OBJECTIVES: To examine the effectiveness of critical time intervention (CTI)-an evidence-based intervention-for abused women transitioning from women's shelters to community living.METHODS: A randomized controlled trial was conducted in nine women's shelters across the Netherlands. 136 women were assigned to CTI (n = 70) or care-as-usual (n = 66). Data were analyzed using intention-to-treat three-level mixed-effects models.RESULTS: Women in the CTI group had significant fewer symptoms of post-traumatic stress (secondary outcome) (adjusted mean difference - 7.27, 95% CI - 14.31 to - 0.22) and a significant fourfold reduction in unmet care needs (intermediate outcome) (95% CI 0.06-0.94) compared to women in the care-as-usual group. No differences were found for quality of life (primary outcome), re-abuse, symptoms of depression, psychological distress, self-esteem (secondary outcomes), family support, and social support (intermediate outcomes).CONCLUSIONS: This study shows that CTI is effective in a population of abused women in terms of a reduction of post-traumatic stress symptoms and unmet care needs. Because follow-up ended after the prescribed intervention period, further research is needed to determine the full long-term effects of CTI in this population.
"Background: Victimization is highly prevalent in individuals with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and is an important risk factor for mental health problems and violent behavior. Not much is known, however, about victimization history in women with MID-BIF admitted to forensic mental health care. Aims: The aim of this multicenter study is to gain insight into victimization histories and mental health problems of female forensic psychiatric patients with MID-BIF. Methods: File data were analyzed of 126 women with MID-BIF who have been admitted to one of five Dutch forensic psychiatric hospitals between 1990 and 2014 and compared to data of 76 female patients with average or above intellectual functioning and to a matched sample of 31 male patients with MID-BIF. Results: All forensic paients had high rates of victimization, but women with MID-BIF showed an even higher prevalence of victimization during both childhood and adulthood and more complex psychopathology compared to female patients without MID-BIF. Compared to male forensic patients with MID-BIF, women with MID-BIF were more often victim of sexual abuse during childhood. During adulthood, the victimization rate in these women was more than three times higher than in men. Conclusions: Victimization is a salient factor in female forensic patients with MID-BIF and more gender-responsive trauma-focused treatment is needed."
Internationaal onderzoek laat zien dat ingrijpende jeugdervaringen, ook wel Adverse Childhood Experiences (ACE’s) genoemd, een sleutelrol spelen in de ontwikkeling van jeugdigen en hun (latere) psychische en fysieke gezondheid (o.a. Felitti et al., 1998; McLaughlin, 2016). Jeugdigen met verstandelijke beperkingen en hun ouders zijn helaas sterk ondervertegenwoordigd in internationaal onderzoek naar ACE’s, terwijl het belangrijk is dat de huidige inzichten ook kunnen bijdragen aan de verbetering van hun gezondheid en welzijn (o.a. Keesler, 2014; Northway, 2017). Uit verschillende studies blijkt namelijk dat mensen met een verstandelijke beperking vaker geestelijke en fysieke gezondheidsproblemen hebben (Northway, 2017). Daarnaast blijkt dat zij vaker worden blootgesteld aan een groter aantal ingrijpende levensgebeurtenissen (o.a. Emerson, 2015; Mason-Roberts et al., 2018) en dat deze blootstelling gerelateerd is aan een verhoogd risico op geestelijke gezondheidsproblemen (zie Vervoort-Schel et al., 2018 voor verwijzingen). De premisse van de ACE’s-studies is dat het voorkomen of verminderen van ingrijpende jeugdervaringen een positieve invloed heeft op gezondheid en welzijn in het leven (Northway, 2017). Het is veelbelovend om daar verder onderzoek naar te doen.
