Depression and Substance Use as Consequences of Exposure to Family Violence: A Moderation Mediation and Self-Medication Hypothesis Study

Post-traumatic stress disorder and its temporal relationship with quality of life in war-affected districts of North Shewa Zone, Amhara Region, Ethiopia

BACKGROUND

People in war-affected and politically violent areas often experience traumatic events that can lead to long-lasting physical and mental health issues. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD), identify associated risk factors, and examine its relationship with the quality of life.

METHOD

A community-based cross-sectional study was conducted Between April 1 and May 15, 2022, in 812 individuals living in war-affected districts of the North Shewa Zone, Amhara Region, Ethiopia. A multistage sampling technique was employed to select the study subjects. Sociodemographic and pre-existing illness data were collected through face-to-face interviews using a pre-tested instrument. The Post-Traumatic Stress Disorder Checklist (PCL-5) was used to measure the PTSD symptoms and cut-off above 33 was used to identify individuals with PTSD. Health-related quality of life was measured using the World Health Organization's (WHO) Quality of Life-brief version (WHOQOL-BREF) questionnaire. Binary logistic regression analysis was used to identify PTSD associated factors, while the independent T-test was applied to compare the quality of life (QOL). The model's fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test and a p-value of 0.05 was considered statistically significant.

RESULT

The prevalence of PTSD was 42.4%. Khat use (AOR = 2.33, 95% CI: 1.33-4.07, p < 0.001), having friends or family who died from mental illness (AOR = 3.91, 95% CI: 1.66-9.20, p < 0.01), conflicts with family, friends or loved ones (AOR = 1.89, 95% CI: 1.18-3.01, p < 0.01), poor social support (AOR = 3.84, 95% CI: 2.53-5.81, p < 0.001), and being coerced into accepting ideas against their will (AOR = 2.04, 95% CI: 1.37-3.03, p < 0.001) were significant factors associated with PTSD. Further, quality of life (QOL) was significantly lower by 0.87 points among individuals with PTSD compared to those without PTSD (t-value = 12.279, p < 0.001).

CONCLUSION

About 4 in 10 individuals living in war-affected districts of the North Shewa Zone, Amhara Region experienced PTSD. Avoiding substance use (a negative coping style) and providing psychotherapy that can adequately addresses the community's medical, social, and psychological needs is essential for improving QOL in war-related PTSD.

Exposure to community violence and internalizing symptoms: The risk of substance use in African American youth

African American adolescents are often disproportionately exposed to community violence, which increases their risk of using substances and developing internalizing symptoms. While these associations are well established in the literature, a limited number of studies have examined substance use as a pathway for the development of internalizing symptoms following exposure to community violence. Using structural equation modeling (SEM) and a cross-sectional design, the current study aimed to explore whether exposure to community violence was associated with substance use. Then, the current study explored whether substance use mediated the association between exposure to community violence and internalizing symptoms while controlling for gender. The sample consisted of 668 African American adolescents from low-resourced neighborhoods in Chicago's Southside. The sample areas were characterized as racially and socioeconomically homogeneous with an average annual income ranging from $24,049 to $35,946, with the city average being $43,628. Results suggested that exposure to community violence was positively associated with substance use. Substance use also mediated the association between exposure to community violence and internalizing symptoms. That is, following exposure to community violence, African American adolescents were more likely to use substances, which increased their susceptibility to developing internalizing symptoms despite gender differences.

The Impact of Trauma and Substance Use on Emotion Regulation and Intimate Partner Violence Perpetration: Implications for Perpetrator Programs

(1) Background: Alcohol and/or other drug use problems (ADUPs) and trauma are key risk factors for intimate partner violence (IPV) that should be addressed in perpetrator programs. Participants with ADUPs and trauma histories may display greater difficulties in emotion regulation, which may increase the likelihood of IPV recidivism. The study aimed to examine differences among participants with trauma, ADUPs, ADUPs and trauma, and without such factors in dropout, IPV, and variables related to emotion regulation at pre- and post-intervention; (2) Methods: A sample of 312 men court-mandated to attend a perpetrator program (Contexto Program) was used. Variables related to emotion regulation difficulties included alexithymia, depressive symptomatology, and clinical syndromes. IPV variables included self-reported physical and psychological IPV and IPV recidivism risk assessed by facilitators. Comparisons between groups were made using one-way ANOVA, chi-square tests, and two-way repeated measures ANOVAs; (3) Results: Participants with ADUPs and trauma presented greater difficulties on variables related to emotion regulation, higher risk of IPV at pre-intervention, and higher dropout rates. At post-intervention, all participants improved their emotion regulation skills and reduced IPV recidivism risk, with participants with ADUPs and trauma maintaining a higher risk of IPV; (4) Conclusions: IPV perpetrators with ADUPs and trauma are high-risk participants. Interventions should target trauma and ADUPs to improve their effectiveness.

Motivational strategies reduce recidivism and enhance treatment adherence in intimate partner violence perpetrators with substance use problems

Introduction

The incorporation of motivational strategies has shown promising results in increasing the effectiveness of intervention programs for intimate partner violence perpetrators, such as enhancing treatment adherence and decreasing risk of intimate partner violence recidivism. This could be particularly important for participants with alcohol and/or other drug use problems (ADUPs), who are at higher risk of recidivating and dropping out from the intervention. Consequently, there is a need to study whether motivational strategies are also effective for high-risk and highly resistant participants. The aim of this study was to determine whether the incorporation of motivational strategies led to improved outcomes in participants with ADUPs compared to those without.

Methods

Participants were intimate partner violence male perpetrators who received a standard intervention (n = 349) or a standard intervention adding an individualized motivational plan (n = 367). Data on official intimate partner violence recidivism, intervention dose, and dropout were collected after the end of the intervention. Comparisons were made between participants with and without ADUPs in each intervention condition.

Results

Results showed that in the full sample of participants, irrespective of their condition, those with ADUPs presented a higher recidivism (p = .007) and dropout rate (p = .003) and lower intervention dose than those without ADUPs (p = .005). When only considering participants in the standard intervention, results also showed that intimate partner violence perpetrators with ADUPs had a higher recidivism (p = .025) and dropout rate (p = .015) and lower intervention dose (p = .048) than those without. However, there were no significant differences between participants with and without ADUPs in the standard intervention adding an individualized motivational plan.

Discussion

When incorporating motivational strategies into the standard interventions for intimate partner violence perpetrators, disparities between participants with and without ADUPs were mitigated. Specifically, participants with ADUPs showed similar outcomes to those without ADUPs after receiving the standard intervention adding an individualized motivational plan. Our results suggest that motivational strategies may be effective in reducing intimate partner violence recidivism and improving treatment adherence in high-risk and highly resistant intimate partner violence perpetrators.

Self-esteem mediates child abuse predicting adulthood anxiety, depression, and substance use symptoms 18 years later

According to biopsychosocial models, experiencing parental child abuse increases susceptibility to adulthood psychopathology. However, there is a paucity of studies examining potential mechanisms of the parental child abuse and adulthood psychopathology relationship. The purpose of the current study was to determine if Time 2 (T2) trait self-esteem mediated levels of Time 1 (T1) retrospectively recalled parental child abuse predicting (T3) past-year major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), alcohol use disorder (AUD), and substance use disorder (SUD) symptoms. The 18-year Midlife Development in the United States (MIDUS) study included participants (N = 3294; T1 average age of 45.62 years) assessed at three different time points, each spaced about nine years apart. We performed structural equation mediation modeling analyses to determine how maternal and paternal child abuse at T1 would independently predict T3 MDD, GAD, PD, AUD, and SUD symptoms. We also examined whether T2 self-esteem mediated these relations while controlling for adulthood T1 psychopathology symptoms, demographics, socioeconomic status, somatic symptoms, and parental psychopathology. Consistent with our hypotheses, higher T1 maternal and paternal abuse predicted increased T3 GAD, PD, AUD, and SUD symptoms via diminished T2 self-esteem as the mediator (% proportion mediated = 33.0-100). However, childhood paternal, but not maternal, abuse predicted adulthood MDD symptoms via reduced self-esteem. Findings remained after adjusting for covariates. Our research highlights the importance of understanding retrospectively recalled parental child abuse-adulthood psychopathology relations, their potential mechanisms, and self-esteem as a malleable treatment target for adults with heightened child abuse.

Internalizing Pathways to Adolescent Substance Use from Adverse Childhood Experiences

The mediating role of anxious, depressive, and somatic symptoms was examined in the association between adverse childhood experiences (ACEs) and adolescent substance use, with attention to the unique effects of each set of symptoms within the same model. Adolescents (n = 701) were assessed over time (ages 3-17) in a majority male (70.5%) and white (89.9%) sample. Findings indicate that depressive symptoms mediated the association between ACEs and adolescent cigarette and marijuana use. Although significant indirect effects remained when accounting for externalizing behavior, a novel protective pathway emerged through parent-reported youth anxiety and alcohol use. Assessing internalizing symptoms as separate facets within the same model is critical if we are to inform prevention programs that are tailored to the individual needs of youth who have experienced ACEs.

Cannabis and anhedonia: A systematic review

This paper employs a systematic review to examine the correlation between anhedonia and marijuana use, exploring whether individuals with anhedonia use marijuana as a coping mechanism or if marijuana use plays a role in the onset of anhedonia. The search utilised PubMed and Web of Science databases, following PRISMA guidelines for paper selection. A total of 21 papers were selected to address this inquiry, and assessments were carried out using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool. The results revealed that 17 studies exhibited moderate and low risk of bias. The evaluation encompassed a total of 12,427 participants, including both animals and humans. Experimental animal studies focused on exploring the association between cannabidiol (CBD) and anhedonia, while human studies primarily employed observational research, examining various forms of anhedonia in individuals with or without mental disorders such as depression or psychosis. These studies also delved into understanding the effects of anhedonia during adolescence and explored the causal relationship between these concepts. The findings indicate a reciprocal rather than unidirectional relationship, establishing that initial anhedonia predisposes individuals to cannabis use, and subsequent consumption significantly intensifies the anhedonia experienced. Particularly, the studies placed special emphasis on adolescents and individuals with mental disorders.

Participants in Court-mandated Intervention Programs for Intimate Partner Violence Perpetrators with Substance Use Problems: A Systematic Review of Specific Risk Factors

Men with alcohol and/or other drug use problems (ADUPs) court-mandated to attend intervention programs for intimate partner violence (IPV) perpetrators have been identified as a high-risk, highly resistant group of IPV perpetrators, as they present lower treatment adherence and higher dropout and recidivism rates. Previous research suggests that IPV perpetrators with ADUPs may require tailored interventions to address their specific risk factors. The present systematic review was conducted using PRISMA guidelines to identify the specific risk factors in men with and without ADUPs on entry to court-mandated perpetrator programs. The following databases were searched from inception to November 2021: Web of Science, PsycINFO, and Scopus. There was a screening of 3,995 records, and 29 quantitative studies were included in the review. Risk factors present in males court-mandated to perpetrator programs were grouped into four categories: sociodemographic risk factors, personality disorders and psychological adjustment, social-relational risk factors, and risk factors related to attitudes towards women. Results indicated that the main risk factors in IPV perpetrators with ADUPs, compared to those without, were higher clinical symptomatology (e.g., anger and impulsivity), personality disorders, poorer executive functions, having experienced more stressful life events, higher exposure to childhood trauma, lower intimate social support, and higher responsibility attributed to the offenders' personal context. These results contribute to a deeper understanding of the complex phenomenon of IPV and ADUPs, and could help to inform key targets for perpetrator programs that may improve the well-being of their (ex)partners and increase the effectiveness of intervention programs for IPV perpetrators.