Suicide attempts among men with histories of child sexual abuse: examining abuse severity, mental health, and masculine norms

Dissociation and Sexual Concerns in Male Survivors of Childhood Sexual Abuse: The Role of Identity Cohesion

Research on male survivors of childhood sexual abuse is notably deficient when it comes to addressing their sexual concerns, such as experiences of sexual distress, negative thoughts, and feelings related to their sexuality. Dissociation, a known consequence of childhood sexual abuse, could be associated with higher sexual concerns through identity cohesion. Precisely, dissociation can potentially be related to lower identity cohesion (e.g., not knowing what you want or need). In return, lower identity cohesion may be related to higher sexual concerns by impeding the capacity to know and accept oneself, which tends to promote a positive and healthy sexuality. This study aimed to examine the role of identity cohesion in the link between dissociation and sexual concerns in 105 men consulting for their history of childhood sexual abuse. Men completed questionnaires assessing dissociation, sexual concerns, and identity cohesion at admission in a community setting. Results of a path analysis revealed an indirect association between dissociation and higher sexual concerns through lower identity cohesion. The model explained 27.6% of the variance in sexual concerns. This study highlights the relevance of interventions targeting dissociative symptoms to improve identity cohesion and sexual health in male survivors of childhood sexual abuse.

Association between Adverse Childhood Experiences and Unmet Health Care Needs among Children in the United States

Although studies have investigated and found an association between adverse childhood experiences and poor health and mental health outcomes, there is a dearth of studies investigating the association between adverse childhood experiences and unmet health care needs among children. The objective of this study is to examine the association between adverse childhood experiences and unmet health care needs after adjusting for predisposing, enabling, and need factors of health care service utilization. Data for this study came from the 2016-2017 National Survey of Children's Health. An analytic sample of 46,081 children (51.3% males; average age 11.5 years) was analyzed using negative binomial regression. Based on parent reports, about 3.5% of children had unmet health care needs, and half (50%) of the sample had experienced at least one childhood adversity. Controlling for other factors, children who experienced three or more childhood adversities had 4.51 times higher odds of having unmet health care needs (AOR = 4.51, p < .001, 95% CI = 3.15-6.45) when compared to their counterparts with no childhood adversity. Children with parents who have someone to turn to for everyday emotional support were 31% less likely to have unmet health care needs (AOR = .69, p < .01, 95% CI = .54-.89). Adverse childhood experiences have a detrimental effect on unmet health care needs. The findings of this study offer an important opportunity for further research on how best to prevent adverse childhood experiences and mitigate their impact on families.

Broadening the Perspective on the Dynamics of Men's Suicide: Thought Suppression as a Mediator between Men's Self-Reliance and Suicidality

OBJECTIVE

In most countries, men are at higher risk than women for suicide death. Research focused on masculinity and men's mental health increasingly demonstrates that relationships between gender and various health outcomes, including suicidality, is complex as these relationships can be further explained by certain psychological processes or health behaviors. The objective of this study was to extend this area of research in a national sample of US men (n = 785) by investigating if their adherence to certain hegemonic masculine gender role norms (toughness and self-reliance through mechanical skills) is associated with the suppression of distressing thoughts and if thought suppression then increases their risk for suicidal thoughts and behaviors.

METHODS

Men in the US who have recently experienced a stressful life event completed an anonymous online survey. Structural Equational Modeling (SEM) was used to test for direct and indirect effects (i.e., mediation) between variables.

RESULTS

Men's engagement in thought suppression mediated the relationship between self-reliance and suicidality. The norm of toughness was both directly related to suicidality and mediated by thought suppression.

CONCLUSIONS

Thought suppression appears to be a process that provides some explanation for the relationships between hegemonic masculine norms and suicidality in men, though this study indicated it may play only a small role. Research continues to build that certain masculine norms, such as self-reliance and toughness, are particularly concerning for men's health.HIGHLIGHTSMen's thought suppression mediates the relationship between self-reliance and suicidalityMen's toughness impacts suicidality both directly and via engagement in thought suppressionThese findings have implications for interventions that help men manage distressing thoughts.

Male Sexual Victimization by Women: Incidence Rates, Mental Health, and Conformity to Gender Norms in a Sample of British Men

Male sexual victimization by women is often neglected within psychological research (Fisher & Pina, 2013). Not only is the topic understudied, incidence rates and associated psychological impacts are inconsistent across the literature (Depraetere et al., 2020; Peterson et al., 2011). The present study provides an additional estimate of male sexual victimization by women, explores its association with victim mental disorders, and examines the potential moderating role of conformity to gender norms. A sample of 1124 heterosexual British men completed an online survey consisting of a modified CDC National Intimate Partner and Sexual Violence Survey, and measures of anxiety, depression, post-traumatic stress disorder, and conformity to masculine norms. In the present sample, 71% of men experienced some form of sexual victimization by a woman at least once during their lifetime. Sexual victimization was significantly associated with anxiety, depression, and post-traumatic stress disorder. However, conformity to masculine gender norms was not a significant moderator between victimization and mental disorders. These findings further illuminate the occurrence of male sexual victimization by women, as well as the importance of continued research on the topic.

The experience of childhood sexual abuse: An exploratory description of psychological and adaptive functioning in Canadian men

BACKGROUND

Childhood sexual abuse (CSA) affects a number of men yet knowledge gaps remain around comprehensively describing psychological and adaptive outcomes for this population.

OBJECTIVE

Examine how a Canadian sample of men with and without CSA histories compares on broader areas of psychological and adaptive functioning.

PARTICIPANTS AND SETTING

This exploratory study included 109 adult men aged 25-60 years who were grouped according to whether they experienced CSA (n = 69) or not (n = 40). Participants were recruited from Ottawa, Ontario, Canada.

METHOD

Using a multi-method approach, we conducted an exploratory and comprehensive examination of how CSA contributes to various areas of psychological (e.g., depression, anxiety, stress, dissociation, anger, PTSD) and adaptive functioning (e.g., friendship quality, employment) using self-report and clinician-administered measures.

RESULTS

CSA men were an average of 8.5 years old at abuse onset. Most (62.3 %) had disclosed their CSA experience, waiting an average of 13.6 years before disclosure. After controlling for covariates (i.e., other types of maltreatment, non-maltreatment adversities, education, income), results indicated a significant association between CSA and men's psychological functioning, but not their adaptive functioning.

CONCLUSIONS

Findings highlight the importance of broadening our understanding of how the experience of CSA, controlling for important covariates, can contribute to the well-being of men in order to better respond to their psychological needs.

The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

"I was the only one talking about the abuse": Experiences and perceptions of survivors who underwent child sexual abuse as boys

OBJECTIVE

Empirical literature on child sexual abuse (CSA) has traditionally focused on the CSA of girls. Much less is known about the CSA of boys, specifically about the survivors' experiences. The current study was designed to examine the experiences and perceptions of male adult survivors who underwent CSA as boys.

METHOD

Fifty-one written narratives were collected from survivors who experienced CSA as boys as part of the Israeli Independent Public Inquiry into CSA. A qualitative inductive thematic analysis guided the data analysis.

RESULTS

The findings highlighted CSA survivors' experiences of not understanding and confusion about the abuse while highlighting the context in which the abuse took place. The findings also emphasized the exploitation of power and the survivors' difficulty identifying being sexually abused during physical fights or public events. Moreover, the survivors referred to their surroundings' failure to notice the abuse and their struggle to establish their identity and overcome the abuse consequences, their loneliness and pain.

CONCLUSION

The present findings advance the literature on the CSA of boys by examining narratives written by male CSA survivors. They highlight the potentially destructive role of the heteronormative and conventional masculinity discourse for male CSA survivors, which often enabled the continuation of abuse and challenges that survivors continued to face throughout their lives. The findings also stress society's crucial role in CSA prevention and treatment and the need for public education to challenge societal perceptions regarding the CSA of boys.

Women Receive More Positive Reactions to Childhood Sexual Abuse Disclosure and Negative Reactions are Associated With Mental Health Symptoms in Adulthood for Men and Women

Although disclosure of sexual abuse has become more socially acceptable for both men and women in recent years, there is much yet to be understood about differences in the disclosure process and associated pathology between men and women. The current study aimed to (a) investigate differences in aspects of the childhood sexual abuse (CSA) disclosure process between adult men and women and (b) explore how timing of disclosure, perceived parental style, and negative social reactions to disclosure relate to various mental health symptoms. Using a cross-sectional, quasi-experimental design, adult men and women in the United States recruited through Amazon's Mechanical Turk (N = 299) completed self-report surveys. Women reported disclosing to a significantly greater number of people than men, and were more likely to disclose to parents, while men were more likely to tell friends. Results revealed that women reported receiving significantly more positive responses and emotionally supportive responses to their CSA disclosures than men. Negative reactions to disclosure were positively associated with internalizing symptoms and externalizing symptoms, while both negative reactions to disclosure and perceived parental dysfunction were positively associated with substance use symptoms. Results signify a need for resources to aid individuals in supporting survivors of CSA, as reactions have the potential to impact recovery trajectory and for clinicians to consider how disclosure experiences impact survivor cognitions and symptom exacerbation.

Impact, Ramifications and Taking Back Control: A Qualitative Study of Male Survivors of Childhood Sexual Abuse

There is increasing recognition of the occurrence and frequency of male childhood sexual abuse (MCSA). Quantitative and qualitative research has demonstrated a number of adverse outcomes associated with MCSA in terms of mental health, physical health and difficulties in behavioural, social or interrelationship functioning. The present study gives voice to male survivors of childhood sexual abuse by exploring themes around the impact of MCSA over the course of their life. Interpretative phenomenological analysis (IPA) of semi-structured interviews with nine male survivors of childhood sexual abuse identified a single overarching theme of control and six related superordinate themes of: (i) responsibility, blame and shame; (ii) development of knowledge about sex and abuse; (iii) avoidance of coping with abuse; (iv) effects on relationships as adults; (v) disclosure of abuse to others; and (vi) gaining a sense of meaning of the abuse. The findings showed that being sexually abused defines and controls a person's life, and that despite the difficulties experienced by victims to move past the abuse, some experienced a degree of personal growth. The findings illustrate the way in which individuals can create meaning around their abuse experiences and take back control.

Childhood Sexual Abuse, Dyadic Empathy, and Intimate Partner Violence Among Men Seeking Psychological Help

Childhood sexual abuse (CSA) and intimate partner violence (IPV) have both been associated with numerous negative repercussions. The first aim of this study is to understand IPV perpetrated by men within a clinical population, by examining the effects of two potential predictors: CSA and dyadic empathy (cognitive and emotional). The second aim of this study is to explore whether dyadic empathy is an intermediary variable of the association between CSA and IPV. A sample of 198 men (aged 18-69 years old) who were seeking help for relationship problems, completed a set of self-administered questionnaires. While controlling for social desirability and family violence history, our findings outlined the mediating and moderating role of dyadic empathy in the link between CSA and perpetrated psychological, but not physical, IPV. Emotional empathy mediated and moderated the link between CSA and psychological IPV, whereas cognitive empathy only moderated this link. The examination of the direct links between the variables also revealed that CSA was related to lower emotional empathy and higher rates of both types of IPV. In addition, cognitive empathy was negatively associated with physical and psychological IPV, whereas emotional empathy was positively associated with psychological IPV. This study contributes to the literature by documenting some of the mechanisms that could explain the perpetration of IPV and highlights the importance of investigating CSA and empathy in men who are seeking help.

"Explode into small pieces": Suicidal ideation among child sexual abuse survivors

BACKGROUND

Child sexual abuse (CSA) has been acknowledged as predisposing survivors to an increased risk of suicidal ideation and attempts. Despite this risk being widely recognized, the study of suicidality has mainly focused on psychopathology, while less attention has been given to survivors' experiences and perceptions.

OBJECTIVE

This study aims to uncover the experiences and perceptions of suicidality among adult CSA survivors.

PARTICIPANTS AND SETTINGS

The sample consisted of 41 adult CSA survivors' written narratives of abuse that included references to suicide.

METHODS

Written narratives of CSA experiences were collected from 41 adult participants as part of the Israeli Independent Public Inquiry on CSA to change public policy. An inductive thematic analysis guided the exploration of the stories.

RESULTS

The findings portrayed several main themes regarding the survivors' experiences before, during and after suicidal thoughts and behaviors. These themes elucidated their motivations leading to suicidal attempts, including the wish to end one's self and suffering, self-blame, communicate the abuse and the request for recognition. Additionally, the survivors' stories illuminated their experiences following the suicidal attempts, depicting inadequate treatment and difficulties with the psychiatric labeling of a mental health disorder.

CONCLUSIONS

The findings of this study uncover new insights regarding the link between trauma, posttraumatic suffering, and suicidality within a social interaction context. Furthermore, these findings call medical and psychosocial health practitioners to view post-CSA suffering as trauma-related rather than personal psychopathology and to adjust practices to adapt to survivors' experiences and needs.

The association between childhood maltreatment and suicidal intrusions: A cross-sectional study

Childhood maltreatment may play an important role in the transition from suicidal ideation to suicidal behavior. Recently, research has begun evaluating the association between childhood maltreatment and involuntary and distressing intrusions about one's own suicide, also called suicidal intrusions. This cross-sectional, multicenter study aimed to investigate the association between childhood maltreatment and the severity of suicidal intrusions using online questionnaires. Participants were suicidal outpatients currently receiving treatment at a Dutch mental health institution (N = 149). The Childhood Trauma Questionnaire-Short Form and Suicidal Intrusions Attributes Scale were administered online. A simple linear regression was performed followed by a multiple linear regression with backward selection to separate the predictors of childhood maltreatment subscales. Next, significant predictor variables were used to perform an additional regression analysis with gender, age, posttraumatic stress disorder (PTSD) diagnosis, and depressive symptoms as potential covariates. The results showed that childhood maltreatment was significantly associated with suicidal intrusion scores, B = .22, t(147) = 2.010, p = .046. A multiple linear regression analysis showed that the only specific form of childhood maltreatment associated with suicidal intrusions was sexual abuse; the association remained after controlling for age, gender, PTSD diagnosis and depressive symptoms, F(5, 143) = 11.15, p < .001. In summary, the present study confirms the link between childhood maltreatment, particularly childhood sexual abuse, and suicidal intrusions. This finding implies that in the treatment of suicidal intrusions and suicidality, childhood sexual abuse should be identified and targeted with evidence-based treatments for PTSD.

Gender Self-Confidence as a Protective Factor for Suicide Risk: Analysis of the Sample of Lithuanian Men

Background

Along with other suicide risk factors, masculinity has been analyzed as an important subject for suicidal behavior in men. This study examines masculinity as a gender self-confidence which is the intensity of an individual's belief that he meets his standards for masculinity. We use Hoffman and her colleague's concept, which provides two theoretical constructs as elements of gender self-confidence: gender self-definition and gender self-acceptance. Gender self-definition relates to how salient masculinity is in one's identity; gender self-acceptance relates to how positively one views his masculinity.

Methods

The quantitative research approach was applied in the study. The survey with a nonprobability quota sampling design was implemented to collect the data. The sample consisted of 562 Lithuanian men from various age groups and regions. The age of participants varied from 18 to 92 years (M = 42.99, SD = 17.18); 40.9% of men were from cities, 28.1% from towns, and 30.8% from rural locations. We used the Hoffman Gender Scale to measure gender self-definition and gender self-acceptance. Suicide risk was estimated with the Suicide Behavior Questionnaire—Revised. Patient Health Questionnaire-2 was used to measure depression symptoms as a controlled variable. Statistical analysis of regression and moderation was used to test the hypothesis.

Results

Higher gender self-definition and higher gender self-acceptance were associated with lower suicide risk. The moderation analysis showed that in men with relatively low gender self-definition, the effect of gender self-acceptance on suicidality was larger than in men with high or moderate gender self-definition.

Discussion

We conclude that a stronger gender self-confidence is an important protective factor in male suicide risk. Both, a smaller part of masculinity in one's identity and a negative view of one's masculinity have a cumulative effect on increased suicide risk. The findings have been discussed in accordance with the theories that explain suicidal behavior through the lenses of self-concept.

Sexual abuse and mental ill health in boys and men: what we do and don't know

The spectrum of adverse mental health trajectories caused by sexual abuse, broadly defined as exposure to rape and unwanted physical sexual contact, is well-known. Few studies have systematically appraised the epidemiology and impact of sexual abuse among boys and men. New meta-analytic insights (k = 44; n = 45 172) reported by Zarchev and colleagues challenge assumptions that men experiencing mental ill health rarely report sexual abuse exposure. Adult-onset sexual abuse rates of 1-7% are observed in the general population, but for men experiencing mental ill health, adult lifetime prevalence was 14.1% (95% CI 7.3-22.4%), with past-year exposure 5.3% (95% CI 1.6-12.8%). We note that these rates are certainly underestimates, as childhood sexual abuse exposures were excluded. Boys and men with a sexual abuse history experience substantial disclosure and treatment barriers. We draw attention to population health gains that could be achieved via implementation of gender-sensitive assessment and intervention approaches for this at-risk population.

Emotion Regulation and Mental Health among Men with Childhood Sexual Abuse Histories

Childhood sexual abuse (CSA) is a form of child maltreatment which has been increasingly recognized as a common experience among men. Research on male CSA remains under-developed but suggests many negative mental health impacts. The current study examined the link between mental health outcomes and different emotion regulation strategies among 69 adult men. Men completed measures on their current mental well-being, and participated in a clinical interview about emotion regulation strategies used to manage memories about their sexual victimization. Results indicated that the most frequently used emotion regulation strategies were expressive suppression, rumination, and cognitive avoidance. For perceived effectiveness, men identified cognitive avoidance, self-medication, and behavioral avoidance as being most helpful in managing their CSA-related distress. Finally, greater use of deliberate self-harm, rumination, and behavioral avoidance was associated with more internalizing difficulties, while greater use of deliberate self-harm and self-medication was linked with more externalizing difficulties. Greater perceived efficacy of positive reappraisal was associated with fewer externalizing behaviors. Although these findings require replication through larger mixed-methods studies, they suggest the importance of incorporating emotion regulation strategies into interventions aimed at improving mental well-being among men with CSA histories.

The effectiveness of a media-based intervention promoting help-seeking for mental health difficulties by Australian men: study protocol for a randomised controlled trial

Background

Approximately one fifth of Australian males aged 16+ experience mood, anxiety or substance use disorders in a given year, and suicide by males accounts for three quarters of all suicides annually. However, males with mental health problems are less likely to seek and receive help than their female counterparts. Media campaigns with videos at their core are gaining popularity as a means of promoting help-seeking for mental health difficulties, but few studies have rigorously tested the impact of such videos. This randomised controlled trial tests the effectiveness of a short video promoting help-seeking by Australian men.

Methods

This study is an online randomised controlled trial (RCT). Participants will attend an online group orientation session, where they will provide consent to participate and complete a baseline questionnaire (T1). After completion of the T1 questionnaire, participants will be randomised to watch either the intervention or control video on a 1:1 basis. After randomisation, participants will be able to access their allocated video for 1 week. Seven days after T1, participants will again be sent links to the video and to the post-exposure questionnaire (T2). One month after T2, participants will be emailed the follow-up questionnaire (T3). The primary outcome will be change in help-seeking intentions from T1 to T2. Secondary outcomes will be changes in help-seeking intentions from T1 to T3, changes in intentions to encourage other males to seek help, self-reliance, and male depression symptoms from T1 to T2 and from T1 to T3. The cost-effectiveness of the intervention will be evaluated. Participants will also complete questions about their opinions of the video and its effects at T2 and T3.

Discussion

Our video-based intervention is designed to promote help-seeking for mental health difficulties among Australian men. If a lack of net harm is shown to be associated with viewing the intervention video, the video will be publicly released and could have broad impacts on individual and community attitudes towards help-seeking for mental health difficulties, and ultimately enhance men’s mental health and wellbeing. An evaluation of the effectiveness of the intervention is essential to ensure the intervention is achieving its objectives.

Trial registration

anzctr.org.au 12621001008819

The influence of emotion on working memory: Exploratory fMRI findings among men with histories of childhood sexual abuse

BACKGROUND

Childhood maltreatment can have detrimental consequences on individual well-being and cognitive functioning. One type of childhood maltreatment that remains stigmatized and under-researched among men is child sexual abuse (CSA). Research examining the neurophysiological consequences of CSA in males is limited even further.

OBJECTIVE

To provide preliminary insight into the neural basis of the impact of CSA during two working memory tasks.

PARTICIPANTS AND SETTING

Men with CSA histories, with and without post-traumatic stress disorder (PTSD; CSA + PTSD n = 7, mean age = 45; CSA-PTSD; n = 9, mean age = 41), and men without a CSA history nor PTSD (n = 13, mean age = 36) participated in the study at a local hospital.

METHODS

Participants completed a letter n-back task and an emotional picture n-back task during fMRI to measure working memory and the influence of emotion on working memory. They also completed self-report measures to assess mental health and childhood abuse histories.

RESULTS

In the letter n-back task, men with CSA + PTSD had less activation in the cerebellum and left fusiform gyrus compared to CSA-PTSD men. During the working memory task with negative emotional pictures the control group had greater frontal activation, while the CSA-PTSD group had greater limbic activation. Analyses were performed with independent-samples t-tests.

CONCLUSIONS

This study provides preliminary empirical evidence of the impact CSA can have on men regarding working memory when negative stimuli are involved. It highlights that CSA, even without a diagnosis of PTSD, can have a significant neurophysiological impact. It also provides clinicians with information to support well-being and help with potential day to day challenges.

Adherence to Masculine Norms and Depressive Symptoms in Young Black Men

Recent reports have highlighted disparities in representation of Black men within research, calling for more work to be done with this group. The authors take up this call by exploring whether adherence to masculine norms influences mental health outcomes among young Black men. The sample included survey responses from 18- to 30-year-old Black men (N = 273) enrolled at five colleges and universities in the midwestern United States. Two theoretically relevant subscales from the Conformity to Masculine Norms Inventory (that is, self-reliance and emotional control) were used to measure adherence to masculine norms, and depressive symptoms were measured using the Patient Health Questionnaire. Confirmatory factor analysis results indicate that the model fit the data well. Furthermore, self-reliance was associated with higher rates of depressive symptoms (β = .358, p < .001), but emotional control was not (β = .137, p = .099). Study findings suggest that depression treatment interventions should be tailored to incorporate aspects of masculinity that are most salient to young Black men. In addition, social work researchers, clinicians, and service providers are uniquely positioned to contribute to the promotion of mental wellness among this underserved population and should be prepared to attend to young Black men's mental health needs.

The Relationship between Trauma Exposure and Psychiatric Hospitalization for Suicide Ideation or Suicide Attempt among Patients Admitted to a Military Treatment Setting

Suicide attempts and psychiatric hospitalization represent the final outcomes of a complex dynamical system of interacting factors that influence a particular individual’s likelihood of engaging in suicidal behavior, as well as their ability to seek help prior to acting upon suicidal impulses. This study examined the association between different types of lifetime trauma exposure and the likelihood of psychiatric hospitalization following a suicide attempt (SA) rather than suicidal ideation (SI) alone. Electronic medical records for 1100 U.S. military service members and their dependents admitted to a military psychiatric inpatient setting for SA or SI were reviewed for documented lifetime trauma exposure history. Findings indicated that exposure to at least one childhood trauma of any type, and childhood neglect in particular, increased the likelihood that an individual would be hospitalized for SA rather than SI. Exploratory gender-stratified analyses demonstrated that childhood neglect, childhood sexual abuse, and adulthood traumatic loss may be linked with the likelihood of being hospitalized for SA. These findings demonstrate the importance of developing more detailed and nuanced conception of factors known to be associated with suicide as their effects may depend on details of their timing and nature, as well as their interactions with other systems.

Child Sexual Abuse and Depression in Late Life for Men: A Population-Based, Longitudinal Analysis

OBJECTIVE

Research investigating long-term effects of childhood sexual abuse (CSA) on mental health for men is vastly underdeveloped. This study strengthened the knowledge base by examining: (a) long-term trajectories of depressive symptoms for men with and without a history of CSA, and (b) moderating effects of social support over time.

METHOD

We analyzed multiple waves of data from the Wisconsin Longitudinal Study. The sample (N = 2,451) consisted of men with histories of CSA and a stratified, randomly sampled comparison group. Growth curve modeling was employed for analyses.

RESULTS

After controlling for demographic, parental, and health factors, men with CSA histories had greater depressive symptoms than those with no history of CSA. For both groups, depressive symptoms decreased over time; slope patterns did not differ. We found a significant moderating effect of social support on the relationship between CSA and depressive symptoms.

DISCUSSION

This innovative, population-based, longitudinal study demonstrated that CSA can undermine mental health for men across the life span and into old age. Social support appears to mitigate these deleterious effects. In early, middle, and late adulthood, practitioners should assess for CSA and strengthen support resources for male survivors.

'The self-destruction force is so strong': male survivors' experience of suicidal thoughts following sexual violence

Suicidal thoughts are common among male sexual violence survivors. However, very few studies have focused specifically on this aspect. The purpose of this study was to explore the experience of male survivors themselves of suicidal thoughts following sexual violence within the framework of men and masculinity. The research methodology was The Vancouver School of Doing Phenomenology, and a total of 17 interviews were conducted with seven male survivors. The main findings of the study are that the source of the suicidal thoughts after sexual violence is based on an experienced strong self-destruction force that involves almost unbearable and unexpressed suffering. The strong self-destruction force appeared among other things in risk behaviour and negligence towards own life and health. Participants all agreed that the thought of suicide was a certain escape route, that is to be constantly trying to escape from oneself and inner suffering. Negative thoughts that were difficult to suppress developed into suicidal thoughts that developed into thinking about the best possible way to commit suicide. Shattered self-esteem, shame and loneliness characterised the lives of participants, and they felt disgusting and worthless as human beings. Much self-degradation was characteristic. Perceived common societal norms about male masculinity had major negative impact on participants, for example that they should not show emotions because they were men and therefore should not express emotional pain or disclose their traumas. This resulted in emotional silencing. Disclosing the violence proved extremely difficult for all participants, but they experienced a high level of positive energy following disclosure. Participants experienced lack of knowledge, understanding and appropriate support from healthcare professionals and felt that sexual violence survivors' trauma history needed to be better explored within health care. It is important that professionals acquire knowledge and understanding of male sexual violence survivors, and their suicidal thoughts, and become able to provide trauma-specific support.

Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis

This comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using the I2 statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from 68 studies based on n = 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76-3.64], physical abuse (OR 2.52, 95% CI 2.09-3.04) and emotional abuse (OR 2.49, 95% CI 1.64-3.77) were associated with two- to three-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52-10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.

The Role of Masculinity and Depressive Symptoms in Predicting Suicidal Ideation in Homeless Men

Men's suicide rates may be influenced by difficulties recognizing externalizing depressive symptoms in men that adhere to hegemonic masculine gender role norms. The purpose of this study was to investigate the ability of externalizing depressive symptoms, internalizing depressive symptoms, and hegemonic masculinity in predicting the existence and severity of suicidal ideation. Homeless men (n = 94) completed questionnaires at a resource center in the Rocky Mountain Western United States. Internalizing symptoms predicted the existence of suicidal ideation, and both externalizing and internalizing symptoms predicted increased severity of suicidal ideation. The masculine norms violence and playboy were correlated with men's suicidal ideation. An externalizing-internalizing model of predicting suicide in men and men's adherence to certain masculine gender role norms may be valuable to further efforts in suicide assessment and prevention.

Willingness to disclose child maltreatment: CSA vs other forms of child abuse in relation to gender

The aim of the study was to examine the role of gender in willingness to disclose childhood sexual abuse (CSA) compared to other forms of abuse (physical, emotional and neglect) in young adolescents. Willingness was examined through two terms: reluctance- the level of unwillingness or disinclination to disclose, and urge-the need to share in order to get rid of unbearable feelings. The sample consisted of 3,156 boys (n = 1,544) and girls (n = 1,612) between the ages of 11-16 who reported having been abused at least once during their life. Participants were divided into three groups: experiencing other than CSA, sexual abuse with no physical contact, and sexual abuse with physical contact. Regarding measures, a self-report questionnaire incorporating the following instruments was administered: Demographics, the Juvenile Victimization Questionnaire (JVQ), and the Disclosure of Trauma Questionnaire (DTQ). Study results indicated that CSA victims were more reluctant to disclose than victims of other than CSA forms of abuse. The more severe the CSA (physical contact) the lower was the willingness to disclose. Boys were more reluctant than girls to disclose sexual abuse whether or not it involved physical contact. Reluctance to disclose was positively associated with emotional reactions to disclosure while urge to talk was negatively correlated with emotional reactions to disclosure.

Childhood Sexual Abuse in Adolescents Adjudicated for Sexual Offenses: Mental Health Consequences and Sexual Offending Behaviors

Most studies on the mental health consequences of childhood sexual abuse (CSA) focus predominantly on CSA survivors who do not commit sexual offenses. The current study examined the effects of CSA on 498 male adolescents adjudicated for sexual offenses who represent the small portion of CSA survivors who engage in sexual offenses. The prevalence of internalizing symptoms, parental attachment difficulties, specific sexual offending behaviors, and risk for sexually offending were compared among participants with and without a history of CSA. Results indicated that participants with a history of CSA were more likely to be diagnosed with major depression and posttraumatic stress disorder than those who did not report a history of CSA. A history of CSA was also positively correlated with risk for sexually offending and with specific offense patterns and consensual sexual behaviors. No significant differences emerged on parental attachment difficulties. These results highlight that adolescents adjudicated for sexual offenses with a history of CSA present with differences in sexual and psychological functioning as well as markedly different offending patterns when compared with those without a CSA history. Clinical implications and future directions are discussed.

Can a documentary increase help-seeking intentions in men? A randomised controlled trial

BACKGROUND

We investigated whether a public health intervention-a three-part documentary called Man Up which explored the relationship between masculinity and mental health, well-being and suicidality-could increase men's intentions to seek help for personal and emotional problems.

METHODS

We recruited men aged 18 years or over who were not at risk of suicide to participate in a double-blind randomised controlled trial. Participants were randomly assigned (1:1) via computer randomisation to view Man Up (the intervention) or a control documentary. We hypothesised that 4 weeks after viewing Man Up participants would report higher levels of intention to seek help than those who viewed the control documentary. Our primary outcome was assessed using the General Help Seeking Questionnaire, and was analysed for all participants. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616001169437, Universal Trial Number: U1111-1186-1459) and was funded by the Movember Foundation.

RESULTS

Three hundred and fifty-four men were assessed for eligibility for the trial and randomised to view Man Up or the control documentary. Of these, 337 completed all stages (nine participants were lost to follow-up in the intervention group and eight in the control group). Linear regression analysis showed a significant increase in intentions to seek help in the intervention group, but not in the control group (coef.=2.06, 95% CI 0.48 to 3.63, P=0.01).

CONCLUSIONS

Our trial demonstrates the potential for men's health outcomes to be positively impacted by novel, media-based public health interventions that focus on traditional masculinity.

TRIAL REGISTRATION NUMBER

ACTRN12616001169437, Results.

The Role of Early Maladaptive Schemas in the Appearance of Psychological Symptomatology in Adult Women Victims of Child Abuse

Child abuse affects people's ways of thinking, feeling, and observing the world, resulting in dysfunctional beliefs and maladaptive schemas. Thus, consequences of child abuse may persist during adulthood. Therefore, the aim of this study was to analyze the psychological consequences (anxiety, phobic anxiety, depression, and hopelessness) of different types of maltreatment (physical, sexual, and emotional abuse and physical and emotional neglect) and to study the role of early maladaptive schemas in the onset of symptomatology in adult female victims of child abuse. The sample consisted of 75 women referred by associations for treatment of abuse and maltreatment in childhood. Sexual abuse was the type of maltreatment that was most strongly related to most dysfunctional symptomatology, followed by emotional abuse and physical abuse, whereas physical neglect was the least related. Also, early maladaptive schemas were found to correlate with child abuse and dysfunctional symptomatology. Finally, early maladaptive schemas mediated the relationship between sexual abuse and dysfunctional symptomatology when the effect of other types of abuse was controlled. These results may provide important guidance for clinical intervention.

"The Heart Desires but the Body Refuses": Sexual Scripts, Older Men's Perceptions of Sexuality, and Implications for Their Mental and Sexual Health

We use sexual scripting theory in the present paper to gain a better understanding of older men's perceptions of their sexuality in relation to dominant Tanzanian cultural norms of masculinity. Qualitative in-depth interviews were conducted with 15 older men, and ten focus group discussions were conducted with 60 men aged 60-82. Participants' recruitment was guided by theoretical sampling strategies. Consistent with the principles of grounded theory, data collection and analysis occurred simultaneously. Our findings indicate that Jando (male initiation rites) serves as a script for male sexuality that outlines the expectations and rewards of male sexuality. Adhering to masculine sexual script affects older men's perceptions of their sexuality in later life and has detrimental effects on their well-being. Older men were concerned with changes in their sexual life, such as the decline in their sexual performance. The majority of the participants said they felt emotionally distressed about the age-related decline in their body and in their sexuality, and they reported that their inability to conform to male sexual scripts undermined their sense of masculinity. Several of the participants reported that in an effort to regain their previous sexual performance, they had turned to remedies and strategies of questionable appropriateness and effectiveness. Our study suggests that older men may benefit from age-related interventions tailored to their cultural background. These interventions may require trained health care providers on mental health issues to bridge the gap between the internalized scripts of ideal male sexuality and the reality of aging.

The relationship between childhood sexual abuse and mental health outcomes among males: Results from a nationally representative United States sample

BACKGROUND

Few studies have examined the associations between childhood sexual abuse (CSA), co-occurrence with other types of maltreatment and adult mental health outcomes, specifically among males. The objectives of this study were to: 1) determine the prevalence of males who have experienced a) childhood maltreatment without CSA; b) CSA without other forms of childhood maltreatment; and c) CSA along with other forms of childhood maltreatment; and 2) determine the relationship between CSA among males and mood, anxiety, substance and personality disorders and suicide attempts.

METHODS

Data were drawn from the 2004-2005 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) and limited to males age 20 years old and older (n=14,564). Child maltreatment included harsh physical punishment, physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect and exposure to intimate partner violence (IPV).

RESULTS

Emotional abuse, physical abuse, and exposure to IPV were the most common forms of maltreatment that co-occurred with CSA among males. A history of CSA only, and CSA co-occurring with other types of child maltreatment, resulted in higher odds for many mental disorders and suicide attempts compared to a history of child maltreatment without CSA.

CONCLUSIONS

Child maltreatment is associated with increased odds of mental disorders among males. Larger effects were noted for many mental disorders and suicide attempts for males who experienced CSA with or without other child maltreatment types compared to those who did not experience CSA. These results are important for understanding the significant long-term effects of CSA among males.

Masculinity and suicidal thinking

PURPOSE

Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.

METHODS

We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.

RESULTS

After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).

CONCLUSIONS

It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence.

The Effect of Child Sexual Abuse on Men: Toward a Male Sensitive Measure

Child sexual abuse (CSA) is a trauma that affects males in substantial numbers, sometimes in ways that are gender-specific (e.g., compromised masculine identity, confusion regarding sexuality). Much of the identification of the male-specific outcomes has been derived from practitioner experience and small qualitative studies. The current study explores gender-specific outcomes and describes the development of a scale to measure the effects of CSA on men. First, qualitative interviews with 20 men who were sexually abused in childhood were thematically analyzed. The emergent themes of sexuality, self-concept, psychological and emotional well-being, and social functioning were used to construct a 30-item instrument which was later completed by 147 men with histories of CSA. The dimensionality of the 30 items was then assessed for suitability as scales using confirmatory factor analysis (CFA). The final instrument, the Male Sexual Abuse Effects Scale (MSAES), combines three subscales: Negative Identity, Guilt and Self-Blame, and Psychological and Emotional Well-Being. Items concerning masculine identity were shown to be valid in the scale. MSAES scores were compared with the General Health Questionnaire-28 (GHQ-28) and found to be significantly correlated. GHQ-28 clinical thresholds were applied to differentiate clinical from nonclinical cases; an independent-samples t test showed that the clinical cases from the GHQ-28 had high scores on the MSAES. The new scale has the potential to help clinicians and researchers identify men who have been severely affected by CSA and who should be of clinical concern.

Mental health indicators fifty years later: A population-based study of men with histories of child sexual abuse

Childhood sexual abuse (CSA) is a widely acknowledged trauma that affects a substantial number of boys/men and has the potential to undermine mental health across the lifespan. Despite the topic's importance, few studies have examined the long-term effects of CSA on mental health in middle and late life for men. Most empirical studies on the effects of CSA have been conducted with women, non-probability samples, and samples of young or emerging adults with inadequate control variables. Based on complex trauma theory, the current study investigated: a) the effect of CSA on mental health outcomes (depressive symptoms, somatic symptom severity, hostility) in late life for men, and b) the moderating effects of childhood adversities and masculine norms in the relationship between CSA and the three mental health outcomes. Using a population-based sample from the 2004-2005 Wisconsin Longitudinal Study, multivariate analyses found that CSA was positively related to both depressive and somatic symptoms and increased the likelihood of hostility for men who reported a history of CSA. Both childhood adversities and masculine norms were positively related to the three outcomes for the entire sample. Among CSA survivors, childhood adversities exerted a moderating effect in terms of depressive symptoms. Mental health practitioners should include CSA and childhood adversities in assessment and treatment with men. To more fully understand the effects of CSA, future studies are needed that use longitudinal designs, compare male and female survivors, and examine protective mechanisms such as social support.

Injury, Interiority, and Isolation in Men's Suicidality

Men’s high suicide rates have been linked to individual risk factors including history of being abused as a child, single marital status, and financial difficulties. While it has also been suggested that the normative influences of hegemonic masculinities are implicated in men’s suicide, the gendered experiences of male suicidality are poorly understood. In the current photovoice study, 20 men who previously had suicidal thoughts, plans, and/or attempts were interviewed as a means to better understanding the connections between masculinities and their experiences of suicidality. The study findings revealed injury, interiority, and isolation as interconnected themes characterizing men’s suicidality. Injury comprised an array of childhood and/or cumulative traumas that fueled men’s ruminating thoughts inhibiting recovery and limiting hopes for improved life quality. In attempting to blunt these traumas, many men described self-injuring through the overuse of alcohol and other drugs. The interiority theme revealed how suicidal thoughts can fuel hopelessness amid summonsing remedies from within. The challenges to self-manage, especially when experiencing muddled thinking and negative thought were evident, and led some participants to summons exterior resources to counter suicidality. Isolation included separateness from others, and was linked to abandonment issues and not having a job and/or partner. Self-isolating also featured as a protection strategy to avoid troubling others and/or reducing exposure to additional noxious stimuli. The study findings suggest multiple intervention points and strategies, the majority of which are premised on promoting men’s social connectedness. The destigmatizing value of photovoice methods is also discussed.

Recent Suicidality in the General Population: Multivariate Association With Childhood Maltreatment and Adult Victimization

Three hundred and eighty-seven participants from the general population completed the Suicidality scale of the Detailed Assessment of Posttraumatic Stress (DAPS) and the Traumatic Events Survey (TES). Within the prior month, 14% of adults reported some degree of suicidal ideation and 2% reported an active or passive suicide attempt. Multinomial logistic analysis indicated that, as compared with nonsuicidal participants, age, childhood physical abuse, childhood sexual abuse, and childhood emotional abuse were associated with recent suicide attempts, whereas recent suicidal ideation without attempts was predicted solely by emotional abuse. In contrast, adult sexual or physical assaults were not associated with recent suicidality in any form.

Integrative review: nurses' roles and experiences in keeping children safe

AIM

To identify nurses' role and experiences of keeping children safe.

BACKGROUND

Approaches to preventing, identifying and responding to child abuse and neglect have moved towards a multidisciplinary approach where all professionals are expected to contribute to the goal of keeping children safe. Frequently in contact with children and families, nurses well positioned to contribute to keeping children safe from abuse and neglect. Much has been published around nurses' experiences of their role in keeping children safe, but this literature has not yet been synthesized to determine the challenges and potential scope of this role.

DESIGN

Integrative review following an Integrative Review framework.

DATA SOURCES

Studies were identified through a search of the electronic databases CINAHL, Medline, Web of Science, Scopus and Informit to identify literature published between 2005-2015.

REVIEW METHODS

All the studies were critically appraised for methodological quality using the Critical Skills Appraisal Programme. Data from each study were extracted and categorized according to the review aims and the study's major findings.

RESULTS

Inclusion criteria were met in 60 studies. Three main findings were identified including nurses' insufficient knowledge, need for validation and improved communication and balancing surveillance and support for vulnerable families.

CONCLUSIONS

Nurses have many roles and experiences in keeping children safe but often felt they did not have the knowledge, skills and support to take action in this area. Further research is needed to understand why nurses feel inadequate and disempowered to advocate and intervene on the behalf of children at risk of abuse or neglect.

How the Interaction of Childhood Sexual Abuse and Gender Relates to HIV Risk Practices among Urban-Dwelling African Americans

Purpose

Previous research has demonstrated that HIV risk practices often differ based on gender and on whether or not people experienced sexual abuse during their formative (i.e., childhood and adolescence) years. The interaction of these two factors, which is the focus of this paper, has received limited attention.

Methods

Based on a model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2012 with 1,864 African American adults residing in Atlanta, Georgia in 80 strategically-chosen consensus block groups.

Results

Based on multiple regression and structural equation analyses, the interaction of sexual abuse and gender was found to be a significant predictor of involvement in (un)protected sex. The interaction of sexual abuse and gender also was related to condom use self-efficacy, which was one of the strongest factors underlying (un)protected sex.

Conclusion

The relationship of sexual abuse history and gender is relevant in the understanding of HIV risk practices. The interaction of these factors with one another and with other relevant influences that shape people's HIV risk profiles is complex. The Syndemics Theory approach used to conceptualize the relationships among relevant variables in this study is an effective way of trying to understand and address HIV risk practices.

Childhood Abuse and Mental Health Problems: Does Gender Matter?

Gender differences in the relationship between mental health problems and childhood abuse have long been of interest to researchers. The purpose of the present study was to examine gender differences in the relationship between childhood abuse and mental health problems among 110 Israeli inmates (50 women and 60 men). The findings indicated that female inmates reported higher prevalence of physical, emotional, and sexual abuse and were more likely to suffer from mental health problems, compared with the male inmates. Additionally, the findings revealed that more female than male inmates had parents with mental health problems. Female inmates who reported mental health problems in their families also reported higher rates of child abuse relative to male inmates with a similar family history.

The Disclosure Experiences of Male Child Sexual Abuse Survivors

This article explores the diversity in the disclosure process of male survivors of child sexual abuse. Disclosure is a complex process for victims of both genders, however masculine norms and stereotypes have contributed to an environment that often negates the experiences of men. The disclosure process of 17 adult male survivors of child sexual abuse was explored using transcripts of telephone interviews. A combination of two qualitative methodologies, the phenomenological method and interpretive description approach, was used to analyze this secondary data. The results indicated that the majority of the men in the study waited until adulthood to disclose their abuse, with negative stereotypes contributing to their delayed disclosures. In terms of specific experiences with disclosure, the participants found they received both positive and negative responses. These results were consistent with the literature.

Maternal history of childhood sexual abuse and preterm birth: an epidemiologic review

BACKGROUND

History of childhood sexual abuse (CSA) is highly prevalent with as many as one in four American women being victims. Exposure to CSA or other early life traumatic experiences has been associated with adverse reproductive and pregnancy outcomes. However, the effects of CSA on preterm delivery (PTB), a leading cause of neonatal mortality, remain poorly understood. The objectives of this review are (i) to synthesize the available research investigating the relationship between maternal history of childhood sexual abuse (CSA) and preterm delivery (PTB); (ii) to provide suggestions for improving future research on this topic; and (iii) to highlight implications for clinical practice and public health.

METHODS

Relevant articles were identified through searches of four electronic databases (PubMed, CINAHL, Web of Science Core Collection and BIOSIS Online) for studies published before March 2014, as well as through reviewing references of published articles.

RESULTS

A total of six studies published from 1992 to 2010 were included in this review. Overall, findings were inconsistent. Three studies reported statistically significant associations of CSA with PTB (<37 weeks gestation) or shorter mean gestational age at birth. Women with a history of CSA had 2.6 to 4.8-fold increased odds of PTB as compared with women without a history of CSA. Three other studies did not observe statistically significant differences in rates of PTB or mean gestational age at birth in relation to a history of CSA.

CONCLUSIONS

Available evidence on this topic is sparse and inconsistent, and limited by a number of methodological challenges. Given the ubiquity of CSA, as well as the clinical and public health significance of PTB, more rigorously designed epidemiologic studies on the association between CSA and PTB are warranted.

Childhood sexual abuse and posttraumatic stress disorder among pregnant and postpartum women: review of the literature

The aims of this review are (i) to summarize and evaluate current knowledge on the association between childhood sexual abuse (CSA) and posttraumatic stress disorder (PTSD) in pregnant and postpartum women, (ii) to provide suggestions for future research on this topic, and (iii) to highlight some clinical implications. Relevant publications were identified through literature searches of four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and PsycARTICLES) using keywords such as "child abuse," "posttraumatic stress," "pregnancy," and "postpartum". Five studies were included in this review. Findings across all studies were consistent with higher prevalence of PTSD diagnosis or symptomatology among women with history of CSA. However, only findings from two studies were statistically significant. One study observed higher overall PTSD scores in women with CSA history compared to women with non-CSA trauma history or no trauma history during pregnancy (mean ± SD 1.47 (0.51) vs. 1.33 (0.41) vs. 1.22 (0.29), p < 0.001), at 2 months postpartum (mean ± SD 1.43 (0.49) vs. 1.26 (0.38) vs. 1.19 (0.35), p < 0.001), and at 6 months postpartum (mean ± SD 1.36 (1.43) vs. 1.20 (0.33) vs. 1.14 (0.27), p < 0.001). Another study observed that the prevalence of PTSD during pregnancy was 4.1 % in women with no history of physical or sexual abuse, 11.4 % in women with adult physical or sexual abuse history, 16.0 % in women with childhood physical or sexual abuse history, and 39.0 % in women exposed to both childhood and adult physical or sexual abuse (p < 0.001); in a subsequent analysis, the investigators reported that pregnant women with PTSD had over 5-fold odds of having a history of childhood completed rape compared to counterparts without PTSD (OR = 5.3, 95 % CI 3.2, 8.7). Overall, available evidence suggests positive associations of CSA with clinical PTSD or PTSD symptomatology among pregnant and postpartum women.

Association of childhood physical and sexual abuse with intimate partner violence, poor general health and depressive symptoms among pregnant women

Objective

We examined associations of childhood physical and sexual abuse with risk of intimate partner violence (IPV). We also evaluated the extent to which childhood abuse was associated with self-reported general health status and symptoms of antepartum depression in a cohort of pregnant Peruvian women.

Methods

In-person interviews were conducted to collect information regarding history of childhood abuse and IPV from 1,521 women during early pregnancy. Antepartum depressive symptomatology was evaluated using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).

Results

Any childhood abuse was associated with 2.2-fold increased odds of lifetime IPV (95%CI: 1.72–2.83). Compared with women who reported no childhood abuse, those who reported both, childhood physical and sexual abuse had a 7.14-fold lifetime risk of physical and sexual IPV (95%CI: 4.15–12.26). The odds of experiencing physical and sexual abuse by an intimate partner in the past year was 3.33-fold higher among women with a history of childhood physical and sexual abuse as compared to women who were not abused as children (95%CI 1.60–6.89). Childhood abuse was associated with higher odds of self-reported poor health status during early pregnancy (aOR = 1.32, 95%CI: 1.04–1.68) and with symptoms of antepartum depression (aOR = 2.07, 95%CI: 1.58–2.71).

Conclusion

These data indicate that childhood sexual and physical abuse is associated with IPV, poor general health and depressive symptoms in early pregnancy. The high prevalence of childhood trauma and its enduring effects of on women’s health warrant concerted global health efforts in preventing violence.

Does history of childhood maltreatment make a difference in prison? A hierarchical approach on early family events and personality traits

This study attempts to assess childhood maltreatment in prison through a hierarchical approach. The hierarchical approach principally aims to disentangle the independent effects of childhood maltreatment upon psychiatric morbidity/personality traits, if any, from the burden that the adverse family conditions have already imposed to the mental health of the maltreated individual-prisoner. To this direction, a conceptual framework with five hierarchical levels was constructed, namely: immutable demographic factors; family conditions; childhood maltreatment (physical abuse, neglect and sexual abuse); personality traits, habits and psychiatric morbidity; prison-related variables. A self-administered, anonymous set (battery) of questionnaires was administered to 173 male prisoners in the Chalkida prison, Greece; 26% of prisoners disclosed childhood maltreatment. Psychiatric condition in the family, parental alcoholism and parental divorce correlated with childhood maltreatment. After adjustment for immutable demographic factors and family conditions, childhood maltreatment was associated with aggression (both in terms of Lifetime History of Aggression and Buss–Perry Aggression Questionnaire scores), illicit substance use, personal history of psychiatric condition, current smoking, impulsivity and alcohol abuse. In conclusion, childhood maltreatment represents a pivotal, determining factor in the life course of male prisoners. Delinquents seem to suffer from long-term consequences of childhood maltreatment in terms of numerous mental health aspects.

Moving Beyond Dwelling in Suffering

The authors present an explanation of the development of a situation-specific theory of men’s healing from maltreatment during childhood. Development of the theory was guided by Rogers’ science of unitary human beings (SUHB). The four multidimensional concepts of the theory are interpreted within the context of the SUHB from themes discovered from the findings of a hermeneutic phenomenological study of men who had been exposed to childhood maltreatment, including neglect and abuse. The concepts are: moving beyond suffering, desiring release from suffering, dwelling in suffering, and experiencing wellbeing. Moving beyond suffering is the process of healing from childhood maltreatment. Desiring release from suffering is the facilitator of men’s life experiences that speeds up the rate of evolution from moving beyond suffering to experiencing healing. Dwelling in suffering is the barrier in men’s life experiences that slows down the rate of evolution from moving beyond suffering to experiencing wellbeing.

The associations among childhood maltreatment, "male depression" and suicide risk in psychiatric patients

In the current cross-sectional study, we aimed to investigate the presence and severity of "male" depressive symptoms and suicidal behaviors in psychiatric patients with and without a history of child abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), as well as to explore the associations among childhood maltreatment, "male depression" and suicide risk. The sample consisted of 163 consecutively admitted adult inpatients (80 men; 83 women). The patients were administered the CTQ, Gotland Male Depression Scale (GMDS), and Suicidal History Self-Rating Screening Scale (SHSS). Those with a moderate-severe childhood maltreatment history were more likely to be female (p<0.05) and reported more "male depression" (p<0.001) and suicidal behaviors (p<0.01) as compared to those not having or having a minimal history of child abuse and neglect. In the multivariate analysis, only the minimization/denial scale of the CTQ (odds ratio=0.31; p<0.001) and "male depression" (odds ratio=1.83; p<0.05) were independently associated with moderate/severe history of child maltreatment. The findings suggest that exposure to abuse and neglect as a child may increase the risk of subsequent symptoms of "male depression", which has been associated with higher suicidal risk.

A hermeneutic phenomenological understanding of men's healing from childhood maltreatment

PURPOSE

To describe and interpret men's experience of healing from childhood maltreatment.

DESIGN

Hermeneutic phenomenological.

METHOD

In-depth interviews. Community-based purposive, maximum variation sampling approach. Recruitment occurred through posting flyers and advertisements. Verbatim data were analyzed and themes of the meaning of healing were identified.

FINDINGS

The meaning of healing was interpreted as "moving beyond suffering." Five themes were identified to capture the multidimensional nature of the phenomenon: (a) breaking through the masculine veneer, (b) finding meaning, (c) choosing to live well, (d) caring for the self using holistic healing methods, and (e) engaging in humanizing relationships.

CONCLUSIONS

Men who survived childhood maltreatment have needs to heal holistically mind, body, and spirit. Meeting their needs requires the provision of highly compassionate humanistic healing environments and healing-promotive nursing care.

Dwelling in suffering: barriers to men's healing from childhood maltreatment

Based on findings from a hermeneutic phenomenological study, this article provides a description and interpretation of barriers to healing that men encountered in the aftermath of childhood maltreatment. An analysis of interview data collected from 52 adult male survivors healing from childhood maltreatment identified a theme, Dwelling in Suffering, as representing the full range of barriers that impeded their healing. Subthemes of Dwelling in Suffering Personally, Relationally, and Social-Environmentally are discussed. This research highlights a complex understanding of the challenges men experience in healing from childhood maltreatment and the need for practice interventions and future research to ameliorate men's suffering.