Risk Behaviors in Sexually Abused Adolescents Diagnosed With Post-Traumatic Stress Disorder and Depression

Introduction

Sexual abuse among adolescents and children is a very important social problem that has been recognized internationally. An analysis of over two hundred and seventeen publications from countries across the world which were published in the timeline between 1980 up to 2008 approximated the sexual abuse prevalence rate before one gets to the age of 18 at 7.6% among men and 18% among women (Stoltenborgh, Van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011).

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A majority of studies that have been published have focussed majorly on the identification of symptoms that are long term in those who have experienced sexual abuse with other retrospective studies having the reliance on samples from adults. There is a clear indication by the results that sexual abuse in children is associated with lots of consequences which are usually long term. Certainly, scholarly literature reviews have come to a conclusion that sexual abuse among children is a risk factor which is nonspecific for a variety of disorders that are psychological, including post-traumatic stress disorder (PTSD), depression, anxiety disorders, suicidal ideations and depression (Maniglio, 2009).

"The hidden epidemic" is what childhood trauma is being called (Lanius, Vermetten, Pain, 2010), as evidence continues mounting in support of experiences that are traumatic which occur in our life has lots of consequences which are both long term and immediate. Events of this nature have effects which can affect someone long into his adulthood as these experiences that are traumatic during childhood lead to higher risks of gastrointestinal, psychiatric, immunological, cardiac and metabolic illness in life later (Felitti, Anda, Nordenberg, 1998). A lot of youths who experience trauma that is significant show disturbances of behavior, mood, and arousal immediately, though many of them actually recover, and just about a third of them develop enduring post-traumatic stress disorder (PTSD) symptoms (Cohen JA, Bukstein O, Walter H, 2010).

Major Depressive Disorder (MDD) is one of the most common mental illnesses, with rates dramatically increasing as much as six-fold from early to late adolescence, and eventually reaching an estimated lifetime prevalence of 20-25 % (Kessler et al. 2001). Furthermore, early onset of depression during adolescence has been associated with many psychosocial problems in adulthood, including poor academic outcomes and increased risk of substance abuse and suicide (Naicker et al.2013).

Problem statement

This research aims in exploring contributions of familial, extra-familial personal to clinical levels prediction of symptoms of PTSD among adolescents while abuse-related variables control (severity, multiple cases of abuse, and type of abuse). Adolescence is an important developmental stage, characterized by a search for identity and a desire for acceptance by peers, and is when a cascade of physical, intellectual, and psychological changes takes place. Young people who have difficulties accomplishing these developmental tasks are especially vulnerable to developing major depression. Literature shows the negative effect of depression on school attendance, academic performance, social well-being, and risky behaviors (McCarty et al., 2013; Montag et.al, 2015; Riglin, Petrides, Frederickson, &Rice, 2014; Verboom, Sijtsema, Verhuist, Penninx, & Ormel, 2014).

Objective

The objective of the research is identifying and coming up with ways of preventing behaviors that are risky among sexually abused adolescents who have been diagnosed with post-traumatic stress disorder and depression.

Significance to Nursing

Many adolescents who have had an experience of trauma often have the reluctance to access the mental health services (Guterman, Hahm, Cameron, 2002). Consequently, adolescent medical practitioners and pediatricians are on most occasions the first line of treatment for youths who have been traumatized. Even though many clinicians who have specialized in adolescent medicine may lack the expertise in providing treatment that is specialized for post-traumatic stress symptoms, it is of vast importance for the community practitioners to have an understanding of the probable manifestations of stress associated with trauma, assess for PTSD and intervention need determination.

Adolescents that are experiencing traumatic stress symptoms often have a fear in them that they are losing their minds and primary care providers together with pediatricians can provide education that is crucial on the traumatic stress effects in anxiety reduction and normalizing experience. Clinicians also can offer assistance through advising gently their patients in a way that is informed of the mental health treatment benefits.

The National Association of School Nurses puts a lot of emphasis on the unique position of the school nurse in identifying students with potential mental health problems. These students tend to visit the school health office frequently with vague somatic symptoms, such as a headache, stomach ache, and musculoskeletal pain. School-based screening programs are feasible and effective in the early identification of depression in an adolescent.

CHAPTER II

Literature Review

Trickett, Noll, and Putnam in 2011 came to a conclusion that post-traumatic stress disorder and depression effects among adolescents are profound, and the clinicians who have specialized in adolescent medicine are usually the ones that are tasked with recognizing youths that are affected. Upon the identification, safety should be established by the clinicians, the adolescent is educated together with those who take care of him/her on PTSD impact on physical and emotional health and behavior plus provide counseling and support. Effective options of treatment should also be a topic of discussion between the clinicians and families (Trickett, Noll, & Putnam, 2011).

In a study conducted by Perez Gonzalez and Pareda in 2015, the conclusion of the research showed that victims of sexual abuse during childhood are at a higher risk of suicidal ideation and suicidal forecasting. Suicidal ideas were reported to be twice as high among victims as non-victims. Alternatively, suicide attempts occur more than three times more often among victims than non-victims (Perez-Gonzalez & Pereda, 2015). Also, sexually abused children have been reported to have few close friends and engage in more conflicts with their parents. They also have more sexual partners and tend to display a former beginning of sexual activity. Moreover, they engage in more frequent unprotected sex as compared to the non-sexually abused (Murat, Karabekiroglu, Yildirim, Sahin, Sapmaz, Babadagi & Aydin, 2015).

During adversities, an important source of emotional support and assistance according to research carried out by Buist, Dekovic, and Prinzie (2013) are the siblings. A relationship that is positive among the siblings promotes strategies of emotion regulation that leads to risk reduction of developing of externalized and internalized problems of behavior (Buist, Dekovic, & Prinzie, 2013). They further came to the conclusion that having a relationship that is close with siblings acts as a factor of protection for those children that are in homes that are disharmonious.

Another study came to a conclusion that youths who have a relationship that is supportive with their siblings usually report less few symptoms of depression as compared to youths who are in high conflict families (Gass, Jenkins, & Dunn, 2007). Analysis of 34 research that has been conducted in recent times all pointed to a conclusion that less conflict and sibling warmth are linked with lower externalized and internalized problems of behavior (Buist et al., 2013).

Although there has been a vast increase in studies over this subject in the past twenty years, knowledge available on the short term consequence among youths that have gone through sexual abuse is still limited. Therefore, little is still known about the trajectories of the victims when they reach adolescence stage which is a crucial time in which they are faced with developmental tasks that are important. Studies that are available highlight a sequel that has a negative association with sexual abuse history among adolescents. Certainly, adolescents that are recruited in centers of intervention and ad treatment after disclosure demonstrate high levels of psychological distress (Brabant, Hebert, & Chagnon, 2012).

Research has highlighted important dissociation symptoms presence and behavior problems that are external as well as sexual behaviors that are risky among adolescents that are sexually abused (Fergusson et al., 2008). Studies have further suggested that during the adolescent stage, sexual abuse victims present a risk that is considerable for suicide attempts (Martin, Bergen, Richardson, Roeger, & Allison, 2004) in addition to victimization in the circumstance of their relationships that are romantic (Hebert, Lavoie, Vitaro, McDuff, & Tremblay, 2008).

Other scholars have proposed that sexually abuse adolescents who are originally asymptomatic may progress serious psychiatric disorders years after undergoing the distress (Murat et al, 2015). A psychiatric evaluation has been utilized to detect any symptoms linking an adolescent to sexual abuse. Common psychiatry diagnoses were adjustment and anxiety disorders. As such, it was recommended that family counseling is undertaken for the risk factors and the affected adolescents be well protected (Hebert, Lavoie & Blais, 2014).

As well as the consequences that are diverse which are associated with sexual abuse among children, Post Traumatic Stress Disorder appears to be one of the many symptoms that are experienced mostly by sexual abuse victims (Paolucci, Genuis, & Violato, 2001). Criteria for the diagnosis of post-traumatic stress disorder are characterized by intrusion symptoms, hyper arousal, and stimuli related to trauma avoidance. Research review that was conducted in the timeline 2000 to 2011 on PTSD during the stage of adolescence reveals that about fifty-seven percent of teenagers who had an experience of sexual trauma had PTSD (Nooner et al., 2012). In actual fact, one of the reviews in empirical studies that were conducted first came to a conclusion that PTSD is one of only two manifestations that are typical which are observed among sexual abuse victims that are young in comparison to other populations (Kendall-Tackett, Williams, & Finkelhor, 1993).

CHAPTER III

Methodology

This study will follow an integrative review methodological approach following the five stages of Whittemore and Knafl (2005). The Cumulative Index to Nursing and Allied Health (CINAHL) will be searched for studies published between 2013 and 2018. Papers to be included should be published in English or Spanish and must be directly related to the subject of this study. A literature search will be conducted through the System Universitario Ana G. Mendez virtual library databases. The author will be systematically searching the literature and collecting the data for critical analysis of the studies included discussion of results and the presentation of the inte...