Re-traumatization among adult women sexually abused in childhood: exploratory analyses in a prospective study

The Prevalence of Post-Traumatic Stress Disorder in Birth Parents in Child Protection Services: Systematic Review and Meta-analysis

BACKGROUND

Birth parents of children in the statutory child protection system have disproportionally high rates of trauma exposure and mental health problems, however, little is known about the extent to which this population display symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex PTSD. This study provides a systematic review and meta-analysis of the PTSD rates in parent samples involved in the child protection services.

METHOD

Articles were identified by searching PSYCINFO, Medline, CINAHL, and PILOTS. The search included terminology pertaining to parents, trauma, and child protective services and we included all peer-reviewed articles that reported a valid measure of PTSD and child protection service involvement.

RESULTS

Fifteen studies were included in the review with a combined prevalence estimate for PTSD based on 11 studies (n = 4871) was 26.0% (95% CI 20.0-32.0%) for mothers, and estimate based on three studies (n = 2606) was 13.0% (95% CI 7.0%-18.0%) for fathers and 23.0% (95% CI 17.0-29.0) for all parents based on 7848 responses. Four studies that did not report prevalence rates, reported sample mean scores for PTSD that were consistently higher than in general population. Factors associated with parents' PTSD symptoms included mental health co-morbidities, victimization of physical and sexual violence, and perpetration of child abuse.

CONCLUSION

There are high rates of PTSD in parents involved in the protective system, thus more targeted efforts are needed to identify and adequately address trauma symptoms of parents as part of child protection interventions.

Immediate and Delayed Reactions to Trauma-related Laboratory Research Among Rape Survivors and Controls

Ethical implications of laboratory-based experimental trauma research are not well studied. Female rape survivors (N = 62) and controls (N = 79) listened to an audio recording of a sexual assault and completed mental health measures and the Reactions to Research Participation Questionnaire-Revised in the first session and again several weeks later. In the first session, mental health symptoms were associated with stronger emotional reactions and personal benefits from participation. Rape survivors also reported stronger emotional reactions than controls, but also more personal benefits, more satisfaction, and fewer perceived drawbacks from participation. Several weeks later, both groups reported diminished posttraumatic stress disorder symptoms and rape survivors' reports of stronger emotional reactions and greater satisfaction with their participation remained significant. Benefit-cost ratios indicate positive responses to participation across groups and time. Findings suggest significant benefits to laboratory trauma research for participants.

Considerations of Dissociation, Betrayal Trauma, and Complex Trauma in the Treatment of Incest

Child sexual abuse committed by a parent (incest) is related to particularly severe physical and psychological symptoms across the life span. Incest is associated with low self-esteem, self-loathing, feelings of contamination, worthlessness, and helplessness, as well as somatization and low self-efficacy. A child's negative constructions often are attempts to derive some meaning that justifies the incest, such as, "it is because of my badness that it happens to me." Survival often involves voluntary or involuntary disconnection from self, others, and the environment, or compartmentalization of the traumatic experiences. Dissociation with survivors of child abuse, especially when the perpetrators are from within the child's caregiver system, can be accounted for by the concept of betrayal trauma. However, with few exceptions, little appears in the literature integrating dissociation, betrayal trauma, complex trauma, and incest for the purpose of treatment. Our purpose of this review to examine the relationship between trauma-related dissociation, betrayal trauma, and complex trauma, and how understanding these concepts and their relationship can inform the treatment of incest.

It's Good to Have You: The Moderator Role of Relationship Satisfaction in the Link Between Child Sexual Abuse and Sexual Difficulties

Research has revealed a significant prevalence of sexual problems in adulthood among child sexual abuse (CSA) survivors, yet many survivors do not report such difficulties. This study examined the moderator role of relationship satisfaction in the association between CSA and sexual difficulties in adulthood. Questionnaires assessing history of CSA, sexual difficulties, and relationship satisfaction were completed by 320 adults in intimate relationships. Analyses indicated that CSA survivors who were highly dissatisfied with their relationships reported more sexual difficulties than those who were satisfied with their relationships. Results highlight the importance of positive intimate relationships when working with CSA survivors.

Causal connection between dissociation and ongoing interpersonal violence: A systematic review

OBJECTIVE

To identify evidence for dissociation as a cause of ongoing interpersonal violence.

METHOD

A systematic review of the literature retrieved from ten databases.

RESULTS

Fifteen studies yielded from our search strategy have been included in the review; eleven of these were longitudinal and four were experimental. The evidence indicates that pathological dissociation may contribute towards enduring interpersonal violence. Thus, dissociation may account for instances of repeated victimisation. There are similar indications concerning offenders, but study designs in this area allow one to draw fewer causal conclusions. There is some evidence that dissociation decreases information processing from the limbic system, which may be one underlying neurofunctional mechanism of persistent violence.

CONCLUSION

There is growing evidence for dissociation as a cause of interpersonal violence. However, the available evidence is still limited, and our review rather reveals an important research gap. Future longitudinal and experimental studies aimed at clarifying the role of dissociation in the context of violence should take into account the theoretical and empirical complexity around the concept of dissociation.

Resilience and protective factors among people with a history of child maltreatment: a systematic review

PURPOSE

To provide an overview of resilience and protective factors associated with a better life following child maltreatment exposure, to compare protective factors across specific subtypes of maltreatment, and to explore existing issues in the current state of the literature.

METHODS

Electronic databases and grey literature up to October 2017 were systematically searched for English language with observational study designs for the research on resilience and childhood maltreatment. Systematic review and qualitative approaches were used to synthesize the results. Study quality and heterogeneity were also examined.

RESULTS

Initial screening of titles and abstracts resulted in 247 papers being reviewed. A total of 85 articles met eligibility criteria of this review. Most of these studies had low or middle study quality. There were two subgroups of studies reviewed: (1) 11 studies examined whether resilience protected against the negative consequence of childhood maltreatment, and, (2) 75 studies explored what protective factor was associated with a kind of adaptive functioning. Although the conceptualization of resilience significantly varied from study to study, protective factors associated with resilience at individual, familial, and societal levels reduced the likelihood of negative consequences of childhood maltreatment. Negative consequences following childhood maltreatment can be prevented or moderated if protective factors are provided in time. Future research needs to address the conceptualization issue of resilience.

CONCLUSIONS

Public and population mental health preventions should focus on early childhood and apply preventive strategies as early as possible. Cost-effective studies should be considered in the evaluation of resilience prevention program.

Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis

The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.

Resilience in Survivors of Child Sexual Abuse: A Systematic Review of the Literature

OBJECTIVE

This review article summarizes empirical research on resilience in survivors of child sexual abuse (CSA) and discusses protective factors that are associated with adaptive functioning in spite of sexual victimization.

METHODS

A literature search to identify studies published up to November 2013 was performed within the databases PsycINFO, MEDLINE/PubMed, Web of Science, and PSYNDEXplus. Additional relevant studies were retrieved using a snowball technique. A total of 37 articles met the inclusion criteria and were included in the final sample.

RESULTS

In the studies included in this review, the percentage of CSA survivors who were found to have a normal level of functioning despite a history of sexual abuse ranged from 10% to 53%. The protective factors that had the best empirical support were found to be education, interpersonal and emotional competence, control beliefs, active coping, optimism, social attachment, external attribution of blame, and most importantly, support from the family and the wider social environment.

CONCLUSIONS

Preventive and clinical interventions for survivors of CSA should utilize psychoeducation and cognitive strategies that are adapted to the developmental level of the victim and that seek to enhance social support from significant others. Future research should focus on longitudinal research designs considering resilience rather as a dynamic process with multiple dimensions in a social and developmental context.

Do Asian-American women who were maltreated as children have a higher likelihood for HIV risk behaviors and adverse mental health outcomes?

OBJECTIVES

This study is the first to systematically investigate whether multiple child maltreatment is associated with HIV risk behaviors and adverse mental health outcomes among Asian-American women.

METHODS

We conducted a cross-sectional study of unmarried Chinese, Korean, and Vietnamese women (n = 400), aged 18 to 35, who are identified as children of immigrants, using computer-assisted survey interviews.

RESULTS

Approximately 7 in 10 women reported having been maltreated as a child and 6.8% reported any type of sexual abuse. Only 15% of our sample reported having sex at age 16 or before, yet almost 60% had ever engaged with potentially risky sexual partners. Contrary to the findings from previous studies of White and Black women, sexual abuse plus other maltreatment was not associated with HIV risk behaviors among Asian-American women. However, it was associated with a marked increase in depression, lifetime suicidal ideation, and suicide attempts. A higher education level was associated with increased odds of HIV risk behaviors, including ever having had anal sex and ever having potentially risky sexual partners.

CONCLUSION

There was no evidence indicating that multiple child maltreatment was linked with HIV risk behaviors, but it exhibited a robust association with poor mental health outcomes. These empirical patterns of internalizing trauma, suffering alone, and staying silent are in accord with Asian-cultural norms of saving face and maintaining family harmony. The prevention of multiple child maltreatment may reduce high levels of depression and suicidal behaviors in this population. It is urgent to identify victims of multiple child maltreatment and provide culturally appropriate interventions.

Experiences of traumatic events and associations with PTSD and depression development in urban health care-seeking women

Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance.