Lifetime Abuse Research Articles

The mental health status of young adult and mid‐life non‐heterosexual Australian women

Objectives: To compare the mental health status of early adult and mid‐life Australian women according to sexual orientation.Methods and sample: Cross‐sectional analyses of the Australian Longitudinal Study on Women's Health (ALSWH) surveys for the younger (22–27 years) and mid‐age (50–55 years) cohorts. Women were classified into one of four groups: exclusively heterosexual, mainly heterosexual, bisexual and lesbian. Regression analyses were used to examine the effects of sexual orientation on mental health after adjusting for age, region of residence and education and to assess the potential mediating roles of stress, abuse and social support.Results: Younger, mainly heterosexual, bisexual and lesbian women had poorer mental health outcomes than exclusively heterosexual women on all outcome measures except anxiety in lesbian women, even after adjustment for age, region and education. Mid‐age mainly heterosexual women had poorer mental health on all outcomes except for medically diagnosed anxiety and bisexual women had significantly higher odds of self‐harm than exclusively heterosexual women. All nonheterosexual women in both cohorts reported higher levels of stress and lifetime abuse. Controlling for stress, abuse and social support attenuated the mental health findings.Conclusions: The poorer mental health in young non‐heterosexual women and midlife mainly heterosexual women highlights the need for health care providers to be particularly sensitive to mental health issues in these women. Stress, social support and lifetime abuse may play a role in explaining the poorer mental health and discrimination may also be important.

Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia

Purpose: Russia has high per capita alcohol consumption and an injection-drug-use-driven HIV epidemic. However, the role of alcohol in the spread of HIV infection in Russia is largely unexplored. Thus, we assessed recent alcohol use and associated HIV risk behaviors among HIV-infected persons in St. Petersburg, Russia. Methods: We recruited HIV-infected hospitalized patients from the Botkin Infectious Disease Hospital between June 2001 and March 2002. Interviewers assessed alcohol and drug use with the addiction severity index (ASI) and sex- and drug-risk behaviors with the risk assessment battery (RAB). Lifetime abuse or dependence diagnoses for alcohol and drugs were established by a physician with addiction medicine training. Results: Among 201 subjects, diagnoses of abuse or dependence (AB/DEP) were common: 9% (19/201) had only alcohol AB/DEP; 39% (78/201) had alcohol and drug AB/DEP; 47% (95/201) had only drug AB/DEP; and 4% (9/201) had no diagnosis of alcohol or drug AB/DEP. Sex- and drug-risk behaviors varied significantly by substance use diagnosis. Subjects with any alcohol AB/DEP had higher sex-risk RAB scores than those with drug only AB/DEP (6.1 versus 3.9, p < .0001). Among subjects with any diagnosis of drug AB/DEP, having in addition an alcohol diagnosis was associated with unclean needle use in the last six months (33% (26/78) versus 21% (20/95), p = 0.08). Conclusions: Lifetime alcohol diagnoses of abuse or dependence were present in nearly one-half of hospitalized HIV-infected patients in St. Petersburg, Russia and were associated with significantly higher sex-risk behaviors and borderline significantly higher drug-risk behaviors. As HIV infection spreads rapidly in Russia and Eastern Europe, these data support the need for HIV risk-reduction interventions in alcohol abusing populations and raise the potential of benefit by addressing alcohol use in HIV-infected populations.

Women's perceived experiences of abuse in the health care system: their relationship to childhood abuse

The aim of this study was to determine whether there was an association between any lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Furthermore, we wanted to ascertain if adult victims of perceived abuse in the health care system reported exposure to childhood emotional, physical and/or sexual abuse more often than non-victims did. A cross sectional questionnaire study. The first hypothesis was tested in the total sample, and the second hypothesis in a case-control analysis. The cases were those women who reported perceived experiences of abuse in the health care system as adults. Exposure was defined as experience of emotional, physical and/or sexual abuse in childhood. Three Swedish gynaecological clinics. A total of 2439 gynaecology patients (response rate 81%). Postal questionnaire. Associations between experiences of emotional, physical and/or sexual abuse, and perceived abuse in the health care system; all operationalised in The NorVold Abuse Questionnaire (NorAQ). A general association was found between lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Adult victims of abuse in the health care system reported experiences of emotional, physical and/or sexual abuse in childhood more often than non-victims did. These findings also held after adjustment for age and educational level. We found associations between experiences of any lifetime abuse and perceived abuse in the health care system. Adult victimisation in the health care system was associated with childhood exposure to emotional, physical and/or sexual abuse. These associations call for attention and need to be further investigated.

Abuse Experiences in a Community Sample of Young Adults: Relations with Psychiatric Disorders, Sexual Risk Behaviors, and Sexually Transmitted Diseases

This study documents significant associations among lifetime abuse experiences, psychiatric diagnoses, and sexual risk behaviors in a multiethnic community sample of young men and women (N = 1803) in South Florida. Self-report data were collected via structured interviews as part of a longitudinal follow-up of a larger school-based study. Participants were grouped according to extent of lifetime abuse experiences. Cumulative lifetime abuse experiences were associated with increased risk for a broad range of individual lifetime psychiatric disorders, as well as cumulative lifetime psychiatric disorders. Both cumulative abuse experiences and cumulative psychiatric disorders were independently associated with (a) higher levels of sexual risk behaviors and (b) higher risk for lifetime sexually transmitted diseases (STDs). Implications for selective prevention of sexual risk behaviors and STDs among young adults with histories of abuse and psychiatric disorders are discussed.

Lifetime Abuse and Mental Health Distress Among English-Speaking Latinas

Domestic violence has adverse consequences on the mental health of abused women, including Latinas, who face stressors that are associated with oppression, resettlement, and minority status, which increase their risk of abuse and its psychological distress. This article presents a descriptive study of lifetime abuse (seven types of childhood abuse and abuse by adult partners) and mental health in a small sample of English-speaking Latinas. Depression, anxiety, and somatization were studied in relation to lifetime abuse. The findings revealed that recent emotional abuse was associated with distress, which was manifested in anxiety, and that childhood abuse elevated the risk of victimization in adulthood. Implications for feminist social work practice are discussed.

Discrimination, historical loss and enculturation: culturally specific risk and resiliency factors for alcohol abuse among American Indians.

This report investigates the effects of discrimination, historical loss and enculturation on meeting diagnostic criteria for 12-month alcohol abuse among American Indians who share a common culture in the upper Midwest. We introduce an empirical measure of historical loss and hypothesize that historical loss will mediate the effects of discrimination on meeting 12-month diagnostic criteria for alcohol abuse. We also hypothesize that enculturation will be negatively associated with 12-month alcohol abuse and mediate or moderate the effects of discrimination. A sample of 452 (351 women) American-Indian parents/caretakers (mean age: women = 39 years, men = 42 years) of children ages 10 to 12 years participated in diagnostic interviews for lifetime and 12-month alcohol abuse. The subjects' perceptions of discrimination, historical loss and enculturation were also measured. Structural equation modeling was used to evaluate direct and potential mediating effects of latent constructs of enculturation (a resiliency factor) and historical loss (a risk factor) on the relationship between discrimination and meeting criteria for 12-month alcohol abuse. Historical loss mediated the effects of discrimination on 12-month alcohol abuse among women. Enculturation neither mediated nor moderated the effects of discrimination but had an independent negative effect on alcohol abuse. In a combined model comprising both enculturation and historical loss, the effects of discrimination on 12-month alcohol abuse were mediated. This study presents important new evidence that historical loss affects American-Indian alcohol abuse. It also provides evidence for the resiliency effects of enculturation on alcohol abuse.

Lifetime Abuse, Mental Health, and African American Women

This study examined the relationship between lifetime abuse and mental health among 126 African American women and 365 White women from a primary health care setting who participated in a telephone interview as part of a larger study. Seven types of childhood and adult intimate partner abuse were measured. Consistent with hypotheses, (1) lifetime abuse was associated with elevated levels of anxiety and depression, and (2) women who experienced childhood abuse were more likely to report adult partner abuse. African American and White women showed more similarities than differences in the associations between most abuse experiences and depression and anxiety, as well as types of childhood abuse. African American abused women reported more excessive jealousy by partners. Nonabused African American women reported higher levels of depression and anxiety than their White counterparts. Results are interpreted and discussed taking into account relevant social and cultural factors.

Cannabis abuse is not a risk factor for treatment outcome in methadone maintenance treatment: a 1-year prospective study in an Israeli clinic.

We addressed the following questions. What are the current and lifetime prevalence of cannabis abuse in an Israeli methadone maintenance treatment (MMT) clinic? Does cannabis abuse change over time during MMT? Is cannabis abuse related to treatment outcome measures such as retention rate and the abuse of drugs? Is the abuse of cannabis related to psychopathology, HIV/HCV risk-taking and infectious diseases? Do cannabis abusers (CAs) have a different psychosocial and demographic profile than nonabusers (NCAs)? Is cannabis abuse part of a polydrug abuse tendency or a distinct substance of abuse? Overlapping samples of either the entire clinic population (n = 283) or all the patients who had completed 1 year of MMT treatment (n = 196 of which 20 were re-entering) underwent random and twice-weekly observed urine analysis for various drugs of abuse, responded to self-report questionnaires (SCL-90-R; HIV/HCV risk-taking behaviours; n = 164), interviews (ASI, n = 176; SCID, n = 151) and hepatitis C and HIV testing (n = 149). Lifetime abuse prevalence was found in 75% and current abuse at MMT intake in 25%. Abuse did not increase significantly over a 1-year period. Cannabis abusers were found to be more often polydrug abusers than NCAs. Cannabis abusers did not suffer from more psychological distress, infectious diseases, and did not engage in more HCV/HIV risk-taking behaviour, nor did they leave treatment earlier than NCAs. Cannabis abuse MMT patients should be treated as polydrug abusers, although no specific influences of cannabis abuse on psychological and medical conditions of MMT patients have been observed. Treatment policy should take these results into consideration.

Is there a progression from abuse disorders to dependence disorders?

Recent studies suggest that a progression occurs from alcohol abuse to alcohol dependence. Although DSM-IV criteria for all substance use-related diagnoses are based largely on the alcohol dependence syndrome, progression from abuse to dependence might not generalize to other substances. This study tested whether a progression from DSM-IV abuse to dependence occurs related to the use of cannabis, cocaine and opiates. Retrospective data from the DSM-IV Substance Use Disorders Work Group (n = 1226) were reanalysed using McNemar's chi2, configural frequency analyses and survival analyses. Participants were men and women who were primarily African-Americans or Caucasians. Participants were recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview-Substance Abuse Module. For all substances, life-time dependence in the absence of life-time abuse was rare. Results were consistent with a progression occurring for alcohol and cannabis, but not for cocaine and opiates. Abuse and dependence occurred in the same year for 66% of the cocaine users who experienced both disorders (57% of users with any cocaine disorder) and 65% of the opiate users who experienced both disorders (46% of users with any opiate disorder). Because cocaine and opiate dependence in the absence of abuse were rare, it is possible that progressions in cocaine and opiate disorders occur more rapidly than cannabis and alcohol. Research is needed to clarify the mechanisms that influence progressions of substance use disorders. Potential factors leading to between-drug variation in rate of progression of disorders are discussed.

Lifetime Physical and Sexual Abuse, Substance Abuse, Depression, and Suicide Attempts Among Native American Women

Although there is preliminary evidence that violence against women and children may be particularly prevalent in some Native American communities, associations between abuse and substance abuse, mental health problems, and suicide attempts have rarely been studied in this population. This study examined lifetime and current physical and sexual abuse among 30 Native American women. Nearly half had experienced physical and/or sexual abuse as children, over half were sexually abused at some time in their lives, and over three-fourths were abused by a partner. All but four women (87%) had experience physical or sexual abuse in their lifetime. Significant relationships were found among childhood abuse, substance abuse, and adult revictimization, and among cumulative lifetime abuse events, substance abuse, and depression. Further research is needed to examine abuse and relationships between abuse and health sequelae in Native American populations. An accelerated public health and community response is needed to address abuse issues in this community.

Prevalence of battering among 1780 outpatients at an internal medicine institution in Mexico

Violence against women has recently drawn attention in the medical community as a leading cause of preventable morbidity and mortality. Specific algorithms designed to identify women at risk can be applied to create an opportunity for screening, diagnosis and treatment during medical care initiated for common conditions. This study investigated the incidence and history of battering among women seeking general medical care, and looked for potential risk factors and associations with presenting symptoms. We used a self-administered, anonymous survey to question 1780 adult female outpatients visiting a tertiary care internal medicine teaching hospital in Mexico City. We calculated current abuse (physical and/or sexual abuse by a partner within the past year), abuse during pregnancy, childhood abuse, and lifetime abuse. We found levels of violence against women in Mexico comparable to those reported from other countries. 152 women (9%) reported current physical and/or sexual abuse. An identical number also reported abuse during pregnancy. Lifetime prevalence was 41%. Women currently or previously abused reported more physical symptoms in the last six months than did non-abused participants. Pelvic pain, depression, headache and substance abuse were frequent among abused women. Currently abused women also scored higher ( p<0.01) on indicators of depression. Current abuse correlated strongly with a childhood history of physical and/or sexual abuse, with low educational level of the victim, with substance abuse by the partner or by the woman herself, and with higher parity.

Chronic fatigue, abuse-related traumatization, and psychiatric disorders in a community-based sample

The relationship between sexual and physical abuse history and negative health effects has been well-documented in medical facility samples. Few studies have examined the role of abuse history and its relationship with chronic fatigue and psychiatric disorders in a diverse, randomly selected community-based sample. The present study compared rates of different types of abuse events in individuals with chronic fatigue and non-symptomatic controls. Relationships between specific types of abuse and psychiatric disorders commonly associated with chronic fatigue were also explored. A stratified random sample of 18,675 adults residing in ethnically and socioeconomically diverse neighborhoods in Chicago first completed a telephone screening questionnaire. A control group and a group of individuals with chronic fatigue symptomatology were identified and administered a semi-structured psychiatric interview assessing DSM-IV Axis I psychiatric disorders and a sexual and physical abuse history questionnaire. Controlling for sociodemographic differences, fatigue outcome was significantly predicted by childhood sexual abuse and the total number of different childhood abuse events. Within the chronic fatigue group, diagnosis of posttraumatic stress disorder (PTSD) was significantly predicted by childhood sexual abuse, childhood death threat, the total number of childhood abuse events, and lifetime abuse events. Sexual abuse during adolescence or adulthood significantly predicted other anxiety disorders among individuals with chronic fatigue. These findings suggest that a history of abuse, particularly during childhood, may play a role in the development and perpetuation of a wide range of disorders involving chronic fatigue. Among individuals with chronic fatigue, PTSD and other anxiety disorders appear to demonstrate the strongest association with abuse history. The implications of these findings are discussed.

Intimate Partner Abuse and Mental Health

Social Support and other protective factors (Education, Employment, Self-Esteem, Health, and Absence of Economic Hardship) were studied in relation to depression, anxiety, and three types of lifetime abuse (recent intimate partner violence and past intimate partner violence, child abuse). Asurvey of 557 women was conducted as part of a domestic violence screening intervention in primary care. Compared to nonabused women, recently abused women may receive less support from partners but reported comparable levels of support from others. Total protective factors potentially provided a buffer for abused women from developing anxiety and depression but appea less effective at severe levels of lifetime abuse.

Lifetime and current abuse, pregnancy risks, and outcomes among Native American women.

This study examines the effects of current abuse, battering during pregnancy, and lifetime physical and sexual abuse on pregnancy risks and outcomes among 30 urban Native American women. One-third of the women in this study were battered during the index pregnancy, and nearly two-thirds had been abused by their current partner. All but 3 women had experienced physical or sexual abuse in their lifetime, and nearly three-fourths had been multiply abused. Significant relationships were found between current partner abuse, decreased birth weight, and inadequate prenatal care. The variable, increased lifetime abuse events, was significantly associated with increased risk factors for preterm birth/low birth weight. High rates of substance use and sexually transmitted diseases were noted among women in this study. Further research is needed to examine abuse and relationships between abuse and pregnancy risks and outcomes among Native American women.

Cumulative Abuse Experiences, Physical Health and Health Behaviors

PURPOSE: Our purpose was to investigate the complex relationship between a range of lifetime abuse experiences with current physical health and health behaviors. METHODS: Between October 1998 and May 1999, interviews were conducted with 557 ethnically diverse women seen at two urban primary care centers. Seven forms of abuse were measured: childhood physical and sexual abuse, past physical and sexual intimate partner violence (IPV), and recent emotional, physical, and sexual IPV. Severity was measured for six of these forms. Multiple non-specific physical symptoms were measured with a modified PRIME-MD, and four health behaviors were ascertained. RESULTS: Approximately 10% of women never experiencing abuse reported multiple non-specific physical symptoms, compared with 25.8% to 78.4% of women reporting a range of abuse experiences. Increases in recent IPV, past IPV, child abuse, and economic hardship were associated with increases in reported symptoms. Women who experienced IPV were more likely to report smoking cigarettes, binge drinking, and having poor nutritional habits. CONCLUSIONS: Recent IPV is associated with physical symptoms and risky health behaviors beyond the effects of child abuse, past IPV, and economic disadvantage. Understanding a person's IPV experiences may inform interventions for health behaviors, such as smoking cessation programs.

Prevalence and incidence of domestic violence in an ambulatory gynecology population and associated risk factors

Objective: To determine the prevalence and incidence of domestic violence in an ambulatory gynecology population and to describe risk factors associated with abuse. Methods: All patients presenting for initial ambulatory gynecology care at an urban private practice over 1 year were asked by a physician about the occurrence of domestic violence using a modified abuse assessment screen (AAS). The prevalence and incidence of physical, emotional, and sexual abuse were calculated. The patient’s records were abstracted for demographic and medical variables. Associations between these variables and the prevalence of abuse were analyzed. Results: Four hundred forty-three women were interviewed. No woman refused to answer the AAS. Among 424 women with completed AASs, 72 (16.2%) reported some form of domestic violence in the past. Among ever-abused women, 46 out of 72 (63.8%) reported physical abuse, 12 (16.6%) reported emotional abuse, and 4 (5.6%) reported sexual abuse. The incidence of physical abuse was 1.6%. In univariate analysis, risk factors associated with lifetime abuse included age greater than 40 ( P = 0.006), non-single status ( P = 0.003), black race ( P = 0.006), history of depression ( P = 0.0001), and sexual inactivity ( P = 0.007). A history of depression ( P = 0.001) and black race ( P = 0.01) were the only factors associated with a past history of domestic abuse in regression analysis. Conclusions: The prevalence of domestic abuse ascertained by the AAS in an ambulatory gynecology setting is high. Demographic and health factors do not accurately predict a history of domestic abuse. Screening of all patients for domestic violence should be a routine part of ambulatory gynecologic care.

Self-reports of physical, sexual and emotional abuse in an alcoholism treatment sample.

There is a growing appreciation that emotional, physical and sexual abuse events are frequently part of the life histories of individuals in treatment for alcohol disorders. The present study examines reports of lifetime abuse in a clinical trial for treatment of alcohol dependency. Data were obtained from baseline assessments conducted with participants (N = 1,726; 1,307 men) entering Project MATCH, a multisite clinical trial conducted at nine geographically dispersed research sites. Differences on a broad range of participant characteristics were examined by gender and by reported abuse type. More than half (59%) of the participants reported lifetime abuse. Women were more likely (77%) to report abuse than were men (54%). A lower proportion of men than women (6% vs 31%) reported experiencing both physical and sexual abuse. Gender differences were found on the majority of psychosocial measures. Comparisons of the psychosocial measures by abuse type generally indicated that participants without abuse histories had better functioning than did participants reporting abuse. The high frequency of lifetime abuse in this geographically dispersed sample underscores the necessity for including assessment of emotional, physical and sexual abuse with alcoholism treatment seeking populations. Participants reporting such events may require other treatment in addition to that for alcohol dependency.

Illicit psychoactive substance use, heavy use, abuse, and dependence in a US population-based sample of male twins.

In order to develop informed approaches to prevention and treatment of illicit psychoactive substance use, abuse, and dependence, we need to understand the sources of individual differences in risk. In personal interviews with 1198 male-male twin pairs (708 monozygotic and 490 dizygotic) ascertained from a population-based registry, we assessed lifetime use, heavy use, and abuse of and dependence on cannabis, sedatives, stimulants, cocaine, opiates, and hallucinogens. Twin resemblance was assessed by probandwise concordance, odds ratio, tetrachoric correlations, and biometrical model fitting. Twin resemblance for substance use, heavy use, abuse, and dependence was substantial, and consistently greater in monozygotic than in dizygotic twins. For any drug use and for cannabis and hallucinogen use, model fitting suggested that twin resemblance was due to both genetic and familial-environmental factors. Twin resemblance for sedative, stimulant, cocaine, and opiate use, however, was caused solely by genetic factors. With 2 exceptions (cocaine abuse and stimulant dependence), twin resemblance for heavy use, abuse, and dependence resulted from only genetic factors, with heritability of liability usually ranging from 60% to 80%. No consistent evidence was found for violations of the equal environment assumption. In accord with prior results in studies of women, the family environment plays a role in twin resemblance for some forms of substance use in men. However, twin resemblance for heavy use, abuse, and dependence in men is largely caused by genetic factors, and heritability estimates are high.

Relationship between gender and substance use among treatment-seeking gamblers

Very little is known about gender differences in psychoactive substance use among gamblers. In this study, 200 individuals seeking treatment for problem gambling were assessed with respect to lifetime and current use and abuse of licit and illicit substances. As a group, they were found to have experience with psychoactive substances exceeding that reported for the general population. There were no gender differences in patterns of illicit drugs; however, the women gamblers reported greater experience with psychiatric medications over the lifetime and during the treatment and follow-up periods.

Drug abuse and partner violence among women in methadone treatment

This study aims to (1) describe rates of lifetime and current partner abuse among women on methadone; (2) examine the relationship between partner violence and demographics, substance abuse, and drug risk behaviors; and (3) explore the association between a victim's current use of crack/cocaine, heroin, marijuana, and drug risk behavior after controlling for demographics, household composition, history of victimization and sex trading. Approximately three-fourths of the women ever experienced physical, sexual, or life-threatening abuse and slightly less than one-third experienced at least one type of abuse during the previous year. A history of childhood victimization was reported by more than half of the women and one-third witnessed her mother being abused. Risk of partner violence was associated with victim's current drug and alcohol use, visiting shooting galleries, and living with someone with drug or alcohol problems. The study discusses the implications of the findings for research and intervention.