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Objectives Deviations from normative trajectories of receptive language abilities following early life adversity (ELA) may indicate an elevated risk for advanced cognitive aging and related morbidities. Accelerated epigenetic aging at midlife may further identify those at greatest risk for advanced cognitive aging following ELA. We examined whether accelerations in epigenetic aging at midlife can identify those individuals who demonstrated the greatest change in receptive language abilities following ELA. Methods Data were drawn from the Female Growth and Development Study (n = 86), a 30-year prospective cohort study of females exposed to substantiated child sexual abuse (CSA), a severe ELA, and a non-CSA comparison condition. The Peabody Picture Vocabulary Test-Revised (PPVT-R) measured receptive language abilities on 6 occasions from childhood to mid-life. Interindividual differences in PPVT-R trajectories were examined in relation to CSA exposure and across 5 independent measures of epigenetic age acceleration derived from first (Horvath DNAmAge, Hannum DNAmAge) and second (GrimAge, PhenoAge, Dunedin Pace of Aging) generation epigenetic clocks. Results Quadratic growth models revealed that PPVT-R scores were significantly lower at age 25 for females exposed to CSA. Specifically, CSA exposed females had lower intercepts when GrimAge was accelerated and a smaller quadratic trend when PhenoAge was accelerated. Discussion ELA is associated with significant differences in development of receptive language abilities with the most pronounced differences observed for females with accelerated epigenetic ages at mid-life. These findings suggest that epigenetic age acceleration could serve as an indicator of differences in cognitive aging and portend to later adulthood cognitive functioning.

Objective Dissociative disorders (DDs) are associated with intensive, long-term treatment, suicidality, recurrent hospitalizations, and high rates of disability. However, little is known about the specifics of the economic burden associated with DDs. This worldwide, systematic review examines the results of studies in adults on direct and indirect costs associated with DDs. Method We searched 6 databases and the reference lists of articles. We also approached researchers to identify unpublished studies. No language restrictions were imposed. Results A total of 1,002 records met the search criteria, of which 29 papers were selected for full-text inspection. Ultimately, of these, we reviewed four empirical studies. We provide a narrative discussion of study findings. Our findings suggest that DDs are costly to society, and that there is a reduction in service utilization and associated costs over time with diagnosing of and specialized treatment for DDs. However, the overall quality of the economic evaluations was low; several types of DDs, comorbid conditions, and costs were not included; and men were underrepresented. Due to the heterogeneity among studies, we could not perform a meta-analysis. Conclusions Due to the heterogeneity and low quality of the identified economic evaluations, no firm conclusions about the economic burden of DDs alone can be drawn. Higher quality research, including a detailed description of the study design, population, and primary outcome measures used, utilizing appropriate clinical alternatives and including major comorbidities, is urgently needed to more rigorously assess the economic impact of DDs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background Following traumatization, caregiver support is a crucial factor contributing to children's successful management of posttraumatic reactions and their recovery. Caregivers who have been traumatically impacted themselves, however, may be compromised in this posttraumatic caregiving role. Although there are a number of evidence-based child trauma treatments that are effective in reducing children's trauma symptoms, the impact of child treatment on participating caregiver's posttraumatic symptoms (PTS) has received less attention. Objective Explore PTS reduction caregivers experience through participation in their child's evidence-based trauma-focused mental health treatment. Participants and setting 640 Child-Caregiver dyads referred for the Child and Family Traumatic Stress Intervention (CFTSI) following formal disclosure of abuse in a Child Advocacy Center (CAC). Methods Data were collected from 10 community treatment sites trained in CFTSI. A multi-site meta-analytic approach was used to evaluate pooled and site-specific therapeutic effect sizes for caregivers and children. Results CFTSI was associated with significant changes (Hedge's g = 1.17, Child-rated; g = 0.66, caregiver-rated) in children's PTS and with clinically meaningful improvements in PTS for 62% of participating caregivers who had started CFTSI with clinical levels of PTS as measured by the Post Traumatic Checklist–Civilian Version (PCL-C). The overall mean PCL-C change (9.31, SD = 12.9) in paired, pre-post PCL-C scores is close to a clinically meaningful change of 10 or higher. There was a robust moderate pooled effect size (g = 0.70, N = 640, p Conclusion The value of a reduction in caregiver PTS as a secondary outcome of children's trauma-focused treatment is discussed.

Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self-injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web-based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web-based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44-0.90, as well as reduced NSSI. The improvements in NSSI among the most self-injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54-1.04 vs. |d|s = 0.24-0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.

Lasting changes in the hypothalamic-pituitary-adrenal (HPA) axis are a potential indication of the biological embedding of early life adversity, yet, prospective and repeatedly collected data are needed to confirm this relation. Likewise, integrating information from multiple biological systems, such as the HPA axis and the epigenome, has the potential to identify individuals with enhanced embedding of early life adversity. The current study reports results from the Female Growth and Development Study, a 30-year prospective cohort study of childhood sexual abuse (CSA). Females exposed to substantiated CSA and a demographically-similar comparison condition were enrolled and resting state cortisol concentrations were sampled on seven subsequent occasions across childhood, adolescence, and adulthood. Differences in participants’ cortisol trajectories were examined in relation to prior CSA exposure and DNA methylation-derived epigenetic age acceleration at midlife. Bilinear spline growth models revealed a trajectory where cortisol secretion increased until approximately age twenty and then declined into mid-life, consistent with normative trends. However, cortisol concentrations peaked at a lower level and transitioned to the decline phase at an earlier age for females in the CSA condition with increased epigenetic age acceleration. Robustness tests across three independent measures of epigenetic age acceleration demonstrated similar results for lower peak cortisol levels and earlier ages at transition. Results suggest that CSA is associated with significant changes in HPA-axis activity over extended periods of time with these changes most pronounced in females with accelerated epigenetic aging in mid-life. Implications for biological embedding models of early life adversity and adulthood health are discussed.

Background Exposure to maltreatment in childhood can lead to increased risk for poor health outcomes in adulthood. Child maltreatment and later poor health may be linked by premature biological aging. We tested whether childhood sexual abuse (CSA) was associated with telomere length (TL) in adult females. We further tested the hypothesis of intergenerational transmission of CSA-related effects by measuring TL in both CSA-exposed and non-exposed mothers and their children. Methods Participants were a subset of females and their children in a prospective-longitudinal cohort study of sexually abused females and a demographically comparable control group from the same Washington, D.C. area. TL was measured using qPCR in both leukocyte and buccal samples from females (N = 108, mean age 36.3 years) and buccal samples from their children (N = 124, mean age 10.5 years). Multilevel models were used to test associations between CSA-exposure and TL measured in leukocytes and buccal tissue in females and to test the intergenerational effect of maternal-CSA exposure on age-adjusted TL in their children. Results CSA-exposure was not associated with TL in adult females. Maternal TL and biological sex were significant predictors of child TL such that longer maternal TL predicted longer TL in children, and female children had longer TL than male children. However, maternal-CSA exposure did not predict TL in children. Discussion CSA-exposure was not associated with TL in this cohort of middle-aged females, nor was there evidence for an intergenerational effect of maternal-CSA exposure on child TL. This finding is in line with some previous results on CSA and adult TL. Previous significant results associating child maltreatment with shorter TL may be capturing a population of individuals exposed to either multiple types of maltreatment compared to controls with no childhood adversity, or maltreatment in childhood with concurrent TL measurements.

Depression is prevalent among mothers who participate in home visitation programs. This case study describes In-Home Cognitive Behavior Therapy (IH-CBT), an empirically based treatment for depressed mothers that is strongly integrated with ongoing home visitation. The use of a Parenting Enhancement for Maternal Depression (PEMD) module was added to address parenting difficulties in a depressed mother. This case describes issues and challenges encountered in delivering treatment in the home with low-income, depressed mothers. Issues involving engagement, adaptation to the setting, responding to the unique needs of low-income mothers, and partnership with concurrent home visiting to optimize outcomes are considered. Long-term follow-up (18 months after the end of treatment) permits examination of sustainability of gains. Implications for treating this high-risk population are discussed.

Home visiting is an effective preventive intervention that can improve parenting outcomes for at-risk, new mothers, thereby optimizing subsequent child development. A history of maltreatment in childhood is common in mothers participating in home visiting, yet the extent to which such a history is related to parenting outcomes during home visiting is unknown. The current study evaluated whether mothers with a history of maltreatment in childhood respond less favorably to home visiting by examining the direct and indirect pathways to subsequent parenting stress, a key parenting outcome affecting child development. First-time mothers (N = 220; age range = 16-42) participating in one of two home visiting programs, Healthy Families America or Nurse Family Partnership, were evaluated at enrollment and again at 9-and 18-month post-enrollment assessments. Researchers administered measures of maternal history of maltreatment in childhood, depressive symptoms, social support, and parenting stress. Maternal history of maltreatment in childhood predicted worsening parenting stress at the 18-month assessment. Mediation modeling identified two indirect pathways, one involving social support at enrollment and one involving persistent depressive symptoms during home visiting, that explained the relation between a history of maltreatment in childhood and parenting stress at the 18-month assessment. Ways to improve the preventive effects of home visiting for mothers with a history of maltreatment in childhood through the identification of relevant intervention targets and their ideal time of administration are discussed.

Background Evidence suggests that maternal interpersonal trauma can adversely affect offspring health, but little is known about potential transmission pathways. We investigated whether interpersonal trauma exposure had direct and indirect associations with offspring social-emotional development at 12-months of age in an at-risk, home visited population. Methods A retrospective cohort study was conducted of 1172 mother-child dyads who participated in a multi-site, early childhood home visiting program. Children were born January 2007 to June 2010 and data were collected at enrolment (prenatal/birth) through 12-months of age. Multivariable path analyses were used to examine the relationship between maternal interpersonal trauma, subsequent psychosocial mediators (maternal depressive symptoms, social support, and home environment), and the outcome of child social-emotional development measured with the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE). Maternal interpersonal trauma was characterized as any previous exposure, the level of exposure, and type (e.g. abuse) of exposure. Results The prevalence of maternal interpersonal trauma exposure was 69.1%, and exposures ranged from 1 type (19.3%) to 7 types (2.3%). Interpersonal trauma was associated with a 3.6 point (95% confidence interval 1.8, 5.4) higher ASQ:SE score among offspring and indicated greater developmental risk. An estimated 23.4% of the total effect was mediated by increased maternal depressive symptoms and lower social support. Differential effects were observed by the level and type of interpersonal trauma exposure. Conclusion Maternal interpersonal trauma exposures can negatively impact child social-emotional development, acting in part through maternal psychosocial factors. Future research is needed to further elucidate the mechanisms of intergenerational risk.

Background To determine the cost-effectiveness of In-Home Cognitive Behavioral Therapy (IH-CBT) for low-income mothers enrolled in a home visiting program. Methods A cost-utility analysis was conducted using results from a clinical trial of IH-CBT and standard of care for depression derived from the literature. A probabilistic, patient-level Markov model was developed to determine Quality Adjusted Life Years (QALYs). Costs were determined using the Medical Expenditure Panel Survey. A three-year time horizon and payer perspective were used. Sensitivity analyses were employed to determine robustness of the model. Results IH-CBT was cost-effective relative to standard of care. IH-CBT was expected to be cost-effective at a three-year time horizon 99.5%, 99.7%, and 99.9% of the time for willingness-to-pay thresholds of US$25,000, US$50,000, and US$100,000, respectively. Patterns were upheld at one-year and five-year time horizons. Over the three-year time horizon, mothers receiving IH-CBT were expected to have 345.6 fewer days of depression relative to those receiving standard home visiting and treatment in the community. Conclusions IH-CBT is a more cost-effective treatment for low-income, depressed mothers than current standards of practice. These findings add to the growing literature demonstrating the cost-effectiveness of CBT for depression, and expand it to cover new mothers. From a payer perspective, IH-CBT is a sound option for treatment of depressed, low-income mothers. Limitations include a restricted time horizon and estimating of standard of care costs.

Background Risk of suicide is a major concern for depressed mothers in the perinatal period. The strongest predictor of completing suicide is having made a previous attempt. Little is known about the clinical features of low-income, depressed mothers who have attempted suicide in contrast to those who have not. Objective This study examined clinical and psychosocial features of 170 low-income, young, depressed mothers with and without previous suicide attempts who were enrolled in an early childhood home visiting program. Method Mothers were identified via screening at three months postpartum and diagnosed with major depressive disorder (MDD) using a semi-structured interview. Psychiatric history and presentation, child maltreatment history, intimate partner violence, and social functioning were measured. Results 31.8% of mothers had previous suicide attempts. Mean age of first attempt was 14.38 years (SD = 2.55) and the median number of lifetime attempts was 2. In contrast to no attempts, those who had attempted suicide had more MDD symptoms, earlier age of first MDD episode, and more episodes. A previous attempt was associated with greater childhood trauma, more current MDD symptoms and PTSD diagnosis. No differences were found on intimate partner violence. Mothers who made an attempt reported lower levels of tangible social support and smaller social networks. Conclusions History of suicide attempts is associated with childhood trauma history and later psychosocial impairments in low income, depressed mothers in home visiting. Implications for addressing the needs of depressed mothers with suicide attempt histories in the context of early childhood programs are discussed.

Exposure to maltreatment during childhood can lead to increased risk for poor health outcomes in adulthood. Child maltreatment and later poor health may be linked by premature biological aging. We tested whether childhood sexual abuse (CSA) is associated with telomere length (TL) in adult females. We further tested the hypothesis of intergenerational transmission of trauma by measuring TL in both CSA-exposed and non-exposed mothers and their children. TL was measured in a subset of participants and their children from a prospective-longitudinal cohort study of sexually abused females and a demographically matched comparison group. Linear regression models were used to test for associations between CSA-exposure and age-adjusted TL in females (N=108, mean age 36.3 years). Multilevel linear models were used to test the intergenerational effect of maternal-CSA exposure on age-adjusted TL in their children (N=124 children mean age 10.5 years across 61 mothers). CSA-exposure was not associated with TL in females. Replicating previous work in this area, maternal TL and sex were significant predictors of child TL in all models tested. Longer maternal TL predicted longer TL in children, and female children had longer TL than male children. Maternal-CSA exposure did not predict TL in children. This finding is in line with some previous results on CSA and TL measured in adulthood. Previous significant results associating child maltreatment with shorter TL in adulthood may be capturing a population of individuals exposed to either multiple types of maltreatment or maltreatment in childhood with concurrent TL measurements.

Prenatal maternal mood may inform the adverse obstetric outcomes seen in disadvantaged populations. The contribution of having a trauma history is not well studied. We examined the impact of trauma exposure and mood symptoms on obstetric outcomes in 358 women. Women with antecedent trauma were more likely to have a history of depression, odds ratio = 2.83, 95% confidence interval [1.81, 4.42], were younger at their first pregnancy, 18.86 years versus 20.10 years, and had a higher number of previous pregnancies, 2.01 versus 1.54, compared to those with no trauma exposure. Women with prenatal anxiety had significantly smaller babies than nonanxious women, 3,313.17 g, (SD = 441.58) versus 3,429.27 g, (SD = 437.82) Trauma history magnified the effects of maternal prenatal mood on birthweight; the moderating effect was limited to those who first experienced a trauma under 18 years of age. Childhood trauma exposure increased vulnerability for low birthweight delivery associated with prenatal mood disturbance. Screening pregnant women for trauma history and current mood symptoms is indicated.

Child maltreatment impacts approximately two million children each year, with physical abuse and neglect the most common form of maltreatment. These children are at risk for mental and physical health concerns and the ability to form positive social relationships is also adversely affected. Child Adult Relationship Enhancement (CARE) is a set of skills designed to improve interactions of any adult and child or adolescent. Based on parent training programs, including the strong evidence-based treatment, Parent-Child Interaction Therapy (PCIT), CARE was initially developed to fill an important gap in mental health services for children of any age who are considered at-risk for maltreatment or other problems. CARE subsequently has been extended for use by adults who interact with children and youth outside of existing mental health therapeutic services as well as to compliment other services the child or adolescent may be receiving. Developed through discussions with Parent-Child Interaction Therapy (PCIT) therapists and requests for a training similar to PCIT for the non-mental health professional, CARE is not therapy, but is comprised of a set of skills that can support other services provided to families. Since 2006, over 2000 caregivers, mental health, child welfare, educators, and other professionals have received CARE training with a focus on children who are exposed to trauma and maltreatment. This article presents implementation successes and challenges of a trauma-informed training designed to help adults connect and enhance their relationships with children considered at-risk.

Maternal depression negatively impacts maternal functioning and parenting behaviors. Mothers participating in home visiting programs are at particularly elevated risk for depressive symptoms due to demographic and associated risk factors. Moreover, additional empirical evidence has demonstrated that mothers with depression do not benefit from home visiting interventions to the same extent as their peers without depression. The purpose of this study was to identify predictors of depression course in mothers participating in home visiting over the first 18 months of service. Participants were 220 low income mothers participating in a home visiting program who completed the Beck Depression Inventory-II (BDI-II) at enrollment and 9 and 18 months later. Measures of childhood maltreatment history, social support, and locus of control were also collected at enrollment. Group-based trajectory modeling revealed 3 groups labeled as minimal (63.6%), mild (30.5%), and moderate-severe (5.9%). Although a slight decrease in depressive symptoms was observed over time in the minimal and mild groups, mothers in the moderate-severe group exhibited a large increase from enrollment to 9 months that persisted through 18 months. Membership in the mild and moderate-severe groups was predicted by history of childhood maltreatment, low levels of social support, and an external locus of control. Implications of these findings for home visiting programs are discussed. (PsycINFO Database Record

Objective This study investigated synergy of commonly co-occurring pairs of childhood traumas/adversities to determine: 1) if synergistic pairings differ by gender and/or age grouping; and 2) if some traumas/adversities were more synergistically reactive. Methods A sample of 10,355 clinic-referred youth (1.5–18 years) from the National Child Traumatic Stress Network Core Data Set was divided by gender and categorized into salient age groups (1.5−5 years, 6−12 years, and 13−18 years). Attributable Proportion (AP), a biomedically relevant metric, was calculated to assess additive synergy for behavior problems on the CBCL. Results Overall, only four pairs of adversities were synergistic. Three involved sexual abuse with physical abuse, parental loss, and domestic violence. When the sample was analyzed by Gender X Age group, however, a more complicated picture emerges. Twelve of the twenty-one possible pairings (57 %) show additive synergy in one or more categories. The mean AP accounted for approximately 40 % of outcome variance. Males had more synergistic pairings (16) than females (7). The average synergistic effect was higher for males (42 % of variance) than females (36 % of variance). The vast majority of synergy occurs in the 6−12 and 13−18 age groups. Sexual abuse was the most synergistically reactive trauma, pairing most frequently (16) followed by physical abuse (10) or neglect (9). Conclusion Sexual abuse was malignantly synergistic, frequently pairing with other adversities, followed by physical abuse, neglect, and domestic violence. The findings underscore that all ACEs are not equal in their contributions to commonly assessed outcomes. The findings also have considerable implications for prevention, intervention, and future research.

Individuals with dissociative disorders (DDs) are underrecognized, underserved, and often severely psychiatrically ill, characterized by marked dissociative and posttraumatic stress disorder (PTSD) symptoms with significant disability. Patients with DD have high rates of nonsuicidal self-injury (NSSI) and suicide attempts. Despite this, there is a dearth of training about DDs. We report the outcome of a web-based psychoeducational intervention for an international sample of 111 patients diagnosed with dissociative identity disorder (DID) or other complex DDs. The Treatment of Patients with Dissociative Disorders Network (TOP DD Network) program was designed to investigate whether, over the course of a web-based psychoeducational program, DD patients would exhibit improved functioning and decreased symptoms, including among patients typically excluded from treatment studies for safety reasons. Using video, written, and behavioral practice exercises, the TOP DD Network program provided therapists and patients with education about DDs as well as skills for improving emotion regulation, managing safety issues, and decreasing symptoms. Participation was associated with reductions in dissociation and PTSD symptoms, improved emotion regulation, and higher adaptive capacities, with overall sample |d|s = 0.44-0.90, as well as reduced NSSI. The improvements in NSSI among the most self-injurious patients were particularly striking. Although all patient groups showed significant improvements, individuals with higher levels of dissociation demonstrated greater and faster improvement compared to those lower in dissociation |d|s = 0.54-1.04 vs. |d|s = 0.24-0.75, respectively. These findings support dissemination of DD treatment training and initiation of treatment studies with randomized controlled designs.Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Un programa educativo online para personas con trastornos disociativos y sus médicos: Seguimiento de uno y dos años INTERVENCIÓN ONLINE PARA TRASTORNOS DISOCIATIVOS Las personas con trastornos disociativos (TDs) se encuentran sub-reconocidas, con pocos servicios y, a menudo, con enfermedades psiquiátricas graves, caracterizadas por marcados síntomas disociativos y de trastorno de estrés postraumático (TEPT) con discapacidad significativa. Los pacientes con TD tienen altas tasas de autolesión no suicida (ALNS) e intentos de suicidio. A pesar de esto, hay una escasez de entrenamiento sobre los TDs. Reportamos el resultado de una intervención psicoeducativa basado en la web para una muestra internacional de 111 pacientes diagnosticados con trastorno de identidad disociativa (TID) u otros TDs complejos. El programa de la Red de Tratamiento de Pacientes con Trastornos Disociativos (TOP DD Network, en su denominación en inglés) se diseñó para investigar si, en el transcurso de un programa psicoeducativo basado en la web, los pacientes con TD exhibirían un mejor funcionamiento y reducción de síntomas, incluso en los pacientes que generalmente han sido excluidos de los estudios de tratamiento por razones de seguridad. Mediante el uso de videos, ejercicios de escritura y prácticas conductuales, el programa TOP DD Network brindó a los terapeutas y los pacientes educación sobre los TDs y las habilidades para mejorar la regulación de las emociones, manejar los problemas de seguridad, y disminuir los síntomas. La participación se asoció con reducciones en los síntomas de disociación y de TEPT, mejor regulación de las emociones y mayores capacidades de adaptación, muestra total ds = .44-.90, así como reducción de ALNS. Las mejoras en ALNS entre los pacientes más auto-agresivos fueron particularmente sorprendentes. Aunque todos los grupos de pacientes mostraron mejoras significativas, los individuos con niveles más altos de disociación demostraron una mejoría mayor y más rápida en comparación con los más bajos en disociación |d|s = .54-1.04 vs. |d|s = .24-.75, respectivamente. Estos hallazgos apoyan la diseminación de la capacitación en el tratamiento del TD y el inicio de estudios de tratamiento con diseños controlados aleatorios.Traditional and Simplified Chinese Abstracts by the Asian Society for Traumatic Stress Studies (AsianSTSS) 簡體及繁體中文撮要由亞洲創傷心理研究學會翻譯 An online educational program for individuals with dissociative disorders and their clinicians: One-year and two-year follow-up Traditional Chinese 標題: 為離解症患者及治療師提供的網上教育計劃:一年及兩年期的跟進 撮要: 離解症(DDs)患者常缺乏關注和照料༌而且精神病情通常嚴重༌有離解症狀、創傷後壓力症(PTSD)症狀及顯著的殘障。DD患者有高比率的非自殺性自殘(NSSI)及自殺行為。儘管如此༌我們卻嚴重缺乏DD的治療訓練。共有111名被診斷患有解離性身份疾患(DID)或其他複雜性DDs的人士༌組成是次研究的國際樣本。本論文將報告一項基於互聯網進行的心理教育干預的成果。「離解症治療網絡(TOP DD 網絡)」計劃的設計༌旨在檢視於互聯網接受心理教育的過程༌會否令DD患者的功能障礙改善及症狀減輕;當中包括因為安全理由一般被排除於治療研究的患者。TOP DD 網絡透過影片、寫作和行為練習༌教育治療師與患者有關DDs的知識༌以及改善情緒調節、安全管理問題及減輕症狀的技巧。參與是次計劃༌跟離解症狀及PTSD症狀減輕、情緒調節改善、應對能力提升(樣本整體 ds = 0.44-0.90)、以及NSSI減低有關。自殘行為最嚴重的患者༌其於NSSI的改善使人震驚。所有患者組別的病情都有顯著改善༌但相比離解症狀水平較低的患者༌有較高水平離解症狀的患者展現較大及較快的改善(分別為 |d|s = 0.24-0.75 比對 |d|s = 0.54-1.04)。結果反映༌我們有需要進一步推廣DD的治療訓練༌並加以推行以隨機對照進行治療研究。 Simplified Chinese 标题: 为离解症患者及治疗师提供的网上教育计划:一年及两年期的跟进 撮要: 离解症(DDs)患者常缺乏关注和照料༌而且精神病情通常严重༌有离解症状、创伤后压力症(PTSD)症状及显著的残障。DD患者有高比率的非自杀性自残(NSSI)及自杀行为。尽管如此༌我们却严重缺乏DD的治疗训练。共有111名被诊断患有解离性身份疾患(DID)或其他复杂性DDs的人士༌组成是次研究的国际样本。本论文将报告一项基于互联网进行的心理教育干预的成果。「离解症治疗网络(TOP DD 网络)」计划的设计༌旨在检视于互联网接受心理教育的过程༌会否令DD患者的功能障碍改善及症状减轻;当中包括因为安全理由一般被排除于治疗研究的患者。TOP DD 网络透过影片、写作和行为练习༌教育治疗师与患者有关DDs的知识༌以及改善情绪调节、安全管理问题及减轻症状的技巧。参与是次计划༌跟离解症状及PTSD症状减轻、情绪调节改善、应对能力提升(样本整体 ds = 0.44-0.90)、以及NSSI减低有关。自残行为最严重的患者༌其于NSSI的改善使人震惊。所有患者组别的病情都有显著改善༌但相比离解症状水平较低的患者༌有较高水平离解症状的患者展现较大及较快的改善(分别为 |d|s = 0.24-0.75 比对 |d|s = 0.54-1.04)。结果反映༌我们有需要进一步推广DD的治疗训练༌并加以推行以随机对照进行治疗研究。.

Childhood sexual abuse (CSA) is implicated in the etiology of eating disorders (ED) and health problems in females, but prospective evidence is limited. ED symptoms are widespread but often undertreated, potentially contributing to subsequent ED-related health problems. Using data from Trickett and colleagues’ Female Growth and Development Study, the present report investigated the prospective associations among CSA, ED symptomatology in adolescence, and ED-related health problems in adulthood. Females with substantiated CSA and demographically-matched comparisons (N = 135) were followed at mean ages 11 through 24. Symptom counts and diagnoses of anorexia nervosa (AN) and bulimia nervosa (BN) over the lifetime were assessed in adolescence. Self-reported physical health problems were assessed in adulthood. Controlling for depression, anxiety, and age, CSA participants reported more symptoms and related health problems of BN, but not AN, relative to comparisons. CSA was not associated with the likelihood of receiving a diagnosis for either ED. BN symptom count accounted for a portion of the association between CSA and increased BN-related health problems. This report provided prospective evidence for the associations between CSA and BN symptoms and BN-related health problems. These findings support the recommendations to bolster resources and expertise for trauma-informed ED screening and treatment, ED treatments for patients with subthreshold symptoms, and enhanced treatments addressing ED and health problems for sexual abuse survivors.

Objective: Literature on the treatment of dissociative disorders (DDs) suggests that these individuals require long-term and specialized treatment to achieve stabilization and functionality. There is considerable empirical support for specialized phasic, dissociation-focused treatment in reducing a myriad of psychological symptoms and self-harm in this population. However, until recently, there has been a paucity of longitudinal treatment research on DD patients. Method: In the present six-year follow-up study, 61 therapists who participated in the initial phase of the Treatment of Patients with Dissociative Disorders (TOP DD) study answered questionnaires about their study patient’s stressors, quality of life, global functioning, victimization, and safety. These results provided a view of patients’ progress six years since the beginning of the TOP DD study. Results: Longitudinal analyses demonstrated patients had significantly fewer stressors (Χ2(6) = 18.76, p

Background: Interpersonal trauma and trauma-related disorders cost society billions of dollars each year. Because of chronic and severe trauma histories, dissociative disorder (DD) patients spend many years in the mental health system, yet there is limited knowledge about the economic burden associated with DDs. Objective: The current study sought to determine how receiving specialized treatment would relate to estimated costs of inpatient and outpatient mental health services. Method: Patients’ and individual therapists’ reports of inpatient hospitalization days and outpatient treatment sessions were converted into US dollars. DD patients and their clinicians reported on use of inpatient and outpatient services four times over 30 months as part of a larger, naturalistic, international DD treatment study. The baseline sample included 292 clinicians and 280 patients; at the 30-month follow-up, 135 clinicians and 111 patients. Missing data were replaced in analyses to maintain adequate statistical power. The substantial attrition rate (>50%) should be considered in interpreting findings. Results: Longitudinal and cross-sectional analyses of cost estimates based on patient reported inpatient hospitalization significantly decreased over time. Longitudinal cost estimates based on clinician-reported outpatient services also significantly decreased over time. Cross-sectional cost estimates based on patient and clinician reported inpatient hospitalization were significantly lower for patients in later stages of treatment compared to those struggling with safety and stabilization. Cross-sectional cost estimates based on clinician-reported outpatient services were significantly lower for patients in later stages of treatment compared to those in early stages. Conclusions: This pattern of longitudinal and cross-sectional reductions in inpatient and outpatient costs, as reported by both patients and therapists, suggests that DD treatment may be associated with reduced inpatient and outpatient costs over time. Although these preliminary results show decreased mental health care utilization and associated estimated costs, it is not clear whether it was treatment that caused these important changes.

Historically, clinical case reports have played an essential role in the professional communication of medical and psychiatric knowledge. Case reports continue to play important roles in the initial identification of new syndromes or unusual variants of established conditions. Case reports and case series also serve to alert clinicians to preliminary evidence of the efficacy of novel treatments or adaptations to new populations. The Jane Doe Case provides a seminal example of the ethical/medico-legal dilemma arising from a patient’s right to confidentiality versus the principle of independent review/replication as a necessary requirement for scientific credibility. As a result of being the subject of dueling case reports concerning the validity of her delayed recall of childhood sexual abuse, Jane Doe’s identity was revealed. Consequently, she suffered significant emotional distress, bankruptcy, and the end of her career as a naval officer and aviator. Current medical journal guidelines call for protection of confidentiality of the patient’s identity; yet, scientific credibility requires the possibility of an independent outside review if there are legitimate reasons to question facts or claims advanced in a case report. A potential solution is proposed as a starting point for resolving the dilemma posed for case study subjects and authors by the conflicting requirements of patient confidentiality and, if warranted, the possibility of an independent scientific review.

Objective To assess the impact of antecedent trauma on the risk of antenatal and postpartum depression in a prospective, longitudinal cohort of pregnant women. Method 374 participants (pregnant women aged 20-34 years) were recruited from a hospital-based obstetrics practice serving a predominantly low-income, inner-city population between May 2007 and May 2012. Clinical diagnostic interviews and psychosocial questionnaires were administered at 18 and 32 weeks of gestation and at 6 weeks and 6 months postpartum. Lifetime exposure to and details of traumatic events were recorded. Depression during pregnancy or the postpartum period was diagnosed according to DSM-IV-TR. Results 39% of the sample reported at least 1 traumatic event; trauma history (odds ratio [OR] = 2.16; 95% CI, 1.31-3.54) and, particularly, experiencing childhood sexual abuse (OR = 2.47; 95% CI, 1.27-4.78), someone close experiencing violence (OR = 2.19; 95% CI, 1.11-4.32), and the unexpected death or illness of someone close (OR = 2.15; 95% CI, 1.14-4.05) predicted antenatal but not postpartum depression. A clear dose-response effect of trauma on antenatal depression was observed; women who experienced 3 or more traumas had a 4-fold risk (OR = 4.34; 95% CI, 2.16-8.70) of antenatal depression compared to women with no trauma history. Conclusions Antecedent trauma significantly increases the risk of antenatal depression, but antenatal depression alone does not appear to predict postpartum depression. Routine screening for trauma exposure and depression is warranted during pregnancy to aid in the early detection and treatment of depression. Future studies need to examine mechanisms that may trigger affective episodes in trauma-exposed women, who may be especially vulnerable to depressive episodes during pregnancy.

Numerous studies find a cumulative effect of different types of childhood adversities on increasing risk for serious adult mental and medical outcomes. This study uses the National Comorbidity Survey-Replication sample to investigate the cumulative impact of 8 childhood adversities on complex adult psychopathology as indexed by (a) number of lifetime diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994); (b) number of 4 DSM-IV disorder categories (mood, anxiety, impulse control, and substance abuse disorders); and (c) coexistence of internalizing and externalizing disorders. Seven of the 8 childhood adversities were significantly associated with complex adult psychopathology. Individuals with 4 or more childhood adversities had an odds ratio of 7.3, 95% confidence interval [4.7, 11.7] for 4 disorder categories. Additive and multiplicative synergistic effects increasing adult psychopathology were found for specific pairwise combinations of childhood adversities. Synergistic patterns differed by gender suggesting that women are more impacted by sexual abuse and men by economic hardship. The absence of childhood adversities was protective, in that it significantly decreased an individual's risk for subsequent adult mental illness. The results support the clinical impression that increased childhood adversity is associated with more complex adult psychopathology. Traditional and Simplified Chinese Abstracts by AsianSTSS 標題:童年協同逆境與複雜成人精神病理學 撮要:眾多研究指出不同種類的童年逆境的累進效應增加成人嚴重精神和身体疾病的風險。我們採用全國共病普查－複製樣本來研究8種童年逆境的累進影響,在下列複雜成人精神病理等方面：(1)終身DSM-IV診斷數目；(2)4個DSM病類別的數目(情緒、焦慮、控制衝動、和物質濫用)；及(3)內化和外化疾病的共存。8種童年逆境中有7種與複雜成人精神病理學有統計學上顯著關連，有4個或以上童年逆境人士對4種疾病類別的優勢比為7.3, 95%CI[4.7,11.7] 。只有童年逆境專屬配對組合才能有添加和相乘的協同效應去增加成人精神病理學方面。協同模式有性別差異,如女性受性侵犯影響大些，而男性則被經濟困難影響多些。沒有任何童年逆境是有保護作用，對日後成人精神病的個人發病風險有統計上顯著的減少。本研究証實臨床經驗，即更多童年逆境與更複雜成人精神病學有相連。 标题:童年协同逆境与复杂成人精神病理学 撮要:众多研究指出不同种类的童年逆境的累进效应增加成人严重精神和身体疾病的风险。我们采用全国共病普查－复制样本来研究8种童年逆境的累进影响,在下列复杂成人精神病理等方面：(1)终身DSM-IV诊断数目；(2)4个DSM病类别的数目(情绪、焦虑、控制冲动、和物质滥用)；及(3)内化和外化疾病的共存。8种童年逆境中有7种与复杂成人精神病理学有统计学上显著关连，有4个或以上童年逆境人士对4种疾病类别的优势比为7.3, 95%CI[4.7,11.7] 。只有童年逆境专属配对组合才能有添加和相乘的协同效应去增加成人精神病理学方面。协同模式有性别差异,如女性受性侵犯影响大些，而男性则被经济困难影响多些。没有任何童年逆境是有保护作用，对日后成人精神病的个人发病风险有统计上显著的减少。本研究证实临床经验，即更多童年逆境与更复杂成人精神病学有相连。

BACKGROUND: Little is known regarding changes in the hypothalamic-pituitary-adrenal axis (HPA axis) of adolescent girls with and without posttraumatic stress disorder (PTSD) who have recently experienced sexual abuse. Therefore, in this pilot study, we utilized non-stressed home saliva collection three times a day for three days to assess the levels, diurnal variation and awakening response of cortisol in recently sexually abused adolescent girls. METHODS: Twenty-four adolescent girls (mean age: 15 ± 1.5 years) with a history of recent sexual abuse (sexual abuse occurred 1-6 months prior to study enrollment) and 12 healthy, nontraumatized comparison subjects (mean age: 14.8 ± 1.3 years) collected saliva at home upon awakening, 30 min after waking, and in the late afternoon on three consecutive school days. RESULTS: Among sexually abused girls, flattening of the morning cortisol awakening response was associated with PTSD severity (r = -.41, P Language: en

Parenting stress is associated with poor maternal and child outcomes. Multiple contributors to parenting stress have been proposed, but disaggregation of distinct pathways has been relatively unexplored. In addition, the contribution of maternal experience of childhood trauma has been inadequately considered. Childhood trauma and parenting stress are common in mothers in home visiting programs. Understanding the relation between childhood trauma and parenting stress holds promise for improvement of home visiting approaches. This study examined the relation between childhood trauma and parenting stress, with a focus on the mediating roles of depression and social support. Participants consisted of 208 first-time mothers enrolled in a home visiting program who were assessed at about 5 months' postpartum. Measures of maternal childhood trauma, depression, social support, and parenting stress were administered. A multiple mediator model revealed that childhood trauma was related to parenting stress, and the relation between childhood trauma and parenting stress was separately mediated by both depression and social support. Depression and social support uniquely and distinctly accounted for the association between childhood trauma and parenting stress. Home visiting programs may improve their impact on parenting stress by augmenting or modifying strategies to more effectively address maternal depression and social support. Abstracts translated in Spanish, French, German, and Japanese can be found on the abstract page of each article on Wiley Online Library at http://wileyonlinelibrary.com/journal/imhj.

Interrogation, the questioning of persons detained by police, military, or intelligence organizations, is designed to extract information that a subject may resist disclosing. Interrogation techniques are frequently predicated on inducing mental states of despair, dread, dependency, and debility that weaken an individual's resistance. Descriptions of techniques from 2 Central Intelligence Agency training manuals are illustrated by examples from interviews of and writings by Murat Kurnaz, who was held at Guantánamo Bay Detention Camp for 5 years. Interrogation techniques are designed to create a destabilizing sense of shock; undermine an individual's grasp on reality; and provoke internal psychological division, self-conflict, and confusion. The long-term effects of interrogation often include posttraumatic stress disorder as well as states of anxiety, depression, and depersonalization.

Physical and sexual abuse are prevalent social hazards. We sought to examine the association between childhood physical and sexual abuse and age at menarche.Among 68,505 participants enrolled in the Nurses' Health Study II, we investigated the association between childhood physical abuse and sexual abuse and menarche before age 11 years (early) or after age 15 years (late) using multivariate logistic regression analysis, mutually adjusting for both types of abuse.Fifty-seven percent of respondents reported some form of physical or sexual abuse in childhood. We found a positive dose-response association between severity of sexual abuse in childhood and risk for early menarche. Compared with women who reported no childhood sexual abuse, the adjusted odds ratio (AOR) for early menarche in women who reported childhood sexual abuse was 1.20 (95% confidence interval [CI]: 1.10, 1.37) for sexual touching and 1.49 (95% CI: 1.34, 1.66) for forced sexual activity. Severe physical abuse predicted early menarche (AOR = 1.22, 95% CI: 1.10, 1.37). Childhood physical abuse had a dose-response association with late age at menarche: AOR 1.17 (95% CI: 1.04, 1.32) for mild, 1.20 (95% CI: 1.08, 1.33) for moderate, and 1.50 (95% CI: 1.27, 1.77) for severe physical abuse. Sexual abuse was not associated with late menarche.Childhood abuse was prevalent in this large cohort of U.S. women. Severity of childhood sexual abuse was associated with risk for early onset of menarche, and physical abuse was associated with both early and late onset of menarche.

Severe dissociative disorders (DD) are associated with high levels of impairment, treatment utilization, and treatment costs, yet relatively little systematic research has focused on treatment for these challenging patients. The goal of this naturalistic observational 30-month follow-up study of an international sample of patients with dissociative disorders was to determine if treatment provided by community providers was associated with improvements in symptoms and adaptive functioning. The patients were diagnosed with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). The patients and their therapists completed surveys at study entry and at 6-, 18-, and 30-month follow-up. At the 30-month follow-up, 119 of the original 226 patients completed the surveys. According to patients’ reports, they showed decreased levels of dissociation, posttraumatic stress disorder symptoms, general distress, drug use, physical pain, and depression over the course of treatment. As treatment progressed, patients reported increased socializing, attending school or volunteering, and feeling good. According to therapists’ reports, patients engaged in less self-injurious behavior and had fewer hospitalizations as well as increased global assessment of functioning scores (American Psychiatric Association, 2000) and adaptive capacities over time. These results suggest that treatment provided by therapists who have training in treating DID/DDNOS appears to be beneficial across a number of clinical domains. Additional research into the treatment of DD is warranted.

Purpose The purpose was to examine whether the timing of puberty, indexed by breast development and pubic hair development, was earlier for sexually abused females compared with a matched comparison group of nonabused females, controlling for key alternative confounds. Methods A cohort of sexually abused females and matched comparisons was followed longitudinally at mean ages 11 through 20 years. Sexually abused participants (N = 84) were referred by protective services. Comparison participants (N = 89) were recruited to be comparable in terms of age, ethnicity, income level, family constellation, zip codes, and nonsexual trauma histories. Stage of puberty was indexed at each assessment by nurse and participant ratings of breast and pubic hair development using Tanner staging—the gold standard for assessing pubertal onset and development. Cumulative logit mixed models were used to estimate the association between sexual abuse status and the likelihood of transitioning from earlier to later Tanner stage categories controlling for covariates and potential confounds. Results Sexual abuse was associated with earlier pubertal onset: 8 months earlier for breasts (odds ratio: 3.06, 95% CI: 1.11–8.49) and 12 months earlier for pubic hair (odds ratio: 3.49, 95% CI: 1.34–9.12). Alternative explanations including ethnicity, obesity, and biological father absence did not eradicate these findings. Conclusions This study confirms an association between exposure to childhood sexual abuse and earlier pubertal onset. Results highlight the possibility that, due to this early onset, sexual abuse survivors may be at increased risk for psychosocial difficulties, menstrual and fertility problems, and even reproductive cancers due to prolonged exposure to sex hormones.

We describe a multiyear pilot dissemination of a trauma-focused group treatment, Trauma and Grief Component Therapy for Adolescents, coupled with a trauma-informed staff training, Think Trauma, to six residential juvenile justice (JJ) facilities. All staff members were trained in Think Trauma. Seventy-seven youth from four facilities completed the treatment groups and 69 completed all pre- and postgroup assessment measures. The aims of this study were to determine whether trauma-focused interventions (a) could be implemented in complex JJ systems, (b) would be associated with a decrease in posttraumatic symptoms and reactions in youth, and (c) might contribute to reduced Incident Reports in facilities. A related question was whether we would receive feedback that youth who participated in the trauma and/or grief narrative components of the intervention were adversely affected. Pre- and postgroup assessments indicated significant reductions in symptoms of posttraumatic stress, depression, and anger, but not in anxiety or sexual concerns. There were significantly greater reductions in posttraumatic stress disorder (PTSD) among incarcerated youth who completed all modules of the group treatment intervention relative to incarcerated youth who received an abbreviated version. Two of the facilities tracked their Incident Reports and reported reductions. No Incident Reports or therapist feedback documented that the trauma/grief processing components of the intervention were destabilizing to the youth.

Although treatment outcome research on dissociative disorders (DD) is increasing, an examination of treatment progress in young adults with these disorders remains noticeably absent from the literature. Many studies of DD patients report mean ages over 35. The present study examined the response to treatment of a subsample of young adults ages 18-30 with dissociative identity disorder and dissociative disorder not otherwise specified who participated in a naturalistic, longitudinal study of DD treatment outcome. Over 30 months, these patients demonstrated decreases in destructive behaviors and symptomatology as well as improved adaptive capacities. Compared to the older adult participants in the study, the young adults were more impaired initially. However, these younger patients improved at a rapid pace, such that their clinical presentations were similar to or more improved than those of the older adults at the 30-month follow-up. This brief report suggests not only that young adult DD patients can benefit from a trauma-focused, phasic treatment approach but that their treatment may progress at a faster pace than that of older adults with DD.

Recent research has suggested that mothers participating in home visitation programs have a high incidence of mental health problems, particularly depression. Posttraumatic stress disorder (PTSD) is a common comorbidity with depression, yet its prevalence among home visiting populations and implications for parenting and maternal functioning have not been examined. This study contrasted depressed mothers with (n = 35) and without PTSD (n = 55) who were enrolled in a home visitation program. Results indicated that depressed mothers with comorbid PTSD were more likely to have experienced childhood sexual abuse, had greater severity of depressive symptoms, increased social isolation, and lower overall functioning than their counterparts without PTSD. Among PTSD mothers, greater severity of PTSD symptoms, in particular avoidance and emotional numbness, were associated with increased maternal psychopathology and parenting deficits even after controlling for depression severity. These findings add to the literature documenting the negative impacts of PTSD on maternal functioning and parenting. Implications for screening and treatment in the context of home visitation are discussed.

The Trauma Treatment Training Center (TTTC) at Cincinnati Children's Hospital examined the imple- mentation and effectiveness of Parent-Child Interaction Therapy (PCIT) in community agencies working with high-risk families through an awarded grant from the Substance Abuse and Mental Health Services Administration. The current study summarizes posttreatment data collected from community clinicians trained by the TTTC. Results include 53 posttreatment outcomes from 23 clinicians in 15 agencies in the United States. Significant improvement was seen on several measures regarding child behavior, child trauma symptoms, child dissociative characteristics, and caregiver stress. Community clinicians trained in PCIT during a five-day workshop did get effective results with even their first PCIT cases. It is only in the last generation that treatments for child mal- treatment establishing efficacy through randomized controlled studies have been developed and tested (Silverman et al., 2008). Trauma-Focused Cognitive Behavioral Therapy, the one well- established treatment for traumatized/maltreated children and their caregivers, includes a brief component about effective parenting, but further research in this area is warranted to help rebuild attachment relationships between maltreated children and their caregivers and to give parents the skills to deal with the emotional and behavioral dysregulations that often accompany child abuse and neglect. Parent-Child Interaction Therapy (PCIT), originally developed for families of children with disruptive behavior disor- ders, has shown potential to fill this gap in childhood trauma treatment by helping physically abusive parents transform their parenting practices and by offering a variety of skills to nonof- fending parents and caregivers (Chaffin et al., 2009). This study examined the dissemination and effectiveness of PCIT in commu- nity practices after clinicians, whose caseloads included substantial numbers of high-risk and maltreated children, were trained in a five-day workshop. PCIT is a dyadic treatment supported by more than 20 years of research and practice (Herschell, Calzada, Eyberg, & McNeil, 2002). It has demonstrated long-term maintenance of treatment gains of up to six years posttreatment (Hood & Eyberg, 2003). More than 100 randomized controlled trials support PCIT's effec- tiveness. Originally developed by Dr. Sheila Eyberg in the 1970s for young children with disruptive behavior disorders, PCIT has been successfully used with a variety of other populations, includ

Not every adolescent exposed to child maltreatment develops symptoms of post-traumatic stress disorder (PTSD), emphasizing the need to identify variables that explain how some maltreated children come to develop these symptoms. This study tested whether a set of variables, respiratory sinus arrhythmia (RSA) and cortisol reactivity as well as experiential avoidance, explained the relationship between child maltreatment and PTSD symptoms.Adolescent females (N=110; n=51 maltreated) 14-19 years of age completed interviews, questionnaires, and a stressor paradigm. A multiple mediator model was used to assess the effect for the set of variables while identifying specific indirect effects for each variable.Results indicated that the set of variables mediated the relationship between child maltreatment and PTSD symptoms. However, only experiential avoidance contributed significantly to this effect when simultaneously estimating all other variables. The indirect effect for experiential avoidance was also significantly stronger than the effects of RSA and cortisol reactivity.Data support the examination of experiential avoidance in understanding how adolescents who have been maltreated develop PTSD symptoms with implications for prevention and intervention.

This retrospective study compared frequencies of aggressive behaviors and abuse histories noted during a psychiatric intake assessment for children where animal cruelty was endorsed and a control sample of youth for whom animal cruelty was not endorsed to determine if rates of concerning behaviors differed significantly. Relative to the control group, the cruelty group was significantly more likely to have had problems with peers, perpetrated bullying, experienced sexual abuse, and have a history of sexually acting out. Recommendations for childhood animal cruelty screening in mental health settings are discussed.

Previous research on anger and childhood sexual abuse (CSA) is largely cross-sectional and retrospective. In this study, we prospectively examined the consequences of expressing anger among sexually abused women in contexts of either voluntarily disclosing or not disclosing a previous abuse episode (n 94). All CSA survivors in the study had documented histories of CSA. These participants and a matched, nonabused sample were asked to describe their most distressing experience while being videotaped to allow coding of anger expression. Approximately two thirds of the CSA survivors voluntarily disclosed a previous abuse experience. Participants completed measures of internalizing symptoms and externalizing symptoms at the time of disclosure and again two years later. The expression of anger was associated with better long-term adjustment (decreased internalizing and externalizing symptoms), but only among CSA survivors who had expressed anger while not disclosing an abuse experience. For CSA survivors who disclosed an abuse experience and for nonabused women, anger expression was unrelated to long-term outcome. These findings suggest that the benefits of anger expression for CSA survivors may be context specific.

This is a report on the research design and findings of a 23-year longitudinal study of the impact of intrafamilial sexual abuse on female development. The conceptual framework integrated concepts of psychological adjustment with theory regarding how psychobiological factors might impact development. Participants included 6- to 16-year-old females with substantiated sexual abuse and a demographically similar comparison group. A cross-sequential design was used and six assessments have taken place, with participants at median age 11 at the first assessment and median age 25 at the sixth assessment. Mothers of participants took part in the early assessments and offspring took part at the sixth assessment. Results of many analyses, both within circumscribed developmental stages and across development, indicated that sexually abused females (on average) showed deleterious sequelae across a host of biopsychosocial domains including: earlier onsets of puberty, cognitive deficits, depression, dissociative symptoms, maladaptive sexual development, hypothalamic–pituitary–adrenal attenuation, asymmetrical stress responses, high rates of obesity, more major illnesses and healthcare utilization, dropping out of high school, persistent posttraumatic stress disorder, self-mutilation,Diagnostic and Statistical Manual of Mental Disordersdiagnoses, physical and sexual revictimization, premature deliveries, teen motherhood, drug and alcohol abuse, and domestic violence. Offspring born to abused mothers were at increased risk for child maltreatment and overall maldevelopment. There was also a pattern of considerable within group variability. Based on this complex network of findings, implications for optimal treatments are elucidated. Translational aspects of extending observational research into clinical practice are discussed in terms that will likely have a sustained impact on several major public health initiatives.

Research has demonstrated that low income mothers participating in home visitation programs have high rates of depression. This study used an open trial design to evaluate In-Home Cognitive Behavioral Therapy (IH-CBT), an evidence-based treatment for depression that is delivered in the home setting and has been adapted to address the needs of low income mothers participating in home visitation. 64 depressed mothers recruited from a home visitation program and who had completed IH-CBT were compared to 241 mothers from the same setting who met identical screening criteria at enrollment but did not receive the treatment. In addition, pre- and post-treatment measures of depression and related clinical features were contrasted in the 64 mothers receiving IH-CBT. There was a significantly greater reduction in depressive symptoms in the IH-CBT group relative to their counterparts who did not receive the treatment. Results from pre-post comparisons showed that treated mothers had decreased diagnosis of major depression, lower reported stress, increased coping and social support, and increased positive views of motherhood at post-treatment. Findings suggest that IH-CBT is a promising approach to addressing maternal depression in the context of home visitation and warrants further study. Public health implications for home visiting programs are discussed.

OBJECTIVES: The objective of this study was to test whether the experience of childhood sexual abuse is associated with long-term receptive language acquisition and educational attainment deficits for females. METHODS: Females with substantiated familial childhood sexual abuse (n = 84) and a nonabused comparison group (n = 102) were followed prospectively for 18 years. Receptive language ability was assessed at 6 time points across distinct stages of development, including childhood, adolescence, and young adulthood. Rates of high school graduation and total educational attainment were assessed during young adulthood. RESULTS: Hierarchical linear modeling revealed that receptive language did not differ between the groups at the initial assessment point in childhood; however, a significant group by time interaction was observed across development with abused females (1) acquiring receptive language at a significantly slower rate throughout development and (2) achieving a lower overall maximum level of proficiency. Significant differences in receptive language scores emerged as early as midadolescence. In addition, abused females reported significantly lower rates of high school graduation and lower overall educational attainment when compared with their nonabused peers. CONCLUSIONS: Exposure to childhood sexual abuse may be a significant risk factor for cognitive performance and achievement deficits for victims. These findings have particular public health relevance given the high prevalence of sexual abuse and that poor cognitive functioning and low levels of educational attainment can contribute to continued adversity throughout the life course. Early intervention may assist victims in improving cognitive functioning, altering deleterious trajectories, and promoting greater life successes.

Objective The primary goal of this study was to explore the relationship between childhood sexual abuse and parenting practices among non-offending mothers of sexually abused girls. Guided by a developmental-ecological perspective of parenting, several models with different potential pathways starting from the mothers’ childhood experiences of sexual abuse and culminating in their parenting practices (e.g., direct, spurious, indirect effect) were hypothesized and explored in the context of the mothers’ past and current psychosocial risks and resources. Two dimensions of parenting were considered: providing positive structure (i.e., ratings of how consistent, fair, easygoing), and using punitive discipline. Methods This study utilized a sample from a longitudinal, multigenerational study in which sexually abused girls, demographically similar comparison girls, and the mothers of both groups of girls participated. For the current study, the data regarding the mothers of the two groups of girls was of primary importance. Results The results from a series of model comparison tests supported the spurious effect of mothers’ childhood sexual abuse on the positive structure dimension. A direct, inverse relationship was found as the most accurate model with the punitive discipline dimension. Overall, childhood experience of punitive discipline, current dissociative symptoms, and satisfaction with social support were indicated as possible correlates of parenting practices among the mothers. Conclusions The significance of these findings is discussed in the context of theories concerning childhood trauma and parenting, as well as the intergenerational process of child maltreatment. Practice implications of the findings are also presented and discussed in terms of intervention programs for families where intrafamilial child sexual abuse occurs.

The present study sought to document an example of how childhood sexual abuse and attachment representation interact while contributing to the trait anxiety of nonoffending mothers following the disclosure of their daughters’ sexual abuse. The study sample consisted of 57 ethnically diverse mothers of sexually abused girls aged 6 to 16 and 47 mothers of comparison girls who were matched with the abused girls on age, socioeconomic status, and family constellation. Results indicate that the mothers’ representations of past attachment relationships with their own fathers were differentially related to their current attachment styles, depending on their daughters’ childhood sexual abuse status. The representation of past attachment relationships with peers had both main and protective effects on the mothers’ trait anxiety symptoms. The relevance of attachment perspectives to adjustment among these mothers and intergenerational process in childhood sexual abuse are discussed, and implications for future research and clinical practices are identified.

Depression is prevalent in new mothers and has been shown to have profound negative impacts on parenting, maternal life course, and child development. High rates of maternal depression have been found in home visitation, a widely disseminated prevention approach for high risk mothers and their children. This paper reviews the emerging literature on the prevalence, impact, and treatment of depression in the context of home visitation. Findings are synthesized and methodological and design limitations are considered in interpretation of results. Promising approaches to addressing maternal depression and supporting home visitors in working with this clinical population are described. Recommendations for research and practice are offered that build upon the strong foundation of current efforts in this area.