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.

HealthDay: Neurologists Should Screen Patients for Abuse: Experts

People with certain disorders might be more vulnerable to violence, says American Academy of Neurology

By Robert Preidt

Wednesday, January 25, 2012

WEDNESDAY, Jan. 25 (HealthDay News) -- Neurologists should screen their patients for abuse by family members, caregivers or other people, the American Academy of Neurology says in a new position statement.

Problems to look for include elder, sexual, child, financial and emotional abuse; bullying, cyberbullying and violence.

Certain neurologic disorders, such as Parkinson's disease, Alzheimer's disease or stroke, may raise the risk for abuse and neglect, the academy said.

The statement outlines 10 principles for neurologists to use when meeting with patients. These include integrating questions about abuse into a patient's medical history and routinely checking patients for past and ongoing violence.

The academy is also offering free training to members interested in learning how to deal with domestic violence issues in their communities.

"Neurologists see patients with neurologic disorders that may make them more susceptible to abuse or neglect. They also see patients with neurologic issues that may be either directly or indirectly related to mistreatment," statement lead author Dr. Elliott Schulman, of Lankenau Medical Center in Wynnewood, Penn., said in an academy news release.

More than 90 percent of all injuries caused by intimate partner violence occur to the head, face or neck and can result in traumatic brain injury, according to the statement.

It also noted that people with neurologic disorders such as stroke, Alzheimer's disease or Parkinson's disease may be at increased risk for abuse and neglect.

"By routinely asking about violence and abuse, the neurologist increases the opportunity for both identifying ongoing abuse and intervening when appropriate," Schulman said. "In addition to further physical and emotional harm, consequences of not asking about abuse might include failure of treatments and, when children are exposed to abuse, perpetuation of the cycle of abuse from generation to generation."

The statement appears Jan. 25 in the online issue of the journal Neurology.

SOURCE: American Academy of Neurology, news release, Jan. 18, 2012

HealthDay

Copyright (c) 2012 HealthDay. All rights reserved.

Study: Child abuse bigger threat than SIDS

4,600 children hospitalized with serious injuries 

By Frederik Joelving

updated 2/6/2012 10:14:15 AM ET

MSNBC: Nearly 4,600 U.S. children were hospitalized with broken bones, traumatic brain injury and other serious damage caused by physical abuse in 2006, according to a new report.


Babies younger than one were the most common victims, with 58 cases per 100,000 infants. That makes serious abuse a bigger threat to infant safety than SIDS, or sudden infant death syndrome, researchers say in the report.

"There is a national campaign to prevent SIDS," said Dr. John Leventhal of Yale University, who led the new study. "We need a national campaign related to child abuse where every parent is reminded that kids can get injured."

The new study, published Monday in the journal Pediatrics, is the first broad U.S. estimate of serious injuries due to child abuse.

Based on data from the 2006 Kids' Inpatient Database, the last such numbers available, Leventhal's team found that six out of every 100,000 children under 18 were hospitalized with injuries ranging from burns to wounds to brain injuries and bone fractures.

The children spent an average of one week in the hospital; 300 of them died.

The rate of abuse was highest among children under one, particularly if they were covered by Medicaid, the government's health insurance for the poor. One out of every 752 of those infants landed in the hospital due to maltreatment.

"Medicaid is just a marker of poverty, and poverty leads to stress," said Leventhal, who is the medical director of the Yale-New Haven Children's Hospital Child Abuse Program.

Last year, a study from four U.S. states showed a clear spike in abusive brain injuries following the financial crash in late 2007, a finding researchers chalked up to the added pressure on parents.

Mom's hug revives baby that was pronounced dead
In that study, too, toddlers appeared to be at higher risk. That led researchers to suggest the maltreatment might have been triggered by crying.

If a caretaker shakes a baby violently to make him or her stop crying, they can cause "shaken baby syndrome," in which the brain bumps up against the skull and starts bleeding.

Leventhal said babies may also be more vulnerable that older kids.

"The most serious injuries tend to be in the younger kids," he told Reuters Health.

Home birth advocate dies in childbirth
The researchers estimate that the hospitalizations cost about $73.8 million in 2006, although that's only a fraction of the overall cost of abuse to society.

"This is a serious problem that affects young children," said Leventhal, whose team is now examining more recent data to refine the findings. "We need to figure out a way to help parents do better."

Copyright 2012 Thomson Reuters.

CDC: Child abuse and neglect cost the United States $124 billion

For Immediate Release: February 1, 2012
Contact :CDC Division of News and Electronic Media
(404) 639-3286

Rivals cost of other high profile public health problems

The total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion, according to a report released by the Centers for Disease Control and Prevention, published in Child Abuse and Neglect, The International Journal.

This study looked at confirmed child maltreatment cases, 1,740 fatal and 579,000 non–fatal, for a 12–month period. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke with a lifetime cost per person estimated at $159,846 or type 2 diabetes, which is estimated between $181,000 and $253,000.  The costs of each death due to child maltreatment are even higher.

“No child should ever be the victim of abuse or neglect – nor do they have to be.  The human and financial costs can be prevented through prevention of child maltreatment,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control.

Child maltreatment has been shown to have many negative effects on survivors, including poorer health, social and emotional difficulties, and decreased economic productivity.  This CDC study found these negative effects over a survivor′s lifetime generate many costs that impact the nation′s health care, education, criminal justice and welfare systems. 
Key findings:

• The estimated average lifetime cost per victim of nonfatal child maltreatment includes:
• $32,648 in childhood health care costs
• $10,530 in adult medical costs
• $144,360 in productivity losses
• $7,728 in child welfare costs
• $6,747 in criminal justice costs
• $7,999 in special education costs

• The estimated average lifetime cost per death includes:
• $14,100 in medical costs
• $1,258,800 in productivity losses

Child maltreatment can also be linked to many emotional, behavioral, and physical health problems. Associated emotional and behavioral problems include aggression, conduct disorder, delinquency, antisocial behavior, substance abuse, intimate partner violence, teenage pregnancy, anxiety, depression, and suicide.
Past research suggests that child maltreatment is a complicated problem, and so its solutions cannot be simple. An individual parent or caregiver′s behavior is influenced by a range inter–related factors such as how they were raised, their parenting skills, the level of stress in their life, and the living conditions in their community.  Because of this complexity, it is critical to invest in effective strategies that touch on all sectors of society. 

“Federal, state, and local public health agencies as well as policymakers must advance the awareness of the lifetime economic impact of child maltreatment and take immediate action with the same momentum and intensity dedicated to other high profile public health problems –in order to save lives, protect the public′s health, and save money,” said Dr. Degutis.

Several programs have demonstrated reductions in child maltreatment and have great potential to reduce the human and economic toll on our society.  Several examples of effective programs include:

• Nurse–Family Partnership, an evidence–based community health program. Partners a registered nurse with a first–time mother during pregnancy and continues through the child′s second birthday.   http://www.nursefamilypartnership.org/
• Early Start, provides coordinated, family–centered system of services:  http://www.dds.ca.gov/earlystart/ California′s response to federal legislation providing early intervention services to infant and toddlers with disabilities and their families.
• Triple P, a multilevel parenting and family support system: http://www.triplep–america.com/ Aims to prevent severe emotional and behavioral disturbances in children by promoting positive and nurturing relationships between parent and child.

The article, "The economic burden of child maltreatment in the United States and implications for prevention," is available at http://www.sciencedirect.com/science/journal/aip/01452134.

CDC′s Injury Center works to prevent injuries and violence and their adverse health consequences.  For more information on public health child maltreatment prevention activities and research, please visit http://www.cdc.gov/ViolencePrevention/childmaltreatment.

If you know or suspect a child is being abused, contact the National Child Abuse Hotline at 1–800–4–A–CHILD or visit the Childhelp website.

2008-2011 Domestic Abuse, Health, and Consequences to Society

Compiled by M.A.S.O. ~ Massachusetts Survivors Outreach

2011 Studies

January 4 - HealthDay News  - Survey Finds Much Victimization of Children Goes Unreported – By UNH - Nearly 60 percent of 10-to-17-year-olds surveyed in a new study say they were victims of violence, abuse or crime in the past year. However, fewer than half said that authorities ever learned about what happened.

"The hidden nature of childhood victimization has multiple sources. Clearly, children and adolescents are easily intimidated by offenders and fear retaliation."

http://domestic-abuse-violence.blogspot.com/2011/04/survey-finds-much-victimization-of.html

 

 

February 23 - MedLine Plus - PTSD Risk in Women Tied to Genetics - Heavily traumatized civilian women with two copies of a specific single nucleotide polymorphism (SNP) in the ADCYAP1R1 gene were more likely to show PTSD with an odds ratio of 1.66 (95% CI 1.32 to 2.09) relative to similar women without the condition, Kessler and colleagues found.

About one-third of the 763 women in the study were diagnosed with PTSD.

Among the individual PTSD symptoms, hyperarousal was the one most strongly associated with the CC genotype.

http://domestic-abuse-violence.blogspot.com/2011/03/ptsd-risk-in-women-tied-to-genetics.html

 

February 24  - Science Daily -  Strong Link Found Between Victimization, Substance Abuse - Researchers compared victimization experiences of unwanted sexual activity, neglect, physical violence, and assault with a weapon,

Three times as many lesbians as heterosexual women reported childhood sexual abuse.

Regardless of sexual identity, women who reported two or more victimization experiences had two to four times the prevalence of alcohol dependence, drug abuse or drug dependence as women who reported no victimization, she said.

http://domestic-abuse-violence.blogspot.com/2011/03/strong-link-found-between-victimization.html

 

 

March 18 -  Medline Plus - Domestic Abuse Often Escapes Notice of ER Staff: Study - Most not identified as victims when treated in emergency department – By UPenn - Three of four domestic violence victims treated in hospital emergency departments are not identified as victims of abuse, a new study reveals. 

80% of women who reported domestic assaults to police came to an emergency department at least once during the four years after the reported assault.  Only 28% of the women were ever identified in EDs as victims of domestic violence.

http://domestic-abuse-violence.blogspot.com/2011/04/domestic-abuse-often-escapes-notice-of.html

 

 

March 31 - Moms With Tough Childhoods More Likely to Have Smaller Babies: Study - Abuse, poverty during a mother's youth is associated with heightened health risks for the next generation

http://domestic-abuse-violence.blogspot.com/2011/04/moms-with-tough-childhoods-more-likely.html

 

 

April 16 – CDC – CDC Report: Adverse Childhood Experiences Reported by Adults

Overall, 59.4% of respondents reported having had at least one ACE while 8.7% reported five or more 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.

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.

http://domestic-abuse-violence.blogspot.com/2011/04/cdc-report-adverse-childhood.html

April 20 - Sciencedaily.com - Biological Links Found Between Childhood Abuse and Adolescent Depression - history of physical, sexual or emotional abuse in childhood substantially increases the risk of depression in adolescence by altering a person's neuroendocrine response to stress.

http://domestic-abuse-violence.blogspot.com/2011/05/biological-links-found-between.html

April 28 - University of Southern California and Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine. - - Child Sexual Abuse Imapct - 23yo Study - 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. 

http://domestic-abuse-violence.blogspot.com/2011/04/child-sexual-abuse-imapct-23yo-study.html

May 10 - Post-Traumatic Childhood - For every soldier returning from Iraq and Afghanistan with symptoms of depression or PTSD, there are around 10 children in the United States who are traumatized by exposure to family violence, sexual abuse, neglect and assault, with consequences comparable to those of adult exposure to war-zone violence. 

The Pew Charitable Trusts estimates that the annual cost of childhood maltreatment like this is $103.8 billion. 

Untreated, traumatized children become failing adults who populate our jails and overwhelm our human services agencies. Cutting the development of effective treatments will produce many years of increasing costs and unquantifiable human misery

http://domestic-abuse-violence.blogspot.com/2011/05/post-traumatic-childhood.html

 

May 17 ScienceDaily.com - Deprivation and Neglect Found to Age Children's Chromosomes - Study, led by researchers at Children's Hospital Boston and Tulane University, shows that early adversity even affects children's chromosomes -- prematurely shortening the chromosome tips, known as telomeres, and hastening how quickly their cells "age."

"The telomere is designed to protect the chromosome, so accelerating how early in life telomeres lose length correlates with shortened life span," says Charles Nelson, PhD, director of the Laboratories of Cognitive Neuroscience at Children's and principal investigator of BEIP. "Shortened telomeres may lead to health consequences downstream."

http://domestic-abuse-violence.blogspot.com/2011/05/deprivation-and-neglect-found-to-age.html

 

 

May 26 -  The Annapolis Chronic Fatigue and Fibromyalgia Research Center. - Abuse History More Common in Those With Pelvic Pain, CFS, and Fibromyagia  - Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association With Neuroendocrine Dysfunction

http://domestic-abuse-violence.blogspot.com/2011/05/abuse-history-more-common-in-those-with.html

May 26 - Ritual Abuse and Torture-based Mind Control: Reducing and Preventing Re-contact with Abusers - The two primary forms of re-contact w/ abusers include reporting back by phone or written correspondence, and physically returning to abusers to be abused again. Perpetrators of ritual abuse and mind control attempt to coerce their victims into submission and service to the abuser group for a lifetime. Abuser methods of exerting long-term contact and control vary in relation to the level of psychological sophistication of the abusers and the size of the abusers’s criminal network.
Some abuser groups rely primarily on threats to force their victims into compliance and to prevent their victims from escaping. For some of these groups, these are empty threats. They make claims of having more power than they have. Some abuser groups have larger criminal networks and thus, more power to carry out their threats. But, they too reliably overstate their power to maximally terrorize their victims. This is not to dismiss the reality that these abusers commit murder, but it is to say that they lie and exaggerate their power. Clearly, people who systematically abuse others lie to further their own interests. Words are just one more tool of manipulation to control their victims. Everything they say should be questioned and examined for underlying motives and feasibility.
Many of these abusers also manipulate their victims’ attachment needs, that is, their basic survival needs and needs for security and love, usually beginning in early childhood. They also go to great lengths to try to make their victims believe that the victims are accomplices to the abuse, that they are as evil as their abusers themselves, and that they are unworthy and incapable of belonging anywhere but with the abusers.
Some abuser groups go a step further and manipulate their victims’ psychological capacity to form dissociated self-states in response to extreme pain and terror. I am using the term, “dissociated self-states,” here to refer to states of consciousness with some sense of self that exist out of the conscious awareness of the most-often conscious parts of the psyche, and that typify DSM-IV Dissociative Identity Disorder, and forms of Dissociative Disorder Not Otherwise Specified in which self-states exist internally, affecting the psyche from within, but never assume complete control of executive functions (e.g., purposive action).
These Machiavellian abusers systematically torture their victims for the intended purpose of coercing their victims’ psyches into forming new dissociated self-states that they then work to exploit. They “torture-hypno-condition” these self-states, that is, they use torture, hypnosis, and behavioral conditioning, to try to coerce these dissociated self-states into fulfilling functions that serve the abusers. (I thank Hans Ulrich Gresch, Ph.D., psychologist, mind control survivor, and respected colleague, for the term, “torture-hypno-conditioning,” the most succinct descriptive phrase that I have found that explains what occurs in most torture-based mind control programming; see: http://www.mind-control.psychoprobleme.de/). These abusers “program” some of these dissociated self-states to take on “reporter” and “re-contact” functions, that is, to report to the abusers on a regular basis from a distance, and to return to the abusers as directed.
In many cases, even though the survivor is working hard to break free of her or his abusers, these programmed self-states continue to report to, and return to, the abusers, often out of the conscious awareness of the most-often conscious parts of the psyche. Ongoing access allows the abusers to retaliate against their victims for attempting to break free and to escalate their abuse and programming in efforts to increase their control of their victims.

http://domestic-abuse-violence.blogspot.com/2011/05/ritual-abuse-and-torture-based-mind.html

June 13 - Boston.com -  Study ties bullying, domestic violence - Boys who are bullies are nearly four times as likely as non-bullies to grow up to physically or sexually abuse their female partners, a study led by researchers from the Harvard School of Public Health found.  http://domestic-abuse-violence.blogspot.com/2011/07/study-ties-bullying-domestic-violence.html

June 30 - msnbc.com -  Effects of sexual abuse last for decades, study finds  - Young girls who are the victims of sexual abuse experience physical, biological and behavioral problems that can persist for decades after, a new study shows.   http://domestic-abuse-violence.blogspot.com/2011/07/effects-of-sexual-abuse-last-for.html

June 30 - Robert Hughes Univ of Illinois - How Custody Evaluators Think about Domestic Violence - some domestic violence involves the use of extreme forms of control that forces a partner to do something she does not want to do. Johnson labeled this form of violence as "intimate terrorism."

These findings raise important questions about the degree to which domestic violence is being thoughtfully considered in custody decisions.  It is important for the legal system to develop training and policies such that custody evaluators can appropriately consider custody arrangements in domestic violence situations.  http://domestic-abuse-violence.blogspot.com/2011/07/how-custody-evaluators-think-about.html

 

July 5 - MedPage Today - 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. 

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.
Risks higher even higher -- 60% -- for children younger than 8.5 yrs 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.

44% of children were reported to child welfare authorities again after the index report.

 http://domestic-abuse-violence.blogspot.com/2011/07/risk-factors-predict-repeat-abuse.html 

 

 

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.  http://domestic-abuse-violence.blogspot.com/2011/08/study-hints-at-how-stress-of-domestic.html

TUESDAY, Aug. 2 (HealthDay News) – Long Term Affects To Heath - Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows. 

In the United States, more than 20% of women have experienced intimate-partner violence, stalking or both. A full 17% have reported rape or attempted rape, according to background information in the study.

15% of women who had been subjected to one form of gender-based violence experienced (PTSD). - Subjected to 3 or more forms of gender-based violence, that number jumped to more than 56%, the investigators found.

"This study really demonstrated the extent of gender-based violence and the long-term consequences of violence against women," said Andrea Gielen, director of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "There are huge implications for health services; this is not just a one-time treatment in the ER for a broken bone. People who treat women for any health-related issues need to think about the extent that such violence can affect women," Gielen said.

http://domestic-abuse-violence.blogspot.com/2011/08/violence-against-women-can-take.html

August 2, 2011 - HealthDay - Violence Against Women Can Take Lifelong Toll: Study - Women who've suffered from gender-based violence are more likely to develop anxiety disorders or other mental woes, experience physical and mental disabilities, and have worse quality of life than other women, new research shows.  Gender-based violence includes rape and other forms of sexual assault, intimate-partner violence (such as spouse abuse) and stalking.    http://domestic-abuse-violence.blogspot.com/2012/01/healthday-violence-against-women-can.html

Wednesday, October 26, 2011 - Reuters Health - Murder, suicide top medical deaths in pregnancy -  Expectant mothers are more likely to die from murder or suicide than several of the most common pregnancy-related medical problems, U.S. researchers have found.

http://domestic-abuse-violence.blogspot.com/2012/01/reuters-health-murder-suicide-top.html

November 13, 2011 - Reuters -  Early Sexual Abuse Increases Heart Risks - CHICAGO (Reuters) - Women who were repeatedly sexually abused as girls have a 62 percent higher risk of heart problems later in life compared with women who were not abused, U.S. researchers said on Sunday.

http://domestic-abuse-violence.blogspot.com/2012/01/reuters-early-sexual-abuse-increases.html

November 13, 2011 -  American Heart Association - Abused girls may have higher risk of heart disease, stroke as adults -

Study Highlights:  Women who experienced unwanted sexual activity as children or adolescents had a higher risks for heart attacks, heart disease and strokes as adults compared to women who reported no unwanted sexual activity. Severe physical abuse as children or teens also was associated with an increased risk of cardiovascular disease as adults.

http://domestic-abuse-violence.blogspot.com/2012/01/abused-girls-may-have-higher-risk-of.html

December 9, 2011 - MedLine Plus - Abuse May Alter Child's Brain Activity.  Children who are abused or exposed to family violence have changes in brain activity similar to those seen in combat veterans, a new study finds. "This underlines the importance of taking seriously the impact for a child of living in a family characterized by violence. Even if such a child is not showing overt signs of anxiety or depression, these experiences still appear to have a measurable effect at the neural level," McCrory said.

http://domestic-abuse-violence.blogspot.com/2012/01/healthday-abuse-may-alter-childs-brain.html

December 14, 2011 - Contact: CDC Division of News & Electronic Media - (404) 639-3286 - Sexual Violence, Stalking, and Intimate Partner Violence Widespread in the US - New survey finds these types of violence affect the health of millions of adults.  On average, 24 people per minute are victims of rape, physical violence, or stalking by an intimate partner in the United States, according to findings released today by the Centers for Disease Control and Prevention. Over the course of a year, that equals more than 12 million women and men. Those numbers only tell part of the story – more than 1 million women reported being raped in a year and over 6 million women and men were victims of stalking in a year, the report says. http://www.cdc.gov/media/releases/2011/p1214_sexual_violence.html

http://domestic-abuse-violence.blogspot.com/2012/01/cdc-sexual-violence-stalking-and.html

 

2010 Studies

January 25 -  MedPage Today - MEDICAL NEWS: Domestic Abuse May Affect Reproductive Freedom - In some abusive relationships, men may use strategies to force women to become pregnant, including sabotaging their birth control, researchers reported.   More than half of the women surveyed -- 53% -- reported physical or sexual partner violence.
Approximately a third of the women who reported partner violence also reported pregnancy coercion or birth control sabotage.   Altogether, the effect of both partner violence and reproductive control nearly doubled a woman's odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to 3.58)

Among the reasons men would want their partners to bear children: "It ranges from things like wanting to leave a legacy, to a straightforward desire for attachment, to having absolute control over her body," Miller said.

"It's about power and control," Mays said. "It's another way of saying, 'this girl's taken, this girl's mine.'”

"Women in abusive relationships are sometimes forced to bear children as a means to keep them dependent on their partner and sometimes as a means to justify additional -- and sometimes more severe -- abuse," Bonomi said.

http://domestic-abuse-violence.blogspot.com/2011/01/medical-news-domestic-abuse-may-affect.html

Study links persistent depression to childhood abuse

Sunday, August 14, 2011
By Kate Kelland, MedLine Plus

LONDON (Reuters) - Doctors treating people for depression should delve into the childhoods of their patients before prescribing, because a history of mistreatment has a significant impact on their illness and ability to recover, scientists said Monday.

Researchers who conducted a combined analysis of 26 studies involving more than 23,000 people found that those who suffered maltreatment as children were twice as likely as those who had normal childhoods to develop persistent and recurrent depression -- one of the world's most common and costly mental illnesses.

Those who had stressful or abusive childhoods were also less likely to be helped with drug or psychological treatment, the analysis found, suggesting doctors and scientists should look for new kinds of treatments and ways of intervening earlier.

"Identifying those at risk of multiple and long-lasting depressive episodes is crucial from a public health perspective," said Andrea Danese of the Institute of Psychiatry(IoP) at King's College London, who led the study.

Danese said the study showed that prevention and early intervention measures to target childhood maltreatment could prove vital in helping prevent the major global health problem.

"Knowing that individuals with a history of maltreatment won't respond as well to treatment may also be valuable for clinicians in determining patients' prognosis," he added.

Depression is a major cause of mortality, disability, and economic burden worldwide and the World Health Organization predicts that by 2020, depression will be the second leading contributor to the global burden of disease across all ages.

In Britain, experts say it affects at least one in 10 people at any one time and can lead to long-term sick leave, relationship breakdown or unemployment. According to a 2006 study, depression is responsible for 100 million lost working days a year in England and Wales alone at a cost of 9 billion pounds ($14.6 billion).

Danese, whose study was published in the American Journal of Psychiatry Monday, told a briefing that previous research has found that people who were maltreated as children also have biological scars from those experiences.

Around one in 10 children worldwide is exposed to maltreatment including psychological, physical or sexual abuse or neglect and as a result abnormalities can show up in biological areas that are particularly sensitive to stress, such as the brain and the immune system, he said.

These biological changes could potentially explain why depressed people with a history of maltreatment are less likely to respond well to treatment and may give clues for research aimed at finding more effective treatments, the scientists said.

"Whilst we still do not know exactly what type of treatment may improve the care of maltreated individuals, it may be that new treatments based on the biological vulnerabilities associated with childhood maltreatment could prove an exciting avenue for research," said Rudolf Uher, also of the IOP, who worked with Danese on the research.

A study published earlier this month found that childhood hardship, including suffering abuse or losing a parent or having a parent with addiction problems, also raised the risk of a range of chronic physical illnesses in later life, such as diabetes, heart disease or asthma

(Reporting by Kate Kelland, editing by Paul Casciato)

Reuters Health

(c) Copyright Thomson Reuters 2011

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.

Science Isn't Golden - “Parental Alienation Syndrome:" Another Alarming DSM-5 Proposal

Matters of the mind and heart

by Paula J. Caplan, Ph.D.

“Parental Alienation Syndrome:" Another Alarming DSM-5 Proposal

Using a medicalizing label to mask child sexual abuse

Published on June 6, 2011 by Paula J. Caplan, Ph.D. in Science Isn't Golden

©Copyright 2011 by Paula J. Caplan All rights reserved

Using a medicalizing label to mask child sexual abuse

Among the scientifically unwarranted and socially dangerous proposals that the Diagnostic and Statistical Manual-5 authors have not yet seen fit to rule out is the addition of something its advocates call Parental Alienation Syndrome. This is a medical-sounding term for nothing more than "She's a vengeful woman who's trying to make her children tell horrific lies about their father."

What often gets short shrift, as a result, is even the consideration of the possibility that the children are truly being molested. Virtually everything that is sometimes a sign that a child is being molested - such as fearfulness when it is time for a visit with the abuser or vaginal bleeding or infection in a 2-year-old - is instead interpreted as further "proof" that the mother has PAS. In these two examples, through use of PAS, the child's fearfulness is cast as the result of the mother's efforts to make the child frightened of the father or terrified of not pleasing her by wanting the visit to take place, and the vaginal problems are assumed to be caused by the mother in order to provide fake evidence of the molesting. If this sounds far-fetched, it is not. I have both done research and consulted in court cases about this.

As Dr. Julie Ancis, who has conducted extensive research about such cases, has noted:

[Richard] Gardner [who invented PAS] claimed that many reports of [child sexual abuse] in the context of divorce cases were false allegations. In this connection, it is important to note that Bala and Schuman (1999) found that only 1.3% of mothers' allegations of abuse by their children's fathers were deemed by civil court judges to be intentionally false, in contrast to 21% of cases in which fathers had made such allegations against mothers. And Meier (2009) reports after reviewing the research that it is a mistaken belief that mothers' allegations in child custody proceedings that fathers have sexually abused their children are usually false. [2]

Gardner not only thought up this label but also condoned adults' sexual assaults on children and said that reports of child sexual abuse were elevated because sexually voyeuristic social workers made them. [1,2] Despite the fact that some judges have quite rightly forbidden the use of the term in their courts, it remains widely used in other courts and sounds more impressive coming from the lips of a testifying mental health professional than "She's just a lying, angry woman."

Ancis writes further:

Gardner's (1998) questionable ethics and clinical judgment are reflected in (but are by no means limited to) the following: (1) he recommends joint interviews with an accused father and child in which the father directly confronts the child about the allegation, and (2) he interprets a child's overt expression of fear of possible retaliation by the father as evidence of the child's embarrassment about lying rather than as possibly a valid fear of a truthtelling child whose father is abusive.

The construct of PAS is unscientific, composed of a group of general symptoms with no empirical basis....

Major professional bodies, including the American Psychological Association, have discredited PAS on the grounds that it is misused indomestic violence cases and that there is no scientific evidence of such a "syndrome." The more recent APA Online document Issues and Dilemmas in Family Violence (http://www.apa.org/pi/essues.html), particularly Issue 5, describes the tendency of family courts to miminize a context of violence, falsely accusing the mother of alienation and granting custody to the father in spite of his history of violence. The National Council on Juvenile and Family Court Judges' 2006 manual states that "parental alienation syndrome or PAS has been discredited by the scientific community" and "should therefore be ruled inadmissible" (p. 19). A number of prominent figures, including Dr. Paul J. Fink, past president of the American Psychiatric Association and president of theLeadership Council on Mental Health, Justice, and the Media, and Professor Jon R. Conte of the University of Washington Social Welfare Doctoral Faculty have also discredited PAS and its lack of scientific basis (see Bruch, 2001).

When applied to a parent in a case involving an allegation of child sexual abuse, it is nearly always applied to a woman whose child is allegedly being molested by the father. Despite not yet being in the DSM, PAS has in some courts proven an astonishingly effective vehicle for deflecting the focus from the abuser and simply claiming that the woman must be lying, and coaching her children to lie, because she has the alleged mental illness of PAS. [1] The claim is that without cause, she wants to turn the children against their father.

Because of the use of PAS as a tactic by many CSA perpetrators to influence decision makers and the court system, abused children have been placed in the hands of their abusers (Childress, 2006). It is estimated that "over 58,000 children a year are ordered into unsupervised contact with physically or sexually abusive parents following divorce in the United States" (http://www.leadershipcouncil.org/1/pas/1.html) and that PAS was used in a large number of these cases. [2]

The DSM-5 editors could at any time have already struck PAS from their planned additions but have so far chosen not to.

If this alarms you, and especially if PAS has been used against you, please consider going to dsm5.org before their June 15 cutoff date for input from the public arrives, and send them your concerns. Please urge everyone else you can think of to do the same. The DSM-5 authors will do themselves and the manual's reputation no favors if they include PAS, and they need to hear from people whom the label has harmed.

[1] Paula J. Caplan. (2004) What is it that's being called "Parental Alienation Syndrome"? In Paula J. Caplan & Lisa Cosgrove (Eds.), Bias in psychiatric diagnosis. Lanham, MD: Rowman & Littlefield.

[2] Julie R. Ancis. Parental alienation syndrome.http://awpsych.org/index.php?option=com_content&view=article&id=1...

References from Ancis article quotations

American Psychological Association (APA). (1996). Report on Violence and the Family: Issues and Dilemmas in Family Violence. APA Presidential Task Force on Violence and the Family. Washington, DC: Author. Retrieved from http://www.nnflp.org/apa/intro.html.
Bala, N., & Schuman, J. (1999). Allegations of sexual abuse when parents have separated. Canadian Family Law Quarterly 17, 191-241.
Bruch, C. (2001). Parental Alienation Syndrome and Parental Alienation: Getting it wrong in child custody cases. Family Law Quarterly, 35(3), 527-552. Retreived from http://ezproxy.gsu.edu:3305/HOL/Page?handle=hein.journals/famlq35...
Gardner, R. A. (1998). The Parental Alienation Syndrome (2nd ed.). Creskill, New
Jersey: Creative Therapeutics, Inc.
Meier, J. S. (2009, January). Parental Alienation Syndrome and parental
alienation: Research reviews. National Online Resource Center on Violence Against Women, 1-17. Retrieved fromhttp://www.leadershipcouncil.org/1/pas/1.html
National Council of Family Court Judges (2006). Navigating Custody and
Visitation Evaluations in Cases with Domestic Violence: A Judge's Guide. Retrieved from http://www.ncjfcj.org/content/blogcategory/256/302/

 

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