Lowitja Institute Repository
We are Australia’s only Aboriginal and Torres Strait Islander community controlled health research institute, named in honour of our namesake and co-patron, the late Dr Lowitja O’Donoghue AC CBE DSG. We deliver high-impact quality research, knowledge exchange, and by supporting a new generation of Aboriginal and Torres Strait Islander health researchers. This repository contains information on Lowitja research outputs.
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Browsing Lowitja Institute Repository by Subject "Adverse childhood experiences"
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Item Childhood stress and adversity is associated with late-life dementia in Aboriginal Australians.(2017-09-18) Radford K.; Delbaere K.; Draper B.; Mack H.A.; Daylight G.; Cumming R.; Chalkley S.; Minogue C.; Broe G.A.Objectives: High rates of dementia have been observed in Aboriginal Australians. This study aimed to describe childhood stress in older Aboriginal Australians and to examine associations with late-life health and dementia. Design A cross-sectional study with a representative sample of community-dwelling older Aboriginal Australians. Setting Urban and regional communities in New South Wales, Australia. Participants 336 Aboriginal and/or Torres Strait Islander Australians aged 60-92 years, of whom 296 were included in the current analyses. Measurements Participants completed a life course survey of health, well-being, cognition, and social history including the Childhood Trauma Questionnaire (CTQ), with consensus diagnosis of dementia and Alzheimer disease. Results CTQ scores ranged from 25-117 (median: 29) and were associated with several adverse childhood indicators including separation from family, poor childhood health, frequent relocation, and growing up in a major city. Controlling for age, higher CTQ scores were associated with depression, anxiety, suicide attempt, dementia diagnosis, and, specifically, Alzheimer disease. The association between CTQ scores and dementia remained significant after controlling for depression and anxiety variables (OR: 1.61, 95% CI: 1.05-2.45). In contrast, there were no significant associations between CTQ scores and smoking, alcohol abuse, diabetes, or cardiovascular risk factors. Conclusions Childhood stress appears to have a significant impact on emotional health and dementia for older Aboriginal Australians. The ongoing effects of childhood stress need to be recognized as people grow older, particularly in terms of dementia prevention and care, as well as in populations with greater exposure to childhood adversity, such as Aboriginal Australians.Copyright © 2017 American Association for Geriatric PsychiatryItem Community perspectives of complex trauma assessment for Aboriginal parents: 'its important, but how these discussions are held is critical'.Chamberlain C.; Gee G.; Gartland D.; Mensah F.K; Mares S.; Clark Y.; Ralph N.; Atkinson C.; Hirvonen T.; McLachlan H.; Edwards T.; Herrman H.; Brown S.J.; Nicholson J.M.Background and Purpose: Becoming a parent can be an exciting and also challenging transition, particularly for parents who have experienced significant hurt in their own childhoods, and may be experiencing 'complex trauma.' Aboriginal and Torres Strait Islander (Aboriginal) people also experience historical trauma. While the parenting transition is an important time to offer support for parents, it is essential to ensure that the benefits of identifying parents experiencing complex trauma outweigh any risks (e.g., stigmatization). This paper describes views of predominantly Aboriginal stakeholders regarding (1) the relative importance of domains proposed for complex trauma assessment, and (2) how to conduct these sensitive discussions with Aboriginal parents. Setting and Methods: A co-design workshop was held in Alice Springs (Central Australia) as part of an Aboriginal-led community-based participatory action research project. Workshop participants were 57 predominantly Aboriginal stakeholders with expertise in community, clinical, policy and academic settings. Twelve domains of complex trauma-related distress had been identified in existing assessment tools and through community consultation. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored. Main Findings: The majority of stakeholders supported the importance of assessing each of the proposed complex trauma domains with Aboriginal parents. However, strong concerns were expressed regarding where, by whom and how this should occur. There was greater emphasis and consistency regarding 'qualities' (e.g., caring), rather than specific 'attributes' (e.g., clinician). Six critical overarching themes emerged: ensuring emotional and cultural safety; establishing relationships and trust; having capacity to respond appropriately and access support; incorporating less direct cultural communication methods (e.g., yarning, dadirri); using strengths-based approaches and offering choices to empower parents; and showing respect, caring and compassion. Conclusion: Assessments to identify Aboriginal parents experiencing complex trauma should only be considered when the prerequisites of safety, trusting relationships, respect, compassion, adequate care, and capacity to respond are assured. Offering choices and cultural and strengths-based approaches are also critical. Without this assurance, there are serious concerns that harms may outweigh any benefits for Aboriginal parents. (PsycInfo Database Record (c) 2022 APA, all rights reserved)Item Healing the past by nurturing the future: a qualitative systematic review and metasynthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment.(2020-04-08) Chamberlain C.; Ralph N.; Hokke S.; Clark Y.; Gee G.; Stansfield C.; Sutcliffe K.; Brown S.J.; Brennan S.Background Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood. Methods A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches. Findings The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future. Conclusions Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.Copyright © 2019 Chamberlain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Item Inequities in maternal stressful life events between Indigenous and non-Indigenous women-evidence from a prospective cohort study in New Zealand.(2022-03-25) Paine S.-J.; Walker R.; Lee A.; Signal T.L.Experiences of major, stressful life events (SLE) prior to and during pregnancy, and in early childhood, are associated with a range of adverse outcomes that disproportionately impact Indigenous women and their families. However, little is known about Indigenous women's experiences of SLE. The aim of this study was to investigate: (1) inequities in the prevalence and patterning of SLE between Indigenous and non-Indigenous mothers over time, and; (2) associations between maternal SLE and ethnicity, age, socioeconomic deprivation and time. Data were from the Moe Kura prospective cohort study of 418 Indigenous Maori and 768 non-Maori women in New Zealand. Questionnaires were completed at 35-37 weeks gestation, 12-weeks postpartum, and when their child was 3-4 years of age. The prevalence of five SLE domains was estimated by ethnicity. Generalised linear mixed effects models examined associations between SLE domains and ethnicity, age, socioeconomic deprivation, and time. The prevalence of SLE was greater for Maori than non-Maori at each time point. The probability of reporting SLE increased as neighbourhood deprivation worsened. The probability of reporting SLE reduced with older age, although changes in the estimates were greater for non-Maori than Maori women. Findings show that Indigenous women experience persistent and significant inequities in SLE. Younger maternal age and greater socioeconomic deprivation explain some but not all of the inequities observed. Policies and interventions to address how colonialism and racism structure experiences of SLE for Indigenous women, including via socioeconomic deprivation, are required.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.Item Integrating the family wellbeing program into practice: a conceptual model.Onnis L.; Moylan R.; Whiteside M.; Klieve H.; Smith K.; Tsey K.The experience of trauma in childhood can have lifelong consequences. For Indigenous people the effects can be overcome through protective factors such as connection to family and country, and feeling empowered by having more control over their lives in the socio-political environment in which they are living. There is growing evidence for trauma-informed social and emotional wellbeing (SEWB) interventions that foster a sense of empowerment and enable positive personal- and community-level outcomes. However, in the face of challenges such as short-term funding cycles, such programs are hard to sustainably implement and evaluate over time, even where they demonstrate promise. This article reflects on a successful experience of integrating the Family Wellbeing empowerment program into an existing child and family support organisation. It presents the essential elements for integrating a SEWB program as a conceptual model and highlights the implications for sustainable implementation of promising SEWB programs in new settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved)Item Parenting after a history of childhood maltreatment: a scoping review and map of evidence in the perinatal period.(2019-03-26) Chamberlain C.; Gee G.; Harfield S.; Campbell S.; Brennan S.; Clark Y.; Mensah F.; Arabena K.; Herrman H.; Brown S.; Atkinson J.; Nicholson J.; Gartland D.; Glover K.; Mitchell A.; Atkinson C.; McLachlan H.; Andrews S.; Hirvoven T.; Ralph N.; Dyall D.Background and aims Child maltreatment is a global health priority affecting up to half of all children worldwide, with profound and ongoing impacts on physical, social and emotional wellbeing. The perinatal period (pregnancy to two years postpartum) is critical for parents with a history of childhood maltreatment. Parents may experience 'triggering' of trauma responses during perinatal care or caring for their distressed infant. The long-lasting relational effects may impede the capacity of parents to nurture their children and lead to intergenerational cycles of trauma. Conversely, the perinatal period offers a unique life-course opportunity for parental healing and prevention of child maltreatment. This scoping review aims to map perinatal evidence regarding theories, intergenerational pathways, parents' views, interventions and measurement tools involving parents with a history of maltreatment in their own childhoods. Methods and results We searched Medline, Psychinfo, Cinahl and Embase to 30/11/2016. We screened 6701 articles and included 55 studies (74 articles) involving more than 20,000 parents. Most studies were conducted in the United States (42/55) and involved mothers only (43/55). Theoretical constructs include: attachment, social learning, relational-developmental systems, family-systems and anger theories; 'hidden trauma', resilience, post-traumatic growth; and 'Child Sexual Assault Healing' and socioecological models. Observational studies illustrate sociodemographic and mental health protective and risk factors that mediate/moderate intergenerational pathways to parental and child wellbeing. Qualitative studies provide rich descriptions of parental experiences and views about healing strategies and support. We found no specific perinatal interventions for parents with childhood maltreatment histories. However, several parenting interventions included elements which address parental history, and these reported positive effects on parent wellbeing. We found twenty-two assessment tools for identifying parental childhood maltreatment history or impact. Conclusions Perinatal evidence is available to inform development of strategies to support parents with a history of child maltreatment. However, there is a paucity of applied evidence and evidence involving fathers and Indigenous parents.Copyright © 2019 Chamberlain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Item Perinatal opportunities for addressing complex intergenerational trauma in Aboriginal and Torres Strait Islander communities.(2019-10-13) Chamberlain C.Complex childhood trauma can have profound and ongoing impacts on development and physical, social and emotional wellbeing. Aboriginal people are particularly affected due to a legacy of violence and destructive policies associated with colonisation. The long-lasting relational effects may be triggered during the transition to parenthood, causing emotional distress and impede the capacity of parents to nurture theirchildren. Conversely, the transition to parenthood offers a unique lifecourse opportunity for healing and preventing intergenerational transmission, even after severe trauma. Yet, despite these opportunities forhealing, particularly during frequent scheduled contacts with health care providers; and the risk of triggering due to the intimate nature of perinatal care - there are currently no systematic perinatal strategies for identifying and supporting parents experiencing complex childhood trauma. In this presentation, Associate Professor Chamberlain will: Outline the physiology and epidemiology of complex trauma, with aspecific focus on the impacts on health and health equity in Aboriginal and Torres Strait Islander communities. Discuss the important opportunities during the perinatal period, including findings from a comprehensive systematic review of the views of parents who have experienced maltreatment in their own childhood. Briefly introduce an Aboriginal-led NHMRC and Lowitja Institute funded project - Healing the Past by Nurturing the Future - which aims to co-design culturally acceptable and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal and Torres Strait Islander parents who have experienced complexchildhood trauma