Gina Fedock

The association between childhood maltreatment and emotion regulation: Two different mechanisms contributing to depression?

BACKGROUND Childhood maltreatment is an established distal risk factor for later emotional problems, although research suggests this relationship is mediated by proximal factors. However, it is unclear if different forms of childhood maltreatment are related to unique emotion regulation strategies. In this study, we examined whether avoidance and rumination, two emotion regulation strategies strongly associated with depression, were associated with different forms of childhood maltreatment, and whether these strategies, in turn, mediated the relationship between childhood maltreatment and current depressive symptoms. METHODS Participants were a community sample of pregnant, primarily low-income women, 55 of whom met criteria for Major Depressive Disorder (MDD) and 85 who had elevated levels of depressive symptoms but did not meet criteria for MDD. RESULTS Significant rates of childhood maltreatment were reported. Childhood emotional neglect was related to behavioural avoidance, and childhood emotional abuse was related to rumination. In path analyses, behavioural avoidance mediated the relationship between childhood emotional neglect and depression. Rumination was a partial mediator of childhood emotional abuse and depression. LIMITATIONS The data were correlational in nature, and replication with a larger sample will help validate the model. DISCUSSION In a clinical, community-based sample different types of childhood maltreatment are related to unique emotion regulation strategies. Implications for understanding the developmental antecedents of emotion regulation and depression are discussed.

Service Needs for Incarcerated Adults: Exploring Gender Differences

Although men comprise the largest segment of the jail population, women are entering jails at increasingly higher rates than men. Previous research has found that incarceration is associated with multiple factors, including homelessness, substance use disorders, and mental illness, however, gender differences in services needs for female and male inmates is understudied. This study explores gender differences among a representative sample of incarcerated individuals (n = 725) from a Midwestern, urban jail. Women in the sample presented with higher rates of homelessness prior to incarceration, anticipated postincarceration homelessness, serious mental illness, substance use disorder, and trauma histories than men, as well as higher rates of multiple and co-occurring risk factors. These findings point to the need for social work interventions initiated at jail intake. Such interventions could impact parenting, housing stability, and mental health and prevent future incarceration, reoffending and relapse for this high-risk population of women.

Patient Preferences for Clinician Interactional Style in Treatment of Perinatal Depression

Most women with depression around the time of childbearing are not treated adequately, or at all. Clinical practice guidelines focus primarily on provision of information rather than on interaction factors. In this study, we explored clinician interactional style characteristics contributing to patient response to perinatal depression referral and treatment. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences with and preferences for clinician interactional style characteristics in the context of obstetrics-setting referral and delivery of depression treatment. Thematic analysis revealed a central theme related to interactional cues that influence women’s reactions to clinical encounters, summarized by the question, “Can this person help me?” Women evaluated this question in four domains: feeling heard, developing trust in the clinician, perceiving technical competence in the clinician, and feeling that the intervention focus is effectively chosen and communicated. Our results imply that, in addition to informational factors, the way in which clinicians interact with patients about depression might strongly influence patient responses.

Provider Screening and Counseling for Intimate Partner Violence A Systematic Review of Practices and Influencing Factors

Background: Primary care providers have an important role in identifying survivors of intimate partner violence (IPV) and providing safety options. Routine screening rates by providers have been consistently low, indicating a need to better understand providers’ practices to ensure the translation of policy into clinical practice. Aim: This systematic review examines common themes regarding provider screening practices and influencing factors on these practices. Method: A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search focused on research articles which met the following criteria: (1) health-care providers as participants, (2) provider reports on screening and counseling practices for IPV, and (3) were in English or Spanish. Results: A total of 35 studies were included in the review. Across studies, providers commonly acknowledged the importance of IPV screening yet often used only selective screening. Influencing factors on clinic, provider, and patient levels shaped the process and outcomes of provider screening practices. Overall, a great deal of variability exists in regard to provider screening practices. This variability may be due to a lack of clear system-level guidance for these practices and a lack of research regarding best practices. Conclusions: These findings suggest the necessity of more facilitative, clearly defined, and perhaps mandatory strategies to fulfill policy requirements. Future research directions are outlined to assist with these goals.

Assessing Short-Term Outcomes of an Intervention for Women Convicted of Violent Crimes

Women convicted of violent offenses represent a small but important subpopulation of women involved in the criminal justice system. Correctional administrators working with these women often rely on treatment and rehabilitation programs developed for violent male offenders. Although women’s trajectories into violent behavior—as well as their trajectory out—differ from their male counterparts, the field is marked by the absence of interventions designed specifically for women with violent offenses. As attention grows in the research literature and in community settings about “women who use force” it is important to develop interventions that effectively modify aggressive behavior as well as the underlying precursors of such aggression. This paper describes a pilot study as one step in a developmental approach to intervention research. Beyond Violence, a gender specific and trauma-informed intervention, was piloted with 35 women incarcerated in a state prison with a conviction for a felony-level assault. Short-term outcomes assessed through changes in pre- and posttest measures show reductions in mental health symptoms associated with depression, anxiety, posttraumatic stress disorder, and serious mental illness. The encouraging results of this pilot study have led to the next step in the intervention research process of testing the program in a randomized controlled trial that is currently underway.

OB CARES — The Obstetric Clinics and Resources Study: providers' perceptions of addressing perinatal depression — a qualitative study

OBJECTIVE We conducted a qualitative study to understand how prenatal care providers perceive influences on their delivery of perinatal depression care. Given that depression screening protocols were in place at the clinics where we sampled providers, we hypothesized that clinic- and system-level factors such as resources, training opportunities and coordination would be dominant in influencing provider decisions. METHODS We conducted semistructured interviews with 20 prenatal care providers from six obstetric clinics. We performed a thematic analysis, including within-case and cross-case comparisons, and built a conceptual model of provider decision making from the data. RESULTS Although depression screening protocols were in place at our study clinics, we found that decisions to address perinatal depression were largely made at the level of the individual provider and were undefined on a clinic level, resulting in highly variable practice patterns. In addition, while providers acknowledged externally derived influences, such as logistical resources and coordination of care, they spoke of internally derived influences, including familiarity with consultants, personal engagement styles and perceptions of role identity, as more directly relevant to their decision making. CONCLUSION Our results highlight the pivotal role of internal factors in decisions to deliver perinatal depression care. Future interventions in obstetric settings should target the intrinsic motivations of providers.

Testing a Violence-Prevention Intervention for Incarcerated Women Using a Randomized Control Trial

Objective: Beyond Violence (BV), a new prevention program for women with assaultive offenses, demonstrated feasibility in previous studies. This study’s purpose is to assess the efficacy of BV using a randomized control trial. Method: Eligible women were randomly assigned to treatment as usual (TAU) and the experimental condition (BV). Measures of mental health and anger were administered to women at pre- and postintervention. Results: Outcomes reveal positive changes for both groups. Significant between-group differences favor BV on measures of anxiety and anger. Moreover, BV is cost-effective with only 20 sessions compared to 44 sessions for TAU. Conclusion: The demonstrated effectiveness of BV is promising for this underserved population of women. Next steps: Replication and assessing long-term outcomes.

Assessing the feasibility and fidelity of an intervention for women with violent offenses

Women convicted of assaultive or violent offenses represent a small but important subpopulation of adults involved in the criminal justice system. The limited treatment and rehabilitation programs that are available for these women are usually developed for male offenders and do not consider factors that are especially relevant to women, such as higher rates of mental health and substance use disorders as well as their likely histories of interpersonal violence. Moreover, womens trajectories into violent behavior - as well as their trajectories out - may differ from their male counterparts. Due to the absence of programs available for this unique population, a new gender-specific and trauma informed intervention, Beyond Violence, was developed. This paper describes a pilot study with a mixed-methods approach that assesses the feasibility and fidelity of the intervention within a state prison for women. Overall, various components of feasibility (i.e. engaging the target population, gaining institutional support, and finding skilled treatment staff), were realized, as were fidelity elements such as adherence to the intervention material, and high attendance and satisfaction by participants. The positive results of this pilot study increase the likelihood of dissemination of the intervention and a randomized control trial is currently underway.

Differences Among Incarcerated Women With Assaultive Offenses: Isolated Versus Patterned Use of Violence

A majority of the existing research on women’s use of violence focuses on intimate partner violence, often excluding other types of violence for which women may be incarcerated. The current study expands this area of research by assessing between and within-group differences among a randomly selected group of incarcerated women (n = 543). Comparisons between violent and nonviolent offense types among women found few differences, but significant differences among women with an assaultive offense, based on the presence or absence of a self-reported uncaught violence, were found. Differences in women with isolated (i.e., single incident of violence perpetration through a review of formal and self-report data) and patterned uses of violence were present in relation to issues of mental health, substance abuse, criminogenic risk, and expressions of anger and personality factors. These findings have important implications for intervention as well as future research.

Reporting Sexual Victimization During Incarceration Using Ecological Theory as a Framework to Inform and Guide Future Research

The U.S. Department of Justice estimates that between 149,200 and 209,400 incidents of sexual victimization occur annually in prisons and jails. However, very few individuals experiencing sexual victimization during incarceration report these incidents to correctional authorities. Federal-level policy recommendations derived from the Prison Rape Elimination Act suggest mechanisms for improving reporting as well as standards for the prevention, investigation, and prosecution of prison-based sexual victimization. Despite these policy recommendations, sexual assault persists in prisons and jails, with only 8% of prisoners who experience sexual assault reporting their victimization. This review focuses on gaps in the existing research about what factors influence whether adult victims in incarcerated systems will report that they have been sexually assaulted. Using ecological theory to guide this review, various levels of social ecology are incorporated, illuminating a variety of factors influencing the reporting of sexual victimization during incarceration. These factors include the role of individual-level behavior, assault characteristics, the unique aspects and processes of the prison system, and the social stigma that surrounds individuals involved in the criminal/legal system. This review concludes with recommendations for future research, policy, and practice, informed by an ecological conceptualization of reporting.