Nicole M. Heath

Emotion regulation difficulties, low social support, and interpersonal violence mediate the link between childhood abuse and posttraumatic stress symptoms

We examined how difficulties with emotion regulation, social support, and interpersonal violence in adult relationships mediated the relationship between childhood abuse and post traumatic symptoms (PTS) in adults. We fit a multiple mediation model to data from 139 socio-economically disadvantaged women (85% African American) of whom 44% endorsed moderate to severe levels of childhood physical, sexual, or emotional abuse and 12% screened positive for probable posttraumatic stress disorder (PTSD). The model accounted for 63% of the variance in adult PTS symptoms. Child abuse exerted a direct effect on PTS symptoms and indirect effects through difficulties with emotion regulation, lower social support, and greater exposure to adult interpersonal violence. Implications of findings for the treatment of individuals at high risk of having experienced childhood abuse and PTS are discussed.

Emotion regulation difficulties mediate associations between betrayal trauma and symptoms of posttraumatic stress, depression, and anxiety

Emotion regulation difficulties following trauma exposure have received increasing attention among researchers and clinicians. Previous work highlights the role of emotion regulation difficulties in multiple forms of psychological distress and identifies emotion regulation capacities as especially compromised among survivors of betrayal trauma: physical, sexual, or emotional maltreatment perpetrated by someone to whom the victim is close, such as a parent or partner. It is unknown, however, whether links between emotion regulation difficulties and psychological symptoms differ following exposure to betrayal trauma as compared with other trauma types. In the present study, 593 male and female university undergraduates completed the Difficulties with Emotion Regulation Scale (Gratz & Roemer, 2004), the Brief Betrayal Trauma Scale (Goldberg & Freyd, 2006), the Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979), and the Trauma Symptom Checklist (Elliott & Briere, 1992). A path analytic model demonstrated that betrayal trauma indirectly impacted symptoms of intrusion (β = .11), avoidance (β = .13), depression (β = .17), and anxiety (β = .14) via emotion regulation difficulties, an effect consistent with mediation. Emotion regulation difficulties did not mediate the relationship between other trauma exposure and psychological symptoms. Results may inform treatment-matching efforts, and suggest that emotion regulation difficulties may constitute a key therapeutic target following betrayal trauma.

Looking Beneath the Surface: The Nature of Incarcerated Women’s Experiences of Interpersonal Violence, Treatment Needs, and Mental Health

Female offenders report higher rates of interpersonal violence (IPV) and mental health problems than incarcerated men. The purpose of this study was to describe the nature of incarcerated women’s (N = 102) IPV experiences, to investigate characteristics of IPV as predictors of current mental health, and to explore women’s perceptions of their treatment needs. Utilizing multivariate multiple regression analyses, the authors found that recent partner violence, multiple types of IPV, chronic IPV, and distress at the time of the IPV were all significant predictors of current mental health. In narrative responses, participants recognized the connection between IPV and their mental health and indicated a need for trauma-informed interventions.

Interpersonal violence, PTSD, and inflammation: potential psychogenic pathways to higher C-reactive protein levels.

Interpersonal violence (IPV) is major public health concern with wide-ranging sequelae including depression, posttraumatic stress disorder (PTSD), and possible alterations of immune and inflammation processes. There is a need to identify the psycho-biological pathways through which IPV may translate to altered inflammatory processes since both PTSD and inflammation are associated with serious physical health conditions such as obesity, diabetes, and cardiovascular disease. This study investigated the relationships between IPV, psychological distress, and the inflammatory marker C-reactive protein (CRP), in a sample of 139 urban women who have a high likelihood for having experienced IPV. Participants were recruited from an outpatient gynecology clinic to complete self-report measures about their IPV histories and psychological symptoms, as well as to have their blood sampled using a finger stick. Results indicated that exposure to IPV predicted the presence of probable depression and PTSD diagnoses. Individuals who experience clinical levels of PTSD exhibited higher CRP levels, and this relationship held after adjusting for comorbid depression. Correlational analyses suggested that reexperiencing symptoms may explain the link between PTSD diagnosis and higher levels of CRP. Follow-up path analytic models provided good fit to the overall data, and indicated that the relationship between probable PTSD status and CRP is not explained by higher BMI. Overall, these findings call for increased attention to the role of PTSD in explaining links between trauma and diminished health.

Reciprocal relationships between resource loss and psychological distress following exposure to political violence: an empirical investigation of COR theory's loss spirals

Abstract We conducted a four-wave prospective study of Palestinian adults living in the West Bank, Gaza Strip, and East Jerusalem, interviewed between 2007 and 2009 at 6-month interval to explore transactional relationships between resource loss (i.e., intra and interpersonal resource loss) and psychological distress (i.e., posttraumatic stress disorder and depression symptoms). Initially, 1196 Palestinians completed the first wave interview and 752 of these participants completed all four interviews. A cross-lagged panel design was constructed to model the effects of trauma exposure on both resource loss and psychological distress and the subsequent reciprocal effects of resource loss and psychological distress across four time waves. Specifically, resource loss was modeled to predict distress, which in turn was expected to predict further resource loss. Structural equation modeling was used to test this design. We found that psychological distress significantly predicts resource loss across shorter, 6-month time waves, but that resource loss predicts distress across longer, 12-month intervals. These findings support the Conservation of Resources theorys corollary of loss spirals.

Rape Myth Acceptance Impacts the Reporting of Rape to the Police A Study of Incarcerated Women

We examined the association between rape myth acceptance (RMA) and reporting rapes to the police. Situational characteristics of the rape (e.g., stranger attack, injury) are known predictors of reporting, but no existing studies have examined the association between beliefs about rape and reporting. In addition, most studies of RMA do not assess victimization history. Incarcerated women experience high rates of sexual assaults prior to incarceration. We recruited 74 rape survivors from a northwestern state prison. Results suggest that women who endorsed higher levels of RMA were less likely to report their rapes to police; however, participants endorsed few rape myths.

Silent Survivors Rape Myth Acceptance in Incarcerated Women’s Narratives of Disclosure and Reporting of Rape

Prior research suggests that rape victims who do not disclose or report to the police give reasons including self-blame and fear of judgment; however, this research has not been conducted with incarcerated women. Female offenders are a unique population because they experience high rates of sexual assault prior to incarceration. This study recruited 74 women at a U.S. state prison, who experienced sexual assault prior to incarceration to explore the associations among rape myth acceptance (RMA), disclosure, and reporting of sexual assaults to the authorities. Participants were asked open-ended questions regarding why they chose to disclose their sexual assaults to others, to report to the police, or to remain silent. Narratives were audiotaped, transcribed, and coded for thematic content. Women’s narratives, particularly those of women who indicated that they remained silent, frequently included a variety of rape myths that involved blaming themselves for the rape, fearing not being believed, believing that familiar perpetrators cannot be rapists, and questioning whether the event was really a rape. Women often described such rape myth beliefs with greater frequency than discussing situational characteristics of the rape as reasons for nonreporting. Implications for these findings in clinical, research, and social justice contexts are discussed.

Examining the effectiveness of a coordinated perinatal mental health care model using an intersectional-feminist perspective

Untreated perinatal depression and anxiety are significant public health problems that disproportionately affect ethno-racial minorities. The purpose of this study was to examine the effectiveness of a coordinated perinatal mental health care model, focusing on socially-disadvantaged, ethno-racial minority women, with an intersectional-feminist perspective. The treatment model was grounded in intersectionality theory with the aim of addressing complex social vulnerability factors in the context of perinatal mental health treatment. Participants were 67 perinatal women (64% African American or Hispanic/Latina) referred by medical providers at an urban teaching hospital. Results demonstrated high treatment engagement and effectiveness, with 65.9% of participants demonstrating reliable improvement in symptoms. Moreover, African American and Hispanic/Latina patients had similar treatment outcomes compared to White patients, despite facing greater socio-economic disadvantages. Findings indicate that the treatment model may be a promising approach to reducing perinatal mental health disparities. Strengths and limitations of the study are discussed within the intersectionality framework.

Predictors of incarcerated women’s postrelease PTSD, depression, and substance-use problems

ABSTRACT This longitudinal project assessed predictors of women’s mental health postrelease from prison. Women (59) completed mental health and trauma exposure assessments while incarcerated and then postrelease. Women’s mental health did not change postrelease. Lifetime exposure to interpersonal violence and maladaptive coping were significantly associated with increased postrelease PTSD. In addition, adaptive and maladaptive coping were significantly associated with postrelease depression. Ethnicity, prior substance dependence, postrelease PTSD and depression, interpersonal violence since release, and coping were all significantly associated with postrelease substance use and problems. The findings of this study contribute to identification of potential points of intervention for women postrelease.