Detecting the Unidentified Victims: Recognized Versus Unrecognized Child Sexual Abuse Sarah DeGue1, John Clemmons1, David DiLillo1, and Issac Martinez2 University of Nebraska-Lincoln1 Family Violence and Injury Lab Our Lady of the Lake University2

1

The Relationship between Neurocognitive
Functioning and Childhood Abuse among Persons
with SMI Mediating Proximal and Distal Factors
L. Felice Reddy, Ashley Wynne, and William D.
Spaulding University of Nebraska-Lincoln
Introduction

Correlations between Variables of Interest (n
177)
Theory Trimmed Path Analysis with Significant
Effects Included

• Neurocognition is a significant predictor of
  outcome among persons with serious mental illness
  (SMI) (Liberman, 2008). The deficits exhibited by
  individuals with SMI have been found to improve
  significantly in the context of integrated
  treatment programs that include cognitive
  rehabilitation (Wykes, 2008).
• Numerous studies have concluded that persons
  with SMI and a history of child abuse tend to
  have more severe cognitive impairments than those
  with SMI and no abuse history (Lysaker et al,
  2001). Extensive biological evidence indicates
  early life trauma may have a permanent impact on
  the developing brain. Rates of child sexual abuse
  (CSA) and child physical abuse (CPA) among
  persons with SMI have been found to range from
  34-60 (Darvez-Bornoz et al, 1995 Ross et al,
  1994 Greenfield et al.,1994).
• Consumers with a history of CPA or CSA have
  more frequent suicide attempts (Read et al.,
  2001), earlier first psychiatric admissions, more
  frequent and longer duration of psychiatric
  hospitalizations, more time in seclusion, and
  receive more medication (Read, van Os, Morrison,
  Ross, 2005).
• However, there is vast heterogeneity in
  cognitive and behavioral functioning among
  persons with SMI and a history of CA. Research
  needs to explore the mediating and moderating
  factors that interact throughout development in
  order to aid in more accurately predicting
  functional outcomes.
• This study is designed to examine potential
  precipitating factors of neurocognitve deficits
  as well as the behavioral and environmental
  mechanisms that facilitate neurocognitive
  improvements. Increased understanding of the
  complex relationship between traumatic events
  experienced in childhood and functional deficits
  in adulthood will vastly improve individualized
  assessment and treatment planning.

Gender male1, female2 Child Abuse Absent1,
Present2 Axis II Diagnosis Absent1,
Present2 p lt 0.05 p lt 0.01
Discussion

• This study provides empirical support for the
  theorized relationship between child abuse and
  neurocognitive functioning at the time of
  admission into an inpatient psychiatric
  rehabilitation program.
• As hypothesized, there are several paths and
  significant mediating variables involved in the
  longitudinal relationship between abuse and
  neurocognitive functioning. Abuse was not a
  significant predictor in the model when more
  proximal predictors were included. Significance
  testing of the variance accounted for by the full
  model in comparison with the reduced model
  revealed that the reduced model fit the data as
  well as the full model (W(11) 8.5, p lt .05).
• As hypothesized, initial correlations between
  the variables of interest showed that they were
  significantly related to one another. There were
  no extreme correlations, however, between
  predictor variables, suggesting that
  multicolinearity was not an issue (Mansfield
  Helms, 1982).
• Our study provides evidence that a sizable
  portion of the variance in neurocognition (30)
  can be explained by the proximal variables that
  have mediating and direct effects on the
  relationship between child abuse and
  neurocognitive functioning in adults with SMI at
  the time of admission to psychiatric
  rehabilitation.
• The results imply that the longitudinal pathways
  are heterogeneous and diverse, yet significant
  factors are identified in the model and should be
  considered important risk and resilience factors.
  It appears increased education may be a
  protective factor and age of onset may be a risk
  factor. Gender was added to the model as a
  predictor of abuse and should be considered in
  the interpretation of the results.
• There is a paucity of research examining the
  relationship between early life trauma and
  functional outcome among adults with SMI,
  especially with an emphasis on mediating
  variables and longitudinal study designs. Future
  research should expand on the current design by
  examining the different components of
  neurocognition (i.e. memory, attention, executive
  functions), as well as social cognition and other
  domains of functioning.

Path Analysis Depicting all Direct and Total
Effects
Methods

• Participants Data from 177 participants (Mean
  age 40, SD 12) at admission to an inpatient
  psychiatric rehabilitation program were used in
  the present analyses.
• Neurocognitive Measure Neurocognition was
  measured using the Repeatable Battery for the
  Assessment of Neuropsychological Status (RBANS
  Randolph, 1998), using standard scores (Mean100,
  SD15).
• History of Childhood Abuse Histories of
  childhood maltreatment (e.g. physical abuse,
  sexual abuse) were collected through medical
  chart reviews. Abuse was coded as present if CSA
  or CPA was documented to have occurred prior to
  age 18. All other historical variables were also
  collected from medical chart reviews.
• Data Analysis Bivariate correlations and
  regression models indicated high colinearity
  among the variables of interest. In an attempt to
  elucidate the temporal paths among the predictors
  and potential mediation effects, a path analysis
  was performed on the variables of interest.

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