Transcript Detecting the Unidentified Victims: Recognized Versus

The Relationship between Neurocognitive Functioning and Childhood Abuse among Persons with SMI:
Mediating Proximal and Distal Factors
L. Felice Reddy, Ashley Wynne, and William D. Spaulding
University of Nebraska-Lincoln
Introduction
Neurocognition is a significant predictor of outcome among persons with
serious mental illness (SMI) (Liberman, 2008). The deficits exhibited by
individuals with SMI have been found to improve significantly in the context of
integrated treatment programs that include cognitive rehabilitation (Wykes, 2008).
Correlations between Variables of Interest (n = 177)
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1. Gender
2. Child Abuse
Consumers with a history of CPA or CSA have more frequent suicide attempts
(Read et al., 2001), earlier first psychiatric admissions, more frequent and longer
duration of psychiatric hospitalizations, more time in seclusion, and receive more
medication (Read, van Os, Morrison, & Ross, 2005).
6. # of Previous Hospitalizations
3. Age of Onset
4. Education
Nebraska-Lincoln: http://www.unl.edu/dsc
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8
e=.90
5. Axis II Diagnosis
.287(.34)
-.23**
--
.18*
.06
e=.953
GENDER
--
-.14
.07
.35(.3)
Neurocognitive
Functioning
e=.991
-.27** .32**
.09
.300(.3)
-.20**
-.26** -.12
AGE OF ONSET
-.176(-.17)
--
-.356(.3)
NUMBER
of PREVIOUS
HOSPITALIZATIONS
.43(.3)
-.271(-.24)
.14
ABUSE
--
.002(-.06)
-.15(-.01)
-.09(-.06)
7. Days in Hospital before PR
-.08
8. RBANS Total
-.03
.06
R2 = .30
e=.858
.213(-.36)
-.01
-.08
-.10
.31*
.31*
.11 .17*
--
.20 -.04
-.02
e=.954
-.051(.07)
--
.196(.13)
AXIS II Dx
DAYS in
HOSPITAL
BEFORE
PR
-.178(-.022)
.29(.19)
e=.891
.39(.16)
e=.971
Gender: male=1, female=2; Child Abuse: Absent=1, Present=2; Axis II Diagnosis: Absent=1, Present=2
* p < 0.05
**p < 0.01
Path Analysis Depicting all Direct and Total Effects
e=.880
EDUCATION
.312 (.31)
-.202(-.25)
-.08(.02)
.213(-.36)
e=.838
.122(-.02)
.287(.34)
.35(.3)
.1(.06)
GENDER
e=.965
.238(.19)
.18(.07)
e=.938
AGE OF ONSET
-.148(-.01)
.145(.1)
-.176(-.17)
.03(.14)
.300(.3)
-.356(.3)
.09(-.04)
NUMBER
of PREVIOUS
HOSPITALIZATIONS
ABUSE
.002(-.06)
-.15(-.01)
e=.954
-.09(-.06)
.03(-.1)
-.051(.07)
.196(.13)
AXIS II Dx
e=.961
Neurocognition
.43(.3)
-.271(-.24)
.39(.16)
Visit the Severe Mental Illness Research Group website at the University of
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--
-.06
Participants: Data from 177 participants (Mean age= 40, SD= 12) at admission
to an inpatient psychiatric rehabilitation program were used in the present analyses.
Data Analysis: Bivariate correlations and regression models indicated high
colinearity among the variables of interest. In an attempt to elucidate the temporal
paths among the predictors and potential mediation effects, a path analysis was
performed on the variables of interest.
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.312 (.31)
.01
Methods
History of Childhood Abuse: Histories of childhood maltreatment (e.g.
physical abuse, sexual abuse) were collected through medical chart reviews. Abuse
was coded as present if CSA or CPA was documented to have occurred prior to age
18. All other historical variables were also collected from medical chart reviews.
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EDUCATION
.34**
This study is designed to examine potential precipitating factors of
neurocognitve deficits as well as the behavioral and environmental mechanisms
that facilitate neurocognitive improvements. Increased understanding of the
complex relationship between traumatic events experienced in childhood and
functional deficits in adulthood will vastly improve individualized assessment and
treatment planning.
Neurocognitive Measure:: Neurocognition was measured using the Repeatable
Battery for the Assessment of Neuropsychological Status (RBANS; Randolph,
1998), using standard scores (Mean=100, SD=15).
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--
Numerous studies have concluded that persons with SMI and a history of child
abuse tend to have more severe cognitive impairments than those with SMI and no
abuse history (Lysaker et al, 2001). Extensive biological evidence indicates early
life trauma may have a permanent impact on the developing brain. Rates of child
sexual abuse (CSA) and child physical abuse (CPA) among persons with SMI have
been found to range from 34%-60% (Darvez-Bornoz et al, 1995; Ross et al, 1994;
Greenfield et al.,1994).
However, there is vast heterogeneity in cognitive and behavioral functioning
among persons with SMI and a history of CA. Research needs to explore the
mediating and moderating factors that interact throughout development in order to
aid in more accurately predicting functional outcomes.
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Theory Trimmed Path Analysis with Significant Effects Included
.29(.19)
DAYS in
HOSPITAL
BEFORE
PR
e=.880
Discussion
This study provides empirical support for the theorized relationship between child abuse
and neurocognitive functioning at the time of admission into an inpatient psychiatric
rehabilitation program.
As hypothesized, there are several paths and significant mediating variables involved in
the longitudinal relationship between abuse and neurocognitive functioning. Abuse was not
a significant predictor in the model when more proximal predictors were included.
Significance testing of the variance accounted for by the full model in comparison with the
reduced model revealed that the reduced model fit the data as well as the full model (W(11)
= 8.5, p < .05).
As hypothesized, initial correlations between the variables of interest showed that they
were significantly related to one another. There were no extreme correlations, however,
between predictor variables, suggesting that multicolinearity was not an issue (Mansfield &
Helms, 1982).
Our study provides evidence that a sizable portion of the variance in neurocognition (30%)
can be explained by the proximal variables that have mediating and direct effects on the
relationship between child abuse and neurocognitive functioning in adults with SMI at the
time of admission to psychiatric rehabilitation.
-.178(-.022)
The results imply that the longitudinal pathways are heterogeneous and diverse, yet
significant factors are identified in the model and should be considered important risk and
resilience factors. It appears increased education may be a protective factor and age of onset
may be a risk factor. Gender was added to the model as a predictor of abuse and should be
considered in the interpretation of the results.
There is a paucity of research examining the relationship between early life trauma and
functional outcome among adults with SMI, especially with an emphasis on mediating
variables and longitudinal study designs. Future research should expand on the current
design by examining the different components of neurocognition (i.e. memory, attention,
executive functions), as well as social cognition and other domains of functioning.