Population Study on the Predictors of Sleeping Difficulties in Young Australian Women

Gender disparity in sleep difficulties in young adults may be driven by higher rates of affective disorders in women. This article investigated a range of factors as potential predictors of “difficulty sleeping” in 9,061 women aged 24 to 30 years, using survey data. Regression analyses and odds ratios showed that depression and anxiety symptoms were indeed the greatest predictors of difficulty sleeping. However, 4 variables (binge-drinking, lower qualifications, dissatisfaction with excessive weight, and a history of abuse) also made significant contributions to sleep difficulty when a range of other variables (including depression and anxiety symptoms) were statistically controlled. Affective problems often predict sleep difficulties in young women, but other predictors are also significant and not necessarily intertwined with anxiety and depression

ORGANISATIONAL BARRIERS IN WORKING WITH CHILD SEXUAL ABUSE (CSA) CASES: THE MALAYSIAN PROFESSIONALS' EXPERIENCES (Halangan Organisasi dalam Mengendalikan Kes Penderaan Seksual Kanak-Kanak: Pengalaman Profesional Malaysia)

ABSTRACT The purpose of this study is to examine organisational barriers faced by professionals working with child sexual abuse (CSA) cases in Malaysia. This study was conducted from a diverse sample of 18 social workers, medical social workers, counsellors and police officers who worked in CSA cases. These participants came from different organisations namely the royal police of Malaysia, the welfare department, hospitals and non-government agency. A qualitative approach was used for collecting and analysing data; and semi structured interview was used to guide the interview. Two main factors had been identified as barriers in working with CSA cases, namely within and between organisations. In terms of within organisations, participants identified factors such as inadequate support, excessive workload, safety issue and lack of resources as the major barriers. As for between organisations, factors such as conflict of power and disorganised system were mentioned as factors preventing capabilities of professionals in giving help. This paper provides an in depth analysis of major barriers facing by professionals working with CSA in Malaysia. Keywords: organisational barriers to service, child sexual abuse in Malaysia ABSTRAK Tujuan artikel ini adalah untuk menilai halangan-halangan organisasi yang dihadapi profesional yang mengendalikan kes penderaan seksual kanak-kanak Malaysia. Kajian ini dijalankan ke atas 18 orang profesional yang terdiri daripada pekerja sosial, pekerja sosial perubatan, kaunselor dan polis dari organisasi seperti jabatan kebajikan masyarakat, hospital dan agensi bukan kerajaan. Kajian ini menggunakan pendekatan kualitatif untuk mengumpul dan menganalisis data. Manakala temuduga separa berstruktur digunakan di dalam temuduga. Hasil kajian mendapati faktor-faktor dalaman organisasi dan kerjasama antara organisasi dikenalpasti sebagai punca yang boleh menjejaskan keupayaan profesional di dalam mengendalikan kes penderaan seksual kanak-kanak. Faktor-faktor ini termasuk kurangnya sokongan, beban kerja melampau, risiko keselamatan dan kekurangan sumber. Faktor-faktor lain ialah konflik kuasa dan sistem yang tidak teratur. Artikel ini memberi analisis mendalam berhubung faktor-faktor utama yang dihadapi oleh profesional dalam memberi bantuan kepada mangsa penderaan seksual kanak-kanak di Malaysia. Kata kunci: halangan organisasi, penderaan seksual kanak-kakak Malaysi

Organisational barriers in working with child sexual abuse (Csa) cases: the Malaysian professionals’ experiences.

The purpose of this study is to examine organisational barriers faced by professionals working with child sexual abuse (CSA) cases in Malaysia. This study was conducted from a diverse sample of 18 social workers, medical social workers, counsellors and police officers who worked in CSA cases.These participants came from different organisations namely the royal police of Malaysia, the welfare department, hospitals and non-government agency. A qualitative approach was used for collecting and analysing data; and semi structured interview was used to guide the interview. Two main factors had been identified as barriers in working with CSA cases, namely within and between organisations. In terms of within organisations, participants identified factors such as inadequate support, excessive workload, safety issue and lack of resources as the major barriers. As for between organisations,factors such as conflict of power and disorganised system were mentioned as factors preventing capabilities of professionals in giving help. This paper provides an in depth analysis of major barriers facing by professionals working with CSA in Malaysia

Violence Against Women and Girls: Mapping the Health Consequences

Rapidly accumulating evidence indicates that gender based violence is a risk factor for multiple physical, mental, reproductive and psychosomatic disorders affecting women. This evidence challenges traditional psychosomatic and psychoanalytic theories that women are biologically vulnerable to psychological disorder, and suggests that socially constructed vulnerabilities need to be better integrated and investigated in the biopsychosocial model of health

Forced Sex: A Critical Factor in the Sleep Difficulties of Young Australian Women

The prevalence of forced sex and its contribution to sleep difficulties among young Australian women aged 24-30 years (n = 9,061) was examined using data from the 2003 Australian Longitudinal Study of Women's Health. The lifetime prevalence of reported forced sex was 8.7%. Significantly higher levels of recurrent sleep difficulties, prescription sleep medication, clinical depression, anxiety disorder, self-harm, and substance use, as well as lower socioeconomic status (SES) indicators, were reported by the forced sex group compared to the no forced sex group. Hierarchical logistic regression revealed the high odds (OR = 1.95, CI = 1.66-2.26) of recurrent sleep difficulty in such women becomes partially attenuated, but remains statistically significant, after adjusting for key psychological, SES, and behavioral variables. Clinical implications for primary care providers and sleep specialists are discussed. Sleep difficulties are highly prevalent and affect more than 30% of those seeking primary health care (Kushida et al., 2005). They negatively impact on the way a person feels and functions (Dinges et al., 1997) and make a significant contribution to accidents, health care costs, and problems at work (Roth, 2005)

Gender disparities in mental health

This paper examines current evidence regarding rates, risk factors, correlates and consequences of gender disparities in mental health. Gender is conceptualized as a structural determinant of mental health and mental illness that runs like a fault line, interconnecting with and deepening the disparities associated with other important socioeconomic determinants such as income, employment and social position. Gender differentially affects the power and control men and women have over these socioeconomic determinants, their access to resources, and their status, roles, options and treatment in society. Gender has significant explanatory power regarding differential susceptibility and exposure to mental health risks and differences in mental health outcomes. Gender differences in rates of overall mental disorder, including rare disorders such as schizophrenia and bipolar disorders, are negligible. However, highly significant gender differences exist for depression, anxiety and somatic complaints that affect more than 20% of the population in established economies. Depression accounts for the largest proportion of the burden associated with all the mental and neurological disorders and is a particular focus of this paper. It is predicted to be the second leading cause of global burden of disease by 2020. To address this mounting problem, a much improved understanding of the gender dimensions of mental health is mandatory. Evidence is available on some aspects of the problem but serious gaps remain. It is known that: • Rates of depression vary markedly between countries suggesting the importance of macrosocial factors. Nevertheless, depression is almost always reported to be twice as common in women compared with men across diverse societies and social contexts. • Despite its high prevalence, less than half the patients with depression disorder are likely to be identified by their doctors in primary care settings. Gender differences in patterns of help seeking and gender stereotyping in diagnosis compound difficulties with identification and treatment. Female gender predicts being prescribed psychotropic drugs. Even when presenting with identical symptoms, women are more likely to be diagnosed as depressed than men and less likely to be diagnosed as having problems with alcohol. • Men predominate in diagnoses of alcohol dependence with lifetime prevalence rates of 20% compared with 8% for women, reported in population based studies in established economies. However, depression and anxiety are also common comorbid diagnoses, highlighting the need for gender awareness training to overcome gender stereotypes and promote accurate diagnosis of both depression and alcohol dependence in men and women if they are present. • Comorbidity is associated with mental illness of increased severity, higher levels of disability and higher utilization of services. Women have higher prevalence rates than men of both lifetime and 12 month comorbidity involving three or more disorders. Depression and anxiety are the most common comorbid disorders but concurrent disorders include many of those in which women predominate such as agoraphobia, panic disorder, somatoform disorders and post traumatic stress disorder. • Reducing the overrepresentation of women who are depressed must be tackled as a matter of urgency in order to lessen the global burden caused by mental and behavioural disorders by 2020. This requires a multi-level, intersectoral approach, gendered mental health policy with a public health focus and gender-specific risk factor reduction strategies, as well as gender sensitive services and equitable access to them. • Gender acquired risks are multiple and interconnected. Many arise from women's greater exposure to poverty, discrimination and socioeconomic disadvantage. The social gradient in health is heavily gendered, as women constitute around 70% of the world's poor and earn significantly less than men when in paid work. • Low rank is a powerful predictor of depression. Women's subordinate social status is reinforced in the workplace as they are more likely to occupy insecure, low status jobs with no decision making authority. Those in such jobs experience higher levels of negative life events, insecure housing tenure, more chronic stressors and reduced social support. Traditional gender roles further increase susceptibility by stressing passivity, submission and dependence and impose a duty to take on the unremitting care of others and unpaid domestic and agricultural labour. Conversely, gains in gender development that improve women's status are likely to bring with them improvements in women's mental health. • Globalization has overseen a dramatic widening of inequality within and between countries including gender-based income disparities. For poor women in developing countries undergoing restructuring, rates of depression and anxiety have increased significantly. Increased sexual trafficking of girls and women is another mental, physical, sexual health and human rights issue. The mental health costs of economic reforms need to be carefully monitored. • Finally, the epidemic of gender based violence must be arrested. The severity and the duration of exposure to violence are highly predictive of the severity of mental health outcomes. Rates of depression in adult life are 3 to 4 fold higher in women exposed to childhood sexual abuse or physical partner violence in adult life. Following rape, nearly 1 in 3 women will develop PTSD compared with 1 in 20 non victims. Current levels of detection of violent victimization are poor and primary health care providers require better training to intervene successfully to arrest the compounding of mental health problems. • Rates of psychiatric comorbidity and multi somatization are high, but neither well identified nor treated. The gendered nature of comorbidity poses complex therapeutic challenges regarding detection and appropriate models of care. • Research needs to be conducted into the relationship of violence to comorbidity. Women are at significantly increased risk of violence from an intimate and are over represented amongst the population of highly comorbid people who carry the major burden of psychiatric disorder. Equally, research is needed to understand better the sources of resilience and capacity for good mental health that the majority of women maintain, despite the experience of violence in their lives. • Access to safe affordable housing is essential if women and children are to escape violent victimization and the cessation of violence is highly therapeutic in reducing depression. Improved balance in gender roles and obligations, pay equity, poverty reduction and renewed attention to the maintenance of social capital would further redress the gender disparities in mental health

Services for victim/survivors of sexual assault Identifying needs, interventions and provision of services in Australia

Little research has been done on the services that currently exist for victim/survivors of sexual assault. Yet high quality services can minimise the harm experienced by the victim/survivor. This paper summarises the international and national literature that exists on sexual assault services. It focuses on the needs of victim/survivors, on existing interventions, and data on the services that currently provide these interventions