Current psychopathology in previously assaulted older adults

Older adult women age 55+ years (N = 549) were interviewed as part of a population-based epidemiological research study of lifetime experiences with physical and sexual assault and current mental health problems. Although overall rates of psychopathology were low, producing very small cells for comparison, women who reported experiencing physical assault an average of 28 years previously were more likely to present with past year substance abuse, depression, and avoidance and reexperiencing symptoms of posttraumatic stress disorder (PTSD) than those with no previous physical or sexual assault. Women who reported experiencing sexual assault an average of 50 years previously were more likely to present with autonomic arousal and avoidance symptoms of PTSD than those with no prior sexual assault. The aforementioned findings should be considered with caution, however, as sample cell sizes were minimal for all but the PTSD symptom subtypes. Mental health service implications for older adults are discussed.     

Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis

This article reviews literature on the prevalence of mental health problems among women with a history of intimate partner violence. The weighted mean prevalence of mental health problems among battered women was 47.6% in 18 studies of depression, 17.9% in 13 studies of suicidality, 63.8% in 11 studies of posttraumatic stress disorder (PTSD), 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. These were typically inconsistent across studies. Weighted mean odds ratios representing associations of these problems with violence ranged from 3.55 to 5.62, and were typically consistent across studies. Variability was accounted for by differences in sampling frames. Dose-response relationships of violence to depression and PTSD were observed. Although research has not addressed many criteria for causal inferences, the existing research is consistent with the hypothesis that intimate partner violence increases risk for mental health problems. The appropriate way to conceptualize these problems deserves careful attention.     

Beyond PTSD: mental health consequences of violence against women: a response to Briere and Jordan

This article proposes that we move beyond posttraumatic stress disorder (PTSD) in our conceptualization of traumatic stress responses of victimized women exposed to serial forms of unrelenting violence, such as intimate partner violence and stalking. It is argued that the traditional PTSD framework is ill fitting in the context of some forms of violence against women (VAW), and these limits have consequences for developing appropriate interventions for some victimized women. The article further suggests going beyond PTSD by developing a more nuanced understanding of the ways in which PTSD and other mental health symptoms contribute to the vast array of deleterious personal, societal, and economic costs of VAW.     

Social Connection to Neighbors,Multiple Victimization,and Current Health Among Women Residing in High Crime Neighborhoods

This study assessed current health [physical health, bodily pain, global distress, posttraumatic stress-related disorder (PTSD) symptoms, and illicit substance use] among 160 minority women residing in high crime areas with varying numbers of different types of victimization histories and varying levels of social connections (SCs) to neighbors. Multivariate analyses of covariance indicated a main effect for number of different types of victimization and for SC to neighbors, after considering ethnicity, immigration, and marital status. Women with two or three+ different types of victimization reported higher global distress, PTSD symptoms, and illicit substance use than women with zero or one type of victimization. Likewise, women with low levels of SC to neighbors reported higher bodily pain than women with high levels of SCs to neighbors.     

Intimate Partner Violence,Psychological Distress,and Suicidality: A Path Model Using Data from African American Women Seeking Care in an Urban Emergency Department

Intimate partner violence (IPV) and suicidal behavior are major public health problems in the African American community. This study investigated whether or not IPV and suicidal ideation are correlated in urban African American women, and if the IPV–suicidal ideation link is explained by symptoms of depression and posttraumatic stress disorder (PTSD). With 323 abused African American females, path analysis revealed that: (1) IPV → depressive symptoms → suicidal ideation, and (2) IPV → PTSD symptoms → depressive symptoms → suicidal ideation. When evaluating abused women, depressive and PTSD symptoms and suicidal thoughts must be assessed. Interventions for reducing suicidal behavior in abused, low income African American women should reduce symptoms of depression and PTSD.     

Examining the Impact of Posttraumatic Stress Disorder Related to Intimate Partner Violence on Antenatal,Intrapartum and Postpartum Women: A Scoping Review

We undertook a comprehensive scoping review of published academic articles to examine the extent, range and nature of research related to the effects of posttraumatic stress disorder (PTSD) among childbearing women who have experienced intimate partner violence (IPV). Fifty-five sources were identified from the electronic databases and two additional sources were identified after searching reference lists. Among the 57 articles, five met the inclusion criteria of childbearing women who have experienced IPV and PTSD. Numerical analysis revealed considerable heterogeneity among articles, with various aims, methodological approaches, patient populations and outcomes of interest. Inductive thematic content analysis revealed three themes: (1) context; (2) outcomes; and (3) changes in practice. The findings from this first attempt at summarizing literature via a scoping review demonstrate the need for additional research related to: identification of, treatment interventions for, and understanding the mechanisms of impact for IPV related PTSD among childbearing women.     

The mental health and substance misuse needs of male ex-armed forces personnel in prison

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.     

Unemployment among women: examining the relationship of physical and psychological intimate partner violence and posttraumatic stress disorder

Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and women's workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms. When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] = 1.60; 95% confidence interval [CI] = 1.22, 2.09) and psychological violence (AOR = 1.78; 95% CI = 1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.     

Bruised Inside Out: The Adverse and Abusive Life Histories of Incarcerated Women as Pathways to PTSD and Illicit Drug Use

The majority of incarcerated women who suffer from diverse traumatic life histories including abusive home lives and intimate partner violence (IPV), develop post-traumatic stress disorder (PTSD) and struggle with heavy illicit drug use. While many have offered examinations of these relationships, the current study is among the first to utilize an integrated feminist pathways and general strain theory (GST) approach to explain them. Using data from a stratified random sample of all incarcerated women in Oklahoma (N = 334), we explore the links between, adverse childhood experiences, including physical, sexual, emotional, and childhood neglect, IPV, PTSD, and heavy illicit drug use. Our findings indicate that the effects of IPV on heavy illicit drug use are mediated by PTSD symptoms suggesting that PTSD plays a significant role in the pathway to illicit drug use among Oklahoma women prisoners. Implications for the importance of utilizing an integrated feminist pathways and GST approach in future research are offered.     

Community violence and PTSD in selected South African townships

Given the high rates of crime in South Africa's townships, nonpolitical violence out-side the home and its psychological impact on women were investigated within two samples, the primary a help-seeking sample and the secondary a community sample. In the help-seeking sample, two thirds of the women reported having experienced several traumatic events outside the home. Those women displayed a median of 9 PTSD (post-traumatic stress disorder) symptoms, with nearly half meeting all criteria for PTSD. In the community sample, 40 women of color were interviewed at a community festival for women, and again two thirds reported having experienced several traumatic events outside the home during the previous year. These women displayed a median of 8.8 PTSD symptoms, with none meeting all criteria for PTSD. South Africa's distinctive culture of violence is discussed as context for understanding issues of community violence and PTSD among women in its minority townships.     

Mental Health Among Incarcerated Women: An Examination of Factors Impacting Depression and PTSD Symptomology

Female offenders experience mental health symptoms at a higher rate than male offenders and females in the community. The current study investigated individual characteristics and experiences that may impact symptoms of depressive disorders and posttraumatic stress disorder (PTSD) among a sample of female inmates in a large Southern prison system. Results showed high rates of reported childhood and adult victimization experiences among the sample. Factors such as seeking mental health treatment prior to incarceration significantly impacted the reporting of depressive and PTSD symptoms, as did victimization histories. Findings suggest that women would benefit from screening to identify mental health needs at the onset of incarceration as well as gender responsive needs assessment and programming to address histories of victimization and current mental health symptomatology.     

Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship?

Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence; however, little is known about the mechanisms of risk between these two public health concerns among this population of women. To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment. In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention strategies. This study is based, in part, on the first author's dissertation. A previous version of this paper was presented at the Society for Social Work and Research Annual Conference held in January 2005 in New Orleans, Louisiana. The following grants provided funding for this study: R01DA11027 and 3T32MH014623-22S1.     

PTSD symptoms and sexual harassment: the role of attributions and perceived control

Researchers have compiled significant evidence demonstrating that sexual harassment leads to psychological harm, including the full symptom picture of PTSD, but few have examined the psychological processes involved. Research on attributions among trauma victims would suggest that causal attributions and perceptions of control may be important predictors of outcomes. The authors discuss a study involving a path model that used data from 189 women involved in sexual harassment litigation. Results indicate that both self-blame and harasser blame were positively related to PTSD symptoms. Control over recovery and the perception that future harassment is unlikely were both related to fewer PTSD symptoms. Unexpectedly, perceived control over future harassment is related to higher levels of PTSD symptoms. Implications for research and practice are discussed.     

Traumatic Event Exposure and Behavioral Health Disorders among Incarcerated Females Self-Referred to Treatment

At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n?=?97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence, other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral health problems within this population and providing effective interventions holds potential promise for preparing incarcerated women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.     

The Relationships Between Childhood Sexual Abuse,Social Anxiety,and Symptoms of Posttraumatic Stress Disorder in Women

The relationships between childhood sexual abuse, social anxiety, and symptoms of posttraumatic stress disorder were examined in a sample of 313 undergraduate women. Thirty-one percent of the women reported some form of sexual abuse in childhood. Women with a history of sexual abuse reported more symptoms of anxiety, distress in social situations, and posttraumatic stress disorder than other women. Women who experienced attempted or actual intercourse reported more avoidance than women with no history of abuse and women with exposure only, and more PTSD symptoms than all other groups of women. Women who experienced fondling reported more PTSD symptoms than women with no history of abuse. Pressure, age of onset of abuse, abuse by a family friend, and abuse by other perpetrators were all significant abuse characteristics in predicting adult social anxiety. Implications of these results for research and interventions are discussed.     

Detection of Malingered PTSD: An Overview of Clinical,Psychometric, and Physiological Assessment: Where Do We Stand?

ABSTRACT: Posttraumatic stress disorder (PTSD) is a condition that can be easily malingered for secondary gain. For this reason, it is important for physicians to understand the phenomenology of true PTSD and indicators that suggest an individual is malingering. This paper reviews the prevalence of PTSD for both the general population and for specific events, such as rape and terrorism, to familiarize evaluators with the frequency of its occurrence. The diagnostic criteria for PTSD, as well as potential ambiguities in the criteria, such as what constitutes an exposure to a traumatic event, are reviewed. Identified risk factors are reviewed as a potential way to help differentiate true cases of PTSD from malingered cases. The question of symptom overreporting as a feature of the disease versus a sign of malingering is discussed. We then examine how the clinician can use the clinical interview (e.g., SIRS, CAPS), psychometric testing, and the patient's physiological responses to detect malingering. Particular attention is paid to research on the MMPI and the subscales of infrequency (F), infrequency-psychopathology (Fp), and infrequency-posttraumatic stress disorder (Fptsd). Research and questions regarding the accuracy of self-report questionnaires, specifically the Mississippi Scale (MSS) and the Personality Assessment Inventory (PAI), are examined. Validity, usability, and cutoff values for other psychometric tests, checklists, and physiological tests are discussed. The review includes a case, which shows how an individual used symptom checklist information to malinger PTSD and the inconsistencies in his story that the evaluator detected. We conclude with a discussion regarding future diagnostic criteria and suggestions for research, including a systematic multifaceted approach to identify malingering.     

Reliability and validity of the SCL-90-R PTSD subscale

Two studies examined the psychometric properties of the Posttraumatic Stress Disorder (PTSD) subscale of the SCL-90-R. Study 1 examined SCL-90-R responses from 2,361 college women to determine whether this subscale can appropriately assess the three dimensions of PTSD. Factor analysis and Cronbach's alpha suggest that this subscale is best conceptualized as a unidimensional index of PTSD symptomatology. Study 2 confirmed these results in a sample of 1,044 college men and women. Findings in the second sample also supported the subscale's validity, as it correlates well with the Posttraumatic Diagnostic Scale and with trauma frequency and can discriminate between individuals with and without PTSD diagnoses. Results suggest that the SCL-90-R PTSD subscale is a reliable, but unidimensional, measure for screening for distress associated with PTSD. Although there is some support for the usefulness of this scale, especially with women, it should only be considered a general indicator of distress with limited use for men.     

Psychological abuse and posttraumatic stress symptoms in college students

Research suggests that among college students, physical and sexual abuse in intimate relationships are associated with posttraumatic stress. Psychological abuse occurs in intimate relationships among college students, and though there is evidence that such abuse has a negative emotional impact, posttraumatic stress has not been extensively researched as an outcome in this population. The purpose of this study is to determine the associations of past-year psychological abuse with posttraumatic stress symptoms while controlling for other types of past-year relationship abuse and lifetime trauma history. The sample consists of 191 college men and women (81.7% women and 89.5% White). Linear regression analyses demonstrate that trauma history, but not past year relationship violence, is a significant predictor of PTSD symptom severity for women, and neither set of variables significantly predicts PTSD symptom severity for men. Implications for future research are discussed.     

Comorbid Pain and PTSD: Integrating Research and Practice with MVC Survivors

Following a serious motor vehicle crash (MVC), an individual may develop posttraumatic stress disorder (PTSD) as well as chronic pain. To date, little work has been done that can empirically guide practitioners with an evidence-based approach for psychological interventions in this population. Issues related to the changing definitions of PTSD and ways in which we conceptualize pain-related concerns are discussed, with implications for understanding the complex interrelationships between these two conditions. Theoretical and practical understanding of the common processes which contribute to the comorbidity of PTSD and pain is shared, along with information regarding assessment and applications from the limited treatment literature. Suggestions drawn from clinical practice are offered regarding assessment and treatment for individuals diagnosed with PTSD and pain in a MVC population.     

PTSD及其法医学相关问题

随着国外对PTSD(posttraumatic stress disorder)的深入研究以及中国心理卫生事业与法医学事业的发展,相关领域的学者开始从事这一方面的研究并取得了不少成就。本文结合国内外的一些理论研究与实践成果,对PTSD的概念、诊断与鉴别以及相关法医学问题作一综述和探讨。