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Stephenson LA, Beck K, Busuulwa P, Rosan C, Pariante CM, Pawlby S, Sethna V. Perinatal interventions for mothers and fathers who are survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2018; 80:9-31. [PMID: 29558671 DOI: 10.1016/j.chiabu.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/04/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Childhood sexual abuse (CSA) is a worldwide problem with severe long-term consequences. A history of CSA can impact the childbearing experience of mothers and fathers; affecting their mental health, parenting skills and compromising infant development. Nonetheless, the perinatal period offers huge opportunity for intervention and hope. This literature review collates evidence for perinatal psychosocial interventions targeting both mothers and fathers who are survivors of CSA. Publications dating from 1970 to June 2016 were searched using Medline, Maternity and Infant Health, PsychINFO, PsychArticles, PubMed and the International Bibliography of the Social Sciences (IBSS). There were no perinatal interventions that considered the needs of survivor fathers. Sixteen publications on 9 psychosocial perinatal interventions for CSA survivors were identified. However, no sub-analyses specific to CSA survivors were reported. Trauma-specific perinatal interventions drew from a range of theoretical models and varied widely in format. Generally interventions were associated with improvements in maternal mental health, parenting competence, infant attachment security and positive public health outcomes. They were safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocols with adequate fidelity. Yet current data is hampered by small sample size, inconsistent reporting of CSA rates and outcome measures, scarcity of observational data and longer-term follow-up. Intervention modifications are proposed for CSA survivors in view of their unique childbearing experiences.
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Affiliation(s)
- Lucy A Stephenson
- South London and the Maudsley NHS Foundation Trust/Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katherine Beck
- Department of Psychosis Studies, Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paula Busuulwa
- GKT School of Medical Education, King's College London, UK
| | - Camilla Rosan
- National Society for the Prevention of Cruelty to Children, UK
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Pawlby
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vaheshta Sethna
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
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Levey EJ, Gelaye B, Koenen K, Zhong QY, Basu A, Rondon MB, Sanchez S, Henderson DC, Williams MA. Trauma exposure and post-traumatic stress disorder in a cohort of pregnant Peruvian women. Arch Womens Ment Health 2018; 21:193-202. [PMID: 28905129 PMCID: PMC5849493 DOI: 10.1007/s00737-017-0776-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/04/2017] [Indexed: 11/28/2022]
Abstract
Women have a higher prevalence of post-traumatic stress disorder (PTSD) than men, with a peak during the reproductive years. PTSD during pregnancy adversely impacts maternal and infant health outcomes. The objectives of this study were to estimate the prevalence of antepartum PTSD symptoms in a population of pregnant Peruvian women and to examine the impact of number of traumatic events and type of trauma experienced. The Traumatic Events Questionnaire was used to collect data about traumatic exposures. The Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C) was used to assess PTSD. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Three thousand three hundred seventy-two pregnant women were interviewed. Of the 2920 who reported experiencing one or more traumatic events, 41.8% met criteria for PTSD (PCL-C score ≥ 26). A quarter of participants had experienced four or more traumas, and 60.5% of those women had PTSD. Interpersonal trauma was most strongly associated with PTSD (aOR, 3.20; 95% CI, 2.74-3.74), followed by unspeakable trauma (aOR, 2.87; 95% CI, 2.35-3.50), and structural trauma (aOR, 1.39; 95% CI, 1.15-1.67). These findings indicate the high prevalence of PTSD during pregnancy in the Peruvian population, which is relevant to other countries suffering from terrorism, war, or high rates of violence. This underscores the importance of screening for PTSD in pregnancy.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
- Institute for Juvenile Research, University of Illinois College of Medicine, Chicago, IL, 60608, USA.
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Karestan Koenen
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Qiu-Yue Zhong
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Archana Basu
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Sixto Sanchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, MA, 02118, USA
- Boston University School of Medicine, Boston, MA, 02118, USA
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Byrne J, Smart C, Watson G. "I Felt Like I Was Being Abused All Over Again": How Survivors of Child Sexual Abuse Make Sense of the Perinatal Period Through Their Narratives. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:465-486. [PMID: 28537852 DOI: 10.1080/10538712.2017.1297880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Sequelae following child sexual abuse pervade the lives of adult survivors, significantly impacting on pregnancy and childbirth. Symptoms of this distress are recognized, but meanings for women are less understood. This research aimed to examine the meaning for women themselves of the impact of child sexual abuse on experiences of pregnancy, childbirth, and the postnatal period. Taking a critical feminist perspective, three open-ended interviews with three survivors enabled women's narratives of pregnancy and childbirth to be heard, explored the structure of these narratives, including how experiences were connected, and identified key themes and how selves and others were positioned. Women themselves contributed to the analysis of their own narratives. The different struggles of each woman occurred within three domains of experience: identity, embodiment, and parenting. They were underpinned by a fluctuation between empowerment and disempowerment. These findings, although based on detailed analysis of the experiences of only three women, dovetail with, integrate, and extend the existent literature, offering a framework for understanding the complexity of meaning making for women. Further research might develop this. The framework may facilitate clinicians' understandings of what it is like for some women having children who have experienced child sexual abuse.
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Affiliation(s)
- Jane Byrne
- a Clinical Psychology Department , Plymouth University , Plymouth , United Kingdom
| | - Cordet Smart
- a Clinical Psychology Department , Plymouth University , Plymouth , United Kingdom
| | - Gilli Watson
- b Clinical Psychology Department , Devon Partnership NHS Trust , Devon , United Kingdom
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Levey EJ, Gelaye B, Bain P, Rondon MB, Borba CPC, Henderson DC, Williams MA. A systematic review of randomized controlled trials of interventions designed to decrease child abuse in high-risk families. CHILD ABUSE & NEGLECT 2017; 65:48-57. [PMID: 28110205 PMCID: PMC5346446 DOI: 10.1016/j.chiabu.2017.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/18/2016] [Accepted: 01/05/2017] [Indexed: 05/24/2023]
Abstract
Child abuse is a global problem, and parents with histories of childhood abuse are at increased risk of abusing their offspring. The objective of this systematic review is to provide a clear overview of the existing literature of randomized controlled trials evaluating the effectiveness of interventions to prevent child abuse. PubMed, PsychINFO, Web of Science, Sociological Abstracts, and CINAHL were systematically searched and expanded by hand search. This review includes all randomized controlled trials (RCTs) of interventions designed to prevent abuse among mothers identified as high-risk. Of the eight studies identified, only three found statistically significant reductions in abuse by any measure, and only two found reductions in incidents reported to child protective services. While much has been written about child abuse in high-risk families, few RCTs have been performed. Only home visitation has a significant evidence base for reducing child abuse, and the findings vary considerably. Also, data from low- and middle-income countries are limited.
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Affiliation(s)
- Elizabeth J Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, 5 Longfellow Pl., Suite 215, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA; Institute for Juvenile Research, University of Illinois College of Medicine, 1747 W Roosevelt Rd., Chicago, IL 60608, USA.
| | - Bizu Gelaye
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
| | - Paul Bain
- Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Marta B Rondon
- Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb Ingeniería, San Martin de Porras, Lima, Peru
| | - Christina P C Borba
- Boston Medical Center, Department of Psychiatry, 840 Harrison Ave., Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA
| | - David C Henderson
- Boston Medical Center, Department of Psychiatry, 840 Harrison Ave., Boston, MA 02118, USA; Boston University School of Medicine, 72 East Concord St., Boston, MA 02118, USA
| | - Michelle A Williams
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA
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Childhood maltreatment and pre-pregnancy obesity: a comparison of obese, overweight, and normal weight pregnant women. Arch Womens Ment Health 2016; 19:355-65. [PMID: 26386682 DOI: 10.1007/s00737-015-0573-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 09/13/2015] [Indexed: 10/25/2022]
Abstract
Pre-pregnancy overweight and obesity is associated with poor health outcomes for the mother and the child. General population studies suggest that childhood maltreatment is associated with obesity in adulthood. The aim of our study was to examine the association between pre-pregnancy overweight and obesity and a history of childhood abuse or neglect including different stages of severity of abuse and neglect. Three hundred twenty-six normal weight, overweight, or obese pregnant women reported demographic data, height and weight, and general psychological distress at 18-22 weeks of gestation. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Associations were examined using logistic regression analyses and a reference group of normal weight women. Fifty percent reported a history of abuse or neglect. After adjusting for age, education, income, marital status, and the number of previous children, pre-pregnancy overweight and obesity were strongly associated with severe physical abuse (overweight: OR = 8.33, 95% CI 1.48-47.03; obesity: OR = 6.31, 95% CI 1.06-37.60). Women with severe physical neglect (OR = 4.25, 95% CI 1.23-14.74) were at increased risk of pregnancy overweight. We found a dose-response relationship between physical abuse and pre-pregnancy overweight and obesity. Whereas other studies report an association between childhood maltreatment and pre-pregnancy obesity, this is the first study that found an association between childhood maltreatment and pre-pregnancy overweight. Considering the severe health risks of pre-pregnancy overweight and obesity and the long-term consequences of childhood maltreatment, affected women constitute a subgroup with special needs in prenatal care. Further research is needed to improve the understanding of the underlying mechanisms.
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LoGiudice JA, Douglas S. Incorporation of Sexual Violence in Nursing Curricula Using Trauma-Informed Care: A Case Study. J Nurs Educ 2016; 55:215-9. [DOI: 10.3928/01484834-20160316-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/28/2016] [Indexed: 11/20/2022]
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Leeners B, Görres G, Block E, Hengartner MP. Birth experiences in adult women with a history of childhood sexual abuse. J Psychosom Res 2016; 83:27-32. [PMID: 27020073 DOI: 10.1016/j.jpsychores.2016.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Although childhood sexual abuse (CSA) may seriously impair childbirth experiences, few systematic evaluations on associations, mediating influences, risk and protective factors are available. As such information is mandatory to improve obstetric care, the present study aimed to provide such data. METHODS The study compared childbirth experiences from 85 women after CSA and at least one pregnancy resulting in a life birth with those from 170 control women matched for nationality, personal age and children's age. Trained specialists from support centers investigated CSA. Obstetrical data were collected from the official personal clinical record of each pregnancy (Mutterpass) and data on CSA as well as childbirth experiences were examined by questionnaires. RESULTS Childbirth was more often highly frightening (24.7 vs. 5.3%; p<0.01) and a negative experience (40.7 vs. 19.6%, p<0.01) in women with a history of CSA than in controls. Multivariate regression models support the hypothesis that at least part of this association was mediated by covariates (specifically, birth preparation classes, presence of a trusted person, participation in medical decision-making, pain relief, emergency during labor and extreme duration of labor), which represent important resources in improving obstetric care. In 41% of women with CSA, memories of traumatic experiences intruded during childbirth, whereas about 58% experienced dissociation. While dissociation may result in loss of contact with obstetric staff, it was also used to reduce labor pain. CONCLUSION Childbirth following a history of CSA is associated with particular challenges. Creating a trusting environment by evaluating and integrating individual needs could ameliorate birth experiences.
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Affiliation(s)
- Brigitte Leeners
- Clinic for Reproductive Endocrinology, University Hospital Zurich, Switzerland.
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Sirois M, Berthelot N, Drouin-Maziade C, Germain P, Martel MJ. [Child abuse and parenting]. SOINS. PEDIATRIE, PUERICULTURE 2015; 36:44-47. [PMID: 26145302 DOI: 10.1016/j.spp.2015.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Maltreatment suffered during childhood has long-term consequences which risk impacting on parenthood. Supporting victims of violence in childhood as they adapt to parenthood represents a challenge for health professionals working in perinatal services.
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Affiliation(s)
- Mathieu Sirois
- Département des sciences infirmières, Université du Québec, CP 500, Trois-Rivières, Québec, Canada/G9A 5H7
| | - Nicolas Berthelot
- Département des sciences infirmières, Université du Québec, CP 500, Trois-Rivières, Québec, Canada/G9A 5H7.
| | - Christine Drouin-Maziade
- Département des sciences infirmières, Université du Québec, CP 500, Trois-Rivières, Québec, Canada/G9A 5H7
| | - Patricia Germain
- Département des sciences infirmières, Université du Québec, CP 500, Trois-Rivières, Québec, Canada/G9A 5H7
| | - Marie-Josée Martel
- Département des sciences infirmières, Université du Québec, CP 500, Trois-Rivières, Québec, Canada/G9A 5H7
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Abstract
Patients with a history of traumatic life events can become distressed or re-traumatized as the result of healthcare experiences. These patients can benefit from trauma-informed care that is sensitive to their unique needs. However, despite the widespread prevalence of traumatic life experiences such as sexual assault and intimate partner violence, trauma-informed care has not been widely researched or implemented. The purpose of this synthesis of the literature is to examine existing research on trauma-informed care for survivors of physical and sexual abuse. The following themes are discussed: trauma screening and patient disclosure, provider-patient relationships, minimizing distress and maximizing autonomy, multidisciplinary collaboration and referrals, and trauma-informed care in diverse settings. This synthesis also explores implications for trauma-informed care research, practice and policy. The themes identified here could be used as a framework for creating provider and survivor educational interventions and for implementing trauma-informed care across disciplines. The findings of this synthesis support further research on patient and provider experiences of trauma-informed care, and research to test the efficacy of trauma-informed care interventions across healthcare settings. Universal implementation of trauma-informed care can ensure that the unique needs of trauma survivors as patients are met, and mitigate barriers to care and health disparities experienced by this vulnerable population.
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Affiliation(s)
- Elizabeth Reeves
- a Duke University, School of Nursing , Durham , North Carolina , USA
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Tekoah SD, Harel-Shalev A. “Living in a movie” — Israeli women combatants in conflict zones. WOMENS STUDIES INTERNATIONAL FORUM 2014. [DOI: 10.1016/j.wsif.2014.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
AIM This paper is a report of a study of the relationship of post-traumatic stress symptoms, depression, and health status to high risk pregnancy status in survivors of childhood sexual abuse. BACKGROUND Studies examining the long-term effects of childhood sexual abuse have delineated diverse psychological, cognitive, and social difficulties in adult survivors that often manifest somatically. METHODS A random sample of 1835 mid-pregnant Jewish women was recruited in Israel over an 18-month period in 2005-2007. Participants were divided into three sub-groups consisting of the different combinations between pregnancy at risk (yes/no), childhood sexual abuse (yes/no), other than childhood sexual abuse trauma (yes no), and no trauma (yes/no). They completed a self-administered questionnaire consisting of five scales: a demographic variables scale, the Post-traumatic Stress Disorder Symptom Scale, Center for Epidemiologic Studies Depression Scale, Traumatic Events Questionnaire, and Childhood Sexual Experiences Scale. FINDINGS Pregnant survivors of childhood sexual abuse suffered higher distress levels which heightened poor health, hence increasing the probability of high risk pregnancy compared to women who had had other than sexual abuse trauma or reported no trauma. Post traumatic stress symptoms and avoidance (a sub-category) were found to explain chronic illnesses, whereas depression was found to explain gynecological problems in pregnant sexually-abused survivors. CONCLUSION Healthcare workers need to recognize and address the psychological state of pregnant child sexual abuse survivors. Screening of pregnant women for child sexual abuse is needed to assess survivors' psychological well-being and recognize their unique concerns during pregnancy monitoring.
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Lev-Wiesel R, Daphna-Tekoah S, Hallak M. Childhood sexual abuse as a predictor of birth-related posttraumatic stress and postpartum posttraumatic stress. CHILD ABUSE & NEGLECT 2009; 33:877-87. [PMID: 19900704 DOI: 10.1016/j.chiabu.2009.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/29/2009] [Accepted: 05/31/2009] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To investigate the extent to which childbirth may function as a retraumatization of childhood sexual abuse, and may exacerbate postpartum posttraumatic stress reactions. METHODS Data was obtained from a convenience sample of 837 women in mid-pregnancy, at 2 and 6 months following childbirth. Three groups were drawn from this sample: women who experienced childhood sexual abuse (CSA), women survivors of trauma other than CSA, and women who reported no-trauma experiences. RESULTS PTSD subcategories of intrusion and arousal were increased in the CSA group following childbirth, although the overall PTSD score did not increase following childbirth in any of the groups CSA survivors scored higher at all data collection time points. CONCLUSIONS CSA is a traumatic event that has greater negative long-term effects than other traumas in the population of pregnant women. PRACTICE IMPLICATIONS Identifying women who are survivors of CSA early in their pregnancy and establishing a risk assessment may significantly reduce delivery complications and consequently mitigate postpartum PTS outcomes.
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Affiliation(s)
- Rachel Lev-Wiesel
- School of Social Work, University of Haifa, Hacarmel, Haifa 31905, Israel
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Leeners B, Stiller R, Block E, Görres G, Imthurn B, Rath W. Effect of Childhood Sexual Abuse on Gynecologic Care as an Adult. PSYCHOSOMATICS 2007; 48:385-93. [PMID: 17878496 DOI: 10.1176/appi.psy.48.5.385] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The study sought to evaluate whether childhood sexual abuse (CSA) experiences significantly affect the gynecologic care received as an adult. A self-administered questionnaire including eight questions on CSA was completed by 85 women exposed to CSA and 170 matched-control women. Women exposed to CSA experienced gynecologic examinations as anxiety-provoking significantly more often and sought more treatment for acute gynecologic problems; 43.5% of these women experienced memories of the original abuse situation during gynecologic consultations. Gynecologic care is particularly distressing for women exposed to CSA.
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Affiliation(s)
- Brigitte Leeners
- Department of Gynecology and Obstetrics, University Hospital, Clinic for Endocrinology, Frauenklinikstr. 10, CH 8091 Zürich, Switzerland.
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Lev-Wiesel R, Daphna-Tekoa S. Prenatal Posttraumatic Stress Symptomatology in Pregnant Survivors of Childhood Sexual Abuse: A Brief Report. JOURNAL OF LOSS & TRAUMA 2007. [DOI: 10.1080/15325020600945988] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Leeners B, Richter-Appelt H, Imthurn B, Rath W. Influence of childhood sexual abuse on pregnancy, delivery, and the early postpartum period in adult women. J Psychosom Res 2006; 61:139-51. [PMID: 16880016 DOI: 10.1016/j.jpsychores.2005.11.006] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 11/28/2005] [Accepted: 11/29/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE With a prevalence of around 20%, childhood sexual abuse (CSA) is a relevant problem in obstetric care. The aim of our systematic review was to present the current knowledge on the influence of CSA on pregnancy, delivery, and early parenthood. DATA SOURCES All English, French, or German primary and secondary literature from the reference lists found after screening the data banks Pubmed, PsycInfo, and Psyndex for publications that include the terms CSA or childhood traumatization and pregnancy, birth, delivery, labor, childbearing, breast feeding, or postpartum, and published after 1970 were reviewed for relevant data. METHODS OF STUDY SELECTION Investigations of psychological/medical data banks and cross references revealed 43 relevant studies. Given the paucity of data on this important subject, we opted to review all of these studies. TABULATION, INTEGRATION, AND RESULTS Although research projects on this topic are rare and the methodological quality of studies published to date is generally poor, women with a history of CSA seem to present a variety of long-term sequelae referring to pregnancy, delivery, and early parenthood. These sequelae include risk behaviors during pregnancy and disturbance of delivery by sudden memories of sexual abuse situations. Prenatal care is often complicated by the tendency to avoid situations that can trigger memories. CONCLUSIONS As effective treatment programs to improve sequelae of CSA are available today, the question of such abuse experiences should be raised as early as possible and adequate interdisciplinary models to care for victimized patients should be established. However, to improve knowledge on the long-term effect of sexual abuse experiences in obstetrical care, methodologically well-designed research projects focusing on the kind and incidence of sequelae, mediating factors as well as prophylactic and therapeutic options are needed.
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Affiliation(s)
- Brigitte Leeners
- Department of Gynaecology and Obstetrics, University Hospital Zürich, CH 8091 Zurich, Switzerland.
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Abstract
Childhood sexual abuse is a serious problem. Significant evidence exists that victims experience both short-term and long-term emotional and psychological problems related to the abuse. Childhood sexual abuse committed by clergy or other adults affiliated with the church may have additional ramifications because of deep violations of trust, honesty, and love. In addition, it can create spiritual distress in victims. Child and adolescent mental health nurses need to actively promote risk-reduction strategies to help prevent the abuse from occurring in their communities.
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Affiliation(s)
- Linda J Cook
- Department of Nursing, Bloomsburg University, Pennsylvania, USA.
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Hobbins D. Survivors of Childhood Sexual Abuse: Implications for Perinatal Nursing Care. J Obstet Gynecol Neonatal Nurs 2004; 33:485-97. [PMID: 15346674 DOI: 10.1177/0884217504266908] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Childhood sexual abuse has a lifelong impact on its survivors and may affect the childbearing experience in a variety of ways. Nurses caring for women during the perinatal period can benefit from understanding the phenomenon of child sexual abuse, its prevalence, and the sequelae experienced by childbearing women. Signs, symptoms, and correlates of prior sexual abuse manifested during the perinatal period are described, and nursing care responses are suggested. Nurses may be able to use this information to recognize survivors and facilitate both a positive childbirth experience and the healing process, by helping the survivor learn to trust, respect, and care for her body.
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Affiliation(s)
- Debra Hobbins
- Primary Care, Veterans Health Administration, Salt Lake City Health Care System, UT 84148, USA.
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Kennedy HP, MacDonald EL. "Altered consciousness" during childbirth: potential clues to post traumatic stress disorder? J Midwifery Womens Health 2002; 47:380-2. [PMID: 12361350 DOI: 10.1016/s1526-9523(02)00271-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Little L, Lowkes E. Critical issues in the care of pregnant women with eating disorders and the impact on their children. J Midwifery Womens Health 2000; 45:301-7. [PMID: 10983428 DOI: 10.1016/s1526-9523(00)00031-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pregnancy and eating disorders is a subject that has received relatively little attention in the literature. Nevertheless, serious complications have been found in both the mother and the baby during both pregnancy and post partum period. This article alerts practitioners to the physical and psychological risks that imperil pregnant women with histories of recent eating disorders, describes the experiences of three women with eating disorders during pregnancy whose children developed eating difficulties, and suggests some guidelines for the screening and care of women with eating disorders and their babies.
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Affiliation(s)
- L Little
- University of New Hampshire, School of Health and Human Services, Department of Nursing, Durham 03824, USA
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