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Pacella R, Nation A, Mathews B, Scott JG, Higgins DJ, Haslam DM, Dunne MP, Finkelhor D, Meinck F, Erskine HE, Thomas HJ, Malacova E, Lawrence DM, Monks C. Child maltreatment and health service use: findings of the Australian Child Maltreatment Study. Med J Aust 2023; 218 Suppl 6:S40-S46. [PMID: 37004185 PMCID: PMC10952869 DOI: 10.5694/mja2.51892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES To examine associations between child maltreatment and health service use, both overall, by type and by the number of types of maltreatment reported. DESIGN, SETTING Cross-sectional, retrospective survey using the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study); computer-assisted mobile telephone interviews using random digit dialling, Australia, 9 April - 11 October 2021. PARTICIPANTS Australians aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16-24 years and 1000 respondents each from the five age groups (25-34, 35-44, 45-54, 55-64, 65 years or more). MAIN OUTCOME MEASURES Self-reported health service use during the past twelve months: hospital admissions, length of stay, and reasons for admission; and numbers of consultations with health care professionals, overall and by type. Associations between maltreatment and health service use are reported as odds ratios adjusted for age group, gender, socio-economic status, financial hardship (childhood and current), and geographic remoteness. RESULTS A total of 8503 participants completed the survey. Respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.16-1.66), particularly admission with a mental disorder (aOR, 2.4; 95% CI, 1.03-5.6). The likelihood of six or more visits to general practitioners (aOR, 2.37; 95% CI, 1.87-3.02) or of a consultation with a mental health nurse (aOR, 2.67; 95% CI, 1.75-4.06), psychologist (aOR, 2.40; 95% CI, 2.00-2.88), or psychiatrist (aOR, 3.02; 95% CI, 2.25-4.04) were each higher for people who reported maltreatment during childhood. People who reported three or more maltreatment types were generally most likely to report greater health service use. CONCLUSIONS Child maltreatment has a major impact on health service use. Early, targeted interventions are vital, not only for supporting children directly, but also for their longer term wellbeing and reducing their health system use throughout life.
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Affiliation(s)
- Rosana Pacella
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Alexandra Nation
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
| | - Ben Mathews
- Queensland University of TechnologyBrisbaneQLD
- Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUnited States of America
| | - James G Scott
- Child Health Research Centrethe University of QueenslandBrisbaneQLD
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | - Daryl J Higgins
- Institute of Child Protection Studies, Australian Catholic UniversityMelbourneVIC
| | - Divna M Haslam
- Queensland University of TechnologyBrisbaneQLD
- The University of QueenslandBrisbaneQLD
| | - Michael P Dunne
- Queensland University of TechnologyBrisbaneQLD
- Institute for Community Health ResearchHue UniversityHue CityVietnam
| | - David Finkelhor
- Crimes against Children Research CenterUniversity of New HampshireDurhamNHUnited States of America
| | - Franziska Meinck
- University of EdinburghEdinburghUnited Kingdom
- North‐West UniversityPotchefstroomSouth Africa
| | - Holly E Erskine
- The University of QueenslandBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Hannah J Thomas
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
- Queensland Centre for Mental Health ResearchBrisbaneQLD
| | - Eva Malacova
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | | | - Claire Monks
- Institute for Lifecourse DevelopmentUniversity of GreenwichLondonUnited Kingdom
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Wang D, You X. Post-disaster trauma and cultural healing in children and adolescents: Evidence from the Wenchuan earthquake. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2021.101878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Social determinants of health, personalized medicine, and child maltreatment. Pediatr Res 2021; 89:368-376. [PMID: 33288877 DOI: 10.1038/s41390-020-01290-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/08/2022]
Abstract
This review begins with a brief summary of the importance of child maltreatment as a major public health problem, given its prevalence and the substantial human and economic costs involved. The focus then shifts to consideration of personalized medicine and child maltreatment, including genetic and genomics factors, as well as the role of social determinants of health. Research on epigenetics related to child abuse and neglect is presented, followed by that pertaining to a few specific social factors, such as poverty, parental depression and substance use, and domestic (or intimate partner) violence. The review ends with a discussion of interventions to help address social determinants of health with brief descriptions of several model programs, and thoughts concerning the role of personalized medicine in addressing child maltreatment in the foreseeable future. IMPACT: This paper synthesizes knowledge on social determinants of health and advances in genetics and genomics related to the prevention of child maltreatment. It provides examples of model approaches to addressing the prevention of child maltreatment in primary care practices.
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Binnie V, Le Brocque R, Jessup M, Johnston ANB. Adult frequent presentation to emergency departments and adverse childhood experiences: a scoping review. Australas Emerg Care 2020; 24:264-279. [PMID: 33358578 DOI: 10.1016/j.auec.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Extensive literature reports the influence of childhood adversity on adult health, however few studies have explored these life antecedents in people who frequently present to the emergency department. This review synthesizes literature exploring childhood adversity influences on emergency department presentations, if and how it is identified, and interventions addressing the health care needs of this group. METHODS Eight electronic databases were searched. Arksey and O'Malley's framework guided this review, and a quality appraisal was undertaken. Searches included all published studies until August 2020. RESULTS Twenty-one articles were included in this review. They revealed that childhood adversity is common among adults who frequently attend the emergency department. It impacts physical and psychological health into adulthood and there is no standardized approach described to documenting childhood adversity, nor any consistent intervention reported by emergency departments to address its sequelae in adulthood. CONCLUSIONS Several studies call for screening, intervention, and education to identify and address impacts of childhood adversity for patients who frequently present to the emergency department. However, reliable high-level studies exploring these topics specific to the emergency department are uncommon. Consequently, definitive interventions to address the healthcare needs of this group is lacking and warrants further research.
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Affiliation(s)
- Vicki Binnie
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia.
| | - Robyne Le Brocque
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Melanie Jessup
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia
| | - Amy N B Johnston
- School of Nursing Midwifery and Social Work, The University of Queensland, St Lucia, Qld, 4072, Australia; Department of Emergency Medicine, Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Qld, 4102, Australia
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Dubowitz H, Saldana L, Magder LA, Palinkas LA, Landsverk JA, Belanger RL, Nwosu US. Protocol for comparing two training approaches for primary care professionals implementing the Safe Environment for Every Kid (SEEK) model. Implement Sci Commun 2020; 1:78. [PMID: 32974614 PMCID: PMC7506208 DOI: 10.1186/s43058-020-00059-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Child maltreatment (CM) is a major public health problem, affecting many lives, in the short and long term, and costing individuals, families, and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents; promote children's health, development, and safety; help prevent CM; and benefit the health of the US population. This study will examine intervention strategies for optimizing SEEK's adoption, implementation, and sustainment, and its effectiveness in preventing CM.Despite strong evidence from two federally funded randomized controlled trials, SEEK has not been widely adopted. The goal of this study is to examine technology-driven implementation strategies to scale-up SEEK-in pediatric and family medicine primary care settings. The aims are to (1) evaluate the effectiveness of training strategies on SEEK's implementation in primary care practices, (2) evaluate barriers and facilitators to successful implementation and sustainment of SEEK, and (3) examine the model's effectiveness in preventing CM and the economic costs of implementing SEEK. METHODS This randomized type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK's adoption and implementation in pediatric and family medicine practices in different regions of the USA. These are independent online training and in-depth structured training via a quality improvement project, approved by the American Boards of Pediatrics and of Family Medicine. We will also evaluate SEEKonline, software that assists primary care practitioners implement the model, and a "Traditional" paper and pencil strategy for their impact on implementation. The study uses the EPIS framework and the Universal Stages of Implementation Completion, quantitative measures, qualitative interviews, and data abstracted from electronic health records. DISCUSSION The knowledge gained should improve pediatric primary care to better address prevalent social determinants of health, benefiting many children and families. The outcomes should enhance the field of implementation science and guide future interventions in primary care. TRIAL REGISTRATION NCT03642327, Clinical Trials, registered August 21, 2018.
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Affiliation(s)
- Howard Dubowitz
- Division of Child Protection, Department of Pediatrics, University of Maryland School of Medicine, 520 W. Lombard St, Baltimore, MD 21201 USA
| | - Lisa Saldana
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd., Eugene, OR 97401 USA
| | - Laurence A. Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201 USA
| | - Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, MC0411, Los Angeles, CA 90089-0411 USA
| | - John A. Landsverk
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd., Eugene, OR 97401 USA
| | - Rose L. Belanger
- Division of Child Protection, Department of Pediatrics, University of Maryland School of Medicine, 520 W. Lombard St, Baltimore, MD 21201 USA
| | - Ugonna S. Nwosu
- Division of Child Protection, Department of Pediatrics, University of Maryland School of Medicine, 520 W. Lombard St, Baltimore, MD 21201 USA
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Thompson-Hollands J, Marx BP, Lee DJ, Sloan DM. Longitudinal change in self-reported peritraumatic dissociation during and after a course of posttraumatic stress disorder treatment: Contributions of symptom severity and time. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2020; 13:665-672. [PMID: 32881568 DOI: 10.1037/tra0000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Peritraumatic dissociation, a dissociative reaction that occurs at the time of a traumatic event, has been established as a strong risk factor for posttraumatic stress disorder (PTSD). However, self-reported peritraumatic dissociation is typically assessed months or years after trauma exposure and may be influenced by current distress levels and other factors. Method: We examined the temporal stability of scores on the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) among 126 treatment-seeking adults with PTSD during and after trauma-focused treatment. Participants reported dissociation during the same index event at baseline and 6, 12, 24, 36, and 60 weeks after the first treatment session. Results: There were substantial changes in PDEQ total scores over time, with > 40% of participants experiencing reliable change from baseline at least once during the study. Multilevel modeling revealed an overall decrease in PDEQ scores over time; scores on the Clinician-Administered PTSD Scale for DSM-5, Beck Depression Inventory-II, and PTSD Checklist for DSM-5 were each significantly associated with PDEQ scores. Conclusions: Our findings suggest the PDEQ does not provide temporally stable assessment of peritraumatic dissociation. Accordingly, it is crucial to control for current PTSD symptom levels when examining the degree to which peritraumatic dissociation confers risk for future symptom severity. Without such an accounting, our understanding of the relationship between PTSD and peritraumatic dissociation may be incorrect. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Gnanamanickam ES, Nguyen H, Armfield JM, Doidge JC, Brown DS, Preen DB, Segal L. Hospitalizations among children involved in the child protection system: A long-term birth cohort study from infancy to adulthood using administrative data. CHILD ABUSE & NEGLECT 2020; 107:104518. [PMID: 32652507 DOI: 10.1016/j.chiabu.2020.104518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite considerable health consequences of child abuse and neglect, there is limited evidence on hospitalizations in this population. OBJECTIVES To describe frequency and reasons for hospitalization by lifetime child protection system (CPS) involvement. PARTICIPANTS 608,540 children born from January 1, 1986 to June 30, 2017 in South Australia, Australia METHODS: Using linked administrative data on CPS involvement and hospitalizations, we descriptively examined cumulative incidence, cumulative count and reasons for hospitalization from infancy to early adulthood by CPS involvement. RESULTS By 16.5 years of age, cumulative incidence of ever-being hospitalized was 58% (95% CI 58-58) for children with no CPS involvement and significantly higher (72% (95% CI 71-73) to 88% (95% CI 86-90), P < 0.001) among those with different levels of CPS involvement. Cumulative mean counts of hospitalizations were highest at every age for those placed in out-of-home-care (reaching 7.7 by 16.5 years), almost four times higher than for children with no CPS involvement (2.0 by 16.5 years). Most frequent reasons for hospitalizations were similar across CPS involvement in the early years. From adolescence through early adulthood, mental health, and 'injury, poisoning or toxic effects of drugs' were frequent reasons for hospitalization among individuals with CPS involvement. CONCLUSIONS This study highlights the vulnerability of children who have been maltreated, or are at risk of maltreatment, and the urgency of implementing effective preventive strategies early in life including consideration of adequate responses of child protection services. Frequent hospitalizations for mental health and injury confirms the potentially preventable nature of these hospitalizations.
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Affiliation(s)
| | - Ha Nguyen
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia
| | - Jason M Armfield
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
| | - James C Doidge
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; Intensive Care National Audit and Research Centre, London, UK; UCL Great Ormond Institute of Child Health, University College London, London, UK
| | - Derek S Brown
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
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Bentivegna K, Durante A, Livingston N, Hunter AA. Child Sexual Abuse identified in Emergency Departments Using ICD-9-CM, 2011 to 2014. J Emerg Med 2019; 56:719-726. [PMID: 31023633 DOI: 10.1016/j.jemermed.2019.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Child sexual abuse (CSA) is poorly identified due to its hidden nature and difficulty surrounding disclosure. Surveillance using emergency department (ED) data may identify victims and provide information on their demographic profile. OBJECTIVES Study aims were to calculate the prevalence of visits assigned an explicit or suggestive medical diagnosis code (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM]) for CSA and compare the demographic profile of ED visits by coding type. METHODS This study examined ED data for children < 10 years of age in Connecticut from 2011 to 2014. Cases involving CSA were identified using explicit and suggestive ICD-9-CM codes and age qualifiers previously established in the literature, and compared across visit characteristics (age, race/ethnicity, sex, and primary insurance payer, and town group). RESULTS ICD-9-CM codes for explicit CSA were identified in 110 ED visits, or 1.7 per 10,000 total ED visits. Inclusion of ICD-9-CM codes for suggestive CSA identified an additional 630 visits (9.7 per 10,000 visits). Suggestive codes identified proportionally more visits of younger (50% vs. 38%) and male (35% vs. 22%) children, compared with the explicit code (p < 0.05). CONCLUSIONS This study demonstrates one method for identifying CSA cases, which has the potential to increase surveillance of victims in the ED. Results imply that explicit codes alone may overlook most cases, whereas use of suggestive codes may identify additional cases, and proportionally more young and male victims. As the health consequences of CSA are severe, innovative forms of surveillance must be explored to detect a higher number of cases and improve the clinical care of patients.
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Affiliation(s)
- Kathryn Bentivegna
- Department of Community Medicine and Healthcare, University of Connecticut, Farmington, Connecticut
| | - Amanda Durante
- Department of Community Medicine and Healthcare, University of Connecticut, Farmington, Connecticut
| | - Nina Livingston
- Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Amy A Hunter
- Department of Community Medicine and Healthcare, University of Connecticut, Farmington, Connecticut; Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut; Injury Prevention Center, Connecticut Children's Medical Center, Hartford, Connecticut
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Koball AM, Rasmussen C, Olson-Dorff D, Klevan J, Ramirez L, Domoff SE. The relationship between adverse childhood experiences, healthcare utilization, cost of care and medical comorbidities. CHILD ABUSE & NEGLECT 2019; 90:120-126. [PMID: 30776737 DOI: 10.1016/j.chiabu.2019.01.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prior research suggests that those experiencing adverse childhood experiences (ACEs) may be higher utilizers of the healthcare system. The frequency and financial impact of kept, cancelled and no-showed visits is largely unknown. OBJECTIVE To examine the impact of adverse childhood experiences (ACEs) on healthcare utilization in a sample of US adults. PARTICIPANTS AND SETTING Two thousand thirty-eight adult patients who completed an ACE screening within the behavioral health department of a medium sized, Midwestern healthcare system during 2015-2017 were included. METHODS Data was extracted retrospectively from 1-year post ACE screen. RESULTS Individuals with high ACEs (4+) made more but kept fewer appointments than those with no or moderate (1-3) ACEs (p < 0.0001). Individuals with high ACES had more late-cancelled and no-showed appointments compared to those with no ACEs (p's < .0001). Relationships were significant even after controlling for age, gender, and insurance type. Those with high ACEs had the greatest impact on potential lost revenue given that they late-cancelled and no-showed more appointments. Those with high ACEs also had more medical comorbidities, medications, and needed care coordinator than those with moderate or no ACEs (p's < .05) CONCLUSIONS: Results from this study should be used to inform providers and health care systems on the effects of adversity on patterns of utilization of health care and encourage innovative strategies to better address the needs of these patients.
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Affiliation(s)
- Afton M Koball
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States.
| | - Cary Rasmussen
- Gundersen Medical Foundation, 1836 South Avenue, La Crosse, WI, 54601, United States
| | - Denyse Olson-Dorff
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
| | - Judy Klevan
- Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States
| | - Luis Ramirez
- Gundersen Medical Foundation, 1836 South Avenue, La Crosse, WI, 54601, United States
| | - Sarah E Domoff
- Central Michigan University, 1200 S Franklin St, Mount Pleasant, MI, 48859, United States
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Goldstein E, Murray-García J, Sciolla AF, Topitzes J. Medical Students' Perspectives on Trauma-Informed Care Training. Perm J 2018; 22:17-126. [PMID: 29401053 DOI: 10.7812/tpp/17-126] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Adults exposed to traumatic events during childhood commonly seek medical services, but health care practitioners hesitate to address and assess early trauma despite its known negative health effects. This study examines medical students' perspectives on a brief course that addressed the health care needs of patients exposed to adverse childhood experiences. METHODS A convenience sample of 20 University of California, Davis medical students from the Summer Institute on Race and Health received 6 hours of trauma-informed care training. The course was delivered in 2-hour modules during the course of 3 days, and included lectures, discussions, and practice. A questionnaire assessing students' perspectives on training benefits, current practice challenges, and necessary resources to provide trauma-informed medical care was distributed posttraining. RESULTS From the students' perspectives, this course increased their ability to recognize various clinical manifestations of adverse childhood experience exposure in adult patients. Students said they learned how to ask about and respond to adverse childhood experience disclosures and identify necessary resources to responsibly implement trauma-informed care in medical settings. Students identified provision of adequate resources and links to appropriate treatment identified as common challenges in providing health care to trauma-affected patients. CONCLUSION Study findings illustrate that trauma training can fill a knowledge gap and provide associated benefits for medical students. Initial training may pique students' interest by demonstrating the relevance of trauma knowledge in clinical practice; additional training likely is needed to support skills and confidence.
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Affiliation(s)
- Ellen Goldstein
- Postdoctoral Fellow at the University of Wisconsin-Madison Department of Family Medicine and Community Health Primary Care Research Fellowship.
| | - Jann Murray-García
- Assistant Health Sciences Clinical Professor at the Betty Irene Moore School of Nursing at the University of California, Davis.
| | - Andrés F Sciolla
- Associate Professor of Clinical Psychiatry in the Department of Psychiatry and Behavioral Sciences at the University of California, Davis.
| | - James Topitzes
- Associate Professor at the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee and the Clinical Director of the Institute for Child and Family Well-Being.
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Sickel AE, Noll JG, Moore PJ, Putnam FW, Trickett PK. The Long-term Physical Health and Healthcare Utilization of Women Who Were Sexually Abused as Children. J Health Psychol 2016; 7:583-97. [DOI: 10.1177/1359105302007005677] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article addresses the relationship between childhood sexual abuse and the long-term physical health and healthcare utilization of 148 female participants in an eight-year prospective study. Five factors of physical health emerged: General Health; Vegetative Health Symptoms; Colds and Flu; Gastrointestinal/Gynecological; and Healthcare Utilization. Abused females scored higher on the healthcare utilization and gastrointestinal/gynecological factors than comparison females. Abused females experiencing multiple perpetrators, violence, longer duration and older age at onset endorsed significantly more gastrointestinal/gynecological problems than did the other abused females and the comparison group. Findings suggest that: (1) sexual abuse affects long-term health outcomes and healthcare utilization; and (2) physical health sequelae of abuse may differentially affect females, depending upon the pattern of abuse characteristics.
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Ullman SE, Brecklin LR. Sexual Assault History and Health-Related Outcomes in a National Sample of Women. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/1471-6402.t01-2-00006] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined correlates of past-year chronic medical conditions and lifetime contact with health care professionals for mental health and substance abuse problems in women with differing histories of sexual victimization ( N = 627) identified from the National Comorbidity Survey (e.g., assault in childhood, adulthood, or both life phases). Posttraumatic stress disorder (PTSD) and stressful life events were associated with greater odds of chronic medical conditions among women sexually assaulted in childhood only. Additional traumatic events were associated with greater odds of chronic medical conditions among victims of adult sexual assault. Older age and being married were associated with greater odds of lifetime health care professional contact for mental health/substance abuse issues among certain victim subgroups. Stressful life events were related to greater help-seeking for child victims, and traumatic events were related to greater help-seeking in adult victims. Alcohol dependence symptoms and PTSD were each associated with greater odds of lifetime health care professional contact among women victimized in both life phases, whereas depression was related to greater odds of help-seeking for women victimized in one life phase only. Psychosocial factors may play unique roles in health outcomes for women with different sexual assault histories.
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Jackson Y, Cushing CC, Gabrielli J, Fleming K, O'Connor BM, Huffhines L. Child Maltreatment, Trauma, and Physical Health Outcomes: The Role of Abuse Type and Placement Moves on Health Conditions and Service Use for Youth in Foster Care. J Pediatr Psychol 2016; 41:28-36. [PMID: 26188052 PMCID: PMC4902865 DOI: 10.1093/jpepsy/jsv066] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/13/2015] [Accepted: 06/16/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of the study was to investigate the relations between abuse types, non-maltreatment-related trauma, and health service utilization in a sample of youth in foster care with and without chronic medical conditions. METHOD A total of 213 youth, aged 8-21 years, provided self-report of general trauma and abuse exposure. Medicaid claims for each child were collected from official state databases. RESULTS Exposure to sexual abuse, neglect, or general trauma but not exposure to physical abuse or psychological abuse increased the rates of medical visits, while only general trauma increased medical hospitalizations. CONCLUSIONS Trauma types are not equally predictive of health care utilization for youth with chronic health conditions.
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Affiliation(s)
- Yo Jackson
- Clinical Child Psychology Program, University of Kansas
| | | | - Joy Gabrielli
- Clinical Child Psychology Program, University of Kansas
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Bonomi AE, Nemeth JM, Altenburger LE, Anderson ML, Snyder A, Dotto I. Fiction or not? Fifty Shades is associated with health risks in adolescent and young adult females. J Womens Health (Larchmt) 2014; 23:720-8. [PMID: 25144515 DOI: 10.1089/jwh.2014.4782] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND No prior study has empirically characterized the association between health risks and reading popular fiction depicting violence against women. Fifty Shades--a blockbuster fiction series--depicts pervasive violence against women, perpetuating a broader social narrative that normalizes these types of risks and behaviors in women's lives. The present study characterized the association between health risks in women who read and did not read Fifty Shades; while our cross-sectional study design precluded causal determinations, an empirical representation of the health risks in women consuming the problematic messages in Fifty Shades is made. METHODS Females ages 18 to 24 (n=715), who were enrolled in a large Midwestern university, completed a cross-sectional online survey about their health behaviors and Fifty Shades' readership. The analysis included 655 females (219 who read at least the first Fifty Shades novel and 436 who did not read any part of Fifty Shades). Age- and race-adjusted multivariable models characterized Fifty Shades' readers and nonreaders on intimate partner violence victimization (experiencing physical, sexual and psychological abuse, including cyber-abuse, at some point during their lifetime); binge drinking (consuming five or more alcoholic beverages on six or more days in the last month); sexual practices (having five or more intercourse partners and/or one or more anal sex partner during their lifetime); and using diet aids or fasting for 24 or more hours at some point during their lifetime. RESULTS One-third of subjects read Fifty Shades (18.6%, or 122/655, read all three novels, and 14.8%, or 97/655, read at least the first novel but not all three). In age- and race-adjusted models, compared with nonreaders, females who read at least the first novel (but not all three) were more likely than nonreaders to have had, during their lifetime, a partner who shouted, yelled, or swore at them (relative risk [RR]=1.25) and who delivered unwanted calls/text messages (RR=1.34); they were also more likely to report fasting (RR=1.80) and using diet aids (RR=1.77) at some point during their lifetime. Compared with nonreaders, females who read all three novels were more likely to report binge drinking in the last month (RR=1.65) and to report using diet aids (RR=1.65) and having five or more intercourse partners during their lifetime (RR=1.63). CONCLUSIONS Problematic depictions of violence against women in popular culture-such as in film, novels, music, or pornography-create a broader social narrative that normalizes these risks and behaviors in women's lives. Our study showed strong correlations between health risks in women's lives-including violence victimization-and consumption of Fifty Shades, a fiction series that portrays violence against women. While our cross-sectional study cannot determine temporality, the order of the relationship may be inconsequential; for example, if women experienced adverse health behaviors first (e.g., disordered eating), reading Fifty Shades might reaffirm those experiences and potentially aggravate related trauma. Likewise, if women read Fifty Shades before experiencing the health behaviors assessed in our study, it is possible that the book influenced the onset of these behaviors by creating an underlying context for the behaviors.
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Affiliation(s)
- Amy E Bonomi
- 1 Human Development and Family Studies and the Research Consortium on Gender-Based Violence, College of Social Science, Michigan State University , East Lansing, Michigan
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Nikulina V. Do race, neglect, and childhood poverty predict physical health in adulthood? A multilevel prospective analysis. CHILD ABUSE & NEGLECT 2014; 38:414-24. [PMID: 24189205 PMCID: PMC4462241 DOI: 10.1016/j.chiabu.2013.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/09/2013] [Accepted: 09/13/2013] [Indexed: 05/03/2023]
Abstract
Childhood neglect and poverty often co-occur and both have been linked to poor physical health outcomes. In addition, Blacks have higher rates of childhood poverty and tend to have worse health than Whites. This paper examines the unique and interacting effects of childhood neglect, race, and family and neighborhood poverty on adult physical health outcomes. This prospective cohort design study uses a sample (N=675) of court-substantiated cases of childhood neglect and matched controls followed into adulthood (M(age)=41). Health indicators (C-Reactive Protein [CRP], hypertension, and pulmonary functioning) were assessed through blood collection and measurements by a registered nurse. Data were analyzed using hierarchical linear models to control for clustering of participants in childhood neighborhoods. Main effects showed that growing up Black predicted CRP and hypertension elevations, despite controlling for neglect and childhood family and neighborhood poverty and their interactions. Multivariate results showed that race and childhood adversities interacted to predict adult health outcomes. Childhood family poverty predicted increased risk for hypertension for Blacks, not Whites. In contrast, among Whites, childhood neglect predicted elevated CRP. Childhood neighborhood poverty interacted with childhood family poverty to predict pulmonary functioning in adulthood. Gender differences in health indicators were also observed. The effects of childhood neglect, childhood poverty, and growing up Black in the United States are manifest in physical health outcomes assessed 30 years later. Implications are discussed.
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Bonomi AE, Anderson ML, Nemeth J, Rivara FP, Buettner C. History of dating violence and the association with late adolescent health. BMC Public Health 2013; 13:821. [PMID: 24015863 PMCID: PMC3847300 DOI: 10.1186/1471-2458-13-821] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 07/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present investigation expands upon prior studies by examining the relationship between health in late adolescence and the experience of physical/sexual and non-physical dating violence victimization, including dating violence types that are relevant to today's adolescents (e.g., harassment via email and text messaging). We examined the relationship between physical/sexual and non-physical dating violence victimization from age 13 to 19 and health in late adolescence/early adulthood. METHODS The sample comprised 585 subjects (ages 18 to 21; mean age, 19.8, SD = 1.0) recruited from The Ohio State University who completed an online survey to assess: 1) current health (depression, disordered eating, binge drinking, smoking, and frequent sexual behavior); and 2) dating violence victimization from age 13 to 19 (retrospectively assessed using eight questions covering physical, sexual, and non-physical abuse, including technology-related abuse involving stalking/harassment via text messaging and email). Multivariable models compared health indicators in never-exposed subjects to those exposed to physical/sexual or non-physical dating violence only. The multivariable models were adjusted for age and other non-dating abuse victimization (bullying; punched, kicked, choked by a parent/guardian; touched in a sexual place, forced to touch someone sexually). RESULTS In adjusted analyses, compared to non-exposed females, females with physical/sexual dating violence victimization were at increased risk of smoking (prevalence ratio = 3.95); depressive symptoms (down/hopeless, PR = 2.00; lost interest, PR = 1.79); eating disorders (using diet aids, PR = 1.98; fasting, PR = 4.71; vomiting to lose weight, PR = 4.33); and frequent sexual behavior (5+ intercourse and oral sex partners, PR = 2.49, PR = 2.02; having anal sex, PR = 2.82). Compared to non-exposed females, females with non-physical dating violence only were at increased risk of smoking (PR = 3.61), depressive symptoms (down/hopeless, PR = 1.41; lost interest, PR = 1.36), eating disorders (fasting, PR = 3.37; vomiting, PR = 2.66), having 5+ intercourse partners (PR = 2.20), and having anal sex (PR = 2.18). For males, no health differences were observed for those experiencing physical/sexual dating violence compared to those who did not. Compared to non-exposed males, males with non-physical dating violence only were at increased risk of smoking (PR = 3.91) and disordered eating (fasting, using diet aids, vomiting, PR = 2.93). CONCLUSIONS For females, more pronounced adverse health was observed for those exposed to physical/sexual versus non-physical dating violence. For both females and males, non-physical dating violence victimization contributed to poor health.
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Affiliation(s)
- Amy E Bonomi
- Human Development and Family Science, The Ohio State University, Columbus, OH, USA.
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17
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Jenny C, Crawford-Jakubiak JE. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics 2013; 132:e558-67. [PMID: 23897912 DOI: 10.1542/peds.2013-1741] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This clinical report updates a 2005 report from the American Academy of Pediatrics on the evaluation of sexual abuse in children. The medical assessment of suspected child sexual abuse should include obtaining a history, performing a physical examination, and obtaining appropriate laboratory tests. The role of the physician includes determining the need to report suspected sexual abuse; assessing the physical, emotional, and behavioral consequences of sexual abuse; providing information to parents about how to support their child; and coordinating with other professionals to provide comprehensive treatment and follow-up of children exposed to child sexual abuse.
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Gunter TD, Chibnall JT, Antoniak SK, McCormick B, Black DW. Relative contributions of gender and traumatic life experience to the prediction of mental disorders in a sample of incarcerated offenders. BEHAVIORAL SCIENCES & THE LAW 2012; 30:615-30. [PMID: 22991312 DOI: 10.1002/bsl.2037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The objective of this study was to quantify the relative contributions of gender and traumatic life experience to psychiatric disorders in a sample of 320 offenders entering a state prison. Women were more likely than men to report traumatic events and personal and family mental health treatment histories; and were more likely to meet criteria for posttraumatic stress, borderline personality, and eating disorders. People reporting traumatic life experiences were more likely than those not so reporting to have family mental histories and to meet criteria for mood, anxiety, psychotic, antisocial personality, and borderline personality disorders, as well as elevated suicide risk. With both gender and trauma included in the logistic regression models, only trauma was a significant predictor of mood, anxiety, psychotic, attention deficit hyperactivity, and antisocial personality disorders, as well as suicide risk. Trauma-informed programming, regardless of gender, is important for incarcerated offenders. To the extent that trauma is also criminogenic, these data suggest that women and men share the risk.
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Affiliation(s)
- Tracy D Gunter
- Indiana University School of Medicine, Department of Psychiatry, Division of Forensic Psychiatry, Indianapolis, Indiana, 46202-7176, USA.
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Widom CS, Czaja SJ, Bentley T, Johnson MS. A prospective investigation of physical health outcomes in abused and neglected children: new findings from a 30-year follow-up. Am J Public Health 2012; 102:1135-44. [PMID: 22515854 PMCID: PMC3483964 DOI: 10.2105/ajph.2011.300636] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2011] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood. METHODS Using a prospective cohort design, we matched children (aged 0-11 years) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children. Both groups completed a medical status examination (measured health outcomes and blood tests) and interview during 2003 through 2005 (mean age=41.2 years). RESULTS After adjusting for age, gender, and race, child maltreatment predicted above normal hemoglobin, lower albumin levels, poor peak airflow, and vision problems in adulthood. Physical abuse predicted malnutrition, albumin, blood urea nitrogen, and hemoglobin A1C. Neglect predicted hemoglobin A1C, albumin, poor peak airflow, and oral health and vision problems, Sexual abuse predicted hepatitis C and oral health problems. Additional controls for childhood socioeconomic status, adult socioeconomic status, unhealthy behaviors, smoking, and mental health problems play varying roles in attenuating or intensifying these relationships. CONCLUSIONS Child abuse and neglect affect long-term health status-increasing risk for diabetes, lung disease, malnutrition, and vision problems-and support the need for early health care prevention.
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Affiliation(s)
- Cathy Spatz Widom
- Psychology Department, John Jay College, City University of New York, New York, NY 10019, USA.
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20
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Sachs-Ericsson N, Keel PK, Holland L, Selby EA, Verona E, Cougle JR, Palmer E. Parental disorders, childhood abuse, and binge eating in a large community sample. Int J Eat Disord 2012; 45:316-25. [PMID: 21608009 DOI: 10.1002/eat.20938] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2011] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Genetic and nonshared environmental factors are implicated in the etiology of binge eating behaviors (BEB), with genetic risk expressed as parental psychopathology. Traumatic experiences including child abuse predict onset of BEB. It is not clear if each separately contribute to BEB, or whether parental pathology leads to abuse which in turn influences BEB. METHOD Data were obtained from the National Comorbidity Survey-Replication (N = 2960). Through structural equation modeling, we estimated unique and combined effects of mother's and father's internalizing (INT) and externalizing (EXT) disorders, and child abuse on BEB. RESULTS Parental INT and EXT psychopathology contributed to child abuse and BEB. Abuse predicted BEB and partially mediated associations between parental psychopathology and BEB. DISCUSSION Results emphasize the value of models that incorporate nature and nurture to understand risk for psychopathology in offspring, with childhood abuse being one mediator of how parental psychopathology may reflect genetic risk and influence environmental risk.
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Affiliation(s)
- Natalie Sachs-Ericsson
- Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, Florida 32306-4301, USA.
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Keeshin BR, Cronholm PF, Strawn JR. Physiologic changes associated with violence and abuse exposure: an examination of related medical conditions. TRAUMA, VIOLENCE & ABUSE 2012; 13:41-56. [PMID: 22186168 DOI: 10.1177/1524838011426152] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although the extant evidence is replete with data supporting linkages between exposure to violence or abuse and the subsequent development of medical illnesses, the underlying mechanisms of these relationships are poorly defined and understood. Physiologic changes occurring in violence- or abuse-exposed individuals point to potentially common biological pathways connecting traumatic exposures with medical outcomes. Herein, the evidence describing the long-term physiologic changes in abuse- and violence-exposed populations and associated medical illnesses are reviewed. Current data support that (a) specific neurobiochemical changes are associated with exposure to violence and abuse; (b) several biological pathways have the potential to lead to the development of future illness; and (c) common physiologic mechanisms may moderate the severity, phenomenology, or clinical course of medical illnesses in individuals with histories of exposure to violence or abuse. Importantly, additional work is needed to advance our emerging understanding of the biological mechanisms connecting exposure to violence and abuse and negative health outcomes.
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Affiliation(s)
- Brooks R Keeshin
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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22
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23
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Dubowitz H, Feigelman S, Lane W, Kim J. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model. Pediatrics 2009; 123:858-64. [PMID: 19255014 DOI: 10.1542/peds.2008-1376] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated. OBJECTIVE Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. METHODS A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. RESULTS Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. CONCLUSIONS The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.
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Affiliation(s)
- Howard Dubowitz
- Department of Pediatrics, University of Maryland School of Medicine, 520 W Lombard St, Baltimore, MD 21201, USA.
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Han C, Masand PS, Krulewicz S, Peindl K, Mannelli P, Varia IM, Pae CU, Patkar AA. Childhood abuse and treatment response in patients with irritable bowel syndrome: a post-hoc analysis of a 12-week, randomized, double-blind, placebo-controlled trial of paroxetine controlled release. J Clin Pharm Ther 2009; 34:79-88. [PMID: 19125906 DOI: 10.1111/j.1365-2710.2008.00975.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although irritable bowel syndrome (IBS) is frequently comorbid with childhood trauma, information on the clinical implications of this comorbidity is limited. We investigated whether a history of abuse was associated with response to treatment in a double blind, randomized, placebo controlled trial of paroxetine controlled release (CR) in IBS. METHODS Seventy-two IBS subjects were randomized to receive paroxetine CR (dose 12.5-50 mg/day) or placebo for 12 weeks. Subject selection was independent of abuse history. Sixty-one subjects completed the Sexual and Physical Abuse Questionnaire about their childhood abuse history. IBS symptoms were recorded using the Interactive Voice Response System (IVRS). Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS) and Clinical Global Impression (CGI) were also measured. The primary outcome was treatment response defined as > or =25% reduction in composite pain scores (CPS) on the IVRS from randomization to end of treatment. RESULTS The rate of abuse history was 50.8% (n = 31/61). Baseline demographic clinical characteristics (CPS, BDI, BAI, PSS, CGI scores) were not associated with abuse history. After 12 weeks of treatment, subjects with abuse history showed significantly higher CPS (t = 2.422, P = 0.018) than subjects without a history and less mean change of CPS (t = 3.506, P = 0.001). In a logistic regression analysis, history of abuse did not predict treatment response as measured by > or =25% reduction in CPS (OR = 0.481, CI = 0.164-1.406, P = 0.181), while the drug status (paroxetine CR) was significantly associated with treatment response as defined by a CGI improvement score of 1-2 (OR = 12.121, CI = 2.923-50.271, P = 0.001). Abuse history did not predict CGI-I (Fisher's exact, P = 0.500) improvements during the trial. CONCLUSIONS History of abuse did not appear to have any significant clinical correlates at baseline and did not predict treatment response. Further studies are needed to confirm whether SSRIs are effective in IBS patients irrespective of their abuse history.
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Affiliation(s)
- C Han
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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25
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Bonomi AE, Anderson ML, Rivara FP, Cannon EA, Fishman PA, Carrell D, Reid RJ, Thompson RS. Health care utilization and costs associated with childhood abuse. J Gen Intern Med 2008; 23:294-9. [PMID: 18204885 PMCID: PMC2359481 DOI: 10.1007/s11606-008-0516-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 10/09/2007] [Accepted: 01/09/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical and sexual childhood abuse is associated with poor health across the lifespan. However, the association between these types of abuse and actual health care use and costs over the long run has not been documented. OBJECTIVE To examine long-term health care utilization and costs associated with physical, sexual, or both physical and sexual childhood abuse. DESIGN Retrospective cohort. PARTICIPANTS Three thousand three hundred thirty-three women (mean age, 47 years) randomly selected from the membership files of a large integrated health care delivery system. MEASUREMENTS Automated annual health care utilization and costs were assembled over an average of 7.4 years for women with physical only, sexual only, or both physical and sexual childhood abuse (as reported in a telephone survey), and for women without these abuse histories (reference group). RESULTS Significantly higher annual health care use and costs were observed for women with a child abuse history compared to women without comparable abuse histories. The most pronounced use and costs were observed for women with a history of both physical and sexual child abuse. Women with both abuse types had higher annual mental health (relative risk [RR] = 2.07; 95% confidence interval [95%CI] = 1.67-2.57); emergency department (RR = 1.86; 95%CI = 1.47-2.35); hospital outpatient (RR = 1.35 = 95%CI = 1.10-1.65); pharmacy (incident rate ratio [IRR] = 1.57; 95%CI = 1.33-1.86); primary care (IRR = 1.41; 95%CI = 1.28-1.56); and specialty care use (IRR = 1.32; 95%CI = 1.13-1.54). Total adjusted annual health care costs were 36% higher for women with both abuse types, 22% higher for women with physical abuse only, and 16% higher for women with sexual abuse only. CONCLUSIONS Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.
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Affiliation(s)
- Amy E Bonomi
- Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA.
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26
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Palm KM, Follette VM. Sexual victimization and physical health: an examination of explanatory mechanisms. JOURNAL OF CHILD SEXUAL ABUSE 2008; 17:117-132. [PMID: 19042241 DOI: 10.1080/10538710801916309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
There is a growing body of research illustrating a significant relationship between a history of sexual victimization and the development of physical health problems; however, few researchers have examined variables that mediate this relationship. The present study examined two potential mediating variables: experiential avoidance and current stress. Results indicated that current stress significantly mediated the relationship between adult sexual assault and physical health complaints, and experiential avoidance may be a partial mediator. Implications of the findings and future directions are discussed.
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Affiliation(s)
- Kathleen M Palm
- Department of Psychology, Clark University, Worcester, MA 01610, USA.
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Thombs BD, Bernstein DP, Ziegelstein RC, Bennett W, Walker EA. A brief two-item screener for detecting a history of physical or sexual abuse in childhood. Gen Hosp Psychiatry 2007; 29:8-13. [PMID: 17189738 DOI: 10.1016/j.genhosppsych.2006.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Revised: 10/31/2006] [Accepted: 10/31/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND A number of medical practice guidelines and recommendations call for screening adult patients for a history of physical or sexual abuse in childhood, but no brief screening tools exist. The objective of this study was to assess the accuracy of a two-item screener for physical or sexual abuse in childhood. METHODS This is a cross-sectional study of randomly selected women (aged 18-65 years) from a large health maintenance organization. One thousand two hundred twenty-five patients were administered a questionnaire, which included two items in a brief screener: (a) "When I was growing up, people in my family hit me so hard that it left me with bruises or marks" and (b) "When I was growing up, someone tried to touch me in a sexual way or tried to make me touch them." A subset of 216 patients completed a semistructured interview for a history of physical or sexual abuse in childhood. RESULTS The two-item screener was sensitive (84.8%) and specific (88.1%) for detecting a history of physical or sexual abuse in childhood, as determined by the semistructured interview. CONCLUSIONS The two-item screener provides an accurate tool, which is easily integrated into a comprehensive health questionnaire or administered verbally by a clinician, to assess for history of abuse.
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Affiliation(s)
- Brett D Thombs
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, Quebec, Canada H3T 1E4.
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Norman SB, Means-Christensen AJ, Craske MG, Sherbourne CD, Roy-Byrne PP, Stein MB. Associations between psychological trauma and physical illness in primary care. J Trauma Stress 2006; 19:461-70. [PMID: 16929502 DOI: 10.1002/jts.20129] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Psychological trauma is associated with poor physical health. We examined whether specific trauma types (assaultive, sexual, any) are associated with specific medical illnesses and whether posttraumatic stress disorder (PTSD) mediated these relationships in 680 primary care patients. For men, trauma history was associated with arthritis and diabetes; PTSD mediated the association between trauma and arthritis but not diabetes. Among women, trauma was associated with digestive diseases and cancer; PTSD did not mediate these relationships. Awareness of the presence of the physical illnesses examined here may help with the identification and treatment of primary care patients with trauma histories.
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Affiliation(s)
- Sonya B Norman
- Department of Psychiatry, University of California, San Diego, CA, USA
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Ginzburg K, Arnow B, Hart S, Gardner W, Koopman C, Classen CC, Giese-Davis J, Spiegel D. The abuse-related beliefs questionnaire for survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2006; 30:929-43. [PMID: 16934330 DOI: 10.1016/j.chiabu.2006.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Revised: 12/28/2005] [Accepted: 01/29/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To evaluate the psychometric properties of a new measure, the Abuse-Related Beliefs Questionnaire (ARBQ), designed to assess abuse-related beliefs among adult survivors of childhood sexual abuse (CSA). Study 1 examined the structure of the scale, and Study 2 evaluated its reliability and validity. METHOD One hundred and seventy female CSA survivors recruited into a group psychotherapy intervention study were administered the ARBQ in Study 1. A subsample of 45 women completed the ARBQ again 12 months later. In Study 2, 70 women from a health maintenance organization who identified themselves as survivors of CSA completed the ARBQ along with the Trauma Symptom Checklist-40 (TSC-40) and the Symptom Checklist 90R (SCL-90-R). RESULTS Three reliable ARBQ subscales emerged in Study 1: Guilt, Shame, and Resilience. Twelve-month test-retest reliability was high (r=.60-.64). The internal consistency of the subscales was further supported in Study 2, and validity was demonstrated by moderate to high correlations with the distress measures. CONCLUSIONS The results indicate that the ARBQ has good psychometric characteristics, supporting the feasibility of its use in measuring abuse-related beliefs in research on survivors of CSA. A next step for validation of the ARBQ would be to evaluate its sensitivity in measuring changes in studies of interventions for treating CSA survivors.
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Affiliation(s)
- Karni Ginzburg
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel
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The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada. Soc Sci Med 2006; 63:1711-9. [PMID: 16793185 DOI: 10.1016/j.socscimed.2006.04.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Indexed: 10/24/2022]
Abstract
Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.
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Fillingim RB, Edwards RR. Is Self-Reported Childhood Abuse History Associated With Pain Perception Among Healthy Young Women and Men? Clin J Pain 2005; 21:387-97. [PMID: 16093744 DOI: 10.1097/01.ajp.0000149801.46864.39] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A self-reported history of childhood physical and/or sexual abuse is frequently reported among chronic pain populations and has been associated with poorer adjustment to pain. In addition, self-reported abuse history has been related to increased pain complaints in population-based studies. One possible explanation for the association between abuse and clinical pain is that abuse victims may display enhanced sensitivity to painful stimuli, which increases the risk of developing clinical pain. However, the limited evidence addressing this issue has been mixed. The purpose of this study was to examine the association between self-reported history of childhood sexual or physical abuse and experimental pain responses in a nonclinical sample of generally healthy young adults. DESIGN Participants were 110 (56 female, 54 male) college students who completed a series of questionnaires assessing abuse history, recent pain, health care utilization, perceived health, and psychologic variables. Also, measures of thermal and ischemic pain threshold and tolerance were obtained in all participants. In addition, a procedure assessing temporal summation of heat pain was conducted in which intensity and unpleasantness ratings of repetitive thermal stimuli were obtained. Systolic and diastolic blood pressure and heart rate were assessed at resting and during the ischemic pain task. RESULTS Participants with a positive childhood abuse history were oversampled, yielding 21 out of 56 (37.5%) women with a positive history of abuse and 13 out of 54 (24.1%) PHA men. No abuse group differences emerged for thermal or ischemic pain thresholds or tolerances (P values>0.05). However, compared to women with no childhood abuse history, women with a positive history of abuse provided significantly lower average pain unpleasantness and peak pain unpleasantness ratings and lower unpleasantness ratings of the first trial during the temporal summation procedure, whereas no abuse group differences emerged for men. Also, compared to participants with no childhood abuse history, participants of both genders with a positive history of abuse demonstrated smaller increases (ie, less temporal summation) in pain unpleasantness ratings across trials of thermal stimulation, and participants with a positive history of abuse showed greater decreases in pain intensity and unpleasantness after reaching their peak pain level (ie, greater wind-down) compared to participants with no childhood abuse history. In addition, participants with a positive history of abuse reported more sites of recent pain, poorer perceived health, greater somatization, and more negative affect. No group differences in resting cardiovascular measures or cardiovascular reactivity were observed. CONCLUSION These findings indicate that a self-reported history of childhood abuse is associated with decreased sensitivity to experimentally induced pain, especially among women. However, abuse history was associated with increased pain complaints, poorer self-reported health, and greater negative affect. These data highlight the complexity of the relationship between abuse history and pain and illustrate the need for further investigation of potential pain-related correlates of abuse.
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Affiliation(s)
- Roger B Fillingim
- University of Florida College of Dentistry and Gainesville VA Medical Center, Gainesville, FL 32610-0404, USA.
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Creed F, Guthrie E, Ratcliffe J, Fernandes L, Rigby C, Tomenson B, Read N, Thompson DG. Reported sexual abuse predicts impaired functioning but a good response to psychological treatments in patients with severe irritable bowel syndrome. Psychosom Med 2005; 67:490-9. [PMID: 15911915 DOI: 10.1097/01.psy.0000163457.32382.ac] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We assessed the effect of reported sexual abuse on symptom severity and health-related quality of life in patients with severe irritable bowel syndrome (IBS) undergoing psychological treatments. METHODS IBS patients entering a treatment trial who reported prior sexual abuse were compared with the remainder in terms of symptom severity and health-related quality of life (SF-36) at trial entry and 15 months later. Analyses used ANCOVA with age, sex, marital status, and treatment group as covariates. We assessed possible mediators using multiple regression analysis. RESULTS Of 257 patients with severe IBS, 31 (12.1%) reported a history of rape and 28 (10.9%) reported forced, unwanted touching. People who reported abuse were more impaired than the remainder on the SF-36 scales for pain (adjusted p = .023) and physical function (p = .029); these relationships followed a "dose-response" relationship and were mediated by SCL-90 somatization score. At 15 months follow-up, the associations between reported abuse and SF-36 scores were lost because people with reported abuse, especially rape, improved more than the remainder when treated with psychotherapy or paroxetine (selective serotonin reuptake inhibitor antidepressant); this improvement was mediated by change in SCL-90 somatization score. CONCLUSIONS In severe IBS, the association between self-reported sexual abuse and impaired functioning is mediated by a general tendency to report numerous bodily symptoms. A reported history of abuse is associated with a marked improvement following psychological treatment.
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Affiliation(s)
- Francis Creed
- School of Psychiatry and Behavioural Science, University of Manchester, Manchester, UK.
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Fiddler M, Jackson J, Kapur N, Wells A, Creed F. Childhood adversity and frequent medical consultations. Gen Hosp Psychiatry 2004; 26:367-77. [PMID: 15474636 DOI: 10.1016/j.genhosppsych.2004.04.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Accepted: 04/06/2004] [Indexed: 12/21/2022]
Abstract
We assessed possible psychological mediators of the relationship between childhood adversity and frequent medical consultations among new outpatients at neurology, cardiology, and gastroenterology clinics. We assessed whether these differed in patients with and without organic disease that explained their symptoms. At first clinic visit we recorded Hospital Anxiety and Depression scale (HADS--anxiety and depression subscale scores), Illness Perception Questionnaire (IPQ--four subscales: consequences, cure, identity, timeline), Health Anxiety Questionnaire (total score), and Symptom Amplification Scale (total score). Subjects were divided into two groups according to whether they had experienced any type of childhood adversity using the Childhood Experience of Care and Abuse Schedule. Outcome was the (log) number of medical consultations for 12 months before and 6 months after the index clinic visits. Multiple regression analysis was used to determine mediators; this was performed separately for patients with symptoms explained and not explained by organic disease. One-hundred and twenty-nine patients (61% response) were interviewed. Fifty-two (40.3%) had experienced childhood adversity; they made a median of 16 doctor visits compared with 10 for those without adversity (adjusted P=.026). IPQ identity score (number of symptoms attributed to the illness) and HAD depression scores were significantly associated with both childhood adversity and number of medical consultations and these variables acted as mediators between childhood adversity and frequency of consultation in the multiple regression analyses. This association was limited to patients with medically unexplained symptoms and was mediated by IPQ Identity Score (number of symptoms attributed to the patient's illness) and HAD depression score. Sexual abuse and overt neglect were the adversities most closely associated with frequent consultations. In patients with medically unexplained symptoms the association between childhood adversity and frequent medical consultations is mediated by the number of bodily symptoms attributed to the illness. Psychological treatments should be targeted at these patients with a view to reducing their frequent doctor visits.
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Affiliation(s)
- Maggie Fiddler
- Department of Psychiatry and Behavioural Sciences, University of Manchester, Manchester, UK
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Raphael KG, Chandler HK, Ciccone DS. Is childhood abuse a risk factor for chronic pain in adulthood? Curr Pain Headache Rep 2004; 8:99-110. [PMID: 14980144 DOI: 10.1007/s11916-004-0023-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Childhood sexual and physical abuse often are viewed as important factors in the development and persistence of chronic pain syndromes in adulthood. Nevertheless, earlier reviews on this issue have reached conflicting conclusions regarding the veracity of the relationship. In this critical review of existing research on childhood abuse and pain in adulthood, surprisingly mixed evidence is found, with significant effects found most consistently in very large cross-sectional studies that rely on self-reported abuse status. The few prospective studies that are available do not support the relationship. When examining the literature from the perspective of epidemiological standards for inferring causation, the authors conclude that the evidence does not demonstrate a causal relationship. It appears that any overall relationship between childhood abuse and pain in adulthood probably is modest in magnitude, if it exists at all. Clinical implications and suggestions for future research directions are discussed.
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Affiliation(s)
- Karen G Raphael
- UMDNJ New Jersey Medical School, Department of Psychiatry, 183 South Orange Avenue, BHSB F-1512, Newark, NJ 07103, USA.
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Biggs AM, Aziz Q, Tomenson B, Creed F. Do childhood adversity and recent social stress predict health care use in patients presenting with upper abdominal or chest pain? Psychosom Med 2003; 65:1020-8. [PMID: 14645781 DOI: 10.1097/01.psy.0000097333.02618.8d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A comprehensive model of health care use by patients with functional gastrointestinal disorders has not been fully tested. This study aimed to establish whether reported childhood and/or recent adversity are independent predictors of health care use when all other relevant factors are also included in the model. MATERIALS AND METHODS Consecutive new patients with upper abdominal or chest pain presenting to a secondary/tertiary clinic were assessed using the Childhood Experience of Care and Abuse and Life Events and Difficulties Schedules. They completed the Hospital Anxiety and Depression and Health Anxiety Questionnaires. Outcome was total number of health care visits recorded in hospital and general practice (GP) records over 18 months. RESULTS One hundred fifty-one patients were included (65% response rate). Health care visits were most frequent in unmarried (p < 0.0005), females (p < 0.0005), and those lacking social support (p = 0.012). In multiple regression analysis to predict number of health care visits, reported sexual abuse (p = 0.042) and death of a sibling during childhood (p = 0.026) were also independent predictors, together with SF36 subscale scores for physical function, health perception, and mental health (35% of variance explained). Childhood adversity predicted health care use in patients with functional gastrointestinal disorders and recent social stress did so in patients with demonstrated pathological findings. CONCLUSION After adjustment for demographic, physical, and psychological factors, childhood adversity, especially in severe form, is an independent predictor of health care use in patients with upper functional gastrointestinal disorders. The same was not true for patients consulting for demonstrable pathological abnormalities, for whom ongoing social stress was an independent predictor.
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Affiliation(s)
- Anne-Marie Biggs
- School of Psychiatry and Behavioural Sciences, Rawnsley Building, Manchester Royal Infirmary, Manchester, UK.
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Spertus IL, Yehuda R, Wong CM, Halligan S, Seremetis SV. Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice. CHILD ABUSE & NEGLECT 2003; 27:1247-1258. [PMID: 14637300 DOI: 10.1016/j.chiabu.2003.05.001] [Citation(s) in RCA: 264] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. METHOD Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. RESULTS A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. CONCLUSIONS Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure.
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Affiliation(s)
- Ilyse L Spertus
- Department of Psychiatry, Columbia Presbyterian Medical Center, 180 Fort Washington Avenue (HP-2), New York, NY 10032, USA
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Abstract
While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical health including some of the potential pathways, and (2) to call for collaborative action among clinicians, psychosocial and biomedical researchers, social service agencies, criminal justice systems, insurance companies, and public policy makers to take a comprehensive approach to both preventing and dealing with the sequelae of childhood abuse.
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Affiliation(s)
- Kristen W Springer
- Received from the Department of Sociology and Center for Demography, University of WisconsinMadison, Wis
| | - Jennifer Sheridan
- Received from the Department of Sociology and Center for Demography, University of WisconsinMadison, Wis
- The Women in Science and Engineering Leadership Institute, University of WisconsinMadison, Wis
| | - Daphne Kuo
- Received from the Department of Sociology and Center for Demography, University of WisconsinMadison, Wis
- The Department of Sociology at the University of WashingtonSeattle, Wash
| | - Molly Carnes
- The Women in Science and Engineering Leadership Institute, University of WisconsinMadison, Wis
- The Department of Medicine and Center for Women's Health and Women's Health Research, University of WisconsinMadison, Wis
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Krinsley KE, Gallagher JG, Weathers FW, Kutter CJ, Kaloupek DG. Consistency of retrospective reporting about exposure to traumatic events. J Trauma Stress 2003; 16:399-409. [PMID: 12895023 DOI: 10.1023/a:1024474204233] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Lifetime exposure to traumatic events was assessed by means of a multimethod protocol applied to 76 male military veterans. Consistency of retrospective reporting was determined for physical and sexual assault and abuse, accidents, disasters, combat and warzone experiences, serious illness or injury, and hazardous duty. Findings demonstrate that respondents are generally consistent in reporting traumatic events, although the majority report more events upon reevaluation. Reporting about traumatic events shows some variation as a function of the life epoch in which events occurred, whether they were directly or indirectly experienced, and the type of trauma involved. Discussion addresses memory-related processes triggered by trauma evaluation or tied to characteristics of events themselves as potential sources of inconsistency.
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Affiliation(s)
- Karen E Krinsley
- VA Boston Healthcare System and Department of Psychiatry, National Center for PTSD, Boston University School of Medicine, Boston, Massachusetts 02130, USA
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Abstract
Toxicogenic and psychogenic theories have been proposed to explain idiopathic environmental intolerance (IEI). Part 2 of this article is an evidence-based causality analysis of the psychogenic theory using an extended version of Bradford Hill's criteria. The psychogenic theory meets all of the criteria directly or indirectly and is characterised by a progressive research programme including double-blind, placebo-controlled provocation challenge studies. We conclude that IEI is a belief characterised by an overvalued idea of toxic attribution of symptoms and disability, fulfilling criteria for a somatoform disorder and a functional somatic syndrome. A neurobiological diathesis similar to anxiety, specifically panic disorder, is a neurobiologically plausible mechanism to explain triggered reactions to ambient doses of environmental agents, real or perceived. In addition, there is a cognitively mediated fear response mechanism characterised by vigilance for perceived exposures and bodily sensations that are subsequently amplified in the process of learned sensitivity. Implications for the assessment and treatment of patients are presented.
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Affiliation(s)
- Herman Staudenmayer
- Behavioral Medicine, Multi-Disciplinary Toxicology, Treatment and Research Center, Denver, Colorado 80222, USA.
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Wyatt GE, Myers HF, Williams JK, Kitchen CR, Loeb T, Carmona JV, Wyatt LE, Chin D, Presley N. Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy. Am J Public Health 2002; 92:660-5. [PMID: 11919068 PMCID: PMC1447133 DOI: 10.2105/ajph.92.4.660] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated history of abuse and other HIV-related risk factors in a community sample of 490 HIV-positive and HIV-negative African American, European American, and Latina women. METHODS Baseline interviews were analyzed, and logistic regressions were used to identify predictors of risk for positive HIV serostatus overall and by racial/ethnic group. RESULTS Race/ethnicity was not an independent predictor of HIV-related risk, and few racial/ethnic differences in risk factors for HIV were seen. Regardless of race/ethnicity, HIV-positive women had more sexual partners, more sexually transmitted diseases, and more severe histories of abuse than did HIV-negative women. Trauma history was a general risk factor for women, irrespective of race/ethnicity. CONCLUSIONS Limited material resources, exposure to violence, and high-risk sexual behaviors were the best predictors of HIV risk.
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Affiliation(s)
- Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, 760 Westwood Plaza-NPI (Room C8-871C), Los Angeles, CA 90024-1759, USA.
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Deykin EY, Keane TM, Kaloupek D, Fincke G, Rothendler J, Siegfried M, Creamer K. Posttraumatic stress disorder and the use of health services. Psychosom Med 2001; 63:835-41. [PMID: 11573033 DOI: 10.1097/00006842-200109000-00018] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Prior research has demonstrated increased use of medical services among persons with anxiety and depression. This investigation examined the possible association of posttraumatic stress disorder (PTSD) with the use of nonmental health services. METHOD A case-comparison design enrolled 102 high users of health services and 54 low users who were assessed for PTSD diagnosis and severity of PTSD symptoms. Subjects were male veterans receiving services from the primary care clinics of the VA Boston Healthcare System during an 18-month period. Data were collected by interview by use of standardized instruments including the Clinician Administered PTSD Scale for DSM-IV, the Life Events Checklist, and the Beck Depression Inventory. Data analysis employed odds ratios, linear and logistic regression, and path analyses. RESULTS High users of health care were almost twice as likely as low users (27.5% vs. 14.8%) to meet diagnostic criteria for current PTSD. The two groups differed significantly on both symptom frequency and intensity. Path analyses showed an indirect positive association between PTSD and health services use, with physician-diagnosed health conditions as a mediating variable. Auxiliary analysis demonstrated that the combined mental health burden of PTSD and depression symptoms also is positively associated with number of health conditions. CONCLUSIONS The findings indicate that PTSD, alone and in combination with depression, has a direct negative relationship with physical health that, in turn, is associated with more frequent use of primary health care services. These results do not suggest that PTSD leads to inappropriate (eg, distress-motivated) use of services.
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Affiliation(s)
- E Y Deykin
- National Center for PTSD, Veterans Administration Boston Healthcare System, Boston, MA 02130, USA
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Gregory RJ. Characteristics Of Patients Assigned Multiple Nonthreatening Medical Diagnoses. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2001; 3:164-167. [PMID: 15014600 PMCID: PMC181182 DOI: 10.4088/pcc.v03n0403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND: Medical diagnoses can be separated on the basis of whether or not they are associated with significant 1-year mortality risk, i.e., "threatening" versus "nonthreatening," by employing the Charlson Comorbidity Index (CCI). The author examined the psychosocial characteristics and medical utilization patterns of patients assigned multiple nonthreatening medical diagnoses. METHOD: The study population included 125 general medical outpatients seen in psychiatric consultation. The author employed blinded reviews of medical charts, psychological measures, and billing records to assess patients' psychosocial characteristics and medical utilization. RESULTS: The number of nonthreatening diagnoses correlated significantly with age (r = 0.35, p </=.001), diagnosis of somatoform disorder (r = 0.29, p </=.001), somatosensory amplification (r = 0.36, p </=.001), number of ambulatory medical visits (r = 0.24, p </=.01), and emergency room visits (r = 0.18, p </=.05), but did not correlate with CCI scores or medical hospitalization. By contrast, the number of threatening diagnoses, as measured by the CCI, did not correlate with a diagnosis of somatoform disorder or somatic amplification, but did correlate with age and all measures of medical utilization, including hospitalization (r = 0.19, p </=.05). CONCLUSION: Patients with multiple nonthreatening medical diagnoses have different psychosocial characteristics and medical utilization patterns than patients with multiple threatening diagnoses. The association between the number of nonthreatening medical diagnoses assigned to a given patient and measures of somatization suggests that psychosocial factors contribute to diagnostic assignment in patients with multiple nonthreatening medical diagnoses.
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Affiliation(s)
- Robert J. Gregory
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, N.Y
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Arnow BA, Hart S, Hayward C, Dea R, Barr Taylor C. Severity of child maltreatment, pain complaints and medical utilization among women. J Psychiatr Res 2000; 34:413-21. [PMID: 11165309 DOI: 10.1016/s0022-3956(00)00037-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
High medical utilization in adults has been linked to both reported history of childhood abuse and mental health problems. However, few studies have explored relationships between abuse severity and psychological distress to identify subgroups with unique utilization patterns and medical complaints. This study compared two groups of psychologically distressed, high utilizers. One group (DS) was comprised of those with psychological distress, who reported a history of child sexual abuse (CSA); the other group (DSP) consisted of those with psychological distress, who reported CSA plus a history of childhood physical abuse. The groups were compared on severity of sexual and nonsexual child maltreatment, medical complaints and medical utilization. From a convenience sample of 206 females age 20-63, recruited while waiting for a physician appointment in a primary care clinic, we compared 25 DSPs to 33 DSs. Compared with DSs, DSPs reported significantly more severe: (1) sexual abuse including completed intercourse; (2) emotional abuse; (3) emotional neglect; and (4) psychological distress. DSPs also showed a nonsignificant trend towards more severe physical neglect. In addition to being significantly higher on emergency room visits, DSPs were marginally higher than DSs on nonpsychiatric outpatient visits. DSPs had significantly more frequent chronic and acute pain complaints at emergency room (ER) visits. Headaches were the most frequently coded diagnosis at ER visits in this sample. DSPs accounted for 89% of these ER visits attributable to headaches. The interaction of psychological distress and reported severity of child maltreatment reveals subgroups with unique utilization patterns and medical complaints. Physicians should screen patients for child maltreatment severity and psychological distress and should be involved in mental health referral where necessary.
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Affiliation(s)
- B A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 94035-5722, Stanford, CA, USA
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