Lifetime Physical and Sexual Abuse,Substance Abuse,Depression, and Suicide Attempts Among Native American Women

Although there is preliminary evidence that violence against women and children may be particularly prevalent in some Native American communities, associations between abuse and substance abuse, mental health problems, and suicide attempts have rarely been studied in this population. This study examined lifetime and current physical and sexual abuse among 30 Native American women. Nearly half had experienced physical and/or sexual abuse as children, over half were sexually abused at some time in their lives, and over three-fourths were abused by a partner. All but four women (87%) had experience physical or sexual abuse in their lifetime. Significant relationships were found among childhood abuse, substance abuse, and adult revictimization, and among cumulative lifetime abuse events, substance abuse, and depression. Further research is needed to examine abuse and relationships between abuse and health sequelae in Native American populations. An accelerated public health and community response is needed to address abuse issues in this community.     

Lifetime physical and sexual abuse,substance abuse,depression, and suicide attempts among Native American women

Although there is preliminary evidence that violence against women and children may be particularly prevalent in some Native American communities, associations between abuse and substance abuse, mental health problems, and suicide attempts have rarely been studied in this population. This study examined lifetime and current physical and sexual abuse among 30 Native American women. Nearly half had experienced physical and/or sexual abuse as children, over half were sexually abused at some time in their lives, and over three-fourths were abused by a partner. All but four women (87%) had experience physical or sexual abuse in their lifetime. Significant relationships were found among childhood abuse, substance abuse, and adult revictimization, and among cumulative lifetime abuse events, substance abuse, and depression. Further research is needed to examine abuse and relationships between abuse and health sequelae in Native American populations. An accelerated public health and community response is needed to address abuse issues in this community.     

Oklahoma Nurses Association 2005 House of Delegates resolution. Intimate partner violence assessment, intervention and documentation

Intimate Partner Violence (IPV), physical and/or sexual assault of a spouse or intimate partner, has been highly associated with severe health problems such as chronic pain, recurring central nervous system symptoms, injuries, chronic disabilities, gastrointestinal disorders, sexually transmitted diseases, gynecological disorders, unintended pregnancies, depression, substance abuse, and post traumatic stress disorder. Statistically, 40-50% of women in IPV experience both physical and sexual assault. IPV is also associated with 3-13% of pregnancies, posing a threat to health and risk of death for the mother or fetus or both from trauma. Further, 40-60% of female murders in North America are committed by intimate partners. Oklahoma ranks 13th in the nation for women murdered by men in single victim, single offender incidents. IPV associated mortality also includes suicide of women with chronic depression related to violence. Women involved with IPV utilize health care providers and the health care system 3 times more frequently than non-battered women' and generate 92% more health plan costs per year as compared to non-battered women. There is sufficient research concurrence to demonstrate a significant number of women in Oklahoma, the nation and world have severe short and long term physical and mental health effects from IPV. Some victims of IPV may turn to health care professionals for help while other victims are fearful of asking for such assistance. Therefore, it is critical that nurses, as the largest group of health care providers and often the first to come in contact with a victim of IPV, do not miss an opportunity for accurate assessment, appropriate intervention and documentation of IPV in order to provide for a safe, timely and healthy resolution.     

Population-based study of police-reported sexual assault in Baltimore, Maryland

OBJECTIVE: To document the population-based incidence of sexual assault in Baltimore, Md, victims' alcohol/drug use, and pre-event circumstances. METHODS: Between 1997 and 1999, the city's sexual assault treatment center treated 1,038 victims (age>or=13 years). Data were extracted from forensic narratives. Analysis was restricted to frequency tables and bar graphs. Incidence was calculated based on 1998 population figures. RESULTS: The incidence of sexual assault among females aged 13 years or older was 117 per 100,000. Seventy percent of patients were less than 30 years old. Fifty-three percent tested positive for alcohol/drugs. Two thirds sustained physical or genital injury; 30% sustained both. The most common pre-event circumstances were walking/being followed (27%) and visiting a friend's home (24%). CONCLUSION: This study revealed a high prevalence of physical/genital injury, supporting the call for an injury severity scale for sexual assault and for increased substance abuse counseling and educational/health resources to mitigate sexual assault and offer meaningful response when such crimes occur.     

Health problems of gay and bisexual men.

Significant mental and physical morbidity occurs among gay and bisexual men because health care providers are often unaware of their actual or potential health concerns. Mental health problems include anxiety, depression, suicide, and both alcohol and substance abuse. Physical health concerns include HIV disease, hepatitis, and other sexually transmitted diseases, as well as an increased risk of heart disease and certain cancers. Health care professionals, who are clinically competent in the care of men who have sex with men, have the opportunity to reduce the risk of disease, while providing unbiased, quality care which recognizes the unique problems of this population of men.     

INTIMATE PARTNER SEXUAL ASSAULT AGAINST WOMEN AND ASSOCIATED VICTIM SUBSTANCE USE,SUICIDALITY, AND RISK FACTORS FOR FEMICIDE

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p = .002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.     

Intimate partner sexual assault against women and associated victim substance use, suicidality, and risk factors for femicide

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p=.002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.     

Childhood abuse and cannabis use among adolescents with mental health needs in Ontario,Canada

Objective: The purpose of this study was to examine the association between childhood abuse (emotional, physical and sexual abuse) and cannabis use among adolescents with mental health needs. Methods: Data on 3681 adolescent in-patients, 12–18 years old, were obtained from the Resident Assessment Instrument for Mental Health (RAI-MH). Using logistic regression, we estimated the odds of using cannabis by adolescents who experienced childhood abuse after controlling for age, gender, Aboriginal origin, problems with addiction, history of criminal justice involvement and symptoms of depression and mania. Results: There were 1844 adolescents, representing 50.1%, who reported using cannabis within the last 12 months. Controlling for demographic and patient characteristics, we found that cannabis use in the past year was strongly associated with childhood sexual and physical abuse. Compared to non-abused females, females who experienced sexual and physical abuse were more likely to have used cannabis. For males, the experience of physical abuse was marginally associated with cannabis use. Conclusion: The current data demonstrate the strong association between childhood sexual and physical abuse and cannabis use with a particularly strong association for females. Efforts aimed at treating cannabis use in adolescents who present with mental health needs should also consider their abuse histories.     

Sexual harassment and assault experienced by reservists during military service: prevalence and health correlates

The current investigation identified the gender-specific prevalence of sexual harassment and assault experienced during U.S. military service and the negative mental and physical health correlates of these experiences in a sample of former reservists. We surveyed a stratified random sample of 3,946 former reservists about their experiences during military service and their current health, including depression, posttraumatic stress disorder, somatic symptoms, and medical conditions. Prevalence estimates and confidence intervals of sexual harassment and assault were calculated. A series of logistic regressions identified associations with health symptoms and conditions. Both men and women had a substantial prevalence of military sexual harassment and assault. As expected, higher proportions of female reservists reported sexual harassment (60.0% vs 27.2% for males) and sexual assault (13.1% vs 1.6% for males). For both men and women, these experiences were associated with deleterious mental and physical health conditions, with sexual assault demonstrating stronger associations than other types of sexual harassment in most cases. This investigation is the first to document high instances of these experiences among reservists. These data provide further evidence that experiences of sexual harassment and assault during military service have significant implications for the healthcare needs of military veterans.     

Schizophrenia and comorbid substance abuse

Research suggests that nearly half of all patients with schizophrenia concurrently abuse substances. However, despite the prevalence of substance abuse among persons with schizophrenia, the effective treatment of these comorbid conditions has eluded mental health professionals for decades. Apart from the obvious problems associated with schizophrenia and alcohol or drug abuse, schizophrenic persons who abuse substances also experience increased rates of depression, suicide, homelessness, unemployment, and illegal activity. These diverse problems necessitate interventions that address the special needs of this population. Research indicates that the use of atypical antipsychotic agents with persons who have a dual diagnosis may prove to be efficacious with treatment, overall. This article reviews the current literature pertaining to the potential expanded therapeutic benefits of enhanced efficacy of atypical antipsychotic medication in association with decreased substance use and craving.     

Are mental health staff getting better at asking about abuse and neglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as ‘schizophrenia’, tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.     

Assessing the risk of suicide at triage

Mental health related presentations to Australian emergency departments are steadily increasing. There is a growing incidence of depression, substance abuse, and other mental illnesses in the Australian population. Mental health problems will contribute 15% of the total world disease burden by 2020. Triage nurses are pivotal to the early detection and management of mental health problems.

The rapid assessment of mental health presentations at triage requires skill, knowledge, experience and confidence. One of the more complex aspects of triage is suicide risk assessment.     

Military sexual trauma: a review of prevalence and associated health consequences in veterans

This article reviews the literature documenting the prevalence of military sexual trauma (MST) and its associated mental and physical health consequences. Existing research indicates that prevalence rates of MST vary depending on method of assessment, definition of MST used, and type of sample. Risk factors for MST have been identified as including age, enlisted rank, negative home life, and previous assault history. MST has been associated with increased screening rates of depression and alcohol abuse, in addition to significantly increased odds of meeting criteria for post-traumatic stress disorder. In addition, MST has been associated with reporting increased number of current physical symptoms, impaired health status, and more chronic health problems in veterans. Available research on health care utilization and MST is also discussed. Researchers are encouraged to utilize standardized definitions of MST, employ standardized assessment methodology, and utilize more male veterans in future research. Policy and practice implications are discussed.     

Depression and suicide assessment

Depressed patients and suicidal patients are common Emergency Department patrons with the potential for serious morbidity or death. Dysphoric mood, vegetative symptoms, and negative perceptions of oneself, the environment, and the future are characteristic of depression. Often, the patient is unaware of the depression and presents with a variety of somatic complaints, chronic fatigue, or pain syndromes. In these instances, the physician must consider the diagnosis of depression and ask the patient about any history of depressive symptoms. In all depressed patients, a careful history and physical examination are needed to identify any drugs or concurrent medical illnesses which might cause or exacerbate the depression. If depression is suspected or if the patient presents after a suicide attempt, then a thorough evaluation of suicide potential is mandatory. Several risk factors for completed suicide exist. Male sex, age under 19 or over 45, few social supports, and a history of previous suicide attempts are all factors associated with increased suicide rates. Concurrent chronic or severe medical illnesses and certain psychiatric illnesses, notably depression, schizophrenia, and substance abuse, also increase an individual's risk for suicide. The method of suicide attempt and the chance for rescue must also be considered when determining risk as well as the presence of an organized plan. Acute psychosis in the suicidal patient is an ominous finding and these patients should be admitted to the hospital. The physician must adopt an empathetic and nonjudgmental attitude when caring for potentially suicidal patients. Disposition can be determined after careful evaluation of risk factors, circumstances surrounding the attempt, and the patient's current feelings. Consultation with a psychiatrist or another mental health professional is desirable for any potentially suicidal patient. Many such patients can be safely treated as outpatients with proper referral; certain high-risk individuals will need to be admitted to the hospital. The decision to either hospitalize or discharge can be difficult and the emergency physician should admit the patient if doubt exists.     

Comparison of psychosocial and behavioral profiles of victimized and nonvictimized homeless women and their intimate partners.

The purpose of this study was to examine the psychosocial, behavioral, and environmental profiles of homeless women, both those with and without a history of victimization, and their intimate partners. Five hundred seven homeless women and their intimate partners participated in the study. Thirty-nine percent of the women reported being physically and/or sexually assaulted as adults. Controlling for potential confounders, victimized women were more likely than others to have a history of childhood sexual and physical abuse, lifetime substance use, greater mental health symptomatology, and current risky sexual activity. Thus, homeless women with mental health and substance abuse problems ought to be screened for violent experiences and encouraged to obtain treatment appropriate to their problems to reduce their ongoing risk of victimization.     

Family Acceptance in Adolescence and the Health of LGBT Young Adults

ISSUE: The role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established. METHODS: A quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents' sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults (N= 245). FINDINGS: Family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors. CONCLUSIONS: Family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.     

Intimate partner violence and mental health symptoms in African American female ED patients

BackgroundIntimate partner violence (IPV) victims often seek care in the ED, whether for an injury from abuse or other sequelae such as mental health symptoms.ObjectivesThe objective of the study was to assess whether depressive symptoms, posttraumatic stress disorder (PTSD), and suicidality were associated with physical, sexual, or emotional IPV in African American female ED patients and to determine if experiencing multiple types of abuse was associated with increased mental health symptoms.MethodsAll eligible African American female patients were approached in the ED waiting room during study periods. Patients participated in the screening process via a computer kiosk. Questions regarding IPV and mental health symptoms were asked using validated tools.ResultsIn this prospective cohort, 569 participated and 36% of those in a relationship in the past year (n = 461) disclosed that there were victims of IPV in the past year. In the past year, 22% experienced recent physical abuse, 9% recent sexual abuse, and 32% recent emotional abuse. A Pearson correlation was conducted and showed that all mental health symptoms were positively correlated with each type of IPV and each type of mental health symptom category. Mental health symptoms increased significantly with amount of abuse: depression (odds ratio [OR], 5.9 for 3 types of abuse), PTSD (OR, 9.4 for 3), and suicidality (OR, 17.5 for 3).ConclusionsEmotional, sexual, and physical IPV were significantly associated with mental health symptoms. Each type of abuse was independently associated with depression, suicidality, and PTSD. Experiencing more than 1 type of abuse was also correlated with increased mental health symptoms.     

Childhood Abuse and Adulthood IPV,Depression, and High-Risk Drinking in Latinas

Little is known about relationships between child maltreatment and adulthood intimate partner violence (IPV), depression, and risky drinking in Latinas. 548 Latinas in a sexual health randomized control trial (RCT) self-reported childhood physical, sexual, and emotional abuse, IPV, depression, and risky drinking. Childhood abuse was related to adulthood IPV, OR?=?1.27, depression, OR?=?2.02, and high-risk drinking, OR?=?2.16. Childhood emotional abuse was linked to depression, OR?=?2.19; childhood physical abuse to risky drinking, OR?=?2.62; and childhood sexual abuse to depression, OR?=?2.78 and risky drinking, OR?=?2.38. Results may inform prevention/intervention efforts for mental health nurses.     

Predictors of eating attitudes and behaviors among gay Hispanic men

Gay men are a vulnerable population at risk for a number of health disparities, but little is known about eating disorders among gay Hispanic men. The purpose of this study was to examine the relationship of eating attitudes and behaviors with alcohol abuse, body image, depression, self-esteem, and sexual behaviors to determine predictors of eating attitudes and behaviors in a community sample of gay Hispanic men. Significant numbers of the participants were at risk for eating disorders (13%), alcohol abuse (18%), body image disturbance (29%), depression (25%), low self-esteem (12%), and high-risk sexual behaviors (34%). Alcohol abuse, body image, depression, self-esteem, and sexual behaviors were significant predictors of eating attitudes and behaviors and accounted for 38% of the variance in eating attitudes and behaviors. Nurses providing care to this population of gay men must be aware of this cluster of related mental health conditions that are experienced by these men. Addressing and treating these health conditions as a group of related mental health conditions are necessary. More research is needed to further explore this cluster of health issues among gay Hispanic men.