History of adversity, health and psychopathology among prisoners: comparison between men and women

Adversity in childhood, risk behaviors and psychopathology are highly prevalent phenomena in inmate populations and have a strong impact on health. Knowing the differences in these variables between the sexes is most important in order to develop appropriate intervention strategies in a prison context. By administering the Socio-demographic and Life History Questionnaire and the Brief Symptoms Inventory, we sought to characterize adverse childhood experiences and relate them to risk behaviors and to psychopathological symptoms, and study the differences between the 65 male and 42 female detainees in Portuguese prison establishments. Men and women report a complex web of adversity in childhood. In a range of ten possible categories, a medium value of 5.05 (DP = 2.63) in total adversity for women and 2.63 (DP = 2.18) for men was encountered, with the prevalence being significantly higher within the female population (Z = -4.33; p = .000). A high prevalence of risk behaviors and psychopathological symptoms was found in both groups, the latter being higher among females. We concluded that the differences between men and women calls for in depth studies in order to provide guidelines for intervention projects in specific populations.Adversidade na infância, comportamentos de risco e psicopatologia são fenómenos muito prevalentes na população reclusa e com forte impacto na saúde. Conhecer as diferenças entre sexos, no que diz respeito a tais variáveis, é de elevada importância no sentido de adequar estraté- gias de intervenção em contexto prisional. Utilizando o Questionário Sociodemográfico e Histó- ria de Vida, o Questionário de Adversidade na Infância e o Brief Symptons Inventory, procuramos caracterizar a adversidade na infância, os comportamentos de risco e as dimensões psicopatológicas, e averiguar as diferenças entre 65 homens e 42 mulheres reclusos em estabelecimentos prisionais Portugueses. Homens e mulheres relatam um quadro complexo de adversidade na infância. Num total possível de dez categorias, verificamos uma média de adversidade total de 5.05 (DP = 2.63) para as mulheres e de 2.63 (DP = 2.18) para os homens, sendo a prevalência significativamente mais elevada junto da população feminina (Z = -4.33; p = .000). Foi ainda encontrada uma elevada prevalência de comportamentos de risco e de sintomatologia psicopatológica em ambos os grupos, sendo esta última superior nas mulheres. Concluímos que as diferenças entre sexos devem ser estudadas para guiarem a adequação dos projetos

Adverse childhood experiences and suicide attempts in morbidly obese adults

Introdução: As tentativas de suicídio surgem frequentemente associadas a problemas alimentares, tanto anorexia quanto bulimia. Do mesmo modo, tem-se verifi cado uma elevada ocorrência de suicídio entre obesos. Investigações têm mostrado que a adversidade na infância pode ser um fator de risco para as tentativas de suicídio. Objetivos: Caracterizar e compreender a relação entre experiências de adversidade na infância e tentativas de suicídio em 100 obesos mórbidos candidatos a cirurgia bariátrica. Métodos: Um total de 100 pacientes foram selecionados de setembro de 2007 a outubro de 2007 e de janeiro de 2008 a janeiro de 2009, sendo que 20 pacientes eram do sexo feminino. A média de idade era de 38,89±9,87 anos, e a média do peso máximo era de 136,43±14 kg. O Questionário da História de Adversidade na Infância foi utilizado para avaliar experiências adversas. Resultados: 88% dos pacientes relataram a existência de pelo menos uma experiência de adversidade na infância, e 25% relataram já ter realizado pelo menos uma tentativa de suicídio. A adversidade na infância esteve associada a um risco aumentado para realizar tentativas de suicídio (odds ratio = 2,026). Conclusão: Esses dados devem ser levados em consideração na avaliação e no acompanhamento desses pacientes.Introduction: Suicide attempts are often associated with eating disorders, both anorexia and bulimia. Likewise, a high incidence of suicide has been observed among obese patients. Previous studies have shown that adverse experiences in childhood may be a risk factor for suicide attempts. Objectives: To characterize and to understand the relationship between adverse experiences and suicide attempts in 100 morbidly obese patients referred for bariatric surgery. Methods: A total of 100 patients were selected from September 2007 to October 2007 and from January 2008 to January 2009. Of these, 20 patients were females. Mean age was 38.89±9.87 years, and mean maximum weight was 136.43±14 kg. The Portuguese version of the Family ACE (Adverse Childhood Experiences) Questionnaire was used to assess the occurrence of adverse events. Results: 88% of the patients reported the existence of at least one adverse experience in childhood, and 25% reported at least one previous suicide attempt. Adversity in childhood was associated with an increased risk for suicide attempts (odds ratio = 2.026). Conclusion: These data should be taken into account in the assessment and monitoring of these patients.Fundação para a Ciência e a Tecnologia (FCT); (SFRH/BD/37069/2007)

Rural–Urban Migration and Experience of Childhood Abuse in the Young Thai Population

Evidence suggests that certain migrant populations are at increased risk of abusive behaviors. It is unclear whether this may also apply to Thai rural–urban migrants, who may experience higher levels of psychosocial adversities than the population at large. The study aims to examine the association between migration status and the history of childhood sexual, physical, and emotional abuse among young Thai people in an urban community. A population-based cross-sectional survey was conducted in Northern Bangkok on a representative sample of 1052 young residents, aged 16–25 years. Data were obtained concerning: 1) exposures—migration (defined as an occasion when a young person, born in a more rural area moves for the first time into Greater Bangkok) and age at migration. 2) outcomes—child abuse experiences were assessed with an anonymous self report adapted from the Conflict Tactics Scales (CTS). There were 8.4%. 16.6% and 56.0% reporting sexual, physical, and emotional abuse, respectively. Forty six percent of adolescents had migrated from rural areas to Bangkok, mostly independently at the age of 15 or after to seek work. Although there were trends towards higher prevalences of the three categories of abuse among early migrants, who moved to Bangkok before the age of 15, being early migrants was independently associated with experiences of physical abuse (OR 1.9 95%CI 1.1–3.2) and emotional abuse (OR 2.0, 95%CI 1.3–3.0) only. Our results suggest that rural–urban migration at an early age may place children at higher risk of physical and emotional abuse. This may have policy implications for the prevention of childhood abuse particularly among young people on the move

Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year’s Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick’s nights) see increased assaults while others (St George’s and Valentine’s Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001). Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence

Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review

<p>Abstract</p> <p>Background</p> <p>Psychological factors and socioeconomic status (SES) have a notable impact on health disparities, including type 2 diabetes risk. However, the link between childhood psychosocial factors, such as childhood adversities or parental SES, and metabolic disturbances is less well established. In addition, the lifetime perspective including adult socioeconomic factors remains of further interest.</p> <p>We carried out a systematic review with the main question if there is evidence in population- or community-based studies that childhood adversities (like neglect, traumata and deprivation) have considerable impact on type 2 diabetes incidence and other metabolic disturbances. Also, parental SES was included in the search as risk factor for both, diabetes and adverse childhood experiences. Finally, we assumed that obesity might be a mediator for the association of childhood adversities with diabetes incidence. Therefore, we carried out a second review on obesity, applying a similar search strategy.</p> <p>Methods</p> <p>Two systematic reviews were carried out. Longitudinal, population- or community-based studies were included if they contained data on psychosocial factors in childhood and either diabetes incidence or obesity risk.</p> <p>Results</p> <p>We included ten studies comprising a total of 200,381 individuals. Eight out of ten studies indicated that low parental status was associated with type 2 diabetes incidence or the development of metabolic abnormalities. Adjustment for adult SES and obesity tended to attenuate the childhood SES-attributable risk but the association remained. For obesity, eleven studies were included with a total sample size of 70,420 participants. Four out of eleven studies observed an independent association of low childhood SES on the risk for overweight and obesity later in life.</p> <p>Conclusions</p> <p>Taken together, there is evidence that childhood SES is associated with type 2 diabetes and obesity in later life. The database on the role of psychological factors such as traumata and childhood adversities for the future risk of type 2 diabetes or obesity is too small to draw conclusions. Thus, more population-based longitudinal studies and international standards to assess psychosocial factors are needed to clarify the mechanisms leading to the observed health disparities.</p

Psychosocial Needs of Children in Foster Care and the Impact of Sexual Abuse

Children in family foster care, especially those who have experienced sexual abuse, require a safe and nurturing environment in which their psychosocial needs are met. However, there is limited knowledge on how youth prioritize various needs and what impact previous experiences have on these needs. In this study, we asked youth (formerly) in family foster care to indicate their psychosocial needs, and analyzed if youth with a history of sexual abuse have different needs. A Q methodological study was conducted with 44 youth (age 16–28). Fifteen of them reported sexual abuse during their childhood. Using by-person factor analyses, respondents who share similar subjective views were grouped together. Qualitative interpretations of the factors show differences and similarities between and within the two groups, related to help from others, being independent, processing the past, and working toward the future. Although the needs of youth with and without experiences of sexual abuse seem mostly similar, one group of sexually abused youth specifically indicated not wanting an emotional connection to foster parents, but instead a strictly instrumental, professional relationship. This study captured the diverse perspectives of youth themselves, revealing that children in foster care differ with regard to what they consider as (most) important safety, belonging, self-esteem and self-actualization needs

Interpersonal violence: an important risk factor for disease and injury in South Africa

<p>Abstract</p> <p>Background</p> <p>Burden of disease estimates for South Africa have highlighted the particularly high rates of injuries related to interpersonal violence compared with other regions of the world, but these figures tell only part of the story. In addition to direct physical injury, violence survivors are at an increased risk of a wide range of psychological and behavioral problems. This study aimed to comprehensively quantify the excess disease burden attributable to exposure to interpersonal violence as a risk factor for disease and injury in South Africa.</p> <p>Methods</p> <p>The World Health Organization framework of interpersonal violence was adapted. Physical injury mortality and disability were categorically attributed to interpersonal violence. In addition, exposure to child sexual abuse and intimate partner violence, subcategories of interpersonal violence, were treated as risk factors for disease and injury using counterfactual estimation and comparative risk assessment methods. Adjustments were made to account for the combined exposure state of having experienced both child sexual abuse and intimate partner violence.</p> <p>Results</p> <p>Of the 17 risk factors included in the South African Comparative Risk Assessment study, interpersonal violence was the second leading cause of healthy years of life lost, after unsafe sex, accounting for 1.7 million disability-adjusted life years (DALYs) or 10.5% of all DALYs (95% uncertainty interval: 8.5%-12.5%) in 2000. In women, intimate partner violence accounted for 50% and child sexual abuse for 32% of the total attributable DALYs.</p> <p>Conclusions</p> <p>The implications of our findings are that estimates that include only the direct injury burden seriously underrepresent the full health impact of interpersonal violence. Violence is an important direct and indirect cause of health loss and should be recognized as a priority health problem as well as a human rights and social issue. This study highlights the difficulties in measuring the disease burden from interpersonal violence as a risk factor and the need to improve the epidemiological data on the prevalence and risks for the different forms of interpersonal violence to complete the picture. Given the extent of the burden, it is essential that innovative research be supported to identify social policy and other interventions that address both the individual and societal aspects of violence.</p