Long-Term Correlates of Childhood Abuse among Adults with Severe Mental Illness: Adult Victimization, Substance Abuse, and HIV Sexual Risk Behavior

Abstract

The prevalence of childhood sexual and physical abuse among persons with severe mental illness (SMI) is disproportionately high. Adults with SMI also engage in high rates of HIV risk behaviors. This study examined the association between childhood abuse and adult victimization, substance abuse, and lifetime HIV sexual risk in a sample of 152 adults with SMI receiving community mental health services. Structured interviews assessed psychiatric, psychosocial, and behavioral risk factors. Seventy percent reported childhood physical and/or sexual abuse, and 32% reported both types of abuse. Participants with childhood abuse were more likely to report adult victimization and greater HIV risk. A structural equation model found that childhood abuse was directly and indirectly associated with HIV risk through drug abuse and adult vicitimization. Integrated treatment approaches that address interpersonal violence and substance abuse may be necessary for HIV risk reduction in this population.

Substance Abuse, Violence, and HIV in Women: A Literature Review of the Syndemic

“…[43][44][45][46][47][48][49][50][51][52][53] Mental health issues were identified as described by study authors in terms of drug or alcohol use disorders, depression, PTSD, IPV-related PTSD, mania, psychosis, personality disorders, or mental health problems requiring treatment. Where identified by the study authors, validated measures to assess mental illness are stated.…”

Rapid Routine HIV Testing for Psychiatric Inpatients

“…While the association between injection drug use, needle sharing and contraction of blood born pathogens is direct, use of non-injection drugs is associated with heightened risk for HIV contraction via risky sex behavior; those who use non-injection drugs have diminished inhibitions, are often more sexually active, involved in prostitution, have lower condom use and more commonly engage in anal sex [32]. A history of sex abuse is also substantially more common in patients with SMI, and is associated with an increase in high-risk sexual activity and further sexual assault [11,33].…”

HIV Risk Behaviors: Risky Sexual Activities and Needle Use Among Adolescents in Substance Abuse Treatment

“…Additionally, study findings revealed that anxiety, traumatic distress, and conduct disorder remained significantly associated with sexual risk; and depression, anxiety, and conduct disorder remained predictive of needle use, after controlling for possible synergistic effects of substance use severity. A recent study reported that childhood trauma exposure such as sexual and physical abuse was highly associated with HIV sexual risk in adulthood [40]. Several prior studies also documented the possible influences of depression on sexual risk taking; however, the findings were inconsistent, probably due to the types of samples studied and the methodological shortcomings [14,[41][42][43][44].…”