The Impact of Substance Use, Sexual Trauma, and Intimate Partner Violence on Sexual Risk Intervention Outcomes in Couples: A Randomized Trial

Background

Few HIV prevention interventions focus on sexual risk reduction as mutual process determined by couple members, though risk behaviors are inter-dependent.

Purpose

This trial examined the impact of substance use, history of sexual trauma, and intimate partner violence on sexual risk associated with participation in a risk reduction intervention.

Methods

HIV seroconcordant and serodiscordant multicultural couples in Miami, Florida (n?=?216) were randomized to group (n?=?112) or individual (n?=?104) couple-based interventions.

Results

Group intervention participants increased condom use in couples in which women had a history of sexual trauma [F(2,221)?=?3.39, p?=?0.036] and by partners of alcohol users. History of sexual trauma was a determinant of conflict resolution, predicting negative communication and intimate partner violence.

Conclusions

Results emphasize the need for group sexual risk reduction interventions targeting sexual trauma, partner violence, and substance use among HIV seroconcordant and serodiscordant couples.     

The interplay of psychosis and victimisation across the life course: a prospective study in the general population

Purpose

Psychosis has been associated with adult victimisation. However, it remains unclear whether psychosis predicts incident adult victimisation, or whether adult victimisation predicts incident psychosis. Furthermore, a moderating effect of childhood victimisation on the association between psychosis and adult victimisation has not been investigated.

Methods

The longitudinal association between baseline psychotic experiences and six-year incidence of adult victimisation was assessed in a prospective general population cohort of 6646 adults using logistic regression analysis. The association between baseline adult victimisation and six-year incidence of psychotic experiences was examined as well. Furthermore, the moderating effect of childhood victimisation on these bidirectional associations was analysed.

Results

Psychotic experiences and childhood victimisation were both associated with an increased risk of incident adult victimisation. However, this was through competing pathways, as suggested by a negative interaction between psychotic experiences and childhood victimisation. Baseline adult victimisation and childhood victimisation both independently increased the risk of incident psychotic experiences, but there was no interaction between adult victimisation and childhood victimisation.

Conclusions

Psychosis and victimisation are interconnected throughout the life course. Childhood victimisation is connected to psychosis through two pathways: one direct and one indirect through adult victimisation. In individuals without childhood victimisation, psychosis and adult victimisation bidirectionally impact on each other.

     

Childhood sexual trauma, cannabis use and psychosis: statistically controlling for pre-trauma psychosis and psychopathology

Purpose

Recurring evidence seems to suggest that sexual trauma in childhood may moderate associations between cannabis consumption and psychosis. It has also been suggested, however, that poor childhood mental health may explain linkages between these phenomena.

Methods

The current study, using data from the National Comorbidity Survey-Replication (N = 2,355), sought to revaluate the stability of the childhood trauma–cannabis interaction while statistically controlling for pre-trauma psychotic experiences and psychopathology in childhood.

Results

Psychotic experiences that occurred before childhood sexual trauma significantly influenced adult psychosis symptomatology (psychosis pre-rape B = 0.10; psychosis pre-sexual assault B = 0.23). Social phobia (B = 0.07) also conferred risk for adult psychosis. Pre-trauma childhood psychopathology, however, did not account for the interaction between childhood sexual trauma and cannabis consumption in a multivariate model. Childhood experiences of rape (B = 0.15) and an interaction between cannabis use and childhood sexual assault (B = 0.05) independently contributed to adult psychosis. Cannabis use conferred no independent risk.

Conclusions

With specific regard to research methodology, the current findings offer further justification for the inclusion of childhood sexual trauma in analyses investigating associations between cannabis use and psychosis.     

Childhood Sexual Abuse and Sociodemographic Factors Prospectively Associated with Intimate Partner Violence Perpetration Among South African Heterosexual Men

Background

Intimate partner violence directed at women by men continues to be a global concern. However, little is known about the factors associated with perpetrating intimate partner violence among heterosexual men.

Purpose

History of childhood sexual abuse and other sociodemographic variables were examined as potential factors associated with severe intimate partner violence perpetration toward women in a sample of heterosexual men in South Africa.

Methods

Longitudinal logistic generalized estimating equations examined associations of childhood sexual abuse and sociodemographic variables at baseline with intimate partner violence perpetration at subsequent time points.

Results

Among participants with a steady female partner, 21.81 % (190/ 871) reported perpetrating intimate partner violence in the past year at baseline. Having a history of childhood sexual abuse (p < .001), binge drinking (p = .002), being employed (p = .050), and more difficulty controlling sexual impulses in order to use a condom (p = .006) at baseline were associated with self-reported intimate partner violence perpetration in the past year at subsequent time points.

Conclusions

With high levels of recent severe physical and/or sexual intimate partner violence perpetration in South Africa, comprehensive interventions are urgently needed. To more fully address gender-based violence, it is important to address associated factors, including exposure to childhood sexual abuse that could impact behavior later in life and that have long-lasting and deleterious effects on men and their female partners.

     

Trauma exposure and PTSD among older adolescents in foster care

Purpose

Youth in foster care represent a highly traumatized population. However, trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the DSM-IV. The current study aims to fill this gap by reporting the prevalence of exposure to specific types of traumatic events for a large sample of youth with foster care experience. The study also reports the likelihood of lifetime PTSD diagnoses associated with each specific type of trauma.

Method

Data are from a longitudinal panel study of 732 adolescents aged 17 and 18 who were in foster care. Lifetime trauma exposure and PTSD diagnosis were assessed using the Composite International Diagnostic Interview. Statistical comparisons were made using logistic regressions.

Results

The majority of respondents had experienced at least one trauma in their lifetime. While overall trauma prevalence did not differ by gender, males were more likely to experience interpersonal violence and environmental trauma, while females were more likely to experience sexual trauma. Caucasian participants reported higher rates of trauma exposure than African-American participants did. The types of trauma associated with the highest probability of a lifetime PTSD diagnosis were rape, being tortured or a victim of terrorists, and molestation.

Conclusions

Youth in foster care are a highly traumatized population and meet diagnostic criteria for PTSD at higher rates than general youth populations. The ongoing impact of trauma may be particularly problematic for these young people given their abrupt transition to independence.     

A model of psychosis and its relationship with impairment

Purpose

Some studies suggest that positive symptoms of psychosis—clinical and sub-clinical alike—reflect a single, continuously distributed dimension in the population. It is unknown, however, whether such a spectrum of positive psychotic experiences is non-linearly related to outcomes such as daily functioning. This work aims to characterize the relationship between positive psychosis and impairment.

Methods

Data from the Office of National Statistics National Psychiatric Morbidity Surveys of Great Britain were used to establish measurement models of psychosis and impairment. Competing linear and nonlinear models of the relationship between the two latent variables were evaluated using mixture structural equation models.

Results

Positive psychosis is best modeled by a continuous, normal distribution. Increases in positive psychosis correlate with roughly linear increases in impairment.

Conclusions

Positive psychotic symptoms occur throughout the population without a discrete, pathological threshold. Functional deficits are linearly associated with the psychosis at all points along the continuum, and a significant portion of the population experiences subclinical psychosis.     

Violent typologies among women inpatients with severe mental illness

Purpose

Extant severe mental illness (SMI) and physical violence literature focus disproportionately on community-based men samples. To address this empirical imbalance, the current study explored violence towards others and oneself among women inpatients with SMI. As those with SMI are more likely to be victims than perpetrators of violence, victimisation was also an important factor assessed in this study.

Methods

The study used a quantitative within-subject cross-sectional design. Data were extracted from 5675 inpatient women cases between 2009 and 2013.

Results

Women with a manic disorder (without psychotic features) were 4.5 times, whilst those with psychotic disorders were 2 times, more likely to be physically violent to others compared to those with major mood disorders. Conversely, women with a major mood disorders were 4.8 times and 7.5 times more likely to engage in violence towards oneself (deliberate self-harm), compared to those with psychotic disorder and manic disorders, respectively. The past victimisation increased the likelihood of later physical violence.

Conclusion

The data illuminate differential risk factors among women inpatients with SMI that may help predict violence occurring towards others and oneself and allow gender comparisons with the established literature.

     

Modelling the emergence of hallucinations: early acquired vulnerabilities, proximal life stressors and maladaptive psychological processes

Background

The study aimed to expand upon existing findings on the vulnerability to psychosis by examining synergistic models of hallucination emergence. Hypothesised vulnerability factors were separated into three stages of vulnerability; early acquired and enduring vulnerabilities (heredity, childhood trauma, early cannabis use), proximal life stressors (life hassles) and psychological appraisals/coping (metacognitions/experiential avoidance).

Methods

Participants were recruited to a non-clinical sample (N?=?133) and a clinical sample of psychosis patients (N?=?100).

Results

Path analyses in the non-clinical sample indicated that experiences of childhood emotional trauma, in combination with subsequent experiences of life hassles, best predicted vulnerability to both hallucinations in general and auditory hallucinations specifically. This pathway was partially mediated by negative metacognitions. The models were then replicated in the clinical sample, with two notable differences: (1) childhood sexual trauma replaced childhood emotional trauma as the best enduring predictor in the clinical model. (2) Experiential avoidance replaced metacognitions as the best cognitive predictor of hallucinations.

Conclusions

The study’s findings highlighted how vulnerability to hallucinations can occur developmentally across time, with early acquired vulnerability factors, combining additively with more proximal day-to-day factors and cognitive style, to propel a person further towards the formation of hallucinations.     

Mental health consequences of intimate partner violence in Vhembe district,South Africa

Objective

The aim of this study was to assess the contributions of different forms of intimate partner violence (physical violence, sexual violence, psychological abuse, and stalking) on symptoms of posttraumatic stress disorder (PTSD) and depression.

Methods

In all 268 women (18 years and older) consecutively receiving a protection order in the Vhembe district in South Africa were assessed by an external interviewer. Hierarchical regressions tested the unique effects of different types of intimate partner violence on PTSD and depression.

Results

In terms of PTSD symptom severity, more than half (51.9%) of the sample reported severe PTSD and 66.4% reported severe depression symptoms. Two types of intimate partner violence (physical and sexual) were significantly associated with PTSD symptoms, while only psychological violence was moderately correlated with depression symptoms. Physical abuse contributed to the prediction of PTSD and psychological abuse to depression.

Conclusions

A significant number of women with protection orders suffer from PTSD and depression. The results confirm a relationship between severity of intimate partner violence and mental health problems (PTSD and depression). Assessment of intimate partner violence should incorporate the multiple dimensions that have been identified as contributing to poor mental health.     

Lifelong robbery victimisation and mental disorders at age 18 years: Brazilian population-based study

Purpose

Urban violence is a major problem in Brazil and may contribute to mental disorders among victims. The aim of this study was to assess the association between robbery victimisation and mental health disorders in late adolescence.

Methods

At age 18 years, 4106 participants in the 1993 Pelotas Birth Cohort Study were assessed. A questionnaire about history of robbery victimisation was administered, the Self-Report Questionnaire was used to screen for common mental disorders, and the Mini International Neuropsychiatric Interview was used to assess major depressive disorder and generalised anxiety disorder. Cross-sectional prevalence ratios between lifetime robbery victimisation and mental disorders were estimated using Poisson regression with robust standard errors, adjusting for socioeconomic variables measured at birth and violence in the home and maltreatment measured at age 15.

Results

There was a dose–response relationship between frequency of lifetime robberies and risk of mental disorders. Adolescents who had been robbed three or more times had twice the risk (PR 2.04; 95% CI 1.64–2.56) for common mental disorders, over four times the risk for depression (PR 4.59; 95% CI 2.60–8.12), and twice the risk for anxiety (PR 1.93; 95% CI 1.06–3.50), compared with non-victims, adjusting for covariates. Experiencing frequent robberies had greater impact on common mental disorders than experiencing an armed robbery. Population attributable fractions with regard to robbery were 9% for common mental disorders, 13% for depression, and 8% for anxiety.

Conclusions

Robberies are associated with common mental disorders in late adolescence, independently of violence between family members. Reducing urban violence could significantly help in preventing common mental illnesses.

     

Systematic review of mental health disorders and intimate partner violence victimisation among military populations

Purpose

There is growing awareness of the problem of intimate partner violence (IPV) among military populations. IPV victimisation has been shown to be associated with mental disorder. A better understanding of the link between IPV and mental disorder is needed to inform service development to meet the needs of military families. We aimed to systematically review the literature on the association between IPV victimisation and mental health disorders among military personnel.

Methods

Searches of four electronic databases (Embase, Medline, PsycINFO, and Web of Science) were supplemented by reference list screening. Heterogeneity among studies precluded a meta-analysis.

Results

Thirteen studies were included. There was stronger evidence for an association between IPV and depression/alcohol problems than between IPV and PTSD. An association between IPV and mental health problems was more frequently found among veterans compared to active duty personnel. However, the link between IPV and alcohol misuse was more consistently found among active duty samples. Finally, among active duty personnel psychological IPV was more consistently associated with depression/alcohol problems than physical/sexual IPV. The review highlighted the lack of research on male IPV victimisation in the military.

Conclusions

There is evidence that the burden of mental health need may be significant among military personnel who are victims of IPV. The influence of attitudes towards gender in the military on research in this area is discussed. Further research is needed to inform development of services and policy to reduce IPV victimisation and the mental health consequences among military personnel.

     

Girls get by with a little help from their friends: gender differences in protective effects of social support for psychotic phenomena amongst poly-victimised adolescents

Purpose

To investigate whether social support is protective for psychotic experiences similarly among poly-victimised adolescent girls and boys.

Methods

We utilised data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative sample of 2232 UK-born twins. Participants were privately interviewed at age 18 about victimisation, psychotic experiences, and social support during adolescence.

Results

Perceived social support (overall and from friends) was found to be protective against psychotic experiences amongst poly-victimised adolescent girls, but not boys. Though boys were similarly protected by family support.

Conclusions

Social support-focused interventions targeting psychotic phenomena amongst poly-victimised adolescents may be more effective for girls.

     

A UK population-based study of the relationship between mental disorder and victimisation

Purpose

To establish the prevalence of victimisation in a UK population-based sample and to investigate the association between mental disorder and victimisation in both cross-sectional and prospective manner, whilst adjusting for potential confounds.

Methods

Data from the National Child Development Study (NCDS) were used to examine criminal victimisation, violent victimisation, and mental disorder at age 46?yerars, and also to measure history of mental disorder, when cohort members were aged 23, 33 and 42?years. Variables considered to be potential confounders or mediators of the association, including socio-economic status, family income, financial strain, education, housing ownership status, heavy drinking and gender, all measured at age 46?years, were considered in multivariate analyses.

Results

The prevalence of criminal victimisation amongst cohort members in the 12?months preceding interview was 15%; 2.2% of the participants reported experiencing violent victimisation in the past year. Mental disorder at age 46 was significantly associated with criminal and violent victimisation, even after adjusting for potential confounds. A prior history of mental disorder was found to be a robust predictor of criminal and violent victimisation.

Conclusions

This study provides evidence that those with a mental disorder are at elevated risk of victimisation, including violent victimisation. That such an association might reflect an underlying causal relationship is further supported by the confirmation that the association holds true when mental disorder is measured well before the assessment of victimisation risk, and that it persists despite adjustment for a number of potential confounding factors.     

Determinants of the development of post-traumatic stress disorder,in the general population

Purpose

To assess (1) the lifetime prevalence of exposure both to trauma and post-traumatic stress disorder (PTSD); (2) the risk of PTSD by type of trauma; and (3) the determinants of the development of PTSD in the community.

Methods

The Diagnostic Interview for Genetic Studies was administered to a random sample of an urban area (N = 3,691).

Results

(1) The lifetime prevalence estimates of exposure to trauma and PTSD were 21.0 and 5.0 %; respectively, with a twice as high prevalence of PTSD in women compared to men despite a similar likelihood of exposure in the two sexes; (2) Sexual abuse was the trauma involving the highest risk of PTSD; (3) The risk of PTSD was most strongly associated with sexual abuse followed by preexisting bipolar disorder, alcohol dependence, antisocial personality, childhood separation anxiety disorder, being victim of crime, witnessing violence, Neuroticism and Problem-focused coping strategies. After adjustment for these characteristics, female sex was no longer found to be significantly associated with the risk of PTSD.

Conclusions

The risk for the development of PTSD after exposure to traumatic events is associated with several factors including the type of exposure, preexisting psychopathology, personality features and coping strategies which independently contribute to the vulnerability to PTSD.     

Factors associated with self-report of sexual violence against men and women with mental disorders in Brazil

Objectives

Patients with mental illness (PMI) are more vulnerable to sexual violence (SV). This study aimed at assessing factors associated with SV against PMI, stratified by gender in Brazil.

Methods

Cross-sectional multicenter study with a national sample of 2,475 PMI randomly selected from 26 psychiatric services. Odds ratios were estimated with 95% confidence interval using logistic regression.

Results

A high prevalence of lifetime SV against PMI was observed (19.8%) and it was higher among women (26.6%) than men (12.5%). Among women, episodes of SV were more often caused by intimate partners and in the domestic environment, and among men, by strangers and in the streets. Among women, the following variables were independently associated (p?Conclusions The prevalence of SV in the studied population was high, especially among women. Women have more behavior factors associated with SV and they need protection, especially those in isolation and socially deprived. However, men also suffer SV, usually more often during childhood than adulthood and special attention should be given to lifetime illegal drug use and earlier psychiatric hospitalization. Preventive actions beyond mental health are important, such as social and economic actions to improve the living conditions of PMI.     

Current Reports on Perinatal Intimate Partner Violence

Purpose of Review

The purpose of this study was to review the literature on perinatal intimate partner violence, focusing on recent knowledge to guide mental health professionals on the best approaches to identify and treat women exposed to perinatal intimate partner violence.

Recent Findings

Risk factors have been broadened from individual victim and perpetrator factors to include relationship, community, and societal factors which interact together. Better information is now available on how to identify, document, and treat women exposed to violence around the time of conception, pregnancy, and the postpartum period.

Summary

Recent information helps psychiatrists and other mental health professionals assist women exposed to violence related to the perinatal period; however, further research is needed to provide improved evidence for optimal interventions for better patient outcomes.

     

Country of birth and hospital treatment for psychosis in New South Wales

Background

Migration has been found to be a risk factor for schizophrenia in several high-income countries.

Aim

To examine whether overseas migrants to New South Wales (NSW) have higher rates of admission to psychiatric hospitals for psychotic disorders, including schizophrenia and mania, compared to people born in Australia.

Methods

The country of birth of people admitted to public mental health units for the treatment of psychotic illness and for non-psychotic disorders between 2001 and 2010 was compared to the country of birth for the NSW population in the 2006 census. Meta-analysis was used to estimate the odds of being admitted for any psychotic disorder, for a schizophrenia-related psychosis and for mania compared to non-psychotic disorder, for those born in Australia, New Zealand and for nine global regions.

Results

Those born in Oceania (including Melanesia, Fiji, Samoa, Tonga and other Polynesian islands, but excluding Hawaii and New Zealand) had the highest odds of admission for the treatment of psychosis compared to a non-psychotic disorder and had the highest odds of being admitted with a diagnosis of schizophrenia or mania.

Conclusions

In the years 2001–2010, those born in Oceania were at an increased risk of admission to NSW psychiatric hospitals for the treatment of psychotic illness.     

Fluvoxamine may prevent onset of psychosis: a case report of a patient at ultra-high risk of psychotic disorder

Background

There is emerging evidence that antidepressants may be effective in preventing patients with non-specific and psychotic-like prodromal symptoms, defined as patients at ultra-high risk (UHR) of psychotic disorder, from transitioning to psychosis. However, the mechanism of such an effect is still unknown.

Methods

We report the case of a 19-year-old Japanese man determined to be at UHR of psychotic disorder in whom fluvoxamine (one of the antidepressants with sigma-1 receptor agonism) showed preventive effects on psychotic-like prodromal symptoms.

Results

Our patient's depressive symptoms were reduced and maintained below remission as a result of treatment with 100 mg/day of fluvoxamine. In addition, it is likely that an additional dose of fluvoxamine (50 mg/day) improved his psychotic-like prodromal symptoms directly, independent of its antidepressive effects.

Conclusion

Fluvoxamine, a sigma-1 receptor agonist, may be effective in preventing patients at UHR of psychotic disorder from onset of psychosis via its neuroprotective/neurotropic actions, independent of its antidepressive effects.     

Patterns of alcohol use, their correlates, and impact in male drinkers: a population-based survey from Goa, India

Purpose

Associations between low socio-economic class and alcohol use disorders are relatively well established in developed countries; however, there is comparably little research in India and other developing countries on the associations between socio-economic class, drinking patterns, and alcohol-related problems. We sought to assess drinking patterns and adverse outcomes among male drinkers and examine whether the association between drinking patterns and adverse outcomes differ by socioeconomic class.

Methods

Population survey of 732 male drinkers screened from 1,899 men, aged 18 to 49 years, randomly selected from rural and urban communities in northern Goa, India.

Results

Usual quantity of alcohol consumed by 14.8 % (rural 16.8 %; urban 13.6 %) current drinkers is at high-risk level. About 28.6 % (rural 31 %; urban 27.2 %) and 33.7 % (rural 30.5 %; urban 35.5 %) of current drinkers reported monthly or more frequent heavy episodic drinking and drunkenness, respectively. Lower education and lower standard of living (SLI) were associated with higher usual quantity of alcohol consumption. More frequent heavy episodic drinking was associated with older age, being separated, lower education, and lower standard of living; weekly or more frequent drunkenness was associated only with rural residence. All three risky drinking patterns were associated with common mental disorders, sexual risk, intimate partner violence, acute alcohol-related consequences, and alcohol dependence. Significant interactions between SLI and risky alcohol use patterns suggested an increased risk of intimate partner violence among men with risky drinking and lower SLI.

Conclusions

Risky drinking patterns are common among male drinkers in Goa and associated with lower socio-economic class. A range of adverse health and social outcomes were associated with risky drinking across all socio-economic classes. Alcohol policy should target risky drinking patterns, particularly among poorer men, to reduce the health and social burden of alcohol use in India.     

Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults

Background

Racial discrimination is related to depression, anxiety, and severe psychological distress, and evidence drawn from studies emanating from the United Kingdom and The Netherlands suggest racial discrimination is also related to clinical psychosis and subthreshold psychotic symptoms in racial and ethnic minority (REM) populations. The present study sought to determine the association between racial discrimination experiences and attenuated positive psychotic symptoms (APPS) in a United States (US) urban, predominantly immigrant and REM young adult population.

Methods

A cohort of 650 young adults was administered a self-report inventory for psychosis risk [i.e., Prodromal Questionnaire (PQ)], and the Experiences of Discrimination Questionnaire. The PQ allowed the dimensional assessment of APPS, as well as the categorical assessment of a potentially “high risk” group (i.e., 8 or more APPS endorsed as distressing), the latter of which was based on previous validation studies using the structured interview for prodromal syndromes. The relations between self-reported racial discrimination and APPS, and racial discrimination and “high” distressing positive PQ endorsement were determined, while accounting for anxiety and depression symptoms.

Results

Racial discrimination was significantly associated with APPS and with significantly higher odds of endorsing eight or more distressing APPS, even after adjusting for anxiety and depression symptoms.

Conclusion

The present study provides preliminary evidence that racial discrimination among US ethnic minorities may be associated with APPS, as well as potentially higher risk for psychosis.