Victims of Intimate Partner Violence at Significantly Increased Risk of Psychiatric Disorders

Source: American Psychiatric Association

ARLINGTON, Va. (Aug. 1, 2011) — Mental disorders are significantly more common among victims of intimate partner violence than among nonvictims, according to research appearing in the August issue of the American Psychiatric Association’s journal Psychiatric Services.

Of adults interviewed, about 5 percent reported being victims of intimate partner violence including 5.6 percent of women and 5.8 percent of men. New onset of psychiatric disorders was more than twice as common among victims, 22 percent, compared to nonvictims, 9.7 percent. More than 25,000 adults participated in the study, including 1,600 who reported being victims of intimate partner violence, as part of the National Epidemiologic Survey on Alcohol and Related Conditions.

For most of the violent acts, the frequency of the acts directly related to the incidence of a psychiatric disorders—an increased frequency of the violent acts contributed to increased risk of developing a psychiatric disorder. Intimate partner violence was associated with an increased risk of posttraumatic stress disorder (PTSD), major depressive disorder, substance use disorders, bipolar disorder, panic disorder and generalized anxiety disorder.

The study looked at adults who reported being married, recently married, or in a romantic relationship in the past 12 months and looked at minor and severe forms of intimate partner violence. As with previous research, they did not find significant different between genders. Men and women were equally likely to have injuries requiring to medical care, however, women were more likely to be victims of sexual violence.

The authors conclude, “Intimate partner violence is highly prevalent in the United States, affects both men and women, and is associated with onset of a broad range of psychiatric disorders.” Health care providers have an opportunity to intervene and to lower the risk of psychiatric disorder onset.

The researchers, led by Mayumi Okuda, M.D., are affiliated with the New York State Psychiatric Institute and the Department of Psychiatry, College of Surgeons of Columbia University.

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.

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

Effects of sexual abuse last for decades, study finds

Levels of so-called stress hormone are altered for years, sometimes causing physical and mental problems, researchers find 

By Joan Raymond, msnbc.com contributor

updated 6/30/2011 2:19:34 PM ET

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.  


Researchers, who tracked a group of girls ranging in age from 6 to 16 at the start of the study in 1987 for the next 23 years, found that they had higher rates of depression and obesity, as well as problems with regulation of brain chemicals, among other issues, compared to a control group of girls who were not abused.


The racially-diverse group of 80 girls, who lived in the Washington, D.C., area, were victims of incest, broadly defined as suffering sexual abuse by a male living within the home. On average, the girls were abused for about two years prior to the abuse coming to the attention of child protective services. Some girls were abused when they were as young as age 2. 

Compared to a non-abused control group, the researchers found the study participants, all of whom were provided three therapy sessions on average in group and individual settings, suffered severe effects during different stages of their lives, which affected their sexual and cognitive development, mental and physical health, as well as their brain chemical profile. Study participants were more likely to be sexually active at younger ages, have lower educational status, and have more mental health problems. 

As children, they had higher levels of cortisol, the so-called "stress hormone," which is released in high levels during the body’s "fight or flight" response. But by about age 15, testing showed that cortisol levels were below normal, compared to the control group. Lower levels of cortisol have been linked to a decrease in the body’s ability to deal with stress, as well as problems with depression and obesity. Lower levels of the hormone have also been linked to post-traumatic stress disorder. 

“The cortisol levels (of some study participants) wound up looking like Vietnam vets,” says study co-author Dr. Frank Putnam, professor of pediatrics and psychiatry at Cincinnati Children's Hospital Medical Center. “That tells us they are in a chronic state of stress, and never feel safe.” 

During the last assessment, when study participants were in their 20s, their cortisol levels remained lower than the control group, on average. “That tells us their stress response system is burned out,” says Putman, which could explain why some are doing so poorly in life.”

The long-term effects of the abuse “were absolutely profound,” says lead author and child psychologist Penelope Trickett, USC professor of Social Work. “It’s just not mental health issues. Some of these women are suffering from a lot of problems today like sleep issues, poor health utilization, and have a lot of risky behaviors. It’s very disturbing.”

Trickett says some women who have been sexually abused themselves have told her the findings validated their realities. “A woman came up to me once at a talk and identified herself as a childhood victim of sexual abuse and thanked me for these findings and for trying to shed light on this issue.”

She also noted that not all of the 80 women in the study are extremely disabled from their experience. In the abused group, some 40 percent are obese as adults, compared to 20 percent in the control group. “But that still means that almost 60 percent of the abused group are not obese,” says Trickett. “The groups are statistically different, and that’s important. But both groups have variability. The abused group just has more variability within the group.”

Trickett also says the findings don’t mean that once someone is abused they are destined to a lifetime of struggle.

“These women are more likely to have problems in mental health and physical health than those who haven’t been abused,” she said. “But it really varies to what degree they are disabled by these challenges. Some are managing their lives pretty well, considering what they went through.”

Though the study participants received some psychological counseling there was no specific treatment for childhood trauma and sexual abuse in the late 1980s. “Three or four sessions isn’t a lot of treatment; it’s some, but it’s little compared to today,” says Trickett. According to Putnam, evidence-based treatments, such as trauma-focused cognitive-behavioral therapy, came about in the 1990s.

“But the big question is does treatment prevent these things from happening or reverse what has happened,” says Putnam. “And the answer is we don’t know.”

The researchers hope that study data are used to develop more comprehensive treatment programs. “What is clear here is that abuse is not something that’s a one-time fix,” says Trickett.

Prevention and getting kids into treatment early is “the first step,” says Carolyn Landis, a clinical psychologist with Rainbow Babies & Children’s Hospital in Cleveland, Ohio. “To see how these girls suffer into adulthood is extremely troubling,” she says.

“From my perspective, this data, especially regarding cortisol levels, can help professionals identify kids who may be at risk much earlier. We need to sensitize people and then find ways to help kids be safe.”

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