Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial.

Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

The study directly compares Skills Training in Affective and Interpersonal Regulation (STAIR) followed by either EMDR or Narrative Therapy in the trauma-processing phase in routine clinical setting.The brief phase-based treatment was found to be effective in reducing both symptoms of PTSD as well as emotion regulation and interpersonal problems in survivors of childhood abuse.Posttraumatic Stress Disorder in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or Narrative Therapy in the trauma-processing phase.

Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years.

BACKGROUND: A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood. METHOD: A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested. RESULTS: We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome DISCUSSION: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential. PUBLIC SIGNIFICANCE: Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care.

Child abuse and neglect and mental health outcomes in adulthood by ethnicity: Findings from a 40-year longitudinal study in New Zealand/Aotearoa.

BACKGROUND: Longitudinal studies consistently report adverse long-term outcomes of childhood maltreatment. Little is known about the impact of childhood maltreatment on mental health among a marginalized population (New Zealand Maori); therefore, we cannot assume the effects of maltreatment are the same across the population. OBJECTIVE: Associations were examined between childhood sexual abuse (CSA), childhood physical punishment (CPP) and childhood neglect (CN) (<16 years) and mental health outcomes 18-40 years, by ethnicity (Maori/non-Maori). PARTICIPANTS AND SETTING: Data from the Christchurch Health and Development Study, a study of a birth cohort of 1265 children born in Christchurch in 1977. By age 40, 17.8 % (n = 191) reported New Zealand Maori ethnic identity; 82.2 % (n = 883) were non-Maori. METHODS: CSA, CPP (<16 years) were measured at 18, 21 years; CN was measured at 40 years. Major depression, anxiety disorder, suicidal ideation, alcohol abuse/dependence and cannabis abuse/dependence were measured at ages 21, 25, 30, 35 and 40 years. Childhood confounding variables controlled. Analyses were extended to include Maori ethnicity. RESULTS: After statistical adjustment, experience of severe childhood maltreatment increased odds of mental health problems 1.8-2.6×, compared to no maltreatment; the effects of maltreatment were similar for males and females. For Maori, some higher rates of mental health problems were seen among those maltreated, no statistically significant associations were detected after Bonferroni correction (among severe maltreatment vs. no maltreatment). Limitations should be considered when interpreting results. CONCLUSIONS: Exposure to childhood maltreatment has long-term effects into middle-age. Further research employing culturally-sensitive approaches may help clarify Maori childhood maltreatment outcomes.

Adverse childhood experiences as a risk factor for non-suicidal self-injury and suicide attempts in forensic psychiatric patients.

BACKGROUND: Exposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals' health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients. METHODS: The current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose-response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression. RESULTS: In file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability of NSSI (p = .016, OR = 1.29; CI = 1.04 to 1.59) but not of suicide attempts. When anxiety and depressive disorders were included in the model, ACE remained a significant predictor of NSSI. CONCLUSIONS: We report extensive ACE, from both files and self-reports. When comparing groups, correlations were found between ACE and NSSI, and ACE and suicide attempts among forensic psychiatric patients. ACE seem to predict NSSI but not suicide attempts in this group, even when controlling for affective and anxiety disorders. Early ACE among forensic psychiatric patients, especially physical and emotional abuse and parental substance abuse, have important impacts on self-harming behaviours that must be acknowledged both by the institutions that meet them as children and in their later assessment and treatment.

History of childhood physical abuse is associated with gut microbiota diversity among adult psychiatric inpatients.

BACKGROUND: Traumatic life events are associated with the development of psychiatric and chronic medical illnesses. This exploratory study examined the relationship between traumatic life events and the gut microbiota among adult psychiatric inpatients. METHODS: 105 adult psychiatric inpatients provided clinical data and a single fecal sample shortly after admission. A modified version of the Stressful Life Events Screening Questionnaire was used to quantify history of traumatic life events. 16S rRNA gene sequencing was used to analyze the gut microbial community. RESULTS: Gut microbiota diversity was not associated with overall trauma score or any of the three trauma factor scores. Upon item-level analysis, history of childhood physical abuse was uniquely associated with beta diversity. Linear Discriminant Analysis Effect Size (LefSe) analyses revealed that childhood physical abuse was associated with abundance of distinct bacterial taxa associated with inflammation. LIMITATIONS: This study did not account for dietary differences, though diet was highly restricted as all participants were psychiatric inpatients. Absolute variance accounted for by the taxa was small though practically meaningful. The study was not powered for full subgroup analysis based on race and ethnicity. CONCLUSIONS: This study is among the first to demonstrate a relationship between childhood physical abuse and gut microbiota composition among adult psychiatric patients. These findings suggest that early childhood adverse events may have long-conferred systemic consequences. Future efforts may target the gut microbiota for the prevention and/or treatment of psychiatric and medical risk associated with traumatic life events.

The Effects of Severe Childhood Physical and Sexual Abuse on Adult Socioeconomic Prosperity.

Our study utilizes Adverse Childhood Experience (ACE) scores to estimate the relationship between forced sexual intercourse and physical abuse on socioeconomic outcomes in adulthood. ACEs have been shown to have long-term negative impacts on health, mental health, and cognition. We expand upon the literature that analyzes the effects of ACEs on human capital investment and adult socioeconomic outcomes by focusing on the ACE scores pertaining to repeated physical and forced sexual abuse in childhood. Specifically, we estimate probit models using data from the Behavioral Risk Factor Surveillance System to measure the marginal effects of childhood sexual abuse (CSA) and physical abuse on the probability of high school completion, unemployment, and the likelihood of living in poverty in adulthood. We find adults who suffered physical abuse in childhood are more likely to live in poverty. Adult survivors of CSA are less likely to finish high school and more likely to live in poverty. The likelihood of high school noncompletion increases when the individual suffered both forms of abuse. We also find that only those who suffered both forms of abuse in childhood had a greater likelihood of being unemployed and high school noncompletion. We find the negative socioeconomic impact in adulthood is larger for women than for men, implying gender heterogeneity in outcomes of CSA and physical abuse. Researchers should control for the correlation between sexual abuse and physical abuse in childhood, particularly in women, when estimating their effects on socioeconomic outcomes.

Risk and Protective Factors for Childhood Physical Abuse and Suicidal Ideation: The Effect of Brain-Derived Neurotrophic Factor Polymorphism and Social Support.

OBJECTIVE: This study aimed to explore the relationship between childhood physical abuse and suicidal ideation considering the effects of genetic and environmental factors in patients with post-traumatic stress disorder (PTSD) by focusing on brain-derived neurotrophic factor (BDNF) polymorphism and social support, respectively. METHODS: One-hundred fourteen patients with PTSD and 94 healthy controls (HCs) were genotyped with respect to BDNF Val66Met polymorphism. All participants underwent psychological assessments. The hierarchical regression analysis and the simple slope analysis were conducted. RESULTS: As for patients with PTSD, the moderation effect of BDNF polymorphism was significant but not for social support. Specifically, the BDNF Val/Val genotype worked as a risk factor and strengthens the relationship between childhood physical abuse and suicidal ideation. As for the HCs, the significant moderation effect was found only in social support, but not for BDNF polymorphism. The relationship between childhood physical abuse and suicidal ideation was weakened for the HCs with high social support. CONCLUSION: This study demonstrated a significant BDNF genetic vulnerability for suicide in patients with PTSD who experienced childhood physical abuse. Our results suggested that social support provided a mitigating effect on the relationship between childhood physical abuse and suicidal ideation only in the HCs.

Association between childhood physical abuse and suicidal behaviors among Chinese adolescents: The mediation of aggression.

BACKGROUND: Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression. METHOD: A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively. RESULTS: During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively. LIMITATIONS: Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment. CONCLUSIONS: CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.

Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters.

Posttraumatic stress symptoms (PTSS) are associated with both childhood physical abuse (CPA) and antisocial (AS) traits, yet their potential as mediators of the CPA-AS traits link is understudied and the specific roles of individual symptom clusters in this relation is unknown. The current study aimed to examine the mediational role of PTSS in the relation between CPA and AS traits in a sample of low-income African American women with histories of intimate partner violence (IPV). It was hypothesized that avoidance would emerge as a significant mediator, whereas reexperiencing, numbing, and hyperarousal would not. Participants (N = 150) were recruited from a level-1 trauma public hospital and evaluated as part of a randomized controlled trial of a group therapy intervention for low-income, African American women suicide attempters with histories of IPV. The Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale (PDS), and International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were used to measure variables of interest. Using bootstrapping analyses, a parallel mediation model compared PTSS clusters as potential mediators of the CPA-AS traits relation, controlling for IPV. When reexperiencing, avoidance, numbing, and hyperarousal were entered simultaneously as potential mediators, only avoidance emerged as a significant mediator of the CPA-AS traits link. Avoidance symptoms may play a unique role in the link between early experiences of CPA and later AS traits among multiply traumatized African American women. Findings have implications for understanding AS traits in the context of early life trauma and suggest that targeting specific PTSS clusters (e.g., avoidance) may improve treatment outcomes for women in this population.

Associations of anxiety and depression with suicide experiences in individuals with and without childhood trauma: The role of social support.

No studies have examined the differences and similarities between individuals with and without experiences of childhood sexual and/or physical abuse in relation to anxiety and depression severity, perceived social support, and suicide experiences. Furthermore, whether the strength of these associations differs between these two groups, and whether the buffering role of perceived social support is equally effective, remain unknown. This study, which was based on 842 British participants, aimed to address these gaps. There were three key findings: i) abused individuals reported significantly more severe depression, anxiety, and suicide experiences, and lower social support, ii) the associations between depression, anxiety, and suicide experiences did not differ between these groups, whereas the association between social support and suicide experiences was more pronounced in abused individuals, and iii) perceived social support acted as a moderator of the association between depression and suicide experiences in both groups. These findings are important because they suggest that for the individuals with childhood trauma perceptions of being less supported by their significant others may lead to suicide acts. Furthermore, perceptions of being socially supported appeared to weaken the association between depression and suicide experiences equally in individuals with and without childhood trauma.

The association of childhood physical abuse, masculinity, intoxication, trait aggression with victimization in nightlife districts.

BACKGROUND: High-risk intoxication, trait aggression and conformity to masculine norms are associated with increased risk of barroom aggression; however, less is understood regarding the factors associated with victimization in the night-time environment. OBJECTIVE: This study aimed to explore the influence of childhood physical abuse, high-risk intoxication, conformity to masculine norms and trait aggression on physical and/or verbal victimization in the night-time environment. PARTICIPANTS AND SETTING: A sample of N = 490 patrons aged 18-50 years (M = 23.02, SD = 5.89, 58.8% female) were recruited in Fortitude Valley and West End district, Queensland. METHOD: Participants completed a street interview, including breathalyser, and a follow-up online survey asking about experiences of aggression on the night of interview, experiences of childhood physical abuse and psychosocial correlates. RESULTS: For males, but not females, childhood physical abuse (OR = 3.98) increased the risk of physical and/or verbal victimization. Conformity to the masculine norm of Winning (OR = 0.21) was protective against physical and/or verbal victimization for males, and trait aggression (OR = 1.51) was significantly associated with increased risk of physical and/or verbal victimization for females. CONCLUSIONS: These findings add to the growing literature surrounding the long-term impacts of childhood physical abuse, demonstrating experiences of childhood physical abuse are significantly associated with victimization in the night-time economy. The current findings should be taken into consideration when constructing public policy or directed interventions, to help reduce aggression and violence in the night-time economy.

Association of childhood physical and sexual abuse with arthritis in adulthood: Findings from a population-based study.

The objective of this cross-sectional study was to investigate childhood physical and sexual abuse as factors associated with arthritis among adults from selected states in the United States. Data for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,717 adults 18-75 years old (49.7% female) was analyzed using log-binomial regression. The outcome variable investigated in this study was arthritis, and the main explanatory variables were childhood physical and sexual abuse. Of the 75,717 respondents examined, 20,938 (representing 27.6%) had arthritis. A little over one in four respondents (25.5%) experienced childhood physical abuse and 5.6% experienced childhood sexual abuse by age 18. In the multivariable regression, respondents who experienced childhood physical abuse had 1.36 times the risk of having arthritis when compared to respondents who did not experience childhood physical abuse (ARR = 1.36, p < .001, 95% CI = 1.28-1.46). Respondents who experienced childhood sexual abuse had 1.60 times the risk of having arthritis when compared to respondents who did not experience childhood sexual abuse (ARR = 1.74, p < .001, 95% CI = 1.54-1.97). The findings of this study demonstrate that childhood physical and sexual abuse are associated with arthritis later in adulthood. The associations persisted even after adjusting for demographic, socioeconomic status, body mass index (BMI), current smoking status, and self-perceived physical health. The findings of this study add to the burgeoning number of studies demonstrating the adverse impact of childhood physical and sexual abuse on chronic health outcomes among adults.

The Mediation Effect of Hyperarousal Symptoms on the Relationship Between Childhood Physical Abuse and Suicidal Ideation of Patients With PTSD.

Objective: This study examined the relationship of childhood physical abuse, posttraumatic stress disorder (PTSD), depression, and suicide in patients with PTSD through path analysis. Materials and Methods: A total of 114 patients with PTSD (36 men and 78 women) were recruited and completed psychological assessments including the Childhood Trauma Questionnaire, the scale for suicidal ideation, the clinician-administered PTSD scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the PTSD checklist, and the Hospital Anxiety and Depression Scale. Structural equation modeling was used to evaluate the results. We developed a model including childhood physical abuse experience as the causal variable, suicidal ideation as a result variable, and PTSD and depression as mediation variables. PTSD symptoms were divided into four clusters [intrusion, avoidance, negative cognition and mood, and altered arousal and reactivity (hyperarousal)] to determine predictive power for suicide. Results: PTSD symptoms fully mediated the relationship between childhood physical abuse and suicidal ideation. Furthermore, PTSD symptoms fully mediated the relationship between childhood physical abuse and depression. Among the PTSD symptoms, hyperarousal was the only symptom cluster that mediated the relationship between childhood physical abuse and suicidal ideation. The symptom clusters of negative cognition and mood as well as hyperarousal mediated the relationship between childhood physical abuse and depression. Conclusions: This study presents a link between childhood physical abuse and current symptoms in patients with PTSD, and highlights specific PTSD symptom clusters (i.e., hyperarousal, negative cognition and mood) that may increase the risk for psychopathology later in life.

Physical Intimate Partner Violence, Childhood Physical Abuse and Mental Health of U.S. Caribbean Women: The Interrelationship of Social, Contextual, and Migratory Influences.

The literature has shown an increased risk for mental health conditions among victims of domestic violence. Few studies have examined the relationship between mental health disorders and domestic violence among Caribbean women, and how the association might be influenced by migratory and contextual factors. This study addresses the mental well-being of U.S. Caribbean Black women victims of domestic violence, and the relationships between acculturation, discrimination, and demographic influences. An analysis of data from the 2001-2003 National Survey of American Life (NSAL) re-interview, the first and most complete study on U.S. Caribbean Blacks, was conducted. Bivariate analysis revealed an association between acts of physical domestic violence and mental health conditions, with generally higher risk among women who reported both severe physical intimate partner violence and childhood physical abuse. Multivariate logistic regression indicates an association between specific mental disorders and acts of domestic violence. Acculturation, length of residence in the United States, age, education, poverty, and country of origin were also associated with mental health. The study highlights future directions for exploration including additional investigation of the influence of acculturation on the physical health of victims of domestic violence.

Examining the Link Between Childhood Physical Abuse and Risk for Violent Victimization in Youth and Young Adulthood in China.

This study examines the association between childhood physical abuse and an increased risk for violent victimization in youth and young adulthood in China. It further assesses if this relationship is mediated by an individual's routine activities. Data used in this study were collected from more than 2,000 individuals of school-based samples in Changzhi, a city of over 3 million people in Northern China. Drawing from a survey that captures childhood physical abuse, violent victimization, and routine activities, this study uses negative binominal regression to examine the relationships between childhood physical abuse, routine activities, and violent victimization among Chinese youth and young adults. We find that individuals who were physically abused in childhood were at a greater risk for violent victimization in youth and young adulthood, and that an individual's routine activities (e.g., drinking) partially mediated this relationship. The findings from this study suggest that routine activity theory provides a useful framework for explaining the link between childhood physical abuse and risk for violent victimization in the Chinese context. Furthermore, our findings stress the importance of future research to look more closely at childhood experiences when studying future behaviors. In addition, our findings challenge beliefs held among Chinese parents about the acceptability of physical punishment to discipline children. These findings can be used to shape programs that create awareness of acceptable parenting practices in China.

The Toxic Triad: Childhood Exposure to Parental Domestic Violence, Parental Addictions, and Parental Mental Illness as Factors Associated With Childhood Physical Abuse.

Childhood physical abuse can result in serious behavioral, mental health, and physical health conditions. There is a need for improved strategies to identify households in which childhood physical abuse occurs. This article explores three potential correlates of childhood physical abuse: childhood exposure to parental domestic violence, parental addictions, and parental mental illness. Secondary analyses were conducted using the regionally representative 2010 Brief Risk Factor Surveillance Survey (BRFSS) of adults (n = 9,241 men, n = 13,627 women) and the analyses were replicated in the 2012 BRFSS (n = 11,656 men, n = 18,145 women). Bivariate and logistic regression analyses were conducted. Approximately one-quarter of the sample was Hispanic and/or Non-White. In 2010, 78.3% of men who had been exposed to all three of these early adversities reported that they had experienced childhood physical abuse compared with 7.5% of males who did not experience these adversities. Women reported similar levels of childhood physical abuse (66.9% for those reporting all three factors, 5.9% for those with zero risk factors). The 2012 BRFSS analyses resulted in comparable findings. Domestic violence, even in the absence of parental addictions and mental illness, was associated with a high prevalence of childhood physical abuse (between 34% and 38%). Currently, the World Health Organization cautions against routine screening for child abuse due to the high rate of false positives. We propose a two-step strategy to improve targeting: first, identifying households in which two or more adversities exist, and subsequently screening children in these households. Our findings will help improve the targeting of screening and outreach efforts to children most at risk, thereby minimizing the risk of false positives. Our data provide support for universal screening for childhood physical abuse in cases of domestic violence, particularly for those families where parental addictions and/or parental mental illness also exist.

Childhood abuse as a risk factor for injection drug use: A systematic review of observational studies.

ISSUES: Childhood abuse is a public health challenge with lifelong impacts, including future drug use. However, previous research has been mixed regarding impacts on injection drug use. This systematic review examines the impact of childhood abuse (sexual, physical and emotional) on adult injection drug use. APPROACH: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and grey literature to identify relevant studies from database inception to 26 September 2018. Studies were eligible if: (i) they were empirical original research published in English; (ii) considered childhood abuse as potential risk factors for lifetime history of injection drug use; and (iii) included adult participants. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. KEY FINDINGS: Of the 1994 articles screened, 17 studies met the inclusion criteria. Most studies were conducted in the USA and utilised cross-sectional research designs. All of the 17 studies measured sexual abuse, six studies measured physical abuse and three studies measured emotional abuse; most (N = 11) of which reported a statistically significant and positive association between at least one sub-scale of childhood abuse and injection drug use. IMPLICATIONS: Our findings highlight the need for devising interventions to reduce the harms associated with childhood abuse. CONCLUSIONS: The evidence base suggests a significant positive association between experiences of childhood physical abuse and elevated risks of injection drug initiation with mixed results for sexual and emotional abuse.

Childhood physical abuse and physical dating violence in young adulthood: The mediating role of adverse mental health.

OBJECTIVE: The purpose of this study was to examine whether adverse mental health (i.e., symptoms of anxiety, posttraumatic stress disorder, and depression) mediated the relation between childhood physical abuse (CPA) and physical dating violence (DV) victimization/perpetration in young adulthood. METHOD: We used four waves of data from an ongoing longitudinal study. The sample consisted of 864 adolescents including 282 Hispanic Americans, 248 European Americans, 240 African Americans, and 94 other, with a mean age of 17 years at Wave 3. RESULTS: Structural equation modeling suggested that posttraumatic stress disorder symptoms mediated the link between CPA and both physical DV victimization (ß = .06, 95% CI: 0.01, 0.11) and perpetration (ß = .07, 95% CI: 0.02, 0.13). Anxiety and depressive symptoms, however, did not show significant indirect effects. CONCLUSIONS: Findings highlight the importance of interventions targeting posttraumatic stress symptoms for adolescents who experienced CPA in preventing physical DV in young adulthood.

Revisiting the link between childhood sexual abuse and adult sexual aggression.

BACKGROUND: Childhood maltreatment poses a risk factor for adult sexual aggression among men. OBJECTIVE: Efforts were made to examine links between childhood sexual abuse (CSA) and sexual aggression after controlling variance associated with other forms of abuse. PARTICIPANTS AND SETTING: This sample was comprised of men (n = 489) who completed a national survey regarding their history of possible abuse and/or sexual aggression. METHODS: Maltreatment indices included CSA, parental and sibling physical abuse, exposure to domestic violence, peer bullying, and family emotional abuse. Self-report indicators of sexual frotteurism, coercion and rape were provided by the Sexual Experiences Survey-Short Form Perpetration. RESULTS: CSA links with the criterion indicators were relatively stronger (r = 0.36, d = 0.65, p <  .001) than those found for non-sexual forms of abuse. CSA accounted for unshared variance in sexual aggression with these effects magnified by the addition of parental physical abuse (d = 2.1) or exposure to domestic violence (d = 2.2). The relative risks of prior acts of rape were elevated by CSA (RR = 4.39, p <  .001), parental physical abuse (RR = 3.85, p < 0.001), exposure to domestic violence (RR = 3.81, p <  .001), or sibling physical abuse (RR = 2.56, p = 0.007). These risks of completed rape were higher as well among respondents polyvictimized by two (RR = 4.92, p <  .001) or more (RR = 8.94, p < 0.001) forms of abuse. CONCLUSIONS: Multiple forms of child maltreatment, particularly CSA, were strongly associated with adult sexual aggression in this sample of men from the general population.

Dual Diagnosis in Prisoners: Childhood Sexual and Physical Abuse as Predictors in Men and Women.

The study aims to determine the rate of dual diagnosis (DD), examine the most common mental disorders, and determine whether a history of childhood sexual/physical abuse (CSA/CPA) is associated with this phenomenon. One-hundred and eighty inmates from a Spanish prison were assessed using the Mini International Neuropsychiatric Interview and the Addiction Severity Index-6. The data showed that 46.8% of the males and 65.1% of the females had a substance use disorder. With regard to CPA, similar percentages were found in both genders. Nevertheless, rates of CSA were highest in females. Logistic regression analysis was performed by gender. CPA was predictor of DD for males, and CSA was predictor of DD for females, showing the greatest weight. In addition, in both cases, the number of drugs of abuse was an adequate predictor. We can state that these forms of maltreatment are risk factors for the development of a broad range of psychopathological problems.