Profiles of Childhood Trauma in Women With Substance Use Disorders and Comorbid Posttraumatic Stress Disorders

Childhood trauma distribution and behavioural problems among Pakistani adolescents

BACKGROUND

Childhood trauma adversely impacts adolescents, and consequently, they develop behavioural problems. Understanding the distribution of childhood traumas and their association with behavioural problems among adolescents is paramount for the preventive efforts.

AIM/OBJECTIVE

The present research aimed to investigate this association among adolescents.

METHODS

This association was investigated among adolescents (N = 200) between 12 and 18 years. Childhood Trauma Questionnaire and Strength and Difficulty Questionnaire was used to assess the distribution of trauma and internalizing and externalizing behavioural problems among adolescents through purposive and convenience sampling technique.

RESULTS

The findings across trauma distribution indicated higher distribution of childhood abuse and neglect across males as compared to females. Males further significantly scored higher on sexual abuse and emotional neglect. Apparently, a large number of adolescents experienced all five sub types of childhood traumas (sexual abuse, emotional abuse, physical abuse, emotional and physical neglect). Additionally, across the severity continuum of childhood traumas, male scored higher on the severe to extreme continuum for all subtypes except physical abuse, where females scored higher. Lastly, logistic regression analysis indicated higher peer problems among those adolescents who have experienced all types of childhood traumas.

CONCLUSION

These findings could be beneficial for intervention-based programs and policies to help trauma-exposed adolescents cope with their lives.

The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis

BACKGROUND

Evidence suggests that the phenotypic expression of substance use disorders (SUD) may be influenced by exposure to childhood maltreatment (CM).

OBJECTIVE

To assess how CM could impact severity (relapse, treatment dropout, withdrawal), age of substance use onset, psychiatric dual diagnosis (depression, anxiety, PTSD, distress), and self-harm behavior/suicide attempts in adults with SUD, we performed a systematic review and meta-analyses.

METHODS

We searched PubMed, Web of Science, PsycINFO, and Embase to identify articles examining the association of maltreatment (physical, sexual, or emotional abuse or neglect) before age 18 years with clinical features and course of illness SUD. Multilevel random effects models were performed. Heterogeneity was quantified using the I2 statistic. Subgroup/meta-regression analyses were employed to investigate sources of heterogeneity. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale.

RESULTS

Forty-five studies were included. CM was associated with all tested outcomes, such as anxiety (OR = 1.52; 95 % CI = 1.39, 1.65), depression (OR = 1.57; 95 % CI = 1.40, 1.77), PTSD (OR = 1.67; 95 % CI = 1.40, 1.99), psychological distress (OR = 1.49; 95 % CI = 1.24, 1.78), self-harm behavior and suicidal attempts (OR = 1.70; 95 % CI = 1.47, 1.96), SUD severity (OR = 1.15; 95 % CI = 1.04, 1.26), and younger age of onset use (OR = 0.76; 95 % CI = 0.69, 0.84). However, comparisons between outcomes revealed that the association was stronger for dual diagnosis symptoms/conditions than for measures of SUD severity itself. Meta-analyses for some outcomes had large statistical heterogeneity, though these were partly addressed through additional analyses. Gender, mean age of participants, polysubstance use pattern, substance of preference, and CM subtype were found to be moderators of these associations.

CONCLUSIONS

The consequences of CM on individuals with SUD are more closely linked to co-occurring psychiatric manifestations than to the severity of common clinical indicators (relapse, treatment dropout, withdrawal), and this finding has important implications.

FUNDING

None.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42021245936).

Childhood Sexual Trauma, Substance Use, and Antiretroviral Therapy Adherence Among Older Adults Living With HIV: A Mediational Analysis

Childhood sexual abuse (CSA) is linked to substance use and lower antiretroviral therapy (ART) adherence. However, studies examining the mediational role of substance use between CSA and ART adherence are lacking. Therefore, the aim of this study was to determine the potential mediational role of substance use between CSA and ART adherence among older adults living with HIV (OALH) (n = 91). Mediation analyses assessed the direct and indirect relationships between CSA, substance use, and ART adherence. Statistically significant differences existed in substance use by gender (male vs. female: 12.3 vs. 9.97) and ART adherence by race (Black vs. White: 98.2% vs. 99.6%) and employment. CSA was associated with ART adherence (β = -3.27, p < .001) and substance use (β = 2.14, p = .035), but substance use was not associated with ART adherence, and did not mediate the pathway between CSA and ART adherence in the adjusted model. Trauma-informed interventions may lower substance use among OALH with CSA.

Intersecting Substance Use Disorder and Unmet Social Needs in Rural Pregnant Women

OBJECTIVE

To describe the unique challenges faced by rural pregnant women with intersecting substance use disorder (SUD) and unmet social needs.

DESIGN

Secondary qualitative data analysis with an analytic expansion approach.

SETTING

Hospital system in northern New England.

PARTICIPANTS

Four rural women with food insecurity who were in recovery for SUD (three were pregnant and one had given birth in the past 15 weeks).

METHODS

In the primary qualitative descriptive study, we interviewed 14 women about their experience of food insecurity during the perinatal period, including facilitators and barriers to being screened and accessing referrals for food insecurity and other social needs during prenatal care. This secondary analysis centered on the perspectives of four participants who reflected specifically on receiving material and mental health support through the integration of prenatal care and SUD treatment.

RESULTS

Rural women with SUD who experience social needs during pregnancy have difficulty accessing appropriate prenatal care and maintaining treatment engagement due to intersecting factors (e.g., food and housing insecurity and transportation) and psychological (e.g., mental health challenges, social isolation, and stigma) factors. Participants emphasized the importance of integrating social support within prenatal and substance use care to promote physical and mental health and engagement in SUD treatment.

CONCLUSION

In line with The Joint Commission's 2022 policy recommendations for universal social determinants of health screening, we support one-stop clinical and social care for pregnant women who face intersecting barriers to health, such as SUD and unmet social needs. Nurses can play an important role in care coordination for people with complex medical and social determinants of health screening needs. This approach is especially relevant to rural areas, where food, housing, and transportation insecurity rates are greater than nonrural areas.

Reported Increase in Substance Use Following Mass Terrorism and the Role of Psychosocial Factors

Importance

Research has shown evidence of increased substance use (ISU) in populations affected by mass terrorism; however, less is known regarding how psychosocial factors interact to estimate ISU following such events.

Objective

To examine which factors are associated with reporting ISU, test whether psychological distress (PD) mediated the association between exposure to trauma and reporting ISU, and whether the mediation effect differed among those with prior mental health (MH) difficulties and those without.

Design, Setting, and Participants

A partially representative cross-sectional survey of the adult Jewish population in Israel (aged 18-70 years) was conducted 4 weeks after October 7, 2023 (October 31 to November 5, 2023). A national Web panel using quotas based on national distributions was used. Randomly chosen adult Jewish members were invited to participate until a predetermined sample size was reached.

Main Outcomes and Measures

The study measures included reporting ISU (outcome), PD (mediator), exposure to terror events and sociodemographic characteristics (variables), and prior MH difficulties (moderator). Hypotheses regarding outcome and variables were formulated before data collection.

Results

A total of 7000 invitations were distributed, 2679 individuals consented, 1432 were excluded owing to quota limits, 74 failed attention tests, and 205 opted out, resulting in 968 participants (490 women [50.6%]; mean [SD] age, 41.5 [14.6] years). Hierarchical regression analysis revealed that participants were significantly more likely to report ISU if they had experienced direct exposure (odds ratio [OR], 5.75; 95% CI, 2.53 to 13.05), indirect exposure (OR, 1.84; 95% CI, 1.27 to 2.67), media exposure (OR, 1.22; 95% CI, 1.09 to 1.36), PD (OR, 1.80; 95% CI, 1.44 to 2.25), or previous MH difficulties (OR, 2.76; 95% CI, 1.86 to 4.09). PD partially mediated the association between indirect exposure (b = 0.20; 95% CI, 0.11 to 0.31) and media exposure (b = 0.14; 95% CI, 0.10 to 0.19) and reporting ISU. No evidence was found to support previous MH difficulties as a moderator of these indirect effects (indirect exposure, b = -0.003; 95% CI, -0.28 to 0.28; media exposure, b = 0.01; 95% CI, -0.06 to 0.08).

Conclusions and Relevance

This study contributes to the research on the association of mass terrorism with ISU while shedding important light on the role it may play in the self-medication of PD following exposure, even in those who might have no previous MH difficulties. These insights are crucial for planning essential health services and preventive measures.

ANK3 rs10994336 and ZNF804A rs7597593 polymorphisms: genetic interaction for emotional and behavioral symptoms of alcohol withdrawal syndrome

OBJECTIVE

Alcohol withdrawal syndrome (AWS) is a complex condition associated with alcohol use disorder (AUD), characterized by significant variations in symptom severity among patients. The psychological and emotional symptoms accompanying AWS significantly contribute to withdrawal distress and relapse risk. Despite the importance of neural adaptation processes in AWS, limited genetic investigations have been conducted. This study primarily focuses on exploring the single and interaction effects of single-nucleotide polymorphisms in the ANK3 and ZNF804A genes on anxiety and aggression severity manifested in AWS. By examining genetic associations with withdrawal-related psychopathology, we ultimately aim to advance understanding the genetic underpinnings that modulate AWS severity.

METHODS

The study involved 449 male patients diagnosed with alcohol use disorder. The Self-Rating Anxiety Scale (SAS) and Buss-Perry Aggression Questionnaire (BPAQ) were used to assess emotional and behavioral symptoms related to AWS. Genomic DNA was extracted from peripheral blood, and genotyping was performed using PCR.

RESULTS

Single-gene analysis revealed that naturally occurring allelic variants in ANK3 rs10994336 (CC homozygous vs. T allele carriers) were associated with mood and behavioral symptoms related to AWS. Furthermore, the interaction between ANK3 and ZNF804A was significantly associated with the severity of psychiatric symptoms related to AWS, as indicated by MANOVA. Two-way ANOVA further demonstrated a significant interaction effect between ANK3 rs10994336 and ZNF804A rs7597593 on anxiety, physical aggression, verbal aggression, anger, and hostility. Hierarchical regression analyses confirmed these findings. Additionally, simple effects analysis and multiple comparisons revealed that carriers of the ANK3 rs10994336 T allele experienced more severe AWS, while the ZNF804A rs7597593 T allele appeared to provide protection against the risk associated with the ANK3 rs10994336 mutation.

CONCLUSION

This study highlights the gene-gene interaction between ANK3 and ZNF804A, which plays a crucial role in modulating emotional and behavioral symptoms related to AWS. The ANK3 rs10994336 T allele is identified as a risk allele, while the ZNF804A rs7597593 T allele offers protection against the risk associated with the ANK3 rs10994336 mutation. These findings provide initial support for gene-gene interactions as an explanation for psychiatric risk, offering valuable insights into the pathophysiological mechanisms involved in AWS.

Giving Voice to Women with Substance Use Disorder: Findings from Expressive Writing About Trauma

Background

Trauma exposure is a risk factor for substance use disorders (SUD) among women. This study explores written content from an expressive writing (EW) intervention conducted within a residential SUD program to examine themes across trauma experiences and characterize their deep insight into such experiences.

Materials and Methods

This qualitative study is a secondary data analysis of written content of the first writing session from women (n = 44) randomized to an EW condition while in residential SUD treatment.

Results

Nearly all participants (72.7% African American; mean age 37.3 years) reported a significant trauma event (93.2%) with an average of 3.7 types of trauma events (54.4% had a current posttraumatic stress disorder diagnosis). Four primary themes emerged: (1) trauma across the lifespan; (2) loss of safety; (3) altered self-concept; and (4) desire to move on. Most participants identified interpersonal trauma, especially at an early age, as well as parental neglect and physical and/or sexual violence. These themes indicate a pattern of interpersonal betrayal and paint a picture of trauma and the subsequent "rippling effect" such that the physical, mental, and emotional consequences were often as impactful as the event itself. However, there was also a desire to move on and gain a sense of normalcy.

Conclusions

Findings highlight the importance of the written word and addressing underlying trauma in addiction treatment to facilitate healing and the woman's desire to move on.

"They just looked at me like I was human": The experiences of parenting women and providers with substance use disorder treatment

BACKGROUND

The current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program.

DESIGN AND METHODS

The study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC).

RESULTS

We conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal).

CONCLUSION

This research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.

Improving Traumatic Stress with Justice-Impacted Women and Women Experiencing Homelessness: A Pilot Study of Narrative Exposure Therapy

OBJECTIVE

We sought to investigate the feasibility, acceptability, and impact of a brief, manualized trauma-focused intervention aimed at improving PTSD symptoms in persons with complex PTSD, Narrative Exposure Therapy (NET).

DESIGN

Using a mixed methods approach, we tested the feasibility, acceptability, and impact of NET in a sample of trauma-affected women in traumatogenic circumstances: justice-impacted women in prison and women experiencing homelessness in a shelter. We quantitatively assessed data using a single sample, pre-/post-intervention design. We qualitatively assessed self-described symptom change and opportunities for intervention adaptation using a content analysis approach.

METHODS

Sixteen trauma-affected participants completed the intervention protocol. NET interventionists included one nurse practitioner, one registered nurse, and one nursing student. All NET participants attended pre-/post-intervention visits and active NET sessions. In-depth interviews were conducted at pre- and post-intervention, alongside a diagnostic battery.

RESULTS

NET was both highly feasible and acceptable among participants. Participants significantly improved on the intervention-specific outcome of PTSD symptoms, as well as somatic symptom burden, with large effect sizes. Participants also improved on subjective self-described symptom change. Participants offered recommendations regarding opportunities to enhance population-specific intervention acceptability.

CONCLUSIONS

Results from this pilot study are consistent with previous evidence demonstrating that NET facilitates improvements in women with traumatic stress. Findings of high feasibility, acceptability, and impact supports the use of NET in JW and WEH. Integrating participant recommendations to optimize acceptability may further support scalability and reach of NET. Replication with a larger sample and within a randomized controlled design is required to definitively determine effectiveness.

'It opened my eyes, my ears, and my heart': Codesigning a substance use disorder treatment programme

BACKGROUND

Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience-based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness.

METHODS

A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct.

RESULTS

The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID-19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start-up phase of an organisation presented implementation challenges.

CONCLUSION

These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care.

PATIENT CONTRIBUTION

Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five-person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members.

Guideline No. 443a: Opioid Use Throughout Women's Lifespan: Fertility, Contraception, Chronic Pain, and Menopause

OBJECTIVE

To provide health care providers with the best evidence on opioid use and women's health. Areas of focus include general patterns of opioid use and safety of use; care of women who use opioids; stigma, screening, brief intervention, and referral to treatment; hormonal regulation; reproductive health, including contraception and fertility; sexual function; perimenopausal and menopausal symptoms; and chronic pelvic pain syndromes.

TARGET POPULATION

The target population includes all women currently using or contemplating using opioids.

OUTCOMES

Open, evidence-informed dialogue about opioid use will lead to improvements in patient care and overall health.

BENEFITS, HARMS, AND COSTS

Exploring opioid use through a trauma-informed approach offers the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Therefore, health care providers and patients must understand the potential role of opioids in women's health (both positive and negative) to ensure informed decision-making.

EVIDENCE

A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, illicit drugs, fertility, pregnancy, breastfeeding, and aging.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

INTENDED AUDIENCE

All health care providers who care for women.

TWEETABLE ABSTRACT

Opioid use can affect female reproductive function; health care providers and patients must understand the potential role of opioids in women's health to ensure informed decision-making.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Improving understandings of trauma and alcohol and other drug-related problems: A social research agenda

Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.

Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023)

Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.

A Comparative Study of Women With Substance Use Disorder With and Without Post-traumatic Stress Disorder: Complex Interaction Between Childhood Trauma, Empathy, Personality Traits, and Substance Use Severity

Objective

Substance use disorders (SUDs) and post-traumatic stress disorder (PTSD) significantly coexist; thus, identifying potential related factors of both illnesses is important for advancing the prevention strategies. The goals of this study were to compare women with SUD with and without PTSD in terms of potentially related variables and to investigate if those factors are associated with SUD severity.

Methods

Ninety-five participants (women) with SUD who had been admitted to the outpatient treatment clinic in Turkey were assessed with borderline personality questionnaire, childhood trauma questionnaire, addiction profile index, Levenson self-report psychopathy questionnaire, and basic empathy scale.

Results

Participants with PTSD had significantly higher severity of addiction, childhood trauma, borderline personality traits, secondary psychopathy scores, and affective empathy scores than participants without PTSD (P = .013, P = .012, P = .008, P = .031, P = .040).

Conclusion

Our study suggested that comorbid PTSD and SUD resulted in more complicated presentation. It seems to be crucial for practitioners to screen PTSD symptoms in women with severe SUD and complicated clinical presentations.

Biopsychosocial Model of Traumatic Stress Symptoms in Women Experiencing Homelessness: A Qualitative Descriptive Study

Trauma is nearly ubiquitous among women experiencing homelessness (WEH). WEH develop post-traumatic stress disorder (PTSD) at rates far exceeding the general population. The consequences of untreated PTSD can cascade, exacerbating existing physical, mental, and social health inequities, placing this population at risk for disproportionate biopsychosocial health adversity. Despite the outsized impact of PTSD, WEH are less likely to access or receive appropriate trauma-focused services. Understanding the unique and intersecting factors that contribute to the disproportionate PTSD toll on WEH may elucidate risk and protective factors, as well as possible intervention pathways to address the disparate trauma burden. This study employed a qualitative descriptive approach to develop understanding of the determinants of trauma risk, exposure, and outcomes among WEH. Semi-structured interviews were completed with 10 WEH, six shelter staff, four mental health professionals. Six deductively biopsychosocial model-derived themes were identified, alongside supporting categories. Themes/categories highlighted the role of biological, psychological, and socio-environmental determinants in shaping risk for and actualization of traumatic events and adverse outcomes. Trauma played an outsized role in shaping the health of WEH participants in this study, and the need for and interest in tailored trauma screening, treatment, psychoeducation options was highlighted. Recursive relationships between biopsychosocial determinants and trauma impact were identified. Participants emphasized population tailored trauma-focused interventions, specifically brief co-designed and community partner implemented interventions that address substance use behaviors, while leveraging the strengths of WEH. Addressing the marked trauma burden in WEH shows promise in promoting measurable biopsychosocial health improvements in this resilient yet overlooked population.

Trauma Across the Life Span and Multisystem Morbidity in Women With HIV

OBJECTIVE

Sexual and physical abuse are highly prevalent among women living with HIV (WLWH) and are risk factors for the development of mental health and substance use disorders (MHDs, SUDs), and cognitive and medical comorbidities. We examined empirically derived patterns of trauma, MHD, and SUD, and associations with later cognitive and health outcomes.

METHODS

A total of 1027 WLWH (average age = 48.6 years) in the Women's Interagency HIV Study completed the World Mental Health Composite International Diagnostic Interview from 2010 to 2013 to identify MHDs, SUDs, and age at onset of sexual and physical abuse. Then, cognitive impairment, cardiovascular/metabolic conditions, and HIV disease outcomes were assessed for up to 8.8 years. Latent class analysis identified patterns of co-occurring trauma, MHDs, and/or SUDs. Generalized estimating equations determined associations between these patterns and midlife cognitive and medical outcomes.

RESULTS

Six distinct profiles emerged: no/negligible sexual/physical trauma, MHD, or SUD (39%); preadolescent/adolescent sexual trauma with anxiety and SUD (22%); SUD only (16%); MHD + SUD only (12%); early childhood sexual/physical trauma only (6%); and early childhood sexual/physical trauma with later MHD + SUD (4%). Profiles including early childhood trauma had the largest number of midlife conditions (i.e., cognitive, cardiovascular, HIV-related). Preadolescent/adolescent sexual trauma with anxiety and SUD predicted both global and domain-specific cognitive declines. Only SUD without trauma predicted lower CD4, whereas childhood trauma with MHD + SUD predicted increased CD8.

CONCLUSIONS

WLWH have complex multisystem profiles of abuse, MHD, and/or SUD that predict midlife cognitive, metabolic/cardiovascular, and HIV outcomes. Understanding the interplay between these factors over time can identify risks and personalize preventative and treatment interventions.

Heterogeneity In Women's Trauma Histories: Impact On Substance Use Disorder Severity

Trauma and substance use disorders (SUDs) frequently co-occur, especially in women. Previous studies have attempted to determine if individual differences in trauma histories could be meaningfully categorized but few studies have focused solely on women, especially those reporting substance use problems. A total of 130 women (M age = 30.7, SD = 7.9) self reporting past-year substance use problems completed comprehensive measures assessing lifetime exposure to a variety of traumatic events as well as substance use patterns and severity. Using latent class analysis, three classes emerged, a Low Lifetime Interpersonal Trauma class (40%, n = 52), a Moderate Lifetime Interpersonal Trauma class (23.8%, n = 31) and a High Lifetime Interpersonal Trauma class (36.2%, n = 47). Groups did not vary on daily/almost daily use of different types of substances and polysubstance use frequency but were significantly different on SUD severity, with the Moderate and the High Lifetime Interpersonal Trauma classes reporting severe SUD severity in comparison to moderate severity for the Low Interpersonal Trauma class. The findings of the current study indicate that women experiencing substance use problems should receive SUD treatment in a trauma-informed manner but that not all may require integrated trauma and substance use interventions.

A retrospective chart review of trauma-related documentation in an Australian substance use treatment service

INTRODUCTION

Trauma exposure among clients of substance use treatment services is almost universal and rates of trauma-related symptoms are correspondingly high. This study examined one aspect of clinical care-clinical documentation-and sought to systematically assess the documentation of trauma-related comorbidities and their treatment in a substance use treatment setting.

METHODS

A retrospective chart review was conducted on a sample of 300 patient records in a public substance use treatment setting. Rates of documentation of trauma-related events, symptoms and treatment, along with variables influencing the documentation of these issues, were examined.

RESULTS

Trauma-related documentation was present in 45.3% of records. There were documented trauma-related symptoms in 15.3% of records, although treatment activities addressing trauma were only present in 2.3% of records. Being female (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.42, 4.69), having prior mental health treatment (OR 1.82, 95% CI 1.05, 1.12) and having more treatment sessions (OR 1.08, 95% CI = 1.05, 1.12) increased the odds of trauma-related documentation being present, while being in the first episode of treatment (OR 0.49, 95% CI = 0.28, 0.84) decreased the odds.

DISCUSSION AND CONCLUSIONS

This study highlights significant under documentation of trauma-related comorbidities in substance-use treatment. There is limited evidence of consideration of trauma-related symptoms or diagnoses, and trauma-related comorbidities are rarely included in treatment planning activities. The lack of documented trauma-related information has important clinical and medico-legal implications for patients, and provides evidence to suggest a lack of integration of treatment for trauma-related disorders in substance use settings.

Measuring childhood trauma in young adults with depression: A latent profile analysis

Childhood traumas are important risk factors for depression in young adults. However, the co-occurrence of childhood traumas is complex, and the specific effects of different types of childhood traumas on depression need further exploration. The aim of this study was to assess the co-occurrence of childhood traumas and the impact of different profiles of childhood trauma on depression. A total of 1053 young adults with depression in China participated. PHQ-9, SHAPS, GAD-7, CTQ-SF, and NLES were evaluated. Latent profile analysis (LPA) was conducted to identify profiles of childhood trauma. The effects of different childhood trauma profiles on depression, anxiety, and anhedonia were assessed using stepwise linear regression. LPA suggested three profiles: no or low childhood traumas, moderate childhood trauma with emotional abuse and childhood neglect, and high childhood trauma with high levels of all trauma types. Regression analyses suggested that high levels of emotional abuse and childhood neglect significantly affected anhedonia. Childhood adverse events cluster in young adults with depression, allowing grouping into three distinct profiles. Specific childhood trauma patterns predict anhedonia symptoms in adult depression.

Epidemiology of opioid use in pregnancy

The world has been experiencing an opioid epidemic for over 20 years, and rates of use and overdose among women, including during pregnancy, have risen markedly. Women receive more prescriptions for opioids compared to men. Data suggest that 20% of women filled at least one prescription for an opioid during their pregnancy, and the prevalence of prenatal exposure averaged 14%. Opioid use by women, especially during pregnancy and while breastfeeding, and management and treatment is complex for healthcare providers, especially related to methadone treatment, pain management during labour, neonatal opioid withdrawal syndrome, nutritional issues and maternal withdrawal. Opioid use during pregnancy has been associated with maternal, foetal and infant complications, and overdose has become a leading cause of death in post-partum women in some countries. Universal screening for opioid use disorder (OUD) is recommended in pregnancy, and prevention and treatment programs that meet the specific needs of women are important to understand and consider as the world continues to try to anticipate and respond to the realities of the opioid epidemic.

Adverse childhood experiences among females in substance use treatment and their children: A pilot study

Women with substance use disorder (SUD) often have experienced adverse childhood experiences (ACEs). The intergenerational nature of ACEs also put their children at risk for experiencing ACEs. However, no research has explored the prevalence of ACEs in children whose mothers have SUD. This study assessed ACE scores in mothers with SUD and their children and compared them with non-SUD participants. Females with SUD were recruited from a treatment center (n = 50) and compared to females without SUD from the same area (n = 50). The ACE scores of the participants and their children were measured as well as sociodemographic variables. ANOVA and Fisher's Exact tests were used to examine univariate differences. Multivariate regression models assessed the difference in ACE scores between the groups and their children and the relationship between maternal and child ACE scores while including sociodemographic confounders. The mean ACE score was significantly higher in SUD participants (4.9, SD = 2.9) when compared to non-SUD participants (1.9, SD = 2.0) after controlling for sociodemographic variables (p < .01). Children of treatment participants also had significantly higher mean ACE scores (3.9, SD = 2.3) than children of comparison participants (1.3, SD = 2.0, p < .01). Maternal ACE score was positively related to children's ACE score after controlling for sociodemographic variables. Given the intergenerational nature of ACEs and their high burden in both mothers and children in substance use treatment, these preliminary findings suggest that mother-child trauma-informed interventions may be appropriate for this population.

Relationships between childhood trauma and perceived stress in the general population: a network perspective

BACKGROUND

Experiences of childhood trauma (CT) are associated with increased psychological vulnerability. Past research suggests that CT might alter stress processing with a subsequent negative impact on mental health. However, it is currently unclear how different domains of CT exert effects on specific subjective experiences of stress during adulthood.

METHODS

In the present study, we used network analysis to explore the complex interplay between distinct domains of CT and perceived stress in a large, general-population sample of middle-aged adults (N = 1252). We used a data-driven community-detection algorithm to identify strongly connected subgroups of items within the network. To assess the replicability of the findings, we repeated the analyses in a second sample (N = 862). Combining data from both samples, we evaluated network differences between men (n = 955) and women (n = 1159).

RESULTS

Results indicate specific associations between distinct domains of CT and perceived stress. CT domains reflecting a dimension of deprivation, i.e. experiences of neglect, were associated exclusively to a stress network community representing low perceived self-efficacy. By contrast, CT associated with threat, i.e. experiences of abuse, was specifically related to a stress community reflecting perceived helplessness. Our results replicated with high accordance in the second sample. We found no difference in network structure between men and women, but overall a stronger connected network in women.

CONCLUSIONS

Our findings emphasize the unique role of distinct domains of CT in psychological stress processes in adulthood, implying opportunities for targeted interventions following distinct domains of CT.

'I do not know where it comes from, I am suspicious of some childhood trauma' association of trauma with psychosis according to the experience of those affected

BACKGROUND

Trauma-related symptoms are often experienced after a first psychotic episode.

OBJECTIVE

In this study, we conduct a qualitative analysis of referred traumatic experiences of outpatients diagnosed with psychotic disorders.

METHOD

Focus groups were formed and in-depth interviews conducted with 30 participants, focusing on their experience with the disorder and the health care received. Given the frequency with which trauma and psychosis have been associated in the scientific literature, the nature of this relation is addressed as a secondary objective, via a qualitative analysis.

RESULTS

Analysis revealed two main themes in the patients' discourse. On many occasions, traumatic experiences were related to the development of the disorder. Although most participants referred to traumatic experiences during childhood, episodes during adult life were also reported, which may have triggered the disorder. The second theme was that of the interlocking relationship between the psychotic experience and certain coercive practices undergone during the provision of health care for psychosis, and the traumatic effects thus generated.

CONCLUSIONS

The participants considered both themes to be highly important. Accordingly, these issues should be carefully assessed and managed in order to provide appropriate person-centred care.

Incidence and Characteristics of Nonfatal Opioid Overdose Among Youths Aged 11 to 24 Years by Sex

IMPORTANCE

Opioid-related overdose has substantially increased among adolescents and young adults in recent years. How overdose differs by age and sex among youths and the factors associated with overdose by sex remain poorly described.

OBJECTIVE

To compare the sociodemographic and clinical characteristics of female and male youths who have experienced a nonfatal opioid overdose (NFOD) and compare the incidence of NFOD by sex.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study used data on US individuals aged 11 to 24 years with a diagnosis of NFOD from the IBM MarketScan Commercial Database from January 1, 2006, through December 31, 2017.

EXPOSURE

Sex.

MAIN OUTCOMES AND MEASURES

The primary outcome was NFOD stratified by sex; covariates included sociodemographic and clinical characteristics.

RESULTS

Among 20 312 youths aged 11 to 24 years who had a history of NFOD and met study eligibility criteria, the median age was 20 years (interquartile range, 18-22 years; mean [SD] age, 20.0 [2.9] years) and 56.7% were male. Compared with male youths, female youths had a higher baseline prevalence of mood or anxiety disorder (65.5% vs 51.9%, P < .001), trauma and stress-related disorders (16.4% vs 10.1%, P < .001), and history of suicide attempt or self-harm (14.6% vs 9.9%, P < .001). Male youths had a higher prevalence of opioid use disorder (44.7% vs 29.2%, P < .001), cannabis use disorder (18.3% vs 11.3%, P < .001), and alcohol use disorder (20.3% vs 14.4%, P < .001). The incidence rate ratio of NFODs in females vs males was greater than 1 for ages 11 to 16 years and was less than or equal to 1 after age 17 years.

CONCLUSIONS AND RELEVANCE

This cohort study found differences between female and male youths in sociodemographic and clinical characteristics and incidence of NFOD. Although female and male youths who experience overdose appear to have different risk factors, many of these risk factors may be amenable to early detection through screening and intervention.

Latent classes of childhood maltreatment in children and adolescents in foster care: associations with ICD-11 PTSD and complex PTSD

Background: Children and adolescents in foster care often experience many co-occurring subtypes of maltreatment. However, little is known about different combinations of maltreatment subtypes, referred to as maltreatment classes. Furthermore, the association between those maltreatment classes and ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) has not been investigated in children and adolescents. In previous studies, classes characterized by cumulative maltreatment were associated with severe psychopathological symptoms. So far, no study investigated ICD-11 PTSD and CPTSD. Objective: The first aim of this study was the detection of distinct maltreatment classes by examining frequently co-occurring maltreatment subtypes. The second aim was the examination of the association between those maltreatment classes and ICD-11 PTSD and CPTSD. Method: Participants were 147 children and adolescents currently living in foster care institutions in Lower Austria. Maltreatment history, ICD-11 PTSD and CPTSD were assessed using standardized self-report questionnaires. Latent class analysis was applied to examine maltreatment subtypes. χ2 difference testing was used to examine class associations with PTSD and CPTSD. Results: Three latent classes that comprised different subtypes of maltreatment were identified (limited maltreatment, n = 49; high neglect, n = 53; cumulative maltreatment, n = 45). Cumulative maltreatment was associated with higher symptom severity of PTSD and CPTSD than the limited maltreatment and the high neglect class, with effect sizes ranging from 0.62 to 0.93. Conclusions: The association of the cumulative maltreatment class with the highest symptom severity of PTSD and CPTSD highlights the detrimental effect of cumulative maltreatment. The detection of a high neglect class identifies children and adolescents, who are at high-risk of experiencing future maltreatment because of their previous experiences of neglect and the associated lack of protection. The examination of the association of distinct maltreatment classes with ICD-11 PTSD and CPTSD might provide implications for targeted prevention, assessment and treatment.

Mothering, Substance Use Disorders and Intergenerational Trauma Transmission: An Attachment-Based Perspective

Background: A growing body of research underlines that interpersonal trauma in childhood leads to heightened susceptibility for substance use disorders (SUDs) in later life. Little research has been conducted on parenting experiences of mothers in recovery from substance use, taking into account their own upbringing as a child and the potential aftermath of interpersonal childhood trauma. Methods: Through in-depth qualitative interviews, 23 mothers with SUDs reflected on parenting experiences and parent-child bonding, related to both their children and parents. Interviews were transcribed verbatim and data were analyzed adopting thematic analysis. Results: Throughout the narratives, consequences of trauma on mothers' sense of self and its subsequent impact on parenting arose as salient themes. Five latent mechanisms of intergenerational trauma transmission were identified: 1) early interpersonal childhood trauma experiences in mothers; 2) trauma as a precursor of substance use; 3) substance use as a (self-fooling) enabler of parental functioning; 4) continued substance use impacting parental functioning; and 5) dysfunctional parental functioning and its relational impact upon offspring. Discussion: Findings suggest disruptive attachment can increase the vulnerability for SUDs on the one hand, but can be an expression of underlying trauma on the other, hence serving as a covert mechanism by which trauma can be transmitted across generations. Results indicate the need for preventive, attachment-based and trauma-sensitive interventions targeted at disruptive intergenerational patterns.