Self-rated health in relation to rape and mental health disorders in a national sample of women

Overall health status is associated with long-term physical morbidity and mortality. Existing research on the correlates of mental health effects of rape suggests that rape victims are at higher risk for poor overall health status. Little is known, however, about how different rape tactics may relate to health status in rape victims. Our aim was to examine prevalence and correlates of self-rated health in a community sample of women, with particular emphasis on lifetime rape history (distinguishing between rape tactics), psychopathology, and substance use outcomes. A nationally representative sample of 3,001 U.S. women (age range: 18-86 years) residing in households with a telephone participated in a structured telephone interview. Poor self-rated health was endorsed by 11.4% of the sample. Final multivariable models showed that poor self-rated health was associated with older age (p<.001), lower educational attainment (p=.01), African American ethnicity (p=.03), lifetime posttraumatic stress disorder (PTSD; p<.001), lifetime major depressive episode (MDE; p=.01), and history of forcible rape (p=.01). Self-rated health was associated with three potentially modifiable variables (forcible rape, PTSD, and MDE). Therefore, trauma-focused interventions for rape victims should include collaboration on treatment or prevention modules that specifically address both mental and physical health.     

Differentiating Genuine and False Rape Allegations: A Model to Aid Rape Investigations

The aim of this study was to compare the victimology, offence demographics and offence behaviours of genuine and false allegations of rape in order to develop a model that could be used to aid in differentiating between genuine and false rape allegations. Eighty false allegations of rape were compared with 160 genuine allegations of rape, obtained from the Serious Crime Analysis Section (SCAS). Data were taken directly from complainant statements and 62 variables were dichotomously coded. Chi-square, odds ratios and Mann-Whitney U tests were initially completed and then the more significant variables were entered into a backwards stepwise logistic regression. The resultant logistic regression model classified 91.7% of the sample correctly. The model was validated using an additional 12 cases, with an 83% success rate. This study found that a number of factors successfully discriminated between genuine and false rape allegations. It thus offers a tool that might aid police investigations, crime analysts and behavioural investigative advisors in the veracity assessment of rape allegations.     

Risk factors for rape, physical assault, and posttraumatic stress disorder in women: examination of differential multivariate relationships

The National Women's Study, a 2-year, three-wave longitudinal investigation, employed a national probability sample of 3,006 adult women to: (a) identify separate risk factors for rape and physical assault, and (b) identify separate risk factors associated with post-rape posttraumatic stress disorder (PTSD) and post-physical assault PTSD. This investigation differed from previous studies in that it prospectively examined risk factors at the multivariate, as opposed to univariate level. Overall, past victimization, young age, and a diagnosis of active PTSD increased women's risk of being raped. By contrast, past victimization, minority ethnic status, active depression, and drug use were associated with increased risk of being physically assaulted. Risk factors for PTSD following rape included a history of depression, alcohol abuse, or experienced injury during the rape. However, risk factors for PTSD following physical assault included only a history of depression and lower education.     

Inadequate management of cerebrovascular risk factors in participants of a public stroke prevention program in Austria

The aim of our investigation was to identify frequencies and treatment quality of stroke risk factors in participants of a stroke prevention program in the province of Salzburg (Austria). A total of 9356 participants free of previous stroke were classified in three risk categories for suffering from ischemic stroke within the next 10 years and analyzed referring to history, therapy, and treatment quality of cerebrovascular risk factors. A total of 6519 (69.7%) participants were classified to be at low (<10%), 2232 (23.9%) at intermediate (10-20%) and 605 (6.5%) at high risk (>20%). Elevated blood pressure with the need for follow-up investigations was found in 5193 persons (55.5%); of 3713 (39.7%) persons with a history of hypertension, 3204 (86.3%) are under medical treatment, which is sufficient only in 765 patients (23.9%). Similar results were present for other well documented modifiable risk factors. In the investigated population there is high presence of stroke risk factors with inadequate treatment in most cases.     

Risk and resilience: a mixed methods investigation of Aboriginal Australian women’s perinatal mental health screening assessments

Purpose

To describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women’s Kimberley Mum’s Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome.

Methods

We used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into ‘risk’ and ‘protective’ factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety.

Results

Protective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11–33% high vs 61–100% no risk) and more commonly had risk factors (22–67% high vs 6–28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety.

Conclusion

Assessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.

     

Assault characteristics and posttraumatic stress disorder in rape victims

A diagnosis of posttraumatic stress disorder (PTSD) encompasses several of the symptoms associated with the response to rape. The object of this study was to determine the incidence of PTSD among 51 rape victims and to compare the groups with and without PTSD with respect to the characteristics of the assaults. The results showed that 70% of the victims had PTSD and further suggested that PTSD was likely to be a long-term problem for these women. The results supported the view that psychological treatment approaches to rape victims should take into account the posttraumatic nature of the response. The incidence of rapes by strangers, of physical force being used, of weapons being displayed and of injuries being sustained by the victim were all higher in the group of women who had PTSD. These are all features that can be readily identified in the initial assessment of the rape victim and may help to identify the victims at risk of developing long-term psychological sequelae after rape. Appropriate therapeutic action taken early may influence the prognosis for a significant proportion of rape victims.     

Multiple risk factors for Parkinson's disease

OBJECTIVE: To determine the relative contribution of various risk factors to the development of Parkinson's disease (PD). METHODS: Ten variables that were independently associated with PD in a health system population-based case-control study of epidemiological risk factors for the disease were jointly assessed. Stepwise logistic regression, adjusted for sex, race and age was used to develop a multiple variate model that best predicted the presence of PD. The population attributable risk was estimated for each variable in the final model, as well as for all factors together. RESULTS: The 10 initial variables included >20 years occupational exposure to manganese or to copper, individually; >20 years joint occupational exposure to either lead and copper, copper and iron, or lead and iron; a positive family history of PD in first- or second-degree relatives; occupational exposure to insecticides or herbicides; occupational exposure to farming; and smoking. Logistic regression resulted in a final model that included >20 years joint occupational exposure to lead and copper (p=0.009; population attributable risk [PAR]=3.9%), occupational exposure to insecticides (p=0.002; PAR=8.1%), a positive family history of PD in first- and second-degree relatives (p=0.001; PAR=12.4%), and smoking 相似文献   

昏迷危险因素的病例对照研究

目的研究昏迷发病的危险因素。方法连续收集223例住院的昏迷病人作为病人组(昏迷组).以同期住院的223例危重非昏迷病人为对照组(非昏迷组)。采用统一调查表和诊断标准对所有对象的一般情况、原发或主要疾病、急性并发症或器官衰竭、慢性脏器功能障碍等进行调查。应用单因素和多因素分析方法对有关因素进行分析。结果单因素分析表明,符合3项和4项标准的全身炎症反应综合征(SIRS 3-4)、急性呼吸衰竭、休克、急性肾衰、血糖过高、继发性全身性癫痫、第二原发疾病、原有脑软化,是昏迷的危险因素(P<0.05)。Logistic回归在校正了休克等因素后,SIRS3-4(OR=7.8,95％CI=4.307-14.001)、急性呼吸衰竭(OR=5.2,95％CI=1.683-16.242),继发性全身性癫痫(OR=2.6,95％CI=1.095-5.998)仍与昏迷密切有关。结论除昏迷的原发疾病外,多种急性并发症或器官衰竭,包括SIRS 3-4、急性呼吸衰竭、继发性全身性癫痫等,也是昏迷的主要危险因素。这些危险因素可以联合或单独作用引起昏迷。     

Chronic posttraumatic stress disorder: a review and checklist of factors influencing prognosis.

Mental health clinicians are often asked to evaluate prognosis in individuals with posttraumatic stress disorder (PTSD) in clinical, administrative, and legal contexts. Although chronicity of PTSD has been addressed in a number of trauma studies, the data have not been integrated into a coherent approach to the assessment of prognosis. In this paper, the peer-reviewed PTSD literature is surveyed to assist clinicians in making informed prognostic evaluations of the course of PTSD in adults. Potential risk factors, grouped into 11 categories (PTSD stressors, PTSD symptoms, current comorbidity, lifetime comorbidity, childhood separation and abuse, demographics, life stressors, family history, support, treatment, and functional impairment), are reviewed. Knowledge of these risk factors, and of factors associated with chronic PTSD, is helpful in assessing the potential for or degree of chronicity present at the initial evaluation of the patient, as well as in measuring treatment response during the course of therapy. Early identification and the appropriate treatment and management of remediable risk and associated factors may help prevent the development of chronic PTSD. Longitudinally assessing the response of treatable risk factors should provide an additional means for evaluating prognosis. A PTSD Prognostic Checklist, which rates risk and associated factors in each category, is proposed. Validity and reliability have not yet been established for this instrument. It is hoped that clinicians will use and conduct research on it as an initial step toward advancing its scientific utility.     

Factors associated with prospective long-term treatment adherence among individuals with bipolar disorder

OBJECTIVE: Clinical characteristics, adverse effects of medication, and treatment attitudes have been associated with adherence in bipolar populations in cross-sectional studies. The aim of this secondary analysis from a larger study was to identify the association between baseline variables and average treatment adherence over a subsequent three-year period. METHODS: Veterans with bipolar disorder were evaluated on self-reported adherence status at baseline and every six months over a three-year period. The sample was dichotomized into two clinically relevant categories: those who were primarily adherent and those who were primarily nonadherent. Demographic and clinical variables were examined for the two groups of patients in relation to their average adherence over the three-year period. RESULTS: The study recruited a sample of 306 persons with severe bipolar disorder. The sample was predominantly male (278 men, or 91%), with a mean+/-SD age of 46.6+/-10.1 years. A total of 240 individuals (78%) were largely adherent to treatment, and 37 individuals (12%) were largely nonadherent to treatment. Nonadherent individuals were less likely to be on intensive somatotherapy regimens (p=.001); experienced more barriers to care, including lack of telephone access (p<.05) and life obligations and commitments (p<.05); and had more prior suicide attempts (p=.003). CONCLUSIONS: Nonadherent individuals with bipolar disorder received less intensive pharmacologic treatments, had more suicide attempts, and experienced more barriers to care than adherent individuals. Nonadherence may have system as well as patient components. Consideration of nonadherence as a function of both patient factors and system factors will enhance our ability to understand nonadherence and intervene more effectively.     

Blitz rape and confidence rape: a typology applied to 1,000 consecutive cases

The case records of 1,000 consecutive rape victims seen at a crisis center were analyzed to identify important categories of rape victimization. The most noteworthy finding was a replication and extension of the blitz rape and confidence rape typology. The distinction between these two types of rape corresponded to a series of significant differences in the victims' characteristics, the rape settings, the victims' activities before they were raped, the assailants' characteristics, and the victims' immediate responses to the assaults. The authors discuss the implications of these differences with respect to specific strategies of outreach and treatment for victims of different types of rape.     

Behavioral and psychiatric comorbidities in pediatric epilepsy: toward an integrative model

It is well recognized that children with epilepsy are at heightened risk for developing behavior problems and psychiatric disorders. Studies identifying factors associated with child behavior were reviewed and findings were placed into two broad categories for review and critique: illness-related variables and psychosocial variables. Illness-related variables were seizure frequency and seizure control, type of epilepsy, age of onset, duration of illness, and antiepileptic drugs. Psychosocial variables were reviewed using a family stress framework: stressors, perceptions, adaptive resources, coping, and family adjustment. After the literature on each category is reviewed, an integrated heuristic model that includes key illness-related and psychosocial variables is presented.     

Validity of diagnosis using the French translation of the semi-structured interview for seizure classification

PURPOSE: The purpose of this study was to assess the acceptability and validity of the French cross-cultural translation of a semistructured interview for seizure classification (SISC). We used the first revised version, the original of which was validated in 1990. METHODS: We administered the French SISC to a sample of 67 adults older than 15 years, comprising 17 controls and 50 patients with epilepsy (without provoked or isolated seizures). A cross-cultural translation was made from American English into French. Medical records were reviewed by epileptologists, who classified seizures, syndromes, and risk factors in accordance with the International League Against Epilepsy (ILAE) classifications. Agreement between interview- and physician-based diagnoses was assessed with a kappa coefficient (kappa) at each level of the recognized schemes for the classification of seizures (both broad and specific categories), syndromes, and risk factors. RESULTS: The sensitivity of the French SISC in diagnosing an epileptic seizure was 100%, with a specificity of 94%. Interview-based diagnoses agreed with those of physicians in 90% of patients for broad seizure categories [i.e., generalized or focal in origin (kappa = 0.74)]. When diagnoses agreed on focal origin, the agreement on seizure types-simple or complex-was 91% (kappa = 0.84). Among generalized seizures, the agreement was 73% (kappa = 0.60). Agreement on epilepsy syndromes was excellent for generalized epilepsy but moderate for focal epilepsy. Agreement on identified risk factors was 93%. CONCLUSIONS: The kappa coefficients demonstrated a good level of reliability. These results support the acceptability of this type of interview and the validity of the French version of the SISC.     

Predictors of entering a long-term drug treatment study of panic disorder

Three hundred thirty-three consecutive individuals with panic and agoraphobic-like symptoms were evaluated as part of the screening for entry in a long-term imipramine treatment study of panic disorder with agoraphobia. The present report compares three subgroups of potential subjects--those who entered the study (n = 139, 41.7%), those who were rejected from participation based on exclusion criteria (n = 161, 48.3%), and those who qualified to enter but refused participation (n = 33, 10.0%)-in order to characterize pretreatment attrition and address two specific questions: What variables other than inclusion and exclusion criteria predict the likelihood of entering the trial?, and What variables significantly predict the likelihood of refusal to participate? Logistic regression analysis revealed that the likelihood of entering the trial was influenced significantly and independently by a number of variables that included extroversion, anxiety, and work satisfaction and performance measures. The refused and rejected groups differed significantly on a number of variables that were not a priori exclusionary criteria, such as a history of substance abuse other than alcohol and current use of alcohol to decrease anxiety, but none of these variables emerged as independent, significant predictors of refusing behavior as a separate category of nonparticipation. Findings suggest the presence of factors common to both the rejected and the refused groups that significantly influence pretreatment attrition and caution that categorizing pretreatment attrition into refused and rejected categories may not always be clear cut. Research and clinical implications are briefly discussed.     

Spatial clusters of suicide in the municipality of São Paulo 1996¿2005: an ecological study

ABSTRACT: BACKGROUND: In a classical study, Durkheim mapped suicide rates, wealth, and low family density and realized that they clustered in northern France. Assessing others variables, such as religious society, he constructed a framework for the analysis of the suicide, which still allows international comparisons using the same basic methodology. The present study aims to identify possible significantly clusters of suicide in the city of Sao Paulo, and then, verify their statistical associations with socio-economic and cultural characteristics. METHODS: A spatial scan statistical test was performed to analyze the geographical pattern of suicide deaths of residents in the city of Sao Paulo by Administrative District, from 1996 to 2005. Relative risks and high and/or low clusters were calculated accounting for gender and age as co-variates, were analyzed using spatial scan statistics to identify geographical patterns. Logistic regression was used to estimate associations with socioeconomic variables, considering, the spatial cluster of high suicide rates as the response variable. Drawing from Durkheim's original work, current World Health Organization (WHO) reports and recent reviews, the following independent variables were considered: marital status, income, education, religion, and migration. RESULTS: The mean suicide rate was 4.1/100,000 inhabitant-years. Against this baseline, two clusters were identified: the first, of increased risk (RR = 1.66), comprising 18 districts in the central region; the second, of decreased risk (RR = 0.78), including 14 districts in the southern region. The downtown area toward the southwestern region of the city displayed the highest risk for suicide, and though the overall risk may be considered low, the rate climbs up to an intermediate level in this region. One logistic regression analysis contrasted the risk cluster (18 districts) against the other remaining 78 districts, testing the effects of socioeconomic-cultural variables. The following categories of proportion of persons within the clusters were identified as risk factors: singles (OR = 2.36), migrants (OR = 1.50), Catholics (OR = 1.37) and higher income (OR = 1.06). In a second logistic model, likewise conceived, the following categories of proportion of persons were identified as protective factors: married (OR = 0.49) and Evangelical (OR = 0.60). CONCLUSIONS: This risk/ protection profile is in accordance with the interpretation that, as a social phenomenon, suicide is related to social isolation. Thus, the classical framework put forward by Durkheim seems to still hold, even though its categorical expression requires re-interpretation.     

Military Psychiatry

Objective: Rape is associated with posttraumatic stress disorder (PTSD) and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies. Method: Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department. Results: Of the 521 diverse female (n = 476) and male (n = 45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability (OR = 0.40, 95% CI = 0.21–0.77), having a current mental illness (OR = 0.25, 95% CI = 0.13–0.49), and being assaulted in public (OR = 0.50, 95% CI = 0.28–0.87) were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition (OR = 3.02, 95% CI = 1.86–4.91), a completed Sexual Assault Nurse Examiner’s (SANE) examination (OR = 2.97, 95% CI = 1.84–4.81), and social support available to help cope with the assault (OR = 3.54, 95% CI = 1.76–7.11) were associated with an increased odds of attending the follow-up. Conclusions: Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage for these patients is warranted and may require alternative service delivery models that engage rape survivors and support posttraumatic recovery.     

颅脑手术部位感染率及危险因素前瞻性研究

目的研究颅脑手术部位感染率及危险因素。方法采用前瞻性方法调查我院颅脑手术病人478例。结果我院颅脑手术部位感染率为3.1%;按美国疾控中心NNIS系统SSI危险因素评分分层得到的感染率分别是:0分者1.2%(4/344),1分者7.4%(9/121),2-3分者15.4%(2/13)。发生SSI的危险因素包括手术时间>4h、术后使用引流管、SSI危险因素评分>0分、本次手术前曾进行过颅脑手术。结论我院颅脑手术SSI发生率为3.1%;危险因素为手术时间>4h、术后使用引流管、SSI危险因素评分>0分、本次手术前曾进行过颅脑手术。     

Tardive dyskinesia: who is at risk?

Tardive dyskinesia (TD) has been associated with female gender, affective symptoms and good outcome, but also with negative symptoms, cognitive deterioration and deteriorating illness course. Furthermore, antipsychotic medication is thought to be an important risk factor, yet abnormal movements also occur in patients who have never received such medication. We followed 166 subjects with recent onset of psychotic illness and brief previous exposure to antipsychotic medication. Information on 17 previously reported risk factors was available for 125 patients at baseline and, for factors that vary over time, again at follow-up 4 years later (median, 50 months; interquartile range, 29-70). Movement disorder was assessed at follow-up using the Abnormal Involuntary Movement Scale (AIMS). Six non-interacting variables were independently associated with the 4-year risk of TD: male sex (OR, 2.5; 95% CI, 1.1-5.0), age (OR over quartiles at baseline, 1.6; 95% CI, 1.1-2.2), lack of insight at baseline (OR over four categories, 2.0; 95% CI, 1.2-3.2), time on antipsychotics during the follow-up period (OR over quartiles, 2.3; 95% CI, 1.5-3.4), an increase in negative symptoms during the follow-up period (OR over quartiles, 1.7; 95% CI, 1.2-2.5), and alcohol/drug misuse at follow-up (OR, 3.0; 95% CI, 1.3-7.4). The presence of individual risk factors was found to be of little use as a screening test for subsequent clinically relevant TD. Given the absence of a risk factor, however, the probability that an individual would not develop TD was high. These results suggest that two discrete effects may operate to increase the risk of TD, namely an exogenous factor (medication, drugs), and an illness-related factor, the highest risk being conferred by deteriorating illness course in male patients.