American Psychology Association 2006

PARTNER ABUSE AND SUICIDAL BEHAVIOR AMONG LOW-INCOME AFRICAN AMERICAN WOMEN: 

PARTNER ABUSE AND SUICIDAL BEHAVIOR AMONG LOW-INCOME AFRICAN AMERICAN WOMEN Nadine J. Kaslow, Ph.D., ABPP Moderator August 12, 2006

THE GRADY NIA PROJECT: 

THE GRADY NIA PROJECT Funded by Centers for Disease Control & Prevention An intervention study for abused, African American, suicide attempters Participation includes Initial interview (Time One) Assignment to enhanced treatment as usual or 10-week intervention Post Intervention Interview (Time Two) Six-Month Follow-up Interview (Time Three) One-Year Follow-up Interview (Time Four)

MEDIATORS OF THE ASSOCIATION BETWEEN CHILDHOOD TRAUMA AND ADULT SUICIDALITY AMONG ABUSED, AFRICAN AMERICAN WOMEN: 

MEDIATORS OF THE ASSOCIATION BETWEEN CHILDHOOD TRAUMA AND ADULT SUICIDALITY AMONG ABUSED, AFRICAN AMERICAN WOMEN Kafi S. Bethea, BA Michael T. Compton, MD, MPH

BACKGROUND: 

BACKGROUND Traumatic experiences in childhood, such as sexual abuse, physical abuse and neglect, or emotional abuse and neglect, are associated with long-term difficulties that extend into adulthood Akyuz, Sar, Kugu, Dogan (2005) Edwards, Holden, Felitti, Anda (2003)

BACKGROUND: 

BACKGROUND Childhood trauma is a risk factor for suicidal behavior in adolescents and adults Rates of childhood trauma among suicide attempters range from 9 to 20% Little research explains why some women who have experienced abuse or neglect during childhood go on to later make a suicide attempt while others do not. Read, Agar, Barker-Collo, Davies, & Moskowitz (2001)

PURPOSE: 

PURPOSE The purpose of this investigation was to explore the relation between traumatic experiences in childhood and later suicide attempts.

HYPOTHESIS: 

HYPOTHESIS It was hypothesized that self-esteem, expectations of success, and positive coping strategies will mediate the link between childhood traumatic events and adult suicidality using a sample of low-income, abused, African American women

SAMPLE: 

SAMPLE Low-income African American women Involved in a relationship with an abusive partner within the past year Engaged in behavior in the past year that they considered to be making a suicide attempt N = 209 Age = 34.8 (SD = 9.4)

SAMPLE: 

SAMPLE 30.3% (N=63) have never been married and 59.9% (N=121) were currently in an abusive relationship 81.6% (N=168) had children, but in 50.5% of cases, the children did not live with the participant 40.4% (N=84) had less than 12th grade education and 84.6% (N=176) were unemployed 71.2% (N=148) had a history of psychiatric or substance abuse treatment

PROCEDURE: 

PROCEDURE IRB approved research protocol Informed consent was obtained Women were recruited from waiting areas, clinics, and emergency rooms at a large, urban hospital Trained interviewers administered a battery of self-report measures Women were financially compensated Referrals were made for additional resources

MEASURES: 

MEASURES Predictor Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998) Emotional Abuse Emotional Neglect Physical Abuse Physical Neglect Sexual Abuse Outcome Beck Scale for Suicide Ideation (BSS; Beck & Steer, 1991) Suicide Ideation

MEASURES: 

MEASURES Mediators Beck Hopelessness Scale (BHS; Beck & Steer, 1988) Expectations of Success Taylor Self-Esteem Inventory (TSI; Taylor & Tomasic, 1996) Rewards – Costs = Self-Esteem Brief COPE (BCOPE; Carver,1997) Positive Coping Strategies Active Coping Positive Reframing Planning Using Emotional Support Using Instrumental Support

DATA ANALYSIS: 

DATA ANALYSIS The Linear Structural Relations Program (LISREL version 8.52) was used for path analyses examining the direct and indirect effects of childhood trauma on suicidal ideation; and the direct effects of childhood trauma on self-esteem, expectations of success, and positive coping Childhood Trauma Emotional Abuse Emotional Neglect Physical Abuse Physical Neglect Sexual Abuse Expectations of Success Self-Esteem Positive Coping Suicidal Ideation

RESULTS: 

RESULTS The data supported a model in which emotional neglect has substantial effects on self-esteem and expectation of success Self-esteem mediated the association between emotional neglect and later suicidal ideation Goodness-of-fit indices for a final trimmed model that eliminated the positive coping path from the initial postulated model revealed good fit to the data

Results: 

Results The final model indicates that emotional neglect in childhood has an indirect path to later suicidal ideation through self-esteem and expectations of success Emotional Neglect Expectations of Success Self-Esteem Suicidal Ideation -0.15 -0.16 0.43 -0.43 1.00 0.98 0.77 0.82 Chi- Square=3.18, df=2, p=0.20365, RMSEA=0.054

CONCLUSIONS: 

CONCLUSIONS Taken together, these findings suggest that interventions for low-income African American women who have experienced childhood trauma should focus on increasing self-esteem, and adaptive coping strategies in order to decrease these women’s risk for suicidal behavior

IMPLICATIONS: 

IMPLICATIONS Intervention/Clinical: For childhood victims of neglect, intervention/clinical efforts should focus on increasing self-esteem and hopefulness Policy: Policy makers should pay more attention to neglected children in addition to abused children The community needs to be educated about the definitions and ramifications of neglect Future Research: Future research should focus on the long-term effects of neglect as well as on abuse

ACCESS TO RESOURCES AS A MODERATOR OF THE RELATION BETWEEN CHILDHOOD ABUSE AND LEVEL OF INTIMATE PARTNER VIOLENCE (IPV) Sarah E. Dunn, MACarli H. Jacobs, MA: 

ACCESS TO RESOURCES AS A MODERATOR OF THE RELATION BETWEEN CHILDHOOD ABUSE AND LEVEL OF INTIMATE PARTNER VIOLENCE (IPV) Sarah E. Dunn, MA Carli H. Jacobs, MA

BACKGROUND: 

BACKGROUND Previously, childhood traumatic events predicted higher levels of current adulthood psychological distress (Grella, Stein & Greenwell, 2005) Women are two to three times more likely to be victims of IPV as adults if they were abused as children (Coid, Petruckevitch, Feder, Chung, Richardson, & Moorey, 2001). Risk of IPV (physical and non-physical) increases with number of types of childhood abuse suffered (Whitfield, Anda, Dube, & Felitti, 2003). Effectiveness in obtaining resources has been found to serve as a protective factor for negative future events (Kaslow, Thompson, Okun, Price, Young, Bender, Wyckoff, Twomey, Goldin & Parker, 2002).

PURPOSE: 

PURPOSE Previous research has consistently found a link between childhood abuse and negative life events later in adulthood Subsequently, the current study aimed to examine the relation between specific types of child abuse and Intimate Partner Violence (IPV) in adulthood, and how the ability to access resources may affect this relation

HYPOTHESES: 

HYPOTHESES Participants who experienced higher levels of childhood abuse (sexual, physical and emotional) report higher levels of adulthood IPV (physical and non-physical) Access to resources would moderate the relation between childhood abuse and adulthood IPV

MEASURES: 

MEASURES Childhood Trauma Questionnaire – Short Form (CTQ) (Bernstien et al.,1994) Index of Spouse Abuse (ISA) (Hudson & McIntosh, 1981) Effectiveness of Obtaining Resources (EOR) (Sullivan et al.,1992)

Slide23: 

MEASURES - EOR Not very Effective Slightly Effective Somewhat Effective Very Effective 1 2 3 4

ANALYSES: 

ANALYSES Childhood Abuse (CTQ) Sexual Abuse (CSA) Physical Abuse (CPA) Emotional Abuse (CEA) IPV (ISA) Physical (P) Non-physical (NP) Access to Resources (EOR)

OVERALL RESULTS: 

OVERALL RESULTS

RESULTS: 

RESULTS *p<.05

RESULTS: 

RESULTS *p<.05; **p<.01

CONCLUSIONS: 

CONCLUSIONS A significant positive relation exists between childhood abuse (all types) and adult IPV (physical & non-physical) The nature and degree of adult IPV may depend on the type of abuse one suffered as a child Access to resources clearly plays a vital role in protecting women who are at risk for IPV based on their experiences of abuse in childhood

IMPLICATIONS: 

IMPLICATIONS Intervention/Clinical: Psychoeducation regarding how to access resources and the value of resources for women abused as children and/or in IPV + relationships Policy: Funding for resources Decrease barriers to accessing resources Future research: Reasons for current findings Examine the effect of most effective types of resources Examine if interventions that target securing resources are associated with better outcomes

COPING MODERATES THE STRESS-DISTRESS RELATION AMONG AFRICAN AMERICAN WOMEN : 

COPING MODERATES THE STRESS-DISTRESS RELATION AMONG AFRICAN AMERICAN WOMEN Carli H. Jacobs, MA Sarah E. Dunn, MA

BACKGROUND: 

BACKGROUND Both adaptive and maladaptive coping styles have been linked to individuals’ subjective reports of experience of life stress (Wong & Wong, 2006; Seiffge-Krenke, 2004) Psychological outcomes are negatively affected by life stress (Brantley, Dutton, & Grothe, 2005)

BACKGROUND: 

BACKGROUND Poorer coping skills predict increases in negative psychological outcomes (Seiffge-Krenke, 2004) Coping strategies have been found to mitigate or exacerbate the relation between life stress and negative psychological outcomes (e.g., Sarafino, 1994)

PURPOSE: 

PURPOSE This is one of the first studies to explore qualifiers (adaptive and maladaptive coping) of the association between life stress and psychological outcomes among low-income African American women (Bennett, Merritt, & Sollers, 2004)

HYPOTHESES: 

HYPOTHESES Life stress would be significantly, positively associated with symptoms of psychological distress Adaptive coping strategies would mitigate the stress-distress relation Maladaptive coping strategies would exacerbate the stress-distress relation

METHODS: MEASURES: 

METHODS: MEASURES Hassles Scale Survey of Recent Life Events (RLE; Kohn & MacDonald, 1992) Brief Cope (BCOPE; Carver, 1997) Adaptive - Active Coping - Positive Reframing - Acceptance - Instrumental Support Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) Brief Symptom Inventory (BSI; Derogatis, 1993) Global Symptom Index Maladaptive - Distraction - Self-Blaming - Venting - Denial

METHODS: DATA ANALYSIS: 

METHODS: DATA ANALYSIS Life Stress (1) Global Symptom Index (2) Depressive Symptoms Adaptive Maladaptive (1) Active Coping (5) Distraction (2) Positive Reframing (6) Self-Blaming (3) Acceptance (7) Venting (4) Instrumental Support (8) Denial Hierarchical multiple regressions were used to test each coping variable as a moderator of the life stress-symptom outcome relation

GLOBAL FINDINGS: ADAPTIVE: 

GLOBAL FINDINGS: ADAPTIVE

GLOBAL FINDINGS:MALADAPTIVE: 

GLOBAL FINDINGS:MALADAPTIVE

MODERATION RESULTS: 

MODERATION RESULTS

MODERATION RESULTS: 

MODERATION RESULTS

CONCLUSIONS: 

CONCLUSIONS Stressful life events consistently predicted both depressive symptoms and global distress Adaptive coping was a strong predictor of decreases in depressive symptoms Maladaptive coping predicted increases in both depressive symptoms and global distress Self-blaming had an especially detrimental consequence for the psychological functioning of low-income African American women under low levels of life stress Seeking instrumental support emerged as a protective factor

IMPLICATIONS: 

IMPLICATIONS Intervention/Clinical: Bolstering adaptive coping skills and identifying maladaptive coping patterns is important for low-income African American women Policy: Need resources available to reduce life stress Areas of focus: employment, neighborhoods, transportation, and childcare Future research: Test model with other ethnic groups Investigate other risk and protective factors Explore other moderators of the stress-distress relation Explore mediators of the stress-distress relation

LONGITUDINAL RELATION BETWEEN EMPLOYMENT, DEPRESSIVE SYMPTOMS, AND SUICIDAL IDEATION IN ABUSED, SUICIDAL AFRICAN AMERICAN WOMEN: 

LONGITUDINAL RELATION BETWEEN EMPLOYMENT, DEPRESSIVE SYMPTOMS, AND SUICIDAL IDEATION IN ABUSED, SUICIDAL AFRICAN AMERICAN WOMEN Natalie C. Arnette, M.S. Nathan Mascaro, Ph.D.

BACKGROUND: 

BACKGROUND Unemployment is a risk factor for depressive symptoms (Catalano et al., 2000; Vuori & Silvonen, 2005) and suicidal behavior (Kraut & Walld, 2003) Obtaining employment has beneficial effects on mood and depressive symptoms (Bromberger & Matthews, 1994) More longitudinal research is needed to clarify the ways in which employment and suicidal behavior influence one another

PURPOSE: 

PURPOSE Given that depressive symptoms and disorders are risk factors for unemployment, and unemployment is a risk factor for depressive symptoms and suicidality, the present study sought to assess the nuanced relations among depressive symptoms, suicidality, and employment

HYPOTHESES: 

HYPOTHESES Level of depressive symptoms at T1 would predict employment at T2 Level of suicidal ideation at T1 would predict employment at T2 Change in employment status during the 1st 10 weeks of the study would predict long-term (1-year) levels of depressive symptoms Change in employment status during 1st 10 weeks would predict long-term levels of suicidal ideation

MEASURES: 

MEASURES Employment status was assessed at T1, as well as 10-wk. and 1-yr. follow-up Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996) Beck Scale for Suicide Ideation (BSS; Beck, Kovacs, & Weissman, 1979; Beck & Steer, 1991) Hassles Scale Survey of Recent Life Experiences (Kohn & MacDondald, 1992)

DATA ANALYSIS: 

DATA ANALYSIS Hierarchical Logistic Regression Analyses were conducted to assess the ability of depressive symptoms and suicidal ideation to predict employment, as well as the ability of employment to predict depressive symptoms and suicidal ideation Depressive Symptoms Suicidal Ideation Employment Status

PROSPECTIVE PREDICTION OF EMPLOYMENT STATUS BY DEPRESSIVE SYMPTOMS: 

PROSPECTIVE PREDICTION OF EMPLOYMENT STATUS BY DEPRESSIVE SYMPTOMS Consistent with the first two hypotheses, T1 BDI-II and BSS scores predicted T2 employment status, controlling for baseline employment status For every one unit increase in baseline BDI-II scores, the odds ratio for being employed at T2 vs. being unemployed decreased by 7% (b = -.074, SE = .035, p < .05, OR = .929) A one unit increase in baseline BSS scores was related to a 9% decrease in the odds ratio for being employed at T2 vs not employed (b = -.094, SE = .050, p < .05, OR = .911) In other words, women who were more depressed or suicidal at T1 were more likely to lose employment and less likely to gain employment by T2

EMPLOYMENT STATUS’ PREDICTION OF DEPRESSIVE SYMPTOMS OVER TIME: 

EMPLOYMENT STATUS’ PREDICTION OF DEPRESSIVE SYMPTOMS OVER TIME Regression analysis assessed the ability of change in employment status to predict depressive symptoms (Hypothesis 3) Changes in employment status from T1 to T2 predicted 12% of the variance in one-year follow-up BDI-II scores, in addition to the variance predicted by T1 BDI-II scores and changes in such scores from T1 to T2 Women who lost employment by T2 were more depressed one year later than women who gained employment However, change in employment status did not predict BSS scores at 1-year follow-up

ROLE OF DAILY STRESSORS: 

ROLE OF DAILY STRESSORS The amount of daily stressors experienced at baseline predicted variance in 10-week employment status above and beyond that predicted by T1 depressive symptoms and suicidal ideation (Odds ratios of .93 and .94 when controlling for BDI-II and BSS respectively) Entering stress into the prediction of ten-week employment status reduced the predictive ability of the BDI-II and BSS to non-significance

CONCLUSIONS: 

CONCLUSIONS Complex relation between employment status and suicidal/depressive symptoms among impoverished, African American sample of females who have undergone major recent life stresses (i.e., IPV and a suicide attempt) Women with higher levels of depressive symptoms and suicidality at T1 were more vulnerable to job loss (and less likely to obtain employment) during the first ten weeks of the study. Changes in employment status during the initial ten weeks of the study predicted changes in levels of depressive symptoms, but not suicidality, during the subsequent year

CONCLUSIONS: 

CONCLUSIONS The degree of daily stressors, and the suicidal ideation and depressive symptoms that accompany them, predict whether or not participants would gain or lose employment in the short term, and this change in employment predicted long-term depressive symptoms levels

IMPLICATIONS: 

IMPLICATIONS Intervention/Clinical: Greater attention to job skills and placement during intervention Helping women maintain lower levels of daily stress Policy: Welfare vs. work Research: Need for further investigations of the complex relations between suicidality and depressive symptoms and employment