Copyright, 2012, Becker-Blease, Freyd, Russo, & Rich-Edwards, 2012 APS Annual Convention, Chicago, IL. 1
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1 The Costs of Not Asking about Abuse: Empirical Evidence Kathryn Becker-Blease Oregon State University Jennifer J. Freyd University of Oregon Nancy Felipe Russo Arizona State University and Oregon State University Janet Rich-Edwards Harvard University 1792 Yellow Fever Epidemic in Philadelphia Possible causes Brought by immigrants Judgment from God Rotten coffee Proposed moderators hot sun, night air, too much liquor, and anything else that might lower their resistance. Race African Americans worked as nurses because it was thought they could not be infected. Photo in public domain, Convention, Chicago, IL. 1
2 Prevention Some left during summer Disinfecting with vinegar Quarantines Benjamin Rush s Treatments Purging Bloodletting To activate body s defenses Rush accused of killing more than saving. Ideas that filth, not immigrants, caused the disease were not politically popular. Good scientific models have benefits. Kill mosquitoes, people don t get sick. Bad scientific models have costs. African American nurses put at risk, and bloodletting could be worse than nothing. Even with vastly improved clinical research methods, we must identify third variables tease apart causal factors from markers model mediation and moderation accurately.to gain benefits, and to avoid costs. Convention, Chicago, IL. 2
3 Researchers and IRBs required to 1) consider the importance of the knowledge that may reasonably be expected to result. -45.CFR , italics added. 2) gather systematic and comprehensive information about proposed research. - The Belmont Report, italics added. The Costs To Society and Science of Not Asking about Abuse: 3 Examples 1. Family Structure and Mental Health 2. Cardiovascular disease 3. Abortion and Mental Health Convention, Chicago, IL. 3
4 1. Family Structure and Mental Health Included causes of childhood depression: Absent father Emotional stress by the mother, who has to fill both roles Financial hardship Social isolation Parental depression (can be taught to child) Lack of supervision and interaction with children (due to working long hours) Convention, Chicago, IL. 4
5 Absent father Maternal depression & stress Financial Burden Lack of supervision and interaction Convention, Chicago, IL. 5
6 Lipman, MacMillan, and Boyle (2001) % abused Single Moms Are More Likely to Have Been Abused as Children Single Married Child Abuse Predicts Mothers Emotional Problems Single Parent Child Abuse Mothers Mood/Anxiety Disorder Mothers Substance Abuse Disorder 2.22* 3.17* Turner, Finkelhor & Ormrod (2006) Depression in 2- to 9-year-olds Model 1 Model 2 Gender, Age, Race/Ethnicity, SES controlled Single Parent ** ns Step-Parent ** ns Sexual Assault ** Child Abuse ** Witness Family Violence ** Other Major Violence ** Adjusted R Convention, Chicago, IL. 6
7 2. Cardiovascular Disease Risk factors By Mayo Clinic Staff Heart disease risk factors include: Your age. Your sex. Family history. Smoking. Poor diet. High blood pressure. High blood cholesterol levels. Diabetes. Obesity. Physical inactivity. High stress. Poor hygiene. Convention, Chicago, IL. 7
8 Hazard ratios for the association of sexual abuse with risk of cardiovascular events, Nurses Health Study 2 (Rich-Edwards et al., 2011) Hazard Ratios No abuse Sexual Touching Forced Sex 0 Model 1 age Model 2 + race, body type, parental education, parental MI/stroke Model 3 + BMI, smoking, alcohol Model 4 + hypertension, diabetes 3. Abortion and Mental Health Convention, Chicago, IL. 8
9 Psychological effects of abortion: Many women suffer with emotional and psychological problems after experiencing abortion. depression, acute feeling of grief fear of disclosure eating disorders, suicide tendencies, anxiety increased consumption of alcohol and drugs. Coleman (2012): Women who had undergone an abortion experienced an 81% increased risk of mental health problems, and nearly 10% of the incidence of mental health problems was shown to be attributable to abortion. Convention, Chicago, IL. 9
10 Abortion Status Risk of PTSD by Abortion Status Steinberg and Russo (2008) B P value Odds Ratio (CI) 2 vs ( ) 2 vs ( ) 1 vs ( ) No control variables. Data Source: National Comorbidity Study Convention, Chicago, IL. 10
11 Abortion Status Risk of PTSD by Abortion Status Controlling for Covariates including abuse Steinberg and Russo (2008) B P value Odds Ratio (CI) 2 vs ( ) 2 vs ( ) 1 vs ( ) Women who were raped, kidnapped/ held captive/threatened with a weapon or physically attacked and those with PTSD before their pregnancy were significantly more likely to have PTSD. In sum: Abuse is a significant predictor of diverse, expensive problems. When we don t ask about abuse when it is relevant, science loses. We miss important predictors, develop bad models, waste time and money. Society loses, too. Public has inaccurate information. Our prevention and intervention strategies are less effective, or even harmful. The costs to science and society of not asking about abuse are high. Convention, Chicago, IL. 11
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