Adverse childhood experiences and delinquent behaviour: Predictors and mediating variables

ABSTRACT Background: Adverse childhood experiences (ACEs) have been identified as a risk factor for the development of mental health and behavioural outcomes throughout life, including delinquent behaviours. This article focuses on the relationship between ACEs and delinquent behaviour (DB), seeking to identify predictors and mediating variables. Methods: The quantitative study comprised 175 Portuguese adolescents, aged 12 and 17 years of age (M = 14.99, SD = 2.26). Results: ACEs and exposure to traumatic events (ETE) are predictive of DB. Antisocial traits (AT) was found to be mediating the relationship between ACEs and DB, as well as the relation between ETE and DB. Conclusion: The results indicate that it is necessary that professionals in health behaviour field prevent and intervene in ACEs and in ETE, both predictors of DB. The results of this study allow to understand the role of ACEs in DB and its mediating variables, which must be considered to mitigate the harmful impact of ACEs in DB.

The prevalence of post traumatic stress disorder in an army unit and its relationship with functional gastrointestinal disorders / 解放军医学杂志

Objective To determine the prevalence of post traumatic stress disorder (PTSD) in the army officers and soldiers (AOSs),and identify its relationship with functional gastrointestinal disorders (FGIDs).Methods PTSD and FGIDs were diagnosed based on the PTSD checklist--civilian (PCL-C) and Rome Ⅲ Modular Questionnaire respectively,the overlaps of PTSD and FGIDs and their correlation were diagnosed.The correlation of PTSD with traumatic and stressful events was investigated using Trauma History and Stressful Event Screening Questionnaire.The coexistence and relationship of PTSD and FGIDs were analyzed.Results Of 927 AOSs,33 were diagnosed with PTSD.The prevalence of PTSD was 3.56％.FGIDs were identified in 435 subjects and the incidence of FGIDs was 46.93％.Among 33 AOSs with PTSD,28 were diagnosed as having FGIDs and the prevalence of FGIDs was 84.85％,which was significantly higher than that of non-PTSD group (45.53％,P＜0.05).Moreover,the FGIDs group had a higher prevalence of PTSD,compared with the non-FGID group (6.43％ vs.1.02％,P＜0.05).Cyclic vomiting syndrome (CVS,33.33％),unspecified functional bowel disorder (24.24％),functional bloating (18.18％) and functional anorectal pain (18.18％) were the four most frequent FGIDs in PTSD AOSs.Multiple regression analysis showed PTSD was the risk factor for CVS (OR=9.118),functional anorectal pain (OR=3.373),functional bloating (OR=4.772),irritable bowel syndrome (OR=3.438),rumination syndrome (OR=16.033),functional vomiting (OR=10.329),functional dysphagia (OR=9.891)(P＜0.05).CVS (OR=4.063),the number of traumatic (OR=1.159) and stress events (OR=1.401) were the risk factors for PTSD in AOSs (P＜0.05).Conclusions PTSD and FGID interact as risk factor each other.The prevalence of PTSD differs significantly in different FGIDs.CVS is the most frequent FGID in PTSD AOSs and risk factor for PTSD,which deserves more concerns.

Investigation of Diagnosis and Treatment of Post-Traumatic Stress Disorder with Moral Injury / 中国医学伦理学

Post-Traumatic Stress Disorder ( PTSD) is a common psychiatric disorder with complicated symp-toms and prolonged course of disease, seriously damages social function of patients and can cause excessive con-sumption of medical resources. As pathogenic factor of PTSD, moral injury has its special pathogenic mechanism. PTSD with moral injury has more symptoms and poorer prognosis, leading to a higher risk of suicide and more com-plicated treatment. Theoretical research from the perspective of psychology and ethics, etiological and clinical re-search from the perspective of biomedical may provide the solution to PTSD with moral injury.

Relationship between Traumatic Events, Stress Coping Strategies and Post-Traumatic Stress Symptoms among Social Workers in Public Sector

OBJECTIVES: Social workers can suffer from occupational stress resulting from dealing with clients, which might lead to metal health problems. We aimed to investigate the association of duty-related traumatic experiences and stress coping strategies with posttraumatic stress symptoms among social workers in public sector. METHODS: A total of 110 social workers in public sector (men 30.9%, 36.5 +/- 7.6 yrs) participated in this study. All subjects were evaluated the frequency and the impact of duty-related traumatic events. Additionally, they completed questionnaires including the Impact of Event Scale-Revised for post-traumatic stress symptoms, the Beck Depression Inventory-II for depressive symptoms, the Scale for Suicidal Ideation for suicide symptoms and the Ways of Coping Checklist for stress coping strategies. RESULTS: The most frequent traumatic events were "Violent or abusive language from a client" (95.0%) and "Client made a fuss" (94.5%). The most distressing traumatic event was "Seeing a dead body on duty" (7.6 out of 10), which predicted post-traumatic stress symptoms (odds ratio 4.04 ; 95% confidence interval, 1.79-9.11). Among 4 types of stress coping strategies, the emotion-focused coping was positively correlated with post-traumatic stress symptoms after controlling age and sex (beta = 0.50, p < 0.001). CONCLUSIONS: Social workers in public sector showed high level of post-traumatic stress symptoms. Duty-related traumatic events and the emotional-focused coping strategies were associated with the severity of post-traumatic stress symptoms. The modification of stress coping strategies would alleviate post-traumatic stress symptoms in social workers in public sector.

Influencing Factors on Turnover Intention of Nurses in Emergency Department / 한국직업건강간호학회지

PURPOSE: This study was to identify the factors determining the turnover intention of nurses in Emergency Department (ED). METHODS: The subjects were 123 ED nurses working at 10 general hospitals in Busan, Korea. The data were collected from August 15th to September 22nd, 2013. The collected data were analyzed using the SPSS program through descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients and stepwise multiple regression. RESULTS: There were positive correlations between traumatic events experience and post-traumatic stress (r=.416, p<.001), between depression and traumatic events experience (r=.212, p=.001), between traumatic events experience and turnover intention (r=.289, p=.001), between post-traumatic stress and depression (r=.251, p=.005), and also between depression and turnover intention (r=.315, p<.001). Factors influencing turnover intention were depression and traumatic events experience with R2 value 16.7%. CONCLUSION: Considering these results, it seems that the important factors determining the turnover intention of nurses in ED are depression and traumatic events experienced by nurses. Therefore, an active plan is needed to develop strategies for reducing nurses' depression and traumatic events experienced by nurses.

Depression, Anxiety and Somatic Complaints in Colombian Children Living in Rural Communities / Depresión, ansiedad y síntomas somáticos en niños que viven en comunidades rurales colombianas

Introduction: In Colombia, children are frequently exposed to traumatic events; however, there are no data regarding the impact on depression, anxiety and somatic correlates of such exposure in children living in rural communities. Objective: To investigate the somatic complaints and symptoms of depression and anxiety among children exposed to traumatic events in a rural community of Colombia. Methods: Design: Cross-Sectional study. Participants: Two hundred and ninety-three Colombian children aged eight to 18 years. Main Outcome Measures: Standardized measures were administered to assess children's depression, anxiety, physical symptoms and exposure to traumatic events. Depression: CDI (Children's Depression Inventory); anxiety: SCARED (The Screen for Child Anxiety Related Emotional Disorders); somatic complaints: CBCL (Child Behavior Checklist, Somatic Complaints scale) and reporting traumatic events during the K-SADS-PL (Diagnostic Interview for Children and Adolescents). Results: Ninety-one of the 293 children (31.1%) reported somatic complaints. The most common somatic complaint was in the gastrointestinal category (35/91). One hundred and seventy eight children (60.5%) had observed traumatic events, including homicides during the last month. Two hundred five (69.9%) of the children showed depressive symptom profiles above established norms, and 239 (81.6%) exhibited anxiety symptoms according to their own reports. The correlation between depression and traumatic events, anxiety and somatic complaints, and between anxiety and depression were statistically significant (p<0.005). Conclusions: As the first study of its kind in children living in rural communities in Colombia, it demonstrates a clear impact of traumatic events on mental health. Information that somatic complaints are commonly an expression of underlying depression and anxiety may facilitate the treatment and thereby help avoid unnecessary medical workups and sequelae from traumatized children. It is important for physicians to probe for "hidden" symptoms in traumatized children.

Introducción: En Colombia, los niños están expuestos con frecuencia a eventos traumáticos, sin embargo, no hay datos sobre el impacto de la depresión, la ansiedad y la correlación somática de dicha exposición en niños que viven en comunidades rurales. Objetivo: investigar las alteraciones somáticas, síntomas de depresión y ansiedad en los niños expuestos a eventos traumáticos en una comunidad rural de Colombia. Metodología: Diseño: Estudio transversal; Participantes: Doscientos noventa y tres niños colombianos de ocho a 18 años. Principales medidas de resultado: se aplicaron medidas estandarizadas para evaluar la depresión infantil, ansiedad, síntomas físicos y la exposición a eventos traumáticos. Depresión:CDI (Children's Depression Inventory)). Ansiedad: SCARED (The Screen for Child Anxiety Related Emotional Disorders), Enfermedades somáticas: CBCL (Child Behavior Checklist, Somatic Complaints scale) e informar los eventos traumáticos durante el K -SADS -PL (Diagnostic Interview for Children and Adolescents). Resultados: Noventa y uno de los 293 niños ( 31,1 % ) informaron de síntomas somáticos. La queja somática más común estuvo en la categoría gastrointestinal (35/ 91). Ciento setenta y ocho niños ( 60,5 % ) habían observado los acontecimientos traumáticos, incluyendo homicidios durante el último mes. Doscientos cinco ( 69,9 % ) de los niños mostraron perfiles de síntomas depresivos por encima de las normas establecidas, y 239 ( 81,6 % ) presentaban síntomas de ansiedad según sus propios informes. La correlación entre la depresión y los eventos traumáticos, la ansiedad y quejas somáticas, y entre la ansiedad y la depresión fueron estadísticamente significativas ( p < 0,005 ). Conclusiones: como el primer estudio de su tipo en los niños que viven en comunidades rurales de Colombia , demuestra un claro impacto de eventos traumáticos en la salud mental. La afirmación que las quejas somáticas son comúnmente una expresión de la depresión y la ansiedad subyacente puede facilitar el tratamiento y de ese modo ayudar a evitar abordajes médicos innecesarios y secuelas en los niños traumatizados . Es importante para los médicos explorar los síntomas "ocultos" en los niños traumatizados.

Factorial Validity and Psychometric Properties of the Korean Version of the Children's Response to Traumatic Events Scale-Revised in Recently Traumatized School Children / 신경정신의학

OBJECTIVES: Posttraumatic stress disorder (PTSD) in children is prevalent and often persists for many years after the trauma. Therefore, screening and early detection using psychometrically sound instruments is a pivotal element of appropriate management. This study tested the reliability and validity of a Korean version of the Child Reaction to Traumatic Events Scale-Revised (K-CRTES-R) in a sample of recently traumatized school children. METHODS: The K-CRTES was administered to a total of 464 school children aged ten to twelve who had witnessed or had been confronted with a tragic accident involving three deaths. Internal consistency, two week test-retest reliability, and construct validity were assessed. A non-random portion of participants also completed the State Anxiety Inventory and the Subjective Unit of Distress Scale for testing convergent validity. Exploratory factor analysis was conducted for a random half of participants (n=232), and, for the remaining half, we tested the model fit by performance of confirmatory factor analysis. RESULTS: Two week test-retest reliability was high (r=0.85), and internal consistency was excellent (Cronbach alpha=0.92). The total score for the K-CRTES-R showed significant correlation with state anxiety and subjective level of anxiety, thus confirming its convergent validity. In addition, the K-CRTES-R distinguished between direct exposure and indirect confrontation, demonstrating the discriminant validity of the scale. In addition, we confirmed the factorial validity by identifying a two-factor structure (intrusion-hyperarousal and avoidance) that explained 56% of the total variance. This two factor solution and other previously suggested PTSD models showed fit indices that were within an acceptable range. CONCLUSION: Findings of our study indicate that the K-CRTES-R is a good measure of reliability and validity that can be used to assess the impact of trauma in Korean speaking children.

The Relationship between Alcohol Consumption and Exposure to Traumatic Events in Male Firefighters / 신경정신의학

OBJECTIVES: This study explored the relationship between alcohol consumption and exposure to traumatic events in male firefighters. METHODS: Data was collected from a sample of 584 firefighters at urban fire stations. We surveyed the firefighters using self-administered questionnaires including sociodemographic and job-related characteristics such as the Alcohol Use Disorders Identification Test (AUDIT), Life Event Checklist (LEC), Perceived Stress Scale (PSS), Korean Occupational Stress Scale-Short Form (KOSS-SF), Impacted Event Scale-Revised (IES-R), Stait Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). RESULTS: There were significant differences in smoking, traumatic events (LEC), post-traumatic stress disorder symptoms (IES-R), and anxiety (STAI-T) between the two drinking groups (p<0.05). In multivariate logistic regression, smoking (OR=2.084, 95% CI=1.172-3.705), LEC (OR=1.163, 95% CI=1.010-1.339) and IES-R (OR=1.024, 95% CI=1.002-1.046) were significant predictors for AUDIT (p<0.05). CONCLUSION: These results indicate that an appropriate intervention about the exposure to traumatic events should play a useful role in preventing firefighter alcohol problems.

Controversias respecto de la conceptualización del trastorno de estrés postraumático / Controversies in regards to the conceptualization of the post-traumatic stress disorder

Las controversias respecto al TEPT, desde su formulación como categoría diagnóstica hasta el presente, han sido múltiples. Se han planteado interrogantes respecto de su estatus como concepto científico por los factores socio históricos que influyeron tanto en su origen como categoría como en la expansión de su empleo, así como cuestionamientos específicos a su validez de constructo. El concepto de evento traumático, la relación de causalidad entre evento traumático y consecuencias psicopatológicas, la especificidad que tendría la respuesta traumática, son parte relevante de esos cuestionamientos. El artículo presenta una visión de estas controversias y señala sus implicaciones para la comprensión y tratamiento de las consecuencias psicológicas de los eventos traumáticos.

The controversies respect to the PTSD, since its formulation as a diagnostic category up to the present, have been multiple. Questions have been posed in relationship to its status as a scientific concept because due to socio-historical factors that influenced in its origin as a category as well as in the expansion of its use. Also, queries have been raised concerning the validity of this construct. The concept of traumatic event, the causal relationship between the traumatic event and its psychopathological consequences, the specificity of the traumatic response, are relevant parts of these queries. The article presents an overview of these controversies and states its implications for the understanding and treatment of the psychological consequences of traumatic events.

Análisis de los deseos en dos cartas de Frida Kahlo / Analysis of desires in two letters by Frida Kahlo

A partir de dos cartas de Frida Kahlo (27 de marzo de 1927 y 29 de julio de 1932), serán analizados los deseos manifiestos y su relación con el período vital de la artista, remitiéndonos a la obra de arte en el mismo período histórico (Autorretrato con traje de terciopelo, septiembre de 1926, y Mi nacimiento o Nacimiento, 1932). El instrumento metodológico utilizado es el Diccionario Computarizado y las grillas diseñadas para el análisis de los actos del habla, aplicadas en los textos seleccionados. El resultado esperado es detectar los deseos dominantes, con independencia de los prejuicios que pueden generarse desde la biografía de la artista, en sus manifestaciones artísticas y cartas.

Based on two of Frida Kahlo’s letters (27 March 1927-29 July 1932), the manifest wishes and their relationship to the vital period of the artist will be analyzed, by referring to the work of art in the same historical period (Self-portrait in velvet clothes, September 1926, and My birth or Birth, 1932). The methodological instrument usedis the Computerized Dictionary and the grids designed for the analysis of speechacts, applied in selected texts. The expected outcome is the detection of the dominant wishes irrespective of the prejudices that could stem from the biography of the artist in its artistic manifestations and letters.

Los eventos traumáticos tempranos y su relación con la psicopatía criminal / Early traumatic events and its relationship with criminal psychopathy

INTRODUCCION: Son diversos los factores que intervienen en el desarrollo de la psicopatía. Se ha observado una predisposición genética que al interactuar con la vivencia de eventos traumáticos en edades tempranas, potencia el desarrollo de este trastorno conductual, fuente de actos agresivos y violentos en contra de la sociedad. OBJETIVO: Conocer la incidencia de eventos traumáticos (p.ej. eventos estresantes, abuso físico, abuso emocional y abuso sexual) y su influencia en el nivel de psicopatía de adultos convictos masculinos. PARTICIPANTES Y MATERIAL: Se realizó una revisión del historial criminal y una entrevista semiestructurada para clasificar a los internos de acuerdo a su nivel de psicopatía. Se les aplicó el Inventario de Eventos Traumáticos para conocer la frecuencia y diversidad de eventos sufridos antes de los 18 años. RESULTADOS: Los internos con alta psicopatía presentaron una alta incidencia de eventos traumáticos, específicamente de eventos estresantes, de abuso emocional y de abuso sexual y un total de eventos significativamente mayor que el grupo con psicopatía baja. Los eventos traumáticos y el abuso emocional fueron variables que contribuyeron significativamente al nivel de psicopatía de los internos. CONCLUSIONES: Los eventos traumáticos vividos durante la infancia y la adolescencia favorecen la manifestación de conductas violentas a través de la afectación de los mecanismos neurobiológicos que subyacen a la psicopatía, en donde se puede observar una asociación entre la frecuencia de eventos vividos y el grado de psicopatía presentes en la vida adulta.

INTRODUCTION: The factors that interact to drive the development of psychopathy are diverse. A genetic predisposition has been observed that, when coupled with the experience of traumatic events at a young age, potentiates the development of this behavioral and affective disorder that leads to aggressive and violent acts against society. OBJECTIVES: To understand the incidence of traumatic events (e.g., stressful events, physical abuse, emotional abuse, and sexual abuse) and their influence in the psychopathy of adult male convicts. PARTICIPANTS AND MATERIALS: Background criminal career reviews and semi-structured interviews were conducted to classify the inmates according to their psychopathy level utilizing the Revised Hare Psychopathic Scale. In addition, the Early Trauma Inventory was applied to assess the frequency and diversity of events experienced before the participants were 18 years of age. RESULTS: Inmates with high psychopathy also presented with a high incidence of traumatic events, as well as stressful events, emotional and sexual abuse in a higher frequency than the group with low psychopathy. The incidence of traumatic events and emotional abuse were found to predict the degree of psychopathy among the inmates. CONCLUSIONS: Traumatic events experienced during infancy and adolescence seem to favor the manifestation of violent conduct by interacting with neurobiological factors that underlie psychopathy, such that an association may be observed between the frequency of childhood traumatic events and the level of psychopathy present in adult life.

A condição errante do desejo: os imigrantes, migrantes, refugiados e a prática psicanalítica clínico-política / The errant condition of desire: immigrants, migrants, refugees and clinical-political psychoanalytic practice

Este artigo pretende avançar na sustentação teórica sobre a prática psicanalítica clínico-política, campo epistemológico ético e político que leva em conta as especificidades dos sujeitos e as vicissitudes de seus processos em contextos de exclusão e violência. A partir da experiência com imigrantes, formula as bases de um trabalho centrado na clínica do traumático mais do que na clínica do sintoma e focaliza as particularidades da escuta psicanalítica nesses contextos, assim como as intervenções coletivas.

Este artículo pretende avanzar en la sustentación teórica sobre la práctica psicoanalítica clínico-política, campo epistemológico ético y político que tiene en cuenta las especificidades de los sujetos y las vicisitudes de sus procesos en los contextos de exclusión y violencia. A partir de la experiencia con inmigrantes formula las bases de un trabajo centrado en la clínica de lo traumático, antes que en la clínica del síntoma, enfocando el tema en la escucha psicoanalítica en esos contextos, así como en las intervenciones colectivas.

Cet article vise à contribuer à l'étayage théorique de la pratique psychanalytique politico-clinique, domaine épistémologique moral et politique qui prend en compte les spécificités des sujets et les vicissitudes de leurs procédures dans des contextesd'exclusion et de violence. À partir de l'expérience avec des immigrés, nous formulons les bases d'un travail centré sur la clinique du traumatique plutôt que sur celle du symptôme et nous concentrons sur les particularités de l'écoute psychanalytique dans ces contextes, ainsi que sur les interventions collectives.

This article is meant as a contribution to the theoretical underpinnings of clinical and political psychoanalytic practice. This ethical, political and epistemological field that addresses the specificities of subjects and the difficulties related to their processes in contexts of violence and exclusion are discussed. Based on experience with immigrants, migrants and refugees, the text describes the bases of work centered on the clinic of traumatic events, rather than on symptoms, and focuses especially on the particularities of psychoanalytic listening within these contexts. Collective interventions are also discussed.

Estudio de casos y controles en un grupo de mujeres embarazadas con experiencias adversas en la infancia y/o adolescencia e infecciones de transmisión sexual / Case studies and controls in a group of pregnant with adverse experience in childhood and/or adolescence and sexually transmitted infections

Introduction Psychic traumas, also called adverse experiences, are events from the subject's life characterized by its intensity, the subject's inability to respond to them properly and the pathogenic lasting effects they cause in the psychic organization. The violence effects against women and girls are usually devastating for their reproductive health and other aspects of their physical and mental well-being. Besides injuries, violence causes an increase in the long-term risk of women developing other health problems. Women with a history of psychic mistreat or sexual abuse face also a bigger risk of non-expected or involuntary pregnancies, sexual transmitted infections and adverse results from pregnancy. High rates of childhood abuse were found: 42.2% had suffered physical mistreat, 21.4% had been insulted, 16.5% was victim of humiliation and 7.6% had been a victim of sexual abuse before fifteen years of age. The main aggressors were male relatives, the stepfather or the father. A study done in the United States found that women exposed to this form of violence suffered STI in adult age in a bigger proportion (10.7%) than the ones that were never exposed (5.7%). An investigation was made in the National Perinatolgy Institute called «STD/HIV-AIDS and Personality Disorders (PD) in pregnant women and their couples. Detection and prevention from high risk practices¼ with the objective -among others- to resolve the existing association between adverse experiences in childhood and the presence of sexually transmitted infections in gestation. Material and method The investigation design was of cases and controls; the characteristics of the study in relation to temporality was prospective with respect to the presence or absence of the pathogenic agent in gestation and retrospective (investigating adverse experiences in childhood), analytical referring to the analysis type and transverse with respect to the capture of the sample. The evaluation of the STIs was made through the Laboratory of the Sexually Transmitted Infections Clinic of the INPer and from the pertinent clinic exams. The diagnostic evaluation was made on the basis of the structured clinic interviews for the diagnostic psychiatric evaluation of I and II axes of DSM-IV. To investigate adverse childhood experiences, a psychodynamic interview was made and answers were transcribed then to the questionnaire made by Whitfields, Dube, Felitti and Anda, who developed the instrument Adverse Experiences in Childhood and/or Adolescence (ACE) with the aim to measure the amplitude of the exposition to emotional, physical and sexual abuse, as well as family dysfunction in these stages of life. It includes seven categories of adverse experiences, three relative to active abuse and five to passive abuse: 1. psychological abuse; 2. physical abuse; 3. sexual abuse; 4. conjugal violence against the mother; 5. living with parent or adults with alcohol problems and/or substance abusers; 6. living with parents or adults with mental disorders or suicidal; 7. living with parents that had been in jail. Results One hundred seventy-eight pregnant women were divided in two groups, the first one with 89 participants, in which a virus that caused the STI was identified, and the second group was the control group with also 89 pregnant women without STI. Significant differences were obtained in the socioeconomic level. There was also a significant association between fathers of the women with STI that had some legal problem and had being sent to jail for a period of time (RM 3.311); they also show small alcoholic problems (RM 2.073). There was a significant association with the different types of passive abuse (carelessness, negligence and indifference) physical, emotional and sexual, emphasizing that the relation between these categories and having an STI by a virus is highly significant; this is, being exposed in childhood to adverse events, more probability to get a viral STI in adulthood. The cases group accumulated three or more in bigger proportion (20.2%) than the control group (9%). The STI pregnant group presented a bigger number of traumatic events (69.9%) in comparison to the group with no STI that was 48.3%. It is appraised the bigger prevalence of mental disorders in the STI pregnant group, having a disorder increased the potential risk of infection by 2.45 times (C:I to 95% that oscillates between 1.303 and 4.61). Conclusions The STI viral group and the control group are different concerning socioeconomic level and schooling, finding in the STI group a bigger proportion of women whose monthly family income is lower, the poverty as a risk factor and/or social vulnerability for the HIV infection, the interaction between living in poverty conditions and the difficulty to access and to stay in the national educative system are closely related. In addition, this case group was integrated in a bigger proportion with pregnant who were not united in the study period. It is important to mention that half of the pregnant that formed the HIV/ AIDS group suffered the pain of seeing their couple die. From the adverse experiences in childhood and/or adolescence that could have been in the start or been a beginning factor for getting afterwards a viral STI in adulthood, the significant ones were having lived with a alcohol abuser adult, thus being victim of carelessness, negligence or indifference, same as being hit, pushed, pushed or hit so hard to leave marks, humiliations, coarses, insults, feelings of being less and victim of being touched or having a sexual experience. These traumatic events happened simultaneously, mainly in the cases group where 40 pregnant declared being exposed to two or more categories in contrast with 22 of the control group. Alcohol abuse is a generalized health problem and common in all societies; pregnant women with STI were in bigger proportion more exposed to familiar alcohol than the control group and approximately half of them were at the same time victims of some forms of abuse or violence by their fathers or stepfathers. Studies made in 21 countries show that between 7% and the 36% of the women had accepted being victims of sexual aggressions during their childhood and, according to most of these studies, the rate of abuses suffered by girls is 1.5 to 3 times bigger than men. The same report makes evident the fact that between 133 and 275 millions of children from all over the world are witnesses of domestic violence each year; this is, witness violent scenes at their home, generally through fights between their parents or between their mother and couple, which can also seriously affect their well-being, development and their social interaction in childhood and adult age. It has also been found that suffering an active abuse in childhood is a risk factor for structuring a borderline personality disorder.

Resumen Introducción Los traumas psíquicos, también denominados experiencias adversas, son acontecimientos de la vida del sujeto caracterizados por su intensidad, la incapacidad del sujeto para responder a ellos adecuadamente y los efectos patógenos duraderos que provocan en la organización psíquica. Los efectos de la violencia contra las mujeres y las niñas suelen ser devastadores para la salud reproductiva de la mujer y otros aspectos de su bienestar físico y mental. Además de causar lesiones, la violencia lleva a que aumente el riesgo a largo plazo de que las mujeres desarrollen otros problemas de salud. Las mujeres con una historia de maltrato físico o abuso sexual también enfrentan un riesgo mayor de embarazos no previstos o involuntarios, infecciones de transmisión sexual (ITS) y resultados adversos del embarazo. En el Instituto Nacional de Perinatología se realizó una investigación titulada «ETS/VIH-SIDA y trastornos de la personalidad en mujeres embarazadas y sus parejas. Detección y prevención de prácticas de alto riesgo¼ con el objetivo -entre otros- de determinar la asociación existente entre experiencias adversas en la infancia y la presencia de infecciones de transmisión sexual en la gestación. Material y método El diseño de la investigación fue de casos y controles; el estudio fue prospectivo respecto de la presencia o ausencia del agente patógeno en la gestación y retrospectivo (indagación de experiencias adversas en la infancia). La evaluación de las ITS se efectuó por medio del laboratorio; la evaluación diagnóstica se efectuó con base en las Entrevistas Clínicas Estructuradas para la evaluación diagnóstica psiquiátrica de los Ejes I y II del DSM-IV. Se aplicó el instrumento Experiencias Adversas en la Infancia y/o Adolescencia (ACE, por sus siglas en inglés), con el fin de medir la amplitud de la exposición al abuso emocional, físico y sexual, así como la disfunción familiar en estas etapas de la vida. El instrumento comprende siete categorías: 1. abuso psicológico; 2. abuso físico; 3. abuso sexual; 4. violencia conyugal contra la madre; 5. vivir con padres o adultos con problemas de alcoholismo y/o que eran abusadores de sustancias; 6. vivir con padres o adultos con trastornos mentales o suicidas; 7. vivir con padres que fueron encarcelados. Resultado Se estudiaron dos grupos, el primero de casos integrado con 89 embarazadas con ITS viral y el segundo fue el grupo control integrado también con 89 gestantes, sin ITS. Se obtuvieron diferencias significativas en el nivel socioeconómico. Así mismo hubo una asociación significativa entre los padres de las mujeres con ITS que tuvieron algún problema con la ley por lo que habían sido encarcelados por un determinado periodo de tiempo (la razón de momios fue 3.311); y los que manifestaron leves problemas de alcoholismo (RM 2.073). Hubo una asociación significativa en: abuso pasivo, físico, emocional y sexual, donde destaca que la relación entre estas categorías y padecer una ITS por virus es altamente significativa. El grupo de las gestantes con ITS presentó un mayor número de problemas traumáticos (69.9%) en comparación con el grupo sin ITS que fue de 48.3%. Conclusiones De las experiencias adversas en la infancia y/o adolescencia, que pudieron estar en el origen o haber sido un factor iniciador para adquirir posteriormente una ITS de origen viral en la edad adulta, fueron significativas haber convivido con un adulto cercano con problema de abuso del alcohol y haber sido víctima de descuido, abuso físico, emocional o sexual.

Posttraumatic Stress Symptoms and Related Factors in Firefighters of a Firestation / 대한산업의학회지

OBJECTIVES: To investigate the factors related with posttraumatic symptoms and to estimate the prevalence of posttraumatic disorder of urban male firefighters. METHODS: From a study sample comprising 260 male firefighters from one fire station, the responses from 146 who had experienced one or more traumatic events, responded to the 'Impact of Event Scale-Revised Korean version' (IES-R-K) and didn't show any evidence of depression were analyzed. We surveyed the firefighters using a self-administered questionnaire including general characteristics, job-related characteristics, IES-R-K, and a 'Firefighters and paramedics' incident stressor'. RESULTS: The mean value of IES-R-K in this study was 11.3 and it was higher in the married firefighters than in the unmarried firefighters (p=0.005) and in the 24-hr shift workers than in the ordinary day shift workers (p=0.032). The frequency of posttraumatic stress disorder (PTSD) of the firefighters in this study using IES-R-K was 13.7%, with a cutoff point of 24/25. The overall number of experiences of 25 traumatic events was larger in emergency medical personnel and rescue workers than in other work functions (p=0.000). CONCLUSIONS: The prevalence of PTSD symptoms in firefighters was estimated to 13.7% using IES-RK and was higher than the prevalence of PTSD in the general population. A program to manage the mental health and provide early detection for mental illness for firefighters is needed.

Prevalence of Traumatic Events and Posttraumatic Stress Disorder among Inpatients with Schizophrenia / 신경정신의학

OBJECTIVES: This study investigated the prevalence of traumatic events and posttraumatic stress disorder (PTSD) in an admission cohort of schizophrenic patients from two university affiliated psychiatric units in Korea. Differences in symptomatology between those with and without trauma were also assessed. METHODS: The consecutive sixty one inpatients (32 women and 29 men), who were diagnosed with schizophrenia by SCID-I, completed the Clinician-Administered PTSD Scale (CAPS), the Positive and Negative Syndrome Scale (PANSS), Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: Forty patients (66%) had at least one traumatic event in their life time. The most common traumatic event was child physical abuse (34%), followed by accidents (21%), traumatic loss (18%), witnessing violence (15%), child sexual abuse (10%), natural disaster (8%), adult physical assaults (8%), adult sexual assaults (5%), and psychotic symptoms (5%). Only one patient (2%), however, was diagnosed with current PTSD. Patients with traumatic events compared to those without traumatic events demonstrated significantly higher scores on State anxiety scale (p=.006) and several subscales of SCL-90-R including paranoia, anxiety, phobia, interpersonal sensitivity, and degree of psychosis. No differences of sociodemographic and clinical background variables were found between the two groups. CONCLUSION: Low rate (2%) of current PTSD found in this study is comparable to North American literature reporting 10-46% of PTSD within the schizophrenic population. Absence of substance abuse or homelessness and low rate of sexual violence in these Korean patients may explain the discrepant rates. However, distinct symptom profiles of patients with trauma may suggest that PTSD diagnosis runs short of describing such patients. The results from this study imply that schizophrenia per se may not be associated with increased prevalence in current PTSD diagnosis.