Sarah E. Romans

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.

Childhood abuse and later medical disorders in women. An epidemiological study.

Background: There have been many studies documenting adverse psychiatric consequences for people who have experienced childhood and adult sexual and physical abuse. These include posttraumatic stress disorder, anxiety, depression, substance abuse, eating disorders and probably some personality disorders or trait abnormalities. Much less is known about the links between abuse and physical/psychosomatic conditions in adult life. Hints of causal links are evident in the literature discussing headache, lower back pain, pelvic pain and irritable bowel syndrome. These studies are not definitive as they use clinic-based samples. Methods: This study used interview data with a random community sample of New Zealand women, half of whom reported childhood sexual abuse and half who did not. Details about childhood physical abuse and adult abuse were also collected in a two-phase study. Results: Complex relationships were found, as abuses tended to co-occur. Seven of 18 potentially relevant medical conditions emerged as significantly increased in women with one or more types of abuse. These were chronic fatigue, bladder problems, headache including migraine, asthma, diabetes and heart problems. Several of these associations with abuse are previously unreported. Conclusions: In this random community sample, a number of chronic physical conditions were found more often in women who reported different types of sexual and physical abuse, both in childhood and in adult life. The causal relationships cannot be studied in a cross-sectional retrospective design, but immature coping strategies and increased rates of dissociation appeared important only in chronic fatigue and headache, suggesting that these are not part of the causal pathway between abuse experiences and the other later physical health problems. This finding and the low co-occurrence of the identified physical conditions suggest relative specificity rather than a general vulnerability to psychosomatic conditions in women who have suffered abuses. Each condition may require separate further study.

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.

Who Is Most at Risk for Intimate Partner Violence?: A Canadian Population-Based Study

Whole population studies on intimate partner violence (IPV) have given contradictory information about prevalence and risk factors, especially concerning gender. The authors examined the 1999 Canadian General Social Survey data for gender patterns of physical, sexual, emotional, or financial IPV from a current or ex-partner. More women (8.6%) than men (7.0%, p = .001) reported partner physical abuse in general, physical IPV causing physical injury (p < .0001), sexual abuse (1.7% vs. 0.2%, p < .0001), and financial abuse (4.1% vs. 1.6%, p < .0001). There were no gender differences for partner emotional abuse. Significant risk factors after multivariate modeling for physical/sexual IPV were younger age, being divorced/separated or single, having children in the household, and poor self-rated physical health. These findings from a large, randomly generated data set further refine our understanding of the risk profile for IPV in the developed world.

Impact of bipolar affective disorder on family and partners

BACKGROUND Successful management of major mental illness in the community relies significantly on an informal or non-professional network of caregivers. The needs and experiences of such caregivers have been little studied with respect to major chronic mood disorders. METHOD A sample of caregivers (n=41) of RDC bipolar disorder was systematically interviewed to determine how this role affected them. RESULTS Caregivers reported significant difficulties in their relationships with the patient when s/he was unwell, with considerable impact on their own employment, finances, legal matters, co-parenting and other social relationships. Violence was a particular worry for partner/parent caregivers of both male and female patients when the patient was manic. The caregivers own mental health appeared unaffected. Despite this, the caregivers appeared emotionally committed to the patients and showed considerable tolerance of problem behaviours, which they rank-ordered for difficulty. Among nonfamily partners, knowledge of the illness before cohabitation was poor. LIMITATION The sampling does not capture caregivers who have abandoned their role, such as spouses who have divorced the bipolar sufferer. CONCLUSIONS Management of this illness requires a partnership between mental health professionals and the informal caregivers and the authors suggest that each group needs to understand the difficulties encountered by the other. Although erosion of relationships is a well-known complication of bipolar disorder, findings indicate that treating clinicians can rely on caregivers committed to the welfare of the patient.

Age of menarche: the role of some psychosocial factors

BACKGROUND The goal of this study was to determine associations between the age of first menstrual period (menarche) and adverse childhood experiences in a random community sample of New Zealand women. Previous reports have linked early menarche to absence of a live-in father figure and to family conflict, as well as genetic determination of early puberty and adiposity. METHOD Two groups of women randomly selected from the community on their responses to a mailed screening questionnaire on childhood sexual abuse (CSA) were interviewed in detail. Data about their childhood experiences, including age of menarche, were collected on two occasions, 6 years apart. Early menarche was defined as first menstruation occurring before the age of 12 years. RESULTS Univariate analyses identified a number of adverse childhood experiences preceded early menarche, which was reported by 20.3% of this sample. These included low family socio-economic status, absence of father, a number of variables showing family conflict, poor relationships between the girl and either/both parents, a self-rated childhood personality style as a loner, childhood physical and sexual abuse. Sequential modelling showed parental rows, being a loner and the duration of CSA to be most important, although lack of a father and any CSA were each also independently associated with early menarche. No variables survived the modelling exercise as predictors of early menarche for those women who did not report childhood sexual abuse. CONCLUSIONS The identified variables statistically interacted with each other in a highly complex manner. The attempt to rank their importance was only partially successful, for methodological reasons (half the sample reporting CSA). Chronic or protracted CSA needs to be added to the list of factors associated with early menarche in future studies.

Gender differences in the symptoms of major depressive disorder.

Data from the Canadian Community Health Survey 1.2 were used for a gender analysis of individual symptoms and overall rates of depression in the preceding 12 months. Major depressive disorder was assessed using the Composite International Diagnostic Interview in this national, cross-sectional survey. The female to male ratio of major depressive disorder prevalence was 1.64:1, with n = 1766 having experienced depression (men 668, women 1098). Women reported statistically more depressive symptoms than men (p < 0.001). Depressed women were more likely to report “increased appetite” (15.5% vs. 10.7%), being “often in tears” (82.6% vs. 44.0%), “loss of interest” (86.9% vs. 81.1%), and “thoughts of death” (70.3% vs. 63.4%). No significant gender differences were found for the remaining symptoms. The data are interpreted against womens greater tendency to cry and to restrict food intake when not depressed. The question is raised whether these items preferentially bias assessment of gender differences in depression, particularly in nonclinic samples.

Spiritual beliefs in bipolar affective disorder: their relevance for illness management.

BACKGROUND There has been growing interest in investigating religion as a relevant element in illness outcome. Having religious beliefs has been shown repeatedly to be associated with lessened rates of depression. Most of the limited published research has been restricted to elderly samples. Religious coping is thought to play a key role in religions effects. Strangely, psychiatric research has neglected this area. METHODS A questionnaire covering religious, spiritual and philosophical beliefs and religious practice was given to a sample of patients with bipolar affective disorder in remission. RESULTS Most patients often held strong religious or spiritual beliefs (78%) and practised their religion frequently (81.5%). Most saw a direct link between their beliefs and the management of their illness. Many used religious coping, and often religio-spiritual beliefs and practice put them in conflict with illness models (24%) and advice (19%) used by their medical advisors. LIMITATIONS This was a cross-sectional design without a control group and thus it is not possible to determine causal associations from the data set. CONCLUSIONS Religio-spiritual ideas are of great salience to many patients with bipolar disorder and shape the ways in which they think about their illness. Many reported experiencing significant paradigm conflict in understanding and managing their illness between medical and their spiritual advisors. These data suggest that the whole area of religion and spirituality is directly relevant to people living with a chronic psychiatric illness and should be firmly on the discussion agenda of clinicians working with patients with bipolar disorder.

Prevalence of migraine in bipolar disorder

BACKGROUND This study was undertaken to estimate the prevalence of migraine in people suffering from bipolar affective disorder. METHODS a headache questionnaire incorporating the newly introduced International Headache Society (IHS) criteria was given to 117 patients on the Dunedin Bipolar Research Register. RESULTS a total of 81 (69%) completed the questionnaire, out of which 21 (25.9%) reported migraine headaches. 25% of bipolar men and 27% of bipolar women suffered from migraine. CONCLUSIONS these rates are higher than those reported in the general population with the rate for bipolar men being almost five-times higher than expected. An increased risk of suffering form migraine was particularly noted in bipolar patients with an early onset of the disorder. This may represent a more severe form of bipolar affective disorder.