The impact of intuitive eating on the association between posttraumatic stress disorder (PTSD) symptoms and disordered eating among women who have experienced intimate partner violence (IPV).

OBJECTIVE: Trauma exposure is associated with disordered eating, with recent evidence suggesting PTSD symptoms may be a more proximal predictor. Intuitive eating is a well-established protective factor against disordered eating; however, no previous studies have assessed whether intuitive eating buffers the association between PTSD symptoms and disordered eating. METHODS: Two hundred sixteen women who had experienced intimate partner violence (IPV) and were residing at a domestic violence shelter completed a survey. The current study assessed the moderating role of intuitive eating in the associations between PTSD symptoms and two types of disordered eating behaviors: binge eating and compensatory behaviors. RESULTS: Intuitive eating did not moderate the association between PTSD symptoms and a dichotomous measure of binge eating (no binge eating vs. any binge eating). However, intuitive eating did moderate the association between PTSD symptoms and binge frequency, among participants endorsing any degree of binge eating, such that PTSD symptoms were significantly associated with binge frequency at low, but not moderate or high, levels of intuitive eating. Intuitive eating did not moderate the association between PTSD symptoms and compensatory behaviors. DISCUSSION: Results suggest intuitive eating may be protective against binge eating frequency among women who have experienced IPV.

Relationships between socioeconomic status and cardiovascular outcomes in patients with complete heart block.

BACKGROUND: Literature illustrates an association between adverse outcomes and lower socioeconomic status (SES) in patients with critical cardiovascular presentations; however. limited data exist on complete heart block (CHB) outcomes in the context of SES. OBJECTIVES: The purpose of this study was to assess the association of SES (using zip code income quartiles) with the outcomes of CHB cases. METHODS: We queried the 2016-2019 Nationwide Inpatient Sample and identified CHB as the primary diagnosis. We compared in-hospital outcomes based on zip code mean income quartiles (≤2 [< $59,000] vs ≥3). The primary outcome was mortality. Secondary outcomes included total and early permanent pacemaker (PPM) and temporary pacemaker (TPM) use, cardiogenic shock, palliative care involvement, mechanical ventilation use, length of stay (LOS), and total charges. Multivariable regression models were used to adjust for potential confounders. RESULTS: Of 150,265 CHB hospitalizations, 76,635 (51%) involved patients with a lower income quartile. Lower quartiles were associated with lower odds of early PPM use (adjusted odds ratio [aOR] 0.86; 95% confidence interval [CI] 0.81-0.90) and higher odds of in-hospital mortality (aOR 1.23; 95% CI 1.05-1.46), total TPM use (aOR 1.08; 95% CI 1.02-1.14), palliative care (aOR 1.2; 95% CI 1.02-1.43), mechanical ventilation use (aOR 1.11; 95% CI 1.01-1.23), cardiogenic shock (aOR 1.15; 95% CI 1.01-1.31), and longer LOS (4 days vs 3.6 days; P <.001) compared to patients in higher quartiles. CONCLUSION: Patients with lower income admitted for CHB were less likely to receive an early PPM and had higher adverse outcomes compared to patients with higher income.

The Associations Between Opioid Use Disorder and Healthcare-Related Outcomes in Vaso-occlusive Crisis.

BACKGROUND: In patients who experience frequent vaso-occlusive crises (VOC), opioid dependence may be due to a need for pain control as opposed to addiction; the implications of opioid use disorder (OUD) in this population are unclear. OBJECTIVE: To compare outcomes in hospitalizations for VOC in those with a history of OUD to those without a history of OUD. DESIGN: A retrospective assessment of hospitalizations for adults in the USA with a primary discharge diagnosis of VOC using the National Inpatient Sample database from 2016 to 2019. We also compared VOC hospitalizations to hospitalizations for all other reasons to assess differences in OUD-associated clinical factors. PARTICIPANTS: In total, 273,460 hospitalizations for VOC; 23,120 (8.5%) of these hospital stays involved a secondary diagnosis of OUD. MAIN MEASURES: Primary outcomes were length of hospital stay and cost. Mortality was a secondary outcome. KEY RESULTS: Hospital length of stay was increased (mean 6.2 vs 4.9 days) in patients with OUD (adjusted rate ratio = 1.24, 95% CI 1.20-1.29, p < 0.001). Mean cost was also higher in those with OUD ($9076) than those without OUD ($8020, p < 0.001). Mortality was decreased in VOC hospitalizations in those with OUD, but the difference was not statistically significant (adjusted OR = 0.64, 95% CI 0.028-1.48, p = 0.30). CONCLUSIONS: OUD is associated with increased length of stay and costs in patients with VOC. While there are many possible explanations, providers should consider undertreatment of pain due to addiction concerns as a potential factor; individualized pain plans to mitigate this challenge could be explored.

Survival sex among a diverse sample of women with histories of intimate partner violence: Results from a domestic violence shelter.

OBJECTIVE: The current study sought to investigate the prevalence and correlates of survival sex among a diverse sample of women residing in a domestic violence (DV) shelter. METHOD: Two hundred seven women (44% Black, 37.7% White, 10.6% Multiracial, 4.3% Latina, 1% Arab, 1% Asian/Pacific Islander, and 1.4% Indigenous or Aboriginal) residing in a Summit County, Ohio, DV shelter completed a survey assessing their involvement in survival sex, the associated contextual factors (e.g., age at first incidence of survival sex, the reason for engaging in survival sex), and self-report measures assessing substance use, post-traumatic stress disorder (PTSD) symptoms, intimate partner violence (IPV) victimization, adverse childhood experiences (ACEs), and empowerment. RESULTS: More than two-thirds of participants reported engaging in survival sex, and participants who did were more likely to have elevated rates of substance use, PTSD symptoms, ACEs, and IPV victimization, along with lower empowerment. Most commonly, women reported engaging in survival sex for fear that the other person would take away valuable support or things they needed. Participants also reported engaging in survival sex for securing shelter, for money, for food, and to obtain drugs or alcohol. Notably, a sizable minority of women first engaged in survival sex as minors, suggesting overlap with the phenomenon of domestic minor sex trafficking. CONCLUSIONS: Engaging in survival sex may be commonly experienced by women residing in DV shelters and is associated with trauma history and post-traumatic stress symptoms. Despite the small, non-representative sample, results indicate education for providers is necessary to interact effectively with this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Race, Social Support, Empowerment, and Posttraumatic Cognitions in Survivors of Intimate Partner Violence Symptoms of Posttraumatic Stress Disorder.

Black women experience more frequent and severe intimate partner violence (IPV), but there are mixed findings on their posttraumatic stress disorder (PTSD) symptom severity. This may be explained by cultural-salient factors which are associated with fewer posttraumatic cognitions. We hypothesized an indirect effect of race on PTSD symptoms via social support, empowerment, and posttraumatic cognitions, serially. Path analysis revealed Black women reported increased social support, which was associated with higher levels of empowerment, which was associated with lower levels of posttraumatic cognitions. Decreased posttraumatic cognitions were associated with less severe PTSD symptoms. Results increase understanding of culturally-salient factors that may impact PTSD symptoms in Black women.

Computer-based intervention for residents of domestic violence shelters with substance use: A randomized pilot study.

BACKGROUND: Intimate Partner Violence (IPV) is a significant public health problem often associated with serious mental health and physical health implications. Substance use disorders (SUDs) are one of the most common comorbidities among women with IPV, increasing risk of subsequent IPV. METHODS: The current study examined the feasibility, acceptability, and preliminary effectiveness of a brief computerized intervention to reduce alcohol and drug use among women with IPV. Fifty women with recent IPV and alcohol and drug use risk were recruited from domestic violence shelters and randomized to the experimental computerized intervention or to an attention and time control condition. The primary outcome was percent heavy drinking or drug using days in 3 month increments over the 6 months after leaving the shelter. Receipt of substance use services and IPV severity were evaluated as secondary outcomes. RESULTS: The computerized intervention was feasible and acceptable, with high (n = 20, 80%) completion rates, engagement with the intervention, and satisfaction scores. As expected in this pilot trial, there were no significant differences between conditions in percent heavy drinking/drug using days or receipt of substance use services and large individual differences in outcomes. For example, receipt of substance use services decreased by a mean of 0.05 times/day from the baseline to the 6-month time period in the control condition (range -1.00 to +0.55) and increased by a mean of 0.06 times/day in the intervention condition (range -0.13 to +0.89). There were large decreases in IPV severity over time in both conditions, but directions of differences favored the control condition for IPV severity. CONCLUSION: A computerized intervention to reduce the risk of alcohol/drug use and subsequent IPV is feasible and acceptable among residents of a domestic violence shelter. A fully powered trial is needed to conclusively evaluate outcomes.

Pregnancy Weight Gain and Postpartum Weight Retention in Active Duty Military Women: Implications for Readiness.

INTRODUCTION: Weight gain in pregnancy is expected; however, excessive gestational weight gain and postpartum weight retention (PPWR) can cause long-term changes to a patient's body mass index (BMI) and increase the risk for adverse health outcomes. This phenomenon is understudied in active duty military women, for whom excess weight gain poses challenges to readiness and fitness to serve. This study examines over 30,000 active duty military women with and without preeclampsia to assess changes in BMI postpartum. MATERIALS AND METHODS: This is a retrospective analysis of claims data for active duty military women, aged 18-40 years, and experiencing pregnancy during fiscal years 2010-2014. Women with eating disorders, high-risk pregnancy conditions other than preeclampsia, scheduled high-risk medical interventions, or a second pregnancy within 18 months were excluded from the analysis. Height and weight were obtained from medical records and used to calculate BMI. Women with and without preeclampsia were categorized into BMI categories according to the Centers for Disease Control and Prevention classification of underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), or obese (>30.0). Linear regressions adjusted by age and race were performed to assess differences in prepregnancy weight and weight gain, retention, and change at 6 months postpartum. RESULTS: The greatest number of pregnant, active duty service women were found among ages 18-24 years, White race, Army service, junior enlisted rank, married status, and with no mental health diagnosis. Overall, over 50% of women in normal and preeclamptic pregnancies returned to their baseline BMI postpartum. Women in both populations more often gained than lost weight postpartum. Preeclampsia strongly affected weight retention, with 40.77% of overweight women and 5.33% of normal weight women progressing to postpartum obesity, versus 32.95% of overweight women and 2.61% of normal weight women in the main population. Mental health conditions were not associated with significant weight gain or PPWR. Women with cesarean deliveries gained more weight during pregnancy, had more PPWR, and lost more weight from third trimester to 6 months postpartum. CONCLUSIONS: Most women remain in their baseline BMI category postpartum, suggesting that prepregnancy weight management is an opportunity to reduce excess PPWR. Other opportunities lie in readiness-focused weight management during prenatal visits and postpartum, especially for patients with preeclampsia and cesarean sections. However, concerns about weight management for readiness must be carefully balanced against the health of the individual service members.

Associations among Intimate Partner Violence, Posttraumatic Stress Disorder Symptoms, and Disordered Eating among Women Intimate Partner Violence Survivors Residing in Shelter.

Previous research has not assessed the association between intimate partner violence (IPV) and disordered eating (DE), nor the potential indirect effect through posttraumatic stress disorder (PTSD) symptoms, among residents of IPV shelters. Among 212 IPV survivors, this study examined these and the differential associations by PTSD symptom cluster and types of DE. In the current sample, 67.9% met criteria for probable PTSD, 20.3% met criteria for a probable eating disorder, and 18.4% had probable comorbid diagnoses. Consistent with escape theory, there was an indirect effect of IPV on DE through PTSD symptoms. Additionally, there was an indirect effect of IPV on weight/shape concerns and binge symptoms through PTSD symptoms. Although there was a significant total effect of IPV on compensatory behaviors, there was no indirect effect through PTSD symptoms. When PTSD symptom clusters were examined concurrently, the only indirect effect of IPV on weight/shape concerns was via the PTSD symptom cluster of negative alterations in cognition and mood. Although there was an indirect effect of IPV on binge symptoms via PTSD symptoms overall, no specific PTSD symptom cluster drove this association. Implications highlight the need for attention to DE within this population. Consistent with escape theory, survivors' DE might serve to distract from psychological distress.

'Sometimes, we don't know if we're getting abused': discussions of intimate partner violence and HIV risk among transgender women.

Transgender women are among the populations at highest risk for HIV in the USA and have elevated risk for intimate partner violence (IPV). There is an urgent need for integrated HIV-IPV prevention interventions for transgender women. Using qualitative methods, we explored transgender women's lived experiences of IPV and the relationship between IPV and HIV risk. Using thematic analysis, we identified four key concepts that warrant inclusion in the development of models for IPV and HIV interventions: (1) considering the boundaries of IPV; (2) normalising expectations of chronic violence; (3) relationship safety; (4) calls for trans-affirming and empowering services.

Predicting emotional abuse among a sample of college students.

Objective This study aims to examine factors related to emotional abuse, an understudied type of intimate partner violence (IPV), among a sample of college students. Participants: 601 undergraduates from one large public university in the Midwestern United States (Spring 2017) and 756 undergraduates from one large public university in the Southern United States (Fall 2019) participated in the study. Methods: Participants completed an online survey measuring demographic information, behavioral variables (viewing porn, alcohol consumption, and hooking up), and history of violence (witnessing a father abuse his spouse, emotional abuse history). Descriptive statistics and binary logistic regression analyses predicting emotional abuse victimization were conducted. Results: Results indicate female, white, older students were more likely to report emotional abuse. Also, students witnessing their father abuse his spouse, frequent pornography use, increased alcohol use, and frequent hookups increased odds of emotional abuse. Conclusion: College campuses should consider emphasizing emotional abuse in IPV programing.

Web-based intervention to reduce intimate partner violence during perinatal period: A modified protocol in response to the COVID-19 pandemic.

Perinatal women are at increased risk of intimate partner violence (IPV), associated with psychiatric disorders and partner revictimization. We describe changes that were made, in response to the COVID-19 pandemic, to an in-person randomized controlled study of perinatal women with IPV who had sought mental health treatment in the last year. All phases of the study's in-person delivered computerized protocol were modified for remote delivery. Special attention was given to study participants' privacy and safety, especially with regard to the use of technology. We describe study protocol and consent procedures that were made to accommodate remote delivery of the study. All phases of remote delivery of the study have been implemented successfully and safely. Compared to the first three months of in-person delivery, the first three months of remote recruitment found that more participants were screened (69% vs. 36%) and more were enrolled in the study (13% vs. 8%). To our knowledge, this is the first remote delivered study involving participants with IPV to use the 5-item Danger Assessment and a spyware and stalkerware survey as screening tools. We demonstrate that remote delivery can reduce the risk of compromising the safety and privacy of study participants with IPV.

Understanding the relationship between interpersonal trauma and disordered eating: An extension of the model of psychological adaptation.

OBJECTIVE: Interpersonal trauma is a nonspecific risk factor for disordered eating (DE). Studies have begun to examine mechanisms that explain the relationship; however, few have tested comprehensive theoretical models. The Model of Psychological Adaptation (McCann, Sakheim, & Abrahamson, 1988) posits that trauma exposure results in core schema disruptions that are associated with varying psychological response patterns, or psychological adaptations, that are also established predictors of DE, such as interpersonal and affective problems. The model has been successfully applied to symptoms of other psychological disorders, such as PTSD and depression, but has not previously been extended to predict DE. The current study addressed this gap in the literature by assessing an extension of the Model of Psychological Adaptation to DE. METHOD: A sample of 371 undergraduate women completed an online survey. RESULTS: Using structural equation modeling, the results of the current study demonstrated positive fit for a model that represents the extension of the Model of Psychological Adaptation to DE. CONCLUSION: These findings corroborate the link between interpersonal trauma and DE, thus demonstrating the potential importance of assessing for DE symptoms among clients who have survived interpersonal trauma and attending to trauma history among clients who have DE. In addition, it highlights mechanisms that may be relevant to the conceptualization and treatment of DE among survivors of interpersonal trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Association Between Demographic, Mental Health, and Intimate Partner Violence Victimization Variables and Undergraduate Women's Intimate Partner Violence Perpetration.

Addressing women's intimate partner violence (IPV) perpetration is essential not only to their partners' safety but also to their own as, for women who are victims of IPV, their IPV perpetration may be a risk factor for their own revictimization. Although many studies have examined risk factors for women's IPV perpetration, results diverge with regard to whether demographic and mental health variables are reliable predictors. Results of several studies have demonstrated that when IPV victimization is examined concurrently with perpetration, demographic and mental health variables are no longer significant correlates. However, this research has been limited in that the type of IPV examined has been restricted to physical, psychological, and sexual abuse. In addition, some demographic variables (e.g., sexual orientation) have yet to be adequately examined. The current study extends this literature by concurrently assessing demographic, mental health, and IPV victimization variables as correlates of IPV perpetration among undergraduate women. Furthermore, the current study examined a wide range of IPV types (i.e., threats of physical abuse, physical abuse, sexual abuse, psychological maltreatment, stalking, cyberstalking). Among a final sample of 398 undergraduate women at a Midwestern public university, results demonstrated that while all variables (i.e., demographic, mental health, IPV victimization) were correlated with at least one type of IPV perpetration, only IPV victimization remained a unique significant correlate of perpetration for each of the six IPV perpetration types when variables were analyzed concurrently in hierarchical regression models. Demographic and mental health variables were nonsignificant correlates for most IPV perpetration types. These results corroborate previous studies and provide additional evidence that targeting women's own victimization, safety planning, and de-escalation may be useful at decreasing violence against women's partners as well as women's own risk for revictimization.

Impact of Surgical Status, Loneliness, and Disability on Interleukin 6, C-Reactive Protein, Cortisol, and Estrogen in Females with Symptomatic Type I Chiari Malformation.

Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η2P = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η2P = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI.

Improving Inpatient Tobacco Treatment Measures: Outcomes Through Standardized Treatment, Care Coordination, and Electronic Health Record Optimization.

INTRODUCTION: The Centers for Disease Control and Prevention states that tobacco use is the largest and most preventable cause of disease and mortality in the United States. The Joint Commission implemented inpatient tobacco treatment measures (TTMs) in 2012 to encourage healthcare systems to create processes that help patients quit tobacco use through evidence-based care. METHODS: A tobacco cessation care delivery system was implemented at James A. Haley Veterans' Hospital and Clinics, which included: standardized pathways within the Veterans Health Administration (VHA) electronic health record system to improve nicotine replacement therapy ordering; evidence-based tobacco cessation counseling; and improved care coordination for tobacco cessation treatment through the use of technological innovation. RESULTS: Outcomes were obtained from the VHA quality metric reporting system known as Strategic Analytics for Improvement and Learning (SAIL). TOB-2 and TOB-3 (two Joint Commission inpatient TTMs) equivalent to tob20 and tob40 within SAIL improved by greater than 300% after implementation at James A. Haley Veterans' Hospital and Clinics. CONCLUSION: Implementation of a tobacco cessation care system at James A. Haley Veterans' Hospital and Clinics enhanced interdisciplinary coordination of tobacco cessation care and resulted in improvements of The Joint Commission inpatient TTMs by greater than threefold.

Analysis of a Modification to the Sexual Experiences Survey to Assess Intimate Partner Sexual Violence.

Greater accuracy is needed in the assessment of sexual victimization that occurs in intimate relationships. Existing assessment strategies in the literature often represent two distinct approaches - intimate partner violence specific strategies vs. sexual violence specific strategies. The current study compared multiple distinct strategies for assessing intimate partner sexual victimization (IPSV) and evaluated a modification that optimizes intimate partner and sexual violence specific strategies. Two samples of undergraduate women were recruited. Sample 1 (N = 236) completed the Severity of Violence Against Women Scales (SVAWS) and a modified version Sexual Experiences Survey-Short Form Victimization (SES-SFV) in which participants were cued to respond both for romantic partners and non-partners (referred to as the SES-RP/NP). Sample 2 (N = 206) completed the SVAWS and was randomized to either the traditional SES-SFV or the SES-RP/NP. Across samples, the prevalence of IPSV varied based on the measure used (SVAWS = 11.7%; SES-SFV = 17.0%; SES-RP/NP = 25.4%). The SES-RP/NP identified significantly more IPSV than the SES-SFV, SVAWS, and prior studies. Both the SES-SFV and the SES-RP/NP were positively and significantly associated with the SVAWS. The results suggested that optimal measurement of IPSV would consider both intimate partner and sexual violence strategies.

An Empirical Exploration Into the Measurement of Rape Culture.

Feminist scholars have long argued the presence of a "rape culture" within the United States; however, limited efforts have been made to quantify this construct. A model of rape culture was first proposed in 1980 and expanded in the 1990s in an effort to quantify rape myth acceptance. This model posits that five underlying components make up a rape culture: traditional gender roles, sexism, adversarial sexual beliefs, hostility toward women, and acceptance of violence. Although these components are proposed as cultural phenomenon and thus distinct from individually held beliefs, they have been exclusively explored on an individual level. Thus, to promote exploration of this phenomenon beyond individually held beliefs, the authors adapted a series of well-established measures to assess the perceived peer support of the constructs proposed to underlie rape culture and assess initial reliability and validity in a sample of 314 college students. Following determination of reliability and validity of these adapted measures, a hierarchical confirmatory factor analysis was run to examine the proposed model of rape culture. Results of this study highlight the uniqueness between individual and cultural factors as several items did not translate from an individual (i.e., personal endorsement) to a cultural level (i.e., perceived peer support) and were subsequently removed from the proposed final measurements. Furthermore, initial support for the aforementioned model of rape culture was identified. These findings are crucial given that limited conclusions may be drawn about the existence and in turn eradication of rape culture without an agreed upon definition and source of measurement.

Sexual Victimization and Disordered Eating in Bisexual Women: A Test of Objectification Theory.

The current study (a) ascertained whether there is a relationship between sexual victimization (SV) and disordered eating (DE) among bisexual women, (b) assessed whether objectification theory explains the relationship, and (c) tested for group differences between bisexual and heterosexual women on SV, DE, and other objectification theory variables. Utilizing a sample of 164 undergraduate bisexual women, there was a significant positive relationship between SV and DE that was serially mediated by self-surveillance and body shame. In addition, bisexual participants endorsed more SV, DE, body shame, and interoceptive deficits than a comparison sample of 335 undergraduate heterosexual women. Implications are discussed.

Computerized intervention for reducing intimate partner victimization for perinatal women seeking mental health treatment: A multisite randomized clinical trial protocol.

Intimate partner victimization (IPV) is a significant social and public health problem among perinatal women. Research suggests that 21% to 33% of perinatal women report IPV and there is an enormous amount of morbidity associated with IPV. Moreover, IPV places women at high risk for several psychiatric disorders, which transforms the perinatal period from an already challenging process into a potentially overwhelming one. Further, IPV and untreated mental illness during the perinatal period pose a dual risk of adverse physical and emotional outcomes for women and their developing fetus/infant. Given the high rates of IPV among women who seek mental health treatment, mental health clinics compared to other medical settings are more effective sites for focused case finding and intervention. Our team has successfully tested an innovative, computerized intervention, Strength for U in Relationship Empowerment (SURE). SURE is a brief, interactive program consistent with motivational interviewing and incorporates empowerment strategies. The proposed multisite randomized clinical trial (N = 186) will test whether SURE relative to control is associated with reduced IPV, greater positive affect and well-being, and greater perceived emotional support. We will also evaluate the role of theoretical mediators of empowerment and self-efficacy. Finally, we will estimate the resources needed and costs to deliver SURE, as well as the incremental cost effectiveness of SURE compared with treatment as usual. If SURE is found to be efficacious and cost effective, it can be easily integrated into clinical care and will fill a critical gap for a vulnerable, high-risk population.