Domestic violence and emotional distress among Nicaraguan women: Results from a population-based study.

This study aimed to measure the prevalence of emotional distress among women in León, Nicaragua, and to identify risk factors for emotional distress, with special reference to wife abuse. A survey was performed among a representative sample of women aged 15–49. Among ever-married women, 20% were classified as experiencing emotional distress at the time of the interview, and 52% reported physical partner abuse at some point in their lives. Women reporting abuse were 6 times more likely to experience emotional distress. An estimated 70% of all cases of emotional distress found among ever-married women were attributable to wife abuse. The study underscores the need to improve screening and care for battered women within mental health services in Nicaragua. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women.

Findings from a study comparing partner abuse in African American women suicide attempters (n?=?148) and nonattempters (n?=?137) revealed higher rates of physical and nonphysical partner abuse among attempters than their demographically similar nonsuicidal counterparts. The partner abuse–suicidal behavior link was mediated by psychological distress, hopelessness, and drug use and moderated by social support. Results also revealed that nonphysical partner abuse accounted for unique variance in the prediction of suicide attempt status beyond that attributable to childhood maltreatment. Implications of the findings for assessing both suicidal and abused women are discussed, and recommendations for preventive interventions for women at risk for suicidal behavior are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of mental health services by women in a male-dominated environment: the VA experience

OBJECTIVE: The study examined whether women in the Veterans Affairs system use mental health services at a lower rate than men because the system is geared to treat a mostly male population. METHODS: Data were obtained on a national cohort of patients utilizing specialty mental health services in the VA during a two-week period in fiscal year 1991 (N = 70,979). Analyses included comparison of the proportion of women among treated veterans with the age-adjusted proportion of women among all veterans, comparison across gender of the likelihood of use of any general psychiatric services or substance abuse care in 1991, comparison of the intensity of services used (inpatient days and outpatient contacts) by service users in 1991, and comparison of the likelihood of receiving care and the intensity of mental health services received two years later. RESULTS: Overall, 3.95 percent of veterans who used VA mental health specialty services were women; 4.02 percent of all veterans were women. No significant differences between genders were found in use of general psychiatric services, either in the likelihood of any use or the intensity of services used. However, women were significantly less likely to receive substance abuse care (16.3 percent of women versus 71.2 percent of men); once receiving care, they used a similar intensity of substance abuse services. CONCLUSIONS: Being a woman does not appear to have a substantial effect on overall access to VA mental health services or use of general psychiatric services; however, women use VA substance abuse treatment services at a lower rate than men.     

Elder mistreatment: its relevance to older women

Elder mistreatment, both abuse and neglect, is an important health care problem for women since they are involved as victims and as perpetrators. The incidence of both forms of such mistreatment is increasing, and both often occur within the context of long-term care. Elder abuse occurs in both unidirectional and dual directional forms, and includes parent abuse and spouse abuse. Elder neglect occurs in two forms; neglect by others and self-neglect. While elderly men and women are both neglected and/or abused, women may suffer greater physical and psychological consequences. To date, researchers have inadequately addressed the relevance of gender to both forms of elder mistreatment. This literature review addresses what is currently known about elder abuse and neglect that is of particular relevance to older women.     

Downward Spiral: a pedagogical game depicting the dangers of substance abuse

We have developed a pedagogical game called Downward Spiral that illuminates the dangers associated with continued drug use (including alcohol). The game provides facts, quotes, and episodic consequences that can adversely affect each player's mental and physical health, social support, and financial/legal situation over the course of the game. The conceptual and empirical foundations of the game (both a college prevention version and substance abuse treatment version) are discussed. Pilot studies with college students and residents at a substance abuse treatment facility for probationers indicate that Downward Spiral is engaging, informative, and thought provoking. Plans for examining the impact of this game as a preventive technique (for the college setting) and as an approach to increasing motivation for substance abuse treatment are described.     

Screening for domestic violence in a rural family practice

This study evaluates the effectiveness of a screening form used to assess the incidence of current and past domestic abuse among patients seen in a rural family practice. Two of nine family physicians screened most adult women they saw at a rural primary care clinic for three months in early 1996. Of the 280 women who completed surveys, 94(34%) reported experiencing physical or emotional abuse at some time in the past. Twenty-three (8%) reported physical abuse within the past year. Fourteen women (5%) reported being currently afraid of their partner or someone else. Although current or past abuse was seen across all groups, women reporting abuse were more likely to be unmarried, younger, and on medical assistance. They were also more likely to have children at home. We concluded that the prevalence of women reporting current abuse in a rural family practice is sufficient to warrant mass screening.     

Symptoms of post-traumatic stress disorder in abused women in a primary care setting

Abuse is a major source of trauma to women, and post-traumatic stress disorder (PTSD) results from exposure to extreme trauma. To describe the relationship between symptoms of PTSD and severity of abuse, an ethnically stratified cohort of 131 abused women in a primary care setting was interviewed. Symptoms of PTSD, both intrusion (i.e., trouble falling asleep, strong waves of feelings about the abuse) and avoidance (i.e., trying not to think or talk about the abuse, staying away from reminders of the abuse), were significantly (p < 0.01) correlated to severity of abuse, regardless of ethnicity. When asked about childhood physical or sexual abuse, women reporting physical abuse had significantly (p < 0.05) higher intrusion scores, whereas those reporting sexual abuse had significantly (p < 0.004) higher avoidance scores. Sixty-five percent of the women reported dreams, flashbacks, or terror attacks and had significantly (p < 0.001) higher mean results on both intrusion and avoidance. The need to offer abused women information about the connection between severity of abuse and symptoms of PTSD is discussed. We recommend that clinicians ask all abused women about dreams, flashbacks, or terror attacks to assess for further symptoms of PTSD.     

Genetic heterogeneity in lamellar ichthyosis

One of the major challenges facing obstetrician-gynecologists, especially those serving populations that are diverse in culture and circumstances, is to identify and address the barriers that keep women from seeking timely preventive and prenatal health care. The Department of Obstetrics and Gynecology at Rochester General Hospital held a community focus groups to learn more about women's attitudes toward health care. In addition to economic issues, such as lack of insurance and an inability to pay, the organizers found that many of the factors that prevent or discourage women from seeking health care involve issues of communication and understanding. Many women wanted what they perceived to be additional services. In reality, many of the things desired involved changes in doctor-patient interactions rather than the addition of any new service, and could be addressed with relative ease and minimal cost. Providing staff members with training in cultural sensitivity and encouraging them to develop a real awareness of patient circumstances are first steps that can lead to better communication between provider and patient and to the development of mutual trust. Other factors, such as the fear of incarceration or of losing one's children if health care is sought, present more serious challenges. Providers of care to high-risk, impoverished populations need to develop strong links to mental health, substance abuse, and family preservation services that allow them to intervene with troubled women and their families with services that are alternatives to incarceration and punitive actions.     

Relationship between genetic anomalies of different levels and deviations in dermatoglyphic traits. Part 2: Dermatoglyphic peculiarities of females with Turner''s syndrome

After reviewing the literature on health effects of intimate violence, we report secondary analyses of responses of 439 black women who participated in the Commonwealth Fund's national survey on women's health. Lower income women were more likely to experience partner violence but not childhood abuse; and income group was related to self-esteem, depressive symptoms, and perceived health status. Childhood physical and sexual abuse and partner violence were intercorrelated; both abuse history and partner violence were related to greater risk for depressive symptoms, lower life satisfaction, and lower perceived health care quality. Partner violence was also related to lower self-esteem and perceived health status. Sexually abused women had more difficulties in interpersonal relationships, including lower perceived health care quality even with self-esteem and depressive symptoms controlled. Implications for prevention, training, and future research as well as methodological issues in research on violence against black women are discussed.     

Child sexual and physical abuse and alcoholism: a review

OBJECTIVE: To examine possible relations between child sexual or physical abuse and adult alcoholism. METHOD: Studies reviewed included prospective studies, retrospective studies on the prevalence of child sexual or physical abuse in alcoholics and nonalcoholics, and retrospective studies in mental health clients and in population samples comparing the prevalence of alcohol use disorders in abused and nonabused subjects. RESULTS: Prospective studies do not indicate a significant association between child sexual or physical abuse and alcoholism. In contrast, studies among alcoholic women do suggest a relationship. Also, a significantly higher prevalence of alcohol problems in abused women than in nonabused women is found in population samples. The results of studies among mental health clients are inconclusive. In addition, several methodological limitations should be taken into consideration when evaluating results of the available studies. CONCLUSIONS: Current evidence is insufficient to draw conclusions about relationships between child sexual or physical abuse and alcoholism among men. Among females, however, there is a higher likelihood of alcohol problems if they were sexually or physically abused as children.     

Keeping a watchful eye. Receipt of preventive service screening recommendations by women in long-term care facilities

This study explored the extent to which women in long-term care facilities received preventive screening services. Physical examination screening of women residents exceeded the 40% recommendation of Healthy People 2000 with the exception of clinical breast examination and Pap smears. Laboratory and screening procedures--cholesterol, thyroid, and tuberculin testing--fell short of recommendations. Nurses in long-term care have an opportunity to enhance residents' quality of life by ensuring consistent use of preventive screening services.     

Group therapy for adult women survivors of child sexual abuse: Differentiation of completers versus dropouts.

Examined intake profiles of 54 depressed women survivors of child sexual abuse presenting for a specialized group therapy program at a community mental health center. The 32 therapy completers were compared with the 22 dropouts. Both groups possessed extensive and severe childhood and adult abuse histories. Both were extremely socially disadvantaged and clinically impaired as measured on the Millon Clinical Multiaxial Inventory (MCMI). Dropouts were more likely to have been battered as children and to have been sexually abused only within the family. Completers were more likely to have been multiply offended both by intrafamilial and extrafamilial perpetrators. The groups differed in terms of marital status and extent of economic dependence on spouse. Dropouts appeared to be more actively enmeshed in the abuse cycle at the time of therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

IS231A transposition: conservative versus replicative pathway

OBJECTIVE:To explore the attitudes and experiences of abused women to identify characteristics that helped or hindered abuse disclosure to clinicians and to determine how women viewed potential interventions to improve detection and treatment in a medical setting. DESIGN: Focus group data conducted and analyzed with qualitative methodology. SETTING: Three community-based mental health centers and one women's shelter. PARTICIPANTS: Twenty-one women in group therapy for domestic violence. MAIN RESULTS: Eighteen (86%) of the 21 women had seen their "regular doctor" in the prior year; only 1 in 3 had discussed the abuse with the clinician. The major discussion themes were medical problems that were exacerbated with abuse, lack of ability to access medical care due to abuser interference, emotional attitudes about abuse that acted as barriers to disclosure, clinician characteristics that helped or hindered disclosure, and treatment experiences and preferences. Women described how their medical problems began or worsened during the abusive period. one in three women described how abusers blocked them from receiving medical care. Women reported intense shame about the abuse and described their self-denial of abuse. Women stated they were inclined to discuss abuse if they felt the clinician was perceived to be caring, was easy to talk to, had a protective manner, or if the clinician offered a follow-up visit. There was no consistent clinician gender preference among the women. One in four women had received psychotropic medication for problems associated with abuse. Many feared addiction, or a loss of alertness, increasing their risk for more abuse. CONCLUSIONS: Many abused women experience worsening health and seek medical care; most do not volunteer a history of violence even to their regular clinicians. Many of the barriers to disclosure of abuse could be overcome by a physician's knowledge of the link between abuse and medical illness, an understanding of the women's emotions about abuse, and her treatment preferences.     

Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial.

The primary purpose of this study was to conduct a randomized effectiveness trial of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) for physically abused youth (mean age = 13.88 years, 55.8% female, 68.6% Black) and their families. Eighty-six families being followed by Child Protective Services due to physical abuse were randomly assigned to MST-CAN or Enhanced Outpatient Treatment (EOT), with both interventions delivered by therapists employed at a community mental health center. Across five assessments extending 16 months post baseline, intent-to-treat analyses showed that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. Also, MST-CAN was significantly more effective at improving natural social support for parents. Effect sizes were in the medium to large range for most outcomes examined. Although fewer children in the MST-CAN condition experienced an incident of reabuse than did counterparts in the EOT condition, base rates were low and this difference was not statistically significant. The findings of this study demonstrate the potential for broad-based treatments of child physical abuse to be effectively transported and implemented in community treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging trends in mental health policy and practice

The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.     

Trauma, Depression, Coping, and Mental Health Service Seeking Among Impoverished Women.

The authors examined the relationship among trauma, coping, depression, and mental health service seeking in a probability sample of sheltered homeless and low-income housed women. Results highlight the diversity of trauma. In a longitudinal analysis, women who lived in shelters or experienced major violence had a twofold increase in their risk of depression over the 6-month follow-up. In a cross-sectional analysis, childhood sexual abuse, living in a shelter, physical violence, childhood physical abuse, and death or injury of a friend or relative predicted avoidant coping and symptoms of depression. Active coping and depression predicted mental health service seeking among traumatized women. Modifying coping strategies may ameliorate some of the negative impact of trauma and potentially enhance mental health service use among at-risk women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of childhood abuse on relapse in a recently homeless substance-dependent veteran population.

The impact of childhood abuse, both childhood sexual abuse (CSA) and childhood physical abuse (CPA), is well documented. Both CSA and CPA have been associated with a number of mental health difficulties, including substance dependence. Though the association between abuse and mental health problems is well documented, what has received little attention is the impact that abuse histories may have on the ability to complete treatment for these problems. This study evaluates the association between abuse and failure to complete treatment due to substance relapse in 70 substance-dependent homeless men served by a Veterans Affairs Domiciliary Residential Rehabilitation and Treatment Program. Demographic and mental health variables were compared with incident rates of sexual and physical abuse as well as with rates of relapse prior to program completion. Contrary to predictions, results found that physical abuse, not sexual abuse, was associated with higher relapse rates. Limitations, implications, and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluations of children who have disclosed sexual abuse via facilitated communication

OBJECTIVE: To review the findings of interdisciplinary team evaluations of children who disclosed sexual abuse via facilitated communication. DESIGN: Case series. SETTING: Tertiary care hospital outpatient child sexual abuse program in central New York. PATIENTS: Between January 1990 and March 1993, 13 children who disclosed sexual abuse via facilitated communication and were referred to a university hospital child abuse referral and evaluation center. The range of previously determined developmental diagnosis included mental retardation, speech delay, and autism. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Medical records were reviewed for (1) disclosure, (2) physical evidence, (3) child's behavioral and medical history, (4) disclosures by siblings, (5) perpetrator's confession, (6) child protective services determinations, and (7) court findings. RESULTS: Four children had evidence of sexual abuse: two had physical findings consistent with sexual abuse, one also disclosed the allegation verbally, and one perpetrator confessed. CONCLUSIONS: These results neither support nor refute validation of facilitated communication. However, many children had other evidence of sexual abuse, suggesting that each child's case should be evaluated without bias.     

Provision of mental health services in women's health centers

Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of care and having a belief in women-centered care. Findings indicate that the majority of women using women's health centers do not receive services in a comprehensive care environment that includes key mental health services.     

Mental health and aging: The need for an expanded federal response.

Discusses the mental health problems that may occur as elderly people must face adjustments because of bereavement, poor physical health, the demands of caring for an ill spouse, drug/alcohol abuse, dementia and cognitive impairments, and multiple health problems. Negative social stereotypes associated with both elderly patients and mental health care, limited access to and a lack of trained professionals in the area of geriatric mental health care, lack of outreach, inadequate benefits under prepaid health plans, Medicare and Medicaid, and special problems of ethnic minority and rural elderly people all contribute to an inadequate mental health care system. The author, a US representative, suggests a redesigning of the system and outlines an initiative that addresses the development of an effective mental health care system for the elderly, modification of Medicare and Medicaid, and improvements in quality assurance and access protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)