Child Abuse and Neglect and Mental Disorders among
Child Abuse and Neglect and Mental Disorders among Native American Women in Primary Care American Native Women’s Health and Maternity Care Indian Health Service August 4, 2004, Albuquerque, New Mexico Bonnie Duran, Dr. PH UNM SOM MPH
Presentation Objectives Current theoretical models of Mental Disorders (MD) and Child abuse and neglect (CAN) Research design Trauma and MD (Lack of) Federal priority on Indian Health 2
Research Questions To determine prevalence rates of psychological disorders among Native American women seeking primary care treatment at an Indian Health Service ambulatory care clinic; To investigate relationships among intimate partner violence and child abuse and mental disorders; 3
Methods Two-stage sampling design: 1 st Stage: 484 consecutive presenting Native American women in a primary care clinic screened with a mental health screening instrument 2 nd State: 234 women--50% (N=117) high and 50% (n=117) low on the GHQ interviewed with battery of instruments 3 rd Stage: 75% Interviewed again after one year Chart abstraction and RPMS data of IHS utilization data 4
Source: Broken Promises: Evaluating the Native American Health Care System. (Draft)(2004). Washington DC: US Commission on Civil Rights: Office of the General Counsel. 5
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Source: Broken Promises: Evaluating the Native American Health Care System. (Draft)(2004). Washington 7 DC: US Commission on Civil Rights: Office of the General Counsel.
Instruments/Data Sources GHQ-12 item version Demographics Questionnaire Composite International Diagnostic Interview-I Shell (DSM IV) Childhood Trauma Questionnaire Conflict Tactics Scale II Utilization Questionnaire: Chart Abstraction and RPMS Spirituality and Social Support Questions in Phase 3 8
Composite International Diagnostic Interview SCREENING QUESTIONS--Depression Yes No In your lifetime, have you ever had two weeks or longer when nearly everyday you felt sad, empty, depressed for most of the day? In your lifetime, have you ever had two weeks or longer when you lest interest inmost things like work, hobbies, and other things you usually enjoyed? DIAGNOSTIC QUESTIONS Lacking Energy: …. Did you lack energy or feel tired all the time nearly every day, even when you had not been working hard? Appetite Change: …. Did you have less or more appetite than usual almost everyday? Sleep Problems: …Did you have trouble sleeping almost every night for two weeks or more--either trouble falling asleep, waking up in the middle of the night, or waking up too early? Lack of Confidence: …. Did you feel that you were not as good as other people? Trouble Thinking: …Did you have a lot more trouble concentrating than is normal for you 9
Childhood Trauma Questionnaire 1 (28 Items) When I was growing up…. Never True Rarely True Sometimes True Often True Very Often True I didn’t have enough to eat. I knew there was someone to take care of me and protect me. People in my family called me things like “stupid”, “lazy”, or “ugly”. People in my family hit me so hard that it left me with bruises or marks. I was punished with a belt, a board, a cord, or some other hard object. Someone tried to make me do sexual things or watch sexual things. 1 Bernstein, D. P. , Fink, L. , Handelsman, L. , & Foote, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. American Journal of Psychiatry, 151(8), 1132 -1136. 10
Conflict Tactics Scale 21 (78 Items-- both ways) How Often Did This Happen? 1 = Once in the past year 4 = 6 -10 times in the past year 2 = Twice in the past year 5 = 11 -20 times in the past year 3 = 3 -5 Times in the past year 6 = more than 20 times in the past year 7 = Not in the past year, but it did happen 0 = this had never happened. I the past 1 2 3 4 5 6 7 0 May partner showed care for me even though we disagreed. I insulted or swore at my partner; my partner swore or insulted me. I threw something at my partner’ my partner threw something at me. I had a sprain, bruise, or small cut because of a fight with my partner: my partner had these due to a fight with me. 1 Straus, M. A. , Hamby, S. L. , Boney-Mc. Coy, S. , & Sugarman, D. B. (1996). The revised Conflict Tactics 11 Scales (CTS 2): Development and preliminary psychometric data. Journal of Family Issues, 17(3), 283 -316.
How Often Did This Happen? 1 = Once in the past year 4 = 6 -10 times in the past year 2 = Twice in the past year 5 = 11 -20 times in the past year 3 = 3 -5 Times in the past year 6 = more than 20 times in the past year 7 = Not in the past year, but it did happen 0 = this had never happened. I the past 1 2 3 4 5 6 7 My partner used a knife or gun on me: I used a knife or gun on my partner. I passed out from being hit on the head in a fight with my partner: My partner passed out from being hit on the head in a fight with me. My partner beat me up: I beat up my partner. I slapped my partner: My partner slapped me. I accused my partner of being a lousy lover: My partner accused me of being a lousy lover. 12 0
Mental Disorder Models 13
World Health Organization. (2001). The world health report 2001 : mental health : new understanding, new hope. Geneva: World Health Organization. Pg. 20 14
World Health Organization. (2001). The world health report 2001 : mental health : new understanding, new hope. Geneva: World Health Organization. Pg. 30 15
Walters, K. L. , & Simoni, J. M. (2002). Reconceptualizing native women's health: an "indigenist" stress- 16 coping model. Am J Public Health, 92(4), 520 -524.
De Bellis, M. D. (2002). Developmental traumatology: a contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology, 27(1 -2), 155 -170. 17
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