Childhood abuse increases the risk of depressive and anxiety symptoms and history of suicidal behavior in Mexican pregnant women

Objective:To explore the relationship between individual and co-occurring childhood sexual, physical, and verbal abuse, prenatal depressive (PDS) and anxiety symptoms (PAS), and history of suicidal behavior (HSB) among Mexican pregnant women at risk of depression.Methods:A sample of 357 women screened for PDS was interviewed using the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), the Beck Depression Inventory (BDI-II), the anxiety subscale of the Hopkins Symptoms Checklist (SCL-90), and specific questions on verbal abuse and HSB.Results:Logistic regression analyses showed that women who had experienced childhood sexual abuse (CSA) were 2.60 times more likely to develop PDS, 2.58 times more likely to develop PAS, and 3.71 times more likely to have HSB. Childhood physical abuse (CPA) increased the risk of PAS (odds ratio [OR] = 2.51) and HSB (OR = 2.62), while childhood verbal abuse (CVA) increased PDS (OR = 1.92). Experiencing multiple abuses increased the risk of PDS (OR = 3.01), PAS (OR = 3.73), and HSB (OR = 13.73).Conclusions:Childhood sexual, physical, and verbal abuse, especially when they co-occur, have an impact on PDS and PAS and lifetime HSB. These findings suggest that pregnant women at risk for depression should also be screened for trauma as a risk factor for perinatal psychopathology.

Childhood abuse increases the risk of depressive and anxiety symptoms and history of suicidal behavior in Mexican pregnant women.

OBJECTIVE: To explore the relationship between individual and co-occurring childhood sexual, physical, and verbal abuse, prenatal depressive (PDS) and anxiety symptoms (PAS), and history of suicidal behavior (HSB) among Mexican pregnant women at risk of depression. METHODS: A sample of 357 women screened for PDS was interviewed using the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), the Beck Depression Inventory (BDI-II), the anxiety subscale of the Hopkins Symptoms Checklist (SCL-90), and specific questions on verbal abuse and HSB. RESULTS: Logistic regression analyses showed that women who had experienced childhood sexual abuse (CSA) were 2.60 times more likely to develop PDS, 2.58 times more likely to develop PAS, and 3.71 times more likely to have HSB. Childhood physical abuse (CPA) increased the risk of PAS (odds ratio [OR] = 2.51) and HSB (OR = 2.62), while childhood verbal abuse (CVA) increased PDS (OR = 1.92). Experiencing multiple abuses increased the risk of PDS (OR = 3.01), PAS (OR = 3.73), and HSB (OR = 13.73). CONCLUSIONS: Childhood sexual, physical, and verbal abuse, especially when they co-occur, have an impact on PDS and PAS and lifetime HSB. These findings suggest that pregnant women at risk for depression should also be screened for trauma as a risk factor for perinatal psychopathology.

Childhood trauma is associated with maladaptive personality traits.

The association between childhood trauma and personality traits has been poorly characterized and reported. Our aim was to evaluate whether distinct types of childhood abuse and neglect are associated with various personality dimensions using data from a large web-based survey. A total of 12,225 volunteers responded anonymously to the Internet versions of the Temperament and Character Inventory-Revised (TCI-R) and the Childhood Trauma Questionnaire (CTQ) via our research website, but only 8,114 subjects (75.7% women, mean age 34.8±11.3yrs) who met the criteria for validity were included in the analysis. Childhood trauma was positively associated with harm avoidance and was negatively associated with self-directedness and, to a lesser extent, with cooperativeness. The associations were robust with emotional abuse and neglect but were non-significant or mild with physical trauma. Emotional neglect was associated with reduced reward dependence and persistence. All types of abuse, but not neglect, were associated with increased novelty seeking scores. Reporting of childhood trauma, especially of an emotional nature, was associated with maladaptive personality traits. Further investigation of the effects of different types of childhood trauma on psychological and neurobiological parameters is warranted.

Exposición a la violencia en el sector salud: otra mirada sobre un riesgo laboral aún no controlado / Exposure to violence in the health sector: another look at an occupational hazard not controlled

La violencia directa es visible, no así, sus raíces culturales o estructurales. Esta se ha implantado en los escenarios cotidianos y el personal de salud, como parte de la sociedad, se ve afectado. La situación pone en peligro: la calidad de atención, la productividad, el desarrollo y la continuidad laboral; por otra parte, ejerce un efecto deletéreo sobre la relación con los pacientes, lo que a su vez genera más violencia, por falta de información, o percepción de mala calidad asistencial. La violencia en el trabajo no es un problema individual, sino estructural, arraigado en lo social, económico, cultural y organizacional; y la respuesta institucional, generalmente se limita y circunscribe a evitar o mitigar “el episodio”. Es imperativo analizar todas las causas, e implementar una amplia variedad de intervenciones estratégicas sobre aquellas que pueden modificarse, no solo ‘brindar protección contra eventos violentos’, sino reducir o eliminar las causas subyacentes que los promueven, y poner especial atención en las acciones a implementar luego de estos eventos, sobre todo el recurso humano afectado, para evitar el daño psicológico y finalmente social de este grupo, que retroalimentará el sistema favoreciendo la aparición de nuevos incidentes.

Exposición a la violencia en el sector salud: otra mirada sobre un riesgo laboral aún no controlado / Exposure to violence in the health sector: another look at an occupational hazard not controlled

La violencia directa es visible, no así, sus raíces culturales o estructurales. Esta se ha implantado en los escenarios cotidianos y el personal de salud, como parte de la sociedad, se ve afectado. La situación pone en peligro: la calidad de atención, la productividad, el desarrollo y la continuidad laboral; por otra parte, ejerce un efecto deletéreo sobre la relación con los pacientes, lo que a su vez genera más violencia, por falta de información, o percepción de mala calidad asistencial. La violencia en el trabajo no es un problema individual, sino estructural, arraigado en lo social, económico, cultural y organizacional; y la respuesta institucional, generalmente se limita y circunscribe a evitar o mitigar ôel episodioö. Es imperativo analizar todas las causas, e implementar una amplia variedad de intervenciones estratégicas sobre aquellas que pueden modificarse, no solo æbrindar protección contra eventos violentosÆ, sino reducir o eliminar las causas subyacentes que los promueven, y poner especial atención en las acciones a implementar luego de estos eventos, sobre todo el recurso humano afectado, para evitar el daño psicológico y finalmente social de este grupo, que retroalimentará el sistema favoreciendo la aparición de nuevos incidentes. (AU)

Dissociative experience during childbirth.

OBJECTIVE: A dissociative experience refers to phenomena such as depersonalization, derealization, amnesia, out of body experience, altered time perception and body image. The aim of this study was to assess dissociative experience during childbirth and the possible related variables. METHOD: A total of 328 women, up to 72 hours postpartum, completed the peritraumatic dissociative experience questionnaire (PDEQ), the socio-demographic and obstetrical questionnaire, the pain numeric rating scale, the Trauma History Questionnaire and an SCID-I for traumatic events. RESULTS: A total of 11.3% of the sample experienced significant dissociation. In particular, symptoms like a sensation of time changes during the event/things seemed to be happening in slow motion, not being aware of things that happened, and disorientation. A traumatic childbirth, previous trauma, obstetrical complications, forceps, prematurity, complications with the baby, dissatisfaction with the maternity care, unemployment, high score pain during labor and years of schooling were the factors considered. CONCLUSION: Dissociative experiences can occur during childbirth.

Medicina y estrés: antecedentes históricos y evidencias científicas / Medicine and stress: historic antecedents and scientific evidence

El estrés puede alterar la capacidad inmunológica de una persona, ya sea a través de neurotransmisores o a través de hormonas. El cambio hormonal que se produce como consecuencia del estrés afectará el desarrollo de cualquier enfermedad. Esto implica que el médico no debe considerar al paciente sólo como portador de una enfermedad sino también como un ser sufriente tanto física como emocionalmente, teniendo en cuenta que esas emociones pueden modificar el curso de su enfermedad. En este trabajo pretendemos llamar la atención sobre un tema que, si bien suele estar presente en el pensamiento médico, no siempre lo está como conocimiento fundamentado. Comenzamos con una breve referencia histórica y describimos las evidencias científicas que avalan la relación que nos ocupa.

Stress can alter a person's immune capacity, eíther through neurotransmitters or through hormones. Hormonal change that occurs as a results of stress affects the development of any disease. This implies that the physician should consider the patient not only as a carrier of a disease but also a suffering being, both physically and emotionally, bearing in mind that these emotions can alter the course of the disease. In this paper, we draw attention to an issue that, while often present in medical thinking, is not always as knowledge based. We begin with a brief historical reference and describe the scientific evidence that supports the relationship in question.