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Magister Psychologiae - MPsych / The outcome of child abuse, i.e. physical, emotional and/or sexual, and child neglect is multifactorial. The severity, duration and nature of abuse and the child’s vulnerabilities are all contributory factors with regards the outcome of abuse. Children who are traumatized are likely to be profoundly affected. Studies have shown and nearly every researcher agrees that early childhood traumas lie at the root of many emotional and psychological illnesses. It has been noted that drug abuse is a major problem in the Western Cape. This thesis explored the relationship between subjectively perceived childhood trauma and drug dependence in an in-patient treatment-seeking sample of adults in the Cape Town Metropolitan Area in the Western Cape. This thesis presents the results of a measure of childhood trauma, namely the Childhood Trauma Questionnaire [CTQ] and a measure of drug dependence, the Drug Use Disorder Identification Test [DUDIT]. The sample consisted of 52 participants and included both males and females. Only participants who were identified as drug dependent were included in the study. Patients who were actively psychotic and/or alcohol dependent were not included in the study. Ethical clearance was obtained from the University of the Western Cape’s higher degree ethical committee. The anonymity of the participants, the importance of responding openly and honestly and the sensitive nature of the questions were highlighted during the test administration. Questionnaires were administered in accordance with the guidelines stipulated in the respective manuals. The data was analysed through correlation. The study found a positive correlation between childhood emotional abuse and drug dependence, and childhood physical abuse and drug dependence.

Background: Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome. Methods: 742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake. Results: The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome. Conclusion: The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting.

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Thesis (PhD)--Stellenbosch Univesity, 2011. / ENGLISH ABSTRACT: It is well established that South African women are disproportionately affected by HIV/AIDS and gender based violence. Research to date has provided evidence for neurocognitive decline in individuals infected with HIV/AIDS and in individuals who have experienced early life trauma. However, many gaps remain in our knowledge about the neurocognitive profile of HIV and childhood trauma in South African women. The present study focused on the neurocognitive effects of HIV infection and childhood trauma, both separately and in combination in South African women. The primary aim of the study was to assess neurocognitive functioning in HIV-positive and matched HIVnegative controls, with and without a history of childhood trauma. Moreover, the study sought to assess the synergistic relationship between HIV and childhood trauma in influencing neurocognitive outcomes, a relationship which has not yet been investigated. A neuropsychological battery sensitive to HIV-related impairments was administered to 83 HIV-positive and 47 matched HIV-negative women with histories of childhood trauma. A history of childhood trauma was assessed using the Childhood Trauma Questionnaire short form (CTQ-SF). Forty eight of the 83 HIV-positive women were exposed to childhood trauma. Among the control subjects, a total of twenty women were exposed to childhood trauma. Findings of the present study revealed neurocognitive deficits in memory and executive functions. Results demonstrated significant HIV effects in memory (HVLT-R learning and delay trials), and executive functions (Halstead Category test). Similarly, a trauma effect was evident in delayed recall (HVLT-R delay). Moreover, results revealed a significant interaction effect between HIV status and trauma status on the WAIS-III Symbol Search Task, a task of psychomotor speed. However, HIV-negative controls with a history of childhood trauma scored the highest on this task. Although this finding was unexpected, it may suggest that psychomotor speed may not be a sensitive or discriminating test of childhood trauma in healthy adults. The present study demonstrated evidence for HIV and trauma effects in the ability domains of learning and delayed recall and executive functions. Although the present study did not find evidence for a synergistic relationship between HIV and trauma, it did provide evidence for both HIV and trauma effects on neurocognition, a finding in keeping with previous studies. Future research should be prospective in nature and should better delineate the nature, severity, and temporal relationship of childhood trauma to neurocognitive outcomes, as well as the mediators and moderators of these outcomes. / AFRIKAANSE OPSOMMING: Dit is alombekend dat Suid-Afrikaanse vroue buite verhouding swaar deur MIV/vigs en geslagsgebaseerde geweld getref word. Navorsing tot dusver lewer bewyse van neurokognitiewe verswakking by individue met MIV/vigs sowel as individue wat vroeg in hulle lewe reeds trauma ervaar het. Tog is daar steeds vele gapings in ons kennis oor die neurokognitiewe profiel met betrekking tot MIV en kindertrauma onder Suid- Afrikaanse vroue. Hierdie studie konsentreer op die neurokognitiewe uitwerking van MIV-infeksie en kindertrauma, afsonderlik sowel as gesamentlik, op Suid-Afrikaanse vroue. Die hoofdoel van die studie was om neurokognitiewe funksionering by MIV-positiewe vroue te bepaal en dit met gepaste MIV-negatiewe kontrolepersone te vergelyk, met én sonder 'n geskiedenis van kindertrauma. Daarbenewens wou die studie die sinergistiese verwantskap tussen MIV en kindertrauma in hul impak op neurokognitiewe uitkomste bepaal – 'n verwantskap wat tot dusver nog nie ondersoek is nie. 'n Neurosielkundige toetsbattery wat gevoelig is vir MIV-verwante swakhede is onder 83 MIV-positiewe vroue en 47 gepaste MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma afgeneem. 'n Geskiedenis van kindertrauma is met behulp van die kort weergawe van die kindertraumavraelys (CTQ-SF) vasgestel. Agt-en-veertig van die 83 MIV-positiewe vroue is as kinders aan trauma blootgestel. Van die kontrolegroep het 20 vroue in hul kindertyd trauma beleef. Die studie het neurokognitiewe tekorte in korttermyngeheue én uitvoerende funksies aan die lig gebring. Die resultate het 'n beduidende MIV-verwante uitwerking op korttermyngeheue (hersiene Hopkins- verbale leer-en-vertragingstoets, oftewel HVLT-R) sowel as uitvoerende funksies (Halstead-kategorietoets) getoon. Eweneens het die studie op 'n duidelike traumaverwante uitwerking op herinneringsvermoë (HVLT-R-vertraging) gedui. Daarbenewens het die WAIS-II- (Wechsler-volwassene-intelligensieskaal) simboolsoekopdrag – 'n psigomotoriese spoedtoets – 'n beduidende wisselwerkingseffek tussen MIV-status en traumastatus getoon. Tog het MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma die beste in hierdie opdrag gevaar. Hoewel hierdie bevinding verrassend was, kan dit daarop dui dat psigomotoriese spoed dalk nie 'n gevoelige of diskriminerende toets van kindertrauma by gesonde volwassenes is nie. Die studie het bewys gelewer van MIV- en traumaverwante uitwerkings op korttermyngeheue en uitvoerende funksies. Hoewel die ondersoek nie bewyse van 'n sinergistiese verwantskap tussen MIV en trauma kon vind nie, het dit wél bevestig dat MIV en trauma neurokognitiewe werking beïnvloed – 'n bevinding wat in pas is met vorige studies. Toekomstige navorsing behoort ondersoekend te wees en die aard, felheid en tydgebondenheid van die verwantskap tussen kindertrauma en neurokognitiewe uitkomste, sowel as die mediator- en moderatorveranderlikes van hierdie uitkomste, beter te omskryf.

Disaster, community-wide trauma, and epidemics can have devastating effects on a child’s emotional and psychological wellbeing (Wethington, Hahn, Fuqua-Whitley et al., 2008). The 2014-2015 Liberian Ebola epidemic was detrimental to a country still recovering from a 14-year war. In Liberia alone there were 10,678 confirmed cases and 4,810 Ebola deaths (CDC, 2016). The physical, emotional, and psychological toll of this epidemic was extraordinary. An United States non-profit, Playing to Live (PTL), worked alongside the Liberian government, ministries and local and international organizations to find an innovative solution to the psychological and emotional healing of children and families most affected. This solution used best practices in expressive arts therapy, mental health, and train the trainer models. The purposes of these studies were to evaluate the process of the PTL programming, the outcome effects based on pre-and posttests of child participants psychological stress symptoms (PSS), and explore lessons learned and implications for future programming. Process evaluation results indicated positive reactions to programming from both facilitators and child participants. Results also brought forth considerations for future programming. Outcome data from the pre-and post PSS symptoms showed a significant decrease for both 5-months and 3-months of PTL programming. In addition, a significant difference on pre-and post-symptoms for the 5-month and 3-month treatment groups was found, indicating that longer treatment yields greater results. A review of best practices and lessons learned was discussed for future implications for PTL and similar programs.

Made available in DSpace on 2016-03-22T17:26:55Z (GMT). No. of bitstreams: 1 l1.pdf: 71453 bytes, checksum: 9470f9e45a5664bf7e48ddccf6576547 (MD5) Previous issue date: 2012-01-12 / Aim: To identify the relationship between childhood trauma and the maternal depression in a sample of young people with mood disorders and without mood disorders. Methods: Cross sectional study with 164 young people and their mothers. Ninety-eight young people were in the group with mood disorders and 66 were without mood disorders group. The diagnosis of mood disorder was conducted through the Structured Clinical Interview for DSM-IV (SCID) and childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Maternal depression was identified by the Mini International Psychiatry Interview (MINI). Results: Young people with mood disorders, were 4.52 (95% CI: 1.05, 7.99) points higher on average decreased as the socioeconomic classification, and those who were children of depressed mothers were 5.36 (CI 95% CI: 1.20, 10.17) points higher than average childhood trauma than those who were not depressed mothers. Young people without mood disorders who were working were -5.94 (95% CI: -10.75, -1.13) points in the middle of the CTQ compared those who were not working. Conclusion: There was a relationship between childhood trauma and maternal depression in young people with mood disorders. The prevention and treatment of maternal psychiatric illness may decrease the risk of adverse effects on young people / Objetivo: Verificar a relação entre trauma na infância e a presença de depressão materna em uma amostra de jovens com e sem transtornos de humor. Métodos: Estudo transversal com 164 jovens e suas mães. Noventa e oito jovens fizeram parte do grupo com transtornos de humor e 66 do grupo sem transtorno de humor. O diagnóstico de transtorno de humor dos jovens foi realizado através da Structured Clinical Interview for DSM-IV (SCID) e o trauma na infância foi avaliado através do Childhood Trauma Questionnaire (CTQ). A depressão materna foi identificada pela Mini International Psychiatry Interview (MINI). Resultados: Jovens com transtorno de humor, tiveram 4,52 (IC 95%:1,05; 7,99) pontos a mais na média conforme diminuía a classificação socioeconômica, e, aqueles que eram filhos de mães deprimidas tiveram 5,36 (IC 95%:1,20; 10,17) pontos a mais na média de trauma na infância do que aqueles que não tinham mães deprimidas. Os jovens sem transtornos de humor que estavam trabalhando tiveram -5,94 (IC 95%:-10,75; -1,13) pontos na média do CTQ comparado aqueles que não estavam trabalhando. Conclusão: Verificou-se a relação entre trauma na infância e depressão materna em jovens com transtornos de humor. A prevenção e tratamento de doenças psiquiátricas materna podem diminuir o risco de efeitos negativos nos jovens

Se a criança é negligenciada ou passou por experiências traumáticas durante o processo de desenvolvimento, isso pode desencadear, além de sofrimento psíquico intenso nesta fase, predisposição para uma série de transtornos mentais e prejuízo ao funcionamento na vida adulta, inclusive levando a tentativa de suicídio. Objetivos: A presente pesquisa teve como objetivo identificar a ocorrência de traumas infantis em adultos sobreviventes de suicídio atendidos no Hospital de Pronto Socorro de Porto Alegre no Rio Grande do Sul, além da ocorrência de perda de figura significativa na infância, presença de doença psiquiátrica atual, intensidade de sintomas depressivos, perda de pessoa significativa recente e apoio social em comparação a controles. Métodos: Tratou-se de um estudo de caso-controle (28 casos; 56 controles). O estudo foi realizado de 20 de agosto de 2015 a 21 de março de 2016, utilizando os seguintes instrumentos: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI), e Medical Outcomes Study (MOS). Justificativa: A escolha do tema justificou-se pelo expressivo número de sujeitos que ingressam no referido hospital por tentativa de suicídio (TS), constituindo uma população em que o entendimento de fatores de risco pode auxiliar na identificação de diferentes fatores envolvidos neste fenômeno e na elaboração de estratégias de intervenção e prevenção. Resultados: A amostra examinada (n=84; 28 casos e 56 controles) demonstrou uma distribuição semelhante em relação ao gênero (M/F = 46,4%/53,6%) com uma idade média de 35,6 anos (DP=12,8). Através do instrumento CTQ foram avaliados os traumas na infância. Os grupos (caso x controle) apresentaram médias distintas nas variáveis abuso emocional (p<0,001), abuso físico (p<0,001), negligência emocional (p<0,001) e negligência física (p<0,001). Nos casos de tentativas de suicídio foi realizada uma análise através do BDI e MINI, onde 94,4% (n=17) tinham risco elevado de reincidência de uma nova tentativa e apresentavam Transtorno Depressivo Grave em comparação aos controles onde nenhum paciente apresentou risco de suicídio elevado e Transtorno Depressivo Grave (p <0,001) . Segundo a MOS, a contagem de um parente e/ou amigo a mais protege o risco de suicídio em 24%. Quando somados, a dimensão afetiva com a interação social, um ponto a mais protege em 70% (p<0,001). Ao relacionarmos a dimensão emocional com a dimensão informação, ficou em 63% (p<0,001). Conclusões: Os resultados do estudo apontaram uma importante associação entre traumas na infância e tentativa de suicídio na vida adulta, apontando por exemplo a importância da adoção de ações preventivas e terapêuticas relacionadas a maus-tratos durante o desenvolvimento infantil como fator importante na redução de risco para o suicídio. A rede de apoio possui importância no suporte social na vida de qualquer pessoa. Nesta pesquisa, os pacientes do grupo controle apresentaram mais suporte social, com maior probabilidade de serem mais ativos e interativos com o meio em que vivem. / If a child is neglected or experiences traumatic events during development, this can unleash—beyond the intense psychological suffering at the time—a predisposition for a number of mental disorders, up to and including suicide attempt, and impair functioning as an adult. Objectives: The present study sought to identify the incidence of childhood trauma as well as the loss of a loved one during childhood, the presence of current psychiatric illness, intensity of depression symptoms, recent loss of a loved one, and social support in comparison to controls in adult suicide attempt survivors treated at Hospital de Pronto Socorro in Porto Alegre, Rio Grande do Sul, Brazil. Methods: The study is considered a case-control study (28 cases, 56 controls). It took place from August 20th, 2015 to March 21st, 2016 and utilized the following instruments: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI), and Medical Outcomes Study (MOS). Justification: The choice of topic was justified by the considerable number of subjects admitted to the hospital for suicide attempt (SA). The subjects constituted a population for which the understanding of risk factors could help in the identification of the various elements involved in this phenomenon and in the elaboration of intervention and prevention strategies. Results: The examined sample (n = 84; 28 cases and 56 controls) had an approximately equal gender distribution (M/F = 46.4%/53.6%) and a mean age of 35.6 years (SD = 12.8). Childhood trauma was evaluated via the CTQ instrument. The groups (case and control) presented distinct means in variables of emotional abuse (p < .001), physical abuse (p < .001), emotional neglect (p < .001), and physical neglect (p < .001). The suicide attempt cases were analyzed using the BDI and MINI, which indicated 94.4% (n = 17) had elevated risk of relapsing into another suicide attempt and presented Major Depressive Disorder relative to the controls, where no patient had an elevated risk of suicide attempt or Major Depressive Disorder (p < .001). According to MOS, having a close relative and/or friend offered the greatest protection against suicide risk in 25% of cases. When added, the affective and social interaction dimensions the protection is 70% (p < .001). By linking the dimension emotional with the informational, 63% is achieved (p < .001). Conclusions: The results of the study point to a strong relationship between childhood trauma and suicide attempt in adulthood, indicating, for example, the importance of the adoption of preventative and therapeutic actions related to mistreatment in childhood as a key factor in the reduction of suicide risk. The support network plays a critical role in the social well-being of any person. In this study, control group patients presented greater social support and were likelier to be more active and interactive in their communities.

CONTEXTO: A exposição a eventos traumáticos durante a infância está associada a uma piora das funções cognitivas, especialmente na função executiva. Estes achados são bem documentados em adultos. Entretanto há poucos estudos que avaliam as alterações cognitivas em crianças em idade escolar com história de trauma precoce. OBJETIVO: Avaliar o desempenho cognitivo em crianças com história de abuso sexual, maus-tratos e/ou negligência, em comparação a controles não expostos a vivências traumáticas. MÉTODO: Em um estudo de caso-controle, foram recrutadas 30 crianças de 5 a 12 anos de idade com história de trauma e 30 controles, pareados por sexo e idade, no período de outubro de 2008 a janeiro de 2010. A cognição foi avaliada através do teste ‗Wisconsin card sorting test’, Escala Wechsler de Inteligência – 3ª Edição (subtestes dígitos, cubos e vocabulário) e do teste ‗Continuos Performance Test‘. O K-SADS-E foi utilizado para identificar sintomas ou transtornos psiquiátricos de acordo com DSM-IV-TR, os quais eram confirmados também em entrevista com psiquiatra. RESULTADOS: A prevalência de sintomas psiquiátricos nas crianças com trauma foi de 56,6% e nos controles foi de 6,7 % (p<0.001). Os casos tiveram um pior desempenho no subteste ‘Dígitos do WISC-III’ (F=8,553, p=0,005) e no teste ‗CPT commission errors‘ (F=5.63, p=0.022) quando comparados aos controles. Em crianças com trauma, o QI foi estatisticamente superior naquelas sem sintomas psiquiátricos (p= 0,025) em comparação com aquelas que apresentavam sintomas. CONCLUSÕES: Os resultados sugerem que crianças com história de trauma apresentam prejuízo na atenção e na memória de trabalho comparado a controles, o que pode ser detectado já nos primeiros anos da idade escolar. A presença de sintomas psiquiátricos também está associada a um pior funcionamento cognitivo nestas crianças e a um pior funcionamento global. Os dados apresentados reforçam a importância de intervenção precoce para prevenir déficit cognitivo quando o trauma não pode ser evitado. / INTRODUCTION: Exposure to traumatic events during childhood is often associated with cognitive impairment. These findings are well documented in adults. However, few studies have examined cognitive function in school-age children with a history of early trauma. OBJECTIVE: To examine cognitive performance in children with trauma compared to age and gender matched controls. METHODS: We recruited thirty 5-12 years old children with a history childhood trauma and thirty age and gender matched controls. The neuropsychological battery assessed broad cognitive domains such as learning/working memory, executive function, attention, verbal/premorbid intellectual functioning (IQ) and impulsivity. The K-SADS-E was used to examine psychiatric symptoms or disorders according to DSM-IV-TR, which were also confirmed in an interview with a psychiatrist. RESULTS: The prevalence of psychiatric symptoms in those with childhood trauma was 56.6% while in controls was 6.7% (p <0.001). Those with trauma showed a worse performance in the Digit Span WISC-III (F = 8.553, p = 0.005) and CPT errors (F=5.63, p=0.022) when compared to controls. In addition, children with psychiatric symptoms and childhood trauma, showed lower IQ scores when compared to those without (p = 0.025). CONCLUSIONS: The results suggest that children with trauma show attention and working memory impairment when compared to controls, which is present as early as in the first school years. Furthermore, there is a high prevalence of psychiatric symptoms in children exposed to traumatic experiences and this seems to be associated with worse cognitive performance and global functioning. These findings further support the need for early intervention to prevent cognitive impairment when childhood trauma could not be avoided.