Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire

Childhood Psychological Maltreatment and Depression among Chinese Adolescents: Multiple Mediating Roles of Perceived Ostracism and Core Self-Evaluation

Previous studies have primarily focused on the separate mediating role of interpersonal context or personal characteristics in the relationship between childhood psychological maltreatment and depression, neglecting the combined effects, which have limited ecological validity. Therefore, this study investigated the multiple mediating roles of perceived ostracism and core self-evaluation in the relationship between childhood psychological maltreatment and depression. A total of 1592 Chinese adolescents (51.1% boys), ranging in age from 11 to 15 years (M = 13.23, SD = 0.96), completed a self-report questionnaire regarding demographics, psychological maltreatment, perceived ostracism, core self-evaluation and depression. A multiple mediation model was tested using Model 6 of the PROCESS macro. After controlling for the variables of gender and age, the results indicated that perceived ostracism and core self-evaluation parallelly and sequentially mediated the link between psychological maltreatment and depression. The multiple mediation model could account for 55% of the total effect. In conclusion, the current study helps us better understand the mechanisms of depression caused by psychological maltreatment, and contributes to preventing and intervening in depression among Chinese adolescents.

Effects of adverse childhood experience on physiological regulation are moderated by evolved developmental niche history

Childhood experiences of early life stress and adversity can lead to long-term detrimental outcomes across the lifespan. Recent evidence suggests avoiding stressors is not enough for species-typical development. Nurturing and responsive care are needed to both buffer adverse experiences as well as promote healthy development, but little is known regarding the interaction between species-typical environmental support in childhood, Evolved Developmental Niche history (EDN-history), and adversity on physiological regulation in adult women. To investigate the interaction between species-typical nurturing and adversity (ACEs, adverse childhood experiences), women (N = 113) were asked to report on EDN-history and ACEs. Physiological regulation was measured using respiratory sinus arrhythmia (RSA) across three conditions that included stress and relaxation. Applying latent basis coefficient modeling, EDN-history moderated vagal withdrawal from baseline to stress and supported vagal activation from stress to recovery, suggesting a link between EDN-history and vagal adaptability. EDN-history acted as a buffer against ACEs on physiological regulation supporting women's vagal adaptability across differing conditions. Physiological adaptability is a key component of physical and psychological wellbeing and resilience. Experiences of the EDN in childhood may not only buffer adversity but also support the physiological building blocks of health and resilience.

Vicious cycle of emotional maltreatment and bullying perpetration/victimization among early adolescents: Depressive symptoms as a mediator

RATIONALE

Emotional maltreatment and bullying (including both bullying perpetration and bullying victimization) are two prevalent and highly related problems among children and adolescents worldwide. The adverse consequences of emotional maltreatment and bullying behoove researchers to identify their causal mechanisms.

OBJECTIVE

We examined the reciprocal relations between emotional maltreatment and bullying perpetration/victimization and whether depressive symptoms functioned as mediator of the relations, after separating within-person effects from between-person effects.

METHODS

A total of 4273 Chinese early adolescents (45.2% girls; M_age = 9.90 years, SD = 0.73) participated in a five-wave longitudinal study with 6-month intervals.

RESULTS

Results from random intercept cross-lagged panel modeling showed: (a) emotional maltreatment and bullying perpetration were bidirectionally related; (b) bullying victimization directly predicted emotional maltreatment, but not vice versa; (c) emotional maltreatment indirectly predicted bullying perpetration/victimization via depressive symptoms; and (d) bullying victimization indirectly predicted emotional maltreatment via depressive symptoms.

CONCLUSIONS

These findings provided evidence for bidirectional spillover effects in the family and peer domains, demonstrating that early adolescents may become trapped in a vicious cycle of negative relationships, directly or indirectly, via their depressive symptoms. To prevent a downward spiral, findings suggested that bullying interventions need to address family and peer relationships as well as individual psychological well-being simultaneously to be most effective.

The mediating role of tolerance for psychological pain in the relationship of childhood trauma to suicidal ideation in individuals with a substance use disorder

OBJECTIVES

The association between childhood trauma and suicidal ideation has been well documented in several populations, including individuals with a substance use disorder (SUD). However, a gap still exists in the literature regarding the mechanisms by which childhood trauma later impacts suicide risk. This cross-sectional study tested the effect of childhood trauma on suicidal ideation, as well as the mediating effect of tolerance for psychological pain (managing the pain and enduring the pain) in that relationship, controlling for the effect of depressive symptoms, in individuals with a SUD.

METHODS

A sample of 102 adults with a SUD participated in the study. Path analysis by structural equation␣modelling tested a mediation model.

RESULTS

Depressive symptoms and lower levels of managing the pain were found to fully mediate the association between childhood trauma and suicidal ideation.

CONCLUSIONS

Our results suggest that depressive symptoms and a lack of ability to manage psychological pain contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions in individuals with SUDs. Moreover, they have relevant implications for prevention and clinical interventions regarding suicidal ideation in this population.

PRACTITIONER POINTS

Childhood trauma relates to suicidal ideation in individuals with a substance use disorder. Depressive symptoms contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions. A lack of ability to manage psychological pain also contributes towards explaining this relationship. The obtained results have relevant implications for the prevention of and clinical intervention for suicidal ideation in SUD individuals.

Childhood maltreatment results in altered deactivation of reward processing circuits in depressed patients: A functional magnetic resonance imaging study of a facial emotion recognition task

Importance and objectives

Childhood adversity is a strong risk factor for the development of various psychopathologies including major depressive disorder (MDD). However, not all depressed patients experience early life trauma. Functional magnetic resonance imaging (fMRI) studies using facial emotion processing tasks have documented altered blood-oxygen-level-dependent (BOLD) responses in specific cortico-limbic networks both in MDD patients and in individuals with a history of childhood maltreatment (CM). Therefore, a history of maltreatment may represent a key modulating factor responsible for the altered processing of socio-affective stimuli. To test this hypothesis, we recruited MDD patients with and without of maltreatment history to study the long-term consequences of childhood trauma and examined the impact of CM on brain activity using a facial emotion recognition fMRI task.

Methods

MDD patients with childhood maltreatment (MDD + CM, n = 21), MDD patients without maltreatment (MDD, n = 19), and healthy controls (n = 21) matched for age, sex and intelligence quotient underwent fMRI while performing a block design facial emotion matching task with images portraying negative emotions (fear, anger and sadness). The history of maltreatment was assessed with the 28-item Childhood Trauma Questionnaire.

Results

Both MDD and MDD + CM patients displayed impaired accuracy to recognize sad faces. Analysis of brain activity revealed that MDD + CM patients had significantly reduced negative BOLD signals in their right accumbens, subcallosal cortex, and anterior paracingulate gyrus compared to controls. Furthermore, MDD + CM patients had a significantly increased negative BOLD response in their right precentral and postcentral gyri compared to controls. We found little difference between MDD and MDD + CM patients, except that MDD + CM patients had reduced negative BOLD response in their anterior paracingulate gyrus relative to the MDD group.

Conclusions

Our present data provide evidence that depressed patients with a history of maltreatment are impaired in facial emotion recognition and that they display altered functioning of key reward-related fronto-striatal circuits during a facial emotion matching task.

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History of childhood maltreatment (CM) can alter socio-cognitive functioning in adults.

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We studied depressed patients with and without CM with age, gender and IQ matched controls.

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Brain activity was assessed with fMRI using a facial emotion matching task.

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CM patients had impaired accuracy to recognize facial emotions, especially sadness.

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CM patients had altered negative BOLD signals in their fronto-striatal circuits.

P2X7R antagonists in chronic stress-based depression models: a review

Depression affects around 320 million people worldwide. Growing evidence proposes the immune system to be the core interface between psychosocial stress and the neurobiological and behavioural features of depression. Many studies have identified purinergic signalling via the P2X7 receptor (P2X7R) to be of great importance in depression genesis yet only a few have evaluated P2X7R antagonists in chronic stress-based depression models. This review summarizes their findings and analyses their methodology. The four available studies used three to nine weeks of unpredictable, chronic mild stress or unpredictable, chronic stress in male mice or rats. Stress paradigm composition varied moderately, with stimuli being primarily psychophysical rather than psychosocial. Behavioural testing was performed during or after the last week of stress application and resulted in depressive-like behaviours, immune changes (NLRP3 assembly, interleukin-1β level increase, microglia activation) and neuroplasticity impairment. During the second half of each stress paradigm, a P2X7R antagonist (Brilliant Blue G, A-438079, A-804598) was applied. Studies differed with regard to antagonist dosage and application timing. Nonetheless, all treatments attenuated the stress-induced neurobiological changes and depressive-like behaviours. The evidence at hand underpins the importance of P2X7R signalling in chronic stress and depression. However, improvements in study planning and reporting are necessary to minimize experimental bias and increase data purview. To achieve this, we propose adherence to the Research Domain Criteria and the STRANGE framework.

The association of child neglect with lifestyles, depression, and self-esteem: Cross-lagged analyses in Chinese primary schoolchildren

Child neglect robustly predicts many behavioral problems and adulthood mental disorders, but little is known about its association with daily lifestyles and psychological development during childhood, particularly in the longitudinal study. We aimed to examine the association of child neglect with physical activity (PA), screen time (ST), eating habits (EHs), and depression/self-esteem using a two-wave follow-up study of primary schoolchildren in Wuhan, China. Data of 1085 schoolchildren aged 8-10 years (boys: 53.5%) were analyzed. Child neglect, lifestyles, and depression/self-esteem were collected in 2018 (T1) and 2019 (T2). Autoregressive cross-lagged models (ARCLMs) were fitted to explore the interrelationships among these variables. In ARCLM including child neglect and lifestyles, higher child neglect at T1 was significantly associated with higher ST and more risky EHs at T2, while insignificantly associated with PA. In ARCLM including child neglect and depression/self-esteem, lower T1 child neglect significantly predicted a higher T2 depression, but insignificantly for T2 self-esteem. In ARCLM including all variables, child neglect still significantly predicted later ST and depression, but insignificantly predicted EHs. Our study underscores that child neglect is strongly intertwined with ST, EHs, and depression during childhood. The prevention of child neglect may promote some healthy lifestyles and depression in children.

Adverse childhood experiences, daytime salivary cortisol, and depressive symptoms in early adulthood: a longitudinal genetically informed twin study

Dysregulated hypothalamic-pituitary-adrenal (HPA)-axis function might underlie the relationship between adverse childhood experiences (ACEs) and depression. However, limited research has examined the possible mediating role of the HPA-axis among young people using longitudinal data. Moreover, it remains unclear whether genetic influences could contribute to these associations. Participants were 290 children from the Twins Early Development Study. ACEs were assessed from age 3-11 years. We calculated a cumulative risk score and also derived different ACEs clusters using factor analysis and latent class analysis. HPA-axis activity was indexed by daytime salivary cortisol at age 11. Depressive symptoms were ascertained at age 21. Genetic liability to altered cortisol levels and elevated depressive symptoms was measured using a twin-based method. We performed causal mediation analysis with mixed-effects regression models. The results showed that ACEs cumulative exposure (b = -0.20, p = 0.03), bullying (b = -0.61, p = 0.01), and emotional abuse (b = -0.84, p = 0.02) were associated with lower cortisol levels at age 11. Among participants exposed to multiple ACEs, lower cortisol was related to higher depressive symptoms at age 21 (b = -0.56, p = 0.05). Lower cortisol levels mediated around 10-20% of the total associations of ACEs cumulative exposure, bullying, and dysfunctional parenting/emotional abuse with higher depressive symptoms. Genetic factors contributed to these associations, but the mediation effects of cortisol in the associations of ACEs cumulative exposure (b = 0.16 [0.02-0.34]) and bullying (b = 0.18 [0.01-0.43]) remained when genetic confounding was accounted for. In conclusion, ACEs were linked to elevated depressive symptoms in early adulthood partly through lower cortisol levels in early adolescence, and these relationships were independent of genetic confounding.

The longitudinal effects of maltreatment class membership on post-traumatic stress & depression

BACKGROUND

While the link between maltreatment and mental illness has been largely established, there is a need to better understand how certain types or profiles of maltreatment place youth at heightened risk for depression and traumatic stress, and when the risk of developing symptoms may be greatest.

OBJECTIVE

We examined the extent to which youth experiences of maltreatment co-occur and how certain combinations of maltreatment work to influence the subsequent development of depression and post-traumatic stress over time.

PARTICIPANTS & SETTING

Data were drawn from NSCAW-II, a nationally representative longitudinal sample of 5872 child welfare involved youth, aged 0-18.

METHODS

Latent Class Analysis was used to investigate profiles of child maltreatment. We then used a longitudinal three-wave panel design to examine whether membership in various maltreatment classes predicted development of depression and post-traumatic stress measured at two future time points.

RESULTS

Three classes emerged: Class 1 (68 %) the "Neglect and Adverse Parental Behaviors Class", Class 2 (20 %) the "Physical Abuse Class", and Class 3 (12 %) the "Sexual Abuse Class". Membership in Class 2 increased depression and trauma symptoms at Wave 2, compared to Class 1 (b = 1.8 and 1.4, respectively; p < 0.05). Membership in Class 3 increased trauma symptoms at Wave 3, compared to Class 1 and Class 2 (b = 2.3 and 2.7, respectively; p < 0.01).

IMPLICATIONS

Child welfare involved youth need to be appropriately screened for psychiatric health annually and provided with services that correspond with their level of need.

Interactive effects of childhood maltreatment and tonic respiratory sinus arrhythmia on young adults' depressive symptoms

The goal of the current study was to investigate the moderating effect of tonic respiratory sinus arrhythmia (RSA) in the relation between childhood maltreatment and depression symptoms among young adults. A total of 98 participants (70 women) aged 17-22 years completed questionnaires on childhood maltreatment and depressive symptoms. RSA data were obtained during a resting condition in the laboratory. Results indicated that childhood maltreatment interacted with tonic RSA to predict depressive symptoms, even after controlling for age and body mass index (BMI) of each participant. Specifically, higher levels of childhood maltreatment were associated with higher levels of depressive symptoms, but only among young adults who exhibited lower tonic RSA. The results indicated that the association between childhood maltreatment and depressive symptoms depends on young adults' physiological functioning/flexibility. Findings suggest that consideration of external environmental factors in combination with internal physiological factors is critical to understand young adults' mental health.

Network of co-expressed circadian genes, childhood maltreatment and sleep quality in bipolar disorders

Bipolar disorder (BD) is a chronic and burdensome psychiatric disease, characterized by variations in mood and energy. The literature has consistently demonstrated an association between BD and childhood maltreatment (CM), and genetic variants of circadian genes have been associated with an increased vulnerability to develop BD. In this context, environmental factors such as CM may also contribute to the susceptibility to BD through alterations in the functioning of the biological clock linked to modifications of expression of circadian genes. In this study, we explored the associations between childhood maltreatment, sleep quality, and the level of expression of a comprehensive set of circadian genes in lymphoblastoid cell lines from patients with BD. The sample consisted of 52 Caucasian euthymic patients with a diagnosis of BD type 1 or type 2. The exposure to CM was assessed with the Childhood Trauma Questionnaire (CTQ), and the sleep quality was assessed using the Pittsburgh Sleep Quality Index. We measured the expression of 18 circadian genes using quantitative RT-PCR: ARNTL2, BHLHE40, BHLHE41, CLOCK, CRY1, CRY2, CSNK1D, CSNK1E, DBP, GSK3B, NPAS2, NR1D1, PER1, PER2, PER3, PPARGC1A, RORA, and RORB. Gene expression networks were analyzed with the disjoint graphs method. Compared to the other investigated transcripts, PPARGC1A was the only one whose expression level was differentially affected in patients who have experienced CM and, more specifically, physical abuse. We observed no significant effects of the other CTQ subscores (emotional and sexual abuses, physical and emotional neglects), nor of the sleep quality on the network of circadian genes expression. Although requiring replication in larger cohorts, the result obtained here is consistent with the hypothesis of an influence of CM exposure on circadian systems and highlights the importance of PPARGC1A in these processes.

Effect of child abuse and neglect on schizophrenia and other psychotic disorders

Childhood experiences impact long-term physical and behavioral health outcomes including potential risk for schizophrenia and psychosis. Negative experiences, such as child abuse and neglect, have been specifically associated with risk for schizophrenia and psychosis. This review provides a brief overview of child abuse and neglect, including its position within the larger field of trauma and adversity and its long term consequences. The link to schizophrenia is then explored. Principles of treatment and outcomes for schizophrenia with antecedent child abuse and neglect are then reviewed. Finally, next steps and points of prevention are highlighted.

Predictors of Adolescent Depressive Symptoms

The present study expands the existing literature and supplements today’s knowledge on the relationship between personal, psychosocial and lifestyle factors and depressive symptoms among adolescents. The study aimed to investigate the variety of depressive symptoms predictors—personal resources, adverse school and family, health, lifestyle-related (sense of coherence, self-esteem, school involvement, negative acts at school, family stress and violence, psychosomatic health complaints, physical activity, smoking, alcohol) as well as gender, employing hierarchical linear regression analysis in a large representative sample of adolescents (N = 2212) in Kaunas, Lithuania. Four blocks of predictors were employed in hierarchical linear regression analysis. In the final model 64.9% of depressive symptoms were explained by all the predictors. Sense of coherence was the strongest predictor of depressive symptoms (standardized regression coefficient β = −605, p < 0.001 in the first model and β = −263, p < 0.001 in the final model after adjustment for all other independent variables) and accounted for 36.6% of variance. In conclusion, this study supports the notion that depressive symptoms among adolescents have multifactorial origins with many predictors showing significant effect seizes. Therefore, high sense of coherence and self-esteem, school involvement, higher levels of physical activity would be protective and influence lower levels of depressive symptoms among adolescents. Exposure to negative acts at school and negative experiences in the family, psychosomatic health complaints, smoking would increase the probability of depressive symptoms. Girls are more prone to depression as compared to boys.

Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis

Background: In recent years, eye movement desensitization and reprocessing (EMDR) has been applied to different psychiatric conditions beyond post-traumatic stress disorder (PTSD), and an increasing number of studies have evaluated its effect on depression. To date, no quantitative synthesis of the efficacy of EMDR on depression has been conducted. Objective: To meta-analytically review the studies on EMDR for depression as the primary target for treatment. Method: Studies with a controlled design evaluating the effect of EMDR on depression were searched on six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Cochrane database, and Francine Shapiro Library) and then selected by two independent reviewers. A systematic review and meta-analysis was conducted. Results: Eleven studies were included for qualitative synthesis. Nine studies were included in the meta-analysis, involving 373 participants. The overall effect size of EMDR for depressive symptoms is large (n = 9, Hedges' g = - 1.07; 95%CI [-1.66; - 0.48]), with high heterogeneity (I ² = 84%), and corresponds to a 'number needed to treat' of 1.8. At follow-up (range 3-6 months), the effect remains significant but moderate (n = 3, Hedges' g = - 0.62; 95%CI [-0.97; - 0.28]; I ² = 0%). The effect of EMDR compared with active controls is also moderate (n = 7, g = - 0.68; 95%CI [-0.92; - 0.43]; I ² = 0%). No publication bias was found, although the results are limited by the small number and poor methodological quality of the included studies. Conclusions: Review findings suggest that EMDR may be considered an effective treatment for improving symptoms of depression, with effects comparable to other active treatments. However, findings need to be interpreted in light of the limited number of the studies and their quality. Further research is required to understand the longer-term of effects EMDR in treating depression and preventing depression relapse. Protocol registration: PROSPERO (CRD42018090086).

Dramaturgical perspective mediates the association between parenting by lying in childhood and adolescent depression and the protective role of parent-child attachment

BACKGROUND

Recent findings reveal that individuals who experience parenting by lying in childhood may exhibit depression through adulthood. Questions remain regarding the cognitive mechanism underlying this association and whether depression manifests as early as adolescence.

OBJECTIVE

Our current study used a survey to test the associations among parenting by lying in childhood, adolescent depression, dramaturgical perspective, and parent-child attachment.

PARTICIPANTS AND SETTING

Adolescents (n = 964, M_age = 13.62, SD_age = 1.04) were recruited from five secondary schools in a city in central China. A total of 446 (46.3 %) boys and 518 (53.7 %) girls participated in the survey.

METHODS

We used questionnaires to measure parenting by lying, dramaturgical perspective, parent-child attachment and depression.

RESULTS

A bias-corrected bootstrapping mediation test indicated that the process by which parenting by lying predicted depression through a dramaturgical perspective was significant,ab = .06, SE = .01, 95 % CI = [.027, .089]. Moderation analysis indicated that the interaction between parenting by lying and parent-child attachment was associated with depression (B = - .05, p < .05).

CONCLUSIONS

Parenting by lying in childhood was found to be positively associated with adolescent depression. The association was mediated by the child's use of a dramaturgical perspective and moderated by parent-child attachment. This study highlights an intriguing but under-researched parenting practice and extends our understanding of its association with adolescent depression. In practice, strengthening parent-child attachment can weaken the association between parenting by lying and depression.

Family Violence, PTSD, and Parent-Child Interactions: Dyadic Data Analysis with Mexican Families

BACKGROUND

Family violence has been shown to have a dramatic impact on individual and family life in the United States and other countries. Numerous studies have assessed the influence that exposure to violence can have on family dynamics and parent-child relationships. However, less is known about the association between family violence and parent-child relationships with Mexican families.

OBJECTIVE

Guided by social interaction learning theory, the purpose of this study was to explore the role of exposure to family violence on PTSD and mother-child interaction patterns.

METHODS

Eighty-seven mother-child dyads from Mexico completed assessments for exposure to family violence, PTSD, and observational tasks were analyzed to assess prosocial parent-child interactions (i.e., positive communication and problem solving). We conducted an actor-partner independence model (APIM) to examine the association between exposure to family violence, PTSD and mother-child relationship dynamics.

RESULTS

As expected, higher exposure to family violence was linked to higher PTSD symptoms for mothers. Unexpectedly, higher maternal PTSD symptoms were associated with better communication during dyadic interaction tasks with their children.

CONCLUSIONS

The present study suggests that individuals from certain cultures (i.e., Mexico) may respond differently to experiencing family violence. The use of multiple measurement methods to assess the relational effects of trauma on family dynamics can advance the scientific understanding of trauma affected families.

Dissociative identity disorder: a developmental perspective

Dissociation is a common and often overlooked symptom in traumatised children. Although there is a lack of a scientific consensus as to the nature of dissociation and very limited research about dissociative identity disorder (DID) in children, the authors have seen children given this diagnosis recently referred to their clinic and are concerned about this practice and the parenting approaches that have ensued. The diagnosis of DID in children may be rare or of doubtful validity, but repeated traumatic experiences of an interpersonal nature can have a profound effect on a child's identity, memory and self-organisation. Furthermore, abuse and neglect can increase the risk of dissociative symptoms. This brief article considers dissociation in post-traumatic stress disorder, then outlines developmental factors hypothesised to be associated with dissociation in childhood and early adulthood. It warns that clinicians should keep an open mind about how dissociation may manifest transdiagnostically, and concludes with recommendations for further research.

Child maltreatment, lifetime trauma, and mental health in Swiss older survivors of enforced child welfare practices: Investigating the mediating role of self-esteem and self-compassion

BACKGROUND

Child maltreatment is a common occurrence and has frequently been shown to adversely impact mental health over the lifespan. Minors affected by welfare practices have a higher risk of exposure to child maltreatment. However, the long-term correlates of child maltreatment in welfare practices and mental health, in addition to potential mediators, are insufficiently examined in later life.

OBJECTIVE

This study aims to a) examine the experiences of child maltreatment, lifetime traumata, and mental health of Swiss older adults affected by enforced child welfare practices, in comparison to an age-matched control group; and b) to examine the potentially protective roles of self-esteem and self-compassion.

PARTICIPANTS AND SETTING

A total of N = 257 participants (risk group: n = 132, M_AGE = 70.8 years, 58 % male; control group: n = 125, M_AGE = 70.6 years, 49 % male) were assessed in a retrospective, cross-sectional study involving two face-to-face interviews.

METHODS

A structured clinical interview for DSM-5 assessed current and lifetime mental health disorders; self-esteem and self-compassion were assessed with psychometric instruments.

RESULTS

Affected individuals (risk group) had higher rates of child maltreatment and lifetime traumata compared to non-affected individuals (control group). Affected individuals also presented with a higher mental health burden over the lifespan. Across both groups, self-esteem, but not self-compassion, acted as a significant mediator between emotional abuse and neglect and mental health.

CONCLUSIONS

Findings suggest that child maltreatment has a lifetime impact and influences mental health into later life, and that self-esteem can mitigate the detrimental impact of emotional abuse and neglect on mental health.

Recognition of child maltreatment in emergency departments in Europe: Should we do better?

OBJECTIVES

To evaluate the different policies to recognize child maltreatment in emergency departments (EDs) in Europe in order to define areas of improvement.

METHODS

A survey was conducted on the recognition of child maltreatment in EDs in European countries with a focus on screening methods, parental risk factors, training and hospital policies. The survey was distributed through different key members from the EUSEM, REPEM and the EuSEN. A summary score based on the NICE guideline (4 questions on child characteristics, 4 questions on parental characteristics and 5 questions on hospital policy) was calculated.

RESULTS

We analysed 185 completed surveys, representing 148 hospitals from 29 European countries. Of the respondents, 28.6% used a screening tool, and 31.8% had guidelines on parental risk factors. A total of 42.2% did not follow training based on child characteristics, and 57.6% did not follow training on parental characteristics. A total of 71.9% indicated that there was a need for training. 50.8% of the respondents reported a standardized policy for the detection of child maltreatment. Translating the survey results to NICE summary scores of the EDs in Europe, we found that 25.6% (34/133) met most, 22.6% (30/133) met some and 51.9% (69/133) met few of the NICE guideline recommendations. More specifically, with respect to hospital policies, 33.8% (45/133) met most, 15.0% (20/133) met some and 51.1% (68/133) met few of the NICE guideline recommendations.

CONCLUSION

There is high variability regarding policies for child maltreatment detection and only a quarter of the EDs met most of the NICE guideline recommendations for child maltreatment. There is a need for the use of screening tools, training of ED staff and implementation of local hospital policies.

Adverse childhood experiences and impact on quality of life in adulthood: development and validation of a short difficult childhood questionnaire in a large population-based health survey

Purpose

A short adverse childhood experiences (ACEs) measure is needed with non-intrusive items that include subjective evaluations of childhood. We validated a short Difficult Childhood Questionnaire (DCQ) that assesses ACEs using personal perceptions of events.

Methods

The study relied on 2019 data from a representative survey (N = 28,047) in Norway. We examined the DCQ’s factor structure, internal consistency, and discriminant validity in a multi-group confirmatory factor analysis. As a group variable, we used whether the respondent had the ACE of parental alcohol use disorder (adult children of alcoholics; ACOA). To assess the DCQ’s convergent validity, we used latent regression analysis with adulthood quality of life (QoL) as the outcome and mental distress and loneliness as potential mediators.

Results

The DCQ’s latent mean was 0.86 (95% CI 0.82–0.90, p < 0.001) higher in the ACOA versus the non-ACOA group. The effect size suggested a large magnitude of this difference. The DCQ score was negatively associated with QoL and positively associated with mental distress and loneliness. For the score’s QoL effect [− 0.84 (95% CI − 0.87 to − 0.80, p < 0.001)], − 0.80 was indirect, and − 0.04 was direct. Thus, most of the association of DCQ with QoL occurred via mediators.

Conclusions

The results confirmed the DCQ’s discriminant and convergent validity and highlight this tool as an empirically supported approach to assess ACEs. Because of its brevity and psychometric strengths, the DCQ is useful for research and likely suited to mental health treatment settings.

Child maltreatment: An intergenerational cascades model of risk processes potentiating child psychopathology

BACKGROUND

Child maltreatment poses substantial risk for compromised mental health in children. Further, child abuse and neglect are potentiated within a cascade of intergenerational and current familial risk processes that require clarification to inform understanding of adverse outcomes and direct prevention and intervention efforts.

OBJECTIVE

Using a multi-informant design, the current study applied an intergenerational cascades approach to examine the interconnected pathways among several familial risk factors associated with child maltreatment and its consequences.

PARTICIPANTS

Participants were 378 children (aged 10-12) and their mothers from economically disadvantaged, ethnically diverse backgrounds. The sample included maltreated children recruited via CPS records and demographically comparable non-maltreated children.

METHODS

Structural equation modeling (SEM) was conducted to test sequential mediation pathways examining the independent and cascading effects of maternal history of childhood maltreatment, maternal adolescent childbearing, current maternal depression, and the child's lifetime history of maltreatment on the child's internalizing and externalizing symptoms.

RESULTS

Multigenerational developmental cascades were identified. Maternal history of maltreatment predicted chronic maltreatment for offspring, which in turn predicted greater internalizing (β = .167, p = .03) and externalizing symptoms (β = .236, p = .005) in late childhood. Similarly, children born to mothers who began childbearing in adolescence were more likely to experience chronic maltreatment during childhood and develop subsequent symptoms. Effects were found over and above a parallel cascade from maternal maltreatment to offspring psychopathology via a maternal depression pathway.

CONCLUSION

Findings reveal targets to prevent or ameliorate progressions of intergenerational risk pathways.

The roles of child maltreatment types and peer relationships on behavior problems in early adolescence

BACKGROUND

Although previous research has established that child maltreatment (CM) and peer relationships (i.e., deviant peer affiliation, being ignored by peers) are strong predictors of adolescent internalizing (INT) and externalizing (EXT) behavior problems, no study has examined the above effects concurrently. Nor have researchers investigated the potential peer relationship differences in the effects of CM types on adolescent behavior problems. Thus, this study aims to examine the independent and combined effects of different types of CM and peer relationships on behavior problems.

METHODS

The Generalized Estimating Equations approach was conducted using the Longitudinal Studies of Child Abuse and Neglect. Child-Protective-Services reports and youth self-reports were used for each type of CM. Deviant peer affiliation (DP) has been assessed using a modified version of the Youth-Risk-Behavior-and-Monitoring-the-Future Survey, while being ignored by peers was assessed using a single question. Adolescent INT and EXT were measured using the Youth-Self-Report.

RESULTS

Emotional abuse was associated with both INT and EXT, whereas physical abuse was associated with EXT. Higher DP and higher incidence of being ignored by peers were both associated with higher levels of INT and EXT. Emotionally abused youth with higher levels of DP had less INT, compared to emotionally abused youth with lower levels of DP.

CONCLUSION

The Findings indicate the need for interventions that 1) take into account the different effects of CM types, specifically for emotionally abused youth; 2) help youth to build positive relationships with peers; and 3) work to reduce the possibility of affiliation with deviant peers.

[Assessment of Maltreatment in Childhood and Adolescence]

Assessment of Maltreatment in Childhood and Adolescence In view of mounting evidence for substantial prognostic relevance of child maltreatment for the future developmental course, assessment of maltreatment in children and adolescents is increasingly gaining attention. At the same time, maltreatment assessment is replete with difficulties, ranging from the definition of maltreatment and establishment of threshold values determining when events meet prognostically relevant criteria, to poor agreement between sources. The aim of this paper is to provide an overview of instruments for assessing maltreatment in children and adolescents. This overview serves as a point of departure to emphasize the importance of various sources for the purpose of assessing maltreatment and to consider the unique role of the child's or young person's perspective. We conclude with preliminary proposals regarding the role of maltreatment assessment in clinical practice.

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.

Maltreatment during childhood and risk for common mental disorders among first year university students in South Africa

PURPOSE

Childhood maltreatment elevates risk for common mental disorders (CMDs) during late adolescence and adulthood. Although CMDs are highly prevalent among university students, few studies have examined the relationship between childhood maltreatment and 12 month CMDs in a low- to middle-income countries. This paper describes the prevalence of maltreatment and the relationship between type, number and patterns of maltreatment exposure and 12 month CMDs among first-year university students in South Africa.

METHODS

Maltreatment and CMD data were collected via well-validated self-report scales (corresponding with DSM-IV diagnoses) in a web-based survey of first-year students from two large urban universities (n = 1290) in South Africa. Various multivariate modelling approaches (additive, restrictive interactive and latent class) were used to examine the relationship between maltreatment and CMDs.

RESULTS

Overall, 48.4% of participants reported childhood maltreatment, the most common type being emotional abuse (26.7%). Regardless of the modelling approach used, emotional abuse was the only type of maltreatment independently associated with 12-month diagnoses of major depressive disorder (MDD), generalised anxiety disorder (GAD) or drug use disorder (DUD) even after adjusting for types and number of types of maltreatment. Similarly, students in the latent class reflecting histories of emotional abuse (either alone or combined with physical abuse) were more likely to meet criteria for 12-month MDD, GAD or DUD.

CONCLUSION

Findings confirm the high prevalence of childhood maltreatment among South African students. As this exposure elevates risk for MDD, GAD and DUD, interventions aimed at preventing and treating CMDs among first-year students should address experiences of childhood maltreatment.

Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R)

Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.

Childhood Emotional Neglect and Adolescent Depression: Assessing the Protective Role of Peer Social Support in a Longitudinal Birth Cohort

Introduction: Childhood adversities have been shown to increase psychopathology risk, including depression. However, the specific impact of childhood emotional neglect on later depression has been understudied. Moreover, few studies have investigated relational protective factors that may offset the risk of depression for children who experienced emotional neglect. Analyzing data (n = 3,265) from the Avon Longitudinal Study of Parents and Children (ALSPAC) study, a longitudinal birth cohort of children born to pregnant women residing in Avon, UK from 1990 to 1992, we assessed the prospective relationship between childhood emotional neglect and depressive symptoms in late adolescence, and tested whether peer social support in mid-adolescence moderates this relationship. Methods: Childhood emotional neglect, defined as the absence of parental attention and support, was measured across seven assessments from age 8 to 17.5. Peer social support was measured at age 15. Depressive symptoms were measured at age 18. We analyzed the associations between emotional neglect and depressive symptoms, and between peer support and depressive symptoms, and also tested interactive effects of peer support on the association between emotional neglect and depressive symptoms. Results: Higher levels of emotional neglect were associated with increased depressive symptoms at 18. Conversely, strong peer social support was associated with reduced depressive symptoms, though no significant interaction with emotional neglect was detected. Conclusion: Although childhood emotional neglect is a risk factor for later depression, our results suggest that strong peer social support at age 15 may generally reduce the risk of depressive symptoms by the time children reach late adolescence. Fostering strong peer support in youth may help offset depression risk for all youth, even among those who have experienced emotional neglect.

Conceptual Analysis: A Social Neuroscience Approach to Interpersonal Interaction in the Context of Disruption and Disorganization of Attachment (NAMDA)

Humans are strongly dependent upon social resources for allostasis and emotion regulation. This applies especially to early childhood because humans-as an altricial species-have a prolonged period of dependency on support and input from caregivers who typically act as sources of co-regulation. Accordingly, attachment theory proposes that the history and quality of early interactions with primary caregivers shape children's internal working models of attachment. In turn, these attachment models guide behavior, initially with the set goal of maintaining proximity to caregivers but eventually paving the way to more generalized mental representations of self and others. Mounting evidence in non-clinical populations suggests that these mental representations coincide with differential patterns of neural structure, function, and connectivity in a range of brain regions previously associated with emotional and cognitive capacities. What is currently lacking, however, is an evidence-based account of how early adverse attachment-related experiences and/or the emergence of attachment disorganization impact the developing brain. While work on early childhood adversities offers important insights, we propose that how these events become biologically embedded crucially hinges on the context of the child-caregiver attachment relationships in which the events take place. Our selective review distinguishes between direct social neuroscience research on disorganized attachment and indirect maltreatment-related research, converging on aberrant functioning in neurobiological systems subserving aversion, approach, emotion regulation, and mental state processing in the wake of severe attachment disruption. To account for heterogeneity of findings, we propose two distinct neurobiological phenotypes characterized by hyper- and hypo-arousal primarily deriving from the caregiver serving either as a threatening or as an insufficient source of co-regulation, respectively.

Childhood maltreatment and adult mental disorders - the prevalence of different types of maltreatment and associations with age of onset and severity of symptoms

Childhood maltreatment (CM) is a risk factor for numerous mental disorders. However, the specificity of CM types in mental disorders is still being discussed. The present study examined the prevalence of five CM types in patients with schizophrenia/schizoaffective disorder (SZ; n = 107), bipolar disorder (BD; n = 103), depression (MDD; n = 604; with the two subgroups Persistent Depressive Disorder (PDD) and non-chronic MDD), and in healthy controls (HC; n = 715). Additionally, associations between CM types, symptom severity, and age of onset were investigated. The prevalence of all CM types was higher in the patient groups compared to HC. Emotional neglect, emotional abuse, and physical neglect were reported most frequently in all groups. Notably, patients with PDD reported more CM of all types than patients with non-chronic MDD. The severity of depression was associated with emotional abuse and neglect; anxiety with emotional abuse, emotional neglect, and sexual abuse; positive SZ symptoms with physical neglect; negative symptoms with emotional and physical neglect; and mania with sexual abuse and physical neglect. CM was associated with a younger age of onset in MDD and BD. The high prevalence of CM in patients with severe mental disorders highlights the importance of considering this issue in the treatment of such patients.

Study Protocol for Teen Inflammation Glutamate Emotion Research (TIGER)

This article provides an overview of the study protocol for the Teen Inflammation Glutamate Emotion Research (TIGER) project, a longitudinal study in which we plan to recruit 60 depressed adolescents (ages 13–18 years) and 30 psychiatrically healthy controls in order to examine the inflammatory and glutamatergic pathways that contribute to the recurrence of depression in adolescents. TIGER is the first study to examine the effects of peripheral inflammation on neurodevelopmental trajectories by assessing changes in cortical glutamate in depressed adolescents. Here, we describe the scientific rationale, design, and methods for the TIGER project. This article is intended to serve as an introduction to this project and to provide details for investigators who may be seeking to replicate or extend these methods for other related research endeavors.

The Interactive Effects of Child Maltreatment and Adolescent Pregnancy on Late-Adolescent Depressive Symptoms

Adolescent females are disproportionately at risk for depression, which is expected to represent the leading cause of disability in 2030 (National Institute of Mental Health [NIMH] 2019). Although prior research has suggested that both child maltreatment and adolescent pregnancy increase the risk for depressive symptoms, less is known about how these two interact to influence depression in late adolescence. The present study tested the unique and interactive effects of adolescent pregnancy and child maltreatment on late-adolescent depressive symptomatology (N = 186) with a prospective, longitudinal design that utilized documented records of maltreatment and included demographically comparable (i.e., economically disadvantaged), nonmaltreated and non-pregnant comparisons. Participants were assessed at ages 10-12 and 18-21. Structural equation modeling was used to test whether adolescent pregnancy amplified the effect of child maltreatment on late-adolescent depressive symptoms. In the context of economic disadvantage, results indicated that the effect of child maltreatment on late-adolescent depressive symptoms was significantly enhanced for those who experienced an adolescent pregnancy. This effect remained after controlling for prior depressive symptoms, peer and maternal relationship quality, and romantic relationship violence. The findings are translated to preliminary guidance for practitioners regarding precision depression screening and tailored preventive interventions.​.

Intergenerational effects of childhood maltreatment: A systematic review of the parenting practices of adult survivors of childhood abuse, neglect, and violence

A history of maltreatment in childhood may influence adults' parenting practices, potentially affecting their children. This systematic review examines 97 studies investigating associations of parental childhood victimization with a range of parenting behaviors that may contribute to the intergenerational effects of abuse: abusive parenting, problematic parenting, positive parenting, and positive parental affect. Key findings include: (1) parents who report experiencing physical abuse or witnessing violence in the home during childhood are at increased risk for reporting that they engage in abusive or neglectful parenting; (2) a cumulative effect of maltreatment experiences, such that adults who report experiencing multiple types or repeated instances of victimization are at greatest risk for perpetrating child abuse; (3) associations between reported childhood maltreatment experiences and parents' problematic role reversal with, rejection of, and withdrawal from their children; (4) indirect effects between reported childhood maltreatment and abusive parenting via adult intimate partner violence; and (5) indirect effects between reported childhood maltreatment and lower levels of positive parenting behaviors and affect via mothers' mental health. Thus, childhood experiences of maltreatment may alter parents' ability to avoid negative and utilize positive parenting practices. Limitations of this body of literature include few prospective studies, an overreliance on adults' self-report of their childhood victimization and current parenting, and little examination of potentially differential associations for mothers and fathers.

The State of Our Understanding of the Pathophysiology and Optimal Treatment of Depression: Glass Half Full or Half Empty?

Major depressive disorder is a remarkably common and often severe psychiatric disorder associated with high levels of morbidity and mortality. Patients with major depression are prone to several comorbid psychiatric conditions, including posttraumatic stress disorder, anxiety disorders, obsessive-compulsive disorder, and substance use disorders, and medical conditions, including cardiovascular disease, diabetes, stroke, cancer, which, coupled with the risk of suicide, result in a shortened life expectancy. The goal of this review is to provide an overview of our current understanding of major depression, from pathophysiology to treatment. In spite of decades of research, relatively little is known about its pathogenesis, other than that risk is largely defined by a combination of ill-defined genetic and environmental factors. Although we know that female sex, a history of childhood maltreatment, and family history as well as more recent stressors are risk factors, precisely how these environmental influences interact with genetic vulnerability remains obscure. In recent years, considerable advances have been made in beginning to understand the genetic substrates that underlie disease vulnerability, and the interaction of genes, early-life adversity, and the epigenome in influencing gene expression is now being intensively studied. The role of inflammation and other immune system dysfunction in the pathogenesis of major depression is also being intensively investigated. Brain imaging studies have provided a firmer understanding of the circuitry involved in major depression, providing potential new therapeutic targets. Despite a broad armamentarium for major depression, including antidepressants, evidence-based psychotherapies, nonpharmacological somatic treatments, and a host of augmentation strategies, a sizable percentage of patients remain nonresponsive or poorly responsive to available treatments. Investigational agents with novel mechanisms of action are under active study. Personalized medicine in psychiatry provides the hope of escape from the current standard trial-and-error approach to treatment, moving to a more refined method that augurs a new era for patients and clinicians alike.

Efficacy of the 'Children in Disaster: Evaluation and Recovery (CIDER)' Protocol for Traumatized Adolescents in Korea

BACKGROUND

We aimed to evaluate the feasibility of trauma-focused group therapy in adolescents exposed to traumatic events in Korea.

METHODS

We recruited 22 adolescents (mean age, 16 years; standard deviation, 1.43; range, 13-18 years). Children in Disaster: Evaluation and Recovery (CIDER) V1.0 is a trauma-focused group therapy comprising eight 50-minute-long sessions. The effectiveness of the intervention was evaluated using the Korean version of the Children's Response to Traumatic Events Scale-Revised (K-CRTES-R), the Beck Depression Inventory (BDI), the State Anxiety Inventory for Children (SAIC), and the Pediatric Quality of Life Inventory (PedsQL). The data were analyzed by the Wilcoxon signed-rank test.

RESULTS

A significant improvement was revealed in trauma-related symptom scores (Z = -2.85, P < 0.01), depressive symptom scores (Z = -2.35, P < 0.05) and quality of life scores (Z = -3.08, P < 0.01). Additionally, a marginally significant improvement was found in anxiety symptom scores (Z = -1.90, P = 0.058).

CONCLUSION

CIDER is a potentially effective intervention for adolescents exposed to traumatic events. Larger controlled trials are needed.

TRIAL REGISTRATION

Clinical Research Information Service Identifier: KCT0004681.

Relationship between childhood trauma and social adaptation in a sample of young people attending an early intervention service for psychosis

INTRODUCTION

Childhood trauma has been associated with an increased risk of psychosis, a greater severity of psychopathological symptoms, and a worse functional prognosis in patients with psychotic disorders. The current study aims to explore the relationship between childhood trauma, psychopathology and social adaptation in a sample of young people with first episode psychosis (FEP) or at-risk mental states (ARMS).

MATERIAL AND METHODS

The sample included 114 young people (18-35 years old, 81 FEP and 33 ARMS) who were attending an Early Intervention Service for Psychosis. Positive, negative and depressive symptoms were assessed with the PANSS and the Calgary Depression Scale; history of childhood trauma was assessed with the Childhood Trauma Questionnaire; social adaptation was assessed with the Social Adaptation Self-evaluation Scale (SASS). Structural equation modeling (SEM) was used to explore the relationship between childhood trauma, psychopathology and SASS dimensions in the global sample (including FEP and ARMS). An exploratory SEM analysis was repeated in the subsample of FEP patients.

RESULTS

ARMS individuals reported more emotional neglect and worse social adaptation compared to FEP. SEM analysis showed that childhood trauma is associated with a worse social adaptation, in a direct way with domains involving interpersonal relationships, and mediated by depressive symptoms with those domains involving leisure, work and socio-cultural interests.

CONCLUSIONS

Childhood trauma has a negative effect on social adaptation in young people with early psychosis. Depressive symptoms play a mediation role in this association, especially in domains of leisure and work.

[Moderated mediation analysis for symptoms of attention deficit/hyperactivity disorder with the symptoms of anxiety in children]

OBJECTIVE

To study the moderated mediation for attention deficit/hyperactivity disorder (ADHD) with the symptoms of anxiety in children.

METHODS

A total of 12 271 students were included with an average age of 8.9±1.9 years, including 6 743 male students and 5 508 female students, and 20 students with missing data on gender. Child psychological trauma questionnaires (parents version) and Conners questionnaires (parent version) were completed by the parents of primary school students. The data was studied by univariate analysis, multivariate analysis and moderated mediation analysis.

RESULTS

The results of the univariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index and childhood trauma were positively correlated with the score of anxiety (P<0.01), and ADHD and childhood trauma positively predicted anxiety disorder (P<0.001). The results of the multivariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index (ADHD symptoms) and childhood trauma positively predicted the score of anxiety (P<0.001), and both ADHD and childhood trauma positively predicted anxiety disorder (P<0.001). The results of the moderated mediation analysis showed that childhood trauma was a mediating factor for the relationship between hyperactivity index and anxiety index in boys and girls (P<0.05), and sex moderated the relationship between hyperactivity index and anxiety index (P<0.001).

CONCLUSIONS

ADHD symptoms/ADHD are closely associated with anxiety symptoms/anxiety disorder. Childhood trauma exerts a mediating effect on the relationship between ADHD symptoms and anxiety symptoms, and sex moderates the relationship between ADHD symptoms and anxiety symptoms.

Associations Among Monoamine Neurotransmitter Pathways, Personality Traits, and Major Depressive Disorder

Major depressive disorder (MDD) is a complex psychiatric disease requiring multidisciplinary approaches to identify specific risk factors and establish more efficacious treatment strategies. Although the etiology and pathophysiology of MDD are not clear until these days, it is acknowledged that they are almost certainly multifactorial and comprehensive. Monoamine neurotransmitter system dysfunction and specific personality traits are independent risk factors for depression and suicide. These factors also demonstrate complex interactions that influence MDD pathogenesis and symptom expression. In this review, we assess these relationships with the aim of providing a reference for the development of precision medicine.

Childhood Maltreatment and Depression in Adulthood in Chinese Female College Students: The Mediating Effect of Coping Style

Depression is the most common psychological disorder of female, with high disability rate and remarkable mortality rate. There is a lack of knowledge about childhood experience, coping style, and adult depression. The aim of the present research was to enrich this knowledge by investigating the mediating effect of coping style between childhood maltreatment and depression in adulthood in Chinese female college students. Self-report questionnaires assessing childhood maltreatment, depression, and coping style were completed in 738 participants. The results illustrated that childhood maltreatment was positively related to depression in adulthood while coping style was negatively related to depression. In addition, childhood maltreatment could influence adult depression through the mediating role of coping style. These findings indicate that childhood maltreatment and negative coping style are associated with depression in adulthood. Psychological intervention strategies for coping style could provide effective treatment direction for depression caused by childhood maltreatment.