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ABSTRACT: The predictive relations of peer victimization, depressive symptoms, and salivary cortisol on memory in 168 children aged 12 at Time 1 (T1) were examined using a longitudinal design in which data were collected on four occasions over a 2-year period. Results indicated that: (1) peer victimization, depressive symptoms, and evening cortisol were stable over time, (2) peer victimization and elevated symptoms of depression were concurrently linked at each time, (3) T1 peer victimization predicted elevated symptoms of depression at T2 which in turn predicted lower cortisol levels at T3, and (4) controlling for earlier associations, T3 peer victimization, depressive symptoms, and higher morning and evening cortisol levels uniquely predicted memory deficits at T4. The links between elevated cortisol, symptoms of depression, and poor memory are consistent with published research on depressed adults and extend the findings to children exposed to peer victimization. These findings highlight that peer abuse is harmful and may impact children's long-term mental health and memory functioning.
Brain and Cognition 08/2011; 77(2):191-9. · 3.17 Impact Factor
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ABSTRACT: We examined the associations between childhood physical and
sexual abuse and labor force outcomes in young adults and the
possible mediating effects of educational attainment, current mental
health, and physical health. Data from the Ontario Child
Health Study (N = 1,893), a province-wide longitudinal study
were analyzed. Controlling for childhood and demographic variables,
severe childhood physical abuse was significantly associated
with reduced income with small mediating effects. There was a
sex difference in the association between child abuse and employment.
Severe childhood physical abuse was significantly associated
with lower likelihood of employment only among males; mediators
partially reduced this association. Further research is needed
to explore the mechanisms linking exposure to child abuse and
economic vulnerability in young adults.
Journal of Aggression Maltreatment & Trauma 01/2011; 20(8):821-844.
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ABSTRACT: For child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse-teen dating violence link.
A random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales.
Over 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63-67%) and nearly half of males (44-49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings.
These results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others.
The present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths' conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare.
Child abuse & neglect 02/2009; 33(1):45-58. · 2.34 Impact Factor
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ABSTRACT: Abstract
Background
The current project undertook a province-wide survey and environmental scan of educational opportunities available to future health care providers on the topic of intimate partner violence (IPV) against women.
Methods
A team of experts identified university and college programs in Ontario, Canada as potential providers of IPV education to students in health care professions at the undergraduate and post-graduate levels. A telephone survey with contacts representing these programs was conducted between October 2005 and March 2006. The survey asked whether IPV-specific education was provided to learners, and if so, how and by whom.
Results
In total, 222 eligible programs in dentistry, medicine, nursing and other allied health professions were surveyed, and 95% (212/222) of programs responded. Of these, 57% reported offering some form of IPV-specific education, with undergraduate nursing (83%) and allied health (82%) programs having the highest rates. Fewer than half of undergraduate medical (43%) and dentistry (46%) programs offered IPV content. Postgraduate programs ranged from no IPV content provision (dentistry) to 41% offering content (nursing).
Conclusion
Significant variability exists across program areas regarding the methods for IPV education, its delivery and evaluation. The results of this project highlight that expectations for an active and consistent response by health care professionals to women experiencing the effects of violence may not match the realities of professional preparation.
BMC Medical Education. 01/2009;
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ABSTRACT: The mental health of Canada's Aboriginal women has received little scholarly attention. This paper describes the mental health of First Nations women living on reserve in Ontario and compares these findings with results from the National Population Health Survey (NPHS). Reserve communities were randomly selected within urban, rural, remote and special access regions. Depression was measured by the Composite International Diagnostic Interview. Alcohol use and health services utilization questions were identical to those used in the NPHS. Compared with NPHS women, First Nations women reported significantly higher rates of depression (18% vs 9%) but significantly lower rates of alcohol use (55% vs 74% reported drinking in the last year), although significantly greater proportions reported having 5+ drinks on one occasion (43% vs 24%). Given the burden of suffering associated with depression and the twofold risk found here, it is important to examine risk and protective factors specific to First Nations women. The findings of a higher proportion of abstainers, but also a higher proportion of consumers of 5+ drinks among First Nations women relative to NPHS women indicate the need for a more careful investigation, based on community rather than clinical data, of patterns of alcohol use.
Archives of Women s Mental Health 07/2008; 11(2):109-15. · 2.06 Impact Factor
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ABSTRACT: We sought to determine the proportion of Canadian emergency departments (EDs) that have intimate partner violence (IPV) universal screening programs and intervention policies and procedures. Of the EDs with programs, we determined what proportion had made changes in their practices during the past 10 years and since the 2003 Canadian Task Force on Preventive Health Care recommendations.
Using the same sampling methods as a 1994 study, we mailed questionnaires to nurse managers of a stratified, random sample of 250 out of 638 (39%) Canadian EDs and followed up with a series of telephone calls.
Of the 250 EDs initially contacted, 6 were excluded before the surveys were mailed. The response rate was 78.3% (191/244). Sixty-one (31.9%) of the studied EDs reported the existence of IPV policies and procedures. In this group, 26 (42.6%) applied universal screening and 13 (21.3%) implemented their screening policies after the 2003 national recommendations were published. When these results were compared with those of the 1994 study, there was no difference in the proportion of EDs with IPV policies and procedures or in the proportion of EDs that applied universal screening.
Despite increased research into IPV there was no significant change between 1994 and 2004 in the existence of IPV polices or universal screening in Canadian EDs. Policies and procedures that address appropriate responses to patients exposed to IPV should be a priority, with most emphasis directed toward developing effective interventions to which women can be referred.
CJEM: Canadian journal of emergency medical care = JCMU: journal canadien de soins medicaux d'urgence 07/2008; 10(4):325-8. · 1.18 Impact Factor
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ABSTRACT: This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3,381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship.
Journal of Interpersonal Violence 01/2008; 22(12):1536-54. · 1.64 Impact Factor
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ABSTRACT: Because of common use of adolescent simulated patients (ASPs), clarification of the risk of negative effects associated with high-stress simulations is essential. This study evaluates the safety of suicidality simulations.
ASPs participated in a suicidality role or pediatric role. Explicit measures of their impact included the Suicidal Ideation Questionnaire (SIQ) and Reynolds Adolescent Depression Scale-2 (RADS-2), both of which were completed pre-/poststudy. Implicit behavioral measures of impact were also collected during training, including the Implicit Association Test.
Three of the 24 participants had clinical RADS-2 and/or SIQ scores. None of these adolescents' mental status deteriorated with SP participation. ASPs in the suicidality role showed behavioral effects consistent with a negative reaction, and two reported brief depression.
ASPs participated in a suicidality simulation without evidence of suicide contagion. However, ASPs' behavioral reactions and self-reported depression suggested a transient depressive reaction.
Academic Medicine 11/2007; 82(10 Suppl):S61-4. · 3.52 Impact Factor
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ABSTRACT: Abstract
Background
Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors.
Methods
A modified Dillman Tailored Design approach was used to survey 1000 nurses and 1000 physicians by mail in Ontario, Canada. Respondents were randomly selected from professional directories and represented practice areas pre-identified from the literature as those most likely to care for women at the point of initial IPV disclosure: family practice, obstetrics and gynecology, emergency care, maternal/newborn care, and public health. The survey instrument had a case-based scenario followed by 43 questions asking about behaviours and resources specific to woman abuse.
Results
In total, 931 questionnaires were returned; 597 by nurses (59.7% response rate) and 328 by physicians (32.8% response rate). Overall, 32% of nurses and 42% of physicians reported routinely initiating the topic of IPV in practice. Principal components analysis identified eight constructs related to whether routine inquiry was conducted: preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures. Each construct was analyzed according to a number of related issues, including clinician training and experience with woman abuse, area of practice, and type of health care provider. Preparedness emerged as a key construct related to whether respondents routinely initiated the topic of IPV.
Conclusion
The present study provides new insight into the factors that facilitate and impede clinicians' decisions to address the issue of IPV with their female patients. Inadequate preparation, both educational and experiential, emerged as a key barrier to routine inquiry, as did the importance of the "real world" pressures associated with the daily context of primary care practice.
BMC Public Health. 01/2007;
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ABSTRACT: Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.
Social Science [?] Medicine 11/2006; 63(7):1711-9. · 2.70 Impact Factor
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ABSTRACT: Community-based population survey data were used to explore whether remaining in school, independent of achievement status, was associated with lower rates of psychopathology in adulthood among participants self-reporting exposure to child physical and/or sexual abuse. Remaining in school, independent of one's achievement status, was significantly associated with a lower probability of experiencing externalizing but not internalizing disorders. Theoretical and educational implications of these results are discussed.
American Journal of Orthopsychiatry 02/2006; 76(1):18-22. · 1.29 Impact Factor
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ABSTRACT: Child neglect is the most common type of child maltreatment. Our objective was to systematically evaluate the available evidence regarding the effectiveness of child neglect treatment programs, including those focused on victims of childhood neglect and (or) their caregivers.
We comprehensively searched the Medline, Psycinfo, and Eric databases from January 1980 to May 2003. Two authors independently reviewed 54 studies that met inclusion criteria. Fourteen articles met our design criterion and were assessed for their methodological quality according to guidelines developed by the US Preventive Services Task Force.
Of the 14 studies included in the review, 2 were rated as good, and 3 were rated as fair. We found evidence that 2 specific types of play therapy and a therapeutic day treatment program had beneficial effects for children. Further, parents and children in families where neglect had occurred showed improvement with multisystemic therapy.
Rigorous studies of treatments for neglected children and their families are lacking. Well-designed and well-conducted evaluations are urgently required to identify effective treatments, which should then be made available to children and their caregivers.
Canadian journal of psychiatry. Revue canadienne de psychiatrie 08/2005; 50(8):497-504. · 2.42 Impact Factor
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ABSTRACT: This exploratory study examined the discriminant validity of 10 human-figure features commonly used by many proponents of the draw-a-person (DAP) projective technique as evidence of childhood sexual abuse. Two exploratory features were also examined.
Rather than drawing human figures, 64 children (M = 8 years, 9 months), including 19 sexually abused children, 26 nonsexually abused but emotionally/behaviourally troubled children, and 19 nonabused, nonclinical children, were instructed to build male and female figures using groups of prefabricated pieces of human-figure body parts. Unbeknownst to the children, each group of parts contained a potential sexual abuse feature (or features).
None of the human-figure features under examination, either individually, or in combination, distinguished the sexually abused group from the other two groups of children.
In accordance with years worth of DAP projective technique research, no support for the validity of the human-figure features under examination as evidence of childhood sexual abuse, was found.
Child Abuse & Neglect 07/2005; 29(6):701-13. · 2.47 Impact Factor
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ABSTRACT: A history of child maltreatment increases the vulnerability to the development of Major Depressive Disorder (MDD) and/or Posttraumatic Stress Disorder (PTSD), especially in females. Both MDD and PTSD are associated with a dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Dysregulation of the HPA axis may be an important etiological link between child maltreatment and subsequent psychiatric disorder, yet little is known about the relationship between exposure and outcome. The aim of this review is to explore the role of HPA axis dysregulation in the link between child maltreatment and MDD/PTSD among women. Studies of females with MDD frequently indicate a hyperactivity of the HPA axis, and contribute to our understanding of the underlying mechanisms involved in mood dysregulation. Evidence for HPA axis dysregulation in PTSD is less convincing and suggests that timing of the stressful experience as well as the type of the trauma may influence the outcome. The strongest evidence to date suggesting that the development of the HPA axis may be affected by early life stressful experiences comes from pre-clinical animal studies. Together these studies add to our understanding of the role of the HPA axis in psychiatric disorders in relation to stress. The literature on HPA axis function in both children and adults following child maltreatment further highlights the potential relevance of early stress to later onset of major psychiatric disorders. Such knowledge may also contribute to the development of early interventions targeted at primary prevention.
Psychoneuroendocrinology 03/2005; 30(2):162-78. · 5.81 Impact Factor
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ABSTRACT: BACKGROUND TO THE DEBATE: The US and Canadian task forces on preventive health recently declared that there is not enough evidence to recommend for or against routine universal screening of women for domestic violence. Yet some experts argue that routine enquiry is justified.
PLoS Medicine 11/2004; 1(1):e4. · 16.27 Impact Factor
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ABSTRACT: "Permanency planning" refers to maximizing stability in living situations for children in the care of child protection agencies. This issue concerns pediatricians who may be involved in assessing and providing care for these children. In North America, permanency planning is widely advocated if not always effectively implemented. The concept, however, is still controversial from the perspective of protecting parents' interests. This paper examines the principles and evidence underlying the concept of permanency planning in order to ascertain whether emphasizing it remains justified in terms of children's emotional health and development. Three related bodies of literature are reviewed: requirements for healthy child development, conditions that create risk for children, and outcomes for children in care. The findings suggest that permanency planning is vitally important for children and is not only justified, but should be given major emphasis. The implications for pediatricians are discussed.
Journal of Developmental & Behavioral Pediatrics 09/2004; 25(4):285-92. · 2.13 Impact Factor
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ABSTRACT: Asking children and adolescents directly about their experience of sexual victimization overcomes some of the methodological weaknesses inherent in other approaches. Yet complex legal, ethical, and methodological issues remain. This paper reviews the psychometric properties of those questions or instruments that have measured exposure to child sexual abuse directly. A search of four electronic databases using descriptors "child sexual abuse" and "measurement" or "instrumentation" yielded four telephone administered tools, 13 face-to-face interviews, and 32 self-administered questionnaires. Few instruments had been subjected to rigorous evaluation. Establishing the validity and reliability of instruments measuring child sexual abuse and other forms of victimization are critical for the growth and expansion of the field.
Journal of Child Sexual Abuse 02/2004; 13(1):39-68. · 0.75 Impact Factor
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ABSTRACT: Despite growing public concern about child maltreatment, the scope and severity of this significant public health issue remains poorly understood. This article examines the nature and severity of the physical harm associated with reports of child maltreatment documented in the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS).
The CIS collected information directly from child welfare investigators about cases of reported child abuse or neglect. A multistage sampling design was used to track child-maltreatment investigations conducted at selected sites from October to December 1998. The analyses were based on the sample of 3780 cases in which child maltreatment was substantiated.
Some type of physical harm was documented in 18% of substantiated cases; most of these involved bruises, cuts and scrapes. In 4% of substantiated cases, harm was severe enough to require medical attention, and in less than 1% of substantiated cases, medical attention was sought for broken bones or head trauma. Harm was noted most often in cases of physical abuse compared to other forms of maltreatment.
Rates of physical harm were lower than expected. Current emphasis on mandatory reporting, abuse investigations and risk assessment may need to be tempered for cases in which physical harm is not the central concern.
Canadian Medical Association Journal 11/2003; 169(9):911-5. · 8.22 Impact Factor
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ABSTRACT: The study's goal was to examine the relationship between a history of parental psychiatric disorder and a history of child abuse in a general population sample of Ontario residents.
A representative community sample of 8548 respondents who participated in the Ontario Mental Health Supplement (OHSUP) were interviewed about parental psychiatric history and completed a self-report measure of childhood physical and sexual abuse.
The lifetime prevalence of either parent with a psychiatric disorder was as follows: 14.1% for depression, 3.7% for manic depression, 2.4% for schizophrenia, 2.4% for antisocial behavior, and 17.3% for any parental psychiatric disorder. Respondents reporting a parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. Parental history of antisocial disorder increased the risk of exposure to physical abuse (adjusted odds ratios [OR 6.1] and any abuse [OR 7.5]). There was no statistically significant difference between parental psychiatric disorder and childhood physical or sexual abuse by gender of the respondent. There was a trend for increasing risk associated with father only, mother only, and both parents having any psychiatric disorder.
The elevated risk for physical and sexual abuse among respondents reporting a parental history of psychiatric illness highlights the need to examine the mechanism for this association. Such information is important in developing approaches to assist families where the risk of child maltreatment is increased.
Child Abuse & Neglect 02/2002; 26(1):11-22. · 2.47 Impact Factor
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ABSTRACT: We examined the relationship between being bullied during childhood and activity of the hypothalamic-pituitary-adrenal (HPA) axis as assessed through repeated measures of salivary cortisol. A non-clinical sample of 154 (74 boys) predominantly Caucasian middle-class 12-year-olds each provided detailed information about their experiences with bullying and six saliva samples were standardized across time and day. Children with a history of child maltreatment, diagnosed psychiatric illness, foster care placement, medication use (psychotropic and oral contraception) and aggression directed toward peers and/or family members were excluded. Using multilevel regression and applying orthogonal polynomial contrasts to model the observed circadian pattern in the data, we found that occasional and frequent verbal peer victimization was associated with hyposecretion of cortisol when controlling for sex, pubertal status, age, depression and anxiety. This relation, however, was moderated by sex. For boys, occasional exposure was associated with higher cortisol levels, whereas for girls exposure was associated with lower cortisol levels. The present study highlights the need to consider the plight of peer-victimized children seriously, as it is associated with alterations to the HPA axis that affect males and females differently, and likely diminishes a person's ability to cope with stress, possibly placing them at risk for psychopathology and ill health.
Aggressive Behavior 34(3):294-305. · 2.63 Impact Factor
