PTSD and CSA Therapies and Future Research

Child Abuse Brown, J., Cohen, P. Johnson, J.G. (1999, December). Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 38(12), 1490-1496. The authors conducted this study in order to investigate the magnitude and independence of the effects of childhood neglect, physical abuse, and sexual abuse on depression and suicidal behavior in adolescents and adults.

Over a 17-year period, a cohort of randomly selected children was assessed for a range of environmental, familial, and childhood risks and psychiatric orders. The history of abuse was verified through official records of abuse and by the retrospective self-report of the 639 youths in the study. The subjects were between the ages of one year and 10 years at the beginning of the study, with a median age of five years.

The results of the study showed that adolescents and young adults that had been neglected, physically abused, and/or sexually abused were three times more likely (significant at p > .01) to become suicidal or depressed when compared with their same age peers who did not have a history of maltreatment such as child neglect, physical abuse, or sexual abuse.

The statistical measures used showed that certain adverse contextual factors, such as the characteristics of the parents, of the children, and other aspects of the family environment -- accounted for a substantial amount of the increased risk for suicide attempts and the occurrence of depression in adolescence (significant at p > .01) but did not account for these conditions in adulthood. Moreover, the researchers found that the effects of childhood sexual abuse were the most independent of associated factors, and the effects of childhood sexual abuse were the largest factors.

Those youths who had a history of sexual abuse were eight times more likely to exhibit the risk of repeated suicide attempts (the odds ratio was = 8.40 and the significance level was p < .01). The researchers concluded that individuals with a history of sexual abuse were at greater risk of becoming suicidal or depressed as adolescents and as young adults. Indeed, adolescence appeared to be a time when young people were the most vulnerable for repeated attempts at suicide.

The effects of neglect, however, were found to be more diffuse, and could be attributed to a wide range of contextual factors. The researchers concluded that a broader research scope would be appropriate for investigating intervention in the cases that involved neglect and maltreatment. The data analysis relied primarily on bivariate associations between the risk for depressive disorders and suicidal behavior in adolescence and young adulthood with childhood maltreatment that included all three types: neglect, physical abuse, and sexual abuse. Statistical control was maintained for gender and age.

The logistic regression analysis used determined when these associations could possibly be accounted for by the effects of the contextual risk factors for maltreatment, which had been previously identified. The analyses were repeated, in this manner, for separate consideration of adolescent and young adult outcomes. Further analyses in this study was used to determine if the effects observed were limited to child maltreatment that fell into certain specific categories. Cloitre, M., Tovall-McClough, K.C., Nooner, K., Zorvas, P., Cherry, S., Jackson, C.L., Weijim, G., and Petkova, E. (2010, July).

Treatment for PTSD related to childhood abuse: a randomized controlled trial. The American Journal of Psychiatry, 167(8), 915-924. dol: 10.1176/appl.ajp.2010.09081247 The focus of the investigation was potential treatment used to help patients with posttraumatic stress disorder (PTSD) to regulate their affect and interpersonal disturbances that contribute to the impairment of PTSD.

Specifically, the researchers evaluated the benefits and risks from a phased intervention that combined skills training in affect and interpersonal regulation (STAIR) with a subsequent exposure, and compared it to control conditions: 1) Supportive counseling followed by exposure (referred to as Support / Exposure) and Supportive Counseling (referred to as STAIR / Support). Women diagnosed as having child abuse-related PTSD were randomly assigned to one of three conditions: STAIR / Exposure, Support / Exposure (exposure comparator), or STAIR / Support (skills comparator). The 104 women were assessed at post-treatment, 3-months, and 6-months.

The group treated with STAIR / Exposure was more likely to achieve full and sustained remission (27%) compared to study participants in the exposure comparator (0%) and than the skills comparator condition (13%). The STAIR / Exposure condition produced more improvement in regulation of emotion than the exposure comparator, and greater improvements in interpersonal problems that both of the conditions. The Cognitive Behavior Therapies (CBTs) were designed specifically to resolve PTSD symptoms.

The CBT did not include interventions to explicitly address the additional emotion and interpersonal regulation difficulties observed among those with PTSD stemming from childhood abuse. This.