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

The role of recurrent trauma on post-traumatic stress disorder symptoms and substance use among trauma exposed youth

Comorbidity between post-traumatic stress disorder (PTSD) and substance use disorder may be explained by a prospective trauma risk conferred by both conditions. The current study modeled concurrent and prospective associations of trauma, PTSD symptoms, and substance use (SU) behavior among trauma exposed youth (ages 8-20). Clinical interviews assessed trauma exposure, PTSD symptom severity, and SU behavior at baseline and at six- and 12-month follow up study visits (N = 2,069). Structural equation models assessed the associations of trauma, PTSD symptoms, and SU behavior. Lifetime trauma was associated with more severe PTSD symptoms and SU behaviors, whereas trauma exposure during the study was only associated with PTSD symptoms. PTSD symptom severity was prospectively associated with trauma exposure. PTSD symptom severity and SU behavior at follow-up study visits were prospectively associated. These results highlight the dynamic interplay between trauma, PTSD symptoms, and SU behavior during youth, a developmental period during which complex psychiatric presentations can have longstanding consequences for health.

Exploring the Experiences of Regional and Rural Revictimized Women in a Group Empowerment Program

Sexual revictimization can have a negative impact on many facets of women's wellbeing, yet limited evidence exists regarding specific interventions that support healing and the reduction of further revictimization. This paper will explore regional and rural women's experience of a group-based empowerment program, the Shark Cage program, in Victoria, Australia. The "Shark Cage" program aims to address revictimization by empowering women and girls to build personal boundaries and assertiveness within the context of gender equality and human rights. Data were collected via participant observations across the 8-week program, in combination with semi-structured interviews with participants (N = 11) pre and post intervention. All participants had access to therapeutic support outside of the program. Findings indicate that the program fostered connections among women with shared experiences of sexual revictimization, reducing feelings of isolation. Participants detailed the benefit of developing and practicing skills in reducing revictimization, such as assertiveness and boundary setting. Program learning and recovery was embedded within a network of embodied emotions, social connections, cultural norms and place-based relations that influenced how participants recovery could be understood, processed and addressed.

Childhood Maltreatment and Revictimization: A Systematic Literature Review

There is established evidence that childhood/adolescent victimization is associated with victimization in adulthood although the underlying mechanisms are not still clear. The current study aimed to systematically review empirical studies examining potential psychological factors linking childhood maltreatment to victimization in adulthood and the gaps in the literature. Following PRISMA protocol, 71 original studies consisting of a total sample of n = 31,633 subjects were analyzed. Symptom severity for various trauma-related disorders, dissociation, emotion dysregulation, and risky sexual behaviors emerged as potential predictors of revictimization. While these potential risk factors mediate the relationship between childhood maltreatment and adulthood victimization, evidence for additional factors such as social support, attachment styles, maladaptive schemas, and risk detection is very limited. Addressing these intrapersonal risk factors, found by prior studies, in interventions and preventive programs might decrease the probability of revictimization. The interactions between the identified risk factors have not been studied well yet. Hence, more research on mediating risk factors of revictimization is needed.

Quality of the Parent-Child Relationship as a Moderator of Witnessing Violence and Youth Trauma Symptoms

Traumatic event exposure affects two in every three adolescents in the United States and there is the potential for numerous deleterious effects including higher levels of youth depression, anxiety, posttraumatic stress symptoms, and emotional and behavioral problems. Witnessing violence is one of the more common experiences associated with trauma exposure. Despite the ample research on mental health outcomes associated with witnessing violence, less is known about the extent to which parent-child relationships play a role in youth mental health outcomes when youth are exposed to violence. With a clinically relevant, diverse sample of 806 youth ages 12 years old who experienced maltreatment or were at risk of being maltreated, we tested hypotheses that the parent-child relationship quality would moderate the associations between witnessing violence and youth mental health outcomes. Results supported hypotheses for youths' symptoms of anxiety, depression, dissociation, and posttraumatic stress. The study contributes to the trauma literature by determining that the quality of the parent-child relationship moderated the effects of witnessing violence on trauma outcomes.

Revictimization Risk Factors Following Childhood Maltreatment: A Literature Review

Revictimization research, to date, has primarily focused on sexual revictimization (i.e., child sexual abuse and adult sexual assault), which has resulted in a lack of understanding of trauma revictimization more generally. Specifically, it is unclear what factors are placing individuals with a history of child maltreatment (i.e., sexual abuse, physical abuse, and witnessing intimate partner violence [IPV]) at greater risk for subsequent adult victimization (i.e., sexual assault and IPV). Existing theoretical and empirical work on revictimization suggest that multiple risk factors are likely present within this framework (e.g., posttraumatic stress symptoms [PTSS], emotion dysregulation, and risk-taking behaviors). Prior research has suggested that PTSS are often linked with these other risk factors, and it is possible that the development of PTSS following child maltreatment may be related to the development or maintenance of additional factors that increase the likelihood of revictimization. The purpose of this review was to synthesize findings regarding risk factors that place maltreated individuals at greater risk for adult revictimization. Approximately 228 studies were identified following a thorough search of the peer-reviewed literature using multiple databases (PsycINFO, PILOTS, and Google Scholar). Each study was critically analyzed for relevance. The included studies were used in our review of prevalence, specific risk factors that have been identified, and unanswered questions in this literature. PTSS were noted to be particularly important in the revictimization framework, and thus, a novel model of revictimization was also proposed where PTSS are illustrated as being associated with the development and maintenance of other factors within the revictimization framework.

Revictimisation of Women in Non-Urban Areas: A Scoping Review

Literature widely acknowledges that women who experience Child Sex Abuse (CSA) have a higher risk of experiencing sexual revictimisation later in life, yet less is known about experiences of revictimisation in non-urban areas. The aim of this review is to examine what is known internationally regarding revictimisation of non-urban women, and to provide future research, practice and policy recommendations. A total of 2414 articles were identified through a comprehensive search across five broad health sciences and humanities databases; 11 articles met inclusion criteria and were included in this review. This review found a general lack of qualitative revictimisation studies, and limited research focusing on non-urban women. While existing studies included non-urban research samples, few articles (n = 3) explored how non-urban location contextualises revictimisation experiences. Most peer-reviewed articles identified within this paper (n = 7) examined intimate partner violence (IPV) revictimisation, highlighting a significant lack of research on sexual revictimisation within non-urban settings. Findings from the review indicate that experiences of violence in childhood and adulthood are frequent among non-urban women, and that experiencing child abuse is associated with a heightened likelihood of poor mental health and IPV in adulthood. The review also found that non-urban women faced significant structural disadvantage including low levels of employment and income, limited-service sector resources, unsafe family environments and exposure to community violence. Additional qualitative research is needed to better understand the experiences and needs of non-urban revictimised women, particularly within an Australian context.

Leveraging Telehealth to Address Sexual Assault Nurse Examiner Access Disparities in Rural Communities

BACKGROUND

There are persistent gaps in access to sexual assault nurse examiners (SANEs) in rural and underserved areas, yielding health and legal disparities for survivors. These inequities prompted federal investment in novel telehealth programs to improve SANE access.

PURPOSE

The aim of this study was to examine program case studies from two sexual abuse/assault (SA) telehealth centers, illuminating successes, challenges, and lessons learned.

METHODS

Two state SA telehealth program directors used a collective instrumental case study approach to understand telehealth SANE (teleSANE) program challenges/lessons learned, outcomes, and recommendations for the field. Cross-program commonalities and differences were examined, pooling experiences to derive recommendations to sustain telehealth to increase SA health equity.

RESULTS

Collectively, the two programs have served 18 remote sites and provided 335 consultations. Both programs provide access to 24/7 teleSANE consultation, quality assurance, and mentoring. Unique to each program were engagement of hospital leadership in advisory boards, use of telehealth technology, training programs, and fiscal sustainability. Both programs identified flexibility, offering a tailored implementation approach, regular site support and communication, and teleSANE mentoring aligned with the Quality Caring Model as essential to success. Critical needs identified to sustain programs included (a) multilevel community and hospital buy-in, (b) sustainable funding specific to local institution needs, and (c) robust processes to oversee clinical and technology support.

CONCLUSIONS

Cross-program similarities and differences show the impact telehealth can have on equitable SA care. Program evaluation showed common challenges, lessons learned, and recommendations to advance equitable SA care access in underresourced communities.

Women's Behavioral Coping Responses During Sexual Assault: Association With Posttraumatic Stress Disorder Symptoms and the Moderating Role of Alexithymia

We examined the associations between women's behavioral coping responses during sexual assault and posttraumatic stress disorder (PTSD) symptoms, and the moderating role of alexithymia in college women (N  =  152). Immobilized responses (b  =  0.52, p < .001), childhood SA (b  =  0.18, p  =  .01), and alexithymia (b  =  0.34, p < .001) significantly predicted PTSD. The interaction between immobilized responses and alexithymia was significant (b  =  0.39, p  =  .002), indicating a stronger association for those higher in alexithymia. Immobilized responses are associated with PTSD, particularly for those with difficulty identifying and labeling emotions.

A preliminary examination of sexual and physical victimization 6 months after recent rape

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than $10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk. TRIAL REGISTRATION: NCT01430624.

Polyvictimization Among Sexual and Gender Minority Youth

INTRODUCTION

Polyvictimization is a significant public health issue. Sexual and gender minority youth are important to include in polyvictimization research because they report higher rates of victimization than nonsexual and gender minority youth. This study examines whether polyvictimization attenuates the associations between individual types of victimization and depressed mood and substance use across gender and sexual identities.

METHODS

Data were collected cross-sectionally from 3,838 youth aged 14-15 years. Youth were recruited through social media between October 2018 and August 2019 across the U.S. Analyses were conducted in July 2022. Sexual and gender minority youth were oversampled. Depressed mood and substance use were dependent variables.

RESULTS

Transgender boys were the most likely to be polyvictims (25%). Transgender girls (14.2%) and cisgender sexual minority girls (13.4%) also reported high rates. Cisgender heterosexual boys were the least likely to be classified as polyvictims (4.7%). When adjusting for polyvictimization, existing relationships between individual types of victimization (e.g., theft) and depressed mood became nonsignificant in most cases. Of exception, witnessing violence and peer victimization remained significant predictors of the odds of depressed mood. Most associations between individual types of victimization and substance use became nonsignificant after considering polyvictimization, with the exception of cisgender heterosexual boys and girls, for whom many remained significant but attenuated (e.g., emotional interpersonal violence).

CONCLUSIONS

Sexual and gender minority youth experience a disproportionate number of victimizations across multiple domains. A comprehensive assessment of victimization exposure may be important when considering prevention and intervention approaches for depressed mood and substance use.

Sexual Victimization Outcomes and Adjustment Among Bisexual Women: A Review of the Quantitative Literature

Bisexual women experience worse mental health outcomes than lesbian and heterosexual women, which may be explained by greater rates of sexual violence among bisexual women. The current comprehensive literature review aimed to synthesize research on mental health and substance use outcomes related to lifetime sexual violence among bisexual women. A comprehensive literature search was conducted within the PsycINFO and Medline databases (final search conducted in August, 2021). Inclusion criteria required articles to examine a mental health or substance use correlate/outcome of lifetime sexual victimization experiences among bisexual women. Fifteen studies met inclusion criteria and were reviewed. Results indicate that there are significant gaps in this literature, including limited research on psychological distress outcomes. Most notably, there is a limited focus on the experiences of bisexual women specifically and the role of bisexual minority stress. Findings indicate that lifetime sexual victimization experiences are linked with increased posttraumatic stress, depression, and alcohol (and other substance) use and consequences. It appears that bisexual women are vulnerable to cumulative victimization, which may further exacerbate outcomes. Clinicians working with bisexual women should provide bisexual-affirmative care, help bisexual women access positive social supports, and build more effective coping strategies for managing post-trauma distress. Future research on outcomes of violence among bisexual women would benefit from contextualizing adjustment following sexual assault within a bisexual minority stress-informed approach for a more comprehensive understanding of this process.

Double-Edged Network Effects on Disclosing Traumatic Experiences Among Korean "Comfort Women"

This study examines the effects of social networks on the disclosure of stigmatizing and traumatic sexual assault experiences. We analyzed publicly archived oral histories of Korean "comfort women" from World War II, employing an innovative method combining word embedding analysis, word frequency comparison, and grounded theory. By extracting their significant social relationships from narrated survivor stories, we parsed two distinctive disclosure patterns according to timing of disclosure: early disclosers and late disclosers. The latter were more socially embedded than the former, indicating the constraining aspect of social networks, in which the size of social networks was positively associated with delayed disclosure. Qualitative findings further elaborated that social networks have double-edged effects. Survivors' familial networks functioned as both social constraints and social support for public disclosure. Yet, the late disclosers tend to exploit it more as constraints for the fear of transgenerational transmission of social scorn and stigma. The findings contribute to enhancing a culturally relevant understanding of trauma and the repercussions of human trafficking.

Comparison of Sorority and non-Sorority Women: Risks for Different Sexual Assault Types

Though rates of sexual assault are high among college women, some studies find even greater prevalence rates among women who are sorority members. This study examined the association between familial risk factors (e.g., child physical abuse), PTSD symptoms, and proximal risk factors (e.g., sexual risk behavior) with three sexual assault types (i.e., coercive, incapacitated by alcohol or drugs, and physically forced) among sorority and non-sorority women at a large Midwestern university. Participants completed a paper-and-pencil survey that included measures of different sexual assault types, childhood maltreatment, parental rejection, PTSD symptoms, and sexual and substance use behaviors. A fully recursive path model was estimated to examine the pathways to three different sexual assault types. Results revealed that sorority women experienced coercive and incapacitated sexual assault more so than non-sorority women though there was no significant difference for physically forced sexual assault. Sorority women also reported engaging in more sexual risk behaviors, which was in turn, associated with all three sexual assault types. Sorority women also reported heavier alcohol use, which in turn, was positively associated with coercive and incapacitated sexual assault. These findings have implications for prevention among college undergraduate women.

The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis

BACKGROUND

The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized.

AIM

This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND).

METHOD

Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates.

RESULTS

This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization (OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample.

CONCLUSION

Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.

Cycles of Violence Among Young Women in Namibia: Exploring the Links Between Childhood Violence and Adult Intimate Partner Violence From the Violence Against Children and Youth Survey

Background: Violence against children is a global public health crisis and is associated with poor mental and physical health outcomes. Childhood violence may also increase the risk of subsequent violence revictimization by an intimate partner. We aimed to understand cycles of violence among adolescent girls and young women in Namibia to inform violence prevention and treatment interventions. Methods: The 2019 Namibia Violence Against Children and Youth Survey (VACS) examined the prevalence of childhood violence and intimate partner violence among 18-24 year old adolescent girls and young women (N = 2434). Using the data, we assessed the prevalence of childhood violence, defined as any physical, sexual, or emotional violence victimization prior to age 18, and estimated the prevalence of intimate partner violence (IPV) after age 18. We used a weighted logistic regression to assess whether childhood violence exposure was associated with subsequent experience of IPV after age 18. Results: Adolescent girls and young women in Namibia had a statistically significant higher odds of experiencing IPV if they had experienced any childhood violence including physical, sexual, and/or emotional violence (adjusted odds ratio [aOR]: 2.93; 95% Confidence Interval [95% CI: 1.64-5.23). IPV was also significantly associated with childhood physical (aOR: 1.81; 95% CI: 1.07-3.05), sexual (aOR: 3.79; 95% CI: 2.54-5.67), or emotional (aOR: 2.39; 95% CI: 1.18-4.86) violence when each were considered separately. We also observed a dose-response relationship between the number of types of childhood violence and IPV experience as a young adult. Conclusions: Childhood violence is a significant predictor of subsequent violence revictimization by an intimate partner. This analysis provides unique insights on cycles of violence among adolescent girls and young women in Namibia and points to the need for interventions during childhood to prevent violence against children and break this cycle among young women in sub-Saharan Africa.

The role of women’s resources in the prediction of intimate partner violence revictimization by the same or different aggressors

The literature studying the characteristics associated with revictimization in Intimate Partner Violence (IPV) is heterogeneous and inconclusive. The absence of studies on the role of the emotional variables of the victims and the failure to distinguish revictimization by the same or different aggressors are two of the main limitations in this area of research. The aim of this work was to study the relative contribution of the material, social, and emotional resources available to IPV victims in predicting revictimization by the same or different perpetrators. The sample consisted of 290 women registered in the city of Madrid who had filed at least one police report for intimate partner violence. The material resources of the victims were evaluated through their level of monthly income and employability status, the social resources through perceived social support, and the emotional resources through emotional regulation and coping strategies. Hierarchical multinomial logistic regression models were estimated to predict single-offender victimization (SRV), same-offender revictimization (VSRSA), and multiple-offender revictimization (VSRDA). The results revealed that: (1) differentiating between revictimization by the same and different aggressors improved the fit of the model by 50.8% compared to when only differentiating between victimized and revictimized women; (2) material resources had no significant weight in the prediction of any type of revictimization; (3) SRV women had more social support than VSRDA women (ExpB = 1.027; p &lt; 0.011); (4), those victims who had made several reports to the authorities of violence by different aggressors (VSRDA), had worse emotional regulation than those victims who had made a single report to the authorities (VSRs; ExpB = 2.934; p &lt; 0.026); and (5) VSRDA obtained the worst mental health indexes and they used more coping strategies based on positive reappraisal than the VSR women (ExpB = 0.863; p &lt; 0.009) and those victims with several reports by the same aggressor (VSRSA; ExpB = 0.891; p &lt; 0.028). These results show that being a victim of several episodes of intimate partner violence by different aggressors should be understood as a form of revictimization of great severity associated with worse emotional regulation and less social support.

Interpersonal Trauma and Risk of Incident Cardiovascular Disease Events Among Women

Background Traumatic experiences have been linked to risk for cardiovascular disease (CVD). Interpersonal violence is a trauma that is prevalent in women. Among midlife women followed up for 2 decades, we examined whether interpersonal violence (childhood abuse, adulthood abuse, or intimate partner violence [IPV]) was related to increased risk of subsequent clinical CVD events. Methods and Results A total of 2201 women, aged 42 to 52 years at baseline, underwent up to 16 in-person visits over 22 years. Measures included questionnaires (including of childhood physical/sexual abuse, adult physical/sexual abuse, and IPV), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). Death certificates were collected. Relationships between childhood abuse, adult abuse, and IPV with incident fatal/nonfatal CVD were tested in Cox proportional hazards models. Women with a childhood abuse history had increased risk for incident CVD (versus no abuse; hazard ratio [HR] [95% CI], 1.65 [1.12-2.44]; P=0.01; adjusted for demographics and CVD risk factors); associations were strongest for childhood sexual abuse. Adult abuse was not significantly associated with CVD. Women with IPV had a doubling of risk for incident CVD in demographic-adjusted models (versus no IPV; IPV: HR [95% CI], 2.06 [1.01-4.23]; P=0.04; no partner: HR [95% CI], 1.79 [0.91-3.53]; P=0.09); systolic blood pressure partially mediated relationships between IPV and CVD. Conclusions Childhood abuse, particularly sexual abuse, was associated with increased risk of CVD in women. IPV was associated with risk for CVD, with the higher systolic blood pressure among IPV-exposed women important in these associations. Interpersonal violence prevention may contribute to CVD risk reduction in women.

Sexual assault and white matter hyperintensities among midlife women

Traumatic experiences have been linked to poor mental and physical health. However, there has been little examination of their relationship to neuroimaging markers of cerebrovascular risk. White matter hyperintensities (WMHs) are markers of brain small vessel disease. WMHs can be detected decades before the onset of dementia and other disorders and can serve as early markers for these brain disorders. We tested whether traumatic experiences were associated with brain WMH volume among midlife women. In the MsBrain study, 145 women (mean age = 59 years) without cardiovascular disease, stroke, or dementia were recruited. Women completed questionnaires [trauma checklist, depression, post-traumatic stress measures]; physical measures [body mass index (BMI), blood pressure (BP)]; phlebotomy; actigraphy sleep measurement, and 3 Tesla magnetic resonance brain imaging for WMHs. Cross-sectional associations between traumatic experiences and WMH volume were assessed in linear regression models. Covariates were age, race/ethnicity, education, BMI, BP, lipids, preeclampsia, sleep, and additionally depressive and post-traumatic stress disorder symptoms. 68% of women endorsed at least one of the traumas assessed. The most common trauma was sexual assault (23% of women). Women with trauma exposure had greater WMH volume than women without trauma [B(SE) = .24 (.09), p = .01, multivariable]. The single trauma most associated with WMH was sexual assault [B(SE) = .25 (.11), p = .02, multivariable]. Results persisted adjusting for depressive or post-traumatic stress symptoms. A trauma history, particularly sexual assault, was associated with greater WMH volume controlling for covariates, including depressive and post-traumatic symptoms. Sexual assault may place women at risk for poor brain health.

Risk-Taking Propensity and Sensation Seeking in Survivors of Adverse Childhood Experiences

Risk-taking propensity and sensation seeking are developmentally meaningful traits for emerging adults, individuals ages 18 to 25 years. Adverse childhood experiences (ACEs) of childhood abuse and neglect, exposure to domestic violence, residing with a substance abusing or mentally ill caregiver, and growing up with an incarcerated family member negatively impact the well-being of emerging adults. However, the specific association between ACEs and risk-taking propensity and sensation seeking has not been previously examined in this age group. This study aims to determine whether ACEs are individually or cumulatively related to risk-taking propensity (assessed by the Domain-Specific Risk-Taking Scale) and sensation seeking (assessed by the Behavior Inhibition System/Behavior Approach System Scales) in a diverse sample of undergraduates, n = 436; M_age = 19.73 years (SD = 1.83 years); 67% female; 22% Hispanic. Multivariate ordinary least squares regressions were run to examine the association between ACEs and risk-taking propensity and sensation seeking. Individually, emotional abuse predicted greater inhibition (B = .28, p < .001), growing up with a mentally ill family member (B = -.12, p < .05) and emotional neglect (B = -.13, p < .05) predicted reduced motivation to pursue rewarding cues, and emotional neglect (B = -.12, p < .05) and witnessing domestic violence (B = -.10, p < .05) predicted less reward responsiveness. No cumulative effects were found. ACEs related to environmental instability may have a unique impact on sensation seeking domains in emerging adults. Clarifying the role of sensation seeking in emerging adults can contribute to better understanding of risk and resilience factors in this vulnerable population.

A retrospective study examining the adverse effect of childhood abuse among adult psychiatric service users in Britain

The long-term effects of childhood abuse have been well studied though the effects of abuse of specific types in adult psychiatric service users are less known. This study aimed to assess the association between childhood abuse and the development of harmful social and behavioural outcomes among adult psychiatric service users. Adult psychiatric service users were accessed from secondary mental health services in South London. A retrospective analysis was conducted of a randomly selected sample of 342 mental health records. Chi-square tests and logistic regression models were used to examine associations between childhood abuse - sexual abuse, physical abuse and psychological/emotional abuse - and health and behavioural outcomes. This study identified that 109 (31.8%) psychiatric service users had some history of childhood abuse and more often presented with high-risk or severe behaviours. Sexual abuse in childhood was linked with social isolation related to loss of friends (odds ratio (OR) = 2.68, P < 0.01), risky behaviours such as binge drinking (OR = 2.15, P < 0.05) and self-harming (OR = 2.86, P < 0.01), while childhood physical abuse was associated with drug abuse in adulthood (OR = 1.88, P < 0.05). Revictimization (adult domestic violence) also impacted on service users' quality of life in terms of loss of housing (OR = 2.21, P < 0.05) and loss of friends/family contact (OR = 2.73, P < 0.01). These findings suggest childhood abuse may play an important role in shaping risk and vulnerability for mental health problems across a lifespan. In acute mental health services, the incorporation of a trauma-informed nursing care model is necessary to generate a shift in culture in the delivery of care.

Prospective Predictors of Sexual Revictimization Among College Students

This study examined the prevalence rates of sexual violence revictimization during each year of college. In addition, the impact of key mental health concerns on these rates was investigated. Incoming first-year students at a large, urban university completed a survey about their exposure to incidences of sexual assault before college and about their mental health symptoms. During each subsequent spring semester, experiences of sexual assault and mental health symptoms were reassessed. The sample was limited to individuals who reported sexual assault for at least one time period (N = 3,294). More than 60% of individuals who endorsed an initial incident of sexual assault reported no subsequent incidences, leading to an overall revictimization rate of 39.5%. Rates of revictimization were higher for those identifying as women, as compared to men, and those identifying as White, as compared to those identifying as Asian or "other." Trauma-related distress and increased symptoms of alcohol use disorder (AUD) and depression were all related to a greater risk of experiencing revictimization. Given that experiencing an initial sexual assault greatly increases the risk of experiencing revictimization, and considering the notable prevalence rates of sexual assault on college campuses, it is imperative to examine trends in revictimization throughout the course of college. Examining factors that increase risk for experiencing revictimization is crucial to developing university-wide effective prevention and intervention efforts. In addition to the efforts to increase the reporting of incidences of sexual assault, universal programming efforts should also focus on factors that promote resilience in the face of sexual assault, such as reducing risky drinking behavior, increasing social support, and reducing stigma around the reporting of mental health symptoms.

Childhood physical abuse and subsequent violent victimization among people who use illegal drugs in Vancouver, Canada

Background

Violent victimization is common among people who use illegal drugs (PWUD) and is a source of significant health-related harm. However, little attention has been paid to how antecedent childhood trauma among PWUD may contribute to the risk of victimization in adulthood.

Objective

This study sought to examine the relationship between childhood physical abuse and victimization by physical assault among adult PWUD.

Participants and setting

Data were derived from three prospective cohorts of PWUD in Vancouver, Canada between 2005 and 2018.

Methods

Childhood physical abuse was assessed using the Childhood Trauma Questionnaire. Generalized linear mixed modeling was used to estimate the relationship between childhood physical abuse and subsequent violent victimization, after adjustment for potential confounders.

Results

Among 2960 PWUD, including 1018 (34.39%) female participants, 1030 (34.8%) participants reported a history of moderate to severe childhood physical abuse, and 949 (32.06%) participants reported recent violent victimization at baseline. In a multivariate analysis, childhood physical abuse (Adjusted Odds Ratio [AOR] = 1.34, 95% confidence interval [CI]: 1.23–1.46) remained independently associated with violent victimization after adjustment for potential confounders.

Conclusions

This study found a high prevalence of childhood physical abuse and that this was associated with a higher risk of subsequent violent victimization among PWUD in this setting. Greater support for PWUD with a history of childhood physical abuse is needed to decrease existing vulnerability to violence, including screening for and treatment of childhood trauma and related violence prevention.

Impulsivity and the effects of alcohol in women with a history of childhood sexual abuse: A pilot study

Women with a history of childhood sexual abuse (CSA) are at greater risk to develop alcohol use disorders. Whereas impulsivity has been postulated as a behavioral mechanism linking childhood trauma and alcohol use, few studies have comprehensively examined impulsivity in women with CSA. We compared women with a history of CSA (n = 21) and control women who did not endorse CSA or other major traumas (CON; n = 21) on self-report measures of impulsivity and risk taking. Additionally, performance on behavioral impulsivity and subjective response to alcohol were examined before and after acute alcohol (0.00, 0.50, 0.75 g/kg) administration. Overall, women with CSA responded more impulsively than CON women on the immediate and delayed-memory tasks (measures of response initiation) and the GoStop task (a measure of response inhibition). Whereas alcohol produced dose-related increases in impulsive responding on the immediate memory task in both groups, alcohol-induced increases in response inhibition on the GoStop task were evident only in the CSA group. In contrast, women with CSA exhibited less risk taking than the CON group on the balloon analogue risk task. Alcohol produced dose-related increases on several subjective response measures (e.g., alcohol liking) in both groups; however, these ratings tended to be greater in women with CSA. These preliminary data suggest that women with CSA may be more impulsive. Importantly, impulsivity can lead to hazardous drinking, and alcohol consumption can further increase impulsivity, putting women with CSA at increased risk for sexual revictimization, particularly in the context of alcohol use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Longitudinal assessment of PTSD and illicit drug use among male and female OEF-OIF veterans

OBJECTIVES

Posttraumatic stress disorder (PTSD) and substance use share both directional ("self-medication") and mutually-reinforcing associations over time. Research on gender differences regarding the co-occurrence of PTSD and substance use over time remains limited and largely focused on alcohol use; less is known regarding the co-occurrence of PTSD and illicit drug use, especially among veteran men vs. women. As the proportion of women in the military expands, we believe a greater focus on gender differences is warranted.

METHOD

We conducted a cross-lagged panel analysis of PTSD symptoms and drug use problems using two waves of data from a large, nationwide longitudinal registry of post-9/11 veterans. Participants included 608 men and 635 women (N = 1243; M_age = 42.3; 75.2% White) who completed self-report PTSD and drug use problem questionnaires at T1 and again at T2 15-37 months later.

RESULTS

Veteran men reported more severe drug use and related problems overall, yet the cross-sectional correlation between PTSD and drug use problems was strongest among drug using veteran women. In our cross-lagged models, we found that PTSD symptoms predicted future drug use problems among veteran men, whereas drug use problems predicted future PTSD symptom severity among women.

CONCLUSIONS

These results support the self-medication pathway among veteran men but not women, for whom drug use problems might prolong or exacerbate PTSD symptom severity over time. These results are consistent with some emerging evidence but also provide novel insight into functional associations governing the longitudinal course of PTSD and drug use problems for men vs. women.

Profiles of Emotion Regulation and Post-Traumatic Stress Severity among Female Victims of Intimate Partner Violence

Emotional dysregulation is a construct that has drawn substantial attention as a transdiagnostic contributing factor to the loss of health. Intimate partner violence (IPV) is a term used to describe physical, psychological, or sexual assault of a spouse or sexual partner. The aim of the study was to determine the variability of emotional dysregulation among women with different types of IPV revictimization and post-traumatic stress. The cross-sectional survey included 120 women attended by the Integrated Monitoring System of Gender Violence of Madrid, Spain, due to a gender violence complaint. The presence of post-traumatic stress disorder (DSM 5 criteria), emotional dysregulation (Emotional Processing Scale (EPS)), childhood trauma, and type of revictimization were evaluated. Cluster analysis found three profiles of emotional regulation: Emotionally Regulated, Avoidance/Non-Impoverished, and Emotional Overwhelm. The results showed that the Emotional Overwhelm group was characterized by a general dysregulation of emotional experiences and a greater intensity of post-traumatic stress symptoms. In addition, women who have suffered several episodes of IPV by different partners showed a differential pattern of emotional regulation than the rest of the victims that entailed greater psychopathology. Findings confirm that emotional dysregulation is a critical pathway to the decrease of health among IPV victims.

Bidirectional associations between alcohol use and intimate partner violence and sexual assault victimization among college women

Whereas some prior studies have explored whether alcohol increases the risk for victimization and/or whether distress resulting from victimization increases the risk for alcohol use, few studies have simultaneously tested these bidirectional hypotheses among a high-risk sample (i.e., undergraduate women), while including both sexual assault (SA) and intimate partner violence (IPV) victimization, and exploring potential moderating effects of PTSD symptoms on these paths. Among 631 college women, the present study tested these bidirectional associations using cross-lagged panel models across two measurement periods (i.e., Time 1 [T1] and Time 2 [T2], six months later). Results suggested that T1 alcohol use increased risk for T2 SA (but not T2 IPV victimization), and PTSD symptoms moderated this association; at lower levels of PTSD symptoms, there were no significant associations between alcohol use and subsequent SA victimization, whereas at higher levels of PTSD symptoms, alcohol use predicted subsequent SA victimization. By contrast, the opposite directional hypothesis was not supported; neither T1 lifetime SA nor IPV were associated with T2 drinking, regardless of the level of their PTSD symptoms. Prevention and intervention efforts should simultaneously address risk factors for alcohol use and victimization using trauma-informed practices.

Executive Functions and Theory of Mind Skills of Sexually Abused Female Adolescents and Their Externalizing and the Internalizing Behavioral Problems

Sexually abused children (SAC) often experience acute and chronic adverse psychological and physiological effects later in life. This study aims to evaluate psychiatric diagnoses, Executive Functions (EF) and Theory of Mind (ToM) skills deficiencies in sexually abused female adolescents and examine the relation of these deficiencies with externalizing and internalizing behavioral problems. The patient group comprised 42 female adolescents aged 14-18 years (mean = 16.42, standard deviation = 1.01). The Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, Dokuz Eylül ToM Index and Reading the Mind in the Eyes test were applied. The Behavior Rating Inventory of Executive Function, Strengths and Difficulties Questionnaire, and Kiddo-KINDL were completed by the participants and their families. A total of 57.2% (n = 24) were classified as SAC with internalizing behavior problems (SAC+I), whereas 66.7% (n = 28) comprised the SAC with externalizing behavior problems (SAC+A) subgroup. SAC+I showed deficits in EF and TOM. Some EF skills were found to be statistically weaker in SAC+A. There was no difference between SAC+A and SAC-A in the TOM tests. The results highlight the need to explore whether these deficiencies are due to psychiatric diseases or whether those who have disabilities in this field carry a higher risk of psychiatric disorder.

Linking experiences of child sexual abuse to adult sexual intimate partner violence: the role of borderline personality features, maladaptive cognitive emotion regulation, and dissociation

BACKGROUND

Child sexual abuse (CSA) has been linked to a higher risk of sexual re-victimization, including sexual intimate partner violence (IPV). The aim of this study was to investigate whether borderline personality disorder (BPD) features, dissociation, and maladaptive cognitive emotion regulation mediate the link between self-reported CSA severity and sexual IPV. Specifically, we were interested in the unique effect of each mediator variable, when accounting for the effect of the other variables.

METHODS

Data was assessed in a cross-sectional anonymous online survey, posted on platforms for people affected by domestic violence, and research platforms of Leiden University. Overall, n = 633 participants completed the survey (including n = 100 participants with CSA and n = 345 reporting at least one incidence of sexual IPV). Multivariate regression analyses and path-analytical modelling were performed for hypothesis testing.

RESULTS

Adult sexual IPV was predicted by more severe CSA, more severe BPD features, higher dissociation, and more maladaptive emotion regulation. Each mediator variable showed a significant effect in the separate mediation models. In the overall model, only dissociation and maladaptive emotion regulation, but not BPD features, mediated the association between CSA and sexual IPV.

CONCLUSIONS

Findings add to the existing literature, suggesting that CSA severity, BPD features, dissociation, and maladaptive emotion regulation are important risk factors for sexual IPV. Given the cross-sectional correlational design of our study, prospective studies are needed to corroborate our findings regarding potential psychological mechanisms underlying sexual re-victimization. Ultimately, this can help developing interventions aimed at breaking the cycle of abuse.

A Systematic Review of the Relationship between Child Sexual Abuse and Substance Use Issues

Child sexual abuse (CSA) and substance use issues later in life have been well documented in the literature. This systematic review from 2009 to 2019 provides an update on what is known about the relationship between CSA and substance use. While the review confirms a clear relationship between CSA and substance use, it also highlights some potential gaps in our current practices, including an acknowledgment of the other risk factors associated with CSA and substance use issues, as well as the need to develop treatment that specifically screens for and addresses CSA in the context of substance use.

A Socioecological Model of Risk Associated With Campus Sexual Assault in a Representative Sample of Liberal Arts College Students

Campus sexual assault (CSA) is a growing area of research and public health concern, yet little research has considered the sociocultural context in which CSA occurs or the effect of sociocultural factors on the posttraumatic stress disorder (PTSD) symptoms of CSA survivors. This study describes the results of a web-based census survey administered to students at a liberal arts college. Of the 1,611 students who completed the survey (74% female; 71.4% White, 4.3% African American, 12% Hispanic), 13.5% reported experiencing at least one type of completed or attempted CSA. Female students, participants in Greek life, and students who reported victimization prior to college were more likely to report having experienced CSA. CSA was positively correlated with PTSD symptoms, and this relationship was stronger for racial/ethnic minorities, those who reported less sense of community, and those who were more aware of campus services to address CSA. This study demonstrates multiple levels of sociocultural influence on the mental health of college students who have experienced CSA and may suggest ways for improving prevention and intervention strategies to address CSA and its consequences.

Academic Correlates of Unwanted Sexual Contact, Intercourse, Stalking, and Intimate Partner Violence: An Understudied but Important Consequence for College Students

Sexual assault, partner abuse, and stalking are major problems on college campuses. Past research has demonstrated a host of physiological and psychological outcomes associated with victimization; however, there has been little research conducted on the potential academic outcomes associated with victimization. The purpose of this study was to measure the relation between academic outcomes and experiences of sexual violence, intimate partner violence, and stalking victimization among college students. A sample of 6,482 undergraduate students currently enrolled at one of eight universities in New England was surveyed using items from the subscales of the College Persistence Questionnaire (Academic Efficacy, Collegiate Stress, Institutional Commitment, and Scholastic Conscientiousness). All four types of victimization were associated with significant differences on academic outcomes after controlling for sex and year in school, with victimized students reporting lower academic efficacy, higher college-related stress, lower institutional commitment, and lower scholastic conscientiousness. Polyvictimization was also significantly correlated with outcomes, with the greater number of types of victimization experienced by students being associated with more negative academic outcomes. Implications for future research and campus response were discussed.

Lifetime Interpersonal Victimization Profiles and Mental Health Problems in a Nationally Representative Panel of Trauma-Exposed Adults From the United Kingdom

Traumatic event exposure has been associated with negative psychological outcomes. There is, however, a dearth of research on revictimization. The current study examined patterns of lifetime interpersonal victimization based on six types of childhood maltreatment, physical and sexual assault, and assault with a weapon during adulthood via latent class analysis (LCA), with gender as covariate. Using a three-step approach, we assessed differences across the latent classes in symptoms and diagnosis of depression, anxiety, and DSM-5 posttraumatic stress disorder (PTSD). A trauma-exposed adult sample representative of the United Kingdom population (N = 1,051) was recruited online through a research panel. The mean participant age 47.18 years (SD = 15.00, range: 18-90 years; 68.4% female). The LCA identified five classes: lifetime polyvictimization (8.3%; 69.5% female), sexual revictimization (13.7%; 96.5% female), physical revictimization (12.5%; 1.5% male), childhood trauma (25.9%; 85.6% female), and limited victimization (39.7%; 40.3% female). Compared to the other classes, the polyvictimization class, followed by the childhood trauma class, demonstrated the highest scores on anxiety, depression, and posttraumatic stress symptoms. The polyvictimization class had nearly a nine- to 33-fold increase in risk of depression, OR = 9.48, 95% CI [3.34, 26.87]; anxiety, OR = 12.10, 95% CI [5.36, 27.36]; and PTSD diagnoses, OR = 33.63, 95% CI [16.35, 69.43], compared to the limited victimization class. The findings facilitate the identification of individuals at risk for revictimization and indicate that evidence-based clinical interventions should be targeted toward those with exposure to revictimization and childhood trauma exposure to alleviate mental health challenges.

Can Physical and/or Sexual Abuse Play a Role in the Female Choice of a Partner? A Cross-Sectional, Correlational Pilot Study

The present study aims to evaluate the relationship in women between a history of physical/sexual abuse and the preferences regarding the choice of a partner for a short/long-term relationship in terms of male facial dimorphism, and to assess their sexual functioning. We enrolled 48 abused women and 60 non-abused women. Facial preferences were evaluated with the Morphing test. Sexual functioning was measured with the Female Sexual Function Index (FSFI). Regarding the choice for a short-term partner, abused and non-abused women did not show any differences, and both groups chose a less masculine male face. On the other hand, regarding the choice for a long-term partner, abused women showed a preference for an average male face, whilst non-abused women preferred a less masculine face. The sexual functioning of abused women was found significantly dysfunctional in all domains of the FSFI. These data, generated from a small but highly selected cohort, demonstrated that physical/sexual abuse may be associated with a more rational and conscious choice of a male partner for a long-term relationship, but not with an instinctive one, as the choice of an occasional partner. In addition, the sexual functioning of abused women appears to be compromised by the traumatic experience.

History of sexual assault, past-year alcohol use, and alcohol-related problems in American Indian adolescents

American Indian (AI) adolescents have been found to experience higher rates of sexual violence, alcohol misuse, and alcohol-related consequences compared to other racial and ethnic groups. Adolescent alcohol use and sexual assault experiences have been linked to increased negative consequences across physical and mental health, school, work, and legal domains. The purpose of the present study was to examine the associations among endorsing a history of experiencing sexual assault, past-year alcohol use, and experiences of alcohol-related problems, and to examine how these associations differed across sex, using a large, nationally-representative sample of reservation-dwelling AI adolescents. The present study utilized secondary data analysis of a sample of 3498 AI 7th to 12th grade students from a larger national epidemiological study. Participants completed The American Drug and Alcohol Survey™ to assess their alcohol use, sexual assault history, and alcohol-related consequences. Multilevel regression analyses revealed a significant effect of an alcohol use by sex by sexual assault history interaction on experiencing alcohol-related problems (b = -0.88, 95%CI [-1.55, -0.22], p = .009). Furthermore, results revealed that males who endorsed a history of experiencing sexual assault demonstrated the strongest relationship between past-year alcohol use and alcohol-related consequences (b = 2.60, p < .001). Results indicate the importance of early intervention for alcohol use, alcohol-related problems, and sexual assault, perhaps particularly among adolescent males. Future research should examine the directionality between alcohol-use and sexual assault among AI adolescents.

The effect of physically or non-physically forced sexual assault on trajectories of sport participation from adolescence through young adulthood

Background

Sexual assault is one of potential factors that may greatly affect an individual’s sport participation. The purpose of this study is to investigate the effect of experiencing physically or non-physically forced sexual activity on trajectories of sport participation from adolescence to young adulthood.

Methods

This study used the National Longitudinal Study of Adolescent Health (Add Health) data. Group-based trajectory modeling was utilized to examine the effect of experiencing sexual assault on trajectories of sport participation from adolescence to young adulthood.

Results

A three-group trajectory model (high-stable group, high-decreasing group, and low-stable group) best fit sport participation among male participants and a two-group trajectory model (high-decreasing group and low-stable group) best fit sport participation among female participants. Both physically and non-physically forced sexual activity did not have significant effect on trajectories of sport participation among male participants. On the other hand, non-physically forced sexual assault significantly affected sport participation trajectory among female participants.

Conclusions

Special care is required in developing sport promotion program for women victims of non-physically forced sexual activity. The results of this study also suggest that group-based trajectory modeling is a useful technique to examine distinct trajectories of sport participation from adolescence through young adulthood.

Gender as Potential Moderator of Associations Among Trauma Exposure, Posttraumatic Stress Disorder Symptoms, and Alcohol Use Disorder Symptoms in Young Adults

Traumatic events (TEs), posttraumatic stress disorder (PTSD) symptoms, and alcohol use disorder (AUD) symptoms can significantly impair functioning, yet little is known about whether associations among these variables differ between men and women within young adult samples. The current study conducted a path analysis of archival, longitudinal data from the Drug Use Trajectories: Ethnic/Racial Comparisons 1998-2002 (DUT) study (Turner, 2011) to examine gender differences as a possible moderator of the relations between TEs, PTSD symptoms, and AUD symptoms among 1,076 young adults (aged 18-23 years) residing in South Florida. The sample included 580 male (53.9%) and 496 female (46.1%) participants, whose ethnicity was self-reported as African American (n = 280, 26.0%), non-Hispanic White (n = 268, 24.9%), other Hispanic (n = 267, 24.8%), and Cuban (n = 261, 24.3%). Significant positive associations were found between TEs and PTSD symptoms, βs = .08-.30; PTSD and AUD symptoms, βs = .09 - .10; PTSD symptoms over time, β = .52; and AUD symptoms over time, β = .46. In addition, for male but not female participants, a higher frequency of PTSD symptoms at Wave I was related to more AUD symptoms at Wave II, β = .09. Findings build upon existing research to further elucidate the role of gender as a potential moderator of the associations among TEs, PTSD symptoms, and AUD symptoms for young adults and provide important implications for future research and clinical practice, including informing mental health prevention and treatment efforts.

Revisiting the link between childhood sexual abuse and adult sexual aggression

BACKGROUND

Childhood maltreatment poses a risk factor for adult sexual aggression among men.

OBJECTIVE

Efforts were made to examine links between childhood sexual abuse (CSA) and sexual aggression after controlling variance associated with other forms of abuse.

PARTICIPANTS AND SETTING

This sample was comprised of men (n = 489) who completed a national survey regarding their history of possible abuse and/or sexual aggression.

METHODS

Maltreatment indices included CSA, parental and sibling physical abuse, exposure to domestic violence, peer bullying, and family emotional abuse. Self-report indicators of sexual frotteurism, coercion and rape were provided by the Sexual Experiences Survey-Short Form Perpetration.

RESULTS

CSA links with the criterion indicators were relatively stronger (r = 0.36, d = 0.65, p <  .001) than those found for non-sexual forms of abuse. CSA accounted for unshared variance in sexual aggression with these effects magnified by the addition of parental physical abuse (d = 2.1) or exposure to domestic violence (d = 2.2). The relative risks of prior acts of rape were elevated by CSA (RR = 4.39, p <  .001), parental physical abuse (RR = 3.85, p < 0.001), exposure to domestic violence (RR = 3.81, p <  .001), or sibling physical abuse (RR = 2.56, p = 0.007). These risks of completed rape were higher as well among respondents polyvictimized by two (RR = 4.92, p <  .001) or more (RR = 8.94, p < 0.001) forms of abuse.

CONCLUSIONS

Multiple forms of child maltreatment, particularly CSA, were strongly associated with adult sexual aggression in this sample of men from the general population.

Polyvictimization, Related Symptoms, and Familial and Neighborhood Contexts as Longitudinal Mediators of Racial/Ethnic Disparities in Violence Exposure Across Adolescence

African American and Hispanic adolescent experience more violence exposure relative to White youth. The present study examined the mediating role of posttraumatic stress symptoms (PTSS), delinquency, earlier victimization, and familial and neighborhood factors in disparities in future victimization. The study utilized data from the National Survey of Adolescents-Replication (N = 3,312), which consists of three waves of data collected approximately 1 year apart. A series of path models, tested polyvictimization, PTSS, delinquency, familial socioeconomic factors, and neighborhood safety as mediators of disparities in new polyvictimization. All cross-lagged and autoregressive paths positively predicted past-year polyvictimization and mediated longitudinal disparities. Familial socioeconomic variables and neighborhood safety mediated initial violence exposure disparities. Overall, results indicate that prior violence exposure, related mental health symptoms, and familial and neighborhood factors account for significant portions of disparities in new violence exposure across adolescence.

"I Kept It to Myself": Young Jamaican Men Who Have Sex with Men's Experiences with Childhood Sexual Abuse and Sexual Assault

The prevalence of HIV is exceptionally high among Jamaican men who have sex with men (JMSM) compared to similar populations within the Caribbean. A noticeable gap in the literature is the impact of childhood sexual abuse (CSA) and sexual assault on the state of the epidemic among this population. This study focused on JMSM's experiences with CSA and sexual assault and how these domains relate to HIV prevention. We analyzed qualitative data from 20 semi-structured in-depth interviews and focus group discussions with 10 men. Common themes emerged that highlight the patterns and nature of the abuse, the characteristics of the perpetrators, and the ways in which participants engage agency and resiliency as a basis to reclaim personal power. These findings serve as a catalyst for understanding how experiences with CSA and sexual assault affect the lives of young JMSM; how those experiences may impact attitudes and behaviors regarding HIV testing, engagement in care; and have implications for shaping legal policy, clinical, and mental health services for JMSM survivors.

Mental disorders and the risk of adult violent and psychological victimisation: a prospective, population-based study

AIMS

Psychiatric patients are at increased risk to become victim of violence. It remains unknown whether subjects of the general population with mental disorders are at risk of victimisation as well. In addition, it remains unclear whether the risk of victimisation differs across specific disorders. This study aimed to determine whether a broad range of mood, anxiety and substance use disorders at baseline predict adult violent (physical and/or sexual) and psychological victimisation at 3-year follow-up, also after adjustment for childhood trauma. Furthermore, this study aimed to examine whether specific types of childhood trauma predict violent and psychological victimisation at follow-up, after adjustment for mental disorder. Finally, this study aimed to examine whether the co-occurrence of childhood trauma and any baseline mental disorder leads to an incrementally increased risk of future victimisation.

METHODS

Data were derived from the first two waves of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): a psychiatric epidemiological cohort study among a nationally representative adult population. Mental disorders were assessed using the Composite International Diagnostic Interview version 3.0. Longitudinal associations between 12 mental disorders at baseline and violent and psychological victimisation at 3-year follow-up (n = 5303) were studied using logistic regression analyses, with adjustment for sociodemographic characteristics and childhood trauma. Furthermore, the moderating effect of childhood trauma on these associations was examined.

RESULTS

Associations with victimisation varied considerably across specific mental disorders. Only alcohol dependence predicted both violent and psychological victimisation after adjustment for sociodemographic characteristics and childhood trauma. Depression, panic disorder, social phobia, generalised anxiety disorder and alcohol dependence predicted subsequent psychological victimisation in the fully adjusted models. All types of childhood trauma independently predicted violent and psychological victimisation after adjustment for any mental disorder. The presence of any childhood trauma moderated the association between any anxiety disorder and psychological victimisation, whereas no interaction between mental disorder and childhood trauma on violent victimisation existed.

CONCLUSIONS

The current study shows that members of the general population with mental disorders are at increased risk of future victimisation. However, the associations with violent and psychological victimisation vary considerably across specific disorders. Clinicians should be aware of the increased risk of violent and psychological victimisation in individuals with these mental disorders - especially those with alcohol dependence - and individuals with a history of childhood trauma. Violence prevention programmes should be developed for people at risk. These programmes should not only address violent victimisation, but also psychological victimisation.

Exposure to Violence and Substance Use Treatment Outcomes Among Female Patients

BACKGROUND

Many female substance use patients have experienced violence in the past, with most estimates showing the majority of patients reporting violent experiences at some point. Prior experience with violence has been linked to increased severity of substance use, and this may contribute to more challenges in the path to recovery.

OBJECTIVES

Existing research has confounded the timing at which violence has occurred with the type of violence to which patients have been exposed. The current study was conducted to specify the extent to which the timing of exposure and the type of violence were associated with substance use after discharge from treatment.

METHODS

Data were collected from 3,439 female patients included in the Comprehensive Assessment and Treatment Outcome Research (CATOR) system.

RESULTS

With regard to the type of exposure, findings indicated female patients who were exposed to multiple forms of violence (i.e. physical and sexual) displayed the greatest severity of substance use upon treatment initiation, as well as the greatest likelihood for use following discharge from treatment. In terms of the timing, female patients who experienced violence at various time points (i.e. before and after 18 years of age) displayed the greatest severity of substance use, but patients who experienced violence after 18 years of age had the highest probability of substance use following discharge from treatment. Conclusions/Importance: Clinicians should collect information related to these important details as treatment protocols are developed, and as patients are connected to aftercare services to minimize post-treatment substance use.

ATTITUDES TOWARDS PEOPLE WITH DRUG USE OF RESIDENTS OF AN URBAN COMMUNITY, LEON, NICARAGUA

ABSTRACT Objective: determine the attitudes of urban residents of a community in León, Nicaragua, towards people with drug use. Method: cross-sectional study with 121 people, aged 18-65, randomly surveyed with a multidimensional Attitude Inventory. Results: the global scale of attitudes showed negative attitudes to marijuana and cocaine (62 and 78%) and ambivalent alcohol (54%). Significant differences were found in relation to whether they had ever consumed in their lives, socio-demographic factors and attitudes towards the drug user. In relation to age, from 18 to 29 years old, the prevailing attitude was ambivalent for both alcohol, marijuana and cocaine. However, in the cases of alcohol and marijuana positive attitude was reported in 7.3% and 4.9% respectively, in these same age ranges. For the sex variable, it was reported that the female had a negative attitude to alcohol and marijuana in contrast to the male sex that their attitude was ambivalent towards these consumers. An important fact is that men presented positive attitude toward people with problematic use of alcohol and marijuana in 4.9% and 3.3% respectively, with a value of p = 0.002. Conclusion: negative attitudes towards users of illegal drugs (cocaine and marijuana) were found, while for alcohol consumption it was more ambivalent, suggesting a high burden of stigma and the need to educate the community. Age, 18-29 years, the prevailing attitude was ambivalent for both alcohol, marijuana and cocaine. For the sex variable it was reported that the female one presented negative attitude to alcohol and marijuana.

Post-traumatic Stress Disorder in Victims of Sexual Assault With Pre-assault Substance Consumption: A Systematic Review

Background: Post-traumatic stress disorder (PTSD) and substance consumption commonly co-occur in victims of sexual assault. Substance consumption can occur pre- andi/or post-assault. Pre-assault substance consumption may have an impact on the subsequent development of PTSD. This review aims to provide an overview of current understanding of the effects of acute substance intoxication and chronic pre-assault problematic substance use on symptoms of PTSD amongst individuals who were victims of sexual assault. Methods: PsycINFO, EMBASE, and MEDLINE were searched using terms related to PTSD, sexual assault, and substance consumption. These yielded 2,121 articles, 268 of which were retrieved for more detailed evaluation and 13 of these met inclusion criteria and were appraised in full. Results: Overall, the reviewed papers supported our hypothesis that acute substance intoxication and chronic pre-assault problematic substance use are associated with fewer initial PTSD symptoms but less improvement over time, resulting in slower overall PTSD recovery. They also highlighted post-assault characterological self-blame and negative social reactions as mediators of recovery in the context of pre-assault substance consumption. Conclusions: Acute substance intoxication and chronic pre-assault problematic substance use appear to have an impact on the development of PTSD symptoms amongst victims of sexual assault. The importance of developing early interventions and routine screening and assessment for PTSD and pre-assault substance consumption is emphasized. The limited research on male victims and on substances other than alcohol is highlighted.

Problematic alcohol use and sexting as risk factors for sexual assault among college women

Sexual assault is a major public health concern and college women are four times more likely to experience sexual assault than any other group. We investigated whether sexting is a mechanism by which alcohol use increases risk for college women to be targeted for sexual assault. We hypothesized that sexting would mediate the relationship between problem drinking and sexual assault, such that drinking (T1 = beginning fall semester) would contribute to increased sexting (T2 = end fall semester), and in turn increase the risk of being targeted for sexual assault (T3 = end spring semester). Results: Among 332 undergraduate women (M(SD)age = 19.15(1.69), 76.9% Caucasian), sexting (T2) predicted sexual assault (T3; b = 3.98, p = .05), controlling for baseline sexual assault (b = 0.82, p < .01). Further, sexting (T2) mediated the relationship between problem drinking (T1) and sexual assault (T3) (b = 0.04, CI[.004,.12]). Conclusion: Findings suggest that sexting is one mechanism through which drinking increases the risk of college women being targeted for sexual assault.

Addressing Intimate Partner Violence to Improve Women's Preconception Health

Exposure to violence can harm women's overall health and well-being. Data suggest that one in three women in the United States experience some form of violence by an intimate partner in their lifetime. In this commentary, we describe the implications of intimate partner violence (IPV) on women's health, specifically for women of reproductive age. We use a life-course perspective to describe the compounded impact of IPV on preconception health. Preconception health generally refers to the overall health and well-being of women (and men) before pregnancy. This report also discusses primary prevention of IPV and healthcare recommendations, and highlights surveillance systems that capture IPV indicators among women of reproductive age. Ongoing collection of state-level surveillance data may inform the implementation of intervention programs tailored to reproductive age women at risk for IPV.

From mother to child: Maternal betrayal trauma and risk for maltreatment and psychopathology in the next generation

The objective of this study was to investigate whether experiences of high betrayal trauma (BT; maltreatment by a parent/caregiver) during mothers' own childhoods may influence the intergenerational transmission of maltreatment and its associated psychopathology from mothers to their children. A prospective, longitudinal design was utilized to assess maternal physical and sexual betrayal trauma in relation to children's own maltreatment experiences, and child mood and behavioral symptoms during pre-adolescence. Data from 706 mothers and children who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) was analyzed, including: mothers' physical and sexual maltreatment histories, child protective services' documented physical and sexual maltreatment during children's first twelve years of life, and mother- and child-reports of child internalizing and externalizing symptoms at age 12. Children of mothers who survived high BT (maltreatment by a caregiver) were 4.52 times more likely to experience maltreatment than children of no BT mothers (mothers whom were not maltreated), and 1.58 times more likely than children whose mothers survived low BT (maltreatment by a non-caregiver). Higher levels of maternal physical BT significantly predicted more internalizing and externalizing symptoms in children at age 12, according to both mother (CBCL) and child (YSR) reports. More incidents of child physical maltreatment partially mediated associations between maternal physical BT and child symptoms. Incidents of sexual maltreatment also partially mediated associations between maternal sexual BT and child internalizing and externalizing symptoms (CBCL only). These findings have implications for understanding the role of betrayal trauma in perpetuating the cycle of maltreatment across generations.

Child Maltreatment and Physical Victimization: Does Heavy Drinking Mediate the Relationship?

Past studies examining the child maltreatment (CM)/victimization pathway have been limited by their focus on sexual victimization, narrow windows of assessment, and failure to examine gender differences. In the current study, we sought to examine (1) the impact of CM on physical victimization (PV) trajectories from adolescence to young adulthood and (2) the extent to which heavy drinking mediated the relationship between CM and later PV. Using three waves of the National Longitudinal Study of Adolescent to Adult Health, we found that CM was associated with a 69% greater odds of later PV for both genders, after the inclusion of control variables, and that the risk continued into adulthood. Further, heavy drinking was found to mediate the CM/victimization pathway at Wave I, but not at later waves. When mediation was examined separately for men and women, support for mediation was found for men and women. The current study suggests that CM represents a liability for interpersonal violence for both genders and highlights the importance of looking at victimization across time.

Postassault Substance Use and Coping: A Qualitative Study of Sexual Assault Survivors and Informal Support Providers

This qualitative interview study examined 45 informal support dyads where a sexual assault was disclosed. Data from matched pairs of survivors and their primary informal support provider (e.g., friend, family, significant other), were used to explore the survivor-support provider (SP) perspectives of coping with assault-related distress via substance use and the effects of survivor substance use on the survivor-SP relationship. Results revealed that survivors' use of drinking and/or drugs to cope had both positive and negative effects on survivor-SP relationships. Findings also showed that SPs play various roles in providing support to survivors who cope via substance use, including engaging in substance use with the survivor and efforts to help get help in their recovery from the assault and substance abuse. Suggestions are made for how safe spaces can be provided where survivors and supporters can get information and treatment, whether formal or informal, that addresses sexual assault, PTSD and substance abuse issues in an integrated way.

The Impact of Experiential Avoidance and Event Centrality in Trauma-Related Rumination and Posttraumatic Stress

Cognitive control strategies like rumination often increase posttraumatic stress disorder (PTSD) symptoms. However, extant research has provided equivocal results when attempting to explain why this phenomenon occurs. The current study explored several mechanisms that may clarify such findings. For this study, 193 trauma-exposed community members completed measures of PTSD, rumination, experiential avoidance, and event centrality. Elevated reports of rumination were associated with greater PTSD symptomology, experiential avoidance, and event centrality. Results suggest that rumination indirectly influenced PTSD symptom severity through experiential avoidance. This pattern held true regardless of whether a trauma survivor viewed their reported trauma as central or peripheral to their personal identity. These data suggest that the link between ruminating about a traumatic experience and enhanced PTSD symptomology may be partially explained by increasingly restrictive cognitive patterns and enhanced avoidance of aversive internal stimuli. Furthermore, they provide preliminary evidence to suggest that rumination and experiential avoidance are strongly associated with one another (and subsequent PTSD symptomology) among trauma survivors, regardless of how central a traumatic event is to an individual’s personal narrative. Such findings support clinical interventions like exposure, which progressively support new learning in response to feared or unwanted experiences in service of expanding an individual’s cognitive and behavioral repertoires.

Developmental Pathways from Child Maltreatment to Adolescent Substance Use: The Roles of Posttraumatic Stress Symptoms and Mother-Child Relationships

While many studies have identified a significant relation between child maltreatment and adolescent substance use, the developmental pathways linking this relation remain sparsely explored. The current study examines posttraumatic stress (PTS) symptoms, mother-child relationships, and internalizing and externalizing problems as potential longitudinal pathways through which child maltreatment influences adolescent substance use. Structural equation modeling was conducted on 883 adolescents drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). The pathways of PTS symptoms linked physical and sexual abuse to substance use, and the pathways of mother-child relationships linked emotional abuse and neglect to substance use. None of the four types of maltreatment affected substance use via internalizing or externalizing problems. The findings suggest that intervention efforts aimed at addressing posttraumatic stress symptoms and improving mother-child relationship quality may be beneficial in reducing substance use among adolescents with child maltreatment histories.