# Presentation: 675648

## Child Abuse and Neglect and Mental Disorders among Native American Women in Primary Care

-    American Native Women’s Health and
- Maternity Care
- Indian Health Service
- August 4, 2004,  Albuquerque, New Mexico

- Bonnie Duran, Dr.PH
- UNM SOM MPH

## Presentation Objectives

- Current theoretical models of Mental Disorders (MD) and Child abuse and neglect (CAN)
-   Research design
- Trauma and MD
- (Lack of) Federal priority on Indian Health

## Research Questions

- To determine prevalence rates of psychological disorders among Native American women seeking primary care treatment at an Indian Health Service ambulatory care clinic;
**To investigate relationships among intimate partner violence and child abuse and mental disorders;**

## Methods

- Two-stage sampling design:
- 1st Stage: 484 consecutive presenting Native American women in a primary care clinic screened with a mental health screening instrument
**2nd State: 234 women--50% (N=117) high and 50% (n=117) low on the GHQ interviewed with battery of instruments**
- 3rd Stage: 75% Interviewed again after one year
- Chart abstraction and RPMS data of IHS utilization data

## Source: Broken Promises: Evaluating the Native American Health Care System. (Draft)(2004). 

*Source: Broken Promises: Evaluating the Native** **American Health Care System*. (Draft)(2004).
- Washington DC: US Commission on Civil Rights: Office of the General Counsel.

## Slide 6

## Source: Broken Promises: Evaluating the Native American Health Care System. (Draft)(2004). Washington DC: US Commission on Civil Rights: Office of the General Counsel.

## Instruments/Data Sources

- GHQ-12 item version
- Demographics Questionnaire
- Composite International Diagnostic Interview-I Shell (DSM IV)
- Childhood Trauma Questionnaire
- Conflict Tactics Scale II
- Utilization Questionnaire: Chart Abstraction and RPMS
- Spirituality and Social Support Questions in Phase 3

##  Composite International Diagnostic Interview

| SCREENING QUESTIONS--Depression | Yes | No |
| --- | --- | --- |
| In your lifetime, have you ever had two weeks or longer when nearly everyday you felt sad, empty, depressed for most of the day? |  |  |
| In your lifetime, have you ever had two weeks or longer when you lest interest inmost things like work, hobbies, and other things you usually enjoyed? |  |  |
| DIAGNOSTIC QUESTIONS |  |  |
| Lacking Energy: ....Did you lack energy or feel tired all the time nearly every day, even when you had not been working hard? |  |  |
| Appetite Change: ....Did you have less or more appetite than usual almost everyday? |  |  |
| Sleep Problems: ...Did you have trouble sleeping almost every night for two weeks or more--either trouble falling asleep, waking up in the middle of the night, or waking up too early? |  |  |
| Lack of Confidence: ....Did you feel that you were not as good as other people? |  |  |
| Trouble Thinking: ...Did you have a lot more trouble concentrating than is normal for you |  |  |

## Childhood Trauma Questionnaire1     (28 Items)

-  1 Bernstein, D. P., Fink, L., Handelsman, L., & Foote, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. *American Journal of Psychiatry, 151*(8), 1132-1136.

| 
     When I was growing up.... | Never True | Rarely True | Some-
times True | Often True | Very Often True |
| --- | --- | --- | --- | --- | --- |
|  I didn’t have enough to eat. |  |  |  |  |  |
|  I knew there was someone to take care of me and protect me. |  |  |  |  |  |
| People in my family called me things like “stupid”, “lazy”, or “ugly”. |  |  |  |  |  |
|  People in my family hit me so hard that it left me with bruises or marks. |  |  |  |  |  |
| I was punished with a belt, a board, a cord, or some other hard object. |  |  |  |  |  |
| Someone tried to make me do sexual things or watch sexual things. |  |  |  |  |  |

## Conflict Tactics Scale 21       (78 Items-- both ways)

- 1 Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. *Journal of Family Issues, 17*(3), 283-316.

|  | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 0 |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| May partner showed care for me even though we disagreed. |  |  |  |  |  |  |  |  |
| I insulted or swore at my partner; my partner swore or insulted me. |  |  |  |  |  |  |  |  |
| I threw something at my partner’ my partner threw something at me. |  |  |  |  |  |  |  |  |
|  I had a sprain, bruise, or small cut because of a fight with my partner: my partner had these due to a fight with me. |  |  |  |  |  |  |  |  |

| 1 =  Once in the past year | 4 = 6-10 times in the past year |
| --- | --- |
| 2 =  Twice in the past year | 5 = 11-20 times in the past year |
| 3 = 3-5 Times in the past year | 6 = more than 20 times in the past year |
| 7 = Not in the past year, but it did happen I the past | 0 = this had never happened.  |

- How Often Did This Happen?

## How Often Did This Happen?

|  | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 0 |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| My partner used a knife or gun on me: I used a knife or gun on my partner. |  |  |  |  |  |  |  |  |
| I passed out from being hit on the head in a fight with my partner: My partner passed out from being hit on the head in a fight with me. |  |  |  |  |  |  |  |  |
| My partner beat me up: I beat up my partner. |  |  |  |  |  |  |  |  |
| I slapped my partner: My partner slapped me. |  |  |  |  |  |  |  |  |
| I accused my partner of being a lousy lover: My partner accused me of being a lousy lover. |  |  |  |  |  |  |  |  |

**How**** ****Often Did This Happen?**

| 1 =  Once in the past year | 4 = 6-10 times in the past year |
| --- | --- |
| 2 =  Twice in the past year | 5 = 11-20 times in the past year |
| 3 = 3-5 Times in the past year | 6 = more than 20 times in the past year |
| 7 = Not in the past year, but it did happen I the past | 0 = this had never happened.  |

## Mental Disorder Models

## World Health Organization. (2001). The world health report 2001 : mental health : new understanding, new hope. Geneva: World Health Organization. Pg. 20

- World Health Organization. (2001). *The world health report 2001 : mental health : new understanding, new hope*. Geneva: World Health Organization. Pg. 20

## World Health Organization. (2001). The world health report 2001 : mental health : new understanding, new hope. Geneva: World Health Organization. Pg. 30

- World Health Organization. (2001). *The world health report 2001 : mental health : new understanding, new hope*. Geneva: World Health Organization. Pg. 30

## Walters, K. L., & Simoni, J. M. (2002). Reconceptualizing native women's health: an "indigenist" stress-coping model. Am J Public Health, 92(4), 520-524.

- Walters, K. L., & Simoni, J. M. (2002). Reconceptualizing native women's health: an "indigenist" stress-coping model. *Am J Public Health, 92*(4), 520-524.

## De Bellis, M. D. (2002). Developmental traumatology: a contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology, 27(1-2), 155-170.

**De Bellis, M. D. (2002). Developmental traumatology: a contributory mechanism for alcohol and substance use disorders. *****Psychoneuroendocrinology, 27*****(1-2), 155-170.**

## Slide 18

## Slide 19