Memory Functioning Trajectories as a Level of Severity

Memory Functioning Trajectories as a Level of Severity of Child Abuse during Inpatient Psychiatric Rehabilitation : An 18 -Month Longitudinal Study Using Multilevel Modeling (MLM) Kee-Hong Choi, L. Felice Reddy, Ashley Wynne, Melissa Tarasenko, Charlie A. Davidson, Elizabeth Cook and William D. Spaulding University of Nebraska-Lincoln Introduction Immediate Memory As a Function of the Level of Child Sexual and Child Physical Abuse Total Memory As a Function of the Level of Child Sexual and Child Physical Abuse Child abuse histories are prevalent among adults with serious mental illness (SMI); the rates are estimated at 40%-90%, which is at least double those found in the general population. Recent research indicates that similar patterns of neurocognitive deficits can be found in persons with a history of child abuse or extreme trauma as those typically found in persons with SMI (Read et al. , 2001). Neuroscientist Robert Sapolsky has also concluded that there are significant correlations between sustained stress, excess cortisol, and significant reductions in hippocampal volume in humans (Sapolsky, 1996). Importantly, research has indicated that intensive psychiatric rehabilitation may normalize cortisol levels (Partridge, 1994; Spaulding & Wyss, 1990; Tafet et al. , 2005). The aim of the present study was to analyze memory functioning and its changes throughout intensive psychiatric rehabilitation in relation to childhood sexual and physical abuse severity. It is hypothesized that 1) people with more severe childhood abuse will show lower memory capacity at admission, 2) memory functioning will be improved over time with ongoing intensive psychiatric rehabilitation, and 3) persons with more severe child abuse histories will show less improvement in memory functioning. Methods Participants: Data from 50 participants (Mean age=38. 16, SD= 12. 46) in an inpatient psychiatric rehabilitation program were used in the present analyses. Monthly average scores were used on memory functioning at 4 time points: admission, 6 months, 12 months, and 18 months. Memory Measure: Memory functioning was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998), using standard scores (Mean=100, SD=15). Severity of Childhood Abuse: Histories of childhood maltreatment (e. g. physical abuse, sexual abuse) were collected through medical chart reviews. The severity of child abuse history was coded based on the child abuse rating system described in Barnett, Manly, and Cicchetti (1993). Inter-rater reliability coefficients (ICCs) for child sexual abuse and child physical abuse in this study were. 93 and. 91, respectively. Data Analysis: Linear mixed models were estimated using SAS PROC MIXED in order to examine the overall pattern of and individual differences in memory functioning over four time points (at admission, 6 months, 12 months and 18 months). Restricted maximum likelihood (REML) was used in reporting model parameters and to assess the significance of random effects; degrees of freedom were estimated using the Satterthwaite method. Delayed Memory As a Function of the Level of Child Sexual and Child Physical Abuse Discussion As hypothesized, people with more severe childhood sexual or physical abuse demonstrated lower capacity in immediate/delayed/overall memory functioning at admission. As hypothesized, immediate memory functioning improved over time, the extent of which varied across individuals. However, it was noted that although people with more severe childhood abuse showed lower capacity in immediate memory at admission, their improvement in immediate memory functioning over the course of psychiatric rehabilitation was steeper, as compared to those with less severe childhood abuse history. Contrary to our hypothesis, delayed memory and overall memory did not improve over time. The results imply that individuals with severe mental illness and histories of childhood abuse normalize their rapid forgetting during inpatient psychiatric rehabilitation. However, given delayed recall was not changed over time during inpatient psychiatric rehabilitation, the results also implicate that there at least two or more brain dysfunctions affecting memory in severe mental illness.