This document discusses childhood emotional abuse and its link to developing depression later in life. It defines emotional abuse and depression, noting that emotional abuse can negatively impact development and is linked to psychological disorders in adulthood. Around 80% of abuse survivors develop mental health issues. The document also explores the effects of emotional abuse, including physical, psychological, and behavioral impacts. Victims are more likely to develop chronic diseases, psychiatric disorders like depression, and engage in risky behaviors. They are also at higher risk of perpetuating the cycle of abuse.

1. Childhood Emotional Abuse and the Development of Depression
Ashley Marks
Christopher Newport University
Social Work Department
December 5, 2014

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The social problem that will be addressed in this research proposal is the development of
depression in adulthood, specifically among individuals with a history of childhood emotional
abuse. In the United States alone, at least four children die daily as a result of child abuse
(ACYF, 2013). In addition, a study showed that about 80% of those who survive the abuse go on
to develop a psychological disorder in adulthood (Giaconia, Reinherz, & Silverman, 1996). In
2012, childhood emotional abuse, or “psychological maltreatment,” made up 8.5% of abuse
victims, with some victims experiencing additional types of abuse, such as neglect or physical
abuse (USDHHS, 2013). Child abuse does not occur only to a specific population; child abuse
may affect children of all different backgrounds, socioeconomic statuses, religions, genders, and
ethnicities. Childhood abuse is not a new problem. In 1974, the Child Abuse Prevention and
Treatment Act (CAPTA) was signed by President Nixon as the first federal legislation to protect
children as well as the first real response to the issue of child abuse and neglect in the United
States (USDHHS, 2014). Since then, many more steps have been taken to spread awareness of
the problem and find ways to protect children from facing abuse.
According to the Children’s Bureau (2013), the characteristics of a child that puts them at
risk for abuse are: “intellectual disability, emotional disturbance, visual or hearing impairment,
learning disability, physical disability, behavioral problems, or another medical problem” (p. 21).
Additionally, the Children’s Bureau (2013) has data implying that the characteristics of
caregivers at risk for abusing are: “alcohol abuse, drug abuse, and [being the perpetrator or
victim of] domestic violence” (p. 21). Statistics also show that relationship to the victim plays a
role. The Children’s Bureau (2013) reports that in 2012, 81.5% of victims were abuse by their
own parent(s) and the majority of nonparent abusers were male relatives (p. 21-22). There also
risk factors that may help predict how abuse impacts a child according to the Child Welfare

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Information Gateway (2013) such as child’s age and developmental status during abuse, the type
of abuse, the frequency and severity of the abuse, and the relationship between the victim and
perpetrator of abuse.
Child abuse is a significant problem in that it has long-term impacts on not only the
victim of abuse, but also families and society as a whole. Some of the long-term consequences of
abuse on the victim may include physical health problems such as impaired brain development
and poor physical health, psychological problems such as poor mental and emotional health and
cognitive difficulties, and behavioral problems such as juvenile and adult delinquency and
alcohol and drug abuse (Child Welfare Information Gateway, 2013). The mental and emotional
health issues that child abuse may lead to include: borderline personality disorder, depression,
and anxiety (Felitti & Anda, 2009). The main long-term consequence of childhood abuse on
families is the statistical fact that those who were abused as children are likely to go on to abuse
their own children as well as being more likely to engage in interpersonal violent acts
(Xiangming & Corso, 2007).
Childhood abuse has an impact on the country as whole as well with the lifetime cost of
child maltreatment and related fatalities costing an estimated $124 billion in just one year (CDC,
2012). There are also indirect costs of child abuse on society according to the Child Welfare
Information Gateway (2013) such as “increase use of [the] health-care system, juvenile and adult
criminal activity, mental illness, substance abuse, and domestic violence” (p. 6).
A theoretical rationale that could be used to explain the cause of the problem is Erik
Erikson’s Stages of Psychosocial Development (Erikson, Paul, Heider, & Gardner, 1959). The
reason for this being a good theoretical framework is that one of the main factors in how child
abuse affects a child is how old the child was during the time of abuse. This implies that where

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the child is in terms of psychosocial stages of development may provide evidence as to whether
or not they develop issues such as depression. According to Erikson et al.(1959), each stage
presents a crisis. Events such as childhood abuse could lead the child to “lose” the crisis, thus
potentially leading to more problems with the child’s psychosocial development as they get
older.
The research question for this study is: Does being emotionally abused as a child affect
the likelihood of developing depression?
Literature Review
Child Emotional Abuse Defined
The American Humane Association (n.d.) defines emotional child abuse, or
psychological maltreatment, as a reoccurring behavior of a caregiver or parent that has a severe
impact on the development of a child cognitively, emotionally, psychologically, or socially.
Emotional child abuse encompasses many actions: verbally assaulting, ignoring, rejecting,
isolating, exploiting or corrupting, terrorizing, and overall neglecting the child. Some childhood
emotional abuse also crosses into other areas of abuse, such as physical or sexual abuse. The
most common form of psychological maltreatment is verbal assault, which involves “constantly
belittling, shaming, ridiculing, or verbally threatening the child” (AHA, n.d.). Ignoring the child
involves psychological and/or physical aspects and may include not acknowledging or
responding to the child (AHA, n.d.). When a caregiver or parents consciously chooses not to
respond to a child’s needs, it is considered rejecting the child (AHA, n.d.). Isolating the child
may include denying the child the ability to have normal social interactions with others,
including family members and peers, as well as confining the movement of that child to seclude
them (AHA, n.d.). Exploitation and corruption of the child occur when the parents or caregivers

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teach, encourage, or force the child to engage in illegal or inappropriate acts such as larceny or
prostitution (AHA, n.d.). Terrorizing a child creates a sense of fear in the child, such as placing
the child or the child’s loved one in a precarious situation or placing “unrealistic expectations on
the child with threats of harm if they are not met” (AHA, n.d.). The last type of emotional abuse
is neglecting the child, which may become physical abuse and includes denying or ignoring a
child’s emotional, mental health, or medical needs (AHA, n.d.).
Child abuse often goes unreported, but statistics show that about 14% of children in the
United States suffered from reported abuse in 2012 (USDHHS, 2013). Doctors Hibbard, Barlow,
MacMillan, the Committee on Child Abuse and Neglect, the American Academy of Child and
Adolescent Psychiatry, and the child Maltreatment and Violence Committee (2012) collected
studies in the United Kingdom and United States that have found that around 8% of women and
4% of men reported enduring psychological maltreatment during childhood. A troubling aspect
of abuse is the lack of predictability as it has the potential to occur in any family, regardless of
background (AHA, n.d.). Some common causes include parental stress, poor parenting skills,
social isolation, lack of available resources, and inappropriate expectations of children (AHA,
n.d.). There is also evidence showing that being abused as a child increases the likelihood of
becoming an abuser (AHA, n.d.).
Depression Defined
The Diagnostic and Statistical Manual of Mental Disorders (2013) 5th
edition defines
depression, or major depressive disorder, as a medical illness that impacts how a person feels,
thinks, and behaves. Depression causes long-lasting feelings of sadness and loss of interest in
previously enjoyed activities (DSM-V, 2013). It also has the potential to cause emotional and
physical problems and is usually a chronic illness that requires long-term treatment (DSM-V,

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2013). The DSM-V (2013) lists the main symptoms that lead to the diagnosis of depression:
despondent mood, a decrease in interest in previously enjoyed activities, changes in sleep,
reduced energy levels, difficulty concentrating or holding a conversation, trouble making
decisions on simple matters, and suicidal thoughts or actions. The DSM-V (2013) includes the
same diagnostic criteria, however, it also includes criteria for someone going through
bereavement. A patient meeting the diagnostic criteria of the DSM-V (2013) allows a physician
to diagnose that patient with depression. The National Institute of Mental Health states that one
of the most common mental disorders in the United States is major depressive disorder (NIMH,
n.d.). In 2012, a study conducted by the National Survey on Drug Use and Health (Substance
Abuse and Mental Health Services Administration, 2013) found that around 16 million people
above the age of 18, 6.9% of all U.S. adults, had a least one major depressive episode during that
year. The Centers for Disease Control and Prevention found that an estimated 1 out of every 10
U.S. adults report having depression (CDC, 2011).
There are different forms of depression as well, such as major depression, persistent
depressive disorder, psychotic depression, postpartum depression, seasonal affective disorder,
and bipolar disorder (NIMH, n.d.). Major depression is characterized by symptoms that are so
severe that they interfere with a person’s ability to work, sleep, study, eat, and live an enjoyable
life (NIMH, n.d.). An episode of major depression may only occur once, but it is more likely that
a person has several episodes throughout their life (NIMH, n.d.). Persistent depressive disorder
occurs when a person has a depressed mood that lasts for two or more years and may accompany
episodes of major depression (NIMH, n.d.). Psychotic depression occurs in people with severe
depression in addition to some form of psychosis (NIMH, n.d.). It may include delusions and
hallucinations (NIMH, n.d.). After giving birth, a woman may experience postpartum depression

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(NIMH, n.d.). This occurs in around 10 to 15% of women after giving birth and is a result of the
overwhelming responsibilities and changes that occur after birth (NIMH, n.d.). Seasonal
affective disorder is a form of depression that develops during the winter months and generally
goes away during spring and summer (NIMH, n.d.). Bipolar disorder, or manic-depressive
illness, is less common than major depression or persistent depressive disorder (NIMH, n.d.). It
involves mood changes from extreme highs (manias) to extreme lows (depression) (NIMH, n.d.).
This study will look at major depressive disorder, persistent depressive disorder, and psychotic
depression. It will focus on people above the age of 18 as the onset of depressive symptoms
typically occurs during a person’s mid-20s (AMN, n.d.).
Treatments for depression include medication, psychotherapy, electroconvulsive therapy
and other brain stimulation therapies (NIMH, n.d.). Antidepressants are a form of treatment for
depression that involves medication that impacts neurotransmitters such as serotonin,
norepinephrine, and dopamine (NIMH, n.d.). Types of psychotherapy treatments include
cognitive-behavioral therapy and interpersonal therapy (NIMH, n.d.). Cognitive-behavioral
therapy involves restructuring negative thought patterns to help people view life in a more
positive or realistic way (NIMH, n.d.). Interpersonal therapy helps people by working through
relationships that cause or worsen their depression (NIMH, n.d.). Psychotherapy alone may not
treat more severe forms of depression (NIMH, n.d.). Electroconvulsive therapy, formerly known
as shock therapy, is a last result when other treatment forms do not work and involves electrical
impulses on the brain while a patient is under anesthesia (NIMH, n.d.). There are also more
recent forms of brain simulation therapies such as vagus nerve stimulation and repetitive
transcranial magnetic stimulation; however, they are not commonly used (NIMH, n.d.).

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Effects of Child Emotional Abuse
Child emotional abuse has many detrimental impacts on not only the victim of the abuse,
but also the family of the abuser and the country as a whole. According to Hibbard et al. (2012),
psychological maltreatment hinders a child’s development and has been linked to attachment and
developmental disorders, educational and socialization problems, and disruptive behavior. It may
also have lifelong physical impacts on them. As an example, maltreatment that occurs during
infancy or early childhood has the potential to disrupt the formation and functionality of certain
regions of the brain (ACYF, 2001). This has long-term consequences on cognitive, language, and
socio-emotional development, as well as the mental health of the child (ACYF, 2001). Child
emotional abuse also increases the risk for the development of certain chronic diseases later in
life such as heart disease, cancer, chronic lung disease, liver disease, obesity, high blood
pressure, high cholesterol, and high levels of c-reactive protein (Felitti et al., 1998; Danese et al.,
2009).
There are also psychological impacts from child emotional abuse. One study found that
80% of young adults who had been victims of abuse as children met the criteria necessary to be
diagnosed with at least one psychiatric disorder by the time they were 21, including problems
such as depression, anxiety, eating disorders, and suicide attempts (Silverman et al., 1996). The
stress of reoccurring abuse also leaves the child more vulnerable to developing problems like
post-traumatic stress disorder, conduct disorder, and learning, attention, and memory difficulties
(Dalam, 2001; Perry, 2001).
The last type of impact that psychological maltreatment may have on a child is
behavioral. Evidence suggests that victims of child emotional abuse have an increased chance of
smoking, alcoholism, and drug abuse as adults, as well as engaging in reckless sexual behaviors

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(Felitti et al., 1998; Runvan et al., 2002). In addition, victims are also an estimated 25% more
likely to experience problems such as delinquency, teen pregnancy, and trouble academically
(Kelly et al., 1997).
Abuse has many impacts on those with relations to the victim and the family of the victim
later on if he or she chooses to start a family of his or her own. As mentioned previously, a risk
factor in becoming an abuser is being abused (AHA, n.d.). This means that when an abuser starts
a family, there is an increased chance that he or she will go on to abuse his or her children as
well (AHA, n.d.). This perpetuates a cycle of abuse where the abused becomes the abuser. As
previously mentioned, psychological maltreatment has many deleterious impacts on the
psychological and behavioral well being of the victim. Some of these, such as disorders of
attachment, socialization problems, and anxiety, may make it hard for the victim and those close
to the victim to have close and enduring relationships (Eng, Heimberg, Hart, Schneier, &
Liebowitz, 2001). This is especially true for those wishing to be intimate with the victim as the
lifelong consequences of the abuse will likely play a large role in the dynamic and success of the
relationship.
All of these negative consequences from child emotional abuse have economic costs as
well. Child abuse costs the country billions of dollars each year. In 2008 alone, a reported $124
billion was spent by the U.S. to combat impacts of abuse such as improper brain development,
impaired cognitive and socio-emotional abilities, lower language development, blindness,
cerebral palsy from head trauma, higher risk for heart, lung, and liver diseases, obesity, cancer,
high blood pressure and cholesterol, anxiety, smoking, alcoholism, and drug abuse (Fang et al.,
2012). The costs include child health care costs, adult medical costs, productivity losses, child
welfare costs, criminal justice costs, and special education costs (Dallam, 2001).

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Factors Affecting the Development of Depression
Depression, or major depressive disorder, is a mood disorder that is influenced by both
biological and environmental factors. The Diagnostic and Statistical Manual of Mental Disorders
V (2013) states that depression is highly affected by situational factors such as “lack of a support
system, stress, illness in self or loved one, legal difficulties, financial struggles, and job
problems.” There are many different factors that play a role in the development of depression.
According to the National Alliance on Mental Illness, life experiences, genetics, age, sex, brain
chemistry imbalance, hormone changes, substance abuse, and other illnesses are all factors in a
person’s life that are involved in the development of depression (NAMI, n.d.). The NAMI also
states that a record of sleeping problems, medical illness, chronic pain, anxiety, attention-deficit
hyperactivity disorder, and alcoholism or drug use are important elements (NAMI, n.d.). There
is also a genetic link since the occurrence of any mood disorder tends to run in families (NAMI,
n.d.). However, the biologically inherited tendency to develop depression is only a factor in those
who develop depression early on; those developing depression for the first time after age 60 are
less likely to be impacted by any genetic predisposition (NAMI, n.d.).
Life factors and events have a large influence into whether or not someone with a genetic
susceptibility to develop depression will ever have an episode of major depressive disorder.
Evidence shows that traumatic life events may alter brain functions for years, with traumatic
events occurring in early-life causing long-term changes in the brain’s response to fears and
stresses (Perry, 2001). Life factors can also act as a buffer to the development of depression, with
studies showing that a support system and higher self-esteem can have a huge impact on whether
or not someone develops depression (Hill et al., 2010).

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Theory: Erikson’s Stages of Psychosocial Development
Erik Erikson’s stages of psychosocial development (Erikson, Paul, Heider, & Gardner,
1959) may help in describing how childhood emotional abuse affects the development of
depression later in life. Erikson’s 8 stages go from birth to death and discuss the crises that
people go through at each stage of development. In previous sections it was discussed that the
age of abuse impacts the effects of the abuse on a person. The first 4 stages are most relevant to
the relationship between childhood emotional abuse and the development of depression. The first
stage, basic trust versus mistrust, occurs during the first two years of life. During this stage of
life, the infant is fully dependent on his or her parents for sustenance and comfort. Trust occurs
when the child is exposed to “warmth, regularity, and dependable affection” (Bee et al., 2009). If
the parents do not provide security for the child and meet his or her basic needs, mistrust occurs
(Bee et al., 2009). In cases of abuse, the child learns mistrust, leading to the child’s
understanding of the world as an undependable and possibly dangerous place (Bee et al., 2009).
The second stage is autonomy versus shame and doubt and occurs when the child is
between the ages of 2 and 4. Autonomy occurs when the caregiver encourages the child to be
more independent. However, in cases where autonomy is not allowed or too much autonomy is
expected to early, shame and doubt occur. These are characteristic of emotional abuse through
isolation and terrorism (AHA, n.d.).
The third stage, initiative versus guilt, occurs between the ages of 4 and 5. Initiative is a
child’s desire to begin and complete actions, whereas guilt is a new feeling for children that is
often felt after a failed attempt at taking initiative. If a caregiver discourages or ignores a child
during this stage, a child may feel guilty concerning their needs or desires (Cherry, n.d.). This
type of behavior towards children often occurs during cases of emotional abuse where the parent

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is verbally assaulting or ignoring their child (AHA, n.d.).
Industry versus inferiority is the fourth stage and occurs when the child is between 5 and
12 years old. This is the stage where children discover their own talents and interests. If a child is
prevented from being able to discover their talents and identity, lack of motivation, low self-
esteem, and lethargy may occur (Allen et al., 2003). Many types of emotional abuse could result
in a child feeling unable to find their own identity, such as verbal assault, isolation, and terrorism
(AHA, n.d.). Depending on when a child endures abuse, Erikson’s stages of psychosocial
development may explain why they developed the disorder they did, such as depression.
The Link Between Child Emotional Abuse and Depression
Various studies have been done on the impacts of child abuse. Two in particular have
found a link between abuse and victimization during childhood and the development of a mental
illness like depression. A study conducted by Hill, Kaplan, French, and Johnson (2010) looked at
the impacts of victimization during the early years of life on mental health in adulthood. In the
study, a group of 2,402 women who were living in low-income neighborhoods in Boston,
Chicago, and San Antonio were examined. These women were also previously interviewed about
their experience with abuse in 1999 and the study focused on those who were above the age of
19 during the original interview. The study aimed to determine whether victimization before age
18 had any impact on psychological distress in adulthood. The psychological resources available
during childhood were additionally looked at to determine if factors such as emotional support
impacted psychological distress. This study yielded evidence that emotional support and self-
esteem act as buffers to the effects that abuse has on a person. It was also able to draw a link
between child abuse and the development of depression in adulthood.
Another study by Herrenkohl, T., Hong, Herrenkohl, R., and Russo (2013) found

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connections between child abuse and neglect and adult mental health, substance use, and
physical health. It was a longitudinal study starting in 1973 on victims of reported abuse. The
ages of the victims during the original study ranged from 18 months to 6 years of age and
involved 457 children total. The researchers interviewed the participants in their mid-30s to
determine the impacts of their childhood abuse. The study found that adults who reportedly
suffered from maltreatment during their childhood also reported more symptoms of depression,
anxiety, and other impairments related to mental and physical health problems as adults. The
study results also suggested that those who suffered from abuse when they were children were
more likely to develop lifetime alcohol problems and were at a greater risk for substance abuse.
The study specifically linked child maltreatment and abuse to adult depression and found that
there were twice as many cases of depression in participants that were abused when compared to
statistics of depression for those who did not experience a form of abuse.
Uniqueness of Study
As previously discussed, Perry (2001) found that life events had a large impact on
whether or not someone would develop depression. This, along with the studies cited above, may
provide insight into why there are more incidences of major depressive episodes in people who
have a history of childhood trauma, such as abuse. The studies show how life factors can also act
as a buffer to the development of depression, with studies showing that a support system and
higher self-esteem can have a huge impact on whether or not someone develops depression (Hill
et al., 2010). A study focusing solely on the impacts of childhood emotional abuse on the
development of depression may be able to build on the information derived from previous
studies. It would differ from other studies involving forms of abuse due to the focus on solely
emotional abuse and its effects. Other studies study abuse as a whole or focus mainly on physical

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or sexual abuse. The study could potentially yield information on what type of emotional abuse
is most damaging, how emotional abuse impacts children differently than other types of abuse,
and what impacts age has on the development of depression in victims of abuse. While studies
have been done to draw some conclusions linking depression to childhood abuse, this study
could give more detailed information and provide data that could be useful in the prevention of
depression and other psychological disorders in victims of childhood emotional abuse. It could
also provide evidence that reinforces the link between the development of depression and
childhood emotional abuse that could impact interventions in the future concerning children in
abusive homes.
Conclusion
This study will look to determine if being emotionally abused as a child affects the
likelihood of the development of depression later in life. The hypothesis is that enduring
emotional childhood abuse will increase the chances of developing depression during
adolescence and adult years.
Method
Design
This study will quantitatively research the effects of childhood emotional abuse on the
development of depression. It will be exploratory and descriptive in that it will focus on gaining
information on the variables and how they are related. This study will be done using a cross-
sectional research design. While a longitudinal approach may provide more detailed information,
it would be difficult to develop a research design that could ethically study children before being
abused. The study is cross-sectional in that it will be completed at one point in time, although
questions about the participants’ past will be included.

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This study will be quasi-experimental and will be a posttest-only nonequivalent
comparison group design. It will be quasi-experimental because it will not have random
assignment to an experimental and control group, as it is not feasible to obtain a control group. It
will consist of two groups, an experimental group and a comparison group, and a posttest. The
experimental group will contain the participants who were emotionally abused during childhood
and the comparison group will consist of the participants who were not. Both groups will be
from the same sampling frame.
Each research design has strengths and threats to validity. Quasi-experimental designs
tend to have better internal validity when compared to pre-experimental designs, as they involve
a comparison group. The posttest-only nonequivalent comparison group design avoids the testing
and retesting bias because it does not have a pretest. Another strength of this design is the
comparison group as it helps in providing data to compare the results of the experimental group
to, which may help in deriving a correlation between the independent variable and the dependent
variable. One of the threats to validity that will occur with my design is selection bias. As
Experimental
group:
Victims
of
emotional
child
abuse
N=500
Comparison
group:
People
who
have
not
experienced
abuse
N=500
Posttest
for
Depression
Posttest
for
Depression

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aforementioned, selection bias will occur partly because it is not possible to randomly select
participants for each group. Additionally, selection bias will occur because the experimental
group of those who were emotionally abused during childhood will consist only of those who
accurately remember their trauma and are willing to be honest about their experiences and
participate in the research study. Maturation bias is another threat to validity of this research
design because there is no pretest. This threat involves the changes that the participants naturally
go through, which make it difficult to determine whether the results are due to the independent
variable or time. The last threat to internal validity of this design is the history bias. The history
bias involves events that occur that impact the participants’ lives and may affect the dependent
variable. Similar to the maturation bias, these extraneous factors cause problems in knowing
whether the results of the study are due to the independent variable or events that occurred in the
past. Correlation does not imply causation, which means that this research study will solely aim
to find a significant relationship between the two variables and will not be able to prove that the
independent variable always leads to the dependent variable.
Participants
This study will represent the population of social workers. The sample will be large with
1000 participants total—500 in each group. It will use stratified sampling, which is a type of
probability sampling. The participants will be selected from a sampling frame, the list of
members of the National Association of Social Workers (NASW), which has over 130,000
members. Using this particular sampling frame limits the generalizability of the study as the
results can only be successfully applied to the population of social workers, not to all victims of
childhood emotional abuse. The participants will be stratified using a preliminary screening
assessment to determine whether or not they had been emotionally abused as children. Out of

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those who indicate they have been emotionally abused, 500 participants will be randomly
selected and placed into the experimental group. The comparison group will consist of another
randomly selected 500 participants who indicated they had not been abused as children (see
Appendix A). To reduce results due to extraneous factors, the participants who indicate they
have been physically or sexually abused will not be included in the study. Using a probability
sampling technique, stratified sampling, will help the data be more useful as it will prevent some
sampling bias and allow the results to be more generalizable to the population of social workers.
Measures
Background Measures. The measure being used to collect data in this research study is an
online survey. Participants will take the survey at one point in time, as is indicated by the cross-
sectional research design. The survey will have multiple parts that will include original questions
and questions from scales that have been used for screening in research in the past. There will
also be some demographic questions to gain general information on the participants such as age,
gender, race, socioeconomic status, marital status, and employment (See Appendix B). These
questions may also help to determine if any other factors are impacting the dependent variable.
Measure of the Independent Variable. The independent variable being researched in this
study is the occurrence of emotional abuse during childhood. Participants of the study will
answer questions pertaining to all abuse to determine if their results will be useful for the study.
The questions will ask about type of abuse, as well as specifically what type of emotional abuse
the participants felt they experienced, if any. There will also be questions to determine the
severity, frequency, and duration of the abuse, in addition to how many people they feel were
abusive to them. Questions from two different assessment scales will be used to measure the
independent variable. Questions from the Family Health History Questionnaire (FHHQ)

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surrounding childhood abuse from the Adverse Childhood Experiences (ACE) Study done by
Felitti and Anda (1997) of the Centers for Disease Control and Prevention will be used (See
Appendix C). The ACE Study questionnaire has separate versions for males and females, as
some questions are not applicable to both genders, but only gender-neutral questions will be
included. There are questions on the scale about demographics, physical abuse, emotional abuse,
sexual abuse, and life events. Most of the questions on the FHHQ focus on gaining information
on what the participant has experienced during the first 18 years of life. For example, one
question asks about how often the participant believes a parent, step-parent, or other adult living
with them while they were under 18 swore at the participant, insulted them, or put them down.
The answers are on a 5-point scale with 1 meaning never and 5 meaning very often. Questions
from the Childhood Maltreatment Interview Schedule Short Form (CMIS-SF) created and used
by Briere (1992) will be used as well (See Appendix D). The first seven questions of the scale
are considered to be part of the Psychological Abuse subscale and look into psychological
maltreatment prior to the age of 18. For example, multiple questions ask the participant how
much they feel various members of their family cared about them. Many of these questions are
on a 4-point scale with 1 meaning not at all and 4 meaning very much. Other questions are more
closed-ended with yes or no answers. Questions surrounding other forms of abuse are included
in the scale as well, such as if they were sexually abused or physically abused, the frequencies of
the abuse, and who the perpetrator was. While there are not studies regarding the overall
reliability and validity of the CMIS-SF, data from the Psychological Abuse subscale (Briere &
Runtz, 1988, 1990) suggests good alpha reliability.
Measure of the Dependent Variable. The dependent variable in this research study is the
development of depression. The variable will be measured using two depression screening

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scales. Questions from the Beck Depression Inventory-Second Edition (BDI-II) created by Beck,
Steer, and Brown (1996) will be used to measure depression (See Appendix E). This is a 21-item
scale that can be completed by the participants and was created to assess the prevalence and
severity of depressive symptoms. The scale includes questions about changes in weight, interest
in activities, feelings of guilt or hopelessness, and irritability and was revised from the original
inventory to meet the DSM-IV criteria. The scale is scored using numbers 0 to 3 to indicate the
severity of symptoms with 0 indicating no depressive symptoms and 3 indicating the most severe
depressive symptoms. The scores for each question are added up to determine how severe the
participant’s depression is or if they are depressed at all. The scale has been used among a
variety of different groups and has proven to have good reliability and validity. One study by
Kuhner, Burger, Keller, and Hautzinger (2007) found that the BDI-II had an alpha internal
consistency score of 0.84 and a retest reliability score of 0.75. Questions from the Zung Self-
Rating Depression Scale (ZSDS) created by Zung (1965) will be used as well (See Appendix F).
This scale looks into all of the symptoms of depression as well. For example, there are questions
about decision making abilities, hopefulness, and sleeping. It uses a 4-point scale with 1 meaning
the participant feels or acts a certain way a little of the time and 4 meaning they feel or act a
certain way most of the time. Scoring is done by adding up all of the responses using the scoring
key, with most people with depression scoring between 50 and 69. DeJonghe and Baneke (1989)
and Leung, Lue, Lee, and Tang (1989) found that the scale had an alpha reliability score of 0.82.
Measure of the Moderating Variable. The moderating variable in this study is undergoing
other forms of abuse in childhood, such as physical and sexual abuse, in addition or instead of
emotional abuse. Other forms of abuse will have an impact on a person as well, so having that as
a moderating variable is important to ensure that the data on the dependent variable is related to

20. CHILDHOOD
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emotional abuse during childhood. The studies mentioned previously, the FHHQ and the CMIS-
SF include questions about the other forms of abuse. Both of these scales will help determine if
the participant has endured other forms of abuse and if they have experienced emotional abuse
during childhood. If they have experienced other forms of abuse in addition to or instead of
emotional abuse, their responses will not be included in the data. This is to draw a stronger
correlation between the independent and dependent variable and help with the validity of the
study.
Procedures
To begin conducting this research, the Christopher Newport University Institutional
Review Board and the National Association of Social Workers must approve the study. The
NASW must approve the study because the sampling frame will be the members of the NASW.
Once the research study has been approved, the researchers will find participants through
emailing members of the NASW with a link to the assessment. Student members will not be
included in the study. The assessment will begin with questions to indicate whether or not the
participant has been emotionally abused and if they have experienced any other forms of abuse.
Out of the participants that indicate they have been only emotionally abused, 500 will be
randomly selected to be in the experimental group. This means the participants will be selected
based on stratified sampling with emotional abuse being the condition that needs to be met to be
included in the experimental group. Out of the participants who indicate that they have not
experienced any forms of abuse, 500 will be randomly selected to be in the comparison group.
After the two groups have been composed, each participant will be emailed a link for the
study. In addition to the link, the participants will be given a contact number for the researchers
as well as the numbers of some 24/7 free counseling hotlines, such as the National Victim Center

21. CHILDHOOD
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hotline. Upon opening the link, each participant will be given an informed consent form giving
the participant general information on the study. Once the participant has read and signed the
informed consent form, they will be able to proceed to the survey portion of the study. As the
participants are completing the survey, if they have any questions they will be able to call the
contact number given on the email. This is to ensure that each participant understands the
questions given and what they are supposed to do to make sure that the results are as accurate as
possible. The survey will be given with the demographics section first, and then questions from
the Family Health History Questionnaire, the Childhood Maltreatment Interview Schedule Short
Form, the Beck Depression Inventory-Second Edition, and lastly the Zung Self-Rating
Depression Scale. After the participants are done with the survey, the result will be sent directly
to the researchers and then it will be evaluated and interpreted.
Upon completion of the survey, each participant will receive an email containing a letter
thanking him or her for his or her participation. To encourage members of the NASW to
participate, 5 of the participants will be randomly selected to receive a twenty-five dollar Visa
gift card.
Implications
This study has many potential implications for social workers. The results of this study
will yield information about the specific outcomes of childhood emotional abuse that could help
a social worker in understanding how the abuse has impacted the child. This could help a social
worker better choose an intervention based on the knowledge of the abuse and the ways that the
abuse could continue to impact the child throughout life. As aforementioned, being a victim of
abuse increases the likelihood of becoming an abuser (Xiangming & Corso, 2007). A social
worker working at a micro level with a client could use this information, as well as the screening

22. CHILDHOOD
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tools used in this study, to prevent a victim of abuse from becoming a perpetrator. Lastly, on a
micro level a social worker would be able to see the warning signs that may indicate that a child
or teenager has been emotionally abused during their childhood through using the screening tools
and choose an intervention based on the results of this study showing the correlation between
childhood emotional abuse and the development of depression. Detecting abuse as early on as
possible can help in stopping the abuse early on and preventing or reducing the severity of the
impacts the childhood abuse has on the victim.

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and adolescent abuse: a longitudinal community study. Child Abuse and Neglect 20(8),
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Appendix A
Participant’s Graphic
N=1000
NASW
N=130,000+
Indicated
they
were
(only)
emotionally
abused
N=(?)
Indicated
they
were
not
abused
N=(?)
Random
Selection
N=500
Random
Selection
N=500

29. CHILDHOOD
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Appendix B
Demographics Portion of Survey (Original)
Please mark the answer that best describes you or fill in the space provided when applicable.
1. What is your age? ____________
2. Please indicate your gender:
_______ Male
_______ Female
_______ Other (Please Specify: _______________________)
3. Please indicate your race/ethnicity:
_______ White
_______ Hispanic or Latino
_______ Black or African American
_______ Native American or American Indian
_______ Asian or Pacific Islander
_______ Multiracial
_______ Other (Please Specify: _______________________)
4. Please indicate your marital status:
_______ Single
_______ Married
_______ Domestic Partnership
_______ Widowed
_______ Divorced
_______ Separated

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5. Please indicate your employment status:
_______ Employed
_______ Self-employed
_______ Unemployed, looking for work
_______ Unemployed, not currently looking for work
_______ Student
_______ Retired
_______ Unable to work
_______ Other (Please Specify: _______________________)
6. Please indicate what you believe your socioeconomic status is:
_______ Low Socioeconomic status
_______ Middle Socioeconomic status
_______ High Socioeconomic status

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Appendix C
Family Health History Questionnaire (FHHQ)
Disclaimer: This Appendix includes only the gender-neutral questions from the scale related to
emotional abuse.
Question
Number
Verbatim Question Response
Categories and
Comments
While you were growing up, during your first 18 years of
life, how true were each of the following statements?
43 You didn’t have enough to eat? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
44 You knew there was someone to take care of you and protect
you?
1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
45 People in your family called you things like “lazy” or
“ugly”?
1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
46 Your parents were too drunk or high to take care of the
family?
1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
47 There was someone in your family who helped you feel
important or special?
1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true

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9=multiple
responses
48 You had to wear dirty clothes? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
49 You felt loved? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
50 You thought your parents wished you had never been born? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
51 People in your family looked out for each other? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
52 You felt that someone in your family hated you? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
53 People in your family said hurtful or insulting things to you? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
54 People in your family felt close to each other? 1=never true
2=rarely true

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3=sometimes true
4=often true
5=very often true
9=multiple
responses
55 You believe that you were emotionally abused? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
56 There was someone to take you to the doctor if you needed
it?
1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
57 Your family was a source of strength and support? 1=never true
2=rarely true
3=sometimes true
4=often true
5=very often true
9=multiple
responses
Sometimes parents or other adults hurt children. While you
were growing up, that is, during your first 18 years of life,
how often did a parents, step-parent, or adult living in your
home:
58a Swear at you, insult you, or put you down? 1=never
2=once, twice
3=sometimes
4=often
5=very often
9=multiple
responses
58b Threaten to hit you or throw something at you, but didn’t do
it?
1=never
2=once, twice
3=sometimes
4=often
5=very often
9=multiple
responses
58e Act in a way that made you afraid that you might be
physically hurt?
1=never
2=once, twice

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3=sometimes
4=often
5=very often
9=multiple
responses

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Appendix D
Childhood Maltreatment Interview Schedule Short Form (CMIS-SF)
Age _____
Sex: Male ___ Female ___
Race: Caucasian/White ___ Black ___ Asian ___ Hispanic ___
Other ___
Are you currently receiving psychotherapy or psychiatric treatment?
Yes ___ No ___
The following survey asks about things that may have happened to
you in the past. Please answer all of the questions that you can,
as honestly as possible.
11) Before age 17, did any parent, step-parent, or foster-parent
ever have problems with drugs or alcohol that lead to medical
problems, divorce or separation, being fired from work, or being
arrested for intoxication in public or while driving?
Yes__ No__ If yes, who? __________________________
About how old were you when it started? ___ years old
About how old were you when it stopped? ___ years old
[Check here if it hasn’t stopped yet __]
2) Before age 17, did you ever see one of your parents hit or beat
up your other parent?
Yes ___ No ___
If yes, how many time can you recall this happening?
____ times
Did your father ever hit your mother? Yes ___ No ___
Did your mother ever hit your father? Yes ___ No ___
Did one or more of these times result in someone
needing medical care or the police being called?
Yes ___ No ___
3) On average, before age 8, how much did you feel that your
father/step-father/foster-father loved and cared about you?
Not at all Very much
1 2 3 4
4) On average, before age 8, how much did you feel that your
mother/step-mother/foster-mother loved and cared about you?
Not at all Very much
1 2 3 4
5) On average, from age 8 through age 16, how much did you feel
that your father/step-father/foster-father loved and cared about
you?
Not at all Very much
1 2 3 4
6) On average, from age 8 through age 16, how much did you feel
that your mother/step-mother/foster-mother loved and cared about

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you?
Not at all Very much
1 2 3 4
7) When you were 16 or younger, how often did the following happen
to you in the average year? Answer for your parents or stepparents
or fosterparents or other adult in charge of you as a child:
once twice 3-5 6-10 11-20 over 20
a a times times times times
never year year a year a year a year a year
0 1 2 3 4 5 6
A) Yell at you 0 1 2 3 4 5 6
B) Insult you 0 1 2 3 4 5 6
C) Criticize you 0 1 2 3 4 5 6
D) Try to make 0 1 2 3 4 5 6
you feel guilty
E) Ridicule or 0 1 2 3 4 5 6
humiliate you
F) Embarrass you 0 1 2 3 4 5 6
in front of others
G) Make you feel 0 1 2 3 4 5 6
like you were
a bad person
8) Before age 17, did a parent, step-parent, foster-parent, or
other adult in charge of you as a child ever do something to you on
purpose (for example, hit or punch or cut you, or push you down)
that made you bleed or gave you bruises or scratches, or that broke
bones or teeth?
Yes__ No__ If yes, who did this? ______________________
How often before age 17? ____ times
How old were you the first time? ___ years
How old were you the last time (before age 17)? ___ years
Were you ever hurt you so badly that you had to see a
doctor or go to the hospital?
Yes__ No__
9. Before you were age 17, did anyone ever kiss you in a sexual way,
or touch your body in a sexual way, or make you touch their
sexual parts?
Yes__ No__
Did this ever happen with a family member?
Yes__ No__ If yes, with who? ___________________________
At what ages? ___________)
Did this ever happen with someone 5 or more years
older than you were?
Yes__ No__
If yes, with who (check all that apply):
___ A friend (at what ages? __________)

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___ A stranger (at what ages? __________)
___ A family member (who? __________________)
(At what ages? _________)
___ A teacher, doctor, or other professional
(who? __________________)
(At what ages? ___________)
___ A babysitter or nanny (At what ages? ___________)
___ Someone else not mentioned above
(who? _______________________________)
(at what ages? _______________)
Did anyone ever use physical force on any of these
occasions?
Yes__ No__ If yes, who? _____________
Overall, about how many times were you kissed or touched in a
sexual way or made to touch someone else’s sexual parts by someone
five or more years older before age 17?
____ times
Overall, how many people (five or more years older than you)
did this?
___ people
10) Before you were age 17, did anyone ever have oral, anal, or
vaginal intercourse with you, or insert a finger or object in your
anus or vagina?
Yes__ No__
Did this ever happen with a family member?
Yes__ No__ If yes, with who? _____________________________
At what ages? ___________)
Did this ever happen with someone 5 or more years
older than you were?
Yes__ No__
If yes, with who (check all that apply):
___ A friend (at what ages? __________)
___ A stranger (at what ages? __________)
___ A family member (who? __________________)
(At what ages? ___________)
___ A teacher, doctor, or other professional (who? __________________)
(At what ages? ___________)
___ A babysitter or nanny (At what ages? ___________)
___ Someone else not mentioned above
(who? _______________________________)
(at what ages? _______________)
Did anyone ever use physical force on any of these
occasions?
Yes__ No__ If yes, who? _____________
About how many times did anyone five or more years older have
oral, anal, or vaginal intercourse with you before

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age 17, or insert a finger or object in your anus or
vagina?
___ times
Overall, how many people (five or more years older than you)
did this?
___ people
11) To the best of your knowledge, before age 17, were you ever
Sexually abused? Yes__ No__
Physically abused? Yes__ No__

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Appendix E
Beck Depression Inventory-Second Edition (BDI-II)
1.
0 I do not feel sad.
1 I feel sad.
2 I am sad all the time and I can’t snap out of it.
3 I am so sad and unhappy that I can’t stand it.
2.
0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.
3.
0 I do not feel like a failure.
1 I feel I have failed more than the average person.
2 As I look back on my life, all I can see is a lot of failures.
3 I feel I am a complete failure as a person.
4.
0 I get as much satisfaction out of things as I used.
1 I don’t enjoy things the way I used to.
2 I don’t get real satisfaction out of anything anymore.
3 I am dissatisfied or bored with everything.
5.
0 I don’t feel particularly guilty.
1 I feel guilty a good part of the time.
2 I feel guilty most of the time.
3 I feel guilty all of the time.
6.
0 I don’t feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7.
0 I don’t feel disappointed in myself.
1 I am disappointed in myself.
2 I am disgusted with myself.
3 I hate myself.
8.
0 I don’t feel I am any worse than anybody else.
1 I am critical of myself for my weaknesses or mistakes.
2 I blame myself all the time for my faults.
3 I blame myself for everything bad that happens.
9.
0 I don’t have any thoughts of killing myself.

40. CHILDHOOD
EMOTIONAL
ABUSE
AND
THE
DEVELOPMENT
OF
DEPRESSION
40
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10.
0 I don’t cry any more than usual.
1 I cry more now than I used to.
2 I cry all the time now.
3 I used to be able to cry, but now I can’t cry even though I want to.
11.
0 I am no more irritated by things than I ever was.
1 I am slightly more irritated now than usual.
2 I am quite annoyed or irritated a good deal of the time.
3 I feel irritated all the time.
12.
0 I have not lost interest in other people.
1 I am less interested in other people than I used to be.
2 I have lost most of my interest in other people.
3 I have lost all of my interest in other people.
13.
0 I make decisions about as well as I ever could.
1 I put off making decisions more than I used to.
2 I have greater difficulty in making decisions more than I used to.
3 I can’t make decisions at all anymore.
14.
0 I don’t feel that I look any worse than I used to.
1 I am worried that I am looking old or unattractive.
2 I feel there are permanent changes in my appearance that make me look
unattractive.
3 I believe that I look ugly.
15.
0 I can work about as well as before.
1 It takes an extra effort to get started at doing something.
2 I have to push myself very hard to do anything.
3 I can’t do any work at all.
16.
0 I can sleep as well as usual.
1 I don’t sleep as well as I used to.
2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
3 I wake up several hours earlier than I used to and cannot get back to sleep.
17.
0 I don’t get more tired than usual.
1 I get tired more easily than I use to.
2 I get tired from doing almost anything.
3 I am too tired to do anything.
18.
0 My appetite is no worse than usual.

41. CHILDHOOD
EMOTIONAL
ABUSE
AND
THE
DEVELOPMENT
OF
DEPRESSION
41
1 My appetite is not as good as it used to be.
2 My appetite is much worse now.
3 I have no appetite at all anymore.
19.
0 I haven’t lost much weight, if any, lately.
1 I have lost more than five pounds.
2 I have lost more than ten pounds.
3 I have lost more than fifteen pounds.
20.
0 I am not more worried about my health than usual.
1 I am worried about physical health problems like aches, pains, upset stomach, or
constipation.
2 I am very worried about physical problems and it’s hard to think of much else.
3 I am so worried about my physical problems that I cannot think of anything else.
21.
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I have almost no interest in sex.
3 I have lost interest in sex completely.
INTERPRETING THE BECK DEPRESSION INVENTORY
Now that you have completed the questionnaire, add up the score for each of the twenty-one
questions by counting the number to the right of each question you marked. The highest possible
total for the whole test would be sixty-three. This would mean you circled number three on all
twenty-one questions. Since the lowest possible score for each question is zero, the lowest
possible score for the test would be zero. This would mean you circled zero on each question.
You can evaluate your depression according to the table below.
Total Score________________________Levels of depression
1-10 _____________________________These ups and downs are considered normal.
11-16 ____________________________Mild mood disturbance.
17-20 ____________________________Borderline clinical depression.
21-30 ____________________________Moderate depression.
31-40 ____________________________Severe depression.
Over 40 __________________________Extreme depression.

42. 42
CHILDHOOD
EMOTIONAL
ABUSE
AND
THE
DEVELOPMENT
OF
DEPRESSION
Appendix F
Zung Self-Rating Depression Scale
Please read each statement and decide how much of the time the statement describes how you
have been feeling during the past several days.
Mark check mark (✓) in appropriate
column.
A little of
the time
Some of
the time
Good part
of the time
Most of
the time
1. I feel down-hearted and blue
2. Morning is when I feel the best
3. I have crying spells or feel like it
4. I have trouble sleeping at night
5. I eat as much as I used to
6. I still enjoy sex
7. I notice that I am losing weight
8. I have trouble with constipation
9. My heart beats faster than usual
10. I get tired for no reason
11. My mind is as clear as it used to be
12. I find it easy to do the things I used to
13. I am restless and can’t keep still
14. I feel hopeful about the future
15. I am more irritable than usual
16. I find it easy to make decisions
17. I feel that I am useful and needed
18. My life is pretty full
19. I feel that others would be better off I
were dead
20. I still enjoy the things I used to
KEY TO SCORING THE ZUNG SELF-RATING DEPRESSION SCALE
Consult this key for the value (1-4) that correlates with patient’s responses to each statement.
Add up the numbers for a total score. Most people with depression score between 50 and 69. The
highest possible score is 80.
Mark check mark (✓) in appropriate
column.
A little of
the time
Some of
the time
Good part
of the time
Most of
the time
1. I feel down-hearted and blue 1 2 3 4
2. Morning is when I feel the best 4 3 2 1
3. I have crying spells or feel like it 1 2 3 4
4. I have trouble sleeping at night 1 2 3 4
5. I eat as much as I used to 4 3 2 1
6. I still enjoy sex 4 3 2 1

43. 43
CHILDHOOD
EMOTIONAL
ABUSE
AND
THE
DEVELOPMENT
OF
DEPRESSION
7. I notice that I am losing weight 1 2 3 4
8. I have trouble with constipation 1 2 3 4
9. My heart beats faster than usual 1 2 3 4
10. I get tired for no reason 1 2 3 4
11. My mind is as clear as it used to be 4 3 2 1
12. I find it easy to do the things I used to 4 3 2 1
13. I am restless and can’t keep still 1 2 3 4
14. I feel hopeful about the future 4 3 2 1
15. I am more irritable than usual 1 2 3 4
16. I find it easy to make decisions 4 3 2 1
17. I feel that I am useful and needed 4 3 2 1
18. My life is pretty full 4 3 2 1
19. I feel that others would be better off I
were dead
1 2 3 4
20. I still enjoy the things I used to 4 3 2 1