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Epe-Jungeblodt F, Pauli P, Schwab F, Andreatta M. Trauma history and course of therapy in a naturalistic cognitive behavior therapy outpatient sample: An archive data study. J Clin Psychol 2024; 80:1937-1948. [PMID: 38747513 DOI: 10.1002/jclp.23702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/20/2024] [Accepted: 04/30/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE Cognitive Behavior Therapy (CBT) is an effective treatment for anxiety and depression disorders. Nonetheless, nearly 50% of all patients do not respond. Besides other factors, nonresponse may be linked to traumatic life events. This study aims to assess the relationship between trauma history, applied therapy interventions, and therapy outcomes. METHODS We analyzed data from 340 CBT outpatients diagnosed with a depression or anxiety disorder and possibly a trauma history treated under naturalistic conditions. Based on their therapy files, we collected information on trauma history, diagnoses, applied interventions, and severity of depression and anxiety symptoms at the start and end of therapy. The relationship between trauma, diagnoses, and intervention use and the development of depression and anxiety symptoms was analyzed using Linear Mixed Models. RESULTS Patients with a trauma history reported higher pre- and posttreatment symptom severity than those without trauma. No differences in applied interventions or decrease in symptom severity were found between patients with and without a trauma history. Specialized interventions were seldom applied. CONCLUSION Although no differences between patients with and without a trauma history were found in therapy response, patients with a trauma history maintained higher levels of symptom severity. These results indicate a need for more personalized interventions and evidence-based guidelines to personalize CBT for patients with a trauma history and high symptom severity.
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Affiliation(s)
- Franziska Epe-Jungeblodt
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology, and Psychotherapy, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Frank Schwab
- Department of Media Psychology, Institute Human-Computer-Media, Faculty of Human Sciences, Julius-Maximilians-Universität Würzburg (JMU), Würzburg, Germany
| | - Marta Andreatta
- Department of General Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Rost K, Ziegenhain U, Fegert JM, Buchheim A, Köhler-Dauner F. Maternal insecure attachment representation as a long-term risk factor for disrupted mother-child-interaction and child mental health. BMC Psychol 2024; 12:385. [PMID: 38982522 PMCID: PMC11234699 DOI: 10.1186/s40359-024-01874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
Maternal childhood maltreatment (CM) represents an important factor in the transmission of trauma that may lead to impaired child mental health. Apart from childhood maltreatment insecure attachment has been identified as a risk factor for insensitive caregiving behavior, which may affect child's mental health. The aim of this study is to identify the working mechanisms in the relationship between maternal CM and child mental health, considering maternal attachment representation, mother-child-interaction und maternal helplessness and fear. N = 103 mother-child-dyads from a longitudinal cohort study were examined at four different measuring points. Data was assessed using self and external report questionnaires as well as the AMBIANCE scales during the Strange Situation Procedure and the Adult Attachment Projective Picture System (AAP). Maternal CM experience did not predict an insecure attachment representation (OR = 2.46 [0.98, 6.53], p = .060). Maternal insecure attachment was associated with higher AMBIANCE scores (F(8, 94) = 11.46, p < .001), which indicates more disrupted communication between mother and child. AMBIANCE scores in turn predicted higher self-perceived helplessness (F(9, 93) = 8.62, p < .001) and fear (F(9, 93) = 7.40, p < .001) in mothers. Helplessness and fear both were associated with higher SDQ-scores, indicating more mental health problems in children (F(10, 92) = 3.98, p < .001; F(10, 92) = 3.87, p < .001). The results of this study highlight how even insecure attachment in a low-risk sample has a long-term impact on parenting behavior and child mental health, therefore underlining the need of early intervention programs in affected and at-risk families.
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Affiliation(s)
- Katharina Rost
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Ulm, Germany.
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Ulm, Germany.
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Hall H, Papp V, Fitzgerald M. Childhood sexual abuse and IL6 mediated by change in BMI over an 18-year period: A growth curve model. CHILD ABUSE & NEGLECT 2024; 154:106914. [PMID: 38986306 DOI: 10.1016/j.chiabu.2024.106914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Childhood sexual abuse can increase both body weight and inflammation later in life. Higher weight or faster changes in weight, as measured by changes in body mass index (BMI), may mediate the relationship between childhood sexual abuse and inflammation, however, most studies to date have used a cross-sectional design limiting causal inferences. OBJECTIVE The current study aimed to investigate the interrelationships between childhood sexual abuse, BMI, and C-reactive protein (CRP) and interleukin-6 (IL6). PARTICIPANTS AND SETTING Data from 461 adults who participated in the Midlife in the United States (MIDUS) study were utilized. METHODS Growth curve modeling was used to test initial levels of BMI and changes of BMI over an 18-year period as mediators linking childhood sexual abuse to CRP and IL6. RESULTS Sexual abuse was not significantly associated with the initial level of BMI; however, sexual abuse was associated with the slope of BMI (b = 0.072, p = .006). BMI intercept (b = 0.080, p = .001) and slope (b = 0.240, p = .002) predicted IL6 values whereas the slope of BMI (b = 0.398, p = .033) but not intercept predicted CRP values. The indirect effect from sexual abuse to IL6 through BMI slope was significant (b = 0.017, 95 % [CI.001, 0.033]) while the indirect effect from sexual abuse to CRP through BMI slope was not significant (b = 0.028, 95 % [CI -0.004, 0.061]). CONCLUSION Childhood sexual abuse was indirectly associated with IL6 through rates of change in BMI over time.
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Affiliation(s)
- Haley Hall
- Oklahoma State University, 230 Nancy Randolph Davis Building, Stillwater, OK, 74074, United States of America.
| | - Viktoria Papp
- Oklahoma State University, 230 Nancy Randolph Davis Building, Stillwater, OK, 74074, United States of America.
| | - Michael Fitzgerald
- Oklahoma State University, 230 Nancy Randolph Davis Building, Stillwater, OK, 74074, United States of America.
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Wu L, Dai Z, Yang X, Tang J, Fang J, Huang J, Zheng Y, Liu Y, Chen L. Linkages between childhood emotional maltreatment and adulthood marital attitudes among rural first-generation college students in China: A latent profile analysis and multigroup comparisons. CHILD ABUSE & NEGLECT 2024; 154:106918. [PMID: 38955052 DOI: 10.1016/j.chiabu.2024.106918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Although there is a wealth of evidence indicating the enduring consequences of childhood emotional maltreatment (CEM) on social and relational functioning across life stages, little known about how CEM affects marital attitudes in emerging adulthood, particularly among rural first-generation college students (rural FGCS) at the critical stage of developing romantic relationships. OBJECTIVE To explore whether differential patterns of CEM existed among rural FGCS in China during emerging adulthood. Furthermore, the study aims to examine the potential differences in the chain mediating role of CEM on the pathway to adulthood marital attitudes across different CEM profiles. PARTICIPANTS AND SETTING Using a cluster sampling approach, a total of 3848 rural first-generation college freshmen (males = 39.2 %, mean age = 18.42 years) were recruited from three universities in China. METHODS Latent profile analysis was utilized to identify potential patterns of CEM using Mplus version 7.4. Structural equation modeling and multigroup comparisons were then performed to investigate the association between CEM and attitudes towards marriage in emerging adulthood, utilizing AMOS 24.0. RESULTS Three profiles of CEM was identified among rural FGCS: a low-CEM group (51.87 %), a moderate-CEM group (36.69 %), and a severe-CEM group (11.44 %). The association between CEM and adulthood marital attitudes was mediated by core self-evaluation and meaning in life. However, the mediation effects varied across the three CEM profiles. In the low-CEM group, core self-evaluation and meaning in life were observed to partially mediate the negative association between CEM and adulthood marital attitudes. On the other hand, in the moderate-CEM and severe-CEM groups, the relationship between CEM and adulthood marital attitudes was fully mediated by core self-evaluation. CONCLUSIONS The study's findings suggest that CEM is a significant predictor of marital attitudes among rural FGCS during emerging adulthood, with the severity of emotional neglect and abuse being the primary distinguishing factor between different CEM profiles. Core self-evaluation plays an important role in this relationship. Future clinical interventions could benefit from focusing on enhancing core self-evaluation and meaning in life, particularly for those with CEM experiences.
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Affiliation(s)
- Liujun Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China; Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Zheru Dai
- Student Affairs Department, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xudong Yang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China; Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Jiayi Tang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China; Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Juan Fang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiahui Huang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yawen Zheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China; Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, Zhejiang, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Li Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China; Zhejiang Provincial Clinical Research Center for Mental Disorders, The affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Köhler-Dauner F, Peter L, Fegert JM, Ziegenhain U, Buchheim A. The role of attachment representation in the relationship between childhood maltreatment, mental health and parental load: A mediation analysis. CHILD ABUSE & NEGLECT 2023; 144:106334. [PMID: 37454555 DOI: 10.1016/j.chiabu.2023.106334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.
| | - Lena Peter
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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Matsukura H, Yamaoka Y, Matsuyama Y, Kondo K, Fujiwara T. Association between adverse childhood experiences and marital status among Japanese older adults. CHILD ABUSE & NEGLECT 2023; 144:106340. [PMID: 37467673 DOI: 10.1016/j.chiabu.2023.106340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/19/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Marital status is a well-known social determinant of health. Adverse childhood experiences (ACEs) affect attachment, critical to establishing and maintaining intimate relationships, such as marital status. OBJECTIVE This study examined the association between ACEs and marital status among older Japanese adults. PARTICIPANTS AND SETTING This research used data from a nationwide population-based study among functionally independent people aged 65 and above in Japan. METHODS ACEs were assessed by self-reported questionnaires on the following experiences before 18 years old: parental death, parental divorce, parental mental disease, exposure to intimate partner violence, physical abuse, psychological neglect, psychological abuse, and poverty. Marital status was asked as currently having a spouse (including common-law marriage), widowed, divorced, or unmarried. Associations between the total number of ACEs and marital status were analyzed by multinomial logistic regression. RESULTS Three or more ACEs showed higher risks of being widowed, divorced, or unmarried. Psychological neglect led to higher divorce risks among males (RRR, 95%CI = 1.41, 1.13-1.76) and females (RRR, 95%CI = 1.56, 1.28-1.89). Childhood poverty showed higher risks of unmarried among males (RRR, 95%CI = 1.25, 1.02-1.53) and females (RRR, 95%CI = 1.41, 1.18-1.69). Association between ACEs and divorce risks showed gender differences (RRR, 95%CI of having three or more ACEs in males: 2.19, 1.66-2.90; in females: 3.45, 2.71-4.38; p for interaction = 0.034). CONCLUSIONS ACEs showed higher risks of being widowed, divorced, and unmarried among older Japanese people. Policy to tackle ACEs and research investigating how ACEs, attachment, and relationship quality influence marital status are required to promote well-being in later life.
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Affiliation(s)
- Hanayo Matsukura
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Yui Yamaoka
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Yusuke Matsuyama
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage Ward, Chiba 263-8522, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu City, Aichi 474-8511, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan.
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Current parental maltreatment and emerging adult psychopathology: indirect effects through family functioning across gender. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Rajkumar RP. Comorbid depression and anxiety: Integration of insights from attachment theory and cognitive neuroscience, and their implications for research and treatment. Front Behav Neurosci 2022; 16:1104928. [PMID: 36620859 PMCID: PMC9811005 DOI: 10.3389/fnbeh.2022.1104928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
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Wang M, Xu M, Sun L. Loneliness and coping skill mediate the association between child maltreatment and depression for rural males and females. BMC Psychiatry 2022; 22:413. [PMID: 35729560 PMCID: PMC9215002 DOI: 10.1186/s12888-022-04056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Child maltreatment is a prevalent and notable problem in rural China, and the prevalence and severity of depression in rural areas are higher than the national norm. Several studies have found that loneliness and coping skills respectively mediated the relationship between child maltreatment and depression. However, few studies have examined the roles of loneliness and coping skills in child maltreatment and depression based on gender differences. METHODS All participants were from rural communities aged more than 18 years in Shandong province, and 879 valid samples (female:63.4%) ranging in age from 18 to 91 years old were analyzed. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Center for Epidemiologic Studies-Depression (CES-D), the Simple Coping Style Questionnaire (SCSQ), and the Emotional and Social Loneliness Scale (ESLS) were used to evaluate child maltreatment, depression, coping skills and loneliness. RESULTS Child maltreatment was more common and severe in males than females (F = 3.99; p < 0.05). Loneliness and coping skills partially mediated the relationship between child maltreatment and depression in males, but loneliness fully mediated the relationship between child maltreatment and depression in females. CONCLUSION In this study, males were more likely to experience child maltreatment. Child maltreatment and depression were correlated. We also found a mediating role of loneliness and coping skills for males and a mediating role of loneliness in females.
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Affiliation(s)
- Meiqi Wang
- grid.27255.370000 0004 1761 1174Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174National Health Commission of China, Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012 Shandong China
| | - Meixia Xu
- grid.495262.e0000 0004 1777 7369Shandong Women’s University, Jinan, 250300 China
| | - Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, Shandong, China. .,National Health Commission of China, Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, Shandong, China.
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