Intergenerational effects of child maltreatment on adolescents' anxiety and depression in Ethiopia: the important mediating and moderating roles of current psychological distress.

BACKGROUND: Child abuse is widespread around the world, and one continent with particularly high rates is Africa. Research in high- and middle-income countries shows the cascading effect of parental history of child abuse and neglect on adolescents' maltreatment and, in turn, on mental health problems. This cascade has been reported in young children but has rarely been studied in parent-adolescent dyads or in low-income countries (LICs). The goal of this study was to test intergenerational associations of child abuse and neglect and to examine how these experiences are in turn associated with youth anxiety and depression in an LIC. METHODS: A total of 231 adolescents (age: 13-21 years) and 185 of their parents (n = 90 fathers and n = 95 mothers) were recruited from secondary schools in Addis Abeba, Ethiopia. Using a cross-sectional design, participants completed a set of questionnaires assessing child maltreatment (in adolescence and own past history in parents), parental psychological distress, youth depression and anxiety, and sociodemographic factors. RESULTS: The frequencies of child maltreatment exposure were 68% for adolescents and 65% for their parents (when they were a child). Fifty-one percent and 42% of adolescents had borderline to clinical levels of anxiety and depression symptoms, respectively. Adolescents of parents with a history of child abuse and neglect also reported higher exposure to maltreatment themselves (p < 0.001). Current paternal, but not maternal, psychological distress mediated this intergenerational association of maltreatment experiences (95% CI [1.164, 9.467]). We further found parents' psychological distress to be a significant moderator of the indirect pathways of the intergenerational effect of child maltreatment on adolescents' anxiety and depression (95% CI [- 0.770, - 0.012]). CONCLUSIONS: We found child maltreatment to be intergenerationally associated, and this effect subsequently affected adolescents' anxiety and depression through different pathways supporting the cascading effects across generations. Intervention plans may be effective through an array of possible indirect pathways and encourage the implementation of multiple access points to facilitate change in the lives of affected youth in Africa.

Knowledge About Eye Movement Desensitization and Reprocessing Therapy and Child Sexual Abuse: A Scoping Review.

Child sexual abuse (CSA) impacts victims in immediate and long-lasting ways, often resulting in traumatic symptomatology. Eye Movement Desensitization and Reprocessing (EMDR) Therapy is an effective treatment to address trauma symptoms. Despite growing research on the efficacy of EMDR therapy, no review has been conducted on EMDR's treatment of trauma related to CSA. This scoping review seeks to explore the literature on EMDR as a treatment for CSA, including outcomes measured related to efficacy and considerations and implications related to the use of EMDR with this population. Four databases and the Francine Shapiro Library were systematically searched and twenty-one articles meeting inclusion criteria (published after 2001, using EMDR with victims of CSA, published in English) were included in this review. A mixture of case studies and empirical research using EMDR with both child and adult survivors of CSA were identified. Outcomes measured were traumatic, psychological, behavioral, and other (e.g., quality of life and physiological) symptoms. Studies reporting on direct-client work identified that EMDR was effective at resolving negative symptoms related to CSA without any necessary protocol modifications. Nearly all studies utilized stabilization in the form of the "safe space" exercise for grounding. Included empirical studies were primarily white and female samples; further research with non-offending males and individuals of color is needed. More research is also needed to understand minimum session frequency and duration of EMDR sessions to achieve resolution of trauma. This review suggests promising evidence of the efficacy of EMDR therapy in the treatment of trauma related to CSA.

The Indirect Effect of Peritraumatic Dissociation on the Relationship Between Childhood Maltreatment and Schizotypy.

Schizotypy is a multidimensional personality construct that is understood as a vulnerability for schizophrenia, often manifesting as more subtle and attenuated symptoms, referred to as schizotypic psychopathology. It has many well-established environmental risk factors, including experiencing childhood maltreatment (CM), but the intermediary mechanisms that relate CM to schizotypic psychopathology are unclear. Prior studies have demonstrated that trait dissociation may indirectly affect the relationship between CM and schizotypic psychopathology. However, less is known about the importance of peritraumatic dissociative experiences during CM and how it relates to schizotypic symptom manifestations in young adulthood. Therefore, the present study explored the independent contributions of peritraumatic and trait dissociation in the relationship between CM and schizotypy. Participants (N = 346) were undergraduate students who completed online self-report measures on CM, trait dissociation, peritraumatic dissociation experienced during CM, and schizotypic symptoms. The indirect effect of peritraumatic dissociation and trait dissociation on the relationship between CM and schizotypy was examined using mediational analyses. Correlational analyses revealed significant associations between self-reported CM, schizotypy, trait dissociation, and peritraumatic dissociation. In addition, mediational analyses indicated a significant indirect effect of peritraumatic dissociation (ß = .06, 95% confidence interval (CI) [0.01, 0.12]), but not trait dissociation (ß = .05, 95% CI [-0.02, 0.12]), on CM and schizotypy. These results highlight peritraumatic dissociation as an important mechanism driving the expression of schizotypic symptoms among individuals with a history of CM. Understanding how trauma sequelae lead to schizotypic psychopathology may be crucial in assessing and treating individuals with maltreatment histories or those on the psychosis spectrum.

Rumination Mediates the Relationship Between Negative Affect and Posttraumatic Stress Disorder Symptoms in Female Interpersonal Trauma Survivors.

Prior research has identified both rumination and negative affect (NA) as dimensional constructs related to the development and maintenance of posttraumatic stress disorder (PTSD). While both dimensions demonstrate significant positive relationships with symptoms of PTSD, the relationship between the two within the context of the disorder has yet to be explored. Consistent with prior research in the social anxiety literature, the present study seeks to examine a model of mediation by which rumination accounts for the significant relationship between NA and PTSD symptoms. Participants included 65 female interpersonal trauma survivors diagnosed with PTSD using structured, clinician-administered interviews. Both NA and rumination were observed as significant predictors of PTSD symptoms, and the variables were significantly associated with each other. However, NA was no longer a significant predictor of PTSD symptoms when rumination was entered into the mediation model, suggesting full mediation of the relationship by rumination. Results from the current study suggest a complex relationship between NA and rumination in interpersonal trauma survivors with PTSD, such that a ruminative cognitive coping style may either mitigate or exacerbate PTSD symptoms in the presence of sustained negative emotion. The current findings provide support for a cognitive model of PTSD, within which PTSD symptoms are influenced via negative, ruminative cognitions. Primary implications of these results include (a) the consideration of assessment of rumination in interpersonal trauma survivors with PTSD in clinical settings; (b) the selection of treatment that may address a ruminative cognitive style in this population, given the mediation between subjective distress and PTSD symptoms by rumination; and (c) the necessity for the validation of this mediation model within other traumatized populations.

Perspectives on Self-Compassion From Adult Female Survivors of Sexual Abuse and the Counselors Who Work With Them.

While compassion-focused therapy (CFT) holds significant promise as an intervention for survivors of sexual abuse, a history of abuse can uniquely impact an individual's capacity to cultivate compassion and may generate a fear of compassion. Understanding the specific perspectives of sexual abuse survivors may inform the application of CFT-based interventions with this client group. Two separate focus groups were established for this purpose, one with adult female survivors of sexual abuse (n = 7) and another with sexual abuse counselors (n = 7). Transcripts were analyzed according to a consensual qualitative research design. Analysis of the survivor focus group identified two core domains, Barriers to Compassion, including poor relational templates, negative perception of self, low coping self-efficacy, and fears, resistance, and misperceptions regarding self-compassion, and Factors Supporting Compassion, including support from others, compassion for others, high coping self-efficacy, motivation and hope for change, and timing and readiness for change. Analysis of the counselor focus group revealed three domains, Therapeutic Factors to Support Compassion, including counselor authenticity and modeling, gradual introduction with consideration to individual needs, acknowledgment of suffering and offering an alternative perspective; Factors Affecting Client Readiness and Capacity, including shame, self-blame, and negative sense of self, response from others, and difficulty in changing self-critical habits; and Anticipated Outcomes, including providing a hope and recovery focus, offering an alternative perspective and coping strategy, and restoring trust. Findings are discussed in relation to clinical implications and relevance to a CFT model of intervention.

The Relationship Between Childhood Adversity and Other Aspects of Clinical Complexity in Psychiatric Outpatients.

Childhood abuse, neglect, and loss are common in psychiatric patients, and the relationship between childhood adversity and adult mental illness is well known. However, beyond diagnoses that are specifically trauma-related, such as posttraumatic stress disorder, there has been little research on how childhood adversity contributes to complex presentations that require more intensive treatment. We examined the relationship between childhood adversity and other contributors to clinical complexity in adult outpatients seeking mental health assessment. In a cross-sectional study, patients completed standard measures of psychological distress and functional impairment. Psychiatrists completed an inventory of clinical complexity, which included childhood abuse, neglect, and loss. Of 4,903 patients seen over 15 months, 1,315 (27%) both consented to research and had the measure of complexity completed. Childhood abuse or neglect was identified in 474 (36.0%) and significant childhood loss in 236 (17.9%). Correcting for multiple comparisons and controlling for psychiatric diagnosis, age, and sex, patients with childhood abuse or neglect were significantly more likely to also have 11 of 31 other indices of clinical complexity, with odds ratios ranging from 1.7 to 5.0. Both childhood abuse or neglect and childhood loss were associated with greater overall complexity (i.e., more indices of complexity, χ2 = 136 and 38 respectively, each p < .001). Childhood abuse and neglect (but not childhood loss) were significantly associated with psychological distress (Kessler Psychological Distress Scale [K10] score, F = 6.2, p = .01) and disability (World Health Organization Disability Assessment Scale 2.0 [WHODAS 2.0] score, F = 5.0, p = .03). Childhood abuse and neglect were associated with many characteristics that contribute to clinical complexity, and thus to suboptimal outcomes to standard, guideline-based care. Screening may alert psychiatrists to the need for intensive, patient-centered, and trauma-informed treatments. Identifying childhood adversity as a common antecedent of complexity may facilitate developing transdiagnostic programs that specifically target sources of complexity.

Developmental Timing of Childhood Physical and Sexual Maltreatment Predicts Adult Depression and Post-Traumatic Stress Symptoms.

Child physical and sexual maltreatment have emerged as documented risk factors for a wide range of health problems in adulthood, including depression and post-traumatic stress symptoms. Prior research focuses on generalized childhood adversities without accounting for how different critical details about the maltreatment may affect outcomes in adulthood. The present study examines the impact of two critical details, timing and type of child maltreatment, on depression and post-traumatic stress symptoms in adulthood. Participants (N = 104) completed the Maltreatment and Abuse Chronology of Exposure scale (MACE) and the Inventory of Depression and Anxiety Scale-Second Version (IDAS-II). Hierarchical multiple regressions compared three different models of child maltreatment predictors and their differential utility for predicting depression and post-traumatic stress symptoms in adulthood: (a) number of child maltreatment experiences, (b) severity of child maltreatment, and (c) timing of child maltreatment. Results indicate that severity of child maltreatment and timing of child maltreatment are greater predictors for adult depression and post-traumatic stress symptoms than number of child maltreatment experiences. Compared with other developmental periods, early childhood sexual maltreatment experiences (5 years of age and below) and late childhood physical maltreatment experiences (13 years of age and above) were stronger predictors of adult depression and post-traumatic stress symptoms. Children maltreated during these age groups may be prioritized for prevention and intervention efforts, particularly when there are limited resources. Clinical interviews with maltreated children should also be expanded to include information about developmental timing and severity of maltreatment, which have ramifications for later health problems. Implications for assessment of maltreated children, prevention of adult depression and post-traumatic stress symptoms, and future research directions are discussed.

The Child PTSD Symptom Scale: An Investigation of Its Psychometric Properties.

The current study addresses the need for accurate measurement of posttraumatic stress disorder (PTSD) symptoms in youth by investigating the psychometric properties of the Child PTSD Symptom Scale (CPSS). The factor structure, reliability, and concurrent and discriminant validity of the CPSS were investigated in a sample of 206 6th- to 12th-grade adolescents. Exploratory and confirmatory factor analysis supported a single-factor structure, which was contrary to the hypothesized three-factor structure. Scores comprising this one-factor structure were also associated with high reliability (α = .93), and tests of concurrent and discriminant validity were also strong. The implications of these findings are discussed, with particular emphasis on future directions for research on self-report measures for adolescent PTSD symptoms.