Screening for History of Childhood Abuse: Beliefs, Practice Patterns, and Barriers Among Obstetrician-Gynecologists

Stories of childhood sexual abuse (CSA) among older adults living with HIV (OALH) in South Carolina: a qualitative study

Childhood sexual abuse (CSA) devastatingly impacts an individual's behavioral, psychological, and social health. Childhood, a developmental stage directly influenced by the home or school environment, leaves a life-long imprint. Compared with the general population, CSA prevalence is doubled among people living with HIV. Thus, the study aimed to explore CSA circumstances among older adults living with HIV (OALH) in South Carolina (SC). We included 24 OALH aged 50 and above who reported CSA. The data were collected at an immunology center in SC. In-depth semi-structured interviews were conducted, audio-recorded, transcribed, and analyzed using a thematic analysis approach. The iterative analytic process included a discussion of initial thoughts and key concepts, identification, and reconciliation of codes, and naming of emergent themes. Six themes emerged: known perpetrators, re-victimization, "nobody believed me", "cannot live like others", lack of CSA disclosure, and interconnections with other adverse childhood experiences (ACEs). CSA experiences and non-disclosure were found to be linked with shame, embarrassment, fear, and trust issues. Hence, trauma-focused interventions are required to resolve these issues and improve the quality of life of OALH with past trauma. Counseling or therapy programs should incorporate psychological and behavioral theoretical models to best target OALH who are CSA survivors.

How Healthcare Providers Reconcile Bad Things Happening to Good Patients: The Role of Just World Beliefs in Attitudes toward Trauma-Informed Care

Despite prevalent trauma exposure among patients seeking health care, as well as widespread frameworks for enacting trauma-informed care, the uptake of trauma-informed practices such as trauma screening and referral among health-care providers remains relatively low. The current study sought to assess the roles of health-care providers' personal histories of adverse childhood experiences (ACEs) and personal beliefs in the just-world hypothesis in understanding their attitudes toward trauma-informed care. Advanced practice graduate nursing students (N = 180; M age = 34.6 years) completed a self-reported survey assessing their personal history of ACEs, global belief in a just world, and attitudes related to trauma-informed care. Results indicated the relation between providers' ACEs and attitudes toward trauma-informed care was fully mediated by their beliefs in a just world, such that providers reporting higher ACEs scores also report greater endorsement of attitudes consistent with trauma-informed care due to less belief in a just world. Implications for both health-care providers' themselves and cultural shifts necessary for provision of trauma-informed health care are discussed.

Assessment of Child Sexual Abuse in Victimized Women

Child sexual abuse (CSA) is a frequent phenomenon, and women who report it are at a higher risk of mental disorders and sexual dysfunction. The application of a brief questionnaire could help gynecologists assessment of CSA history in women. This study was carried out including women (n = 593) who had been victims of CSA before the age of 18 years. We used the Early Trauma Inventory Self Report-Short Form (ETISR-SF) Part 4, the Female Sexual Function Index (FSFI), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and a semi-structured instrument to assess CSA. Among the 593 women included, 77 agreed to answer the questionnaires, 62(80.5%) had traumatic sexual events, 53(68.8%) had a total FSFI score ≤ 26.55, and 64(84.2%) considered themselves victims of CSA. There was an association regarding the belief that CSA influenced their sex life and their being at risk for GAD (p = 0.001), PTSD (p = 0.02), and sexual abuse by a family member (p = 0.01). The risk factors were the presence of risk for GAD (OR = 5.88[1.3-27.03]) and CSA by a family member (OR = 5.78[1.57-21.28]). This methodology can assist gynecologists in assessing a patient's history of CSA.

The impact of childhood maltreatment on women's reproductive health, with a focus on symptoms of polycystic ovary syndrome

BACKGROUND

Childhood maltreatment leads to lifelong health risks, particularly in women. Although reproductive health has been linked to such maltreatment, limited literature exists on its association with polycystic ovary syndrome (PCOS).

OBJECTIVES

In a sample of psychiatrically healthy women, we evaluated the impact of child maltreatment (subtypes of abuse and neglect) on women's reproductive health outcomes, specifically PCOS.

PARTICIPANTS AND SETTING

The 237 psychiatrically healthy women, aged between 18 and 79 years, were control participants in a case-control study (SHARED ROOTS), conducted in Cape Town, South Africa, between May 2014 and June 2017.

METHODS

Probable PCOS was based on a history of symptoms of ovulatory dysfunction and hyperandrogenism or a diagnosis of PCOS. We conducted hierarchical logistic regression models to assess which child maltreatment subtypes (emotional, physical and sexual abuse and emotional and physical neglect) were significantly associated with PCOS, controlling for sociodemographic and clinical factors.

RESULTS

Probable PCOS was present in 29 (12.2 %) women. Emotional abuse (31.6 %) was the most frequent type of child maltreatment and was significantly associated with PCOS (OR = 5.11, CI 1.87; 13.98), including when other maltreatment types were accounted for (OR = 3.90, CI 1.27; 12.02). Physical abuse was associated with PCOS (OR = 4.21, CI 1.43; 12.38), but was not significant when other maltreatment types were factored in.

CONCLUSIONS

Child maltreatment is independently associated with PCOS in women without psychiatric disorders. In the context of all maltreatment subtypes, emotional abuse remained associated with PCOS, suggesting its unique effect on this endocrinopathy.

Trauma-Informed Radiation Therapy: Implementation and Evaluation of a Sensitive Practice Tool for Female Patients Undergoing Radiotherapy for Breast Cancer

PURPOSE

For childhood sexual abuse survivors, cancer care can be retraumatizing because of perceived similarities to the original sexual violence. The authors' group designed and implemented a sensitive practice tool (SPT) and evaluated the feasibility of the tool in female patients receiving breast radiation.

METHODS

The SPT was offered as a "universal precaution" to patients with breast cancer as part of standard clinical care. Patients were given the SPT, which included an instructional video about radiotherapy and a survey about triggers and preferences. The survey results were provided to radiation therapists and used to personalize patients' care. A retrospective chart review and quality improvement survey of therapists were performed.

RESULTS

Of 739 eligible patients, 493 (66.7%) completed the SPT from November 2013 to June 2019. Among respondents, 281 (57.0%) reported potential triggers, 395 (80.1%) reported distress management preferences, and 59 (12.0%) requested psychosocial referrals. Mean patient satisfaction was high, and a majority of patients were likely to recommend the SPT to other patients (85.3%). Among radiation therapists (n = 13), 100% reported that the SPT made it easier to customize or individualize patient care. Trauma disclosure was not significantly associated with increased frequency of trigger endorsement (P = .07) but was associated with increased endorsement of distress management preferences (P = .02) and psychosocial referral requests (P < .001).

CONCLUSIONS

The reported experience with the SPT in the breast radiotherapy setting demonstrated that potential triggers and distress management preferences among patients are common and that patient satisfaction with the SPT is high, yielding clinically meaningful and actionable sensitive practice information.

Knowledge, experiences and attitudes of midwives in maternity care in encounters with pregnant women with obesity - are adverse childhood experiences understood and explored as a contributing factor?

OBJECTIVE

To explore knowledge, experiences and attitudes of midwives in maternity care in encounters with pregnant women with obesity, and whether they investigate adverse childhood experiences as a contributing factor to the weight challenges.

DESIGN

Semi-structured interviews were undertaken to explore midwives' experiences of providing maternity care for women with obesity. For data analysis, Malterud's systematic text condensation was used, a method for thematic cross-case analysis of qualitative data with an inductive approach.

PARTICIPANTS AND SETTING

Nine midwives working in maternity care in Central Norway. The interviews were conducted online or at the midwives' workplace.

FINDINGS

The midwives routinely investigated pregnant women's childhood, but few saw a link between adverse childhood experiences and obesity. Pregnant women with obesity were perceived by the midwives as particularly vulnerable, which led to a sensitive, individualised approach focusing on trust and relationship building. This approach, in addition to pointing out complications that can occur with obesity, was described as a balancing act. The midwives described preventative healthcare as a natural task, but hectic days with many competing tasks were seen as an obstacle. The women's motivation for lifestyle change was experienced differently by the midwives; some described strong motivation while others mentioned poor motivation. The midwives found it reassuring to have experience to draw on in broaching difficult topics.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Midwives' many years of experience enable them to approach obese pregnant women in an individual and careful way. Their mission in public health could be better utilised if they explored negative childhood experiences in relation to pregnant women's weight challenges.

Inter-Clinician Variability in Primary Care Providers' Adverse Childhood Experience Knowledge, Training, Screening Practices, and Perceived Intervention Barriers: an Exploratory Cross-Sectional Study

Adverse childhood experiences (ACEs) are traumatic events that occur before the age of 18 that can have immediate and long-term negative health, behavioral, and social outcomes. Primary care providers (PCPs) can help mitigate the negative effects of ACEs by identifying at-risk children and families in need of support. This cross-sectional study, that incorporates inter-clinician variability into the sample, explored PCPs ACE knowledge, training, screening practices, and perceived intervention barriers to addressing ACEs. Results found that PCPs had limited familiarity with the ACE study and the effects of ACEs, few PCPs received training on ACEs, only some PCPs formally screened their patients for ACEs, and lack of time and training were PCPs most cited perceived barriers to addressing ACEs. A statistically significant difference in PCPs ACE knowledge and perceived barriers to addressing ACEs by inter-clinician variability was found. To more effectively address ACEs in the primary care setting, the following is recommended - effective ACEs educational tools and resources for both resident and attending PCPs, training on addressing sensitive topics including ACEs beginning in resident physician education, efficient models for ACEs office-based screening, increased access to mental health care for patients, strengthened care coordination with community organizations, and collaborative practice networks.