How are adverse childhood experiences and women's mental health associated? A latent class analysis.

BACKGROUND: Adverse childhood experiences (ACEs) have a cumulative effect on adult mental health; however, the effect of such combinations is less well known. The purpose of this study is to assess the association between specific combinations of early adversities and women's mental health. METHODS: A total of 378 women (Myears = 41.4; SDyears = 13) receiving support from mental health and social services participated in this cross-sectional study. Latent class analysis was performed to classify participants based on the number of ACEs types. RESULTS: Our results provided support for four latent classes which differed in ACEs types reported: class 1 range of maltreatment but no family disruption (16.40 %; n = 62), class 2 range of maltreatment with family disruption (24.87 %; n = 94), class 3 few ACEs (44.71 %; n = 169), class 4 high maltreatment/high family disruption (14.02 %; n = 53). Differences in psychological functioning (presence of psychopathology, attachment, emotion dysregulation, and coping strategies) were found between the classes, especially between few ACEs and high maltreatment/high family disruption classes. In addition, women who lived in a low-adversity home and those who lived in a home with maltreatment, but no family disruption, differed in their desire for closeness, problem-solving and emotional expression strategies. CONCLUSION: This study highlights that the probability of exposure to different combinations of ACEs is associated with differences in adult psychological functioning. Deeper insight into this association may contribute to a better understanding of mental health problems and to improved prevention and intervention strategies in public support systems.

Configurations of Adult Attachment, Indicators of Mental Health and Adverse Childhood Experiences in Women: A Cross-Sectional Study.

The relationship between adverse childhood experiences, attachment and adult mental health has been pointed out in a large amount of studies. In a sample of 339 women receiving support from mental health and social services, this research analyzed the association between three adult attachment variables (fear of rejection or abandonment-FRA; desire for closeness-DC; preference for independence-PI) and four mental health indicators. After dichotomizing these variables, we constructed eight configurations of attachment and examined their association with mental health indicators. BAB people (those below the median in FRA, above in DC and below in PI) obtained the most favorable scores in mental health, whereas the ABA configuration (above the median in FRA, below in DC and above in PI) was the least favorable. The association between attachment configurations and mental health indicators was different to what might be expected, aggregating the effects of individual attachment variables. When analyzing the relationship between configurations and adverse childhood experiences (ACEs), women with an ABA configuration reported the highest number of ACEs and eight ACE types had a higher-than-expected contingency coefficient. In conclusion, these findings suggest that certain adult attachment configurations are associated with a greater number of ACEs and poorer mental health indicators in adult women.

Adverse Childhood Experiences and Mental Health in Women: Pathways of Influence in a Clinical Sample.

BACKGROUND: While the negative impacts of Adverse Childhood Experiences (ACEs) on mental health have already been established in previous research, the pathways through which these events affect psychological well-being are still unclear. This cross-sectional study analyzed the relationship between ACEs and psychological distress. It also examined the role of coping strategies, emotion regulation, and adult attachment in this association. METHOD: The sample consisted of 207 women receiving psychotherapeutic support from Public Mental Health Services in Spain. Just under half (46.4%) being treated by clinical psychology services and just over half (53.1%) were also being treated by psychiatry services. Descriptive and association analysis were performed on the variables involved. RESULTS: 48.3% of participants reported four or more ACEs and the correlation with symptom severity was significant. Regression equations showed that four variables explained 56.2% of the variance: Fear of Rejection and Abandonment, Lack of Control, Rejection and Cognitive Restructuring. CONCLUSIONS: ACEs are directly associated with the severity of psychological distress. The data suggest that appropriate, sensitive exploration of these experiences can be therapeutic. The relationships between type of adversity, attachment relationships, emotion regulation, and coping strategies reveal indirect pathways through which ACEs affect women's mental health.

The Direct and Indirect Influences of Adverse Childhood Experiences on Physical Health: A Cross-Sectional Study.

A growing and significant body of research has documented the close relationship between adverse childhood experiences (ACEs) and health outcomes in adults. Less is known about the complex pathways through which ACEs exert their influence. This article examines the direct relationship between the quality of perceived physical health and childhood adversities. The association between the adversities and the physical health with other psychological and social variables is also analyzed. Data were collected from a sample of 170 subjects, using tools to assess adverse childhood experiences, physical health-related quality of life, socioeconomic vulnerability, emotion regulation, coping strategies, attachment, and social support. Results showed a high frequency of ACEs among the adult population, and the correlation with poor physical health was highly significant. Regression equations to predict physical health also revealed the following as significant variables: wishful thinking, social withdrawal, and cognitive restructuring as coping styles; reappraisal to achieve emotion regulation; fear of rejection or abandonment, and desire for closeness in relation to attachment figures; hardship; and poor financial support. The relationship between the different forms of ACE and social vulnerability identifies the important indirect contribution of childhood adversity to health and socioeconomic conditions in adulthood.

Contextual determinants of psychopathology. The singularity of attachment as a predictor of mental dysfunction.

The general aim of this research is to evaluate the singular weight of attachment relationships in psychopathology, to determine the point to which these relationships cannot be subsumed by other variables that are famously related to attachment, such as experience of stressful life events, social support, and coping styles. 172 people treated in mental health centers provided data related to these four aspects and about manifestations of psychopathology. Multiple linear regression analyses determined that 51% of the variance in the level of symptomatology is explained with six variables: two related to adult attachment (fear of rejection and abandonment in romantic relationships, and the degree of similarity to the fearful prototype), one related to social support (family appreciation), one to life events (overall perceived stress), and two to coping style (cognitive restructuring and social withdrawal). Fear of rejection was the variable accounting for the most variance. The findings suggest that adult attachment is a non-redundant individual factor associated with manifestations of psychological dysfunction and highlight the desirability of taking attachment history into account in clinical practice.

Adolescents at Serious Psychosocial Risk: What Is the Role of Additional Exposure to Violence in the Home?

Research into the effects of interpartner violence on the psychosocial development of the children of maltreated mothers is a relatively new field. This work examines the impact of exposure to interpartner violence (EIPV) on minors in middle and late adolescence, where this vicarious maltreatment is in addition to other situations of severe psychosocial risk. A group of adolescents who had suffered various types of direct maltreatment were compared with another group who, in addition to experiencing direct maltreatment, had mothers who had also been the victims of interpartner violence. There were 276 participants in total (138 adolescents and their mothers) reporting via questionnaires about their experiences related to maltreatment and about maladaptation and psychological dysfunction. The results demonstrate significant dysfunction in the adolescents, especially as indicated in the mothers' reports. In addition, the results make it clear that the adolescents are actively and directly involved in the episodes of interpartner violence and that the additional negative impact of vicarious maltreatment is evident in almost every aspect of their lives. Only the attitude toward teachers scored worse in the no-EIPV group. EIPV minors scored higher on personal and social maladjustment and worse on adaptive skills, and showed a more marked tendency to internalize problems. This study emphasizes the importance of considering EIPV as a form of child maltreatment and including it in programs of protection and intervention.

Prenatal co-exposure to neurotoxic metals and neurodevelopment in preschool children: The Environment and Childhood (INMA) Project.

We sought to determine whether prenatal co-exposure to As, Cd, Hg, Mn, and Pb was associated with impaired neurodevelopment in preschool children from the Spanish Environment and Childhood (INMA) Project, using the placenta as exposure matrix. We measured metal levels in placenta tissue samples randomly selected from five of the seven population-based birth cohorts participating in the INMA Project, collected between 2000 and 2008. Neuropsychological assessment of cognitive and motor function was carried through the use of the McCarthy Scales of Children's Abilities (MSCA) at the age of 4-5years. Data on placental metal levels, MSCA scores, and relevant covariates was available for 302 children. Mn was detected in all placental samples, Cd in nearly all placentas (99%) and As, Hg, and Pb in 22%, 58%, and 17% of the placentas, respectively. After adjusting for potential confounders, detectable As levels were associated with decrements in global and verbal executive functions and quantitative abilities; detectable Hg was associated with lower scores on the verbal function of posterior cortex in a dose-response manner, and non-linearly related to poorer motor function and gross motor skills; and Mn levels were associated with decrement in perceptual-performance skills in a dose-response manner but with better memory span and quantitative skills. A synergistic interactive effect was found between As and Pb with respect to the general cognitive score, whereas an antagonistic interaction was found between Mn and Hg. Prenatal exposure to As and Hg may be a risk factor for cognitive and motor impairment in children, while the effects of Cd and Mn on neurodevelopment are less clear. Future studies should examine combined and interactive effects of exposure to multiple metals during vulnerable periods of brain development prospectively.

Patología alimentaria en adolescentes: efecto del apego y de la regulación emocional / Eating pathology in adolescents: effects of attachment and emotion regulation

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Eating Pathology in adolescents: Effects of Attachment and Emotion Regulation. The aim of the present work is to explore associations between eating pathology (EP), emotion regulation (ER) and attachment in a non-clinical adolescent sample; and whether insecure attachment and difficulties in emotion regulation explain EP. A sample of 485 adolescents (240 females) aged 12-18, completed the EDI-2, DERS and EPERIC questionnaires. Sex differences were analyzed. Sex differences in EP level occur since the age of 14-15. Associations with high effect sizes between these three constructs were found. It is possible to predict EP from difficulties in emotion regulation and insecure attachment features (R2 Nagelkerke= .305 in females, and .236 in males). EP shows strong association with fear of rejection or abandonment in females and with preference for independence in males. Conclusions. There are sex differences on the associations between these three constructs considered in the present study and in EP explanation too. This has implications in prevention (AU)

Apego y bienestar en mujeres en proceso de tratamiento del cáncer de mama / Attachment and wellbeing in women undergoing breast cancer treatment

Este estudio explora la contribución del vínculo de apego al bienestar de las pacientes en tratamiento por cáncer de mama. Su objetivo es aportar conocimientos sobre cómo favorecer el afrontamiento del cáncer y de las dificultades que suelen concurrir con él. Un total de 58 mujeres que iban a comenzar un tratamiento de radioterapia por cáncer de mama informaron a través de cuestionarios sobre: síntomas y disfunciones relacionados con la enfermedad y el tratamiento, afectos positivos y negativos, bienestar emocional, contrariedades diarias y vínculo de apego. El análisis de regresión revela que el componente Temor al rechazo y al abandono del apego, la presencia de contrariedades -principalmente las económicas- y la presencia de síntomas físicos predicen el grado de bienestar. Los otros dos componentes del apego (Deseo de cercanía y Preferencia por la independencia) no presentan ninguna relación significativa. Contrariamente a lo esperado, la merma de capacidad funcional no predice una disminución del bienestar. Se discute sobre el peso diferencial de las variables médicas y psicosociales en la calidad de vida relacionada con la salud y se concluye la importancia de las intervenciones encaminadas a mejorar el estado emocional durante los tratamientos del cáncer a través de la mejora de las relaciones cercanas

This study investigates the contribution of the attachment to the wellbeing of patients during breast cancer treatment with the aim to provide evidence on how to enhance coping with cancer and its related difficulties. The sample consisted of 58 women who were about to begin radiotherapy for breast cancer. They completed questionnaires about: symptoms and dysfunctions related to disease and treatment, positive and negative affect, emotional wellbeing, daily hassles, and adult attachment. A regression analysis revealed that the component Fear of rejection and abandonment of attachment, the presence of daily hassles -mainly economic-, and physical symptoms predict the degree of wellbeing. The other two components of attachment (Desire for closeness and Preference for independence) show no significant relationships, and contrary to expectations, the loss of functional capacity does not predict a decrease in wellbeing. We discuss the differential weight of medical and psychosocial variables on health-related quality of life. Results emphasize the importance of interventions aimed at improving emotional state through improved relationships during cancer treatments

Validation of the Scale of Preferences and Expectations in Close Interpersonal Relationships (EPERIC) / Validación de la Escala de Preferencias y Expectativas en las Relaciones Interpersonales Cercanas (EPERIC)

Method: This study presents the Scale of Preferences and Expectations in Close Interpersonal Relationships (Escala de Preferencias y Expectativas en las Relaciones Interpersonales Cercanas, EPERIC), made up of 22 items, and based upon the Relationship Scales Questionnaire (RSQ) of Griffin and Bartholomew. Exploratory and confirmatory factorial analyses (EFA and CFA) were undertaken using data from a sample of 594 people. Results: Factor analysis distinguishes three sub-scales: Fear of rejection or abandonment, Desire for closeness and Preference for independence, which explains 42.78% of the total variance. The alpha coefficients reveal a high internal consistency of the instrument and its sub-scales. Regarding validity, CFA showed an adequate fit for the trifactorial solution, and the expected correlations with other instruments for assessing attachment style in adults were found. EPERIC is also suitable for predicting affective states and psychological well-being. Conclusions: The EPERIC is a potentially useful and valid instrument for research and clinical purposes. The discussion focuses on the fact that our results support a model of three factors rather than two, as is usual in studies on adult attachment (AU)

Antecedentes: los instrumentos utilizados para evaluar el apego adulto han mostrado divergencias importantes en las combinaciones de ítems y en las subescalas resultantes. Método: en el presente estudio se ha construido la Escala de Preferencias y Expectativas en las Relaciones Interpersonales Cercanas (EPERIC) con un total de 22 ítems, partiendo del Cuestionario-Escala de Relaciones Interpersonales (RSQ) de Griffin y Bartholomew, y se han realizado análisis factoriales exploratorio y confirmatorio (AFE y AFC) con los datos procedentes de una muestra de 594 personas. Resultados: el análisis factorial sugiere la existencia de tres subescalas: Temor al rechazo o al abandono, Deseo de cercanía y Preferencia por la independencia, que explican un 42,78% de la varianza total. Los coeficientes alfa revelan una alta consistencia interna del instrumento y sus subescalas. En cuanto a la validez, el AFC muestra un adecuado ajuste para la solución trifactorial y se encontraron las correlaciones esperadas con otros instrumentos de evaluación del estilo de apego en adultos. El instrumento resulta también adecuado para predecir estados afectivos y bienestar psicológico. Conclusiones: el EPERIC es un instrumento potencialmente útil y válido para la investigación y la clínica. Se discute en torno al hecho de que los datos apoyen un modelo de tres factores en lugar de dos, como viene siendo habitual en los estudios sobre el apego adulto (AU)

Validation of the Scale of Preferences and Expectations in Close Interpersonal Relationships (EPERIC).

BACKGROUND: The most commonly used instruments for assessing adult attachment have shown differing combinations of items and divergences in the resulting sub-scales. METHOD: This study presents the Scale of Preferences and Expectations in Close Interpersonal Relationships ( Escala de Preferencias y Expectativas en las Relaciones Interpersonales Cercanas, EPERIC), made up of 22 items, and based upon the Relationship Scales Questionnaire (RSQ) of Griffin and Bartholomew. Exploratory and confirmatory factorial analyses (EFA and CFA) were undertaken using data from a sample of 594 people. RESULTS: Factor analysis distinguishes three sub-scales: Fear of rejection or abandonment , Desire for closeness and Preference for independence , which explains 42.78% of the total variance. The alpha coefficients reveal a high internal consistency of the instrument and its sub-scales. Regarding validity, CFA showed an adequate fit for the trifactorial solution, and the expected correlations with other instruments for assessing attachment style in adults were found. EPERIC is also suitable for predicting affective states and psychological well-being. CONCLUSIONS: The EPERIC is a potentially useful and valid instrument for research and clinical purposes. The discussion focuses on the fact that our results support a model of three factors rather than two, as is usual in studies on adult attachment.

Calidad de la sesión, ajuste en las tareas y efectividad de las sesiones psicoterapéuticas / Session quality, task adjustment, and effectiveness of therapeutic sessions

Against the backdrop of studies of therapeutic alliance and unspecific factors in psychotherapy, this paper explores the relationship between the kind of help that clients obtain in therapeutic sessions and its results. Data was obtained by means of a clinical questionnaire in which clients expressed, session by session, their priorities regarding therapeutic tasks, their satisfaction with each session and their assessment of the achieved outcomes. The statistical analysis of 679 questionnaires showed that, contrary to expectations, the therapist's adjustment to the client's requests improves neither satisfaction nor perceived outcome. The better predictor of both is the amount of help the client feels he or she has received during the session, regardless of the client's priorities. Of the nine different kinds of therapeutic tasks considered in the study, help understanding what is happening correlates the most with both satisfaction and improvement, independently of whether the client prioritized this. This article discusses the kinds of assistance that achieve therapeutic goals and calls into question the value of adjusting sessions to the client's demand. The concept of conformity instead of adjustment is proposed (AU)

En el marco de los estudios sobre alianza terapéutica y los factores inespecíficos de la psicoterapia, este trabajo estudia la relación entre el tipo de ayuda que los consultantes obtienen en las sesiones terapéuticas y los resultados de las mismas. Los datos se obtuvieron a través de un cuestionario de uso clínico que recoge, sesión a sesión, las preferencias de los consultantes en cuanto las tareas terapéuticas, su grado de satisfacción con la sesión y su valoración de los cambios logrados. El análisis de 679 cuestionarios revela que, en contra de lo esperado, el ajuste del terapeuta a las peticiones del consultante no redunda en mayor satisfacción ni en mejores resultados. La variable que mejor predice ambas cosas es la cantidad de ayuda indistinta que el consultante considera haber recibido durante la sesión. De las nueve tareas terapéuticas contempladas, la ayuda para la tarea entender lo que ocurre es la más relevante tanto a efectos de satisfacción como de resultados, y con independencia de que se señalara o no como preferente. Se discute sobre el tipo de ayuda que media en la consecución de las metas terapéuticas y sobre la conveniencia de acomodar las tareas a las solicitudes de los consultantes. Se cuestiona el propio concepto de ajuste y se propone el de conformidad (AU)

Tareas terapéuticas: ¿qué clase de ayuda se busca en las consultas de psicoterapia? / Therapeutic tasks: What kind of help is sought in psychotherapeutic sessions?

Una de las condiciones que definen una buena alianza terapéutica es el acuerdo mutuo en cuanto a metas y tareas terapéuticas. Con el objetivo de contribuir al estudio de los factores que promueven este ajuste, este artículo explora el tipo de ayuda que las personas esperan obtener cuando acuden a psicoterapia. Mediante un cuestionario escrito, los consultantes de un centro privado de psicoterapia expresaron antes de cada sesión sus preferencias sobre el trabajo a desarrollar en la misma. El análisis de 873 cuestionarios revela que los consultantes prefieren abordar tareas terapéuticas que les ayuden a planificar actuaciones, a entender lo que les ocurre y a valorar las posibilidades de cambio. También son importantes las tareas que ayudan a valorar actuaciones propias, tanto pasadas como planeadas. La importancia que otorgan a unas y otras clases de ayuda cambia sobre todo dependiendo de lo cerca que se sientan de la solución de los problemas. La lista de nueve clases de tareas terapéuticas que resultan del trabajo parece agotar los requerimientos que un consultante pueda tener hacia su terapeuta. Finalmente se discute sobre la importancia clínica del uso de este modelo como base para planificar o clasificar intervenciones terapéuticas (AU)

One of the main conditions for a good psychotherapeutic alliance is the agreement on therapeutic tasks and goals. This article explores the kind of help that clients expect from therapeutic sessions. By means of a written questionnaire, the clients of a private psychotherapy center, prior to the sessions, expressed their priorities regarding the work to be carried out in them. The assessment of 873 questionnaires showed that clients prefer to participate in therapeutic work that helps them plan actions, understand what is happening, and assess possibilities for change. Also important are therapeutic tasks that help clients evaluate their own actions, both past and planned. The importance that clients attach to different kinds of help varies above all according to how near they feel to resolving their problems. Nine different kinds of psychotherapeutic tasks are identified, which cover the possible requests a client can make of his/her therapist. This article discusses the clinical application of this model as a basis for planning and classifying psychotherapeutic interventions (AU)

[Therapeutic tasks: what kind of help is sought in psychotherapeutic sessions?]. / Tareas terapéuticas: qué clase de ayuda se busca en las consultas de psicoterapia?

One of the main conditions for a good psychotherapeutic alliance is the agreement on therapeutic tasks and goals. This article explores the kind of help that clients expect from therapeutic sessions. By means of a written questionnaire, the clients of a private psychotherapy center, prior to the sessions, expressed their priorities regarding the work to be carried out in them. The assessment of 873 questionnaires showed that clients prefer to participate in therapeutic work that helps them plan actions, understand what is happening, and assess possibilities for change. Also important are therapeutic tasks that help clients evaluate their own actions, both past and planned. The importance that clients attach to different kinds of help varies above all according to how near they feel to resolving their problems. Nine different kinds of psychotherapeutic tasks are identified, which cover the possible requests a client can make of his/her therapist. This article discusses the clinical application of this model as a basis for planning and classifying psychotherapeutic interventions.

Prevalencia del maltrato de pareja contra las mujeres / Prevalence of intimate partner violence against women

Se ha elaborado una tipología del maltrato y una encuesta inspirándonos en los planteamientos de Goffman (1971) y en los conceptos de cara positiva y cara negativa de Brown y Levinson (1987), sistematizados por Kerbrat-Orecchioni (1992). Se ha realizado un muestreo estratificado según la zona de residencia sobre una población de unas 450.000 mujeres y se entrevistó a 421 mujeres sobre sus experiencias respecto al maltrato en parejas. Los resultados del estudio indican que el 20,2% de la población femenina ha sufrido maltratos a manos de su pareja y que el 6,2% de las mujeres han sufrido maltrato durante el último año

We have elaborated an Abuse Typology and a survey research based on Goffman’s approach (1971) and on Brown and Levinson’s (1987) concepts of positive and negative face, as systematized by Kerbrat-Orecchioni (1992). A stratified sampling according to the zone of residence upon a population of 450.000 women has been made, and 421 women were interviewed with regard to their experience of abuse in couple relationships. The results of the study indicate that 20.2 % of the population have suffered or are suffering abuse by their partner, with a maximum error of 4.3%. Moreover 6.2% of the women have suffered abuse during the year previous to the interview