Higher Rates Of Emotional Abuse Research Articles

Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy.

Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms. The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping. Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles. Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment. More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles. Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.

Childhood trauma and neurocognitive functions in individuals with bipolar disorder and unaffected siblings of individuals with bipolar disorder

Previous studies have suggested a possible connection between childhood trauma, the course of illness, and neurocognitive impairment in individuals with bipolar disorder (BD). This cross-sectional study aimed to investigate the relationship between childhood trauma and neurocognitive functioning in a sample consisting of 41 euthymic individuals with BD, 37 individuals who have at least one sibling with BD, and 48 healthy controls (HCs). We assessed childhood trauma history using the Childhood Trauma Questionnaire (CTQ). Both the BD and Sibling groups showed higher rates of emotional abuse, neglect, and higher total trauma scores compared to the HCs. A principal component analysis of the neurocognitive test battery revealed a global cognition factor responsible for 49.40% of the variance and five subsequent neurocognitive components: working memory & response inhibition, verbal memory, visual copying, verbal fluency, and processing speed. Individuals with BD had lower scores in verbal memory, visual copying, processing speed, and global cognitive factor domains than the Siblings and HCs. The Siblings' performance was similar to that of the HC group. Correlation analyses showed significant correlations between physical neglect, sexual abuse, and neurocognitive domains like processing speed, verbal fluency, working memory, and the global cognitive factor. However, the linear regression analyses didn’t reveal a significant influence of childhood trauma on neurocognitive domains. Our findings indicate that both individuals with BD and their unaffected siblings have a high occurrence of childhood trauma, but presence of bipolar disorder itself appears to influence neurocognitive functioning independently of childhood traumatic experiences or familial predisposition to bipolar disorder.

Childhood Maltreatment, Mental Well-Being, and Healthy Lifestyle in Patients With Chronic Thromboembolic Pulmonary Hypertension.

IntroductionChronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition associated with high morbidity and mortality. However, advances in medical, surgical and interventional treatment have markedly improved the outcome of patients with CTEPH. Additional factors potentially influencing quality of life (QoL) and outcome in CTEPH are yet to be defined. Child maltreatment is a major risk factor for unfavorable behavioral, mental as well as physical health outcomes and has been associated with decreased QoL. To date, no study assessed the impact of childhood trauma in patients with CTEPH.MethodsPatients with CTEPH were invited to complete the Childhood Trauma Questionnaire (CTQ). Data were compared to prevalence data from the German population. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS) and quality of life was measured using the WHO Quality of Life Questionnaire (WHOQOL). Furthermore, lifestyle factors and physical health parameters were studied.Logistic regression analysis was used to investigate a possible impact of child maltreatment on markers of disease severity.ResultsOne-hundred and seven patients with CTEPH completed the CTQ. These patients reported higher rates of emotional abuse and physical abuse and emotional neglect compared to the German population while rates of physical neglect and sexual abuse did not differ between patients and German population with prevalence of 20.6% for emotional abuse, 20% for physical abuse, 22% for emotional neglect, 46% for physical neglect, and 6% for sexual abuse in patients with CTEPH. Higher CTQ scores were associated with anxiety symptoms as well as negatively associated with QoL. No direct impact of childhood trauma on CTEPH severity was found.ConclusionWe found a higher rate of child maltreatment in patients with CTEPH in comparison to the German population. Correlations suggest moderate associations between CTQ scores and mental health and QoL. Child maltreatment had no significant impact on disease severity. Further investigation on proper interventions to support affected patients is needed.

Childhood Trauma in Patients With PAH-Prevalence, Impact on QoL, and Mental Health-A Preliminary Report.

Background/ObjectiveChild maltreatment is associated with increased risk of psychological consequences, contributes to morbidity and has long lasting effects on mental health and quality of life. Child maltreatment has not been assessed in patients with pulmonary arterial hypertension (PAH). We examined the prevalence of child maltreatment and determined their impact on disease severity in patients with PAH.MethodsA cross-sectional observational multicenter study at two PH centers in Germany was conducted. Patients with a confirmed diagnosis of PAH were given a self-administered questionnaire. Child maltreatment using the Childhood Trauma Questionnaire (CTQ), quality of life (QoL), anxiety, depression, and lifestyle factors were assessed and enhanced by clinical parameters 6-min walk distance (6MWD), WHO functional class (WHO FC), and serum levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP). Prevalence rates of child maltreatment were compared to the general population and impact of child maltreatment on disease severity was calculated by logistic regression analysis.ResultsTwo-hundred and seventeen patients, 71% female and a median age of 56 years were enrolled in this study. Patients with PAH had higher rates of emotional abuse and lower rates of physical neglect compared to the German population while rates of emotional neglect, physical abuse, and sexual abuse did not differ between patients and German population. Patients with any form of child maltreatment were more likely to be active smokers, had a worse QoL and more anxiety or depression. Moderate associations between child maltreatment, mental health, QoL, lifestyle factors and clinical parameters could be observed. Logistic regression analysis showed a significant impact of CTQ-total score on disease severity with an OR of 1.022 (95%-CI: 1.001–1.042, p = 0.035).ConclusionWe found a higher rate of child maltreatment in patients with PAH in comparison to the German population. Correlations suggest moderate associations between CTQ-scores and mental health as well as QoL. Child maltreatment had significant impact on disease severity. However, effects were moderate. We conclude that child maltreatment has effects on mental health and quality of life in patients with PAH and may have limited effect on disease severity.

Minority stress in consensually non-monogamous individuals: mental health implications

Consensual non-monogamy (CNM) is an area of increasing empirical and clinical interest. Few studies have explored the mental health of CNM individuals. Using the minority stress framework, we sought to address this gap. We analyzed a data set of college students gathered through the Healthy Minds Network. A sample of 91 participants with data fit for analyses were identified as CNM. Random samples of participants in other relationship structures were also selected yielding a total sample of n = 455. Results indicated CNM individuals are significantly more likely to identify as gender/sexual minorities, be significantly younger, and report significantly higher rates of emotional abuse, physical abuse, sexual assault, and depression compared to non-CNM individuals. CNM individuals did not differ from non-CNM individuals in terms of sex assigned at birth, race, and financial stress. When controlling for demographics, CNM individuals reported significantly higher depressive symptoms compared to those who were dating and married. Multinomial regression analysis with all significant covariates entered suggested CNM individuals have significantly higher odds of probable depression and history of sexual assault compared to those who were dating and married. We discuss areas for continued research as well as implications for clinicians working with CNM clients.

Abuse after abuse: The recurrent maltreatment of American Indian children in foster care and adoption

BackgroundWhile maltreated children are at risk for recurrent maltreatment, less is known about the maltreatment recurrence of American Indian children in foster and adoptive homes. ObjectiveThis study examined the recurrent maltreatment of American Indian children in foster and adoptive homes, specifically the physical, emotional, sexual, and spiritual abuse subtypes, as well as poly-victimization of American Indian children in comparison to their White peers. Participants and SettingData originated from the Experiences of Adopted and Fostered Individuals Project. The sample (n = 230) consisted of 99 American Indian and 131 White participants who experienced foster care and/or adoption during childhood. MethodChi-square analyses and a t-test were used to test differences in maltreatment recurrence. Ordinary least squares regression analysis was used to examine the factors that contributed to poly-victimization. ResultsBoth American Indian and White participants reported high rates of emotional abuse. American Indian participants were particularly vulnerable to maltreatment recurrence in the forms of physical, sexual, and spiritual abuse, as well as poly-victimization in their foster and adoptive homes. ConclusionsOur findings reflect high rates of maltreatment recurrence in foster care and adoption, which may be the result of retrospective self-report, rather than measures of rereport or substantiated recurrence.

Examining the Prevalence of Adverse Childhood Experiences and Associated Cardiovascular Disease Risk Factors Among Low-Income Uninsured Adults.

Adverse childhood experiences (ACEs) are linked to poor adult health outcomes, including cardiovascular disease. However, little is known about its prevalence, specifically in low-income populations. The objective of this study was to estimate the extent of ACEs in a low-income, nonclinical, uninsured adult population and assess the relationship between ACEs and cardiovascular disease risk factors. This study leverages the OHIE's (Oregon Health Insurance Experiment) study population, uninsured adults who were randomly selected to apply for Medicaid, and data collected through in-person health screenings. We objectively measured obesity, cholesterol, blood pressure, and blood sugar. Smoking, physical activity, and history of chronic disease were self-reported. Independent variables were the 10-item ACEs questions covering neglect, abuse, and household dysfunction. The sample consisted of 12 229 low-income, nonelderly uninsured adults who participated in the OHIE health screenings from 2009 to 2010. A total of 5929 (48%) returned a follow-up survey reporting ACEs in 2012. ACEs were more prevalent in low-income adults compared with previous estimates in a general clinical population, with notably high rates of emotional abuse, emotional neglect, and household dysfunction. ACEs were statistically associated with higher rates of obesity, smoking, and physical inactivity, but not high cholesterol or diabetes mellitus. We detected a strong relationship between ACEs and a self-reported history of a hypertension diagnosis but no statistically significant differences in being hypertensive. This study design allowed us to assess the prevalence of ACEs among uninsured low-income adults and the association between ACEs and clinical indicators of cardiovascular disease risk that are difficult to ordinarily observe. Low-income adults have high rates of ACEs than previous prevalence estimates and ACEs were associated with higher rates of multiple cardiovascular disease risk factors. As states continue to expand Medicaid to the previously uninsured, providers may want to consider incorporating trauma-based approaches to care delivery.

Childhood trauma and insulin resistance in patients suffering from depressive disorders

ObjectiveInsulin resistance (IR) is a metabolic dysfunction often co-morbid with major depressive disorder (MDD). The paths to development of MDD remain largely unspecified, highlighting a need for identification of risk factors. Here, we tested whether specific subscales of childhood trauma as well as family history of type-2 diabetes (Fam-Hx-Dm2) are risk factors for development of metabolic dysfunction and severity of depressive symptoms. Research design and methodsWe used a sample of 45 adults suffering from MDD that was well-characterized for insulin resistance and sensitivity as assessed by measures of fasting plasma glucose (FPG) plasma insulin (FPI) levels, body mass index (BMI), weight, homeostasis model assessment of insulin sensitivity (HOMA), Matsuda index as well as both glucose and insulin responses to oral glucose challenges. Severity of depressive symptoms was assessed with the Hamilton Depression Rating Scale (HDRS-21). Physical, sexual and emotional abuse as well as physical and emotional neglect were assessed with the Childhood Trauma Questionnaire. First- or second-degree relatives with type-2 diabetes defined fam-Hx-DM2. ResultsIndividuals reporting higher rates of emotional abuse were more likely to have greater IR as showed by elevated FPI levels and HOMA. No association was found with any of the other subscales of childhood trauma (e.g., physical abuse). Similarly, Fam-Hx-DM2 was associated with greater degree of IR as shown by elevated FPI, HOMA, but also FPG, weight and BMI. Moreover, we report a relationship and interaction between Fam-Hx-DM2 and emotional abuse on severity of depressive symptoms. Specifically, emotional abuse and Fam-HX-DM2 predicted severity of depressive symptoms at HDRS-21. Also, severity of depressive symptoms was greater with higher reported rates of emotional abuse but only in patients with negative Fam-Hx-Dm2. Individuals reporting higher emotional abuse and negative Fam-Hx-Dm2 also showed higher FPG levels. Conversely, individuals reporting higher emotional abuse and positive Fam-Hx-Dm2 showed higher FPI levels. This data suggest that Fam-Hx-Dm2 may define two different metabolic endophenotypes. ConclusionsOur findings suggest that Fam-HX-DM2 and emotional abuse represent separate risk factors for developing metabolic dysfunction (i.e.: IR) in patients suffering from MDD, and that the effects of emotional abuse on psychiatric illness may depend upon the personal characteristics, including Fam-Hx-DM2.

Gender differences in childhood trauma in first episode psychosis: Association with symptom severity over two years

Early life adversity is associated with increased risk for psychosis onset and poor clinical outcome. Male compared to female patients often show a more severe course of psychotic illness. The aim of the present study was to investigate gender differences in childhood trauma (CT) and their impact on symptomatic and functional outcome following psychosis onset.The study included 210 patients (144 men, 66 women) diagnosed with a first-episode of psychosis (FEP). Early adversity was assessed with the Childhood Trauma Questionnaire. Psychotic symptoms and general functioning were rated with the Brief Psychiatric Rating Scale and Global Assessment of Functioning scale at baseline, 12 and 24 months of follow-up in an established early intervention service.Male patients reported higher rates of physical or emotional neglect, whereas female patients indicated significantly higher rates of emotional abuse. More severe CT was related to higher levels of depression in women and to negative symptoms in men. Distinct CT effects were observed on positive and negative symptom severity and global functioning in male patients at 24 months. Emotional abuse was the strongest predictor of depression in both genders. In male patients only, emotional abuse predicted positive symptom severity and impaired global functioning, whereas emotional neglect predicted more severe negative symptoms.Our results suggest differences in CT experiences in male and female FEP patients, with a more pronounced impact on longer-term outcome in male patients. The findings support the notion that sex differences in stress vulnerability account for the relatively poor illness course in male psychosis patients.

Elder Abuse in Nursing Homes: Do Special Care Units Make a Difference? A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project

Background: In special care units (SCUs) for residents with advanced dementia, both personnel and organizations are adapted to the needs of residents. However, whether these adaptations have a preventive effect on elder abuse has not yet been explored. Objective: To describe the prevalence of observed emotional abuse, neglect, and physical abuse in Swiss nursing homes, to compare SCUs with non-SCUs concerning the frequency of observed emotional abuse, neglect, and physical abuse, and to explore how resident-related characteristics, staff outcomes/characteristics, and organizational/environmental factors relate to observed elder abuse. Methods: This is a secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP), a cross-sectional multicenter study. Data were collected from 2012 to 2013 and are based on observed rather than perpetrated elder abuse. We performed multilevel mixed-effects logistic regressions taking into account the hierarchical structure of the data with personnel nested within units and facilities. Results: Of 4,599 care workers in 400 units and 156 facilities, 50.8% observed emotional abuse, 23.7% neglect, and 1.4% physical abuse. There was no significant difference between SCUs and non-SCUs regarding observed emotional abuse and neglect. Higher scores for ‘workload' and sexual aggression towards care workers were associated with higher rates of emotional abuse and neglect. Verbal and physical resident aggression, however, were only associated with higher rates of emotional abuse. Negative associations were found between ‘teamwork and resident safety climate' and both forms of abuse. Conclusion: Improving teamwork and the safety climate and reducing work stressors might be promising points of intervention to reduce elder abuse. More specific research about elder abuse in SCUs and the interaction between work climate and elder abuse is required.

The role of the brain in urban violent offending: integrating biology with structural theories of ‘the streets’

Some of the most enduring structural theories of crime center on the existence of a criminal subculture. Several ecological theories have attempted to explain the etiology of subcultures, but few have endured the rigors of empirical investigation, and shortcomings of these perspectives remain. To date, subcultural theories have neglected to examine biological influences in explaining the formulation of criminal subcultures and their direct and indirect relationships with criminal behavior. This article offers a ‘new’ look at subcultural theories of crime by integrating biological factors into existing theories of social ecology and criminal behavior. Specifically, we focus on how the structural pressures of poverty, discrimination, concentrated violence, and high rates of emotional abuse lead to stress on the brain in the form of high allostatic load, over-activation of the hypothalamic–pituitary–adrenal axis, and an imbalance of cortisol levels. These stressors, subsequently, lead to violence and aggression often associated with delinquent groups and gangs. Our efforts seek to spur more research on how biology affects behavior in conjunction with the environment. This is essential not only in continuing to specify criminological theories but also for developing effective prevention and intervention programs that home in on all relevant factors implicated in criminal behavior.

Intimate Partner Violence Reported by Two Samples of Deaf Adults via a Computerized American Sign Language Survey

A computerized sign language survey was administered to two large samples of deaf adults. Six questions regarding intimate partner violence (IPV) were included, querying lifetime and past-year experiences of emotional abuse, physical abuse, and forced sex. Comparison data were available from a telephone survey of local households. Deaf respondents reported high rates of emotional abuse and much higher rates of forced sex than general population respondents. Physical abuse rates were comparable between groups. More men than women in both deaf samples reported past-year physical and sexual abuse. Past-year IPV was associated with higher utilization of hospital emergency services. Implications for IPV research, education, and intervention in the Deaf community are discussed.

Emotional abuse towards children by schoolteachers in Aden Governorate, Yemen: A cross-sectional study

BackgroundEmotional abuse is central to other forms of abuse. The primary objective of this paper was to estimate the prevalence of emotional abuse among pupils in basic education schools and the risk factors associated with it in Aden governorate, Yemen.MethodsFour districts were randomly selected from across the governorate of Aden, 2 schools were selected at random in each district, and then 1066 pupils were randomly selected from the 8 schools. An anonymous self-administered questionnaire was used for data collection. Data were analyzed using Statistical Package for Social Sciences ver.15. Mean, standard deviation and chi square were used for descriptive statistics. Univariate and Multivariate logistic regression analysis was used to examine the associations between emotional abuse with pupils/parents characteristics.ResultsPupils reported high rates of emotional abuse 55.2% at least once in their school lifetime. Male pupils had higher prevalence of emotional abuse 72.6% than females 26.1%. Teachers constituted the highest proportion of perpetrators 45.6%. Odds Ratio (95% confidence interval) showed statistically significant association between emotional abuse and pupils' gender, family type and father education: 9.94 (7.19-13.74), 1.40 (1.02-1.91), .58 (.39-.86) respectively.ConclusionEmotional child abuse was highly prevalent in pupils in basic school education. Pupils' gender, family type and father education were the main risk factors associated with emotional abuse.

Gender differences in the associations between childhood trauma and parental bonding in panic disorder

The aim of this study is to evaluate the association between childhood trauma and the quality of parental bonding in panic disorder compared to non-clinical controls. 123 patients and 123 paired controls were evaluated with the Mini International Neuropsychiatric Interview, the Childhood Trauma Questionnaire and the Parental Bonding Instrument. The Parental Bonding Instrument and the Childhood Trauma Questionnaire were highly correlated. Panic disorder patients presented higher rates of emotional abuse (OR = 2.54, p = 0.001), mother overprotection (OR = 1.98, p = 0.024) and father overprotection (OR = 1.84, p = 0.041) as compared to controls. Among men with panic disorder, only mother overprotection remained independently associated with panic disorder (OR = 3.28, p = 0.032). On the other hand, higher father overprotection (OR = 2.2, p = 0.017) and less father warmth (OR = 0.48, p = 0.039) were independently associated with panic disorder among female patients. Higher rates of different types of trauma, especially emotional abuse, are described in panic disorder patients as compared to controls. The differences regarding gender and parental bonding could be explained in the light of the psychodynamic theory.

A window of opportunity: Referral of adolescents to the hospital Child Protection Team

The arrival of an adolescent at the hospital provides a window of opportunity to help those exposed to abuse or neglect, by looking beyond the presenting symptom. The Child Protection Team (CPT) assesses cases of suspected abuse or neglect (SCAN) referred by hospital staff. As adolescents pose a particular array of presentations, this study assessed their socio-demographic features and characteristics of hospitalization in order to improve procedures for identifying SCAN. The study group included all 674 referrals of 10-17-year-olds to the CPT from 1991-2007. Their files were abstracted and demographics compared to similarly-aged Emergency Department (ED) admissions. Different patterns were found by gender and age group. The youngest group (10-13 years) included a higher rate of boys than girls (47.9% vs. 27.6%), and among the oldest (16-17 years) the rate of girls was higher (31.9% vs 15.8%). Comparison with all ED admissions indicated a lower rate of younger girls and a higher rate of 14-15-year-old girls in the study group. The study group also had a higher rate of immigrants (12.8% vs. 4.7%). The most frequent reason for arrival at the hospital was suicidal behavior (30.9%). Older age was related to fewer arrivals for trauma/burn and more suicidal behavior. In 83.1% of the referrals, reports were made to welfare authorities and/or police. The suspicion in 64.2% of the referrals was emotional abuse or physical/emotional neglect; in 18.8%, physical and/or sexual abuse was suspected. The older groups had lower rates of physical and/or sexual abuse and higher rates of emotional abuse or physical/emotional neglect. This study highlights the importance of age-by-gender analysis and understanding of the differential susceptibility of early, middle and late adolescence to SCAN.

Childhood Maltreatment in Extremely Obese Male and Female Bariatric Surgery Candidates**

To examine rates of self-reported childhood maltreatment in extremely obese bariatric surgery candidates and to explore associations with sex, eating disorder features, and psychological functioning. Three hundred forty (58 men and 282 women) extremely obese consecutive candidates for gastric bypass surgery completed a questionnaire battery. The Childhood Trauma Questionnaire was given to assess childhood maltreatment. Overall, 69% of patients self-reported childhood maltreatment: 46% reported emotional abuse, 29% reported physical abuse, 32% reported sexual abuse, 49% reported emotional neglect, and 32% reported physical neglect. Except for higher rates of emotional abuse reported by women, different forms of maltreatment did not differ significantly by sex. Different forms of maltreatment were generally not associated with binge eating, current BMI, or eating disorder features. At the Bonferonni-corrected significance level, emotional abuse was associated with higher eating concerns and body dissatisfaction, and emotional neglect was associated with higher eating concerns. In terms of psychological functioning, at the Bonferonni-corrected level, emotional abuse and emotional neglect were associated with higher depression and lower self-esteem, and physical abuse was associated with higher depression. Extremely obese bariatric surgery candidates reported rates of maltreatment comparable with those reported by clinical groups and roughly two to three times higher than normative community samples. Reported experiences of maltreatment differed little by sex and were generally not significantly associated with current BMI, binge eating, or eating disorder features. In contrast, maltreatment-notably emotional abuse and neglect-were significantly associated with higher depression and lower self-esteem.

Substance use and intimate violence among incarcerated males

The purpose of this study was to examine substance use patterns among a sample of incarcerated males who report engaging in levels of intimate violence, as well as identifying similarities and differences in demographic, economic status, mental health, criminal justice involvement, relationships, and treatment factors for three groups of incarcerated males - those who report perpetrating low intimate violence, those who report perpetrating moderate intimate violence, and those who report perpetrating extreme intimate violence the year preceding their current incarceration. Findings indicated that low intimate violence group's perpetration consisted almost exclusively of emotional abuse. Moderately intimate violent males and extremely intimate violent males, however, report not only high rates of emotional abuse but physical abuse as well. The distinction between moderate and extremely violent groups was substantial. Findings also indicated that perpetrators at different levels of violence in this study did not vary significantly in age, employment history, marital status, or race. However, the three groups showed significant differences in three main areas: (1) cocaine and alcohol use patterns, (2) stranger violence perpetration and victimization experiences, and (3) emotional discomfort. Implications for substance abuse and mental health treatment interventions and for future research are discussed.

HIV/STD Risk Factors for Women with Violent Male Partners

This study compared 167 women, categorized as nonabused, emotionally abused, or physically abused in their primary relationships, on sexual risk factors. Physically abused women differed in several ways: greater STD risk, psychosocial distress, and substance use; more traditional gender role beliefs; lower self-esteem; more likely to have been raped and to engage in sex for pay; and less likely to attend the project's STD/HIV risk reduction groups. Within primary relationships, they differed in amount of decision-making power about safer sex, likelihood of nonmonogamy, use of substances before sex, and self-efficacy about initiating condom use. African American women reported higher rates of emotional abuse than White women, a finding related mainly to their lower socioeconomic status in this sample.

Characteristics of women physically abused by their spouses and who seek treatment regarding marital conflict.

Physically abused women seeking treatment for marital difficulties (abused women, n = 49) were compared with maritally discordant, nonabused women (discordant only, n = 23) and maritally satisfied nonabused women (community control, n = 25). Abused women reported significantly more fear of their spouses and reported that their spouses were significantly more coercive and psychologically aggressive than women in the 2 matched nonabused groups. Abused women did not report higher rates of abuse as a child, nor did they report higher rates of past psychopathology than women in the nonabused groups. However, abused women and nonabused discordant women reported higher rates of emotional abuse in childhood than maritally satisfied nonabused women. Furthermore, both clinical groups had a tendency to have higher lifetime rates of major depression before their current marriage than the maritally satisfied women. This result suggests that childhood abuse and a history of depression may be risk factors for women in abusive and nonabusive discordant relationships. As expected, abused women reported higher rates of posttraumatic stress disorder than women in the discordant-only and community control groups. Treatment implications for both standard treatments for marital problems and treatments for victims of physical abuse are discussed.

Characteristics of women physically abused by their spouses and who seek treatment regarding marital conflict.

Physically abused women seeking treatment for marital difficulties (abused women, n = 49) were compared with maritally discordant, nonabused women (discordant only, n = 23) and maritally satisfied nonabused women (community control, n = 25). Abused women reported significantly more fear of their spouses and reported that their spouses were significantly more coercive and psychologically aggressive than women in the 2 matched nonabused groups. Abused women did not report higher rates of abuse as a child, nor did they report higher rates of past psychopathology than women in the nonabused groups. However, abused women and nonabused discordant women reported higher rates of emotional abuse in childhood than maritally satisfied nonabused women. Furthermore, both clinical groups had a tendency to have higher lifetime rates of major depression before their current marriage than the maritally satisfied women. This result suggests that childhood abuse and a history of depression may be risk factors for women in abusive and nonabusive discordant relationships. As expected, abused women reported higher rates of posttraumatic stress disorder than women in the discordant-only and community control groups. Treatment implications for both standard treatments for marital problems and treatments for victims of physical abuse are discussed.