Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status

Asociación Española de Neurogastroenterología y Motilidad (ASENEM) updated review on the management of functional abdominal pain

Functional abdominal pain is a disorder in which central and peripheral sensitization processes converge, leading to hypersensitivity and allodynia. Differential diagnosis is made with organic digestive, renal, gynecological, endocrine, or neurological diseases. Treatment should be individualized for each patient. In cases of debilitating pain, therapy combining drugs with different mechanisms of action can be initiated, while in less severe cases, therapy with a progressive introduction of drugs based on clinical response is advised. The first line includes general lifestyle advice and antispasmodic substances, like peppermint oil, anticholinergic/antimuscarinic, and calcium channels antagonists. In the second line of treatment, neuromodulating agents are added. Finally, when these measures fail, third-line treatments such as gabapentine and atypical antipsychotics are considered. Psychological interventions should be considered if specialized therapists are available to manage these disorders.

The Impact of Psychotrauma and Emotional Stress Vulnerability on Physical and Mental Functioning of Patients with Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic health condition thought to be influenced by personal life experiences and emotional stress sensitivity (neuroticism). In the present study, we examined the impact of cumulative trauma experiences and trait neuroticism (as a measure for emotional stress vulnerability) on physical and mental functioning of n = 211 patients diagnosed with IBD (112 Crohn's disease, 99 ulcerative colitis). All patients were assessed for self-reported trauma histories, emotional stress vulnerability, clinical disease activity, functional gastrointestinal (GI) symptoms, and quality of life. Results showed that patients with severe IBD activity have endured significantly more interpersonal trauma and victimization than those with quiescent IBD. Moreover, cumulative trauma was found to exert an indirect (neuroticism-mediated) effect on patients' symptom complexity, with trauma and neuroticism conjointly explaining 16-21% of the variance in gastrointestinal and 35% of the variance in mental symptoms. Upon correction for condition (using a small group of available controls, n = 51), the predictive capacity of trauma and neuroticism increased further, with both predictors now explaining 31% of the somatic-and almost 50% of the mental symptom heterogeneity. In terms of trauma type, victimization (domestic violence and intimate abuse) proved the best predictor of cross-sample symptom variability and the only trauma profile with a consistent direct and indirect (neuroticism-mediated) effect on patients' mental (QoL) and physical fitness. Results are consistent with the growing body of evidence linking experiential vulnerability factors (trauma and neuroticism) and associated feelings of personal ineffectiveness, helplessness, and uncontrollability to interindividual differences in (GI) disease activity and quality of life.

Adverse Impact of Intimate Partner Violence Against HIV-Positive Women During Pregnancy and Post-Partum: Results From a Meta-Analysis of Observational Studies

Objectives: Intimate partner violence (IPV) against pregnant or human immunodeficiency virus (HIV)-positive women have been previously studied. However, data on the impact of IPV on HIV-positive pregnant women have not been systematically synthesized. We performed a meta-analysis to explore this issue and provide evidence regarding IPV prevention and HIV infection control. Method: The PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched. Studies that quantitatively assessed the association between IPV and its adverse impact on HIV-positive women during pregnancy and post-partum were eligible for inclusion. Pooled odds ratios (ORs) were calculated. Findings: Eight studies were identified to meet our eligibility criteria. The adverse impacts of IPV against HIV-positive pregnant women mainly included nonadherence to maternal antiretroviral treatment during pregnancy, nondisclosure of HIV-positive status to male partners, nonadherence to infant antiretroviral prophylaxis, and antenatal depression. IPV caused a 180% and 145% increase in the odds of antenatal depression and nonadherence to infant antiretroviral prophylaxis, respectively, among HIV-positive women, compared to the odds of their IPV-free counterparts [OR = 2.80, 95% confidence interval (CI): 1.66-4.74; OR = 2.45, 95% CI: 1.40-4.27]. Conclusion: Limited evidence has suggested that IPV against HIV-positive pregnant women caused maternal depression during pregnancy and led to the possible failure of HIV prophylaxis adherence in infants. Interventions to address IPV may ultimately reduce the risk of depression-related adverse birth outcomes and vertical transmission in infants exposed to maternal HIV. Prevention and control against IPV should be developed for HIV-positive pregnant women.

The role of family doctors in the management of domestic violence cases - a qualitative study in Portugal

BACKGROUND

Domestic violence leads to multiple health problems in victims and their families. Family doctors are in a particularly privileged position to detect, follow up, refer and report cases of domestic violence. However, little is known about the perception of these physicians regarding their role in managing domestic violence cases.

METHODS

We conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews were audio recorded, transcribed, and analysed using thematic analysis.

RESULTS

Fifty-four family doctors participated in this study (n = 39 women, n = 15 men). The themes and subthemes that emerged from the data analysis translated doctors' broad responsibilities when approaching victims and aggressors. These included: "Implement preventive measures", "Empower the victim leading them to recognize the violent situation", "Detect domestic violence cases", "Treat health problems related to violence", "Provide emotional support", "Refer victims to specialized services", "Register the episode on the victims and/or aggressor clinical records", "Incentivize the victim to report", "Report the case to the authorities", "Intervene with the aggressor", "Protect other individuals" and "Follow up the patient and the process".

CONCLUSIONS

The results of this study provide an overview of the current practical approaches being adopted by physicians and may provide a base for developing new interventions to support physicians to manage cases of domestic violence.

Clinical Stakes of Sexual Abuse in Adolescent Psychiatry

BACKGROUND

The extent and nature of sexual abuse (SA) and its consequences in psychiatry are still poorly described in adolescence.

OBJECTIVE

This article describes the frequency of SA reported in an adolescent population hospitalized in psychiatry, and assesses its links with the severity of mental disorders and the medical issues of these adolescents.

METHODS

The study includes 100 patients for whom SA has been mentioned, among all patients aged 13 to 17 years old hospitalized for about 4 years. The characteristics of sexual abuse were correlated with the medical severity of the patients, as well as the number, the duration of their hospitalization(s), and the time until disclosure.

RESULTS

The results show the central place of SA in adolescent psychiatry, with a prevalence of 28.5% and a cumulative hospital stay which is five times longer than average. Correlations have been observed between the number of suicide attempts and the number of abuses reported. The medical severity of patients is significantly increased when the named aggressor is an adult. The number of hospitalizations is positively correlated with the number of reported abuses, as well as with the intrafamilial and adult status of the perpetrator. Finally, an early age of onset, repeated abuse, and the intrafamilial nature of the abuse are associated with a longer time to disclosure.

CONCLUSIONS

The severity of adolescent psychiatric situation is statistically in favor of a history of SA, which should therefore be actively explored during care.

Suicide and Inflammation

Suicide is a leading cause of death worldwide. Although the neurobiological dysfunction underlying suicidal behavior remains unclear, recent work suggests that the immune system may play a role in the pathophysiology of suicide. In this chapter, we discuss a nascent body of literature suggesting that peripheral and central nervous systems (CNS) inflammation are associated with suicidal behavior. Because early-life stress is a major risk factor for suicidal behavior and is also associated with immune dysregulation, we hypothesize that such immune dysregulation may be the mechanism by which childhood maltreatment leads to an increased risk of suicidal behavior and suicide. Targeting inflammatory processes may be a novel treatment strategy, especially in populations that have experienced childhood trauma and exhibit elevated inflammation. Future work should directly test the hypothesis that reducing inflammation would result in a reduction in suicidal behavior.

Adverse Childhood Experiences and Their Effect on Irritable Bowel Syndrome Among Saudi Arabian Adults

Background

Adverse childhood experiences (ACEs) are traumatic events that occur before 18 years of age. ACEs have been associated with many negative health problems, including the development of chronic diseases, such as irritable bowel syndrome (IBS), a functional gastrointestinal disorder characterized by abdominal pain. We investigated the prevalence of ACEs among patients with IBS, identified the types of ACEs commonly related to patients with IBS, and further assessed the impact of ACEs on IBS severity.

Methodology

A cross-sectional study was performed. The study targeted patients with IBS aged ≥ 18 years who were recruited from gastroenterology outpatient clinics at King Abdulaziz University Hospital. Adults were contacted and invited to take part in the study by completing a survey. Data were collected using two validated questionnaires, the ACE questionnaire for adults and the IBS symptom severity scoring system.

Results

The study included 109 patients with IBS (59.6% females). The prevalence of ACEs (patients with IBS exposed to at least one ACE) was 63.3%. The most prevalent type was emotional abuse (34.9%), followed by both physical abuse and emotional neglect (28.4%). Females reported significantly more ACEs (p = 0.035) than males. The overall IBS symptoms (r = 0.195, p = 0.043) and abdominal pain (r = 0.240, p = 0.012) severity were significantly correlated with total ACEs score.

Conclusions

Our findings point to a probable association between ACEs exposure and IBS, demonstrating their long-term impacts on symptoms severity. Further studies are needed to acquire a better understanding of the potential impact of ACEs on IBS.

The Experiences of Persistent Pain Among Women With a History of Intimate Partner Violence: A Systematic Review

Women experience persistent pain at higher rates than men; however, women are less likely to be provided with adequate or appropriate care and more likely to have their pain experiences dismissed. The purpose of this review is to consider the complex interaction of the biopsychosocial factors in the experience of persistent pain in order to inform improved models of care. Given persistent pain is among the most frequently reported health consequences of intimate partner violence (IPV), this review focused on studies exploring the association between persistent pain and IPV. Three reviewers independently and systematically searched seven databases. Qualitative and quantitative studies describing the association between IPV and persistent pain published between January 2000 and June 2018 were included. Twelve studies met the inclusion criteria. The included studies demonstrated that a history of IPV places an additional burden on women who experience persistent pain that cannot be explained by an underlying psychological condition. Health care practitioners should be aware of this phenomena to ensure diagnosis, assessment, and treatment plans are targeted accordingly. Future policy directives and research should account for and seek to elucidate this additional burden.

Psychological Flexibility, Pain Characteristics and Risk of Opioid Misuse in Noncancerous Chronic Pain Patients

Chronic pain has an estimated annual prevalence rate between 10 and 35%. In the US, first-line treatment for chronic pain is often opioids.

OBJECTIVE

To our knowledge, this is the first study exploring psychological flexibility and its association with pain severity, pain interference and risk of opioid misuse in chronic pain patients.

METHODS

Data were collected at two outpatient pain clinics in the northeastern United States. Adults (N = 99) completed a cross-sectional survey with validated measures. Pain severity and pain interference were hypothesized to uniquely predict the risk of opioid misuse. Pain severity was hypothesized to predict pain interference. Finally, psychological flexibility was hypothesized as an indirect effect in these relationships.

RESULTS

Main findings suggest that pain severity predicts risk of opioid misuse, mediated by psychological flexibly. Pain interference also predicts risk of opioid misuse, mediated by psychological flexibility. Finally, results suggest pain severity predicts pain interference, mediated by psychological flexibility.

DISCUSSION

Implications of findings are discussed in terms of future psychological and medical assessments and interventions for chronic pain patients seeking prescription opioids.

Impact of abuse on migraine-related sensory hypersensitivity symptoms: Results from the American Registry for Migraine Research

BACKGROUND AND OBJECTIVES

Prior studies have established an association between a history of abuse and the development of migraine. This cross-sectional observational study explored the relationship between self-reported abuse history with migraine-related sensory hypersensitivity symptoms.

METHODS

In total, 588 adult patients with migraine from the American Registry for Migraine Research completed questionnaires: Generalized Anxiety Disorder-7, Patient Health Questionnaire-2 for depression, Photosensitivity Assessment Questionnaire, Hyperacusis Questionnaire, and Allodynia Symptom Checklist. Using four binary screening questions, patients were asked to self-report if they believed they had suffered emotional, physical, or sexual abuse in their lifetime. Differences in questionnaire scores between groups with and without a history of abuse were determined. Regression models adjusted for age, sex, and basic headache features analyzed the relationship between abuse history and sensory hypersensitivity symptoms. Moderation analysis explored the role of headache frequency in this relationship. Mediation analysis assessed the indirect (Mediated) effect (IE) of abuse on sensory hypersensitivity through depression or anxiety. Additional models analyzed relationships between sensory hypersensitivity symptoms and abuse subtypes or the number of abuse subtypes.

RESULTS

Of 588 participants, 222 (38%) reported a history of abuse. Patients with a history of abuse reported statistically significantly greater average headache frequency (7.6 vs. 4.7 days, p = 0.030). Patients with a history of abuse also reported higher average or median questionnaire scores: anxiety (7.6 vs. 4.7, p < 0.001, d = 0.56), depression (1.7 vs. 1.3, p = 0.009, d = 0.24), photophobia (0.54 vs. 0.44, p < 0.001, d = 0.32), hyperacusis (19.6 vs. 14.9, p < 0.001, d = 0.49), ictal allodynia (6.0 vs. 3.0, p < 0.001, d = 0.46), and interictal allodynia (1.0 vs. 0.0, p < 0.001, d = 0.30). After controlling for patient age, sex and years lived with headache, abuse maintained a significant association with every sensory hypersensitivity measure. Headache frequency significantly moderated the relationship between a history of abuse with increased ictal allodynia (p = 0.036). Anxiety significantly mediated the relationships between abuse with photophobia (IE = 0.03, 95% CI = 0.01-0.04), hyperacusis (IE = 1.51, 95% CI = 0.91-2.24), ictal allodynia (IE = 0.02, 95% CI = 0.01-0.04), and interictal allodynia (IE = 0.02, 95% CI = 0.01-0.06). Depression significantly mediated the relationship between abuse with photophobia (IE = 0.02, 95% CI = 0.01-0.03) and with hyperacusis (IE = 0.45, 95% CI = 0.11-0.88). The association between the individual subtypes of abuse and the number of subtypes of abuse with sensory hypersensitivity symptoms varied.

CONCLUSION

A history of abuse is associated with greater migraine-related sensory hypersensitivity symptoms. To reduce the impact of abuse on migraine symptoms, future studies should explore mechanistic connections between abuse and migraine-associated symptoms.

Somatic symptoms following sexual assault in adolescents: a prospective longitudinal study

Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective cohort study of adolescents seen in specialized clinics in London in the first 6 weeks following a sexual assault and at 4-5 months follow-up. We enquired about somatic symptoms (headaches, abdominal pain and sickness) pre and post assault, and we assessed psychiatric disorders and functional impairment at follow-up using validated scales. Information was obtained on 94 females (mean age 15.6, SD 1.3). There was a statistically significant increase in the number of adolescents reporting somatic symptoms at 4-5-month follow-up (65/94, 69%) (p = 0.035), compared with estimated pre-assault rates (52/94, 55%) and a significant increase in somatic symptoms at follow-up among the victims of violent sexual abuse (p < .001). Subjects with somatic symptoms at follow-up had significant higher rates of psychiatric disorders - especially generalised anxiety disorder, panic disorder and major depressive disorders - as well as lower psychosocial functioning (p < 0.01), than those without somatic symptoms.

The Price of Pre-adolescent Abuse: Effects of Sexual Abuse on Perinatal Depression and Anxiety

INTRODUCTION

Childhood abuse is a major public health concern and a risk factor for subsequent poor maternal mental health. This study of 176 racially diverse women explored the associations between the histories of childhood sexual abuse and depression and anxiety during pregnancy, at six weeks postpartum, and 12 weeks postpartum.

METHODS

Data on depressive and anxiety symptoms were gathered during pregnancy, at six weeks postpartum, and 12 weeks postpartum. Sociodemographic data were collected during pregnancy, while data on childhood sexual abuse were gathered during the 12-week postpartum period. Bivariate analyses and repeated mixed-effects linear regression with bootstrapping were used to assess the association between childhood sexual abuse and perinatal depressive and anxiety symptoms.

RESULTS

Childhood sexual abuse was significantly associated with depressive symptoms (β = 2.52, 95% CI 1.72, 3.32, p < .001) and anxiety symptoms (β = 4.44, 95% CI 3.70, 5.81, p < .001) over time, while controlling for demographic characteristics and lifetime major depression and anxiety. Depressive and anxiety symptoms decreased over the perinatal period and were highest during pregnancy. Black women were more likely to report higher depressive symptoms (β = 1.35, 95% CI 0.51, 2.19, p = .002) and anxiety symptoms (β = 3.29 95% CI 1.72, 4.87, p < .001) over time compared to White women.

DISCUSSION

The results highlight the importance of assessing the long-term effects of childhood sexual abuse on perinatal depressive and anxiety symptoms to help inform the development of interventions for women, particularly Black women.

Traumatic Experience, Polytraumatization, and Perinatal Depression in a Diverse Sample of Adolescent Mothers

This study examines the prevalence of trauma subtypes, polytraumatization, and perinatal depression (PND) in a diverse sample of adolescent mothers to help inform PND prevention, screening, and treatment efforts. We conducted a secondary analysis of a sample (N = 210) of adolescent mothers aged 14 to 20 years from a prospective longitudinal study of PND. Participants were recruited from a county-based, public health prenatal clinic, and data were collected in the prenatal and postpartum periods. In this sample, 81% of adolescent mothers reported at least one trauma experience and 75% reported lifetime experience of intimate partner violence (IPV). The most prevalent trauma types among adolescent mothers reporting PND were sexual trauma prior to age 13 (11.9%), loss of a caregiver or sibling (28.3%), emotional adversity (17.1%), and polytraumatization (43%). Trauma is alarmingly prevalent among adolescent mothers. Results suggest standards of care for adolescent mothers should include screening adolescent mothers for trauma history and provision of appropriate referrals for IPV. Findings support the need for trauma-informed treatment in perinatal public health clinics to decrease potential health risks to both mother and baby.

Impact of hypnotic safety on disorders of gut-brain interaction: A pilot study

Functional gastrointestinal disorders, i.e., abdominal conditions without identifiable structural etiologies, are seen frequently in primary care and specialty practices. As subtle physiological processes have been identified as potential contributing factors to these functional disorders, these disorders have been recently relabeled, Disorders of Gut-Brain Interaction (DGBI). Moreover, some of these processes, e.g., sympathetic nervous system activity and inflammation, are being increasingly related to psychosocial factors such as situational stress and histories of trauma, abuse, and neglect. As the activity of the autonomic nervous system (ANS) has been long considered to be a contributory factor for DGBI, the present study utilized a theory-driven model based on the Polyvagal Theory to optimize ANS activity for the promotion of healthy digestive activity. Specifically, a hypnotic intervention to increase neuroception of safety was employed with three female college students diagnosed with functional dyspepsia and irritable bowel syndrome in a single-subject design. This intervention was found to be associated with increases in the experience of safe/warm positive affect and decreases in symptoms of functional dyspepsia and irritable bowel syndrome as well as depression and anxiety. The hypnotic intervention for the promotion of a sense of safety is recommended for the treatment of other functional somatic disorders as well as trauma-related conditions. Potential complications related to individuals with prolonged trauma and attachment issues also are reviewed.

Long-term healthcare utilisation following child sex abuse: A follow-up study utilising five years of medical data

BACKGROUND

Limited attention has been paid to the long-term physical health consequences experienced by CSA survivors. Research has found that CSA is often associated with increased health burden in adulthood. However, research in this area is plagued by a range of methodological difficulties, rendering it difficult to draw conclusions regarding the health status of CSA survivors.

OBJECTIVE

This research sought to investigate associations between child sexual abuse (CSA) victimisation and rates of subsequent healthcare utilisation.

METHOD

The forensic medical records of 2759 cases of CSA between 1964 and 1995 were linked to commonwealth Australian medical data recorded between 2010 and 2015. Differences in rates of health service utilisation during this five-year period were compared between CSA victims and a age and gender matched comparison cohort without known abuse history.

FINDINGS

CSA was associated with increased levels of attendance at health professionals (OR = 1.51, p < .001) for medical care and for consultations related to dental (OR = 1.28, p < .001) and chronic disease (OR = 1.23, p <.001). CSA was associated with lower mean rates of attendance at gynaecologists. Gender and age at abuse significantly influenced the relationship between CSA and frequency of health service utilisation.

CONCLUSIONS

Experiencing CSA was associated with increases in rates of contact with health professionals. Abused females and victims abused after 12 years of age demonstrated the greatest elevations in rates of service utilisation. These findings have significance for both researchers in this field, and medical practitioners providing primary care.

Associations between recent intimate partner violence and receipt and quality of perinatal health services in Uttar Pradesh

BACKGROUND

India suffers some of the highest maternal and neonatal mortality rates in the world. Intimate partner violence (IPV) can be a barrier to utilization of perinatal care, and has been associated with poor maternal and neonatal health outcomes. However, studies that assess the relationship between IPV and perinatal health care often focus solely on receipt of services, and not the quality of the services received.

METHODS AND FINDINGS

Data were collected in 2016-2017 from a representative sample of women (15-49yrs) in Uttar Pradesh, India who had given birth within the previous 12 months (N = 5020), including use of perinatal health services and past 12 months experiences of physical and sexual IPV. Multivariate logistic regression models assessed whether physical or sexual IPV were associated with perinatal health service utilization and quality. Reports of IPV were not associated with odds of receiving antenatal care or a health worker home visit during the third trimester, but physical IPV was associated with fewer diagnostic tests during antenatal visits (beta = -0.30), and fewer health topics covered during home visits (beta = -0.44). Recent physical and recent sexual IPV were both associated with decreased odds of institutional delivery (physical IPV AOR 0.65; sexual IPV AOR 0.61), and recent sexual IPV was associated with leaving a delivery facility earlier than recommended (AOR = 1.87). Neither form of IPV was associated with receipt of a postnatal home visit, but recent physical IPV was associated with fewer health topics discussed during such visits (beta = -0.26).

CONCLUSIONS

In this study, reduced quantity and quality of perinatal health care were associated with recent IPV experiences. In cases where IPV was not related to care receipt, IPV remained associated with diminished care quality. Additional study to understand the mechanisms underlying associations between IPV and care qualities is required to inform health services.

Risk and Protective Factors Related to Early Adverse Life Events in Irritable Bowel Syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a stress-sensitive disorder of brain-gut interactions associated with a higher prevalence of early adverse life events (EALs). However, it is incompletely understood how trauma severity or disclosure influence the risk of developing IBS or symptom severity.

AIMS

To determine whether (1) IBS patients report a greater number of EALs compared with healthy controls; (2) trauma severity and first age of EAL increase the odds of IBS; (3) confiding in others reduces the odds of IBS; (4) the number, trauma severity, and first age of EAL are associated with symptom severity; (5) sex differences exist.

METHODS

In total, 197 IBS patients (72% women, mean age=30.28 y) and 165 healthy controls (59% women, mean age=30.77 y) completed the Childhood Traumatic Events Scale, measuring severity of EALs and degree of confiding in others. Regression analyses were used to predict IBS status from EALs and association between gastrointestinal symptoms and EALs.

RESULTS

A greater number of EALs [odds ratio (OR)=1.36, 95% confidence interval (CI), 1.14-1.62; P<0.001] and higher perceived trauma severity (OR=1.13, 95% CI, 1.08-1.19; P<0.001) were associated with increased odds of IBS. Confiding in others decreased the odds of having IBS (OR=0.83, 95% CI, 0.72-0.96; P=0.012). The first age of EAL was not predictive of IBS. No sex differences were found.

CONCLUSIONS

Assessing the traumatic severity of EALs and amount of confiding in others is important as they can affect the risk of having IBS. Our findings emphasize early intervention to improve health outcomes in individuals with EALs.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort

Background

Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset.

Methods

Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes.

Results

T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2–3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (OR_adj = 1.14; 95% CI 1.02–1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI).

Conclusion

ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.

Traumatic stress and the autonomic brain-gut connection in development: Polyvagal Theory as an integrative framework for psychosocial and gastrointestinal pathology

A range of psychiatric disorders such as anxiety, depression, and post-traumatic stress disorder frequently co-occur with functional gastrointestinal (GI) disorders. Risk of these pathologies is particularly high in those with a history of trauma, abuse, and chronic stress. These scientific findings and rising awareness within the healthcare profession give rise to a need for an integrative framework to understand the developmental mechanisms that give rise to these observations. In this paper, we introduce a plausible explanatory framework, based on the Polyvagal Theory (Porges, Psychophysiology, 32, 301-318, 1995; Porges, International Journal of Psychophysiology, 42, 123-146, 2001; Porges, Biological Psychology, 74, 116-143, 2007), which describes how evolution impacted the structure and function of the autonomic nervous system (ANS). The Polyvagal Theory provides organizing principles for understanding the development of adaptive diversity in homeostatic, threat-response, and psychosocial functions that contribute to pathology. Using these principles, we outline possible mechanisms that promote and maintain socioemotional and GI dysfunction and review their implications for therapeutic targets.

Consequences of Elder Abuse and Neglect: A Systematic Review of Observational Studies

This article presents the results of a systematic review of the consequences of elder abuse and neglect (EAN). A systematic search was conducted in seven electronic databases and three sources of gray literature up to January 8, 2016, supplemented by scanning of citation lists in relevant articles and contact with field experts. All observational studies investigating elder abuse as a risk factor for adverse health outcomes, mortality, and health-care utilization were included. Of 517 articles initially captured, 19 articles met our inclusion criteria and were analyzed. Two reviewers independently performed abstract screening, full-texts appraisal, and quality assessment using the Newcastle-Ottawa Scale. Across 19 studies, methodological heterogeneity was a prominent feature; seven definitions of EAN and nine measurement tools for abuse were employed. Summary of results reveals a wide range of EAN outcomes, from premature mortality to increased health-care consumption and various forms of physical and psychological symptoms. Higher risks of mortality emerged as the most credible outcome, while the majority of morbidity outcomes originated from cross-sectional studies. Our findings suggest that there is an underrepresentation of older adults from non-Western populations and developing countries, and there is a need for more population-based prospective studies in middle- and low-income regions. Evidence gathered from this review is crucial in upgrading current practices, formulating policies, and shaping the future direction of research.

Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective

Chronic diffuse pain disorders, such as fibromyalgia, and functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, place substantial burden on those affected and on the medical system. Despite their sizable impact, their pathophysiology is poorly understood. In contrast to an approach that focuses on the correlation between heart rate variability (HRV) and a specific organ or symptom, we propose that a bio-evolutionary threat-related autonomic response—as outlined in the Polyvagal Theory—may serve as a plausible explanation of how HRV, particularly respiratory sinus arrhythmia (RSA), would index the pathophysiology of these disorders. Evidence comes from: (1) the well-documented atypical autonomic regulation of the heart common to fibromyalgia and irritable bowel syndrome reflected in dampened RSA, (2) the neural architecture that integrates the heart, pain pathways, and the gastrointestinal tract, (3) the common physical co-morbidities shared by chronic diffuse pain and FGIDs, many of which are functionally regulated by the autonomic nervous system, (4) the elevated risk of chronic diffuse pain and FGIDs following traumatic stress or abuse, (5) and the elevated risk of chronic diffuse pain and FGIDs in individuals with anxiety and panic disorders. This novel conceptualization points to a pathogenesis rooted in changes to brain-body autonomic feedback loops in response to evolutionarily-salient threat cues, providing an integrated biopsychosocial model of chronic diffuse pain and FGIDs and suggesting new, non-pharmacological treatment strategies.

Adverse life events, psychiatric history, and biological predictors of postpartum depression in an ethnically diverse sample of postpartum women

BACKGROUND

Race, psychiatric history, and adverse life events have all been independently associated with postpartum depression (PPD). However, the role these play together in Black and Latina women remains inadequately studied. Therefore, we performed a case-control study of PPD, including comprehensive assessments of symptoms and biomarkers, while examining the effects of genetic ancestry.

METHODS

We recruited our sample (549 cases, 968 controls) at 6 weeks postpartum from obstetrical clinics in North Carolina. PPD status was determined using the MINI-plus. Psychiatric history was extracted from medical records. Participants were administered self-report instruments to assess depression (Edinburgh Postnatal Depression Scale) and adverse life events. Levels of estradiol, progesterone, brain-derived neurotrophic factor, oxytocin, and allopregnanalone were assayed. Principal components from genotype data were used to estimate genetic ancestry and logistic regression was used to identify predictors of PPD.

RESULTS

This population was racially diverse (68% Black, 13% Latina, 18% European). Genetic ancestry was not a predictor of PPD. Case status was predicted by a history of major depression (p = 4.01E-14), lifetime anxiety disorder diagnosis (p = 1.25E-34), and adverse life events (p = 6.06E-06). There were no significant differences between groups in any hormones or neurosteroids.

CONCLUSIONS

Psychiatric history and multiple exposures to adverse life events were significant predictors of PPD in a population of minority and low-income women. Genetic ancestry and hormone levels were not predictive of case status. Increased genetic vulnerability in conjunction with risk factors may predict the onset of PPD, whereas genetic ancestry does not appear predictive.

Embodied pain in fibromyalgia: Disturbed somatorepresentations and increased plasticity of the body schema

Fibromyalgia syndrome (FMS) is a highly prevalent, chronic musculoskeletal condition characterized by widespread pain and evoked pain at tender points. This study evaluated various aspects of body awareness in a sample of 14 women with FMS and 13 healthy controls, such as plasticity of the body schema, body esteem, and interoceptive awareness. To this end, the Rubber Hand Illusion (RHI), the Body Esteem Scale (BES), and the Body Perception Questionnaire (BPQ) were used, respectively. Consistent with increased plasticity of the body schema, FMS patients scored higher, with large or very large effect sizes, across all three domains evaluated in the RHI paradigm, namely proprioceptive drift and perceived ownership and motor control over the rubber hand. Scores on all items addressed by the BES were consistently lower among FMS subjects (2.52, SEM .19 vs 3.89, SEM .16, respectively, p < .01, Cohen’s d = .38-.66). In the FMS sample, BES scores assigned to most painful regions also were lower than those assigned to the remaining body sites (1.58, SEM .19 vs 2.87, SEM .18, respectively, p < .01). Significantly higher scores (p < .01, Cohen’s d = .51-.87) were found in the FMS sample across awareness (3.57 SEM .15 vs 1.87 SEM .11), stress response (3.76 SEM .11 vs 1.78 SEM .11), autonomic nervous system reactivity (2.59 SEM .17 vs 1.35 SEM .07), and stress style 2 (2.73 SEM .27 vs 1.13 SEM .04) subscales of the BPQ. Intensity of ongoing clinical pain was found to be strongly correlated with interoceptive awareness (r = .75, p = .002). The results suggest a disturbed embodiment in FMS, characterized by instability of the body schema, negatively biased cognitions regarding one’s own body, and increased vigilance to internal bodily cues. These manifestations may be interpreted as related with the inability of incoming sensory inputs to adequately update negatively biased off-line somatorepresentations stored as long-term memory.

Impact of Abuse on Adjustment and Chronic Pain Disability: A Structural Equation Model

INTRODUCTION/AIM

Sexual abuse, state and trait psychosocial factors, pain intensity, and pain-related disability have been shown to be correlated among individuals with chronic pain. However, the interacting relationships among these factors are poorly understood. The current study aims to test model which examines the effect of abuse, state and trait psychosocial factors, and pain intensity on pain-related disability among individuals with chronic pain.

METHODS

In total, 229 participants diagnosed with chronic pain were recruited from a specialist chronic pain hospital in London, Ontario. Participants completed self-report measures related to sexual abuse history, pain intensity, personality (anxiety sensitivity, experiential avoidance, perfectionism), and adjustment (depression, anxiety, disability, maladaptive worrying). A path analysis was used to test the relationship among these variables.

RESULTS

The model provided a close fit to the data (χ21=17.02; P=0.71; root-mean-square error of approximation=0.00; normal fit index=0.97; comparative fit index=1.0). The model demonstrates the direct and indirect effects of childhood sexual abuse on state and trait psychosocial factors among individuals with chronic pain. Pain anxiety, maladaptive worrying, and pain intensity were the main determinants of pain-related disability.

DISCUSSION/CONCLUSIONS

The current model has important implications in understanding the interplay of factors involved in adjustment of individuals with chronic pain. Sexual abuse did not have a direct effect on pain-related disability. However, indirect effects through other psychosocial factors were demonstrated.

Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial

IMPORTANCE

The menopause transition and early postmenopausal period are associated with a 2- to 4-fold increased risk for clinically significant depressive symptoms. Although a few studies suggest that hormone therapy can effectively manage existing depression during this time, to our knowledge, there have been no studies testing whether hormone therapy can prevent the onset of perimenopausal and early postmenopausal depressive symptoms.

OBJECTIVE

To examine the efficacy of transdermal estradiol plus intermittent micronized progesterone (TE+IMP) in preventing depressive symptom onset among initially euthymic perimenopausal and early postmenopausal women. A secondary aim was to identify baseline characteristics predicting TE+IMP's beneficial mood effects.

DESIGN, SETTING, AND PARTICIPANTS

Double-blind, placebo-controlled randomized trial at the University of North Carolina at Chapel Hill from October 2010 to February 2016. Participants included euthymic perimenopausal and early postmenopausal women from the community, aged 45 to 60 years.

INTERVENTIONS

Transdermal estradiol (0.1 mg/d) or transdermal placebo for 12 months. Oral micronized progesterone (200 mg/d for 12 days) was also given every 3 months to women receiving active TE, and identical placebo pills were given to women receiving placebo.

MAIN OUTCOME MEASURES

Scores on the Center for Epidemiological Studies-Depression Scale (CES-D), assessed at baseline and months 1, 2, 4, 6, 8, 10, and 12 after randomization, and the incidence of clinically significant depressive symptoms, defined as a CES-D score of at least 16.

RESULTS

Of 172 participants, 130 were white (76%), and 70 were African American (19%), with a mean household income of $50 000 to $79 999. The mean age was 51 years, and 43 developed clinically significant depressive symptoms. Women assigned to placebo were more likely than those assigned to TE+IMP to score at least 16 on the CES-D at least once during the intervention phase (32.3% vs 17.3%; odds ratio [OR], 2.5; 95% CI, 1.1-5.7; P = .03) and had a higher mean CES-D score across the intervention period (P = .03). Baseline reproductive stage moderated the effect of treatment (β, -1.97; SEM, 0.80; P for the interaction = .03) such that mood benefits of TE+IMP vs placebo were evident among women in the early menopause transition (β, -4.2; SEM, 1.2; P < .001) but not the late menopause transition (β, -0.9; SEM, 0.3; P = .23) or among postmenopausal women (β, -0.3; SEM, 1.1; P = .92). Stressful life events in the 6 months preceding enrollment also moderated the effect of treatment on mean CES-D score such that the mood benefits of TE+IMP increased with a greater number of events (β, 1.22; SEM, 0.40; P = .003). Baseline estradiol levels, baseline vasomotor symptoms, history of depression, and history of abuse did not moderate treatment effects.

CONCLUSIONS

Twelve months of TE+IMP were more effective than placebo in preventing the development of clinically significant depressive symptoms among initially euthymic perimenopausal and early postmenopausal women.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01308814.

Traumatic events: exploring associations with maternal depression, infant bonding, and oxytocin in Latina mothers

Background

Childhood and adulthood traumatic experiences negatively impact maternal-infant bonding and increase risk of postpartum depression (PPD). Lower oxytocin levels have also been associated with PPD and compromised mother-infant bonding. Despite advances in these areas of investigation, much of the research has not included Latinas, who are important because they have high rates of fertility, traumatic events, and PPD.

Methods

To address gaps identified in the literature, we explored associations between traumatic life events, PPD, and bonding subscale scores (e.g., Impaired Bonding, Rejection and Anger, Anxiety about Care) in a sample of 28 Latinas. We also examined associations between these factors and oxytocin (OT). Wilcoxon signed-rank tests were employed to examine differences in subscale scores over time. Kruskal–Wallis one-way analysis of variance was used to examine differences in bonding subscale scores and OT by maternal depression status and traumatic events. We also explored interaction effects of traumatic events and OT AUC on bonding subscale scores.

Results

Women with PPD at 8 weeks had significantly higher Rejection and Anger subscale scores (p = 0.054) than non-PPD women, where higher scores represent more compromised bonding. Significant differences in Rejection and Anger (p = 0.042) and Anxiety about Care (p = 0.005) by adulthood traumatic histories were observed at 8 weeks postpartum. There was also a significant difference in Anxiety about Care scores at 4 weeks postpartum (p = 0.024) and Impaired Bonding at 8 weeks postpartum (p = 0.041) by trauma events involving an infant. There was a significant interaction between OT and childhood sexual abuse on Impaired Bonding (p = 0.038).

Conclusion

We observed differential responses in bonding subscale scores by traumatic histories. Women who experienced a trauma involving an infant had higher compromised bonding scores, whereas those with adulthood traumatic histories, such as intimate partner violence, had lower scores. We also found an interaction between childhood trauma and oxytocin levels on bonding scores, suggesting a physiological response to early abuse that can have implications on mothers’ bonding perceptions. These preliminary results suggest the need for additional research on the long-term emotional and physiological effects of traumatic events occurring prior to parturition.

Early Life Abuse Moderates the Effects of Intranasal Oxytocin on Symptoms of Premenstrual Dysphoric Disorder: Preliminary Evidence From a Placebo-Controlled Trial

Background: Although intranasal oxytocin (OXT) has been proposed to be a promising treatment for some psychiatric disorders, little research has addressed individual difference factors that may predict response to OXT. One such factor is early life abuse (ELA), which has widespread influences on social-emotional processing and behavior. This single-blind, placebo-controlled crossover trial examined the role of ELA in shaping the effects of intranasal OXT (vs. placebo) on daily behavioral symptoms in women with three or more prospectively-diagnosed cycling symptoms of premenstrual dysphoric disorder (PMDD). Methods: Participants were ten women with PMDD (n = 8) or subthreshold PMDD (n = 2), who had experienced ELA prior to age 13 (n = 5) or no ELA (n = 5). They completed two study visits during the late luteal (premenstrual) phase: once following administration of intranasal OXT and once following intranasal placebo (counterbalanced). Participants then self-administered OXT or placebo at home three times per day for 5 days or until menstrual onset, and prospectively rated daily emotional symptoms of PMDD. Power was adequate to detect medium main and interactive effects. Results: Among women with ELA, intranasal OXT (vs. placebo) increased the premenstrual emotional symptoms of PMDD, whereas among women without ELA, OXT decreased symptoms. Conclusion: This study adds to a growing literature highlighting the importance of considering historical social contexts and traits (such as ELA) as moderators of therapeutic response to OXT.

A nociceptive stress model of adolescent physical abuse induces contextual fear and cingulate nociceptive neuroplasticities

Adolescent physical abuse impairs emotional development and evokes cingulate pathologies, but its neuronal and circuit substrates are unknown. Conditioning adolescent rabbits with noxious colorectal distension for only 2 h over 3 weeks simulated the human child abuse in amplitude, frequency, and duration. Thermal withdrawal thresholds were unchanged suggesting that sensitized spinal mechanisms may not be operable. Unchanged weight, stools, colorectal histology, and no evidence of abdominal pain argue against tissue injury or irritable bowel syndrome. Contextual fear was amplified as they avoided the site of their abuse. Conditioning impacted anterior cingulate and anterior midcingulate (ACC, aMCC) neuron excitability: (1) more neurons responded to cutaneous and visceral (VNox) noxious stimuli than controls engaging latent nociception (present but not manifest in controls). (2) Rear paw stimulation increased responses over forepaws with shorter onsets and longer durations, while forepaw responses were of higher amplitude. (3) There were more VNox responses with two excitatory phases and longer durations. (4) Some had unique three-phase excitatory responses. (5) Long-duration VNox stimuli did not inhibit neurons as in controls, suggesting the release of an inhibitory circuit. (6) aMCC changes in cutaneous but not visceral nociception confirmed its role in cutaneous nociception. For the first time, we report neuroplasticities that may be evoked by adolescent physical abuse and reflect psychogenic pain: i.e., no ongoing peripheral pain and altered ACC nociception. These limbic responses may be a cognitive trace of abuse and may shed light on impaired human emotional development and sexual function.

The Role of Chronic Psychosocial Stress in Explaining Racial Differences in Stress Reactivity and Pain Sensitivity

OBJECTIVE

To examine the role of psychosocial factors in mediating the relationship between African American (AA) race and both increased pain sensitivity and blunted stress reactivity.

METHODS

Participants included 133 AA and non-Hispanic white (nHW) individuals (mean [SD] age, 37 [9]) matched for age, sex, and socioeconomic status. Participants underwent mental stress testing (Trier Social Stress Test) while cardiovascular, hemodynamic, and neuroendocrine reactivity were measured. Participants completed questionnaires assessing potential sources of psychosocial stress and were tested for pain responses to cold pain and the temporal summation of heat pulses. Mediation analyses were used to determine the extent to which exposure to psychosocial stress accounted for the observed racial differences in stress reactivity and pain.

RESULTS

Chronic stress exposure and reactivity to mental stress was largely similar among AAs and nHWs; however, AAs exhibited heightened pain to both cold (p = .012) and heat (p = .004). Racial differences in the relationship between stress reactivity and pain were also observed: while greater stress reactivity was associated with decreased pain among nHWs, reactivity was either unrelated to or even positively associated with pain among AAs (e.g., r = -.21 among nHWs and r = .41 among AAs for stroke volume reactivity and cold pressor intensity). Adjusting for minor racial differences in chronic psychosocial stress did not change these findings.

CONCLUSIONS

Accounting for psychosocial factors eliminated racial differences in stress reactivity but not racial differences in sensitivity to experimental pain tasks. Increased exposure to chronic stress may not explain AAs' increased pain sensitivity in laboratory settings.

Paradise Lost: The Neurobiological and Clinical Consequences of Child Abuse and Neglect

In the past two decades, much evidence has accumulated unequivocally demonstrating that child abuse and neglect is associated with a marked increase in risk for major psychiatric disorders (major depression, bipolar disorder, post-traumatic stress disorder [PTSD], substance and alcohol abuse, and others) and medical disorders (cardiovascular disease, diabetes, irritable bowel syndrome, asthma, and others). Moreover, the course of psychiatric disorders in individuals exposed to childhood maltreatment is more severe. Recently, the biological substrates underlying this diathesis to medical and psychiatric morbidity have been studied. This Review summarizes many of the persistent biological alterations associated with childhood maltreatment including changes in neuroendocrine and neurotransmitter systems and pro-inflammatory cytokines in addition to specific alterations in brain areas associated with mood regulation. Finally, I discuss several candidate gene polymorphisms that interact with childhood maltreatment to modulate vulnerability to major depression and PTSD and epigenetic mechanisms thought to transduce environmental stressors into disease vulnerability.

The Long-term Physical Health and Healthcare Utilization of Women Who Were Sexually Abused as Children

This article addresses the relationship between childhood sexual abuse and the long-term physical health and healthcare utilization of 148 female participants in an eight-year prospective study. Five factors of physical health emerged: General Health; Vegetative Health Symptoms; Colds and Flu; Gastrointestinal/Gynecological; and Healthcare Utilization. Abused females scored higher on the healthcare utilization and gastrointestinal/gynecological factors than comparison females. Abused females experiencing multiple perpetrators, violence, longer duration and older age at onset endorsed significantly more gastrointestinal/gynecological problems than did the other abused females and the comparison group. Findings suggest that: (1) sexual abuse affects long-term health outcomes and healthcare utilization; and (2) physical health sequelae of abuse may differentially affect females, depending upon the pattern of abuse characteristics.

Barriers to Screening and Possibilities for Active Detection of Family Medicine Attendees Exposed to Intimate Partner Violence

INTRODUCTION

In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors.

METHODS

In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme.

RESULTS

Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection.

CONCLUSION

All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection.

Centrally Mediated Disorders of Gastrointestinal Pain

Centrally Mediated Abdominal Pain Syndrome (CAPS), formerly known as Functional Abdominal Pain Syndrome, can be distinguished from other functional GI disorders by its strong central component and relative independence from motility disturbances. CAPS is a result of central sensitization with disinhibition of pain signals rather than increased peripheral afferent excitability. A newly described condition, Narcotic Bowel Syndrome (NBS)/Opioid-Induced GI Hyperalgesia, is characterized by the paradoxical development of or increases in abdominal pain associated with continuous or increasing dosages of opioids. Patients only have relief when opioids are withdrawn. We define both conditions in the context of epidemiology, pathophysiology, clinical evaluation and treatment, emphasizing the importance of a physician-patient relationship in all aspects of care.

Childhood Maltreatment Is Associated with Ulcerative Colitis but Not Crohn's Disease: Findings from a Population-based Study

BACKGROUND

Previous research suggests a link between childhood adversities and inflammatory bowel disease (IBD); however, study limitations prevent generalization of findings. To address this, the current study uses a Canadian population-based sample to investigate the relationship between 3 childhood adversities and 2 types of IBD while controlling for a range of factors.

METHODS

Secondary data analysis of a subsample of the nationally representative 2012 Canadian Community Health Survey-Mental Health consisted of those with no missing data on any of the variables of interest (n = 21,852). The survey response rate was 68.9%. This study used logistic regression to estimate odds ratios of 3 types of childhood adversities (physical abuse, sexual abuse, and witnessing parental domestic violence) separately for ulcerative colitis and Crohn's disease, each compared with those without IBD. The final model controls for sociodemographics, health behaviors, and mental health. The exposure was assessed by retrospective self-report, and the outcome was by self-report of a health professional diagnosis.

RESULTS

In a fully adjusted model, those who are physically (odds ratio = 2.28; confidence interval, 1.39-3.75) or sexually abused (odds ratio = 2.64; confidence interval, 1.61-4.33) during childhood had significantly higher odds of ulcerative colitis than their non-maltreated peers. No relationship is found between witnessing parental domestic violence and ulcerative colitis. None of the early adversities are significantly related to Crohn's disease.

CONCLUSIONS

Childhood physical and sexual abuse are related to ulcerative colitis, but not Crohn's disease. Future research that can address epigenetic and neuroendocrine factors should investigate pathways through which early adversities may translate into one type of IBD but not another.

Sexual abuse predicts functional somatic symptoms: an adolescent population study

The main aim of this study was to investigate the effect of childhood sexual abuse on medically not well explained or functional somatic symptoms (FSSs) in adolescents. We hypothesized that sexual abuse predicts higher levels of FSSs and that anxiety and depression contribute to this relationship. In addition, we hypothesized that more severe abuse is associated with higher levels of FSSs and that sexual abuse is related to gastrointestinal FSSs in particular. This study was part of the Tracking Adolescents' Individual Lives Survey (TRAILS): a general population cohort which started in 2001 (N=2,230; 50.8% girls, mean age 11.1 years). The current study uses data of 1,680 participants over four assessment waves (75% of baseline, mean duration of follow-up: 8 years). FSSs were measured by the Somatic Complaints subscale of the Youth Self-Report at all waves. Sexual abuse before the age of sixteen was assessed retrospectively with a questionnaire at T4. To test the hypotheses linear mixed models were used adjusted for age, sex, socioeconomic status, anxiety and depression. Sexual abuse predicted higher levels of FSSs after adjustment for age sex and socioeconomic status (B=.06) and after additional adjustment for anxiety and depression (B=.03). While sexual abuse involving physical contact significantly predicted the level of FSSs (assault; B=.08, rape; B=.05), non-contact sexual abuse was not significantly associated with FSSs (B=.04). Sexual abuse was not a stronger predictor of gastrointestinal FSSs (B=.06) than of all FSSs. Further research is needed to clarify possible mechanisms underlying relationship between sexual abuse and FSSs.

Suicidal Behavior Outcomes of Childhood Sexual Abuse: Longitudinal Study of Adjudicated Girls

Childhood sexual abuse (CSA) histories are prevalent among adolescent girls in the juvenile justice system (JJS) and may contribute to their high rates of suicidal behavior. Among 166 JJS girls who participated in an intervention trial, baseline CSA and covariates were examined as predictors of suicide attempt and nonsuicidal self-injury (NSSI) reported at long-term follow-up (7-12 years later). Early forced CSA was related to lifetime suicide attempt and NSSI history and (marginally) to postbaseline attempt; effects were not mediated by anxiety or depressive symptoms. Findings suggest that earlier victimization and younger entry into JJS are linked with suicide attempt and NSSI.

Fatigue in HIV-Infected People: A Three-Year Observational Study

CONTEXT

HIV-related fatigue remains the most frequent complaint of seropositive patients.

OBJECTIVES

To describe the natural course of fatigue in HIV infection, in a sample (n=128) followed for a three-year period.

METHODS

A longitudinal prospective design was used to determine what factors influenced changes in fatigue intensity and fatigue-related impairment of functioning in a community-dwelling sample of HIV-infected individuals. Participants were followed every six months for a three-year period. At each study visit, we collected data on a large number of physiological and psychosocial markers that have been shown to be related to fatigue in HIV-infected people. At three month intervals between study visits, we collected data on fatigue via mailed questionnaires.

RESULTS

Fatigue in HIV infection is largely a result of stressful life events, and is closely tied to the anxiety and depression that accompany such events. Fatigue did not remit spontaneously over the course of the study, indicating the need for interventions to ameliorate this debilitating symptom.

CONCLUSION

Intervening to help people who are suffering from HIV-related fatigue to deal with stressful life events may help to ameliorate this debilitating symptom.

The influence of early life sexual abuse on oxytocin concentrations and premenstrual symptomatology in women with a menstrually related mood disorder

Oxytocin (OT), associated with affiliation and social bonding, social salience, and stress/pain regulation, may play a role in the pathophysiology of stress-related disorders, including menstrually-related mood disorders (MRMD's). Adverse impacts of early life sexual abuse (ESA) on adult attachment, affective regulation, and pain sensitivity suggest ESA-related OT dysregulation in MRMD pathophysiology. We investigated the influence of ESA on plasma OT, and the relationship of OT to the clinical phenomenology of MRMD's. Compared to MRMD women without ESA (n=40), those with ESA (n=20) displayed significantly greater OT [5.39pg/mL (SD, 2.4) vs. 4.36pg/mL (SD, 1.1); t (58)=-2.26, p=0.03]. In women with ESA, OT was significantly, inversely correlated with premenstrual psychological and somatic symptoms (r's=-0.45 to -0.64, p's<0.05). The relationship between OT and premenstrual symptomatology was uniformly low and non-significant in women without ESA. In women with ESA, OT may positively modulate MRMD symptomatology.

Bullying, abuse and family conflict as risk factors for chronic pain among Dutch adolescents

PURPOSE

Psychosocial stress seems to serve as an important risk factor for the occurrence of pain. The present study aims to examine if early adversities, e.g. bullying, abuse and family conflict are risk factors for chronic pain in adolescents. The secondary aim of the present study was to describe the pain characteristics of chronic pain in adolescents in a community sample of Dutch adolescents.

METHODS

Participants in the present study were 15,220 adolescents, attending schools (grade 7 and 8) in Rotterdam, the Netherlands. Chronic pain was measured with a newly developed questionnaire; the Pain Barometer. Early adversities were measured using single-item questions from the Rotterdam Youth Monitor, a longitudinal youth health surveillance system. Cross-sectional associations between early adversities and chronic pain were investigated using logistic multilevel analysis, adjusted for potential confounding.

RESULTS

In school year 2010-2011, 9.2% of the 15,220 adolescents reported chronic pain. Physical abuse by others (OR = 1.51, 95% CI =  1.07-2.14), sexual abuse (OR = 1.46, 95% CI = 1.05-2.05), family conflict (OR = 1.79, 95% C = 1.61-1.99) and being bullied (OR = 1.23, 95% CI = 1.17-1.29) are more common in adolescents with chronic pain. Physical abuse (OR = 1.28, 95% CI = 0.95-1.71) by parents and parental divorce (OR = 1.07, 95% CI = 0.93-1.22) were not significantly related to chronic pain.

CONCLUSIONS

The results of the present study suggest that bullying, abuse and family conflict may be risk factors for chronic pain in adolescents. Early signalling these stressors might prevent chronic pain.

IMPLICATIONS AND CONTRIBUTION

Early adversities, i.e. physical and sexual abuse, being bullied and family conflict, might be risk factors for developing chronic pain. In addition, the present study suggests that chronic pain is common among Dutch adolescents and interferes with their daily activities. If future studies confirm our results, this knowledge can be used to improve the signalling and prevention of chronic pain in adolescents.

Health problems of partner violence victims: comparing help-seeking men to a population-based sample

BACKGROUND

National population-based studies show that 40%-50% of physical partner violence victims in a 1-year time period are men. However, studies assessing the health concerns related to partner violence victimization tend to focus on women, and none have assessed the health of male physical partner violence victims who sought help for their victimization.

PURPOSE

To understand men's mental and physical health concerns that may be related to partner violence victimization.

METHODS

In 2012-2013, two samples of men-611 physical partner violence victims who sought help and 1,601 men from a population-based sample-completed online questionnaires on their demographics, various types of partner violence victimization, physical health, mental health, and other risks. Data were analyzed using logistic regression, log binomial models, and robust Poisson models in 2013.

RESULTS

In comparison to the population-based sample of men, male partner violence victims who sought help had significantly poorer health, particularly with regard to post-traumatic stress disorder, depression, high blood pressure, sexually transmitted diseases, and asthma. These differences remained after controlling for sample differences in demographics, substance use, previous traumatic exposure, and social support.

CONCLUSIONS

Practitioners should assess for health problems among partner violence victims and for partner violence victimization among men presenting with health problems.

High prevalence of symptoms in a severely abused "non-patient" women population

OBJECTIVE

The objective of this article is to assess the prevalence of somatic symptoms and of gastrointestinal (GI) syndromes in abused "non-patient" women and the association with the time of perpetration, type, and severity of abuse.

METHODS

Sixty-seven women, 18-58 years, receiving shelter in anti-violence associations were invited to fill out an anonymous questionnaire with a medical and an abuse section. The severity of abuse was expressed as the 0-6 Abuse Severity Measure (ASM). The association between abuse characteristics and the number of symptoms, and GI syndromes was assessed by Poisson regression model.

RESULTS

Most women suffered from childhood and adulthood sexual and physical abuse. They reported a mean of 5.1 GI symptoms (range 0-13; median 5; IQR 6) and of 1.3 extra-GI symptoms (range 0-6; median 1; IQR 2); 30% of women matched the Rome II Criteria for one, 36% for two, and 4.4% for three or more syndromes, respectively. Women with an ASM of 5-6, having suffered from both sexual and physical abuse, reported significantly (p = 0.02) more GI symptoms, but not extra-GI ones (p = 0.07), and met criteria for more GI syndromes than women with an ASM ≤4 and those reporting only one type of abuse. No association was found between the time of perpetration of the abuse and the number of GI and extra-GI symptoms.

CONCLUSIONS

Symptoms in abused "non-patient" women mainly concern the abdomen and the GI tract. A history of severe, combined physical and sexual abuse is associated with a higher number of GI symptoms.

Association between functional gastrointestinal diseases and exposure to abuse in teenagers

Abdominal pain-predominant functional gastrointestinal diseases (AP-FGD) are common in children and commonly attributed to exposure to child abuse. However, this relationship has not been studied in teenagers, and the main objective of the current study was to assess it. Teenagers were recruited from four randomly selected schools in Western province of Sri Lanka. Data were collected using a validated self-administered questionnaire. AP-FGD were diagnosed using Rome III criteria. A total of 1850 teenagers aged 13-18 years were included. Three hundred and five (16.5%) had AP-FGD. AP-FGD were significantly higher in those exposed to sexual (34.0%), emotional (25.0%) and physical (20.2%) abuse, than in those not abused (13.0%, p < 0.001). Those with AP-FGD exposed to abuse had a higher severity score for bowel symptoms (30.8% vs. 24.7% in not abused, p < 0.05). This study highlights the importance of identifying exposure to abuse in management of teenagers with AP-FGD.

Attachment, childhood abuse, and IBD-related quality of life and disease activity outcomes

BACKGROUND

This study examined attachment style as a moderator of the relationship between childhood abuse and inflammatory bowel disease (IBD)-related outcomes.

METHODS

Study participants were 205 patients with IBD from Mount Sinai Hospital in Toronto. Participants completed self-report questionnaires regarding personal relationships, abuse history, and IBD-related information. Multiple regression models were fit using 3 outcome variables: disease-related quality of life (QOL), disease activity for ulcerative colitis, and disease activity for Crohn's disease.

RESULTS

Patients reporting less severe abuse and low levels of avoidant attachment had the highest levels of QOL, whereas patients reporting high levels of avoidant attachment had the lowest levels of QOL, regardless of abuse severity. Patients reporting greater anxious attachment had lower QOL scores. Patients reporting less severe abuse and low levels of avoidant attachment had the lowest levels of disease activity, whereas patients reporting high levels of avoidant attachment had the highest levels of ulcerative colitis-related disease activity, regardless of abuse severity. However, for anxious attachment, there was no significant main effect or significant interaction of abuse by anxious attachment on ulcerative colitis-related disease activity. Childhood abuse and attachment style were not found to be associated with Crohn's disease-related disease activity.

CONCLUSIONS

Adult attachment style may moderate the relationship between childhood abuse and IBD-related outcomes, by impacting one's QOL and disease activity. Distinct types of insecure attachment styles may impact these relationships differently. Psychological interventions focusing on attachment styles of patients with IBD have the potential to improve IBD-related QOL and disease activity.

History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain

OBJECTIVE

We sought to determine the relationship among a history of physical or sexual abuse, pain experience, and depressive symptoms among women with chronic pelvic pain (CPP).

STUDY DESIGN

This was a cross-sectional study of women who presented to a tertiary referral center for evaluation of CPP (N = 273). All participants completed standardized questionnaires to assess a history of physical or sexual abuse, pain severity, pain disability, and depressive symptoms. Subjects were grouped by abuse category and compared to CPP participants without history of abuse. Multinomial logistic regression models were used to determine the association between adolescent or adult and childhood physical or sexual abuse with pain intensity, pain-related disability, and depressive symptoms.

RESULTS

Logistic regression analyses indicated that, after controlling for age and education, none of the abuse categories was associated with pain severity. However, adolescent or adult sexual abuse predicted greater pain-related disability (odds ratio, 2.39; 95% confidence interval, 1.05-5.40), while both adolescent or adult physical and sexual abuse were associated with higher levels of depression (both P < .05). Level of education was significantly associated with pain intensity, pain disability, and depression.

CONCLUSION

For our sample of women with CPP, a history of abuse during childhood or adulthood was not associated with differences in pain intensity, but adolescent or adult sexual abuse was associated with greater pain-related disability. A history of physical abuse or sexual abuse appears to hold a stronger relationship with current depressive symptoms than pain experience for women with CPP. Educational achievement holds a robust relationship with pain morbidity and depression for this population.

Patterns of drug and alcohol use associated with lifetime sexual revictimization and current posttraumatic stress disorder among three national samples of adolescent, college, and household-residing women

Sexual revictimization (experiencing 2 or more rapes) is prevalent and associated with increased risk for posttraumatic stress disorder (PTSD) and substance use. However, no national epidemiologic studies have established the prevalence or relative odds of a range of types of substance use as a function of sexual victimization history and PTSD status. Using three national female samples, the current study examined associations between sexual revictimization, PTSD, and past-year substance use. Participants were 1763 adolescent girls, 2000 college women, and 3001 household-residing women. Rape history, PTSD, and use of alcohol, marijuana, other illicit drugs, and non-medical prescription drugs were assessed via structured telephone interviews of U.S. households and colleges in 2005-2006. Chi-square and logistic regression were used to estimate the prevalence and odds of past-year substance use. Relative to single and non-victims: Revictimized adolescents and household-residing women reported more other illicit and non-medical prescription drug use; revictimized college women reported more other illicit drug use. Past 6-month PTSD was associated with increased odds of drug use for adolescents, non-medical prescription drug use for college women, and all substance use for household-residing women. Revictimization and PTSD were associated with more deviant substance use patterns across samples, which may reflect self-medication with substances. Findings also could be a function of high-risk environment or common underlying mechanisms. Screening and early intervention in pediatric, primary care, and college clinics may prevent subsequent rape, PTSD, and more severe substance use.

Prevalence and risk factors for irritable bowel syndrome in recovered and non-recovered borderline patients over 10 years of prospective follow-up

This study examined rates of irritable bowel syndrome (IBS) over 10 years of prospective follow-up among recovered and non-recovered patients with borderline personality disorder (BPD). Subsequently, risk factors for IBS were examined in female BPD patients. As part of the McLean Study of Adult Development, 264 BPD patients were assessed at baseline, and their medical conditions and time-varying predictors of IBS were assessed over five waves of follow-up (from 6-year follow-up to 16-year follow-up). Semi-structured interviews were used to assess both our IBS outcome variable and our baseline and time-varying predictor variables. Rates of IBS were not significantly different between recovered and non-recovered borderline patients when men and women were considered together and when men were considered alone. However, a significant difference in IBS rates was found between recovered and non-recovered female BPD patients, with the latter reporting significantly higher rates. The rates of IBS in women with BPD were found to be significantly predicted by a family history of IBS and a childhood history of verbal, emotional and/or physical abuse. Taken together, the results of this study suggest that both biological/social learning factors and childhood adversity may be risk factors for IBS in women with BPD.