Helpful Resources for Childbirth Educators and Parents

In this column, reviewers offer perspectives and comments on a variety of books and DVDs that address topics related to maternity care in the United States, health and childbearing experiences of women in third-world countries, traumatic birth, and pregnancy massage.     

Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents

OBJECTIVE: Child abuse is a risk factor for developing Posttraumatic Stress Disorder (PTSD) and subsequent Substance Use Disorder (SUD). The purpose of this review is to summarize current knowledge about effective treatments for adolescent abuse-related PTSD, SUD, and the co-occurrence of these conditions.METHOD: The literature on empirical treatment studies for these conditions in adolescence was reviewed, summarized, and synthesized.RESULTS: Randomized controlled studies of abuse-related PTSD and SUD in adolescents have supported the efficacy of cognitive behaviorally-based individual and family treatment components. Components overlap considerably in empirically supported treatments for each disorder. An integrated treatment approach is described for use in adolescents with abuse-related PTSD and SUD, with recommendations for optimizing services for this population and for future research.CONCLUSIONS: The available evidence on effective treatments suggests that integrated PTSD- and SUD-focused cognitive-behavioral and family treatment for adolescents with comorbid abuse-related PTSD and SUD may optimize outcomes for this population.     

Association of autistic traits in adulthood with childhood abuse,interpersonal victimization,and posttraumatic stress

Persons with autistic traits may be at elevated risk for interpersonal victimization across the life course. Children with high levels of autistic traits may be targeted for abuse, and deficits in social awareness may increase risk of interpersonal victimization. Additionally, persons with autistic traits may be at elevated risk of posttraumatic stress disorder (PTSD) symptoms subsequent to trauma. We examined retrospectively reported prevalence of childhood abuse, trauma victimization and PTSD symptoms by autistic traits among adult women in a population-based longitudinal cohort, the Nurses’ Health Study II (N = 1,077). Autistic traits were measured by the 65-item Social Responsiveness Scale. We estimated odds ratios (OR) for childhood sexual and physical/emotional abuse and PTSD symptoms by quintiles of autistic traits. We examined possible mediation of PTSD risk by abuse and trauma type. Women in the highest versus lowest quintile of autistic traits were more likely to have been sexually abused (40.1% versus 26.7%), physically/emotionally abused (23.9% versus 14.3%), mugged (17.1% versus 10.1%), pressured into sexual contact (25.4% versus 15.6%) and have high PTSD symptoms (10.7% versus 4.5%). Odds of PTSD were elevated in women in the top three quintiles of autistic traits compared with the reference group (OR range = 1.4 to 1.9). Childhood abuse exposure partly accounted for elevated risk of PTSD in women with autistic traits. We identify for the first time an association between autistic traits, childhood abuse, trauma victimization, and PTSD. Levels of autistic traits that are highly prevalent in the general population are associated with abuse, trauma and PTSD.     

First,Do No Harm: How Routine Interventions,Common Restrictions,and the Organization of Our Health-Care System Affect the Health of Mothers and Newborns

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the “First, do no harm” principle in a different way. New research on the potentially harmful effects of intravenous lines demonstrates that refraining from routine interventions in labor protects the safety of women and babies. A new systematic review of movement and position changes in labor shows that eliminating unfounded restrictions also protects maternal and infant health and well-being. Finally, a study of patterns of use of neonatal intensive care units reveals how the organization of the maternity care system itself can affect the health outcomes of its beneficiaries.     

Childhood trauma and neighborhood-level crime interact in predicting adult posttraumatic stress and major depression symptoms

Previous research has identified several individual-level factors that modify the risk of childhood trauma on adult psychiatric symptoms, including symptoms of major depression (MD) and posttraumatic stress (PTS). Neighborhood-level factors also influence the impact of individual-level exposures on adult psychopathology. However, no prior studies to our knowledge have explored cross-level interactions between childhood trauma and neighborhood-level factors on MD and PTS symptoms. The purpose of this study was therefore to explore cross-level interactions between a neighborhood-level factor – neighborhood-level crime – and childhood trauma on MD and PTS symptoms. Participants in this study (N = 3192) were recruited from a large public hospital, and completed self-report inventories of childhood trauma and MD and PTS symptoms. Participant addresses were mapped onto 2010 census tracts, and data on crime within each tract were collected. Multilevel models found a significant cross-level interaction between childhood trauma and neighborhood crime on MD symptoms, such that the influence of high levels of childhood trauma on MD symptoms was enhanced for participants living in high-crime neighborhoods. Supplementary analyses found variation in the strength of cross-level interaction terms by types of childhood trauma and crime, with the strongest associations including emotional neglect paired with personal and property crime. The results provide preliminary support for interventions that help childhood trauma survivors find housing in less vulnerable neighborhoods and build skills to cope with neighborhood crime.     

Childhood maltreatment and post-traumatic stress disorder among incarcerated young offenders

Young offenders have a high prevalence of mental illness and a large proportion report experiencing a number of traumatic events during childhood, but there is little research exploring this association. This study describes the prevalence of, and association between, child maltreatment and post-traumatic stress disorder (PTSD) among young offenders. The study uses data collected as part of the 2009 NSW Young People in Custody Health Survey which was conducted in nine juvenile detention centers. This paper reports on findings from the baseline questionnaires and 18-months of re-offending data. The analysis included 291 participants who were assessed for PTSD and child maltreatment. The sample was 88% male, 48% Aboriginal, with an average age of 17 years (range 13–21 years). One in five (20%) participants were diagnosed with PTSD, with females significantly more likely to have PTSD than males (40% vs. 17%, p < 0.05). Over half (60%) of young offenders reported any child abuse or neglect, with females nearly 10 times more likely to report three or more kinds of severe child maltreatment than males. The main correlate for a diagnosis of PTSD was having three or more kinds of severe child maltreatment (OR = 6.73, 95% CI: 1.06–42.92). This study provides evidence for the need to comprehensively assess child abuse and neglect among young offenders in order to provide appropriate treatment in custody and post-release.     

Prevention and treatment of posttraumatic stress disorder in the school setting

Trauma has the potential to undermine both the educational and personal achievement of students. This article will provide a review and an integration of theoretical and empirical literature on the prevention and treatment of stress disorders, particularly posttraumatic stress disorder (PTSD) in children and teens. An initial review of the biopsychosocial factors related to the development of stress disorders is followed by a comprehensive model of preventive intervention. Recommendations for best practices to prevent and treat PTSD in the school setting are guided by existing treatment‐outcome literature. © 2006 Wiley Periodicals, Inc. Psychol Schs 43: 461–470, 2006.     

Narrative fragmentation in child sexual abuse: The role of age and post-traumatic stress disorder

The present study aimed to assess the effects of age and PTSD on the narrative fragmentation in memories for child sexual abuse. Lexical complexity, cohesion and coherence were analyzed within a group of 86 allegations of children (M = 10 years; SD = 3.7; range: 4–17) who were victims of sexual abuse. Results illustrated that age played an important role in establishing narrative coherence and predicted the level of orientation, the sequence of events and the level of evaluation of the event. Instead, PTSD was related to narrative coherence and cohesion. Therefore, in children, the narrative fragmentation could be an effective diagnostic tool for understanding the effects of PTSD. Moreover in a legal setting the traumatic effects of PTSD on the narrative coherence and cohesion could be significant indices in the evaluation of child testimony.     

Childhood trauma,PTSD, and psychosis: Findings from a highly traumatized,minority sample

Trauma, especially early life trauma, is a risk factor for the development of both posttraumatic stress disorder and psychosis. The goal of the present study was to determine specific associations between exposure to childhood abuse, PTSD symptoms, and current psychotic disorder. Subjects were recruited from a public, urban hospital (N = 328, >90% African American). Psychotic disorders were measured using the MINI International Neuropsychiatric Interview, PTSD was measured using the Clinician Administered PTSD Scale, child abuse was measured with the Childhood Trauma Questionnaire, and lifetime trauma exposure was measured with the Traumatic Events Inventory. Logistic regression analyses showed that both child abuse and current PTSD were statistically significant predictors of psychotic disorder beyond the effects of lifetime trauma load. When PTSD symptom clusters were examined, avoidance and numbing symptoms showed unique association with psychotic disorder independent of demographic variables and trauma exposure. Using bootstrapping techniques, we found a full indirect effect of PTSD on the association between child abuse and, suggesting a particularly important role of PTSD symptoms in relation to psychotic disorder in the presence of early life trauma. Because this is a cross-sectional study, continued research is needed to determine causality of such models. Identifying co-occurring psychosis and PTSD, particularly in populations with high levels of trauma exposure, is critical and will likely aid in more successful treatment interventions.     

Patients' perspectives on the role of prepared childbirth education in decision making regarding elective labor induction

The purpose of our study was to explore reasons why nulliparous women chose to have an elective labor induction and to identify the influence of prepared childbirth classes on their decision. The study included 1,349 nulliparous women at term who participated in a survey regarding their choices for childbirth, their attendance at prepared childbirth classes, and their experience with labor and birth. Sixty-three percent of women who attended childbirth classes and did not have elective induction reported that classes provided helpful information to assist in their decision-making process. Study results suggest attendance at prepared childbirth classes can be an effective source of information regarding elective labor induction and influential in women's decisions regarding whether or not to have elective labor induction. Women perceive prepared childbirth classes positively and find the information provided valuable.     

深化对简单劳动、复杂劳动和创新劳动的认识

马克思创立劳动价值论一百多年以来 ,社会经济发生了很大的变化 ,我们应当在坚持马克思主义劳动价值论的基础上 ,深化对简单劳动和复杂劳动、特别是创新劳动的认识 ,从而为我国社会主义现代化建设提供理论和现实的指导     

Best practices and emerging trends in assessment of trauma in students with autism spectrum disorder

Children and adolescents with autism have a higher likelihood of being exposed to bullying, abuse, and sexual assault which, through repeated exposure, has been demonstrated to impede academic, social, and physical functioning among this population. However, the complexity of unpacking the characteristics of autism and trauma can pose a challenge for school psychologists in using the most appropriate clinical method of intervention. This paper summarizes the co-occurrence of autism and trauma in an effort to better inform practitioners and recommends the need for valid and reliable assessments that measure adverse experiences for children with autism. A practitioner assessment guide of childhood trauma and autism spectrum disorder is also provided to facilitate a comprehensive assessment process. We conclude that there is a pressing need for more research examining the relationship between autism and trauma by better understanding the relationship of these constructs, and for the development of more effective assessments to provide more evidence-based interventions.     

Posttraumatic cognitions,childhood sexual abuse characteristics,and posttraumatic stress disorder in men who have sex with men

BackgroundHigh rates of experience of childhood sexual abuse (CSA) among in men who have sex with men (MSM) place this population at increased risk for posttraumatic stress disorder (PTSD).ObjectiveThis study explores how specific characteristics of CSA relate to posttraumatic cognitions (PTCs) and explores the role that specific PTCs play in the relationship between CSA and PTSD in MSM.MethodsTwo-hundred and ninety MSM completed a CSA interview, the Davidson Trauma Scale, and the Posttraumatic Cognitions Inventory.ResultsControlling for sociodemographic factors, CSA involving physical injury and CSA with intense fear were associated with higher levels of PTCs about the self and world, but not with self-blame. We did not find significant associations for CSA involving a family member, CSA with penetration, or duration or frequency of CSA with any subscale on the PTCI. Experiencing CSA for the first time during adolescence was associated with higher self-blame. Analyses revealed that physical injury and intense fear each had indirect effects on PTSD symptoms through negative cognitions about the self and world. First CSA episode during adolescence had an indirect effect on PTSD symptoms through self-blame. CSAs accounted for 16.7% and PTCs accounted for 31.7% of the variance in PTSD, underlining the importance of PTCs.ConclusionsAssessing for physical injury, intense fear, and age at first CSA are particularly relevant to PTCs and of critical importance to advancing assessment and treatment strategies for PTSD in MSM.     

创伤经历大学生创伤后成长与其心理健康的关系研究

采用创伤后成长量表和心理健康量表对高校237名经历创伤的大学生进行调查。结果发现:创伤后成长总分及其各维度存在显著的性别差异,但不存在专业差异;不同等级的创伤后成长水平在心理健康的心理症状与负向情绪上不存在差异,在其它几个维度上存在极其显著的差异。创伤后成长各因子与心理健康各因子有显著相关,能有效预测心理健康水平。     

Abnormal emotional processing in maltreated children diagnosed of Complex Posttraumatic Stress Disorder

Maltreated children usually show a specific pattern of emotional and behavioral symptoms that exceed those relating to posttraumatic stress disorder (PTSD). These symptoms have been defined as Complex PTSD (CPTSD). The underlying attentional mechanisms of abnormal emotional processing and their relation to the clinical presentation of CPTSD are not well understood. A visual dot-probe paradigm involving pre-attentive (i.e., 500 ms) and attentive (i.e., 1500 ms) presentation rates of neutral versus emotional (i.e., angry, happy or sad) facial expressions was applied. Twenty-one maltreated CPTSD children were compared with twenty-six controls. The results are as follows: an attention bias away from threatening faces and an attentional bias towards sad faces were observed in maltreated CPTSD children during pre-attentive and attentive processing. Whereas the attentional bias away from angry faces was associated with social problems, the attentional bias towards sad faces was associated with depressive and withdrawn symptoms. Therefore, CPTSD children develop maladaptive negative cognitive styles, which may underlie not only social problems (by a cognitive avoidance of threatening stimuli) but also depressive symptoms (by a cognitive approach to sad stimuli). Attention processing abnormalities should be considered as therapeutic targets for new treatment approaches in this population.     

When the levees break: the cost of vicarious trauma,microaggressions and emotional labor for Black administrators and faculty engaging in race work at traditionally White institutions

Abstract

The purpose of this article is to offer insight to administrators and human resource professionals at Traditionally White Institutions (TWIs) about developing action plans that provide meaningful support to Black administrators and faculty who are coping with racial trauma. Operationalizing tenets of Critical Race Methodology (CRM), the counter-narratives presented here are drawn from 15 years of unpublished professional and personal communication created by an individual Black faculty and administrator. The lectures, conference presentations, commencement addresses and other ephemera trace the development of battlements and emotional battle scars over the early years of one scholar-activist’s career at TWIs. The calamitous aftermath of Hurricane Katrina is considered in this context both as metaphor and collective psychic wound. As such, it illuminates other instances of vicarious trauma, foreshadows the Movement for Black Lives, and provides a devastating illustration of administrative unpreparedness. Revealing the ramifications of racial trauma can serve to help others who suffer to feel less alone and can provide stakeholders in higher education with valuable knowledge for the sake not only of recruitment and retention, but institutional transformation.     

Child maltreatment and trauma exposure among deaf and hard of hearing young adults

The purpose of the present study was to examine the prevalence of child maltreatment and lifetime exposure to other traumatic events in a sample of deaf and hard of hearing (DHH; n = 147) and matched hearing (H; n = 317) college students. Participants completed measures of child maltreatment (CM), adult victimization and trauma exposure, and current symptoms of posttraumatic stress disorder (PTSD). Overall, DHH participants reported significantly more instances of CM compared to H participants, with 76% of DHH reporting some type of childhood abuse or neglect. Additionally, DHH participants reported experiencing a higher number of different types of CM, and also reported increased incidents of lifetime trauma exposure and elevated PTSD symptoms. Severity of deafness increased the risk of maltreatment, with deaf participants reporting more instances of CM than hard of hearing participants, and hard of hearing participants reporting more instances of CM than H participants. Among DHH participants, having a deaf sibling was associated with reduced risk for victimization, and identification with the Deaf community was associated with fewer current symptoms of PTSD. A regression model including measures of childhood physical and sexual abuse significantly predicted adult re-victimization and accounted for 27% of the variance among DHH participants. DHH participants report significantly higher rates of CM, lifetime trauma, and PTSD symptoms compared to H participants. Severity of deafness appears to increase the risk of being victimized. Being part of the Deaf community and having access to others who are deaf appear to be important protective factors for psychological well-being among DHH individuals.     

The roles of peritraumatic dissociation, child physical abuse, and child sexual abuse in the development of posttraumatic stress disorder and adult victimization

OBJECTIVE: Previous research has indicated that women who experience childhood physical abuse or childhood sexual abuse are at increased risk for posttraumatic stress disorder (PTSD) and adult victimization. Recently, peritraumatic dissociation (PD) has been suggested as another possible risk factor for PTSD and adult victimization. The purpose of the present study was to investigate the effects of childhood physical and sexual abuse and PD on PTSD and adult victimization. METHOD: A sample of 467 female college students completed questionnaires about childhood and adult sexual and physical abuse experiences, PD, and PTSD symptoms. RESULTS: The combined sexual and physical abuse (CA) and sexual abuse only (SA) groups reported significantly higher numbers of PTSD symptoms than the physical abuse only (PA) and no abuse (NA) groups. The CA and PA groups reported significantly more adult sexual and physical victimization than the SA and NA groups. Across all four groups, higher levels of PD were associated with higher levels of PTSD and adult sexual and physical victimization. CONCLUSIONS: The results of the current study suggest that different types of childhood abuse may lead to different adult problems. The results also indicated that PD may have a broad effect on PTSD development and adult victimization.