Revictimization and interpersonal resource loss predicts PTSD among women in substance-use treatment

Psychosocial Sequalae of Sexual Assault in a Sample of Partnered Adults Experiencing Alcohol Use Disorder and Intimate Partner Violence

Research has shown that experiencing a sexual assault results in significant and lasting effects in many psychosocial domains. However, most studies on the impact of sexual assault examine university samples or the immediate aftermath of the assault, not taking into account the longer-term complexities and contexts of life for many victims. The current study seeks to evaluate the role of lifetime sexual assault history on several psychosocial outcomes in adults who are in intimate relationships that have included both intimate partner violence (IPV) and alcohol use disorder. The study included 100 adult romantic couples who were part of a larger project addressing violence and alcohol use. A majority of participants were Caucasian (74.3%) and female (53%). Participants reported on lifetime sexual assault history, depression, perceived stress, maladaptive cognitive emotion regulation, and perceived intimate relationship functioning. Multilevel analyses controlled for couple interdependence as well as current levels of alcohol use and IPV. Results indicated that the presence/absence of sexual assault was only related to perceived life stress (p = .016), while the total number of lifetime assault experiences was related to depression symptoms (p < .001), perceived life stress (p = .052), maladaptive cognitive emotion regulation (p = .048), and dyadic adjustment (p = .003). These findings underscore the importance of investigating sexual assault outcomes in complex populations, as well as the need for more thorough and regular assessment of sexual assault history. Focusing on empowerment and recovery for sexual assault victims of any age is an important tool to prevent the detrimental outcomes that particularly accompany multiple victimizations.

Violent Assault on a Chinese Man: COVID-19 Psychosocial Resource Loss Diminishes Right Wing Authoritarianism Variability in Societal Reactions

We examined whether prejudice-related personality characteristics (i.e., right wing authoritarianism [RWA]) and COVID-19-driven psychological resource loss might predict perpetrator-directed punitive responding (i.e., support for criminal charges) to a COVID-19-related attack on a Chinese victim by a White male. Across two studies, participants completed an RWA measure and reported the extent they had experienced COVID-19-related psychosocial resource loss. They then read a passage describing the COVID-19-related physical assault. For both studies, at low resource loss levels, low RWA participants reported greater punitive responding toward the perpetrator than high RWA participants. This RWA-punitive responding association was mediated by greater victim-directed suffering sensitivity (i.e., empathy) for Study 1 and greater anti-perpetrator reactions (i.e., hate crime perceptions) for Study 2. The RWA association with the relevant outcome variables (i.e., suffering sensitivity, anti-perpetrator bias, and punitive responding) was eliminated at high psychological resource loss levels. Specifically, low and high RWA participants reported similar reactions. While previous research has demonstrated that high RWA individuals tend to report greater outgroup-directed prejudicial responses due to COVID-19-driven perceptions of threat, our findings demonstrate that the COVID-19 pandemic can also elicit feelings of resource loss that can diminish the egalitarian reactions typically reported by low RWA individuals. In sum, we demonstrate that experiencing difficult life circumstances such as COVID-19 psychosocial resource loss can diminish supportive reactions toward victimized minority group members even among low RWA participants who are typically expected to be more sensitive to the struggles of those who are disadvantaged.

Interpersonal Trauma Exposure and Depression in Young Adults: Considering the Role of World Assumptions

The transition to young adulthood confers heightened risk for depression, and exposure to interpersonal trauma (IPT) can magnify this risk. However, not all IPT-exposed young adults develop depressive symptoms, and not all young adults with depressive symptoms report past IPT, suggesting a need to identify moderators of the IPT-depression link. This study investigated whether four different world assumptions-core beliefs about the nature of the world-moderated the association between IPT exposure and depressive symptoms in college students (N = 1,084, M age = 19.5, 74.1% female). Participants self-reported IPT exposure, depressive symptoms, and world assumptions via an online survey. We predicted that the IPT-depressive symptom association would be weaker among young adults with more positive assumptions about the safety of the world, trustworthiness of people, predictability of people, and controllability of events, versus those with more negative world assumptions in these domains. Hierarchical regression results supported this prediction with respect to one world assumption type: more positive beliefs about the world's safety significantly attenuated the relation between past IPT exposure and present depressive symptoms, ΔF(1, 1061) = 9.54, ΔR2 = 0.01, p = .002. The IPT-depressive symptom link was over 3 times as strong for young adults with weak "world-is-safe" assumptions, versus those with strong "world-is-safe" assumptions. No other world assumption types emerged as moderators. Lay theories of the world's safety may represent a basic, survival-oriented belief with implications for depressive symptoms following safety threats, such as IPT. Addressing "world-is-safe" assumptions may enhance depression prevention efforts for IPT-exposed young adults.

A gender comparative analysis of post-traumatic stress disorder among a community-based cohort of people who use drugs in Vancouver, Canada

BACKGROUND

While exposure to traumatic events and subsequent post-traumatic stress disorder (PTSD) are common among people who use drugs (PWUD), little is known about gender-based differences associated with PTSD in this population. We explore gender-based differences in factors associated with a probable PTSD diagnosis in a cohort of PWUD from Vancouver, Canada.

METHODS

Data were collected through the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), two community-recruited cohorts of PWUD. Participants were administered the PTSD Checklist for DSM-5. Multivariable logistic regression was used to investigate social-structural factors and substance use patterns and behaviours associated with a probable PTSD diagnosis, stratified by self-identified gender. PTSD symptom clusters and brief descriptions of the worst traumatic event experienced were also reported.

RESULTS

Between December 2016 and December 2018, of 797 eligible participants, 295 (37.0%) identified as women. PTSD was more commonly reported in women compared to men (53.2% vs. 31.5%, p < 0.001). In multivariable analysis involving men, no correlates were associated with PTSD. In multivariable analysis involving women, PTSD was positively associated with exposure to violence (AOR: 3.66; 95%CI: 1.14-11.72), daily stimulant use (AOR: 2.32; 95%CI: 1.32-4.08) and heavy alcohol use (AOR: 3.84; 95%CI: 1.84-8.00), and negatively associated with being in a stable relationship (AOR: 0.46; 95%CI: 0.25-0.84).

CONCLUSIONS

Gender-based differences in PTSD diagnosis among a cohort of PWUD point to the need to develop gender-focused and trauma-informed health and social services to meet the immediate needs of PWUD living with PTSD.

The Relationship between Women's Resources and Health-Related Quality of Life in a Sample of Female Victims of Intimate Partner Violence

While it is known that resource inadequacy increases the risk of exposure to intimate partner violence (IPV) and that women's health is significantly impacted by IPV, scant research has documented diminished resources as a primary determinant of women's health. Fifty female victims of moderate to severe IPV completed assessments of their physical, sexual and psychological experiences of IPV, resource profile, symptoms of posttraumatic stress disorder (PTSD) and depression and mental and physical health-related quality of life (HRQoL). Women's resources, controlling for age, income, psychological abuse and sexual coercion, were unique predictors of symptoms of PTSD, symptoms of depression; and mental HRQoL. The public health implications of the adequacy of women's resources are discussed in the context of IPV prevention and intervention. Future studies should evaluate the efficacy of economic empowerment programs regarding the impact on IPV survivors' mental and physical health and safety.

Multiple Losses: The Psychological and Economic Well-Being of Survivors of Intimate Partner Violence

This study advanced knowledge regarding the mechanisms through which intimate partner violence relates to psychological and financial distress with a sample of diverse low-income women. Data were collected from 147 female domestic violence survivors who were abused by a male partner within the past 6 months. Three hierarchical regression analyses revealed that psychological, physical, and economic abuse were predictive of posttraumatic stress, depression, and economic self-sufficiency among survivors. Guided by the Conservation of Resources Theory, the loss of financial, work, and interpersonal resources also predicted these three outcomes, above and beyond abuse experiences (i.e., economically controlling behaviors, economic sabotage, and interpersonal resource loss were unique predictors). In addition, bootstrap mediation analyses showed that interpersonal resource loss partially mediated the relationship between psychological abuse and mental health outcomes. Together, these findings can be used to inform future interventions to promote the financial and psychological well-being of survivors.

Race-related differences in acute pain complaints among inner-city women: the role of socioeconomic status

Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data were extracted from psychosocial questionnaires completed at the participants' baseline interview. Structural equation modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women's pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ethnic differences in SES. These findings highlight the role of social inequality in persistent health disparities facing inner-city, AA women.

PTSD Symptoms and Acute Pain in the Emergency Department: The Roles of Vulnerability and Resilience Factors Among Low-income, Inner-city Women

BACKGROUND

Given high levels of traumatic stress for low-income, inner-city women, investigating the link between posttraumatic stress disorder (PTSD) and pain is especially important.

PURPOSE

Using the conservation of resources theory, we investigated direct and indirect relationships of PTSD symptoms, vulnerability factors (ie, resource loss, depressive symptoms, and social undermining), and resilience factors (ie, optimism, engagement, and social support) to acute pain reports in a sample of low-income, inner-city women.

METHODS

Participants (N=341; mean age=28 y; 58.0% African American) were recruited from an inner-city Emergency Department following presentation with acute pain. Study data were gathered from psychosocial questionnaires completed at a baseline interview.

RESULTS

Structural equation modeling examined direct and indirect relationships among PTSD symptoms, vulnerability factors, and resilience factors on self-reported pain intensity and pain interference. PTSD symptoms were directly related to higher pain intensity and pain interference and indirectly related through positive associations with vulnerability factors (all Ps<0.05). Pathways through resilience factors were not supported.

CONCLUSIONS

Results suggest that presence of PTSD symptoms is associated with elevated acute pain responses both indirectly via psychosocial vulnerability factors and directly, independent of the psychosocial factors assessed. Resilience factors did not play a significant role in determining acute pain responses. Consistent with conservation of resources theory, the negative effects of vulnerability factors outweighed the positive effects of resilience factors.

Resource Loss Moderates the Association Between Child Abuse and Current PTSD Symptoms Among Women in Primary-Care Settings

This study examined if abuse during childhood, rape in adulthood, and loss of resources predict a woman's probability of reporting symptoms of posttraumatic stress disorder (PTSD), and whether resource loss moderates the association between reporting childhood abuse and PTSD symptoms. The sample included 767 women and was collected in publicly funded primary-care settings. Women who reported having been abused during childhood also reported more resource loss, more acute PTSD symptoms, and having suffered more adult rape than those who reported no childhood abuse. Hierarchical logistic regression yielded a two-variable additive model in which child abuse and adult rape predict the probability of reporting or not any PTSD symptoms, explaining 59.7% of the variance. Women abused as children were 1 to 2 times more likely to report PTSD symptoms, with sexual abuse during childhood contributing most strongly to this result. Similarly, women reporting adult rape were almost twice as likely to report symptoms of PTSD as those not reporting it. Resource loss was unexpectedly not among the predictors but a moderation analysis showed that such loss moderated the association between child abuse and current PTSD symptoms, with resource loss increasing the number and severity of PTSD symptoms in women who also reported childhood abuse. The findings highlight the importance of early assessment and intervention in providing mental health care to abused, neglected, and impoverished women to help them prevent and reverse resource loss and revictimization.

Work-related social support modulates effects of early life stress on limbic reactivity during stress

Early life stress (ELS) affects stress- reactivity via limbic brain regions implicated such as hippocampus and amygdala. Social support is a major protective factor against ELS effects, while subjects with ELS experience reportedly perceive less of it in their daily life. The workplace, where most adults spend a substantial amount of time in their daily lives, might serve as a major resource for social support. Since previous data demonstrated that social support attenuates stress reactivity, we here used a psychosocial stress task to test the hypothesis that work-related social support modulates the effects of ELS. Results show decreased amygdala reactivity during stress in ELS subjects who report high levels of work- related social support, thereby indicating a signature for reduced stress reactivity. However, this effect was only observable on the neural, but not on the behavioral level, since social support had no buffering effect regarding the subjective experience of stress in daily life as well as regarding feelings of uncontrollability induced by the stress task. Accordingly, our data suggest that subjects with ELS experiences might benefit from interventions targeted at lowering their subjective stress levels by helping them to better perceive the availability of social support in their daily lives.

Effectiveness of interpersonal psychotherapy-trauma for depressed women with childhood abuse histories

BACKGROUND

Women with depression and childhood sexual abuse histories constitute more than 20% of the female patient population in publicly funded community mental health centers (CMHCs). Interventions are needed that address depression and posttraumatic stress disorder (PTSD) symptoms and social health.

METHOD

We compared Interpersonal Psychotherapy-Trauma (IPT-T), an IPT adaptation for this population and setting, to Clinic Psychotherapy (CP). CP clinicians were free to implement the psychotherapy of choice. Women (n = 162; 54% White, 10.5% Hispanic; 52.2% Medicaid-insured) with a major depressive episode (MDE) and history of sexual abuse before 18 were randomly assigned to IPT-T or CP. Participants were offered 16 free sessions of IPT-T or CP. Outcomes were MDE remission, improved depression (Beck Depression Inventory, Hamilton Depression Rating Scale) and PTSD symptoms (Modified PTSD Symptom Scale), and improved social health (e.g., UCLA Loneliness Scale). Weighted generalized estimating equations were used to examine outcomes at 8 (primary) and 20 (secondary) months postrandomization.

RESULTS

IPT-T led to greater improvements in PTSD symptoms and many social health indicators, including loneliness and social support, at both 8- and 20-month follow-up. Effect sizes ranged from .18 to .39 at the primary endpoint (8 months). IPT-T and CP yielded comparable improvements in depression symptoms and MDE remission.

CONCLUSION

Evidence-based psychotherapies like IPT-T are needed in CMHCs, where some of the most vulnerable patients receive treatment. With comparable findings for depression, IPT's superior improvements in social health and PTSD symptoms are cause for optimism. IPT-T should be evaluated in dissemination trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Revictimization as a high-risk factor for development of posttraumatic stress disorder: a systematic review of the literature

Objective:

Much research has been published on the role of sexual revictimization in the emergence of mental disorders in adulthood, but findings have sometimes been contradictory. The present systematic review sought to assess the state of the evidence on revictimization as a potential factor for the emergence of posttraumatic stress disorder (PTSD).

Methods:

Electronic searches were conducted in five databases (MEDLINE/PubMed, Cochrane Library, Campbell Library, PsycINFO, and LILACS), using the terms PTSD, posttraumatic stress disorder, child abuse, and rape.

Results:

We identified nine articles that established a connection among childhood sexual abuse (CSA), sexual revictimization in adulthood, and development of PTSD. Eight of the nine papers included were classified as having strong methodological quality (grade VI). One was classified as IV, with an average quality-of-evidence rating. The mean methodological quality score of the articles was 5.5, and the quality of evidence was deemed strong.

Conclusion:

In the included studies, PTSD symptoms were most prevalent in the CSA + adult sexual assault groups, providing further evidence for the revictimization hypothesis.

From child maltreatment to ICD-11 complex post-traumatic stress symptoms: The role of emotion regulation and re-victimisation

OBJECTIVE

Complex post-traumatic stress disorder (CPTSD) will be introduced in ICD-11 and comprises symptoms of PTSD and disturbances in self-organisation (DSO). The association of trauma with PTSD and DSO is not yet fully understood. We investigated the path from child maltreatment to PTSD and DSO and examined the mediating role of emotion regulation (ER) and adult interpersonal re-victimisation.

METHOD

Adult patients (N = 193) from a Scottish National Health Service clinic participated in the project. Participants completed measures of life events, ICD-11 PTSD and CPTSD, and ER. Path analysis was used to assess possible direct and indirect effects from childhood trauma on current post-traumatic psychopathology.

RESULTS

Overall results indicate that the path from child maltreatment to PTSD is a direct one, while the path to DSO is indirectly mediated by ER.

CONCLUSIONS

Future research should address the potentially beneficial effect of treatment protocols for CPTSD explicitly aiming at reducing ER difficulties.

Recent violence in a community-based sample of homeless and unstably housed women with high levels of psychiatric comorbidity

OBJECTIVES

We determined associations between co-occurring psychiatric conditions and violence against homeless and unstably housed women.

METHODS

Between 2008 and 2010, we interviewed homeless and unstably housed women recruited from community venues about violence, socioeconomic factors, and psychiatric conditions. We used multivariable logistic regression to determine independent correlates of violence.

RESULTS

Among 291 women, 97% screened positive for 1 or more psychiatric conditions. Types of violence perpetrated by primary partners and persons who were not primary partners (non-primary partners) included emotional violence (24% vs 50%; P < .01), physical violence (11% vs 19%; P < .01), and sexual violence (7% vs 22%; P < .01). The odds of primary partner and non-primary partner violence increased with each additional psychiatric diagnosis and decreasing levels of social isolation.

CONCLUSIONS

All types of violence were more commonly perpetrated by non-primary partners, suggesting that an exclusive focus on domestic violence screening in health care or social service settings will miss most of the violence in this population. Contrary to some previous studies, the odds of violence decreased as social isolation increased, suggesting that social isolation may be protective in homeless and unstably housed communities with high levels of comorbidity and limited options.

The effect of cognitive therapy on structural social capital: results from a randomized controlled trial among sexual violence survivors in the Democratic Republic of the Congo

OBJECTIVES

We evaluated changes in social capital following group-based cognitive processing therapy (CPT) for female survivors of sexual violence.

METHODS

We compared CPT with individual support in a cluster-randomized trial in villages in South Kivu province, Democratic Republic of the Congo. Local psychosocial assistants delivered the interventions from April through July 2011. We evaluated differences between CPT and individual support conditions for structural social capital (i.e., time spent with nonkin social network, group membership and participation, and the size of financial and instrumental support networks) and emotional support seeking. We analyzed intervention effects with longitudinal random effects models.

RESULTS

We obtained small to medium effect size differences for 2 study outcomes. Women in the CPT villages increased group membership and participation at 6-month follow-up and emotional support seeking after the intervention compared with women in the individual support villages.

CONCLUSIONS

Results support the efficacy of group CPT to increase dimensions of social capital among survivors of sexual violence in a low-income conflict-affected context.

Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers

This study examined associations among childhood abuse, emotion dysregulation, and probable posttraumatic stress disorder (PTSD) within a sample of 93 substance use disorder (SUD) patients in residential treatment. SUD patients with probable PTSD (vs. non-PTSD) reported (a) greater severity of childhood sexual, physical, and emotional abuse and (b) significantly higher levels of overall emotion dysregulation and the specific dimensions of difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Additionally, significant positive associations were found between both childhood physical and emotional (but not sexual) abuse on the one hand and dimensions of emotion dysregulation on the other. Further analyses indicated that difficulties controlling impulsive behaviors when distressed accounted for the associations of both childhood physical and emotional abuse with probable PTSD status. Findings of the present study highlight a potential mechanism underlying the relationships between both childhood emotional and physical abuse and PTSD in SUD patients.

Emotion regulation difficulties, low social support, and interpersonal violence mediate the link between childhood abuse and posttraumatic stress symptoms

We examined how difficulties with emotion regulation, social support, and interpersonal violence in adult relationships mediated the relationship between childhood abuse and post traumatic symptoms (PTS) in adults. We fit a multiple mediation model to data from 139 socio-economically disadvantaged women (85% African American) of whom 44% endorsed moderate to severe levels of childhood physical, sexual, or emotional abuse and 12% screened positive for probable posttraumatic stress disorder (PTSD). The model accounted for 63% of the variance in adult PTS symptoms. Child abuse exerted a direct effect on PTS symptoms and indirect effects through difficulties with emotion regulation, lower social support, and greater exposure to adult interpersonal violence. Implications of findings for the treatment of individuals at high risk of having experienced childhood abuse and PTS are discussed.

Child sexual abuse and adulthood-interpersonal outcomes: Examining pathways for intervention

We examined a dual pathway, longitudinal mediational model in which child sexual abuse (CSA) influences adulthood-interpersonal functioning and sexual risk through its impact on resiliency resources and psychological distress. Women were recruited from two obstetrics and gynecological clinics serving primarily low-income, inner-city women (N = 693) and interviewed at pretest (Time 1) and 6-month follow-up (Time 2). The proposed mediators were resiliency resources (i.e., self-esteem and self-efficacy) and psychological distress (i.e., depressive and posttraumatic stress symptoms). The interpersonal outcomes were general interpersonal problems (measured via recent loss of interpersonal resources, lack of perceived current social support, and recent social conflict) and HIV/sexual risk (measured via lack of confidence asserting safe-sex practices, intimate-partner risk, and perceived barriers to safe sex). A respecified, partial structural equation model implying full mediation supported our hypotheses. Model fit was assessed using the chi-square goodness-of-fit statistic, comparative-fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR; CFI = .96, RMSEA = .05, SRMR = .04). The impact of CSA on interpersonal problems was mediated through its effect on psychological distress, whereas the impact of CSA on HIV/sexual risk was mediated through its effect on resiliency resources. Implications for intervention are discussed. (PsycINFO Database Record

Cumulative victimization, psychological distress, and high-risk behavior among substance-involved women

This research addressed two questions: (a) What is the relationship between different patterns of cumulative victimization and psychological distress? And (b) How does the pattern of cumulative victimization and psychological distress influence women's engagement in substance- and sex-related risk behavior? Data were analyzed from interviews with 149 sexually active, crack-using women who completed a follow-up interview after participating in the Kentucky National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement. Findings from the multivariate analyses indicated that victimization accounted for 5% and 39% of the variance in psychological distress and high-risk behavior, respectively; cumulative victimization and psychological distress accounted for 6% to 11% of the variance in the high-risk behaviors. Results highlight the affects of childhood and adult victimization on psychological distress and the associations between different types of psychological distress and risk behavior.

The role of protective self-cognitions in the relationship between childhood trauma and later resource loss

The authors examined a prospective model investigating posttraumatic stress disorder (PTSD) symptoms and protective self-cognitions (self-esteem and self-efficacy) with later resource loss among 402 inner-city women who experienced childhood abuse. They predicted that women with PTSD may fail to develop or sustain protective self-cognitions that could protect against future stress. Results from the hypothesized model suggest that child abuse was associated with greater PTSD symptoms and later resource loss. PTSD symptoms were also related to protective self-cognitions, which, in turn, were associated with less resource loss. The authors also examined an alternative model exploring the relationship between resource loss and later PTSD symptoms. Findings allude to the relationship of risk and resiliency variables among women with childhood trauma histories.

What are the needs of alcohol dependent patients with a history of sexual violence? A case-register study in a metropolitan region

BACKGROUND

Sexual violence has become increasingly apparent as a factor determining more complex treatment needs in patients with substance abuse. However, empirical evidence on specific patterns of differences between patients with and without a history of sexual violence is scarce.

METHODS

Our sample consisted of alcohol dependent outpatients treated during a two-year period in a German metropolitan region. The analysis was based on a local case register and included all patients for whom information on lifetime sexual violence was available (N=1981; 33.4% female). In a case-control design, patients with a history of sexual violence were compared to patients without such experiences regarding a wide range of clinical and social factors indicative of potential needs.

RESULTS

More than 35% of the female patients and 6% of the male patients reported a history of sexual violence. Victims differed from non-victims across a variety of domains, including psychiatric symptoms and suicide attempts, legal problems, financial and family problems, previous use of services, and need for additional services during the current treatment. Patient gender emerged as a significant moderator of several of these associations.

CONCLUSIONS

The findings indicate that an effort needs to be made to link addiction treatment, other parts of the health care system, and further institutions, such as family services and parts of the legal system, so that the complex needs of this vulnerable population can be met in an adequate way.

Abuse history is related to autonomic regulation to mild exercise and psychological wellbeing

We investigated the potential impact of abuse history on autonomic regulation and psychological wellbeing in a sample of women who reported a history of abuse without Post Traumatic Stress Disorder. To measure autonomic regulation, heart rate data was collected before and after the participant rode a stationary bike for one mile. We found that abuse history was associated with less vagal regulation of the heart (i.e., respiratory sinus arrhythmia) and an inability to rapidly re-engage vagal regulation immediately following mild exercise to support a calm physiological state. These findings are consistent with clinical impressions that abused individuals may have a lower threshold to express fight/flight behaviors in response to stress and have difficulty shifting from mobilization to calmness. We also found that abuse history was related to psychological wellbeing. Women with an abuse history reported a greater use of dysfunctional coping methods and lower self-concept. Further, analyses indicated that there was a cumulative effect, whereby women who reported more recent abuse reported using more dysfunctional coping methods, having more mood disturbance, and lower self-concept. The findings underscore the importance of evaluating both the psychological and physiological effects of trauma, even in the absence of a diagnosis of PTSD.

Child sexual abuse, post-traumatic stress disorder, and substance use: predictors of revictimization in adult sexual assault survivors

This study examined the unique effects of child sexual abuse simultaneously with post-traumatic stress disorder symptom clusters, problem drinking, and illicit drug use in relation to sexual revictimization in a community sample of female adult sexual assault victims. Participants (N=555) completed two surveys a year apart. Child sexual abuse predicted more post-traumatic stress disorder symptoms in adult sexual assault victims. Posttraumatic stress disorder numbing symptoms directly predicted revictimization, whereas other post-traumatic stress disorder symptoms (reexperiencing, avoidance, and arousal) were related to problem drinking, which in turn predicted revictimization. Thus, numbing symptoms and problem drinking may be independent risk factors for sexual revictimization in adult sexual assault victims, particularly for women with a history of childhood sexual abuse.

Loss of resources as mediators between interpersonal trauma and traumatic and depressive symptoms among women with cancer

We hypothesized that loss of interpersonal, financial and work resources would mediate the relationship between physical and sexual abuse, cancer-related Posttraumatic Stress Disorder (PTSD) symptoms, noncancer-related PTSD symptoms and depressive mood among women with cancer. Participants were 64 women with heterogeneous cancers (64.1% breast cancer) seeking outpatient treatment. Structured interviews were conducted to assess for pre-cancer interpersonal trauma, recent loss of interpersonal, financial and work resources, cancer-related PTSD symptoms, noncancer-related PTSD symptoms and depressive mood. Only interpersonal loss mediated the relationship between earlier interpersonal trauma and current PTSD symptoms and depressive mood. Implications of the findings are discussed.

The role of anxiety sensitivity and difficulties in emotion regulation in posttraumatic stress disorder among crack/cocaine dependent patients in residential substance abuse treatment

Current research suggests the importance of anxiety sensitivity (AS) in the risk for posttraumatic stress disorder (PTSD), and a growing body of research has demonstrated that difficulties in emotion regulation may also play a role. This study examined the unique relationships between AS dimensions, difficulties in emotion regulation, and a probable PTSD diagnosis among a sample of inner-city crack/cocaine dependent patients in residential substance abuse treatment. Probable PTSD participants exhibited higher levels of the AS dimension of social concerns and emotion regulation difficulties. Emotion regulation difficulties reliably distinguished probable PTSD participants from non-PTSD participants above and beyond both anxiety symptom severity and the AS dimension of social concerns. Further, social concerns did not account for unique variance when difficulties in emotion regulation was entered into the model. Results provide support for the central role of difficulties in emotion regulation relative to AS dimensions in the prediction of PTSD within a crack/cocaine dependent population.

'Nobody ever chooses this ...': a qualitative study of service providers working in the sexual violence sector - key issues and challenges

This paper describes the findings from the first stage of a study designed to assess the impact of sexual violence (SV) on the lives of Irish women. Stakeholder interviews (n = 18) were undertaken to explore experiences of delivering services to people who have experienced SV, in rural and urban settings in Ireland. A range of themes and sub-themes were identified through a thematic analysis, and interrelationships between two of the main themes (barriers to services and current gaps in service provision) are discussed. Sub-themes include: survivor guilt and shame, difficulties in naming the incident as SV, problems with the Criminal Justice System and the availability of Sexual Assault Treatment Units. Participants identified an urgent need for a co-ordinated national strategy in the form of a public awareness and education campaign in order to undermine commonly held rape myths and stereotypes. The findings will be of interest to all health and social care professionals who are in contact with women who have experienced SV. They will also help to raise an awareness of the 'hidden' costs of SV, and inform appropriate policies and community-based responses to this important social problem.

Resource loss and naturalistic reduction of PTSD among inner-city women

Halting the process of psychosocial and material resource loss has been theorized as being associated with the reduction of posttraumatic stress disorder (PTSD). This study examines how the limiting of resource loss is related to alleviation of PTSD symptoms among 102 inner-city women, who originally met diagnostic criteria for PTSD after experiencing interpersonal traumatic events such as child abuse, rape, and sexual assault. Participants whose PTSD symptoms improve and become nondiagnostic for PTSD are compared with those who remain diagnostic. The two groups are not significantly different at pretest. However, at the 6-month time point, those who become nondiagnostic for PTSD report less resources loss in three of four domains. This pattern suggests that as PTSD symptoms decrease, women's material and psychosocial resource loss diminishes, which in turn, may aid their recovery process.

Violent behavior in female inmates: possible predictors

Research findings have been equivocal regarding the relationship between experiencing trauma and exhibiting violent behavior in women. This study seeks to determine predictors of violent behavior in female inmates utilizing various conceptualizations of traumatic experiences. Results indicate a significant univariate relationship between experiencing more frequent physical abuse experiences, both interpersonal and noninterpersonal types of trauma, and both physical and sexual assaults with frequency of engagement in violent behavior. The regression model explained approximately 21.0% of the variance in violent behavior. Furthermore, frequency of physical abuse experiences was a significant predictor of frequency of engagement in violent behavior and explained 12.74% of unique variance. These results suggest that the frequency of physical abuse experiences may serve as a risk factor for women's violent behavior. Although more research is needed, it appears that addressing the potential for violence in women who experience abuse may be an appropriate target of treatment.

Posttraumatic Stress Disorder and Older Women

This article examines the literature related to the identification and treatment of post traumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are underdiagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women- even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.

The relative contribution of abuse severity and PTSD severity on the psychiatric and social morbidity of battered women in shelters

Intimate partner violence (IPV) is a severe health problem associated with significant distress and impairment in women. The most common psychiatric difficulty in battered women is posttraumatic stress disorder (PTSD); however, no research to date has investigated the relative impact of the severity of IPV and IPV-related PTSD symptoms on battered women's psychosocial functioning. In a sample of 177 sheltered battered women, PTSD severity was associated with considerable psychiatric morbidity, social maladjustment, and personal and social resource loss. Moreover, PTSD severity mediated the relationship between IPV severity and psychiatric severity and loss of personal and social resources. Results highlight the need for the assessment and treatment of IPV-related PTSD in battered women's shelters.

PTSD compromises battered women's future safety

Intimate partner violence continues to be a social crisis that results in a complex array of physical and mental health problems. Although resources to counteract the effects of the violence are sometimes available, the posttrauma sequelae may prevent access by those in need. Using the Chicago Women's Health Risk Study, a naturalistic longitudinal study of 320 abused women, the current study examined the impact of posttraumatic stress disorder (PTSD) and depression on battered women's safety at follow-up. Participants completed both a baseline and follow-up interview, including data on abuse experiences. Results suggest symptoms of PTSD predict severity of violence at follow-up over the impact of help-seeking behaviors, perceived helpfulness of these behaviors, and social support. Implications of results are discussed.

An examination of the perceived social support levels of women in methadone maintenance treatment programs who experience various forms of intimate partner violence

BACKGROUND

Intimate partner violence (IPV) has emerged as a serious problem among women in drug treatment programs. Research has underscored the importance of social support for abused women as well as women who use substances.

OBJECTIVES

The main objectives of this study were to describe the perceived social support levels and examine the associations between various forms of IPV and perceived levels of available social support perceived levels among a sample of women in drug treatment programs.

METHODS

Face-to-face, structured interviews were conducted with randomly selected 416 women on methadone.

RESULTS

The prevalence of physical, sexual, and injurious IPV in the sample was 39%, 31%, and 16% respectively, and the combined IPV prevalence was 44.5%. Findings from multiple linear regression models revealed that lower levels of perceived social support were significantly associated with physical aggression (beta = -4.71; p = .0001), sexual assaults (beta = -4.10; p = .003), and injurious attacks (beta = -4.03; p = .022). Respondents perceived highest levels of social support from their "significant others" (mean = 5.64; standard deviation [SD] = 1.27) and lowest levels of social support from friends (mean = 4.20; SD = 1.48). The average network size was 2.7 individuals.

IMPLICATIONS

Findings from this study highlighted significantly lower levels of perceived social support levels for drug-using women in the context of IPV experiences. Interventions with these women should focus on strengthening social support networks that enable help seeking for both IPV and substance abuse issues.

Emotional numbing weakens abused inner-city women's resiliency resources

Conservation of resources theory (S. E. Hobfoll, 1988, 1999) hypothesizes that loss of resiliency resources can contribute to abused women's posttraumatic stress disorder (PTSD) symptoms, which, in turn, contribute to a further loss of resources, which can make abused women even more vulnerable to future stressors. This study investigates the impact of PTSD symptoms on abused women's future loss of resources-resources that women both value and need to aid their ongoing adjustment. Posttraumatic stress disorder symptoms contributed to future resource loss in abused women, even when controlling for the effects of prior resource loss and depression. Emotional numbing symptoms of PTSD accounted most for women's resource loss. Findings highlight the importance of research and intervention that more directly examines the link between emotions and resource loss.

Cumulative interpersonal traumas and social support as risk and resiliency factors in predicting PTSD and depression among inner-city women

This study represents one of the largest examinations of how child abuse, adult rape, and social support impact inner-city women (N = 777). Using retrospective self-report, the effects of interpersonal trauma were shown to be cumulative such that women who experienced either child abuse or adult rape were 6 times more likely to have probable posttraumatic stress disorder (PTSD), whereas women who experienced both child abuse and rape were 17 times more likely to have probable PTSD. High social support predicted lower PTSD severity for women who experienced both child abuse and adult rape, but not for women who reported one or none of these traumas. Results suggest that social support, when left intact, might buffer the cumulative impact of child and adult interpersonal traumas.

Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic

Childhood sexual abuse (CSA) is associated with a wide range of negative outcomes. The authors investigated the relation between CSA and sexual risk behavior in 827 patients recruited from a sexually transmitted disease (STD) clinic. Overall, CSA was reported by 53% of women and 49% of men and was associated with greater sexual risk behavior, including more sexual partners, unprotected sex, and sex trading. Alcohol use for men and drug use for women mediated the relation between CSA and the number of sexual partners in the past 3 months; intimate partner violence mediated the relation between CSA and the number of episodes of unprotected sex in the past 3 months for women. These results document the prevalence of CSA among patients seeking care for an STD and can be used to tailor sexual risk reduction programs for individuals who were sexually abused.

The double-barreled burden of child abuse and current stressful circumstances on adult women: The kindling effect of early traumatic experience

Child sexual abuse and child physical abuse were compared to assess how these experiences might both positively predict and sensitize women to the effects of current stress exposure, assessed in terms of psychosocial resource loss (e.g., personal and interpersonal resources). Resource loss was in turn, hypothesized to increase later depressive mood and posttraumatic stress disorder severity. Participants were 176 low-income women (58% African American, 38% European American), interviewed twice over 6 months. Child sexual abuse predicted increases in resource loss, which then predicted posttraumatic stress disorder and depressive mood. Women who reported higher levels of child physical abuse were more negatively impacted by resource loss than those who reported lower child physical abuse. Results suggest that child abuse results in both greater stress exposure later and greater vulnerability to that exposure.

Telephone self-monitoring among alcohol use disorder patients in early recovery: a randomized study of feasibility and measurement reactivity

Frequent symptom self-monitoring protocols have become popular tools in the addiction field. Interactive Voice Response (IVR) is a telephone monitoring system that has been shown to be feasible for collecting frequent self-reports from a variety of research populations. Little is known, however, about the feasibility of using IVR monitoring in clinical samples, and few controlled trials exist assessing the impact of any type of frequent self-report monitoring on the behaviors monitored. This pilot study with patients in early recovery from an alcohol use disorder (n=98) evaluated compliance with two IVR monitoring protocols, subjective experiences with monitoring, and change in symptoms associated with monitoring (i.e., measurement reactivity). Participants were randomly assigned to call an IVR system daily for 28 days, once per week for 4 weeks, or only to complete 28-day follow-up assessment including retrospective drinking reports. Monitoring calls assessed alcohol craving, substance use, emotional well-being, and PTSD symptoms. Most monitoring participants completed calls on at least 75% of scheduled days (72.2% and 59.2% for daily and weekly, respectively). Including reconstructed data from follow-up of missed calls yielded 77.8% and 74.1% of maximum data points, respectively. Most monitoring participants indicated the protocol was manageable and reported positive or no effects of monitoring on urges to use alcohol, actual drinking, and PTSD symptoms. Analyses of measurement reactivity based on assessment one month after randomization found no significant group differences on drinking, craving for alcohol, or PTSD-related symptoms. Results suggest that IVR technology is feasible and appropriate for telephone symptom monitoring in similar clinical samples.

Impact, psychological sequelae and management of trauma affecting children and adolescents

PURPOSE OF REVIEW

In this review we examine the most recent literature on the impact, psychological sequelae and management of trauma affecting children and adolescents. We focus on consequences of early traumatic events in childhood, adolescence and adulthood; mediating variables (risk and protective factors) intervention strategies and available treatments.

RECENT FINDINGS

Increasingly often, mental health professionals are being asked to address the needs of children and adolescents who have been exposed to traumatic events, either as individuals or in groups. Studies on a wide range of age groups, populations and types of trauma revealed that traumatized children and adolescents are at high risk for developing a range of different behavioural, psychological and neurobiological problems. Social support may have a protective effect on the relationship between exposure to traumatic events and psychosocial symptoms.

SUMMARY

Several recent studies analyze a wide range of early traumatic events that may be directly or indirectly experienced by youth. These studies raise many fundamental questions such as validity of current diagnostic criteria for post-traumatic stress disorder, comorbidity with anxiety, depressive disorders and childhood traumatic grief symptoms. Vulnerability and protective factors, mainly gender, age and social support are considered. A common problem in research into the impact of trauma on children is the presence of many limitations: studies are often retrospective, use self-report questionnaires and the results may not be generalizable (i.e. they are trauma or population specific). There is a lack of well designed studies, addressing in particular treatments for post-traumatic symptoms in children and adolescents.