The impact of parental acceptance and childhood maltreatment on mental health and physical pain in Burundian survivors of childhood sexual abuse.

BACKGROUND: Parental support has been suggested to mitigate mental and physical consequences following childhood sexual abuse (CSA). However, many CSA survivors experience parental rejection post-CSA. OBJECTIVE: We aimed to understand the impact of abuse-specific parental acceptance on post-traumatic stress disorder (PTSD) and physical pain in Burundian CSA-survivors. We further assessed the significance of parental acceptance among known risk factors for predicting PTSD. METHODS, PARTICIPANTS, AND SETTINGS: Participants (N = 131, 80.9 % female, mean age 16.21 years) were recruited via primary health care centers for survivors of sexual violence which survivors approached post-CSA. Survivors reported on PTSD symptoms, daytime/nighttime pain, and adverse childhood experiences in semi-structured interviews. Parental acceptance levels were categorized (acceptance, no acceptance, no contact) for mothers and fathers separately. Kruskal-Wallis tests assessed group differences. Conditional random forests (CRF) evaluated the significance of parental acceptance in predicting PTSD symptom severity. RESULTS: No significant differences regarding PTSD symptoms and physical pain between levels of maternal acceptance were obtained. Pairwise comparisons revealed significant differences in PTSD symptom severity between paternal acceptance and no acceptance (d = 1.04) and paternal acceptance and no contact (d = 0.81). The CRF identified paternal acceptance as important variable for the prediction of PTSD symptom severity. Even though results were less conclusive, medium effect sizes hint at less pain perception within the paternal acceptance group. CONCLUSIONS: The results highlight paternal acceptance as a potential risk or protective factor regarding psychological and possibly physical well-being in the aftermath of CSA, even in the context of other known risk factors.

Is shame the missing link between traumatic experiences and post-traumatic stress disorder in Burundian children living on the streets?

BACKGROUND: Shame is an emotion reflecting an anticipated social devaluation of the self. It is strongly associated with experiences of humiliation and rejection in early life. Individuals suffering from post-traumatic stress disorder (PTSD) often struggle with shame. However, little is known about how shame contributes to the development and maintenance of PTSD symptoms in children. The present study investigated the ways childhood exposure to human-induced traumatic events promotes a coping mechanism of defeat and withdrawal facilitated by the experience of shame. We tested a dose-response relationship between lifetime experienced traumatic event types and PTSD in children using shame as a mediator. METHODS: We conducted semi-structured interviews with 33 male children who lived and worked on the streets of Bujumbura, the capital of Burundi at the time of data collection. We assessed self-reported PTSD symptom severity, lifetime traumatic event load, violence experienced on the streets and shame intensity. RESULTS: Mediation analyses revealed a significant indirect effect of lifetime traumatic events on PTSD symptom severity through shame intensity and a significant indirect effect of violence experienced on the streets on PTSD symptom severity through shame intensity. CONCLUSION: Our study suggests the mediating role of shame between traumatic experiences as well as violent experiences and PTSD symptom severity in children living on the streets. Shame in children suffering from PTSD seems to play a crucial role in the development and maintenance of PTSD symptoms.