Childhood sexual abuse severity and disclosure as predictors of depression among adult African-American and Latina women

The Strong Black Woman Archetype and Therapeutic Outcomes: Examining Relationships Among Women with Childhood Sexual Abuse Histories

The Strong Black Woman archetype (SBWA) describes a cultural pattern where Black women are expected to and present as physically and mentally strong, regardless of past and ongoing stressors. The SBWA has served the historical purpose of aiding survival for Black women throughout years of racial and gender oppression. However, the practice has also been associated with adverse mental health and with behaviors, such as self-silencing, that could impede therapeutic process. The purpose of this empirical study was to investigate the relationships between adherence to the SBWA and therapeutic outcomes (i.e., satisfaction with therapy, satisfaction with therapist, perceptions of one's global improvement in therapy) among Black women with childhood sexual abuse histories-a subpopulation at increased need for mental health treatment and who may be susceptible to high levels of adherence to the SBWA. Black adult female participants (N = 103) completed an online survey including a demographic questionnaire, an assessment of SBWA endorsement, and treatment outcomes from their current or most recent therapy experience. Three hierarchical linear regressions were conducted with SBWA as the independent variable and (i) satisfaction with therapist, (ii) satisfaction with therapy, and (iii) global improvement as the dependent variables. Consistent with our hypotheses, we found that SBWA inversely predicted satisfaction with therapy and the therapist. While the relationship between SBWA and global improvement was statistically significant, the finding was not practically significant. Still, our study findings suggest that higher levels of SBWA predict less favorable therapy outcomes. Future research directions and clinical implications are discussed.

Mental health and substance use among sexual minority women who report childhood sexual abuse: A systematic literature review

OBJECTIVE

A growing body of literature provides evidence that sexual minority women (SMW; e.g., lesbian, bisexual) are at greater risk of negative mental health and substance use outcomes than are heterosexual women. While minority stress may partially explain these disparities, it does not fully account for them. Therefore, it is necessary to identify how other risk factors (i.e., childhood sexual abuse [CSA]) contribute to SMW's increased risk of negative mental health and substance use outcomes.

METHOD

We conducted a systematic literature review to identify and synthesize the state of knowledge about CSA and mental health and substance use outcomes among SMW. Two independent reviewers screened 347 articles identified in searches of five databases (Web of Science, PsycInfo, CINAHL, PubMed, and Embase). Eligible articles were peer-reviewed, reported quantitative or mixed methods results focused on mental health or substance use outcomes among adult SMW with a history of CSA.

RESULTS

Twenty-four papers were included in the review. Findings clearly show that SMW report higher rates of CSA than heterosexual women. Findings also suggest that CSA may mediate the relationship between minority sexual identity and some negative outcomes.

CONCLUSIONS

Future studies should include minority stress factors, a broader range of mental health outcomes (apart from substance use and suicide), and more nuanced measures of CSA. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Novel methodologies using history to document the effects of African American sexual trauma: Perspectives of Gail E. Wyatt, PhD

This article describes the nearly half a century career of Dr. Gail E. Wyatt, PhD, and her development of novel methodologies and measures of sexual trauma, specifically the Wyatt Sex History Questionnaire and the University of California, Los Angeles, Life Adversities Screener. These approaches broke the silence around experiences of sexual violence, particularly among African Americans, identifying their effects on sexual functioning and mental health. These novel methods are designed without assuming sexual literacy of respondents, knowledge of anatomy, or that discussing sex is easy or common; they include topics that are considered private and may evoke emotions. Trained professionals administering face-to-face interviews can serve to establish rapport and educate the participant or client while minimizing possible discomfort and shame around the disclosure of sexual practices. In this article, four topics are discussed focusing on African Americans, but they may also be relevant to other racial/ethnic groups: (a) breaking the silence about sex, (b) sexual harassment: its disclosure and effects in the workplace, (c) racial discrimination: identifying its effects as a form of trauma, and (d) the cultural relevance of promoting sexual health. Historical patterns of abuse and trauma can no longer be ignored but need to be better understood by psychologists and used to improve policy and treatment standards. Recommendations for advancing the field using novel methods are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence of Child Sexual Abuse in Spain: A Representative Sample Study

The prevalence of child sexual abuse (CSA) is difficult to assess, and rates vary widely across studies due to methodological and sample differences. In Spain, prevalence data from representative samples are lacking. The objective of this study was to determine the prevalence of different CSA experiences in a sample that was representative of the Spanish population in terms of gender, age, and region. The sample comprised 1,071 (539 male and 532 female) Spanish adults (M_age = 45.37; SD = 14.84). Participants completed an anonymous online survey about different types of CSA and were asked whether they had disclosed the experience at the time. Prevalence was analyzed as a function of gender and generation. Results indicated prevalence rates ranging from 2.8% to 18.5%, depending on the type of experience. The most common experience suffered during childhood was being shown pornographic material, while that with the lowest prevalence was being forced to perform a sexual act involving penetration. Prevalence was higher in females than males for eight of the ten experiences considered. Young adults from Generation Z were the most likely to report having suffered three of the CSA experiences, two of them related to technology. Only 27.5% of respondents said that they had told someone about the abuse at the time, mainly their mother (more common among females) or a friend/peer (more frequent among males). The results suggest that CSA is prevalent in Spain, with considerable rates for several types of abusive experience, especially among females and the youngest generation. The implications of the results are discussed. The findings may inform social policy and the development of effective prevention programs.

Assessing the Influence of Child Sexual Behavior on Depression among Black SMM in the Southeastern United States

Limited studies have examined the associations between child sexual abuse (CSA) and depression among Black sexual minority men (SMM) in the Southeastern United States (US). As, such, the current study examined the critical gap in understanding the impact of CSA on Black SMM's mental health. Specifically, we tested the associations between contextual CSA factors and depression among a large population-based sample of Black SMM living in two cities in the Southern US. Data were obtained from the MARI Study, a sample of Black SMM ages 18-66 years, recruited from the Jackson, MS and Atlanta, GA metropolitan areas (n = 507). Depression was assessed using the 9-item CES-D scale. We conducted multivariable regression analyses to examine the association between depression with history of CSA and other child sexual-related variables (i.e., age of perpetrator and age of sexual abuse), controlling for key confounders. Our results indicated that CSA (β = 0.14, p < 0.001) was positively associated with depression. Our results also indicated that Black SMM who reported being sexually abused at the ages of 6 to 10 (β = 0.30, p < 0.01) and 16 to 18 (β = 0.25, p < 0.05) were positively associated with depression. These findings suggest that there is a need to provide culturally and safe mental health services in the Southeastern US for CSA survivors.

Longitudinal trajectories of depressive symptoms among sexually abused adolescents involved in child protection services

BACKGROUND

Childhood sexual abuse (CSA) contributes to depression in several populations. However, there is a significant lack of longitudinal research on depressive symptoms among sexually abused adolescents involved in Child Protection Services (CPS). Given the systemic challenges in CPS research, it is also unclear as to whether depressive symptoms vary according to CSA severity.

OBJECTIVE

The research aimed to determine whether depressive symptoms increased over time and to assess whether CSA severity predicted the variation of change in depressive symptoms over time.

PARTICIPANTS AND SETTING

The study included 135 sexually abused adolescents (M = 16.01, 71.9 % female) from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study who were involved in three densely populated urban CPS agencies in Ontario, Canada.

METHODS

The project involved the collection of self-report questionnaires to be completed every six-months for three years. The questionnaires encompassed measures on psychological outcomes, selected resiliency factors, and abuse and neglect history. Hierarchical Linear Modeling (HLM) via mixed model analyses were used to estimate depressive symptom trajectories.

RESULTS

We found that depressive symptoms significantly reduced over time (β. = -3.62, p < .001). Furthermore, the results showed that CSA severity significantly predicted depressive symptoms over time (β = 0.19, p < .001).

CONCLUSIONS

The findings contrast previous longitudinal research in community-based samples, suggesting a different trajectory for depressive symptoms among sexually abused adolescents involved in CPS. Moreover, the results reveal a strong association between depressive symptoms and CSA severity, further supporting early mental health screening practices.

Superwoman, Racial Identity, and Teen Dating Violence Victimization among Young Black Women

Young Black women consistently report the highest rates of teen dating violence (TDV) in the United States. They are also navigating a world in which they are facing historical marginalization and intersectional oppression. The Superwoman stereotypic role, in which Black women showcase strength and resist vulnerability, is often adapted in reaction to this normalized existence. Yet little research has examined how these constructs are related. In addition, research suggests that a positive racial identity may function as a psychological buffer against society's negative view of Black Americans and reduce involvement in violence. The current study examined the relationship between endorsement of a Superwoman role and TDV victimization among young Black women. A total of 481 Black women, aged 18-19, completed online survey measures assessing their racial identity beliefs, endorsement of racial stereotypes, and TDV experiences. The results of the path models showed that endorsement of a Superwoman role was associated with increased TDV victimization. Results also showed that racial centrality was inversely associated with TDV; the more the young women felt that being Black was a central part of their identity, the less they reported victimization. Findings suggest a need for attention to stereotype development and racial identity in the development of healthy romantic relationships for Black youth.

Exploring Correlates of Social Reactions to Disclosure Among Latina Sexual Assault Survivors

Social reactions to sexual assault (SA) disclosure are well-documented in the literature, but less is known about disclosure and reactions received by Latina survivors. The current study analyzed correlates of positive and negative social reactions to sexual assault disclosure in a community sample of Latina survivors (n = 239). Compared to White survivors, Latina survivors were more likely to report turning against and acknowledgement without support reactions. Among Latina survivors, contrary to hypotheses, both "stereotypical" (e.g. more violent assaults) and "non-stereotypical" (e.g. pre-assault substance use) assault characteristics were associated with acknowledgement without support negative social reactions. Furthermore, total number of sources Latina survivors disclosed to were associated with turning against social reactions. Implications for future research on disclosure/social reactions and Latina survivors are discussed.

An examination of the sociodemographic and psychiatric characteristics of children who have suffered penetrative and non-penetrative sexual abuse in Malatya, Eastern Turkey

Penetrative and nonpenetrative sexual abuse can cause short- and long-term psychiatric problems in victims. This study aimed to examine the sociodemographic characteristics and psychiatric diseases of children in Malatya, eastern Turkey, according to whether the abuse was penetrative or nonpenetrative. A retrospective examination was conducted on the records of 115 cases of sexual abuse that had been referred to judicial authorities from January 1, 2012-July 30, 2019. The subjects were evaluated by a committee formed of 5-7 separate specialized department faculty members. It was determined that 51.3% (n = 59) of the cases had suffered nonpenetrative sexual abuse, and 48.7% (n = 56) had suffered penetrative sexual abuse. The majority of the perpetrators were known to the child from their close environment. A psychiatric diagnosis was made by the committee in 20.3% (n = 12) of the nonpenetrative cases and in 42.9% (n = 24) of the penetrative cases. There was a significant difference between penetrative and nonpenetrative sexual abuse in terms of psychiatric diagnoses. Of the cases of penetrative sexual abuse, 87.5% (n = 14) had attempted suicide. As a result, early diagnosis of sexual abuse, which has devastating effects on mental health in the early and late periods before it penetrates, can reduce the devastating effects on the child. For this reason, it is crucial for doctors, psychologists, social workers, and teachers who work with children to be informed about this issue.

Sexual Self-Concept and Psychological Functioning of Women With a History of Childhood Sexual Abuse in Hong Kong

Sexual self-concept (SSC) is an important component of health that is closely associated with the well-being of survivors of child sexual abuse (CSA). Compared with non-CSA respondents, SSC of CSA survivors was deleteriously affected, resulting in ineffective psychological functioning (negative self-evaluation, psychological ill-health, and difficulties in interpersonal relationships). Negative SSC (sexual anxiety, sexual depression, and sexual fear) played a significant role in mediating the adverse effects of CSA on psychological functioning. Future studies may recruit a sample with greater variation in CSA characteristics and use externalizing problems as outcome measures to cross-validate findings of this study.

Estimation of the Development of Depression and PTSD in Children Exposed to Sexual Abuse and Development of Decision Support Systems by Using Artificial Intelligence

The most common diagnoses after childhood sexual abuse are Post-Traumatic Stress Disorder and depression. The aim of this study is to design a decision support system to help psychiatry physicians in the treatment of childhood sexual abuse. Computer aided decision support system (CADSS) based on ANN, which predicts the development of PTSD and Major Depressive Disorder, using different parameters of the act of abuse and patients was designed. The data of 149 girls and 21 boys who were victims of sexual abuse were included in the study. In the designed CADDS, the gender of the victim, the type of sexual abuse, the age of exposure, the duration until reporting, the time of abuse, the proximity of the abuser to the victim, number of sexual abuse, whether the child is exposed to threats and violence during the abuse, the person who reported the event, and the intelligence level of the victim are used as input parameters. The average accuracy values for all three designed systems were calculated as 99.2%. It has been shown that the system designed by using these data can be used safely in the psychiatric assessment process, in order to differentiate psychiatric diagnoses in the early post-abuse period.

The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life

BACKGROUND

Adverse childhood experiences (ACEs) have been shown to be associated with adult physical, psychological, and socioeconomic well-being, indicative of poor health-related quality of life (HRQoL). However, the association between child sexual abuse (CSA) and adult HRQoL, independent of other ACEs, has been less well examined.

OBJECTIVES

To examine associations between self-reported CSA, including the nature of CSA, and adult HRQoL.

PARTICIPANTS

Data are from 10,624 respondents to CSA and HRQoL questions on the 2015 Texas Behavioral Risk Factor Surveillance System survey.

METHODS

Analyses included chi square and t-tests to compare sociodemographic and HRQoL differences among those with and without history of CSA. Multivariable logistic regressions were used to evaluate associations between nature of CSA and HRQoL, controlling for covariates.

RESULTS

The prevalence of self-reported CSA in the sample was 10.3%. Compared to the non-exposed group, individuals exposed to CSA were more likely to report their general health as poor (AOR, 1.51; 95% CI, 1.09-2.09), report 14 or more physical unhealthy days (AOR, 1.46; 95% CI, 1.06-2.02), 14 or more mental unhealthy days (AOR, 1.86; 95% CI, 1.30-2.64), and 14 or more activity limitation days (AOR, 2.22; 95% CI, 1.58-3.10) in a month. HRQoL outcomes were worse for respondents who reported being forced to have sex as a child compared with those who reported being touched or forced to touch someone.

CONCLUSIONS

Self-reported CSA is associated with lower HRQoL. The association varies by the nature of reported sexual abuse. Understanding the long-term impacts of CSA can inform adult treatment options and policies to prevent and treat CSA.

Racial/ethnic discrimination: Dimensions and relation to mental health symptoms in a marginalized urban American population

That racial/ethnic discrimination has adverse physical and psychological consequences, including stress, anxiety, depression, and their attendant health effects, is well documented. However, the particular dimensions within the broad construct of discrimination and their role in mental health are less well understood. This study investigates the dimensions of discrimination and explores their relation to depression and posttraumatic stress (PTS) symptoms. Using the Brief Perceived Ethnic/Racial Discrimination Questionnaire-Community Version, discrimination experiences were assessed among a community sample of African American and Latinx participants (N = 500). Factor analyses revealed 4 dimensions: Social Rejection, Stereotyping, Direct Threats/Attacks, and Police Mistreatment. In multivariate analyses, full regression models were significantly related to PTS and depression symptoms. Among the individual predictors, Social Rejection and ethnicity (Latinx) uniquely contributed to PTS symptoms in men, whereas Stereotyping and Direct Threat/Attack were associated with PTS symptoms for women. In regards to depressive symptoms, income, ethnicity (Latinx), and Social Rejection were significant predictors for men, while Social Rejection had an independent contribution for women. Thus, social rejection emerged as a significant unique predictor in 3 of the four models, suggesting that social ostracism may be a particularly harmful aspect of discrimination. Implications of these findings include the use of proactive and intervention strategies that emphasize a sense of belonging and mitigate the effects of exclusion and rejection. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Family processes among Latino Early Head Start families: Understanding the role of caregiver acculturation

The Family Stress Model (FSM) provides a framework for how economic pressure can impact family processes and outcomes, including parent's mental health, parenting, and child problem behaviors. Although the FSM has been widely replicated, samples disproportionately impacted by poverty, including early childhood samples and in particular Latino families with young children, have been largely excluded from FSM research. Therefore, among a sample of Latino Early Head Start children (N = 127), the current study evaluated a modified FSM to understand the direct and indirect pathways among economic pressure, parental depression, parenting self-efficacy, the parent-child relationship, child problem behaviors, and parental acculturation. Results showed that the majority of the direct FSM pathways were well-replicated among Latino caregivers of young children. Further analyses illuminated how some pathways were replicated among more but not among less-acculturated Latino parents. Implications for future FSM research with Latino families as well as for parent-focused interventions are discussed.

Social reactions to disclosure of interpersonal violence and psychopathology: A systematic review and meta-analysis

Public attention has been increasingly paid to how friends, family members, and others can best support survivors of sexual assault and other forms of violence. The broader social support literature posits that perceiving social support positively is more important to mental health than the degree to which social support is actually received, and that negative interactions with social supporters are more harmful than positive interactions are helpful (potentially because negative reactions violate survivors' expectations of their social supporters). This may be especially true after a crisis, such as interpersonal violence. Thus, this systematic review and meta-analysis summarizes the literature on social reactions to interpersonal violence. Meta-regression analyses were performed on 1871 correlations from 51 studies reflecting the degree to which receiving specific reactions more frequently, or perceiving reactions more positively, was associated with psychopathology. Results indicated that negative social reactions to disclosure-especially reactions involving controlling, distracting, and treating survivors differently-were associated with worse psychopathology, whereas positive social reactions did not appear to be protective. Perceiving reactions more positively was associated with less severe psychopathology, but (although causation cannot be concluded) positive perceptions' potential benefit appeared to be smaller than the potential risk conveyed by negative reactions. These findings indicate that interventions which reduce the degree to which survivors receive negative social reactions are needed.

An Exploration of Coping with Childhood Sexual Abuse in Arab American Women

This research used a descriptive qualitative approach to explore coping with childhood sexual abuse (CSA) and to identify long-term psychological outcomes among Arab American women. Ten Arab American women participated in the study. Data were collected by individual semi-structured interviews and analyzed using content analysis. Five categories emerged for CSA experience among the participants: CSA characteristics, social support, Arabic culture, coping, and long-term psychological outcomes. Most of the women had experienced familial and contact CSA . and had disclosed their CSA and received different reactions from family and friends. Arabic cultural values influenced the women's experience of CSA and their coping strategy, especially regarding the CSA disclosure and seeking mental health services. The women used a spectrum of strategies to cope with their abuse including seeking support, positive reappraisal,,, accepting responsibilities, avoidance and protective coping. All women experienced negative long-term psychological outcomes of CSA such as flashbacks and low self-esteem. Prior to this research, no known studies have explored coping with CSA experience among Arab American women. Thus, this study can be used to inform practice guidelines to minimize the stigma of CSA and to promote help-seeking behavior for Arab American female CSA survivors and their families.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.

Childhood physical maltreatment with physical injuries is associated with higher adult psychopathology symptoms

BACKGROUND

Previous research has neglected the distinction between childhood physical maltreatment (CPM) behaviors and the physical sequelae resulting from CPM. Prior empirical work has combined CPM behaviors (e.g., beat, hit with a belt) and CPM physical sequelae (e.g., bruises, fractures) into a single conceptual category to predict adverse psychological consequences in adults. This is preventing the examination whether specific subgroups of CPM exposure may report a higher risk of psychopathology symptoms in adulthood. The aim of this study was to examine whether distinct experiences of CPM histories (no physical maltreatment, physical maltreatment only, and physical maltreatment with physical sequelae) would be differentially associated with specific psychopathology dimensions in adulthood. symptoms METHOD: Data were drawn from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect (N = 941). Participants completed the Childhood History Questionnaire and the Brief Symptom Inventory.

RESULTS

Three groups were created based on participants' experience of CPM assessed by the Childhood History Questionnaire. Participants who reported that suffered physical sequelae of the CPM exhibited significantly higher symptoms in all psychopathology dimensions than participants with no history of CPM and participants that were exposed to physical maltreatment without sequelae.

CONCLUSIONS

These findings suggest that clinicians should discriminate CPM behavior from CPM physical sequelae in order to increase effectiveness of mental health treatment with adults with history of CPM. Our findings are discussed in light of the evolutionary-developmental frameworks of adaptative development and cumulative risk hypothesis.

Correlates of disclosure of sexual violence among Kenyan youth

INTRODUCTION

Sexual violence (SV) against children is a global health and human rights issue that can have short and long-term consequences for health and wellbeing. Disclosing SV increases the likelihood that children can access health and protective services and receive psychosocial support. Research in high-income countries has found that child SV survivors are more likely to disclose when they are girls/women, experience fewer SV events, and experience SV perpetrated by a stranger. No studies have examined correlates of SV disclosure in Kenya.

OBJECTIVE

The objective of this research was to assess the correlates of disclosing SV among Kenyan youth ages 13-24 who reported an SV experience before age 18.

METHODS

In 2010, the Kenya Ministry of Gender, Children and Social Development, the U.S. Centers for Disease Control and Prevention's (CDC) Division of Violence Prevention, the UNICEF Kenya Country Office, and the Kenya National Bureau of Statistics (KNBS) conducted a national survey of violence against children. These data were used to conduct weighted logistic regression analyses to determine which factors were correlated with reporting SV disclosure.

RESULTS

Among the 27.8% of girls/women and 14.5% of boys/men who reported SV before age 18, 44.6% of girls/women and 28.2% of boys/men reported to have disclosed the experience. In weighted logistic regression analysis, the odds of disclosure were lower among survivors who were boys/men and among survivors who reported more SV events, and higher when any perpetrator was a family member.

CONCLUSION

More context-specific research on SV disclosure among young people is needed globally.

Racial Differences in Pregnancy Intention, Reproductive Coercion, and Partner Violence among Family Planning Clients: A Qualitative Exploration

BACKGROUND

Unintended pregnancy (UIP) is a persistent public health concern in the United States disproportionately experienced by racial/ethnic minorities and women of low socioeconomic status. UIP often occurs with experiences of reproductive coercion (RC) and intimate partner violence (IPV). The purpose of the study was to qualitatively describe and compare contexts for UIP risk between low-income Black and White women with histories of IPV/RC.

STUDY DESIGN

Semistructured interviews were conducted with low-income Black and White women with histories of IPV or RC, ages 18 to 29 years, recruited from family planning clinics in Pittsburgh, Pennsylvania.

RESULTS

Interviews with 10 non-Hispanic Black women and 34 non-Hispanic White women (N = 44) were included in the analysis. Differences between White and Black women emerged regarding IPV/RC experiences, gender roles in intimate relationships, and trauma histories, including childhood adversity. Fatal threats and IPV related to childbearing were most influential among White women. Among Black women, pregnancy was greatly influenced by RC related to impending incarceration, subfertility, and condom nonuse, and decisions about contraception were often dependent on the male. Sexual abuse, including childhood sexual assault, in the context of sexual/reproductive health was more prominent among White women. Childhood experiences of neglect impacted pregnancy intention and love-seeking behaviors among Black women.

CONCLUSIONS

Racial differences exist in experiences of IPV/RC with regard to UIP even among women with similar economic resources and health care access. These findings provide much-needed context to the persistent racial/ethnic disparities in UIP and illustrate influences beyond differential access to care and socioeconomic status.

Early life maltreatment but not lifetime depression predicts insecure attachment in women

Early life maltreatment (ELM) poses a risk for the development of insecure attachment and depression over the life span, depending on the type of maltreatment (physical, sexual, emotional, neglect) and its severity. The aim of this study was to investigate the influence of ELM and lifetime depression on adult insecure attachment in a female sample (N = 188), consisting of n = 81 women with ELM and n = 107 without ELM. Women with ELM reported significantly higher scores on insecure attachment than women without ELM. A significant interaction effect for ELM × lifetime depression was found: Contradictory to the hypotheses, women with ELM but without lifetime depression scored highest on avoidant attachment, differing significantly from women with ELM and lifetime depression, even though the severity of ELM was higher among women with ELM and lifetime depression and they experienced significantly more severe neglect and sexual abuse, but not physical or emotional abuse. Regression analyses revealed that ELM was the only predictor of avoidant attachment, explaining 15.5% of the variance. Results underline the strong influence of ELM on adult attachment and are of special importance for prevention and intervention programs.

How the Interaction of Childhood Sexual Abuse and Gender Relates to HIV Risk Practices among Urban-Dwelling African Americans

Purpose

Previous research has demonstrated that HIV risk practices often differ based on gender and on whether or not people experienced sexual abuse during their formative (i.e., childhood and adolescence) years. The interaction of these two factors, which is the focus of this paper, has received limited attention.

Methods

Based on a model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2012 with 1,864 African American adults residing in Atlanta, Georgia in 80 strategically-chosen consensus block groups.

Results

Based on multiple regression and structural equation analyses, the interaction of sexual abuse and gender was found to be a significant predictor of involvement in (un)protected sex. The interaction of sexual abuse and gender also was related to condom use self-efficacy, which was one of the strongest factors underlying (un)protected sex.

Conclusion

The relationship of sexual abuse history and gender is relevant in the understanding of HIV risk practices. The interaction of these factors with one another and with other relevant influences that shape people's HIV risk profiles is complex. The Syndemics Theory approach used to conceptualize the relationships among relevant variables in this study is an effective way of trying to understand and address HIV risk practices.

Neurological changes in brain structure and functions among individuals with a history of childhood sexual abuse: A review

OBJECTIVE

Review literature focused on neurological associations in brain structure among individuals with a history of childhood sexual abuse (CSA).

METHODOLOGY

A review of literature examining physiological irregularities in brain structures of individuals with a history of CSA was conducted.

RESULTS

Results revealed that a history of CSA was associated with irregularities in the cortical and subcortical regions of the brain. These irregularities have been recognized to contribute to various cognitive, behavioral, and psychological health outcomes later in life. Age of CSA onset was associated with differential neurological brain structures.

CONCLUSION

Mental and behavioral health problems such as anxiety, depression, substance abuse, dissociative disorders, and sexual dysfunction are associated with CSA and may persist into adulthood. Research depicting the associations of CSA on neurological outcomes emphasizes the need to examine the biological and subsequent psychological outcomes associated with CSA. Early intervention is imperative for CSA survivors.

Associations between mental health, substance use, and sexual abuse experiences among Latinas

This study examined self-reported sexually abusive experiences in childhood and adulthood as correlates of current drug use, alcohol abuse, and depression and posttraumatic stress disorder (PTSD) symptoms. Participants were 204 Latina women 18-34 years old. Results indicated significant relationships between history of sexual abuse (regardless of age of occurrence), depression symptoms, PTSD symptoms, alcohol abuse, and drug use. When examined separately, childhood sexual abuse was associated with symptoms of depression, PTSD, and substance use but not alcohol abuse behaviors. Experiencing sexual abuse in adulthood was associated with symptoms of depression, alcohol abuse behaviors, and substance use but not PTSD symptoms. Structural equation modeling showed that substance use partially mediated the relationship between sexual abuse and mental health outcomes. These findings suggest mental health and substance use services should incorporate treatment for trauma, which may be the root of comorbid mental health and substance use issues.

Mediators of sexual functioning and marital quality in chronically depressed adults with and without a history of childhood sexual abuse

INTRODUCTION

Sexual dysfunction is common among depressed adults. Childhood sexual abuse (CSA) and depressive symptomology are among the risk factors for sexual dysfunction, and these factors may interact to predict adult relationship functioning. Several models have been developed postulating interactions between these variables.

AIM

We tested models of the effects of CSA and elucidate the associations between CSA, sexual dysfunction, depression severity, anxiety, and relationship quality in chronically depressed adults.

METHODS

Baseline data from 808 chronically depressed outpatients enrolled in the Research Evaluating the Value of Augmenting Medication with Psychotherapy study were evaluated using structural equation modeling.

MAIN OUTCOME MEASURES

The Inventory of Depressive Symptomology, self-report version (IDS-SR) assessed depression severity, and the Mood and Anxiety Symptom Questionnaire Anxious Arousal subscale assessed anxiety. Sexual function was assessed with the Arizona Sexual Experiences Scale (ASEX), and the Quality of Marriage Index (QMI) assessed relationship quality for patients in stable relationships.

RESULTS

CSA scores predicted depression severity on the IDS-SR, as well as lower relationship quality and sexual satisfaction. ASEX scores were significantly associated with depression severity but were not correlated with the QMI. Two models were evaluated to elucidate these associations, revealing that (i) depression severity and anxious arousal mediated the relationship between CSA and adult sexual function, (ii) anxious arousal and sexual functioning mediated the association between CSA and depression symptoms, and (iii) when these models were combined, anxious arousal emerged as the most important mediator of CSA on depression which, in turn, mediated associations with adult sexual satisfaction and relationship quality.

CONCLUSIONS

Although CSA predicts lower relationship and sexual satisfaction among depressed adults, the long-term effects of CSA appear to be mediated by depressive and anxious symptoms. It is important to address depression and anxiety symptoms when treating patients with CSA who present with sexual dysfunction or marital concerns.

Characterizing the sexual abuse experiences of young adolescents

The purpose of this descriptive study was to: (a) compare the demographics of maltreated youth initially labeled as sexually abused by the Department of Child and Family Services (DCFS) to maltreated youth classified as sexually abused using current and past case records, (b) identify differences in sexual abuse experiences and types of perpetrators between boys and girls, and (c) provide a detailed description of the sexual abuse experiences for boys and girls. Participants were youth ages 9-12 years old with a recent maltreatment allegation. The Maltreatment Case Record Abstraction Instrument (MCRAI) was used to code child welfare records of 303 maltreated youth of whom 60 experienced sexual abuse. Perpetrators were classified by gender into four categories (biological parent, parental figure, relative, and unrelated) and type of abuse was classified into three categories (penetrative, contact without penetration, and non-contact). Using Chi-Square tests, perpetrator categories and sexual abuse types were compared by child gender for significant differences. Only 23 (38.3%) of the 60 sexually abused youth were labeled as sexually abused in the most recent DCFS report when they entered the study. About three-quarters of the sexually abused youth experienced non-penetrative physical contact, 40% experienced penetration, and 15% experienced sexual abuse without physical contact. Most youth (91.7%) were victimized by a male, and 21.7% were abused by a female. Youth experienced a large range of sexual abuse experiences, the details of which may be important for exploration of consequences of childhood sexual abuse.

Persistence of chronic major depression: a national prospective study

BACKGROUND

Chronic major depressive disorder (CMDD) is highly prevalent and associated with high personal and societal cost. Identifying risk factors for persistence and remission of CMDD may help in developing more effective treatment and prevention interventions.

METHODS

Prospective cohort study of individuals participating in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1; n=43,093) and its 3-year follow-up (Wave 2; n=34,653) who met a diagnosis of CMDD at the Wave 1 assessment.

RESULTS

Among the 504 respondents who met criteria for present CMDD at Wave 1, only 63 (11.52%) of them continued to meet criteria of CMDD. A history of childhood sexual abuse, earlier onset of MDD, presence of comorbidity and a history of treatment-seeking for depression predicted persistence of CMDD three years after the baseline evaluation.

LIMITATIONS

Our sample is limited to adults, our follow-up period was only three-years and the diagnosis of CMDD at baseline was retrospective.

CONCLUSIONS

CMDD shows high rates of remission within three years of baseline assessment, although some specific risk factors predict a persistent course. Given the high personal and societal cost associated with CMDD, there is a need to develop and disseminate effective interventions for CMDD.

A sexual risk and stress reduction intervention designed for HIV-positive bisexual African American men with childhood sexual abuse histories

OBJECTIVES

HIV transmission risk is high among men who have sex with men and women (MSMW), and it is further heightened by a history of childhood sexual abuse (CSA) and current traumatic stress or depression. Yet, traumatic stress is rarely addressed in HIV interventions. We tested a stress-focused sexual risk reduction intervention for African American MSMW with CSA histories.

METHODS

This randomized controlled trial compared a stress-focused sexual risk reduction intervention with a general health promotion intervention. Sexual risk behaviors, psychological symptoms, stress biomarkers (urinary cortisol and catecholamines), and neopterin (an indicator of HIV progression) were assessed at baseline and at 3- and 6-month follow-ups.

RESULTS

Both interventions decreased and sustained reductions in sexual risk and psychological symptoms. The stress-focused intervention was more efficacious than the general health promotion intervention in decreasing unprotected anal insertive sex and reducing depression symptoms. Despite randomization, baseline group differences in CSA severity, psychological symptoms, and biomarkers were found and linked to subsequent intervention outcomes.

CONCLUSIONS

Although interventions designed specifically for HIV-positive African American MSMW can lead to improvements in health outcomes, future research is needed to examine factors that influence intervention effects.

Rates and predictors of prenatal depression in women living with and without HIV

Depression is a significant mental health and public health concern, and women living with HIV are at increased risk for depression. This risk may be especially elevated during pregnancy; however, few studies have attempted to identify rates and predictors of depression in pregnant, HIV-infected women. The purpose of the present study was to investigate rates and predictors of prenatal depression, such as history of depression, childhood sexual abuse (CSA), and social support among HIV-infected and HIV-uninfected women in Philadelphia, Pennsylvania. It was hypothesized that pregnant women with HIV will have higher rates of depressive symptoms and will exhibit a greater number of mood disorder diagnoses as compared to HIV-uninfected pregnant women. It was also hypothesized that HIV status, history of depression, CSA, and inadequate social support will emerge as predictors of depressive symptoms. A sample of 163 women, 31% (n=50) of whom were HIV-infected and 69% (n=113) of whom were HIV-uninfected, were recruited from an obstetrics/gynecology clinic affiliated with an urban university hospital. The Center for Epidemiological Studies-Depression Scale (CES-D) was used to identify depressive symptoms, and Modules A and D of the Structured Clinical Interview for DSM-IV (SCID) confirmed the presence of a mood disorder. Findings demonstrated that rates of depressive symptoms and mood disorder diagnoses during pregnancy did not differ according to HIV serostatus. History depression, CSA, and inadequate social support predicted depressive symptoms during pregnancy in this sample. Due to their association with depressive symptoms, history of depression, CSA, and inadequate social support may be important to identify during pregnancy.