Examining the role of posttraumatic stress disorder symptoms in intimate partner violence among couples with alcohol use disorder

Separate literatures indicate that both alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) are robust risk factors for using intimate partner violence (IPV). Despite the strength of these relative literatures, and the common co-occurrence of AUD and PTSD, their combined effects on IPV have rarely been examined. This study begins to address this gap by exploring the moderating effects of provisional PTSD diagnosis on the relation between heavy alcohol consumption and physical IPV using a multilevel modeling approach. Participants were adult romantic couples (N = 100) with current AUD and a history of physical IPV in their relationship. Results from the between-couple comparison indicate that couples who reported more heavy drinking days also experienced more physical IPV when at least one partner had probable PTSD. However, the within-couple comparison indicated that among partners without a provisional PTSD diagnosis, those with fewer heavy drinking days compared to their partner also reported more physical IPV perpetration. These preliminary and exploratory findings require replication and extension but provide new and important information regarding the complex intersection of heavy drinking, PTSD, and IPV among couples with AUD.

Effects of alcohol problem discrepancy on relationship adjustment: The moderating role of conflict negotiation among couples with alcohol use disorder and intimate partner violence

Alcohol use disorder (AUD) has well-known negative effects on romantic relationship functioning, including the occurrence of intimate partner violence (IPV). A separate literature focused on community couples indicates that relationship functioning is more likely to suffer when partners report greater discrepancies in alcohol consumption. It is important to expand this literature to couples with AUD and to examine the role of impactful AUD domains in dyadic functioning. Furthermore, few studies have examined adaptive, treatment-malleable factors that could potentially offset the negative impact of alcohol discrepancies on relationship functioning. This study examined the association between couples' alcohol problem discrepancies and relationship adjustment, as well as the moderating effect of self-reported adaptive conflict negotiation behaviors. Participants were 100 couples (N = 200 individual participants) with intimate partner violence wherein at least one partner met diagnostic criteria for AUD. Actor-Partner Interdependence Models indicated that greater alcohol problem discrepancy was associated with lower dyadic adjustment. Moderation analyses revealed that the highest level of relationship adjustment was observed among couples with lower alcohol problem discrepancy and greater negotiation behaviors, while relationship adjustment was similar for couples with larger alcohol problem discrepancy, regardless of negotiation behaviors. Although further study is needed to clarify under what specific conditions adaptive negotiation behaviors are most helpful, they appear to be beneficial for some couples in this sample. We found no evidence that negotiation behaviors may be harmful among these high-risk couples.

Childhood Maltreatment and Use of Aggression among Veterans with Co-occurring PTSD and Alcohol Use Disorder: The Mediating Role of Hostile Cognitions

History of childhood maltreatment is common among military veterans, particularly those with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Childhood maltreatment is associated with negative psychosocial outcomes, including use of aggression during adulthood. Prior research has identified maladaptive cognitions as a key mediating variable in the association between early life trauma and aggression. Given the high rates of comorbid PTSD and AUD among veterans and the increased risk of aggression when these conditions co-occur, it is critical to examine malleable intervention targets, such as maladaptive cognitions, for this population. The current secondary analyses examined the mediating role of hostile cognitions on the associations between childhood maltreatment and adulthood aggression in a sample of dually diagnosed veterans. Participants were veterans with co-occurring PTSD and AUD (N = 73) who were enrolled in a larger randomized controlled laboratory trial. Participants completed self-report measures of childhood maltreatment, hostile cognitions, and aggressive behavior. Three models were tested to examine the mediating effect of hostility on the associations between childhood maltreatment, abuse, and neglect on aggression. Results indicated that hostility fully mediated the effect of maltreatment on aggression and partially mediated the effect of childhood abuse on aggression. The effect of childhood neglect on aggression was nonsignificant. Hostile cognitions may be a critical intervention target for veterans with co-occurring PTSD and AUD and history of childhood maltreatment, particularly for those who have experienced higher levels of childhood abuse.

Intimate partner violence: Opening the door to a safer future

These recommendations can help you to identify patients at risk of violence, create an environment where they feel comfortable disclosing their experiences, and help them plan for their safety.

A randomized controlled trial examining the effects of intranasal oxytocin on alcohol craving and intimate partner aggression among couples

BACKGROUND

While alcohol use disorder (AUD) is a well-established risk factor for intimate partner aggression (IPA), effective treatments for co-occurring AUD and IPA (AUD/IPA) are lacking. Oxytocin is one promising pharmacological candidate for AUD/IPA given its potential to modulate social behavior and attenuate alcohol use. However, emerging data suggests that oxytocin's prosocial effects are inconsistent, and a small number of studies have also found that oxytocin might have the potential to be aggressogenic. No studies have directly examined the impact of oxytocin on alcohol- or IPA-related outcomes in a dyadic context.

METHODS

The goal of this double-blind, randomized, and placebo-controlled trial was to examine the effects of a single dose of intranasal oxytocin (40 international units) on cue-induced alcohol craving, subjective aggression, laboratory task-based IPA, and cortisol reactivity in a sample of 100 couples (N = 200 individuals) with AUD and physical IPA in their current relationship.

RESULTS

There were no statistically significant differences between the oxytocin and placebo conditions for any of the primary outcomes.

CONCLUSIONS

Findings suggest that a single dose of intranasal oxytocin was not efficacious in mitigating alcohol craving or aggression in this sample. Although hypotheses were not supported, the findings provide important evidence that oxytocin was not aggressogenic in this high-risk sample. Future research investigating dispositional and contextual moderators of oxytocin response in addition to the therapeutic effects of more intensive oxytocin dosing or administration strategies on alcohol craving and aggression is warranted.

Advancing our understanding of the intersection between emotion regulation and alcohol and drug use problems: Dyadic analysis in couples with intimate partner violence and alcohol use disorder

BACKGROUND

An extensive body of literature has linked emotion regulation to alcohol and drug use problems, including among populations characterized by intimate partner violence (IPV). Advancing this research, the goal of the current study was to examine cognitive emotion regulation strategies and alcohol and drug use problems within a dyadic framework. Specifically, we examined actor and partner effects of maladaptive and adaptive cognitive emotion regulation strategies on alcohol and drug use problems.

METHODS

Eighty-four romantic couples (N = 168 total participants) participating in a randomized controlled trial who reported physical IPV and an alcohol use disorder completed self-reported measures of cognitive emotion regulation as well as alcohol and drug use problems.

RESULTS

Regarding actor effects, men's greater use of maladaptive cognitive emotion regulation strategies was positively related to their alcohol use problems (p < .001), whereas both women's (p = .02) and men's (p = .047) greater use of adaptive cognitive emotion regulation strategies was negatively related to their own alcohol use problems. In terms of partner effects, men's greater use of maladaptive cognitive emotion regulation strategies (p = .001) and less use of adaptive cognitive emotion regulation strategies (p = .017) was related to their partners' greater drug use problems.

CONCLUSIONS

Findings replicate and extend existing work in this area, showing that men's and women's emotion regulation strategies are related to their own alcohol and drug use problems and that men's cognitive emotion regulation strategies are also related to their partners' drug use problems.

Cognitive and Affective Mediators of Alcohol-Facilitated Intimate Partner Aggression

This multisite study examined whether aggressive cognitions and facial displays of negative affect and anger experienced during provocation mediated the association between alcohol intoxication and intimate partner aggression (IPA). Participants were 249 heavy drinkers (148 men, 101 women) with a recent history of IPA perpetration. Participants were randomly assigned to an Alcohol or No-Alcohol Control beverage condition and completed a shock-based aggression task involving apparent provocation by their intimate partner. During provocation, a hidden camera recorded participants' facial expressions and verbal articulations, which were later coded using the Facial Action Coding System and the Articulated Thoughts in Simulated Situations paradigm. Results indicated that the positive association between alcohol intoxication and partner-directed physical aggression was mediated by participants' aggressive cognitions, but not by negative affect or anger facial expressions. These findings implicate aggressogenic cognitions as a mediating mechanism underlying the association between the acute effects of alcohol and IPA perpetration.

Trauma Cognitions and Partner Aggression: Anger, Hostility, and Rumination as Intervening Mechanisms

OBJECTIVE

Previous research has demonstrated a significant association between trauma and intimate partner aggression (IPA) perpetration. However, the precise mechanisms underlying this relationship have yet to be fully elucidated. In the present study, we examined the impact of several key factors implicated in Ehlers and Clark's (2000) cognitive model of trauma (i.e., trauma cognitions, anger, hostility, and rumination) on IPA perpetration.

METHOD

Participants in this study were 271 male and female heavy drinkers at high risk for IPA from the community who completed measures of dysfunctional posttraumatic cognitions, dispositional rumination, trait anger and hostility, and IPA perpetration. A moderated mediational model was tested to determine how these variables interact to predict IPA perpetration.

RESULTS

Results indicated that anger and hostility mediated the effect of negative cognitions about the world on IPA perpetration, with this indirect effect being stronger for individuals with higher levels of rumination.

CONCLUSION

These findings suggest that cognitive and affective processes that may result from trauma exposure are associated with IPA and should be targeted in prevention and intervention programs for individuals at risk for perpetration.

Problematic alcohol use and acute intoxication predict anger-related attentional biases: A test of the alcohol myopia theory

Previous research has demonstrated a significant association between alcohol and aggression. However, the precise mechanisms underlying this relationship have yet to be fully elucidated. In the present study, we examined alcohol's effects on an attentional bias toward aggressogenic cues as the first step in a possible mediation model of alcohol-facilitated intimate partner aggression. More specifically, we tested an interactive effect of problematic alcohol use and acute alcohol intoxication on an attentional bias toward anger words. Participants in this study were 249 male and female heavy drinkers from the community with a history of past-year intimate partner aggression perpetration who participated in an alcohol-administration laboratory study assessing the effect of alcohol intoxication on cognitive biases. Multiple linear regression was used to test the proposed moderation model. Acute alcohol intoxication moderated the effect of problematic alcohol use on an attentional bias toward anger, with this effect being stronger for individuals in the alcohol compared to no-alcohol control condition. These findings suggest that problematic drinkers may be more likely to attend to aggressogenic stimuli while acutely intoxicated, relative to when they are sober. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Some types of hookups may be riskier than others for campus sexual assault

OBJECTIVE

The high prevalence of campus sexual assault (CSA) among college students in the United States is a chronic public health crisis. Some risk factors for CSA victimization, such as alcohol consumption and female gender, are firmly established, but the evidence for others is less robust. One factor that has received little attention in the literature on CSA is "hooking up," defined as a physically intimate dyadic encounter that may not entail further contact between partners. The purpose of the present study was to examine the role of hooking up, both as a general risk factor for CSA victimization, and the roles of different types of hookups, varying in degree of relatedness between partners, for different types of victimization.

METHOD

A stratified random sample of female undergraduate students (n = 373) from a single, small campus in the northeastern United States completed measures of demographics, alcohol consumption, hooking up, and sexual victimization in an online survey.

RESULTS

Results revealed high-risk levels of drinking, and a low-to-moderate frequency of hooking up. Overall prevalence of CSA reported by this sample was 44%, with 40% reporting nonconsensual sexual contact, and 33% attempted rape or rape. Follow-up questions to reports of sexual assaults indicated that most (78%) took place during hookups, and that the riskiest hookups were those with acquaintances and previous romantic partners.

CONCLUSION

If found to generalize to other campus populations, the role of hooking up in sexual assault should be added to systems-based models of sexual assault (e.g.,Heise, 1998) and to educational prevention programs. (PsycINFO Database Record

Gender attitude to the empowerment of women: an independent right to contraceptive acceptance, choice and practice

Multiple factors influence the acceptance, choice and utilisation of contraceptive. The objective of the study is to identify individual attitude towards the empowerment of women to an independent right to accept, choose and utilise a contraceptive method of their choice without recourse to their male partners. This is a cross sectional study of men and women of different socio-cultural background working or utilising the services of the Federal Medical Centre Gombe, Nigeria. There were 554 respondents. Only 187 (34.4%) respondents thought that all women, irrespective of marital status, should have an independent right to contraceptive acceptance, choice and practice. Significantly more men (85.4%) than women (61.8%) rejected that women should have an independent right to contraceptive acceptance, choice and practice. Majority of both gender favoured male influence in the acceptance and choice of method of contraception. Our study has re-echoed the importance of male involvement in contraception decision-making.

Caesarean delivery at the Federal Medical Centre Gombe: a 3-year experience

BACKGROUND

Caesarean delivery carries a higher morbidity and mortality than vaginal delivery. This first audit of caesarean delivery in our centre will be compared with previous studies around the world. Our objective is to document the indications and outcome of caesarean delivery.

METHOD

This was a retrospective study of patients who had caesarean delivery in Federal Medical Centre Gombe, from January 2001 to December 2003. The biosocial characteristics, indication for surgery, booking status, number and type of caesarean deliveries, type of uterine incision, complications, and cadre of surgeon and duration of hospital stay were obtained for each patient.

RESULTS

264 caesarean deliveries were performed, 250 cases made the criteria for inclusion. There were 2,172 total deliveries during the study period giving a caesarean delivery rate of 12.2%. The majority, 181 (72.4%) of the patients had emergency caesarean delivery while 69 (27.6%) had elective caesarean delivery. The commonest indication for caesarean delivery was cephalopelvic disproportion (20.8%), followed by preeclampsia/eclampsia (18.8%) and ante partum haemorrhage (14.4%). Others were fetal distress (8.8%), and previous caesarean delivery (7.2%). Majority of the patients, 104 (41.6%) were booked with the Federal Medical Centre Gombe, 88 (35.2%) booked elsewhere and 58 (23.2%) were unbooked. Twenty one (8.4%) had complications of which wound infection 11 (5.2%) was the commonest morbidity encountered. There were two maternal deaths and twenty one perinatal deaths giving a maternal and perinatal mortality rates of 800/100,000 and 82/1000 respectively.

CONCLUSION

The indications for caesarean delivery in our study are comparable to findings from other parts of the world. The high emergency caesarean delivery rate among those booked elsewhere is a cause for concern. Health education could reduce the number of emergency caesarean deliveries. Consequently this might reduce the high infectious morbidity associated with the procedure in this study.

The analysis of eclamptic morbidity and mortality in the Specialist Hospital Gombe, Nigeria

We conducted an analysis of caesarean sections (CS) in a tertiary care hospital in Pakistan to determine the rate of CS, indications and outcome. This information will be useful to formulate strategies to control the rate of CS and its associated complications in our hospital. This was a descriptive study conducted at the Obstetrics and Gynaecology Unit III, Sir Ganga Ram Hospital, Lahore during a period of 6 months, from 1 September 2000 to 28 February 2001. A proforma was constructed to document the details of all caesarean sections during the study period. During the 6-month period, of a total of 1424 deliveries conducted in the unit, 300 women had CS. These caesarean deliveries were analysed for the present study. The rate of caesarean sections in the study group was 21.07%. Of 300 caesarean deliveries, 34 were elective (11.33%) and 266 were emergency caesarean sections (88.67%). The main indications for the emergency caesarean deliveries were dystocia (28.2%), fetal distress (22.18%), CPD (6.77%) and a previous one (5.64%) or two caesarean sections (7.52%), while the main indications in the elective caesarean deliveries were a previous two (50%) or three (2.94%) CS. One hundred and two (34%) women were primigravida, 152 (50.67%) were gravida 2-4 and 45 (15%) women were among gravida 5-9. The mean age of the study group was 29 years. There was one maternal death and overall maternal morbidity was 14%. The majority of women were hospitalised for 2-6 days. In the group of emergency caesarean sections, there were four stillbirths (1.5%) and seven perinatal deaths (2.63%). The overall perinatal mortality rate was 4% in the study group. High-risk pregnancies without antenatal care constitute a major reason for the increased rate of caesarean deliveries and its associated morbidity and mortality.

Risk factors for obstetric fistulae in north-eastern Nigeria

This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally palatable messages that will change their attitude and practices to taking responsibility in reproductive health could be a winning strategy.

Heterotopic pregnancy in a natural conception cycle. A case report

We report a case of combined intrauterine and tubal pregnancy in a 32 year old para. The patient presented at the Gynaecological emergency unit, with lower abdominal pain, and vaginal bleeding. A pelvic scan confirmed an intrauterine pregnancy. While being managed as a case of threatened abortion, her condition deteriorated and the likelihood of an ectopic pregnancy was entertained. A repeat scan revealed significant peritoneal collection. suggestive of haemoperitoneum, and laparotomy confirmed heterotopic pregnancy. She had a right salpingectomy without complications. The patient had a supervised antenatal care and safe delivery of the intrauterine pregnancy.

Obstructed labour: a public health problem in Gombe, Gombe State, Nigeria

This study reviewed retrospectively the cases of obstructed labour as seen at the specialist Gombe Hospital (SHG), Gombe State, over a period of 5 years. The incidence of obstructed labour was 4.0%. There was a progressive decline in the time trend over the study period. About 80.3% of the patients were unbooked emergencies and 99.5% of them had been in labour elsewhere before presenting at the hospital. The leading cause of obstructed labour was cephalopelvic disproportion (83.0%). Caesarean section (72.2%) was the most common method of delivery. Puerperal sepsis was the most frequent morbidity. However, the longest duration of hospital stay was as a result of a bedsore. The maternal mortality for cases of obstructed labour was 7605/100,000 and the perinatal mortality was 628/1000 births. The study aims to reinstate public interest in this health problem and offers suggestions on how to curb this human tragedy.

Study of the immunopotentiator effects of dialyzable leukocyte extracts obtained out of leukocytes previously used for interferon production

The existence of immunopotentiator factors able to induce blastogenesis, chemotaxis and able of inhibiting migration of leukocytes was investigated in alcohol precipitates of different batches of dialyzed leukocyte extracts (DLE). These were prepared either out of fresh leukocytes from a large pool of buffy coats obtained from all blood collected from healthy donors with irrelevant antigen sensitiveness (DLE-NS) or from similar leukocytes which were incubated during 19 h for interferon production (DLE-NS-I). Alternatively, the same factors were investigated on a batch of DLE obtained from a donor exquisitely sensitive to Candida antigen (C-DLE-CS). It was observed that all the three batches contained equal amounts of either specific or nonspecific immunological enhancing factors. The similarity of the intensity of specific factors between the so-called nonspecific batches (DLE-NS and DLE-NS-I) and the specific batch (C-DLE-CS) was interpreted to be the result of the random selection of the donors for the preparation of the nonspecific batches, which consequently contain randomized relevant specificities. It is postulated, therefore, that batches of DLE which represent a large waste of leukocytes used for interferon production can be a useful tool for double-blind DLE therapy purposes.