this class. In addition, Hispanic youth in the
psychological + physical violence class had significantly
higher scores on anxiety than non-Hispanics in the same
class. There were no significant interactions between
psychological abuse class membership and psychosocial
J Youth Adolescence

Table 3 Predictors of membership in latent class of dating violence

EV FSC PPV PA
B SE OR B SE OR B SE OR B SE OR

Female 0.50* 0.21 1.64 0.55 0.29 1.73 1.42*** 0.39 4.15 0.63* 0.31 1.87
Hispanic (vs. others) 0.28 0.39 1.32 0.78 0.51 2.18 0.72 0.65 2.05 0.24 0.64 1.27
White (vs. others) 0.11 0.37 1.12 0.29 0.53 1.34 −0.94 0.88 0.39 0.90 0.59 2.47
African-American (vs. others) 0.77* 0.37 2.16 0.29 0.57 1.33 1.29* 0.65 3.62 0.66 0.63 1.93
Parental education −0.20 0.11 0.82 0.04 0.13 1.04 −0.12 0.17 0.89 −0.30* 0.15 0.74
Acceptance of couple (male-to-female) violence −0.62 0.42 0.54 −0.30 0.40 0.74 0.25 0.36 1.29 −0.07 0.38 0.93
Acceptance of couple (female-to-male) violence 0.32 0.22 1.37 0.75** 0.25 2.13 1.04*** 0.26 2.83 1.08*** 0.26 2.94
Note The latent class of nonviolence was set as the reference group
EV emotional/verbal abuse class, FSC forced sexual contact class, PPV psychological + physical violence class, PA psychological abuse class
*p < .05, **p < .01, ***p < .001

Fig. 2 Distal outcomes of each latent class. EmoV emotional/verbal the same subscripted alphabet letter are statistically indistinguishable
abuse class, FSC forced sexual contact class, PPV psychological + at the .001 alpha level. P was set at .001 to avoid Type I error due to
physical violence class, PA psychological abuse class. Estimates with multiple comparisons

factors (e.g., parental education, acceptance of violence) in
this study.
Depressive symptoms
Youth in the psychological abuse class with less educated
parents reported significantly more depressive symptoms
than did youth in the same class with a parent having higher
education levels. Interactions between other classes and
psychosocial factors were not significant.
Hostility
Youth in the emotional/verbal abuse class who had less
acceptance of male-to-female violence had significantly
greater hostility scores than did their counterparts in the
same class. On the other hand, youth with greater accep-
tance of female-to-male violence in this class had sig-
nificantly more hostility than their counterparts in the same
class. Female youth in the psychological + physical violence
class had significantly stronger hostility than did male youth
in the same class. Further, Hispanic youth in this class were
less likely to have stronger hostility when compared with
non-Hispanic youth in the same class.
Alternate Model Analysis
We estimated LCA models with different cut points
(e.g., 1+, 2+, 3+) of emotional/verbal abuse indicators.
Although the models with different cut points regarding
 J Youth Adolescence

Table 4 Moderator effects of each class on anxiety, depression, and hostility

Nonviolence EV FSC PPV PA
b se b se b se b se b se

Anxiety
Female 0.20*** 0.06 0.28** 0.08 −0.01 0.14 −0.01 0.14 0.13 0.13
Hispanic −0.10 0.09 −0.04 0.14 −0.07 0.23 0.58* 0.23 −0.20 0.22
White −0.28** 0.08 −0.03 0.15 0.13 0.22 0.23 0.23 −0.32 0.20
African-American −0.23** 0.09 −0.04 0.13 −0.05 0.19 0.44 0.24 −0.19 0.18
Parental education 0.06* 0.03 −0.02 0.04 −0.08 0.08 0.04 0.07 −0.02 0.06
Acceptance of male-female violence −0.03 0.07 0.03 0.12 −0.19 0.19 −0.23 0.15 −0.20 0.16
Acceptance of female-male violence 0.06 0.05 −0.03 0.07 0.00 0.12 0.10 0.11 0.04 0.10
Depressive symptoms
Female 0.12 0.07 0.15 0.11 0.12 0.17 0.49 0.34 0.19 0.14
Hispanic −0.13 0.13 −0.21 0.19 −0.45 0.42 0.33 0.34 −0.07 0.31
White −0.31** 0.11 −0.12 0.20 0.10 0.43 0.60 0.32 0.06 0.32
African-American −0.25* 0.11 −0.16 0.19 −0.21 0.40 0.36 0.40 −0.01 0.29
Parental education 0.03 0.03 −0.05 0.05 0.01 0.10 0.03 0.10 −0.19** 0.06
Acceptance of male-female violence 0.03 0.10 −0.07 0.11 −0.06 0.28 0.15 0.34 −0.01 0.15
Acceptance of female-male violence 0.02 0.07 0.05 0.09 0.00 0.14 −0.26 0.29 0.12 0.11
Hostility
Female 0.03 0.08 −0.01 0.14 0.16 0.09 0.85* 0.35 0.31 0.18
Hispanic −0.20 0.13 −0.14 0.27 −0.10 0.13 −0.82* 0.39 −0.45 0.41
White −0.12 0.10 −0.25 0.24 −0.09 0.13 −0.40 0.38 −0.30 0.39
African-American −0.01 0.11 0.11 0.26 −0.10 0.15 −0.76 0.51 −0.11 0.37
Parental education −0.03 0.04 −0.09 0.06 0.05 0.05 0.04 0.10 −0.01 0.09
Acceptance of male-female violence 0.02 0.12 −0.31* 0.13 −0.04 0.13 0.46 0.34 −0.06 0.20
Acceptance of female-male violence 0.06 0.07 0.22* 0.11 0.13* 0.06 −0.35 0.35 0.19 0.15
EV emotional/verbal abuse class, FSC forced sexual contact class, PPV psychological + physical abuse abuse class, PA psychological abuse class
*p < .05, **p < .01, ***p < .001

these indicators provided slightly different probabilities
across all indicators, the 5 class provided the best model fit
based on fix criteria (e.g., lowered BIC) across all cut
points. Further, these models resulted in similar classes such
as nonviolence, emotional/verbal abuse, forced sexual
contact, psychological + physical violence, and psycholo-
gical abuse class.
Discussion
Due to the complex nature of teen dating violence (e.g.,
different definitions, types, experiences, severity), previous
studies often focus on specific types (e.g., East and Hokoda
2015; Buttar, et al. 2013) and either perpetration (e.g.,
Temple et al. 2016; Johnson et al. 2015) or victimization
(e.g., Cascardi 2016; Vagi et al. 2015). Our goal was to
provide a more comprehensive description of teen dating
violence by collectively considering perpetration of and
victimization by emotional/verbal abuse, physical violence,
threatening behavior, sexual abuse, and relational abuse.
Indeed, while we know that certain psychosocial factors
(e.g., gender) increase risk for experiencing teen dating
violence (Foshee, et al. 2009; Temple et al. 2013; Williams
et al. 2008), and that both victims (Exner-Cortens et al.
2013) and perpetrators (Temple et al. 2016) experience poor
psychological health, it is unclear how these variables relate
when examined jointly and simultaneously. Using 3-step
latent class analysis, the current study investigated the latent
classes based on experiences (e.g., perpetration and victi-
mization) and types of dating violence (e.g., physical,
psychological). In addition, we tested whether gender,
ethnicity, parental education, and acceptance of couple
violence would predict class membership; we compared
rates of anxiety, depressive symptoms, and hostility among
classes; and we examined interaction effects on mental
health as outcomes between latent class and membership
predictors.
J Youth Adolescence
Latent Classification of Teen Dating Violence
We identified five mutually exclusive between, yet homo-
genous within latent classes: (1) nonviolence (40.7 %), (2)
emotional/verbal abuse (30.6 %), (3) forced sexual contact
(11.7 %), (4) psychological + physical violence (8.7 %), and
(5) psychological abuse (8.3 %). We confirmed the limited
previous research demonstrating the mutuality of violence
among adolescents (Ybarra et al. 2016; Haynie et al. 2013).
Also, this finding is partially consistent with previous stu-
dies using nationally representative samples but including
only some types of abuse (Haynie et al. 2013). In addition
to identifying similar classes (nonviolence, emotional/ver-
bal abuse, and psychological + physical violence classes),
we also identified classes reflecting psychological abuse and
forced sexual contact. The emergence of these additional
classes may be due to different operationalization of teen
dating violence and time frames used (Vezina and Hebert
2007). Although teen dating violence has been categorized
as physical, psychological, or sexual (Ybarra et al. 2016) in
the literature, almost 17 % of youth in our sample engaged
in multiple violent acts. Research should therefore extend
the theoretical framework and empirical focus from only
one type of violence or victimization vs. perpetration to a
more comprehensive examination of multiple types and
experiences of teen dating violence. For example, social
learning theory (Bandura 1973) or the developmental sys-
tem model (Capaldi et al. 2005) can guide research on how
and why victims can also be perpetrators, victimization and
perpetration can co-occur, and violence can be exacerbated.
Notably, a third of adolescents engaged in emotional and
verbal abuse. These two forms of abuse were important
across almost all latent classes. Despite the high frequency
of psychological abuse including these two forms (Fritz and
Slep 2009), researchers generally focus on physical and
sexual abuse. This is an important limitation in the literature
as youth in the emotional/verbal abuse class reported nearly
the same amount of anxiety, depressive symptoms, and
hostility as did youth in the psychological abuse and psy-
chological + physical violence classes. Indeed, research on
intimate partner violence has consistently demonstrated that
psychological abuse is as or more harmful than physical
violence (Mechanic et al. 2008; Pico-Alfonso 2005).
Although results from the current study do not allow us to
infer whether physical violence and psychological abuse
occur simultaneously with the same partner, it is clear that
youth who engage in physical violence are also engaging in
emotional/ verbal abuse—whether in different ways in
different relationships or the same way in all relationships.
It is possible that emotional/verbal abuse serves as a
“gateway” or risk factor for other types of violence. Addi-
tional research is needed to understand how violence
develops, but it appears increasingly clear that emotional
and verbal abuse is an important component of teen dating
violence.
Finally, the psychological abuse class had asymmetrical
patterns of teen dating violence while the emotional/verbal
abuse and psychological + physical violence classes
had almost symmetrical patterns as shown in Fig. 1. For
example, the emotional/verbal abuse class had high
response probabilities on emotional/verbal perpetration and
victimization but low response probabilities on the
remaining indicators (e.g., relational abuse victimization).
However, the psychological abuse class had higher response
probabilities on only emotional/verbal perpetration but high
response probabilities on relational, emotional/verbal, and
threatening behavior victimization. Also, the psychological
abuse class had a high response probability on physical
abuse victimization. This class illustrated that youth were
mutually or reciprocally involved in emotional/verbal dat-
ing violence, yet they had experienced different types of
psychological forms of dating violence along with physical
abuse. Thus, these results indicate that emotional/verbal
abuse could be mutual which is consistent with previous
literature (Haynie et al. 2013), but other forms of psycho-
logical violence and physical abuse can be one-directional.
Psychosocial Factors and Membership Predictions in
Latent Classes and Mental Health
Our findings with regard to Research Question 3 replicate
and extend existing research. Consistent with previous
studies, gender (Foshee and Matthew 2007; Foshee, et al.
2009), ethnicity (Haynie et al. 2013; Foster et al. 2004),
parental education (Foshee et al. 2009), and acceptance of
couple violence (Karlsson et al. 2016; Temple et al. 2013)
were associated with teen dating violence. Our finding
indicated that female youth were more likely to be both
victims and perpetrators. Also, the finding showed that
female youth were more likely to be a member of the
psychological abuse class compared with male youth. This
finding may explain inconsistent previous findings: females
were more likely victims (Wolitzky-Taylor et al. 2008) or
perpetrators (Foshee et al. 2009). That is, a gender
difference could occur depending upon the operationaliza-
tion of teen dating violence or research design. Also,
females may be victims of different forms of psychological
abuse (e.g., spreading rumors from a dating partner) and
physical abuse even though they are involved in some
degree of emotional/verbal abuse.
Youth involved in dating violent relationships had poorer
mental health compared to adolescents without a history of
dating violence, which is consistent with previous literature
(Temple et al. 2016). Surprisingly, the forced sexual contact
class had levels of anxiety, depressive symptoms, and
hostility most similar to the nonviolence class.

Given the fact that forcing a partner to have sex is illegal
(and reportable), it is possible that youth did not endorse
their or their partner’s sexually violent behavior in this
survey. This information can involve different mental health
outcomes. Indeed, in our sample, sexual abuse victimization
was made up primarily of youth who endorsed “unwanted
kiss” (perpetration: 97 % and victimization: 91 %). One
possible explanation is that youth may think this “unwanted
kiss” is part of normal behavior in relationship and a sign of
love (Henton et al. 1983). However, this and other less
severe forms of sexual abuse should be examined further to
determine whether youth perceive such behaviors as
abusive.
Findings in this study illustrate that individual and con-
textual factors (e.g., gender, acceptance of violence) related
to mental health may vary depending on dating violence
class based on their experience and violent acts. For
example, females in the emotional/verbal abuse class and
Hispanics in the psychological + physical violence class
exhibited higher anxiety levels compared to other youth in
the same classes, respectively. Level of parental education
was particularly important for youth in the psychological
abuse class with respect to depressive symptoms. Female
and non-Hispanic youth in the psychological + physical
violence class showed greater hostility compared with male
and Hispanic youth in the same class, respectively.
These findings indicate that contextual factors such as
gender, ethnicity, and parental education can be risk factors
or be protective to mental health. Hispanic youth might not
be differently involved in teen dating violence compared
with other ethnicities; Hispanic youth could be at-risk in
terms of mental health once they are involved in physical
and psychological dating violence.
Acceptance of couple violence was related with poor
mental health within the forced sexual contact and emo-
tional/verbal abuse classes. Youth with higher scores of
acceptance of female-to-male violence might have higher
hostility resulting in sexual abuse victimization. Because
hostility is positively related with dating violence (Connolly
et al. 2010), youth in the forced sexual contact class may be
at a greater risk of re-victimization (Humphrey and White
2000). Counterintuitively, youth with less acceptance of
male-to-female violence in emotional/verbal violence abuse
class were more likely to have high rates of hostility. This
finding may be understood in how class membership was
predicted. Given our finding that females were more likely
to be members of the emotional/verbal abuse class, females
in this class may have higher acceptance of female-to-male
violence and lower acceptance of male-to-female violence.
That is, acceptance of couple violence would be positively
associated with hostility when youth involved in emotional
and verbal dating violence. A recent study (Temple et al.
2016) showed that psychological perpetration mediated the
J Youth Adolescence
relationship between acceptance of couple violence and
hostility. Acceptance of couple violence and hostility may
be related in a more complex way with teen dating violence
than other predictive factors.
Intervention programs should target victimization and
perpetration of multiple types of abuse and target at-risk
youth. Given our findings and those of others (Connolly
et al. 2010; Stocker and Richmond 2007), special emphasis
should be placed on recognizing and preventing the
occurrence of psychological abuse and characteristics of
healthy and unhealthy romantic relationships. Because
psychosocial factors such as gender and acceptance of
violence can be used to predict membership in teen dating
violence classes and may have different effects on mental
health, targeted and tailored dating violence interventions
should be developed. For example, dating violence inter-
ventions could be tailored to youth with low parental edu-
cation/socio-economic status and for youth who have
permissive attitudes toward to the use of violence—perhaps
those who have witnessed interparental violence (Karlsson
et al. 2016). In addition, our findings indicated that African
Americans were more likely to be involved in mutual
emotional/verbal abuse and physical abuse, and that His-
panics were more likely to experience greater anxiety when
involved in mutual emotional/verbal abuse and physical
dating violence. Therefore, culturally targeted or tailored
programs may be useful for prevention and intervention.
For example, our results suggest intervention programs
designed for Hispanic students should incorporate techni-
ques for coping with anxiety.
Limitations
Our findings should be interpreted in light of several lim-
itations. First, severity, duration, and recency of teen dating
violence were not considered. Second, our categorization of
emotional/verbal abuse can influence identification of latent
teen dating violence classes. However, this was necessary as
approximately four-fifths of youth in our sample endorsed
at least one emotional/verbal abuse item (e.g., of 10 items).
Moreover, Follingstad (2007) argued that psychological
abuse has a larger chance of happening than not happening
in romantic relationships. Consequently, increasing the
threshold for emotional/verbal abuse was necessary to
identify latent classes in this study. Third, our data were
from self-reported survey with participants in southeast
Texas. Although the sample is ethnically diverse, our results
may not be generalizable to other regions. Fourth, we did
not control for previous mental health status. Finally, our
measures did not allow us to distinguish whether youth
engaged in mutual violence with the same partner or if
youth experienced violence from one partner and then
engaged in violence with another partner.
J Youth Adolescence
Conclusion
We extended past research on dating violence among ado-
lescents by examining their perpetration of and victimiza-
tion by five types of behaviors: emotional/verbal abuse,
relational abuse, threats, physical violence, and sexual
abuse. A latent class analysis of these variables provided
support for five distinct classes of dating violence repre-
senting nonviolence, emotional/verbal abuse, psychological
+ physical violence, forced sexual contact, and psycholo-
gical abuse. In addition, we found that female gender was
associated with membership in dating violence classes
except forced sexual contact, supporting consistent recent
research that females are more likely than males to report
perpetration of less severe violence (Foshee et al. 2009).
Lower levels of parental education were associated with
membership in the psychological abuse class, and accep-
tance of female to male violence specifically was associated
with membership in the forced sexual contact, psychologi-
cal abuse, or psychological + physical violence classes
relative to membership in the nonviolence class. Further-
more, we found that mental health outcomes varied by class
and, in some cases, outcomes were moderated by psycho-
social factors. These results have implications for inter-
vention (vs. prevention) programs. Targeted programming
can be delivered for students based on screening for specific
types of violence with psychosocial factors.
Funding This research was supported by Award Number
K23HD059916 (PI: Temple) from the Eunice Kennedy Shriver
National Institute of Child Health & Human Development (NICHD)
and 2012-WG-BX-0005 (PI: Temple) from the National Institute of
Justice (NIJ). The content is solely the responsibility of the authors and
does not necessarily represent the official views of NICHD or NIJ.
Authors’ Contributions HJC conceived of the study, participated
in its design and interpretation of the data, performed the statistical
analysis, and drafted the manuscript; RW participated in interpretation
of the data and helped to draft the manuscript; JT conceived of the
study, participated in its design and coordination, interpretation of the
data and drafted the manuscript. All authors read and approved the
final manuscript.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Ethical Approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical
standards.
Informed Consent Informed consent was obtained from all indi-
vidual participants included in the study.
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Hye Jeong Choi Ph.D. is an Assistant Professor at University of
Missouri-Columbia. Her research focuses on adolescent social
interactions and influence within health and prevention. She is
particularly interested in adolescent informal communication
regarding prevention and its influence.
Rebecca Weston Ph.D. is an Associate Professor in the Department of
Psychology at the University of Texas at San Antonio. Her research
focuses on interpersonal violence and influences of victimization on
women’s health.
Jeff R. Temple is an Associate Professor at the University of Texas
Medical Branch. He received his doctorate in counseling psychology
from the University of North Texas. His major research interests
include the predictors, consequences, and development and evaluation
of interventions to reduce intimate partner violence.