Relationships Between Childhood Sexual Abuse Characteristics and Intimate Partner Violence, PTSD and Psychological Distress Among Women in Methadone Treatment

Background and Purpose: Women in substance abuse treatment are significantly more likely to be affected by childhood sexual abuse (CSA) and intimate partner violence (IPV) than women in community samples. Recent research begins to explicate mechanisms of risk between CSA and IPV, suggesting that this relationship is mediated by posttraumatic stress disorder (PTSD) and overall psychological distress. However, the previous research is limited by cross-sectional data and does not examine the ways in which characteristics of CSA, such as the presence of force or familial relationship, may influence this relationship. Additionally, given the role of PTSD and psychological distress in the CSA-IPV relationship, there is a need to understand the effects of CSA characteristics on psychological concerns among this population.

Methods: In order to address these gaps in knowledge and to inform practice with greater precision, this study relied on baseline and 12-month follow-up data from structured interviews with a random sample of 416 women in methadone treatment. CSA was measured with the Childhood Sexual Abuse Interview, which draws upon interview schedules by Finkelhor (1979) and Sgroi (1982). IPV was measured with the Revised Conflict Tactics Scale. The Posttraumatic Stress Diagnostic Scale assessed the presence of PTSD and the Brief Symptom Inventory assessed overall psychological distress. Multiple imputation of missing data and logistic regression analyses were conducted using Stata/SE 10.1.

Results: Participants had a mean age of 39.9 years (SE=.33), an average annual income of $10,143.20 (SE=469.26), and were predominantly Latina/Hispanic (47.8%) or African American/Black (30.8%). A total of 56.3% of the women reported a history of CSA. CSA involving a relative and force was the most prevalent form of CSA (27.7%), followed by CSA involving a relative (9.9%), CSA with someone 5+ years older (9.7%), and CSA involving force (9.0%). Lifetime prevalence of IPV was 89.7%. Prevalence of IPV in the past six months was 78.1% at baseline and 62.5% at 12-month follow-up. In the bivariate models, CSA involving a relative and force was associated with increased risk of IPV in one's lifetime (OR=3.13, CI=1.24, 7.89), PTSD (OR=2.92, CI=1.70, 5.04), and overall psychological distress (OR=4.67, CI=2.45, 8.89). CSA involving force was also associated with increased risk of overall psychological distress (OR=3.19, CI=1.30, 7.84). In the multivariate models, there were no statistically significant relationships between CSA characteristics and IPV; however, CSA involving a relative and force continued to be associated with PTSD (OR=2.62, CI=1.43, 4.81) and with overall psychological distress (OR=3.68, CI=1.82, 7.46). Additionally, CSA involving force continued to be associated with psychological distress in the multivariate model (OR=3.68, CI=1.32, 10.29).

Conclusions and Implications: To varying degrees, CSA characteristics are differentially associated with IPV, PTSD, and psychological distress. The multivariate models suggest that there are key factors associated with heightened risk of IPV, PTSD and psychological distress that are amenable to change with appropriate interventions. Such factors include targeting drug use and financial independence to reduce IPV risk and targeting social support and IPV exposure to reduce risk of PTSD and psychological distress.