RESUMEN
Since the 1990s, cases of serious violence and abuse, particularly sexual abuse in educational and social institutions of the Catholic Church, have been reported in numerous countries, including Ireland, the United States, and Australia. In many countries, commissions have been set up to investigate the widespread cases of abuse that could not be prosecuted under criminal law. The testimonies of survivors and other witnesses are used by the commissions of inquiry in their work. Since 2016 the Independent Inquiry into Child Sexual Abuse in Germany has collected more than 2,500 reports from survivors of child sexual abuse. Forty-four testimonies were analyzed in a study seeking to understand more about lifetime abuse. In an explorative analysis, aspects of time as a key category in the reports were identified using the structured content analysis method. The results highlight the importance of time in the reports and during all phases of the survivors' lives. Overall, four themes are relevant: (a) the identification of turning points, (b) time to make sense of what happened, (c) the practice of waiting, and (d) time-bound experiences of testifying.
Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños , Abuso Sexual Infantil , Humanos , Abuso Sexual Infantil/estadística & datos numéricos , Femenino , Niño , Masculino , Adulto , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Sobrevivientes/psicología , Alemania , Persona de Mediana Edad , Adulto JovenRESUMEN
Existing research suggests that prior victimizations during a person's lifetime, particularly childhood traumas and maltreatment, are risk factors for abuse and revictimization in adulthood, although longitudinal evidence is sparse. Using data from a 30-year ongoing longitudinal study of the long-term consequences of childhood maltreatment, this paper describes the extent to which childhood maltreatment predicts subsequent victimization and partner violence victimization at two time points in adulthood. Data were obtained from a prospective cohort design study in which children with court-substantiated cases of maltreatment (ages 0-11 years) and demographically matched controls were followed into adulthood and interviewed over several waves. Childhood maltreatment was assessed through juvenile and adult court records from 1967 to 1971 in a midwestern county area in the United States. Victimization experiences were assessed from 2000 to 2002 (Mage = 39.5 years) and 2009 to 2010 (Mage = 47.5) and included two types based on information from the lifetime trauma and victimization history instrument and questions about past year partner violence victimization. Individuals with histories of childhood maltreatment were more likely to report physical and sexual assaults and kidnapping and stalking victimization than controls through age 39.5. In contrast, the two groups did not differ at the later assessment at age 47.5, except maltreated individuals reported greater risk for sexual assault/abuse than controls. For intimate partner violence victimization at age 39.5, maltreated and control groups differed only in terms of victimization involving injury. Later in adulthood, more individuals with histories of childhood maltreatment reported partner physical violence victimization compared to controls. Although these longitudinal findings showed a general decline in victimization experiences over the two time points, these results demonstrate that childhood maltreatment increases risk for subsequent revictimization in middle adulthood, specifically for sexual assault/abuse and intimate partner physical violence victimization. These findings have implications for prevention and intervention efforts targeting maltreated children.
Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños , Víctimas de Crimen , Violencia de Pareja , Humanos , Víctimas de Crimen/estadística & datos numéricos , Víctimas de Crimen/psicología , Femenino , Adulto , Masculino , Estudios Longitudinales , Violencia de Pareja/estadística & datos numéricos , Violencia de Pareja/psicología , Estudios Prospectivos , Persona de Mediana Edad , Niño , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Preescolar , Maltrato a los Niños/estadística & datos numéricos , Maltrato a los Niños/psicología , Adolescente , Factores de Riesgo , Lactante , Adulto JovenRESUMEN
BACKGROUND: Stigma is a key barrier to disclosing traumatic experiences of violence in childhood with adverse consequences for help-seeking behaviour. Disclosing behavior differs by gender and the form of violence experienced. However, there is a lack of comprehensive studies that address societal perceptions of males and females with a history of sexual or physical violence in childhood. Therefore, our aim is to focus on the impact of gender on the perception of individuals who experienced sexual or physical violence in childhood. METHODS: We conducted a study on a representative sample of the German general population in terms of age and gender. Participants were randomly assigned to brief case vignettes addressing sexual or physical violence in childhood. Analyses base on a sample of n = 659 individuals (50.1% female). Stigma was assessed through examining respondents' readiness to address specific traumas in conversation and respondents' attitudes toward the individuals in the vignettes. Mann-Whitney U tests were applied to check for differences between female and male victims and survivors as well as female and male respondents. RESULTS: Our results reveal that male victims and survivors face higher negative stereotypes (harm, unpredictability) and evoke communication barriers more often when compared to female victims and survivors, especially in male respondents. Sexual violence is associated with more distinct gender differences than physical violence. CONCLUSIONS: Findings reflect greater stigma toward male victims and survivors of sexual violence than female ones. Men had a greater tendency to stigmatize - especially toward their same-gender peers. Socially ingrained gender roles may act as a basis for different communication cultures and the notion of victim-perpetrator constellations in which males are not envisaged as victims.
Asunto(s)
Estigma Social , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Adolescente , Alemania , Niño , Factores Sexuales , Anciano , Estereotipo , Abuso Físico/psicología , Abuso Físico/estadística & datos numéricos , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricosRESUMEN
BACKGROUND: Childhood Maltreatment (CM) is linked to adverse outcomes, including Borderline Personality Disorder (BPD) and increased propensity for offending behaviors. However, research on the specific role that BPD plays between the two is limited and highly relevant given the high prevalence of CM in Australia. OBJECTIVE: The present study aimed to investigate (1) the relationship between CM and subsequent offending behaviors, (2) whether BPD mediates the relation between CM and offending behaviors, and (3) which type of CM (physical, sexual, emotional abuse, neglect, exposure to domestic violence, multitype maltreatment) predicts BPD. PARTICIPANTS: The sample comprised 106 self-identified Australian female survivors of interpersonal violent crimes. METHODS: Participants completed an online survey consisting of the Adverse Childhood Events Questionnaire, the McLean Screening Instrument for BPD, and a self-created questionnaire to measure offending behaviors. Regression, mediation analysis, and logistic regression were conducted. RESULTS: CM significantly predicted offending behaviors (path c, B = 1.39, p <. 001) with BPD partially mediating the relationship (path c', B = 1.04, 95 % CI [0.31, 1.77], p = .006; path a, B = 0.47, 95 % CI [0.12, 0.83], p = .009, path b, B = 0.34, 95 % CI [0.07, 0.61], p = .014). Emotional abuse and multitype exposure were identified as predictors of BPD symptom development (OR = 9.42, 95 % CI OR [2.58, 34.40]; OR = 3.81, 95 % CI OR [1.41; 10.28], respectively). CONCLUSION: These findings indicate the necessity of early interventions addressing CM, with a particular focus on emotional abuse and exposure to more than one type of maltreatment, to reduce the risk of developing BPD symptomatology and mitigate future offending behaviors.
Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños , Trastorno de Personalidad Limítrofe , Humanos , Trastorno de Personalidad Limítrofe/psicología , Trastorno de Personalidad Limítrofe/epidemiología , Femenino , Adulto , Australia/epidemiología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Adulto Joven , Persona de Mediana Edad , Encuestas y Cuestionarios , Adolescente , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Niño , Criminales/psicología , Criminales/estadística & datos numéricosRESUMEN
OBJECTIVES: Working alliance is considered an important determinant of outcome of psychotherapy. Patients with posttraumatic stress disorder (PTSD) following childhood abuse (CA-PTSD) may have challenges in building interpersonal relationships, including working alliance. Phase-based treatment provides an opportunity to strengthen alliance prior to trauma-focused treatment. This study aimed to compare the development of working alliance among patients with CA-PTSD in three variants of prolonged exposure (PE) therapy: standard PE, intensive PE (iPE), and skill training in affective and interpersonal regulation + prolonged exposure (STAIR + PE). We also examined the effect of alliance on treatment outcome and dropout. METHOD: Self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (Blevins et al., 2015) and patient-rated Working Alliance Inventory (Tracey & Kokotovic, 1989) were assessed in a clinical trial. We analyzed data from 138 adult patients (76.1% female; 42% non-Western). Analyses were performed using mixed-effects models. RESULTS: Patients established a satisfactory alliance early in treatment, which increased over time. For PE and STAIR + PE, a larger decrease in PTSD symptom severity was related to a higher alliance in the subsequent session, but not the other way around. In STAIR + PE, a higher alliance in Phase 1 was related to lower PTSD symptoms in Phase 2. In all conditions, a higher initial working alliance was related to a lower chance of treatment dropout. CONCLUSION: In the treatment of CA-PTSD, all three variants of prolonged exposure foster positive development of the working alliance. Across conditions, working alliance did not precede symptom decline. Therapists should strive for a strong alliance at the beginning of treatment as this reduces the likelihood of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Asunto(s)
Terapia Implosiva , Trastornos por Estrés Postraumático , Alianza Terapéutica , Humanos , Trastornos por Estrés Postraumático/terapia , Trastornos por Estrés Postraumático/psicología , Femenino , Masculino , Terapia Implosiva/métodos , Adulto , Persona de Mediana Edad , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Resultado del Tratamiento , NiñoRESUMEN
BACKGROUND: Although maternal childhood maltreatment has been associated with offspring externalizing symptoms, little is known about the potential mechanisms that contribute to breaking the intergenerational effect of maternal childhood maltreatment. OBJECTIVE: The current study aimed to (a) investigate the intergenerational effect between maternal childhood maltreatment and offspring externalizing symptoms in the Chinese family; (b) examine maternal supportive and harsh parenting as potential mediators of this intergenerational effect; and (c) explore the moderating roles of paternal support parenting, as well as paternal harsh parenting, in this mediation process of maternal supportive and harsh parenting. PARTICIPANTS AND SETTING: The sample consisted of 1111 mother-father-child triads from Beijing, recruited when the children were one and three years old. METHODS: Mothers completed the Childhood Trauma Questionnaire, and both parents completed the Infant-Toddler Social and Emotional Assessment and Comprehensive Early Childhood Parenting Scale. RESULTS: Our results showed that maternal childhood maltreatment was a risk factor for offspring externalizing symptoms at T2 (ß = 0.24, t = 6.51, p < .001), and this effect was mediated by maternal supportive (indirect effect = 0.03, 95%CI = [0.02, 0.05]) and harsh parenting (indirect effect = 0.03, 95%CI = [0.02, 0.07]) at T1. Furthermore, paternal harsh parenting moderated the indirect effect of maternal childhood maltreatment on child externalizing symptoms through maternal supportive parenting. CONCLUSIONS: These findings contribute to our understanding and provide valuable information for disrupting the intergenerational effect of maternal childhood maltreatment.
Asunto(s)
Responsabilidad Parental , Humanos , Femenino , Responsabilidad Parental/psicología , Masculino , Preescolar , Lactante , Adulto , Maltrato a los Niños/psicología , Madres/psicología , Relaciones Madre-Hijo/psicología , Relaciones Intergeneracionales , Factores de Riesgo , Beijing , Padre/psicología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Relaciones Padre-HijoRESUMEN
BACKGROUND: Childhood abuse is associated with an increased risk of migraines. However, the literature on this association is limited. OBJECTIVE: To determine the pooled effect size of the association between childhood abuse and migraines. PARTICIPANTS AND SETTING: System review and meta-analysis. METHODS: A systematic literature search for studies published until September 20, 2023, was performed using the Embase, PubMed, and Web of Science databases. Specifically, original articles reporting the statistical effect size (odds ratio) of the association between childhood abuse and migraines were selected. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using random- or fixed-effects models. Publication bias was examined using funnel plots, and sensitivity analysis was used to explore the stability of the pooled results. RESULTS: Twelve studies involving 110,776 participants were included. Individuals with childhood abuse (OR = 1.60, 95 % CI: 1.49, 1.71) were at increased risk of migraine when compared with individuals with no childhood abuse. Of the different types of childhood abuse examined, sexual abuse (OR = 1.71, 95 % CI: 1.43, 2.04), physical abuse (OR = 1.47, 95 % CI: 1.38, 1.56), and emotional abuse (OR = 1.71, 95 % CI: 1.52, 1.93) were associated with an increased risk of migraine. CONCLUSIONS: Childhood abuse increases migraine risk. Multifaceted interventions to curb abuse and related behaviors can effectively reduce migraine risk. However, considering that multiple factors, such as obesity and anxiety, are causatively associated with both childhood abuse and migraines, our findings should be interpreted with caution.
Asunto(s)
Maltrato a los Niños , Trastornos Migrañosos , Humanos , Trastornos Migrañosos/epidemiología , Niño , Maltrato a los Niños/estadística & datos numéricos , Maltrato a los Niños/psicología , Factores de Riesgo , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricosRESUMEN
BACKGROUND: Maternal childhood maltreatment (CM) has been repeatedly associated with negative offspring's emotional outcomes. The dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis has emerged as the main underlying physiological mechanism. OBJECTIVE: To explore the association between maternal CM and newborns' physiological and neurobehavioral stress responses, considering the role of perinatal maternal depression and bonding. PARTICIPANTS AND SETTING: 150 healthy women were followed throughout pregnancy. 79 mother-infant dyads were included in the final analyses. Maternal CM was evaluated using the Childhood Trauma Questionnaire and depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS) at each trimester. At 7 weeks postpartum, the EPDS and the Postpartum Bonding Questionnaire were administered. Newborns' behavioral responses were assessed using "States Organization" (SO) and "States Regulation" (SR) subdomains of the Neonatal Behavioral Assessment Scale (NBAS). Newborns' salivary samples were collected before and after the NBAS to study cortisol reactivity. METHODS: A cross-lagged panel model was employed. RESULTS: Infants born to mothers with higher CM presented more optimal scores on SO (ß (0.635) = 0.216, p ã001) and SR (ß (0.273) = 0.195, p = .006), and a higher cortisol reactivity after NBAS handling (ß(0.019) = 0.217, p = .009). Moreover, newborns of mothers with higher CM and postpartum depressive symptoms exhibited a poorer performance on SR (ß (0.156 = -0.288,p = .002). Analyses revealed non-significant relationships between mother-infant bonding, newborns' cortisol reactivity and SO. CONCLUSIONS: Newborns from mothers with greater CM present higher cortisol reactivity and more optimal behavioral responses, which may reflect a prenatal HPA axis sensitization. However, those exposed to maternal postnatal depressive symptoms present poorer stress recovery.
Asunto(s)
Depresión , Hidrocortisona , Relaciones Madre-Hijo , Estrés Psicológico , Humanos , Femenino , Adulto , Recién Nacido , Embarazo , Relaciones Madre-Hijo/psicología , Hidrocortisona/metabolismo , Depresión/psicología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Madres/psicología , Masculino , Saliva/química , Saliva/metabolismo , Sistema Hipotálamo-Hipofisario/metabolismo , Sistema Hipófiso-Suprarrenal/metabolismo , Apego a Objetos , Depresión Posparto/psicología , Adulto JovenRESUMEN
BACKGROUND: The study aimed to investigate the potential link between a history of childhood sexual abuse (CSA) and the experience of technology-facilitated sexual violence on dating apps (TFSV), considering distinct motivations for app usage among CSA survivors. OBJECTIVE: To explore the association between CSA and TFSV on dating apps, while also examining the potential moderating role of motivations for app usage and differences based on sexual orientation. PARTICIPANTS AND SETTING: The study utilized an online survey among 534 dating app users in Israel. METHODS: Participants completed an online survey assessing history of CSA, experiences of TFSV on dating apps, and motivations for app usage. RESULTS: The study found that individuals with a history of CSA experienced more TFSV on dating apps. Survivors of CSA showed lower motivation for love and higher motivation for self-worth validation, ease of communication, and thrill of excitement. Differences between heterosexual and LGBTQ+ participants were observed, with LGBTQ+ individuals reporting higher levels of CSA prevalence and TFSV on dating apps. Motivations for app usage and sexual orientation were found to moderate the association between CSA history and TFSV on dating apps. Among LGBTQ+ participants, those who experienced CSA had a higher likelihood of encountering TFSV on dating apps, regardless of their motivations. Heterosexual individuals with a history of CSA were more prone to TFSV on dating apps if they had a strong motivation for love. CONCLUSIONS: This study shed light on unique vulnerabilities among individuals with a history of CSA, including increased susceptibility to TFSV on dating apps.
Asunto(s)
Aplicaciones Móviles , Motivación , Humanos , Femenino , Masculino , Adulto , Israel , Adulto Joven , Abuso Sexual Infantil/psicología , Niño , Encuestas y Cuestionarios , Adolescente , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Persona de Mediana Edad , Delitos Sexuales/psicología , Minorías Sexuales y de Género/psicologíaRESUMEN
ABSTRACT: Schizophrenia is a debilitating mental health disorder that imposes profound economic, societal, and personal burdens. The negative symptoms of schizophrenia ( i.e. , blunted affect, alogia, anhedonia, asociality, and avolition) are highly prevalent and pervasive in the psychotic disorder and pose significant resistance to available treatment options. Traumatic childhood experiences are strongly linked with the risk of developing schizophrenia. Most prior studies have primarily focused on positive symptoms of schizophrenia ( e.g. , hallucinations and delusions), whereas less attention has been given to negative symptoms. The current study investigated the relationship between childhood trauma ( i.e. , physical abuse, sexual abuse, and emotional abuse and neglect) and negative symptoms in a sample of schizophrenia outpatients and healthy controls ( n = 159 participants, including 99 patients with schizophrenia). The observations from the current study revealed that schizophrenia patients experienced a significantly greater degree of childhood trauma and negative symptoms than the control individuals. The results of the current study also indicated that more severe experiences of total childhood trauma ( i.e. , summation of all trauma types), physical abuse, and emotional neglect may increase the risk of schizophrenia patients reporting negative symptoms. However, childhood sexual and emotional abuse was found to have no impact on the degree of negative symptoms experienced by schizophrenia patients. Implications and limitations of the current study are discussed. In conclusion, we found that the severity of overall childhood trauma, physical abuse, and emotional neglect may play an important role in increasing the likelihood of schizophrenia patients reporting negative symptoms.
Asunto(s)
Experiencias Adversas de la Infancia , Esquizofrenia , Humanos , Masculino , Femenino , Esquizofrenia/epidemiología , Adulto , Experiencias Adversas de la Infancia/estadística & datos numéricos , Persona de Mediana Edad , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Psicología del Esquizofrénico , Maltrato a los Niños/psicología , NiñoRESUMEN
BACKGROUND: Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population. METHODS: 481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days. RESULTS: Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance. LIMITATIONS: The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases. CONCLUSIONS: Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress.
Asunto(s)
Apego a Objetos , Ideación Suicida , Intento de Suicidio , Humanos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricos , Factores de Riesgo , Encuestas y Cuestionarios , Adulto Joven , Suicidio/psicología , Suicidio/estadística & datos numéricos , Estrés Psicológico/psicología , Ansiedad/psicología , Experiencias Adversas de la Infancia/estadística & datos numéricos , Experiencias Adversas de la Infancia/psicología , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Anciano , Adolescente , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricosRESUMEN
According to biopsychosocial models, experiencing parental child abuse increases susceptibility to adulthood psychopathology. However, there is a paucity of studies examining potential mechanisms of the parental child abuse and adulthood psychopathology relationship. The purpose of the current study was to determine if Time 2 (T2) trait self-esteem mediated levels of Time 1 (T1) retrospectively recalled parental child abuse predicting (T3) past-year major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), alcohol use disorder (AUD), and substance use disorder (SUD) symptoms. The 18-year Midlife Development in the United States (MIDUS) study included participants (N = 3294; T1 average age of 45.62 years) assessed at three different time points, each spaced about nine years apart. We performed structural equation mediation modeling analyses to determine how maternal and paternal child abuse at T1 would independently predict T3 MDD, GAD, PD, AUD, and SUD symptoms. We also examined whether T2 self-esteem mediated these relations while controlling for adulthood T1 psychopathology symptoms, demographics, socioeconomic status, somatic symptoms, and parental psychopathology. Consistent with our hypotheses, higher T1 maternal and paternal abuse predicted increased T3 GAD, PD, AUD, and SUD symptoms via diminished T2 self-esteem as the mediator (% proportion mediated = 33.0-100). However, childhood paternal, but not maternal, abuse predicted adulthood MDD symptoms via reduced self-esteem. Findings remained after adjusting for covariates. Our research highlights the importance of understanding retrospectively recalled parental child abuse-adulthood psychopathology relations, their potential mechanisms, and self-esteem as a malleable treatment target for adults with heightened child abuse.
Asunto(s)
Trastornos de Ansiedad , Trastorno Depresivo Mayor , Autoimagen , Trastornos Relacionados con Sustancias , Humanos , Femenino , Masculino , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/epidemiología , Persona de Mediana Edad , Adulto , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/epidemiología , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/epidemiología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Trastorno de Pánico/psicología , Trastorno de Pánico/epidemiología , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Estados Unidos/epidemiología , Niño , Ansiedad/psicología , Ansiedad/epidemiología , Depresión/psicología , Depresión/epidemiología , Alcoholismo/psicología , Alcoholismo/epidemiologíaRESUMEN
OBJECTIVE: Patients who have experienced child abuse often have complex clinical presentations; whether a history of child abuse (HCA) affects psychotherapy outcomes is unclear. The authors examined relationships between HCA, clinical baseline variables, and change in these variables after three different psychotherapies for panic disorder (PD). METHODS: Two hundred adults with PD (with or without agoraphobia) were randomly assigned to one of three treatments across two sites: panic-focused psychodynamic psychotherapy (PFPP), cognitive-behavioral therapy (CBT), or applied relaxation training (ART). Differences in demographic and clinical variables between those with and without HCA were compared. The primary analysis addressed odds of meeting clinical response criteria on the Panic Disorder Severity Scale (PDSS) between treatments, as moderated by HCA. This effect was examined via continuous outcomes on the PDSS and psychosocial functioning (Sheehan Disability Scale). RESULTS: Compared with patients without HCA (N=154), patients with HCA (N=46) experienced significantly more severe symptoms of PD (d=0.60), agoraphobia (d=0.47), and comorbid depression (d=0.46); significantly worse psychosocial impairment (d=0.63) and anxiety sensitivity (d=0.75); greater personality disorder burden (d=0.45)-particularly with cluster C disorders (d=0.47)-and more severe interpersonal problems (d=0.54). HCA significantly moderated the likelihood of clinical response, predicting nonresponse to ART (B=-2.05, 95% CI=-4.17 to -0.30, OR=0.13, z=-2.14, p=0.032) but not CBT or PFPP. HCA did not interact with treatment condition to predict slopes of PDSS change. CONCLUSIONS: The results of this study highlight the importance of HCA in formulating treatment recommendations. Increased awareness of HCA's effects on severity of PD and treatment responsiveness among patients with PD may improve outcomes.
Asunto(s)
Terapia Cognitivo-Conductual , Trastorno de Pánico , Psicoterapia Psicodinámica , Índice de Severidad de la Enfermedad , Humanos , Trastorno de Pánico/terapia , Trastorno de Pánico/psicología , Trastorno de Pánico/complicaciones , Femenino , Masculino , Adulto , Terapia Cognitivo-Conductual/métodos , Resultado del Tratamiento , Terapia por Relajación , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Agorafobia/terapia , Agorafobia/psicología , Agorafobia/complicaciones , Persona de Mediana Edad , NiñoRESUMEN
BACKGROUND: Childhood maltreatment (CM) has long-term consequences for the regulation of stress biology which are particularly pronounced when mental and physical health sequelae have manifested. C-reactive protein (CRP) has been shown to be elevated in the non-pregnant state in association with CM as well as in the setting of CM-associated mental and physical health sequelae. In pregnancy, however, the association between CM and CRP is less clear. We sought to examine this association and consider the moderating role of four common health sequelae of CM (maternal depressive symptoms, overweight/obesity, smoking, and hypertensive disorders during pregnancy). METHODS: A prospective, longitudinal study of 744 healthy pregnant participants was conducted, with analyses focusing on a sample of 643 participants. CM was assessed with the Childhood Trauma Questionnaire (CTQ) and categorized by whether no vs. one or more moderate to severe CM experiences were reported. Blood serum concentrations of CRP, maternal depression severity (continuous scores of the Center for Epidemiologic Studies Depression Scale, CES-D) and smoking during pregnancy were assessed in early (16.52 ± 2.50 weeks gestation) and late (33.65 ± 1.18 weeks gestation) pregnancy. Pre-pregnancy body mass index (BMI) was obtained at the first study visit and hypertensive disorders diagnosed during pregnancy were obtained from the medical record. Linear mixed effects models were employed to assess main effects of CM as well as interactive effects of CM and four common CM-associated sequelae as well as a sum score of these sequelae on repeatedly measured CRP concentration. In secondary analyses, we conducted latent class analyses to classify participants based on their specific experiences of childhood abuse and/or neglect and to assess the association of these CM subgroups with CM sequelae and CRP. All analyses were adjusted for potential confounders (maternal race and ethnicity and education/income). RESULTS: CRP concentration decreased from early to late pregnancy (B = -0.06, SE = 0.01, p < 0.001). While there was no main effect of CM on CRP (p = 0.49), the interaction of CM and depressive symptoms was associated with CRP concentration (B = 0.08, SE = 0.04, p < 0.05), indicating higher CRP across pregnancy with increasing levels of depressive symptoms during pregnancy in participants with CM experience. This interaction was mainly driven by participants with co-occurring physical and emotional maltreatment. For none of the other CM-associated sequelae a statistically significant interaction with CM on CRP concentration was observed. CONCLUSIONS: These results add to the growing empirical evidence suggesting higher inflammation during pregnancy in participants exposed to CM who experience depressive symptoms and highlight the detrimental effects of multiple co-occurring experiences of maltreatment. Given the negative consequences of chronic inflammatory state for the mother and the developing fetus, monitoring and treating psychiatric sequelae during pregnancy among participants exposed to CM is potentially an important opportunity to dampen long-term detrimental effects of CM, serving at least two generations.
Asunto(s)
Proteína C-Reactiva , Depresión , Humanos , Femenino , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/análisis , Embarazo , Adulto , Depresión/psicología , Depresión/metabolismo , Estudios Longitudinales , Estudios Prospectivos , Fumar/psicología , Complicaciones del Embarazo/psicología , Complicaciones del Embarazo/sangre , Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Índice de Masa Corporal , Experiencias Adversas de la Infancia/psicología , Obesidad/psicología , Obesidad/metabolismo , Sobrepeso/psicología , Sobrepeso/metabolismoRESUMEN
BACKGROUND: Postpartum psychosis (PP) is a psychological emergency requiring rapid intervention, hospitalization and psychiatric management. However, PP has been neglected in the postpartum literature. Understanding the detrimental consequences of childhood trauma across mother's life span is crucial to prevent this serious condition. The study's objectives were to demonstrate the relationship between childhood trauma and postpartum psychotic experiences (PPEs) and to look over the mediating role of postnatal depression (PD) and anxiety (PA) in this relationship. METHODS: This cross-sectional study, which enrolled 438 postpartum females 4-6 weeks after delivery (mean age: 31.23 ± 5.24 years), was carried out from September 2022 to June 2023. The Arabic validated versions of the Postpartum Psychotic Experiences Scale, the Edinburgh Postnatal Depression Scale, the Perinatal Anxiety Screening Scale, and the Child Abuse Self Report Scale were used. RESULTS: Both PD and PA partially mediated the correlation between psychological abuse and PPEs, and fully mediated the association between neglect and PPEs. Higher psychological abuse and neglect were significantly associated with higher PD (Beta = 1.11) and PA (Beta = 3.94), higher PD (Beta = 0.84) and PA (Beta = 0.26) were significantly associated with higher PPEs in both models, whereas greater child psychological abuse (Beta = 1.37) (but not neglect) was directly and strongly correlated with higher PPEs in all models. CONCLUSION: The significant mediating effect of PA and PD on the association between childhood adversities and PPEs among postpartum females may offer additional therapeutic avenues to help attenuate various postpartum mental health issues and their potential serious risks on both mother and child.
Asunto(s)
Depresión Posparto , Trastornos Psicóticos , Humanos , Femenino , Adulto , Estudios Transversales , Depresión Posparto/psicología , Trastornos Psicóticos/psicología , Trastornos Psicóticos/complicaciones , Experiencias Adversas de la Infancia/psicología , Ansiedad/psicología , Periodo Posparto/psicología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Escalas de Valoración Psiquiátrica , Trastornos Puerperales/psicologíaRESUMEN
BACKGROUND: Child sexual abuse is a universal social challenge and the victims of childhood sexual abuse suffer a range of short and long term psychological, social, behavioral and physical problems that vary in different cultures. The study was carried out to explore the perceived impacts of childhood sexual abuse in Pakistan, because no such study was conducted in Pakistan earlier. METHODS: Interpretative phenomenological analysis was used to analyze the data. A snowball sampling technique was used to approach the sample of current study. The sample of the study comprised ten female survivors of childhood sexual abuse of age ranged between 18 and 22 years (Mage= 20.10 years) with the education ranging from matric to BSc. Out of these participants, four were married and six were unmarried and belonged to different cities of Punjab, Pakistan. Data were collected via a semi-structured interview schedule and all interviews were verbatim transcribed. RESULTS: A rigorous iterative process of data analysis resulted in three super-ordinate themes and ten sub-ordinate themes: Experiencing Abuse (emotional trauma, and physical distress), Psycho-social Distress (low self-esteem, negative self-concept, psychological pain, social suffering, and retaliation vs. forgiveness), and Sexual Difficulties (passive role, emotionally aloof, aversion from hetero-sexuality and avoidance). CONCLUSION: It was concluded that childhood sexual abuse is an intense experience that has short- and long-term negative impacts on the lives of female survivors and engulfs their lives as a whole. The study has implications for psychiatrists, psychologists, family counselors, social scientists, educationists, and parents.
Asunto(s)
Adultos Sobrevivientes del Maltrato a los Niños , Abuso Sexual Infantil , Humanos , Femenino , Pakistán , Adolescente , Adulto Joven , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Abuso Sexual Infantil/psicología , Adulto , Autoimagen , Investigación Cualitativa , Niño , Estrés Psicológico/psicología , Distrés PsicológicoRESUMEN
Childhood maltreatment (CM) is thought to be associated with altered responses to social stimuli and interpersonal signals. However, limited evidence exists that CM is linked to larger comfortable interpersonal distance (CID) - the physical distance humans prefer towards others during social interactions. However, no previous study has investigated this association in a comprehensive sample, yielding sufficient statistical power. Moreover, preliminary findings are limited to the European region. Finally, it is unclear how CM affects CID towards different interaction partners, and whether CID is linked to social functioning and attachment. To address these outstanding issues, adults (N = 2986) from diverse cultures and socio-economic strata completed a reaction time task measuring CID towards an approaching stranger and friend. Higher CM was linked to a larger CID towards both friends and strangers. Moreover, insecure attachment and less social support were associated with larger CID. These findings demonstrate for the first time that CM affects CID across countries and cultures, highlighting the robustness of this association.
Asunto(s)
Amigos , Relaciones Interpersonales , Humanos , Masculino , Femenino , Adulto , Amigos/psicología , Adulto Joven , Persona de Mediana Edad , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Distancia Psicológica , Apego a Objetos , Adolescente , Interacción Social , Apoyo Social , Tiempo de ReacciónRESUMEN
BACKGROUND: Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression. METHODS: We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study. FINDINGS: 253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in ß -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046). INTERPRETATION: CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health. FUNDING: The German Research Foundation and the German Federal Ministry of Education and Research.
Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Pruebas Psicológicas , Autoinforme , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Maltrato a los Niños/psicología , Maltrato a los Niños/terapia , Análisis por Conglomerados , Terapia Cognitivo-Conductual/métodos , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Psicoterapia/métodos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Cognitive deficits might contribute to the elevated risk of life-course psychopathology observed in maltreated children. Leading theories about the links between childhood maltreatment and cognitive deficits focus on documented exposures (objective experience), but empirical research has largely relied on retrospective self-reports of these experiences (subjective experience), and the two measures identify largely non-overlapping groups. We aimed to test the associations of objective and subjective measures of maltreatment with cognitive abilities within the same individuals. METHODS: We studied a cohort of individuals from the US Midwest with both objective, court-documented evidence of childhood maltreatment and subjective self-reports of individuals' histories at age 29 years. Between the ages of 29 years and 41 years, participants were assessed with a comprehensive set of cognitive tests, including tests of general verbal intelligence (Quick Test and Wide Range Achievement Test-Revised [WRAT]), non-verbal intelligence (Matrix Reasoning Test [MRT]), executive function (Stroop Test and Trail Making Test Part B [TMT-B]), and processing speed (Trail Making Test Part A [TMT-A]). Participants were also assessed for psychopathology (Center for Epidemiologic Studies Depression Scale and Beck Anxiety Inventory). We tested the associations between objective or subjective measures of childhood maltreatment with cognitive functions using ordinary least squares regression. To test whether cognitive deficits could explain previously described associations between different measures of maltreatment and subsequent psychopathology, we re-ran the analyses accounting for group differences in the Quick Test. People with lived experience were not involved in the research or writing process. FINDINGS: The cohort included 1196 individuals (582 [48·7%] female, 614 [51·3%] male; 752 [62·9%] White, 417 [34·9%] Black, 36 [3·8%] Hispanic) who were assessed between 1989 and 2005. Of the 1179 participants with available data, 173 had objective-only measures of childhood maltreatment, 492 had objective and subjective measures, 252 had subjective-only measures, and 262 had no measures of childhood maltreatment. Participants with objective measures of childhood maltreatment showed pervasive cognitive deficits compared with those without objective measures (Quick Test: ß=-7·97 [95% CI -9·63 to -6·30]; WRAT: ß=-7·41 [-9·09 to -5·74]; MRT: ß=-3·86 [-5·86 to -1·87]; Stroop Test: ß=-1·69 [-3·57 to 0·20]; TMT-B: ß=3·66 [1·67 to 5·66]; TMT-A: ß=2·92 [0·86 to 4·98]). The associations with cognitive deficits were specific to objective measures of neglect. In contrast, participants with subjective measures of childhood maltreatment did not differ from those without subjective measures (Quick Test: ß=1·73 [95% CI -0·05 to 3·50]; WRAT: ß=1·62 [-0·17 to 3·40]; MRT: ß=0·19 [-1·87 to 2·24]; Stroop Test: ß=-1·41 [-3·35 to 0·52]; TMT-B: ß=-0·57 [-2·69 to 1·55]; TMT-A: ß=-0·36 [-2·38 to 1·67]). Furthermore, cognitive deficits did not explain associations between different measures of maltreatment and subsequent psychopathology. INTERPRETATION: Previous studies based on retrospective reports of childhood maltreatment have probably grossly underestimated the extent of cognitive deficits in individuals with documented experiences of childhood maltreatment, particularly neglect. Psychopathology associated with maltreatment is unlikely to emerge because of cognitive deficits, but might instead be driven by individual appraisals, autobiographical memories, and associated schemas. FUNDING: National Institute of Justice, National Institute of Mental Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute on Aging, Doris Duke Charitable Foundation, and National Institute for Health and Care Research.
Asunto(s)
Disfunción Cognitiva , Humanos , Femenino , Masculino , Adulto , Estudios de Cohortes , Disfunción Cognitiva/psicología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Maltrato a los Niños/psicología , Maltrato a los Niños/estadística & datos numéricos , Niño , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Adultos Sobrevivientes del Maltrato a los Niños/estadística & datos numéricos , Estados Unidos/epidemiología , Pruebas Neuropsicológicas/estadística & datos numéricos , Autoinforme , Función Ejecutiva , Medio Oeste de Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Suicide is a severe public health problem. Impacts of childhood traumas, unsecure adult attachment styles and personality traits have been suggested as possible risk factors for suicide attempts. The aim of this cross-sectional, case-controlled study is to investigate the impact of childhood traumas, adult attachment styles and personality traits on suicide attempt. METHODS: The sample consisted of psychiatric patients who attempted suicide (n=101) on the one hand and those who did not attempt suicide (n=114) on the other. The questionnaires used were the Hungarian validated versions of Adult Attachment Scale (AAS), Childhood Trauma Questionnaire (CTQ), Temperament and Character Inventory (TCI) and a demographic questionnaire. RESULTS: Results indicated that Novelty Seeking (NS) temperament trait [EH=1.043; 95% C.I.=(0.950-1.145)] p=0.376; emotional abuse [EH=1.034; 95% C.I.=(0.966-1.107)] p=0.336; emotional neglect [EH=1.022; 95% C.I.=(0.936-1.116)] p=0.626; and sexual abuse [EH=1.047; 95% C.I.=(0.959-1.142)] p=0.305 were associated with nonsignificant increases in the odds of suicide attempts. Whereas secure attachment style [EH=0.908; 95% C.I.=(0.842-0.980)] p=0.013 appeared to be a significantly protective factor (c2(1)=6.515 p=0.011). Furthermore, when examining the connection between childhood traumas and adult attachment styles it was found that the anxious attachment style had a positive significant correlation with emotional abuse (rs(197)=0.293) p<0.001, avoidant attachment style with emotional neglect (rs(197)= 0.273) p<0.001. CONCLUSION: Our findings suggest that individuals with avoidant attachment style and childhood traumas are likely to present a higher suicide risk. However secure attachment style likely to present a lower risk for suicide.