Author ORCID Identifier

Date of Award

Spring 5-14-2021

Degree Type

Closed Dissertation

Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Shannon Self-Brown

Second Advisor

Greta Massetti

Third Advisor

Terri Pigott


This dissertation has three studies. The first study explored associations of age of first victimization, sexual violence (SV), physical violence (PV), polyvictimization, and mental distress among females in Nigeria (n=1,766, 13-24 years old) using 2014 Nigeria Violence Against Children Survey (VACS). Multinomial logistic regressions were performed. SV was significantly associated with moderate and severe mental distress. Age of first PV was significantly associated with severe mental distress. Polyvictimization was significantly associated with moderate and severe mental distress. The second study examined the associations between individual/cumulative ACEs and negative mental health outcomes using 2014 Zambia VACS (18-24 years old, n=1034). Bivariate and adjusted logistic models were performed. Independent variables were experienced physical violence (PV), sexual violence (SV), and emotional violence (EV); witnessed intimate partner violence (IPV) and community violence (CV); orphan status; cumulative exposure of ACE; sociodemographic factors. Dependent variables were mental distress and suicide risk. PV, EV, cumulative ACE exposure, older age, being single, and stronger friendship were significantly related to mental distress, and cumulative exposure to ACE had significantly higher suicide risk. The third study systematically searched/reviewed English-language original articles that presented quantitative associations of childhood polyvictimization and health outcomes from six databases, grey literature, and citation mining (June 2020 to January 2021). A total of 96 studies was included. Polyvictimization was operationalized as continuous (30.21%) and/or categorical (72.92%). The majority of health outcomes were mental, behavioral, and social (96.88%); physical health (11.45%) and general health conditions (10.42%) were examined. More than half of studies used U.S. samples (56.25%). The study results highlight the need of evidence-based programs that strengthen coping skills and resilience to improve the trajectories of individuals with polyvictimization and cumulative ACEs. More research may be necessary on the timing of violence exposure in the life of a child (Nigeria VACS) and for protective factors that can mitigate mental distress and suicide risk (Zambia VACS). Finally, the importance of conducing more studies in global context on how polyvictimization and cumulative trauma impact youth is highlighted.

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Available for download on Wednesday, May 03, 2023