Institutional Abuse: The Long-Term Consequences for Mental Health

This proposal comprises a comprehensive study focusing on institutional abuse (IA), which aims to provide an empirical basis for the traumatic stress perspective. Although children in care systems have been identified as being especially vulnerable and care settings as potentially abusive, the fundamental questions raised in this context lack sufficient evidence. Additionally, adverse family experiences are often found in the biography of children in care institutions. To date, few studies have looked at the long-term consequences for mental health of this group of persons. Almost 1200 survivors of IA have so far disclosed their experiences to a Viennese victims protection commission, and constitute the target group addressed by this study. After consenting to participate in this study, the relevant survivors will be compared with a stratified control group taken from the general population. During the entire research process, the ethical standards for dealing with vulnerable groups will be fulfilled. Our research will address the following topics: (1) Survey of specific patterns of IA, focusing on pre-removal family-related risk factors, as well as the types of institutional violence experienced and predictors of specific forms of abuse. All these aspects will be compared with the results of the control group. (2) Consideration of the long-term psychological consequences following IA, based on a bio-psychosocial model. These refer to psychological disorders, especially those relating to traumatic stress, with due regard for current classification systems and changes (ICD-10ICD-11, DSM-IVDSM-5). Analysis of a persons cortisol level as a long-term stress-indicator, and of social aspects such as frequent relational problems. (3) Examination of the relationship between specific patterns of IA and the current mental health status of adult survivors, with a validation of the results based on a comparison with the control group. In order to gain more comprehensive knowledge on aspects of IA, we will assess and integrate types of information. Firstly, we will use the unique opportunity of access both to the reports of the commission and to those of the care institutions run by the City of Vienna, where the survivors had stayed as children. Secondly, we will apply valid and reliable psychological measurements (SCID I&II, trauma-severity indices, and further questionnaires), and, thirdly, qualitative interviews will provide the survivors with the opportunity to state their own point of view. All these findings will then be compared with the results of the standardized measures. The documents and data generated by the questionnaires will be analysed, using appropriate statistical methods, and the interviews will be incorporated into the qualitative content analysis. Based on a multi-method approach the proposed research project will contribute significantly to answering important questions in the field of IA.

The overall aim of the study was to identify the long-term mental health consequences of violence and abuse committed in out-of-home-care institutions of the Vienna Child-welfare system. After written comment the victims of Institutional Abuse (IA) were contacted. They were offered two forms of participation: a) passive participation (analysis of clearing reports for the redressing commission, files of the archive of the child welfare system), b) active participation: additionally interviews and psychological assessments were conducted. The comparison group included individuals that were not in out-of-home-care. 417 survivors consented to the analysis of their files. Notably about 70% of them were placed in several institutions. The analysis of the clearing reports showed that all of them were exposed to physical and emotional violence, a majority additionally to sexual violence. The analysis of their archival files revealed a degrading and disrespectful diction. Reasons for taking them out their families were e.g. risky family, emergencies in parenting. Out of the active participation data from 220 former foster care children were analyzed, with 46 of them interviews were conducted. The average age for participants and members of the comparison group was 60 years. Men dominated the participants group, female the comparison group. The educational level of the participants was far lower in relation with the comparison group and the general population. The comparison group consisted of 234 individuals. Almost all survivors suffered from multiple forms childhood maltreatment, including sexual violence. In relation to the comparison group we found that the survivors were exposed to a higher degree to various forms of violence in the family of origin. Currently and lifetime a higher rate of them suffered from psychological disorders (e.g. PTSD, substance abuse, depression) in relation to the comparison group. For the survivors we found a higher anger reaction, which is of relevance for the development of problems in which anger and aggression are of relevance. Furthermore we found a lower self-efficacy (achieving aims effectively) and a lower self-esteem. This hinders the survivors to believe in themselves and trust in the benefit of their own efforts when aiming to achieve goals, and intensifies psychological disorders. A lot of survivors reported barriers for seeking psychological treatment. These difficulties and barriers were also found in a systematic literature review. The survivors also reported supportive measures when intending to seek out for psychological treatment, e.g. financial support. Within the last years the hormone cortisol (a stress hormone) was identified in hair. A lower dose of cortisol in hair was also given for patients suffering from PTSD. We could not found any relation of experienced violent events, the current mental health and the dose of cortisol in the hair. We consider that the relation is much more complex than expected.