The effects of childhood maltreatment on brain structure, function and connectivity

Long-term effect of childhood trauma: Role of inflammation and white matter in mood disorders

Bipolar disorder (BD) and major depressive disorder (MDD) are severe psychiatric illnesses that share among their environmental risk factors the exposure to adverse childhood experiences (ACE). Exposure to ACE has been associated with long-term changes in brain structure and the immune response. In the lasts decades, brain abnormalities including alterations of white matter (WM) microstructure and higher levels of peripheral immune/inflammatory markers have been reported in BD and MDD and an association between inflammation and WM microstructure has been shown. However, differences in these measures have been reported by comparing the two diagnostic groups. The aim of the present study was to investigate the interplay between ACE, inflammation, and WM in BD and MDD. We hypothesize that inflammation will mediate the association between ACE and WM and that this will be different in the two groups. A sample of 200 patients (100 BD, 100 MDD) underwent 3T MRI scan and ACE assessment through Childhood Trauma Questionnaire. A subgroup of 130 patients (75 MDD and 55 BD) underwent blood sampling for the assessment of immune/inflammatory markers. We observed that ACE associated with higher peripheral levels of IL-2, IL-17, bFGF, IFN-γ, TNF-α, CCL3, CCL4, CCL5, and PDGF-BB only in the BD group. Further, higher levels of CCL3 and IL-2 associated with lower FA in BD. ACE were found to differently affect WM microstructure in the two diagnostic groups and to be negatively associated with FA and AD in BD patients. Mediation analyses showed a significant indirect effect of ACE on WM microstructure mediated by IL-2. Our findings suggest that inflammation may mediate the detrimental effect of early experiences on brain structure and different mechanisms underlying brain alterations in BD and MDD.

Hormonal contraceptive usage influences stress hormone effects on cognition and emotion

Men and women partially differ in how they respond to stress and how stress in return affects their cognition and emotion. The influence of hormonal contraceptives (HCs) on this interaction has received little attention, which is surprising given the prevalence of HC usage. This selective review illustrates how HC usage modulates the effects of stress hormones on cognition and emotion. As three examples, we discuss stress hormone effects on episodic memory, fear conditioning and cognitive emotion regulation. The identified studies revealed that stress effects on cognitive-emotional processes in women using HCs were at times reduced or even absent when compared to men or naturally cycling women. Especially striking were the few examples of reversed effects in HC women. As underlying neuroendocrine mechanisms, we discuss influences of HCs on the neuroendocrine stress response and effects of HCs on central glucocorticoid sensitivity. The summarized findings emphasize the need for additional translational research.

Linking Mild Childhood Adversity with Conflict and False Feedback Monitoring

It was proposed that dimensions of childhood adversity (i.e., deprivation and threat) have distinct effects on neural development and function. Present study examined the relationships between mild deprivation/threat and performance monitoring among undergraduate students without psychiatric diagnoses. By using event-related potentials (ERPs), 78 participants underwent a modified Flanker task in which false feedback on approximately 10% of the correct response trials was administered. The dynamic stages of performance monitoring in this task were differentiated into interference monitoring, feedback processing, and behavior adjustment. Childhood adversity was assessed by a Childhood Trauma Questionnaire (CTQ), which was further divided into subscales of neglect (as a proxy for deprivation dimension) and abuse (as a proxy for threat dimension). Our results showed that higher score of childhood neglect was associated with more interference cost indicated by longer RT to interference trials at the behavioral level, and altered interference monitoring indicated by smaller N2 amplitude to interference trials at the neural level. Meanwhile, higher score of childhood abuse was related to smaller P3 amplitude to unexpected negative feedback. These results suggested that mild childhood deprivation might be associated with altered processing of interference monitoring, while mild childhood threat might be linked to lower electrophysiological response to unexpected negative feedback among young adults without psychiatric disorders.

Gender-related association among childhood maltreatment, brain structure and clinical features in bipolar disorder

Bipolar disorder (BD) and exposure to childhood maltreatment (CM), which is present at high rates in BD, are both associated with hippocampus and prefrontal cortex structural alterations thought to contribute to clinical features. Gender-related differences are implicated in BD for CM exposure, brain structure and clinical features. However, relationships among these factors in BD are understudied. This study aimed to investigate associations among gender, CM, hippocampus and prefrontal gray matter structure and clinical features in BD. Childhood trauma questionnaire, structured clinical assessments and 3 Tesla structural magnetic resonance imaging were obtained for 236 adults (18-63 years, 32.0 ± 12.6): 119 with BD (58.8% women) and 117 healthy controls (HCs, 50.4% women). Women with BD reported higher CM severity than men with BD and HCs (B=-14.34, 95% confidence intervals (CI)[-22.71,-5.97], p<.001). CM and gender showed a significant interaction for left hippocampus (B=-7.41, 95% CI[-14.10,-0.71], p<.05); CM severity was negatively associated with left hippocampus only in women with BD. In women with BD, CM was associated with post-traumatic stress disorder comorbidity (B = 25.68, 95% CI[15.11,36.25], p<.001). In men with BD, CM severity was associated with lower left frontal pole (B=-0.71, 95% CI[-1.14,-0.28], p<.05) and right superior frontal (B=-17.78, 95% CI[-30.66,-4.90], p<.05) surface area; the latter related to earlier age of first mood symptoms (B = 33.97, 95% CI[7.61, 60.33], p<.05). Findings support gender-related effects of CM on frontotemporal structure and clinical features of BD. The findings bring novel perspectives for gendered pathophysiological models of effects of CM in BD.

Childhood maltreatment experiences and emotion perception in young Chinese adults: Sex as a moderator

Men and women seem to perceive and react differently to emotional stimuli and have different susceptibilities to childhood trauma. With a cross-sectional design, this study aimed to investigate whether specific patterns of childhood-maltreatment experiences are associated with specific patterns of emotion perception and the sex differences in this relationship. A total of 173 adults rated valence, arousal, and dominance for 60 pictures (varying in pleasantness, unpleasantness, and neutral emotion) from the International Affective Picture System and completed the Childhood Trauma Questionnaire-Short Form. Using a partial least squares (PLS) regression analysis, after controlling for depressive and anxious states, recent stressful life events, personality, and cognitive reappraisal strategy, we identified a profile (linear combination) of childhood-maltreatment experiences (emotional neglect, physical neglect, and physical abuse) that was associated with a profile of emotion-perception dimensions (perceiving negative visual stimuli as more unpleasant and subservient, positive stimuli as more pleasant and dominant, and neutral stimuli as more arousing). This association pattern was significant only for the male participants. Hence, our findings suggest that childhood maltreatment might make men more "emotional" in their adulthood. The impact of this childhood-maltreatment-associated alteration in emotion perception on male mental health needs further investigation.

Maternal Childhood Maltreatment Is Associated With Lower Infant Gray Matter Volume and Amygdala Volume During the First Two Years of Life

Background

Childhood maltreatment affects approximately 25% of the world's population. Importantly, the children of mothers who have been maltreated are at increased risk of behavioral problems. Thus, one important priority is to identify child neurobiological processes associated with maternal childhood maltreatment (MCM) that might contribute to such intergenerational transmission. This study assessed the impact of MCM on infant gray and white matter volumes and infant amygdala and hippocampal volumes during the first 2 years of life.

Methods

Fifty-seven mothers with 4-month-old infants were assessed for MCM, using both the brief Adverse Childhood Experiences screening questionnaire and the more detailed Maltreatment and Abuse Chronology of Exposure scale. A total of 58% had experienced childhood maltreatment. Between 4 and 24 months (age in months: mean = 12.28, SD = 5.99), under natural sleep, infants completed a magnetic resonance imaging scan using a 3T Siemens scanner. Total brain volume, gray matter volume, white matter volume, and amygdala and hippocampal volumes were extracted via automated segmentation.

Results

MCM on the Adverse Childhood Experiences and Maltreatment and Abuse Chronology of Exposure scales were associated with lower infant total brain volume and gray matter volume, with no moderation by infant age. However, infant age moderated the association between MCM and right amygdala volume, such that MCM was associated with lower volume at older ages.

Conclusions

MCM is associated with alterations in infant brain volumes, calling for further identification of the prenatal and postnatal mechanisms contributing to such intergenerational transmission. Furthermore, the brief Adverse Childhood Experiences questionnaire predicted these alterations, suggesting the potential utility of early screening for infant risk.

Linking gene expression patterns and brain morphometry to trauma and symptom severity in patients with functional seizures

Within stress-diathesis models, adverse life experiences (ALEs) increase the susceptibility to functional neurological symptoms through neuroplasticity effects. We aimed to characterize potential genetic influences on this relationship in 20 patients with functional seizures. Questionnaires, structural MRIs and Allen Human Brain Atlas gene expression information were used to probe the intersection of symptom severity (Somatoform Dissociation Questionnaire, SDQ-20), ALE burden, and gray matter volumes. SDQ-20 scores positively correlated with sexual trauma, emotional neglect, and threat to life experiences. Higher SDQ-20 scores related to lower bilateral insula, left orbitofrontal, right amygdala, and perigenual/posterior cingulate volumes. Higher sexual trauma burden correlated with lower right posterior insula and putamen volumes; higher emotional neglect related to lower bilateral insula/right amygdala volumes. Findings in left insula/ventral precentral gyrus (SDQ-20), right insula/putamen (sexual trauma), and right amygdala (emotional neglect) held when controlling for comorbid psychopathology. At the intersection of symptom severity and sexual trauma volumetric findings, genes overrepresented in adrenergic, serotonergic, and oxytocin receptor signaling as well as in cortical and amygdala development were spatially correlated. In conclusion, ALEs and symptom severity were associated with gray matter volumes in cingulo-insular and amygdala areas, spatially overlapping with expression patterns of genes involved in stress-related signaling and neurodevelopment.

Decreased functional coupling within default mode network in major depressive disorder with childhood trauma

OBJECTIVE

Childhood trauma (CT) has been supported to be a high-risk factor for major depressive disorder (MDD), but the neural mechanism linking CT and depression remains unclear. The aim of this study is to deepen our understanding of this issue by establishing the neuroimaging correlations between CT and depression.

METHODS

A sample of 123 MDD patients (91 with moderate-to-severe CT and 32 with no or low CT) and 79 healthy controls (HC, 33 with moderate-to-severe CT and 46 with no or low CT) participated. All participants completed assessments of depression level, anxiety, recent perceived stress, and resting-state functional MRI scan.

RESULTS

Participants with moderate-to-severe CT showed elevated depression level and trait anxiety, and reduced spontaneous neural activity in left inferior temporal gyrus (ITG). Abnormalities of seed-based functional connectivity (FC) of left ITG - bilateral precuneus/posterior cingulate cortex (PCC), left middle temporal gyrus (MTG), left medial orbitofrontal cortex (mOFC), and bilateral medial prefrontal cortex (mPFC)/anterior cingulate cortex (ACC) were observed. CT was associated with decreased FCs in MDD, but with increased FCs in HC. The total altered FCs of left ITG - bilateral precuneus/PCC and left mOFC mediated relationship between CT and depression in MDD, and total altered FCs and trait anxiety have a significant chain mediation effect in the association between CT and depression in HC.

CONCLUSION

These findings highlight the changes of default mode network (DMN) functions and trait anxiety as targets of CT. The decreased functional coupling within DMN may be involved in the mechanism of MDD following CT.

The nature and extent of child maltreatment in Denmark: Using self-report and administrative data from the 1984 birth cohort

BACKGROUND

Research on child maltreatment (CM) has few longitudinal studies that combine self-report data with objective administrative data that has been collected continuously for decades.

OBJECTIVE

To give an overview of 20 studies investigating the impact of CM in a Danish representative sample.

PARTICIPANTS AND SETTING

From the full 1984 Danish birth cohort, 2980 24-years old were randomly selected. There was an oversampling of child protection cases.

METHODS

The participants were interviewed by trained interviewers and Computer Assisting Methods were used for sensitive topics. The survey data were linked to several national registers using the Civil Registry Number for a series of studies on risk factors and outcomes. Linkage with parental data enabled parental risk factors before the birth to be analysed as well as several physical, psychological, and social events during their lifetime. These factors were studied in relation to the CM classes that were identified via the survey.

RESULTS

The maltreatment classes had both several specific and shared effects pertaining to risk factors before birth, during childhood through to early adulthood. Their problems included many arenas within health, mental and social life.

CONCLUSIONS

Data linkage studies provide an opportunity to conduct research using accurate sources of information which can be used to explore risk and protective factors. The prospective nature of this combined data facilitates temporal ordering which strengthen the conclusions based on longer-term follow-up.

Child health nurses' experiences of using the Safe Environment for Every Kid (SEEK) model or current standard practice in the Swedish child health services to address psychosocial risk factors in families with young children - A mixed-methods study

BACKGROUND

Child maltreatment (CM) is often hidden, and the youngest children are often those most exposed. CM can be prevented through programs that address risk factors, but few primary prevention strategies have been evaluated.

OBJECTIVE

To examine the experiences of nurses using the Safe Environment for Every Kid (SEEK) model compared to nurses using current standard practice in the Swedish child health services (CHS) to address psychosocial risk factors in the family environment.

PARTICIPANTS AND SETTING

Nurses at 27 child health centers in the CHS in the county of Dalarna, Sweden participated in the study. A survey was answered by 55 nurses and 18 nurses participated in focus-group interviews.

METHODS

A convergent mixed methods research design with focus-group interviews and survey data was used. Qualitative Content Analysis was used to analyze the interview data and Mann Whitney U test was used to analyze the survey data.

RESULTS

The qualitative analysis identified four categories - "Framing the prerequisites for successful practice"; "Managing the mission of the CHS"; "Meeting the family as a professional"; and "Working with psychosocial risk factors can be emotional" - under the overarching theme "Universal application of a structured method adds value to experience-based knowledge when addressing psychosocial risk factors". Survey data showed that SEEK nurses rated to a greater degree that they possessed adequate knowledge, competence and sense of security to address psychosocial risk factors in their work.

CONCLUSIONS

This study indicates that using SEEK can strengthen the nurses in identifying and responding to families in need of psychosocial support.

How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder

Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.

Effects of Parental Internalizing and Externalizing Behavior Problems on Children’s Limbic Brain Structures—An MRI Study

Parental behavior problems have long-term effects on children’s limbic brain structures and functions. Parental behavior problems-related brain changes in children may lead to mental disorders and behavior dysfunction later in life. However, our understanding of the relationship between parental behavior and children’s brain structures is less obvious when children and adolescents are studied in a general population without mental disorders. The majority of studies on the relationship between parental behavior and adolescent brain structure have been focused on severe forms of the following parental behavior problems: (1) internalizing behavior associated with mood and anxiety disorders, and (2) externalizing behavior associated with substance use and violence. A few studies examined the effect of normative variations or subtle differences in parental behavior. Therefore, we utilized a large study—Adolescent Brain Cognitive Development (ABCD)—to determine relationships between normative variation in parental internalizing and externalizing behavior and limbic brain structures in children and adolescents without mental disorders. Quantile (median) regression models were used to compute associations between parental behavior and children’s limbic structures. We found that parental internalizing and externalizing behaviors are uniquely associated with children’s limbic structures after adjustment for biological confounders and parental socioeconomic status. Our findings indicate that normative parental behavior may have a significant early influence on limbic structures of normally developing children and adolescents. Accelerated or delayed limbic structure maturation may account for children’s and adolescents’ behavioral inadequacies and a risk of developing specific mood disorders or substance abuse problems later in life.

Trauma exposure among cannabis use disorder individuals was associated with a craving-correlated non-habituating amygdala response to aversive cues

The relationship of cannabis-use disorder and trauma exposure at the level of the brain is not well-understood. Cue-reactivity paradigms have largely focused on characterizing aberrant subcortical function by averaging across the entire task. However, changes across the task, including a non-habituating amygdala response (NHAR), may be a useful biomarker for relapse vulnerability and other pathology. This secondary analysis utilized existing fMRI data from a CUD population with (TR-Y, n = 18) or without trauma (TR-N, n = 15). Amygdala reactivity to novel and repeated aversive cues was examined between TR-Y vs. TR-N groups, using a repeated measures ANOVA. Analysis revealed a significant interaction between TR-Y vs. TR-N and amygdala response to novel vs. repeated cues in the amygdala (right: F (1,31) = 5.31, p = 0.028; left: F (1,31) = 7.42, p = 0.011). In the TR-Y group, a NHAR was evident, while the TR-N group exhibited amygdala habituation, resulting in a significant difference between groups of amygdala reactivity to repeated cues (right: p = 0.002; left: p < 0.001). The NHAR in the TR-Y (but not TR-N) group was significantly correlated with higher cannabis craving scores, yielding a significant group difference (z = 2.1, p = 0.018). Results suggest trauma interacts with the brain's sensitivity to aversive cues, offering a neural explanation for the relationship between trauma and CUD vulnerability. These findings suggest the importance of considering the temporal dynamics of cue reactivity and trauma history in future studies and treatment planning, as this distinction may help decrease relapse vulnerability.

Nicotinamide reverses deficits in puberty-born neurons and cognitive function after maternal separation

Background

Early life stress (ELS) is associated with the development of schizophrenia later in life. The hippocampus develops significantly during childhood and is extremely reactive to stress. In rodent models, ELS can induce neuroinflammation, hippocampal neuronal loss, and schizophrenia-like behavior. While nicotinamide (NAM) can inhibit microglial inflammation, it is unknown whether NAM treatment during adolescence reduces hippocampal neuronal loss and abnormal behaviors induced by ELS.

Methods

Twenty-four hours of maternal separation (MS) of Wistar rat pups on post-natal day (PND)9 was used as an ELS. On PND35, animals received a single intraperitoneal injection of BrdU to label dividing neurons and were given NAM from PND35 to PND65. Behavioral testing was performed. Western blotting and immunofluorescence staining were used to detect nicotinamide adenine dinucleotide (NAD⁺)/Sirtuin3 (Sirt3)/superoxide dismutase 2 (SOD2) pathway-related proteins.

Results

Compared with controls, only MS animals in the adult stage (PND56–65) but not the adolescent stage (PND31–40) exhibited pre-pulse inhibition deficits and cognitive impairments mimicking schizophrenia symptoms. MS decreased the survival and activity of puberty-born neurons and hippocampal NAD⁺ and Sirt3 expression in adulthood. These observations were related to an increase in acetylated SOD2, microglial activation, and significant increases in pro-inflammatory IL-1β, TNF-α, and IL-6 expression. All the effects of MS at PND9 were reversed by administering NAM in adolescence (PND35–65).

Conclusions

MS may lead to schizophrenia-like phenotypes and persistent hippocampal abnormalities. NAM may be a safe and effective treatment in adolescence to restore normal hippocampal function and prevent or ameliorate schizophrenia-like behavior.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12974-022-02591-y.

Evaluation of brain structure and metabolism in currently depressed adults with a history of childhood trauma

Structural differences in the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), hippocampus, and amygdala were reported in adults who experienced childhood trauma; however, it is unknown whether metabolic differences accompany these structural differences. This multimodal imaging study examined structural and metabolic correlates of childhood trauma in adults with major depressive disorder (MDD). Participants with MDD completed the Childhood Trauma Questionnaire (CTQ, n = 83, n = 54 female (65.1%), age: 30.4 ± 14.1) and simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI). Structure (volume, n = 80, and cortical thickness, n = 81) was quantified from MRI using Freesurfer. Metabolism (metabolic rate of glucose uptake) was quantified from dynamic ¹⁸F-fluorodeoxyglucose (FDG)-PET images (n = 70) using Patlak graphical analysis. A linear mixed model was utilized to examine the association between structural/metabolic variables and continuous childhood trauma measures while controlling for confounding factors. Bonferroni correction was applied. Amygdala volumes were significantly inversely correlated with continuous CTQ scores. Specifically, volumes were lower by 7.44 mm³ (95% confidence interval [CI]: -12.19, -2.68) per point increase in CTQ. No significant relationship was found between thickness/metabolism and CTQ score. While longitudinal studies are required to establish causation, this study provides insight into potential consequences of, and therefore potential therapeutic targets for, childhood trauma in the prevention of MDD. This work aims to reduce heterogeneity in MDD studies by quantifying neurobiological correlates of trauma within MDD. It further provides biological targets for future interventions aimed at preventing MDD following trauma. To our knowledge, this is the first simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) study to assess both structure and metabolism associated with childhood trauma in adults with MDD.

Maternal warmth is associated with network segregation across late childhood: A longitudinal neuroimaging study

The negative impact of adverse experiences in childhood on neurodevelopment is well documented. Less attention however has been given to the impact of variations in “normative” parenting behaviors. The influence of these parenting behaviors is likely to be marked during periods of rapid brain reorganization, such as late childhood. The aim of the current study was to investigate associations between normative parenting behaviors and the development of structural brain networks across late childhood. Data were collected from a longitudinal sample of 114 mother-child dyads (54% female children, M age 8.41 years, SD = 0.32 years), recruited from low socioeconomic areas of Melbourne, Australia. At the first assessment parenting behaviors were coded from two lab-based interaction tasks and structural magnetic resonance imaging (MRI) scans of the children were performed. At the second assessment, approximately 18 months later (M age 9.97 years, SD = 0.37 years) MRI scans were repeated. Cortical thickness (CT) was extracted from T1-weighted images using FreeSurfer. Structural covariance (SC) networks were constructed from partial correlations of CT estimates between brain regions and estimates of network efficiency and modularity were obtained for each time point. The change in these network measures, from Time 1 to Time 2, was also calculated. At Time 2, less positive maternal affective behavior was associated with higher modularity (more segregated networks), while negative maternal affective behavior was not related. No support was found for an association between local or global efficacy and maternal affective behaviors at Time 2. Similarly, no support was demonstrated for associations between maternal affective behaviors and change in network efficiency and modularity, from Time 1 to Time 2. These results indicate that normative variations in parenting may influence the development of structural brain networks in late childhood and extend current knowledge about environmental influences on structural connectivity in a developmental context.

Interaction of recent stressful life events and childhood abuse on orbitofrontal grey matter volume in adults with depression

BACKGROUND

The diathesis-stress model of major depressive disorder (MDD) predicts interactions of recent stressful life events (SLEs) in adulthood and early developmental risk factors. We tested, for the first time, the diathesis stress model on brain structure in a large group of MDD patients.

METHODS

Structural magnetic resonance imaging data of 1465 participants (656 with lifetime diagnosis MDD; 809 healthy controls) were analyzed using voxel-based morphometry to identify clusters associated with recent SLEs (Life Events Questionnaire). Those clusters were then examined for group (healthy/MDD) × early developmental risk (operationalized as childhood abuse [Childhood Trauma Questionnaire] and a major psychiatric disorder [i.e., MDD, bipolar disorder, schizophrenia, and schizoaffective disorder] in a first-degree relative) × recent SLEs three-way interactions on grey matter volume.

RESULTS

There was a group × childhood abuse × recent SLEs interaction on left medial orbitofrontal cortex grey matter volume. This three-way interaction arose because childhood abuse and recent SLEs interacted in MDD subjects but not in healthy subjects.

LIMITATIONS

We are not able to draw conclusions about the cause and effect relationship due to our cross-sectional study design.

CONCLUSIONS

Our data provides evidence for an interplay between orbitofrontal cortex structure, childhood abuse and recent SLEs. These factors have previously been linked to MDD and their complex interaction contributes to the pathogenesis of MDD.

Functional neuro-anatomy of social cognition in posttraumatic stress disorder: A systematic review

OBJECTIVE

Post-traumatic stress disorder (PTSD) is a common mental disorder following one or more traumatic events in which patients exhibit behavioural and emotional disturbances. Recent studies report alterations in social cognition with cerebral functioning modifications. While it is now established that brain function can be modified and severely altered following successive childhood traumas, less studies have focused on brain alterations in adults with normal social cognition development.

METHODS

We conducted a selective literature review by querying PubMed and Embase databases for titles of articles research on PTSD adults published from January 2000 to December 2021 focusing on adulthood traumatic events.

RESULTS

Majority of studies reported frontolimbic rupture, with limbic structures like amygdala missing top-down control of frontal regulation. These cerebral dysfunctions could be observed even without overt behavioural defects on social cognition tests.

CONCLUSION

These results can be analysed in light of intrinsic cerebral networks and we propose an attentional model of social threat information processing opening up perspective of social attentional rehabilitation in adjunction to usual care.

Pathways to Suicidal Behavior in Children and Adolescents: Examination of Child Maltreatment and Post-Traumatic Symptoms

Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.

No evidence for association between late pregnancy maternal cortisol and gray matter volume in a healthy community sample of young adolescents

A compelling amount of animal and human research has shown that perceived maternal stress during pregnancy can affect the neurodevelopment of the offspring. Prenatal maternal cortisol is frequently proposed as the biological key mechanism underlying this link; however, literature that investigates the effects of prenatal cortisol on subsequent neurodevelopment in humans is scarce. By using longitudinal data from a relatively large community sample of mother-child dyads (N = 73), this pre-registered study prospectively examined the role of maternal prenatal cortisol concentrations on subsequent individual differences in gray matter volume (GMV) and hippocampal subfield volumes at the onset of puberty of the offspring (12 years of age). Two markers of cortisol, that is, evening cortisol and circadian decline over the day, were used as indicators of maternal physiological stress during the last trimester of pregnancy. The results indicate that prenatal maternal cortisol levels were not associated with GMV or hippocampal subfield volumes of the children. These findings suggest that late pregnancy maternal cortisol may not be related to the structural development of the offspring's brain, at least not in healthy community samples and at the onset of puberty. When examining the influence of prenatal stress on offspring neurodevelopment, future investigations should delineate gestational timing effects of the cortisol exposure, cortisol assessment method, and impact of additional biomarkers, as these were not investigated in this study.

A meta-analysis of childhood maltreatment in relation to psychopathic traits

Psychopathy is a personality disorder characterized by a mix of traits belonging to four facets: affective (e.g., callous/lack of empathy), interpersonal (e.g., grandiosity), behavioral instability (e.g., impulsivity, poor behavioral controls), and social deviance (e.g., juvenile delinquency, criminal versatility). Several scholars have argued that early childhood maltreatment impacts the development of psychopathy, although views regarding its role in the four facets differ. We conducted a meta-analysis including 47 studies comprising a total of 389 effect sizes and 12,737 participants, to investigate the association between psychopathy and four types of child maltreatment: physical abuse, emotional abuse, neglect, and sexual abuse. We found support for a moderate link between overall psychopathy and childhood physical abuse, emotional abuse, and neglect, as well as overall childhood maltreatment. The link between psychopathy and childhood sexual abuse was small, but still statistically significant. These associations were stronger for the behavioral and antisocial facets than for the affective and interpersonal facets of psychopathy, but nearly all associations were statistically significant. Our findings are consistent with recently developed theories on the role of complex trauma in the development of severe personality disorders. Trauma-focused preventive and therapeutic interventions can provide further tests of the trauma-psychopathy hypothesis.

Assessment of Unresolved/Disorganized State of Mind in Relation to Attachment: A ROC Curve Study Using the Adult Attachment Interview and the Measure of Parental Style

OBJECTIVE

The main objective of the present study was to use the Receiver Operating Characteristic (ROC) curve analysis to identify cut-off points for a self-report measure assessing parental style, i.e., the Measure of Parental Style (MOPS), that are able to discriminate individuals with disorganized internal working models (IWMs) of attachment with adequate accuracy, in terms of sensitivity and specificity. Establishing cut-off points for the MOPS could provide clinicians and researchers with a valuable tool to investigate the role of disorganized IWMs as a link between parental styles and mental health.

METHOD

A sample of 90 university students (mean age = 21.21 ± 2.05, females = 66) was enrolled in the study. We used the Adult Attachment Interview (AAI) to assess disorganized IWM and the MOPS to assess parental styles. Subsequently, we used ROC curve analysis to pursue the objective of the study.

RESULTS

The ROC curve analysis showed that the MOPS total score (i.e., the combination of maternal and paternal dimensions) was able to discriminate individuals with disorganized IWMs from individuals with organized IWMs (AUC= 0.77). Specifically, a score ≥ 25 (Youden index= 0.497) categorized individuals with a sensitivity of 0.69 (69% of participants with disorganized IWMs were correctly identified) and a specificity of 0.81 (19% of participants were incorrectly identified as having disorganized IWMs).

CONCLUSIONS

Although the AAI has demonstrated high psychometric properties for assessing attachment representations in adulthood, its use is difficult when studies with large samples are to be conducted. As an alternative to the AAI, the MOPS can be used in studies with large populations, but no cut-off has yet been proposed. Here, we have identified cut-off points for the MOPS that are capable of detecting disorganized IWMs of attachment with adequate accuracy, and we suggest that this self-report is a useful brief instrument for detecting disorganized IWMs when time constraints prevent the use of the AAI (e.g., in studies with large samples or epidemiological studies).

Examining Mothers' Childhood Maltreatment History, Parental Reflective Functioning, and the Long-Term Effects of the Minding the Baby® Home Visiting Intervention

Research is needed to better understand how childhood maltreatment history affects parental reflective capacities, and whether early childhood interventions help mitigate these effects. We examined associations between childhood maltreatment and current parenting (parental reflective functioning, parenting behaviors) among mothers who participated in a follow-up study (N = 97) of the Minding the Baby® (MTB) randomized control trial. MTB is a home visiting program that aims to help mothers understand their child's mental states (feelings, intentions, needs) by promoting parental reflective functioning. Mothers retrospectively reported childhood maltreatment using the Childhood Trauma Questionnaire. Endorsing a higher number of childhood maltreatment subtypes was associated with less supportive/engaged parenting and higher pre-mentalizing modes, or difficulty with appropriately reflecting on the child's mental states. These relationships were not moderated by participation in the MTB intervention. However, exploratory analyses of individual maltreatment subtypes revealed that participation in MTB may mitigate the harmful effects of childhood emotional abuse on pre-mentalizing modes, specifically. Further research is needed to understand the mechanisms through which early childhood interventions may prevent intergenerational cycles of maltreatment.

The Association Between Adverse Childhood Experiences and Positive Dementia Screen in American Older Adults

BACKGROUND

Adverse childhood experiences (ACEs) are linked to higher risk of common conditions driving mortality in adulthood, but little evidence exists on whether ACEs are associated with risk of dementia, a leading cause of death in the USA.

OBJECTIVE

To estimate the relationship between US adults' reported ACE scores and a positive screen for dementia.

DESIGN

Cross-sectional analysis of a longitudinal, national population-based survey of US older adults.

PARTICIPANTS

Survey respondents aged ≥ 65 years with dementia screening data from the 2017 wave of the Panel Study of Income Dynamics (PSID) and ACE scores from the 2014 PSID Childhood Retrospective Circumstances Survey supplement (1,488 eligible participants unweighted).

MAIN MEASURES

Dementia screening data was collected in the 2017 wave of the PSID using the 8-item informant interview to differentiate normal cognition and dementia (AD8). Mean change in AD8 score and probability of a positive dementia screen by ACE score were calculated using adjusted regression models with post-estimation. Analyses were stratified by age group. Measures were analyzed in 2020.

RESULTS

Complete data were available for 1,223 (82%) participants, with a mean age of 73.4 years (SD 7.1, range 65 to 96 years). Adjusted estimated probability of a positive dementia screen increased with each additional adverse childhood experience reported. Older adults with ≥ 4 ACEs had higher rates of a positive dementia screen (AD8 score ≥ 2 points) compared to those with no ACEs (adjusted rate 26.6% versus 16.3%, p = 0.034). Compared to those with no ACE history, respondents with ≥ 4 ACEs had higher odds of a 1-point increase in AD8 score across all intervals of the AD8 scale (aOR 1.79, 95% CI 1.05-3.04). The ACE-positive dementia screen associations were strongest among those aged 65-75.

CONCLUSIONS

Greater exposure to ACEs is independently associated with higher probability of a positive dementia screen in older adulthood.

Disparities by Gender and Race/Ethnicity in Child Maltreatment and Memory Performance

Adverse childhood experiences, which include child maltreatment, are a major public health issue nationally. Child maltreatment has been linked to poorer cognitive functioning, which can start in childhood and persist into adulthood. However, studies examining the potential disparities by gender and race/ethnicity are lacking. The aim of this study was to assess the gender and racial/ethnic disparities in the association between child maltreatment and memory performance. Data were obtained from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (N = 11,624). Weighted multiple linear regression models were used to assess the associations between sexual abuse, physical abuse, neglect, and child maltreatment score and memory. Models were stratified by gender, race, and ethnicity. Men who were exposed to sexual abuse, neglect and two or three child maltreatment types scored one to three points lower (β = -1.44; 95% CI: -2.83, -0.06; β = -2.41; 95% CI: -3.75, -1.08; β = -3.35; 95% CI: -5.33, -1.37; β = -2.31; 95% CI: -3.75, -0.86) in memory performance compared to men who did not report sexual abuse, neglect, or child maltreatment, respectively. Black respondents who were exposed to sexual abuse scored two points lower (β = -1.62; 95% CI: -2.80, -0.44) in memory performance compared to Black respondents who did not report sexual abuse. Among Other race and Hispanic respondents, those who reported neglect scored four points lower (β = -4.06; 95% CI: -6.47, -1.66; β = -4.15; 95% CI: -5.99, -2.30) in memory performance, respectively, compared to their counterparts who did not report neglect. Gender- and racial/ethnic-responsive memory performance interventions addressing child maltreatment may be beneficial for affected populations.

Adverse Childhood Experiences and Their Relationship with Poor Sexual Health Outcomes: Results from Four Cross-Sectional Surveys

Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. Exposure to adverse childhood experiences (ACEs) can increase the risk of poor sexual health outcomes, but most research is US-based. This study explored associations between ACEs and poor sexual health outcomes in the UK. Data from four cross-sectional ACE surveys with adult general populations in different regions of the UK from 2013−2015 (n = 12,788) were analysed. Data included participants’ demographics, ACE exposure, and four sexual health outcomes: having early sex (<16 years), having an accidental teenage pregnancy, becoming a teenage parent, or having a lifetime diagnosis of a sexually transmitted infection. ACE count was a consistent and significant predictor of all four sexual health outcomes for both males and females, with odds of these outcomes between three and seven times higher for those with 4+ ACEs compared to those with no ACEs. Increased risks of some, but not all, sexual health outcomes were also found with higher residential deprivation, younger age, being of white ethnicity, and being born to a teenage mother. Findings highlight the need for effective interventions to prevent and ameliorate the lifelong effects of ACEs. Trauma-informed relationships and sex education, sexual health services, and antenatal/postnatal services, particularly for teenagers and young parents, could provide opportunities to prevent ACEs and support those affected. Ensuring that those living in deprived areas have access to services and that barriers to uptake are addressed is also key.

Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE): Initial Evaluation of the Clinical Effects of RISE Administered in Routine Care in the US Veterans Health Administration

Intimate partner violence (IPV) is a common concern among military Veterans that negatively impacts health. The United States' Veterans Health Administration (VHA) has launched a national IPV Assistance Program (IPVAP) to provide comprehensive services to Veterans, their families and caregivers, and VHA employees who use or experience IPV. Grounded in a holistic, Veteran-centered psychosocial rehabilitation framework that guides all facets of the program, the IPVAP initiated the pilot implementation of a novel intervention called Recovering from IPV through Strengths and Empowerment (RISE). This evidence-based, person-centered, trauma-informed, and empowerment-oriented brief counseling intervention is designed to support those who experience IPV and to improve their psychosocial wellbeing. This program evaluation study describes clinical outcomes from patients who participated in a pilot implementation of RISE in routine care. We examined changes in general self-efficacy, depression, and valued living, as well as treatment satisfaction among patients who received RISE and completed program evaluation measures at VHA facilities during the pilot. Results from 45 patients (84% women) indicate that RISE was associated with significant pretreatment to posttreatment improvements in self-efficacy, depression, and valued living (Cohen's d s of 0.97, 1.09, and 0.51, respectively). Patients reported high satisfaction with treatment. Though preliminary results were similar across gender and IPV types, findings from the evaluation of the pilot implementation of RISE demonstrate the intervention's feasibility, acceptability, and clinical utility in routine VHA care and inform the scalability of RISE. Additionally, findings provide preliminary support for the effectiveness and acceptability of RISE with men. Modification to RISE and its implementation are discussed, which may be useful to other settings implementing IPV interventions.

Childhood maltreatment is associated with cortical thinning in people with eating disorders

Childhood maltreatment (CM) is a non-specific risk factor for eating disorders (ED) and is associated with a greater severity in their clinical presentation and poorer treatment outcome. These data suggest that maltreated people with ED may be biologically other than clinically different from non-maltreated people. The aim of the present study was to investigate cortical thickness (CT), a possible biomarker of neurodevelopment, in people with ED with or without history of CM and in healthy women. Twenty-four healthy women, 26 with anorexia nervosa and 24 with bulimia nervosa underwent a 3T MRI scan. All participants filled in the childhood trauma questionnaire. All neuroimaging data were processed by FreeSurfer. Twenty-four participants with ED were identified as maltreated and 26 participants with ED as non-maltreated. All healthy women were non-maltreated. Compared to healthy women, maltreated people with ED showed lower CT in the left rostral anterior cingulate gyrus, while compared to people with ED without history of CM showed lower CT values in the left superior frontal and in right caudal middle frontal and superior parietal gyri. No significant differences emerged in CT measures between healthy women and people with ED without history of CM. The present findings show for the first time that in adult people with ED childhood maltreatment is associated with cortical thinning in areas implicated in the modulation of brain processes that are acknowledged to play a role in the psychopathology of ED.

Complex post-traumatic stress disorder

Complex post-traumatic stress disorder (complex PTSD) is a severe mental disorder that emerges in response to traumatic life events. Complex PTSD is characterised by three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships. Complex PTSD has been adopted as a new diagnosis in the ICD-11. Individuals with complex PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence. The disorder has a 1-8% population prevalence and up to 50% prevalence in mental health facilities. Progress in diagnostics, assessment, and differentiation from post-traumatic stress disorder and borderline personality disorder is reported, along with assessment and treatment of children and adolescents. Studies recommend multicomponent therapies starting with a focus on safety, psychoeducation, and patient-provider collaboration, and treatment components that include self-regulatory strategies and trauma-focused interventions.

Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis

Alterations in hypothalamic-pituitary-adrenal (HPA) axis and its effector hormone cortisol have been proposed as one possible mechanism linking child maltreatment experiences to health disparities. In this series of meta-analyses, we aimed to quantify the existing evidence on the effect of child maltreatment on various measures of HPA axis activity. The systematic literature search yielded 1,858 records, of which 87 studies (k = 132) were included. Using random-effects models, we found evidence for blunted cortisol stress reactivity in individuals exposed to child maltreatment. In contrast, no overall differences were found in any of the other HPA axis activity measures (including measures of daily activity, cortisol assessed in the context of pharmacological challenges and cumulative measures of cortisol secretion). The impact of several moderators (e.g., sex, psychopathology, study quality), the role of methodological shortcomings of existing studies, as well as potential directions for future research are discussed.

Adverse Childhood Experiences and Neurocognition in Borderline Personality Disorder: A Call-to-Action Perspective Review

Adverse childhood experiences (ACEs) contribute to the development of personality traits leading to adult borderline personality disorder (BPD). Neurocognitive changes could partly mediate the association between ACEs and BPD. We discuss how exposure to ACEs could induce alterations in neurocognition, which, in turn, would contribute to the development of BPD. We conducted a review of MEDLINE articles through 2021, documenting a link between ACEs, neurocognitive impairments, and BPD, and also focusing on the pairwise associations. ACEs appear to have a strong impact on neurocognition and are a predictive factor for BPD. Maltreated, abused, and emotionally invalidated children are more likely to present BPD traits. Neurocognitive impairments in adults exposed to ACEs and in patients with BPD arise from similar brain alterations in the amygdala, hippocampus, and prefrontal cortex. These impairments seem to be linked with clinical dimensions of BPD: increased impulsivity to altered inhibitory control; dissociative experiences to nonspecific autobiographical memory; and emotionally biased facial recognition to unstable interpersonal relationships. This perspective review highlights the contributory role of neurocognition in the association between ACEs and BPD. Additional research is needed, however, on the interconnections among ACEs, neurocognition, and BPD. Future studies could also focus on developing tools to assess early adversity in BPD specifically and on psychotherapeutic approaches to promptly remedy neurocognitive impairments.

Principles for humanistic responsiveness to children and adolescents coping with the pandemic

Pandemic stress can be a dehumanizing experience, especially for children and adolescents, and can be described in terms of the research paradigm of chronic variable stress (CVS). Humanistic counseling speaks to this particular kind of stress. This article presents eight principles for humanistic responsiveness for working with children and adolescents.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

The Chinese version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale: Psychometric properties in a sample of young adults

There are several effective self-report instruments used by Chinese researchers to retrospectively assess exposure to childhood maltreatment. However, these measures do not assess the timing of exposure, restricting efforts to identify periods of development when childhood maltreatment maximally increases vulnerability to psychopathology and health outcomes. In the current study we created a Chinese version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale, which assesses multiplicity (number of types of maltreatment experienced) and severity of maltreatment as well as when it occurred during childhood and adolescence. Rasch modeling was used for scale development in a sample of 812 undergraduate students. Item reduction analysis of the original 75 items produced a 58-item Chinese version with ten subdimensions. The new scale showed good three-week test-retest reliability, and good convergent validity with the Childhood Trauma Questionnaire (CTQ) and the revised Adverse Childhood Experiences Questionnaire (ACEQ-R). Variance decomposition analyses found that compared to the CTQ and ACE, the MACE Severity and Multiplicity scores explained higher variance in self-reported depression and anxiety symptom ratings on the Depression Anxiety Stress Scales (DASS). The results of the present study confirmed that the Chinese version of the MACE has sound psychometric properties in the Chinese cultural context. This new instrument will be a valuable tool for Chinese researchers, psychiatrists and psychologists to ascertain the type and timing of exposure to maltreatment.

"Today I Can Look in the Mirror and Like Myself": Effects of a Trauma-Informed Mindful Recovery Program on Self-Compassion

Background

Opioid-related deaths continue to rise. Psychological trauma is commonly comorbid with Opioid Use Disorder (OUD). Adverse childhood experiences can disrupt the development of emotion regulation, increasing risk of substance use. Self-compassion may reduce OUD risk and outcomes by facilitating emotion regulation, decreasing the toxicity of shame, and reducing internalized stigma that can hinder recovery. Mindfulness practice enhances self-compassion.

Methods

This study is part of a pilot (N = 18) of the Mindful Recovery OUD Care Continuum (M-ROCC) during buprenorphine office-based opioid treatment (OBOT). The present study was conducted to gain a deeper understanding of the intervention’s effects on self-compassion development, and to explore differential changes in self-compassion during the intervention among participants with varying intensity of trauma exposure measured by high levels of childhood adversity (defined by 4+ adverse childhood experiences (ACEs) at baseline). We conducted secondary analyses of a subset of qualitative interview data (N = 11 unique participants) collected for the pilot study (weeks 4 and 24, 14 total interviews) to elaborate upon changes in Self-Compassion Scale (SCS-SF) scores.

Results

In the primary pilot study, participants’ mean SCS-SF scores shifted significantly from baseline to week 24, β = 0.22, p = 0.028. This change is elaborated upon through interviews. Despite pervasive challenges to becoming more self-compassionate (e.g., trauma histories and substance use), participants reported increased compassionate self-responding and decreased uncompassionate self-responding. Mindfulness training was identified as the primary mechanism underlying the shift. Kindness to self and others and—to a lesser extent an increased sense of common humanity—were also identified as key to overall self-compassion. Compared to those in the lower ACEs group, participants in the higher ACEs group tended to have lower baseline self-compassion scores (d = 1.09, p = 0.055).

Conclusion

M-ROCC may increase self-compassion among patients with OUD during OBOT by increasing compassionate, and decreasing uncompassionate, self-responding. Patients with OUD with greater childhood adversity tended to have lower levels of self-compassion, which improved with M-ROCC. Future trials with larger samples are needed to confirm these potential outcomes, mechanisms, and differential impacts between ACEs subgroups.

A meta-analytic study of the effects of early maternal separation on cognitive flexibility in rodent offspring

Adverse early life experiences, such as maternal separation, are associated with an increased risk for several mental health problems. Symptoms induced by maternal separation that mirror clinically relevant aspects of mental problems, such as cognitive inflexibility, open the possibility of testing putative therapeutics prior to clinical development. Although several animal (e.g., rodent) studies have evaluated the effects of early maternal separation on cognitive flexibility, no consistent conclusions have been drawn. To clarify this issue, in this study, a meta-analysis method was used to systematically explore the relationship between early maternal separation and cognitive flexibility in rodent offspring. Results indicate that early maternal separation could significantly impair cognitive flexibility in rodent offspring. Moderator analyses further showed that the relationship between early maternal separation and cognitive flexibility was not consistent in any case, but was moderated by variations in the experimental procedures, such as the deprivation levels, task characteristics, and rodent strains. These clarify the inconsistent effects of maternal separation on cognitive flexibility in rodents and help us better understand the association between early life adversity and cognitive development.

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Meta-analysis method was used to discuss the inconsistent effects of maternal separation on cognitive flexibility in rodent.

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Maternal separation was found to necessarily impair the cognitive flexibility in rodent.

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Variations in the experimental procedures moderated the relationship between maternal separation and cognitive flexibility.

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Further studies on environment-cognition associations in rodents should take experimental procedural factors into account.

Associations between childhood maltreatment and psychiatric disorders: analysis from electronic health records in Hong Kong

There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.

Evaluating the mental health impacts of the COVID-19 pandemic: perceived risk of COVID-19 infection and childhood trauma predict adult depressive symptoms in urban South Africa

BACKGROUND

South Africa's national lockdown introduced serious threats to public mental health in a society where one in three individuals develops a psychiatric disorder during their life. We aimed to evaluate the mental health impacts of the COVID-19 pandemic using a mixed-methods design.

METHODS

This longitudinal study drew from a preexisting sample of 957 adults living in Soweto, a major township near Johannesburg. Psychological assessments were administered across two waves between August 2019 and March 2020 and during the first 6 weeks of the lockdown (late March-early May 2020). Interviews on COVID-19 experiences were administered in the second wave. Multiple regression models examined relationships between perceived COVID-19 risk and depression.

RESULTS

Full data on perceived COVID-19 risk, depression, and covariates were available in 221 adults. In total, 14.5% of adults were at risk for depression. Higher perceived COVID-19 risk predicted greater depressive symptoms (p < 0.001), particularly among adults with histories of childhood trauma, though this effect was marginally significant (p = 0.063). Adults were about two times more likely to experience significant depressive symptoms for every one unit increase in perceived COVID-19 risk (p = 0.021; 95% CI 1.10-3.39). Qualitative data identified potent experiences of anxiety, financial insecurity, fear of infection, and rumination.

CONCLUSIONS

Higher perceived risk of COVID-19 infection is associated with greater depressive symptoms during the first 6 weeks of quarantine. High rates of severe mental illness and low availability of mental healthcare amidst COVID-19 emphasize the need for immediate and accessible psychological resources.

The effects of developmental trauma on theory of mind and its relationship to psychotic experiences: A behavioural study

BACKGROUND

Developmental psychological trauma induces vulnerability to psychosis. However, the mechanisms underlying this association are poorly understood. Impairments in Theory of Mind (ToM) have been observed in adult survivors of developmental trauma and individuals with psychosis. ToM is therefore a candidate mechanism underlying the association between developmental trauma and psychosis.

METHODS

We used a computerised version of the Director task - where a participant is instructed by a confederate to move an object around a 4 × 4 grid, whilst taking account of whether these objects are visible to a confederate who instructs the participant - to investigate impairments in ToM in 209 participants (age: M = 37.8, SD=13.6; 56% female). Participants were divided into a) developmental trauma-positive (DT+) and control groups (DT-) based on their history of developmental trauma and b) then further into subclinical (S) and healthy groups (H) as based on psychotic experiences indexed by the CAPE-P15. After exclusion, the numbers in each group were: DT+H (47), DT+S (84), DT-H (54), DT-S (12). (Total: 197).

RESULTS

Developmental trauma exposure was associated with psychotic experiences (OR: 7.89, p < .001), which remained significant after controlling for demographic and clinical confounds (adjusted R² = 0.452, R² change = 0.0184, p = .009). Participants with developmental trauma (F_{1, 194}) = 5.46, p = .020, ηp² = 0.027) and participants more prone to psychotic experiences (F_{1, 194}) = 4.71, p = .031, ηp² = 0.024) demonstrated significantly lower accuracy on the Director task relative to their respective control, after controlling for the effects of age.

CONCLUSIONS

ToM deficits are associated with self-reported developmental trauma and psychotic experiences. Further work is needed to explore these relationships further and whether they represent generalised or specific effect effects on developmental trauma and psychopathological domains.

Individual Differences in Hemispheric Emotional Valence by Computerized Test Correlate with Lateralized Differences in Nucleus Accumbens, Hippocampal and Amygdala Volumes

Purpose

Conventional theories of hemispheric emotional valence (HEV) postulate fixed hemispheric differences in emotional processing. Schiffer’s dual brain psychology proposes that there are prominent individual differences with a substantial subset showing a reversed laterality pattern. He further proposed that hemispheric differences were more akin to differences in personality than in emotional processing. This theory is supported by findings that unilateral treatments, such as transcranial magnetic stimulation, are effective if they accurately target individual differences in laterality. The aim of this paper was to assess if a computer test of hemispheric emotional valence (CTHEV) could effectively identify individual differences in HEV and to ascertain if these individual differences were associated with underlying differences in brain structure and connectivity.

Patients and Methods

The CTHEV was administered to 50 (18 male/32 female) right-handed participants, aged 18–19 years, enrolled in a study assessing the neurobiological effects of childhood maltreatment. Based on a literature review, we determined whether CTHEV correlated with lateralized volumes of the nucleus accumbens, amygdala, hippocampus, and subgenual anterior cingulate as well as volume of the corpus callosum.

Results

CTHEV scores correlated with laterality indices of the nucleus accumbens (p = 0.00016), amygdala (p = 0.0138) and hippocampus (p = 0.031). A positive left hemispheric valence was associated with a larger left-sided nucleus accumbens and hippocampus and a smaller left amygdala. We identified four eigenvector network centrality DTI measures that predict CTHEV, most notably the left amygdala, and found that CTHEV results correlated with total and segment-specific corpus callosal volumes.

Conclusion

Individual differences in HEV can be readily assessed by computer test and correlate with differences in brain structure and connectivity that could provide a mechanistic understanding. These findings provide further support for a revised understanding of HEV and provide a tool that could be used to guide lateralized brain treatments.

Left amygdala structure mediates longitudinal associations between exposure to threat and long-term psychiatric symptomatology in youth

Traumatic experiences during childhood can have profound effects on stress sensitive brain structures (e.g., amygdala and hippocampus) and the emergence of psychiatric symptoms. Recent theoretical and empirical work has delineated dimensions of trauma (i.e., threat and deprivation) as having distinct neural and behavioral effects, although there are few longitudinal examinations. A sample of 243 children and adolescents were followed for three time points, with each assessment approximately 1 year apart (ages 9–15 years at Time 1; 120 males). Participants or their caregiver reported on youths' threat exposure, perceived stress (Time 1), underwent a T1‐weighted structural high‐resolution MRI scan (Time 2), and documented their subsequent psychiatric symptoms later in development (Time 3). The primary findings indicate that left amygdala volume, in particular, mediated the longitudinal association between threat exposure and subsequent internalizing and externalizing symptomatology. Greater threat exposure related to reduced left amygdala volume, which in turn differentially predicted internalizing and externalizing symptoms. Decreased bilateral hippocampal volume was related to subsequently elevated internalizing symptoms. These findings suggest that the left amygdala is highly threat‐sensitive and that stress‐related alterations may partially explain elevated psychopathology in stress‐exposed adolescents. Uncovering potential subclinical and/or preclinical predictive biomarkers is essential to understanding the emergence, progression, and eventual targeted treatment of psychopathology following trauma exposure.

Subregion-specific, modality-dependent and timescale-sensitive hippocampal connectivity alterations in patients with first-episode, drug-naïve major depression disorder

BACKGROUND

Despite accumulating evidence for the hippocampus as a key dysfunctional node in major depressive disorder (MDD), previous findings are controversial possibly due to heterogeneous and small clinical samples, complicated hippocampal structure, and different imaging modalities and analytical methods.

METHODS

We collected structural and resting-state functional MRI data from 100 first-episode, drug-naïve MDD patients and 99 healthy controls. A subset of the participants (34 patients and 33 controls) also completed a battery of neuropsychological tests and childhood trauma questionnaires. Seed-based morphological and functional (static and dynamic) connectivity were calculated for ten hippocampal subregions, followed by analyses of dynamic functional connectivity states (k-means clustering), connectivity cross-modality relationships (cosine similarity), and connectivity associations with clinical and neuropsychological variables (Spearman correlation).

RESULTS

Between-group comparisons revealed abnormal hippocampal connectivity in the patients that depended on 1) hippocampal subdivisions: the cornu ammonis (CA) was the most seriously affected subregion, in particular the right CA1 for functional connectivity alterations; 2) imaging modality: morphological connectivity revealed seldom and sporadic alterations with different lobes, while functional connectivity identified numerous and convergent alterations with prefrontal regions; and 3) time scale: dynamic functional connectivity was more sensitive than static functional connectivity, in particular in revealing alterations between the right CA1 and contralateral prefrontal cortex. Among the 34 patients, functional connectivity alterations of the CA1 were related to the history of childhood trauma in the patients.

LIMITATIONS

Only a subset of the patients completed the neuropsychological tests, which may cause underestimation of cognitive relevance of hippocampal connectivity alterations.

CONCLUSIONS

Disrupted hippocampal CA1 functional connectivity plays key roles in the pathophysiology of MDD and may act as a potential diagnostic biomarker for the disease.

Maternal Separation Alters Ethanol Drinking and Reversal Learning Processes in Adolescent Rats: The Impact of Sex and Glycine Transporter Type 1 (GlyT1) Inhibitor

Adverse early life experiences are associated with an enhanced risk for mental and physical health problems, including substance abuse. Despite clinical evidence, the mechanisms underlying these relationships are not fully understood. Maternal separation (MS) is a commonly used animal model of early neglect. The aim of the current study is to determine whether the N-methyl-D-aspartate receptor (NMDAR)/glycine sites are involved in vulnerability to alcohol consumption (two-bottle choice paradigm) and reversal learning deficits (Barnes maze task) in adolescent rats subjected to the MS procedure and whether these effects are sex dependent. By using ELISA, we evaluated MS-induced changes in the NMDAR subunits (GluN1, GluN2A, GluN2B) expression, especially in the glycine-binding subunit, GluN1, in the prefrontal cortex (PFC) and ventral striatum (vSTR) of male/female rats. Next, we investigated whether Org 24598, a glycine transporter 1 (GlyT1) inhibitor, was able to modify ethanol drinking in adolescent and adult male/female rats with prior MS experience and reversal learning in the Barnes maze task. Our findings revealed that adolescent MS female rats consumed more alcohol which may be associated with a substantial increase in GluN1 subunit of NMDAR in the PFC and vSTR. Org 24598 decreased ethanol intake in both sexes with a more pronounced decrease in ethanol consumption in adolescent female rats. Furthermore, MS showed deficits in reversal learning in both sexes. Org 24598 ameliorated reversal learning deficits, and this effect was reversed by the NMDAR/glycine site inhibitor, L-701,324. Collectively, our results suggest that NMDAR/glycine sites might be targeted in the treatment of alcohol abuse in adolescents with early MS, especially females.

In vivo social regulation of high-risk parenting: A conceptual model of Parent-Child Interaction Therapy for child maltreatment prevention

Meta-analyses show that Parent-Child Interaction Therapy (PCIT) significantly reduces child abuse and neglect in families where maltreatment has already occurred; however, research into the underlying mechanisms of change (i.e., how PCIT effects positive changes in parenting) remains limited. In this article, we discuss a new conceptual model of PCIT's active ingredients that is informed by biobehavioral research documenting the physiological underpinnings of problematic parenting. We describe deficits in self-regulation observed in child maltreating parents and PCIT's unique live coaching approach and associated techniques that may form the basis for in-vivo social regulation in the act of parenting that supports more effective, positive parenting behavior, strengthens parents' self-regulation skills, and reduces child maltreatment.

Age-Varying Associations between Child Maltreatment, Depressive Symptoms, and Frequent Heavy Episodic Drinking

Child maltreatment represents a prevalent public health issue that has been shown to predict both adolescent and young adult depressive symptoms and heavy episodic drinking; however, little is known regarding how associations between specific types of maltreatment (e.g., physical abuse, sexual abuse, care neglect, supervisory neglect) and depressive symptoms and heavy episodic drinking change across adolescence and into young adulthood. Similarly, there is lack of research that has examined how an accumulation of child maltreatment types relates to depressive symptoms and heavy episodic drinking across ages. Time-varying effect models-a statistical approach that allows researchers to pinpoint specific ages where the association between two variables is strongest-were used in the current study to address these gaps. Nationally representative data came from the first four waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 16,053; 49.4% female; 51.0% European American/White, 21.0% African American, 10.2% Biracial, 9.1% Hispanic; MAGE W1 = 17.00). Results suggested that certain types of maltreatment are more predictive of negative outcomes than others and that different types of maltreatment confer greater risk in different developmental periods. In addition, while victims of between one and three types of maltreatment had comparable prevalence of depressive symptoms and heavy episodic drinking across adolescence and young adulthood, victims of four types of maltreatment had a much higher prevalence of these outcomes indicating the extreme risk that accompanies an accumulation of maltreatment.

Dental health personnel's experience with receiving inquiries from child welfare services: a national cross-sectional study

OBJECTIVES

To assess if and to what extent public dental health personnel (PDHP) receive inquiries from child welfare services (CWS), and to assess whether PDHP's experience of receiving inquiries is associated with PDHP's characteristics and whether the associations are influenced by PDHP's experience of reporting to CWS.

MATERIAL AND METHODS

Questionnaires were distributed to 1542 PDHP in Norway. Descriptive statistics were used for analysis. Negative-binominal-regression analyses with incidence rate ratios (IRRs) and confidence intervals (CIs) were used to estimate the association between received inquiries from CWS and PDHP characteristics.

RESULTS

From a total of 1074 respondents, 52.4% had received inquiries from CWS (2012-2014) with a mean number of 3.9 (SD = 4.5). PDHP's likelihood of receiving inquiries was significantly associated with having many patients, working in small municipalities, working in eastern Norway, having good knowledge of the Health Personnel Act, and having experience reporting to CWS. Regional differences were the only association that varied according to PDHP reporting activity.

CONCLUSIONS

PDHP receive inquiries from the CWS. The likelihood of receiving inquiries is associated with several characteristics of PDHP. To increase PDHP's likelihood of receiving inquiries, it is important to establish contact between the CWS and PDHS and ensure that the PDHP has good knowledge of the Health Personnel Act.

The expected and the unexpected in recovery and development after abuse and neglect: The role of early foster carer commitment on young children's symptoms of attachment disorders and mental health problems over time

BACKGROUND

Whilst we know that foster care is better than institutional care for abused and neglected children, we know less about the specific qualities of foster care that are important for their development and recovery from maltreatment effects.

OBJECTIVE

This is the first study to investigate the effects of foster carer commitment on symptoms of Attachment Disorders (AD) and mental health problems in young children post-maltreatment.

PARTICIPANTS & SETTING

144 children, age 0-5, recently accommodated into foster care as part of an ongoing Randomised Controlled Trial.

METHODS

Children were assessed using the Disturbances of Attachment Interview and the Strengths and Difficulties Questionnaire, then followed up 15 months and 2.5 years thereafter. Commitment of the foster carer was measured by 'This Is My Baby' interview. Multiple regression was used to analyse the data.

RESULTS

Higher initial foster carer commitment, measured shortly after entry to care, was associated with a reduction in Reactive Attachment Disorder symptoms 15 months after placement, with a modest (non-significant) association persisting 2.5 years later. Initial commitment was not associated with symptoms of Disinhibited Social Engagement Disorder at any follow-up time point, nor with symptoms of mental health problems at 15 months. However, higher initial commitment was unexpectedly associated with higher mental health symptom scores at 2.5 years post-accommodation.

CONCLUSIONS

This study highlights the complex and non-linear development of children in committed foster care, underscoring the need to examine multiple time-points and to consider symptoms of Attachment Disorders separately from those of other mental health problems.