Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions

"Because I Am a Female": Stigma and Safety Perspectives from Racially/Ethnically Diverse Women with Serious Mental Illnesses

Individuals with serious mental illnesses (SMIs) face safety risks related to their mental health conditions that are often compounded by experiences of trauma, victimization, residence in impoverished neighborhoods, and histories of homelessness. Stigma and safety challenges significantly impact community integration for individuals with SMIs, particularly women, who often bear a disproportionate burden of vulnerability, gender-based stigma, violence, and other inequalities. This study investigates how women with SMIs engage in the meaning-making of their safety and stigma experiences that, in turn, influence their community integration. From a large multi-site study exploring community experiences of racially/ethnically diverse participants with SMIs, a subsample of 28 cis and trans-gender women, who reported experiencing gendered stigma and a lack of safety, were chosen for the current study. The interviews were analyzed using modified principles of Interpretive Phenomenological Analysis (IPA) to understand how women with SMIs made meaning of their safety and stigma encounters in their families, communities, and neighborhoods. IPA analysis resulted in the emergence of themes within a broad category of safety that represented participants' meaning-making about their physical safety and stigma experiences. Specifically, we used the broad themes from an existing framework of safety called 'Navigating Safety' model as sensitizing concepts for our analysis. Physical and psychological aspects of safety for this study were experienced in tandem whereby the women made sense of how their experiences of a lack of physical safety in multiple contexts shaped their sense of self, internalized stigma, and their social relationships. Within the broad theme of physical safety, participants described unsafe neighborhoods, exposure to domestic and intimate partner violence, and vulnerability to sexual violence. Additionally, under psychological safety, we identified how gender-based norms, race and ethnicity, sources of stigma (internalized, familial, and societal), and social isolation contributed to their mental health and social relationships (particularly with family). These findings highlight how the compounding influence of the intersection of multiple stigmatized identities exerts safety challenges on the lives and community experiences of women with SMIs. Focusing on access and affordability of appropriate gender-responsive resources for women, including trauma-informed care, could reduce hospitalizations, mental health symptoms, and stigma so they can safely integrate into their communities.

Physical and sexual victimization of persons with severe mental illness seeking care in central and southwestern Uganda

Purpose

This study established the prevalence of physical and sexual victimization, associated factors and psychosocial consequences of victimization among 1,201 out-patients with severe mental illness at Butabika and Masaka hospitals in Uganda.

Methods

Participants completed structured, standardized and locally translated instruments. Physical and sexual victimization was assessed using the modified adverse life events module of the European Para-suicide Interview Schedule. We used logistic regression to determine the association between victimization, the associated factors and psychosocial consequences.

Results

The prevalence of physical abuse was 34.1% and that of sexual victimization was 21.9%. The age group of > = 50 years (aOR 1.02;95% CI 0.62-1.66; p = 0.048) was more likely to have suffered physical victimization, while living in a rural area was protective against physical (aOR 0.59; 95% CI 0.46-0.76; p = <0.001) and sexual (aOR 0.48, 95% CI 0.35-0.65; p < 0.001) victimization. High socioeconomic status (SES) (aOR 0.56; 95% CI 0.34-0.92; p = <0.001) was protective against physical victimization. Females were more likely to have been sexually victimized (aOR 3.38; 95% CI 2.47-4.64; p = <0.001), while being a Muslim (aOR 0.60; 95% CI 0.39-0.90; p = 0.045) was protective against sexual victimization. Risky sexual behavior was a negative outcome associated with physical (aOR 2.19; 95% CI 1.66-2.90; p = <0.001) and sexual (aOR 3.09; 95% CI 2.25-4.23; p < 0.001) victimization. Mental health stigma was a negative outcome associated with physical (aOR 1.03; 95% CI 1.01-1.05; p < 0.001) and sexual (aOR 1.03; 95% CI 1.01-1.05; p = 0.002) victimization. Poor adherence to oral anti-psychotic medications was a negative outcome associated with physical (aOR 1.51; 95% CI 1.13-2.00; p = 0.006) and sexual (aOR 1.39; 95% CI 0.99-1.94; p = 0.044) victimization.

Conclusion

There is a high burden of physical and sexual victimization among people with SMI in central Uganda. There is need to put in place and evaluate complex interventions for improving detection and response to abusive experiences within mental health services. Public health practitioners, policymakers, and legislators should act to protect the health and rights of people with SMI in resource poor settings.

An ecological approach to understanding the impact of sexual violence: a systematic meta-review

Aim

A systematic meta-review was conducted to examine (1) the broad range of negative and positive individual and interpersonal changes following adult sexual violence, as well as (2) the risk/protective factors at multiple levels of the social ecology (e.g., individual, assault, and micro/meso/exo/macro/chronosystem factors)-influencing the impact of sexual violence.

Methods

Searches of Web of Science, Pubmed, and ProQuest resulted in inclusion of 46 systematic reviews or meta-analyses. Review findings were extracted for summary and a deductive thematic analysis was conducted.

Results

Experiencing sexual violence is associated with many negative individual and sexual difficulties as well as revictimization risk. Only a limited number of reviews reported on interpersonal and positive changes. Factors at multiple levels of the social ecology play a role in the intensity of these changes. Reviews including macrolevel factors were non-existent, however.

Conclusion

Reviews on sexual violence are fragmented in nature. Although the use of an ecological approach is often lacking, adopting such a perspective in research is necessary for a fuller understanding of the multiple influences on survivor outcomes. Future research should evaluate the occurrence of social and positive changes following sexual violence, as well as the role of macrolevel factors in influencing post-assault outcomes.

Associations Between Adverse Childhood Experiences and Tobacco, Alcohol, and Drug Use Among Individuals with Serious Mental Illnesses in Public-Sector Treatment Settings

Adverse childhood experiences (ACEs) increase risk of substance use disorders (SUDs). Little research has focused on individuals with serious mental illnesses (SMI), despite their high prevalence of both ACEs and SUDs. We combined two datasets from prior studies (n = 299 and n = 240, total n = 539) that measured ACEs and made research diagnoses for SUDs. When controlling for other variables-age, gender, race, diagnostic category (psychotic disorder versus mood disorder), and study site (Washington, DC-area versus southeast Georgia)- in logistic regression models, ACE score was associated with tobacco use, presence of any SUD, alcohol use disorder, cannabis use disorder, and cocaine use disorder. Each one-unit increase in the ACE score increased the odds of SUD-related outcomes by 9-18%. Clinicians, program planners, and researchers should be aware of the powerful and long-lasting impact of ACEs, and the need for thorough screening and assessment of both SUDs and ACEs among patients with SMI.

Sexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review

BACKGROUND AND HYPOTHESIS

The sexual and reproductive health (SRH) of young people with psychosis has been largely overlooked. We hypothesised that there are key deficiencies in the existing literature on the SRH of adolescents and young adults with psychotic disorders.

STUDY DESIGN

We conducted a systematic scoping review using Pubmed, Web of Science, Embase, PsycINFO, and CINAHL. We included empirical studies and case reports focused on SRH issues in young people (aged 14-24 years) with psychotic disorders. A qualitative synthesis was completed. Joanna Briggs Institute Critical Appraisal Tools were utilized to assess study quality.

STUDY RESULTS

Seventeen empirical studies and 52 case reports met inclusion criteria. Most focused on sexual dysfunction which was identified as common among this cohort and associated with both psychotic disorders and antipsychotics. The study population was more likely to engage in sexual risk-taking behavior and was at higher risk of sexually transmissible infections than those without psychosis. SRH topics of clinical relevance in older patients with psychosis such as pregnancy, abortion, sexual violence, coercion, sexual identity, and gender were poorly addressed in this younger group. We found empirical studies generally lacked identification and controlling of confounders whilst case reports provided limited description of mental health and SRH outcomes following clinical intervention.

CONCLUSION

Research and clinical practice addressing sexual and reproductive health is needed for young people living with psychosis. To address research gaps future studies should focus on women's health, sexual violence, gender, and sexuality in young people with psychosis.

Domains of Vulnerability, Resilience, Health Habits, and Mental and Physical Health for Health Disparities Research

Health disparities associated with severe mental illness (SMI) have become a major public health concern. The disparities are not directly due to the SMI. They involve the same leading causes of premature death as in the general population. The causes of the disparities are therefore suspected to reflect differences in health-related behavior and resilience. As with other problems associated with SMI, studying non-clinical populations at risk for future onset provides important clues about pathways, from vulnerability to unhealthy behavior and compromised resilience, to poor health and reduced quality of life. The purpose of this study was to identify possible pathways in a sample of public university students. Four domains of biosystemic functioning with a priori relevance to SMI-related vulnerability and health disparities were identified. Measures reflecting various well-studied constructs within each domain were factor-analyzed to identify common sources of variance within the domains. Relationships between factors in adjacent domains were identified with linear multiple regression. The results reveal strong relationships between common factors across domains that are consistent with pathways from vulnerability to health disparities, to reduced quality of life. Although the results do not provide dispositive evidence of causal pathways, they serve as a guide for further, larger-scale, longitudinal studies to identify causal processes and the pathways they follow to health consequences.

Violent victimization and revictimization in patients with depressive disorders: context characteristics, disclosure rates, and gender differences

BACKGROUND

Depressed patients are prone to violent victimization, and patients who were victimized once are at increased risk to fall victim to violence again. However, knowledge on the context of victimization in depressed patients is lacking, and research identifying targets for prevention is urgently needed.

METHODS

This cross-sectional study explored context characteristics, disclosure rates and gender differences regarding violent victimization in 153 recently victimized depressed patients. Additionally, 12-month prevalence rates of repeat threat, physical assault, and sexual assault were examined, and gender differences were investigated using t-tests, Chi-square tests, and Fisher's exact tests. Furthermore, logistic regression analyses were used to identify factors associated with repeat victimization.

RESULTS

Overall, depressed men were most often victimized by a stranger in public, and women by their partner or ex-partner at home. Regarding sexual assault, no gender differences could be examined. Patients were sexually assaulted most often by an acquaintance (50.0%) or stranger (27.8%). In all patients, the most recent incidents of threat (67.6%) and physical assault (80.0%) were often preceded by a conflict, and only a minority had been intoxicated prior to the assault. Notably, less than half of patients had disclosed their recent experience of threat (40.6%) and physical assault (47.1%) to their mental health caregiver. For sexual assault, this was only 20%. Less than one third of patients had reported their recent experience of threat (27.9%), physical assault (30.0%) and sexual assault (11.1%) to the police. 48.4% of patients had been victimized repeatedly in the past year, with no gender differences found. Only depressive symptoms and unemployment were univariately associated with repeat victimization, but not in the multiple model.

CONCLUSIONS

The high prevalence of repeat victimization in depressed patients and their low disclosure rates stress the need to implement routine enquiry of victimization in mental health care, and to develop preventive interventions accounting for specific needs of men and women.

Learning to forget: Hippocampal-amygdala connectivity partially mediates the effect of sexual trauma severity on verbal recall in older women undiagnosed with posttraumatic stress disorder

Verbal learning deficits are common among sexually traumatized women who have not been formally diagnosed with posttraumatic stress disorder (PTSD). Aberrant resting-state functional connectivity (rsFC) of the amygdala and hippocampus are implicated in PTSD and verbal memory impairment. We tested rsFC between bilateral dentate gyrus (DG) and both centromedial (CM) and basolateral (BL) nuclei of the amygdala as statistical mediators for the effect of sexual trauma-related symptom severity on delayed verbal recall performance in 63 older women (age: 60-85 years) undiagnosed with PTSD. Participant data were drawn from the NKI-Rockland Study. Individuals completed a 10-min resting-state scan, Rey Auditory Verbal Learning Test (RAVLT), and the Sexual Abuse Trauma Index (SATI) from the Trauma Symptom Checklist. Z-scores indicating rsFC of DG with BL and CM amygdala seeds were evaluated in two separate mediation models. Higher SATI scores were associated with lower RAVLT after controlling for age, β = -.23, 95% CI [.48, .03], p = .039. This effect was negated upon adding a negative path from SATI to rsFC of left DG and right CM, β = -.29, 95% CI [-.52, -.02], p = .022, and a positive path from that seed pair to RAVLT List A recall, β = .28, 95% CI [.03, 0.48], p = .015. Chi-square fit indices supported partial mediation by this seed pair, p = .762. In the absence of PTSD sexual trauma symptoms partially relate to verbal learning deficits as a function of aberrant rsFC between left hippocampus DG and right amygdala CM nuclei.

Estimating the Relationship Between Perceived Stigma and Victimization of People With Mental Illness

Over the past two decades, we have substantially increased our understanding of violence committed by individuals with mental illness, while comparatively less is known about the victimization experiences of this population. What has been established in the literature is that individuals with mental illness are more likely to experience victimization than the general public, and certain risk factors influence the likelihood of victimization. What remains unexplored is the possibility that a person with mental illness' perception that mental illness is stigmatized may be significantly associated with victimization experiences. Thus, the purpose of the current study is to examine whether stigma and victimization are associated, and in what direction. In other words, does perceived stigma lead to victimization? Or does victimization lead to perceived stigma? To assess these research questions, data from the Community Outcomes of Assisted Outpatient Treatment study are used, which is a longitudinal study of individuals with serious mental illness (n = 184). A variety of methods are employed to assess the association between victimization and perceived stigma including logistic and ordinary least squares regression models. Results from the logistic regression model indicate that perceived stigma is associated with an increase in the odds that a person with mental illness will experience victimization at later follow-ups. Results from the ordinary least squares regression analysis, however, show that victimization at baseline does not predict perceived stigma at later times. Implications regarding future research and clinical practice are discussed.

Mental illness, physical and sexual abuse associated with HIV risk behaviors among adults evaluated for substance use and treatment planning in the National Addictions Vigilance Intervention and Prevention Program - United States, 2014-2019

Background

The association between sexual and physical abuse history, mental illness, and HIV risk behaviors among persons starting treatment for substance use is not well-understood.

Methods

The study population included 216,877 US residents in the National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) from January 1, 2014-December 31, 2019. We used logistic regression models to estimate strength of pairwise association between mental illness, sexual or physical abuse histories and each of 3 HIV risk outcomes.

Results

Compared with no history of physical or sexual abuse, a history of sexual and physical abuse combined was associated with greater odds ratios for: (1) injection drug use among persons without a history of mental illness (odds ratio [OR] 2.4; 95% confidence interval [CI]: 2.3-2.6) than among persons with a history of mental illness (OR 2.0; 95% CI: 1.9-2.0); (2) prostitution conviction among persons without mental illness (OR 3.8; 95% CI: 2.8-5.1) than among persons with mental illness (OR 2.8; 95% CI: 2.4-3.4); and (3) and ≥2 sex partners within the past 30 days with a history of mental illness (OR 1.3; 95% CI: 1.2-1.4).

Conclusions

The findings imply that efforts to reduce HIV risk behaviors during and after substance use treatment can be improved by considering the patient's history of physical or sexual abuse and mental illness when providing care.

Adversity in childhood/adolescence and premorbid tobacco, alcohol, and cannabis use among first-episode psychosis patients

AIM

Premorbid substance use is widely recognized as a crucial factor in early psychosis. We explored the effects of childhood/adolescent adversity on premorbid tobacco, alcohol, and cannabis use. We hypothesized that adversity in childhood would be associated with an increased likelihood of use, and amount of intake, of tobacco, alcohol, and cannabis. We analysed which domains of adversity have the greatest impact.

METHODS

First-episode psychosis patients were enrolled from six inpatient psychiatric units in Atlanta, Georgia and Washington, D.C. Premorbid substance use was thoroughly measured, and childhood/adolescent adversity was rated using 14 scales/subscales. Factor analysis was used to reduce these scales/subscales to the three domains of adversity (termed Violence and Environmental Adversity, Interpersonal Abuse, and Neglect and Lack of Connectedness). Regression analyses determined associations between adversity domains and premorbid substance use.

RESULTS

Our sample (n = 247) primarily consisted of African Americans (86.2%) and males (74.5%). Violence and Environmental Adversity was significantly associated with five of six substance use variables and marginally associated with the sixth. Interpersonal Abuse was unassociated with substance use, and Neglect and Lack of Connectedness was associated only with a lower likelihood cannabis use. When Violence and Environmental Adversity results were stratified by gender, effects on tobacco use and amount of tobacco use were stronger among females.

CONCLUSIONS

Childhood/adolescent trauma and adversity have meaningful associations with premorbid substance use in first-episode psychosis patients. First-episode psychosis and clinical high-risk treatment settings may benefit from expanding the assessment of childhood/adolescent adversity to include factors pertaining to violence exposure and adversities beyond abuse and neglect.

Program evaluation of trauma-informed yoga for vulnerable populations

BACKGROUND

Trauma is highly prevalent among vulnerable populations, including those who are incarcerated, in treatment for substance use, or seeking mental health services. Trauma-informed yoga seeks to create a safer yoga practice for individuals with a trauma history and may improve emotional and physical wellbeing. Thus, we conducted an evaluation of a trauma-informed yoga program to gain insight into participant experiences.

METHODS

Trauma-informed yoga classes were led by trained volunteers and held in three sectors that work with vulnerable populations: corrections and reentry, substance use treatment and recovery, and community and mental health. Data were collected via anonymous survey using a retrospective pre-post design. The survey instrument captured reasons for student participation and perceived effects of yoga on emotional and physical wellbeing.

RESULTS

Students were motivated to participate in yoga classes by expectations of physical, mental, and spiritual benefit. Students reported perceived improvements in emotional and physical wellbeing and greater use of self-regulation skills after starting yoga.

CONCLUSION

Our findings suggest trauma-informed yoga is perceived as beneficial by vulnerable individuals, especially those in the correctional system or recovering from substance use. Our results support the value of offering trauma-informed yoga in institutionalized and community settings. Improvements in emotional and physical wellbeing warrant formal study.

Parental Buffering of Stress in the Time of COVID-19: Family-Level Factors May Moderate the Association Between Pandemic-Related Stress and Youth Symptomatology

Nearly all families in the United States were exposed to varying degrees of stress related to the COVID-19 pandemic during the spring of 2020. Building on previous research documenting the pernicious effects of stress on youth mental health, we aimed to test the effects of exposure to COVID-19-related stress on youth symptomatology. Further, in light of evidence suggesting that parents play an important role in buffering children from environmental stress, we assessed how specific parental behaviors (i.e., parental emotion socialization, maintenance of home routines, and availability to discuss the pandemic with child) contributed to effective parental buffering of the impact of pandemic-related stress on children's symptomatology. Conversely, we tested whether parental anxiety-related symptomatology and parenting stress exacerbated the effect of children's exposure to pandemic-related stress on children's symptomatology. Results suggest that parents who engaged in relatively higher levels of emotion coaching of children's negative emotions and who maintained more stable home routines during the pandemic were more effectively able to buffer the effects of pandemic-related stress on children's symptomatology. Parents who reported higher levels of parenting stress and anxiety-related symptomatology were less likely to effectively buffer stress. Though interpretation of the findings is limited due to sole reliance on parental report and the cross-sectional study design due to the constraints of collecting data during a global pandemic, findings underscore the importance of assessing family-level factors when considering the impact of stressors on children's symptomatology and highlight the need to support parents during global events that place families under significant stress.

Intervening for HIV prevention and mental health: a review of global literature

INTRODUCTION

Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre-exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare.

METHODS

We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention.

RESULTS AND DISCUSSION

We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare.

CONCLUSIONS

Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.

The Contingent Effect of Guardianship on Victimization: An Examination of People With and Without Mental Health Problems

Mixed effects of guardianship on victimization have been found in the literature. It is possible that these divergent findings have emerged because research has not recognized how the need for guardianship may shape the results. That is, individuals who are not suitable targets (i.e., individuals without mental health problems-those who are not perceived as vulnerable or incapable of defending themselves) do not need guardianship, resulting in null findings for the protective effects of guardianship on victimization. We examine the possibility that mental health problems and guardianship interact to produce victimization in the Life Opportunities Survey, a nationally representative survey of individuals in the United Kingdom (N = 27,516). Logistic regression analyses support our hypothesis that the effects of guardianship on victimization, which is measured as violence or the threat of violence against an individual, are contingent on the presence of mental health problems (i.e., any emotional or psychological health condition). The risk of victimization for those with mental health problems who had guardianship was substantially lower than for those with mental health problems who lacked guardianship (11.5% vs. 17%, respectively). We discuss this finding in light of routine activities theory and crime prevention for people with mental health problems.

The investigation of the mediating role of coping trategies on the relationship between childhood traumas, depression and alcohol use disorder in university students

The aim of this study is to investigate the mediating effect of coping strategies on the relationship among childhood traumas, depression, and alcohol use disorder in university students. The participants of this study consisted of 735 (209 males and 526 females) university students. Participants completed measures of depressive symptoms, childhood traumas, problematic alcohol consumption, and coping strategies as well as a sociodemographic information form. According to results, coping strategies fully mediated the relationship between childhood traumas and alcohol use disorder, and partially mediated the relationship between childhood traumas and depression.

Mental illness and the risk of self- and other-directed aggression: Results from the National Survey on Drug Use and Health

Aggression and mental illness have been classically interlinked, often causing controversy and debate. Previous studies have shown that mental illness can be a risk factor to self- and other-directed aggression. However, these associations have rarely been simultaneously studied within the same population. Therefore, we aimed to study whether psychiatric disorders differentially increase the likelihood of one subtype of aggression over the other. We used the publicly available data of the National Survey on Drug Use and Health (NSDUH) from 2008 through 2014, for a total sample of 270,227 adult respondents. We designed our independent variable according to three categories: no mental illness (NMI), low or moderate (LMMI) and serious (SMI). We constructed regression models to estimate the odds ratios for those having a mental illness committing (a) a subtype of aggression over the past year compared with no aggression and (b) other-directed compared to self-directed aggression. We found that most respondents with mental illness reported no past-year aggression of any type. However, respondents with mental illness had higher odds of perpetrating all subtypes of aggression. Additionally, respondents with LMMI and SMI were respectively 1.7 and 3 times more likely to engage in self- rather than other-directed aggression. Future research should focus on identifying accurate and reliable predictors of self- and other-directed aggression among individuals with mental illness.

The association between neighbourhood characteristics and physical victimisation in men and women with mental disorders

BACKGROUND

How neighbourhood characteristics affect the physical safety of people with mental illness is unclear.

AIMS

To examine neighbourhood effects on physical victimisation towards people using mental health services.

METHOD

We developed and evaluated a machine-learning-derived free-text-based natural language processing (NLP) algorithm to ascertain clinical text referring to physical victimisation. This was applied to records on all patients attending National Health Service mental health services in Southeast London. Sociodemographic and clinical data, and diagnostic information on use of acute hospital care (from Hospital Episode Statistics, linked to Clinical Record Interactive Search), were collected in this group, defined as 'cases' and concurrently sampled controls. Multilevel logistic regression models estimated associations (odds ratios, ORs) between neighbourhood-level fragmentation, crime, income deprivation, and population density and physical victimisation.

RESULTS

Based on a human-rated gold standard, the NLP algorithm had a positive predictive value of 0.92 and sensitivity of 0.98 for (clinically recorded) physical victimisation. A 1 s.d. increase in neighbourhood crime was accompanied by a 7% increase in odds of physical victimisation in women and an 13% increase in men (adjusted OR (aOR) for women: 1.07, 95% CI 1.01-1.14, aOR for men: 1.13, 95% CI 1.06-1.21, P for gender interaction, 0.218). Although small, adjusted associations for neighbourhood fragmentation appeared greater in magnitude for women (aOR = 1.05, 95% CI 1.01-1.11) than men, where this association was not statistically significant (aOR = 1.00, 95% CI 0.95-1.04, P for gender interaction, 0.096). Neighbourhood income deprivation was associated with victimisation in men and women with similar magnitudes of association.

CONCLUSIONS

Neighbourhood factors influencing safety, as well as individual characteristics including gender, may be relevant to understanding pathways to physical victimisation towards people with mental illness.

Suffering in Silence: Stories of Indian Women with Chronic Mental Illness and Sexual Coercion

BACKGROUND

Patriarchy exposes women to various forms of discrimination and oppression. Women are more often blamed for mental illness, which can result in social isolation and stigma.

METHOD

Case Study.

RESULTS

Psycho-social intervention aided in empowering women by giving them voices to speak as well as by utilizing their strengths and available community resources to develop a sense of self-efficacy, coping strategies, and support system.

CONCLUSION

Women with chronic mental illness have unique needs and challenges. Mentally ill women face sexual coercion in childhood or adulthood. The factors related to help-seeking in the context of abuse were family reactions, social support, and stigma. Our findings highlight the need to conduct risk assessments and provide community-based and coordinated services during follow-up visits.

KEY MESSAGES

Trauma-focused intervention should be culturally appropriate and should focus on reducing emotional distress, restoring self-adaptation, and enhancing social support.

Epidemiology of Interpersonal Trauma among Women and Men Psychiatric Inpatients: A Population-Based Study

OBJECTIVE

Small clinical samples suggest that psychiatric inpatients report a lifetime history of interpersonal trauma. Since past experiences of trauma may complicate prognosis and treatment trajectories, population-level knowledge is needed about its prevalence and correlates among inpatients.

METHODS

Using health-administrative databases comprising all adult psychiatric inpatients in Ontario, Canada (2009 to 2016, n = 160,436, 49% women), we identified those who reported experiencing physical, sexual, and/or emotional trauma in their lifetime, 1 year, and 30 days preceding admission. We described the prevalence of each type of trauma, comparing women and men using modified Poisson regression, and identified individual-level characteristics associated with lifetime trauma history using multivariable logistic regression.

RESULTS

31.7% of inpatients reported experiencing trauma prior to admission. Lifetime prevalence was higher in women (39.6% vs. 24.1%; age-adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.65 to 1.71), including sexual (22.7% vs. 8.4%; aPR = 2.81; 95% CI, 2.73 to 2.89), emotional (33.3% vs. 19.4%; aPR = 1.76; 95% CI, 1.72 to 1.79), and physical trauma (24.2% vs. 14.8%; aPR = 1.68; 95% CI, 1.65 to 1.72). Factors most prominently associated with lifetime trauma were witnessing parental substance use (adjusted odds ratio [aOR] = 8.68; 95% CI, 8.39 to 8.99), female sex (aOR = 2.29; 95% CI, 2.23 to 2.35), and number of recent stressful life events (aOR = 1.62; 95% CI, 1.59 to 1.65).

CONCLUSIONS

These results suggest that trauma-informed approaches are essential to consider in the design and delivery of inpatient psychiatric services for both women and men.

Inconsistent trauma reporting is associated with emotional and behavioural problems and psychotic experiences in young people

BACKGROUND

Little is known about the prevalence of inconsistent trauma reporting in community samples and about its associations with psychopathology. This study aimed to assess for the first time the prevalence of inconsistent trauma reporting in a community sample of children/adolescents and to explore associations with both psychotic experiences and with psychopathology more generally.

METHOD

A community-based sample of 86 children/adolescents (baseline mean age 11.5) were interviewed at two time points with data collected in relation to potentially traumatic events through the K-SADS. Emotional and behavioural problems were assessed at follow-up (mean age 15.7) through the Youth Self Report questionnaire while the presence of psychotic experiences was based on expert consensus post interview. Logistic regression models were used to test associations between inconsistent reporting and psychotic experiences at baseline and follow-up, with associations with emotional and behavioral problems at follow-up also assessed.

RESULTS

Overall, 16.3% of adolescents failed to report previously reported potentially traumatic events at follow-up and were therefore defined as inconsistent trauma reporters. Inconsistent reporting was associated with emotional and behavioural problems as assessed by the Youth Self Report with the exception of rule breaking behaviour and with psychotic experiences as assessed on interview.

CONCLUSIONS

Inconsistent trauma reporting is associated with psychotic experiences and emotional and behavioural problems in young people and may represent an important marker for psychopathology in youth.

Financial hardship among individuals with serious mental illness

This study explored financial hardship, defined as difficulty in obtaining food, shelter, or medicine in the past 12 months and its personal and clinical correlates in individuals with serious mental illness (SMI) in a sample of 271 adults with SMI newly admitted to two inner city community mental health centers. The study found that 59 percent (n = 161) reported experiencing financial hardship in the past 12 months. Patients with financial hardship were more likely to be female, to experience self-stigma, to experience medical care delays, and to use emergency services. Patients who experienced financial hardship typically had more severe psychiatric symptoms, including depressive symptoms, emotional lability, and interpersonal problems. Financial hardship persisted in nearly half of those with hardship interviewed a year later. The findings highlight the role of multiple social and economic challenges that the SMI patients face in recovery from serious mental illness and the importance of awareness of such challenges by providers treating this population. Though mental health treatment may help alleviate the psychiatric symptoms it alone is not sufficient in addressing persistent hardship. These findings highlight the need for multidisciplinary interventions in order to better serve this vulnerable population.

It All Just Piles Up: Challenges to Victim Credibility Accumulate to Influence Sexual Assault Case Processing

The underreporting of sexual assault is well known to researchers, practitioners, and victims. When victims do report, their complaints are unlikely to end in arrest or prosecution. Existing research on police discretion suggests that the police decision to arrest for sexual assault offenses can be influenced by a variety of legal and extra-legal factors particularly challenges to victim credibility. Although extant literature examines the effects of individual behaviors on police outcomes, less is known about how the accumulation of these behaviors, attributions, and characteristics affects police decision making. Using data collected from the Los Angeles Police Department and Sheriff's Department, we examine one police decision point-the arrest to fill this gap in the literature. First, we examine the extent to which the effects of potential challenges to victim credibility, based on victim characteristics and behaviors, influence the arrest decision, and next, how these predictors vary across circumstances. Specifically, we examine how factors that challenge victim credibility affect the likelihood of arrest in sexual assault cases where the victim and offender are strangers, acquaintances, and intimate partners.

Rates and profile of victimization in a sample of Egyptian patients with major mental illness

BACKGROUND

Patients with major mental illness have an increased risk of victimization. Nevertheless, this topic was not thoroughly studied in Egyptian patients with major mental illness.

OBJECTIVES

The objectives of this study are to investigate the rates of victimization and understand its profile, psycho-demographic and clinical correlates among a sample of Egyptian patients with major mental illness.

PARTICIPANTS AND METHODS

A total of 300 patients (100 patients with schizophrenia, 100 with bipolar and 100 with major depression) were recruited from the inpatient wards and outpatient clinics at Ain Shams University. They were subjected to a demographic questionnaire, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI) and a Victimization Questionnaire (VQ).

RESULTS

In our study population, 130 (43.3%) of patients were victimized, of them 52 (40%) were diagnosed with major depressive disorder, 48 (36.9%) with bipolar disorder and 30 (23.1%) with schizophrenia. Victimization was more in female, married, unemployed individuals and those living in rural areas. Patients exposed to domestic violence or abuse during childhood had higher rates of victimization. All victimized patients were subjected to emotional victimization, 64.6% were physically victimized and 53.8% were subjected to miscellaneous types of victimization. Patients were victimized mainly by acquaintance followed by family members. The majority of patients did not report their victimization and considered it as a personal issue or not important enough to be reported.

CONCLUSION

Patients with major mental illness are susceptible to significant victimization. Clinicians should explore possible history of abuse or victimization in their patients, empower and support the victimized ones.

Psychiatric symptoms and risk of victimisation: a population-based study from Southeast London

AimsAlthough violence is a vital public health problem, no prospective studies have tested for subsequent vulnerability to violence, as a victim or witness, in members of the general population with a range of psychiatric symptoms, or evaluated the importance of higher symptom burden on this vulnerability.

METHODS

We used successive waves of a household survey of Southeast London, taken 2 years apart, to test if association exists between psychiatric symptoms (symptoms of psychosis, common mental disorders, post-traumatic stress disorder and personality disorder) and later victimisation, in the form of either witnessing violence or being physically victimised, in weighted logistic regression models. Statistical adjustment was made for prior violence exposure, sociodemographic confounders, substance/alcohol use and violence perpetration. Sensitivity analyses were stratified by violence perpetration, sex and history of mental health service use.

RESULTS

After adjustments, psychiatric symptoms were prospectively associated with reporting any subsequent victimisation (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.25-2.83), a two times greater odds of reporting witnessed violence (OR 2.24, 95% CI 1.33-3.76) and reporting physical victimisation (OR 1.76, 95% CI 1.01-3.06). One more symptom endorsed was accompanied by 47% greater odds of subsequent victimisation (OR 1.47, 95% CI 1.16-1.86). In stratified analyses, statistical associations remained evident in non-perpetrators, and among those without a history of using mental health services, and were similar in magnitude in both men and women.

CONCLUSIONS

Psychiatric symptoms increase liability to victimisation compared with those without psychiatric symptoms, independently of a prior history of violence exposure and irrespective of whether they themselves are perpetrators of violence. Clinicians should be mindful of the impact of psychiatric symptoms on vulnerability to victimisation, including among those with common psychiatric symptoms and among those who are not considered at risk of perpetrating violence.

When Sexual Trauma Survivors with Severe Psychiatric Disabilities Experience Institutional Care

Individuals with severe psychiatric disabilities face many challenges from their experience of mental health problems, but also from disenfranchisement, marginalization, and stigmatization from a sociocultural experience. Those who are sexual trauma survivors also have unique challenges and intersecting experiences, which are not historically well understood, acknowledged, or treated in U.S. systems of care. Both in historic and modern mental health systems there have been methods thought of as interventions that have been or are currently reported as traumatizing to those who experience them. This article highlights the specific challenges, needs, and organizational shifts that U.S. systems of care need to be aware of and embark upon in order to provide treatment that is more efficacious with and cognizant of the experiences of those who are sexual trauma survivors. Furthermore, new paradigms for providing mental health treatment are offered in the context of providing trauma-informed as well as trauma treatment to those who are sexual trauma survivors and experience severe psychiatric disabilities.

The utility of outpatient commitment: Reduced-risks of victimization and crime perpetration

BACKGROUND

Outpatient civil commitment (OCC) provisions, community treatment orders (CTOs) in Australia and Commonwealth nations, are part of mental health law worldwide. This study considers whether and by what means OCC provides statutorily required "needed-treatment" addressing two aspects of its legal mandate to protect the safety of self (exclusive of deliberate-self-harm) and others.

METHOD

Over a 12.4-year period, records of hospitalized-psychiatric-patients, 11,424 with CTO-assignment and 16,161 without CTO-assignment were linked to police-records. Imminent-safety-threats included perpetrations and victimizations by homicides, rapes, assaults/abductions, and robberies. "Need for treatment" determinations were validated independently by Health of the Nations Scale (HoNOS) severity-score-profiles. Logistic regressions, with propensity-score- adjustment and control for 46 potential confounding-factors, were used to evaluate the association of CTO-assignment with occurrence-risk of perpetrations and victimizations.

RESULTS

CTO-assignment was associated with reduced safety-risk: 17% in initial-perpetrations, 11% in initial-victimizations, and 22% for repeat-perpetrations. Each ten-community-treatment-days in interaction with CTO-assignment was associated with a 3.4% reduced-perpetration-risk. CTO-initiated-re-hospitalization was associated with a 13% reduced-initial-perpetration-risk, a 17% reduced-initial-victimization-risk, and a 22% reduced-repeat-victimization-risk. All risk-estimates appear to be the unique contributions of the CTO, CTO-initiated-re-hospitalization, or the provision of ten-community-treatment-days-i.e. after accounting for the influence of prior crimes and victimizations, ethnic-bias, neighborhood disadvantage and other between-group differences in the analysis.

CONCLUSIONS

CTO assignment's association with reduced criminal-victimization and perpetration-risk, in conjunction with requiring participation in needed-treatment via re-hospitalization and community-service, adds support to the conclusion that OCC is to some extent fulfilling its legal objectives related to protecting safety of self (exclusive of deliberate-self-harm), and others.

Violence towards people with mental illness: Assessment, risk factors, and management

AIM

Violence is an important problem for clinicians, for public health, and for victims. Aside from greater risk of perpetrating violence, people with mental illness are also more commonly victimized than the general population. However, guidance on the assessment and management of violent victimization in clinical settings is limited.

METHODS

We carried out a review and consolidation of clinical and research literature on violent victimization in people with mental illness.

RESULTS

Assessment of mental state in someone who has been victimized should evaluate both historical factors (such as pattern, timing, perpetrator characteristics, and contextual factors) and clinical factors (including affective and cognitive changes).

CONCLUSION

Concerted clinical and policy attention to factors that might increase vulnerability, such as alcohol use, lack of support, and the social environment, could improve outcomes.

The Parent Trauma Response Questionnaire (PTRQ): development and preliminary validation

Background: Following a child's experience of trauma, parental response is thought to play an important role in either facilitating or hindering their psychological adjustment. However, the ability to investigate the role of parenting responses in the post-trauma period has been hampered by a lack of valid and reliable measures. Objectives: The aim of this study was to design, and provide a preliminary validation of, the Parent Trauma Response Questionnaire (PTRQ), a self-report measure of parental appraisals and support for children's coping, in the aftermath of child trauma. Methods: We administered an initial set of 78 items to 365 parents whose children, aged 2-19 years, had experienced a traumatic event. We conducted principal axis factoring and then assessed the validity of the reduced measure against a standardized general measure of parental overprotection and via the measure's association with child post-trauma mental health. Results: Factor analysis generated three factors assessing parental maladaptive appraisals: (i) permanent change/damage, (ii) preoccupation with child's vulnerability, and (iii) self-blame. In addition, five factors were identified that assess parental support for child coping: (i) behavioural avoidance, (ii) cognitive avoidance, (iii) overprotection, (iv) maintaining pre-trauma routines, and (v) approach coping. Good validity was evidenced against the measure of parental overprotection and child post-traumatic stress symptoms. Good test-retest reliability of the measure was also demonstrated. Conclusions: The PTRQ is a valid and reliable self-report assessment of parenting cognitions and coping in the aftermath of child trauma.

A Pilot Study of Neurofeedback for Chronic PTSD

EEG Biofeedback (also known as neurofeedback) has been in use as a clinical intervention for well over 30 years; however, it has made very little impact on clinical care. One reason for this has been the difficulty in designing research to measure clinical change in the real world. While substantial evidence exists for its efficacy in treating attention deficit/hyperactivity disorder, relatively little evidence exists for its utility in other disorders including posttraumatic stress disorder (PTSD). The current study represents a "proof-of-concept" pilot for the use of neurofeedback with multiply-traumatized individuals with treatment-resistant PTSD. Participants completed 40 sessions of neurofeedback training two times per week with sensors randomly assigned (by the study coordinator, who was not blind to condition) to sensor placements of either T4-P4 or T3-T4. We found that neurofeedback significantly reduced PTSD symptoms (Davidson Trauma Scale scores averaged 69.14 at baseline to 49.26 at termination), and preceded gains in affect regulation (Inventory of Altered Self-Capacities-Affect Dysregulation scores averaged 23.63 at baseline to 17.20 at termination). We discuss a roadmap for future research.

Borderline personality disorder and polycystic ovary syndrome: A review of the literature

OBJECTIVE

This review examines the existing evidence for the relationship between borderline personality disorder and polycystic ovary syndrome, and to identify commonalities in etiological mechanisms of borderline personality disorder and polycystic ovary syndrome that might explain the relationship between these seemingly disparate disorders.

METHODS

A search of Medline, EMBASE and Cochrane Central was undertaken on 5 December 2016 to identify studies investigating women with borderline personality disorder and polycystic ovary syndrome (or symptoms and markers specific to polycystic ovary syndrome).

RESULTS

Nine studies were identified, including three cross-sectional studies investigating symptoms of polycystic ovary syndrome in women with borderline personality disorder, two cross-sectional and one cohort study examining the prevalence of psychiatric diagnoses in women with polycystic ovary syndrome and three case reports of comorbid borderline personality disorder and polycystic ovary syndrome.

CONCLUSION

Overall, the literature shows women with borderline personality disorder to have higher than expected serum androgen levels and incidence of polycystic ovaries, which can be key features of polycystic ovary syndrome. However, this research is still in its infancy, which limits our understanding of this potential comorbid phenomenon. Given the emerging anecdotal and empirical evidence to date, a theoretical discussion of the potential psychoneuroendocrinological mechanism underlying the borderline personality disorder and polycystic ovary syndrome comorbidity is provided. Further rigorous studies using standardized diagnostic criteria for polycystic ovary syndrome are warranted. Specifically, the use of prospective controlled cohort studies may be able to determine the causality and temporality of observed comorbid borderline personality disorder and polycystic ovary syndrome.

Posttraumatic growth among people with serious mental illness, psychosis and posttraumatic stress symptoms

Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop posttraumatic symptomatology related to these experiences, some appear to experience posttraumatic growth (PTG). Little is known, however, about PTG as a possible outcome among people who experienced psychosis as well as posttraumatic stress symptoms (PTSS). For further understanding of the relationship between PTSS and PTG among people with SMI who experienced psychosis, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires. Results revealed that while high levels of traumatic exposure were common, most participants experienced some level of PTG which was contingent upon meaning making and coping self-efficacy. In addition, posttraumatic avoidance symptoms were found to be a major obstacle to PTG. The range of effect sizes for significant results ranged from η²=0.037 to η²=0.144. These findings provide preliminary evidence for the potential role of meaning making and coping self-efficacy as mediators of PTG in clinical, highly traumatized populations of people with SMI and psychosis. Implications of these findings for future research and clinical practice are discussed.

Increased Suicidal Ideation in Patients with Co-Occurring Bipolar Disorder and Post-Traumatic Stress Disorder

Suicide risk increases for those with Bipolar Disorder or PTSD, however little research has focused on risk for co-occurring Bipolar Disorder and PTSD. The aim of this article was to evaluate increased suicide risk in co-occurring disorders, and differences in suicide risk for patients with Bipolar I versus Bipolar II. This study evaluated suicide risk in patients with co-occurring PTSD and Bipolar Disorder (n = 3,158), using the MADRS and Suicide Questionnaire. Those with history of PTSD had significantly higher suicidal ideation than those without (U = 1063375.00, p < .0001). Those with Bipolar I had higher risk than those with Bipolar II. Patients with Bipolar I and PTSD were at higher risk for suicidal ideation, implying the importance of diagnosis and risk assessment.

Multimodal examination of distress tolerance and posttraumatic stress disorder symptoms in acute-care psychiatric inpatients

Distress tolerance (DT), the actual or perceived capacity to withstand negative internal states, has received increasing scholarly attention due to its theoretical and clinical relevance to posttraumatic stress disorder (PTSD). Past studies have indicated that lower self-reported - but not behaviorally observed - DT is associated with greater PTSD symptoms; however, studies in racially and socioeconomically diverse clinical samples are lacking. The current study evaluated associations between multiple measures of DT (self-report and behavioral) and PTSD symptoms in an urban, racially and socioeconomically diverse, acute-care psychiatric inpatient sample. It was hypothesized that lower self-reported DT (Distress Tolerance Scale [DTS]), but not behavioral DT (breath-holding task [BH]; mirror-tracing persistence task [MT]), would be associated with greater PTSD symptoms, above and beyond the variance contributed by trauma load, substance use, gender, race/ethnicity, and subjective social status. Participants were 103 (41.7% women, M_age=33.5) acute-care psychiatric inpatients who endorsed exposure to potentially traumatic events consistent with DSM-5 PTSD Criterion A. Results of hierarchical regression analyses indicated that DTS was negatively associated with PTSD symptom severity (PCL-5 Total) as well as with each of the four DSM-5 PTSD symptom clusters (p's<0.001), contributing between 5.0%-11.1% of unique variance in PTSD symptoms across models. BH duration was positively associated with PTSD arousal symptom severity (p<0.05). Covariates contributed between 21.3%-40.0% of significant variance to the models. Associations between DT and PTSD in this sample of acute-care psychiatric inpatients are largely consistent with those observed in community samples.

Eye movement desensitization and reprocessing therapy versus supportive therapy in affective relapse prevention in bipolar patients with a history of trauma: study protocol for a randomized controlled trial

BACKGROUND

Up to 60% of patients with bipolar disorder (BD) have a history of traumatic events, which is associated with greater episode severity, higher risk of comorbidity and higher relapse rates. Trauma-focused treatment strategies for BD are thus necessary but studies are currently scarce. The aim of this study is to examine whether Eye Movement Desensitization and Reprocessing (EMDR) therapy focusing on adherence, insight, de-idealisation of manic symptoms, prodromal symptoms and mood stabilization can reduce episode severity and relapse rates and increase cognitive performance and functioning in patients with BD.

METHODS/DESIGN

This is a single-blind, randomized controlled, multicentre trial in which 82 patients with BD and a history of traumatic events will be recruited and randomly allocated to one of two treatment arms: EMDR therapy or supportive therapy. Patients in both groups will receive 20 psychotherapeutic sessions, 60 min each, during 6 months. The primary outcome is a reduction of affective episodes after 12 and 24 months in favour of the EMDR group. As secondary outcome we postulate a greater reduction in affective symptoms in the EMDR group (as measured by the Bipolar Depression Rating Scale, the Young Mania Rating Scale and the Clinical Global Impression Scale modified for BD), and a better performance in cognitive state, social cognition and functioning (as measured by the Screen for Cognitive Impairment in Psychiatry, The Mayer-Salovey-Caruso Emotional Intelligence Test and the Functioning Assessment Short Test, respectively). Traumatic events will be evaluated by The Holmes-Rahe Life Stress Inventory, the Clinician-administered PTSD Scale and the Impact of Event Scale.

DISCUSSION

The results of this study will provide evidence whether a specific EMDR protocol for patients with BD is effective in reducing affective episodes, affective symptoms and functional, cognitive and trauma symptoms.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov, identifier: NCT02634372 . Registered on 3 December 2015.

Involuntary Outpatient Commitment and the Elusive Pursuit of Violence Prevention

OBJECTIVE

Involuntary outpatient commitment (OPC)-also referred to as 'assisted outpatient treatment' or 'community treatment orders'-are civil court orders whereby persons with serious mental illness and repeated hospitalisations are ordered to adhere to community-based treatment. Increasingly, in the United States, OPC is promoted to policy makers as a means to prevent violence committed by persons with mental illness. This article reviews the background and context for promotion of OPC for violence prevention and the empirical evidence for the use of OPC for this goal.

METHOD

Relevant publications were identified for review in PubMed, Ovid Medline, PsycINFO, personal communications, and relevant Internet searches of advocacy and policy-related publications.

RESULTS

Most research on OPC has focussed on outcomes such as community functioning and hospital recidivism and not on interpersonal violence. As a result, research on violence towards others has been limited but suggests that low-level acts of interpersonal violence such as minor, noninjurious altercations without weapon use and arrests can be reduced by OPC, but there is no evidence that OPC can reduce major acts of violence resulting in injury or weapon use. The impact of OPC on major violence, including mass shootings, is difficult to assess because of their low base rates.

CONCLUSIONS

Effective implementation of OPC, when combined with intensive community services and applied for an adequate duration to take effect, can improve treatment adherence and related outcomes, but its promise as an effective means to reduce serious acts of violence is unknown.

Predictors of criminal justice system trajectories of homeless adults living with mental illness

OBJECTIVES

This study examines whether baseline profiles of criminal justice involvement are independently associated with 24-month trajectories of arrests in a sample of homeless adults living with mental illness.

METHODS

Interviews with justice-involved participants from the At Home/Chez soi project, a multisite trial of Housing First in Canada, yielded information related to arrests, as well as demographic, clinical, and contextual predictors of criminal justice system involvement. All potential predictors were entered into logistic and negative binomial regression models to assess their effect on re-arrest.

RESULTS

Of the 584 individuals involved with the criminal justice system at baseline, and for whom follow-up data was obtained, 347 (59%) were re-arrested within two years. Of those, 283 (82%) had an episodic pattern of re-arrest and 64 (18%) had a continuous trajectory of re-arrest. Results indicate that participants involved with the legal system for minor (mostly theft and public order) offenses at baseline were most likely to be repeatedly arrested. Gender, Aboriginal status, and recent victimization were also independently associated with re-arrest.

CONCLUSIONS

These findings have implications for the delivery of police and clinical services alike, as well as for policies that aim to divert vulnerable individuals who commit minor crimes from a long-term trajectory of justice involvement.

Exposure to Political Violence in Northern Ireland and Outcome of First Episode Psychosis

The impact of political violence on individuals presenting with an episode of first episode psychosis has not been examined. Individuals were assessed for exposure to political violence in Northern Ireland (the "Troubles") by asking for a response to 2 questions: one asked about the impact of violence "on your area"; the second about the impact of violence "on you or your family's life." The participants were separated into 2 groups (highandlowimpact) for each question. Symptom profiles and rates of substance misuse were compared across the groups at baseline and at 3-year follow up. Of the 178 individuals included in the study 66 (37.1%) reported ahighimpact of the "Troubles" on their life and 81 (45.5%) ahighimpact of the "Troubles" on their area. There were no significant differences in symptom profile or rates of substance misuse betweenhighandlowgroups at presentation. At 3-year follow-uphighimpact of the "Troubles" on life was associated with higher Positive and Negative Symptom Scale (PANSS) Total (P= .01), PANSS-Positive (P< .05), and PANSS-General (P< .01) scores and lower global assessment of functioning disability (P< .05) scores, after adjusting for confounding factors. Impact of the "Troubles" on area was not associated with differences in symptom outcomes. This finding adds to the evidence that outcomes in psychosis are significantly impacted by environmental factors and suggests that greater attention should be paid to therapeutic strategies designed to address the impact of trauma.

The future of mental health care: peer-to-peer support and social media

AIMS

People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group.

METHODS

In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing.

RESULTS

People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one's health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks.

CONCLUSION

Future research must explore these opportunities to support and empower people with serious mental illness through online peer networks while carefully considering potential risks that may arise from online peer-to-peer interactions. Efforts will also need to address methodological challenges in the form of evaluating interventions delivered through social media and collecting objective mental and physical health outcome measures online. A key challenge will be to determine whether skills learned from peers in online networks translate into tangible and meaningful improvements in recovery, employment, or mental and physical wellbeing in the offline world.

Childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness

PURPOSE

To investigate the association between childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness (SMI), and to explore this association in terms of gender differences and potential mediators.

METHOD

A cross-sectional survey of 318 people living in the community who were receiving care from Community Mental Health Teams. Associations were assessed using logistic regression of multiply imputed data.

RESULTS

63 % (95 % CI 55-71 %) of men and 71 % (95 % CI 63-79 %) of women reported childhood maltreatment, 46 % (95 % CI 37-54 %) of men and 67 % (95 % CI 59-76 %) of women reported adulthood domestic violence victimisation, and 22 % (95 % CI 15-28 %)of men and 62 % (95 % CI 53-70 %)of women reported adulthood sexual violence victimisation. Men and women with SMI who reported experiences of childhood maltreatment were two to five times more likely to report domestic and sexual violence victimisation in adulthood after adjusting for confounders. The associations held for each of emotional, physical and sexual childhood abuse.

CONCLUSION

People with severe mental illness have high prevalence of experiences of childhood maltreatment and adulthood domestic and sexual violence victimisation. Childhood maltreatment appears to be an independent risk factor for adulthood victimisation among men and women with SMI.

Posttraumatic Growth in Psychosis

OBJECTIVE

Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop full blown PTSD related to these experiences, it has been noted that some may also experience posttraumatic growth (PTG). However, few studies have examined PTG as a possible outcome in people who have experienced psychosis.

METHOD

To further understand the relationships between psychosis and PTG, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires.

RESULTS

High levels of traumatic exposure were found in the sample. Regarding our main focus of study, we observed that people who endured psychosis can experience PTG, and that PTG is mediated by meaning making and coping self-efficacy (CSE) appraisal. Psychotic symptoms were found to be a major obstacle to meaning making, CSE, and PTG, whereas negative symptoms were found to be significantly related to PTG when mediated by meaning making and CSE.

CONCLUSION

The current research provides preliminary evidence for potential role of meaning making and CSE as mediators of PTG in the clinical, highly traumatized population of people with SMI who have experienced psychosis. This may have both research as well as clinical practice relevance for the field of psychiatric rehabilitation.

The impact of adverse child and adult experiences on recovery from serious mental illness

OBJECTIVE

The purpose of this study was to compare effects of adverse childhood experiences and adverse adult experiences on recovery from serious mental illnesses.

METHODS

As part of a mixed-methods study of recovery from serious mental illnesses, we interviewed and administered questionnaires to 177 members of a not-for-profit health plan over a 2-year period. Participants had a diagnosis of bipolar disorder, affective psychosis, schizophrenia, or schizoaffective disorder. Data for analyses came from standardized self-reported measures; outcomes included recovery, functioning, quality of life, and psychiatric symptoms. Adverse events in childhood and adulthood were evaluated as predictors.

RESULTS

Child and adult exposures to adverse experiences were high, at 91% and 82%, respectively. Cumulative lifetime exposure to adverse experiences (childhood plus adult experiences) was 94%. In linear regression analyses, adverse adult experiences were more important predictors of outcomes than adverse childhood experiences. Adult experiences were associated with lower recovery scores, quality of life, mental and physical functioning and social functioning and greater psychiatric symptoms. Emotional neglect in adulthood was associated with lower recovery scores.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Early and repeated exposure to adverse events was common in this sample of people with serious mental illnesses. Adverse adult experiences were stronger predictors of worse functioning and lower recovery levels than were childhood experiences. Focusing clinical attention on adult experiences of adverse or traumatic events may result in greater benefit than focusing on childhood experiences alone.

Incidence of childhood abuse among women with psychiatric disorders compared with healthy women: Data from a tertiary care centre in India

Childhood abuse has been recognized as a precursor and a maintaining factor for adult psychopathology. There are very few studies that have investigated the incidence of childhood abuse in adult women with psychiatric disorders. Hence, this current investigation is an attempt to study and compare the incidence of childhood abuse (physical, emotional and sexual) among women seeking treatment for psychiatric disorders to healthy women. Using consecutive sampling, women seeking treatment for psychiatric disorders (N=609) and a group of age-education matched healthy women (N=100) were recruited for the study from a tertiary mental health-care hospital in India. The participants were screened for childhood abuse using the ISPCAN Child Abuse Screening Tool - Retrospective (ICAST)-R (I-CAST R, International Society for the Prevention of Child Abuse and Neglect (ISPCAN) and The United Nations Children's Fund (UNICEF), 2009). Emotional abuse was significantly more common among women with psychiatric disorders compared with healthy women (p<0.05). On overall abuse, there was a trend to significance in women with psychiatric disorders compared with healthy women (p=0.07). There was no statistically significant difference between the two groups on physical and sexual abuse (all p>0.13). There was no statistically significant difference in all three types of abuse across disorder categories, though the report was more among women with severe mental disorders. Women with psychiatric disorders reported more emotional and overall abuse compared with healthy women. Sexual and physical abuse was similar in both groups. It is likely that more emotional abuse predisposes these women to psychiatric disorders.

[Violence by and against people with mental illnesses]

There is robust evidence for an increased risk of violence through people with psychotic disorders. Until recently this was frequently denied to prevent stigmatization. Alcohol and drug abuse equally increases the risk, while appropriate treatment reduces it drastically. Staff in psychiatric hospitals is exposed to an elevated risk of aggressive assaults. A limited number of severely ill and socially disintegrated patients accounts for these incidents, which are often recurrent. Besides patient characteristics, factors such as ward climate, staffing levels, education and attitudes of staff, and physical environment play a major role in aggressive escalations. On the other hand, mentally ill people, particularly women, are themselves at a higher risk of becoming victims of violent and non-violent crime. This also applies after correction for variables such as social status and living environment. Additionally mentally ill people are confronted with violence in the form of coercive interventions legitimised by the state (involuntary admission, involuntary treatment, freedom-restrictive measures such as seclusion or manual/physical restraint). In contrast to other countries in Central and Western Europe, involuntary outpatient treatment has never been legalized in Germany. Efforts to reduce violence and coercion in psychiatric facilities by evidence-based interventions are widespread nowadays, treatment guidelines are available.

Psychotic experiences and PTSD: exploring associations in a population survey

BACKGROUND

Extensive evidence has shown that experiencing a traumatic event and post-traumatic stress disorder (PTSD) are associated with experiences of psychosis. However, less is known about specific PTSD symptoms and their relationship with psychotic experiences. This study aimed to examine the relationship between symptoms of PTSD with paranoia and auditory hallucinations in a large-scale sample.

METHOD

The Adult Psychiatric Morbidity Survey (APMS) was utilized to examine the prevalence of lifetime trauma, symptoms of PTSD, and experiences of paranoia and auditory hallucinations (n = 7403).

RESULTS

There were significant bivariate associations between symptoms of PTSD and psychotic experiences. Multiple logistic regression analyses indicated that reliving and arousal symptoms were significant predictors for paranoia while reliving, but not arousal symptoms, also significantly predicted auditory hallucinations. A dose-response relationship was found, the greater the number of PTSD symptoms, the greater the odds were of experiencing both paranoia and hallucinations.

CONCLUSIONS

These findings illustrate that symptoms of PTSD are associated with increased odds of experiencing auditory hallucinations and paranoia. Overlaps appear to be present between the symptoms of PTSD and psychotic experiences. Increasing awareness of this association may advance work in clinical practice.

Court orders on procreation

OBJECTIVE

The aim of this study is to empirically evaluate judgments entered from 1913 to 2013 in the matters of compulsory sterilization.

METHODS

Holdings and dispositions at the U.S. Appellate and Supreme courts are randomly located in LexisNexis using Shepard's symbols. Continuous variables are processed with the Mantel-Haenszel method. Court orders are used as units of analysis.

RESULTS

The majority of cases (56.4 %) concern minors at a mean age of 11.7 years. Forty-four (80 %) petitions are filed by the parents or guardians; 11 (20 %) are parens patriae. Petitions for female sterilization are denied in 56.4 % cases under the Federal Laws (2 U.S.C. 431; 28 U.S.C; 29 U.S.C; 42 U.S.C; 424 U.S.), Procedural due process clause of the 14th Amendment, statutes, and common law precedents. Petitions for female sterilization are granted in 36.4 % cases under the statutory penal codes, the Law of the land, precedents, and the dicta. No significant associations are found between the parity and degree of mental impairment (r = 0.342). Substantial correlations are met between the gender, degree of impairment (r (2) = 0.724), and dispositions (r (2) = 802). The mean age of women is 20.78 years; the mean age of men is 30.25 years. Correlations fail to establish reasoning between the age of the subjects and the entered judgments (r (2) = 0. 356).

CONCLUSIONS

(1) The female/male ratio (8:1) and age gap of the respondents indicate on a disproportionate impact of the statutes. (2) The procedure of sterilization in itself is incommensurate with equality, as the volume of surgery is uneven in males and females. (3) The case law is instructive with respect to which arguments have not been advanced. (4) Lastly, due to the etiological intricacy of mental impairment, with genetic transmission strikingly different in men and women, expert-witnesses ought to act in a medical vacuum because there is no mathematical certainty as to the transmission mode of the traits in question (exon and intron mutations, triplet repeat disorders, histone disorders, autosomal-dominant or autosomal-recessive transmission, sex chromosome-linkage, polygenomic imprinting, and organic reasons).

Trauma-informed Care and the Research Literature: How Can the Mental Health Nurse Take the Lead to Support Women Who Have Survived Sexual Assault?

Many women who access mental health services have been subjected to violent acts, including childhood sexual abuse and adult sexual assault, often at the hands of family members and partners. The vulnerability of these women can be further complicated when health professionals lack sensitivity to the issues involved; and the treatment received by the women is insensitive, leading to experiences of re-traumatisation. This article considers the principles of trauma-informed care and practice, as represented in the literature; and explains how mental health nurses can lead the way in multidisciplinary environments to ensure that women who have experienced violence receive the most appropriate health care, and are thereby supported to attain the best possible outcome.