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Nass BYS, Dibbets P, Markus CR. The Impact of Psychotrauma and Emotional Stress Vulnerability on Physical and Mental Functioning of Patients with Inflammatory Bowel Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6976. [PMID: 37947534 PMCID: PMC10648781 DOI: 10.3390/ijerph20216976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic health condition thought to be influenced by personal life experiences and emotional stress sensitivity (neuroticism). In the present study, we examined the impact of cumulative trauma experiences and trait neuroticism (as a measure for emotional stress vulnerability) on physical and mental functioning of n = 211 patients diagnosed with IBD (112 Crohn's disease, 99 ulcerative colitis). All patients were assessed for self-reported trauma histories, emotional stress vulnerability, clinical disease activity, functional gastrointestinal (GI) symptoms, and quality of life. Results showed that patients with severe IBD activity have endured significantly more interpersonal trauma and victimization than those with quiescent IBD. Moreover, cumulative trauma was found to exert an indirect (neuroticism-mediated) effect on patients' symptom complexity, with trauma and neuroticism conjointly explaining 16-21% of the variance in gastrointestinal and 35% of the variance in mental symptoms. Upon correction for condition (using a small group of available controls, n = 51), the predictive capacity of trauma and neuroticism increased further, with both predictors now explaining 31% of the somatic-and almost 50% of the mental symptom heterogeneity. In terms of trauma type, victimization (domestic violence and intimate abuse) proved the best predictor of cross-sample symptom variability and the only trauma profile with a consistent direct and indirect (neuroticism-mediated) effect on patients' mental (QoL) and physical fitness. Results are consistent with the growing body of evidence linking experiential vulnerability factors (trauma and neuroticism) and associated feelings of personal ineffectiveness, helplessness, and uncontrollability to interindividual differences in (GI) disease activity and quality of life.
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Affiliation(s)
- Boukje Yentl Sundari Nass
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Dr. Rath Health Foundation, 6422 RG Heerlen, The Netherlands
| | - Pauline Dibbets
- Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - C. Rob Markus
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Pacella R, Nation A, Mathews B, Scott JG, Higgins DJ, Haslam DM, Dunne MP, Finkelhor D, Meinck F, Erskine HE, Thomas HJ, Malacova E, Lawrence DM, Monks C. Child maltreatment and health service use: findings of the Australian Child Maltreatment Study. Med J Aust 2023; 218 Suppl 6:S40-S46. [PMID: 37004185 PMCID: PMC10952869 DOI: 10.5694/mja2.51892] [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: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To examine associations between child maltreatment and health service use, both overall, by type and by the number of types of maltreatment reported. DESIGN, SETTING Cross-sectional, retrospective survey using the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study); computer-assisted mobile telephone interviews using random digit dialling, Australia, 9 April - 11 October 2021. PARTICIPANTS Australians aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from the five age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES Self-reported health service use during the past twelve months: hospital admissions, length of stay, and reasons for admission; and numbers of consultations with health care professionals, overall and by type. Associations between maltreatment and health service use are reported as odds ratios adjusted for age group, gender, socio-economic status, financial hardship (childhood and current), and geographic remoteness. RESULTS A total of 8503 participants completed the survey. Respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.16-1.66), particularly admission with a mental disorder (aOR, 2.4; 95% CI, 1.03-5.6). The likelihood of six or more visits to general practitioners (aOR, 2.37; 95% CI, 1.87-3.02) or of a consultation with a mental health nurse (aOR, 2.67; 95% CI, 1.75-4.06), psychologist (aOR, 2.40; 95% CI, 2.00-2.88), or psychiatrist (aOR, 3.02; 95% CI, 2.25-4.04) were each higher for people who reported maltreatment during childhood. People who reported three or more maltreatment types were generally most likely to report greater health service use. CONCLUSIONS Child maltreatment has a major impact on health service use. Early, targeted interventions are vital, not only for supporting children directly, but also for their longer term wellbeing and reducing their health system use throughout life.
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Affiliation(s)
- Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Alexandra Nation
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - James G Scott
- Child Health Research Centrethe University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Daryl J Higgins
- Institute of Child Protection Studies, Australian Catholic UniversityMelbourneVIC
| | - Divna M Haslam
- Queensland University of TechnologyBrisbaneQLD
- The University of QueenslandBrisbaneQLD
| | - Michael P Dunne
- Queensland University of TechnologyBrisbaneQLD
- Institute for Community Health ResearchHue UniversityHue CityVietnam
| | - David Finkelhor
- Crimes against Children Research CenterUniversity of New HampshireDurhamNHUnited States of America
| | - Franziska Meinck
- University of EdinburghEdinburghUnited Kingdom
- North‐West UniversityPotchefstroomSouth Africa
| | - Holly E Erskine
- The University of QueenslandBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Eva Malacova
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | | | - Claire Monks
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
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Okwori G, Stewart S, Quinn M, Lawson D. Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:727-739. [PMID: 35958731 PMCID: PMC9360380 DOI: 10.1007/s40653-021-00390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 06/15/2023]
Abstract
To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs' exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.
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Affiliation(s)
- Glory Okwori
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN USA
| | - Steven Stewart
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN USA
| | - Megan Quinn
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN USA
| | - Delaney Lawson
- Department of Biostatistics and Epidemiology, East Tennessee State University, Johnson City, TN USA
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Barriers to Accessing Treatment Services: Child Victims of Youths with Problematic Sexual Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105302. [PMID: 34067519 PMCID: PMC8156196 DOI: 10.3390/ijerph18105302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022]
Abstract
Child sexual abuse (CSA) remains a significant public health problem. Although the deleterious effects on the child victims could be mitigated through evidence-based interventions, victims often fail to be identified and receive clinical assessment and therapy services, particularly when they have been victimized by another youth. Given that at least a third of CSA cases are committed by another youth, understanding the process of identifying and addressing the needs of CSA victims of youth is the focus of the present study. Factors impacting services for child victims of youths with problematic sexual behavior (PSB) were examined through qualitative interviews (N = 226) with mental health agency administrators, direct service providers, and community stakeholders from eight geographically diverse communities across the United States. Responses focused on macro and micro level barriers to the identification and service provision for child victims of PSB of youths. Implications for clinicians and policymakers are discussed, along with strategies to enhance access and provision of services to meet the needs of the child victims.
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Sexual assault as a risk factor for gynaecological morbidity: An exploratory systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 255:222-230. [DOI: 10.1016/j.ejogrb.2020.10.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022]
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Van Tu P, Ngoc TU, Nguyen PL, Thuong NH, Van Tuan N, Van Hung N, Nga VT, Van Quan T, Lam LT, Chu DT. The impact of sexual harassment on obesity in female adolescents: An update and perspective to control. Diabetes Metab Syndr 2020; 14:1931-1939. [PMID: 33038851 DOI: 10.1016/j.dsx.2020.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Sexual victimization, happened during childhood and beyond, is known to be a substantial contributing factor for obesity development later in life. This work aims to bring about updated information on the relationship between sexual harassment and obesity. METHODS Based on an intensive scientific literature review in Google Scholar, Pubmed databases, the total of 106 studies (N = 141,199) were assessed including 52 studies on the connection between negative lifetime impacts and obesity, 11 studies on post-traumatic stress disorder (PTSD) symptoms with proposed biological mechanisms related to obesity, 15 studies on the relationship between major depressive disorder (MDD) symptoms and obesity, 11 studies on the body dismorphic disorder (BDD) and 17 studies on the binge eating disorder (BED) were also examined to evaluate the association of obesity and traumatic life experiences. RESULTS Although 40-70% of all cases related to obesity have been considered to be hereditary, many experts argue that deviations in the environment contribute to excessive food intake and depressed physical activity in numerous Western countries. Several studies have identified that childhood sexual abuse (CSA) may be nearly as common as obesity. However, just a few researchers have taken notice of the possible connection between these two. CONCLUSIONS By mentioning some possible obesity-related psychological disorders in response to CSA, we present updated information on the relationship between sexual harassment and obesity.
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Affiliation(s)
- Pham Van Tu
- Faculty of Social Work, Hanoi National University of Education, Hanoi, Viet Nam
| | - Tran Uyen Ngoc
- Department of Animal Sciences, Wageningen University & Research, Wageningen, Netherlands
| | | | - Nguyen Hiep Thuong
- Faculty of Social Work, Hanoi National University of Education, Hanoi, Viet Nam
| | | | - Nguyen Van Hung
- National Center for Special Education, the Vietnam National Institute of Educational Sciences, Hanoi, Viet Nam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, Danang, Viet Nam
| | | | - Le Thi Lam
- University of Science and Education - the University of Da Nang, Viet Nam
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Viet Nam.
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7
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Stress & sleep: A relationship lasting a lifetime. Neurosci Biobehav Rev 2020; 117:65-77. [DOI: 10.1016/j.neubiorev.2019.08.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/28/2019] [Accepted: 08/31/2019] [Indexed: 12/29/2022]
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Lindsay KL, Entringer S, Buss C, Wadhwa PD. Intergenerational transmission of the effects of maternal exposure to childhood maltreatment on offspring obesity risk: A fetal programming perspective. Psychoneuroendocrinology 2020; 116:104659. [PMID: 32240906 PMCID: PMC7293953 DOI: 10.1016/j.psyneuen.2020.104659] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 12/19/2022]
Abstract
Childhood obesity constitutes a major global public health challenge. A substantial body of evidence suggests that conditions and states experienced by the embryo/fetus in utero can result in structural and functional changes in cells, tissues, organ systems and homeostatic set points related to obesity. Furthermore, growing evidence suggests that maternal conditions and states experienced prior to conception, such as stress, obesity and metabolic dysfunction, may spill over into pregnancy and influence those key aspects of gestational biology that program offspring obesity risk. In this narrative review, we advance a novel hypothesis and life-span framework to propose that maternal exposure to childhood maltreatment may constitute an important and as-yet-underappreciated risk factor implicated in developmental programming of offspring obesity risk via the long-term psychological, biological and behavioral sequelae of childhood maltreatment exposure. In this context, our framework considers the key role of maternal-placental-fetal endocrine, immune and metabolic pathways and also other processes including epigenetics, oocyte mitochondrial biology, and the maternal and infant microbiomes. Finally, our paper discusses future research directions required to elucidate the nature and mechanisms of the intergenerational transmission of the effects of maternal childhood maltreatment on offspring obesity risk.
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Affiliation(s)
- Karen L Lindsay
- Department of Pediatrics, University of California, Irvine, School of Medicine, California 92697, U.S.A,Departments of Development, Health and Disease Research Program, University of California, Irvine, School of Medicine, California 92697, U.S.A
| | - Sonja Entringer
- Department of Pediatrics, University of California, Irvine, School of Medicine, California 92697, U.S.A,Departments of Development, Health and Disease Research Program, University of California, Irvine, School of Medicine, California 92697, U.S.A,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology
| | - Claudia Buss
- Department of Pediatrics, University of California, Irvine, School of Medicine, California 92697, U.S.A,Departments of Development, Health and Disease Research Program, University of California, Irvine, School of Medicine, California 92697, U.S.A,Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology
| | - Pathik D Wadhwa
- Department of Pediatrics, University of California, Irvine, School of Medicine, CA 92697, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, School of Medicine, CA 92697, USA; Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, CA 92697, USA; Department of Epidemiology, University of California, Irvine, School of Medicine, CA 92697, USA; UCI Development, Health and Disease Research Program, University of California, Irvine, School of Medicine, CA 92697, USA.
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9
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McWhorter KL, Parks CG, D’Aloisio AA, Rojo-Wissar DM, Sandler DP, Jackson CL. Traumatic childhood experiences and multiple dimensions of poor sleep among adult women. Sleep 2019; 42:zsz108. [PMID: 31260523 PMCID: PMC6941710 DOI: 10.1093/sleep/zsz108] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 03/29/2019] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Exposure to traumatic childhood experiences (TCEs) may contribute to poor sleep in adulthood. Previous studies have been limited to mainly investigating physical and sexual abuse and did not consider betrayal trauma, or whether the victim regarded the perpetrator as someone socially close to them, the age group at occurrence, and trauma-related distress/anxiety. METHODS We used a large cohort of US women, 35-74 years old, enrolled in the Sister Study from 2003 to 2009. Self-reports of specific TCEs occurring before the age of 18 years included sexual, physical, and psychological/emotional trauma; natural disasters; major accidents; and household dysfunction. Participants self-reported average sleep duration (short: <7 hours vs recommended: 7-9 hours), sleep onset latency (SOL) at least 30 vs less than 30 minutes, at least 3 night awakenings once asleep at least 3 times/week (Night awakenings [NA], yes vs no), and napping at least 3 vs less than 3 times/week. RESULTS Among 40 082 women, 55% reported a TCE, with 82% reporting betrayal trauma. Compared to women reporting no TCE, women with any TCE were more likely to report short sleep (prevalence ratio [PR] = 1.08, [95% confidence interval (CI) = 1.04 to 1.11]), longer SOL (1.11, [1.06 to 1.16]), frequent NAs (1.06, [1.00 to 1.11]), and frequent napping (1.05, [0.99 to 1.12]). The relationship between experiencing any TCE and short sleep was stronger for TCEs by a perpetrator considered socially close vs not close (1.12, [1.09 to 1.16]), SOL (1.27, [1.22 to 1.33]), NA (1.20, [1.14 to 1.27]), and napping (1.24, [1.17 to 1.32]). CONCLUSIONS TCEs were associated with poor sleep in women with greater impact when the perpetrator was regarded as close. More research is warranted to better understand pathways between childhood trauma and sleep health in adulthood to develop effective interventions.
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Affiliation(s)
- Ketrell L McWhorter
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | | | - Darlynn M Rojo-Wissar
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC
- Intramural Program, National Institute on Minority Health and Health Disparities, Department of Health and Human Services, Bethesda, MD
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Steine IM, Skogen JC, Krystal JH, Winje D, Milde AM, Grønli J, Nordhus IH, Bjorvatn B, Pallesen S. Insomnia symptom trajectories among adult survivors of childhood sexual abuse: A longitudinal study. CHILD ABUSE & NEGLECT 2019; 93:263-276. [PMID: 31129428 DOI: 10.1016/j.chiabu.2019.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Childhood sexual abuse (CSA) is associated with sleep disturbances in adulthood. However, longitudinal studies have yet to identify among CSA-survivors subgroups distinguished by the trajectory of their insomnia severity, or predictors of subgroup membership. OBJECTIVE The objective of this study was to examine longitudinal insomnia symptom trajectories, as well as predictors and correlates of the identified trajectories, over a 4 year study period in a sample of adult, mainly female CSA-survivors. PARTICIPANTS AND SETTING The sample comprised 533 adult survivors of CSA (94.9% women, mean age 39.2 years, mean age of abuse onset 6.5 years), recruited from support centers for sexual abuse survivors in Norway. METHODS Latent class growth analyses were used to identify insomnia symptom trajectories. RESULTS Three distinct trajectories of insomnia symptoms were identified; one characterized by high insomnia symptom scores minimally decreasing over the study period ('high and decreasing', 30.6%), one characterized by stable intermediate insomnia symptom scores ('intermediate and stable', 41.5%), and one characterized by stable low insomnia symptom scores ('low and stable', 27.9%). Predictors of belonging to the high and decreasing trajectory (using the low and stable trajectory as a reference), was lower age of abuse onset (expotentiated coefficient (EC): 0.93, p = 0.026), abuse involving penetration (EC: 2.36, p = 0.005), threats (EC: 3.06, p < 0.001) or physical violence (EC: 3.29 p < 0.001), a higher score on a composite variable comprising multiple other abuse and perpetrator aspects (EC: 2.55, p < 0.001), as well as scoring above a clinical cut-off on a measure of posttraumatic stress symptoms (EC: 12.17, p < 0.001). Those belonging to the high and decreasing trajectory also reported lower levels of perceived social support and higher levels of subjectively experienced relational difficulties compared to those belonging to the two other trajectories. CONCLUSIONS We conclude that different longitudinal insomnia trajectories exist among adult CSA survivors. The overall results, as well as the significant predictors, are discussed alongside their potential clinical implications.
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Affiliation(s)
- Iris M Steine
- UC Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94704, USA; Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway.
| | - Jens Christoffer Skogen
- Department of Health Promotion, Division for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway; Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
| | - John H Krystal
- Clinical Neuroscience Division, VA National Center for PTSD, 950 Campbell Avenue, West Haven, CT, 06516, USA; Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Dagfinn Winje
- Department of Clinical Psychology, University of Bergen, Christiesgate 12, 5015, Bergen, Norway
| | - Anne Marita Milde
- NORCE AS - Regional Centre for Child and Youth Mental Health and Child Welfare, Postbox 7810, 5020, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, 5009, Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, 5009, Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, University of Bergen, Christiesgate 12, 5015, Bergen, Norway; Institute of Basic Medical Sciences, University of Oslo, PO Box 1110, Blindern, 0317, Oslo, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway; Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway; Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, PO Box 1400, 5021, Bergen, Norway
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Schickedanz AB, Escarce JJ, Halfon N, Sastry N, Chung PJ. Adverse Childhood Experiences and Household Out-of-Pocket Healthcare Costs. Am J Prev Med 2019; 56:698-707. [PMID: 30905486 PMCID: PMC6475485 DOI: 10.1016/j.amepre.2018.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Adverse childhood experiences are associated with higher risk of common chronic mental and physical illnesses in adulthood, but little evidence exists on whether this influences medical costs or expenses. This study estimated increases in household medical expenses associated with adults' reported adverse childhood experience scores. METHODS Household out-of-pocket medical cost and adverse childhood experience information was collected in the 2011 and 2013 waves of the Panel Study of Income Dynamics and its linked 2014-2015 Panel Study of Income Dynamics Childhood Retrospective Circumstances Study supplement and analyzed in 2017. Generalized linear regression models estimated adjusted annual household out-of-pocket medical cost differences by retrospective adverse childhood experience count and compared costs by family type and size. Logistic models estimated odds of out-of-pocket costs that were >10% of household income or >100% of savings, as well as odds of household debt. RESULTS Adverse childhood experience scores were associated with higher out-of-pocket costs. Annual household total out-of-pocket medical costs were $184 (95% CI=$90, $278) or 1.18-fold higher when respondents reported one to two adverse childhood experiences and $311 (95% CI=$196, $426) or 1.30-fold higher when three or more adverse childhood experiences were reported by an adult in the household. Odds of household medical costs >10% of income, >100% of savings, and the presence of household medical debt were 2.48-fold (95% CI=1.40, 4.38), 2.25-fold (95% CI=1.69, 2.99), and 2.29-fold (95% CI=1.56, 3.34) higher when an adult in the household reported three or more adverse childhood experiences compared with none. CONCLUSIONS Greater exposure to adverse childhood experiences is associated with higher household out-of-pocket medical costs and financial burden in adulthood.
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Affiliation(s)
- Adam B Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
| | - José J Escarce
- Department of Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Neal Halfon
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Narayan Sastry
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California
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Mejía-Rodríguez D, Rodríguez R, Restrepo D. Sociodemographic Characterization and Psychiatric Symptoms of Patients With Medically Unexplained Symptoms in a Healthcare Institution in Medellin (Colombia). ACTA ACUST UNITED AC 2019; 48:72-79. [PMID: 30981330 DOI: 10.1016/j.rcp.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/02/2017] [Accepted: 08/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Medically unexplained symptoms are defined as physical symptoms that have been present for several weeks and that an adequate medical evaluation has not revealed any disease that explains them; when these symptoms become persistent, they lead to comprehensive clinical investigations and multiple interventions. These patients have a greater or at least comparable commitment to physical functioning, mental health, and negative health perception than patients with multiple chronic medical conditions; have significantly more stressful life events (psychological, physical and/or sexual abuse) and are more likely to meet diagnostic criteria for anxiety and depression. OBJECTIVE To characterize sociodemographic and psychiatric characteristics of a group of patients identified in primary care with medically unexplained symptoms. METHODOLOGY A descriptive, cross-sectional study with patients from 18 to 70 years old who were given PHQ-15, PHQ-9 and PHQ for anxiety, and a survey designed for the study. RESULTS 36 patients were analysed, 94.4% women, median age 45 [RIC, 20] years-old, 33.3% married, 91.7% had children. 55% had severe functional somatic symptoms, 77.8% had one or more functional somatic disorders, and 77.7% had clinically relevant affective or anxiety symptoms. 25% of the patients reported a history of child abuse, 41.7% were mistreated by a partner, and 41.6% were victims of the Colombian armed conflict. CONCLUSIONS The main finding of this study was that 8 out of 10 patients met criteria for a functional somatic disorder with great symptomatic severity and three out of ten patients met criteria for two functional disorders, most of these patients without other basic medical diseases. In addition, we found a high prevalence of exposure to different types of violence that these patients have been subjected to throughout their life.
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Letourneau EJ, Brown DS, Fang X, Hassan A, Mercy JA. The economic burden of child sexual abuse in the United States. CHILD ABUSE & NEGLECT 2018; 79:413-422. [PMID: 29533869 PMCID: PMC6542279 DOI: 10.1016/j.chiabu.2018.02.020] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/09/2018] [Accepted: 02/20/2018] [Indexed: 05/05/2023]
Abstract
The present study provides an estimate of the U.S. economic impact of child sexual abuse (CSA). Costs of CSA were measured from the societal perspective and include health care costs, productivity losses, child welfare costs, violence/crime costs, special education costs, and suicide death costs. We separately estimated quality-adjusted life year (QALY) losses. For each category, we used the best available secondary data to develop cost per case estimates. All costs were estimated in U.S. dollars and adjusted to the reference year 2015. Estimating 20 new cases of fatal and 40,387 new substantiated cases of nonfatal CSA that occurred in 2015, the lifetime economic burden of CSA is approximately $9.3 billion, the lifetime cost for victims of fatal CSA per female and male victim is on average $1,128,334 and $1,482,933, respectively, and the average lifetime cost for victims of nonfatal CSA is of $282,734 per female victim. For male victims of nonfatal CSA, there was insufficient information on productivity losses, contributing to a lower average estimated lifetime cost of $74,691 per male victim. If we included QALYs, these costs would increase by approximately $40,000 per victim. With the exception of male productivity losses, all estimates were based on robust, replicable incidence-based costing methods. The availability of accurate, up-to-date estimates should contribute to policy analysis, facilitate comparisons with other public health problems, and support future economic evaluations of CSA-specific policy and practice. In particular, we hope the availability of credible and contemporary estimates will support increased attention to primary prevention of CSA.
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Affiliation(s)
- Elizabeth J Letourneau
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington St., Suite 531, Baltimore, MD, 21231, USA.
| | - Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
| | - Xiangming Fang
- College of Economics and Management, China Agricultural University, Beijing, 100083, China; School of Public Health, Georgia State University, Atlanta, GA, 30303, USA.
| | - Ahmed Hassan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
| | - James A Mercy
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
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Abajobir AA, Kisely S, Williams G, Strathearn L, Najman JM. Childhood maltreatment and adulthood poor sleep quality: a longitudinal study. Intern Med J 2018; 47:879-888. [PMID: 28422454 DOI: 10.1111/imj.13459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Available evidence from cross-sectional studies suggests that childhood maltreatment may be associated with a range of sleep disorders. However, these studies have not controlled for potential individual-, familial- and environmental-level confounders. AIM To determine the association between childhood maltreatment and lower sleep quality after adjusting for potential confounders. METHODS Data for the present study were obtained from a pre-birth cohort study of 3778 young adults (52.6% female) of the Mater Hospital-University of Queensland Study of Pregnancy follow up at a mean age of 20.6 years. The Mater Hospital-University of Queensland Study of Pregnancy is a prospective Australian pre-birth cohort study of mothers consecutively recruited during their first obstetric clinic visit at Brisbane's Mater Hospital in 1981-1983. Participants completed the Pittsburgh Sleep Quality Index at the 21-year follow up. We linked this dataset to agency-recorded substantiated cases of childhood maltreatment. A series of separate logistic regression models was used to test whether childhood maltreatment predicted lower sleep quality after adjustment for selected confounders. RESULTS Substantiated physical abuse significantly predicted lower sleep quality in males. Single and multiple forms of childhood maltreatment, including age of maltreatment and number of substantiations, did not predict lower sleep quality in either gender in both crude and adjusted models. Not being married, living in a residential problem area, cigarette smoking and internalising were significantly associated with lower sleep quality in a fully adjusted model for the male-female combined sample. CONCLUSIONS Childhood maltreatment does not appear to predict young adult poor sleep quality, with the exception of physical abuse for males. While childhood maltreatment has been found to predict a range of mental health problems, childhood maltreatment does not appear to predict sleep problems occurring in young adults. Poor sleep quality was accounted for by concurrent social disadvantage, cigarette smoking and internalising.
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Affiliation(s)
- Amanuel A Abajobir
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Steve Kisely
- Faculty of Medicine, School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Gail Williams
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Lane Strathearn
- Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jake M Najman
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Humanities and Social Sciences, School of Social Sciences, University of Queensland, Brisbane, Queensland, Australia.,Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, Queensland, Australia
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Brownlie EB, Graham E, Bao L, Koyama E, Beitchman JH. Language disorder and retrospectively reported sexual abuse of girls: severity and disclosure. J Child Psychol Psychiatry 2017; 58:1114-1121. [PMID: 28407233 DOI: 10.1111/jcpp.12723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite emerging evidence for an association between communication disorders and maltreatment, little research has examined sexual abuse characteristics or disclosure experiences among individuals with language disorder (LD). Given that communication difficulties may constitute a barrier to disclosure, the disclosure experiences among individuals with and without communication difficulties may also differ. METHODS Five-year-old children identified with a language and/or speech disorder from a nonclinical community sample and a control group were followed to adulthood in a prospective longitudinal study. At age 31, participants completed a behaviorally specific questionnaire on experiences of sexual abuse and questionnaires on disclosure experiences and social reactions to disclosure. Due to low endorsement of sexual victimization among male participants and low sample size, results are reported for women only and exclude nine participants with speech disorder without LD. Participation rates were 28 of 40 in the LD cohort and 45 of 51 controls. Sexual victimization severity was defined using an index combining five indicators (duration, invasiveness, relationship to perpetrator, coercive tactics used, and number of perpetrators). Subthreshold sexual victimization was defined as a single, noncontact incident with a perpetrator unknown to the child; experiences with greater severity were classified as child sexual abuse. RESULTS Among women who reported sexual victimization by age 18, invasiveness and overall severity were greater in the LD cohort than in the control cohort. Women in the LD cohort (43%) were more likely than controls (16%) to report child sexual abuse, excluding subthreshold experiences. There were no differences between cohorts in probability of disclosure, latency to disclosure, or social reactions. CONCLUSIONS Women with a history of child LD in a nonclinical sample reported substantial child sexual abuse experiences. Implications for understanding associations between LD and mental health and for prevention and early intervention are discussed.
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Affiliation(s)
- E B Brownlie
- Child, Youth and Emerging Adult Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Lin Bao
- Simon Fraser University, Vancouver, BC, Canada
| | - Emiko Koyama
- Child, Youth and Emerging Adult Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Joseph H Beitchman
- Child, Youth and Emerging Adult Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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16
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Abajobir AA, Kisely S, Williams G, Strathearn L, Najman JM. Childhood maltreatment and high dietary fat intake behaviors in adulthood: A birth cohort study. CHILD ABUSE & NEGLECT 2017; 72:147-153. [PMID: 28802911 DOI: 10.1016/j.chiabu.2017.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/16/2017] [Accepted: 08/01/2017] [Indexed: 05/24/2023]
Abstract
Childhood maltreatment has been associated with a wide range of chronic medical conditions including obesity, other metabolic events and eating disorders. However, little is known about the association between childhood maltreatment and high dietary fat intake. This study addresses the extent to which co-occurring and specific forms of substantiated childhood maltreatment are associated with self-reported high dietary fat intake in adulthood and whether there is a gender-childhood maltreatment interaction in predicting this association. The study also examines the association between age at substantiation of maltreatment, number of childhood maltreatment substantiations and high dietary fat intake-related behaviors. The data were from a prospective Australian pre-birth mother-child dyads study, the Mater-University of Queensland Study of Pregnancy. The study followed 7223 mother-child dyads following the birth of a live, singleton baby at the Mater hospital. Recruitment was early in pregnancy, and then follow-ups at 3-5days postpartum and again when the child was 6 months, 5, 14 and 21 years of age. The data were linked to agency-substantiated cases of childhood maltreatment 0-14 years. This study extended the data linkage to 3766 (47.4% female) participants who had complete data on dietary fat intake behaviors at the 21-year follow-up. Consecutive logistic regressions were used to estimate odds ratios with respective 95% confidence intervals for high dietary fat intake for multiple and specific forms of childhood maltreatment, as well as age at and number of childhood maltreatment substantiations. Finally, a gender-childhood maltreatment interaction term was used to predict the outcome. In both unadjusted and adjusted analyses, substantiated childhood maltreatment including physical abuse were associated with high dietary fat intake-related behaviors. Similarly, substantiation of childhood maltreatment between the ages of 5 and 14 years was significantly associated with high dietary fat intake-related behaviors as were two or more substantiations of maltreatment. Inclusion of gender-childhood maltreatment interaction only had a minor impact on the size and direction of the association. Chronic and severe forms of childhood maltreatment including physical abuse are associated with a higher rate of dietary fat intake in young adulthood. Further research to replicate this association might focus on possible neuro-hormonal mechanisms that might explain this behavior.
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Affiliation(s)
- Amanuel Alemu Abajobir
- Faculty of Medicine, School of Public Health, The University of Queensland, Public Health Building, Herston, 4006 Queensland, Australia.
| | - Steve Kisely
- Faculty of Medicine, School of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, 4102 Queensland, Australia; Faculty of Medicine, Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Gail Williams
- Faculty of Medicine, School of Public Health, The University of Queensland, Public Health Building, Herston, 4006 Queensland, Australia
| | - Lane Strathearn
- Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa, Iowa City, IA, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Jake Moses Najman
- Faculty of Medicine, School of Public Health, The University of Queensland, Public Health Building, Herston, 4006 Queensland, Australia; Queensland Alcohol and Drug Research and Education Centre, The University of Queensland, Herston, 4006 Queensland, Australia; Faculty of Humanities and Social Sciences, School of Social Sciences, The University of Queensland, St. Lucia, 4072 Queensland, Australia
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Porcerelli JH, Jones JR, Klamo R, Heeney R. Childhood abuse in adults in primary care: Empirical findings and clinical implications. Int J Psychiatry Med 2017; 52:265-276. [PMID: 29065808 DOI: 10.1177/0091217417730290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the healthcare setting, adult patients with histories of childhood abuse are of significant concern and are frequently encountered in the primary care setting. However, there is a dearth of studies investigating the relationships between psychopathology, overall health, healthcare utilization, physician ratings of patient difficulty, and childhood abuse. The present study examines these relationships in primary care patients with (N = 45) and without (N = 129) histories of childhood abuse (physical, sexual, and both). Findings revealed that adult patients with histories of childhood abuse generally scored significantly higher on measures of psychopathology, emergency room use, and doctor-patient relationship difficulty, and lower on a measure of mental and physician-rated physical health. In a multiple regression analysis, income and a history of childhood sexual abuse significantly predicted overall mental health. In a second multiple regression analysis, income, depression, somatization, borderline personality disorder, and difficult doctor-patient relationship ratings significantly predicted physician-rated physical health. Overall, these findings suggest that a history of childhood abuse is associated with a host of negative health outcomes. Findings also suggest that negative feelings about a patient may help physicians identify patients with histories of childhood abuse. It is especially important for physicians to routinely include an assessment of childhood abuse during the psychosocial portion of the medical interview or through screening instruments.
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Affiliation(s)
| | - John R Jones
- 1 Department of Psychology, University of Detroit Mercy, MI, USA
| | - Rachel Klamo
- 2 Department of Family Medicine and Public Health Sciences, Wayne State University, MI, USA
| | - Rebecca Heeney
- 2 Department of Family Medicine and Public Health Sciences, Wayne State University, MI, USA
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18
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Steine IM, Winje D, Skogen JC, Krystal JH, Milde AM, Bjorvatn B, Nordhus IH, Grønli J, Pallesen S. Posttraumatic symptom profiles among adult survivors of childhood sexual abuse: A longitudinal study. CHILD ABUSE & NEGLECT 2017; 67:280-293. [PMID: 28327414 DOI: 10.1016/j.chiabu.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
In the present study, our aim was to examine longitudinal posttraumatic stress symptom (PTSS) trajectories in a Norwegian sample of adults who had experienced sexual abuse during childhood, and to identify predictors of PTSS-trajectory belongingness. The sample consisted of 138 adult survivors of childhood sexual abuse (96.4% women, mean age=42.9years, mean age at the first abuse=5.9 years), recruited from support centers for sexual abuse survivors. The majority (78.3%) reported penetrative abuse, and a large proportion of the sample reported that the perpetrator was a biological parent (38.4%) or someone they trusted (76.1%), reflecting a high severity level of the abusive experiences. Latent Profile Analyses revealed the best overall fit for a two PTSS-trajectories model; one trajectory characterized by sub-clinical and decreasing level of PTSS (54.9%), and the other by high and slightly decreasing level of PTSS (45.1%). Increased odds for belonging to the trajectory with clinical level symptoms was found among those who reported higher levels of exposure to other types of childhood maltreatment (OR=3.69, p=0.002), sexual abuse enforced by physical violence (OR=3.04, p=0.003) or threats (OR=2.56, p=0.014), very painful sexual abuse (OR=2.73, p=0.007), or who had experienced intense anxiety, helplessness or fear during the abuse (OR=2.97, p=0.044). Those in the trajectory with clinical level PTSS reported lower levels of perceived social support and more relational difficulties compared to those in the sub-clinical PTSS trajectory. In conclusion, different longitudinal PTSS trajectories can be found among adult survivors of childhood sexual abuse. Significant predictors of PTSS-trajectory belongingness are discussed alongside their potential implications for preventive efforts and clinical interventions.
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Affiliation(s)
- Iris M Steine
- Department of Clinical Psychology, University of Bergen, Christiesgate 12, 5015 Bergen, Norway; Visiting Scholar, UC Berkeley, Department of Psychology, 4123 Tolman Hall, Berkeley, CA 94720-1690, USA.
| | - Dagfinn Winje
- Department of Clinical Psychology, University of Bergen, Christiesgate 12, 5015 Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Christiesgate 13, 5020 Bergen, Norway
| | - John H Krystal
- Clinical Neuroscience Division, VA National Center for PTSD, 950 Campbell Avenue West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511 USA
| | - Anne Marita Milde
- Regional Centre for Child and Youth Mental Health and Child Welfare, Postbox 7810, 5020 Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway; Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, University of Bergen, Christiesgate 12, 5015 Bergen, Norway; Institute of Basic Medical Sciences, University of Oslo, PO Box 1110 Blindern 0317 Oslo, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway; Washington State University, PO BOX 1495 Spokane, WA 99210-1495, USA
| | - Ståle Pallesen
- Norwegian Competence Center of Sleep Disorders, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway; Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015 Bergen, Norway
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20
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Mental health trajectories from adolescence to adulthood: Language disorder and other childhood and adolescent risk factors. Dev Psychopathol 2015; 28:489-504. [PMID: 26611829 DOI: 10.1017/s0954579415001054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Longitudinal research on mental health development beyond adolescence among nonclinical populations is lacking. This study reports on psychiatric disorder trajectories from late adolescence to young adulthood in relation to childhood and adolescent risk factors. Participants were recruited for a prospective longitudinal study tracing a community sample of 5-year-old children with communication disorders and a matched control cohort to age 31. Psychiatric disorders were measured at ages 19, 25, and 31. Known predictors of psychopathology and two school-related factors specifically associated with language disorder (LD) were measured by self-reports and semistructured interviews. The LD cohort was uniquely characterized by a significantly decreasing disorder trajectory in early adulthood. Special education was associated with differential disorder trajectories between LD and control cohorts, whereas maltreatment history, specific learning disorder, family structure, and maternal psychological distress were associated with consistent trajectories between cohorts. From late adolescence to young adulthood, childhood LD was characterized by a developmentally limited course of psychiatric disorder; maltreatment was consistently characterized by an elevated risk of psychiatric disorder regardless of LD history, whereas special education was associated with significantly decreasing risk of psychiatric disorder only in the presence of LD.
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21
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Mansbach-Kleinfeld I, Ifrah A, Apter A, Farbstein I. Child sexual abuse as reported by Israeli adolescents: social and health related correlates. CHILD ABUSE & NEGLECT 2015; 40:68-80. [PMID: 25542832 DOI: 10.1016/j.chiabu.2014.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 11/16/2014] [Accepted: 11/21/2014] [Indexed: 05/25/2023]
Abstract
The objectives of the study were to assess the prevalence of child sexual abuse (CSA) in a nation-wide representative sample of 14-17 year old Israeli adolescents, and to examine the associations between CSA, socio-demographic correlates and various measures of physical and mental health. The study population consisted of 906 mother-adolescent dyads, belonging to a community based, representative sample of Israeli 14-17 year olds, interviewed in 2004-5. Response rate was 68%. Subjects provided demographic data, and information about CSA, physical symptoms, body image, well-being and use of mental health services. DAWBA was used to obtain information regarding mental disorders and suicidality. SDQ was used to obtain data on bullying. Statistical analyses were conducted using an SPSS-17 complex sample analysis module and multivariate analyses were conducted to assess the associations between CSA and risk factors and social and health related correlates. Findings show that CSA was reported by 3.3% of adolescents. Higher risk of exposure to CSA was found among girls, among adolescents living in a one-parent household and among adolescents with a chronic disability. In multivariate models adjusting for gender, learning disabilities and depression, CSA was associated with suicidal attempts, stomach ache, dizziness, sleep problems, well being at home and bullying behaviors. No association was found with suicidal ideation or other physical symptoms. Our findings confirm that the associations between CSA and different outcomes vary depending on the socio-psychological context, and underline the importance of addressing the complexity of variables associated with CSA.
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Affiliation(s)
| | - Anneke Ifrah
- The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Alan Apter
- Department of Child and Adolescent Psychiatry, Schneider Medical Center for Children in Israel, Petach Tikvah, Israel
| | - Ilana Farbstein
- Department of Child and Adolescent Psychiatry, Ziv Hospital, Zfat, Israel
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Kajeepeta S, Gelaye B, Jackson CL, Williams MA. Adverse childhood experiences are associated with adult sleep disorders: a systematic review. Sleep Med 2015; 16:320-30. [PMID: 25777485 DOI: 10.1016/j.sleep.2014.12.013] [Citation(s) in RCA: 238] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 12/21/2022]
Abstract
Adverse childhood experiences (ACEs) represent substantial threats to public health and affect about 58% of youth in the US. In addition to their acute effects such as injury and physical trauma, ACEs are associated with an increased risk of several negative health outcomes throughout the life course. Emerging evidence suggests that sleep disorders may be one such outcome, but existing studies have not been systematically reviewed and summarized. We conducted a systematic review to summarize the evidence concerning the relationship between ACEs and sleep disorders and disturbances, with a focus on adult women. Original publications were identified through searches of the electronic databases MEDLINE, Embase, and Web of Science using the keywords "childhood," "adversity," "abuse," and "sleep" as well as searches of the reference lists of eligible studies. Studies evaluating ACEs that occurred before 18 years of age and sleep outcomes that were assessed at 18 years or older were adjudicated and included. A total of 30 publications were identified. Of the 30 studies, 28 were retrospective analyses and there was vast heterogeneity in the types of ACEs and sleep outcomes measured. The majority of retrospective studies (N = 25 of 28) documented statistically significant associations between sleep disorders including sleep apnea, narcolepsy, nightmare distress, sleep paralysis, and psychiatric sleep disorders with a history of childhood adversity. In many studies, the strengths of associations increased with the number and severity of adverse experiences. These associations were corroborated by the two prospective studies published to date. Notably, investigators have documented statistically significant associations between family conflict at 7-15 years of age and insomnia at 18 years of age (odds ratio, OR = 1.4; 95% confidence interval, CI = 1.2-1.7) and between childhood sexual abuse and sleep disturbances 10 years later in adult women (β = 0.24, p <0.05). There is a growing scientific body of knowledge suggesting an association between ACEs and multiple sleep disorders in adulthood. The available evidence indicates the need to develop treatment strategies such as trauma-informed care for survivors of abuse who suffer from sleep disorders and disturbances. Further, longitudinal studies among diverse populations are needed to improve the overall understanding of this association and to investigate potential gender and racial/ethnic disparities in the strength of the association.
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Affiliation(s)
- Sandhya Kajeepeta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chandra L Jackson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Spiegel DR, Chatterjee A, McCroskey AL, Ahmadi T, Simmelink D, Oldfield EC, Pryor CR, Faschan M, Raulli O. A Review of Select Centralized Pain Syndromes: Relationship With Childhood Sexual Abuse, Opiate Prescribing, and Treatment Implications for the Primary Care Physician. Health Serv Res Manag Epidemiol 2015; 2:2333392814567920. [PMID: 28462250 PMCID: PMC5266436 DOI: 10.1177/2333392814567920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pain can be broadly divided into 3 classes, including nociceptive or inflammatory pain (protective), neuropathic (pathological, occurring after damage to the nervous system), or centralized (pathological, due to abnormal function but with no damage or inflammation to the nervous system). The latter has been posited to occur when descending analgesic pathways are attenuated and/or glutamatergic transmission is facilitated. Additionally, this "pain prone phenotype" can be associated with early life trauma and a suboptimal response to opiates. This article will review the relationships between centralized pain syndromes (ie, fibromyalgia, chronic low back pain), childhood sexual abuse, and opiate misuse. Finally, treatment implications, potentially effecting primary care physicians, will be discussed.
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Affiliation(s)
- David R. Spiegel
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Aparna Chatterjee
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Aidan L. McCroskey
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Tamana Ahmadi
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Drew Simmelink
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Edward C. Oldfield
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Christopher R. Pryor
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Michael Faschan
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Olivia Raulli
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
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Thompson R, Flaherty EG, English DJ, Litrownik AJ, Dubowitz H, Kotch JB, Runyan DK. Trajectories of Adverse Childhood Experiences and Self-Reported Health at Age 18. Acad Pediatr 2015; 15:503-9. [PMID: 25441654 PMCID: PMC4409920 DOI: 10.1016/j.acap.2014.09.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/27/2014] [Accepted: 09/13/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Despite growing evidence of links between adverse childhood experiences (ACEs) and long-term health outcomes, there has been limited longitudinal investigation of such links in youth. The purpose of these analyses was to describe the patterns of exposure to ACEs over time and their links to youth health. METHODS The current analyses used data from LONGSCAN, a prospective study of children at risk for or exposed to child maltreatment, who were followed from age 4 to age 18. The analyses focused on 802 youth with complete data. Cumulative exposure to ACEs between 4 and 16 was used to place participants in 3 trajectory-defined groups: chronic ACEs, early ACEs only, and limited ACEs. Links to self-reported health at age 18 were examined using linear mixed models after controlling for earlier health status and demographics. RESULTS The chronic ACEs group had increased self-reported health concerns and use of medical care at 18 but not poorer self-rated health status. The early ACEs only group did not significantly differ from limited ACEs on outcomes. CONCLUSIONS In addition to other negative outcomes, chronic ACEs appear to affect physical health in emerging adulthood. Interventions aimed at reducing exposure to ACEs and early mitigation of their effects may have lasting and widespread health benefits.
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Affiliation(s)
- Richard Thompson
- Richard H. Calica Center for Innovation in Children and Family Services, Juvenile Protective Association, Chicago, Ill.
| | - Emalee G. Flaherty
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | | | - Howard Dubowitz
- Dept. of Pediatrics, University of Maryland School of Medicin, Baltimore, MD
| | - Jonathan B. Kotch
- Dept. of Child and Maternal Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Desmond K. Runyan
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO
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Abstract
BACKGROUND This study examined attachment style as a moderator of the relationship between childhood abuse and inflammatory bowel disease (IBD)-related outcomes. METHODS Study participants were 205 patients with IBD from Mount Sinai Hospital in Toronto. Participants completed self-report questionnaires regarding personal relationships, abuse history, and IBD-related information. Multiple regression models were fit using 3 outcome variables: disease-related quality of life (QOL), disease activity for ulcerative colitis, and disease activity for Crohn's disease. RESULTS Patients reporting less severe abuse and low levels of avoidant attachment had the highest levels of QOL, whereas patients reporting high levels of avoidant attachment had the lowest levels of QOL, regardless of abuse severity. Patients reporting greater anxious attachment had lower QOL scores. Patients reporting less severe abuse and low levels of avoidant attachment had the lowest levels of disease activity, whereas patients reporting high levels of avoidant attachment had the highest levels of ulcerative colitis-related disease activity, regardless of abuse severity. However, for anxious attachment, there was no significant main effect or significant interaction of abuse by anxious attachment on ulcerative colitis-related disease activity. Childhood abuse and attachment style were not found to be associated with Crohn's disease-related disease activity. CONCLUSIONS Adult attachment style may moderate the relationship between childhood abuse and IBD-related outcomes, by impacting one's QOL and disease activity. Distinct types of insecure attachment styles may impact these relationships differently. Psychological interventions focusing on attachment styles of patients with IBD have the potential to improve IBD-related QOL and disease activity.
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Sutherland MA, Fantasia HC, McClain N. Abuse experiences, substance use, and reproductive health in women seeking care at an emergency department. J Emerg Nurs 2013; 39:326-33. [PMID: 22088770 PMCID: PMC5096447 DOI: 10.1016/j.jen.2011.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 09/08/2011] [Accepted: 09/14/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Abuse experiences can have negative health consequences for women. Many women present to the emergency department for episodic, nonemergent care and may have unique needs as survivors of abuse. The purpose of this study was to describe child sexual abuse experiences, intimate partner violence, substance use, and reproductive health outcomes in a sample of adult women who were seeking care from a rural emergency department to better understand the health care needs of this unique population. METHODS One hundred forty-five adult women (18-45 years old) were recruited at an emergency department in the southeastern United States. Questionnaires were used to assess for demographic characteristics, history of child sexual abuse (CSA), intimate partner violence, reproductive health, and substance use. RESULTS In the sample, 42.8% of women (n = 62) reported a positive history of CSA and 34.7% of women (n = 49) experienced intimate partner physical violence during the past year. More than 46% of the women (n = 65) had harmful drinking patterns in the past year and more than 50% reported some type of substance use in the past 3 months. Women who experienced CSA had a significantly greater number of lifetime sexual partners, were more likely to report pain with sexual intercourse, and were more likely to report a medical history of an abnormal Papanicolaou smear. DISCUSSION The women in this sample had high rates of abuse, harmful drinking patterns, and substance use and were at risk for sexually transmitted infections. Through screening for lifetime violence, including sexual violence, emergency nurses can be an important liaison between women who have experienced CSA and appropriate referrals within the health care system.
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Affiliation(s)
- Melissa A. Sutherland
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, 617 552-8814 (phone) 617 552 0745 (fax),
| | - Heidi Collins Fantasia
- University of Massachusetts Lowell, School of Health and Environment, Department of Nursing,
| | - Natalie McClain
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, 617 552-6379 (phone) 617 552 0745 (fax),
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Kuria MW, Omondi L, Olando Y, Makenyengo M, Bukusi D. Is Sexual Abuse a Part of War? A 4-Year Retrospective Study on Cases of Sexual Abuse at the Kenyatta National Hospital, Kenya. J Public Health Afr 2013; 4:e5. [PMID: 28299094 PMCID: PMC5345424 DOI: 10.4081/jphia.2013.e5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 04/24/2013] [Indexed: 11/30/2022] Open
Abstract
The harmful effects of sexual abuse are long lasting. Sexual abuse when associated with violence is likely to impact negatively on the life of the victim. Anecdotal reports indicate that there was an increase in the number of cases of sexual violence following the 2007 post election conflict and violence in Kenya. Although such increases in sexual abuse are common during war or conflict periods the above reports have not been confirmed through research evidence. The purpose of the current study is to establish the trend in numbers of reported cases of sexual abuse at Kenyatta National Hospital over a 4-year period (2006-2009). Data on sexually abused persons for the year 2006-2009 was retrieved from the hospitals record. A researcher designed questionnaire was used to collect relevant data from the completed Post Rape Care (PRC) form. The PRC-Ministry of Health no. 363 (MOH363) form is mandatorily completed by the physician attending the sexually abused patient. There was an increase in the number of cases of sexual abuse reported in 2007 election year in Kenya, with a statistically significant increase in the sexually abused male cases. Sexual crime is more prevalent when there is war or conflict.
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Affiliation(s)
| | - Lilian Omondi
- School of Nursing Sciences, College of Health Science, University of Nairobi
| | | | | | - David Bukusi
- Kenyatta National Hospital Youth Centre, VCT and HIV Prevention Unit , Kenya
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Kendall-Tackett K, Cong Z, Hale TW. Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: a comparison of breastfeeding, mixed-feeding, and formula-feeding mothers. Breastfeed Med 2013; 8:16-22. [PMID: 23249130 DOI: 10.1089/bfm.2012.0024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Women with a history of sexual assault are at increased risk for sleep difficulties and depression in their first year of motherhood. Breastfeeding improves sleep parameters and lowers risk of depression for women in general. However, it is unknown whether breastfeeding is related to maternal depression, sleep quality, and maternal well-being in sexual assault survivors. We examined the association between sexual assault and several indices of sleep, depression, and maternal well-being in a large sample of sexual assault survivors in the first year postpartum. We also explored whether feeding method was related to our outcome variables for both sexually assaulted and non-assaulted women. SUBJECTS AND METHODS A sample of 6,410 mothers of infants 0-12 months old participated in the online Survey of Mothers' Sleep and Fatigue; 994 women had a history of sexual assault. RESULTS As predicted, women with a history of sexual assault had a number of sleep difficulties, increased risk of depression, and overall poorer subjective well-being than their non-assaulted counterparts. However, sexual assault survivors who were breastfeeding were at lower risk on all of the sleep and depression parameters than sexual assault survivors who were mixed or formula feeding. CONCLUSIONS Sexual assault has a pervasive negative effect on new mothers' sleep quality and risk of depression. However, these negative effects were less severe for the breastfeeding mothers than they were for the mixed- or formula-feeding mothers.
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McGregor K, Gautam J, Glover M, Jülich S. Health care and female survivors of childhood sexual abuse: health professionals' perspectives. JOURNAL OF CHILD SEXUAL ABUSE 2013; 22:761-775. [PMID: 23924181 DOI: 10.1080/10538712.2013.811143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The present study explored health professionals' experiences with adult survivors of child sexual abuse in New Zealand. Face-to-face, semistructured interviews of up to an hour took place with 13 health professionals. The participants were asked about training, screening practices, their response to disclosures, and advice to other health professionals. A model-transition to ethical practice-emerged from the data, where delivering more sensitive health care to child sexual abuse survivors sits on a continuum from lack of awareness of child sexual abuse to delivery of care where all patients are comfortable. We recommend making sensitive care for all as the standard care of practice and providing training for health professionals on how to deal with disclosures.
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Affiliation(s)
- Kim McGregor
- Rape Prevention Education-Whakatu Mauri, Auckland, New Zealand
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Nerum H, Halvorsen L, Straume B, Sørlie T, Øian P. Different labour outcomes in primiparous women that have been subjected to childhood sexual abuse or rape in adulthood: a case-control study in a clinical cohort. BJOG 2012; 120:487-95. [PMID: 23157417 PMCID: PMC3600530 DOI: 10.1111/1471-0528.12053] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the duration and outcome of the first labour in women who have been subjected to childhood sexual abuse (CSA) and women who have been raped in adulthood (RA). DESIGN Case-control study in a clinical cohort. SETTING University Hospital of North Norway. SAMPLE In all, 373 primiparas: 185 subjected to CSA, 47 to RA and 141 controls without a history of abuse. METHODS Data on birth outcomes were retrieved from the patient files. Information on sexual abuse was reported in consultation with specialised midwives in the mental health team. Birth outcomes were analysed by multinominal regression analysis. MAIN OUTCOME MEASURES Vaginal births, delivery by caesarean section, operative vaginal delivery and duration of labour. RESULTS As compared with controls, the RA group showed a significantly higher risk for caesarean section (adjusted OR 9.9, 95% CI 3.4-29.4) and operative vaginal delivery (adjusted OR 12.2, 95% CI 4.4-33.7). There were no significant differences between the CSA and the control group. The RA group displayed significantly longer duration of labour in all phases as compared with the control and CSA groups. CONCLUSIONS There were major differences in the duration of labour and birth outcomes in the two abuse groups. Despite a higher proportion of obstetric risk factors at onset of labour in the CSA group, women subjected to CSA had shorter labours and less risk for caesarean section and operative vaginal deliveries than women subjected to RA. The best care for birthing women subjected to sexual abuse needs to be explored in further studies.
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Affiliation(s)
- H Nerum
- Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway
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Breckenridge J, Salter M, Shaw E. Use and abuse: understanding the intersections of childhood abuse, alcohol and drug use and mental health. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/17523281.2012.703224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rich-Edwards JW, Mason S, Rexrode K, Spiegelman D, Hibert E, Kawachi I, Jun HJ, Wright RJ. Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women. Circulation 2012; 126:920-7. [PMID: 22787111 PMCID: PMC3649533 DOI: 10.1161/circulationaha.111.076877] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 06/21/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although child abuse is widespread and has been associated with cardiovascular disease (CVD) risk factors, its association with CVD events is not established. METHODS AND RESULTS We examined associations of child abuse with CVD events among 66 798 women in the Nurses' Health Study 2. Proportional hazards models estimated hazard ratios and 95% confidence intervals (CIs) for myocardial infarction (n=262), stroke (n=251), and total CVD (n=513). Severe physical abuse was reported by 9% and forced sex by 11% of participants. After adjustment for age, race, childhood body type, parental education, and family CVD history, the hazard ratios for CVD events were 0.91 (95% CI, 0.70-1.17) for mild physical abuse, 1.02 (95% CI, 0.82-1.26) for moderate physical abuse, and 1.46 (95% CI, 1.11-1.92) for severe physical abuse compared with no abuse. Compared with women without childhood sexual abuse, the hazard ratio was 1.10 (95% CI, 0.88-1.35) for unwanted sexual touching and 1.56 (95% CI, 1.23-1.99) for forced sex. After adjustment for adult lifestyle and medical risk factors, the hazard ratio for severe physical abuse was 1.13 (95% CI, 0.85-1.51) and that for forced sex was 1.25 (95% CI, 0.98-1.60); these intermediates accounted for much of the association of severe child abuse with CVD. Associations were similar for retrospectively and prospectively reported events. Women with abuse were less likely to release medical records. The associations were stronger for unconfirmed self-reported events than end points that were corroborated with additional information or medical record review. CONCLUSION Severe child abuse is a prevalent risk for early adult CVD that is partially mediated by preventable risk factors.
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Affiliation(s)
- Janet W Rich-Edwards
- Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA.
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Widom CS, Czaja SJ, Bentley T, Johnson MS. A prospective investigation of physical health outcomes in abused and neglected children: new findings from a 30-year follow-up. Am J Public Health 2012; 102:1135-44. [PMID: 22515854 PMCID: PMC3483964 DOI: 10.2105/ajph.2011.300636] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2011] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood. METHODS Using a prospective cohort design, we matched children (aged 0-11 years) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children. Both groups completed a medical status examination (measured health outcomes and blood tests) and interview during 2003 through 2005 (mean age=41.2 years). RESULTS After adjusting for age, gender, and race, child maltreatment predicted above normal hemoglobin, lower albumin levels, poor peak airflow, and vision problems in adulthood. Physical abuse predicted malnutrition, albumin, blood urea nitrogen, and hemoglobin A1C. Neglect predicted hemoglobin A1C, albumin, poor peak airflow, and oral health and vision problems, Sexual abuse predicted hepatitis C and oral health problems. Additional controls for childhood socioeconomic status, adult socioeconomic status, unhealthy behaviors, smoking, and mental health problems play varying roles in attenuating or intensifying these relationships. CONCLUSIONS Child abuse and neglect affect long-term health status-increasing risk for diabetes, lung disease, malnutrition, and vision problems-and support the need for early health care prevention.
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Affiliation(s)
- Cathy Spatz Widom
- Psychology Department, John Jay College, City University of New York, New York, NY 10019, USA.
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Fang X, Brown DS, Florence CS, Mercy JA. The economic burden of child maltreatment in the United States and implications for prevention. CHILD ABUSE & NEGLECT 2012; 36:156-65. [PMID: 22300910 PMCID: PMC3776454 DOI: 10.1016/j.chiabu.2011.10.006] [Citation(s) in RCA: 504] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 09/30/2011] [Accepted: 10/12/2011] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. METHODS This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used attributable costs whenever possible. For those categories that attributable cost data were not available, costs were estimated as the product of incremental effect of child maltreatment on a specific outcome multiplied by the estimated cost associated with that outcome. The estimate of the aggregate lifetime cost of child maltreatment in 2008 was obtained by multiplying per-victim lifetime cost estimates by the estimated cases of new child maltreatment in 2008. RESULTS The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion. CONCLUSIONS Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment.
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Affiliation(s)
- Xiangming Fang
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway,Atlanta, GA 30341, USA
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Tansill EC, Edwards KM, Kearns MC, Gidycz CA, Calhoun KS. The mediating role of trauma-related symptoms in the relationship between sexual victimization and physical health symptomatology in undergraduate women. J Trauma Stress 2012; 25:79-85. [PMID: 22354511 DOI: 10.1002/jts.21666] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous research suggests that posttraumatic stress symptomatology is a partial mediator of the relationship between sexual assault history in adolescence/adulthood and physical health symptomatology (e.g., Eadie, Runtz, & Spencer-Rodgers, 2008). The current study assessed a broader, more inclusive potential mediator, trauma-related symptoms in the relationship between sexual victimization history (including both childhood and adolescent/adulthood sexual victimizations) and physical health symptomatology in a college sample. Participants were 970 young women (M = 18.69, SD = 1.01), who identified mostly as Caucasian (86.7%), from 2 universities who completed a survey packet. Path analysis results provide evidence for trauma-related symptoms as a mediator in the relationship between adolescent/adulthood sexual assault and physical health symptomatology, χ(2) (1, N = 970) = 1.55, p = .21; comparative fit index = 1.00; Tucker-Lewis index = 0.99; root mean square error of approximation = .02, 90% confidence interval [.00, .09], Bollen-Stine bootstrap statistic, p = .29. Childhood sexual abuse was not related to physical health symptomatology, but did predict trauma-related symptoms. Implications of these findings suggest that college health services would benefit from targeted integration of psychiatric and medical services for sexual assault survivors given the overlap of psychological and physical symptoms.
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Affiliation(s)
- Erin C Tansill
- Department of Psychology, Ohio University, Athens, Ohio 43138, USA.
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Brown DS, Fang X, Florence CS. Medical costs attributable to child maltreatment a systematic review of short- and long-term effects. Am J Prev Med 2011; 41:627-35. [PMID: 22099241 DOI: 10.1016/j.amepre.2011.08.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/14/2011] [Accepted: 08/05/2011] [Indexed: 11/24/2022]
Abstract
CONTEXT Child maltreatment is a serious and prevalent public health problem, which has been shown to be associated with numerous short- and long-term effects on mental and physical health. Few estimates of the medical costs of these effects have been published to date. To determine the range and quality of currently available estimates and identify the gaps and needs for future research, this article reviews research on medical costs of child maltreatment. EVIDENCE ACQUISITION Peer-reviewed literature on child maltreatment and medical costs was identified by searching major databases. Twelve articles on the medical costs of child maltreatment were identified. EVIDENCE SYNTHESIS Eight studies describe short-term costs among children; four describe adult, long-term costs. Most studies used convenience samples, captured a partial share of the total costs, and did not follow best practices for econometric analysis of medical costs. CONCLUSIONS Child maltreatment is associated with substantial medical costs in childhood and adulthood, but estimates vary widely because of differences in research designs, types of cost data, and study quality. Econometric estimates of the annual medical costs in adulthood range from zero to about $800. Per-episode estimates of child costs, based on mean comparisons, range from $0 to >$24,000.
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Affiliation(s)
- Derek S Brown
- Public Health Economics Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
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Langfristige Folgen sexuellen Missbrauchs Minderjähriger. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2011. [DOI: 10.1007/s11757-011-0129-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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McGregor K, Glover M, Gautam J, Jülich S. Working Sensitively with Child Sexual Abuse Survivors: What Female Child Sexual Abuse Survivors Want from Health Professionals. Women Health 2010; 50:737-55. [DOI: 10.1080/03630242.2010.530931] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rich-Edwards JW, Spiegelman D, Lividoti Hibert EN, Jun HJ, Todd TJ, Kawachi I, Wright RJ. Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. Am J Prev Med 2010; 39:529-36. [PMID: 21084073 PMCID: PMC3003936 DOI: 10.1016/j.amepre.2010.09.007] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 09/01/2010] [Accepted: 09/01/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although child abuse is associated with obesity, it is not known whether early abuse increases risk of type 2 diabetes. PURPOSE To investigate associations of child and adolescent abuse with adult diabetes. METHODS Proportional hazards models were used to examine associations of lifetime abuse reported in 2001 with risk of diabetes from 1989 to 2005 among 67,853 women in the Nurses' Health Study II. Data were analyzed in 2009. RESULTS Child or teen physical abuse was reported by 54% and sexual abuse by 34% of participants. Models were adjusted for age, race, body type at age 5 years, and parental education and history of diabetes. Compared to women who reported no physical abuse, the hazards ratio (HR) was 1.03 (95% CI=0.91, 1.17) for mild physical abuse; 1.26 (1.14, 1.40) for moderate physical abuse; and 1.54 (1.34, 1.77) for severe physical abuse. Compared with women reporting no sexual abuse in childhood or adolescence, the HR was 1.16 (95% CI=1.05, 1.29) for unwanted sexual touching; 1.34 (1.13, 1.59) for one episode of forced sexual activity; and 1.69 (1.45, 1.97) for repeated forced sex. Adult BMI accounted for 60% (95% CI=32%, 87%) of the association of child and adolescent physical abuse and 64% (95% CI=38%, 91%) of the association of sexual abuse with diabetes. CONCLUSIONS Moderate to severe physical and sexual abuse in childhood and adolescence have dose-response associations with risk of type 2 diabetes among adult women. This excess risk is partially explained by the higher BMI of women with a history of early abuse.
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Affiliation(s)
- Janet W Rich-Edwards
- Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
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Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clin Proc 2010; 85:618-29. [PMID: 20458101 PMCID: PMC2894717 DOI: 10.4065/mcp.2009.0583] [Citation(s) in RCA: 545] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. PATIENTS AND METHODS We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity. RESULTS The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape. CONCLUSION A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.
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Affiliation(s)
- Laura P Chen
- Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA
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Corso PS, Fertig AR. The economic impact of child maltreatment in the United States: are the estimates credible? CHILD ABUSE & NEGLECT 2010; 34:296-304. [PMID: 20347486 DOI: 10.1016/j.chiabu.2009.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 09/03/2009] [Accepted: 09/08/2009] [Indexed: 05/29/2023]
Affiliation(s)
- Phaedra S Corso
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
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van Tilburg MAL, Runyan DK, Zolotor AJ, Graham JC, Dubowitz H, Litrownik AJ, Flaherty E, Chitkara DK, Whitehead WE. Unexplained gastrointestinal symptoms after abuse in a prospective study of children at risk for abuse and neglect. Ann Fam Med 2010; 8:134-40. [PMID: 20212300 PMCID: PMC2834720 DOI: 10.1370/afm.1053] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediated by psychological distress. METHODS Data were obtained from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 prospective studies of child maltreatment. The 845 children who were observed from the age of 4 through 12 years were the subjects of this study. Every 2 years information on gastrointestinal symptoms was obtained from parents, and maltreatment allegations were obtained from Child Protective Services (CPS). At the age of 12 years children reported gastrointestinal symptoms, life-time maltreatment, and psychological distress. Data were analyzed by logistic regression. RESULTS Lifetime CPS allegations of sexual abuse were associated with abdominal pain at age 12 years (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.1-2.47). Sexual abuse preceded or coincided with abdominal pain in 91% of cases. Youth recall of ever having been psychologically, physically, or sexually abused was significantly associated with both abdominal pain and nausea/vomiting (range, OR = 1.5 [95% CI, 1.1-2.0] to 2.1 [95% CI, 1.5-2.9]). When adjusting for psychological distress, most effects became insignificant except for the relation between physical abuse and nausea/vomiting (OR = 1.5; 95% CI, 1.1-2.2). CONCLUSION Youth who have been maltreated are at increased risk for unexplained gastrointestinal symptoms, and this relation is partially mediated by psychological distress. These findings are relevant to the clinical care for children who complain of unexplained gastrointestinal symptoms.
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Affiliation(s)
- Miranda A L van Tilburg
- Division of Gastroenterology and Hepatology, Center for Functional GI & Motility Disorders, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599-7080, USA.
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43
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Björklund K, Häkkänen-Nyholm H, Huttunen T, Kunttu K. Violence victimization among Finnish university students: prevalence, symptoms and healthcare usage. Soc Sci Med 2010; 70:1416-22. [PMID: 20171000 DOI: 10.1016/j.socscimed.2009.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 11/22/2009] [Accepted: 12/16/2009] [Indexed: 11/29/2022]
Abstract
The present study examined the prevalence of various forms of violence victimization among university students in Finland. Violence victimization was analyzed in relation to physical and mental health symptoms, and the use of student healthcare services. A cross-sectional Student Health Survey was performed as a national postal survey for Finnish university students in 2004. In the next phase of the study, an additional postal survey regarding violence victimization was sent to those who had answered the original survey, which resulted in a sample of 905 students. It was found that violence victimization and violence-related health issues were markedly prevalent among Finnish university students. The students reported multiple forms of violence and injury demonstrating the diversity of violence victimization. Male and female victims differed both in the amount and type of symptoms, and in their relationship to the abuser/offender. Violence victimization and gender had a significant main effect on specific symptoms, while no interaction effect was found. The data also showed that violence victimization is overrepresented among frequent healthcare users. These findings have implications for clinical practice and public policy. The present findings provide useful information for policy makers and healthcare professionals concerning the health effects of violence in accordance with the use of healthcare services. More specifically, this information should be taken into consideration when planning student healthcare and could serve as a guideline for student healthcare management.
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Affiliation(s)
- Katja Björklund
- Department of Psychology, University of Helsinki, P.O. Box 9, Helsinki 00014, Finland.
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44
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Cwikel J, Segal-Engelchin D, Mendlinger S. Mothers’ Coping Styles During Times of Chronic Security Stress: Effect on Health Status. Health Care Women Int 2010; 31:131-52. [DOI: 10.1080/07399330903141245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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45
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Irish L, Kobayashi I, Delahanty DL. Long-term physical health consequences of childhood sexual abuse: a meta-analytic review. J Pediatr Psychol 2009; 35:450-61. [PMID: 20022919 DOI: 10.1093/jpepsy/jsp118] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE The purpose of the present article was to systematically review the literature investigating the long-term physical health consequences of childhood sexual abuse (CSA). METHODS Literature searches yielded 31 studies comparing individuals with and without a history of CSA on six health outcomes: general health, gastrointestinal (GI) health, gynecologic or reproductive health, pain, cardiopulmonary symptoms, and obesity. Exploratory subgroup analyses were conducted to identify potential methodological moderators. RESULTS Results suggested that a history of CSA was associated with small to moderate group differences on almost all health outcomes assessed, such that individuals with a history of CSA reported more complaints for each health outcome. Suggestive trends in moderating variables of study design and methodology are presented. CONCLUSIONS Results highlight the long-term physical health consequences of CSA and identify potential moderators to aid in the design of future research.
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Affiliation(s)
- Leah Irish
- Department of Psychology, 118 Kent Hall, Kent State University, Kent, OH 44242, USA
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46
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Abstract
OBJECTIVE To summarize the relationship between abuse during childhood and physical health outcomes in adulthood and to examine the role of potential moderators, such as the type of health outcome assessed, gender, age, and the type of abuse. Studies using self-report assessment methods were compared with studies using objective or independently verifiable methods. METHOD The current study is a quantitative meta-analysis comparing results from 78 effect sizes across 24 studies including 48,801 individuals. RESULTS Experiencing child abuse was associated with an increased risk of negative physical health outcomes in adulthood (effect size d = 0.42, 95% Confidence Interval = 0.39-0.45). Neurological and musculoskeletal problems yielded the largest effect sizes, followed by respiratory problems, cardiovascular disease, gastrointestinal and metabolic disorders. Effect sizes were larger when the sample was exclusively female and when the abuse was assessed via self-report rather than objective, independently verifiable methods. CONCLUSIONS Child abuse is associated with an increased risk of poor physical health in adulthood. The magnitude of the risk is comparable to the association between child abuse and poor psychological outcomes. However, studies often fail to include a diverse group of participants, resulting in a limited ability to draw conclusions about the population of child abuse survivors as a whole. Important methodological improvements are also needed to better understand potential moderators.
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Childhood sexual abuse is associated with physical illness burden and functioning in psychiatric patients 50 years of age and older. Psychosom Med 2009; 71:417-22. [PMID: 19251869 PMCID: PMC2746033 DOI: 10.1097/psy.0b013e318199d31b] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the association of childhood sexual abuse (CSA) with cumulative illness burden, physical function, and bodily pain (BP) in a sample of male and female psychiatric patients >or=50 years of age. Previous research on the health consequences of sexual abuse has focused on nonpsychiatric samples of younger-age adults, especially women. The health implications of abuse for mixed-gender samples of older psychiatric patients have not been explored. METHODS Participants were 163 patients with primary mood disorders. Sexual abuse histories were collected via patient self-report, as was BP. The measure of medical illness burden was based on chart review. Clinical interviewers rated physical function, using the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) scales. Linear and logistic regressions examined the association between CSA and health outcomes. RESULTS As hypothesized, severe childhood sexual abuse was associated with higher cumulative medical illness burden, worse physical function, and greater BP. Comparisons of regression coefficients revealed that severe CSA's influence on illness burden is roughly comparable to the effects of adding 8 years of age. For ADL impairment and BP, the effects are comparable to adding 20 years of age. CONCLUSIONS Strong relationships exist between CSA and medical illness burden, function, and pain among psychiatric patients >or=50 years of age. These relationships cannot be ascribed to shared method variance. Early detection of patients' abuse histories could inform targeted interventions to prevent or decelerate the progression of morbidity in this high-risk group.
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Leserman J, Barroso J, Pence BW, Salahuddin N, Harmon JL. Trauma, stressful life events and depression predict HIV-related fatigue. AIDS Care 2009; 20:1258-65. [PMID: 18608079 DOI: 10.1080/09540120801919410] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite the fact that fatigue is a common and debilitating symptom among HIV-infected persons, we know little about the predictors of fatigue in this population. The goal of this cross-sectional study was to examine the effects of early childhood trauma, recent stressful life events and depression on intensity and impairment of fatigue in HIV, over and above demographic factors and clinical characteristics. We studied 128 HIV-infected men and women from one southern state. The median number of childhood traumatic events was two and participants tended to have at least one moderate recent stressful event. Multiple regression findings showed that patients with less income, more childhood trauma, more recent stressful events and more depressive symptoms had greater fatigue intensity and fatigue-related impairment in daily functioning. Recent stresses were a more powerful predictor of fatigue than childhood trauma. None of the disease-related measures (e.g. CD4, viral load, antiretroviral medication) predicted fatigue. Although stress and trauma have been related to fatigue in other populations, this is the first study to examine the effects of traumatic and recent stressful life events on fatigue in an HIV-infected sample.
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Affiliation(s)
- J Leserman
- University of North Carolina at Chapel Hill, NC, USA.
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Bonomi AE, Cannon EA, Anderson ML, Rivara FP, Thompson RS. Association between self-reported health and physical and/or sexual abuse experienced before age 18. CHILD ABUSE & NEGLECT 2008; 32:693-701. [PMID: 18602692 DOI: 10.1016/j.chiabu.2007.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 10/12/2007] [Accepted: 10/24/2007] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The present study evaluated the association between women's health and physical and sexual abuse suffered before age 18. METHODS A total of 3,568 randomly sampled insured women ages 18-64 completed a telephone interview to assess history of physical only, sexual only, or both physical and sexual abuse before age 18 (Behavioral Risk Factor Surveillance System); and current health (Short Form-36, Center for Epidemiologic Studies-Depression, Presence of Symptoms surveys). Adjusted analyses compared the health of women with physical abuse only, sexual abuse only, or physical and sexual abuse to the health of women without these abuse histories. RESULTS Poorest health status was observed in women with a history of both physical and sexual child abuse compared to women without these abuse histories. In models that adjusted for age and income, women with both abuse types had increased prevalence of depression (prevalence ratio, 2.16), severe depression (PR, 2.84), physical symptoms (PR range, 1.33 for joint pain to 2.78 for nausea/vomiting), fair/poor health (PR, 1.84), and lower SF-36 scores (3.15-5.40 points lower). Women with physical abuse only or sexual abuse only also had higher prevalence of symptoms and lower SF-36 scores but the associations were not as strong. CONCLUSIONS This study adds to the literature showing a graded association between multiple adverse events in childhood and adult health.
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Affiliation(s)
- Amy E Bonomi
- Human Development and Family Science, The Ohio State University, 135 Campbell Hall, 1787 Neil Avenue, Columbus, OH 43210, USA
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Herrenkohl TI, Sousa C, Tajima EA, Herrenkohl RC, Moylan CA. Intersection of child abuse and children's exposure to domestic violence. TRAUMA, VIOLENCE & ABUSE 2008; 9:84-99. [PMID: 18296571 DOI: 10.1177/1524838008314797] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This review addresses research on the overlap in physical child abuse and domestic violence, the prediction of child outcomes, and resilience in children exposed to family violence. The authors explore current findings on the intersection of physical child abuse and domestic violence within the context of other risk factors, including community violence and related family and environmental stressors. Evidence from the studies reviewed suggests considerable overlap, compounding effects, and possible gender differences in outcomes of violence exposure. The data indicate a need to apply a broad conceptualization of risk to the study of family violence and its effects on children. Further testing of competing theoretical models will advance understanding of the pathways through which exposure leads to later problems in youth, as well as protective factors and processes through which resilience unfolds.
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Affiliation(s)
- Todd I Herrenkohl
- School of Social Work, University of Washington, Seattle, WA 98105-6299, USA.
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