Associations between voluntary and involuntary forms of perinatal loss and child maltreatment among low-income mothers

Public Health Impact of Legal Termination of Pregnancy in the US: 40 Years Later

During the 40 years since the US Supreme Court decision in Doe versus Wade and Doe versus Bolton, restrictions on termination of pregnancy (TOP) were overturned nationwide. The use of TOP was much wider than predicted and a substantial fraction of reproductive age women in the U.S. have had one or more TOPs and that widespread uptake makes the downstream impact of any possible harms have broad public health implications. While short-term harms do not appear to be excessive, from a public perspective longer term harm is conceiving, and clearly more study of particular relevance concerns the associations of TOP with subsequent preterm birth and mental health problems. Clearly more research is needed to quantify the magnitude of risk and accurately inform women with the crisis of unintended pregnancy considering TOP. The current US data-gathering mechanisms are inadequate for this important task.

Effectiveness of group psychotherapy for adult outpatients traumatized by abuse, neglect, and/or pregnancy loss: a multiple-site, pre-post-follow-up, naturalistic study

The New Experience for Survivors of Trauma (NEST) is a group psychotherapy intervention for clients traumatized by consequences of abuse, neglect, and pregnancy loss. This multiple site study is the first investigation of its effectiveness. Ninety outpatients from a naturalistic setting completed the Symptom Checklist and the Sense of Coherence questionnaire at baseline, end of treatment, and one-year follow-up. Effectiveness was tested with statistical significance, effect size, and clinical significance. Clients from the total sample as well as from the abortion subsample showed improvement at the end of treatment and at follow-up. Lack of a control group is balanced to some extent by the high ecological validity. The findings suggest that the NEST treatment may be beneficial for traumatized clients and call for further research.

Is there an "abortion trauma syndrome"? Critiquing the evidence

The objective of this review is to identify and illustrate methodological issues in studies used to support claims that induced abortion results in an "abortion trauma syndrome" or a psychiatric disorder. After identifying key methodological issues to consider when evaluating such research, we illustrate these issues by critically examining recent empirical studies that are widely cited in legislative and judicial testimony in support of the existence of adverse psychiatric sequelae of induced abortion. Recent studies that have been used to assert a causal connection between abortion and subsequent mental disorders are marked by methodological problems that include, but not limited to: poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects. By way of contrast, we review some recent major studies that avoid these methodological errors. The most consistent predictor of mental disorders after abortion remains preexisting disorders, which, in turn, are strongly associated with exposure to sexual abuse and intimate violence. Educating researchers, clinicians, and policymakers how to appropriately assess the methodological quality of research about abortion outcomes is crucial. Further, methodologically sound research is needed to evaluate not only psychological outcomes of abortion, but also the impact of existing legislation and the effects of social attitudes and behaviors on women who have abortions.

Health-related quality of life among adults who experienced maltreatment during childhood

OBJECTIVES

We sought to assess the difference in a preference-based measure of health among adults reporting maltreatment as a child versus those reporting no maltreatment.

METHODS

Using data from a study of adults who reported adverse childhood experiences and current health status, we matched adults who reported childhood maltreatment (n = 2812) to those who reported no childhood maltreatment (n = 3356). Propensity score methods were used to compare the 2 groups. Health-related quality-of-life data (or "utilities") were imputed from the Medical Outcomes Study 36-Item Short Form Health Survey using the Short Form-6D preference-based scoring algorithm.

RESULTS

The combined strata-level effects of maltreatment on Short Form-6D utility was a reduction of 0.028 per year (95% confidence interval=0.022, 0.034; P<.001). All utility losses for the childhood-maltreatment versus no-childhood-maltreatment groups by age group were significantly different: 18-39 years, 0.042; 40-49 years, 0.038; 50-59 years, 0.023; 60-69 years, 0.016; 70 or more years, 0.025.

CONCLUSIONS

Persons who experienced childhood maltreatment had significant and sustained losses in health-related quality of life in adulthood relative to persons who did not experience maltreatment. These data are useful for assessing the cost-effectiveness of interventions designed to prevent child maltreatment in terms of cost per quality-adjusted life years saved.

Child maltreatment, youth violence, and intimate partner violence: developmental relationships

BACKGROUND

Understanding the cycle of violence, from victimization to perpetration across the life span, is critical for designing successful prevention interventions. This study uses a nationally representative sample to examine the developmental relationships among three forms of child maltreatment, youth violence perpetration or victimization, and young adult intimate partner violence (IPV) perpetration or victimization.

METHODS

Data describing self-reported youth violence perpetration (or victimization) from Wave I of the National Longitudinal Study of Adolescent Health (1994-1995) were matched with self-reported IPV perpetration (or victimization) in young adult sexual relationships and retrospective reports of child maltreatment collected during Wave III (2001-2002). Bivariate probit regression models were used to analyze the developmental relationships between child maltreatment, youth violence, and IPV. Analyses were completed in September 2006.

RESULTS

Compared to nonvictims of child maltreatment, victims of child maltreatment are more likely to perpetrate youth violence (a likelihood increase ranging from -1.2% to 6.6% for females and 3.7% to 11.9% for males) and young adult IPV (an increase from 8.7% to 10.4% for females and from 1.3% to 17.2% for males), although the direct and indirect effects vary by type of child maltreatment experienced. Gender differences exist in the links between child maltreatment, youth violence and IPV, and in the effects of socioeconomic factors on youth violence and IPV.

CONCLUSIONS

Results suggest that it may be important to account for gender differences when designing violence prevention programs, and an integrative approach is critical for stopping the developmental trajectory of violence.