Utilizing the salutogenic paradigm to investigate well-being among adult survivors of childhood sexual abuse and other adversities

Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence

BACKGROUND

In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention.

OBJECTIVE

We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA.

PARTICIPANTS AND SETTING

A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified.

RESULTS

Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan.

CONCLUSIONS

Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.

The Associations Between Adverse Childhood Experiences, Physical and Mental Health, and Physical Activity: A Scoping Review

BACKGROUND

Adverse childhood experiences (ACEs) may be associated with worse physical and mental health in adulthood, and low physical activity engagement, but the relationships are not fully understood.

OBJECTIVES

To establish the scope of the literature exploring associations between ACEs, physical activity, and physical and mental health.

METHODS

We conducted this scoping review according to PRISMA-ScR guidelines. We searched MEDLINE, Scopus, SPORTDiscus, and PsycInfo for relevant articles.

RESULTS

Eighteen studies were included, 17 observational and 1 randomized controlled trial. The majority of studies were cross-sectional and employed self-reported physical activity and ACE measures. Six studies explored physical health, 9 explored mental health, and 3 explored both. Associations between ACEs and poor physical health outcomes (poor self-reported physical health, inflammation, high resting heart rate, and obesity) were consistently weaker or attenuated among those who were physically active. Physical activity may also moderate the associations between ACEs and depressive symptoms, psychological functioning, and health-related quality of life.

CONCLUSION

Associations between ACEs and poor physical and mental health were observed in those with less frequent physical activity engagement, though the majority of evidence relies on cross-sectional observational designs with self-report instruments. Further research is required to determine whether physical activity can prevent or treat poor physical and mental health in the presence of ACEs.

Assessment of adult learning outcomes from a school-based training on adverse childhood experiences science and trauma-informed care

BACKGROUND

Implementing trauma-informed care (TIC) practices in educational settings requires preparing school staff to understand adverse childhood experiences (ACEs) and their impact to provide a restorative rather than a punitive response.

OBJECTIVES

To assess learning outcomes of a TIC training delivered to kindergarten to 12-grade (K-12) staff.

PARTICIPANTS AND SETTING

A TIC training informed by the Substance Abuse and Mental Health Service Administration (SAMHSA) Framework was delivered August to December 2017 to twenty-seven K-12 staff in Southeastern U.S. Majority were women (93 %) aged 25 to 58 years; 52 % were White and 48 % were Black/African American (48 %).

METHODS

Curricular content included an overview of ACEs; stress physiology; recognition of symptoms in self and others; strategies for response; and self-care. A post-training questionnaire with 11 learning statements was administered to assess participants' level of agreement with learning each concept using a 5-point Likert scale. Self-reflective narratives of challenging situations with students were also submitted and qualitatively analyzed for applications of TIC.

RESULTS

Between 62.9 % to 96 % of participants agreed/strongly agreed with learning new concepts related to ACEs and their symptoms. Qualitative data indicated that participants were able to recognize stress symptoms in students and in themselves and integrate strategies learned such as breathing and creating safe space to allow students to have voice and choice.

CONCLUSIONS

TIC training curriculum that includes ACEs and toxic stress science is a critical component that promotes recognition of trauma symptoms in themselves and others. Self-reflective practice using narratives is an essential training tool for implementing TIC.

Recipients of children's and adolescents' disclosures of childhood sexual abuse: A systematic review

Disclosure of childhood sexual abuse (CSA) is a complex, multifaceted process with many barriers that are largely shaped by individual, familial, and systemic characteristics. Children and youth tend to withhold or delay disclosure for many years, such that most CSA goes unreported. This systematic review aimed to synthesize evidence regarding the pathways and recipients of CSA disclosures and to identify potential developmental and gender differences in the recipients of disclosures. Thirty-seven studies conducted between 1990 and 2017 were selected for review. Results indicated that children and youth follow a gradual pattern of disclosure, whereby they first disclose to peers before disclosing to a parent or trusted adult, who can then help the child report to a person of authority. Key developmental patterns in CSA disclosure were identified, whereby older children and adolescents are significantly more likely to turn to peers, keeping the abuse largely hidden from adults. Gender differences were also found, whereby girls are more likely to seek emotional support by disclosing to peers, whereas boys are significantly less likely to disclose the abuse all together; when boys do disclose, they tend to do so for practical reasons, such as protection or accessing services. This review contributes to our understanding of the various pathways of CSA disclosure and highlights the importance of further understanding youth-directed disclosures and how the reactions of informal recipients of disclosures may impact further disclosures to authorities and professionals. Research and clinical implications of the findings are discussed.

Suffering and Salutogenesis: A Conceptual Analysis of Lessons for Psychiatry From Existential Positive Psychology (PP2.0) in the Setting of the COVID-19 Pandemic

The COVID-19 pandemic has had a widespread effect on the thoughts, emotions and behavior of millions of people all around the world. In this context, a large body of scientific literature examining the mental health impact of this global crisis has emerged. The majority of these studies have framed this impact in terms of pre-defined categories derived from psychiatric nosology, such as anxiety disorders, depression or post-traumatic stress disorder. These constructs often fail to capture the complexity of the actual experiences of the individuals being studied; more specifically, they describe these experiences exclusively in terms of disease, while neglecting their potentially adaptive or “salutogenic” aspects. Similarly, discussion of psychological assistance for these individuals has largely been confined to a reiteration of “evidence-based” psychological or pharmacological techniques which can be delivered using remote access technology. In the context of the COVID-19 pandemic, these approaches are likely to be of mixed efficacy. Conversely, “negative emotions” or distressing psychological experiences may actually be functional in the setting of a disaster or crisis, serving to minimize harm, maximize social coherence and compliance, and facilitate adherence to safety measures. The limitations of the “conventional” approach are, to a certain degree, inherent to the prevailing medical model of mental health. Beyond these considerations lies the concept of “salutogenesis,” a term which refers to the innate capacity of individuals to create and maintain health and well-being in the face of adversity. Using principles derived from the second wave of positive psychology (PP2.0), particularly its emphasis on the totality of human experience and the possibility of deriving meaning and character growth from suffering, this paper conceptually analyses the relevant aspects of salutogenesis and PP2.0, and proposes an alternate approach for addressing mental health concerns during the COVID-19 pandemic. Such an approach, while acknowledging the utility of the conventional medical-psychotherapeutic model in specific cases, reduces the risk of medicalizing human experience, and provides individuals and communities with opportunities for growth and adaptation. The benefits of this proposal could potentially extend far beyond the current crisis, offering an opportunity for the field of psychiatry and mental health research to move away from a purely “disease-centered” model.

Future directions for the concept of salutogenesis: a position article

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass, San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC) that helps to mobilize resources to cope with stressors and manage tension successfully (determining one's movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensional SOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about the origin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in the international Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer, New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. To strengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal) of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis. During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky's original contribution and then present suggestions for future development. These ideas will help guide GWG-Sal's work to strengthen salutogenesis as a theory base for health promotion.

Health Assets, Vocation and Zest for Healthcare work. A Salutogenic Approach to Active Coping among Certified Nursing Assistant Students

People's health assets (HA) mapping process and design dynamization strategies for it are paramount issues for health promotion. These strategies improve the health heritage of individuals and communities as both the salutogenic model of health (SMH) and health assets model (HAM) defend. Connecting and mobilizing HA and strengthens the 'sense of coherence' (SOC) are both related to enhancing stress active and effective coping strategies. This study aims to describe the HA present in a population of certified nursing assistant students (n = 921) in Spain and then to explore their relationships with the SOC, the motivation to choose healthcare studies and their academic performance. A great variety of HA were identified and mapped. Findings showed that individuals with greater motivation towards self-care and 'caring for others' as internal HA, possessed higher SOC levels and a strong vocation for healthcare work. Differences in HA were identified according to gender, age and employment situation. Consistent connections between the care-relation factor and vocational factor with interpersonal and extrapersonal HA were reported. Evidence and results substantiated the salutogenic and asset-based approach as a proper strategy to strengthen SOC, dynamize their HA map, reinforce the sense of calling and enable Certified Nurse Assistant (CNA) students to buffer against caregiving-related stress and thrive in their profession.

Neighborhood Environment and Health of Injured Urban Black Men

INTRODUCTION

Urban black males are at disproportionately high risk of poor health outcomes; thus, we need to measure neighborhood environments appropriately in order to understand aspects of neighborhoods that influence their mental and physical health. We explored associations between physical and mental health of injured, urban black men with objectively measured and perceived neighborhood characteristics.

METHODS

In 2017-2018, we analyzed data from 486 black, adult males in Philadelphia admitted to a trauma center with injury between January 2013 and February 2017. Area-level measures of social, economic, and built environments were obtained from multiple sources. At enrollment, participants answered questions about neighborhood environment and self-reported physical and mental health 30 days before injury. We conducted factor analysis to identify neighborhood characteristics, then estimated odds of poor physical or mental health, accounting for spatial correlation of participants.

RESULTS

Poor physical and mental health was reported by 12% and 22% of participants, respectively. In participants' neighborhoods, 29% of adults lived in poverty. Individually, 73% of men reported abandoned buildings, and 31% reported not feeling safe walking around their neighborhood. Physical health was associated with neighborhood poverty and disconnectedness. Mental health was associated with neighborhood economics and individual perceptions of social disorder and safety. Individual-level factors were not correlated with area-level factors.

CONCLUSIONS

We found both area-level and individual-level measures were associated with health, perhaps operating through different mechanisms, but individual experiences may not be easily extrapolated from area-level data. By identifying important components of neighborhood environments, we may better understand how neighborhoods contribute to health in vulnerable populations.

Examining the relationship between higher educational attainment, trauma symptoms, and internalizing behaviors in child sexual abuse survivors

The trauma symptoms of child sexual abuse (CSA) survivors don't end with the abuse, or even with the advent of adulthood. Instead, these symptoms can persist into all the realms of a survivor's life, including education, which sets the foundation for career advancement. This retrospective study of adult survivors of childhood sexual abuse (n=260) examined the relationships between trauma symptoms, dissociation, dissociative amnesia, anxiety, depression, sleep problems and higher education attainment. The purpose of this study was to determine if these factors are associated with higher education completion for childhood sexual abuse (CSA) survivors. Linear regressions and ANOVAs suggest that many of these variables are significantly associated with survivors' educational trajectory, and multiple linear regressions show that trauma symptoms (as measured by the Trauma Symptom Checklist-40), caregivers' education levels, and age at onset of abuse are significant predictors of decreased education levels. This information can provide insight into additional risk and protective factors for CSA survivors in order to enhance acute and long-term management of trauma symptoms to increase levels ofattainment of higher education.