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Testa A, Jacobs B, Thompson J, Pang N, Jackson DB, Nagata JM, Ganson KT. Adverse Childhood Experiences and Police Contact in Canada. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241270047. [PMID: 39143752 DOI: 10.1177/08862605241270047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
A growing body of research has demonstrated that adverse childhood experiences (ACEs) are a risk factor for criminal justice system contact. However, much of this research is limited by (1) being conducted in the United States and (2) a lack of details on specific types of harmful experiences of criminal justice system contact, such as police contact characterized by intrusion or harassment. Using survey data from 940 individuals aged 16 to 30 in Canada from the Canadian Study of Adolescent Health Behaviors, this study investigates the relationship between ACEs and police contact, focusing on encounters involving intrusion or harassment. Results from logistic and multinomial logistic regression analyses reveal that individuals with high ACE exposure, particularly those with four or more ACEs, are more likely to have police contact, including experiences of intrusion and harassment. The results are significant in understanding the interplay between childhood trauma and later encounters with the criminal justice system, emphasizing the need for trauma-informed approaches in policing and healthcare. The study highlights the importance of early interventions to mitigate the effects of ACEs and prevent adverse outcomes in police interactions.
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Affiliation(s)
| | | | | | | | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Silva C, Moreira P, Moreira DS, Rafael F, Rodrigues A, Leite Â, Lopes S, Moreira D. Impact of Adverse Childhood Experiences in Young Adults and Adults: A Systematic Literature Review. Pediatr Rep 2024; 16:461-481. [PMID: 38921705 PMCID: PMC11206640 DOI: 10.3390/pediatric16020040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Investigations have shown the different impacts that ACEs have on an individual's adult life, on both physical and mental health, but they have not yet shown the issue of the influence of ACEs on adults and young adults. Objective/Participants and Setting: This systematic review, performed according to the PRISMA norms and guidelines, intended to understand the most frequent outcomes of adverse childhood experiences in the life of young adults and adults. METHODS Studies were identified through multiple literature search databases at EBSCOhost, Web of Science, and PubMed April 2023, and a total of 279 studies, published between 1999 and 2002, were excluded, 256 because of multiple factors: being duplicates, showing statistical analysis with correlations only, being systematic reviews or case studies, comprising individuals under the age of 18, and not meeting the intended theme; ultimately, we selected for the review a total of 23 studies. RESULTS AND CONCLUSIONS The impacts of the various articles are subdivided into three main themes: antisocial and criminal behaviour; sexual Behaviour and intimate partner violence; and attachment, quality of life, and therapeutic alliance.
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Affiliation(s)
- Candy Silva
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 1649-023 Braga, Portugal; (C.S.); (P.M.); (A.R.); (Â.L.)
| | - Patrícia Moreira
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 1649-023 Braga, Portugal; (C.S.); (P.M.); (A.R.); (Â.L.)
| | - Diana Sá Moreira
- Institute of Psychology and Neuropsychology of Porto—IPNP Health, 4100-136 Porto, Portugal;
| | - Filipa Rafael
- School of Education, The Polytechnic Institute of Oporto (IPP), 4200-465 Porto, Portugal;
| | - Anabela Rodrigues
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 1649-023 Braga, Portugal; (C.S.); (P.M.); (A.R.); (Â.L.)
| | - Ângela Leite
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 1649-023 Braga, Portugal; (C.S.); (P.M.); (A.R.); (Â.L.)
| | - Sílvia Lopes
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 1649-023 Braga, Portugal; (C.S.); (P.M.); (A.R.); (Â.L.)
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Diana Moreira
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 1649-023 Braga, Portugal; (C.S.); (P.M.); (A.R.); (Â.L.)
- Institute of Psychology and Neuropsychology of Porto—IPNP Health, 4100-136 Porto, Portugal;
- Centro de Solidariedade de Braga/Projecto Homem, R. do Alcaide 31, 4700-024 Braga, Portugal
- Observatory Permanent Violence and Crime (OPVC), FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences and CPUP—Center for Psychology at University of Porto, 4200-135 Porto, Portugal
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LeMay CC, Stinson JD. Persons With Histories of Traumatic Brain Injury and Problematic Sexual Behavior: An Exploratory Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024; 68:183-206. [PMID: 34963350 DOI: 10.1177/0306624x211066831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Persons with traumatic brain injuries (TBI) who have engaged in problematic or illegal sexual behavior present with complex assessment and intervention needs yet remain understudied within the empirical literature. In the current exploratory analysis, important differences in adaptive and clinical functioning, adverse childhood experiences, and criminal offense history are examined in 25 persons with previous brain injury, 118 persons with intellectual disability but no known TBI, and 103 persons with no history of brain injury or intellectual disability, all of whom have engaged in problematic sexual behavior and who were residing in secure forensic inpatient care. Group differences were examined using comparisons of means and chi-squares. Results highlight important differences in education and employment experiences, diagnostic presentation, exposure to childhood maltreatment, and justice system involvement and characteristics of their sexual offense victims. Associations with prior literature and future research directions are discussed.
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Rabbany JM, Ellis S, Metts A, Burke A, Brent DA, Melhem N, Marcott S, Mann JJ. Mood Disorders and Aggressive Traits Mediate Effects of Reported Childhood Adversity on Suicide Attempt Risk. Arch Suicide Res 2023; 27:1207-1230. [PMID: 36052407 DOI: 10.1080/13811118.2022.2112118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Childhood adversity (CA) is linked to suicidal behavior as well as to mood disorders and aggressive traits. This raises the possibility that depression and aggressive traits mediate the relationship of childhood adversity to suicide risk. Moreover, it is not known if they operate independently or interactively. AIMS To determine whether, and how, mood disorders and aggressive traits mediate the effects of reported physical and sexual abuse on future suicidal behavior. METHODS Five hundred and forty-eight subjects, offspring of parents with mood disorders, were interviewed at baseline and at yearly follow-ups with questionnaires assessing aggression, mood disorders, and suicidal behavior. The mediation analysis involved a three-step process, testing the relationships between (1) CA and attempt; (2) CA and putative mediators; and (3) putative mediators and suicide attempt, adjusting for CA. RESULTS Aggressive trait severity and mood disorder onset each mediated the relationship between CA and future suicide attempts. Greater aggression severity also raised the hazard of the development of a mood disorder. If aggressive trait severity was clearly elevated, then onset of mood disorder did not increase further the hazard of the suicide attempt. Including family as a random effect had a much bigger effect on attempt outcome for physical abuse compared with sexual abuse. CONCLUSIONS Amelioration of aggressive traits and treatment of mood disorders in CA-exposed offspring of a parent with a mood disorder may prevent future suicide attempts and may reduce the risk of mood disorder. Familial factors influence the impact of childhood physical abuse but not sexual abuse. HIGHLIGHTSChildhood Adversity (CA) predicted future mood disorder and aggression severity.Depression and aggression mediate the relationship between CA and suicide attempts.When one mediator is present, the presence of the other does not increase the hazard.Between family variation contributed much more to suicidal behavior outcomes relative to the effect of physical abuse, but sexual abuse contributed to suicidal outcomes more than family variation.
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Belfry KD, Ham E, Kolla NJ, Hilton NZ. Adverse Childhood Experiences and Offending as a Function of Acquired Brain Injury Among Men in a High Secure Forensic Psychiatric Hospital. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:453-460. [PMID: 36537143 PMCID: PMC10331256 DOI: 10.1177/07067437221144629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acquired brain injury (ABI) is a serious problem that disproportionately affects individuals in correctional services, but relatively little is known about ABI risks and correlates in forensic psychiatric services. METHODS We conducted a retrospective chart review of all admissions to a high secure forensic hospital in Ontario, Canada from January 2009 to December 2012 (n = 637) and collected data on ABI, psychiatric diagnoses, developmental disadvantage, criminal offending, and in-hospital aggression. A k-means cluster analysis was employed to assess risk factors by which men with ABI could be identified and multivariate general linear models were used to identify ABI-related differences in offending history and in-hospital aggression. RESULTS One-fifth of the men had a documented ABI indicator. Based on our cluster analysis, ABI was more likely to be identified by greater adverse childhood experiences (ACEs), more health problems from pregnancy to childhood, and lower socioeconomic status, suggesting that ABI within the forensic context is associated with greater developmental disadvantage. Men with ABI had more serious pre-admission offences, but not more serious admission offences or in-hospital aggression. Men with ABI were more likely than those without to have higher scores on the Violence Risk Appraisal Guide or to be diagnosed with mood and personality disorders, and less likely to have a schizophrenia diagnosis, suggesting an association between ABI and general mental health pathologies but not with psychotic illness. CONCLUSIONS The disadvantage of ABI among men in forensic psychiatric hospitals is most likely evinced in antisocial behaviour rather than serious mental illness. Given that ACEs are likely to precede or co-occur with ABI, strategies that mitigate ACEs hold promise for ABI prevention.
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Affiliation(s)
- Kimberly D. Belfry
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Elke Ham
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Nathan J. Kolla
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - N. Zoe Hilton
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
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Johnstone S, Dela Cruz GA, Kalb N, Tyagi SV, Potenza MN, George TP, Castle DJ. A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:21-42. [PMID: 36283062 DOI: 10.1080/00952990.2022.2130348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/16/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
Background: Integrated and gender-responsive interventions, designed to target co-occurring substance use and psychiatric disorders in women, may be effective in addressing gender-specific challenges.Objectives: This systematic review aims to identify integrated gender-responsive substance use disorder treatments for women, summarize evaluations of these treatments, and address gaps in the literature.Methods: We searched PsycINFO, PubMed, and MEDLINE on September 24, 2021, and March 10, 2022. Included articles were randomized-controlled trials, secondary analyses of naturalistic studies, or open-label studies of integrated and gender-responsive treatments from any year that assessed both substance use and mental health/trauma outcomes.Results: We identified N = 24 studies (participants = 3,396; 100% women) examining Seeking Safety, Helping Women Recover and Beyond Trauma, A Woman's Path to Recovery, Modified Trauma Recovery and Empowerment Model (TREM), Breaking the Cycle, VOICES, Understanding and Overcoming Substance Misuse, Women's Recovery Group, Female Specific Cognitive Behavioral Therapy, and Moment by Moment in Women's Recovery. Across treatments there were significant improvements over time; Seeking Safety, Helping Women Recover, and TREM were associated with significantly better substance use and mental health outcomes relative to the comparison groups.Conclusions: Integrated gender-responsive treatments are a promising approach to treating women with co-occurring substance use and mental health concerns, and broad clinical implementation stands to benefit women. However, there remains a lack of studies evaluating substance use treatments in women with severe mental illness (e.g., psychotic-spectrum disorders) who differ in their needs and capacity.
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Affiliation(s)
- Samantha Johnstone
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gil Angela Dela Cruz
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Kalb
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Smita Vir Tyagi
- Departments of Psychiatry and Neuroscience and the Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Marc N Potenza
- Forensic Consultation and Assessment Team, CAMH, Toronto, Ontario, Canada
- Child Study Centre, Connecticut Mental Health Center, New Haven, CT, USA
- Women's Health Research, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Tony P George
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David J Castle
- Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Meddeb A, Berlin J, Laporte N, Wallinius M. Adverse childhood experiences do not moderate the association between aggressive antisocial behavior and general disinhibition in a forensic psychiatric inpatient sample. Front Psychol 2022; 13:1019246. [DOI: 10.3389/fpsyg.2022.1019246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
Adverse childhood experiences (ACE) and high levels of disinhibition have been associated with a variety of negative outcomes such as aggressive antisocial behavior (AAB). However, forensic psychiatric populations remain an understudied group in this field of research. This study aimed to fill that gap by investigating associations between ACE, AAB, and disinhibition in a forensic psychiatric sample. Furthermore, we aimed to explore such findings by investigating whether ACE might have a moderating effect on the association between disinhibition and AAB. A sample of forensic psychiatric patients (n = 89) was recruited from a high-security forensic psychiatric facility in Sweden. All study variables were moderately to strongly related to each other, although we found no moderating effect of ACE. Post hoc analysis indicated that our ACE items had differential effects on AAB scores, with placement outside the family home, absent parents, and parental drug abuse producing the largest effect on AAB levels. Our findings are in line with previous research demonstrating a significant and robust relationship between ACE, AAB, and disinhibition. Forensic psychiatric populations are exposed to high levels of both self-reported and documented ACE. This calls for trauma-informed care and highlights the importance of considering ACE in risk assessment, preventive work, and policy making.
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Testa A, Jackson DB, Ganson KT, Nagata JM. Adverse Childhood Experiences and Criminal Justice Contact in Adulthood. Acad Pediatr 2022; 22:972-980. [PMID: 34752957 DOI: 10.1016/j.acap.2021.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the relationship between adverse childhood experiences (ACEs) and formal criminal justice system processing during young adulthood and middle adulthood. METHODS Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 8531). Logistic regression, multinomial logistic regression, and Poisson regression models were used to assess the relationship between accumulating ACEs (0, 1, 2, 3, or 4 or more) and criminal justice system processing during young adulthood (24-32) and middle adulthood (33-43). RESULTS Accumulating ACEs -especially 4 or more ACEs- was significantly associated with various forms of criminal justice contact during young and middle adulthood, including having been arrested, experiencing a greater number of arrests, having been incarcerated in adulthood, having been incarcerated multiple times, and having spent longer periods of time incarcerated. CONCLUSIONS This study documents that the association between ACEs and formal criminal justice extends into young and middle adulthood. Considering the consequences of both ACEs and criminal justice system contact for a variety of life domains, the findings suggest the need for developing and employing early interventions to disrupt pathways to criminal justice system involvement.
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Affiliation(s)
- Alexander Testa
- The University of Texas at San Antonio, San Antonio (A Testa), Tex.
| | | | - Kyle T Ganson
- University of Toronto, Toronto, Ontario (KT Ganson), Canada
| | - Jason M Nagata
- University of California, San Francisco (JM Nagata), Calif
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Testa A, Jackson DB. Adverse Childhood Experiences and Perceived Unfair Police Treatment: Differences by Race and Ethnicity. J Adolesc Health 2022; 70:804-809. [PMID: 35131166 DOI: 10.1016/j.jadohealth.2021.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE The purpose of the study was to examine racial/ethnic heterogeneity in the relationship between adverse childhood experiences (ACEs) and perceived unfair police treatment in the United States. METHODS Data are from the National Longitudinal Study of Adolescent to Adult Health (n = 8,876). Logistic regression models were used to assess the relationship between accumulating ACEs and perceived unfair police treatment. Moderation analyses were conducted to assess interactions between ACEs, race, and ethnicity. RESULTS Those with four or more ACEs were 3.4 times as likely to report perceived unfair police treatment by adulthood, relative to individuals with zero ACEs (odds ratio = 3.411, 95% confidence interval = 2.634, 4.418). Still, Black individuals have the highest probability of experiencing unfair police contact, and this pattern remains relatively stable irrespective of the number of ACEs. The probability of perceived unfair police treatment significantly increases alongside accumulating ACEs for all other racial and ethnic groups. DISCUSSION Exposure to accumulating ACEs substantially elevates the likelihood of perceived unfair police treatment. However, perceived unfair police treatment is so common in the lives of Black Americans; it occurs at considerably high rates irrespective of ACE exposure.
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Affiliation(s)
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Roy L, Keays N, Lemieux A, Nicole M, Crocker AG. Traumatismes complexes et services psycholégaux : vers des pratiques sensibles au trauma. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094143ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Graf GHJ, Chihuri S, Blow M, Li G. Adverse Childhood Experiences and Justice System Contact: A Systematic Review. Pediatrics 2021; 147:peds.2020-021030. [PMID: 33328338 PMCID: PMC7786827 DOI: 10.1542/peds.2020-021030] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Given the wide-ranging health impacts of justice system involvement, we examined evidence for the association between adverse childhood experiences (ACEs) and justice system contact in the United States. OBJECTIVE To synthesize epidemiological evidence for the association between ACEs and justice system contact. DATA SOURCES We searched 5 databases for studies conducted through January 2020. The search term used for each database was as follows: ("aces" OR "childhood adversities") AND ("delinquency" OR "crime" OR "juvenile" OR criminal* OR offend*). STUDY SELECTION We included all observational studies assessing the association between ACEs and justice system contact conducted in the United States. DATA EXTRACTION Data extracted from each eligible study included information about the study design, study population, sample size, exposure and outcome measures, and key findings. Study quality was assessed by using the Newcastle-Ottawa Scale for nonrandomized trials. RESULTS In total, 10 of 11 studies reviewed were conducted in juvenile population groups. Elevated ACE scores were associated with increased risk of juvenile justice system contact. Estimates of the adjusted odds ratio of justice system contact per 1-point increase in ACE score ranged from 0.91 to 1.68. Results were consistent across multiple types of justice system contact and across geographic regions. LIMITATIONS Most studies reviewed were conducted in juvenile justice-involved populations with follow-up limited to adolescence or early adulthood. CONCLUSIONS ACEs are positively associated with juvenile justice system contact in a dose-response fashion. ACE prevention programs may help reduce juvenile justice system contacts and improve child and adolescent health.
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Affiliation(s)
| | - Stanford Chihuri
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; and
| | | | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health and
- Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; and
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Goodman H, Papastavrou Brooks C, Price O, Barley EA. Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: a qualitative study. Int J Ment Health Syst 2020; 14:59. [PMID: 32774452 PMCID: PMC7397665 DOI: 10.1186/s13033-020-00392-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023] Open
Abstract
Background Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours. Methods Semi-structured individual interviews (n = 12) and focus groups (n = 3) were conducted with eight patients, four carers and 25 staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training.
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Affiliation(s)
- Helena Goodman
- Kate Granger Building, University of Surrey, Guildford, GU2 7YH UK
| | | | - Owen Price
- Jean McFarlane Building, University of Manchester, Manchester, M13 9PY UK
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Moulden HM, Mamak M, Chaimowitz G. A preliminary evaluation of the effectiveness of dialectical behaviour therapy in a forensic psychiatric setting. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2020; 30:141-150. [PMID: 32483870 DOI: 10.1002/cbm.2158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 12/09/2019] [Accepted: 05/09/2020] [Indexed: 06/11/2023]
Abstract
Dialectical behaviour therapy (DBT) is a therapy model incorporating elements of Eastern philosophies and cognitive behavioural principles. Originally designed for people struggling with chronic suicidality and borderline personality disorder (BPD), it has been adapted to treat complex, multi-diagnostic presentations, such as those in forensic mental health settings. To date, there has been little evaluation when the primary diagnosis is of psychosis. To explore the effectiveness of DBT, with patients, with multiple comorbidities, including psychosis, in a forensic psychiatric inpatient setting. A descriptive outcome study with a cohort of offender-patients in one specialist forensic mental health unit. Before and after treatment change scores were compared on anger, aggression, hopefulness, coping abilities, emotional intelligence, insight and subjective symptom severity scales, as well as staff-rated risk, and length of stay. Nine men and five women residents in one Canadian secure hospital completed a standard DBT programme, and self-ratings, over about 1 year. Scale scores indicated significantly increased insight and acknowledgment of problems. Apparently increased anger and vengeance scores were clinically associated. Independent staff ratings indicated reductions in risk and most patients achieved early release. This study provides support for extension of the use of DBT to offender-patients with psychosis among the complex mix in their presentation. It suggests that a randomised controlled trial with cost-benefit analysis is warranted, as well as further work, to promote understanding of mechanisms of effectiveness.
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Affiliation(s)
- Heather M Moulden
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | - Mini Mamak
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | - Gary Chaimowitz
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
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Evans EA, Goff SL, Upchurch DM, Grella CE. Childhood adversity and mental health comorbidity in men and women with opioid use disorders. Addict Behav 2020; 102:106149. [PMID: 31855783 PMCID: PMC7405712 DOI: 10.1016/j.addbeh.2019.106149] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/15/2019] [Accepted: 09/27/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION To examine gender differences in associations between mental health comorbidity and adverse childhood experiences (ACE) among adults with DSM-5 lifetime opioid use disorders (OUD). METHODS In 2018, we analyzed 2012-13 nationally-representative data from 388 women and 390 men with OUD (heroin, prescription opioid misuse). Using weighted multinomial logistic regression, we examined factors associated with mental health comorbidity, tested a gender-by-childhood-adversity interaction term, and calculated predicted probabilities, controlling for covariates. RESULTS Among adults with OUD, women are more likely than men to have comorbid mood or anxiety disorders (odds ratio [95% CI] 1.72 [1.20, 2.48]), and less likely to have conduct disorders. More women than men have prescription OUD (3.72 [2.24, 6.17]), and fewer have heroin use disorder (0.39 [0.27, 0.57]). Among both genders, ACE prevalence is high (>80%) and more than 40% are exposed to ≥3 types of ACE. Women more than men are exposed to childhood sexual abuse (4.22 [2.72, 6.56]) and emotional neglect (1.84 [1.20, 2.81]). Comorbid mood or anxiety disorders are associated with female gender (1.73 [1.18, 2.55]) and exposure to ≥3 types of ACE (3.71 [2.02, 6.85]), controlling for covariates. Moreover, exposure to more ACE elevates risk for comorbid mood or anxiety disorders more among women than men. CONCLUSION Among adults with OUD, ACE alters the gender gap in risk for comorbid mood or anxiety disorders. Using gender-tailored methods to address the harmful effects ACE on the mental health of individuals with OUD may help to prevent and ameliorate the current opioid epidemic.
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Affiliation(s)
- Elizabeth A Evans
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA, USA.
| | - Sarah L Goff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA, USA
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Christine E Grella
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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15
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Gatov E, Koziel N, Kurdyak P, Saunders NR, Chiu M, Lebenbaum M, Chen S, Vigod SN. Epidemiology of Interpersonal Trauma among Women and Men Psychiatric Inpatients: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:124-135. [PMID: 31262196 PMCID: PMC6997970 DOI: 10.1177/0706743719861374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Small clinical samples suggest that psychiatric inpatients report a lifetime history of interpersonal trauma. Since past experiences of trauma may complicate prognosis and treatment trajectories, population-level knowledge is needed about its prevalence and correlates among inpatients. METHODS Using health-administrative databases comprising all adult psychiatric inpatients in Ontario, Canada (2009 to 2016, n = 160,436, 49% women), we identified those who reported experiencing physical, sexual, and/or emotional trauma in their lifetime, 1 year, and 30 days preceding admission. We described the prevalence of each type of trauma, comparing women and men using modified Poisson regression, and identified individual-level characteristics associated with lifetime trauma history using multivariable logistic regression. RESULTS 31.7% of inpatients reported experiencing trauma prior to admission. Lifetime prevalence was higher in women (39.6% vs. 24.1%; age-adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.65 to 1.71), including sexual (22.7% vs. 8.4%; aPR = 2.81; 95% CI, 2.73 to 2.89), emotional (33.3% vs. 19.4%; aPR = 1.76; 95% CI, 1.72 to 1.79), and physical trauma (24.2% vs. 14.8%; aPR = 1.68; 95% CI, 1.65 to 1.72). Factors most prominently associated with lifetime trauma were witnessing parental substance use (adjusted odds ratio [aOR] = 8.68; 95% CI, 8.39 to 8.99), female sex (aOR = 2.29; 95% CI, 2.23 to 2.35), and number of recent stressful life events (aOR = 1.62; 95% CI, 1.59 to 1.65). CONCLUSIONS These results suggest that trauma-informed approaches are essential to consider in the design and delivery of inpatient psychiatric services for both women and men.
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Affiliation(s)
| | - Nicole Koziel
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Natasha R Saunders
- ICES, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Lebenbaum
- ICES, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Simone N Vigod
- ICES, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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16
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Fosse R, Eidhammer G, Selmer LE, Knutzen M, Bjørkly S. Strong Associations Between Childhood Victimization and Community Violence in Male Forensic Mental Health Patients. Front Psychiatry 2020; 11:628734. [PMID: 33633598 PMCID: PMC7901946 DOI: 10.3389/fpsyt.2020.628734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Childhood abuse and neglect increase the risk of both mental disorders and violent behavior. Associations between child relational adversities and violent behavior have not been extensively investigated in forensic mental health settings. We asked whether the extent of child adversities predicts the extent of violence in the community in forensic mental health patients. Methods: We included 52 male patients at a medium security forensic mental health ward, with diagnoses of predominantly paranoid schizophrenia and other schizophrenia and psychotic disorders. Seventy-five percent had comorbid substance abuse. We extracted information on six types of child adversities based on clinicians' administrations of the Historical Clinical Risk Management 20 version 3 (HCR 20) scale and summary notes in electronic patient journals. These same sources were used to extract information on war trauma and interpersonal violence in the community. We established cumulative scales for exposure to number of types of child adversities and number of incidents of community violence. Results: Physical and emotional abuse, emotional and physical neglect, and bullying were associated with higher levels of community violence. We observed a linear, significant increase in the frequency of community violence with cumulative numbers of child adversity types. Conclusions: Cumulative exposure to child adversities may be associated with higher degrees of violence in forensic mental health patients, with the most violent patients having the most extensive exposures to adversities. An enhanced focus on child adversities in risk assessment and management of violence may be considered in forensic inpatient settings.
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Affiliation(s)
- Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Gunnar Eidhammer
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.,Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Lars Erik Selmer
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.,Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Maria Knutzen
- Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Stål Bjørkly
- Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, Molde University College, Molde, Norway
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17
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Madole JW, Johnson SL, Carver CS. A Model of Aggressive Behavior: Early Adversity, Impulsivity, and Response Inhibition. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2019; 29:594-610. [PMID: 33716492 PMCID: PMC7951085 DOI: 10.1080/10926771.2019.1591561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 06/12/2023]
Abstract
Exposure to adverse environments during childhood is robustly linked to future aggressive behavior. In this study we tested a model of emotional and neurocognitive mechanisms related to aggressive behavior in the context of childhood adversity. More specifically, we used path analysis to assess the distal contribution of childhood adversity and the more proximal contributions of emotion-related and non-emotion-related forms of impulsivity, and behavioral response inhibition to aggressive behavior. Participants were 180 undergraduates who completed well-validated self-report measures and an emotional version of the Go/No-Go task. The structural equation model was a poor fit for the data (χ2(3) = 23.023, p <. 001; RMR = .131; CFI = .682; RMSEA = .142), though several significant paths emerged. Childhood adversity, emotion-related impulsivity, and behavioral response inhibition displayed direct effects on aggression, collectively accounting for 16.3% of variance. Findings demonstrate the specificity of emotional subtypes of impulsivity in linking childhood adversity and aggression. This study extends work on pathways to aggressive behavior by illustrating the complex relationships of early environmental, cognitive, and emotional mechanisms related to aggression.
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18
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Maguire D, Taylor J. A Systematic Review on Implementing Education and Training on Trauma-Informed Care to Nurses in Forensic Mental Health Settings. JOURNAL OF FORENSIC NURSING 2019; 15:242-249. [PMID: 31764528 DOI: 10.1097/jfn.0000000000000262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Engaging in trauma-informed approaches in nonforensic mental health settings improves therapeutic relationships, promotes healing, promotes posttraumatic growth, improves staff well-being, and fosters hope and empowerment, yet little is known of its influences in forensic settings. This literature review explores trauma-informed education and its training implications for nurses working in forensic mental health. METHOD Using a range of electronic databases, a systematic search of literature was carried out focusing on trauma-informed practice in adult forensic mental health settings. Before searching, predefined inclusion and exclusion criteria were agreed. FINDINGS After duplication removal, abstract review, and full screening, nine articles met review criteria for inclusion. A thematic analysis of the literature identified two key themes: "education for trauma-informed practice" and "applying theory into practice." Each had several subordinate themes. IMPLICATIONS FOR FORENSIC PRACTICE Organizations and their staff must recognize that operational change and ongoing training will be required. By adopting a trauma-informed approach, forensic mental health nurses can better understand their patients' traumatic experiences, improve their therapeutic relationships, and engage patients in collaborative care. Training in trauma-informed care should start with nurses who will change their personal practice and can support and train their colleagues.
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Affiliation(s)
- Donna Maguire
- Author Affiliations: Community Forensic Mental Health Services, NHS Ayrshire and Arran
| | - James Taylor
- School of Health & Life Sciences, University of the West of Scotland
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19
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Hall KL, Stinson JD, Moser MR. Impact of Childhood Adversity and Out-of-Home Placement for Male Adolescents Who Have Engaged in Sexually Abusive Behavior. CHILD MALTREATMENT 2018; 23:63-73. [PMID: 28731386 DOI: 10.1177/1077559517720726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Child maltreatment and household dysfunction have long been linked to delinquency, adult criminality, and sexual offending. However, the association between adverse childhood experiences (ACEs), factors related to out-of-home placement, and the onset of maladaptive behaviors has not thoroughly been explored in adolescents who have engaged in sexually abusive behavior. In the present study, we examined archival records of 120 male youths who have received treatment for sexually abusive behavior. As expected, the male adolescents in this sample have experienced higher rates of ACEs than samples of adult males in the community, adult males who committed sexual offenses, and juvenile justice-involved males as reported in the literature. Discrete-time survival analyses yielded increased risks of onset of aggression and sexually abusive behavior during early childhood and mid-to-late childhood, with significant associations between higher ACE scores and a greater number of out-of-home placements. Implications and future directions are discussed.
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Affiliation(s)
- Kelcey L Hall
- 1 Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Jill D Stinson
- 1 Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Michele R Moser
- 2 Department of Psychiatry and Behavioral Sciences, East Tennessee State University, Johnson City, TN, USA
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20
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Serafini G, Canepa G, Adavastro G, Nebbia J, Belvederi Murri M, Erbuto D, Pocai B, Fiorillo A, Pompili M, Flouri E, Amore M. The Relationship between Childhood Maltreatment and Non-Suicidal Self-Injury: A Systematic Review. Front Psychiatry 2017; 8:149. [PMID: 28970807 PMCID: PMC5609590 DOI: 10.3389/fpsyt.2017.00149] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/28/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Childhood maltreatment (CM) has been associated with an increased risk of non-suicidal self-injury (NSSI) and suicidal behaviors. However, the exact nature of the association between CM and NSSI is currently unclear. The present review aimed to systematically investigate the association between CM and NSSI in adolescence and early adulthood. METHODS A systematic search of four major electronic databases covering both medical and social science research (PubMed, Scopus, Science Direct, and PsycINFO) was conducted. RESULTS Overall, 20 cross-sectional studies including a total of 22,517 individuals, 3 longitudinal follow-up studies including 1,728 individuals, and 3 retrospective studies including 62,089 individuals were selected. It appears that CM is a significant risk factor for both NSSI and suicide attempts. The increased vulnerability to NSSI seems to be related to experiences of CM, particularly sexual abuse. Gender differences were also found. Generally, when compared to males, females who experienced CM seem to be more vulnerable to presenting with NSSI and suicidal behaviors. CONCLUSION There is a positive association between CM and NSSI. The importance of early detection and risk reduction of self-injurious behavior for adolescents is discussed.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Giovanna Canepa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Giulia Adavastro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Jacopo Nebbia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Benedetta Pocai
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Eirini Flouri
- Department of Psychology and Human Development, UCL Institute of Education, University College London, London, United Kingdom
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
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21
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Portnova AA, Sivolap YP. Substance abuse: a relationship with childhood traumas. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:92-95. [DOI: 10.17116/jnevro20171174192-95] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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