Relationship between childhood maltreatment and women’s mental health : perspectives of clinicians and survivors. Don’t ask - Don’t tell.

The relationship between child abuse and later mental health issues is complex and is most likely due to a combination of multiple factors. Past research has demonstrated the negative effects of different types of child abuse on mental health; however, multiple types of child abuse were rarely accounted for. There has also been a paucity of research exploring health service use by women survivors of child abuse and health practitioners’ practices in identifying and responding to the needs of women survivors. The aim of this thesis was to investigate the relationship between child abuse and mental illness in women. In addition, the thesis aimed to examine the perceptions and practices of health professionals (specifically, general practitioners and mental health practitioners) in identifying and supporting women survivors. Two studies resulting in four manuscripts were conducted to meet these aims. Study One explored the perceptions of women survivors of child abuse. Manuscript one examined responses from 108 women survivors of child abuse who completed questions exploring five types of child abuse and current mental health. Results indicated that all women sampled experienced multiple types of child abuse, with 98% having experienced emotional abuse, 94% witnessed family violence and 92% experienced physical abuse. The majority reported at least mild levels of depression (63%), at least mild levels of anxiety (71%) and 46% reported probable diagnosis of post-traumatic stress disorder. After accounting for interactions between different types of child abuse, witnessing family violence, child neglect and child sexual abuse were significant predictors of depression severity, whilst child neglect and witnessing family violence were significant predictors of post-traumatic stress. Witnessing family violence moderated the effects of physical child abuse on depressive and post-traumatic stress symptoms, and emotional child abuse on post-traumatic stress symptoms. Manuscript two examined child abuse disclosures, health service use and women’s thoughts on being asked about child abuse experiences by general practitioners in a subsample of 105 women survivors. Findings indicated that 52.8% of women disclosed their child abuse experiences to others including relatives and friends. In addition, 19% of women were asked about their child abuse history by a general practitioner while 5% of women disclosed to general practitioners without being asked. Of the women who were asked by their general practitioner about their child abuse history, 58% reported feeling hopeful or relieved and none reported feeling offended. A third of women surveyed also sought assistance from mental health practitioners, with 75% reporting that they were asked about child abuse experiences by a mental health practitioner. Study Two comprising manuscripts three and four explored the perceptions and current practices of various health practitioners with respect to screening and supporting women survivors of child abuse. Specifically, manuscript three examined the responses of 127 psychologists with main findings indicating that self-reported confidence and a belief in the importance of screening predicted actual screening behaviours. Manuscript four examined responses from 186 health practitioners, of which 67.9% were psychologists, 13.9% were general practitioners and 18.2% were other mental health practitioners. Results indicated that the majority of practitioners reported that they saw women survivors of child abuse with mental health issues on a daily or weekly basis (76%), 95.1% agreed or strongly agreed that child abuse is a health issue, and 95.2% indicated that child abuse is a problem for women in their practice. Twelve per cent of general practitioners, 78% of psychologists and 73.3% of other professionals agreed or strongly agreed that they routinely screen women for child abuse experiences. General practitioners were significantly less likely to routinely screen and reported lower levels of confidence and comfort in conducting screening compared to psychologists and other practitioners. The majority of practitioners saw it as psychologists’ role to routinely screen; however, 57-82% of practitioners within each group reported they would benefit from further training in areas relating to asking about and supporting survivors.