PARTNER ABUSE AND SUICIDAL BEHAVIOR AMONG LOWINCOME AFRICAN AMERICAN WOMEN

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

• Nadine J. Kaslow, Ph.D., ABPP
• Moderator
• August 12, 2006

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THE GRADY NIA PROJECT

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

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

• Kafi S. Bethea, BA
• Michael T. Compton, MD, MPH

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BACKGROUND

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

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BACKGROUND

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

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PURPOSE

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

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HYPOTHESIS

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

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SAMPLE

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

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SAMPLE

• 30.3 (N63) have never been married and 59.9
  (N121) were currently in an abusive relationship
• 81.6 (N168) had children, but in 50.5 of
  cases, the children did not live with the
  participant
• 40.4 (N84) had less than 12th grade education
  and 84.6 (N176) were unemployed
• 71.2 (N148) had a history of psychiatric or
  substance abuse treatment

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PROCEDURE

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

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MEASURES

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

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MEASURES

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

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DATA ANALYSIS

• The Linear Structural Relations Program (LISREL
  version 8.52) was used for path analyses
  examining the direct and indirect effects of
  childhood trauma on suicidal ideation and the
  direct effects of childhood trauma on
  self-esteem, expectations of success, and
  positive coping

Self-Esteem
Childhood Trauma Emotional Abuse Emotional
Neglect Physical Abuse Physical Neglect Sexual
Abuse
Suicidal Ideation
Expectations of Success
Positive Coping
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RESULTS

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

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Results

• The final model indicates that emotional neglect
  in childhood has an indirect path to later
  suicidal ideation through self-esteem and
  expectations of success

0.98
Self-Esteem
-0.15
1.00
0.82
Emotional Neglect
Suicidal Ideation
0.43
-0.43
-0.16
Expectations of Success
0.77
Chi- Square3.18, df2, p0.20365, RMSEA0.054
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CONCLUSIONS

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

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IMPLICATIONS

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

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

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

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PURPOSE

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

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HYPOTHESES

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

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MEASURES

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

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MEASURES - EOR

Not very Effective Slightly Effective
Somewhat Effective Very Effective
1 2
3 4
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ANALYSES
Childhood Abuse (CTQ) Sexual Abuse (CSA) Physical
Abuse (CPA) Emotional Abuse (CEA)
IPV (ISA) Physical (P) Non-physical (NP)
Access to Resources (EOR)
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OVERALL RESULTS
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RESULTS
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RESULTS

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CONCLUSIONS

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

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IMPLICATIONS

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

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COPING MODERATES THE STRESS-DISTRESS RELATION
AMONG AFRICAN AMERICAN WOMEN

• Carli H. Jacobs, MA
• Sarah E. Dunn, MA

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BACKGROUND

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

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BACKGROUND

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

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PURPOSE

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

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HYPOTHESES

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

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METHODS MEASURES

• Hassles Scale Survey of Recent Life Events (RLE
  Kohn MacDonald, 1992)
• Brief Cope (BCOPE Carver, 1997)
• Adaptive
• - Active Coping
• - Positive Reframing
• - Acceptance
• - Instrumental Support
• Beck Depression Inventory-II (BDI-II Beck,
  Steer, Brown, 1996)
• Brief Symptom Inventory (BSI Derogatis, 1993)
• Global Symptom Index

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

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

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IMPLICATIONS

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

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

• Natalie C. Arnette, M.S.
• Nathan Mascaro, Ph.D.

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BACKGROUND

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

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PURPOSE

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

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HYPOTHESES

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

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MEASURES

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

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DATA ANALYSIS

• Hierarchical Logistic Regression Analyses were
  conducted to assess the ability of depressive
  symptoms and suicidal ideation to predict
  employment, as well as the ability of employment
  to predict depressive symptoms and suicidal
  ideation

Depressive Symptoms Suicidal Ideation
Employment Status
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PROSPECTIVE PREDICTION OF EMPLOYMENT STATUS BY
DEPRESSIVE SYMPTOMS

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

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EMPLOYMENT STATUS PREDICTION OF DEPRESSIVE
SYMPTOMS OVER TIME

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

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ROLE OF DAILY STRESSORS

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

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CONCLUSIONS

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

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CONCLUSIONS

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

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IMPLICATIONS

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