Using Baseline Data to Predict Chronic PTSD 48-months After Mothers Report Intimate Partner Violence: Outcomes for Mothers and the Intergenerational Impact on Child Behavioral Functioning

Derivation and validation of risk prediction for posttraumatic stress symptoms following trauma exposure

BACKGROUND

Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS.

METHODS

Self-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale - Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample).

RESULTS

Twenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms.

CONCLUSIONS

These analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.

Mothering in the context of intimate partner violence: A feminist intersectional critique of the nursing literature

AIMS

To describe how mothers and mothering in the context of IPV are conceptualized in the nursing research and practice literature with attention to underlying ideologies, biases and potential harms.

DESIGN

Feminist intersectionality was used as a theoretical and analytic lens.

DATA SOURCES

Articles published between 2000 and 2021 in the nursing literature, identified by searching Google Scholar, CINAHL, PubMed and Scopus databases, and conducting bibliographic reviews of published articles.

REVIEW METHODS

Search terms included: intimate partner violence, domestic violence, parenting, mother and nursing. Initial screening resulted in inclusion of 98 papers for analysis.

RESULTS

Four dominant ways of conceptualizing mothering in the context of IPV were identified: (1) IPV is conceptualized as a discrete acute event and/or crisis, (2) mothering is treated as a practice, (3) mothers are valued as vehicles for child health and well-being and (4) mothers are seen as vulnerable and 'at risk'. These narrow constructions are rooted in ideologies such as normative motherhood, deficit and grit/resilience and neoliberalism. Emerging shifts in the literature are providing an important counter-balance.

CONCLUSION

Biases in nursing knowledge about mothering in the context of IPV may limit nursing's capacity to support the health of these women and their children. The integration of emerging perspectives that emphasize strengths and equity is critical in strengthening nursing knowledge and practice and in beginning to redress existing limitations and potential harms.

IMPACT

This critique focused on higher-income countries of the Global North but raises fundamental questions that should be considered in other contexts. Applying broader conceptualizations of mothers, mothering and IPV to research and practice can help improve the quality of care available.

'Now My Eyes are Open': Latina women's experiences in long-term support groups for intimate partner violence survivors

One in four women has experienced intimate partner violence in their lifetimes. The effects of intimate partner violence on women's mental health may be long-term; possible conditions include post-traumatic stress disorder, depression, and anxiety. Latina women may be particularly vulnerable to long-term effects of intimate partner violence. The purpose of this study was to describe Latina women's experiences in long-term support groups for survivors of intimate partner violence. Forty-nine Latina women were interviewed about their experiences in a nurse-led long-term support group, with participation from 2 months to 9 years. The women ranged in age from 26 to 73 years and all but two interviews were in Spanish. Five themes emerged from the qualitative data: awakening, transformation, community, empowerment, and advocate. Women described their thoughts of still feeling the 'ugliness of the abuse', even years after it occurred with some women enduring abuse for as long as 32 years. The need for long-term support groups was evident as women described the value of the group for providing support and gaining an understanding that they are not alone, or their awakening to the idea that they can have a life without abuse. Long-term support groups give voice to Latina women who are survivors of intimate partner violence. By raising their awareness and sense of community, women survivors can be transformed and empowered to improve their lives and advocate for others who face similar struggles.

Posttraumatic stress disorder in urban women

PURPOSE OF REVIEW

To provide an update of recent or relevant studies on posttraumatic stress disorder (PTSD) in urban women, with a special focus on biopsychosocial risk factors.

RECENT FINDINGS

Urbanization itself can increase the risk for PTSD due to the concentration of poverty, substance use and crime. Women are usually at a greater social and economic disadvantage and are victims of collective and domestic violence more often than men. Accordingly, urban women are more exposed to traumatic events that increase the prevalence of PTSD than rural women and both rural and urban men, especially those with lack of social and family protection and support (including refugees) and/or with a history of interpersonal violence. This type of events has sensitizing effects on the PTSD response to other traumatic experiences even if they are of a lesser magnitude, which may reflect women's biological susceptibility to PTSD, and could explain their higher risk of developing chronic PTSD.

SUMMARY

A complex interaction of biopsychological factors may contribute to the ultra-high-risk for PTSD among urban women. The socially modifiable factors involved highlight the importance of strategies focused on women's social development that could reduce their social suffering and its negative mental health outcomes.

Evaluating an Intergenerational Model to Explain the Path From Violence Against Mothers to Child Behavior and Academic Outcomes

An intergenerational model to explain the long-term effect of partner violence against mothers on child behavior was evaluated 48 months after 278 mothers first sought safe shelter or justice services. Twelve percent reported recent abuse, and six mothers reported severe or extreme danger. Self-efficacy (-.58, p < .05), social support (-28, p < .05), and financial support (-.25) were inversely associated with mental health concerns. Higher maternal mental health concerns (.55, p < .05) and child witnessing abuse (.70, p < .05) were associated with child behavioral problems. Child behavioral problems were inversely associated with child academic functioning (-.22, p < .05). To improve child outcomes, interventions that establish safety for mothers and children and promote maternal mental health are needed.