Intimate partner violence and miscarriage: examination of the role of physical and psychological abuse and posttraumatic stress disorder

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse, psychological abuse, PTSD, and miscarriage among 118 primarily ethnic minority women. The interaction between maximum severity of abuse and age provided the best multivariate predictor of miscarriage rate, accounting for 26.9% of the variance between live birth and miscarriage outcome. Mean scores of psychological abuse, physical violence, forced sex, and PTSD were significantly higher in the miscarriage group than in the live birth group. Women who experience physical violence and psychological abuse during pregnancy may be at greater risk for miscarriage. Prospective studies can confirm findings and determine underlying mechanisms. Routine screening for traumatic stress and PTSD may reduce rates of miscarriage.     

Women in the Czech Republic: Feminism, Czech Style

Many years after the Velvet Revolution, feminism remains close to a dirty word in the Czech Republic, even among women who share the views of Western feminists. Surprisingly, this may in part hark back to the negative views of bourgeois feminism propounded by the Communists. Equally surprising is the very high proportion of women who are employed, almost all of them full-time, although they continue to do the lion's share of homemaking. This strategy enables Czech women to have a high sense of personal efficacy and independence. This paper emphasizes the historical roots of women's position in Czech society, and the importance of the cultural and social context for the emergence of what we term Feminism, Czech Style.     

What we know and what we still need to learn

Research has changed the conceptualization of the causes and consequences of violence. Yet some questions remain unanswered. Infants and young children have largely been overlooked, and intraethnic and cultural group variations have not been addressed. There is still a need to address macro-level systematic discrimination in the health care system along with the intrapersonal physiological changes that result from exposure to violence. Fortunately, studies are beginning to show how longitudinal and intervention research can be safely conducted.     

Parental Predictors of Motivational Orientation in Early Adolescence: A Longitudinal Study

Using latent variable path analysis with partial least squares (LVPLS), the study examines the pathways between parenting practices and children's motivational orientation toward school work over the transition to middle school. Greater external control and lack of guidance by parents in the 5th-grade year were related to children's poorer academic achievement that year, which in turn predicted a more extrinsic motivational orientation in 7th grade. In contrast, greater parental autonomy-supporting behavior in the 5th-grade year was related to children's higher academic achievement that year, which in turn predicted a more intrinsic motivational orientation in 7th grade. In all instances, children's perceptions of their academic competence mediated the relation between 5th-grade academic performance and 7th-grade motivational orientation. Associate Professor, Division of Child and Adolescent Psychiatry, Johns Hopkins University, School of Medicine. Her current research focuses on anxiety and depression in childhood.     

The duty to warn/protect: issues in clinical practice

The duty of therapists to warn or protect third parties when a patient expresses a threat was established by the court in the Tarasoff decision. Confidentiality, disclosure, and prediction of violence are clinical, ethical, and legal issues that the therapist must address in the context of a therapeutic relationship. Clinical case material from the literature, as well as cases from the authors' experiences, indicate that when confidentiality is breached and a potential victim is warned, the therapeutic results may be positive, especially if the patient participated in the process. Other methods of protection, such as commitment, use of medications, police involvement, and confiscation of a weapon, may be necessary. Each case deserves individual consideration as to what appropriate and necessary steps should be taken. Through careful assessment of a patient's threats, concern for the patient and victim, adherence to ethical standards of care, and knowledge of the law, one can often protect a victim as well as engage the patient in an ongoing therapeutic relationship.