Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes

US Department of Health & Human Services: CHRONIC DISEASE:  Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes The frequency of posttraumatic stress disorder (PTSD) ranges from 10 to more than 50 percent in urban primary care settings where the prevalence of trauma is high. There is also growing evidence that PTSD is linked with chronic disease, such as diabetes and heart disease, and with poorer health outcomes. In fact, a recent study found that PTSD was significantly associated with a hemoglobin (Hb) A1c level (a marker of diabetes control) greater than 7 percent among low-income minorities. The researchers recruited men and women with type 2 diabetes from four community-based primary care clinics in Harlem, New York City. In addition to demographic information, participants were screened for depressive symptoms and for lifetime PTSD. A total of 103 adults were included in the final analysis. Within the group, 12 percent had lifetime full PTSD, while another 12 percent had sub-threshold PTSD. Those with lifetime PTSD were significantly more likely to have an HbA1c level of greater than 7 percent compared to patients not experiencing PTSD symptoms. The most common sources of trauma were childhood physical abuse (22 percent) and the death of a child (18 percent). Patients with PTSD were also more likely to suffer from depressive symptoms and to be taking a psychiatric medication. In addition to PTSD, patients with HbA1c levels above 7 percent had diabetes for 15 or more years and were more likely to be taking insulin. The researchers encourage physicians to consider a diagnosis of PTSD in low-income patients with diabetes who are experiencing poor glucose control. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00066). See "Associations between posttraumatic stress disorder and hemoglobin A1c in low-income minority patients with diabetes," by Samantha A. Miller, M.D., M.S., Carol A. Mancuso, M.D., Carla Boutin-Foster, M.D., M.S., and others in General Hospital Psychiatry 33, pp. 116-122, 2011.

Study Hints at How Stress of Domestic Violence Might Be Passed to Unborn Child

Doesn't show cause-and-effect, but suggests low-stress pregnancies are best

Tuesday, July 19, 2011

TUESDAY, July 19 (HealthDay News) -- A new study provides evidence that stress from domestic violence during pregnancy may make offspring more prone to stress as an adult.

However, the research doesn't directly prove a cause-and-effect relationship.

It may be difficult to ever prove that stress affecting the bodies of stressed-out pregnant mothers disrupts the inner chemistry of their children. The study does point to the importance of a low-stress pregnancy, however.
"Healthy development starts in the womb, and it is not only nutritional," said study co-author Axel Meyer, an evolutionary biologist at the University of Konstanz in Germany. "Behavioral and emotional factors are important, and the effects are long-lasting."

In recent years, scientists have tried to understand how stress during pregnancy affects the fetus, possibly by altering genes. Research has suggested that anxious and stressed mothers are more likely to have children who develop attention and behavior problems and other issues, said Thomas G. O'Connor, director of the Wynne Center for Family Research at the University of Rochester Medical Center in new York.

It's challenging to figure out whether there's a direct link because many factors other than maternal stress -- such as the environment in which a child is raised -- could explain why kids turn out the way they do.

In science, the gold standard of research is to randomly assign groups of subjects to undergo different treatments or experiences and watch what happens to them. But it would be unethical to expose pregnant mothers to stress. So, researchers examine the effects of stress on pregnant animals, or they try to look backwards to find women who were stressed while pregnant and examine how it may have affected their offspring.

In this study, researchers looked at the genes of women and their children that are thought to be connected to stress.

They found that genetically, mothers stressed by domestic violence appear to "program their offspring to respond in a more costly way when exposed to stressors," Meyer said. The genes in the women themselves weren't affected by exposure to domestic violence.

Meyer said the ongoing stress of the domestic relationships may have been the key problem for the women. "Data from many studies suggest that stressors need not be physical," he said. "Emotional neglect, ongoing familial conflict and other severe forms of adversity may also take their toll."

Could something in the women that makes them more likely to become victims of domestic violence be passed down to their children? Probably not. The researchers linked domestic violence during pregnancy to genetic differences in their children, but they didn't find a link to mothers who experienced domestic violence before pregnancy.

How is the research helpful? "If it really were the case that stress in pregnancy did have persistent effects, then we should invest a great deal more effort and resources in trying to improve well-being in pregnancy," said O'Connor. "It would presumably be cost-effective because you're preventing something from happening."
The study appears in the July 19 issue of Translational Psychiatry.

SOURCES: Axel Meyer, Ph.D., professor, evolutionary biology, University of Konstanz, Germany; Thomas G. O'Connor, Ph.D., director, Wynne Center for Family Research, University of Rochester Medical Center, New York; July 19, 2011, Translational Psychiatry

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Risk Factors Predict Repeat Abuse

By Nancy Walsh, Staff Writer, MedPage Today

Published: July 05, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

When child abuse has been substantiated, a number of risk factors can predict the likelihood that abuse will be repeated if the child is returned to the care of the abuser, according to a prospective cohort study. For instance, when the parents or caregivers were in their teens or twenties, were survivors of abuse, and had never taken parenting classes -- the child faced a 54% risk of being harmed again, wrote Suzanne R. Dakil, MD, and colleagues from the University of Texas Southwestern Medical Center in Dallas. But the risk was higher even higher -- 60% -- for children younger than 8.5 years who were returned to parents that had taken parenting class, the researchers reported online in the Archives of Pediatrics and Adolescent Medicine. Because both Federal and state laws encourage keeping children in the family home if possible after abuse, it's crucial that accurate ways of predicting future risk be identified, Dakil's group stated. Previous research into risk factors for repeated abuse has been limited in its focus primarily on individual factors, rather than the interaction of many factors. To look for patterns of characteristics associated with risk of repeated abuse, Dakil and colleagues used a statistical technique known as recursive partitioning analysis, which can identify multiple variables associated with a given outcome. They identified 2,578 children in the National Survey for Child and Adolescent Well-Being who remained in the home after a report of abuse, following them for five years. Child characteristics included in the analyses were age, sex, race, and health, while caregiver characteristics included age, marital and employment status, education, and physical and emotional health. Family and environmental characteristics included stress from unemployment, poverty, or drug use, social support, and domestic violence. A total of 44% of children in the sample were reported to child welfare authorities again after the index report. Bivariate analysis determined that these repeated reports were more likely when the child was between 3 years and 10 years of age and had behavior disturbances or developmental delays. A new report also was more likely if caregivers were younger, had themselves been abused, and were limited in their employment because of health or emotional problems. A family factor associated with repeated report was income below $20,000, while active domestic violence was less likely. The finding of lower risk in the presence of domestic violence may be explained by the possibility that children in such homes are more likely to be removed or to be provided with closer support and monitoring, according to the researchers. The recursive partitioning analysis identified risk clusters beginning with the determination of whether the index case had been substantiated, and found that in unsubstantiated cases, 56% were reported a second time. Among the 1,252 substantiated index cases, 38% involved a second report. However, this rose to 86% when the caregiver had a history of abuse and was younger than 33.5 years, the child was younger than 12.5 years but showed no behavioral difficulties, and when five or more children were present in the home. A cluster of characteristics associated with low incidence of repeated abuse -- 26% -- was a substantiated index report, older age of the caregiver, no parenting classes, and non-African-American race. "The findings, which go beyond prior research via a data-driven approach to identifying risk clusters, demonstrate that some risk factors, when combined, are powerful predictors of a child's future abuse risk," wrote Dakil and colleagues. The finding that risk was still high in cases where there had been parenting classes suggests that classes may not be adequate for high-risk families, and additional support or removal might be considered, they noted. And the increased risk seen with low income and behavior difficulties signals a need for assistance in basics such as housing, employment, medical care, and behavioral services. In contrast, lower-risk families might not need these intensive services. "These findings might be useful to [child protection services] in identifying at-risk children and making evidence-based decisions regarding child placement, families' service needs, and the duration and intensity of monitoring that families require," the researchers concluded. They acknowledged that their study was limited by reliance on caseworker reports, which can be influenced by high worker turnover, and families being lost to follow-up. The authors reported no financial disclosures.

Primary source: Archives of Pediatrics and Adolescent Medicine Source reference: Dakil S, et al "Recidivism in the child protection system: identifying children at greatest risk of reabuse among those remaining" Arch Pediatr Adolesc Med 2011; DOI:10.1001/archpediatrics.2011.129. Please go to MedPage Today for more information.

CDC: Majority of U.S. adults had troubled childhoods

USA TODAY
Updated 12/17/2010 8:18 PM

By Steven Reinberg HealthDay

 

Almost 60% of American adults say they had difficult childhoods featuring abusive or troubled family members or parents who were absent due to separation or divorce, federal health officials report.

 

In fact, nearly 9% said that while growing up they underwent five or more "adverse childhood experiences" ranging from verbal, physical or sexual abuse to family dysfunction such as domestic violence, drug or alcohol abuse, or the absence of a parent, according to the U.S. Centers for Disease Control and Prevention (CDC).

"Adverse childhood experiences are common," said study coauthor Valerie J. Edwards, team lead for the Adverse Childhood Experiences Team at CDC's National Center for Chronic Disease Prevention and Health Promotion. "We need to do a lot more to protect children and help families," she said.

About a quarter of the more than 26,000 adults surveyed reported experiencing verbal abuse as children, nearly 15% had been physical abused, and more than 12% — more than one in 10 — had been sexually abused as a child.

Since the data are self-reported, Edwards believes that the real extent of child abuse may be still greater. "There is a tendency to under-report rather than over-report," she said.

The findings are published in the Dec. 17 issue of the CDC's journal Morbidity and Mortality Weekly Report.

For the report, researchers used data from the Behavioral Risk Factor Surveillance System, which surveyed 26,229 adults in Arkansas, Louisiana, New Mexico, Tennessee and Washington. Edwards is cautious about extrapolating these results, but based on other data they probably are about the same in other states, she said.

While there were few racial or ethnic differences in reports of abuse, the report confirmed that women were more likely than men to have been sexually abused as children. In addition, people 55 and older were less likely to report being abused as a child compared to younger adults.

One theory why older people did not report as much childhood abuse is that since these takes a toll on health in adulthood, many of these older abuse victims may have died early, Edwards said. The CDC report, for example, notes that adverse childhood experiences are associated with a higher risk of depression, heart disease, diabetes, cancer, substance abuse and premature death. "So (childhood abuse) may be associated with years of life lost," she said.

There was no difference in the number of people reporting childhood abuse in any other age group, Edwards added.

Adverse childhood experiences included in the report included verbal abuse, physical abuse, sexual abuse, incarceration of a family member, family mental illness, family substance abuse, domestic violence and divorce.

According to the report, about 7.2% had had a family member in prison during their childhood and 16.3% had witnessed domestic violence in the family home. In addition, about 29% grew up in a home where someone abused alcohol or drugs. "These cases occur across all racial groups and ethnicities," Edwards noted.

Almost one in five respondents (19.4 percent) had lived as a child with someone who was depressed, mentally ill or suicidal, the report noted.

Although the volume of abuse and dysfunction is significant, such traumatic experiences cannot be used to describe a person or determine what that person will be, the researchers cautioned. Instead, they said, keeping track of these abusive experiences is important to gain a better understanding of them and their effect on society.

In addition, it's crucial to work harder to prevent abuse and household stress as well as finding better ways to identify and treat children at risk, they said.

"For adults who have had these experiences and feel they are still causing them problems, they are not alone and there is help available," Edwards said.

Dr. Lee M. Sanders, an associate professor of pediatrics at the University of Miami Miller School of Medicine said that "one of the things we don't realize when we look around at our neighborhoods and communities is that these problems are so common."

"That's something to be concerned about. That's something to take communal action on," he added.

Identifying and treating abuse early can prevent many serious health consequences later in life. Programs that provide quality care for children, as well as home visitation programs in early infancy and parenting programs, are part of the solution to this problem, Sanders said.

"These interventions are important not just because abuse is so common, but because of the lifelong health implications," Sanders said. "There is a connection of these events to lifelong implications, not just for mental health for adults, but also for physical health."

For example, a person who has several of these events is more likely to get cancer and heart disease, Edwards said. "This is serious and it's not just a quirk of statistics. It's a real relationship."

Child Sexual Abuse Imapct - 23yo Study

This is a new study about CSA cases by University of Southern California and Cincinnati Children’s Hospital Medical Center, University of Cincinnati College

of Medicine.

It is an amazing summary of a rigorous, 23 year prospective, longitudinal study of sexually abused girls, 
followed up through some of them having their own children. 

ABSTRACT 

This is a report on the research design and findings of a 23-year longitudinal 
study of the impact of intrafamilial sexual abuse on female development.
 The conceptual framework integrated concepts of psychological 
adjustment with theory regarding how psychobiological factors might 
impact development. Participants included 6- to 16-year-old females with
 substantiated sexual abuse and a demographically similar comparison 
group. A cross-sequential design was used and six assessments have taken
 place, with participants at median age 11 at the first assessment and 
median age 25 at the sixth assessment. Mothers of participants took part
 in the early assessments and offspring took part at the sixth 
assessment. Results of many analyses, both within circumscribed 
developmental stages and across development, indicated that sexually 
abused females (on average) showed deleterious sequelae across a host of
 biopsychosocial domains including: earlier onsets of puberty, cognitive
 deficits, depression, dissociative symptoms, maladaptive sexual 
development, hypothalamic–pituitary–adrenal attenuation, asymmetrical 
stress responses, high rates of obesity, more major illnesses and 
healthcare utilization, dropping out of high school, persistent 
posttraumatic stress disorder, self-mutilation, Diagnostic and 
Statistical Manual of Mental Disorders diagnoses, physical and sexual 
revictimization, premature deliveries, teen motherhood, drug and alcohol
 abuse, and domestic violence. Offspring born to abused mothers were at 
increased risk for child maltreatment and overall maldevelopment. There 
was also a pattern of considerable within group variability. Based on 
this complex network of findings, implications for optimal treatments 
are elucidated. Translational aspects of extending observational 
research into clinical practice are discussed in terms that will likely 
have a sustained impact on several major public health initiatives.

Click Here to read more about the study 

CDC Report: Adverse Childhood Experiences Reported by Adults

Adverse childhood experiences (ACEs) include verbal, physical, or sexual abuse as well as family dysfunction (an incarcerated, mentally ill, or substance-abusing family member, domestic violence, and absence of a parent due to divorce or separation).

Adverse Childhood Experiences (ACEs) have been linked to a wide range of health outcomes in adulthood including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality.


Using the 2009 ACE module of the Behavioral Risk Factor Surveillance System (BRFSS) to examine whether a history of ACEs was common, 26,229 adults were interviewed in 5 states- Arkansas, Louisiana, New Mexico, Tennessee, and Washington. The MMWR report on ACEs among U.S. adults summarizes the results of that analysis. The module consisted of 11 questions that yielded 8 categories of ACEs (verbal abuse, physical abuse, sexual abuse, household mental illness, household substance abuse, domestic violence, parental separation/divorce and incarcerated family members). Respondents were asked to refer to the time period before they were 18 years of age when answering questions.


Overall, 59.4% of respondents reported having had at least one ACE while 8.7% reported five or more ACEs. Given the high prevalence of ACEs, additional efforts are needed at the state and local level to reduce and prevent childhood maltreatment and associated family dysfunction in the US, and further the development and dissemination of trauma-focused services to treat stress-related health outcomes associated with ACEs.
The most common ACEs were:

• Separated or divorced parents
• Verbal abuse
• Family member with depression or mental illness
• Witness of domestic violence
• Physical abuse
• Sexual abuse

Differences by gender

Men and women reported similar prevalence for having grown up with a mentally ill household member (22.0% for women, 16.7% for men) and growing up with a substance-abusing family member (30.6% for women, 27.5% for men). A difference between men and women was observed in the ACE category of sexual abuse, where women reported more than twice as many experiences as men (17.2% for women, 6.7% for men).

Differences by race/ethnicity

Black, non-Hispanic respondents had the lowest prevalence of each ACE category among all racial-ethnic groups. However, compared to all racial-ethnic groups Black non-Hispanics reported higher prevalence of having had an incarcerated family member (12.9%) and experiencing parental divorce (37.9%). Compared to Whites, Hispanics more frequently reported physical abuse (14.6% for Whites, 19.8% for Hispanics), witnessing domestic violence (15.1% for Whites, 21.7% for Hispanics), and having an incarcerated family member (6.2% for Whites, 9.5% for Hispanics).


These findings reinforce that adverse childhood experiences are common across racial/ethnic groups and states, further reinforcing the need to expand evidence-based child abuse prevention programs such as home visiting and parent education.

Data Source

CDC. Adverse Childhood Experiences Reported by Adults — Five States, 2009. MMWR 59(49);1609-1613.

More Information

• Academy on Violence and Abuse
• Adverse Childhood Experiences Study
• American Professional Society on the Abuse of Children
• American Psychological Association Trauma Psychology Division
• Childhood Maltreatment Prevention
• Legacy for Children™
• National Clearinghouse on Child Abuse and Neglect Information
• Preventing Child Maltreatment: Program Activities Guide

STRYVE to Prevent Youth Violence

From:  CDC's National Center for Injury Prevention and Control.   

Youth violence is preventable. Learn how STRYVE helps communities build comprehensive strategies that are based on the best available evidence and implemented through multisector action.  

STRYVE, or Striving To Reduce Youth Violence Everywhere, is a national initiative led by the Centers for Disease Control and Prevention (CDC) to prevent youth violence before it starts. 

STRYVE provides community tools through mechanisms such as STRYVE Online. STRYVE Online offers community leaders and others working to prevent youth violence

• Effective strategies based upon the best available evidence;
• Training and technical assistance;
• Online community workspaces; and
• Connections to other communities.

More Information

• STRYVE to Prevent Youth Violence
• STRYVE Online
• Violence Prevention