REGULAR ARTICLE Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents PATRICK J. FOWLER, CAROLYN J. TOMPSETT, JORDAN M. BRACISZEWSKI, ANGELA J. JACQUES-TIURA, AND BORIS B. BALTES Wayne State University Abstract Meta-analytic techniques were used to estimate the effects of exposure to community violence on mental health outcomes across 114 studies. Community violence had its strongest effects on posttraumatic stress disorder (PTSD) and externalizing problems and smallest impact on other internalizing symptoms. Victimization by community violence most predicted symptomatology compared to witnessing or hearing about community violence. Witnessing community violence had a greater effect than hearing about violence on externalizing problems, but both types of exposure had an equal impact on other internalizing problems. PTSD symptoms were equally predicted by victimization, witnessing, or hearing about community violence. Compared to children, adolescents reported a stronger relationship between externalizing behaviors and exposure, whereas children exhibited greater internalizing problems than did adolescents. Community violence plagues American youths living in urban communities. Prevalence esti- mates consistently show that 50% to 96% of children and adolescents who reside in urban areas are exposed to some form of violence in their neighborhoods (Stein, Jaycox, Kataoka, Rhodes, & Vestal, 2003). The majority of youths are confronted with less severe but per- vasive forms of violence on their streets, such as drug deals or robberies, whereas a substantial portion of children and adolescents are exposed to the most extreme forms of neighborhood violence, including witnessing stabbings and shootings or being the victim of such acts (Gor- man-Smith, Henry, & Tolan, 2004). Further- more, youths seem unable to escape from this violence; longitudinal studies indicate that the rates of exposure to violence remain constant across years (Gorman-Smith et al., 2004; Lam- bert, Ialongo, Boyd, & Cooley, 2005; Lynch & Cicchetti, 1998). Researchers have recognized the potential harmful effects of such pervasive exposure to violence and since the late 1980s have pro- duced a vast body of work exploring the poten- tial consequences of community violence on mental health. Reviews of this literature show a significant positive correlation between expo- sure and psychological symptoms, including externalizing symptoms, posttraumatic stress disorder (PTSD), and other internalizing beha- viors (Buka, Stichick, Birdthistle, & Earls, 2001; Gorman-Smith & Tolan, 2003; Lynch, 2003). However, the strength of this relation- ship varies between outcomes as well as Address correspondence and reprint requests to: Patrick J. Fowler, Department of Psychology, Wayne State Uni- versity, Maccabees Building, 7th Floor, 5057 Woodward Avenue, Detroit, MI 48201; E-mail: pfowler@wayne.edu. Development and Psychopathology 21 (2009), 227–259 Copyright # 2009 Cambridge University Press Printed in the United States of America doi:10.1017/S0954579409000145 227