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OBJECTIVE: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. METHODS: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. RESULTS: Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI 1.4, 3.2); and with two or more disorders (PR = 2.3; 95% CI = 1.6, 3.4). CONCLUSION: CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women. 相似文献
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OBJECTIVE: This survey was conducted to: (1) document child protective services (CPS) agencies' actual practices regarding prenatal drug exposure; (2) examine urban and rural differences in CPS responses; (3) explore whether CPS practices varied as a function of county median income, birth rate, population size, or percent minority births; and (4) assess respondent satisfaction with their county's current responses. METHOD: Data were collected via a nationwide telephone survey of child welfare supervisors from two urban and two rural counties in every state (N = 200). RESULTS: Ninety percent of counties (100% of urban and 80% of rural) reported receiving referrals of infants with prenatal drug exposure. Among those receiving referrals, extreme variations in practice were found; all possible response options (from very inactive to very aggressive) were equally represented on key questions (e.g., filing court petitions, taking custody). Rural counties tended to have stronger responses than urban counties (t[175] = -2.26, p = .024). County response did not vary with county-level median family income, percent minority births, or birth rate. Despite wide variations in practice, the majority of respondents (69%) felt their county's response was appropriate. Of respondents who did indicate that their county's response was inappropriate, most (85%) felt that the county needed to do more to protect children. CONCLUSIONS: There is currently tremendous variation across US counties in CPS responses to, and beliefs regarding, the issue of prenatal drug exposure. Some of this variation is due to differences between urban and rural counties, with little variation explained by differences in median income or percent minority births at the county level. There is a need for research-based guidance and consensus building in CPS practice in this area. 相似文献
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