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Wallace C, Krugman R. More Than What You Eat: A Review on the Association Between Childhood Maltreatment and Elevated Adult BMI. Curr Nutr Rep 2024; 13:377-381. [PMID: 38922364 PMCID: PMC11327177 DOI: 10.1007/s13668-024-00558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE OF REVIEW Obesity is an overwhelmingly common medical entity seen in the adult population. A growing body of research demonstrates that there is a significant relationship between child maltreatment and adult obesity. RECENT FINDINGS Emerging research demonstrates a potential dose-response relationship between various types of child abuse and adulthood BMI. Recent work also explores the potential role of the hypothalamic-pituitary-adrenal (HPA) axis, and other hormonal mediators such as sex-hormone binding globulin and leptin. There are also studies that suggest factors such as depression and socioeconomic and environmental influences mediate this relationship. Comorbidities that have been reported include cardiovascular and metabolic disease, diabetes, and insulin resistance. Preliminary work also demonstrates potential gender and racial disparities in the effect of abuse on adulthood obesity. In this narrative review, we summarize the existing work describing the different child maltreatment types (physical, sexual, emotional, verbal, and child neglect) and their relation to adult obesity, what is known about a potential dose-response relationship, potential mediators and pathophysiology, comorbidities, and preliminary work on gender and racial/ethnic disparities. We review the limited data on interventions that have been studied, and close with a discussion of implications and suggestions for clinicians who treat adult obesity, as well as potential future research directions.
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Affiliation(s)
- Carmelle Wallace
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
- Section of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Richard Krugman
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Diallo A, Minier N, Bonnet JB, Bourrié C, Lacroix V, Robert A, Lefebvre P, Joumaa S, Avignon A, Renard E, Nocca D, Galtier F. Traumatic Life Events, Violence, and Obesity: A Cross-Sectional Study from 408 Patients Enrolled in a Bariatric Surgery Program. Obes Facts 2024; 17:237-242. [PMID: 38569475 PMCID: PMC11149977 DOI: 10.1159/000535067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/30/2023] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Obesity is a chronic disease that increases cardiovascular and metabolic morbidity and mortality, decreases quality of life, and increases health care costs. While the role of lifestyle behavioral factors in the development of obesity is well established, the role of traumatic life events, including violence, is unclear. The purpose of this study was to describe situations of traumatic life events reported by patients undergoing a bariatric surgery program, with a particular focus on sexual violence and its clinical correlates. METHODS In this cross-sectional study, patients with grade II or III obesity, admitted to our digestive surgery department for bariatric surgery from August 01, 2019, to December 31, 2020, underwent a structured interview by a trained psychologist to describe the history of traumatic life events self-reported by the patients. The primary endpoint was the presence of a history of sexual violence (SV). Multivariate logistic regressions were applied to identify independent risk factors for SV. RESULTS Of the 408 patients interviewed, 87.1% reported at least one traumatic life event and 33.1% reported having had an SV in the past. Female gender (aOR = 7.44, 95% confidence interval: 3.85-15.73; p < 0.001) and higher body mass index (1.05, 1.02-1.08; p = 0.002) were associated with an increased risk of SV. Male gender was associated with a higher risk of difficulties including sports cessation, depression, and work-related distress. CONCLUSION In the context of obesity, psychosocial trauma is characterized by a high frequency and several gender specificities that must be taken into account in the management of these patients.
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Affiliation(s)
- Alhassane Diallo
- Clinical Investigation Center (CIC) 1411, INSERM, CHU of Montpellier, University of Montpellier, Montpellier, France
| | - Nadine Minier
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Jean-Baptiste Bonnet
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- UMR, Institute Desbrest of Epidemiology and Public Health, University Montpellier, INSERM, CHU, Montpellier, France
| | - Christine Bourrié
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Valérie Lacroix
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Alexandrine Robert
- Digestive Surgery Department Montpellier University Hospital, Montpellier, France
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Saadeddine Joumaa
- Digestive Surgery Department Montpellier University Hospital, Montpellier, France
| | - Antoine Avignon
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Eric Renard
- Clinical Investigation Center (CIC) 1411, INSERM, CHU of Montpellier, University of Montpellier, Montpellier, France
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - David Nocca
- Digestive Surgery Department Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Florence Galtier
- Clinical Investigation Center (CIC) 1411, INSERM, CHU of Montpellier, University of Montpellier, Montpellier, France
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
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3
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Semenza D, Silver I, Stansfield R, Boen C. Concentrated disadvantage and functional disability: a longitudinal neighbourhood analysis in 100 US cities. J Epidemiol Community Health 2023; 77:676-682. [PMID: 37451845 DOI: 10.1136/jech-2023-220487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Socioeconomic disadvantage related to poverty, unemployment and social disinvestment contributes to significant disparities in community health in the USA. Yet, there remains limited ecological research on the relationship between neighbourhood disadvantage and functional disability. Much of the work in this area has focused on elderly populations without attention to variation across age and sex groups. METHODS Using a longitudinal dataset of almost 16 000 neighbourhoods, we examine the relationship between neighbourhood disadvantage and functional disability. Leveraging a series of cross-lagged panel models, we account for reciprocal dynamics and a range of pertinent covariates while assessing differences across age- and sex-specific groups. RESULTS Accounting for reciprocal effects, we found that the association between concentrated disadvantage and functional disability varies across age and sex groups. Concentrated disadvantage is most consistently associated with increased functional disability among boys (5-17 years), young men (18-34 years) and middle-aged men (35-64 years). Similar associations are found among girls (5-17 years) and middle-aged women (35-64 years). CONCLUSION Local neighbourhood economic conditions are significantly associated with functional disability among relatively young populations of males and females. Exposure to neighbourhood disadvantage and deprivation may accelerate disablement processes and shift the age curve of disability risk.
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Affiliation(s)
- Daniel Semenza
- Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
- Urban-Global Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Ian Silver
- Center for Courts and Corrections Research, Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - Richard Stansfield
- Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, New Jersey, USA
| | - Courtney Boen
- Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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McKay T. When State Violence Comes Home: From Criminal Legal System Exposure to Intimate Partner Violence in a Time of Mass Incarceration. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2683-2715. [PMID: 35696614 DOI: 10.1177/08862605221106141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Exceptionally high rates of partner violence perpetration are evident among men returning from prison. Two bodies of scholarship, one on family stress and another on exposure to state violence, each suggest that criminal legal system exposure could promote partner violence perpetration via changes in men's behavioral health and interpersonal approach and in couples' conflict dynamics. Such relationships have not been tested in quantitative research. Structural equation models were fitted to longitudinal, couples-based survey data from the Multi-site Family Study on Incarceration, Parenting, and Partnering. Participants included men returning from a state prison term in five U.S. states (N = 1112) and their committed intimate or co-parenting partners (N = 1112). Models tested hypothesized pathways from three dimensions of criminal legal system exposure to later partner violence perpetration. In fitted models, men's childhood criminal legal system exposure predicts their post-prison partner violence perpetration via adult post-traumatic stress symptoms, reactivity, avoidance, and dysfunctional couple conflict dynamics. Men's cumulative criminal legal system exposure in adulthood predicts their post-prison partner violence perpetration via addiction and dysfunctional couple conflict. These initial results suggest that mass-scale incarceration could worsen partner violence via men's psychological and interpersonal adaptations to criminal legal system contact, particularly when such contact is sustained or occurs at a developmentally significant period in the life course.
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Affiliation(s)
- Tasseli McKay
- Department of Sociology, 3065Duke University, Durham, NC, USA
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5
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Ford-Gilboe M, Varcoe C, Wuest J, Campbell J, Pajot M, Heslop L, Perrin N. Trajectories of Depression, Post-Traumatic Stress, and Chronic Pain Among Women Who Have Separated From an Abusive Partner: A Longitudinal Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:NP1540-NP1568. [PMID: 35512192 PMCID: PMC9709554 DOI: 10.1177/08862605221090595] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This longitudinal study explored changes in women's health after separation from an abusive partner by characterizing the trajectories of their mental health (depression and post-traumatic stress disorder [PTSD]) and physical health (chronic pain) over a 4-year period. We examined how the severity of intimate partner violence (IPV) affected these trajectories, controlling for selected baseline factors using 5 waves of data collected from a community sample of 309 English-speaking, Canadian women. IPV severity was measured using the Index of Spouse Abuse where women were asked to consider the entire period of their partner relationship up to present at wave 1 and to rate their IPV experiences in the previous 12 months at waves 2-5. Mental health was measured using established self-report measures of depression (CESD) and PTSD (Davidson Trauma Scale), while chronic pain was measured using the Chronic Pain Grade Scale. Trajectories were estimated using MLM techniques with severity of IPV and selected co-variates (time since separation, age, financial strain) included. Our results show that women's health improved significantly over time, although significant levels of depression, PTSD symptoms and disabling chronic pain remained at the end of wave 5. Regardless of time since separation, more severe IPV was associated with higher levels of depression, PTSD, and disabling chronic pain, with IPV having a stronger effect on these health outcomes over time, suggesting cumulative effects of IPV on health. The results of this study contribute to quantifying the continuing mental and physical health burdens experienced by women after separation from an abusive partner. Increased attention to the long-term effects of violence on women's health beyond the crisis of leaving is critically needed to strengthen health and social services and better support women's recovery and healing.
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Affiliation(s)
- Marilyn Ford-Gilboe
- Arthur Labatt Family School of
Nursing, Western
University London, ON, Canada
| | - Colleen Varcoe
- School of Nursing,
University
of British Columbia, Vancouver, BC,
Canada
| | - Judith Wuest
- Faculty of Nursing,
University
of New Brunswick, Fredericton, NB,
Canada
| | | | - Michelle Pajot
- Arthur Labatt Family School of
Nursing, Western
University London, ON, Canada
| | - Lisa Heslop
- Arthur Labatt Family School of
Nursing, Western
University London, ON, Canada
| | - Nancy Perrin
- Johns Hopkins University School of
Nursing, Baltimore, MA, USA
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Jagielski CH, Harer KN. Working with Trauma in the Gastroenterology Setting. Gastroenterol Clin North Am 2022; 51:867-883. [PMID: 36376001 DOI: 10.1016/j.gtc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with gastrointestinal (GI) complaints report high rates of previous psychological trauma such as physical, emotional abuse and neglect, sexual trauma, and other traumatic experiences. History of trauma is considered a risk factor for the development of disorders of gut-brain interaction, including irritable bowel syndrome. This article discusses key points for providers in understanding how various aspects of trauma can affect patients' physical and mental health and medical interactions, as well as trauma-informed strategies providers can use to increase patient comfort, improve communication, and improve effectiveness of treatment.
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Affiliation(s)
- Christina H Jagielski
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, 3912, SPC 5362, Ann Arbor 48109 - 5362, USA.
| | - Kimberly N Harer
- Division of Gastroenterology and Hepatology, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, 3912, SPC 5362, Ann Arbor 48109 - 5362, USA
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7
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Jagielski CH, Riehl ME. Behavioral Strategies for Irritable Bowel Syndrome: Brain-Gut or Gut-Brain? Gastroenterol Clin North Am 2021; 50:581-593. [PMID: 34304789 DOI: 10.1016/j.gtc.2021.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) that is associated with significant physical, emotional, and occupational burden. Factors such as early life stress, sleep disruption, maladaptive coping strategies, symptom hypervigilance, and visceral hypersensitivity negatively affect gut-brain communication and increase the likelihood of developing IBS or worsen IBS severity. Behavioral strategies, such as cognitive behavioral therapy, gut-directed hypnosis, and mindfulness-based treatments, have shown benefit in improving gastrointestinal (GI)-specific quality of life, as well as reducing GI symptoms. Partnering with a GI-specific mental health provider can assist gastroenterologists in providing comprehensive treatment of IBS and other DGBIs.
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Affiliation(s)
- Christina H Jagielski
- Internal Medicine-Gastroenterology, Michigan Medicine, 380 Parkland Plaza, Ann Arbor, MI 48103, USA.
| | - Megan E Riehl
- Internal Medicine-Gastroenterology, Michigan Medicine, 3912 Taubman Center, SPC 5362, Suite 3436, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA
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8
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Zimmer Z, Fraser K, Korinek K, Akbulut-Yuksel M, Young YM, Toan TK. War across the life course: examining the impact of exposure to conflict on a comprehensive inventory of health measures in an aging Vietnamese population. Int J Epidemiol 2021; 50:866-879. [PMID: 33395485 DOI: 10.1093/ije/dyaa247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The majority of evidence indicates that exposure to war and other traumatic events continue to have negative impacts on health across the life course. However, existing research on health effects of war exposure primarily concentrates on short-term impacts among veterans in high-income countries sent elsewhere to battle. Yet, most wars situate in lower- and middle-income countries, where many are now or will soon be entering old age. Consequently, the current burden of exposure to war has ignored an important global population. METHODS The Vietnam Health and Aging Study (VHAS) is a longitudinal study designed to examine historical exposure to highly stressful events during the American War. Two modes of data collection, involving a sample of 2447 individuals aged 60+ years in northern Vietnam, took place between May and August 2018. Using this first wave of data, we generate indexed measures of war exposure and analyze their associations with a set of 12 health outcomes, accounting for confounding variables. RESULTS Results indicate that greater exposure to three types of war exposure (death and injury, stressful living conditions, and fearing death and/or injury) in earlier life is associated with worse health in later-life across a large number of health outcomes, such as number of diagnosed health conditions, mental distress, somatic symptoms, physical functioning, post-traumatic stress symptoms and chronic pain. CONCLUSIONS Findings support a life course theory of health and point to long-term effects of war on health that require detailed attention.
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Affiliation(s)
- Zachary Zimmer
- Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Kathryn Fraser
- Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Kim Korinek
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Tran Khanh Toan
- Family Medicine Department, Hanoi Medical University, Hanoi, Vietnam
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9
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Jagielski CH, Chey WD, Riehl ME. Influence of trauma on clinical outcomes, quality of life and healthcare resource utilization following psychogastroenterology intervention. J Psychosom Res 2021; 146:110481. [PMID: 33867174 DOI: 10.1016/j.jpsychores.2021.110481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Patients with disorders of gut-brain interaction (DGBI) are more likely to report a history of psychological trauma, including abuse, compared with controls. The purpose of this study was to evaluate the prevalence of trauma amongst patients in a GI behavioral health program and assess the impact of trauma on GI-specific quality of life, psychological distress, and healthcare utilization. METHODS We conducted a retrospective analysis for 205 patients who completed treatment in the GI behavioral health program. Measures included the IBS-QOL and the Brief Symptom Inventory-18 (BSI-18), as well as a retrospective chart review to examine healthcare utilization (HCU). RESULTS Patients with a trauma history had significantly greater psychological distress on the BSI-18 compared with controls (63.32 vs 57.40, p < .001). Patients with trauma also endorsed significantly poorer GI-specific QOL compared with controls (54.57 vs 64.15, p = .001). Patients with and without trauma demonstrated improvements in distress and GI-specific QOL following behavioral treatment. Comparison of one year pre and post treatment HCU revealed a mean decrease in HCU from 6.87 contacts to 4.21 contacts per year. CONCLUSIONS In a sample of GI behavioral health patients, those with a history of trauma endorsed higher levels of distress and poorer GI-specific QOL at baseline. Both groups benefitted equally from behavioral treatment. The impact of GI behavioral treatment on patient mental health, GI-specific quality of life and HCU lends support to the assessment of patient trauma history by gastroenterologists in order to provide more comprehensive treatment for their GI health.
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10
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Wuest J, O'Donnell S, Scott-Storey K, Malcolm J, Vincent CD, Taylor P. Cumulative Lifetime Violence Severity and Chronic Pain in a Community Sample of Canadian Men. PAIN MEDICINE 2021; 22:1387-1398. [PMID: 33347593 DOI: 10.1093/pm/pnaa419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To create a descriptive profile of chronic pain severity in men with lifetime cumulative violence histories, as a target and/or a perpetrator, and investigate how chronic pain severity is associated with and predicted by lifetime cumulative violence severity and known determinants of chronic pain. METHODS Analysis of variance and binary logistic regression were performed on data collected in an online survey with a community convenience sample of 653 men who reported experiences of lifetime violence. RESULTS The prevalence of high-intensity / high-disability pain in men with lifetime violence was 35.8%. Total Cumulative Lifetime Violence Severity-44 (CLVS-44) scores were significantly associated with high-intensity / high-disability chronic pain measured by the Chronic Pain Grade Scale (odds ratio= 8.40). In a model with 10 CLVS-44 subscale scores, only psychological workplace violence as a target (adjusted odds ratio [aOR]= 1.44) and lifetime family physical violence as a target (aOR= 1.42) significantly predicted chronic pain severity. In a multivariate model, chronic pain severity was predicted by CLVS-44 total score (aOR= 2.69), age (aOR= 1.02), injury with temporary impairment (aOR= 1.99), number of chronic conditions (aOR= 1.37), and depressive symptoms (aOR= 1.03). CONCLUSION The association between lifetime cumulative violence severity and chronic pain severity in men is important new information suggesting the need for trauma- and violence-informed approaches to assessment and intervention with men. This is the first analysis using CLVS-44 subscales to understand which configurations of lifetime cumulative violence may be most predictive of chronic pain severity; further investigation is needed to confirm these findings.
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Affiliation(s)
- Judith Wuest
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Sue O'Donnell
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Kelly Scott-Storey
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Jeannie Malcolm
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Charlene D Vincent
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Petrea Taylor
- Faculty of Nursing, University of New Brunswick, Moncton, New Brunswick, Canada
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11
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Taylor PL, O'Donnell S, Wuest J, Scott-Storey K, Vincent C, Malcom J. The Mental Health Effects of Cumulative Lifetime Violence in Men: Disruptions in the Capacity to Connect with Others and Finding Ways to Reengage. Glob Qual Nurs Res 2021; 8:23333936211021576. [PMID: 34212068 PMCID: PMC8216408 DOI: 10.1177/23333936211021576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
We report qualitative findings of our Men's Violence Gender and Health Study, a multiple method study using a sequential design in which we explored the mental health manifestations of cumulative lifetime violence in men. Survey results revealed that higher cumulative lifetime violence scores were significantly associated with higher scores on depression, post-traumatic stress disorder, and anxiety in a community sample of men (n = 685) living in Eastern Canada. To obtain a deeper understanding of men's scores, we used an interpretive description approach to analyze data derived from 32 participant interviews. The main mental health manifestation of cumulative lifetime violence is perceptual interference, a sense of being disconnected or detached from others. This is managed by rectifying detachment, a process that includes efforts to gain connections with others. Findings suggest mental health needs in men with cumulative lifetime violence contradict gender role expectations to be stoic. Implications for nurses are explored.
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Affiliation(s)
| | | | - Judith Wuest
- University of New Brunswick, Fredericton, Canada
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12
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Nichter B, Hill M, Norman S, Haller M, Pietrzak RH. Associations of childhood abuse and combat exposure with suicidal ideation and suicide attempt in U.S. military veterans: a nationally representative study. J Affect Disord 2020; 276:1102-1108. [PMID: 32777648 DOI: 10.1016/j.jad.2020.07.120] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Military veterans with a history of childhood abuse are at increased risk for suicidality. To date, however, little research has examined whether exposure to childhood abuse may heighten veterans' susceptibility to the effects of combat exposure and increase risk for suicidal behavior. This study examined whether childhood abuse has an additive or interactive effect on the association between combat exposure and suicide-related outcomes in a national sample of veterans. METHODS Data were from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. veterans (n = 3,157). Analyses compared veterans with/without current suicidal ideation and lifetime suicide attempts (SI/SA) on sociodemographic, military, and clinical characteristics; and examined the unique contribution of childhood physical and sexual abuse and combat exposure, and their interaction, with SI/SA. RESULTS After adjusting for sociodemographic characteristics and lifetime trauma burden, a significant interaction emerged between childhood sexual abuse and combat exposure predicting SI, such that combat-exposed veterans with histories of abuse were nearly three times more likely to currently be contemplating suicide relative to those without such histories. Childhood sexual abuse predicted lifetime suicide attempt, above and beyond sociodemographic characteristics, lifetime trauma burden, and combat exposure. LIMITATIONS Cross-sectional design precludes causal inference. CONCLUSIONS Results indicate that childhood sexual abuse exposure may operate both independently and synergistically with combat exposure to increase risk for suicidality among veterans. Findings suggest that veterans who experience childhood sexual abuse represent a subgroup that may be especially vulnerable to experiencing suicidal ideation following combat exposure.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, University of California, San Diego, CA 92093, United States.
| | - Melanie Hill
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Sonya Norman
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; National Center for PTSD, White River Junction, VT, United States; VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States
| | - Moira Haller
- Department of Psychiatry, University of California, San Diego, CA 92093, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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13
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A Systematic Review of the Associations of Adult Sexual Abuse in Women with Cardiovascular Diseases and Selected Risk Factors. Glob Heart 2020; 15:65. [PMID: 33150130 PMCID: PMC7518072 DOI: 10.5334/gh.760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aim To systematically assess the association between adult sexual abuse (ASA) and cardiovascular diseases (CVDs) of heart attack and stroke, and their risk factors of hypertension, diabetes, dyslipidaemia and obesity. Methods Two authors conducted a PubMed, Scopus and Web of Science review of the literature published prior to 1 October 2019. Relevant English language studies irrespective of study design and data collection techniques were included. Included articles needed to have examined ASA per se independent of physical or psychological/emotional abuse, and childhood sexual abuse. Results Of the 3260 articles identified, nine were selected from 97 full-text articles assessed for eligibility (n = 855 206 women). Six studies were cross-sectional in design while three articles were from longitudinal studies; all emanated from the United States. One study only (n = 867) performed clinical assessments (heights and weights) to determine the relevant outcome (obesity), four presented self-reported outcomes (heart attack, stroke, hypertension, diabetes, obesity), two reviewed clinical records and two did not provide details on outcome assessments (obesity). Sexual abuse by an intimate partner was examined in five articles, three assessed military sexual trauma and a single study evaluated any perpetrator. A meta-analysis could not be conducted because of the heterogeneity across studies. The available evidence was insufficient to quantify the relationship, if any, between ASA and CVDs and their risk factors. Conclusions Currently, no longitudinal studies of ASA in general populations have objectively investigated the development of CVDs and their risk factors using clinical and biochemical measurements. In view of the high CVD burden, and the frequency of ASA, it is important to fully understand the relationship between the two.
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14
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Scott-Storey K, O'Donnell S, Wuest J, MacIntosh J, Merritt-Gray M. Cumulative lifetime violence severity scale: development and initial testing among men. BMC Public Health 2020; 20:418. [PMID: 32228553 PMCID: PMC7106715 DOI: 10.1186/s12889-020-08551-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/18/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Knowledge of the relationship between men's health and violence is flawed by narrow and faulty conceptualization and measurement of violence that often results in attribution of health problems to one form or type of violence without consideration of other exposures. Our purpose is to describe the development and initial testing of the Cumulative Lifetime Violence Severity scale designed for use in health research to measure men's perceptions of the severity of their cumulative lifetime violence. METHODS We framed the dimensions of violence severity as: type (physical, psychological, sexual), timing (childhood, adulthood), focus (perpetrator, target), context, frequency, and degree of distress. Items reflecting these dimensions were vetted by local experts including individuals who identified as men, with particular attention to meaningful language for men. The measure was pretested, revised to 64 items, and tested for test-retest reliability prior to use in a study of 685 English-speaking Eastern Canadian men, ages 19 to 65 years. We used Principal Components Analysis to illuminate the underlying dimensionality of the items. RESULTS Principal Components Analysis yielded a 44-item 11 component solution that accounted for 64.06% of variance with good model fit and a Cronbach's alpha of .92. All dimensions of our conceptualization of violence severity were reflected in the components, except Adult Target Sexual Violence. Convergent validity between the Cumulative Lifetime Violence Severity-44 Scale and a global lifetime violence rating scale was r = .750 (p < .001) and concurrent validity was moderate and significant between the Cumulative Lifetime Violence Severity-44 scale and measures of mental health problems commonly experienced by people with violence histories. CONCLUSIONS The Cumulative Lifetime Violence Severity-44 scale shows promise as the first comprehensive measure of cumulative lifetime violence for health research that considers gender, individual distress and experiences as both perpetrator and target. Next steps include further exploratory analysis with a more diverse sample of men and confirmatory factor analysis.
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Affiliation(s)
- Kelly Scott-Storey
- University of New Brunswick, Faculty of Nursing, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
| | - Sue O'Donnell
- University of New Brunswick, Faculty of Nursing, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Judith Wuest
- University of New Brunswick, Faculty of Nursing, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Judith MacIntosh
- University of New Brunswick, Faculty of Nursing, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Marilyn Merritt-Gray
- University of New Brunswick, Faculty of Nursing, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
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Scott-Storey KA, Hodgins M, Wuest J. Modeling lifetime abuse and cardiovascular disease risk among women. BMC Cardiovasc Disord 2019; 19:224. [PMID: 31619166 PMCID: PMC6796408 DOI: 10.1186/s12872-019-1196-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 09/11/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the most significant health challenges facing women today. Abuse is a serious gendered issue also affecting the health of women. Despite beginning evidence that abuse may increase the risk of CVD among women, causal pathways linking abuse to CVD have received little attention. Our purpose was to test Scott-Storey's conceptual model showing direct and indirect pathways through which lifetime abuse severity may affect women's CVD risk. METHODS Using data collected from a community sample of 227 Canadian women who had left an abusive partner, we conducted structural equation modeling with latent growth curve analysis using a phantom variable approach to test the direct effects of severity of lifetime abuse on CVD risk (indicated by measures of systolic and diastolic blood pressure) as well as its indirect effects through CVD risk behaviors and through women's initial level of depressive symptoms and the observed rate of change in their depressive symptoms over time. RESULTS Women in this sample had above average CVD risk factors (i.e., smoking, overweight/obesity, depressive symptoms, high blood pressure) in comparison to women in the general population. Further, CVD risk behaviors increased with severity of lifetime abuse and remained present long after leaving the abusive relationship. Results of the tested model provide preliminary evidence supporting many of the hypothesized pathways by which severity of lifetime abuse can increase CVD risk among women; the model fit the data reasonably well explaining 41% of the variance in CVD risk. CONCLUSIONS Findings support the growing recognition of the long-term effects of lifetime abuse on cardiovascular health, suggest important implications for clinicians working with women, and provide a novel approach for studying the concept of cumulative lifetime abuse through the use of a phantom variable.
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Affiliation(s)
- Kelly A. Scott-Storey
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
| | - Marilyn Hodgins
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
| | - Judith Wuest
- Faculty of Nursing, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
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Salihoğlu S, Doğan SC, Kavakçı Ö. Effects of childhood psychological trauma on rheumatic diseases. Eur J Rheumatol 2019; 6:126-129. [PMID: 31364980 DOI: 10.5152/eurjrheum.2019.18184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 04/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The etiology of rheumatic diseases is unclear, but it is thought that environmental factors added to immunogenetic mechanisms in chronic inflammatory diseases play a role. Many inflammatory disorders, autoimmune diseases, and painful conditions have been shown to be associated with the psychological trauma of childhood. The aim of the present study was to investigate childhood psychological trauma that is considered to be one of the environmental factors that initiate inflammation on patients with rheumatic diseases. METHODS In our study, a total of 440 patients (220 patients who have rheumatic diseases as the case group and 220 patients who have no rheumatic disease as the control group) were examined. The Childhood Trauma Questionnaire-28 (CTQ-28) was administered and was completed by the patients. This was a cross-sectional study design. RESULTS No statistically significant differences were found between the case and control groups with respect to age, gender, marital status, and educational level. The CTQ-28 scale was found to be significantly higher in patients with rheumatic diseases (ankylosing spondylitis, rheumatoid arthritis, and connective tissue disease) in our study. CONCLUSION We think that childhood psychiatric traumas are effective in the etiopathogenesis of rheumatic diseases. To make this relationship more understandable, multidisciplinary research and long-term follow-up studies are needed to examine neuroendocrine, genetic, and epidemiological factors.
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Affiliation(s)
- Salih Salihoğlu
- Department of Physical Medicine and Rehabilitation, Medicana Sivas Hospital, Sivas, Turkey
| | - Sevil Ceyhan Doğan
- Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Önder Kavakçı
- Department of Psychiatry, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
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17
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Brennan-Olsen SL, Taillieu TL, Turner S, Bolton J, Quirk SE, Gomez F, Duckham RL, Hosking SM, Duque G, Green D, Afifi TO. Arthritis in adults, socioeconomic factors, and the moderating role of childhood maltreatment: cross-sectional data from the National Epidemiological Survey on Alcohol and Related Conditions. Osteoporos Int 2019; 30:363-373. [PMID: 30132028 DOI: 10.1007/s00198-018-4671-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED These data present associations between socioeconomic status (SES), different types of childhood maltreatment (CM) history and family dysfunction, and arthritis in men and women across a wide age range. Arthritis was less likely among those with higher SES, regardless of CM history. INTRODUCTION CM has been associated with increased risk of adult-onset arthritis; however, little is known about whether socioeconomic status moderates arthritis risk in those with CM history. We investigated arthritis across education, income, and race/ethnicity and whether CM moderated associations between SES and arthritis. METHODS Data were drawn from Wave 2 (2004-2005) of the nationally representative (USA) National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n = 34,563; aged ≥ 20 years). Self-reported CM history included physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence (IPV). We used descriptive statistics and logistic regression to determine relationships between SES, CM, and arthritis. Interaction terms were used to test if CM moderated relationships between SES and arthritis. RESULTS Arthritis prevalence was 21.1% (n = 3093) among men and 30.1% (n = 6167) among women. In unadjusted analyses, women (p ≤ 0.001) and older age (both sexes, p ≤ 0.01) were associated with increased odds of arthritis. All CM types were associated with increased odds of arthritis, except exposure to IPV among women. In sex-stratified, age-adjusted analyses, lower education and income, family dysfunction, being Hispanic or Asian/Native Hawaiian/Pacific Islander, and ≥ 1 physical comorbidity were associated with increased odds of arthritis among those with and without CM: trends were similar for both sexes. In age-adjusted two-way interaction terms, CM did not moderate associations between SES and arthritis. CONCLUSIONS Although CM was associated with arthritis, associations between SES and arthritis were not amplified. Arthritis was less likely among those with higher SES, regardless of CM history.
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Affiliation(s)
- S L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia.
| | - T L Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J Bolton
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S E Quirk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - F Gomez
- Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia
| | - R L Duckham
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - S M Hosking
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
- IMPACT SRC, Deakin University, Geelong, Victoria, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - G Duque
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - D Green
- Department of Medicine-Western Health, The University of Melbourne, Level 3, WCHRE Building, C/- Sunshine Hospital, 176 Furlong Road, St Albans, Victoria, 3021, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - T O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
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18
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Karatekin C, Almy B, Mason SM, Borowsky I, Barnes A. Mental and Physical Health Profiles of Maltreated Youth. CHILD ABUSE & NEGLECT 2018; 84:23-33. [PMID: 30036690 DOI: 10.1016/j.chiabu.2018.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 06/08/2023]
Abstract
To examine both mental and physical health profiles of children diagnosed as maltreated in the community, we studied diagnoses in the electronic health records (EHRs) of youth assigned maltreatment-related diagnoses (N = 406) and well-matched youth without a maltreatment-related diagnosis (N = 406) during a four-year period in a large healthcare system that covers eight hospitals and over 40 clinics. Data extracted automatically from the EHRs was supplemented by manual chart review. The odds of the maltreated group being assigned a code for mental illness was 2.69 times higher than the odds for the comparison group, with large differences in mood and anxiety disorders and suicidality. The odds of having an injury or poisoning diagnosis were 3.45 times higher in maltreated than in comparison youth. Maltreated youth were also less likely to have been immunized. Nevertheless, contrary to our hypothesis, maltreated youth had significantly lower rates of diagnoses across almost all major physical disease categories assessed and did not differ from comparison youth in terms of body mass index (BMI). Furthermore, maltreated youth were assigned fewer diagnoses than comparison youth whether they came in for at least one preventive visit or not. Findings suggest a need for health care professionals to be prepared to address the high rates of mental disorders in maltreated youth, to be more vigilant about possible physical disorders in this population, and to take greater advantage of opportunities to immunize these youth.
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Affiliation(s)
- Canan Karatekin
- Institute of Child Development, University of Minnesota, United States.
| | - Brandon Almy
- Institute of Child Development, University of Minnesota, United States
| | | | - Iris Borowsky
- Department of Pediatrics, University of Minnesota, United States
| | - Andrew Barnes
- Department of Pediatrics, University of Minnesota, United States
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Goodfellow A, Bone C, Gelberg L. They Didn't Believe Her Pain: My Education in Interpersonal Violence. Ann Fam Med 2018; 16:361-363. [PMID: 29987088 PMCID: PMC6037522 DOI: 10.1370/afm.2266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022] Open
Abstract
In my first year of medical school, I began to care for patients who were survivors of interpersonal violence. As I transitioned from didactics to clinical experiences, I was struck by how common the hidden threads of physical and sexual violence were in my patients' stories of chronic pain, depression, and poor health outcomes. Their symptoms often seemed intangible and challenging to treat, unable to fit neatly into typical diagnostic and therapeutic algorithms. In response, I saw clinicians become frustrated and dissatisfied with their ability to treat these patients. Better care for survivors may begin simply with believing our patients' pain.
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Affiliation(s)
| | - Curtis Bone
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.,Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California
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Byrskog U, Hussein IH, Yusuf FM, Egal JA, Erlandsson K. The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women’s views, knowledge and opinions. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:39-44. [PMID: 29804773 DOI: 10.1016/j.srhc.2018.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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Stolbach BC, Anam S. Racial and Ethnic Health Disparities and Trauma-Informed Care for Children Exposed to Community Violence. Pediatr Ann 2017; 46:e377-e381. [PMID: 29019632 DOI: 10.3928/19382359-20170920-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Racial and ethnic disparities in health outcomes and access have been consistently documented for a wide variety of physical and behavioral health conditions. Health inequities are most pronounced in areas with high levels of racial and ethnic segregation, where children and adolescents are also more likely to face economic inequality, which places them at high risk for exposure to neighborhood violence and traumatic loss. Community violence exposure (CVE) has been increasingly recognized as a prominent contributor to negative physical and mental health outcomes. CVE has been linked to children's risk for negative psychological outcomes, such as posttraumatic stress disorder, externalizing behavior, and internalizing symptoms, as well as obesity, asthma, and health-risk behaviors. Providers of pediatric care have opportunities to address CVE and related health disparities by developing trauma-informed systems that routinely screen for CVE, provide basic support for affected families, and link those in need to trauma-focused intervention. [Pediatr Ann. 2017;46(10):e377-e381.].
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Abrahams N, Seedat S, Lombard C, Kengne AP, Myers B, Sewnath A, Mhlongo S, Ramjee G, Peer N, Garcia-Moreno C, Jewkes R. Study protocol for a longitudinal study evaluating the impact of rape on women's health and their use of health services in South Africa. BMJ Open 2017; 7:e017296. [PMID: 28965098 PMCID: PMC5640088 DOI: 10.1136/bmjopen-2017-017296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION South Africa is a country known for its high levels of HIV infection and sexual violence. Although the interface between gender-based violence, HIV and mental health has been described, there are substantial gaps in knowledge of the medium-term and long-term health impact. The 2010 Global Burden of Disease study excluded many health outcomes associated with rape and other forms of gender-based violence because systematic reviews revealed huge gaps in data and poor evidence of health effects. This study aims to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a 2-year postrape period, through comparison with a cohort of women who have not been raped. The study will substantially advance our understanding of the impact of rape and will generate robust data to assist in the development of postrape health services and the delivery of evidence-based care. METHODS AND ANALYSIS This longitudinal study seeks to recruit 1008 rape-exposed and 1008 rape non-exposed women. Women were recruited from health services, and assessments were carried out at baseline, 3, 6, 9, 12, 18 and 24 months. Outcome measures include exposure to risk factors; mental health status; cardio-metabolic risks; and biomarkers for HIV, sexually transmitted infections, pregnancy and stress. The primary analysis will be to compare HIV incidence in the two groups using log-rank tests. Appropriate models to predict health outcomes over time will also be applied. ETHICS AND DISSEMINATION The South African Medical Research Council's Ethics Committee approved the study. As rape is a key element of the study, the safety and protection of participants guides the research process. We will adopt a research uptake strategy to ensure dissemination to policy makers, service providers and advocacy groups. Peer-reviewed journal articles will be published.
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Affiliation(s)
- Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Soraya Seedat
- Anxiety and Stress Disorder Unit, University of Stellenbosch, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Alesha Sewnath
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nasheeta Peer
- Non-Communicable Disease Research Unit, South African Medical Research Council, Durban, South Africa
| | - Claudia Garcia-Moreno
- Department of Reproductive Health and Research, World Health Organisation, Geneva, Switzerland
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Vu C, Rothman E, Kistin CJ, Barton K, Bulman B, Budzak-Garza A, Olson-Dorff D, Bair-Merritt MH. Adapting the Patient-Centered Medical Home to Address Psychosocial Adversity: Results of a Qualitative Study. Acad Pediatr 2017; 17:S115-S122. [PMID: 28865642 DOI: 10.1016/j.acap.2017.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/04/2017] [Accepted: 01/21/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The patient-centered medical home (PCMH) seeks to improve population health. However, PCMH models often focus on improving treatment of chronic diseases rather than on addressing psychosocial adversity. We sought to gather key stakeholder input about how PCMHs might feasibly and sustainably address psychosocial adversity within their patient populations. METHODS We conducted 25 semistructured interviews with key stakeholders, such as physicians, nurses, medical assistants, and patients. The audiorecorded interviews focused on participants' perceptions of the best ways to modify the PCMH to address patients' psychosocial adversity. To facilitate information gathering, a fictional patient case was presented. Analyses were conducted using a 3-stage content-analysis process. RESULTS Participants identified provider-related and systems-level changes necessary for addressing these psychosocial adversities effectively. On the provider level, participants thought that practitioners should foster trusting relationships with patients and should be emotionally present as patients describe their life experiences. Participants also emphasized that providers need to have sensitive conversations about adversity and resilience. On a systems level, participants discussed that documentation must balance privacy and include relevant information in the medical record. In addition, care should be delivered not by a single provider but by a team that has a longitudinal relationship with the patient; this care team should include behavioral health support. CONCLUSIONS Participants provided practical strategies and highlighted provider and systems level changes to adequately address patients' prior psychosocial adversity. Future studies need to assess the degree to which such a trauma-informed approach improves patient access, outcomes, and care quality, and reduces cost.
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Affiliation(s)
- Cecilia Vu
- Boston University School of Public Health, Boston, Mass
| | - Emily Rothman
- Boston University School of Public Health, Boston, Mass
| | - Caroline J Kistin
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | | | | | | | - Megan H Bair-Merritt
- Division of General Pediatrics, Boston University School of Medicine, Boston, Mass.
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Gordon AR, Krieger N, Okechukwu CA, Haneuse S, Samnaliev M, Charlton BM, Austin SB. Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults. Qual Life Res 2017; 26:2129-2138. [PMID: 28315179 PMCID: PMC5511094 DOI: 10.1007/s11136-017-1545-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Gender nonconformity, that is, transgressing conventionally "masculine" vs. "feminine" characteristics, is often stigmatized. Stigmatization and discrimination are social stressors that raise risk of adverse mental and physical health outcomes and may drive health inequities. However, little is known about the relationship between such social stressors and health-related quality of life (HRQOL). This paper aimed to examine associations between perceived gender nonconformity and HRQOL in a cohort of U.S. adolescents and young adults. METHODS Using data from 8408 participants (18-31 years) in the U.S. Growing Up Today Study (93% white, 88% middle-to-high income), we estimated risk ratios (RRs) for the association of gender nonconformity (three levels: highly gender conforming, moderately conforming, and gender nonconforming) and HRQOL using the EuroQol questionnaire (EQ-5D-5L). Models were adjusted for demographic characteristics, including sexual orientation identity. RESULTS Gender nonconformity was independently associated with increased risk of having problems with mobility [RR (95% confidence interval): 1.76 (1.16, 2.68)], usual activities [2.29 (1.67, 3.13)], pain or discomfort [1.59, (1.38, 1.83)], and anxiety or depression [1.72 (1.39, 2.13)], after adjusting for sexual orientation and demographic characteristics. Decrements in health utility by gender nonconformity were observed: compared to persons who were highly gender conforming, mean health utility was lower for the moderately gender conforming [beta (SE): -0.011 (.002)] and lowest for the most gender nonconforming [-0.034 (.005)]. CONCLUSIONS In our study, HRQOL exhibited inequities by gender nonconformity. Future studies, including in more diverse populations, should measure the effect of gender-related harassment, discrimination, and violence victimization on health and HRQOL.
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Affiliation(s)
- Allegra R Gordon
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Mihail Samnaliev
- Department of Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, USA
| | - Brittany M Charlton
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave. (AU-Box 17, BCH 3189), Boston, MA, 02115, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
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Bond RM, Bushman BJ. The Contagious Spread of Violence Among US Adolescents Through Social Networks. Am J Public Health 2016; 107:288-294. [PMID: 27997233 DOI: 10.2105/ajph.2016.303550] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To test the hypothesis that violence among US adolescents spreads like a contagious disease through social networks. METHODS Participants were a nationally representative sample of 90 118 US students aged 12 to 18 years who were involved in the National Longitudinal Study of Adolescent Health. Violence was assessed by having participants report the number of times in the preceding 12 months they had been involved in a serious physical fight, had hurt someone badly, and had pulled a weapon on someone. RESULTS Participants were 48% more likely to have been involved in a serious fight, 183% more likely to have hurt someone badly, and 140% more likely to have pulled a weapon on someone if a friend had engaged in the same behavior. The influence spread up to 4 degrees of separation (i.e., friend of friend of friend of friend) for serious fights, 2 degrees for hurting someone badly, and 3 degrees for pulling a weapon on someone. CONCLUSIONS Adolescents were more likely to engage in violent behavior if their friends did the same, and contagion of violence extended beyond immediate friends to friends of friends.
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Affiliation(s)
- Robert M Bond
- All of the authors are with the School of Communication, The Ohio State University, Columbus. Brad J. Bushman is also with the Department of Communication Science, VU University Amsterdam, Amsterdam, The Netherlands
| | - Brad J Bushman
- All of the authors are with the School of Communication, The Ohio State University, Columbus. Brad J. Bushman is also with the Department of Communication Science, VU University Amsterdam, Amsterdam, The Netherlands
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Wong SPY, Chang JC. Altered Eating Behaviors in Female Victims of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:3490-3505. [PMID: 25957061 DOI: 10.1177/0886260515585535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Little is known about altered eating behaviors that are associated with the experience of intimate partner violence (IPV) victimization. Our aim was to explore the experiences and perspectives of IPV victims regarding their eating behaviors and their attitudes toward and use of food. We conducted focus groups and individual interviews with 25 IPV victims identified at a domestic violence agency and asked them about their eating behaviors and how, if at all, these behaviors related to their experience of IPV. Qualitative analysis of the transcribed encounters identified themes explicating the relationship between their eating behaviors and experiences of IPV. All women described altered eating behaviors related to IPV that were categorized into several major themes: (a) somatization (victims experience significant somatic symptoms as a result of abuse); (b) avoiding abuse (victims modify their eating behaviors to avoid abuse); (c) coping (victims use food to handle the psychological effects of abuse); (d) self-harm (victims use food to hurt themselves as a reaction to the abuse); and (e) challenging abusive partners (victims use their eating behaviors to retaliate against their abusers). IPV can provoke altered eating behaviors in victims that may be harmful, comforting, or a source of strength in their abusive relationships. Understanding the complex relationship between IPV and victims' altered eating behaviors is important in promoting healthy eating among victims.
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Affiliation(s)
- Susan P Y Wong
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Judy C Chang
- Departments of Obstetrics, Gynecology and Reproductive Sciences and Internal Medicine, Magee-Women's Hospital of UPMC, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Chung EK, Siegel BS, Garg A, Conroy K, Gross RS, Long DA, Lewis G, Osman CJ, Jo Messito M, Wade R, Shonna Yin H, Cox J, Fierman AH. Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. Curr Probl Pediatr Adolesc Health Care 2016; 46:135-53. [PMID: 27101890 PMCID: PMC6039226 DOI: 10.1016/j.cppeds.2016.02.004] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources.
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Affiliation(s)
- Esther K Chung
- The Department of Pediatrics, The Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Nemours, Wilmington, DE.
| | - Benjamin S Siegel
- The Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Arvin Garg
- The Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Kathleen Conroy
- The Division of General Pediatrics, Boston Children׳s Hospital, Boston, MA
| | - Rachel S Gross
- The Department of Pediatrics, Albert Einstein College of Medicine, The Children׳s Hospital at Montefiore, Bronx, NY
| | - Dayna A Long
- The Department of Pediatrics, UCSF Benioff Children׳s Hospital Oakland, Oakland, CA
| | - Gena Lewis
- The Department of Pediatrics, UCSF Benioff Children׳s Hospital Oakland, Oakland, CA
| | - Cynthia J Osman
- The Department of Pediatrics, New York University, New York, NY
| | - Mary Jo Messito
- The Department of Pediatrics, New York University, New York, NY
| | - Roy Wade
- The Department of Pediatrics, The Children׳s Hospital of Philadelphia, Philadelphia, PA
| | - H Shonna Yin
- The Department of Pediatrics, New York University, New York, NY
| | - Joanne Cox
- The Division of General Pediatrics, Boston Children׳s Hospital, Boston, MA
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Addressing Psychosocial Adversity Within the Patient-Centered Medical Home: Expert-Created Measurable Standards. J Prim Prev 2016; 36:213-25. [PMID: 25787893 DOI: 10.1007/s10935-015-0390-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Patient-Centered Medical Home (PCMH) may be improved by embedding identification and response for patients' experiences with psychosocial adversity, but how this might optimally occur in practice has not been well-specified. We sought input from an expert panel to define feasible elements that could adapt the PCMH to adequately respond to patients' experiences with psychosocial adversity. From December 2012 through September 2013, we used a Delphi process to systematically obtain expert opinions and reach consensus. We invited 37 experts to participate in three successive and iterative rounds of questionnaires, with each round based on aggregated, de-identified data from the prior round. We first asked experts to generate elements to adapt the PCMH, using the National Committee for Quality Assurance (NCQA's) established six PCMH standards as the foundation. We then asked the experts to rate these elements on a 5-point Likert scale, and finally specify what they considered the most and least valuable elements. Eighteen of the 37 (49 %) invited experts responded to the first survey, and constituted our sample. Experts identified 35 elements that fell under the six NCQA standards. The top rated elements included using a screening tool to identify adversity; training providers to address psychosocial adversity; having a team member with mental health expertise; providing culturally-competent care; and having written patient information related to adversity and coping. This study derived key elements that may enhance the PCMH's ability to improve patient outcomes by purposefully identifying and responding to their psychosocial adversity.
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Childhood trauma in patients with self-reported stress-precipitated seizures. Epilepsy Behav 2015; 51:210-4. [PMID: 26295447 DOI: 10.1016/j.yebeh.2015.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/20/2015] [Accepted: 07/14/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Stress is the most commonly reported precipitant of epileptic seizures, but the mechanism by which stress precipitates seizures and the risk factors for stress as a seizure precipitant are poorly understood. Previously, we observed higher levels of anxiety symptoms in patients with epilepsy who reported stress as a seizure precipitant. Given that childhood trauma increases the risk of general psychiatric symptom burden, including anxiety symptoms, we sought to examine the relationship between childhood adversity and stress as a seizure precipitant. METHODS Sequential outpatients (N=236) evaluated at the Epilepsy Center of the University of Cincinnati Neuroscience Institute who had previously enrolled in an earlier study of stress and seizures were enrolled. Subjects either endorsed stress as a seizure precipitant [Stress (+)] or not [Stress (-)]. The Childhood Trauma Questionnaire Short Form (CTQ-SF), a 28-question scale that evaluates 5 domains of childhood adversity (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) was sent via mail and returned on paper or electronically from participants. Total CTQ-SF score and CTQ-SF domain scores were compared between Stress (+) and Stress (-) groups using Wilcoxon rank sum test. Spearman's rank correlation between CTQ-SF scores with depression and anxiety was also determined, and these analyses were followed by a multivariate analysis to identify the association of childhood trauma with other factors including anxiety and depression. RESULTS A total of 119 out of 236 CTQ-SFs that were sent out were completed. Response rates were 91/195 for Stress (+) and 28/41 for Stress (-). The Stress (+) group reported higher scores in emotional abuse compared with the Stress (-) group (p=0.029); CTQ-SF total scores were higher in the Stress (+) group compared with the Stress (-) group (p=0.08), and sexual abuse scores were higher in Stress (+) group (p=0.07), but there were no statistically significant differences for other types of trauma. Depression and anxiety scores were higher in the Stress (+) group, but anxiety was the only independent factor associated with the Stress (+) group in the multivariate analysis (p=0.0021). CONCLUSION Patients with epilepsy who report stress as a seizure precipitant are more likely to endorse a history of childhood traumatic experiences, particularly emotional abuse, compared with those who do not perceive stress as a precipitant. Further study is needed to identify how childhood trauma interacts with anxiety in modulating stress response in patients with epilepsy.
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Lifetime co-occurrence of violence victimisation and symptoms of psychological ill health: a cross-sectional study of Swedish male and female clinical and population samples. BMC Public Health 2015; 15:979. [PMID: 26415496 PMCID: PMC4587579 DOI: 10.1186/s12889-015-2311-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Lifetime co-occurrence of violence victimisation is common. A large proportion of victims report being exposed to multiple forms of violence (physical, sexual, emotional violence) and/or violence by multiple kinds of perpetrators (family members, intimate partners, acquaintances/strangers). Yet much research focuses on only one kind of victimisation. The aim of this study was to investigate the association between symptoms of psychological ill health, and A) exposure to multiple forms of violence, and B) violence by multiple perpetrators. Method Secondary analysis of cross-sectional data previously collected for prevalence studies on interpersonal violence in Sweden was used. Respondents were recruited at hospital clinics (women n = 2439, men n = 1767) and at random from the general population (women n = 1168, men n = 2924). Multinomial regression analysis was used to estimate associations between exposure to violence and symptoms of psychological ill health. Results Among both men and women and in both clinical and population samples, exposure to multiple forms of violence as well as violence by multiple perpetrators were more strongly associated with symptoms of psychological ill health than reporting one form of violence or violence by one perpetrator. For example, in the female population sample, victims reporting all three forms of violence were four times more likely to report many symptoms of psychological ill health compared to those reporting only one form of violence (adj OR: 3.8, 95 % CI 1.6–8.8). In the male clinical sample, victims reporting two or three kind of perpetrators were three times more likely to report many symptoms of psychological ill health than those reporting violence by one perpetrator (adj OR 3.3 95 % CI 1.9–5.9). Discussion The strong association found between lifetime co-occurrence of violence victimisation and symptoms of psychological ill-health is important to consider in both research and clinic work. If only the effect of one form of violence or violence by one kind of perpetrator is considered this may lead to a misinterpretation of the association between violence and psychological ill health. When the effect of unmeasured traumata is ignored, the full burden of violence experienced by victims may be underestimated. Conclusion Different kinds of victimisation can work interactively, making exposure to multiple forms of violence as well as violence by multiple perpetrators more strongly associated with symptoms of psychological ill health than any one kind of victimisation alone.
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Randell KA, Evans SE, O'Malley D, Dowd MD. Intimate Partner Violence Programs in a Children's Hospital: Comprehensive Assessment Utilizing a Delphi Instrument. Hosp Pediatr 2015; 5:141-7. [PMID: 25732987 DOI: 10.1542/hpeds.2014-0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to conduct a baseline assessment of intimate partner violence (IPV) practices in a pediatric hospital system. METHODS The Delphi Instrument for Hospital-based Domestic Violence Programs was used to assess the structure and components of the hospital system's IPV practices. Through key stakeholder interviews, we also assessed IPV practices in individual patient care areas. Qualitative analysis of interview data used a grounded theory approach. RESULTS The hospital scored 17 of 100 points on the Delphi instrument assessment. Key areas of weakness identified by the Delphi instrument and interviews included lack of coordinated provider training and evaluation of IPV-related processes and no standards for IPV screening, safety assessment, and documentation. Most interviewees supported addressing IPV; all identified barriers to IPV screening at individual provider and institutional levels. Institutional barriers included lack of a standardized response to IPV disclosure, need for individualized screening protocols for different patient care settings, lack of standardized provider training, concerns about overextending social work resources, and lack of resources for hospital staff experiencing vicarious trauma. Individual barriers included concern that screening may harm physician-patient-family relationships and the perception that physicians are unwilling to address psychosocial issues. CONCLUSIONS The Delphi Instrument for Hospital-based Domestic Violence Programs identified weaknesses and key areas for improvement in IPV practices. Deficiencies revealed by the Delphi instrument were affirmed by individual interview results. Institutional and individual provider level barriers must be addressed to optimize IPV practices in a pediatric hospital system.
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Affiliation(s)
| | - Sarah E Evans
- Division of Developmental and Behavioral Sciences, The Children's Mercy Hospital, Kansas City, Missouri
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The Impact of Childhood Adversity on the Clinical Features of Schizophrenia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2015; 2015:532082. [PMID: 26345291 PMCID: PMC4539488 DOI: 10.1155/2015/532082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/26/2015] [Indexed: 12/19/2022]
Abstract
Introduction. Recent research has drawn attention to the link between childhood maltreatment and schizophrenia. Child abuse and neglect may have an impact on symptoms and physical health in these patients. This association has not been studied to date in India. Materials and Methods. Clinically stable patients with schizophrenia (n = 62) were assessed for childhood adversity using the Childhood Trauma Questionnaire. The association of specific forms of adversity with symptomatology and associated variables was examined. Results. Emotional abuse was reported by 56.5% patients and physical abuse by 33.9%; scores for childhood neglect were also high. Persecutory delusions were linked to physical abuse, while anxiety was linked to emotional neglect and depression to emotional abuse and childhood neglect. Physical abuse was linked to elevated systolic blood pressure, while emotional abuse and neglect in women were linked to being overweight. Conclusions. Childhood adversity is common in schizophrenia and appears to be associated with a specific symptom profile. Certain components of the metabolic syndrome also appear to be related to childhood adversity. These results are subject to certain limitations as they are derived from remitted patients, and no control group was used for measures of childhood adversity.
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Cunningham TJ, Ford ES, Croft JB, Merrick MT, Rolle IV, Giles WH. Sex-specific relationships between adverse childhood experiences and chronic obstructive pulmonary disease in five states. Int J Chron Obstruct Pulmon Dis 2014; 9:1033-42. [PMID: 25298732 PMCID: PMC4186575 DOI: 10.2147/copd.s68226] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Adverse childhood experiences (ACEs) before age 18 have been repeatedly associated with several chronic diseases in adulthood such as depression, heart disease, cancer, diabetes, and stroke. We examined sex-specific relationships between individual ACEs and the number of ACEs with chronic obstructive pulmonary disease (COPD) in the general population. Materials and methods Data from 26,546 women and 19,015 men aged ≥18 years in five states of the 2011 Behavioral Risk Factor Surveillance System were analyzed. We used log-linear regression to estimate prevalence ratios (PRs) and their corresponding 95% confidence intervals (CIs) for the relationship of eight ACEs with COPD after adjustment for age group, race/ethnicity, marital status, educational attainment, employment, asthma history, health insurance coverage, and smoking status. Results Some 63.8% of women and 62.2% of men reported ≥1 ACE. COPD was reported by 4.9% of women and 4.0% of men. In women, but not in men, there was a higher likelihood of COPD associated with verbal abuse (PR =1.30, 95% CI: 1.05, 1.61), sexual abuse (PR =1.69, 95% CI: 1.36, 2.10), living with a substance abusing household member (PR =1.49, 95% CI: 1.23, 1.81), witnessing domestic violence (PR =1.40, 95% CI: 1.14, 1.72), and parental separation/divorce (PR =1.47, 95% CI: 1.21, 1.80) during childhood compared to those with no individual ACEs. Reporting ≥5 ACEs (PR =2.08, 95% CI: 1.55, 2.80) compared to none was associated with a higher likelihood of COPD among women only. Conclusion ACEs are related to COPD, especially among women. These findings underscore the need for further research that examines sex-specific differences and the possible mechanisms linking ACEs and COPD. This work adds to a growing body of research suggesting that ACEs may contribute to health problems later in life and suggesting a need for program and policy solutions.
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Affiliation(s)
- Timothy J Cunningham
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Earl S Ford
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa T Merrick
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Italia V Rolle
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne H Giles
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Halland M, Almazar A, Lee R, Atkinson E, Larson J, Talley NJ, Saito YA. A case-control study of childhood trauma in the development of irritable bowel syndrome. Neurogastroenterol Motil 2014; 26:990-8. [PMID: 24813232 DOI: 10.1111/nmo.12353] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/31/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The etiology of irritable bowel syndrome (IBS) is not been fully elucidated, but childhood trauma may disturb the brain-gut axis and therefore be important. Thus, we conducted a family based case-control study of IBS cases and their relatives with the aims to (i) determine the frequency of childhood trauma among IBS cases and controls as well as their relatives, and (ii) assess childhood trauma among IBS cases with affected relatives (familial IBS). METHODS Outpatients with IBS, matched controls, and their first-degree relatives completed a self-report version of Bremner' Early Trauma Inventory. Percent of cases and controls with a family history were compared and odds ratios were computed using chi-squared test; recurrence risks to relatives were computed using logistic regression and generalized estimating equations. KEY RESULTS Data were collected from 409 cases, 415 controls, 825 case relatives, and 921 control relatives. IBS cases had a median age of 50 and 83% were women. Of IBS cases, 74% had experienced any general trauma compared to 59% among controls, yielding an odds ratio of 1.56 (95% CI: 1.13-2.15, p < 0.008). There were no statistical differences between IBS relatives and control relatives with regards to lifetime trauma. CONCLUSIONS & INFERENCES IBS is associated with childhood trauma, and these traumas often occur prior to onset of IBS symptoms. This provides further insight into how traumatic childhood events are associated with development of adult IBS.
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Affiliation(s)
- M Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the most serious health challenges facing women today. Investigations into CVD risk factors specific to women have focused primarily on sex-based differences, with little attention paid to gender-based influences. Abuse, such as child abuse, intimate partner violence, and sexual assault, is a serious gendered issue affecting one quarter to one-half of all women within their lifetime. Despite beginning evidence that abuse may increase CVD risk in women, the biological, behavioral, and psychological pathways linking abuse to CVD have received little attention from researchers and clinicians. PURPOSE The aim of this study was to propose a conceptual model that delineates the pathways by which abuse may increase CVD risk among women. Within the model, lifetime abuse is positioned as a chronic stressor affecting CVD risk through direct and indirect pathways. Directly, abuse experiences can cause long-term biophysical changes within the body, which increase the risk of CVD. Indirectly, smoking and overeating, known CVD risk behaviors, are common coping strategies in response to abuse. In addition, women with abuse histories frequently report depressive symptoms, which can persist for years after the abusive experience. Depressive symptoms are a known predictor of CVD and can potentiate CVD risk behaviors. Therefore, depressive symptoms are proposed as a mediator between lifetime abuse and CVD as well as between lifetime abuse and CVD risk behaviors. CONCLUSIONS AND CLINICAL IMPLICATIONS To better promote cardiovascular health among women and direct appropriate interventions, nurses need to understand the complex web by which abuse may increase the risk for CVD. In addition, nurses need to not only pay attention to an abuse history and symptoms of depression for women presenting with CVD symptoms but also address CVD risk among women with abusive histories.
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Conner-Warren R. Effects of cumulative trauma load on perceptions of health, blood pressure, and resting heart rate in urban African American youth. J SPEC PEDIATR NURS 2014; 19:127-38. [PMID: 24502662 DOI: 10.1111/jspn.12063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 12/03/2013] [Accepted: 12/06/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE This study examined relationships between cumulative trauma (CT) and urban African American (AA) adolescents' blood pressure (BP), heart rate (HR), and perceptions of health. DESIGN AND METHOD A correlational design using secondary data analysis studied effects of CT, health outcomes, and perceptions of health. Participants were 175 urban AA youth (11-16 years) who completed structured surveys and physiological measures of HR and BP before and after exercise. RESULTS AA youth were experiencing high levels of CT. Negative correlations were obtained between AA females' perceptions of their health and systolic BP with levels of trauma. No gender differences were found in HR or BP. PRACTICE IMPLICATIONS AA females with high CT may perceive themselves as less healthy and can be at risk for health problems.
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Affiliation(s)
- Rhonda Conner-Warren
- Health Practice, College of Nursing, Michigan State University, East Lansing, Michigan, USA
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Schei B, Lukasse M, Ryding EL, Campbell J, Karro H, Kristjansdottir H, Laanpere M, Schroll AM, Tabor A, Temmerman M, Van Parys AS, Wangel AM, Steingrimsdottir T. A history of abuse and operative delivery--results from a European multi-country cohort study. PLoS One 2014; 9:e87579. [PMID: 24498142 PMCID: PMC3909197 DOI: 10.1371/journal.pone.0087579] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/23/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. DESIGN The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. RESULTS Among 3308 primiparous women, sexual abuse as an adult (≥ 18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28-3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24-11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46-11.3). Neither physical abuse (in adulthood or childhood <18 years), nor sexual abuse in childhood increased the risk of any operative delivery among primiparous women. Among 3416 multiparous women, neither sexual, nor emotional abuse was significantly associated with any kind of operative delivery, while physical abuse had an increased AOR for emergency CS of 1.51 (1.05-2.19). CONCLUSION Sexual abuse as an adult increases the risk of an elective CS among women with no prior birth experience, in particular for non-obstetrical reasons. Among multiparous women, a history of physical abuse increases the risk of an emergency CS.
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Affiliation(s)
- Berit Schei
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St.Olav's University Hospital, Trondheim, Norway
| | - Mirjam Lukasse
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Elsa Lena Ryding
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet/University Hospital, Stockholm, Sweden
| | - Jacquelyn Campbell
- John Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
| | - Helle Karro
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
| | - Hildur Kristjansdottir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
- Directorate of Health, Reykjavik, Iceland
| | - Made Laanpere
- Department of Obstetrics and Gynaecology, University of Tartu, Tartu, Estonia
| | - Anne-Mette Schroll
- Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann Tabor
- Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - An-Sofie Van Parys
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | | | - Thora Steingrimsdottir
- Department of Obstetrics and Gynaecology, Landspitali University Hospital, Reykjavik, Iceland
- Primary Health Care of the Capital Area, Centre of Development, Reykjavik, Iceland
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Bair-Merritt M, Zuckerman B, Augustyn M, Cronholm PF. Silent victims--an epidemic of childhood exposure to domestic violence. N Engl J Med 2013; 369:1673-5. [PMID: 24171514 DOI: 10.1056/nejmp1307643] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Megan Bair-Merritt
- From the Department of Pediatrics, Johns Hopkins Medical Center, Baltimore (M.B.-M.); the Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston (B.Z., M.A.); and the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia (P.F.C.)
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