The 4‐item Hurt/Insult/Threaten/Scream (HITS) tool accurately detects past‐year intimate partner violence (IPV) among female Veterans Health Administration (VHA) patients; however, it lacks a sexual ...IPV item. This study evaluated the accuracy of an extended HITS (E‐HITS), which adds a sexual IPV item, in female VHA patients. A sample of 80 female U.S. veteran VHA patients in New England completed a mail survey (50.0% response rate) that included the 5‐item E‐HITS and the Revised Conflict Tactics Scales (CTS‐2). Women were included if they were in an intimate relationship in the past year. The women averaged 49 years of age and 86.0% of the sample was White. Accuracy of the 4‐item HITS was compared to the 5‐item E‐HITS, using the CTS‐2 as the reference. There were 20 women (25.0%) who reported past‐year IPV on the CTS‐2. The receiver operator characteristic curves demonstrated that the HITS and E‐HITS performed nearly identically at their optimal cutoff scores of 6 and 7, respectively. At these cutoff scores, the sensitivity of both tools was .75, 95% CI .55, .95. The specificities were similar; .83 for the HITS, 95% CI .73, .92, and .82 for the E‐HITS, 95% CI .72, .90. Including a sexual IPV item may be clinically beneficial; it also attains the same accuracy of case identification as the HITS.
Resumen
El instrumento de 4 ítems HITS (Hurt/Insult/Threaten/Scream) detecta en forma precisa la violencia en la pareja (IPV) en el último año entre pacientes mujeres de la Administración de Salud de Veteranos (VHA); sin embargo, carece de un ítem de IPV de tipo sexual. Este estudio evaluó la precisión de un HITS extendido (E‐HITS), que agrega un ítem de IPV sexual, en pacientes de sexo femenino de VHA. Una muestra de 80 mujeres veteranas de EUA, pacientes de VHA en New England, completaron una encuesta (Tasa de respuesta de 50%) que incluyó el E‐HITS de 5 ítems y el Revised Confict Tactics Scales (CTS‐2). Fueron incluidas las mujeres que estuvieron en una relación el último año. El promedio de edad fue de 49 años y el 86% de la muestra era de raza blanca. La precisión del HITS de 4 ítems fue comparada a la del E‐HITS de 5 ítems usando la CTS‐2 como referencia. Hubo 20 mujeres (25%) que reportaron IPV del último año en el CTS‐2. Las curvas de Características Operativas del Receptor (ROC) demostraron que el HITS y el E‐HITS rindieron de forma prácticamente idéntica en sus puntajes de corte óptimos de 6 y 7, respectivamente. En esos puntajes de corte, la sensibilidad de ambos instrumentos fue .75 (IC .55, .95). Las especificidades fueron similares, .82 para el HITS CI .73, .93 y .82 para el E‐HITS CI .72, .90. El incluir un ítem de IPV sexual puede ser clínicamente beneficioso; a la vez que alcanza la misma precisión en la identificación de casos que el HITS.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題 : 親密伴侶暴力篩檢工具對VHA女病人的精確性：一次重複驗證和擴展
撮要: 針對「傷害、侮辱、恐嚇、叫囂」(HITS)四個項目的篩檢工具準確偵查美國退役軍人健康管理局(VHA)女病人在過去一年的親密伴侶暴力(IPV)，但它缺乏性方面的IPV項目。本研究評核一個加上性方面的IPV項目的篩檢工具──擴展的HITS(E‐HITS)，其對VHA女病人的精確度。新英格蘭80名美國VHA退役女病人組成樣本，完成了包含五個項目的E‐HITS和「修訂衝突策略量尺」(CTS‐2)的郵寄調查（反應率為50.0%）。研究包含在過去一年曾有親密關係的女性。樣本中的女性平均年齡為49歲，樣本中86.0%為白人。以CTS‐2為參考，含四個項目的HITS跟含五個項目的E‐HITS作對比。在CTS‐2中，20名女士（25.0%）報稱在過去一年有IPV。接收者操作特性曲線顯示，HITS和E‐HITS在分別為6和7分的最佳臨界分數表現近乎一致。在最佳臨界分數，兩種工具的敏感度為.75 (CI .55, .95)。它們的特殊性相似：HITS為.82 (CI .73, .93)，E‐HITS為.82 (CI .72, .90)。包含性方面的IPV項目可能對臨床有幫助，而那樣做跟HITS在個案鑑定方面達同樣的精確度。
标题 : 亲密伴侣暴力筛检工具对VHA女病人的精确性：一次重复验证和扩展
撮要: 针对「伤害、侮辱、恐吓、叫嚣」(HITS)四个项目的筛检工具准确侦查美国退役军人健康管理局(VHA)女病人在过去一年的亲密伴侣暴力(IPV)，但它缺乏性方面的IPV项目。本研究评核一个加上性方面的IPV项目的筛检工具──扩展的HITS(E‐HITS)，其对VHA女病人的精确度。新英格兰80名美国VHA退役女病人组成样本，完成了包含五个项目的E‐HITS和「修订冲突策略量尺」(CTS‐2)的邮寄调查（反应率为50.0%）。研究包含在过去一年曾有亲密关系的女性。样本中的女性平均年龄为49岁，样本中86.0%为白人。以CTS‐2为参考，含四个项目的HITS跟含五个项目的E‐HITS作对比。在CTS‐2中，20名女士（25.0%）报称在过去一年有IPV。接收者操作特性曲线显示，HITS和E‐HITS在分别为6和7分的最佳临界分数表现近乎一致。在最佳临界分数，两种工具的敏感度为.75 (CI .55, .95)。它们的特殊性相似：HITS为.82 (CI .73, .93)，E‐HITS为.82 (CI .72, .90)。包含性方面的IPV项目可能对临床有帮助，而那样做跟HITS在个案鉴定方面达同样的精确度。
To examine associations of administratively recorded sexual assault victimization during military service with subsequent mental health and negative career outcomes among US Army women controlling ...for nonrandom victimization exposure.
We used data from the Army Study to Assess Risk and Resilience in Servicemembers to apply propensity score methods to match all 4238 female Regular Army soldiers with administratively recorded sexual assault victimization during 2004 to 2009 to 5 controls per case with similar composite victimization risk. We examined associations of this victimization measure with administratively recorded mental health treatment, suicide attempt, and Army career outcomes over the subsequent 12 months by using survival analysis for dichotomous outcomes and conditional generalized linear models for continuous outcomes.
Women with administratively recorded sexual assault had significantly elevated odds ratios (ORs) of subsequent mental health treatment (any, OR = 2.5; 95% confidence interval CI = 2.4, 2.6; specialty, OR = 3.1; 95% CI = 2.9, 3.3; inpatient, OR = 2.8; 95% CI = 2.5, 3.1), posttraumatic stress disorder treatment (any, OR = 6.3; 95% CI = 5.7, 6.9; specialty, OR = 7.7; 95% CI = 6.8, 8.6; inpatient, OR = 6.8; 95% CI = 5.4, 8.6), suicide attempt (OR = 3.0; 95% CI = 2.5, 3.6), demotion (OR = 2.1; 95% CI = 1.9, 2.3), and attrition (OR = 1.2; 95% CI = 1.1, 1.2).
Sexual assault victimization is associated with considerable suffering and likely decreased force readiness.
Abstract Objective Female veterans are at high risk for intimate partner violence (IPV). A critical issue in the provision of health care to women who experience IPV is the delivery of effective ...brief counseling interventions that address women's unique needs. We aimed to identify female veterans' priorities and preferences for healthcare-based IPV counseling. Method A 2014 Web-based survey was administered to a national sample of US female veterans. Among 411 respondents (75% participation rate), 55% ( n = 226) reported IPV during their lifetime. These women identified priorities for the content focus of IPV-related counseling and preferences for the delivery of these services. Results Women prioritized counseling that focuses on physical safety and emotional health, with learning about community resources being a relatively lower priority. Participants preferred counseling to focus specifically on enhancing coping skills and managing mental health symptoms. In addition, women want counseling to be individualized and preferred the option to meet with a counselor immediately following disclosure. Affordable services and attention to privacy concerns were of paramount importance in the context of IPV-related counseling. Conclusion These findings can inform patient-centered brief counseling interventions for women who experience IPV, which may ultimately reduce health disparities and violence among this population.
Polycyclic aromatic hydrocarbons (PAH) are carcinogenic and neurotoxic combustion by-products commonly found in urban air. Exposure to PAH is disproportionately high in low income communities of ...color who also experience chronic economic stress.
In a prospective cohort study in New York City (NYC) we previously found a significant association between prenatal PAH exposure and Attention Deficit Hyperactivity Disorder (ADHD) behavior problems at age 9. Here, we have evaluated the joint effects of prenatal exposure to PAH and prenatal/childhood material hardship on ADHD behavior problems.
We enrolled nonsmoking African-American and Dominican pregnant women in New York City between 1998 and 2006 and followed their children through 9 years of age. As a biomarker of prenatal PAH exposure, PAH-DNA adducts were measured in maternal blood at delivery and were dichotomized at the limit of detection (to indicate high vs. low exposure). Maternal material hardship (lack of adequate food, housing, utilities, and clothing) was self-reported prenatally and at multiple time points through child age 9. Latent variable analysis identified four distinct patterns of hardship. ADHD behavior problems were assessed using the Conners Parent Rating Scale- Revised. Analyses adjusted for relevant covariates.
Among 351 children in our sample, across all hardship groups, children with high prenatal PAH exposure (high adducts) generally had more symptoms of ADHD (higher scores) compared to those with low PAH exposure. The greatest difference was seen among the children with hardship persisting from pregnancy through childhood. Although the interactions between high PAH exposure and hardship experienced at either period (“persistent” hardship or “any” hardship) were not significant, we observed significant differences in the number of ADHD symptoms between children with high prenatal PAH exposure and either persistent hardship or any hardship compared to the others. These differences were most significant for combined high PAH and persistent hardship: ADHD Index (p < 0.008), DSM-IV Inattentive (p = 0.006), DSM-IV Hyperactive Impulsive problems (p = 0.033), and DSM-IV Index Total (p = 0.009).
The present findings add to existing evidence that co-exposure to socioeconomic disadvantage and air pollution in early life significantly increases the risk of adverse neurodevelopmental outcomes. They suggest the need for multifaceted interventions to protect pregnant mothers and their children.
•PAH are common carcinogenic and neurotoxic combustion-related air pollutants.•Exposure to PAH tends to be disproportionately high in low income communities.•Prenatal PAH exposure was measured by PAH-DNA adducts in maternal blood.•We evaluated the combined effects of prenatal PAH and material hardship on ADHD.•We observed significant effects of combined exposures on ADHD behavior problems.
The goal of this investigation was to examine gender differences in experiences of sexual harassment during military service and the negative mental health symptoms associated with these experiences. ...Female (
n
= 2,319) and male (
n
= 1,627) former reservists were surveyed about sexual harassment during their military service and current mental health symptoms. As expected, women reported a higher frequency of sexual harassment. Further, women had increased odds of experiencing all subtypes of sexual harassment. Being female conferred the greatest risk for experiencing the most serious forms of harassment. For both men and women, sexual harassment was associated with more negative current mental health. However, at higher levels of harassment, associations with some negative mental health symptoms were stronger for men than women. Although preliminary, the results of this investigation suggest that although women are harassed more frequently than men, clinicians must increase their awareness of the potential for sexual harassment among men in order to provide the best possible care to all victims of harassment.
Significant research has focused on intimate partner violence (IPV) victimization among women Veterans, yet much less is known about women Veterans’ IPV perpetration. Although military sexual trauma ...(MST) is a predictor of IPV victimization, military sexual assault (MSA), a component of MST, may predict especially adverse consequences for women Veterans. This study examined the unique effects of MSA on IPV victimization of, and perpetration by, women Veterans, and investigated posttraumatic stress disorder (PTSD) symptoms and prior IPV victimization as potential mediators of IPV perpetration. Participants included 187 women Veterans drawn from a larger web-based survey. We assessed the two components of MST (MSA and harassment) at Time 1 (T1), PTSD symptoms at Time 2 (T2), IPV victimization at T2 and Time 3 (T3), and IPV perpetration at T3. MSA predicted multiple subtypes of IPV victimization and perpetration, whereas harassment predicted neither. Those who reported MSA were more likely to experience T3 psychological and sexual IPV victimization, with PTSD symptoms significantly mediating this path. MSA was also directly related to T3 psychological IPV perpetration and indirectly related to physical and sexual IPV perpetration through PTSD symptoms. MSA was directly related to T2 PTSD symptoms while T2 IPV victimization was directly related to T3 IPV perpetration. These findings underscore that women Veterans’ IPV perpetration may be in response to their own IPV victimization through self-defense and/or due to their PTSD symptoms. Results support prevention, screening, and treatment for IPV victimization and PTSD symptoms to lower risk of future IPV revictimization and perpetration.
Accurate documentation of the associations between stress disorders and suicide attempts provides important information about a high‐risk population and target group for preventative interventions. ...In this case‐cohort study, cases were all individuals born or residing in Denmark who made a nonfatal suicide attempt during 1995–2015 (n = 22,974). The comparison subcohort included a 5% random sample of the Danish population on January 1, 1995 (n = 265,183). Stress disorder diagnoses and suicide attempts were identified using ICD‐10 codes from national medical registries. The presence of any stress disorder substantially increased the rate of suicide attempts versus the comparison subcohort, rate per 100,000 person‐years (PYs) = 604 vs. 13. We observed associations between each type of stress disorder and suicide attempts, hazard ratios (HRs) = 10.1–37.6, even after adjustment for potential confounders, adjusted HRs = 1.8–8.3, with the strongest associations for adjustment disorder relative to other diagnoses. After adjusting for demographic and health variables, the rate of suicide attempts among individuals with any stress disorder diagnosis was nearly 13 times the suicide attempt rate in the comparison cohort. A bias analysis demonstrated that associations remained robust despite potential differential misclassification of suicide attempts. Study strengths included the use of individual‐level data linked across administrative and medical registries in the setting of universal health care and the use of longitudinal analyses capturing data over 20 years. The study demonstrated associations between the full range of stress disorders and suicide attempts, extending research specific to posttraumatic stress disorder.
Background and Aims
Persons with substance use disorders (SUDs) are at elevated risk of suicide death. We identified novel risk factors and interactions that predict suicide among men and women with ...SUD using machine learning.
Design
Case–cohort study.
Setting
Denmark.
Participants
The sample was restricted to persons with their first SUD diagnosis during 1995 to 2015. Cases were persons who died by suicide in Denmark during 1995 to 2015 (n = 2774) and the comparison subcohort was a 5% random sample of individuals in Denmark on 1 January 1995 (n = 13 179).
Measurements
Suicide death was recorded in the Danish Cause of Death Registry. Predictors included social and demographic information, mental and physical health diagnoses, surgeries, medications, and poisonings.
Findings
Persons among the highest risk for suicide, as identified by the classification trees, were men prescribed antidepressants in the 4 years before suicide and had a poisoning diagnosis in the 4 years before suicide; and women who were 30+ years old and had a poisoning diagnosis 4 years before and 12 months before suicide. Among men with SUD, the random forest identified five variables that were most important in predicting suicide; reaction to severe stress and adjustment disorders, drugs used to treat addictive disorders, age 30+ years, antidepressant use, and poisoning in the 4 prior years. Among women with SUD, the random forest found that the most important predictors of suicide were prior poisonings and reaction to severe stress and adjustment disorders. Individuals in the top 5% of predicted risk accounted for 15% of all suicide deaths among men and 24% of all suicides among women.
Conclusions
In Denmark, prior poisoning and comorbid psychiatric disorders may be among the most important indicators of suicide risk among persons with substance use disorders, particularly among women.
Risk for nonfatal suicide attempts is heightened in the month after psychiatric hospitalization discharge. Investigations of factors associated with such attempts are limited.
We conducted a ...case-subcohort study using data from Danish medical, administrative, and social registries to develop sex-specific risk models using two machine learning methods: classification trees and random forests. Cases included individuals who received a diagnostic code for a nonfatal suicide attempt within 30 days of discharge following a psychiatric hospitalization between January 1, 1995 and December 31, 2015 (n = 3166, 56.5% female). The comparison subcohort consisted of a 5% random sample of individuals living in Denmark (n = 24,559, 51.3% female) on January 1, 1995 who had a psychiatric hospitalization during the study period.
Histories of self-poisoning, substance-related disorders, and eating disorders were important predictors of nonfatal suicide attempt among women, with notable interactions observed between age, self-poisoning history, and other characteristics (e.g., medication use). Self-poisoning, substance-related disorders, and severe stress reactions were among the most important variables for men, with key interactions noted between self-poisoning history, age, major depressive disorder diagnosis, and prescription classes.
Findings are based on Danish administrative data, which may be subject to inaccuracies, missingness, etc. It is unclear whether results would generalize to other populations.
Markers of behavioral dysregulation were important predictors of nonfatal suicide attempts in the 30 days after psychiatric hospitalization discharge for both sexes. Examining risk markers for nonfatal suicide attempt following discharge is important to enhance support for this vulnerable population.
•Suicide attempt risk is heightened after discharge from psychiatric hospitalization.•There has been limited research on factors associated with risk of nonfatal suicide attempts.•Sex-specific risk markers for nonfatal suicide attempts in the 30 days following psychiatric hospitalization were identified using machine learning algorithms applied to Danish population-wide administrative datasets.•Diagnoses associated with behavioral dysregulation were linked to nonfatal suicide attempts.
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