Gender, victimization, and outcomes: Reconceptualizing risk.

Large-scale studies of gender differences in psychopathological reactions to victimization have focused on posttraumatic stress disorder, overlooking other trauma-related disorders. The present study expands this literature with a contextualized examination of interpersonal aggression exposure and sequelae. Using k-means cluster analysis on a sample of 16,000, the authors identified 8 distinct profiles of exposure to sexual violence, physical assault, stalking, and emotional abuse. Analyses of covariance then suggested links among victimization profile, gender, and mental and physical health. Results revealed no meaningful interactive effects of gender and interpersonal aggression on outcomes, once lifetime exposure to aggressive events was adequately taken into account. These findings argue against theories of female victims' greater vulnerability to pathological outcomes, instead linking risk to exposure history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of minority stress on mental health and substance use among sexual minority women.

Objective: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. Method: A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social–psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social–psychological resources as a mediator between minority stress and health. Results: The final model demonstrated acceptable fit, χ2(79) = 414.00, p confirmatory fit index = .93, Tucker–Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social–psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. Conclusions: Findings indicate a significant impact of minority stressors and social–psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cultural mistrust and mental health help-seeking attitudes among Filipino Americans.

As low as the rate of mental health help-seeking is among Asian Americans, Filipino Americans seek mental health services at a much lower rate even compared with other Asian Americans. Despite the field’s progress in identifying and understanding factors that may influence mental health help-seeking attitudes among Asian Americans, despite research on other minority groups suggesting that cultural mistrust may influence attitudes toward seeking professional psychological help, and despite the abundance of literature documenting the historical and contemporary experiences of oppression by Filipino Americans, the possibility that cultural mistrust may play a significant role in Filipino Americans’ mental health help-seeking attitudes have yet to be empirically investigated. Thus, using a sample of 118 Filipino Americans, the current study demonstrates that higher levels of cultural mistrust is related to lower likelihood of seeking professional psychological help. Furthermore, cultural mistrust predicted variance in mental health help-seeking attitudes that are not accounted for by income, generational status, loss of face, and adherence to Asian cultural values. Implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of interpersonal violence in adulthood on women's job satisfaction and productivity: The mediating roles of mental and physical health.

Objective: With growing awareness of the prevalence of interpersonal violence victimization among women, research has begun to examine the impact of these experiences on employment. To date, much of this work in the United States has centered on low-income women moving from public assistance to paid employment and research gaps in our understanding of a broader range of working women's experiences still exist. The present study explored the impact of multiple types of victimization (sexual violence, physical intimate partner violence, psychological abuse, and stalking) on a range of work outcomes (job satisfaction, job benefits, job interference). Method: A random-digit-dial telephone survey of 1,079 women living in New Hampshire was conducted. Measures included questions about victimization in adulthood and current perceptions of employment. Results: A multivariate analysis of variance and regression analyses showed clear links between victimization experiences and negative work outcomes. Mental and physical health symptoms represent important mediators explaining these links. Conclusion: Results support the need for workplace policies and supports that provide safety nets for survivors and encourages the development of community norms that assist survivors in accessing such supports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health pathways from interpersonal violence to health-related outcomes in HIV-positive sexual minority men.

Objective: We examined mental health pathways between interpersonal violence (IPV) and health-related outcomes in HIV-positive sexual minority men engaged with medical care. Method: HIV-positive gay and bisexual men (N = 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban setting. Participants (M age = 44.1 years, 36% non-White) filled out a computer-assisted survey and had health-related data extracted from their electronic medical records. We used structural equation modeling to test associations among the latent factors of adult abuse and partner violence (each comprising indicators of physical, sexual, and psychological abuse) and the measured variables: viral load, health-related quality of life (HRQOL), HIV medication adherence, and emergency room (ER) visits. Mediation was tested for the latent construct mental health problems, comprising depression, anxiety, symptomatology of posttraumatic stress disorder, and suicidal ideation. Results: The final model demonstrated acceptable fit, χ2(123) = 157.05, p = .02, CFI = .95, TLI = .94, RMSEA = .04, SRMR = .06, accounting for significant portions of the variance in viral load (13%), HRQOL (41%), adherence (7%), and ER visits (9%), as well as the latent variable mental health problems (24%). Only 1 direct link emerged: a positive association between adult abuse and ER visits. Conclusions: Findings indicate a significant role of IPV and mental health problems in the health of people living with HIV/AIDS. HIV care providers should assess for IPV history and mental health problems in all patients and refer for evidence-based psychosocial treatments that include a focus on health behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of specialty mental health services by Asian Americans with psychiatric disorders.

Research suggests that Asian Americans underutilize mental health services but an understanding of the multiple factors involved in utilization has not been examined in a nationally representative sample. The current study analyzed data from the National Latino and Asian American Study (NLAAS) and examined 368 individuals with disorders to understand utilization and what factors were related to the utilization of specialty mental health services. Significant underutilization was found for Asian Americans; moreover, underutilization was especially acute among Asian American immigrants. For U.S.-born Asian Americans, use of primary care services was significantly associated with use of mental health services, but for foreign-born Asian Americans, use of primary care services was unrelated to mental health services use. For both U.S.-born and foreign-born Asian Americans, use of alternative services appeared to significantly affect whether Asian Americans with disorders utilize mental health services, but the nature of the influence varied depending on the individual’s level of English-language proficiency. These findings revealed that a major mental health disparity, the underutilization of mental health services by Asian Americans, was nuanced by use of other health-related services and immigration-related factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school.

This study examined victimization during high school based on sexual orientation of 350 lesbian, gay, or bisexual (lgb) youths aged 21 and younger. Experiences of direct victimization as well as knowledge of other lgb youths' victimization were assessed. Over half reported verbal abuse in high school because of their sexual orientation, and 11% said they had been physically assaulted. Youths who were more open in high school about their sexual orientation and who had a history of more gender atypical behavior were victimized more often. Male youths were targeted significantly more often than females, Youths' current mental health symptoms, especially traumatic stress reactions, were associated with having experienced more verbal abuse in high school. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive–behavioral therapy for PTSD and depression symptoms reduces risk for future intimate partner violence among interpersonal trauma survivors.

Objective: Women who develop symptoms of posttraumatic stress disorder (PTSD) and depression subsequent to interpersonal trauma are at heightened risk for future intimate partner violence (IPV) victimization. Cognitive–behavioral therapy (CBT) is effective in reducing PTSD and depression symptoms, yet limited research has investigated the effectiveness of CBT in reducing risk for future IPV among interpersonal trauma survivors. Method: This study examined the effect of CBT for PTSD and depressive symptoms on the risk of future IPV victimization in a sample of women survivors of interpersonal violence. The current sample included 150 women diagnosed with PTSD secondary to an array of interpersonal traumatic events; they were participating in a randomized clinical trial of different forms of cognitive processing therapy for the treatment of PTSD. Participants were assessed at 9 time points as part of the larger trial: pretreatment, 6 times during treatment, posttreatment, and 6-month follow-up. Results: As hypothesized, reductions in PTSD and in depressive symptoms during treatment were associated with a decreased likelihood of IPV victimization at a 6-month follow-up even after controlling for recent IPV (i.e., IPV from a current partner within the year prior to beginning the study) and prior interpersonal traumas. Conclusions: These findings highlight the importance of identifying and treating PTSD and depressive symptoms among interpersonal trauma survivors as a method for reducing risk for future IPV. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Parent and Peer Predictors of Physical Aggression and Conflict Management in Romantic Relationships in Early Adulthood.

Violence between romantic partners is widespread, but developmental precursors of perpetration and victimization are little understood. Among participants followed from birth to 23 years of age, familial and extrafamilial childhood and adolescent relationships were examined in connection with couple violence in early adulthood. Predictors included early childhood physical abuse and witnessing of parental partner violence, features of parent-child interactions at the age of 13 years, and close friendship quality at the age of 16 years. Controlling for early familial violence, intrusive or overly familiar behavior in videotaped parent-child collaborations at 13 years of age consistently predicted violence perpetration and victimization in early adulthood. Friendship quality at the age of 16 years contributed over and above familial predictors. Understanding the role of both familial and extrafamilial close relationship precursors may lead to effective strategies for ameliorating the problem of romantic partner violence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal investigation of interpersonal violence in relation to mental health and substance use.

The authors examined longitudinally the mental health status of women as a function of different types and combinations of exposure to interpersonal violence. A structured telephone interview was administered to a household probability sample of 4,008 women (18-89 years of age), who were then recontacted for 1- and 2-year follow-up interviews. Interviews assessed lifetime violence history (i.e., sexual assault, physical assault, witnessed serious injury or violent death), past-year mental health functioning (i.e., posttraumatic stress disorder [PTSD], depression, and substance use problems), and new instances of violence occurring after the baseline interview. Results indicate that (a) lifetime violence exposure was associated with increased risk of PTSD, depression, and substance use problems; (b) odds of PTSD, depression, and substance use problems increased incrementally with the number of different types of violence experienced; (c) relations were fairly stable over a 2-year period; and (d) new incidents of violence between the baseline and follow-up interviews were associated with heightened risk of PTSD and substance use problems. Greater understanding of the cumulative impact of violence exposure will inform service provision for individuals at high risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Future directions in studies of trauma among ethnoracial and sexual minority samples: Commentary.

Objective: Studies examining psychological trauma or posttraumatic stress disorder (PTSD) in ethnoracial or sexual minority groups are relatively few. The Journal of Consulting and Clinical Psychology recently published 4 articles (Balsam, Lehavot, Beadnall, & Circo, 2010; Harrington, Crowther, & Shipherd, 2010; Lester, Resick, Young-Xu, & Artz, 2010; Marshall, Schell, & Miles, 2009) that examine trauma exposure and posttraumatic outcomes in ethnoracial and sexual minority samples. This commentary focuses on the overlap between traumatic stress and diversity studies in order to consider future areas in need of development. Method: Within the framework of a generalized overview of current trends in the study of traumatic stress, an assessment of the strengths and limitations of these 4 articles is provided. Populations and syndromes covered by the articles include ethnoracial differences in child maltreatment and adverse mental health outcomes among sexual minority participants, PTSD symptom elevations among Hispanic Americans, binge eating and the strong Black woman schema, and retention of African American female participants in cognitive behavioral psychotherapy trials for PTSD. Results: Recommendations to enhance culturally competent traumatic stress studies include increasing the examination of within-group cultural variability and key social, contextual, and cultural variables and constructs; examining the temporal sequencing of traumatic events and key transitions in sexual and ethnic minority identity development; and conducting prevention and treatment studies for those sexual minority children most at risk for maltreatment. Conclusions: By following these recommendations, the next generation of studies of traumatic stress studies will be enhanced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The potential impact of violent victimization on somatic symptoms among Asian American adolescents: A national longitudinal study.

This study explored the mental health repercussions among Asian American adolescents following experiences of violent victimization. Utilizing a subsample of Asian American adolescents from Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health), this study examined the relationship between violent victimization and somatic symptoms one year later, as well as moderators of this relationship. Results from a hierarchical multiple regression analysis showed that emotional bonds with fathers were negatively related to somatic symptoms. In addition, instrumental bonds with mothers weakened the link between violent victimization and somatic symptoms. The practical implications of these results for addressing the psychosocial needs of Asian American adolescents were discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Minority stress and mental health among Dutch LGBs: Examination of differences between sex and sexual orientation.

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the “gay-friendly” Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Initiation, desistance, and persistence of men's sexual coercion.

Patterns of sexually coercive behavior were examined among 266 Asian American and 299 European American men over 1 year. Noncoercer (n = 358), desister (n = 120), initiator (n = 39), and persistent (n = 48) sexually coercive groups were identified. The strongest predictor of sexual coercion was past sexual coercion. Persistent sexual coercers were higher than the other groups in delinquency and hostile masculinity and were nearly twice as likely to engage in laboratory sexual harassment. Loss of face attenuated self-reported sexual coercion and laboratory sexual harassment risk among Asian Americans and attenuated only laboratory sexual harassment risk among European Americans. These findings suggest that the heterogeneity of sexually coercive behavior and ethnicity are important research and clinical considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On integrating variables and separating facts in the complex relationship between dependency and domestic violence.

Presents a reply by Robert Bornstein to comments from Chronister (see record 2007-14606-021) and Dutton (see record 2007-14606-022) regarding his article, "The complex relationship between dependency and domestic violence: Converging psychological factors and social forces," (see record 2006-11202-003). In addition to raising some important issues regarding the link between dependency and domestic violence, the comments by Chronister and Dutton illustrate the importance of integrating variables and separating facts. Chronister's call for scrutiny of the bidirectional influence between emotional and economic dependency not only enhances our understanding of the dependency-abuse relationship but also points to useful interventions that may reduce the incidence and severity of domestic violence among married and cohabiting couples. Dutton's conflation of gender differences in abuse perpetration rates with the underlying causes of domestic violence tells us little about the state of the discipline but illustrates the importance of separating facts-in this case distinguishing epidemiological data from data that assess directly the intra- and interpersonal dynamics of abuse perpetration and victimization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Examining the correlates of psychological aggression among a community sample of couples.

In this study, the authors examined the correlates of psychological aggression victimization and perpetration among a community sample of 145 heterosexual couples. For both women and men, psychological aggression victimization was associated with greater psychological distress, anxiety, and physical health symptoms beyond the effects of physical aggression. Psychological aggression victimization was also uniquely associated with higher levels of depression for women. Trait anger and poor relationship adjustment were the strongest correlates of psychological aggression perpetration across genders. Childhood father-to-child and father-to-mother aggressions were associated with psychological aggression perpetration for men only, suggesting possible distinct etiologies across genders. These data highlight the importance of the further development of models for psychological aggression in both women and men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family-of-origin maltreatment, posttraumatic stress disorder symptoms, social information processing deficits, and relationship abuse perpetration.

In this study, the authors examined the interrelations among family-of-origin maltreatment variables, posttraumatic stress disorder (PTSD) symptoms, social information processing deficits, and male-to-female psychological and physical intimate relationship abuse perpetration in adulthood among a community sample of 164 men and their partners. In bivariate analyses, higher family-of-origin childhood parental rejection was associated with the perpetration of psychological and physical abuse in adulthood, and childhood exposure to interparental violence was also associated with adult psychological abuse perpetration. Structural equation modeling analyses indicated that when childhood variables and other study variables were considered together, only childhood parental rejection was associated with the abuse perpetration outcomes, and these effects were indirect through PTSD symptoms and social information processing deficits. Results indicate a need for further investigation into the mechanisms accounting for the impact of early maltreatment on the development of abusive intimate relationship behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial sequelae of violent victimization in a national youth sample.

In a national telephone sample of youths aged 10–16 years, over one third reported having been the victims of an assault. Victimized respondents displayed significantly more psychological and behavioral symptomatology than did non victimized respondents (more symptomatology related to post traumatic stress disorder, more sadness, and more school difficulties), even after controlling for some other possible sources of distress. Sexual assault was associated with particularly high levels of symptomatology. However, victims of other forms of assault—nonfamily assaults involving weapons or physical injury (aggravated assaults), assaults by parents, violence to genitals, and attempted kidnappings—also evidenced levels of distress that were not statistically lower than those suffered by victims of sexual assault. The findings suggest that substantial mental health morbidity in the general child and adolescent population is associated with victimization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual assault and other types of sexual harassment by workplace personnel: A comparison of antecedents and consequences.

Although sexual assault by workplace personnel is widely viewed as a type of sexual harassment, little is known about whether these overlapping constructs may possess some unique characteristics. This article compares the theoretical antecedents and consequences of sexual assault by workplace personnel and other types of sexual harassment among 22,372 women employed in the U.S. military. Path analysis revealed that low sociocultural and organizational power are associated with an increased likelihood of both types of victimization. Organizational climate and job gender context are directly associated with sexual harassment but are only indirectly associated with sexual assault by workplace personnel. Both types of victimization are associated with a variety of negative outcomes, but the pattern of negative consequences differs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prioritized assignment to intake appointments for Asian Americans at an ethnic-specific mental health program.

This study examined the relationship of demographic, clinical, and therapist factors to decisions about prioritized assignment to the earliest intake appointment for 983 Asian Americans who contacted an Asian-oriented, ethnic-specific mental health program. The logistic regression results showed that Asian language preference, ethnicity, suicidality, violent behavior, physical and sexual abuse, and psychotic symptoms increased the likelihood of a prioritized decision for the earliest intake appointment but that being female, being of an older age, and having somatic complaints decreased the likelihood. Given these findings, Asian American clinicians at an ethnic-specific program were found to consider clinical, demographic, and ethnically related factors in prioritized decisions about intake assignment, which could improve intake attendance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)