Associations of perceived adverse lifetime experiences with brain structure in UK Biobank participants

BACKGROUND

Adversity experiences (AEs) are major risk factors for psychiatric illness, and ample evidence suggests that adversity-related changes in brain structure enhance this vulnerability. To achieve greater understanding of the underlying biological pathways, increased convergence among findings is needed. Suggested future directions may benefit from the use of large population samples which may contribute to achieving this goal. We addressed mechanistic pathways by investigating the associations between multiple brain phenotypes and retrospectively reported AEs in early life (child adversity) and adulthood (partner abuse) in a large population sample, using a cross-sectional approach.

METHODS

The UK Biobank resource was used to access imaging-derived phenotypes (IDPs) from 6,751 participants (aged: M = 62.1, SD = 7.2, range = 45-80), together with selected reports of childhood AEs and adult partner abuse. Principal component analysis was used to reduce the dimensionality of the data prior to multivariate tests.

RESULTS

The data showed that participants who reported experiences of childhood emotional abuse ('felt hated by family member as a child') had smaller cerebellar and ventral striatum volumes. This result was also depicted in a random subset of participants; however, we note small effect sizes ( ηp2  < .01), suggestive of modest biological changes.

CONCLUSIONS

Using a large population cohort, this study demonstrates the value of big datasets in the study of adversity and using automatically preprocessed neuroimaging phenotypes. While retrospective and cross-sectional characteristics limit interpretation, this study demonstrates that self-perceived adversity reports, however nonspecific, may still expose neural consequences, identifiable with increased statistical power.

Early life stress is associated with earlier emergence of permanent molars

Exposure to adversity can accelerate biological aging. However, existing biomarkers of early aging are either costly and difficult to collect, like epigenetic signatures, or cannot be detected until late childhood, like pubertal onset. We evaluated the hypothesis that early adversity is associated with earlier molar eruption, an easily assessed measure that has been used to track the length of childhood across primates. In a preregistered analysis (n = 117, ages 4 to 7 y), we demonstrate that lower family income and exposure to adverse childhood experiences (ACEs) are significantly associated with earlier eruption of the first permanent molars, as rated in T2-weighted magnetic resonance images (MRI). We replicate relationships between income and molar eruption in a population-representative dataset (National Health and Nutrition Examination Survey; n = 1,973). These findings suggest that the impact of stress on the pace of biological development is evident in early childhood, and detectable in the timing of molar eruption.

Amygdala Allostasis and Early Life Adversity: Considering Excitotoxicity and Inescapability in the Sequelae of Stress

Early life adversity (ELA), such as child maltreatment or child poverty, engenders problems with emotional and behavioral regulation. In the quest to understand the neurobiological sequelae and mechanisms of risk, the amygdala has been of major focus. While the basic functions of this region make it a strong candidate for understanding the multiple mental health issues common after ELA, extant literature is marked by profound inconsistencies, with reports of larger, smaller, and no differences in regional volumes of this area. We believe integrative models of stress neurodevelopment, grounded in "allostatic load," will help resolve inconsistencies in the impact of ELA on the amygdala. In this review, we attempt to connect past research studies to new findings with animal models of cellular and neurotransmitter mediators of stress buffering to extreme fear generalization onto testable research and clinical concepts. Drawing on the greater impact of inescapability over unpredictability in animal models, we propose a mechanism by which ELA aggravates an exhaustive cycle of amygdala expansion and subsequent toxic-metabolic damage. We connect this neurobiological sequela to psychosocial mal/adaptation after ELA, bridging to behavioral studies of attachment, emotion processing, and social functioning. Lastly, we conclude this review by proposing a multitude of future directions in preclinical work and studies of humans that suffered ELA.

Promoting better functioning among children exposed to high levels of family adversity: the protective role of childcare attendance

BACKGROUND

Children exposed to early adversity are vulnerable to cognitive impairments and externalizing behaviors. Attending childcare may, however, partly buffer this detrimental effect by providing social and cognitive stimulation in a secure environment. The aims of this study were (a) to determine whether the association between exposure to adversity and later externalizing behaviors is mediated by children's cognitive abilities, and (b) to examine if childcare attendance moderates this mediation-thereby highlighting a protective function of children's childcare attendance.

METHODS

Data come from the Avon Longitudinal Study of Children and Parents (N = 6,149). Exposure to adversity was assessed by maternal reports three times from the second trimester of the mother's pregnancy to the child's fourth year of age. Childcare attendance was assessed on four occasions between eight months and three years of age. Factors explaining differences in childcare attendance were controlled using propensity score weights. Children's cognitive abilities were assessed by the Weschler Intelligence Scale for Children at eight years of age, and externalizing behaviors were reported by mothers using the Development and Well-Being Assessment interview at 10, 13, and 15 years of age.

RESULTS

Notably, lower cognitive abilities partly accounted for the higher levels of externalizing behaviors in adolescents exposed to adversity (B indirect effect = 0.02, 95% CI = 0.007-0.03, p < .01). Importantly, childcare attendance moderated this indirect effect. For children exposed to adversity, being in maternal care was associated with lower cognitive abilities which were related to higher levels of externalizing behaviors. On the contrary, for children exposed to adversity, attending childcare was associated with higher cognitive abilities which were linked to lower levels of externalizing behaviors.

CONCLUSIONS

Easily accessible community childcare may be a relatively low-cost public health strategy to prevent the emergence of externalizing behavioral problems in adolescence through its positive effects on cognitive abilities.

Women living with HIV in Nigeria: Predictive influence of hardiness on perceived stress

Background: Women living with HIV experience severe HIV-related stress in sub-Saharan Africa. But evidence shows that individuals with high levels of the psychological hardiness characteristic who accept stressful situations as meaningful experience may withstand psychological stress. However, the literature on associations between hardiness and HIV-related stress among women living with HIV is scarce. The objective of this study was to investigate the relationship between hardiness and HIV-related stress among women living with HIV in Niger State, Nigeria.Methods: This study used a cross-sectional design. A systematic sampling technique was used to recruit 748 participants from three selected hospitals in Niger State. The perceived stress scale and the health-related hardiness scale were used for data collection. A total of 676 questionnaires were returned in usable form and were analysed using hierarchical regression analysis.Results: Pearson's correlation analysis showed that there is a statistically significant association between perceived stress and subscales of hardiness (p < 0.001). Hierarchical regression analysis results showed that hardiness significantly predicted perceived stress among the study sample with R2 = 0.286, F(3, 669) = 90, p < 0.001. Conclusion: The finding of this study that higher hardiness is associated with lower perceived stress suggests the potential helpfulness to women living with HIV of this personality for coping. The finding also suggests that nurses and other health care workers may facilitate the development and/or improvement of hardiness characteristics through cognitive behavioural interventions among women living with HIV to ameliorate HIV-related stress.

Disentangling adversity timing and type: Contrasting theories in the context of maternal prenatal physical and mental health using latent formative models

Research on the effects of adversity has led to mounting interest in examining the differential impact of adversity as a function of its timing and type. The current study examines whether the effects of different types (i.e., physical, sexual, and emotional abuse) and timing (i.e., early, middle childhood, adolescence, or adulthood) of adversity on maternal mental and physical health outcomes in pregnancy, are best accounted for by a cumulative model or independent effects model. Women from a prospective pregnancy cohort (N =3,362) reported retrospectively on their experiences of adversity (i.e., physical, sexual, and emotional abuse) in early childhood (0-5 years], middle childhood (6-12 years], adolescence (13-18 years], and adulthood (19+ years]. Measures of overall health, stress, anxiety, and depression were gathered in pregnancy. Results showed that a cumulative formative latent model was selected as more parsimonious than a direct effects model. Results also supported a model where the strength of the effect of adversity did not vary across abuse timing or type. Thus, cumulative adversity resulted in greater physical and mental health difficulties. In conclusion, cumulative adversity is a more parsimonious predictor of maternal physical and mental health outcomes than adversity at any one specific adversity timing or subtype.

Depression in midlife women attending a menopause clinic is associated with a history of childhood maltreatment

A growing body of literature has suggested that the perimenopause and the early postmenopausal years are associated with an increased risk of experiencing symptoms of depression and the development of first-onset and recurrent episodes of major depressive disorder. Multiple risk factors have been identified, including stressful life events and lower socioeconomic status, as well as early life adversity. The objective of the current study was to characterize the influence of early life childhood maltreatment and incident depression among women experiencing bothersome menopausal symptoms. Participants were recruited from two university-affiliated specialty clinics caring for women with bothersome menopausal symptoms. Assessments included the Childhood Trauma Questionnaire (CTQ), the Center for Epidemiological Studies - Depression (CES-D) scale and the Greene Climacteric Scale. Findings from this cross-sectional study indicate that adverse childhood experiences, as measured using the CTQ, were highly prevalent among women seeking care for bothersome menopausal symptoms (66%). Further, a greater score on the CTQ was significantly associated with higher CES-D scores, as well as with a greater burden of menopausal symptoms, after adjusting for confounding. Our findings lend support to the growing body of literature suggesting that early life stress affects mental health well into adulthood.

The impact of organisational values on nurse resilience: A mixed-methods study

AIM

To investigate the impact of organisational values on nurse resilience.

BACKGROUND

Nurses encounter significant occupational adversity, which can result in negative psychological consequences. Investigating the role of resilience as a protective factor focuses on what enables some nurses to positively adapt in challenging work environments. Comparatively, little attention has been paid to organisational factors and nurse resilience.

METHOD

A two-phase mixed-methods design comprising a cross-sectional survey and focus groups.

RESULTS

Three hundred and ninety-four nurses responded to the survey with 25 participating in four follow-up focus groups. Significant associations were found between resilience levels and agreement with organisational values (p = .022) and agreement about the importance of values (p = .018). Three themes relating to organisational values were identified: pressures and challenges; supports and strategies; and impact of organisational values.

CONCLUSIONS

Organisational values may positively impact resilience if nurses concur with those values and believe they are shared by their employer.

IMPLICATIONS FOR NURSING MANAGEMENT

To promote nurse resilience, organisations and nurse leaders should consider developing, implementing and operating with a set of employee-adopted values, which need to be demonstrably upheld across the organisation.

The coping insights involved in strengthening resilience: The Self-Reflection and Coping Insight Framework

BACKGROUND

Recent theoretical work suggests that self-reflection on daily stressors and the efficacy of coping strategies and resources is beneficial for the enhancement of resilient capacities. However, coping insights emerging from self-reflection, and their relationship to resilient capacities, is an existing gap in our understanding.

OBJECTIVES

Given that insights come in many forms, the objective of this paper is to delineate exemplar coping insights that strengthen the capacity for resilience.

METHODS

After providing an overview of self-reflection and insight, we extend the Systematic Self-Reflection model of resilience strengthening by introducing the Self-Reflection and Coping Insight Framework to articulate how the emergence of coping insights may mediate the relationship between five self-reflective practices and the enhancement of resilient capacities.

RESULTS

We explore the potential for coping insights to convey complex ideas about the self in the context of stressor exposure, an awareness of response patterns to stressors, and principles about the nature of stress and coping across time and contexts.

CONCLUSIONS

This framework adds to existing scholarship by providing a characterization of how coping insight may strengthen resilient capacities, allowing for a guided exploration of coping insight during future research.

Deprivation and psychopathology in the Fragile Families Study: A 15-year longitudinal investigation

BACKGROUND

Early adversity consistently predicts youth psychopathology. However, the pathways linking unique dimensions of early adversity, such as deprivation, to psychopathology are understudied. Here, we evaluate a theoretical model linking early deprivation exposure with psychopathology prospectively through language ability.

METHODS

Participants included 2,301 youth (47.5% female) enrolled in the Fragile Families and Child Wellbeing Study. We include data from assessment points at ages 1, 3, 5, 9, and 15. Latent factors for deprivation and threat were modeled from multiple indicators at ages 1 and 3. Youth language ability was assessed at Age 5. Indicators of psychopathology were assessed at ages 5, 9, and 15. A structural equation model tested longitudinal paths to internalizing and externalizing psychopathology from experiences of deprivation and threat.

RESULTS

Deprivation from birth to Age 3 was associated with an indirect effect on internalizing and externalizing symptoms in early childhood (Age 5), later childhood (Age 9), and adolescence (Age 15) via language ability in early childhood (Age 5). Early threat exposure was associated with increased internalizing and externalizing psychopathology across all ages. There was no significant indirect effect from threat to psychopathology via language ability.

CONCLUSIONS

The effects of deprivation on psychopathology during early childhood, late childhood, and adolescence are explained, in part, through early childhood language ability. Results provide insight into language ability as a possible opportunity for intervention.

The Opportunity of Social Ecological Resilience in the Promotion of Youth Health and Wellbeing: A Narrative Review

Youth experience adversity that increases their risk for immediate and long-term health consequences. Resilience has traditionally been conceptualized as an internal disposition or trait that supports youth to overcome that risk and avoid the negative impact on their health and wellbeing. However, this model of resilience overemphasizes the role of the individual and their capacity to control their environment, while minimizing the integral role of relational, social, structural, and cultural contexts in which they live. Instead, social ecological resilience (SER) emphasizes the influence of social and environmental factors on individual processes and outcomes and offers different pathways for preventive interventions to promote youth health and wellbeing. Within preventive medicine, it is important for researchers and practitioners to understand the processes that support or impede SER, particularly in youth when adversity can impact health throughout the lifespan. The purpose of this review was to examine the contributions and scope of the SER model in research on youth, with the goal of advancing SER-informed research and interventions within preventive medicine. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach as a guiding framework, we conducted a narrative review of the literature. The review characterizes 37 existing studies across the fields of education, psychology, and social work in terms of topic, focal population, methods, use of SER, and implications. We conclude with recommendations for future applications of SER to promote the health and wellbeing of youth.

Parental Incarceration, Child Adversity, and Child Health: A Strategic Comparison Approach

Background: Research points to parental incarceration as an important social determinant of child health. Even so, studies examining the health impact of parental incarceration in the context of diverse childhood stressors and adversities are lacking. Methods: The present study uses a large, nationally representative sample to compare U.S. children who were exposed to parental incarceration to a strategic comparison group of U.S. children who were not exposed to parental incarceration, but were nonetheless exposed to alternative family stressors and adversities. Results: The initial findings generally reveal worse health among children exposed to parental incarceration compared to those who are not exposed. Even so, these differences were partially or completely attenuated when comparing the incarceration-exposed group to more comparable groups of children exposed to a varying degree of alternative stressors/adversities. Conclusions: Programmatic efforts targeting parental incarceration as a means of promoting child health may be enhanced by adequately addressing co-occurring family stressors and child adversities.

Tutor of Resilience: A Model for Psychosocial Care Following Experiences of Adversity

This article describes a model for training service providers to provide interventions that build resilience among individuals who have experienced adversity. The Tutor of Resilience model emphasizes two distinct dimensions to training: (1) transforming service providers' perceptions of intervention beneficiaries by highlighting their strengths and capacity for healing; and (2) flexibly building contextually and culturally specific interventions through a five-phase model of program development and implementation. Tutor of Resilience has been employed successfully with child and youth populations under stress in humanitarian settings where mental health and psychosocial support professionals are required to design and deliver interventions that enhance resilience among vulnerable children.

Edwardsiella piscicida YefM-YoeB: A Type II Toxin-Antitoxin System That Is Related to Antibiotic Resistance, Biofilm Formation, Serum Survival, and Host Infection

The emergence of drug resistant bacteria is a tricky and confronted problem in modern medicine, and one of important reasons is the widespread of toxin-antitoxin (TA) systems in pathogenic bacteria. Edwardsiella piscicida (also known as E. tarda) is the leading pathogen threatening worldwide fresh and seawater aquaculture industries and has been considered as a model organism for studying intracellular and systemic infections. However, the role of type II TA systems are completely unknown in aquatic pathogenic bacteria. In this study, we identified and characterized a type II TA system, YefM-YoeB, of E. piscicida, where YefM is the antitoxin and YoeB is the toxin. yefM and yoeB are co-expressed in a bicistronic operon. When expressed in E. coli, YoeB cause bacterial growth arrest, which was restored by the addition of YefM. To investigate the biological role of the TA system, two markerless yoeB and yefM-yoeB in-frame mutant strains, TX01ΔyoeB and TX01ΔyefM-yoeB, were constructed, respectively. Compared to the wild strain TX01, TX01ΔyefM-yoeB exhibited markedly reduced resistance against oxidative stress and antibiotic, and markedly reduced ability to form persistent bacteria. The deletion of yefM-yoeB enhanced the bacterial ability of high temperature tolerance, biofilm formation, and host serum resistance, which is the first study about the relationship between type II TA system and serum resistance. In vitro infection experiment showed that the inactivation of yefM-yoeB greatly enhanced bacterial capability of adhesion in host cells. Consistently, in vivo experiment suggested that the yefM-yoeB mutation had an obvious positive effect on bacteria dissemination of fish tissues and general virulence. Introduction of a trans-expressed yefM-yoeB restored the virulence of TX01ΔyefM-yoeB. These findings suggest that YefM-YoeB is involved in responding adverse circumstance and pathogenicity of E. piscicida. In addition, we found that YefM-YoeB negatively autoregulated the expression of yefM-yoeB and YefM could directly bind with own promoter. This study provides first insights into the biological activity of type II TA system YefM-YoeB in aquatic pathogenic bacteria and contributes to understand the pathogenesis of E. piscicida.

Childhood adversity, pubertal timing and self-harm: a longitudinal cohort study

BACKGROUND

The occurrence of early childhood adversity is strongly linked to later self-harm, but there is poor understanding of how this distal risk factor might influence later behaviours. One possible mechanism is through an earlier onset of puberty in children exposed to adversity, since early puberty is associated with an increased risk of adolescent self-harm. We investigated whether early pubertal timing mediates the association between childhood adversity and later self-harm.

METHODS

Participants were 6698 young people from a UK population-based birth cohort (ALSPAC). We measured exposure to nine types of adversity from 0 to 9 years old, and self-harm when participants were aged 16 and 21 years. Pubertal timing measures were age at peak height velocity (aPHV - males and females) and age at menarche (AAM). We used generalised structural equation modelling for analyses.

RESULTS

For every additional type of adversity; participants had an average 12-14% increased risk of self-harm by 16. Relative risk (RR) estimates were stronger for direct effects when outcomes were self-harm with suicidal intent. There was no evidence that earlier pubertal timing mediated the association between adversity and self-harm [indirect effect RR 1.00, 95% confidence interval (CI) 1.00-1.00 for aPHV and RR 1.00, 95% CI 1.00-1.01 for AAM].

CONCLUSIONS

A cumulative measure of exposure to multiple types of adversity does not confer an increased risk of self-harm via early pubertal timing, however both childhood adversity and early puberty are risk factors for later self-harm. Research identifying mechanisms underlying the link between childhood adversity and later self-harm is needed to inform interventions.

Sporting Resilience During COVID-19: What Is the Nature of This Adversity and How Are Competitive Elite Athletes Adapting?

The COVID-19 pandemic is a global health issue which has severely disrupted and deferred several landmark international sporting competitions. Like the general population, athletes have faced direct psychological consequences from COVID-19 in addition to cancelation of events, loss of support, lack of training, loss of earnings, hypervigilance, and anxiety among others. The aim of the present research was to identify the adversity experiences of athletes caused by COVID-19 (study 1) and explore the process of resilience used by competitive elite athletes for positive adaptation (study 2). Research has indicated psychological resilience to be a protective factor against similar adversities in the sporting context. The study uses an across-cases qualitative design comparing the real-time lived experiences of athletes during COVID-19 using narrative analysis. Data were collected from 10 competitive elite athletes from various countries, as part of a larger doctoral dissertation study during the lockdown period, using in-depth experiential interviews. Study 1 presents detailed narratives on the loss and incongruence, which were the two major adversities experienced. Study 2 outlines the process of resilience as narrated by the participants through the emergent and minimal-impact resilience trajectories. We discuss recommendations for interventions and the role of sports psychologists, coaches, and sporting organizations in ensuring athletes' mental health and their rehabilitation into post-COVID sports life.

Prevalence of language and pre-literacy difficulties in an Australian cohort of 5-year-old children experiencing adversity

BACKGROUND

Early reading success is predicated on language and pre-literacy skills. Children who are behind their peers in language and pre-literacy development before formal schooling are less likely to be proficient beginner readers, and difficulties may persist throughout primary school and beyond. We know children experiencing adversity are at greater risk of early language and pre-literacy difficulties; we do not know the prevalence of these difficulties in an Australian adversity context.

AIMS

To investigate the prevalence and co-occurrence of language and pre-literacy difficulties in a cohort of Australian 5-year-old children experiencing social adversity.

METHODS & PROCEDURES

Data were drawn from a large Australian community-based trial of nurse home visiting (right@home), which aimed to support women experiencing social adversity from pregnancy until their child turned 2 years of age. Social adversity was determined by two of more risk factors: young pregnancy, not living with another adult, no support, poorer health, current smoker, long-term illness, anxious mood, not finishing high school, no household income and no previous employment. Children whose mothers were enrolled in the control group (receiving usual maternal and child healthcare) were included in the current study (n = 359). Language and pre-literacy skills were measured at age 5 using the Clinical Evaluation of Language Fundamental Preschool-Second Edition (CELF-P2) and the School Entry Alphabetic and Phonological Awareness Readiness Test (SEAPART). Language difficulties were defined as ≥ 1.25 standard deviations (SD) below the Australian normative mean on CELF-P2 Core Language scores. Pre-literacy difficulties were defined as children scoring in the Beginner (versus Developing or Competent) criterion-referenced level on the SEAPART First Sound Identification and/or Alphabet Letter Identification subtests. Co-occurrence of language and pre-literacy difficulties was also determined.

OUTCOMES & RESULTS

At the 5-year follow-up, 201/359 (56%) children were assessed (mean age = 5.1 years, SD = 0.1). Mean Core Language score for this cohort (91.8, SD = 15.9) was 0.54 SD below the normative mean (100, SD = 15). The proportion of children presenting with language difficulties was 24.9%. Regarding pre-literacy skills, 43.8% of children were 'Beginner' for identifying first sounds and 58.6% for identifying alphabet letters/sounds. There was also considerable overlap whereby 76.7% of children with language difficulties also exhibited pre-literacy difficulties.

CONCLUSIONS & IMPLICATIONS

This is the first empirical Australian-based study highlighting the high prevalence and co-occurrence of language and pre-literacy difficulties in preschool children experiencing social adversity. Clinicians should be aware of co-morbid language and pre-literacy difficulties in disadvantaged populations and consider both areas during assessment and intervention planning. What this paper adds What is already known on the subject The prevalence of language and literacy difficulties is substantially higher in cohorts experiencing social adversity when compared with more advantaged families. There is some evidence that adversity also contributes to pre-literacy difficulties, but less is known here. What this paper adds to existing knowledge This study presents new prevalence data showing high rates of language and pre-literacy difficulties for 5-year-old children experiencing adversity within an Australian context. It is the first to explore these skills in a large cohort of pre-schoolers recruited from community settings in Australia. What are the potential or actual clinical implications of this work? In this cohort experiencing adversity, most children who presented with language difficulties likewise exhibited pre-literacy difficulties. This concordance reflects how early oral language and pre-literacy skills develop together. Clinicians should assess both skills in preschool populations-especially those working with children experiencing adversity-to ensure all children have strong foundations to become proficient beginner readers.

Child-parent cardiac transference is decreased following disrupted/absent early care

Parental input shapes youth self-regulation development, and a lack of sensitive caregiving is a risk factor for youth mental health problems. Parents may shape youth regulation through their influence over biological (including neural) and behavioral development during childhood at both micro (moment-to-moment) and macro (global) levels. Prior studies have shown that micro-level parent-child interactions shape youth's biology contributing to youth mental health. However, it remains unclear whether prior disrupted/absent care affects those moment-to-moment parent-youth interactions in ways that increase risk for youth psychopathology. In the current study, we calculated transfer entropy on cardiac data from parent-youth dyads where the youth had either been exposed to disrupted care prior to adoption or not. Transfer Entropy (TE) tracks information flow between two signals, enhancing quantification of directional coupling, allowing for the examination of parent-child and child-parent influences. Using this novel approach, we identified lower cardiac information transfer from youth-to-parents in dyads where the youth had been exposed to disrupted/absent early care. Moreover we showed that the degree to which the parent's physiology changed in response to youth's physiology was negatively related to the youth's mental health, representing a potential pathway for elevated mental health risk in populations exposed to disrupted/absent early care.

Integrating and synthesizing adversity and resilience knowledge and action: The ICARE model

This article proposes a model for understanding the effects of adverse childhood experiences (ACEs) as dynamic and interrelated biobehavioral adaptations to early life stress that have predictable consequences on development and health. Drawing upon research from multiple theoretical and methodological approaches, the intergenerational and cumulative adverse and resilient experiences (ICARE) model posits that the negative consequences of ACEs result from biological and behavioral adaptations to adversity that alter cognitive, social, and emotional development. These adaptations often have negative consequences in adulthood and may be transmitted to subsequent generations through epigenetic changes as well as behavioral and environmental pathways. The ICARE model also incorporates decades of resilience research documenting the power of protective relationships and contextual resources in mitigating the effects of ACEs. Examples of interventions are provided that illustrate the importance of targeting the dysregulated biobehavioral adaptations to ACEs and developmental impairments as well as resulting problem behaviors and health conditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Post-traumatic growth as positive personality change: Challenges, opportunities, and recommendations

OBJECTIVE

Post-traumatic growth typically refers to enduring positive psychological change experienced as a result of adversity, trauma, or highly challenging life circumstances. Critics have challenged insights from much of the prior research on this topic, pinpointing its significant methodological limitations. In response to these critiques, we propose that post-traumatic growth can be more accurately captured in terms of personality change-an approach that affords a more rigorous examination of the phenomenon.

METHOD

We outline a set of conceptual and methodological questions and considerations for future work on the topic of post-traumatic growth.

RESULTS

We provide a series of recommendations for researchers from across the disciplines of clinical/counseling, developmental, health, personality, and social psychology and beyond, who are interested in improving the quality of research examining resilience and growth in the context of adversity.

CONCLUSION

We are hopeful that these recommendations will pave the way for a more accurate understanding of the ubiquity, durability, and causal processes underlying post-traumatic growth.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence

PURPOSE

While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important.

METHOD

The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality.

RESULTS

Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality.

CONCLUSIONS

Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials

Background

The lack of availability of evidence-based services for people exposed to adversity globally has led to the development of psychological interventions with features that will likely make them more scalable. The evidence for the efficacy of e-mental health from high-income countries is compelling, and the use of these interventions could be a way to increase the coverage of evidence-based psychological interventions in low- and middle-income countries. Step-by-Step is a brief (5-session) intervention proposed by the World Health Organization as an innovative approach to reducing the suffering and disability associated with depression.

Objective

This study aims to evaluate the effectiveness and cost-effectiveness of a locally adapted version of Step-by-Step with Syrian nationals (trial 1) and Lebanese nationals and other populations residing in Lebanon (trial 2).

Methods

This Step-by-Step trial involves 2 parallel, two-armed, randomized controlled trials comparing the e-intervention Step-by-Step to enhanced care as usual in participants with depressive symptoms and impaired functioning. The randomized controlled trials are designed and powered to detect effectiveness in 2 populations: Syrians in Lebanon (n=568) and other people residing in Lebanon (n=568; Lebanese nationals and other populations resident in Lebanon). The primary outcomes are depressive symptomatology (measured with the Patient Health Questionnaire-9) and functioning (measured with the World Health Organization Disability Assessment Scale 2.0). Secondary outcomes include anxiety symptoms, posttraumatic stress disorder symptoms, personalized measures of psychosocial problems, subjective well-being, and economic effectiveness. Participants are mainly recruited through online advertising. Additional outreach methods will be used if required, for example through dissemination of information through partner agencies and organizations. They can access the intervention on a computer, tablet, and mobile phone through a hybrid app. Step-by-Step has 5 sessions, and users are guided by trained nonspecialist “e-helpers” providing phone-based or message-based support for around 15 minutes a week.

Results

The trials were funded in 2018. The study protocol was last verified June 20, 2019 (WHO ERC.0002797) and registered with ClinicalTrials.gov (NCT03720769). The trials started recruitment as of December 9, 2019, and all data collection was completed in December 2020.

Conclusions

The Step-by-Step trials will provide evidence about the effectiveness of an e-mental health intervention in Lebanon. If the intervention proves to be effective, this will inform future scale-up of this and similar interventions in Lebanon and in other settings across the world.

Trial Registration

ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769

International Registered Report Identifier (IRRID)

DERR1-10.2196/21585

Adverse childhood experiences and transcriptional response in school-age children

This study evaluated whether children with higher adverse childhood experiences (ACE) scores had alterations in immune cell gene expression profiles. RNA sequencing was conducted on dried blood spot samples from 37 generally healthy English-speaking children (age 5-11) who were recruited from well-child visits at a university-affiliated pediatric practice. The Whole Child Assessment was used to assess ACE exposure. Primary analyses examined an a priori-specified composite of 19 pro-inflammatory gene transcripts. Secondary analyses examined a 34-gene composite assessing Type I interferon response, and used Transcript Origin Analyses to identify cellular mechanisms. After controlling for age, body mass index percentile, sex, race/ethnicity, current insurance status, and household smoking exposure, pro-inflammatory gene expression was elevated by 0.094 log2 RNA expression units with each Child-ACE total score point (p = .019). Type I interferon gene expression was similarly upregulated (0.103; p = .008). Transcript origin analyses implicated CD8+ T cell as the primary sources of gene transcripts upregulated, and nonclassical (CD16+) monocytes as sources of downregulated transcripts. These preliminary analyses suggest that parent-reported ACE exposures are associated with increased expression of both inflammatory and interferon gene transcripts in children's circulating blood cells.

BSTP Review of 12 Case Studies Discussing the Challenges, Pathology, Immunogenicity, and Mechanisms of Inhaled Biologics

The inhalation route is a relatively novel drug delivery route for biotherapeutics and, as a result, there is a paucity of published data and experience within the toxicology/pathology community. In recent years, findings arising in toxicology studies with inhaled biologics have provoked concern and regulatory challenges due, in part, to the lack of understanding of the expected pathology, mechanisms, and adversity induced by this mode of delivery. In this manuscript, the authors describe 12 case studies, comprising 18 toxicology studies, using a range of inhaled biotherapeutics (monoclonal antibodies, fragment antigen-binding antibodies, domain antibodies, therapeutic proteins/peptides, and an oligonucleotide) in rodents, nonhuman primates (NHPs), and the rabbit in subacute (1 week) to chronic (26 weeks) toxicology studies. Analysis of the data revealed that many of these molecules were associated with a characteristic pattern of toxicity with high levels of immunogenicity. Microscopic changes in the airways consisted of a predominantly lymphoid perivascular/peribronchiolar (PV/PB) mononuclear inflammatory cell (MIC) infiltrate, whereas changes in the terminal airways/alveoli were characterized by simple ("uncomplicated") increases in macrophages or inflammatory cell infiltrates ranging from mixed inflammatory cell infiltration to inflammation. The PV/PB MIC changes were considered most likely secondary to immunogenicity, whereas simple increases in alveolar macrophages were most likely secondary to clearance mechanisms. Alveolar inflammatory cell infiltrates and inflammation were likely induced by immune modulation or stimulation through pharmacologic effects on target biology or type III hypersensitivity (immune complex disease). Finally, a group of experts provide introductory thoughts regarding the adversity of inhaled biotherapeutics and the basis for reasonable differences of opinion that might arise between toxicologists, pathologists, and regulators.

Racial discrimination and ethnic racial identity in adolescence as modulators of HPA axis activity

We review evidence of racial discrimination as a critical and understudied form of adversity that has the potential to impact stress biology, particularly hypothalamic-pituitary-adrenal (HPA) axis activity. We highlight ethnic racial identity (ERI) as a positive regulatory influence on HPA axis activity, as indexed by levels of salivary cortisol. In past research by our group, Black individuals with high adolescent discrimination had low adult cortisol levels (hypocortisolism). Here, we present new analyses showing that ERI, measured prospectively from ages 12 through 32 in 112 Black and white individuals, is related to better-regulated cortisol levels in adulthood, particularly for Black participants. We also describe ongoing research that explores whether the promotion of ERI during adolescence can reduce ethnic-racial disparities in stress biology and in emotional health and academic outcomes.

Characterizing competence among a high-risk sample of emerging adults: Prospective predictions and biological considerations

Few conditions epitomize severe and chronic stress to a greater extent than child maltreatment, which can derail development across multiple domains of functioning and throughout the life course. Furthermore, child maltreatment tends to co-occur with other adversities, such as poverty. Many individuals grow up under the stressful conditions of these adversities and exhibit developmental competence. The current study prospectively charted the developmental progression of economically disadvantaged maltreated and nonmaltreated children from childhood to emerging adulthood, and examined patterns of competence across multiple developmental domains of functioning central to the period of emerging adulthood. The study investigated childhood precursors to these patterns of adaptation and maladaptation, as well as the physiological cost of these patterns of adaptation (i.e., C-reactive protein; CRP). Latent class analysis revealed four distinct classes of functioning: multifaceted competence across domains (Multifaceted Competence); (multifaceted maladaptation across domains (Multi-Problem); (c) and two classes with mixed patterns of competence and maladaptation (Externalizing Problems and Work/School Impairment). Maltreated individuals were less likely than nonmaltreated individuals to demonstrate patterns of multifaceted competence and more likely to demonstrate aggregate maladaptation across domains. Additionally, Black men who demonstrated a pattern of multifaceted psychosocial competence also evidenced higher levels of low-grade inflammation (indexed by CRP), suggesting physiological distress was associated with adaptation in the context of stress among these individuals. Findings demonstrate the heterogenous patterns of functioning and diverse developmental outcomes that follow early adversity.

The Impact of the COVID-19 Lockdown on Coaches' Perception of Stress and Emotion Regulation Strategies

The recent global outspread of the COVID-19 pandemic has influenced the lives of people across multiple countries including athletes, coaches, and supporting staff. Along with everybody else, coaches found themselves constrained to an at-home self-isolation, which limited their ability to normally engage with their profession and to interact with their athletes. This situation may also have impacted their own psychological well-being. With this study, we explored coaches’ perceptions of stress in relation to their emotion regulation strategies depending upon their gender and competitive level (elite vs. non-elite). A sample of 2272 Italian coaches were surveyed during the period of lockdown. Mean values for perceived stress and emotion regulation strategies were compared to normative data of the two instruments as reported in the original studies. Furthermore, two Multivariate analyses of variance (MANOVAs) were completed to observe the potential differences in the coaches’ emotion regulation strategies and perception of stress. Finally, a blockwise regression analysis was run to assess how coaches’ emotion regulation strategies impacted upon their perception of stress. Both women and men reported higher levels of perceived stress than those reported in the normative data. Similarly, average scores for emotion regulation strategies were significantly different from those reported for normative data, in particular, coaches reported slightly higher use of emotion regulation strategies than participants in the original study. Significant gender-based differences emerged in terms of emotional regulations, with men adopting more suppression than women. No differences by competitive level were found. In terms of perceived stress, male coaches and elite coaches showed to be more in control of the situation (positive stress) than female coaches and non-elite coaches, respectively, while women experienced more negative stress than men. The blockwise regression evidenced how reappraisal resulted to be predictive in helping coaches to reduce their perception of stress, while suppression predicted higher stress perceptions.

Inspiration and Exasperation: The Challenges of Inhaled Biologics

The delivery of biotherapeutic molecules (antibodies, proteins, peptides) and nucleic acids via the respiratory route has presented challenges for regulatory approval, due in part to a lack of understanding of the expected pathology, mechanisms of toxicity, and immunogenicity induced by the inhalation route. Although the first inhaled biotherapeutic was approved some time ago (Dornase Alfa, Pulmozyme; Genetech, 1993), no other inhaled biotherapeutics have been marketed for the treatment of human disease other than the inhaled insulins (Exubera; Pfizer, 2006 and Afrezza; Mannkind Corporation, 2014). As a result, scientific knowledge within the toxicologic pathology community is fragmented with precious little publicly available data. Therefore, one of the aims of this special edition was to generate a collection of manuscripts that pathologists and toxicologists could refer in order to understand the pathology, mechanisms of toxicity, immunogenicity, and challenges associated with the development of inhaled biotherapeutics.

Protective Factors to the Wellbeing of Undocumented Latinx Immigrants in the United States: A Socio-Ecological Approach

Undocumented immigrants often experience multiple chronic stressors that over time can increase health risk. This qualitative study used data from 7 focus groups and 15 key informant interviews to identify relevant protective factors to the heath of undocumented immigrants in the U.S. Findings showed that at the individual level, undocumented immigrants rely primarily on motivation to cope with adversity, while also relying on family support and community cohesion at the interpersonal level. At the policy level, safe neighborhoods and non-stigmatizing environments, protection from abuse/exploitation, and activism were identified as protective factors. English proficiency was also identified as important.

Developing the Resilience Framework for Nursing and Healthcare

Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.

The role of lifetime stressors in adult fibromyalgia: systematic review and meta-analysis of case-control studies

BACKGROUND

Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain. Although accumulating evidence suggests that exposure to stressful events increases the risk for this complex disorder, this is the first meta-analysis to compare the impact of a full range of lifetime stressors (e.g. physical trauma through to emotional neglect) on adult fibromyalgia.

METHODS

This review was performed in accordance with PRISMA guidelines. Random-effects models examined associations between different stressor exposures and fibromyalgia status with meta-regression investigating the effects of publication year and study quality on effect sizes.

RESULTS

Nineteen studies were included in the meta-analysis. Significant associations with fibromyalgia status were observed for all six exposure types examined: odds ratios (OR) were highest for physical abuse (OR 3.23, 95% confidence interval 1.99-5.23) and total abuse (3.06, 1.71-5.46); intermediate for sexual abuse (2.65, 1.85-3.79) and smaller for medical trauma (1.80, 1.19-2.71), other lifetime stressors (1.70, 1.31-2.20), and emotional abuse (1.52, 1.27-1.81). Results were not significantly changed when childhood, as opposed to adult, exposures were used in studies that reported both. Meta-regression analyses demonstrated no effect of publication year or study quality on effect sizes.

CONCLUSIONS

This study confirmed a significant association between stressor exposure and adult fibromyalgia with the strongest associations observed for physical abuse. Limitations related to current available literature were identified; we provide several suggestions for how these can be addressed in future studies. Stressors are likely to be one of many risk factors for fibromyalgia which we argue is best approached from a biopsychosocial perspective.

The validity and reliability of benevolent childhood experiences scale in Chinese community adults

BACKGROUND

Several studies have indicated that positive childhood experiences (PCEs) might have important protective effects on adulthood mental health. However, the instruments to assess PCEs are scarce.

OBJECTIVE

In this study, we assessed the validity and reliability of the Benevolent Childhood Experiences (BCEs) scale, a new instrument of PCEs, in a large sample of Chinese adults. Furthermore, we examined associations of PCEs with symptoms of posttraumatic stress disorder (PTSD) and depression, as well as, prosocial behaviours across different levels of trauma.

METHOD

Participants were 6929 adults (33% male; mean age 38.04 years, SD = 7.81, ranging from 18 to 81.) recruited from Jiangxi and Hunan provinces in China. Self-administrated questionnaires were used to measure PCEs, childhood trauma, lifetime trauma, PTSD, depression, and prosocial behaviours. Multiple linear regression models were conducted to examine the interdependent and interactive effects of PCEs, lifetime trauma, childhood trauma on symptoms of PTSD and depression and prosocial behaviours.

RESULTS

In the current sample, the Cronbach's α of the BCEs scale was 0.70. PCEs were not related to lifetime trauma, while modestly associated with childhood trauma, demonstrating excellent discriminant validity. PCEs were negatively correlated with severity of PTSD and depression, while positively correlated with prosocial behaviours, indicating good predictive validity. PCEs, lifetime trauma and childhood trauma were independently associated with severity of PTSD and depression and prosocial behaviours. Moreover, the interaction of PCEs and lifetime trauma negatively predicted severity of PTSD and depression, while the interaction of PCEs and childhood trauma negatively predicted prosocial behaviours. PCEs had a protective effect on PTSD and depression in high level of lifetime trauma, and showed a reduced positive effect on prosocial behaviours in high level of childhood trauma.

CONCLUSIONS

The Chinese BCEs scale is a reliable and valid instrument. PCEs can buffer adversity and foster positive outcomes in adulthood.

The Impact of Psychopathology Associated With Childhood Trauma on Quality of Life in Portuguese Adolescents: A Two-Wave Longitudinal Study

Introduction: The aim of this study was to explore the mediating effect of psychopathology between childhood adversity and trauma and quality of life (QOL) in adolescents. The second aim of the study was testing the moderation by social support of this mediation effect. Methods: Self-reports of childhood adversity and trauma, QOL, social support, and psychopathology were collected from 150 Portuguese adolescents' who had been exposed to at least one traumatic event or one childhood adversity (M _age = 16.89, SD = 1.32). The surveys were administered at two time points with an approximate time interval of 1 year. Results: Indirect effects were observed for depression (B = -0.33, CI [-0.62, -0.11]), somatization (B = -0.52, CI [-0.82, -0.23]), and post-traumatic stress symptoms (PTSS) (B = -0.23, CI [-0.45, -0.01]), but not for anxiety (B = 0.20, CI [-0.08, 0.50]). A moderated mediation was found between social support and depression (B = -0.10, CI [-16, -0.04]), and PTSS (B = 0.03, CI [-0.1, -0.05]), but not for somatization (B = -0.02, CI [-0.8, 0.05]). Conclusions: We found that depression and somatization were strong mediators of the relationship between adversity/trauma and QOL, whereas PTSS was moderately mediated this relationship. Anxiety did not mediate this relationship. The moderated-mediation effect of social support was only found for depression and PTSS. The improvement of QOL in adolescents exposed to childhood adversity and trauma should include the assessment of psychopathology symptoms and social support, with the aim of identifying risk and protective factors.

Global Adversities, the Media, and Mental Health

Global communities are currently confronted with a number of complex problems and threats, the reality of which is amplified by the media. These environmental and socio-political stressors have been accompanied by the spread of problematic psychological and behavioural tendencies, such as the growing polarisation of opinions and values, online radicalisation and extremism, deepening xenophobia and nationalism, the proliferation of irrational beliefs and conspiracy theories, and resistance to rational public policy measures. Here we argue that although they fall outside the scope of psychopathology, they nevertheless currently constitute a major challenge for psychiatry as a research domain and a clinical practise. To substantiate this claim, we outline the mechanisms by which media-transmitted stressors impact mental well-being and possibly psychopathology. The common denominator of these global problems and the media's construction of reality is the increase in uncertainty, unpredictability, and uncontrollability, which prompts defensive responding and, in predisposed individuals, functions as a potent source of chronic stress. These contribute to cognitive inflexibility, a strong predisposing factor for the development of rigid beliefs and attitudes, which to varying degrees underlie the adverse psychological and behavioural tendencies mentioned above. We suggest that the tightening of beliefs and ideas that is the result of cognitive rigidity may correspond to the clinical characteristics of induced delusional disorder. This can be seen as a (ultimately maladaptive) defensive strategy for coping with a high degree of uncertainty and unpredictability. We conclude by briefly outlining the possible ways in which psychiatry can face this challenge.

DNA methylation signatures of adolescent victimization: analysis of a longitudinal monozygotic twin sample

Accumulating evidence suggests that individuals exposed to victimization at key developmental stages may have different epigenetic fingerprints compared to those exposed to no/minimal stressful events, however results are inconclusive. This study aimed to strengthen causal inference regarding the impact of adolescent victimization on the epigenome by controlling for genetic variation, age, gender, and shared environmental exposures. We conducted longitudinal epigenome-wide association analyses (EWAS) on DNA methylation (DNAm) profiles of 118 monozygotic (MZ) twin pairs from the Environmental Risk study with and without severe adolescent victimization generated using buccal DNA collected at ages 5, 10 and 18, and the Illumina EPIC array. Additionally, we performed cross-sectional EWAS on age-18 blood and buccal DNA from the same individuals to elucidate tissue-specific signatures of severe adolescent victimization. Our analyses identified 20 suggestive differentially methylated positions (DMPs) (P < 5e-05), with altered DNAm trajectories between ages 10–18 associated with severe adolescent victimization (∆Beta range = −5.5%−5.3%). Age-18 cross-sectional analyses revealed 72 blood (∆Beta range = −2.2%−3.4%) and 42 buccal (∆Beta range = −3.6%−4.6%) suggestive severe adolescent victimization-associated DMPs, with some evidence of convergent signals between these two tissue types. Downstream regional analysis identified significant differentially methylated regions (DMRs) in LGR6 and ANK3 (Šidák P = 5e-09 and 4.07e-06), and one upstream of CCL27 (Šidák P = 2.80e-06) in age-18 blood and buccal EWAS, respectively. Our study represents the first longitudinal MZ twin analysis of DNAm and severe adolescent victimization, providing initial evidence for altered DNA methylomic signatures in individuals exposed to adolescent victimization.

Non-visible disease, the hidden disruptive experiences of chronic illness in adversity

Objective: This study's principal aim was to describe the lived reality for people with cardiovascular disease (CVD) and other chronic health conditions, who live in economically deprived neighbourhoods in a city in North West England. Methodology: This is a qualitative, exploratory study based on in-depth, semi-structured interviews with participants experiencing compromised cardiovascular health, conducted in August 2017. The study sample comprised 14 adults (3 females) aged 54 to 76. Thematic analysis was used for data analysis, and the biographical disruption concept was used as theoretical reference to explore the results. Wider health inequalities literature supplemented the individual experiences of chronic illness. Results: Four main themes were developed from the data: (1) chronic illness as a disruptive experience; (2) struggling for money; (3) lifestyle and health risks; and (4) reflections on current inequalities. The varied nature of participants' narratives about their chronic illness indicated that the experience of biographical disruption depends on the wider socioeconomic and cultural factors of the individual. Discussion: This study suggests that biographical disruption theory combined with health inequalities contexts highlights the role of hidden suffering and enhances the understanding of chronic illness experiences and thus informs clinical management, service and public health planning.

Caregiving influences on emotional learning and regulation: Applying a sensitive period model

Early caregiving experiences play a central role in shaping corticolimbic development and emotional learning and regulation. Given dynamic changes in corticolimbic maturation, the effects of caregiving experiences are likely to depend on the developmental timing of exposure. Cross-species evidence has identified timing-related differences in the effects of caregiving adversity. However, the extent to which developmental differences in associations between caregiving adversity and corticolimbic circuitry align with a sensitive period model has remained unclear. Converging evidence from studies of caregiver deprivation points to a sensitive period for caregiving influences on corticolimbic circuitry and emotional development during infancy. By contrast, differential associations between maltreatment and corticolimbic circuitry at specific ages in childhood and adolescence may reflect experience-dependent mechanisms of plasticity. Delineating sensitive periods of development and the precise experience-related mechanisms by which caregiving experiences influence corticolimbic development is essential for refining conceptual models and understanding risk and resilience following early adversity.

Pregnancy as a period of risk, adaptation, and resilience for mothers and infants

The pregnancy period represents a unique window of opportunity to identify risks to both the fetus and mother and to deter the intergenerational transmission of adversity and mental health problems. Although the maternal-fetal dyad is especially vulnerable to the effects of stress during pregnancy, less is known about how the dyad is also receptive to salutary, resilience-promoting influences. The present review adopts life span and intergenerational perspectives to review four key areas of research. The first part describes how pregnancy is a sensitive period for both the mother and fetus. In the second part, the focus is on antecedents of maternal prenatal risks pertaining to prenatal stress response systems and mental health. The third part then turns to elucidating how these alterations in prenatal stress physiology and mental health problems may affect infant and child outcomes. The fourth part underscores how pregnancy is also a time of heightened fetal receptivity to maternal and environmental signals, with profound implications for adaptation. This section also reviews empirical evidence of promotive and protective factors that buffer the mother and fetus from developmental and adaptational problems and covers a sample of rigorous evidence-based prenatal interventions that prevent maladaptation in the maternal-fetal dyad before babies are born. Finally, recommendations elaborate on how to further strengthen understanding of pregnancy as a period of multilevel risk and resilience, enhance comprehensive prenatal screening, and expand on prenatal interventions to promote maternal-fetal adaptation before birth.

Defining Immediate Effects of Sensitive Periods on Infant Neurobehavioral Function

During a sensitive period associated with attachment, the infant brain has unique circuitry that enables the specialized adaptive behaviors required for survival in infancy. This infant brain is not an immature version of the adult brain. Within the attachment relationship, the infant remains close (proximity seeking) to the caregiver for nurturing and survival needs, but the caregiver also provides the immature infant with the physiological regulation interaction needed before self-regulation matures. Here we provide examples from the human and animal literature that illustrate some of these regulatory functions during sensitive periods, recent advances demonstrating the supporting transient neural mechanisms, and how these systems go awry in the absence of species-expected caregiving.

Understanding of Resilience of Older Adults in Hong Kong: A Qualitative Investigation

Purpose: Resilience is an important trait for older adults facing adversity. This qualitative study aimed to identify the characteristics that contribute to resilience in a group of community-dwelling older adults in Hong Kong. Methods: Twenty-five Chinese older adults were invited. Interviews were conducted to collect information about the adverse events in their lives, their attitudes towards adversity and the beliefs underlying their approaches to overcoming adversity. The transcripts were analyzed using qualitative content analysis. Results: Seven themes emerged from the interviews: equanimity, positive attitudes towards life; meaningfulness, self-reliance, social support, environmental support, and spirituality and faith. Conclusion: Our qualitative analysis found that resilience among older adults in Hong Kong is characterized by internal, external and existential factors. The results may be useful for the development of proactive interventions aimed at assisting older adults to enhance the positive experiences in their lives.

Prenatal exposure to polycyclic aromatic hydrocarbons modifies the effects of early life stress on attention and Thought Problems in late childhood

BACKGROUND

Risk for childhood psychopathology is complex and multifactorial, implicating direct and interacting effects of familial and environmental factors. The role of environmental neurotoxicants in psychiatric risk is of growing concern, including polycyclic aromatic hydrocarbons (PAH), common in air pollution. Prenatal PAH exposure is linked to adverse physical, behavioral, and cognitive outcomes as well as increasing psychiatric risk. It is unclear whether environmental exposures, like PAH, magnify the effects of exposure to early life stress (ELS), a critical risk factor for psychopathology. The current work aimed to test potential interactions between prenatal PAH exposure and psychosocial/socioeconomic stress on psychiatric symptoms in school-age children.

METHODS

Data were from the Columbia Center for Children's Environmental Health Mothers and Newborns longitudinal birth cohort study. Prenatal PAH exposure was ascertained though air monitoring during pregnancy and maternal PAH-DNA adducts at delivery. Mothers reported on ELS (child age 5) and on child psychiatric symptoms across childhood (child age 5, 7, 9, and 11) using the Child Behavior Checklist (CBCL).

RESULTS

Significant prenatal airborne PAH × ELS interactions (FDR-corrected) predicted CBCL Attention (β = 0.22, t(307) = 3.47, p < .001, p_fdr  = .003) and Thought Problems T-scores (β = 0.21, t(307) = 3.29, p = .001, p_fdr  = .004) at age 11 (n = 319). Relative to those with lower exposure, children with higher prenatal PAH exposure exhibited stronger positive associations between ELS and CBCL Attention and Thought Problem T-scores. This interaction was also significant examining convergent ADHD measures (Conners, DuPaul) and examining maternal PAH-DNA adducts (β = 0.29, t(261) = 2.48, p = .01; n = 273). A three-way interaction with assessment wave indicated that the PAH × ELS interaction on Attention Problems was stronger later in development (β = 0.03, t(1,601) = 2.19, p = .03; n = 477).

CONCLUSIONS

Prenatal exposure to PAH, a common neurotoxicant in air pollution, may magnify or sustain the effects of early life psychosocial/socioeconomic stress on psychiatric outcomes later in child development. This work highlights the critical role of air pollution exposure on child mental health.

Adverse Childhood Experiences Are Associated with Childhood-Onset Arthritis in a National Sample of US Youth: An Analysis of the 2016 National Survey of Children's Health

OBJECTIVES

To determine whether there is an association between adverse childhood experiences (ACEs) and childhood-onset arthritis, comparing youth with arthritis to both healthy youth and youth with other acquired chronic physical diseases (OCPD); and to examine whether ACEs are associated with disease-related characteristics among children with arthritis.

STUDY DESIGN

In a cross-sectional analysis of data from the 2016 National Survey of Children's Health we examined whether ACEs were associated with having arthritis vs either being healthy or having a nonrheumatologic OCPD. ACE scores were categorized as 0, 1, 2-3, ≥4 ACEs. Multinomial logistic regression models examined associations between ACEs and health status while adjusting for age, sex, race/ethnicity, and poverty status. Among children with arthritis, associations between ACEs and disease-related characteristics were assessed by Pearson χ² analyses.

RESULTS

Compared with children with no ACEs, children with 1, 2-3, and ≥4 ACEs had an increased odds of having arthritis vs being healthy (adjusted OR for ≥4 ACEs, 9.4; 95% CI, 4.0-22.1) and vs OCPD (adjusted OR for ≥4 ACEs, 3.7; 95% CI-1.7, 8.1). Among children with arthritis, ACEs were associated with worse physical impairment.

CONCLUSIONS

Children with higher numbers of ACEs are more likely to have arthritis, when arthritis status is compared either with being healthy or with having OCPD. Further studies are needed to determine the direction of the association between ACEs and childhood arthritis, its impact on disease course, and potential intervention targets that might mitigate these effects.

Considerations for working with youth with socially complex needs

TOPIC

The presence of adverse childhood experiences offers a glimpse into the social complexity in the lives of youth. Thus far, youth have been categorized as "at-risk" or "vulnerable,"-identifiers which highlight a deficits-based framework and continue to stigmatize youth. To combat this systemic marginalization, we propose using the term youth with socially complex needs. These youth, often minority ethnic/racial and/or sexual/gender minorities, experience repeated adversity and discrimination.

PURPOSE

The purpose of this paper is to conceptualize the unique considerations of working with youth with socially complex needs-who have an increased vulnerability for social marginalization.

SOURCES USED

Given the adversity experienced and challenges inherent in working with youth with socially complex needs, ethical principles, and relevant care delivery models were explored.

CONCLUSIONS

Delivering mental health care and/or conducting research in collaboration with youth with socially complex needs requires thoughtful consideration of ethical principles and models of care. In conclusion, we propose a strengths-based, individualized approach to working with youth with socially complex needs that requires a dynamic, fluid, multisystemic approach to care and research.

The Role of Adolescence in Development Paths Toward Suicide: Specificities and Shaping of Adversity Trajectories

Purpose: Adolescence is a key period of transitions in the psychological, cognitive, neurobiological and relational domains, which is associated to high susceptibility to adverse life experiences. However, the way adolescent development alters life paths toward suicide remains unclear. Thereby, we aimed at testing whether and how adolescence interfered with the adversity trajectories of individuals who died by suicide. Methods: In a sample of 303 individuals who died by suicide, longitudinal Burden of Adversity ratings were derived from extensive psychological autopsies and life trajectory narrative interviews conducted with informants. Piecewise Joint Latent Class Models allowed the identification of patterns of adversity trajectories and tested the introduction of breakpoints in life-paths. Classes inferred from the optimal model were compared in terms of socio-demographics, psychopathology, and rate of different adverse life events. Results: The most accurate model derived 2 trajectory patterns with a breakpoint in early adolescence. In the first class (n = 39), the burden of adversity increased steadily from birth to death, which occurred at 23 (SE = 1.29). In the second class (n = 264), where individuals died at 43 years of age (SE = 0.96), the burden of adversity followed a similar trajectory during infancy but stabilized between 10 and 14 years and started to increase again at about 25. Childhood family instability, dependent events, exposure to suicide, intra-family sexual victimization and affective disorders at death were more frequent in class 1. Conclusions: A bifurcation in trajectories between early and late suicides occurs during adolescence. The dynamic pattern of adversity during this period is a key issue to understand the developmental heterogeneity in suicide risk.

Associations between lifetime stress exposure, race, and first-birth intendedness in the United States

This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants' stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States.

Expectable Environments in Early Life

Humans develop in the context of environmental information that can be considered either experience-expectant or experience-dependent. Though the exact timing of sensitive period closures and consequences of environmental experiences have not been well delineated, early life is a period of increased vulnerability. While some forms of care (e.g., institutional care for children; representing the absence of experience-expectant caregiving) are not present in the evolutionary history of humans, it is likely that what is considered significant hardship today may have been more typical experience-dependent environmental information in the evolutionary timescale. Thus, assumptions that threatening or neglectful experiences are unexpected for the human child may not fit well in the scope of the broader timescale of human history. We argue that it is important to consider early caregiving experiences from the context of what has been expected in our evolutionary past rather than what is expected in modern sociocultural terms.

A Predictive Study of Resilience and Its Relationship with Academic and Work Dimensions during the COVID-19 Pandemic

BACKGROUND

The aim of the present study was to describe the resilience levels in a Spanish population during the Coronavirus (COVID-19) pandemic and to analyze the existing associations between high resilience and socio-demographic, work, and academic parameters.

METHOD

1176 individuals aged 18-67 years participated in a descriptive cross-sectional study. The participants were administered the 10-item resilience scale developed by Connor-Davidson (CD-RISC-10) and an ad-hoc questionnaire that collected information on socio-demographic, work, and academic variables. Basic descriptive data were used to statistically analyze the data, and a binary logistic regression model was developed incorporating the professional occupation, academic level, whether the respondent worked in emergency services, and whether the respondent had dependents.

RESULTS

Slightly more than a quarter of the participants showed low resilience, almost half reported moderate resilience, and slightly more than a quarter had high resilience. Those who were employed were 2.16-times more likely to have high resilience, whilst those with higher education were 1.57-times more likely. Those working in emergency services were 1.66-times more likely, and those with dependents were 1.58-times more likely to have high resilience.

CONCLUSION

In addition to the relationships found, a need to improve the resilience levels in the population was found.

Sexual minority status and symptoms of psychosis: The role of bullying, discrimination, social support, and drug use - Findings from the Adult Psychiatric Morbidity Survey 2007

OBJECTIVE

Sexual minorities have an increased risk of psychosis, potentially explained by experiences of social adversity. Sexual minorities may also have a specific risk of paranoid symptoms. The current study aimed to determine whether sexual minorities have increased risk of psychosis, whether they have a specific increased risk of paranoia when compared to auditory verbal hallucinations (AVHs), and whether social adversity such as bullying, recent discrimination, lack of social support, and drug use can explain this risk.

METHODS

The study used data from the Adult Psychiatric Morbidity Survey 2007 (n = 7,403), exploring both sexual identity and past sexual behaviour. Associations between sexual minority status and probable psychosis, paranoia, and AVH were analysed using logistic regression. Mediation analysis was also conducted using the Karlson-Holm-Breen method, with bullying, recent discrimination, social support, and drug use as mediators assessing pathways between sexual minority status and paranoia/AVH. Socio-demographic confounders were included in analyses.

RESULTS

Sexual minority status did not significantly predict probable psychosis. Findings generally indicated a specific association between sexual minority status and paranoia when contrasted with AVH. However, sexual behaviour remained significantly associated with AVH in logistic regression models. Bullying, lack of social support, and drug use partially mediated the association between sexual minority status and paranoia.

CONCLUSIONS

Sexual minority status appears to have a specific association with paranoia symptoms, which may be partially explained by experiences of social adversity. However, the cross-sectional nature of the study limits direct inference about causality of such symptoms.

PRACTITIONER POINTS

Sexual minority groups may be more likely to experience symptoms of paranoia. It may be important to consider experiences of social adversity such as bullying, lack of social support, and also history of drug use in the context of paranoia within these groups.

Coalescing investments in school mental health in South Carolina

BACKGROUND

Improving child and adolescent mental health requires states and jurisdictions to invest in school mental health efforts. In recent years, there has been notable expansion and improvement in school mental health services in the state of South Carolina related to a number of investments that are cumulatively promoting capacity building.

METHODS

This narrative overview examines the history of the school mental health movement in one southern state and details efforts by multiple key stakeholders that have coalesced to form a strong system for advancing school mental health.

RESULTS

Resting on a strong university-community partnership, five separate initiatives are described that together provide enhanced workforce training and support and expansion of school mental health services. Themes of this work are identified with a goal of supporting and advancing the development of school mental health systems in the United States.

CONCLUSION

Strong collaborations and communication efforts both within the university setting and between partners in education and community settings, along with engaged funders keen to enhance well-being of children, youth, and families statewide have set the stage for the growth and expansion of school mental health services.

Network structure reveals clusters of associations between childhood adversities and development outcomes

Exposure to childhood adversity is common and associated with a host of negative developmental outcomes. The most common approach used to examine the consequences of adversity exposure is a cumulative risk model. Recently, we have proposed a novel approach, the dimensional model of adversity and psychopathology (DMAP), where different dimensions of adversity are hypothesized to impact health and well-being through different pathways. We expect deprivation to primarily disrupt cognitive processing, whereas we expect threat to primarily alter emotional reactivity and automatic regulation. Recent hypothesis-driven approaches provide support for these differential associations of deprivation and threat on developmental outcomes. However, it is not clear whether these patterns would emerge using data-driven approaches. Here we use a network analytic approach to identify clusters of related adversity exposures and outcomes in an initial study (Study 1: N = 277 adolescents aged 16-17 years; 55.1% female) and a replication (Study 2: N = 262 children aged 8-16 years; 45.4% female). We statistically compare our observed clusters with our hypothesized DMAP model and a clustering we hypothesize would be the result of a cumulative stress model. In both samples we observed a network structure consistent with the DMAP model and statistically different than the hypothesized cumulative stress model. Future work seeking to identify in the pathways through which adversity impacts development should consider multiple dimensions of adversity.