Author's personal copy Poly-Victimization in a National Sample of Children and Youth Heather A. Turner, PhD, David Finkelhor, PhD, Richard Ormrod, PhD Background: Most studies of children’s exposure to violence focus on separate, relatively narrow categories of victimization (such as sexual abuse, physical maltreatment, or bullying), paying less attention to exposure to multiple forms of victimization. Purpose: This study documents children’s lifetime exposure to multiple victimization types (i.e., “poly-victimization”) and examines the association between poly-victimization and extent of trauma symptomatology. Methods: Analyses were based on telephone interviews conducted between January 2008 and May 2008 with a nationally representative sample of 4053 children aged 2–17 years and their caregivers. Results: Exposure to multiple forms of victimization was common. Almost 66% of the sample was exposed to more than one type of victimization, 30% experienced fıve or more types, and 10% experienced 11 or more different forms of victimization in their lifetimes. Poly-victims comprise a substantial portion of the children who would be identifıed by screening for an individual victimization type, such as sexual assault or witnessing parental violence. Poly- victimization is more highly related to trauma symptoms than experiencing repeated victimiza- tions of a single type and explains a large part of the associations between individual forms of victimization and symptom levels. Conclusions: Studies focusing on single forms of victimization are likely to underestimate the full burden of victimization that children experience and to incorrectly specify the risk profıles of victims. Research, clinical practice, and intervention strategies are likely to improve with more comprehen- sive assessments of victimization exposure. (Am J Prev Med 2010;38(3):323–330) © 2010 American Journal of Preventive Medicine Introduction C onsiderable research has documented 1–6 high levels of childhood exposure to abuse, violence, and crime, as well as its damaging physical and mental health consequences. Most of this substantial body of literature focuses on separate, relatively narrow categories of experiences. For example, investigators have documented linkages between psychological disorder and specifıc forms of maltreatment, such as child physical abuse 7,8 and child sexual abuse. 9 –11 Associations between mental health impairments and exposure to neighbor- hood violence, 12,13 peer bullying, 14,15 and witnessing pa- rental violence 16,17 are also well established. In this liter- ature, however, little attention has been paid to the possibility that children may often be exposed to multiple forms of victimization. Yet there is reason to suspect that children who suffer one type of victimization are also likely to experience other types. 18 –20 Focusing on only one or a few types of the large spec- trum of victimizations that children experience has sev- eral important limitations. First, it is likely to substan- tially underestimate the full burden of victimization exposure and the full strength of the relationship between victimization and child mental health. 21 Second, a nar- row focus on specifıc types of victimization can lead to a serious overestimation of the impact of individual victim- ization experiences because outcomes may be related to other victimizations or their co-occurrence rather than individual victimization events. 22 Third, this fragmented approach hampers the identifıcation of the most highly victimized children, who are at greatest risk for serious mental health problems and who may be the most impor- tant targets for intervention. To the extent that such chil- From the Crimes Against Children Research Center, University of New Hampshire, Durham, New Hampshire Address correspondence and reprint requests to: Heather A. Turner, PhD, Crimes Against Children Research Center, University of New Hamp- shire, 126 Horton Social Science Center, 20 Academic Way, Durham NH 03857. E-mail: haturner@cisunix.unh.edu. 0749-3797/00/$17.00 doi: 10.1016/j.amepre.2009.11.012 © 2010 American Journal of Preventive Medicine • Published by Elsevier Inc. Am J Prev Med 2010;38(3)323–330 323 CV195