Childhood maltreatment among Hispanic women in the United States: an examination of subgroup differences and impact on psychiatric disorder

The Hispanic paradox in child maltreatment: Does it fade over time?

BACKGROUND

The "Hispanic Paradox" refers to a commonly noted tendency for Hispanic immigrants to have good health outcomes relative to risks faced. This paper demonstrates the presence of the Hispanic Paradox relative to child maltreatment, with a focus on how it appears to "fade" generationally.

OBJECTIVES

To use national child maltreatment and census data to determine if the protective effects of the Hispanic Paradox are weaker ("fade") for counties with fewer foreign-born Hispanics.

DESIGN

Census data, including the percentage of Hispanics in a county who were foreign-born, was used to predict child maltreatment rates as observed in the National Child Abuse and Neglect Data System. The analysis was done at a county level and included a number of covariates (e.g. Hispanic Median Income, Rural/Urban status…).

PARTICIPANTS AND SETTING

We included national child maltreatment data at the county level.

RESULTS

A negative binomial mixed effects model showed that for each point of increase in the percentage of the Hispanic foreign-born population of a county, the county Hispanic child maltreatment rate was expected to drop by 1 %. Variation in Hispanic national origin (i.e. Puerto Rico) was found to significantly moderate this relationship.

CONCLUSION

Counties with higher percentages of foreign-born Hispanics have lower child maltreatment rates after controlling for other factors. This is consistent with emerging findings in the child mortality data and suggests that for child maltreatment, the Hispanic Paradox may fade generationally.

Linkages Between Childhood Maltreatment, Intimate Partner Violence, and Posttraumatic Stress Disorder Symptoms in Pregnant Hispanic Women: A Network Analysis

Pregnant Hispanic women are at increased risk for posttraumatic stress disorder (PTSD) in part due to greater risk of childhood maltreatment, intimate partner violence (IPV), and pregnancy-related vulnerabilities. However, PTSD, is a highly heterogenous diagnosis with numerous presentations. Individual PTSD symptoms may be differentially associated with specific types of maltreatment, IPV. Determining how IPV exposure across the lifespan is associated with specific symptoms of PTSD in pregnant Hispanic women is necessary to develop group-relevant models of this disorder and targeted interventions. The present study examined a network model of PTSD symptoms, childhood maltreatment, and adulthood IPV in a sample of pregnant Hispanic women (N = 198). Childhood emotional abuse and adulthood psychological distress had the highest bridge centrality. These types of exposures were most strongly associated with social isolation. Childhood emotional abuse was associated with more individual PTSD symptoms than any IPV type. These findings suggest that associations between PTSD symptoms and different types of IPV exposure vary. In addition, robust associations between childhood emotional abuse and PTSD symptoms suggest that this domain may be particularly important for the clinical assessment and intervention for pregnant women.

Adverse childhood experiences and prenatal depression in the maternal and development risks from environmental and social stressors pregnancy cohort

The aim of this study was to examine the association between adverse childhood experiences (ACEs) and risk for depression among 480 predominantly low-income Hispanic/Latina women in the Maternal and Development Risks from Environmental and Social Stressors pregnancy cohort. Models were fitted to evaluate associations between ACEs and prenatal probable depression measured by the Center for Epidemiologic Studies-Depression Scale adjusting for recruitment site, age, income, race/ethnicity, marital status and parity. The ACEs Questionnaire parameterised experiences as counts (0-10), categories (0, 1-3 and 4+ ACEs) and domains. Participants had a significantly higher likelihood of prenatal probable depression per unit increase in ACEs count or if they reported 4+ ACEs relative to 0 ACEs. Higher likelihood of probable depression was also associated with higher counts of each ACEs domains: abuse, neglect and household dysfunction. Findings suggest systematic screening for depressive symptoms in those with a history of childhood adversities may be important in prenatal care practice.Impact StatementWhat is already known on this subject? Experiencing depression during pregnancy has been associated with later adverse maternal mental and physical health outcomes. Emerging studies indicate that adverse childhood experiences (ACEs) may maintain or increase the predisposition to prenatal depression.What do the results of this study add? Although prenatal depressive symptoms are prevalent among racial/ethnic minority samples including Hispanic/Latinas, research determining whether the association between ACEs and prenatal depression varies by nativity is scarce. Overall, ACEs were common among Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) participants and were associated with a higher likelihood of probable depression during pregnancy. These patterns did not significantly differ among the foreign-born versus U.S.-born Hispanic/Latina women, although the associations were stronger among U.S.-born Hispanic/Latina women.What are the implications of these findings for clinical practice and/or further research? Research should continue to focus on the effects of ACEs in communities that have been historically excluded in perinatal mental health services such as pregnant women from racial and ethnic minority groups. It may be important for clinicians to routinely screen for mental health during pregnancy as an adverse, psychological environment may impact both women and children. These findings suggest a need for improvement in systematic screening for depressive symptoms in those with a history of childhood adversities.

Prevalence of Interpersonal Violence Among Latinas: A Systematic Review

Violence against women continues to be a great concern in today's society. In the United States, women experience high rates of interpersonal violence throughout their lifetime. Among Latinas, interpersonal violence is also highly prevalent however the wide variation of interpersonal prevalence rates among Latinas is problematic. The aims of this systematic review of the literature were to (1) document the prevalence rates of violence among Latinas, (2) determine the types of violence that Latinas are most impacted by, and (3) assess the prevalence rates of interpersonal across Latina subethnicities. The research was based on seven databases including PsycArticles, PsycCRITIQUES, PsycINFO, ScienceDirect, Social Services Abstracts, Social Work Abstracts, and PubMED for articles published from January 2007 up to July 2017. The following key words were used in the search: (Latinas OR Latinos OR Hispanics) AND (victim OR victimization) AND (domestic violence OR intimate partner violence OR Interpersonal Violence). We identified 41 articles in our search that reported rates of interpersonal violence which ranged from 1% to 83% with intimate partner violence and domestic violence being the most prevalent. Interpersonal violence was found to be more prevalent among individuals who identified as Mexican. Based on the findings, it is clear that efforts should be focused on conducting a lager national survey of interpersonal violence among Latinas. It would need to include subethnicity, immigration status, and type of abuse experienced and possibly add socioeconomic factors.

The Healthy Immigrant Paradox and Child Maltreatment: A Systematic Review

Prior studies suggest that foreign-born individuals have a health advantage, referred to as the Healthy Immigrant Paradox, when compared to native-born persons of the same socio-economic status. This systematic review examined whether the immigrant advantage found in health literature is mirrored by child maltreatment in general and its forms in particular. The author searched Academic Search Premier, CINAHL, CINAHL PLUS, Family and Society Studies Worldwide, MEDLINE, PsychINFO, Social Work Abstracts, and SocINdex for published literature through December 2015. The review followed an evidence-based Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist. The author identified 822 unique articles, of which 19 met the inclusion criteria. The reviewed data showed strong support for the healthy immigrant paradox for a general form of maltreatment and physical abuse. The evidence for emotional and sexual abuse was also suggestive of immigrant advantage though relatively small sample size and lack of multivariate controls make these findings tentative. The evidence for neglect was mixed: immigrants were less likely to be reported to Child Protective Services; however, they had higher rates of physical neglect and lack of supervision in the community data. The study results warrant confirmation with newer data possessing strong external validity for immigrant samples.

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.

Culture and context in understanding child maltreatment: Contributions of intersectionality and neighborhood-based research

In the early 1990s, the U.S. Advisory Board on Child Abuse and Neglect commissioned a series of reviews that appeared as the edited volume, Protecting Children from Abuse and Neglect (Melton & Barry, 1994). Using the 1994 review "Sociocultural Factors in Child Maltreatment" (Korbin, 1994) as a background, this article reconsiders culture and context in child maltreatment work. Since 1994, conditions promoting research and practice attention in this area include immigration-driven global increases in diverse, multicultural societies where different beliefs and practices meet (and clash); expanding purview of the human rights discourse to children; and the disproportionate and disparate representation of cultural, ethnic, and racial groups in child-welfare systems. Although research on child maltreatment has advanced in many ways over 20 years, the complexity of child maltreatment leaves many critical questions demanding further attention, culture and context among them. To help address these questions, we propose two approaches for future maltreatment research: intersectionality - the simultaneous examination of multiple identities (such as gender, race, and socioeconomic status) - as a framework for understanding the complexity of cultural factors; and neighborhood-based research as a means for understanding the context of child maltreatment from the perspective of an ecological framework.

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.

Barriers to treatment engagement for depression among Latinas

In spite of successful treatment options for depression, the majority of Americans with severe depression do not receive treatment. Latinos are even less likely to engage in treatment than non-Hispanic Whites. The purpose of this study is to explore barriers to treatment engagement and, more specifically, how childhood adversity and gender-based violence (GBV) contribute to a lack of perceived support for treatment engagement. Experiences of GBV and childhood adversity can call into question deeply held family, cultural, and religious values, and affect the perceived quality of the therapeutic relationship and attitudes about depression treatment. A qualitative descriptive methodology was used to understand the experiences of a sample of 12 Latinas who were part of a diabetes prevention study (n = 67) and had been referred for treatment because of elevated symptoms of depression. Results indicate that the often-cited barriers to mental health care (i.e., language barriers, economic considerations, and lack of illness recognition) did not serve as deterrents for Latinas in this study. Participants recognized that they were depressed and agreed with the assessment of depression. However, none of the women followed up on the recommendation to seek care. What has emerged from this study is how cultural values, such as familismo and marianismo, and the lack of responsiveness from family and religious leaders in the context of exposure to GBV and childhood adversity created significant barriers to treatment engagement. This study highlights the need for nurses to screen for these exposures and to engage in shared decision making about treatment.