Shame, Guilt, and Suicide Ideation among Bondage and Discipline, Dominance and Submission, and Sadomasochism Practitioners: Examining the Role of the Interpersonal Theory of Suicide

To date, no study has examined rates of suicide ideation or theory-based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty-seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma-related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.

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By: Roush JF1, Brown SL1, Mitchell SM1, Cukrowicz KC1.

• 1Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA.
• Suicide Life Threat Behav. 2016 Jun 20. doi: 10.1111/sltb.12267 

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Lessons Learned: Conducting Research with Victims Portrayed in Sexual Abuse Images and Their Parents

Victims portrayed in sexual abuse images may be resistant to participate in research because of embarrassment or shame due to the sensitive nature and potential permanency of images. No studies we are aware of explore reactions to participating in research after this type of crime. 

Telephone interviews were conducted with convenience samples of parents (n= 46) and adolescents who were victims of child sexual abuse (n= 11; some of whom were portrayed in sexual abuse images), and online surveys were completed by adult survivors depicted in abuse images (N= 133). 

• The first lesson was that few agencies tracked this type of crime. This lack of tracking raises the question as to what types of data should be collected and tracked as part of an investigation. 
• The second lesson was that few victims at the two participating agencies had been portrayed in sexual abuse images (4%-5%). 
• The third lesson was that once possible cases were identified, we found relatively high percentages of consent to contact and interview completions. 
• This implies that researchers and service providers should not be hesitant about conducting research after an investigation of child sexual abuse. 
• The fourth lesson was that the vast majority of participants reported not being upset by the questions. 

We hope that the data presented here will encourage agencies to reconsider the types of data being tracked and will encourage researchers to conduct in-depth research with populations that are often difficult to reach to continue improving the professional response to child victimization.

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By:  Walsh WA1, Wolak J2, Lounsbury K3, Howley S4, Lippert T5, Thomas L6.

• 1University of New Hampshire, Durham, NH, USA Wendy.walsh@unh.edu.
• 2University of New Hampshire, Durham, NH, USA.
• 3National Children's Alliance, Washington, DC, USA.
• 4National Center for Victims of Crimes, Washington, DC, USA.
• 5Kaiser Permanente, Portland, OR, USA.
• 6The Harris County Children's Assessment Center, Houston, TX, USA. 
• J Interpers Violence. 2016 Mar 27. pii: 0886260516640545

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Attitudes Toward Sexual Violence Survivors: Differences Across Professional Sectors in Kenya and the Democratic Republic of the Congo

Sexual violence survivors who decide to report their assault interact with health care, law enforcement, and legal and judicial professionals. Professionals' attitudes about sexual violence and survivors play an important role in caring for survivors and in the pursuit of justice. Despite evidence showing the relationship between service provider beliefs and survivor outcomes, relatively little is known about professionals' beliefs about sexual violence or their attitudes toward sexual violence survivors. 

Between June 2012 and December 2014, our study examined the beliefs and attitudes of 181 professionals from the health care, legal, and law enforcement sectors in the Eastern Democratic Republic of the Congo (DRC) and the Rift Valley region of Kenya, areas with a high prevalence of sexual violence. To determine correlates of beliefs and attitudes about sexual violence and sexual violence survivors, multiple logistic regression models were adjusted for demographic and occupational characteristics. 

Respondents who agreed that survivors got what they deserved (7%) or that survivors should feel ashamed (9%) were the minority, while those who would be willing to care for a family member with a history of sexual violence (94%) were the majority. Profession was significantly associated with beliefs and attitudes about sexual violence and survivors. Law enforcement professionals were more likely than health professionals and lawyers to indicate that survivors should feel ashamed. 

Our findings suggest a need for interventions that adequately address potentially harmful beliefs and attitudes of some professionals serving sexual violence survivors.

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By:  Ferdowsian H1, Kelly S2, Burner M3, Anastario M4, Gohlke G5, Mishori R6, McHale T7, Naimer K7.

• 1Georgetown University School of Medicine, Washington, DC, USA Physicians for Human Rights, Boston, MA, USA hopemd@gwu.edu.
• 2George Washington University, USA.
• 3Johns Hopkins University, Baltimore, MD, USA.
• 4RTI International, Research Triangle Park, NC, USA.
• 5Berkeley School of Law, Berkeley, CA, USA.
• 6Georgetown University School of Medicine, Washington, DC, USA.
• 7Physicians for Human Rights, Boston, MA, USA. 

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Shame, Catastrophizing & Negative Partner Responses Are Associated with Lower Sexual & Relationship Satisfaction & More Negative Affect in Men with Peyronie's Disease

Introduction

Peyronie's disease (PD) has a negative impact on men's sexual functioning and quality of life, but little is known about why some men cope better than others and what the effects of PD are on their relationships. The aims of the present study were to describe negative affect, pain, relationship and sexual satisfaction in men with PD, and to explore their psychosocial correlates.

Methods

Participants were 110 men diagnosed with PD. All men completed questionnaires. Main outcome measures The main outcome measures were: Global Measure of Sexual Satisfaction, Dyadic Adjustment Scale, McGill Pain Questionnaire and Negative Affect Scale. The predictor variables were the following: Experience of Shame Scale, Body Esteem Scale, Body Image Self-Consciousness Scale, Index of Male Genital Image, a modified Pain Catastrophizing Scale and a modified Multidimensional Pain Inventory.

Results

Although men with PD had mean sexual/relationship satisfaction and negative affect scores indicating mild impairment, there was a wide range of variation, with 42-52% scoring in the clinical range. Catastrophizing was significantly associated with reduced sexual satisfaction and increased negative affect and pain. Shame was also associated with increased negative affect. The significant associations of relationship satisfaction were partner responses and shame.

Conclusions

Given the lack of curative treatment in PD, understanding why some men cope better than others may guide therapy. Shame, catastrophizing and partner responses may be important therapeutic targets.

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By:  Davis S1, Ferrar S2, Sadikaj G3, Binik Y3, Carrier S4.

• 1 Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada.
• 2 Department of Psychology , Concordia University , Montreal , Quebec , Canada.
• 3 Department of Psychology , McGill University , Montreal , Quebec , Canada.
• 4 Department of Surgery, Division of Urology , McGill University Health Centre, McGill University , Montreal , Quebec , Canada.
• J Sex Marital Ther. 2016 Feb 2:0.  

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Anxiety and Depressive Symptoms among People Living with HIV and Childhood Sexual Abuse: The Role of Shame and Posttraumatic Growth

There is a critical need to examine protective and risk factors of anxiety and depressive symptoms among people living with HIV in order to improve quality of life. 

Structural equation modeling was used to examine the associations between HIV-related shame, sexual abuse-related shame, posttraumatic growth, and anxiety and depressive symptoms among a cohort of 225 heterosexual women and men who have sex with men (MSM) living with HIV who have experienced childhood sexual abuse (CSA). 

• Higher sexual abuse-related shame was related to more anxiety and depressive symptoms for heterosexual women. 
• Higher posttraumatic growth predicted less anxiety symptoms for only heterosexual women. 
• Higher posttraumatic growth predicted less depressive symptoms for heterosexual women and MSM, but the magnitude of this effect was stronger for heterosexual women than MSM. 

Psychosocial interventions may need to be tailored to meet the specific needs of heterosexual women and MSM living with HIV and CSA.

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By:  Willie TC1,2, Overstreet NM3, Peasant C1, Kershaw T1,2, Sikkema KJ4, Hansen NB5.

• 1Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
• 2Division of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
• 3Department of Social Psychology, Clark University, Worcester, MA, USA.
• 4Department of Psychology and Neuroscience, and Duke Global Institute, Duke University, Durham, NC, USA.
• 5Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA. nhansen@uga.edu. 
• AIDS Behav. 2016 Feb 2.

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Mysore Study: A Study of Suicide Notes

BACKGROUND:

Suicide is one of the leading causes of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in the world. In 2013, 134,799 people committed suicide in India according to the statistics released by the National Crime Records Bureau. Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of the world are sparse.

OBJECTIVE:

The aim was to study the themes in suicide notes that might be useful in prevention strategies.

MATERIALS AND METHODS:

A descriptive study of all suicide notes of those individuals who committed suicide between 2010 and 2013 available with Police Department, Mysore district was obtained and analyzed.

RESULTS:

A total of 22 suicide note were available. A majority of suicide note was in age group of 16-40 years (86%) and most were men (59%). All suicide notes were handwritten, the majority (70%) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology/shame/guilt (80%), love for those left behind (55%) and instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% mentioned that they are committing suicide to prove their innocence. 32% mentioned a last wish.

CONCLUSION:

The majority of suicidal note contained "guilt" which is a strong indicator of possible depression in deceased. Creating awareness about suicide among public and ensuring access to professionals trained in suicide prevention is need of the hour in this part of the world.

Below:  Gender and marital status of those who left suicide note

Below:  Overall content in 22 suicide notes

Full article at:   http://goo.gl/gazM4W

By:  P. Namratha, M. Kishor, T. S. Sathyanarayana Rao, and Rajesh Raman

Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore, Karnataka, India

Address for correspondence: Dr. M. Kishor, Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore - 570 004, Karnataka, India. E-mail: moc.liamg@dmrohsikrd

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Help, I Am Losing Control! Examining the Reporting of Sexual Harassment by Adolescents to Social Networking Sites

Sexual harassment is often encountered by adolescents on social networking sites (SNS). One option to cope with a situation of harassment on SNS is to alarm the provider by reporting the transgressive content. It is yet unclear what the determinants of reporting a sexual harassment situation on SNS are, as well as the subsequent actions to these reports from the part of the SNS provider. 

In this article, we seek to address these gaps, and in particular examine whether control-by-the-self over the situation and negative emotions play a role in the reporting of sexual harassment on SNS. Findings indicate that a low situational control-by-the-self, indirectly (namely through a higher experience of negative emotions such as anger and shame) increases the reporting of sexual harassment by the victim. Public visibility of the incident and the impossibility to remove the content reduce the situational control-by-the-self. 

Results further suggest that SNS providers often ignore reported situations of sexual harassment. The study concludes with suggestions for responses to reported harassment on SNS, which should be directed toward increasing behavioral control and thereby alleviating negative emotions.

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By:  Van Royen K1, Poels K1, Vandebosch H1.

• 1Department of Communication Studies, University of Antwerp , Antwerp, Belgium .
• Cyberpsychol Behav Soc Netw. 2016 Jan;19(1):16-22. doi: 10.1089/cyber.2015.0168.

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Factors Related to Sexual Abuse & Forced Sex in Women Experiencing Police-Involved Intimate Partner Violence

Intimate partner sexual violence (IPSV) is a significant social problem, particularly among women who are concurrently experiencing physical violence in their intimate relationships. 

This research examined the prevalence and factors associated with IPSV among a sample of women recruited at the scene of police-involved intimate partner violence incidents (N = 432). Within this sample, 43.98 percent of participants reported experiencing IPSV; this includes 17.36 percent who reported sexual abuse and 26.62 percent who reported forced sex. Multinomial logistic regression was used to examine the factors related to sexual abuse and forced sex, controlling for victim and relationship characteristics. 

Compared with women not reporting IPSV, women who were sexually abused or forced into sexual intercourse were significantly more likely to experience strangulation, feelings of shame, and posttraumatic stress disorder symptoms. Women whose partners had forced sex were more likely to report that they had a child in common with their abusive partner; and that their partner was sexually jealous, had threatened to kill them, had stalked or harassed them, or caused them to have a miscarriage due to abuse. 

These findings can be used to better inform social work practitioners about the prevalence and nature of IPSV and the associated risk factors, and can assist in routine screening and intervention.

Full article at:   http://goo.gl/oEmpI5

By:   Messing JT, Thaller J, Bagwell M.

Jill Theresa Messing, PhD, MSW, is associate professor, School of Social Work, Arizona State University, 411 North Central Avenue, Suite 800, Phoenix, AZ 85004;.

Jonel Thaller, MSW, is assistant professor, Department of Social Work, Ball State University, Muncie, IN. 

Meredith Bagwell, MSW, is a doctoral student, School of Social Work, Arizona State University.

Health Soc Work. 2014 Aug;39(3):181-91. 

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Intimate Partner Aggression-Related Shame & Posttraumatic Stress Disorder Symptoms: The Moderating Role of Substance Use Problems

A dearth of literature has examined the consequences of women's use of aggression in intimate relationships. Women's use of aggression against their intimate partners, regardless of their motivation (e.g., self-defense, retaliation), may elicit shame. Shame, in turn, may contribute to the maintenance and/or exacerbation of posttraumatic stress disorder (PTSD) symptoms, which are commonly experienced in this population. 

Further, emerging research suggests that emotionally avoidant coping strategies, such as substance use, may strengthen the relation between shame and PTSD symptoms. The goal of the present study was to examine whether women's shame concerning their use of intimate partner aggression is associated with their PTSD symptoms, and whether drug and alcohol use problems moderate this association. Participants were 369 community women who had used and been victimized by physical aggression in an intimate relationship with a male partner in the past six months. 

The intimate partner aggression-related shame × drug (but not alcohol) use problems interaction on PTSD symptom severity was significant. Analysis of simple slopes revealed that women's intimate partner aggression-related shame was positively associated with their PTSD symptoms when drug use problems were high, but not when drug use problems were low. 

Findings have implications for the potential utility of PTSD treatments targeting a reduction in shame and maladaptive shame regulation strategies (i.e., drug use) in this population.

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By:   Weiss NH1, Duke AA1, Overstreet NM2, Swan SC3, Sullivan TP1.

• 1Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
• 2Department of Psychology, Clark University, Worcester, Massachusetts.
• 3Department of Psychology, University of South Carolina, Columbia, South Carolina. 

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Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening

Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. 

Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai'i-based project on anal cancer screening tools. Krueger's focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. 

Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being "on the radar" of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through "real talk" (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. 

Application of strategies for health practice are specific to the Hawai'i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales.

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By:  Ka'opua LS1, Cassel K2, Shiramizu B3, Stotzer RL4, Robles A4, Kapua C5, Orton M5, Milne C4, Sesepasara M5.

• 1University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA lskaopua@hawaii.edu.
• 2University of Hawai'i Cancer Center, Honolulu, HI, USA.
• 3University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA.
• 4University of Hawai'i-Ma-noa, Honolulu, HI, USA.
• 5Life Foundation of O'ahu, Honolulu, HI, USA. 

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HIV-Related Stigma, Shame & Avoidant Coping: Risk Factors for Internalizing Symptoms among Youth Living with HIV?

Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. 

We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. 

Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. 

In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. 

The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.

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By:  Bennett DS1, Hersh J2, Herres J3, Foster J4.

• 1Department of Psychiatry, GLAD Program, Drexel University, 4700 Wissahickon Avenue, Philadelphia, PA, 19144, USA. david.bennett@drexelmed.edu.
• 2Psychology Department, Immaculata University, Immaculata, PA, USA.
• 3Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA.
• 4Government Affairs, Gilead Sciences Inc., Philadelphia, PA, USA. 

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Motherhood and the "Madness of Hunger": "…Want Almal Vra vir My vir 'n Stukkie Brood" ("…Because Everyone Asks Me for a Little Piece of Bread")

It is widely assumed that the social and economic conditions of poverty can be linked to common mental disorders in low-, middle- and high-income countries. Despite the considerable increase in quantitative studies investigating the link between poverty and mental health, the nature of the connection between poverty and emotional well-being/distress is still not fully comprehended. 

In this qualitative study, exploring how one group of Coloured South African women, diagnosed with depression and residing in a semi-rural low-income South African community, subjectively understand and experience their emotional distress, data was collected by means of in-depth semi-structured interviews and social constructionist grounded theory was used to analyse the data. 

We will attempt to show

1. that the depressed women in this group of respondents frequently refer to the emotional distress caused by hungry children and 
2. that the emotional distress described by the respondents included emotions typically associated with depression (such as sadness, hopelessness and guilt), but also included emotions not necessarily associated with depression (such as anxiety, anger and anomie). 

In our attempt to understand (both psychologically and politically) the complex emotional response of mothers to their children's hunger, we argue that powerful gender and neo-liberal discourses within which mothers are interpellated to care for children, and more specifically, to make sure that children are not hungry, mean that the mothers of hungry children felt that they were not fulfilling their responsibilities and thus felt guilty and ashamed. 

This shame seemed, in turn, to lead to anger and/or anomie, informing acting out behaviours ranging from verbal and physical aggression to passive withdrawal. 

A vicious cycle of hunger, sadness and anxiety, shame, anger and anomie, aggression and withdrawal, negative judgement, and more shame, are thus maintained. As such, the unbearable rebukes of hungry children can be thought of as evoking a kind of "madness" in low-income mothers.

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By: Kruger LM1, Lourens M2.

• 1Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa. lkrug@sun.ac.za.
• 2Clinical Psychology, Department of Psychology, Stellenbosch University, 1 Whitnall Street, Grahamstown, 6139, South Africa. lourens.marleen@gmail.com. 

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Cervical Cancer, Human Papillomavirus, and Vaccination: Knowledge, Awareness, and Practices Among Turkish Hospital Nurses

In cancer prevention programs, healthcare professionals are the main resource for ensuring community participation in cervical cancer screening as well as in enhancing individuals' knowledge and practices regarding cervical cancer, human papillomavirus (HPV), and HPV vaccines.

This descriptive, cross-sectional study was conducted to determine Turkish hospital nurses' knowledge, awareness, and practices in relation to cervical cancer, HPV, and HPV vaccination.

This study was conducted from February 1 to March 30, 2013. A total of 464 nurses working in a university hospital located in the central Black Sea region in northern Turkey participated.

Among participating nurses, 13.8% of the nurses underwent cervical cancer screening and 11.6% received Pap smear tests. Reasons for not engaging in cervical cancer screening included lack of sexual activity, not considering themselves to be at risk, and shame (28.2%, 18.3%, and 16.8%, respectively). None of the nurses had received the HPV vaccine; reasons included not having sufficient knowledge about the vaccine and a belief that the vaccine was not very common (57.3% and 20.7%, respectively). Nearly half (44%) stated that they would not recommend the HPV vaccine to their patients because they did not believe they had sufficient knowledge about it (56%).

Knowledge about HPV infection and HPV vaccines and willingness to be vaccinated were very low among Turkish hospital nurses. Effective education strategies are needed to improve knowledge needed to support patients to receive effective cervical cancer screening and preventive services.

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By: Koç Z1, Çinarli T.

• 1Zeliha Koç, PhD, is Associate Professor, Samsun School of Nursing, Ondokuz Mayıs University, Turkey. Tuğba Çinarli, MSc, is Research Assistant, Health Science Institute, Ondokuz Mayıs University, Samsun, Turkey.  

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