Effect of partner violence in adolescence and young adulthood on blood pressure and incident hypertension

Military sexual trauma and incident hypertension: a 16-year cohort study of young and middle-aged men and women

OBJECTIVES

Veterans, especially women, are three times more to experience sexual harassment and assault [military sexual trauma (MST)] than civilians. As trauma is associated with elevated cardiovascular risk, we investigated whether MST independently contributes to risk for incident hypertension and whether the effects are distinct among women.

METHODS

We assessed 788 161 post-9/11 Veterans ( Mage  = 32.14 years, 13% women) who were free of hypertension at baseline, using nationwide Veterans Health Administration data collected 2001-2017. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of MST to new cases of hypertension while sequentially adjusting for demographics, lifestyle and cardiovascular risk factors, including baseline blood pressure, and psychiatric disorders including posttraumatic stress disorder. We then tested for effect modification by sex.

RESULTS

Over 16 years [mean = 10.23 (SD: 3.69)], 35 284 Veterans screened positive for MST (67% were women). In the fully adjusted model, MST was associated with a 15% greater risk of hypertension [95% confidence interval (95% CI) 1.11-1.19]. In sex-specific analyses, men and women with a history of MST showed a 6% (95% CI, 1.00-1.12, P  = 0.042) and 20% greater risk of hypertension (95% CI, 1.15-1.26, P  < 0.001), respectively.

CONCLUSION

In this large prospective cohort of young and middle-aged Veterans, MST was associated with incident hypertension after controlling for established risk factors, including trauma-related psychiatric disorders. Although MST is disproportionately experienced by women, and the negative cardiovascular impact of MST is demonstrated for both sexes, the association with hypertension may be greater for women. Subsequent research should determine if early MST assessment and treatment attenuates this risk.

The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature

AIM

The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019.

METHODS

SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words "intimate partner violence" and "health." To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening.

RESULTS

IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes.

CONCLUSION

The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.

How Valid is the Question of Fear of a Partner in Identifying Intimate Partner Abuse? A Cross-Sectional Analysis of Four Studies

Intimate partner abuse (IPA) affects women's health, requiring accurate questions to identify the abuse. We investigated the accuracy of three questions about fear of an intimate partner in identifying exposure to IPA. We compared the sensitivity and specificity of these questions with the Composite Abuse Scale (CAS) using secondary data analysis of four existing studies. All studies recruited adult women from clinical settings, with sample sizes ranging from 1,257 to 5,871. We examined associations between demographic factors and fear through multivariate logistic regression, and analysis of the sensitivity and specificity of the questions about fear and IPA (CAS), generating a receiver operating curve (ROC). The prevalence of lifetime fear of a partner ranged from 9.5% to 26.7%; 14.0% of women reported fear in the past 12 months; and current fear ranged from 1.3% to 3.3%. Comparing the three questions, the question "afraid of a partner in the past 12 months" was considered the best question to identify IPA. This question had the greatest area under the ROC (0.80, 95% confidence interval (CI) = [0.78-0.81]) compared with "are you currently afraid" (range 0.57-0.61) or "have you ever been afraid" (range 0.66-0.77); and demonstrated better sensitivity (64.8%) and specificity (94.8%). Demographic factors associated with "fear of a partner in the past 12 months" included being divorced/separated (odds ratio [OR] = 8.49, 95% CI = [6.70-10.76]); having a low income (OR = 4.21, 95% CI = [3.46-5.13]); and having less than 12 years of education (OR = 2.48, 95% CI = [2.04-3.02]). The question "In the last 12 months did you ever feel frightened by what your partner says or does?" has potential to identify a majority of women experiencing IPA, supporting its utilization where more comprehensive measures are not possible.

Sexual Violence and Risk of Hypertension in Women in the Nurses' Health Study II: A 7-Year Prospective Analysis

Background Hypertension is a prevalent condition in women and an important modifiable risk factor for cardiovascular disease. Despite women's experiences of sexual violence being common, no prospective studies have examined lifetime sexual assault and workplace sexual harassment in relationship to hypertension in large civilian samples with extended follow-up. Here, we examined whether these experiences were prospectively associated with greater risk of developing hypertension over 7 years. Methods and Results Data are from a substudy of the Nurses' Health Study II and include women free of hypertension at the time of sexual assault and workplace sexual harassment assessment in 2008 (n=33 127). Hypertension was defined as self-reported doctor diagnosis or initiating antihypertensive medication use, assessed biennially through 2015. We performed Cox proportional hazards regression models to predict time to developing hypertension associated with sexual violence exposure, adjusting for relevant covariates. Over follow-up, 7096 women developed hypertension. Sexual assault and workplace sexual harassment were prevalent (23% and 12%, respectively; 6% of women experienced both). Compared with women with no exposure, women who experienced both sexual assault and workplace sexual harassment had the highest risk of developing hypertension (hazard ratio [HR], 1.21; 95% CI, 1.09-1.35), followed by women who experienced workplace sexual harassment (HR, 1.15; 95% CI, 1.05-1.25) and then by women who experienced sexual assault (HR, 1.11; 95% CI, 1.03-1.19), after adjusting for relevant covariates. Conclusions Sexual assault and workplace sexual harassment are prospectively associated with greater risk of hypertension. Reducing such violence is important in its own right and may also improve women's cardiovascular health.

Cardiovascular Risk and Outcomes in Women Who Have Experienced Intimate Partner Violence: An Integrative Review

BACKGROUND

Cardiovascular disease (CVD) and intimate partner violence (IPV) are 2 major chronic problems that prevalently affect women's health and quality of life in the United States. However, whether female IPV survivors are at risk for developing adverse cardiovascular outcomes has not been clearly understood.

OBJECTIVE

This integrative review was conducted to bridge the literature gap by examining cardiovascular health in female adults with a history of IPV experience.

METHODS

Three electronic databases including PubMed, CINAHL, and Web of Science were used to search for studies published between 1998 and 2019. The search process followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

RESULTS

Of the 229 records retrieved from the literature, 19 met the criteria for review. All included studies were quantitative research. Although the overall findings showed a mixed relationship between IPV and CVD, women who experienced abuse were more likely to engage in unhealthy behaviors, have higher levels of CVD biomarkers, experience cardiovascular symptoms, and exhibit long-term cardiovascular complications when compared with nonabused women.

CONCLUSIONS

Intimate partner violence is a stressor that directly and indirectly influences women's cardiovascular health. Therefore, it is essential for healthcare providers to routinely screen IPV status in clinical practice. Targeted interventions, such as assessing women's coping strategies and evaluating their cardiovascular health using a total risk factor approach, are recommended to prevent or reduce the deleterious effects of violence on this large, vulnerable group of women.

Exposure to Intimate Partner Violence and Hypertension Outcomes among Young Women in South Africa

Hypertension and intimate partner violence is affecting longevity and quality of life among women worldwide. In this study, intimate partner violence is identified as a risk factor for hypertension outcomes among young women in South Africa. Using a nationally representative sample of 216 (N) young women (15-34 years old) from the South African Demographic and Health Survey, this study uses cross-tabulations and logistic regression methods to identify the odds of hypertension outcomes. Results show that between 20 and 41% of 15-34-year-old women have hypertension. Further, 68% of women with hypertension experienced physical intimate partner violence. Finally, the odds of hypertension are increased if young women experience physical (OR: 4.07; CI: 1.04726-15.82438) or sexual (OR: 2.56; CI: 1.18198-5.55834) intimate partner violence. Efforts to reduce hypertension outcomes in the country should include intimate partner violence awareness and assistance.

Sexual Assault and Carotid Plaque Among Midlife Women

Background

Sexual assault is a risk factor for poor mental health, yet its relationship to cardiovascular disease risk is not understood. We tested whether women with a sexual assault history had greater carotid atherosclerosis levels and progression over midlife.

Methods and Results

A total of 169 non‐smoking, cardiovascular disease‐free women aged 40 to 60 years were assessed twice over 5 years. At each point, women completed questionnaires, physical measures, phlebotomy, and carotid ultrasounds. Associations between sexual assault and carotid plaque level (score 0, 1, ≥2) and progression (score change) were assessed in multinomial logistic and linear regression models, adjusted for age, race/ethnicity, education, body mass index, blood pressure, lipids, insulin resistance, and additionally depression/post‐traumatic stress symptoms; 28% of the women reported a sexual assault history. Relative to non‐exposed women, women with a sexual assault history had an over 4‐fold odds of a plaque score of ≥2 at baseline (≥2, odds ratio [OR] [95% CI]=4.35 [1.48–12.79], P=0.008; 1, OR [95% CI]=0.49 [0.12–1.97], P=0.32, versus no plaque; multivariable); and an over 3‐fold odds of plaque ≥2 at follow‐up (≥2, OR [95% CI]=3.65 [1.40–9.51], P=0.008; 1, OR [95% CI]=1.52 [0.46–4.99], P=0.49, versus no plaque; multivariable). Women with a sexual assault history also had an over 3‐folds greater odds of a plaque score progression of ≥2 (OR [95% CI]=3.48[1.11–10.93], P=0.033, multivariable). Neither depression nor post‐traumatic symptoms were related to plaque.

Conclusions

Sexual assault is associated with greater carotid atherosclerosis level and progression over midlife. Associations were not explained by standard cardiovascular disease risk factors. Future work should consider whether sexual assault prevention reduces women's cardiovascular disease risk.

Adverse Childhood Experiences and Blood Pressure in Women in the United States: A Systematic Review

INTRODUCTION

Elevated blood pressure is a leading contributor to adverse cardiovascular outcomes. Some studies suggest there is an association between adverse childhood experiences (ACEs) and subsequent elevated blood pressure in adulthood. The literature specific to ACEs and blood pressure in women has not been synthesized; thus the purpose of this systematic review was to examine what is known about the association between ACEs and blood pressure in women living in the United States.

METHODS

In collaboration with a medical librarian, a systematic search of the literature published between January 1998 and December 2019 was conducted. Original, peer-reviewed publications were identified from PubMed, CINAHL, and PsycINFO databases. Studies were excluded if they (1) were conducted outside the United States, (2) measured acute stress or adult stressors, or (3) measured childhood- or pregnancy-related outcomes.

RESULTS

Of 1740 articles, 12 publications met criteria for inclusion in this study, 8 of which were from cohort studies. Racial and ethnic diversity was limited, with half of the articles in this review consisting of samples that were majority white. Of the studies that used a self-reported history of hypertension, 60% obtained significant associations with ACEs, compared with only 30% of the studies that had objective blood pressure data. ACEs were associated with lower blood pressure in 3 studies.

DISCUSSION

More research is needed to elucidate the relationship between ACEs and elevated blood pressure. Inconsistencies in the findings may be related to the measurement of blood pressure, assessment of ACEs, and population characteristics. Future studies should incorporate diverse population-representative samples with consideration for sex- or race-specific stressors such as pregnancy or racism and their potential influence on blood pressure. Health care providers may consider the history of ACEs as part of screening for cardiovascular risk factors among female patients, especially younger women presenting with elevated blood pressure.

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

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

Mixed methods assessment of women's risk of intimate partner violence in Nepal

Background

Intimate partner violence (IPV) is a significant public health issue that affects one in three women globally and a similarly large number of women in Nepal. Although important policy and programmatic steps have been taken to address violence against women in Nepal over the past decade, there is still a gap on IPV research in Nepal, particularly with regard to social norms.

Methods

This mixed-methods study used in-depth interviews with women and their husbands as well as baseline survey data from a cluster randomized trial testing a primary prevention intervention for IPV to examine the prevalence and risk factors for IPV. Baseline survey data included 1800 women from Nawalparasi, Chitwan, and Kapilvastu districts in Nepal. Multivariate regression was used to identify risk and protective factors for exposure to physical and / or sexual IPV in the prior 12 months. Case-based analysis was used to analyze one of 18 pairs of in-depth interviews to examine risk and protective factors within marriages.

Results

Of 1800 eligible participants, 455 (25.28%) were exposed to IPV. In multivariate analyses, low caste, wife employment, income stress, poor marital communication, quarrelling, husband drunkenness, exposure to IPV as a child, in-law violence, and gender inequitable normative expectations were associated with IPV. The selected case interview represented common themes identified in the analysis including the wife’s exposure to violence as a child, husband alcohol use, and marital quarrelling.

Conclusions

Gender inequitable norms in the community and the intergenerational transmission of attitudes and behaviors supportive of IPV are important to address in intervention measures.

Lifetime Spousal Violence Victimization and Perpetration, Physical Illness, and Health Risk Behaviours among Women in India

The aim of this study was to assess the association between lifetime spousal violence victimization, spousal violence perpetration, and physical health outcomes and behaviours among women in India. In the 2015⁻2016 National Family Health Survey, a sample of ever-married women (15⁻49 years) (N = 66,013) were interviewed about spousal violence. Results indicate that 29.9% of women reported lifetime spousal physical violence victimization and 7.1% lifetime spousal sexual violence victimization (31.1% physical and/or sexual violence victimization), and 3.5% lifetime spousal physical violence perpetration. Lifetime spousal violence victimization and lifetime spousal violence perpetration were significantly positively correlated with asthma, genital discharge, genital sores or ulcers, sexually transmitted infections (STIs), tobacco use, alcohol use, and termination of pregnancy, and negatively associated with daily consumption of dark vegetables. In addition, lifetime spousal violence victimization was positively associated with being underweight, high random blood glucose levels, and anaemia, and negatively correlated with being overweight or obese. Lifetime spousal violence perpetration was marginally significantly associated with hypertension. The study found in a national sample of women in India a decrease of lifetime physical and/or sexual spousal violence victimization and an increase of lifetime spousal physical violence perpetration from 2005/5 to 2015/6. The results support other studies that found that, among women, lifetime spousal physical and/or sexual spousal violence victimization and lifetime spousal physical violence perpetration increase the odds of chronic conditions, physical illnesses, and health risk behaviours.

Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies

OBJECTIVE

We reviewed cohort studies to determine the magnitude and temporal direction of the association between recent intimate partner violence (IPV) and a range of adverse health outcomes or health risk behaviours.

DESIGN

Systematic review and meta-analysis.

METHODS

Medline, EMBASE and PsycINFO were searched from the first record to November 2016. Recent IPV was defined as occurring up to and including the last 12 months; all health outcomes were eligible for inclusion. Results were combined using random-effects meta-analysis.

RESULTS

35 separate cohort studies were retrieved. Eight studies showed evidence of a positive association between recent IPV and subsequent depressive symptoms, with a pooled OR from five estimates of 1.76 (95% CI 1.26 to 2.44, I²=37.5%, p=0.172). Five studies demonstrated a positive, statistically significant relationship between depressive symptoms and subsequent IPV; the pooled OR from two studies was 1.72 (95% CI 1.28 to 2.31, I²=0.0%, p=0.752). Recent IPV was also associated with increased symptoms of subsequent postpartum depression in five studies (OR=2.19, 95% CI 1.39 to 3.45, p=0.000), although there was substantial heterogeneity. There was some evidence of a bidirectional relationship between recent IPV and hard drug use and marijuana use, although studies were limited. There was no evidence of an association between recent IPV and alcohol use or sexually transmitted infections (STIs), although there were few studies and inconsistent measurement of alcohol and STIs.

CONCLUSIONS

Exposure to violence has significant impacts. Longitudinal studies are needed to understand the temporal relationship between recent IPV and different health issues, while considering the differential effects of recent versus past exposure to IPV. Improved measurement will enable an understanding of the immediate and longer term health needs of women exposed to IPV. Healthcare providers and IPV organisations should be aware of the bidirectional relationship between recent IPV and depressive symptoms.

PROSPERO REGISTRATION NUMBER

CRD42016033372.

Depressive Symptoms, Antidepressant Use, and Hypertension in Young Adulthood

BACKGROUND

Among adults, depressive symptoms are associated with higher rates of cardiovascular disease; however, the evidence is mixed regarding the association between depressive symptoms and hypertension, especially among young adults. The deleterious effects of some antidepressant medications on blood pressure may contribute to mixed findings.

METHODS

Adolescents enrolled in Add Health (N = 11,183) (1994-2008) completed an abbreviated Center for Epidemiologic Studies Depression Scale at three waves (mean ages, 16, 22, and 29). Antidepressant use was measured at age 22 and at age 29. Hypertension at age 29 was defined as measured systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or staff-inventoried anti-hypertensive medication use.

RESULTS

The prevalence of hypertension at age 29 was 20%. High depressive symptoms in adolescence or young adulthood were not associated with hypertension in young adulthood. Antidepressant use at age 29 was associated with increased prevalence of hypertension (prevalence ratio [PR], 1.4; 95% CI, 1.2, 1.7) and an interaction with sex was observed (PRMen, 1.6; 95% CI, 1.2, 2.0; PRWomen, 1.2; 95% CI, 0.89, 1.6; pinteraction = 0.0227). Selective serotonin reuptake inhibitor and non-selective serotonin reuptake inhibitor antidepressant use were associated with hypertension (PRSSRI, 1.3; 95% CI, 1.0, 1.6; PRnon-SSRI, 1.6; 95% CI, 1.2, 2.1).

CONCLUSIONS

In this sample, antidepressant use, but not depressive symptoms, was associated with hypertension in young adulthood. Further research is recommended to examine joint and independent relationships between depression and antidepressant use and hypertension among young adults. See video abstract at, http://links.lww.com/EDE/B355.

Intimate Partner Violence perpetration and cardiovascular risk: A systematic review

Intimate Partner Violence (IPV) perpetration may induce cardiovascular reactivity and risk markers thereby precipitating early onset cardiovascular disease (CVD). However, this relationship has been largely under-researched in comparison to the health impacts of IPV victimisation. We therefore aimed to systematically review the current evidence investigating the relationship between IPV perpetration and CV risk. Six databases (CINAHL, Ovid MEDLINE, Pubmed, Scopus, ProQuest, Google Scholar) were searched between August 2016 and August 2017 using a predefined search strategy. Inclusion criteria were studies of cross sectional and longitudinal design published since 2010, presenting IPV status by perpetrators (as distinct from victims) and an outcome of CVD (e.g. cardiac disease, stroke), CV risk markers (e.g. blood pressure) and/or a composite CV risk score. Twenty two potentially eligible studies were identified and full texts recovered. After ineligible studies were excluded, four remained (total n = 10,665). Positive relationships were observed between IPV perpetration and (i) short term CV reactivity markers (higher heart rate, lower vagal ratios, shorter pre-ejection periods) and (ii) longer term CV risk factors and outcomes including greater systolic blood pressure, incident hypertension, elevated 30 year CV risk score and self-report cardiac disease. Despite being a neglected area of research characterised by a high degree of heterogeneity, the early evidence suggests that IPV perpetration may be associated with elevated risk of CVD. We discuss these findings in the context of CVD prevention from the individual, family and inter-generational perspectives and directions for future studies.

Social norms and women's risk of intimate partner violence in Nepal

Social norms increasingly are the focus of intimate partner violence (IPV) prevention strategies but are among the least examined contextual factors in quantitative violence research. This study assesses the within-community, between-community, and contextual effect of a new measure of social norms (PVNS: Partner Violence Norms Scale) on women's risk of IPV. Data come from baseline surveys collected from 1435 female, married, reproductive-age participants, residing in 72 wards in three districts (Chitwan, Kapilvastu, Nawalparasi) in Nepal who were enrolled in a cluster randomized trial testing the impact of a social behavioral change communication intervention designed to prevent IPV. Results of unconditional multilevel logistic regression models indicated that there was cluster-level variability in the 12-month prevalence of physical (ICC = 0.07) and sexual (ICC = 0.05) IPV. Mean PVNS scores also varied across wards. When modeled simultaneously, PVNS scores aggregated to the ward-level and at the individual-level were associated with higher odds of physical (OR_ind = 1.12, CI = 1.04, 1.20; OR_ward = 1.40, CI = 1.15, 1.72) and sexual (OR_ind = 1.15, CI = 1.08, 1.24; OR_ward = 1.47, CI = 1.24, 1.74) IPV. The contextual effect was significant in the physical (0.23, se = 0.11, t = 2.12) and sexual (0.24, se = 0.09, t = 2.64) IPV models, suggesting that the ward-level association was larger than that at the individual-level. Adjustment for covariates slightly attenuated the ward-level association and eliminated the contextual association, suggesting that individual perceptions and the collective community phenomena were equally strong predictors of women's risk of IPV and should be taken into consideration when planning interventions. PVNS is a promising measure of social norms underpinning women's risk of IPV and warrants further psychometric testing.

Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: a cross-sectional study

BACKGROUND

This study examined the association between the type, and cumulative number of lifetime potentially traumatic events (PTEs), and chronic physical conditions, in a South African sample. PTE exposures have been associated with an increased risk for a wide range of chronic physical conditions, but it is unclear whether psychiatric disorders mediate this association. Given the established differences in trauma occurrence, and the epidemiology of posttraumatic stress disorder (PTSD) in South Africa relative to other countries, examining associations between PTEs and chronic physical conditions, particularly while accounting for psychiatric comorbidity is important.

METHODS

Data were drawn from the South African Stress and Health Study, a cross-sectional population-representative study of psychological and physical health of South African adults. Twenty-seven PTEs, based on the World Health Organization Composite International Diagnostic Interview Version 3.0, DSM-IV PTSD module were grouped into seven PTE types (war events, physical violence, sexual violence, accidents, unexpected death of a loved one, network events, and witnessing PTEs). Five clusters of physical conditions (cardiovascular, arthritis, respiratory, chronic pain, and other health conditions) were examined. Logistic regressions assessed the odds of reporting a physical condition in relation to type and cumulative number of PTEs. Cochran-Armitage test for trend was used to examine dose-response effect of cumulative PTEs on physical conditions.

RESULTS

After adjusting for sociodemographic variables and psychiatric disorders, respondents with any PTE had increased odds of all assessed physical conditions, ranging between 1.48 (95 % CI: 1.06-2.07) for arthritis and 2.07 (95 % CI: 1.57-2.73) for respiratory conditions, compared to those without PTE exposure. Sexual violence, physical violence, unexpected death of a loved one, and network PTEs significantly increased the odds of all or nearly all the physical conditions assessed. There was a dose-response relationship between number of PTEs and increased odds of all physical conditions.

CONCLUSIONS

Results from this study, the first in an African general population, are consistent with other population-based studies; PTEs confer a broad-spectrum risk for chronic physical conditions, independent of psychiatric disorders. These risks increase with each cumulative PTE exposure. Clinically, comprehensive evaluations for risk of mental and physical health morbidities should be considered among PTE survivors.

Intimate partner violence in late adolescence and young adulthood and subsequent cardiovascular risk in adulthood

BACKGROUND

Childhood maltreatment has been linked to adulthood cardiovascular disease (CVD). Little is known about the relationship between intimate partner violence (IPV) in late adolescence and young adulthood and CVD risk later in adulthood.

PURPOSE

To examine whether IPV perpetration and victimization experienced in late adolescence and young adulthood are associated with CVD risk among adults in the United States and whether this relationship differs by sex.

METHODS

Data include 9976 participants (50% female) in the National Longitudinal Study of Adolescent to Adult Health. Physical and sexual IPV were measured at wave 3 (2001/02) with items from the revised Conflict Tactics Scales. Participants'30-year risk of CVD was calculated at wave 4 (2008/09) using a Framingham prediction model. Linear regression models adjusted for confounders and IPV by sex interaction terms were tested to examine the relationship.

RESULTS

The mean CVD risk score was 13.18% (95% CI: 12.71, 13.64). Aone-standard deviation increase in the victimization score was associated with a 0.28% (95% CI: 0.03, 0.54) increase in CVD risk. Perpetration was similarly positively associated with CVD risk (beta: 0.33, 95% CI: 0.03, 0.62). When measured as a composite, all violence types were associated with increased CVD risk but only prior exposure to both victimization and perpetration reached statistical significance (0.62%, 95% CI: 0.01, 1.22). No differences by sex were detected.

CONCLUSIONS

Effect sizes are not large, but early detection of increased CVD risk in this relatively young population is notable and worthy of further study to inform the clinical response.

Adverse childhood experiences and intimate partner aggression in the US: sex differences and similarities in psychosocial mediation

Six in ten people in the general population have been exposed to adverse childhood experiences (ACEs). Intimate partner violence (IPV) is a major public health problem in the US. The main objective of this study was to assess sex differences in the role of posttraumatic stress disorder (PTSD), substance abuse, and depression as mediators in the association between ACEs and intimate partner aggression. Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Structural equation modeling was used to determine the mediational role of PTSD, substance abuse and depression in the association between ACE constructs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration/psychopathology) and intimate partner aggression. Among men, PTSD mediated the relationship between sexual abuse and intimate partner aggression. However, among men and women, substance abuse mediated the relationship between physical and psychological abuse and intimate partner aggression. IPV programs geared towards aggressors should address abuse (sexual, physical and psychological), which occurred during childhood and recent substance abuse and PTSD. These programs should be implemented for men and women. Programs aimed at preventing abuse of children may help to reduce rates of depression and PTSD in adulthood, and subsequent intimate partner aggression.