New policies on skin-to-skin contact warrant an oxytocin-based perspective on perinatal health care

Background

In 2023, the World Health Organization (WHO) published a Global Position Paper on Kangaroo Mother Care (KMC), which is applicable to all countries worldwide: from the moment of birth, every "small and sick" newborn should remain with mother in immediate and continuous skin-to-skin contact (SSC), receiving all required clinical care in that place. This was prompted by the startling results of a randomized controlled trial published in 2021: in which 1,609 infants receiving immediate SSC were compared with 1,602 controls that were separated from their mothers but otherwise received identical conventional state-of-the-art care. The intervention infants showed a 25% reduction in mortality after 28 days.

New perspectives

The new WHO guidelines are a significant change from earlier guidance and common clinical practice. The author presents that separating mothers and babies is assumed to be "normal" (a paradigm) but actually puts newborns at increased risk for morbidity and mortality. The author presents arguments and ethical perspectives for a new perspective on what is "normal," keeping newborns with their mothers is the infant's physiological expectation and critical requirement for healthy development. The author reviews the scientific rationale for changing the paradigm, based on synchronous interactions of oxytocin on both mother and infant. This follows a critique of the new policies that highlights the role of immediate SSC.

Actionable recommendations

This critique strengthens the case for implementing the WHO guidelines on KMC for small and sick babies. System changes will be necessary in both obstetric and neonatal settings to ensure seamless perinatal care. Based on the role of oxytocin, the author identifies that many current routine care practices may actually contribute to stress and increased vulnerability to the newborn. WHO has actionable recommendations about family involvement and presence in newborn intensive care units.

Discussion

The concepts of resilience and vulnerability have specific definitions well known in perinatal care: the key outcome of care should be resilience rather than merely the absence of vulnerability. Newborns in all settings and contexts need us to re-evaluate our paradigms and adopt and implement the new WHO guidelines on KMC in perinatal care.

Bonding and Attachment with Baby in the Womb or in the Neonatal Intensive Care Unit: The Critical Role of Early Emotional Connections

Bonding and attachment are known to be critically important for the well-being of infants and children. Both bonding and attachment can begin before birth, which impacts fetal and infant brain development and may improve birth outcomes. Babies in the womb and preterm babies in the neonatal intensive care unit (NICU) can hear and respond to maternal voices with positive effects on physiologic stability, brain development, and language development. Supporting emotional connections before and after birth is the responsibility and the privilege of health-care providers who care for pregnant mothers and babies in the NICU.

Understanding emotion dysregulation from infancy to toddlerhood with a multilevel perspective: The buffering effect of maternal sensitivity

Challenges with childhood emotion regulation may have origins in infancy and forecast later social and cognitive developmental delays, academic difficulties, and psychopathology. This study tested whether markers of emotion dysregulation in infancy predict emotion dysregulation in toddlerhood, and whether those associations depended on maternal sensitivity. When children (N = 111) were 7 months, baseline respiratory sinus arrhythmia (RSA), RSA withdrawal, and distress were collected during the Still Face Paradigm (SFP). Mothers' reports of infant regulation and orientation and maternal sensitivity were also collected at that time. Mothers' reports of toddlers' dysregulation were collected at 18 months. A set of hierarchical regressions indicated that low baseline RSA and less change in RSA from baseline to stressor predicted greater dysregulation at 18 months, but only for infants who experienced low maternal sensitivity. Baseline RSA and RSA withdrawal were not significantly associated with later dysregulation for infants with highly sensitive mothers. Infants who exhibited low distress during the SFP and who had lower regulatory and orienting abilities at 7 months had higher dysregulation at 18 months regardless of maternal sensitivity. Altogether, these results suggest that risk for dysregulation in toddlerhood has biobehavioral origins in infancy but may be buffered by sensitive caregiving.

Cumulative risk factors for injuries and poisoning requiring hospital care in youth with prenatal substance exposure: A longitudinal controlled cohort study

Aim: To investigate whether the youth with prenatal substance exposure (PSE) (aged 15-24 years, n = 615) had been in hospital care more often due to injuries and poisoning in comparison with unexposed matched controls (n = 1787). Methods: Data from medical records (exposure) and national health and social welfare registers (outcome and confounders) were combined and youths were monitored from birth until either outpatient or inpatient hospital care for injury or poisoning, death or the end of the study period (December 2016). Cox regression models were used in the analyses accounting for associated child and maternal risk factors. Results: Half (50.4%) of the exposed group and 40.6% of controls had been in hospital care due to injury or poisoning during the follow-up (p < 0.001). The difference between groups was diminished after controlling for postnatal child and maternal risk factors (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.72-1.07, p > 0.05). Cumulative adversity, especially out-of-home care in combination with a diagnosed attention or behavioural dysregulation problem, posed the highest risk in both groups (exposed: HR = 1.65, 95% CI 1.24-2.19, p < 0.001; controls: HR = 1.84, 95% CI 1.33-2.56, p < 0.001). Conclusion: Hospital care for injury and poisoning is more common in youth with PSE, but this is largely explained by the related postnatal child and maternal factors. Long-term support to families with maternal substance abuse problems could prevent injury and poisoning among youth with PSE.

Mitigating adverse social determinants of health in the vulnerable population: Insights from a home visitation programme

Introduction

Low-income families are exposed to adverse childhood experiences and psychosocial risks that impact child development. At the KK Women's and Children's Hospital in Singapore, Kids Integrated Development Service (KIDS0-3) is a home visitation programme that aims to optimise the development of children from low-income families.

Method

Data comprising family demographics, maternal psychosocial risks and outcomes of child development were collated through a chart review of 469 mother-child dyads enrolled from June 2014 to October 2022.

Results

Based on the Family and Adult Support Tool, 312 families (67%) were identified as moderate or high-risk. Children from moderate and high-risk families had poorer Bayley cognitive (mean 95.88 [SD 8.25] versus [vs] 98.44 [SD 8.72], P=0.014) and language scores (mean 87.38 [SD 10.35] vs 90.43 [SD 9.61], P=0.016] at 24 months of age, compared to the low-risk group. Children of teenage mothers had lower Bayley cognitive scores (mean 95.16 [SD 8.42] vs 97.76 [SD 8.55], P=0.037), and children of mothers who experienced sexual abuse had lower Bayley cognitive scores (mean 93.1 [SD 5.68] vs 99.7 [SD 8.17], P=0.013) and language scores (mean 82.3 [SD 12.87] vs 91.3 [SD 10.86], P=0.021]. Antenatal enrolment yielded better child language (mean 90.1 [SD 9.37] vs 87.13 [SD 10.79], P=0.04) and motor outcomes (mean 99.62 [SD 9.45] vs 94.72 [SD 9.51], P=0 .001) than postnatal enrolment.

Conclusion

Psychosocial risks impact the development of children from low-income families in Singapore. Findings underscore the importance of early, integrated intervention for vulnerable families.

As the Twig is Bent so the Tree is Inclined? Exploring the Associations of Adverse Childhood Experiences and Adult Relational Impairments in Ghana

Studies on adverse childhood experiences (ACEs), which have been conducted predominantly with samples from Western cultures have found ACEs to be associated with poor health outcomes and relational impairments in adulthood. This study sought to contribute to the ACEs literature by investigating the long-term consequences of ACEs on the interpersonal functioning of adult survivors in Ghana, a non-Western culture. In the current study, the associations of five ACEs (high parental conflict, physical abuse, sexual abuse, emotional abuse, and neglect) with four types of relational impairments (alienation, insecure attachment, egocentricity, and social incompetence) were examined using a community sample of 403 adults who retrospectively provided self-reports of ACEs. The most frequently reported ACE in this sample was high parental conflict, while sexual abuse was the least frequently reported ACE. Participants with ACE histories had significantly more relational impairments than those with no ACE histories, however multiple regression analyses revealed no significant relational impairments in adulthood following any ACE experience, whether alone or in any combination, suggesting that cultural values such as collectivism and religiosity may play a protective role against ACEs negative effects in the interpersonal domain. The study's limitations, and the implications of these findings for the Ghanaian and other similar contexts are discussed.

Association between negatively perceived parenting attitudes and dissociation: a cross-sectional study on the general population in Japan

Objectives

Many studies have reported that early traumatic experiences, mainly abuse, are associated with forming dangerous attachments and a contributing factor to dissociation. On the other hand, other studies have investigated the association of non-abusive nurturing and attachment styles with dissociation. The aim of this study is to determine the frequency of dissociative experiences in the general Japanese population and investigate the effects of "overprotection" and "lack of care" as nurturing styles and "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation.

Methods

A total of 1,042 residents aged 18 to 69 years were administered with the Dissociative Experiences Scale (DES), the Japanese version of the WHO-5 Well-Being Index (WHO-5-J), the Parental Bonding Instrument (PBI), and the Experiences in Close Relationships Inventory-the-generalized-other-version (ECR-GO). Hierarchical multiple regression analyses on the effects of "overprotection" and "care" as nurturing attitudes "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation (DES-NDI and DES-T) were conducted.

Results

Based on the findings of this study, "care" and "overprotection" as nurturing attitudes were shown to be a contributing factor to dissociation (DES-NDI and DES-T). "Avoidance of intimacy" as an attachment style was shown to contribute to pathological dissociation. On the other hand, the influence of attachment style on the relationship between nurturing style and dissociation was not determined.

Discussion

This study provided essential data on the distribution of dissociative experiences in the general Japanese population. It was indicated that nurturing style, particularly overprotection, may be linked to nonfunctional stress coping and interpersonal anxiety and could be a contributing factor to mental disorders, including dissociation. Furthermore, considering that the effect of nurturing styles on dissociation does not vary with attachment styles, the effect of nurturing styles on dissociation may be more profound.

Relationship-based intervention for children who were prenatally alcohol exposed in South Africa

BACKGROUND

This early intervention study investigated the effectiveness of a relationship-based, developmental enhancement process for children who were prenatally exposed to alcohol in the South African context.

METHODS

Groups were created according to the child's level of risk for alcohol-related developmental issues based on each mother's alcohol use during pregnancy as assessed using the Alcohol Use Disorders Identification Test (AUDIT). Primary caregiver/child dyads were the focus of the intervention and child development was monitored by the Ages and Stages Questionnaire (ASQ). Eighteen caregiver/child dyads were in the heavily alcohol-exposed group, and 20 caregiver/child dyads were in the no or light alcohol-exposure group. The Home Observation Measurement of the Environment (HOME) was measured pre and post intervention.

RESULTS

The results indicated significant improvements in the home environment (p < .001) post-intervention for the entire cohort. For the total HOME score, there was a statistically significant main effect for time (pre- vs post-test), F(1, 36)= 65.205, p < .001, partial η2 = .64. with 99% confidence limits from .35 to .78. The offspring and parents from both the heavy alcohol exposure group and the no/low alcohol exposure group benefitted from the intervention over the duration of the intervention. Of the HOME domains affected, responsivity was the most improved in the households. The children's scores on the ASQ varied substantially over the months of the intervention, and the offspring of the heavy exposure group often performed significantly worse than the no/low exposure group. Nevertheless, further analysis revealed that children with the lowest performance at baseline improved their performance on most ASQ domains throughout the intervention and performed significantly better on all ASQ domains over time and at completion of the intervention.

CONCLUSIONS

This relationship-based, early intervention program for children resulted in benefits to all of the children over time.

Individual, Peer, and Family Correlates of Depressive Symptoms among College Students in Hong Kong

In this study, an ecological model and developmental psychopathology theory focusing on an ontogenic system (hopelessness) and microsystems (peer alienation and childhood abuse and trauma) was adopted to examine the individual, peer, and family correlates of depressive symptoms among college Chinese students in Hong Kong, China. A cross-sectional survey research design with a convenience sampling procedure was used to examine a sample of college students (n = 786) aged 18 to 21 years old in Hong Kong. Among them, 352 respondents (44.8%) reported having depressive symptoms, with a Beck Depression Inventory-II (BDI-II) score of 14 or above. The results of this study indicated that childhood abuse and trauma, peer alienation, and hopelessness were positively related to depressive symptoms. The underlying arguments and implications were discussed. The study results provided further support for the ecological model and the developmental psychopathology theory on the predictive roles of individual, peer, and family correlates of adolescent depression.

Ecological Study of Urbanicity and Self-reported Poor Mental Health Days Across US Counties

Geography may influence mental health by inducing changes to social and physical environmental and health-related factors. This understanding is largely based on older studies from Western Europe. We sought to quantify contemporary relationships between urbanicity and self-reported poor mental health days in US counties. We performed regression on US counties (n = 3142) using data from the County Health Rankings and Roadmaps. Controlling for state, age, income, education, and race/ethnicity, large central metro counties reported 0.24 fewer average poor mental health days than small metro counties (t = - 5.78, df = 423, p < .001). Noncore counties had 0.07 more average poor mental health days than small metro counties (t = 3.06, df = 1690, p = 0.002). Better mental health in large central metro counties was partly mediated by differences in the built environment, such as better food environments. Poorer mental health in noncore counties was not mediated by considered mediators.

Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive 'threat' system and underactive 'soothing' system, might keep the 'salience network' (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.

Relación entre modelos operantes internos y nivel educacional materno, con la teoría de la mente en niños chilenos de 3 y 4 años: rol mediador del lenguaje mentalizante materno

La teoría de la mente (ToM) es la capacidad de reconocer los propios estados mentales y predecir los de otros, habilidad fundamental en el desarrollo socioemocional/cognitivo en preescolares. El presente estudio buscó describir la ToM de niños chilenos de 3 y 4 años, analizar las diferencias en su desarrollo según la edad y el rol mediador del lenguaje mentalizante(LM) materno, considerando el sexo de los niños, los modelos operantes internos (MOI) y el nivel educacional materno. La muestra fueron 110 niños con sus madres. Se aplicó un cuestionario sociodemográfico, pruebas para evaluar la ToM, el LM y los MOI de las madres. Un 50.9 % de los niños se ubicó en el quintil 1 de la ToM y ninguno logró llegar al quinto. Las habilidades de la ToM con un mayor nivel de logro diferenciaron entre pretender y realidad (60.0 %) y la de diferenciar laperspectiva visual propia y de otro (50.9 %). Un 59.1 % de los niños no logró inferir deseos a través de la mirada, un 83.6 % no logró la habilidad de acceso al conocimiento, y un 100 % no logró la falsa creencia. Los resultados muestran diferencias significativas entre niños de distintos rangos etarios en el desarrollo de la ToM, sugiriendo una creciente dificultad de adquisición de sus habilidades. Además, un mayor lm de las madres se relacionó con mayor desarrollo de la ToM en los niños,con un rol mediador en la influencia de los moi y nivel educacional materno sobre la ToM.

Child sexual abuse survivors: Differential complex multimodal treatment outcomes for pre-COVID and COVID era cohorts

BACKGROUND

Child sexual abuse (CSA) is a form of early-life trauma that affects youth worldwide. In the midst of the current COVID-19 pandemic, it is imperative to investigate the potential impact of added stress on already vulnerable populations.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a multimodal treatment program on mental health outcomes for youth CSA survivors aged 8-17. Secondary to this, we explored the potential impact of the COVID-19 on treatment outcomes.

PARTICIPANTS AND SETTING

Participants of this study were children and youth aged 8-17 who were engaged in a complex multimodal treatment program specifically designed for youth CSA survivors.

METHODS

Participants were asked to complete self-report surveys at baseline and at the end of two subsequent treatment rounds. Surveys consisted of measures pertaining to: (1) PTSD, (2) depression, (3) anxiety, (4) quality of life, and (5) self-esteem.

RESULTS

Median scores improved for all groups at all timepoints for all five domains. For the pre-Covid participants, the largest improvements in the child program were reported in depression (36.6 %, p = 0.05); in the adolescent program anxiety showed the largest improvement (-35.7 %, p = 0.006). Improvements were generally maintained or increased at the end of round two. In almost every domain, the improvements of the pre-COVID group were greater than those of the COVID-I group.

CONCLUSIONS

A complex multimodal treatment program specifically designed for youth CSA survivors has the capacity to improve a number of relevant determinants of mental health and well-being. The COVID-19 pandemic may have retraumatized participants, resulting in treatment resistance.

Evolving Our Understanding: Housing Instability as an ACE for Young Children

We investigated the conceptualization and impact of adverse childhood experiences (ACEs) in a sample of 231 children ages 3-5 living in poverty and experiencing homelessness, focusing specifically on caregiver well-being and housing instability. Data was collected using the Neurodevelopmental Ecological Screening Tool (NEST), which screens for developmental risk and resilience across three domains (neurodevelopmental, caregiver, and environment). We used structural equation modelling (SEM) to test the association between domains and ACE scores and assessed the impact on neurodevelopmental constructs. Fifty-five percent of the sample had high ACE scores (> 3), which were associated with lower attention, social skills, and emotional regulation. ACEs were strongly associated with 0.17 standard deviation units of higher levels of caregiver distress (p < .001), which was also associated with 0.26 standard deviation units of lower levels of child neurodevelopmental functioning (p = .001). For each unit increase in housing instability, there was a three-fourths increase in ACE (0.78 ACE at p = .004); four or more moves were associated with the worst neurodevelopmental outcomes (53% of the sample). We must use an ecological, developmental lens to understand how early adversity impacts children, at what age, and in what context. Housing stability plays a critical role in developmental well-being and should be accounted for in conceptualizations of child ACE scales. Caregiver and child relationships are reciprocal, and so the impacts of ACEs are also bidirectional. Our policies and practices at individual, community, and systemic levels should account for these dynamics to improve child well-being.

A Comprehensive Review on Multifaceted Mechanisms Involved in the Development of Breast Cancer Following Adverse Childhood Experiences (ACEs)

BACKGROUND AND AIM OF THE WORK

Adverse Childhood Experiences (ACEs) may give rise to harmful effects on health throughout life. Epigenetic changes explain how preexisting risk factors may contribute to produce altered biological responses and cancer risk. The main aim of the review is to summarize studies examining the means in which Adverse Childhood Experiences (ACEs) can modulate individual vulnerability to breast cancer (BC) development through multifaceted mechanisms.

METHODS

Studies selection, data extraction, and assessments agreed to PRISMA criteria. We included original research with clinical samples following BC interventions, investigating potential mechanisms linking ACEs and BC in adults.

RESULTS

From the 3321 papers found, nine articles involving 2931 participants were selected. All studies included ACEs retrospective assessments and psychological measures, and seven of them considered biomarkers. Individuals exposed to greater ACEs were at increased BC risk compared with individuals with no ACEs. Associations were found between child abuse and/or neglect, depression, perceived stress, fatigue, and plasma levels of cytokines interleukin (IL-6), C-reactive protein (CRP), soluble tumor necrosis factor receptor type II (sTNF-RII), interleukin IL-1 receptor antagonist (IL-1ra), and psycho-physiological adjustments that may lead to BC.

CONCLUSIONS

Exposure to multiple ACEs appears a risk factor for BC development in adulthood. Although the clinical relevance of findings such as this is ambiguous, the review added evidence for a link between the presence of childhood adversity and BC occurrence, pointing to psychological, hormonal, and immunological dysregulations.

The nested hierarchy of self and its trauma: In search for a synchronic dynamic and topographical re-organization

The sense of self has always been a topic of high interest in both psychoanalysis and most recently in neuroscience. Nowadays, there is an agreement in psychoanalysis that the self emerges from the relationship with the other (e.g., the caregiver) in terms of his/her capacity to attune, regulate, and synchronize with the emergent self of the infant. The outcome of this relational/intersubjective synchronization is the development of the sense of self and its regulatory processes both in dynamic psychology and neuroscience. In this work, we propose that synchrony is a fundamental biobehavioral factor in these dialectical processes between self and others which shapes the brain-body-mind system of the individuals, including their sense of self. Recently in neuroscience, it has been proposed by the research group around Northoff that the self is constituted by a brain-based nested hierarchical three-layer structure, including interoceptive, proprio-exteroceptive, and mental layers of self. This may be disrupted, though, when traumatic experiences occur. Following the three levels of trauma theorized by Mucci, we here suggest how different levels of traumatic experiences might have an enduring effect in yielding a trauma-based topographic and dynamic re-organization of the nested model of self featured by dissociation. In conclusion, we propose that different levels and degrees of traumatic experience are related to corresponding disruptions in the topography and dynamic of the brain-based three-layer hierarchical structure of the self.

Rediscovering latent trauma: An adopted adult's perspective

Though studies showing a causal relationship between adoption and trauma are scarce, there is enough cross-disciplinary research to suggest such a connection. Likewise, there are many adult adopted persons, like myself, who see their adoption narratives as traumatic in one way or another. Mental health outcomes for adopted people also indicate adoption might be a source of and not just a preventative measure against trauma. In this paper, I utilize an autoethnographic approach to highlight the relationship between infant adoption and what I refer to as "latent traumatic memories." Recounting several major life events that led to traumatic upheavals in my understanding of my own identity as an adopted person, I then relate my story to current research on trauma experienced very early in life and how it is remembered implicitly in the body. My account, I argue, highlights the need to further research adopted people's evolving views about their adoption and how and to what extent certain events in adulthood precipitate the rediscovery of latent trauma.

Integrative Model of Human-Animal Interactions: A One Health-One Welfare Systemic Approach to Studying HAI

The Integrative Model of Human-Animal Interactions (IMHAI) described herewith provides a conceptual framework for the study of interspecies interactions and aims to model the primary emotional processes involved in human-animal interactions. This model was developed from theoretical inputs from three fundamental disciplines for understanding interspecies interactions: neuroscience, psychology and ethology, with the objective of providing a transdisciplinary approach on which field professionals and researchers can build and collaborate. Seminal works in affective neuroscience offer a common basis between humans and animals and, as such, can be applied to the study of interspecies interactions from a One Health-One Welfare perspective. On the one hand, Jaak Panksepp's research revealed that primary/basic emotions originate in the deep subcortical regions of the brain and are shared by all mammals, including humans. On the other hand, several works in the field of neuroscience show that the basic physiological state is largely determined by the perception of safety. Thus, emotional expression reflects the state of an individual's permanent adaptation to ever-changing environmental demands. Based on this evidence and over 5 years of action research using grounded theory, alternating between research and practice, the IMHAI proposes a systemic approach to the study of primary-process emotional affects during interspecies social interactions, through the processes of emotional transfer, embodied communication and interactive emotional regulation. IMHAI aims to generate new hypotheses and predictions on affective behavior and interspecies communication. Application of such a model should promote risk prevention and the establishment of positive links between humans and animals thereby contributing to their respective wellbeing.

Repeated maternal non-responsiveness to baby's crying during postpartum and infant neuropsychological development: The Japan Environment and Children's Study

BACKGROUND

Longitudinal adverse effects of neglect-related behaviors during postpartum, especially repeated maternal non-responsiveness to the crying baby on their neuropsychological developmental trajectory, have not been fully clarified.

OBJECTIVE

This study aimed to examine the association between postpartum maternal neglect-related behaviors and infant neuropsychological outcomes using the Japan Environment and Children's Study (JECS).

PARTICIPANTS AND SETTING

JECS data on 100,286 mother-child pairs were analyzed. Explanatory variables were "frequency of leaving the baby alone at home" (i.e., leaving the baby alone at home) and "frequency of ignoring the baby when he or she cries" (i.e., ignoring the crying baby) at one month postpartum. The outcomes were measured using the Japanese version of the Ages & Stages Questionnaires-Third Edition (J-ASQ-3).

METHODS

After multiple imputations, logistic regression analysis was performed to evaluate the association between neglect-related behaviors and the J-ASQ-3 domains at each age.

RESULTS

The "sometimes or more" group of "ignoring the crying baby" from six months to three years reported relatively consistent significant associations with developmental delay in communication (maximum adjusted odds ratio [aOR]: 1.456, 95% confidence interval [CI]: 1.261-1.682), gross motor (maximum aOR: 1.279, 95% CI: 1.159-1.411), fine motor (maximum aOR: 1.274, 95% CI: 1.113-1.457), problem-solving (maximum aOR: 1.178, 95% CI: 1.104-1.256), and personal-social domains (maximum aOR: 1.326, 95% CI: 1.255-1.402). The adverse effects of "leaving the baby alone at home" disappeared in many domains by the age of one.

CONCLUSIONS

Repeated maternal non-responsiveness to baby's crying during postpartum may suppress multiple neuropsychological development during early childhood.

Unshakeable Hope: Pandemic Disruption, Climate Disruption, and the Ultimate Test of Theologies of Abundance

Leaders on the forefront of the rapidly escalating climate crisis continually seek effective strategies to help communities stay engaged without burning out or spiraling into despair. This paper examines the concept of adaptive change for its potential to reframe disruption and intentionally harness its potential for building resilience in both practical and psychological ways. In particular, social science suggests that secure communal bonds lay the foundation for the adaptive ability to build resilience through and from disruption. Swiss history offers an intriguing example of this phenomenon: held up as a model for its social, political, and ecological resilience, Swiss democracy evolved as part of the restructuring of society after a series of disruptive historical pandemics. This paper uses the Swiss example and the current COVID-19 (Coronavirus Disease) pandemic in order to explore the potential of transcendent and adaptive sociological and theological frameworks for the development of robust concepts of resilience in the face of climate destabilization. It further argues that a wide theological interpretation of Eucharistic abundance offers a lens through which to claim the liberative resurrection of disruptions, even, or perhaps especially, in the extreme case of human or planetary annihilation.

Is shame the missing link between traumatic experiences and posttraumatic stress disorder in Burundian children living on the streets?

BACKGROUND

Shame is an emotion reflecting an anticipated social devaluation of the self. It is strongly associated with experiences of humiliation and rejection in early life. Individuals suffering from posttraumatic stress disorder (PTSD) often struggle with shame. However, little is known about how shame contributes to the development and maintenance of PTSD symptoms in children. The present study investigated the ways childhood exposure to human-induced traumatic events promotes a coping mechanism of defeat and withdrawal facilitated by the experience of shame. We tested a dose-response relationship between lifetime experienced traumatic event types and PTSD in children using shame as a mediator.

METHODS

We conducted semi-structured interviews with 33 male children who lived and worked on the streets of Bujumbura, the capital of Burundi at the time of data collection. We assessed self-reported PTSD symptom severity, lifetime traumatic event load, violence experienced on the streets, and shame intensity.

RESULTS

Mediation analyses revealed a significant indirect effect of lifetime traumatic events on PTSD symptom severity through shame intensity and a significant indirect effect of violence experienced on the streets on PTSD symptom severity through shame intensity.

CONCLUSION

Our study suggests the mediating role of shame between traumatic experiences as well as violent experiences and PTSD symptom severity in children living on the streets. Shame in children suffering from PTSD seems to play a crucial role in the development and maintenance of PTSD symptoms.

When the Good Object is also a Thief: A Memoir of Adoption

This contemporary Kleinian memoir explores the possible existence of an intrapsychic, adoption-specific preoedipal triad including child, birth mother, and adoptive mother that can shape the emerging mind. As an intrapsychic construct, the adoption triad comes to exist in the infantile mind, requiring that adoptees contend with four additional part-object maternal representations: a villain (bad birth mother), a victim (good birth mother), a rescuer (good adoptive other), and a thief (bad adoptive mother). The psychic complexities of this possible adoption triad are explored, with an eye to how it might illuminate the psychosocial challenges experienced by some adoptees, including dysregulated behavior, rage, dissociation, and shame. To this end, Bion's ideas regarding presymbolic, nondefensive communication and Winnicott's understanding of use of the object are invoked. Expanding the preoedipal paradigm of adoption to include the possibility of an intrapsychic, adoption-specific maternal triad can enhance our understanding of the psychology of adoption, as well as highlight the need to consider the ways in which internal objects can exist simultaneously in both dyadic and triadic paradigms.

Predictors of Intimate Partner Violence Victimization by Multiple Partners Over a Period of 8 Years

Intimate partner violence (IPV) is a pervasive social issue with broad physical and mental health implications. Although 35%-56% of women report IPV victimization with more than one violent partner, few studies have identified factors that increase the risk of experiencing IPV across multiple partners (i.e., IPV reengagement). In the current study, multilevel modeling was used to examine the roles of trauma exposure, mental health, and sociodemographic factors in the risk for reengagement in a sample of women (N = 120) with IPV victimization. Participants were drawn from a randomized control trial of an intervention for mothers who had experienced IPV. The results revealed that more psychological but less sexual IPV was associated with increased reengagement. Higher degrees of posttraumatic reexperiencing symptoms were associated with less reengagement. Depressive symptoms were also significantly associated with reengagement such that lower levels of positive affect and increased somatic symptoms were associated with increased reengagement. Higher income levels and less housing instability were associated with more reengagement, β_range = -.13-.16. Finally, compared to the control condition, participation in the intervention program was significantly associated with lower levels of reengagement at 8-year follow-up, β = -.75, p = .001. These findings suggest that it is not what happened (i.e., experiences of abuse) but rather a woman's posttraumatic experience (i.e., posttraumatic stress and depressive symptoms) that creates risk for reengagement. The findings support the long-term effectiveness of a brief intervention in reducing reengagement.

Eating in Synch: An investigation of parent-infant behaviour coordination during feeding interactions

During feeding, parents have been described to move their mouth as if they were eating themselves. Such matching of behaviours between parents and their infants during face-to-face interactions represents an example of behavioural synchrony. To date, however, the function of these synchronous eating-like mouth movements by the caregiver remains unexplored. To address this question, two competing hypotheses were tested: 1) the instructional hypothesis proposing that parents make eating-like mouth movements, such as opening and closing their mouth, to demonstrate to their infants what they need to do; 2) the mimicry hypothesis suggesting that parents imitate their infant's mouth actions to enhance affiliation. To test these hypotheses, we examined the temporal dependencies between parents' and infants' mouth movements. We reasoned that parents' mouth movements would occur before their infants' if they serve an instructional purpose, but that they would happen after, if parents mimic their infants. Additionally, we expected that parents' matching mouth movements would be more likely when their infants looked at them in both cases. To examine these hypotheses, fifteen caregivers were observed as they were feeding their six-month-old infants. Time-window sequential analysis was conducted to quantify how likely parents were to display mouth opening and closing before or after their infants did. The results revealed that parents' mouth movements were more likely to follow infants' movements and are thus in line with the mimicry hypothesis. Interestingly, these mouth movements of parents were independent of infant's gaze.

Early shaming experiences and psychological distress: The role of experiential avoidance and self-compassion

OBJECTIVES

Early shaming experiences have been suggested to be associated with later psychopathological symptoms. Understanding this relationship is complex, due to a number of psychological processes potentially influencing this. Therefore, the aim of the current study was to further explore the nature of the mediating effect of experiential avoidance in the association between early shame experiences and psychological distress, and whether self-compassion moderates this relationship by mitigating the effects of this.

DESIGN

A cross-sectional design was conducted using self-report measures of early shaming experiences, experiential avoidance, self-compassion, and psychological distress.

METHOD

An online study of 556 participants, comprised of participants from the general population and university students participated within this online study.

RESULTS

The moderated mediation model explained 51% of variance within depressive symptoms. Experiential avoidance was found to mediate the association between early shaming experiences and depressive symptoms. This mediating relationship was shown to be moderated by self-compassion, with higher levels of self-compassion being associated with lower levels of depressive symptoms across all levels of experiential avoidance levels (low, medium, and high).

CONCLUSION

These findings suggest that self-compassion may play a significant buffering role within attenuating the effects of experiential avoidance associated with depressive symptoms. Such findings present important clinical and theoretical implications in further understanding the protective role of self-compassion within early shaming experiences and the relationship between depressive symptoms.

PRACTITIONER POINTS

Early shaming experiences have been linked to later psychological distress. Experiential avoidance identified a core underlying psychological process in the relationship between early shaming experiences and psychological distress. Self-compassion offers a range of protective features that may alleviate the effects of experiential avoidance and depressive symptoms. Self-compassion-based interventions that target experiential avoidance may offer greater reductions within depressive symptoms.

Mother-Newborn Couplet Care from theory to practice to ensure zero separation for all newborns

With an increasing awareness of the importance of nurturing care and within a framework of Infant- and Family-Centred Developmental Care (IFCDC), zero separation, keeping parent and infant in continuous close physical and psychological proximity to each other, is key. In modern neonatology, high technological and pharmaceutical treatments are consistently integrated with caregiving considerations. Mother-Newborn Couplet Care is a concept of care where the dyad of the ill or prematurely born infant and the mother, needing medical care of her own, are cared for together, from the birth of the baby to its discharge. Mother-Newborn Couplet Care requires systems changes in both obstetrics and paediatrics considering planning and organisation of care, equipment and design of units. Accordingly, strong leadership setting clear goals and changing the professional mindset by providing targeted education and training is crucial to ensure the warranted high quality of care of all mother-baby dyads.

Prenatal expectations and other psycho-social factors as risk factors of postnatal bonding disturbance

The mother's bond to her baby starts to develop during pregnancy, and it is related to the baby's attachment. We study how the mother's prenatal expectations of her unborn baby, the mother's adult relationships, and postnatal psycho-social factors (stress, depression, and anxiety) are related to the risk of bonding disturbance. The study comprised 1398 mothers and their unborn babies assessed both during pregnancy and when the babies were 3 months old (47.7% girls). The mother's risk of bonding disturbance was investigated using Brockington's Postpartum Bonding Questionnaire. According to the results, 71 (5.1%) of all the mothers in the study had a risk of a bonding disturbance. In a final adjusted logistic regression model, the most important risk factors were the mother's inability to form positive expectations about relationships with the baby during the third trimester of pregnancy (AOR = 7.78, p ≤ .001), maternal postnatal stress (AOR = 4.95, p ≤ .001) and maternal postnatal depression (AOR = 3.46, p ≤ .01). The results challenge healthcare professionals to screen pregnant mothers to identify at-risk groups for post-partum bonding disturbances. Intervention programs to prevent the development of bonding disturbances, and thus their possible serious consequences for children's development, should be considered.

Prenatal exposure to opioids: Associations between the caregiving environment and externalizing behaviors

Maternal opioid use during pregnancy is a rapidly growing public health crisis and is associated with a range of adverse developmental outcomes including externalizing behaviors among exposed children. Recent work has highlighted the role of indirect pathways from prenatal opioid exposure to behavioral outcomes through aspects of the caregiving environment, including parenting. This review highlights maternal sensitivity and related aspects of the caregiving environment that may impact the development of externalizing behaviors among children with a history of prenatal exposure to opioids. We conclude by providing suggestions for future directions in research examining development among children with prenatal opioid exposure.

Validation and cross-cultural comparisons of the German Childhood Attachment and Relational Trauma Screen (CARTS)

Background: Child maltreatment is embedded in a complex system of familial, societal and cultural influences. However, the microsystemic framework in which child maltreatment occurs has not been sufficiently accounted for in previous measures of trauma history. In order to include this relational context, a novel survey method, the Childhood Attachment and Relational Trauma Screen (CARTS), was developed, focusing specifically on the familial environment and childhood attachment relationships. Prior validation studies of the English and Italian versions of the CARTS have tended to support its use. Objective: The current study aims at evaluating the psychometric properties of the German version of the CARTS as well as conducting cross-cultural comparison analyses. It is part of an international research project of the Global Collaboration on Traumatic Stress which was initiated by the International Society for Traumatic Stress Studies (ISTSS). Method: The sample consisted of n = 140 participants from the German general population aged 18 or older. Further trauma specific measures (GPS, BSI-18, CTQ-SF, ECR-R, PBI) were included for validation. Cross-cultural comparisons were conducted with a German subsample of students in reference to Italian- and English-speaking student samples. Results: Most CARTS subscales showed acceptable internal consistency. Statistically significant relationships were observed with other measures of childhood trauma exposure and parental bonding, as well as PTSD- and other distress-related outcomes. Comparing the German-speaking sample with Italian- and English-speaking samples indicated significant differences with regard to childhood attachment and child maltreatment. Conclusion: The present findings are consistent with previous results concerning the CARTS and advance the validation of this novel survey method within German-speaking samples. Further, the CARTS appears to be sensitive to cross-sample differences in childhood attachment and child maltreatment. Further psychometric evaluations of the CARTS in other languages and within further German-speaking samples are needed.

Effects of Early Vocal Contact in the Neonatal Intensive Care Unit: Study Protocol for a Multi-Centre, Randomised Clinical Trial

Preterm infants are at risk for developing altered trajectories of cognitive, social, and linguistic competences compared to a term population. This is mainly due to medical and environmental factors, as they are exposed to an atypical auditory environment and simultaneously, long periods of early separation from their parents. The short-term effects of early vocal contact (EVC) on an infant’s early stability have been investigated. However, there is limited evidence of its impact on the infant’s autonomic nervous system maturation, as indexed by heart rate variability, and its long-term impact on infant neurodevelopment. Our multi-centric study aims to investigate the effects of EVC on a preterm infant’s physiology, neurobehaviour, and development. Eighty stable preterm infants, born at 25–32 weeks and 6 days gestational age, without specific abnormalities, will be enrolled and randomised to either an intervention or control group. The intervention group will receive EVC, where mothers will talk and sing to their infants for 10 min three times per week for 2 weeks. Mothers in the control group will be encouraged to spend the same amount of time next to the incubator and observe the infant’s behaviour through a standard cluster of indicators. Infants will be assessed at baseline; the end of the intervention; term equivalent age; and 3, 6, 12, and 24 months corrected age, with a battery of physiological, neurobehavioral, and developmental measures. Early interventions in the neonatal intensive care unit have demonstrated effects on the neurodevelopment of preterm infants, thereby lowering the negative long-term effects of an atypical auditory and interactional environment. Our proposed study will provide new insight into mother–infant early contact as a protective intervention against the sequelae of prematurity during this sensitive period of development. Early intervention, such as EVC, is intuitive and easy to implement in the daily care of preterm infants. However, its long-term effects on infant neurodevelopment and maternal sensitivity and stress are still unclear. Trial Registration: NCT04759573, retrospectively registered, 17 February 2021.

Validation and Adaptation of the Slovak Version of the Childhood Trauma Questionnaire (CTQ)

Background: Previous research has shown a strong relationship between childhood trauma and worsened physical and mental health. The Childhood Trauma Questionnaire (CTQ) is a commonly used tool assessing early traumatic experiences. The aim of this study was to verify the psychometric properties of the Slovak version of the CTQ. Methods: Data were collected on a representative Slovak sample (N = 1018, mean age 46.24 years, 48.7% of men). The dimensional structure of the CTQ was tested by confirmatory factor analysis (CFA); convergent validity was assessed using the Adverse Childhood Questionnaire (ACE-IQ). Results: CFA confirmed the standard 5-factor CTQ model. The subscales of the CTQ and the ACE-IQ questionnaires showed moderate to high correlations. The internal consistency of the scale was found to be acceptable. Emotional neglect (EN) was reported in 48.1%, physical neglect (PN) in 35.8%, emotional abuse in 15.8%, physical abuse (PA) in 11.0%, and sexual abuse (SA) in 9.1% of the Slovak population, according to the scoring, when even low abuse or neglect is assessed as trauma. Conclusion: The CTQ questionnaire fulfilled the validation criteria and appeared to be a suitable method for assessing retrospectively reported childhood trauma experiences in the Slovak population.

The Influence of Youth Gender and Complex Trauma on the Relation Between Treatment Conditions and Outcomes in Therapeutic Residential Care

Complex trauma (CT) is the experience, or witness, of prolonged abuse or neglect that negatively affects children's emotional and psychological health. Youth in residential care experience higher incidences of complex trauma than youth in community-based care, with notable gender differences and presentation of psychological symptoms. This study examined the effects of trauma-informed residential care and the relation between CT and gender. A sample (n = 206) from an evaluation of a youth psychiatric residential facility in the Midwest that transitioned from a traditional care model to a trauma-informed care model was used. A hierarchical regression was used to model the main effects of model of care, gender, CT, length of stay, and crisis response on treatment outcomes; and the moderating effects of gender and CT. The results support the high prevalence of CT in residential care populations. The final model explained 30.2% of the variance with a statistically significant interaction between gender and length of stay in treatment, indicating that longer lengths of stay in treatment are associated with less change in functional impairment for girls than boys. Youth gender and prior trauma are important factors to consider when monitoring experiences and treatment outcomes in youth residential care.

Drawing on Dialogues in Arts-Based Dynamic Interpersonal Therapy (ADIT) for Complex Depression: A Complex Intervention Development Study Using the Medical Research Council (UK) Phased Guidance

Aim: The aim of this paper is to present the development and evaluation of an art psychotherapy brief treatment method for complex depression for patients referred to mental health services.

Background: Art Psychotherapy literature describes a range of processes of relational change through the use of arts focused and relationship focused interventions. Complex depression has a prevalence of 3% of the population in the West and it is recorded that in 2016 only 28% of that population were receiving psychological treatment. This study was developed to test the hypothesis of whether an accessible and acceptable approach to the treatment of complex depression could be developed in relation to existing evidence-based practice within mental health services.

Method: The United Kingdom Medical Research Council phased guidance for complex intervention development was used (Phases I and II) to develop the intervention. The process included producing a literature overview, systematic description of clinical practice, including a logic model and a clinical protocol. The art psychotherapy protocol described an arts-based dynamic interpersonal therapy approach (ADIT), offered 1:1 over 24 sessions. Further to this the intervention was tested for referrer acceptability. The intervention is in the early stages of evaluation, using changes to the patient's depression and anxiety measured pre- and post-treatment with a follow-up measure at 3 months following completion of treatment.

Results: Phase I of the study provided a good basis for developing a logic model and protocol. The authors found that there was good clinical consensus about the use of a structured clinical art psychotherapy method (ADIT) and the literature overview was used to support specific examples of good practice. The verification of clinical coherence was represented by a logic model and clinical protocol for delivering the intervention. The acceptability study demonstrated very high levels of acceptability for referrers reporting that (i) ADIT was acceptable for patients with complex/major depression, (ii) that they were likely to refer to ADIT in the future (iii) that the use of arts was likely to improve accessibility (iv) the use of arts was likely to improve outcomes and (v) that offering ADIT was an effective use of mental health resources.

Discussion: Phase I of this intervention development study (following MRC guidance) demonstrated theoretical and practice coherence resulting in a clinical protocol and logic model. Whilst Phase II of this study showed promising results, Phase II would need to be sufficiently scaled up to a full trial to further test the intervention and protocol.

Development and Health of Adults Formerly Placed in Infant Care Institutions - Study Protocol of the LifeStories Project

A growing volume of research from global data demonstrates that institutional care under conditions of deprivation is profoundly damaging to children, particularly during the critical early years of development. However, how these individuals develop over a life course remains unclear. This study uses data from a survey on the health and development of 420 children mostly under the age of three, placed in 12 infant care institutions between 1958 and 1961 in Zurich, Switzerland. The children exhibited significant delays in cognitive, social, and motor development in the first years of life. Moreover, a follow-up of a subsample of 143 children about 10 years later revealed persistent difficulties, including depression, school related-problems, and stereotypies. Between 2019 and 2021, these formerly institutionalized study participants were located through the Swiss population registry and invited to participate once again in the research project. Now in their early sixties, they are studied for their health, further development, and life-course trajectories. A mixed-methods approach using questionnaires, neuropsychological assessments, and narrative biographical interviews was implemented by a multidisciplinary team. Combining prospective and retrospective data with standardized quantitative and biographical qualitative data allows a rich reconstruction of life histories. The availability of a community sample from the same geographic location, the 1954-1961 cohort of the Zurich Longitudinal Studies, described in detail in a paper in this issue (Wehrle et al., 2020), enables comparison with an unaffected cohort. This article describes the study design and study participants in detail and discusses the potential and limitations of a comparison with a community sample. It outlines a set of challenges and solutions encountered in the process of a lifespan longitudinal study from early childhood into the cusp of old age with a potentially vulnerable sample and summarizes the lessons learned along the way.

The direct and indirect impact of trauma types and cumulative stressors and traumas on executive functions

The goal was to measure the effects of trauma types, cumulative trauma, posttraumatic stress disorder (PTSD), existential annihilation anxiety (EAA), and posttraumatic growth (PTG) on executive functions. The study sample consists of 1155 from Egypt and Kuwait. Measures included adults working memory deficits (WMD) and inhibition deficits (ID), and cumulative stressors and traumas (CST) and trauma types, PTSD, EAA, and PTG. We used Stepwise regression and PROCESS macro to analyze the data. Results indicated that survival and cumulative traumas have direct effects on a lower WMD and ID, attachment traumas and gender discrimination by parents have direct impacts on higher WMD and ID, while personal identity, status identity, secondary trauma, gender discrimination by society, community violence do not have any direct effects on WMD or ID. All traumas have indirect effects on higher WMD or/and ID via PTSD. Gender discrimination by society, community violence, and CST has an additional indirect higher impact on WMD and ID via EAA. There were indirect trajectories from survival trauma, personal identity, status identity trauma, secondary trauma, gender discrimination by society, and CST on lower WMD or/and ID via PTG. Attachment trauma, gender discrimination by parents, perpetration traumas, and community violence were not associated with PTG and its trajectories of lower WMD or/and ID. We discussed the research and clinical implication for these results.

Neonatal male circumcision is associated with altered adult socio-affective processing

BACKGROUND

Neonatal male circumcision is a painful skin-breaking procedure that may affect infant physiological and behavioral stress responses as well as mother-infant interaction. Due to the plasticity of the developing nociceptive system, neonatal pain might carry long-term consequences on adult behavior. In this study, we examined whether infant male circumcision is associated with long-term psychological effects on adult socio-affective processing.

METHODS

We recruited 408 men circumcised within the first month of life and 211 non-circumcised men and measured socio-affective behaviors and stress via a battery of validated psychometric scales.

RESULTS

Early-circumcised men reported lower attachment security and lower emotional stability while no differences in empathy or trust were found. Early circumcision was also associated with stronger sexual drive and less restricted socio-sexuality along with higher perceived stress and sensation seeking.

LIMITATIONS

This is a cross-sectional study relying on self-reported measures from a US population.

CONCLUSIONS

Our findings resonate with the existing literature suggesting links between altered emotional processing in circumcised men and neonatal stress. Consistent with longitudinal studies on infant attachment, early circumcision might have an impact on adult socio-affective traits or behavior.

Childhood maltreatment type and severity predict depersonalization and derealization in treatment-seeking women with posttraumatic stress disorder

The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is characterized by clinically significant dissociative symptoms in addition to typical PTSD symptoms. Prior research has found childhood maltreatment contributes to dissociation and D-PTSD susceptibility, but more nuanced questions about the nature of childhood maltreatment remain unexplored. We investigated how childhood maltreatment type and severity are associated with the dissociative symptoms of D-PTSD among women with PTSD (N = 106) receiving psychiatric care at a program specializing in trauma-related disorders. Participants completed self-report surveys of psychiatric symptoms and prior trauma exposure including the PTSD Checklist for DSM-5, the Dissociative Subtype of PTSD Scale, and the Childhood Trauma Questionnaire. We used multivariate linear regression to model the association of childhood maltreatment types and dissociation. In our final model childhood emotional abuse and physical abuse significantly predicted the dissociative symptoms of D-PTSD. This suggests childhood maltreatment type and severity, in particular of emotional and physical abuse, are associated with the dissociative symptoms of D-PTSD. This work points toward potential etiological contributions to D-PTSD.

It Takes More Than Two to Tango: Building Secure Attachment Through Hypnotic and Ego-State Relationships

This article explores how hypnotic strategies can be used within a polyvagal science framework to help create more secure attachment within the therapeutic relationship, as well as within the client in terms of ego-state relationships. Principles of safety and connection are emphasized, along with specific strategies to access the attachment circuits of the ventral vagal system, including the necessity of being present with the client without agenda. Uses of hypnosis related to safety and connection and methods to work with the center core self to facilitate empowerment, self-cohesion, and conflict-free experience are also reviewed. From an ego-state therapy perspective, a discussion of hypnosomatic approaches to connect with preverbal, nonverbal, and somatic aspects of self to accomplish developmental repair and facilitate secure attachment is also offered, along with case examples. A three-step model, which attempts to integrate polyvagal, somatic, and hypnotic approaches, is offered by the author to help structure corrective experiences for clients with trauma.

Pinpointing Neural Correlates of Attachment in Poly-Drug Use: A Diffusion Tensor Imaging Study

An increasing amount of evidence indicates the significance of attachment in the etiology of poly-drug use disorder (PUD). The aim of this study was to investigate associations between PUD and adult attachment in particular, with a focus on white matter (WM) fiber tract integrity. For this purpose, we selected several regions-of-interest based on previous findings which were examined for their role in PUD and estimated whole-brain associations between adult attachment and WM integrity. A total sample of 144 right-handed males were investigated (Age: M = 27; SD = 4.66). This included a group of patients diagnosed with PUD (n = 70) and a group of healthy controls (HC; n = 74). The Adult Attachment Scales (AAS) was applied to assess attachment attitudes in participants. Diffusion Tensor Imaging was used to investigate differences in WM integrity. The findings suggest substantially less attachment security in PUD patients compared to HC. Furthermore, PUD patients exhibited reduced integrity in WM fiber tracts, most pronounced in the bilateral corticospinal tract, the fronto-occipital fasciculus, and the right inferior longitudinal fasciculus. However, these results were not controlled for comorbid depressiveness. With regard to associations between adult attachment and WM integrity, the results for PUD patients indicate a negative relationship between "Comfort with Closeness" and the structural integrity of a cluster comprising parts of the right anterior thalamic radiation, the inferior fronto-occipital fasciculus and the uncinate fasciculus. Despite being limited by the cross-sectional design of this study, the results emphasize the significance of attachment in PUD etiology, both at a behavioral and a neurological level. Largely in line with previous research, the findings revealed tentative links between adult attachment and WM fiber tracts related to cognitive and affective functions in PUD patients.