The association of pain severity and pain interference levels with abuse experiences and mental health symptoms among 300 mothers: baseline data analysis for a 7-year prospective study

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

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

Exploring stress, cognitive, and affective mechanisms of the relationship between interpersonal trauma and opioid misuse

BACKGROUND

People with a history of interpersonal trauma, including intimate partner violence, sexual assault, and adverse childhood experiences, are disproportionately affected by the current opioid epidemic. Interpersonal trauma has been shown to increase risk for chronic pain conditions, prescription opioid use, and opioid misuse. Stress, cognition, and affective function have been examined as potential mechanisms that may influence opioid misuse among individuals with a history of interpersonal trauma. However, no studies have examined these factors simultaneously, despite their interrelatedness.

OBJECTIVE

The purpose of this study was to 1) examine perceived stress, perceived cognitive function, depressive symptoms, and PTSD symptoms as potential mechanisms of opioid misuse among individuals with a history of interpersonal trauma, 2) examine the types of interpersonal trauma that are associated with opioid misuse, and 3) assess the mediating role of pain and opioid prescription.

METHODS

A cross-sectional, observational study design was conducted. Data were collected through a confidential self-report online survey using validated instruments (n = 230). A series of regression analyses were conducted to identify mechanistic factors and interpersonal trauma types associated with opioid misuse, opioid prescription, and pain intensity. Structural equation modeling was used to examine mediating effects of pain intensity and opioid prescription.

RESULTS

Opioid prescription, depressive symptoms, and intimate partner violence increased the odds of reporting opioid misuse. Pain intensity and adverse childhood experiences increased the odds of opioid prescription. Higher levels of perceived stress and depressive symptoms were associated with increased pain intensity. Pain intensity emerged as a mediator of the relationship between depressive symptoms and opioid misuse.

CONCLUSIONS

Our work shows that there are likely several pathways through which interpersonal trauma can lead to opioid misuse. Interventions aimed at improving depressive symptoms and coping with traumatizing events should be included as part of comprehensive trauma-informed pain management practices.

Evaluating an Intergenerational Model to Explain the Path From Violence Against Mothers to Child Behavior and Academic Outcomes

An intergenerational model to explain the long-term effect of partner violence against mothers on child behavior was evaluated 48 months after 278 mothers first sought safe shelter or justice services. Twelve percent reported recent abuse, and six mothers reported severe or extreme danger. Self-efficacy (-.58, p < .05), social support (-28, p < .05), and financial support (-.25) were inversely associated with mental health concerns. Higher maternal mental health concerns (.55, p < .05) and child witnessing abuse (.70, p < .05) were associated with child behavioral problems. Child behavioral problems were inversely associated with child academic functioning (-.22, p < .05). To improve child outcomes, interventions that establish safety for mothers and children and promote maternal mental health are needed.

The Relationship of Intimate Partner Violence With Psychiatric Disorders and Severity of Pain Among Female Patients With Fibromyalgia

Objectives

This study aims to compare the prevalence of intimate partner violence and comorbid psychiatric disorders among patients with fibromyalgia syndrome (FMS) and healthy controls and also to investigate the relationship of intimate partner violence with psychiatric disorders and severity of pain in FMS patients.

Patients and methods

The study group consisted of 136 females including 68 patients with FMS (mean age 43±10.4 years; range, 25 to 70 years) and 68 FMS-free healthy females (mean age 38.5±11.3 years; range, 22 to 70 years). Following a Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I Disorders by a psychiatrist experienced in psychological trauma, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Visual Analog Scale (VAS) for the severity of pain and Domestic Violence Against Women Scale (DVAWS) were applied.

Results

In FMS group, 85% of the patients were diagnosed with mood or anxiety disorder. Almost half of these patients had major depressive disorder. The total scores of DVAWS and all subscales were significantly higher in the FMS group than in the control group (p<0.01). The severity of domestic violence were related to the presence of any psychiatric disorder only in FMS patients (p<0.01). Almost half of the FMS patients with high DVAWS score had comorbid mood and anxiety disorders. There was a significant positive correlation between the total scores of DVAWS, HDRS, HARS, and VAS (p<0.01).

Conclusion

Although the etiology of FMS is still uncertain, psychosocial factors may play role as risk factors. Therefore, a multidisciplinary approach to the treatment should be considered.

Coercive Control and the Stay-Leave Decision: The Role of Latent Tactics Among a Sample of Abused Pregnant Women

Prior research on intimate partner violence (IPV) and a survivor's decision whether to remain in or leave a violent relationship has often been framed by the question "why do they stay?" This study looks reframe the discussion and examine one facet of this stay-leave decision: abusers' use of coercive control tactics. Using a qualitative approach with a sample of pregnant women exposed to IPV, we sought to expand on the current knowledge by looking at coercive control more broadly via an open-ended assessment. Interview responses show that (a) coercive control was experienced by most of the women in this sample and (b) coercion most often took the form of "latent" or hidden control, including such tactics as providing incentives, showing remorse, and making promises. However, such latent coercive tactics are rarely assessed in IPV survivors and represent an important factor deserving of further research and recognition.

Maternal-child dyads of functioning: the intergenerational impact of violence against women on children

Violence against women is a global epidemic with potential consequences of injury, illness, and death. Children exposed to the violence may also be impacted with functional impairments. Little is known of the inter-generational impact of violence experienced by the mother from an intimate partner on functioning of her children. No dyad analysis was found in the literature. To examine the inter-generational impact of violence against women on the behavioral functioning of children, 300 mothers reporting intimate partner abuse and one randomly chosen child, age 18 months to 16 years of age; were evaluated for borderline and clinical diagnostic levels of problem behaviors. Linear, Logistic, and Ordinal regression models were applied. Mothers' problem behavior scores were significantly related to children's problem behavior scores (internalizing r = 0.611, externalizing r = 0.494, total problems r = 0.662, all ps < 0.001). Mothers who reported clinical and borderline clinical internalized problems (i.e., depression, anxiety) were 7 times more likely to have children with the same problems and mothers with borderline clinical and clinical external problems (i.e., aggression, hostility) were 4.5 times more likely to have children with the same external problems. These dyadic analyses provide evidence of a direct relationship of maternal functioning on child behavioral functioning. Intervention strategies to decrease internalizing maternal behavioral problems, such as depression, anxiety, and post traumatic stress disorder, and/or externalizing problems, such as hostility and aggression, can be expected to have a pass through, secondary impact on the behavioral functioning of children. Awareness of the relationship between intimate partner violence against mothers and child behavioral function can support interventions that decrease the distress experienced by mothers and their children, interrupt intergenerational transmission of abusive behaviors, and promote better maternal child functioning.

Modeling the intergenerational impact of partner abuse on maternal and child function at 24 months post outreach: Implications for practice and policy

OBJECTIVE

Many women are exposed to partner violence during their lifetime which affects mental health and child development. This study revalidates an intergenerational model connecting partner violence to poor functioning for mothers and children using structural equation techniques.

METHOD

A longitudinal design collected data on 300 mother-child pairs. Comparisons between the model, tested at study entry and again at 24 months, are reported. Maternal measures included childhood experiences of abuse, partner abuse, chronic pain, and mental health. The Child Behavior Checklist measured child function.

RESULTS

Comparison of both models revealed that maternal chronic pain, maternal mental health, and child witnessing of mother's abuse remain strong predictors of child dysfunction. Maternal social support and self-efficacy are significant predictors of more positive maternal mental health with a conduit effect on child behavior.

CONCLUSION

Intimate partner violence directly impacts the victim and also has a secondary impact on the children of abuse victims.

Predicting Abused Women With Children Who Return to a Shelter: Development and Use of a Rapid Assessment Triage Tool

To develop a tool to predict risk for return to a shelter, 150 women with children, exiting a domestic violence shelter, were evaluated every 4 months for 24 months to determine risk factors for returning to a shelter. The study identified four risk factors, including danger for murder, woman's age (i.e., older women), tangible support (i.e., access to money, transportation), and child witness to verbal abuse of the mother. An easy to use, quick triage tool with a weighted score was derived, which can identify with 90% accuracy abused women with children most likely to return to shelters.

The impact of pain on health-related quality of life 3 months after stroke

BACKGROUND

Pain is common in stroke; however, its impacts on health-related quality of life (HRQoL) are unclear due to the limitations of previous studies.

OBJECTIVES

The current study aims to examine and compare the demographic and clinical characteristics of Chinese stroke patients with and without pain and explore the correlations between poststroke pain and HRQoL.

METHOD

Four hundreds and forty-one participants recruited in an acute stroke unit in a regional hospital. They were assessed 3 months after the index stroke with the following instruments. HRQoL was measured using the Short Form-12 (SF-12). The Chinese version of the Faces Pain Rating Scale-Revised (FPS-R) was used to determine the presence and intensity of pain. The demographic and clinical characteristics of patients were obtained using Barthel Index (BI), Fatigue Severity Scale (FSS), Geriatric Depression Scale (GDS), Anxiety subscale of the Hospital Anxiety and Depression Scale (HADSA), Instrumental Activities of Daily Living (IADL), Mini Mental State Examination (MMSE), Modified Rankin Scale (MRS), and National Institutes of Health Stroke Scale (NIHSS).

RESULTS

Of all participants screened, 167 reported pain and 69 had novel pain. The pain group had significantly lower physical component summary (PCS) scores after adjusting for sex, education, DSM-IV depression and BI, GDS, HADSA, and FSS scores. The FPS score was negatively correlated with a lower PCS score in patients with pain and with novel pain.

CONCLUSION

The presence and intensity of pain have significant negative effects on HRQoL in stroke survivors. Interventions for pain could make a valuable contribution to improving HRQoL in stroke survivors.

Risk of behaviors associated with lethal violence and functional outcomes for abused women who do and do not return to the abuser following a community-based intervention

BACKGROUND

To determine the differential risk of behaviors associated with lethal violence and functioning outcomes for abused women with children who received an intervention of shelter or justice services and return to the abuser were compared with women who did not return.

METHODS

The study was carried out using a matched-pair analysis of 152 women. Measures of risk of behaviors associated with lethal violence, type, and severity of abuse, and poor mental health symptoms were measured every 4 months for 24 months.

RESULTS

Irrespective of service used, women returning to the abuser reported significantly (p<0.001) more risk of behaviors associated with lethal violence compared to women who did not return. Additionally, severity of physical abuse was significantly higher (p<0.01) for women returning to the abuser who had been in a shelter but not for women who received a protection order. Similarly, levels of depression, posttraumatic stress disorder, and anxiety were significantly higher (p<0.01) for sheltered women who returned to the abuser but not for women using a protection order who returned.

CONCLUSIONS

Risk of behaviors associated with lethal violence increases when abused women return to live with the abuser. Abused women should be informed of the heightened risk and greater probability for poor mental health.

Psychological processing in chronic pain: a neural systems approach

Our understanding of chronic pain involves complex brain circuits that include sensory, emotional, cognitive and interoceptive processing. The feed-forward interactions between physical (e.g., trauma) and emotional pain and the consequences of altered psychological status on the expression of pain have made the evaluation and treatment of chronic pain a challenge in the clinic. By understanding the neural circuits involved in psychological processes, a mechanistic approach to the implementation of psychology-based treatments may be better understood. In this review we evaluate some of the principle processes that may be altered as a consequence of chronic pain in the context of localized and integrated neural networks. These changes are ongoing, vary in their magnitude, and their hierarchical manifestations, and may be temporally and sequentially altered by treatments, and all contribute to an overall pain phenotype. Furthermore, we link altered psychological processes to specific evidence-based treatments to put forth a model of pain neuroscience psychology.