Paul E. Mullen

Prevalence of Childhood Sexual Abuse Experiences in a Community Sample of Women

OBJECTIVE The study was designed to ascertain the prevalence and nature of sexual abuse in childhood for a community sample of women. METHOD A two-stage design, using questionnaires and face-to-face interviews, was employed, providing information on prevalence rates, types of abuse, ages of victims, relationship to the abuser, and cohort effects. RESULTS Nearly one woman in three reported having one or more unwanted sexual experiences before age 16 years. A significant number of these experiences (70%) involved genital contact or more severe abuse, and 12% of those abused were subjected to sexual intercourse. The abusers were usually known to the victim, being family members in 38.3% of cases and acquaintances in another 46.3%. Stranger abuse accounted for 15% of all abuse experiences. Most of the abusers were young men, disclosure of the abuse was infrequent, and only 7% of all abuse was ever officially reported. Prevalence rates showed no urban/rural differences, no cohort effect with subject age, and no age differences in disclosure rates. CONCLUSIONS Child sexual abuse is common, serious, infrequently reported, and the abuser is usually known to the child. Preadolescent girls are at greatest risk.

Asking about child sexual abuse: Methodological implications of a two stage survey☆

In a two stage retrospective survey on child sexual abuse (CSA), a majority of CSA incidents were reported at both postal and interview stages of the survey. Incidents that involved genital contact were most likely to be reported at both stages. A significant number of women reported abuse by a close family member in the postal questionnaire but not at interview. In contrast, incidents mentioned only at interview were more likely to be carried out by a stranger. At interview, many women who replied negatively to a general screening question on CSA went on to report abuse in response to detailed descriptive questions. This was especially true for noncontact experiences. Increasingly restrictive definitions of CSA lowered the prevalence rate for CSA under the age of 16 years from 34.4% to 19.7%. The implication of these findings for the design of future studies is discussed.

Validity of the GHQ-28 in New Zealand Women

The GHQ-28 was validated against the short PSE in a New Zealand community study of female psychiatric morbidity. The GHQ-28 total scores were significantly correlated with the PSE scores. Higher coefficients were obtained using the scoring method of Good child and Duncan-Jones than with the standard scoring method. In this data set, the 3/4 cutoff had the best sensitivity and specificity. The correlations of the GHQ-28 subscales with ICD diagnostic classes and ad hoc PSE sub-scores were also statistically significant. Because the distribution of the GHQ-28 scores is positively skewed, non-parametric statistics may be preferable to the traditional Pearsons correlation coefficient. Overall, the results from this study confirm the GHQ-28 to be a valid and practical screen for presence or absence of psychiatric disorder in New Zealand women.

Social Networks and Psychiatric Morbidity in New Zealand Women

A random community survey of urban and rural New Zealand women revealed higher rates of psychiatric morbidity in subjects who reported poorer social support. Substantial differences in social networks were found between demographic subgroups. Rural women described better than expected social relationships, giving some support to the pastoral ideal of well integrated rural communities. Women in part-time employment also described better social networks. Elderly, low socio-economic, and widowed, separated and divorced women had poorer social relationships. It is suggested that normative values for social network measures for each demographic subgroup will need to be established before the clinical significance of deviations from the norm can be meaningfully evaluated. Also, the mechanisms linking social networks to health may vary in different subgroups.

Cigarette Smoking and Psychiatric Morbidity in Women

A random community survey of psychiatric morbidity in adult New Zealand women, the Otago Womens Health Survey, investigated the association of cigarette smoking with mental health. Of the women interviewed, just over one quarter (26.1%) smoked, with one third of these smokers consuming more than 20 cigarettes per day. Demographic factors associated with smoking were younger age, lower socioeconomic status, poor education, caring for preschool children, dissatisfaction with female caring roles and financial strife. Psychiatric morbidity as measured by the short PSE was statistically associated with smoking. The unexpected finding reported here is a higher rate of recovery from their psychiatric morbidity amongst women who smoked. This result fits with previously reported data indicating that women use cigarette smoking to regulate mood and cope with the pressures of relentless child care in the context of strained financial resources. The profile of the woman who smokes differed substantially from that of the woman who drinks alcohol in a hazardous manner. Different preventive strategies are therefore required for these two risky behaviours.

Mental disorder and dangerousness.

Psychiatrists are called upon to make judgements on the future dangerousness of mentally disordered subjects in civil commitment procedures, in the criminal courts, and during the decision process on the release of offenders on indeterminate sentences or committals. The ability of psychiatrists to make these judgements is increasingly under challenge. The difficulties of making useful predictions when the base rate for the event to be predicted is low, is now well recognised. Less obvious are the problems attendant upon making socially useful predictions on psychiatric grounds in populations with a high base rate for future offending. The evidence pertaining to the level of violence amongst the mentally disordered is reviewed. The lesson to be drawn from the empirical evidence is that mental abnormality of and in itself contributes littie to the prediction of the predisposition to act violently. The question remains as to whether there are definable groups or classes within the generality of mentally abnormal individuals for whom there is an increased risk of future violence. It would be compatible with both the research studies and common clinical impression if the mentally abnormal contained subgroups with unusually violent predispositions balanced by larger groups with less than average propensities to aggression. The literature is largely inadequate to delineate such high risk groups with the degree of certainty ideally needed to instruct clinical decisions, but does suggest that such groups exist and are capable of further empirical definition.

A Phenomenology of Jealousy

Phenomenology is the study of conscious mental events [1]. That it is conscious events requires emphasis, particularly at this moment in the historical development of psychiatry when we are still emerging from the thrall of psychodynamic causalities, said to lie in unconscious and unknowable realms, and are in danger of descending into another mythology of extra conscious mechanisms compounded from neurobiological speculations.

The long-term impact of the physical, emotional and sexual abuse of children: A community study

The associations between giving a history of physical, emotional, and sexual abuse in children and a range of mental health, interpersonal, and sexual problems in adult life were examined in a community sample of women. Abuse was defined to establish groups giving histories of unequivocal victimization. A history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. The similarities between the three forms of abuse in terms of their association with negative adult outcomes was more apparent than any differences, though there was a trend for sexual abuse to be particularly associated to sexual problems, emotional abuse to low self-esteem, and physical abuse to marital breakdown. Abuse of all types was more frequent in those from disturbed and disrupted family backgrounds. The background factors associated with reports of abuse were themselves often associated to the same range of negative adult outcomes as for abuse. Logistic regressions indicated that some, though not all, of the apparent associations between abuse and adult problems was accounted for by this matrix of childhood disadvantage from which abuse so often emerged.

A Double Blind Trial of Moclobemide versus Amltrlptyllne in the Treatment of Depressive Disorders

The antidepressant efficacy and side-effect profile of amitriptyline were compared to those of moclobemide, a reversible monoamine oxidase inhibitor with selectivity for the type A isozyme. Forty nine patients with DSM-Ill major depression were randomly assigned to receive either amitriptyline or moclobemide. Thirty seven patients (amitriptyline n=l6, moclobemide n=21) completed the six week protocol, which was conducted under double blind conditions. The results indicated a comparable antidepressant time course and efficacy for the two treatments. Amitriptyline produced significantly more sedation and antimuscarinic side-eff ects. Moclobemide appears to be a well tolerated antidepressant without the liability to produce significant postural hypotension and without the need for a tyramine-poor diet.

Alcohol-Related Problems in New Zealand Women

As total alcohol consumption has increased this half century in most developed countries, alcohol-related problems have become more frequent. Most research has either studied only men or failed to mention gender. This study examined the prevalence of alcohol problems and their socio-demographic associations in a random sample of New Zealand women. Women of younger age, who were unmarried, well educated, in employment, with child care support and who lived in rural communities saw themselves as having more problems with alcohol. Women who had experienced physical or sexual abuse as adults had increased rates of alcohol problems as did those with more psychiatric morbidity as assessed by the General Health Questionnaire and the short Present State Examination. However, women with multiple social roles, particularly caring responsibilities, were less likely than women with one or two social roles to view themselves as having alcohol problems. The data provided no support for the role strain hypothesis of alcohol abuse. It is argued that the findings support a social explanation for alcohol problems based on varying social sanctions on drinking and alcohol availability rather than a psychoanalytic one of unconscious conflicts over femininity, sexuality or female social roles.