Recovering the Lost Soul: Older Women's Reflections on Past Intrafamilial Child Sexual Abuse.

Intrafamilial child sexual abuse (IFCSA) is a social problem with longstanding effects on victims' lives. While scholarly literature has focused on the adverse aftermath of sexual abuse, only a few studies have acknowledged older women's perspectives on their experience of IFCSA and their journey of healing and recovery. The aim of the present study was to explore how older survivors of IFCSA construct and shape their experience of healing in later life and the meaning they assign to this process. Narrative inquiry was selected to explore the narratives of 11 older women survivors of IFCSA. Participants were interviewed using a biographical narrative interviewing method. The narratives were then transcribed and analyzed using thematic, structural, and performance analyses. Four major themes emerged from the participants' narratives: Achieving closure; Spiritual framing of IFCSA as a platform for self-growth; Becoming whole in old age; and Looking to the future after IFCSA. During the aging years, IFCSA survivors may redefine their identity and their place in the world. Using life review processes, older women in this study were striving to heal and reconcile with their past.

The role of positive childhood experiences in the link between childhood maltreatment and affective lability in a sample of incarcerated men and women.

BACKGROUND: Individuals with a history of child maltreatment (CM) tend to show high affective lability (AL) and criminal behavior. However, positive childhood experiences (PCEs) may act as a protective factor even in the presence of child maltreatment. OBJECTIVE: The present study aimed to analyze the relationship between CM, PCEs, and AL in adulthood, identify the predictors of AL and analyze the moderating role of PCEs in the relationship between CM and AL in a sample of 424 incarcerated men (n = 343) and women (n = 81), aged between 18 and 73 years (M = 37.88). METHODS: Participants responded to an online protocol consisting of a sociodemographic questionnaire, the Childhood Trauma Questionnaire (CTQ), the Benevolent Childhood Experiences Scale (BCEs), and the Affective Lability Scale - Short Version (ALS-18). RESULTS: CM was positively associated with AL and negatively associated with PCEs, and PCEs are negatively associated with AL. Regression analyses, after controlling for age, sex, and education, confirmed the role of PCEs on AL, above and beyond CM. However, moderation analysis showed that PCEs did not moderate the relationship between CM and AL for either men or women. CONCLUSIONS: These results highlight the complexity of human development and behavior from early childhood into adulthood. Further studies are needed to better understand the role of PCEs in the relationship between ACEs and AL among inmates in order to develop more appropriate prevention and intervention programs.

Mentorship in adolescence and subsequent depression and adiposity among child maltreatment survivors in a United States nationally representative sample.

Child maltreatment (CM) is associated with multiple adverse health outcomes. Hence, there is a great need to identify factors that promote resilience in CM survivors. Mentorship may promote positive coping in CM survivors, but this may vary by health outcome and mentor/mentee characteristics. Among participants in a United States nationally representative sample, the National Longitudinal Study of Adolescent to Adult Health, who retrospectively reported any CM before age 18 (sexual, emotional or physical, abuse or neglect; N = 3364), we examined associations between mentorship during adolescence and body mass index (BMI), obesity, and depressive symptoms at ages 24-32 (in 2008-2009). We utilized linear regression and predictive margins with complex sample weighting. Models were stratified by sex and race/ethnicity. Thirty-one percent and 40% of participants' most influential mentor was inside and outside the family, respectively, and 29% reported no mentor. Any mentorship was associated with decreased depressive symptoms in females (adjusted beta for any mentor = -0.78, 95% CI:-1.54,-0.02). By contrast, any mentorship was associated with increased adiposity, namely among Latinas (adjusted beta for BMI = 2.23, 95% CI:0.45,4.02, adjusted risk ratio for obesity = 1.42, 95% CI:1.03,1.97). The influence of mentorship in CM survivors is heterogeneous. While mentorship was associated with reduced psychopathology, it was also linked with worse physical health, underscoring that mentoring does not necessarily promote long-term resilience to physical health outcomes, particularly in minorities. A better understanding of how mentors influence specific mentee behaviors may be important in informing how mentors can promote better physical health and lower obesity risk among CM survivors.

Adverse childhood experiences and resilience among adult women: A population-based study.

Background: Adverse childhood experiences (ACEs) have consistently been associated with elevated risk of multiple adverse health outcomes, yet their contribution to coping ability and psychiatric resilience in adulthood is unclear. Methods: Cross-sectional data were derived from the ongoing Stress-And-Gene-Analysis cohort, representing 30% of the Icelandic nationwide female population, 18-69 years. Participants in the current study were 26,198 women with data on 13 ACEs measured with the ACE-International Questionnaire. Self-reported coping ability was measured with the Connor-Davidson Resilience Scale and psychiatric resilience was operationalized as absence of psychiatric morbidity. Generalized linear regression assuming normal or Poisson distribution were used to assess the associations of ACEs with coping ability and psychiatric resilience controlling for multiple confounders. Results: Number of ACEs was inversely associated with adult resilience in a dose-dependent manner; every 1SD unit increase in ACE scores was associated with both lower levels of coping ability (ß = -0.14; 95% CI-0.15,-0.13) and lower psychiatric resilience (ß = -0.28; 95% CI-0.29,-0.27) in adulthood. Compared to women with 0 ACEs, women with ≥5 ACEs had 36% lower prevalence of high coping ability (PR = 0.64, 95% CI 0.59,0.70) and 58% lower prevalence of high psychiatric resilience (PR = 0.42; 95% CI 0.39,0.45). Specific ACEs including emotional neglect, bullying, sexual abuse and mental illness of household member were consistently associated with reduced adult resilience. We observed only slightly attenuated associations after controlling for adult socioeconomic factors and social support in adulthood. Conclusions: Cumulative ACE exposure is associated with lower adult resilience among women, independent of adult socioeconomic factors and social support, indicating that adult resilience may be largely determined in childhood. Funding: This work was supported by the European Research Council (Consolidator grant; UAV, grant number 726413), and the Icelandic Center for Research (Grant of excellence; UAV, grant number 163362-051). HBD was supported by a doctoral grant from the University of Iceland Research Fund.

Women with abuse-related posttraumatic stress disorder sleep more fitfully but just as long as healthy controls: an actigraphic study.

STUDY OBJECTIVES: Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results. METHODS: We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 nontraumatized mentally healthy women (healthy controls, HC group). RESULTS: The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments. CONCLUSIONS: Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se. SUBSET OF DATA FROM CLINICAL TRIAL: Treating Psychosocial and Neural Consequences of Childhood Interpersonal Violence in Adults (RELEASE), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000000, German Clinical Trials registration number: DRKS00005578.

Abuse in Childhood and Cardiometabolic Health in Early Adulthood: Evidence From the Avon Longitudinal Study of Parents and Children.

Background Although childhood abuse has been consistently associated with cardiovascular disease in later adulthood, its associations with cardiometabolic health in younger adults are poorly understood. We assessed associations between childhood physical, sexual, and psychological abuse and cardiometabolic outcomes at 18 and 25 years. Methods and Results We used data on 3223 participants of the ALSPAC (Avon Longitudinal Study of Parents and Children). Exposure to childhood abuse was self-reported retrospectively at 22 years. We used linear regression to assess the associations between childhood abuse and cardiometabolic outcomes at 18 and 25 years. At 18 years, physical (ß 1.35 kg/m2; 95% CI, 0.66-2.05), sexual (ß 0.57 kg/m2; 95% CI 0.04-1.11), and psychological (ß 0.47 kg/m2; 95% CI 0.01-0.92) abuse were associated with higher body mass index. Physical abuse was also associated with lower high-density lipoprotein cholesterol (ß -0.07 mmol/L; 95% CI, -0.13 to -0.01) and higher C-reactive protein (31%; 95% CI, 1%-69%), and sexual abuse was associated with higher heart rate (ß 1.92 bpm; 95% CI 0.26-3.58). At age 25, all 3 types of abuse were additionally associated with higher insulin, and sexual abuse was associated with lower cholesterol (-0.14 mmol/L; 95% CI, -0.26 to -0.01). The age at which abuse occurred (<11or 11-17 years) had little influence on the associations, and when sex differences were evident, associations were stronger in men. Conclusions Childhood abuse is associated with negative cardiometabolic outcomes even by young adulthood. Further follow-up will determine whether associations strengthen across the life course and whether sex differences persist, which is essential for targeting effective screening programs and early interventions in those who suffered abuse in childhood.

Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial.

Background: It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD. Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy. Method: We recruited adults with CA-PTSD. Participants were randomly assigned to Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12 sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8 sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline), week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary outcome was clinician-rated PTSD symptom severity. Results: We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline to 1-year follow-up (Cohen's d > 1.6), with no significant differences among treatments. iPE led to faster initial symptom reduction than PE for self-report PTSD symptoms (t135 = -2.85, p = .005, d = .49) but not clinician-assessed symptoms (t135 = -1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported (t135 = -4.11, p < .001, d = .71) and clinician-assessed symptoms (t135 = -2.77, p = .006, Cohen's d = .48) STAIR+PE did not result in significantly more improvement from baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between conditions. Conclusions: Variants of exposure therapy are tolerated well and lead to large improvements in patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall better outcomes. The trial is registered at the clinical trial registry, number NCT03194113, https://clinicaltrials.gov/ct2/show/NCT03194113.

Antecedentes: No está claro si los tratamientos basados en la evidencia para el TEPT son tan efectivos en pacientes con TEPT relacionado con abuso infantil (TEPT-AI).Objetivo: Nuestro objetivo fue investigar la efectividad de tres variantes de la terapia de exposición prolongada.Método: Reclutamos adultos con TEPT-AI. Los participantes fueron asignados aleatoriamente a Exposición Prolongada (EP; 16 sesiones en 16 semanas), Exposición Prolongada intensificada (EPi; 12 sesiones en 4 semanas seguidas de dos sesiones de refuerzo) o un tratamiento basado en fases, en el que 8 sesiones de EP fueron precedidas por 8 sesiones de Entrenamiento de Habilidades en Regulación Afectiva e Interpersonal (STAIR+EP; 16 sesiones en 16 semanas). Las evaluaciones se llevaron a cabo en la semana 0 (línea de base), semana 4, semana 8, semana 16 (postratamiento) y en un seguimiento de 6 y 12 meses. El resultado primario fue la gravedad de los síntomas de TEPT calificada por el médico.Resultados: Asignamos aleatoriamente 149 pacientes a EP (48), EPi (51) o STAIR+EP (50). Todos los tratamientos dieron como resultado grandes mejoras en los síntomas de TEPT evaluados por el médico y autoinformados, desde el inicio hasta el seguimiento de 1 año (d de Cohen > 1.6), sin diferencias significativas entre los tratamientos. La EPi condujo a una reducción más rápida de los síntomas iniciales que la EP para los síntomas de TEPT autoinformados (t135 = −2.85, p =.005, d =.49) pero no los síntomas evaluados por el médico (t135 = −1.65, p =.10) y una reducción más rápida de síntomas iniciales que STAIR+EP para los síntomas autoinformados (t135 = −4.11, p <.001, d =.71) y evaluados por el médico (t135 = −2.77, p =.006, d de Cohen =.48) STAIR+EP no dio como resultado una mejora significativamente mayor desde el inicio hasta el seguimiento de 1 año en los resultados secundarios de regulación emocional, problemas interpersonales y autoestima en comparación con la EP y la EPi. Las tasas de abandono no difirieron significativamente entre las condiciones.Conclusiones: Las variantes de la terapia de exposición se toleran bien y conducen a grandes mejoras en pacientes con TEPT-AI. La intensificación del tratamiento puede conducir a una mejora más rápida, pero no a mejores resultados en general.

The importance of child abuse and neglect in adult medicine.

The risk for adverse consequences and disease due to the trauma of child abuse or neglect is easily assessed using the self-administered modified ACEs questionnaire. Exposure to child maltreatment is endemic and common. At least one out of every ten USA adults has a significant history of childhood maltreatment. This is a review of the literature documenting that a past history of childhood abuse and neglect (CAN) makes substantial contributions to physical disease in adults, including asthma, chronic obstructive pulmonary disease, lung cancer, hypertension, stroke, kidney disease, hepatitis, obesity, diabetes, coronary artery disease, pelvic pain, endometriosis, chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, and auto immune diseases. Adults who have experienced child maltreatment have a shortened life expectancy. The contribution of CAN trauma to these many pathologies remains largely underappreciated and neglected compared to the attention given to the array of mental illnesses associated with child maltreatment. Specific pathophysiolologic pathways have yet to be defined. Clinical recognition of the impact of past CAN trauma will contribute to the healing process in any disease but identifying specific effective therapies based on this insight remains to be accomplished. Recommendations are made for managing these patients in the clinic. It is important to incorporate screening for CAN throughout adult medical practice now.

The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder.

Background: Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD). Objective: This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms. Method: A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses. Results: Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding 'impulse control difficulties' (F(1,299) = 38.97, p < .001, ηp2 = .115), 'limited access to emotion regulation strategies' (F(1,299) = 4.66, p = .032, ηp2 = .015), and 'lack of emotional clarity' (F(1,299) = 9.38, p = .002, ηp2 = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R2 = .429). Subscale analyses revealed 'impulse control difficulties' as the aspect of difficulties in emotion regulation that has the greatest impact on this association (B = .021, 95% CI [.003; .045]). Conclusions: Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.

Antecedentes: El maltrato infantil y las dificultades en la regulación emocional son frecuentesw en pacientes con trastorno límite de personalidad (TLP) y pacientes con trastornos depresivos (TD).Objetivo: Este estudio examina las diferencias entre pacientes con TLP y pacientes con TD, en cuanto al maltrato infantil y las dificultades en la regulación de las emociones, así como el efecto mediador de diferentes aspectos de los déficits en la regulación de las emociones sobre la asociación entre el maltrato infantil y los síntomas del TLP.Método: Un total de 305 participantes, 177 pacientes con TLP y 128 pacientes con TD completaron una evaluación que incluyó el Cuestionario de Trauma Infantil (CTQ), la Escala de Regulación de las Emociones (DERS), el Inventario Breve de Síntomas (BSI) y la Entrevista Clínica Estructurada para DSM-IV (SCID). Los datos se analizaron mediante múltiples análisis de variaciones y análisis de mediación.Resultados: Los pacientes con TLP informaron más maltrato infantil y más dificultades en la regulación de las emociones que los pacientes con TD. Cuando la gravedad de los síntomas generales, la edad y el sexo se incluyeron en el análisis como covariables, solo las diferencias de grupo con respecto a las 'dificultades de control de impulsos' (F (1.299) = 38,97, p <.001, ηp2 = .115), 'acceso limitado a estrategias de regulación de las emociones '(F (1,299) = 4.66, p = .032, ηp2 = .015) y' falta de claridad emocional '(F (1,299) = 9.38, p = .002, ηp2 = .030) permanecieron estadísticamente significativas. Un análisis de mediación, incluidas las covariables antes mencionadas, indicó una asociación entre el abuso emocional y los síntomas del TLP, que fue mediada por dificultades en la regulación de las emociones (efecto indirecto B = .012, IC del 95% [.001; .031], R2 =. 429). Los análisis de subescalas revelaron "dificultades de control de impulsos" como el aspecto de las dificultades en la regulación de las emociones que tiene el mayor impacto en esta asociación (B = .021, IC del 95% [.003; .045]).Conclusiones: Los pacientes con TLP presentan más maltrato infantil y dificultades en la regulación de las emociones que los pacientes con TD. Las dificultades en la regulación de las emociones, especialmente las dificultades en el control de los impulsos, parecen jugar un papel importante en la asociación entre el abuso emocional infantil y los síntomas del TLP.

Lifetime post-traumatic stress disorder in older individuals with a history of institutional upbringing in childhood: the role of social acknowledgement and stressful life events.

Background: Child maltreatment (CM), particularly in institutional contexts, can affect the development of post-traumatic stress disorder (PTSD). Research suggests that factors during CM (e.g. severity, variety, duration) and in the aftermath of CM (e.g. stressful life events, and social acknowledgement, i.e. the degree to which an individual feels validated and supported following a traumatic event) can explain some of the heterogeneity in PTSD development. However, there is a lack of research on long-term correlates of CM and mitigating factors, with only a few studies having been conducted with older survivors of institutional upbringing. Such research is relevant, given the long-term associations between CM and the older age status of many survivors. Objective: The current study examined the link between CM and PTSD in older individuals with a history of institutional upbringing (risk group; RG) and a matched control group (CG). Differences in stressful life events and social acknowledgement were also investigated. Method: Participants were n = 116 RG (Mage = 70.25 years, 41% female) and n = 122 CG (Mage = 70.71 years, 51% female). Data was assessed using self-report questionnaires and a clinical interview. Results: The RG reported higher levels of exposure to CM. Lifetime PTSD showed a bigger association with the level of exposure to CM, compared to having an institutional upbringing. Participants with higher CM levels reported more stressful life events. High levels of social acknowledgement mediated the relationship between CM and PTSD in the CG. Conclusions: Exposure to CM had a stronger association with PTSD than a history of institutional upbringing. In the CG, the survivors' perception of social acknowledgement ameliorated lifetime PTSD to a small extent. A critical issue for policy makers should be to enhance safeguarding measures against CM exposure, not only in institutional contexts, but also more generally, given the link to PTSD.

Antecedentes: El maltrato infantil (MI), particularmente en contextos institucionales, puede incidir en el desarrollo del trastorno de estrés postraumático (TEPT). La investigación sugiere que los factores durante el MI (ej. gravedad, variedad, duración) y en el periodo posterior al MI (ej. eventos estresantes de la vida y reconocimiento social, es decir, el grado en que un individuo se siente validado y apoyado después de un evento traumático) pueden explicar en parte la heterogeneidad en el desarrollo del TEPT. Sin embargo, hay una falta de investigación sobre los correlatos a largo plazo del MI y los factores atenuantes, y solo se han realizado unos pocos estudios con personas mayores que han sobrevivido a la crianza institucional. Dicha investigación es relevante, dadas las asociaciones a largo plazo entre MI y el estado a mayor edad de muchos sobrevivientes.Objetivo: El presente estudio examinó el vínculo entre MI y TEPT en personas mayores con antecedentes de crianza institucional (grupo de riesgo; GR) y un grupo de control emparejado (GC). También se investigaron las diferencias en los eventos vitales estresantes y el reconocimiento social.Método: Los participantes fueron N = 116 en GR (edad promedio = 70,25 años, 41% mujeres) y N = 122 en GC (edad promedio = 70,71 años, 51% mujeres). Los datos se evaluaron mediante cuestionarios de auto-reporte y una entrevista clínica.Resultados: El GR reportó niveles más altos de exposición a MI. El TEPT durante la vida mostró una mayor asociación con el nivel de exposición a MI, en comparación con la crianza institucional. Los participantes con niveles más altos de MI reportaron más eventos vitales estresantes. Altos niveles de reconocimiento social mediaron la relación entre MI y TEPT en el GC.Conclusiones: La exposición a MI tuvo una asociación más fuerte con el TEPT que el historial de crianza institucional. En el GC, la percepción de reconocimiento social de los sobrevivientes mejoró en pequeña medida el TEPT durante la vida. Una cuestión fundamental para los responsables de la formulación de políticas debería ser mejorar las medidas de protección contra la exposición a MI, no solo en contextos institucionales, sino también de manera más general, dado el vínculo con el trastorno de estrés postraumático.

Intergenerational transmission of child maltreatment in South Australia, 1986-2017: a retrospective cohort study.

BACKGROUND: The extent of intergenerational transmission of child maltreatment is unclear due to methodological limitations in previous studies. In this study, we aimed to examine factors associated with intergenerational transmission of child maltreatment and quantify its extent in a population sample over a 30-year period in South Australia. METHODS: In this retrospective cohort study, we used linked administrative data from the South Australian Birth Registry to identify dyads of mothers and their children both born in South Australia between July 1, 1986, and June 30, 2017. Three child protection system (CPS) outcomes (any CPS involvement, substantiated maltreatment, and time spent in out-of-home care) were computed from data obtained from the South Australian Department for Child Protection. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for child CPS outcomes according to their mother's CPS exposure. FINDINGS: 38 556 unique mother-child dyads were included. 458 (2·0%) of 23 437 children whose mothers had no CPS involvement in childhood had a substantiated report of maltreatment and 127 (0·5%) spent time in out-of-home care. By comparison, 970 (22·1%) of 4382 children whose mothers experienced substantiated maltreatment in childhood had substantiated maltreatment and 469 (10·7%) spent time in out-of-home care. After adjusting for potential confounders, children of mothers with any CPS involvement in childhood had an increased risk of CPS contact compared with children whose mothers had no CPS involvement; this risk was greatest for children of mothers who had both substantiated maltreatment and spent time in out-of-home care (HR 6·25 [95% CI 5·59-6·98] for any CPS involvement, 13·69 [10·08-16·92] for substantiated maltreatment, and 25·78 [18·23-36·45] for any time in out-of-home care). Risks of child CPS outcomes were substantially increased for children of mothers who had a first CPS notification under the age of 1 year or who had any CPS notification at age 13-17 years. INTERPRETATION: Children are at high risk of maltreatment if their mother experienced maltreatment as a child. Assisting survivors of childhood maltreatment, particularly female survivors, provides a crucial intervention opportunity to help prevent further child abuse and neglect. FUNDING: Australian National Health and Medical Research Council; Channel 7 Children's Research Foundation.

Prevalence of Childhood Maltreatment and Posttraumatic Stress Symptoms Among Male Inmates in Iceland.

INTRODUCTION: Childhood maltreatment is highly correlated with adult criminal behavior, and the prevalence of childhood maltreatment within prison populations is high. Furthermore, studies have repeatedly shown a higher prevalence of posttraumatic stress disorder (PTSD) symptoms in samples of prisoners compared with the general public. PURPOSE AND METHODOLOGY: The aims of the current study were to determine the frequency of childhood maltreatment among male inmates in Iceland and the percentage of male inmates meeting screening criteria for PTSD. The Icelandic versions of the Childhood Trauma Questionnaire-Short Form and the PTSD Symptom Scale-Self-Report (PSS-SR) were used in the study. RESULTS: Results show a high prevalence of childhood maltreatment among the sample (N = 48), where 87% of participants reported having experienced at least one of the five categories listed (M = 2.33, SD = 1.68). Approximately 52% had experienced emotional abuse, 27% had experienced physical abuse, 48% had experienced sexual abuse, and over half reported experiencing neglect in their childhood. Two thirds of the participants were above the cutoff score for PTSD on the PTSD Symptom Scale-Self-Report, all of whom expressed a reduced quality of life and/or functional impairment because of their symptoms. DISCUSSION: The results indicate that most male inmates in Icelandic prisons were maltreated during their childhood and that many of them report severe posttraumatic stress symptoms. CONCLUSION: By integrating trauma-focused interventions into Iceland's Prison Service, mental health nurses and other mental health professionals have an opportunity to profoundly affect prisoners' functioning and quality of life, thereby potentially reducing the likelihood of recidivism for a large part of this population in the future.

Gene-environment correlations and causal effects of childhood maltreatment on physical and mental health: a genetically informed approach.

BACKGROUND: Childhood maltreatment is associated with poor mental and physical health. However, the mechanisms of gene-environment correlations and the potential causal effects of childhood maltreatment on health are unknown. Using genetics, we aimed to delineate the sources of gene-environment correlation for childhood maltreatment and the causal relationship between childhood maltreatment and health. METHODS: We did a genome-wide association study meta-analysis of childhood maltreatment using data from the UK Biobank (n=143 473), Psychiatric Genomics Consortium (n=26 290), Avon Longitudinal Study of Parents and Children (n=8346), Adolescent Brain Cognitive Development Study (n=5400), and Generation R (n=1905). We included individuals who had phenotypic and genetic data available. We investigated single nucleotide polymorphism heritability and genetic correlations among different subtypes, operationalisations, and reports of childhood maltreatment. Family-based and population-based polygenic score analyses were done to elucidate gene-environment correlation mechanisms. We used genetic correlation and Mendelian randomisation analyses to identify shared genetics and test causal relationships between childhood maltreatment and mental and physical health conditions. FINDINGS: Our meta-analysis of genome-wide association studies (N=185 414) identified 14 independent loci associated with childhood maltreatment (13 novel). We identified high genetic overlap (genetic correlations 0·24-1·00) among different maltreatment operationalisations, subtypes, and reporting methods. Within-family analyses provided some support for active and reactive gene-environment correlation but did not show the absence of passive gene-environment correlation. Robust Mendelian randomisation suggested a potential causal role of childhood maltreatment in depression (unidirectional), as well as both schizophrenia and ADHD (bidirectional), but not in physical health conditions (coronary artery disease, type 2 diabetes) or inflammation (C-reactive protein concentration). INTERPRETATION: Childhood maltreatment has a heritable component, with substantial genetic correlations among different operationalisations, subtypes, and retrospective and prospective reports of childhood maltreatment. Family-based analyses point to a role of active and reactive gene-environment correlation, with equivocal support for passive correlation. Mendelian randomisation supports a (primarily bidirectional) causal role of childhood maltreatment on mental health, but not on physical health conditions. Our study identifies research avenues to inform the prevention of childhood maltreatment and its long-term effects. FUNDING: Wellcome Trust, UK Medical Research Council, Horizon 2020, National Institute of Mental Health, and National Institute for Health Research Biomedical Research Centre.

Repeat induced abortion and adverse childhood experiences in Aquitaine, France: a cross-sectional survey.

OBJECTIVE: The aim of the study was to analyse the relationship between adverse childhood experiences (ACEs) and repeat induced abortion, with regard to the potential effects of social deprivation and intimate partner violence. METHODS: An observational cross-sectional survey was conducted across each of the 25 abortion centres in Aquitaine, France, from 15 June to 15 September 2009. The sample comprised 806 women >18 years who had requested an induced abortion. Data were collected through a self-reported anonymous questionnaire on ACEs and experience of previous abortion. The main outcome measure was the percentage of repeat induced abortions. RESULTS: Among the participants, 473 (58.7%) were having their first induced abortion and 333 (41.3%) had already had a previous induced abortion. The abortion rank (first, second, third or more) was inversely related to the proportion of women with no ACE exposure (28%, 20% and 9%, respectively) and positively related to the proportion of women with a high ACE exposure (17%, 27% and 32%, respectively). Compared with women with no ACE exposure who were having a first induced abortion, in those with high ACE exposure, the odds of a third or more request for abortion was high: adjusted odds ratio 7.73 (95% confidence interval 3.56, 16.77). CONCLUSION: We found a strong graded link between the extent of ACE exposure and the occurrence of repeat induced abortion.

Childhood Physical and Sexual Abuse as a Predictor of Reoffending: A Systematic Review.

Experiences of childhood trauma such as physical and sexual abuse are common among offender populations, and a trauma history is related to increases in the risk of criminal conduct. Previous reviews on the link between childhood trauma and reoffending are limited in scope as they only investigate adolescent populations. The aim of the current systematic review was to explore the association between childhood physical and sexual abuse and its prediction on actual reoffending rates in adult population(s). Four databases (PsycINFO, Web of Science, PubMed, and PILOTS) were searched, and the final included articles were quality assessed by two reviewers. A total of 3,151 studies were identified, and 13 met the a priori eligibility criteria. Most of the studies obtained high quality ratings. A narrative synthesis of the results suggests that childhood physical and sexual abuse are generally high among the prison population and tend to be even higher among those who reoffend. A substantial number of studies found that childhood physical and sexual abuse predict reoffending, and the majority of the studies found a positive direction for this association, albeit of a small magnitude. These findings suggest that prisons should consider trauma-informed assessment and rehabilitation of offenders.

Association of Adverse Childhood Experiences With Cardiovascular Disease Later in Life: A Review.

Importance: Adverse childhood experiences (ACEs) are potentially harmful events that occur during childhood, spanning neglect, physical or sexual abuse, parental separation, or death, among others. At least 50% of the US adult population has experienced 1 or more ACEs before the age of 18 years, but in clinical practice, ACEs remain underrecognized. Adults who have experienced ACEs are at increased risk of developing health risk behaviors and, ultimately, cardiovascular disease (CVD). This review summarizes the evidence regarding the association of ACEs with CVD and the accompanying diagnostic and therapeutic approaches in the adult population. Observations: ACEs are commonly classified into 3 domains: abuse (psychological, physical, or sexual), household dysfunction (eg, substance use by household members, mental illness, parental separation), and neglect. These experiences elicit chronic activation of the stress response system, leading to autonomic, neuroendocrine, and inflammatory dysfunction. The subsequent development of traditional risk factors, such as diabetes, hypertension, smoking, and obesity, results in the onset of CVD and premature mortality. Adults with 4 or more ACEs compared with those with none have a more than 2-fold higher risk of developing CVD and an almost 2-fold higher risk of premature mortality. Conclusions and Relevance: Identifying methods of mitigating the health consequences of ACEs may lead to better cardiovascular outcomes. Inquiry into ACE exposure during clinical encounters and subsequent referral to psychological services when appropriate may be helpful, but strategies aimed at CVD prevention via management of ACEs in adults continue to lack adequate evidence.

Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature.

BACKGROUND: Child sexual abuse is related to many negative outcomes but less known is the effect on pregnancy and childbirth. OBJECTIVE: This review critically examined the literature on the occurrence of child sexual abuse and outcomes associated with this abuse during pregnancy and childbirth. METHODS: Five databases were searched over 50 years using an iterative approach and the terms pregnancy, sexual abuse/assault, childbirth/labour, identifying 49 studies. RESULTS: The prevalence of child sexual abuse in pregnant women ranged from 2.63% to 37.25 with certain characteristics more common with a higher (e.g., specific questions, low income) or lower (broad questions, higher education) prevalence. Compared to women with no history of abuse, child sexual abuse survivors may have more concerns with their care, greater health complaints, fear childbirth and have difficulties with delivery. They also had a higher likelihood of PTSD symptomology and anxiety, consumed more harmful substances (e.g., alcohol, cigarettes, and drugs) and had greater concerns with their appearance, poorer health, sleep and may also have a higher risk of re-victimisation. CONCLUSIONS: The balance of evidence suggests that compared to non-abused women, women with a child abuse history have more adverse experiences with pregnancy, childbirth, and care, with their abuse history, likely contributes to harmful behaviours and psychopathology. However, variability in operationalisation and measurement of abuse may contribute to these findings so tentative conclusions are drawn. Future research should examine the generalisability of the findings (relating to scale limitations) and recommendations for screening (e.g., sensitive items, scoring). Clinical implications of the findings point to the need for early identification of women with a child abuse history as such women require trauma-sensitive care and consideration. A useful tool is the Pregnancy-related Anxiety Scale which provides insights into specific areas of concern.

Psychiatric and Forensic Differences Between Men Charged with Sex Offences and Men Charged with Other Offences.

Studies on differences between individuals convicted of sexual offences and nonsexual offences are sparse and there is an on-going debate as to whether sexual offenders differ from other offenders. The primary aim of this study was to determine demographic characteristics, prevalence of mental disorders, alcohol and drug use at the time of the crime and the criminal responsibility of individuals charged with sexual offences, compared to nonsexual crimes, with the aim of bringing awareness to the similarities and differences between men charged with sex offences and those charged with other crimes. This is a single-institution retrospective study of subjects charged with sexual offences and sent for institutional psychiatric evaluation to a Forensic Psychiatric Centre in an urban, academic, tertiary-care center. The control group consisted of individuals charged with nonsexual offences referred to the same center. Results showed significant differences between individuals charged with sexual offences and nonsexual offences. Men charged with sex offences more frequently committed their crimes alone and victimized children equally as often as adults. They also less frequently pleaded guilty in court. They were more likely to be abused in childhood and more often had antisocial personality disorder and paraphilias and less often substance-related disorders. The majority were considered criminally responsible. Our results show that sex offenders are different from nonsex offenders in many characteristics of their personal history, offence characteristics and forensic evaluations and these particular differences warrant different approaches to the prevention of future re-offending, compared to nonsex offenders.

Childhood maltreatment and lead levels in middle adulthood: A prospective examination of the roles of individual socio-economic and neighborhood characteristics.

BACKGROUND: Lead is a common environmental hazard because of its past use as an additive to gasoline and household paint. Some evidence suggests that children with histories of child abuse and neglect are at elevated risk for residence in communities and households with less desirable characteristics and high levels of exposure to environmental hazards and toxins. OBJECTIVES: To understand whether childhood maltreatment leads to higher levels of household dust lead and blood lead in adulthood and the extent to which characteristics of a person's physical environment or individual level socio-economic status (SES) (based on unemployment, poverty, and receipt of public assistance) contribute to understanding the relationship. METHODS: A large prospective cohort design study in which abused and neglected children (ages 0-11) were matched with non-maltreated children and assessed in adulthood. Objective and subjective neighborhood characteristics were assessed at approximate age 40 and household dust lead (cleaned and less often cleaned) and blood lead levels were measured at age 41. Blood was collected through venipuncture by a registered nurse as part of a medical status exam. RESULTS: Childhood maltreatment predicted higher levels of dust lead in less often cleaned household places, residence in worse neighborhoods defined by objective (census tract data) and subjective (reports of physical disorder and lack of social cohesion and control), and higher levels of poverty, receiving public assistance, and unemployment. Only objective neighborhood characteristics mediated the relationship between childhood maltreatment and dust lead level in adulthood. There were also significant paths from objective neighborhood disadvantage and individual level SES to higher levels of blood lead. DISCUSSION: Thirty years after their childhood experiences, individuals with documented histories of childhood maltreatment are at higher risk for living in environments as adults with elevated lead levels that may impact other aspects of their lives and compromise their health.

Quality of Parental Care and Traumatic Experiences in Childhood Related to Schizophrenic Disorders.

In recent times, an increasing interest in the role of childhood adversities in schizophrenia can be seen. In this study, 37 schizophrenic patients were compared with 25 individuals from the general population with regard to the quality of parental care and traumatic experiences in childhood. Two self-report scales for retrospective measurement of these variables were used that differentiate between maternal and paternal rejection, emotional warmth and control on the one hand, and trauma subtypes on the other. The schizophrenic patients scored lower regarding both parents' emotional warmth and higher regarding emotional and physical abuse and neglect. Group membership was correctly predicted with these childhood variables in 83% of cases, with the mother's emotional warmth being the best predictor. The findings underline the relevance of childhood adversities in schizophrenic diseases in adulthood, with special emphasis on the role of emotional acceptance from the primary caregiver.