Sarah Brennenstuhl

Making a link between childhood physical abuse and cancer: results from a regional representative survey.

Abuse in childhood is associated with many negative adult health outcomes. Only 1 study to date has found an association between childhood abuse and cancer. By using a regionally representative community sample, this preliminary study sought to investigate the association between childhood physical abuse and cancer while controlling for 3 clusters of risk factors: childhood stressors, adult health behaviors, and adult socioeconomic status.

The association between childhood physical abuse and heart disease in adulthood: findings from a representative community sample.

OBJECTIVES Although, the relationship between childhood physical abuse and adult heart disease has been documented, very few studies have controlled for many of the known risk factors for heart disease. The objective of the current study, therefore, was to investigate the association between childhood physical abuse and adult heart disease while controlling for the following established risk factors: (1) childhood stressors; (2) adult health behaviors; (3) adult stressors; (4) depression; and, (5) high pressure. METHODS Data was obtained from the 2005 Canadian Community Health Survey. The sample included 13,093 respondents from the Canadian provinces of Manitoba and Saskatchewan, of whom 7.4% (n=1025) reported that they had been physically abused as a child by someone close to them and 4.4% (n=850) reported that they had been diagnosed with heart disease by a health professional. The regional level response rate was 84%. RESULTS The age-gender-race adjusted odds ratio of heart disease among those who had reported childhood physical abuse was 1.57 (95% CI=1.12, 2.20). When adjustments were made for all of the established risk factors the odds ratio declined to 1.45 (95% CI=1.01, 2.08). CONCLUSIONS The relationship between childhood physical abuse and heart disease persists even when controlling for five types of factors previously thought to mediate the relationship. PRACTICE IMPLICATIONS Further research would benefit from a closer analysis of the potential mechanisms linking childhood physical abuse and heart disease.

The association between depression and epilepsy in a nationally representative sample

Purpose:  To determine the: (1) national prevalence of epilepsy and depression; (2) prevalence of depression among those with epilepsy; (3) odds ratio of depression among those with epilepsy compared to those without, controlling for demographic characteristics; (4) demographic correlates of depression among those with epilepsy and those without; and, (5) health services utilization of those with epilepsy and depression.

The robust association between childhood physical abuse and osteoarthritis in adulthood: findings from a representative community sample

OBJECTIVE Research suggests a role of early-life trauma in the development of arthritis. This study investigated the relationship between childhood physical abuse and osteoarthritis (OA) while controlling for age, sex, race, and socioeconomic status (SES), in addition to the following types of risk factors for OA: 1) concurrent childhood stressors, 2) adult health behaviors, and 3) depression. METHODS Data from the provinces of Manitoba and Saskatchewan were selected from the 2005 Canadian Community Health Survey (n = 13,093). Respondents with missing arthritis data or with arthritis types other than OA were excluded (n = 1,985). Of the 11,108 remaining respondents, 6.9% (n = 854) reported childhood physical abuse by someone close to them, and 10.1% (n = 1,452) reported that they had been diagnosed with OA by a health professional. The regional-level response rate was 84%. RESULTS When adjusting for all 3 types of risk factors, a significant association between childhood physical abuse and OA was found (odds ratio [OR] 1.56, 95% confidence interval [95% CI] 1.21-2.00). In contrast, when adjusting for age, sex, race, and SES only, the OR was 1.99 (95% CI 1.57-2.52). CONCLUSION The association between childhood physical abuse and OA remained significant, even after controlling for many risk factors that may mediate the relationship. Further research is needed to investigate potential pathways through which arthritis develops as a consequence of childhood physical abuse.

Protective and risk factors associated with stigma in a population of older adults living with HIV in Ontario, Canada

Although the deleterious effects of HIV stigma are well documented, less is known about how various types of stigma impact older adults living with HIV disease and what factors exacerbate or lessen the effects of HIV stigma. Using cross-sectional data from the OHTN cohort study (OCS), we undertook multiple linear regression to determine the predictors of overall HIV stigma, and enacted, anticipated, and internalized stigma subscales in a sample of OCS participants age 50 and over (n=378). Being female, heterosexual, engaging in maladaptive coping, and having poor self-rated health were associated with greater overall stigma while being older, having greater mastery, increased emotional-informational social support, and a longer time since HIV diagnosis were associated with lower levels of stigma. The final model accounted for 31% of the variance in overall stigma. Differences in these findings by subscale and implications for practice are discussed.

Investigating the Association Between Childhood Physical Abuse and Migraine

(Headache 2010;50:749‐760)

The Link between Childhood Sexual Abuse and Myocardial Infarction in a Population-Based Study.

OBJECTIVES This study examined the relationship between childhood sexual abuse (CSA) and myocardial infarction in men and women, while controlling for social determinants (i.e., socioeconomic status, social support, mental health) and traditional cardiovascular risk factors (i.e., age, race, obesity, smoking, physical inactivity, diabetes mellitus). METHODS Population-based data were obtained from the 2010 Behavioral Risk Factor Surveillance System. Myocardial infarction was ascertained by self-report of a health-professional diagnosis. CSA was defined as forced sex with someone at least 5 years older before the age of 18. The final sample included 5,095 men and 7,768 women. RESULTS After adjustment for 15 factors, abused males had nearly 3 times the odds of heart attack compared to non-abused males (OR=2.96; 95% CI=1.12, 7.85). Among women, CSA was not associated with heart attack in the age-race adjusted (OR=1.20; 95% CI=0.39, 3.68) or fully-adjusted (OR=0.88; 95% CI=0.28, 2.75) analyses. CONCLUSIONS CSA was associated with heart attack in men, even when controlling for traditional risk factors; however, no association was found among women. Future research is needed to replicate the studys unique findings.

The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter?

The purpose of this study was to examine the independent influence of age on levels of HIV-related stigma experienced by adults living with HIV/AIDS. To accomplish this, cross-sectional data from the Ontario HIV Treatment Network Cohort Study were used to determine whether older age is associated with overall stigma among HIV-positive adults living in Ontario, Canada (n = 960). The relationship was also tested for enacted, anticipated, and internalized stigma. Covariates included sociodemographic (e.g., gender, sexual orientation, race) and psychosocial variables (e.g., depression). Modifying effects of covariates were also investigated. Those 55 and older have significantly lower overall and internalized stigma than adults under age 40, even when accounting for gender, sexual orientation, income, time since diagnosis, depression, maladaptive coping, and social support. Age does not predict enacted or Anticipated Stigma when accounting for the demographic and psychosocial variables. A significant interaction between depression and age suggests that stigma declines with age among those who are depressed but increases to age 50 and then decreases in older age groups among those who are not depressed. Age matters when it comes to understanding stigma among adults living with HIV/AIDS; however, the relationship between age and stigma is complex, varying according to stigma type and depression level.

Comparison of Disability Rates Among Older Adults in Aggregated and Separate Asian American/Pacific Islander Subpopulations

OBJECTIVES We assessed the prevalence and adjusted odds of 4 types of disability among 7 groups of older Asian American/Pacific Islander (AAPI) subpopulations, both separately and aggregated, compared with non-Hispanic Whites. METHODS Data were from the nationally representative 2006 American Community Survey, which included institutionalized and community-dwelling Hawaiian/Pacific Islander (n = 524), Vietnamese (n = 2357), Korean (n = 2082), Japanese (n = 3230), Filipino (n = 5109), Asian Indian (n = 2942), Chinese (n = 6034), and non-Hispanic White (n = 641 177) individuals aged 55 years and older. The weighted prevalence, population estimates, and odds ratios of 4 types of disability (functional limitations, limitations in activities of daily living, cognitive problems, and blindness or deafness) were reported for each group. RESULTS Disability rates in older adults varied more among AAPI subpopulations than between non-Hispanic Whites and the aggregated Asian group. Asian older adults had, on average, better disability outcomes than did non-Hispanic Whites. CONCLUSIONS This study provides the strongest evidence to date that exclusion of institutionalized older adults minimizes disparities in disabilities between Asians and Whites. The aggregation of Asians into one group obscures substantial subgroup variability and fails to identify the most vulnerable groups (e.g., Hawaiian/Pacific Islanders and Vietnamese).

Migraine and Despair: Factors Associated with Depression and Suicidal Ideation among Canadian Migraineurs in a Population-Based Study

This study sought to (1) investigate the association between migraine and both depression and suicidal ideation and (2) to identify the factors independently associated with each of these mental health problems among Canadian men and women with migraine. Data were analyzed from the 2005 Canadian Community Health Survey (CCHS). Presence of migraine was assessed by self-report of a health professional diagnosis. Current depression was measured using the CIDI-SF, and suicidal ideation was based on a question about serious consideration of suicide at any point during the respondents lifetime. Migraineurs were found to have elevated odds of depression (men: OR = 2.02; 95% CI = 1.70, 2.41; women: OR = 1.89; 95% CI = 1.71, 2.10) and suicidal ideation (men: OR = 1.70; 95% CI = 1.55, 1.96; women: OR = 1.72; 95% CI = 1.59, 1.86) even when adjusting for sociodemographic variables and disability status. The odds of depression and suicidal ideation were higher among both genders of migraineurs who were younger, unmarried and had more activity limitations; associations with poverty and race depended on gender and whether the focus was on depression or suicidal ideation. While screening for depression is already recommended for those with migraine, this research helps identify which migraineurs may require more immediate attention, including those who are younger, unmarried, and experiencing limitations in their activities.