Kathleen A. Kendall-Tackett

The health effects of childhood abuse: four pathways by which abuse can influence health

OBJECTIVES This article describes four possible pathways by which childhood abuse relates to health problems in adults. METHOD Literature on the long-term effects of childhood abuse is organized in a health psychology framework describing behavioral, social, cognitive, and emotional pathways. Key studies from the health psychology and behavioral medicine literature are included to demonstrate how these pathways relate to health. RESULTS Childhood abuse puts people at risk of depression and post-traumatic stress disorder, participating in harmful activities, having difficulties in relationships, and having negative beliefs and attitudes towards others. Each of these increases the likelihood of health problems, and they are highly related to each other. CONCLUSIONS Childhood abuse is related to health via a complex matrix of behavioral, emotional, social, and cognitive factors. Health outcomes for adult survivors are unlikely to improve until each of these factors is addressed.

The effects of neglect on academic achievement and disciplinary problems: a developmental perspective.

The present study examines the effect of child neglect, alone and in combination with abuse, on academic achievement and school disciplinary problems for elementary, junior high, and senior high students. The sample included 324 neglected children and adolescents, and a matched nonmaltreated sample of 420 children and adolescents. All subjects were in grades K through 12 in a small city in New York state. The results revealed that neglected children did perform more poorly than their nonmaltreated counterparts, having lower grades, more suspensions, more disciplinary referrals, and more grade repetitions, even when controlling for gender of child and SES. Neglect alone and neglect in combination with physical or sexual abuse was related to lower grades and more suspensions. The combination of abuse and neglect had a particularly strong effect on the number of disciplinary referrals and grade repetitions. Abused/neglected students in junior high had the highest number of grade repetitions. The number of disciplinary referrals continued to increase through senior high for both neglected and abused/neglected students. Interestingly, the academic performance of all subjects dropped during junior high. Neglect and neglect in combination with abuse appeared to exacerbate a decline in academic performance that occurs as children enter junior high school.

A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health

BackgroundResearch in the field of psychoneuroimmunology (PNI) has revealed that depression is associated with inflammation manifested by increased levels of proinflammatory cytokines.DiscussionThe old paradigm described inflammation as simply one of many risk factors for depression. The new paradigm is based on more recent research that has indicated that physical and psychological stressors increase inflammation. These recent studies constitute an important shift in the depression paradigm: inflammation is not simply a risk factor; it is the risk factor that underlies all the others. Moreover, inflammation explains why psychosocial, behavioral and physical risk factors increase the risk of depression. This is true for depression in general and for postpartum depression in particular. Puerperal women are especially vulnerable to these effects because their levels of proinflammatory cytokines significantly increase during the last trimester of pregnancy – a time when they are also at high risk for depression. Moreover, common experiences of new motherhood, such as sleep disturbance, postpartum pain, and past or current psychological trauma, act as stressors that cause proinflammatory cytokine levels to rise. Breastfeeding has a protective effect on maternal mental health because it attenuates stress and modulates the inflammatory response. However, breastfeeding difficulties, such as nipple pain, can increase the risk of depression and must be addressed promptly.ConclusionPNI research suggests two goals for the prevention and treatment of postpartum depression: reducing maternal stress and reducing inflammation. Breastfeeding and exercise reduce maternal stress and are protective of maternal mood. In addition, most current treatments for depression are anti-inflammatory. These include long-chain omega-3 fatty acids, cognitive therapy, St. Johns wort, and conventional antidepressants.

Use of physical and neurologic observations in assessment of gestational age in low birth weight infants

The relative validities of three clinical assessment methods for estimating gestational age in newborn low birth weight infants were evaluated with reference to estimates based on the date of the mothers last menstrual period. For 1246 infants in eight diverse institutions, estimates based on physical criteria correlated more strongly with dates estimates, yielded estimates more similar on average to dates estimates, and yielded higher proportions of correct classifications of prematurity and small for gestational age than did estimates based on neurologic criteria or neurologic and physical criteria combined. These results support the use of physical criteria rather than neurologic or combined criteria for the clinical assessment of gestational age in low birth weight infants. In a subsample of 511 black and white infants, there were no ethnic differences in mean error of estimate for any of the three methods.

Health consequences of abuse in the family : a clinical guide for evidence-based practice

Family Violence As A Health Issue, Kathleen Kendall-Tackett The Spectrum Of Victimization And The Implications For Health, Sherry L. Hamby Screening For Family Violence With Perioperative Clients, Debra Pilling Hastings And Glenda Kaufman Kantor Domestic Violence Interventions With Women Of Colour - Intersection Of Victimization And Cultural Diversity, Catherine Koverola And Subadra Panchandeswaran Why Healthcare Professionals Are Reluctant To Intervene In Cases Of Ongoing Domestic Abuse, L. Kevin Hamberger And Darshana Patel Adverse Childhood Experiences And Health-Related Quality Of Life As An Adult, Valerie J. Edwards Et Al The Victimization Of Children With Disabilities, Liza Little Elder Abuse - Clinical Assessment And Obligation To Report, L. Rene Bergeron The Healthcare Needs Of Abuse Survivors At Midlife And Beyond, Jane Rysberg Links Between Traumatic Family Violence And Chronic Pain - Biopsychosocial Pathways And Treatment Implications, Mary W. Meagher Victimiztion And Health Risk Behaviours - Implications For Prevention Programs, Joanne L. Davis Et Al. (Part Contents).

Perpetrators and their acts: data from 365 adults molested as children

Intake interviews were analyzed from 365 adults molested as children (AMACs). The AMACs were entering treatment at the Child Sexual Abuse Treatment Program (San Jose, CA). This study presents data on the relationship of the perpetrator to the victim, and whether most molestations include intercourse. The majority of the perpetrators (62%) were either biological fathers or father-surrogates. Ninety-nine percent of the perpetrators were known to the victim; 97% were male. As in past studies, fondling from the waist down was the most common type of molestation, occurring in 92% of the cases. Forty-four percent of cases included intercourse. The present findings are compared with past research and are discussed in the context of common misconceptions associated with child sexual abuse.

Chronic Pain Syndromes and Violence Against Women

Abstract Chronic pain is a common form of disability, and is often reported among women with a history of victimization. In the present study, we combine six pain symptoms into a measure of self-reported pain, and compare women who have experienced child or domestic abuse with those who do not report such a history. A sample of 110 female patients (57 abused, 53 non-abused controls) was drawn from an adult primary-care practice of 905 patients in a small, affluent, predominantly Caucasian community in northern New England. The subjects ranged in age from 18 to 88 (M = 47). Subjects completed a self-administered questionnaire that was used clinically as part of the new-patient work-up. Women who reported either child or domestic abuse were significantly more likely to report pain symptoms than women in the control group. There was no significant difference between women who had experienced domestic abuse vs. child abuse alone. These findings held true even after controlling for depression.

Recruitment and retention in a clinical trial for low birth weight, premature infants

We report on recruiting and retaining a sample of low birth weight, premature infants for a clinical trial as well as results of tests evaluating sampling and retention biases. A total of 4551 infants were screened, and 1302 were found eligible. Consent was obtained for 1028 infants. After randomization and the presentation of group assignment, the number of infants enrolled was 985 (75.7% of those eligible). Of these, 92.7% completed the 3-year study. Tests to evaluate recruitment bias revealed significant relationships between nonenrollment and site, maternal race, and infant birth weight. Tests to evaluate retention bias revealed a significant relationship between dropout and maternal education. Additionally, infant birth weight and maternal age interacted with treatment in predicting dropout. Despite these statistically significant recruitment and retention biases, there was no evidence of problems with sample representativeness to the population of interest or of treatment group differences on study-relevant background variables. J Dev Behav Pediatr 14:1–7, 1993. Index terms: bias, infant, recruitment, retention, sample.

Victimization and diabetes: an exploratory study.

In recent years, researchers have documented higher rates of health problems in adult survivors of abuse than in the general population. These problems include diffuse soft tissue pain (Boisset-Pioro, Esdaile & Fitzcharles, 1995), irritable bowel syndrome (Leserman, Drossman, Li, Toomey, Nachman & Glogau, 1996), and chronic pelvic pain (Walling, Reiter, O’Hara, Milburn, Lilly & Vincent, 1994). While this past research has done much to increase our understanding, it is somewhat limited. For example, the samples are typically drawn from populations with specific medical problems (e.g., those presenting at a gastroenterology clinic), which influences the choice of illness studied (Laws, 1993). In the present study, we focus on diabetes. Diabetes has not been examined with regard to past victimization, but we believe that it is potentially fruitful. Chronic stress can lead to an elevation in blood levels of triglycerides, free fatty acids, cholesterol, glucose, and insulin (Lovallo, 1997; Meaney, 1997; Sapolsky, 1994). When glucose and insulin levels are chronically elevated, the body responds by becoming less sensitive to insulin. The person then becomes “insulin resistant,” a hallmark symptom of diabetes (American Diabetes Association, 1997). We propose that child and domestic abuse are chronic stressors, and as such they can create an even wider variety of health problems than ones already studied. To summarize, the present study considers diabetes and symptoms of diabetes in patients with a past history of victimization. Since our sample is from primary care and essentially healthy, we expect relatively low incidence of illness but we do expect a greater reporting of both illness and symptoms in members of the abused group.

Breasifeeding and the Sexual Abuse Survivor

In this paper, the possible effects of child sexual abuse on a mothers breastfeeding experience are described. The long-term effects of sexual abuse are divided into seven domains that may impact breastfeeding behavior: posttraumatic stress disorder, cognitive distortions, emotional distress, impaired sense of self, avoidance, interpersonal difficulties, and health problems. In each section, the potential impact of past sexual abuse on current breastfeeding behavior and the mother-infant relationship is described. Finally, specific suggestions and strategies for lactation consultants are offered.