Health care needs, experiences, and satisfaction after terrorism: a longitudinal study of parents of survivors of the Utøya attack.

BACKGROUND: There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up. METHODS: Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up. RESULTS: Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported "very high/high" needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received. CONCLUSIONS: Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.

Comparing Factors Shaping Sexual Violence Perpetration for Sexual and Gender Minority Youth and Cisgender Heterosexual Youth.

Sexual and gender minority (SGM) youth experience higher rates of sexual violence victimization than their cisgender heterosexual counterparts. Very little is known about how the minority status of SGM youth contextualizes their victimization and perpetration experiences. In one-on-one interviews with 39 SGM youth and 11 cisgender heterosexuals (non-SGM) youth, we compared the contextual factors shaping sexual violence victimization and perpetration between the two groups using a qualitative descriptive approach. Interviews highlighted how SGM youth continue to experience extensive discrimination that negatively impacts all aspects of their lives, while non-SGM youth do not discuss having to navigate stigma and discrimination in their lives. SGM youth pointed to a lack of understanding of sexual violence within the SGM community. Both groups believed that SGM perpetration was unlikely: while most SGM and non-SGM youth agreed that sexual violence between youth was a problem, same-gender perpetration was seldom discussed. Unlike their non-SGM counterparts, SGM youth felt that they were targeted because of their sexual and gender identity. SGM youth also felt that they were more vulnerable to sexual violence because of how they physically looked, particularly if their gender expression did not match cis-normative expectations. SGM youth reported facing unique pressures when seeking support as a victim, particularly a fear of being outed or stigmatized as part of the process. They also conveyed that SGM people worried about being treated unfairly if they reported sexual violence to authorities. Findings suggest that stigma and concerns of discrimination are unique aspects of sexual violence for SGM compared to non-SGM youth. All youth need to have access to sexual violence prevention education that includes SGM and non-SGM youth as both victims and perpetrators to begin addressing these noted disparities in experiences.

Adolescent abuse victims displayed physical health complaints and trauma symptoms during post disclosure interviews.

AIM: We investigated whether adolescents who had recently disclosed sexual abuse or family violence displayed more psychological trauma symptoms and physical health complaints than unaffected controls. We also investigated to what degree physical health complaints were associated with trauma symptoms in these abuse victims. METHODS: Abuse, trauma symptoms and physical health complaints were assessed during face-to-face interviews with 40 sexual abuse victims and 35 family violence victims aged 10-18 years. They had all attended forensic interviews at the Barnehus in Oslo, a specialised Norwegian police unit where evidence is gathered in adolescent-friendly surroundings, from October 2016 to November 2018. Their symptoms were compared with 41 controls from the general population. Linear regression analyses investigated associations between trauma symptoms and physical health complaints. RESULTS: Sexually abused adolescents displayed higher levels of post-traumatic stress reactions, depression, dissociation and physical health complaints than unaffected controls. Family violence victims displayed higher levels of post-traumatic stress reactions. Trauma symptoms were associated with physical health complaints, and these were most prominent in the adolescents with the highest burden of symptoms. CONCLUSION: Based on the high burden of symptoms revealed, clinical examinations of abused adolescents should include a systematic assessment of trauma symptoms and physical health complaints.

The Social Context of Violence: A Study of Repeated Victimization in Adolescents and Young Adults.

Multiple factors may influence the risk of exposure to childhood violence and repeated victimization, although most research has focused on individual rather than contextual factors. Moreover, it is unclear whether family background factors associated with exposure to childhood violence also are associated with revictimization in young adulthood. This article investigates individual and contextual factors associated with childhood abuse and revictimization. Data from a community telephone survey, collected at two different time points (N = 1,011, 16-33 years of age), were used. Logistic regression analysis was applied to analyze family background factors in childhood violence-exposed cases and non-exposed controls. Similar analyses were conducted for the relationship of individual and contextual variables in the revictimized and the non-revictimized groups. The adjusted analyses showed that social problems (≥2 or more social problems: odds ratio [OR] = 2.89, 95% confidence interval [CI] = [1.41, 5.94]) and frequent binge drinking (OR = 1.21, 95% CI = [1.05, 1.40]) were significantly associated with repeated victimization whereas social support decreased the odds (OR = 0.74, 95% CI = [0.55, 0.99]). Family problems and low family cohesion growing up (although measured at Wave 2) were significantly associated with childhood exposure to violence, but not with revictimization. Our findings emphasizes that it is useful to separate factors associated with childhood abuse from factors related to revictimization to identify current ecological aspects that can be addressed to prevent further abuse.

Am I an island? A network analysis exploring aspects of social landscapes after childhood violence.

OBJECTIVE: Exposure to violence during childhood can have severe long-term consequences for social relationships. In the current study, we sought to disentangle some of the phenomena involved by utilizing a network approach to study the perceptions of aspects of social landscapes in young adulthood of victims of childhood violence. METHOD: We used network analysis to describe the connections between perceived positive social support, barriers to social support, violence-related shame, childhood family cohesion, and perceived negative responses from others for 443 individuals exposed to childhood violence. RESULTS: Respondents' enjoyment of spending time with family in childhood was strongly connected to many other aspects of their social landscapes. The highest values for expected influence were found for worrying about what others thought and experiencing support from others. Finding that other people withdrew from them after the violence had occurred had both high strength centrality and a high value of expected influence and was associated with shame and barriers to social support. CONCLUSIONS: The results suggest that these elements can play important roles in the social landscapes of victims of childhood violence. Further research specifying the directionality between these elements is necessary. It may be helpful for clinicians working with victims of childhood violence to explore their perceptions of their social landscapes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The mediating role of posttraumatic stress reactions in the relationship between child abuse and physical health complaints in adolescence and young adulthood.

Background: Child abuse is associated with physical health problems in adolescence and adulthood, but the mechanisms involved are unclear. A possible mediating effect of posttraumatic stress reactions (PTSR) linking child abuse with later physical health complaints has not been fully investigated. Objective: The current study investigated whether PTSR could be a potential mediator in the relationship between child abuse and physical health complaints in adolescents and young adults. If so, we also investigated whether this was the case for different child abuse types alone or in combination. Method: The study sample comprised 506 adolescents and young adult victims of child abuse and 504 unexposed matched controls aged 16-33 from a community sample. We measured child abuse retrospectively and current PTSR at wave 1 (2013), and current physical health complaints at wave 2 (2014/15). We tested a model of PTSR as a possible mediator between child abuse and physical health complaints and conducted causal mediation analysis to estimate direct and indirect pathways. Each child abuse type was studied in isolation and in combination with other abuse types. Results: PTSR had a notable, significant mediating effect on the relationship between child abuse and physical health complaints in our overall model (average causal mediation effect; ACME = 0.14, p < 0.001), accounting for 85% of the total effect. The mediated pathway was also significant in analyses of the different child abuse types. The mediating effect of PTSR was most prominent in individuals reporting exposure to more than one child abuse type. Conclusions: The current study indicates that PTSR may be an important mediator in the relationship between child abuse and physical health complaints. Health professionals should be aware of the important role that PTSR may have in maintaining or exacerbating physical health problems in child abuse victims. However, a reverse model could not be tested in this study and the results need confirmation in future prospective studies.

Antecedentes: El maltrato infantil se encuentra asociado con problemas de salud física en la adolescencia y en la adultez, pero los mecanismos involucrados no son claros. Un posible efecto mediador de las reacciones de estrés traumático (PTSR en su sigla en inglés) relacionando el maltrato infantil con quejas de salud física posteriores no ha sido investigado suficientemente.Objetivo: El presente estudio investigó si la PTSR podría ser un mediador potencial en la relación entre el maltrato infantil y las quejas de salud física en adolescentes y adultos jóvenes. También investigamos si esto era el caso para diferentes tipos de maltrato infantil de forma individual o en combinación.Método: La muestra del estudio consistió en 506 adolescentes y adultos jóvenes víctimas de maltrato infantil y 504 controles sin exposición al maltrato con edades de 16 a 33 años provenientes de una muestra comunitaria. Medimos el maltrato infantil retrospectivamente, el actual PTSR en la ola 1 (2013), y las quejas actuales de salud física en la ola 2 (2014/2015). Pusimos a prueba un modelo de la PTSR como un posible mediador entre el maltrato infantil y las quejas de salud física y llevamos a cabo un análisis de mediación causal para estimar los efectos directos e indirectos. Cada tipo de maltrato fue estudiado de forma separada y en combinación con otros tipos de abuso.Resultados: La PTSR tuvo un efecto mediador significativo en la relación entre el maltrato infantil y las quejas de salud física en nuestro modelo general (efecto mediador causal promedio; ACME en sus siglas en inglés = 0.14, p <0.001), correspondiendo al 85% del efecto total. La mediación fue también significativa en los análisis de los diferentes tipos de maltrato infantil. El efecto mediador de la PRSR fue más prominente en aquellos individuos que reportaron la exposición a más de un tipo de maltrato infantil.Conclusiones: PTSR podría ser un mediador importante en la relación entre el maltrato infantil y las quejas de salud física. Los profesionales de la salud deberían estar conscientes del rol que la PTSR puede tener en la mantención y la exacerbación de los problemas de salud física en las víctimas de maltrato infantil. Sin embargo, un modelo reverso no pudo ser probado y los resultados necesitan confirmación en futuros estudios prospectivos.

Shame predicts revictimization in victims of childhood violence: A prospective study of a general Norwegian population sample.

OBJECTIVE: Victims of childhood violence often experience new victimization in adult life. However, risk factors for such revictimization are poorly understood. In this longitudinal study, we investigated whether violence-related shame and guilt were associated with revictimization. METHOD: Young adults (age = 17-35) exposed to childhood violence (n = 505) were selected from a (Country) population study of 6,589 persons (Wave 1), and reinterviewed by telephone 12-18 months later (Wave 2). Wave 1 measures included shame, guilt, social support, posttraumatic stress, and binge drinking frequency, as well as childhood violence. Logistic regression was used to estimate associations between Wave 1 risk factors and Wave 2 revictimization (physical or sexual violence, or controlling partner behavior). RESULTS: In total, 31.5% (n = 159) had been revictimized during the period between Wave 1 and 2. Of these, 12.9% (n = 65) had experienced sexual assault, 22% (n = 111) had experienced physical assault and 7.1% (n = 36) had experienced controlling behavior from partner. Both shame and guilt were associated with revictimization, and withstood adjustment for other potentially important risk factors. In mutually adjusted models, guilt was no longer significant, leaving shame and binge drinking frequency as the only factors uniquely associated with revictimization. CONCLUSIONS: Violence-prevention aimed at victims of childhood violence should be a goal for practitioners and policymakers. This could be achieved by targeting shame, both on both on the individual level (clinical settings) and the societal level (changing the stigma of violence). (PsycINFO Database Record (c) 2018 APA, all rights reserved).

But were you drunk? Intoxication during sexual assault in Norway.

Background: Sexual assault often occurs when victims are intoxicated. Rape myth research indicates that intoxicated assaults are sometimes seen as less severe or not as 'real' assaults; however, it is unclear if victims of intoxicated sexual assaults differ from victims of non-intoxicated assaults in terms of health and functioning. Objective: We investigated possible differences in mental health, social support and loneliness between intoxicated and non-intoxicated sexual assault victims. Methods: Participants were 1011 young adults (505 exposed to childhood violence and 506 non-exposed) selected from a community telephone survey (T1), and a follow-up survey 12-18 months later (T2). Analyses include one-way ANOVA with Tamhane post hoc tests. Results: There were no significant differences in mental health, social support and loneliness between victims of intoxicated and non-intoxicated sexual assault, although both groups differed significantly from those who did not report sexual assault. Conclusions: These results indicate that intoxicated sexual assaults are no less clinically important than non-intoxicated assaults.

Antecedentes: La agresión sexual a menudo ocurre cuando las víctimas están intoxicadas. La investigación acerca del mito de la violación indica que las agresiones intoxicadas son a veces vistas como menos severas o no como agresiones 'reales'; sin embargo, no está claro si las víctimas de agresiones sexuales intoxicadas difieren de las víctimas de agresiones no intoxicadas en términos de salud y funcionamiento.Objetivo: Investigamos posibles diferencias en salud mental, apoyo social y soledad entre víctimas de agresiones sexuales intoxicadas y no intoxicadas.Métodos: Los participantes fueron 1,011 adultos jóvenes (505 expuestos a violencia en la infancia y 506 no expuestos) seleccionados de una encuesta telefónica comunitaria (T1), y de una encuesta de seguimiento 12-18 meses después (T2). Los análisis incluyen ANOVA de una dirección con tests post hoc Tamhane.Resultados: No hubo diferencias significativas en salud mental, apoyo social y soledad entre las víctimas de agresiones sexuales intoxicadas y no intoxicadas, aunque ambos grupos difirieron significativamente de quienes no reportaron agresiones sexuales.Conclusiones: Estos resultados indican que las agresiones sexuales intoxicadas no son menos importantes clínicamente que las agresiones no intoxicadas.

Loneliness as a mediator of the relationship between shame and health problems in young people exposed to childhood violence.

RATIONALE: Shame related to childhood violence can be detrimental to mental and physical health. Shame may erode social bonds. OBJECTIVE: In this study we tested whether loneliness is an important pathway between violence-related shame and health problems. METHOD: Individuals who reported exposure to childhood violence in a telephone interview survey in 2013 (wave one) were re-contacted 12-18 months later (wave two), as part of a more general survey of the Norwegian adult population. In total, 505 adolescent and young adult participants (mean age = 21 years) responded to questions about violence exposure, violence-related shame, loneliness, anxiety/depression symptoms, and somatic health complaints. We used counterfactually based causal mediation analysis within the structural equation modelling framework to test whether loneliness mediated a potential association between shame and health. RESULTS: Shame had a profound effect on anxiety/depression symptoms and we identified both direct and indirect effects. Loneliness mediated about one third of the relationship between shame and anxiety/depression symptoms. The relationship between shame and somatic health complaints was weaker in total, but this more modest effect largely occurred indirectly through loneliness. CONCLUSIONS: Our results add to the literature by highlighting the role of loneliness in the relationship between shame and health. Shame may have the potential to break down social connectedness, with a detrimental effect on health. Clinicians may find it helpful to pay close attention to the way shame regulates social interaction. Preventing social isolation and loneliness may promote good health in violence victims.

The mediating role of shame in the relationship between childhood bullying victimization and adult psychosocial adjustment.

Background: Psychological distress following experiencing bullying victimization in childhood has been well documented. Less is known about the impact of bullying victimization on psychosocial adjustment problems in young adulthood and about potential pathways, such as shame. Moreover, bullying victimization is often studied in isolation from other forms of victimization. Objective: This study investigated (1) whether childhood experiences of bullying victimization and violence were associated with psychosocial adjustment (distress, impaired functioning, social support barriers) in young adulthood; (2) the unique effect of bullying victimization on psychosocial adjustment; and (3) whether shame mediated the relationship between bullying victimization and these outcomes in young adulthood. Method: The sample included 681 respondents (aged 19-37 years) from a follow-up study (2017) conducted via phone interviews derived from a community telephone survey collected in 2013. Results: The regression analyses showed that both bullying victimization and severe violence were significantly and independently associated with psychological distress, impaired functioning, and increased barriers to social support in young adulthood. Moreover, causal mediation analyses indicated that when childhood physical violence, sexual abuse, and sociodemographic factors were controlled, shame mediated 70% of the association between bullying victimization and psychological distress, 55% of the association between bullying victimization and impaired functioning, and 40% of the association between bullying victimization and social support barriers. Conclusions: Our findings support the growing literature acknowledging bullying victimization as a trauma with severe and long-lasting consequences and indicate that shame may be an important pathway to continue to explore. The unique effect of bullying victimization, over and above the effect of violence, supports the call to integrate the two research fields.

Planteamiento: La angustia psicológica después de haber experimentado victimización por acoso en la infancia ha sido bien documentada. Se sabe menos sobre el impacto de la victimización por acoso en los problemas de ajuste psicosocial en la adultez joven y sobre vías potenciales, como la vergüenza. Además, la victimización por acoso a menudo se estudia aisladamente de otras formas de victimización. Objetivo: Este estudio investigó (1) si las experiencias infantiles de victimización por acoso y violencia estaban asociadas con el ajuste psicosocial (angustia, funcionamiento, barreras al apoyo social) en la edad adulta; (2) el efecto único de la victimización por intimidación en el ajuste psicosocial; y (3) si la vergüenza mediaba en la relación entre la victimización por acoso y estos resultados en la adultez temprana. Método: La muestra incluyó 681 encuestados (con edades entre 19 y 37 años) de un estudio de seguimiento (2017) realizado a través de entrevistas telefónicas derivadas de una encuesta telefónica comunitaria recopilada en 2013. Resultados: Los análisis de regresión mostraron que tanto la victimización por acoso como la violencia grave se asociaban de manera significativa e independiente con la angustia psicológica, el deterioro del funcionamiento y el aumento de las barreras al apoyo social en la edad adulta. Además, los análisis de mediación causal indicaron que cuando se controlaba la violencia física infantil, el abuso sexual y los factores sociodemográficos, la vergüenza mediaba en un 70% de la asociación entre la victimización por acoso y la angustia psicológica, en un 55% de la asociación entre la victimización por acoso y el deterioro del funcionamiento y en el 40% de la asociación entre la victimización por acoso y las barreras al apoyo social. Conclusiones: Nuestros hallazgos apoyan la creciente literatura que reconoce la victimización por acoso como un trauma con consecuencias severas y duraderas, e indican que la vergüenza puede ser un camino importante para continuar explorando. El efecto singular de la victimización por acoso, más allá del efecto de la violencia, respalda la llamada a integrar los dos campos de investigación.

School performance after experiencing trauma: a longitudinal study of school functioning in survivors of the Utøya shootings in 2011.

BACKGROUND: The psychological impact on survivors of terrorism has been well documented. However, studies on adolescent survivors and the academic performance of high school students following a terrorist attack are lacking. OBJECTIVE: This study investigated academic performance, absenteeism, and school support amongst survivors of a terrorist attack in Norway. METHOD: Data from a longitudinal interview study were linked to officially registered grades of students (N=64) who successfully completed their 3-year senior high school program. Statistical tests of mean differences and linear regression were used to compare the survivors' registered grades with the national grade point average, before and after the event, as well as to assess absenteeism, self-reported grades and to test the association with school support. RESULTS: The students' grades were lower the year after the event than they had been the year before, and they were also lower than the national grade point average (p<0.001). However, their grades improved in the last year of high school, indicating possible recovery. Absence from school increased after the event, compared to the previous year. However, students reported high satisfaction with school support. CONCLUSION: The results indicate that academic functioning was reduced in the year after the traumatic event, but for students who successfully completed high school, the school situation improved 2 years after the event. The findings underscore the importance of keeping trauma-exposed students in school and providing support over time. A more defined educational approach to maintaining school attendance and educational measures which compensate for learning loss are needed in trauma-sensitive teaching.

A prospective study of the potential moderating role of social support in preventing marginalization among individuals exposed to bullying and abuse in junior high school.

Negative physical and psychological long-term consequences of abuse and bullying are well documented. It is reasonable to assume that abuse and bullying early in life also may have an impact on the ability to work and stay economically independent later in life, but such prospective studies are lacking. This study investigates the consequences of exposure to abuse and bullying in junior high school, as measured by receiving long-term social welfare benefits in young adulthood. In addition, it explores the potential protective role of social support. Self-reported data from 13,633 (50.3% female) junior high school students were linked to registry data on their use of social welfare benefits from the age of 18 and for eight consecutive years. Cox regression analyses were applied to test the relationship between exposure to life adversities and the use of social welfare benefits, and the potential moderating role of social support. The analyses showed that individuals exposed to abuse and bullying had an increased likelihood of receiving social-welfare benefits compared with individuals not exposed to these types of abuse. Exposure to multiple types of abuse led to a higher likelihood of using social welfare benefits compared with single types of abuse and no abuse. The findings on the potential moderating role of social support were mixed, depending on the source of social support. Family support and classmate relationships were protective in reducing the likelihood of the use of social welfare benefits, whereas peer and teachers' support showed inconsistent patterns. These results are promising in terms of preventing the long-term negative consequences of abuse and bullying.

Exposure to life adversity in high school and later work participation: a longitudinal population-based study.

This paper investigates whether exposure to violence, sexual abuse, or bullying is associated with later work participation and whether high school completion has a potential mediating role. Self-reported junior high school questionnaire data were linked for eight consecutive years to prospective registry data for the demographics, educational progress, employment activity, and social benefits of 11,874 individuals. Ordinal regression analysis showed that violence and/or bullying at 15 years of age predicted negative work participation outcomes eight years later, independent of high school completion and other relevant factors. Although increasing educational level may have some preventive effect, these results indicate that prevention efforts should be initiated at an early age and should target adverse life experiences.

Violence, bullying and academic achievement: a study of 15-year-old adolescents and their school environment.

OBJECTIVES: This study investigated academic achievement among adolescents exposed to violence, sexual abuse and bullying. Moreover, we sought to determine the individual and contextual influence of the adolescents' school environment in terms of bullying, classmate relationships and teacher support on academic achievement. Finally, we wished to assess whether school-level influence is different for the adolescents exposed to violence and sexual abuse versus the adolescents not exposed to these forms of abuse. METHODS: This is a cross-sectional study of a sample of 7,343 adolescents between the ages of 15 and 16 from 56 schools in Oslo, Norway. We investigated associations between violence, sexual abuse, bullying, classmate relationships, teacher support and academic achievement. Linear regression was used to investigate associations on the individual level. Multilevel analyses were conducted to test for school level differences while controlling for both individual and contextual factors. RESULTS: On the individual level, all combinations of violence and sexual abuse categories were significantly associated with lower grades. This was also true for bullying, while teacher support resulted in better grades. At the school level, the analysis showed that students in schools with higher levels of bullying performed worse academically. Each unit of increment in bullying in school corresponded to an average 0.98 point decrease in grades (p<.01) when we controlled for sociodemographic characteristics. The association remained significant when the model was tested separately for the nonbullied students, with a small reduction in the coefficient value (-.84, p<.01). No overall significance was found for the interaction between the school environment and adolescent exposure to violence, indicating that the school environment affects all students. CONCLUSION: Factors on both levels can contribute to reduced grades. This stresses the need to investigate individual and contextual factors simultaneously when examining academic achievement. Our results indicated that students attending schools with higher levels of bullying may show poorer school performance. This was true for all students regardless of previous exposure to violence and sexual abuse. This emphasizes the need for preventive efforts that focus not only on vulnerable groups, but on all students and the school context.