Jonathan Egan

Adult Adjustment of Survivors of Institutional Child Abuse in Ireland.

OBJECTIVE To document the adult adjustment of survivors of childhood institutional abuse. METHOD Two hundred and forty-seven adult survivors of institutional abuse with a mean age of 60 were interviewed with a protocol that included the Childhood Trauma Questionnaire, modules from the Structured Clinical Interview for Axis I Disorders of DSM IV and the Structured Clinical Interview for DSM IV Personality Disorders, the Trauma Symptom Inventory, and the Experiences in Close Relationships Inventory. RESULTS The prevalence of psychological disorders among adult survivors of institutional abuse was over 80% and far higher than in the normal population, with anxiety, mood and substance use disorders being the most prevalent diagnoses. Survivors also had high rates of trauma symptoms and insecure adult attachment styles, and these were higher for those who had experienced both institutional and intrafamilial abuse. CONCLUSIONS There was an association between the experience of institutional abuse in childhood and the prevalence of adult mental health problems, particularly anxiety, mood and substance use disorders. PRACTICE IMPLICATIONS Policies, practices and procedures should be regularly reviewed and revised to maximize protection of young people in institutional care. Evidence-based psychological treatment should be made available to adult survivors of institutional abuse.

Sources of Stress Among Adult Siblings of Irish people with Intellectual Disability

Siblings play an important role in the lives of their brothers and sisters with intellectual disability when they reside in the parental home. Many assume a primary caregiving role following the death of their parents or when parents are no longer able to give care. Sources of stress reported by 39 adult siblings of Irish men and women with intellectual disability were explored. Siblings who were primary caregivers were older and earned less income than their counterparts in a second group who lived in the parental home and who had an especially close bond with their brother or sister with intellectual disability. Perceived social support as well as their brother or sister’s independence were significantly related to the stress reported by siblings on the short form of the QRS-F. Neither levels of reported stress nor the presence of a plan for their relative’s future distinguished the two groups of siblings.

Development and initial validation of the institutional child abuse processes and coping inventory among a sample of Irish adult survivors of institutional abuse

OBJECTIVE To develop a psychometric instrument to evaluate psychological processes associated with institutional abuse and coping strategies used to deal with such abuse. METHODS As part of a comprehensive assessment protocol, an inventory containing theoretically derived multi-item rational scales which assessed institutional abuse-related psychological processes and coping strategies were administered to 247 Irish adult survivors of institutional child abuse. Exploratory and confirmatory factor analyses were used to derive 6-factor scales, the reliability and validity of which were assessed. RESULTS Factor scales to assess the following constructs were developed (1) traumatization, (2) re-enactment, (3) spiritual disengagement, (4) positive coping, (5) coping by complying, and (6) avoidant coping. There were varying degrees of support for the validity of the scales with most support for the traumatization and re-enactment scales. CONCLUSIONS The Institutional Child Abuse Processes and Coping Inventory (ICAPCI), particularly its traumatization and re-enactment scales, may be used in future research on adult survivors of institutional child abuse because they are currently the only scales that have been developed with this population to provide reliable and valid assessments of these constructs. PRACTICE IMPLICATIONS The ICAPCI may be used, cautiously, to assess adult survivors of institutional child abuse.

Profiles of Irish survivors of institutional abuse with different adult attachment styles

Two hundred and forty seven survivors of institutional abuse in Ireland were classified with the Experiences in Close Relationships Inventory as having fearful (44%), preoccupied (13%), dismissive (27%), or secure (17%) adult attachment styles. The group with the secure adult attachment style had the most positive profile, while the most negative profile occurred for the fearful group in terms of DSM IV diagnoses and scores on the Trauma Symptom Inventory, the Global Assessment of Functioning Scale, the World Health Organization Quality of Life 100 scale, and the Kansas Marital Satisfaction Scale. The profile of the preoccupied group was more similar to that of the fearful group. The profile of the dismissive group was more similar to that of the secure group.

‘Systemic Trauma’: The Impact on Parents Whose Children Have Experienced Sexual Abuse

This article examines the impact on parents in an Irish context whose children have experienced sexual abuse and aims to explore the pathways to distress. This is in order to understand what factors facilitate or hinder parents from supporting their child to the best of their ability, given that parental support is a crucial moderating factor in children’s recoveries. Semistructured interviews were carried out with 13 parents in this context and analyzed using a grounded theory methodology. The overall concept that emerged was termed “systemic trauma” and was composed of eight categories that help to explain the pathways of impact for parents. This model can help clinicians understand and respond to the needs of parents in the aftermath of CSA.

What about me? The loss of self through the experience of traumatic childbirth

BACKGROUND AND OBJECTIVE birth trauma has become an increasingly recognised maternal mental health issue and has important implications for both mother and infant. The importance of subjective birth experience in the development of birth trauma has been identified and may mediate the lack of theoretical consistency in this area. The current study aims to explore the subjective experience of birth trauma among first time mothers in Ireland. It aims to separate the potential effects of peripartum depression (PPD) from this in limiting this qualitative investigation to women who reported birth trauma, without PPD. DESIGN mixed methods: Quantitative methods facilitated the recruitment of participants, the selection of a homogenous sample and addressed previous methodological flaws in birth trauma research. Interpretative Phenomenological Analysis (IPA) was used to explore the subjective experience of traumatic childbirth. PARTICIPANTS seven, first- time mothers who reported a traumatic childbirth, without significant symptoms of PPD participated. MEASUREMENT AND FINDINGS screening measures of birth trauma and PPD were completed by participants. A semi-structured interview was then conducted with each participant about their childbirth experience. Interviews were transcribed and analysed using IPA. The primary superordinate theme recounted how the identity and individuality of women is ignored and discounted, throughout the process of childbirth. Identity is challenged and altered as a result of womens incompatibility with the maternity system. CONCLUSIONS this study supports the existence of birth trauma in an Irish context and highlights the subjective experience of women as central to the development of birth trauma. IMPLICATIONS FOR PRACTICE acknowledgement and inclusion of the mother as an individual throughout the process of childbirth may be protective in limiting the experience of birth trauma.

Protocol for a systematic review with network meta-analysis of the modalities used to deliver eHealth interventions for chronic pain

BackgroundAs eHealth interventions prove both efficacious and practical, and as they arguably overcome certain barriers encountered by traditional face-to-face treatment for chronic pain, their number has increased dramatically in recent times. However, there is a dearth of research that focuses on evaluating and comparing the different types of technology-assisted interventions. This is a protocol for a systematic review that aims to evaluate the eHealth modalities in the context of psychological and non-psychological (other than non-drug) interventions for chronic pain.Methods/designWe will search the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase and PsycINFO. Randomised controlled trials (RCTs) with more than 20 participants per trial arm that have evaluated non-drug psychological or non-psychological interventions delivered via an eHealth modality and have pain as an outcome measure will be included. Two review authors will independently extract data and assess the study suitability in accordance with the Cochrane Collaboration Risk of Bias Tool. Studies will be included if they measure at least one outcome variable in accordance with the IMMPACT guidelines (i.e. pain severity, pain interference, physical functioning, symptoms, emotional functioning, global improvement and disposition). Secondary outcomes will be measures of depression and health-related quality of life (HRQoL). A network meta-analysis will be conducted based on direct comparisons to generate indirect comparisons of modalities across treatment trials, which will return rankings for the eHealth modalities in terms of their effectiveness.DiscussionMost trials that use an eHealth intervention to manage chronic pain typically use one modality. As a result, little evidence exists to support which modality type is the most effective. The current review will address this gap in the literature and compare the different eHealth modalities used for technology-assisted interventions for chronic pain. With the growing reliance and use of technology as a medium for delivering treatment for chronic conditions more generally, it is imperative that research identify the most efficacious eHealth modalities and systematically identify the most important features of such treatment types, so they may be replicated and used for research and in the provision of care.Trial registrationPROSPERO, CRD42016035595

Staff perceptions of the quality of life of individuals with an intellectual disability who transition from a residential campus to community living in Ireland: An exploratory study

Abstract Background This study explores the quality of life (QoL) of individuals with a severe intellectual disability (ID) who had recently moved from an institutional setting (i.e., “residential campus”) to independent housing in the community (i.e., “community living”) and whether aspects of their QoL were perceived to have changed over the course of this move. Method A qualitative approach was adopted by interviewing the key workers of 8 individuals with an ID (M age = 37.38, range: 26–44, male n = 6, female n = 2). An interview tool focusing on aspects of QoL was utilised and the interviews were analysed using thematic analysis (Braun & Clarke, 2006). Results Ten themes emerged from the analysis that provided insight into the experience of transitioning to community living. Conclusions The emotional wellbeing, health, privacy, freedom, and material wellbeing of all the individuals were perceived to have improved, as well as independence, choice, and social opportunities for many.

Emotional expression and eating in overweight and obesity

ABSTRACT Objectives: To explore psychological factors associated with emotional eating and obesity in a sample of overweight and obese adults attending a weight management programme. Design: A cross-sectional quantitative research design. Methods: Participants (n = 97) completed the Emotional Eating Subscale of the Dutch Eating Behaviour Questionnaire, the Attitude towards Emotional Expression (AEE) scale and the mindful awareness observe subscale of the Kentucky Inventory of Mindfulness Skills scale. Clinical measures of body mass index (BMI) were also recorded. Results: Regression analyses revealed that AEE was a significant predictor of emotional eating (β = 0.59, p = .000). Control, the belief that emotions should be controlled (β = 0.39, p = .026) and the response to eat to diffuse emotion (β = 0.37, p = .045) were statistically significant predictors of BMI. Mediation analyses revealed that mindful awareness skills had a significant indirect effect on the relationship between AEE and emotional eating. Conclusions: Findings highlight the influence of AEE on emotional eating and body weight, thereby helping to validate recent developments in an affect phobia model of emotional eating. The authors highlight the prevalence of emotional eating in overweight and obese adults. The potential preventative role of mindful awareness skills may be limited. Validation of the model may be a useful framework for the development and implementation of future weight management interventions.

What was once essential, may become detrimental: The mediating role of depersonalization in the relationship between childhood emotional maltreatment and psychological distress in adults

ABSTRACT Depersonalization (DP) is a dissociative phenomenon, characterized by feeling “unreal” or detached from one’s own emotions, thoughts, and behavior (APA, 2013). It is considered to be a defense mechanism, employed in response to overwhelming events, whereby thoughts and emotions are suppressed in order to enhance the individual’s capacity to function in traumatic environments. DP has been found to co-occur with anxiety and depressive disorders, and childhood emotional maltreatment (EM) has been identified as an important predisposing factor. The study’s primary aim was to investigate the mediating role of DP in the relationship between childhood EM and psychological distress in young adults. Additionally, it aimed to confirm that a history of childhood EM (emotional abuse and emotional neglect) predicted current levels of DP and to explore how both a person’s attitude towards experiencing and expressing emotions (with an emphasis on the affect phobia model) and their current attachment security are related to current DP. A cross-sectional design was employed, which included young adults (N = 761) aged between 18 and 25 years. Participants completed an online survey that comprised of several self-report measures. Regression and mediation analyses were conducted. The results indicated that: (1) DP significantly mediated the relationship between childhood EM and current psychological distress; (2) that a history of EM, but no other forms of childhood abuse, significantly predicted current DP experiences; and (3) EM, attachment-related anxiety, and negative attitudes toward emotions predicted clinical cutoff levels of DP. The results are discussed in detail, including clinical implications and direction for future research.