A Multi-Cohort Examination of the Independent Contributions of Maternal Childhood Adversity and Pregnancy Stressors to the Prediction of Children's Anxiety and Depression

Women's social experiences can have long-term implications for their offspring's health, but little is known about the potential independent contributions of multiple periods of stress exposures over time. This study examined associations of maternal exposure to adversity in childhood and pregnancy with children's anxiety and depression symptoms in a large, sociodemographically diverse sample. Participants were 1389 mother-child dyads (child age M = 8.83 years; SD = 0.66; 42% Black, 42% White; 6% Hispanic) in the ECHO-PATHWAYS Consortium's three U.S. pregnancy cohorts. Women reported their exposure to childhood traumatic events (CTE) and pregnancy stressful life events (PSLE). Children self-reported on their symptoms of anxiety and depression at age 8-9 years. Regression analyses estimated associations between maternal stressors and children's internalizing problems, adjusting for confounders, and examined child sex as a modifier. Exploratory interaction analyses examined whether geospatially-linked postnatal neighborhood quality buffered effects. In adjusted models, PSLE counts positively predicted levels of children's anxiety and depression symptoms ([ßAnxiety=0.08, 95%CI [0.02, 0.13]; ßDepression=0.09, 95%CI [0.03, 0.14]); no significant associations were observed with CTE. Each additional PSLE increased odds of clinically significant anxiety symptoms by 9% (95%CI [0.02, 0.17]). Neither sex nor neighborhood quality moderated relations. Maternal stressors during pregnancy appear to have associations with middle childhood anxiety and depression across diverse sociodemographic contexts, whereas maternal history of childhood adversity may not. Effects appear comparable for boys and girls. Policies and programs addressing prevention of childhood internalizing symptoms may benefit from considering prenatal origins and the potential two-generation impact of pregnancy stress prevention and intervention.

Academic Outcomes Among Children Who Experienced or Were Exposed to Physical Abuse

All forms of family violence may negatively affect a child's development. However, research on child maltreatment is primarily focused on the child who is directly maltreated and does not often account for how other children in the family experience the abuse. The central aim of our study was to better understand how children's direct experience of physical abuse and exposure to physical abuse influence their academic outcomes. Data were taken from the Minnesota Departments of Education and Human Services. The sample was developed from a population-level cohort of 8-10 years old children (N = 1740) from two groups: Child Protective Service (CPS)-involved (a child who allegedly experienced physical abuse or a child who was exposed to the alleged physical abuse of another child in their household) and the matched comparison. Exposure to intimate partner violence (IPV) was also measured for CPS-involved children. School attendance and academic achievement were examined over 4 years. Descriptive statistics and Generalized Estimating Equations (GEE) were used to answer the three research questions. Over time, declines in attendance for children exposed to physical abuse were significantly greater than those of their matched peers. Exposure to IPV for CPS-involved children resulted in further declines in attendance. Math proficiency of children who experienced physical abuse declined at a significantly faster rate than their matched peers. The decline in reading proficiency of both children who experienced physical abuse and children exposed to physical abuse was more significantly pronounced than that of their matched peers. Differences in math and reading proficiency were eliminated when IPV exposure was taken into account. Child protection workers and school professionals should be aware of negative effects of experiences of and exposures to child maltreatment and work collaboratively to provide academic support, counseling, and other interventions to support children's academic stability.

"They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program

BACKGROUND

Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches.

METHODS

We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis.

RESULTS

Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing.

CONCLUSIONS

Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.

Health Care Providers' Readiness to Identify and Respond to Intimate Partner Violence

Screening rates for intimate partner violence (IPV) among most health care providers are low; yet, positive interactions with providers can benefit people who experience IPV, with respect to increased safety, support, and self-efficacy. Missing is a broad assessment and comparison of knowledge, attitudes, and behavior across the range of providers who are likely to be involved in a response to IPV disclosure. The purpose of our study was to assess health care providers' IPV preparation, knowledge, opinions, and practices and examine differences across three types of health care providers (medical providers, nursing staff, and social/behavioral health providers). We used an anonymous online survey to gather self-reported information on preparation, knowledge, opinions, and practices around IPV. A random sample of 402 providers was drawn from 13 clinics in a large multispecialty outpatient practice setting. The respondents (N = 204) consisted of medical providers (n = 70), nursing staff (n = 107), and social/behavioral health providers (n = 27). Data analyses consisted of univariate, bivariate, and multivariate analyses. Social/behavioral health providers reported more preparation, knowledge, victim understanding, and less job-related constraints, yet they reported lower screening rates than medical providers and nursing staff. Overall, no provider group seemed well-equipped to work with patients who disclose IPV. Our findings identify unmet needs within our health system to better train health care providers and restructure care models to support IPV identification and response. A focus on interprofessional training and care collaboration would bolster competency and reduce constraints felt by the health care workforce.

Longitudinal trends in screening males and females for intimate partner violence as part of a systemic multi-specialty health system intervention

Objective

To assess intimate partner violence screening for males and females in a health system that underwent a systemic intervention to improve survivor identification and response. Electronic health record data from 13 clinics were accessed for February of 2017, 2018, and 2019 to calculate screening rates and positive screening rates for intimate partner violence by clinic and sex-race groups (n  =  11,693 non-Hispanic White females; n  =  4318 Other females; n  =  9184 non-Hispanic White males; n  =  3441 Other males). Linear mixed effects models were used to examine whether screening rates differed significantly over time and by sex-race group.

Results

Screening rates were 31% for the first 2 years and 16% for 2019. Screening rates varied greatly by clinic. Dermatology, psychiatry, and otolaryngology clinics had average or above screening rates all 3 years. Differences in screening rates across sex-race groups were minimal. Average positive screen rates were 1.3%, 0.4%, and 2.6% in 2017, 2018, and 2019, respectively, with psychiatry having the highest positive screen rate. Positive screen rates were highest for non-Hispanic White females (3.5%). Universal screening in this health system was not yielding survivors comparable to existing estimates among clinic-based populations. Other identification approaches require testing to effectively identify survivors within the health sector.

A New Factor Solution for the Domestic Violence-Related Financial Issues Scale (DV-FI)

Economic abuse is a distinct form of intimate partner violence (IPV); yet, few measures of economic or financial factors exist. Weaver, Sanders, Campbell, and Schnabel's Domestic Violence-Related Financial Issues Scale (DV-FI) was developed to assess the role of financial-related issues in an individual's experiences of IPV as well as perceptions of financial self-efficacy and the future role that financial issues will play in one's sense of financial security. Despite its relevance to research focused on IPV, only portions of the DV-FI have been used in a handful of studies. The original factor analysis of the DV-FI identified five subscales within a shelter-based sample of impoverished, predominantly African American women. The DV-FI demonstrated good psychometric properties at the time of development; yet, to our knowledge, the factor structure of this measure has not been evaluated with another sample. Given the importance of identifying economic abuse and financial self-efficacy among women who experience IPV, it is essential to have a reliable and valid measure of these constructs. In this article, we describe the results of a confirmatory and exploratory factor analysis of the DV-FI using a community sample of 150 predominantly White, low-income women seeking civil legal services. We identified a four-factor solution of the DV-FI. Our findings provide support for the Financial Self-Efficacy subscale as a domain-specific measure of financial self-efficacy among women who experience IPV, but further validation is needed to explain the divergent findings for the remaining factors.

Intimate partner violence and social connection among married women in rural Bangladesh

BACKGROUND

Intimate partner violence (IPV) is high among married women in Bangladesh. Social isolation is a well-established correlate of women's exposure to IPV, but the role of such factors in low-income and middle-income countries is not well understood. In this study, we explore whether social connection is protective against IPV among married women in rural Bangladesh.

METHODS

Data were drawn from a multistage, stratified, population-based longitudinal sample of 3355 married women in rural Bangladesh, who were surveyed on individual and contextual risk factors of IPV. Negative binomial regression models were used to estimate the association between three different domains of social connection (natal family contact, female companionship and instrumental social support), measured at baseline in 2013, and the risk of three different forms of IPV (psychological, physical and sexual), approximately 10 months later, adjusted for woman's level of education, spouse's level of education, level of household wealth, age and age of marriage.

RESULTS

Adjusted models showed that instrumental social support was associated with a lower risk of past year psychological IPV (risk ratio (RR)=0.84, 95% CI 0.769 to 0.914), sexual IPV (RR=0.90, 95% CI 0.822 to 0.997) and physical IPV (RR=0.81, 95% CI 0.718 to 0.937). Natal family contact was also associated with a lower risk of each type of IPV, but not in a graded fashion. Less consistent associations were observed with female companionship.

CONCLUSION

Our findings suggest that social connection, particularly in the form of instrumental support, may protect married women in rural Bangladesh from experiencing IPV.

Detection and Referral of Orbital and Ocular Injuries Associated With Intimate Partner Violence Following an Educational and Screening Initiative in an Emergency Department

Importance

Intimate partner violence (IPV) is a substantial cause of morbidity and mortality in the US. Previous studies indicate gaps in identifying and referring female patients with IPV-associated orbital and ocular injuries to ancillary services.

Objective

To determine the number of IPV-associated orbital floor fractures, zygomaticomaxillary complex (ZMC) fractures, and ruptured globes referred to ancillary services in adult female patients following an educational and screening intervention to health care professionals.

Design, Setting, and Participants

This single-center retrospective quality improvement analysis examined electronic medical records of adult female patients seen in a single level 1 trauma center emergency department and ophthalmology clinic between January 2015 and February 2019, after the initiative began. Female adults who sustained orbital floor fractures, ZMC fractures, or ruptured globes were included. Preinitiative data were previously collected between January 1995 and January 2015 on adult female patients and published. Data analysis for this study occurred from May 2020 to September 2020.

Interventions

A 2-part, ongoing initiative began January 2015. First, enhancement of IPV screening protocols in the emergency department was conducted. Second, an educational campaign on IPV injury patterns was presented to residents and faculty in ophthalmology, emergency, otolaryngology, and trauma departments.

Main Outcomes and Measures

Comparison of ancillary service involvement preinitiative (January 1995 to January 2015) and postinitiative (January 2015 to February 2019).

Results

A total of 216 adult female patients (mean [SD] age, 55.0 [22.7] years; age range, 18-99 years) sustained orbital floor or ZMC fractures postinitiative. A total of 22 of 216 (10.2%) sustained fractures from IPV compared with 31 of 405 (7.6%) preinitiative (95% CI, -2.2% to 7.3%; P = .28). Documented social work referrals (11 of 31 preinitiative vs 20 of 22 postinitiative; difference, 55% [95% CI, 35%-76%]; P < .001), homegoing safety assessments (1 of 31 preinitiative vs 18 of 22 postinitiative; difference, 79% [95% CI, 61%-96%]; P < .001), and law enforcement involvement (7 of 21 preinitiative vs 16 of 22 postinitiative; difference, 50% [95% CI, 26%-74%]; P < .001) were higher in patients who presented after the initiative with orbital floor and ZMC fractures. A total of 51 adult female patients (mean [SD] age, 57.7 [20.8] years; age range 20-93 years) sustained ruptured globes postinitiative. A total of 5 of 51 patients (9.8%) sustained injury due to IPV postinitiative, compared with 5 of 141 (3.5%) preinitiative (95% patients, -2.5% to 15.0%; P = .08).

Conclusions and Relevance

Following the start of the initiative, referral patterns of adult female patients with IPV-associated orbital fractures improved. Targeted IPV screening of patients with orbital and ocular injuries is essential for effective intervention.

Race and sex differences in adverse childhood experiences among Asian/Pacific Islander college students

Adverse childhood experiences (ACEs) may be detrimental to health, yet are understudied in Asians/Pacific Islanders (API). We described the prevalence of individual ACEs among API college students compared to White college students. Participants: College students (n = 8,472) from 17 Minnesota postsecondary institutions completed the College Student Health Survey in spring 2015. Methods: Students self-reported on 11 ACEs. We assessed differences in prevalence of individual ACEs between APIs and Whites. Results: APIs were more likely to report having been physically abused (adj. OR = 2.04), verbally abused (adj. OR = 1.25), and raped (adj. OR = 1.75) relative to Whites. Stratification by sex showed API males were more likely to have been sexually abused relative to White males, with additional ACEs differing significantly by sex and race. Conclusions: Individual ACE prevalence differed between APIs and Whites and is often sex-specific. Additional research is needed to estimate ACE prevalence in other racial/ethnic groups and their health impacts.

Psychological Well-Being Among Women Who Experienced Intimate Partner Violence and Received Civil Legal Services

Intimate partner violence (IPV) victimization is often associated with negative mental health outcomes; yet, little is known about the psychological well-being of women who experience IPV and receive civil legal services. Civil legal services are not specifically designed to focus on women's mental health needs but Sullivan's Social and Emotional Well-Being Framework helps to explain why women receiving this type of formal assistance may demonstrate positive changes in psychological well-being. Using a panel study design and data from 85 women who experienced IPV and sought civil legal services, we examined women's psychological well-being over a one-year period of time. Approximately two thirds of the women received assistance from Iowa Legal Aid (ILA) for a civil protective order (n = 56) and the rest were represented in a family law matter. We used measures of mental health (depression, posttraumatic stress disorder [PTSD]) and well-being (social support, resilience, goal directed thinking, empowerment). Our hypotheses that women would experience a decrease in mental health symptoms and an increase in well-being were partially supported. Women reported a decrease in depressive and PTSD symptoms over one year but there were no changes in their goal-oriented thinking or resilience. Implications for practice and future research are included.

Implications of Severe Polyvictimization for Cardiovascular Disease Risk Among Female Survivors of Violence

In this study, we examined the impact of severe polyvictimization on 30-year cardiovascular disease (CVD) risk among female survivors of intimate partner violence (IPV). Data were collected from 34 participants in the "Leave it on the Mat" pilot study. The study was conducted in an urban city in a Midwestern state from August 2012 to April 2014. Severe polyvictimization was considered present if participants reported a history of three or more forms of victimization (childhood exposure to domestic violence, being psychologically or physically abused in childhood, and lifetime sexual assault) in addition to IPV. CVD risk factors included smoking, body mass index (BMI), and systolic blood pressure (SBP). A Framingham-based prediction model was used to estimate 30-year CVD risk. A linear regression model, adjusted for age, education, race/ethnicity, and family history of CVD, was calculated. Fifty percent (n = 17) of the study participants reported severe polyvictimization and the average 30-year risk of CVD in the full sample was 22.3. Participants who experienced severe polyvictimization had higher 30-year CVD risk scores when compared to participants who experienced two or fewer forms of victimization. The findings revealed that severe polyvictimization was prevalent among survivors of IPV and was associated with increased scores on the 30-year CVD risk model. Screening for abuse history could aid identification of individuals at high CVD risk.

Intimate Partner Violence Screening and Referral Practices in an Outpatient Care Setting

Health care providers who screen for intimate partner violence (IPV) and counsel patients can reduce victimization and positively impact women's health and well-being; yet only 2% to 50% of medical professionals report routinely screening female patients. The purpose of this study was to identify current practices, policies, barriers, and opportunities for a coordinated and routinized response to IPV in an outpatient academic primary care clinic. Data were collected through interviews and the Physician Readiness to Manage Intimate Partner Violence questionnaire. Data on IPV screening practices over a 5-month period were also available through the electronic health record. Study participants expressed that there was no uniform method of documenting screening results and great variability in the patient populations and circumstances that prompted screening. Over two thirds of the survey respondents reported either a lack of IPV protocol or a lack of knowledge about one if it existed. Providers and staff who participated believed it was within their scope of work to screen for IPV and recognized IPV as a serious health threat; however, they cited an absence of patient education resources, a lack of staff training and awareness, and no established IPV referral network as barriers to screening for IPV. The results of the pilot are in line with existing research highlighting a general lack of screening, variability in process, and the absence of systems-level policies and protocols and linkages to community resources. Pilot findings have been used to initiate a project which encompasses routinized screening, documentation, and care coordination between providers and community organizations to improve patient well-being.

Process evaluation of a systemic intervention to identify and support partner violence survivors in a multi-specialty health system

BACKGROUND

Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization.

METHODS

Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description.

RESULTS

Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology.

CONCLUSIONS

The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.

Risk and protective factors for symptoms of depression and anxiety among American Indians: Understanding the roles of resilience and trauma

OBJECTIVE

Depression and anxiety are comorbid conditions that are disproportionately high among American Indians (AIs) or Alaska Natives. The purpose of this study was to identify potential risk (e.g., low income, intimate partner violence [IPV], adverse childhood experiences [ACEs]) and protective factors (e.g., family resilience, social and community support) related to symptoms of depression and anxiety among AI adults.

METHOD

As part of larger exploratory sequential mixed-methods research, the study focused on survey data with 127 AI adults from two Southeastern tribes (n = 117 when missing data were removed). We used the following three-stage hierarchical regression to understand factors related to depressive and anxiety symptoms: (a) demographics, including income; (b) ACEs and IPV; and (c) family resilience, along with family and community support.

RESULTS

Many participants experienced elevated levels of clinically significant symptoms of depression and anxiety (15% and 20%, respectively). Results indicated lower income was associated with higher depressive and anxiety symptoms. IPV and ACE variables were positively associated with depressive and anxiety symptoms. Family resilience was negatively associated with symptoms of anxiety and depression. Social and community support were associated with symptoms of anxiety.

CONCLUSIONS

The findings provide strong preliminary support for the role of family protective and promotive factors in offsetting symptoms of anxiety and depression. This is contrary to most models of interventions for anxiety and depression focusing on individual psychotherapy rather than promoting family resilience or involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The contribution of interpersonal violence victimization types to psychological distress among youth

BACKGROUND

Associations between different types of victimization and symptomology among youth remain unclear due to methodological limitations preventing the identification of the independent contribution of each type of violence.

OBJECTIVE

The purpose was to examine associations between different types of victimization and the odds of experiencing clinically significant levels of anxiety, depression, and anger/aggression. We also examined the unique contribution of each type of victimization to these outcomes.

PARTICIPANTS

Participants were a nationally representative sample of youth ages 10-17 (n = 1019) who were residing in the United States when data were collected in 2002-2003.

METHODS

Youth reported on their experiences of different forms of victimization (e.g., physical abuse, emotional abuse, neglect, sibling abuse, bullying, sexual assault, and witnessing violence) within the past year. Logistic regression and relative weights analyses were used to examine associations between victimization and symptoms of depression, anxiety, and anger/aggression.

RESULTS

The prevalence of reported victimization ranged from 1.3 % for neglect to 41.3% for sibling abuse. Physical and emotional child abuse, sibling abuse, bullying, and emotional bullying were associated with increased odds of clinically significant anxiety, depression, and anger/aggression. Witnessing parent intimate partner violence was associated with increased odds of clinically significant anger/aggression. Witnessing parental assault of a sibling was associated with increased odds of clinically significant anxiety and anger/aggression. Emotional bullying predicted the largest percentage of variance in anxiety and depression, followed by emotional abuse and sibling aggression.

CONCLUSIONS

These findings underscore the need for further assessment and treatment for sibling abuse and emotional bullying.

The Family Resilience Inventory: A Culturally Grounded Measure of Current and Family-of-Origin Protective Processes in Native American Families

The purpose of this article is to introduce the Family Resilience Inventory (FRI) and present findings on initial efforts to validate this measure. The FRI is designed to assess family resilience in one's current family and in one's family of origin, enabling the assessment of family protective factors across these generations. The development of the FRI was the result of many years of ethnographic research with Southeastern Native American tribes; yet, we believe that this scale is applicable to families of various backgrounds. Items for the FRI were derived directly from thematic analysis of qualitative data with 436 participants, resulting in two 20-item scales. Due to missing data, eight cases were removed from the 127 participants across two tribes, resulting in an analytic sample size of 119. Conceptually, the FRI is comprised of two factors or scales measuring distinct dimensions of family resilience (i.e., resilience in one's current family and resilience in one's family of origin). The results of the confirmatory factor analysis supported the hypothesized two-factor structure (X2 (644) = 814.14, p = .03, X2 /df = 1.10, RMSEA = .03, CFI = .97, TLI = .96). Both the subscales and the total FRI scale (α = .92) demonstrated excellent reliability. The results also provided preliminary evidence of convergent and discriminant validity. This measure fills a gap in the absence of community-based, culturally grounded, and empirical measures of family resilience. The examination of family resilience, which may occur across generations, is an exciting new contribution of the FRI.

The Historical Oppression Scale: Preliminary conceptualization and measurement of historical oppression among Indigenous peoples of the United States

Indigenous peoples of the United States are distinct from other ethnic minorities because they have experienced colonization as the original inhabitants. Social and health disparities are connected to a context of historical oppression-the chronic, pervasive, and intergenerational experiences of oppression that, over time, may be normalized, imposed, and internalized into the daily lives of many Indigenous peoples (including individuals, families, and communities). As part of the critical Framework of Historical Oppression, Resilience, and Transcendence (FHORT), in this article, we introduce the Historical Oppression Scale (HOS), a scale assessing internalized and externalized oppression. Our study reports on survey data (N = 127) from a larger convergent mixed-methodology study with scale items derived from thematic analysis of qualitative data (N = 436), which informed the resultant 10-item scale. After six cases were removed from the 127 participants who participated in the quantitative component to the study due to missing data across two tribes, the sample size for analysis was 121. Confirmatory factor analysis testing of the hypothesized unidimensional construct indicated acceptable model fit (X² = 58.10, X2/df= 1.94, CFI = .98, TLI = .97, RMSEA = .088, 90% CI = .05, .12). Reliability of the 10-item scale was excellent (α = .97) and convergent and discriminant validity were established. The HOS explicates complex associations between historical oppression and health and social disparities and may be an important clinical and research tool in an understudied area.

Long-Term Effects of Truancy Diversion on School Attendance: a Quasi-Experimental Study with Linked Administrative Data

Over 60% of US school districts implement court diversion programs to address chronic unexcused absenteeism, yet the effectiveness of these programs is not known. We evaluated whether the Truancy Intervention Program (TIP) improved the school attendance of students in grades 7-10 in a metropolitan county in the Midwestern USA. Similar to most truancy court diversion programs, TIP consisted of three increasingly intrusive steps: (1) a parent meeting, (2) a hearing to develop an attendance contract, and (3) a petition to juvenile court. The intervention group consisted of students from the intervention county who had been referred to TIP between 2006 and 2009. The comparison group was drawn from a contiguous, same-sized, and socio-demographically similar county that petitioned truant students directly to court. To construct the comparison group, we applied multi-level matching procedures to linked, individual-level administrative data from eight state and local agencies for all public school students in the state between 2004 and 2015. Using the matched samples, we conducted difference-in-differences analyses to identify program effects for two intervention groups: all students referred to TIP and students whose family participated in the group parent meeting. In the 4 years after the intervention, the intervention groups had similar or slightly lower attendance than the comparison groups. However, most coefficients were not statistically significant, and there was no consistent pattern of effects across different samples and different specifications of the intervention. This pattern of findings was not robust enough to conclude that the program influenced school attendance.

Linking partner violence survivors to supportive services: impact of the M Health Community Network project on healthcare utilization

BACKGROUND

Intimate partner violence (IPV) is associated with adverse health effects and increased healthcare utilization. Systems-level interventions have been shown to be effective in identifying and referring survivors but little is known about how these strategies impact future utilization. The objective of this study is to examine the impact of a systems-level response on healthcare utilization among patients screening positive for IPV from November 2016 to February 2019 in a large multi-specialty outpatient health system in the Midwest.

METHODS

Using electronic health record (EHR) data, we identified patients who screened positive for IPV (N = 756) and categorized their response as accepted printed material (N = 116), accepted direct referrals (N = 85), declined both (N = 271), or missing (N = 255). We used negative binomial models to model post-period utilization as a function of decision group, pre-period utilization, and clinical and demographic factors.

RESULTS

After controlling for demographic characteristics and baseline utilization, the printed materials and direct referral groups had higher utilization rates than those who declined printed materials and direct referral during the post-period for every type of service. However, these differences were only statistically significant for outpatient, behavioral health, and social work services. Specifically, the visit rate for patients receiving printed materials was two times higher (rate ratio: 2.18; 95% CI: 1.21, 3.94) for behavioral health services and three times higher (rate ratio: 3.33; 95% CI: 1.3, 8.52) for social work services compared to those who refused printed material and direct referral. For those opting for a direct referral, the visit rate was two times higher for outpatient services (rate ratio: 1.97; 95% CI: 1.13, 3.42) compared to those who refused.

CONCLUSIONS

Patients receiving printed materials or direct referrals had more social work and behavioral health visits, highlighting an important outcome of the protocol. However, higher utilization rates among outpatient services and a trend toward higher utilization of other services, including the emergency department, suggest greater health service utilization is not diminished by the systems level response-at least not within a two-year time frame.

The Framework of Historical Oppression, Resilience and Transcendence to Understand Disparities in Depression Amongst Indigenous Peoples

Given chronic experiences of historical oppression, Indigenous peoples tend to experience much higher rates of depression than the general US population, which then, drives disproportionately high rates of suicide and other health disparities. The purpose of this research was to examine the core components of the culturally grounded Framework of Historical Oppression, Resilience, and Transcendence as they relate to depressive symptoms experienced by Indigenous peoples. As part of a larger convergent mixed-methods study, in this quantitative survey component, we utilised data from a sample of 127 Indigenous adults across two Southeastern US tribes. Regression analysis results signified support for the framework, indicating that historical oppression and proximal stress (daily stressors and lower incomes) were risk factors, whereas family resilience and life satisfaction (a measure of transcendence) were protective factors related to depressive symptoms. The results provide a foundation for future research to build upon in identifying culturally relevant risk and protective factors to ameliorate depression and other health disparities.

Screening, management, and treatment of intimate partner violence among women in low-resource settings

The prevention of intimate partner violence continues to be a high priority for health practitioners and researchers around the world. Screening practices and intervention efforts utilized within high- and/or middle-income areas may not translate effectively to low-resource areas due to differences in financial, social, and physical context. However, little is known about the evidence-base of intervention efforts in such areas. Using the Arksey and O'Malley framework for scoping reviews, the purpose of this review was to synthesize what is known about intimate partner violence screening, management, and treatment in low-resource areas. A total of 31 programs reported across 34 articles were included in this scoping review. The programs incorporated a range of intervention activities, including group-based education and skill-development combined with microfinance to screening and referral to community resources. Slightly less than half of the studies (n = 14) were randomized controlled trials or clustered randomized controlled trials. Many barriers were common across the programs, including limited financial support, lack of community support, and lack of coordination across programs. Despite considerable barriers related to the limited available resources, the literature base had many strengths, such as strong evaluation methodologies, inclusion of a theoretical or conceptual framework to guide the intervention, and community engagement before and during the intervention implementation. However, insufficient statistical power and barriers related to cultural differences or inadequate cultural sensitivity were also common. With a variety of barriers to program implementation noted within the articles, it is important for researchers and practitioners to consider the geographic, social, cultural, and economic contexts when implementing intimate partner violence programs in low-resource areas. Given the significant differences in context across low-resource areas, additional research to establish effective protocols for tailoring and implementing evidence-based programs using a community-engaged framework would be beneficial to future research and practice.

Exploring Protective Strategies among Rural Women in an Abusive Relationship

The purpose of this study was to explore rural women's accounts of intimate partner violence and the strategies they used to protect themselves from such adversity. Convenience sampling included women currently in an abusive relationship (N = 22), who were receiving mental health services at a rural victim-service provider. Standardized measures indicated, on average, that study participants were symptomatic for depression, anxiety and posttraumatic stress disorder (PTSD), yet exhibited higher resilience than other PTSD populations. Participants used a variety of strategies to halt, escape, or resist violence in their lives. Informal and safety planning strategies were rated as most helpful, though resistance and placating strategies were most commonly used. Formal strategy use among participants was associated with higher levels of resilience and depressive symptoms; while participants' increased use of safety planning and resistance strategies were also related to greater resilience. Implications for rural victim service providers include addressing psychological distress and hardiness for women currently in an abusive relationship, while providing the necessary resources to secure their safety.

Physical family violence and externalizing and internalizing behaviors among children and adolescents

Family violence has been associated with various negative outcomes among children and adolescents. Yet, less is known about how unique forms of physical family violence contribute to externalizing and internalizing behaviors based on a child's developmental stage. Using data from the Illinois Families Study and administrative Child Protective Services data, we explored the relation between 3 types of physical family violence victimization and externalizing and internalizing behaviors among a sample of 2,402 children and adolescents. After including parent and family level covariates in Poisson regressions, we found that a unique form of family violence victimization was associated with increased externalizing behaviors among children at each age group: exposure to physical intimate partner violence (IPV) among children ages 3-5, exposure to the physical abuse of a sibling among children ages 6-12, and child physical abuse among adolescents ages 13-18. No form of physical family violence was significantly associated with internalizing behaviors for children in any age group. Including exposure to the child maltreatment of a sibling is crucial when attempting to contextualize children's responses to family violence and providing comprehensive services in an effort to enhance the well-being of all children in a family. (PsycINFO Database Record

Patterns of Dating Violence Perpetration and Victimization in U.S. Young Adult Males and Females

Dating violence (DV) is frequently reported by young adults in intimate relationships in the United States, but little is known about patterns of DV perpetration and victimization. In this study, we examined sexual and physical violence perpetration and victimization reported by young adults to determine how the violence patterns differ by sex and race/ethnicity. Data from non-Hispanic White, non-Hispanic Black, and Hispanic participants in Wave 3 of the National Longitudinal Study of Adolescent to Adult Health were analyzed. DV was assessed using responses to four questions focused on perpetration and four questions focused on victimization. The information on DV was taken from the most violent relationship reported by participants prior to Wave 3. Latent class analysis was first conducted separately by sex, adjusting for age, race/ethnicity, and financial stress, then by race/ethnicity, adjusting for age and financial stress. Relative model fit was established by comparing Bayesian Information Criteria (BIC), adjusted BIC, entropy, interpretability of latent classes, and certainty of latent class assignment for covariate-adjusted models. The results indicate that patterns of violence differed by sex and for females, by race/ethnicity. A three-class model was the best fit for males. For females, separate four-class models were parsimonious for White, Black, and Hispanic females. Financial stress was a significant predictor of violence classification for males and females and age predicted membership in White and Black female models. Variations in DV patterns by sex and race/ethnicity suggest the need for a more nuanced understanding of differences in DV.

Does Type of Child Risk Affect Whether Mothers Seek Assistance for Intimate Partner Violence From Civil or Criminal Court?

We examined whether risks to children of intimate partner violence survivors affected the type of legal assistance accessed. We hypothesized that the level and type of perceived child risk would be associated with whether women sought a protection order in civil court or filed charges against a current or former intimate partner in criminal court. Using data from a sample of predominantly African American women (N=293), we found that some forms of child risk were positively associated with seeking a civil order of protection but negatively associated with pressing criminal charges. Implications for practice, policy, and future research are presented.

Disparities in long-term cardiovascular disease risk by sexual identity: The National Longitudinal Study of Adolescent to Adult Health

OBJECTIVE

To examine long-term cardiovascular disease (CVD) risk disparities by sexual identity using a nationally representative sample of young adults in the United States.

METHODS

Data include participants in wave 4 (2008/09; ages 24-34years) of the National Longitudinal Study of Adolescent to Adult Health (7087 females; 6340 males). Sexual identity was self-reported (heterosexual, mostly heterosexual, bisexual, mostly homosexual, homosexual) and a Framingham-based prediction model was used to estimate participants' risk of a CVD event over 30years. Differences in CVD risk by sexual identity, relative to heterosexuals, were calculated with linear regression models adjusted for age, race/ethnicity, education, and financial distress.

RESULTS

Average 30-year CVD risk was 17.2% (95% CI: 16.7, 17.7) in males and 9.0% (95% CI: 8.6, 9.3) in females. Compared to heterosexual females, mostly heterosexual (0.8%; 95% CI: 0.2, 1.4) and mostly homosexual females (2.8%; 95% CI: 0.8, 4.9) had higher CVD risk. Bisexual and homosexual females had higher but not statistically significant CVD risk compared to heterosexuals. Among males, differences in CVD risk by sexual identity were not statistically significant.

CONCLUSION

Sexual identity was associated with CVD risk in sexual minority subgroups. Population- and clinic-based prevention strategies are needed to minimize disparities in subsequent disease.

Individual and interpersonal risk factors for physical intimate partner violence perpetration by biological sex and ethnicity

Intimate partner violence (IPV) is a public health problem that reaches across age, sex, and ethnicity. In this study, we examined risk factors for physical IPV perpetration among young adult males and females from four ethnic groups. Data were taken from Waves 1-3 of the National Longitudinal Study of Adolescent Health (Add Health). The sample included 10,141 Wave 3 respondents (ages ranged from 18-27 years old) who reported being in a current romantic relationship. Physical IPV perpetration was reported by 14.10% of White, 23.28% of Black, 18.82% of Latino, and 18.02% of Asian males. Physical IPV perpetration was reported by 19.01% of White, 24.80% of Black, 25.97% of Latina, and 19.21% of Asian females. Following an ecological framework, proximal risk factors at intrapersonal and interpersonal levels were included in the analyses. Despite finding fairly consistent percentage of physical IPV perpetration across sample groups, the risk factors for physical IPV perpetration were rather uncommon across sex and ethnicity. Only 1 factor--psychological IPV perpetration toward a romantic partner--was consistently associated with physical IPV perpetration across all groups. Our findings have implications for tailoring prevention and intervention efforts toward risk factors of physical IPV perpetration that are uniquely associated with biological sex and ethnicity.

Strain, depressed mood and suicidal thoughts among maltreated adolescents in the United States

Almost one-fourth of maltreated adolescents report they have thought about killing themselves in the last two weeks. We draw on Agnew's strain theory to develop a model to account for variability in suicidal thoughts among this high-risk group. We used data from a nationally representative sample of 572 maltreated adolescents, aged 11-15. One dimension of relational strain (poorer relationship with peers) and greater depressed mood were directly related to whether adolescents did or did not think about suicide. Depressed mood mediated the relationship between two strain variables (relationship with caregiver and with school) and suicidal thoughts. Child maltreatment strain (being severely harmed) and substance use were not directly related to suicidal thoughts; however, depressed mood appeared to mediate the relationship between drug use and suicidal thoughts. Adolescents who experience child maltreatment and who appear to be disconnected from caregivers, friends and school should be screened for depression and suicidal thoughts.

Child and family-level correlates of direct and indirect peer victimization among children ages 6-9

The purpose of this study was to examine the prevalence and child and family-level correlates of direct and indirect victimization by peers among children ages 6-9. Four hundred and twenty-five children were included in the final sample. Data for this study were drawn from the first wave of the Developmental Victimization Survey. Logistic regression models were used to examine associations between children's demographics, anxiety, depression, anger, parent-child relationship, and exposure to family violence and children's experience of direct or indirect victimization by peers. The results showed that increased depression scores and exposure to family violence were associated with increased risk for direct and indirect victimization by peers. Black children were more likely to experience direct victimization and less likely to experience indirect victimization compared to White children. Child's race significantly moderated the association between parental criticism and indirect victimization. Child's gender did not significantly moderate these associations. Implications for developmentally specific prevention and intervention approaches that are grounded in a social-ecological framework are discussed.

Individual and familial risk and protective correlates of physical and psychological peer victimization

The purpose of this study was to explore the association between youth characteristics, parenting behavior, and family violence and risk of physical and/or psychological peer victimization using a sample of 856 adolescents aged 10-17. Additionally, we examined whether the relation between parenting behaviors and victimization was moderated by age and gender. Data for this study were drawn from the first wave of the Developmental Victimization Survey. The results revealed unique associations between youth and familial correlates and odds for experiencing physical, psychological, and both types of victimization. Gender was found to be a statistically significant moderator of the relation between parental monitoring and odds of experiencing both physical and psychological peer victimization. Implications for bully prevention and intervention are discussed.

Recovery: resilience and growth in the aftermath of domestic violence

This mixed-methods study explored the recovery process and outcomes for 37 women formerly in an abusive intimate partner relationship. Standardized measures of current psychosocial functioning indicated participants were largely asymptomatic for posttraumatic stress disorder and had relatively strong resilience. Qualitative analysis revealed how social and spiritual support was instrumental to participants' recovery, growth, and resilience. Implications for helping professionals include gaining a more comprehensive understanding of recovery from domestic violence. This type of knowledge may contribute to interventions that build on women's strengths and resourcefulness.

Factors from Durkheim's family integration related to suicidal ideation among men with histories of child sexual abuse

Men who were sexually abused during childhood represent a highly stigmatized, marginalized population at risk for a variety of long-term mental health problems. Using the family integration dimension of Durkheim's theory of suicide, factors associated with suicidal ideation among a purposive sample of 487 men with histories of child sexual abuse were examined. Four variables--length of cohabitation, maternal support after disclosure, parental divorce, and older age--were negatively related to suicidal ideation. The analysis provides partial support for Durkheim's model. Implications for education, clinical practice, and future research are presented.

Suicide attempts among men with histories of child sexual abuse: examining abuse severity, mental health, and masculine norms

OBJECTIVE

Men who were sexually abused during childhood are at risk for a variety of long-term mental health problems, including suicidality. However, little is known about which factors are related to recent suicide attempts for this vulnerable, under-researched population. The purpose of this study was to examine the relationship between abuse severity, mental health, masculine norms and recent suicide attempts among men with histories of child sexual abuse (CSA).

METHODS

We analyzed survey data gathered from a purposive sample of 487 men who were sexually abused during childhood. The age of the sample ranged from 19 to 84 years (μ = 50.4 years). Recent suicide attempts served as the dependent variable in the study. Self-reported measures of sexual abuse severity, child physical abuse, mental health, masculine norms, and demographic information (age, race) represented the independent variables.

RESULTS

The results from logistic regression modeling found that five variables - duration of the sexual abuse, use of force during the sexual abuse, high conformity to masculine norms, level of depressive symptoms, and suicidal ideation - increased the odds of a suicide attempt in the past 12 months.

CONCLUSION

To improve mental health services for men with histories of CSA, mental health practitioners should incorporate sexual abuse severity, current mental health, and adherence to masculine norms into assessment and treatment planning.

The association of intimate partner violence and depressive symptoms in a cohort of rural couples

PURPOSE

The purpose of this study was to estimate the prevalence of physical and emotional intimate partner violence (IPV) perpetration and victimization among adult, cohabitating couples. The association between IPV and depressive symptoms, as well as the severity of depressive symptoms, was reported for both males and females.

METHODS

In a rural cohort study, 548 couples completed survey items concerning physical and emotional IPV, and mental health.

FINDINGS

Males and females who perpetrated physical IPV were 17.7 and 11.5 times more likely, respectively, to also be victims of physical IPV. Male and female perpetrators of emotional IPV were 18.7 and 5.2 times as likely, respectively, to also be victims of emotional IPV. Males and females with IPV histories were 3.0 and 2.4 times more likely, respectively, to have depressive symptoms (P < .001) than those without abuse histories. Females reported higher scores than males on the depressive symptoms index.

CONCLUSIONS

This study suggests that many couples in rural areas use physical and emotional violence against each other in their relationships, and that both males and females who report a history of IPV are more likely to report depressive symptoms. These findings support IPV screening for physical and emotional violence among all patients and providing follow-up intervention programs in health care settings.

Risk factors for unidirectional and bidirectional intimate partner violence among young adults

OBJECTIVE

The purpose of this study was to identify common and unique risk factors for intimate partner violence (IPV) among young adults in relationships. Guided by two models of IPV, the same set of risk factors was used to examine outcomes of unidirectional (perpetration or victimization) and bidirectional (reciprocal) IPV separately for males and females.

METHODS

The sample included 10,187 young adults, ages 18-27, from the National Longitudinal Study of Adolescent Health. The respondents were drawn from Wave 3 and stated they had a romantic relationship during the time of the study. The risk factors were primarily related to violent socialization (e.g., childhood maltreatment, youth violence) and personal adjustment (e.g., alcohol use, depression).

RESULTS

Approximately 47% of the respondents experienced some form of IPV in romantic relationships, and the majority of respondents reported bidirectional violence. For males, childhood sexual abuse was associated with perpetration and bidirectional IPV, and childhood neglect was associated with bidirectional IPV. For females, childhood neglect was associated with all three IPV outcomes, and childhood physical abuse was associated with bidirectional IPV. Youth violence perpetration during adolescence increased the odds for all IPV outcomes among females, while low self-esteem increased the odds for all IPV outcomes among males. A history of suicide attempts predicted bidirectional IPV across genders. Being married and living with a partner predicted all three IPV outcomes for males and females.

CONCLUSIONS

The results revealed more common risk factors for bidirectional IPV than unidirectional IPV and few common risk factors across genders. The results indicate that IPV prevention and intervention strategies should be tailored to the unique risk experiences of males and females rather than focus on a common factors approach. However, child abuse, youth violence, and suicide prevention efforts may reduce incidents of later IPV for males and females, and these strategies should continue to be an emphasis in practice and research.

Academic achievement despite child maltreatment: a longitudinal study

PURPOSE

Although researchers have concluded that child maltreatment has a negative effect on children's learning and academic achievement, not all children are negatively affected by maltreatment, and some children seem to succeed academically despite being maltreated. Drawing on risk and resilience theory, we examined a broad range of potential risk, promotive, and protective factors within children and their environments along with characteristics of the maltreatment to account for variability in test scores.

METHODS

A national longitudinal probability sample of 702 maltreated school-aged children, ages 6-10, and their caregivers was used to predict reading and math scores among maltreated children over three years.

RESULTS

We found that chronic maltreatment, poorer daily living skills, and lower intelligence explained a substantial proportion of the variance in maltreated children's math scores (39%), whereas type of maltreatment, poorer daily living skills and lower intelligence explained a substantial proportion of the variance in reading scores (54%) over time. Contrary to our prediction, having a behavior problem seemed to protect chronically maltreated children from poorer performance in math over time.

CONCLUSIONS

To increase academic achievement among maltreated children, it is imperative that we prevent chronic maltreatment and help children increase their competency on daily living skills.

Gender differences in risk and promotive classifications associated with adolescent delinquency

How likely are children exposed to multiple risk factors to engage in delinquent behavior, to what extent do promotive factors mitigate exposure to these risk factors, and do the predictors of delinquent behavior differ by gender? To address these questions, the authors analyzed data from youths (229 boys, 187 girls) who completed the third wave of the Lehigh Longitudinal Study using Latent Profile Analysis. A unique risk and promotive class with slightly elevated rates of exposure to parental violence, mean levels of other risk factors and low levels of promotive factors was present for girls but not for boys. Additionally, for boys and girls, high-risk, low-promotive individuals were significantly more likely to engage in delinquent behavior than low-risk, high-promotive cases. Findings suggest the need to examine risk and promotive factors in combination to account for their shared influences on developmental outcomes for youth.

GENDER DIFFERENCES IN RISK/PROTECTION PROFILES FOR LOW ACADEMIC PERFORMANCE

Using holistic-interactionistic theory, the simultaneous nature of risk and protection factors for both males and females (age 6-11 in Wave 1) is examined using Latent Profile Analysis (LPA). Risk/protection classes are estimated using multiple risk factor variables (e.g., physical child abuse) and multiple protective factors (e.g., extracurricular activities). These risk/protection classes were used to predict low academic performance. For both males and females, high risk, low protection individuals were significantly more likely to experience low academic performance than low risk, high protection cases. Gender differences emerged in a class for females that included the importance of parental/peer disapproval of anti-social behavior as a protective factor that was not present for males. Findings support elements of the holistic-interactionistic theory for human development and suggest the need to examine risk and protective factors in combination to account for their shared influences on developmental outcomes. Implications for youths underperforming academically are discussed.

Intimate partner violence victimization and parenting stress: assessing the mediating role of depressive symptoms

Guided by the spillover hypothesis and process model of parenting, this study examined relationships between intimate partner violence (IPV) victimization and parenting characteristics among a sample of 1,153 lower-income women. Hierarchical regression was used to investigate a mediational model examining women's self-reports of physical and psychological IPV, depressive symptoms, and parenting stress. Results suggest that depressive symptoms partially mediate the link between a mother's psychological IPV victimization and later self-reported parenting stress. Findings from this study highlight the importance of including maternal psychopathology and other stress and support variables when assessing parenting outcomes among women with histories of IPV.

Improving the retention of child welfare workers by strengthening skills and increasing support for supervisors

Increasingly, effective supervision has been found to be critical in the retention of child welfare workers. In 2006 the State of Missouri Children's Division implemented a supervisory strategic plan to concentrate on supervisory training and effectiveness, with the expectation that emphasis on supervision would improve the retention of frontline workers. Using annual responses to the survey of organizational excellence and retention data, this study examines perceptions of child welfare workers and supervisors on three workplace constructs. Analyses support hypotheses that retention of workers improved in the year following the implementation of the supervisory plan, and measures of supervisor effectiveness, team effectiveness, and job satisfaction also increased. Explanations of primary findings are provided and implications for practice and policy are discussed.

Intimate partner violence and child maltreatment: understanding intra- and intergenerational connections

OBJECTIVE

The purpose of this study is to assess the extent to which intimate partner violence and different forms of child maltreatment occur within and across childhood and adulthood for a high-risk group of women.

METHOD

Low-income adult women were interviewed, retrospectively, regarding their experiences with intimate partner violence and child maltreatment in childhood and adulthood, and intra- and intergenerational relationships between multiple forms of family violence were identified.

RESULTS

Analyses demonstrated weak to moderate associations between various forms of violence within generations. Only weak support was found for the transmission of violence hypothesis that maltreated children are more likely to grow up to maltreat their own children. Stronger support was found for the theory of learned helplessness, whereby children maltreated or witness to violence during childhood are more likely to be victimized as an adult.

CONCLUSION

The results from this study suggest that interventions with children who are identified for one form of victimization should be assessed for other forms of victimization, and interventions should also address learned behaviors or beliefs associated with continued or future victimization.