Epidemiology of multiple childhood traumatic events: child abuse, parental psychopathology, and other family-level stressors

Early adverse childhood experiences and preschoolers' attentional regulation: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) profoundly disrupt preschoolers' attentional regulation development. Different patterns of ACEs may be associated with different attentional regulation outcomes.

OBJECTIVE

Drawing from developmental systems theory and attachment theory, this study aimed to identify distinct patterns of early ACEs at age three and examined the associations of these patterns with preschoolers' attentional regulation at age five.

PARTICIPANTS AND SETTING

This study used the two waves of longitudinal data from the Future of Families and Child Wellbeing Study (N = 4457).

METHODS

First, this study applied latent class analysis (LCA) across nine indicators of ACEs at age three. Second, class membership was examined for associations with preschoolers' attentional regulation at age five.

RESULTS

LCA identified four latent classes of ACEs: separation (41.2 %), parental incarceration (33 %), family dysfunction (20.8 %), and child abuse (5 %). Children in the child abuse class exhibited lower levels of attentional regulation than those in the family dysfunction class (0.33 standard deviation difference, p < .01) or separation class (0.48 standard deviation difference, p < .001). Children in the parental incarceration class demonstrated lower levels of attentional regulation than those in the separation class (0.63 standard deviation difference, p < .001).

CONCLUSIONS

Findings provide implications for the need to prevent early child abuse and incorporate trauma-informed intervention programs to support preschoolers' attentional regulation during school-entry age.

Associations between early child adversity and lifetime suicide attempts among gender diverse individuals: A moderated mediation

BACKGROUND

This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women).

OBJECTIVE

To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators.

PARTICIPANTS AND SETTINGS

We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019.

METHODS

Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity.

RESULTS

LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity.

CONCLUSIONS

By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.

Early Child Adversity and Delinquent Behavior in Foster Care Youth: Do Future Expectations and Sexual Identity Moderate the Mediating Role of Posttraumatic Stress?

Purpose

Delinquency in youth is a significant public health concern for individuals who experienced adversity and complex trauma as children. The present study explored the longitudinal associations between adverse child experiences and future engagement in delinquent behavior.

Methods

Using a sample of 1,245 foster youth who are aging out of the child welfare system, mediation, moderation, and moderated mediation analysis was used to test the mechanistic role of post-traumatic stress symptoms and the moderating role of sexual identity and positive future expectations on engagement in delinquent behavior.

Results

Results showed a positive and significant association between adverse child experiences and engagement in delinquent behavior. Post-traumatic stress symptoms partially mediated the ACEs-delinquency relationship. In addition, sexual minority youth and youth who were less optimistic about the future, but who experienced more ACEs, were at risk for heightened levels of post-traumatic stress.

Conclusions

Interventions that promote positive future outlooks may minimize the psychological sequelae of early child adversity and delinquent behavior particularly when tailored to the needs of sexual minority youth.

The Relationship of Risky Online Behaviors and Adverse Childhood Experiences to Online Sexual Victimization Among Korean Female Adolescents

Prior research has demonstrated that online sexual victimization (OSV) is a significant social problem and is associated with adolescents' negative developmental outcomes. However, it remains unclear whether adolescents' risky online behaviors and offline victimization are related to the risk of OSV. The present study examined whether female adolescents' risky online behaviors (mood regulation through the Internet, ingratiating behavior, disclosure of personal information, harassing behavior, talking with someone met online, and sexual behavior) and offline victimization (adverse childhood experiences [ACEs]) would be associated with OSV. This study recruited female adolescents and their mothers within six metropolitan cities and provinces of residential areas of South Korea. A total of 509 female adolescents participated in the survey (aged 13-18 years). The present study employed multivariate regression to examine the relationship of risky online behaviors and offline victimization to the experience of OSV. Female adolescents' risky online behaviors (harassing behavior, talking with someone met online, and sexual behavior) were significantly associated with OSV, and those with high exposure to maltreatment and family dysfunction during childhood were more at risk of OSV than adolescents with low exposure to ACEs. The results suggest that it is important to address the effects of risky online behaviors and exposure to offline victimization on female adolescents' sexual victimization online. Identifying risky online behaviors and offline victimization related to OSV can help researchers and practitioners further understand female adolescents' online victimizations in the context of offline and online dynamics.

How adverse and benevolent childhood experiences influence depression and suicidal ideation in Chinese undergraduates: a latent class analysis

BACKGROUND

There has been minimal research on the role of benevolent childhood experiences (BCEs) and how such events may offer protection from the insidious effects of adverse childhood experiences (ACEs) or later in life.

OBJECTIVES

This research aims to learn how BCEs and ACEs interact to affect adolescents' psychological distress.

METHODS

Cross-sectional survey was conducted in three cities (Xuzhou, Nanjing, and Wuhan) in China from March 2021 to May 2021. Latent class analysis (LCA) was used to classify the patterns of ACEs and BCEs. We adopted hierarchical multivariable regression to examine the influences of ACEs and BCEs on depression and suicidal ideation.

RESULTS

To explore the relationship between childhood experience and suicidal ideation and depression, LCA revealed three patterns of ACEs: (1) emotional abuse (10.57%); (2) high ACEs (0.55%); and (3) low ACEs classes (88.88%). Adolescents with emotional abuse (depression: OR = 3.82, 95%CI = 2.80-5.22, P < 0.001; suicidal ideation: OR = 5.766, 95%CI = 3.97-8.38, P < 0.001) and high ACEs class (suicidal ideation: OR = 5.93, 95%CI = 1.19-29.66, P < 0.05) had an increased risk of psychological distress (reference: low ACEs). LCA revealed four patterns of BCEs: (1) relationship support (14.54%); (2) low BCEs (4.85%); (3) high BCEs (55.34%); and (4) high quality of life classes (25.28%). Adolescents with a high quality of life (depression: OR = 0.09, 95%CI = 0.05-0.16, P < 0.001; suicidal ideation: OR = 0.22, 95%CI = 0.12-0.40, P < 0.001) and high BCEs (depression: OR = 0.05, 95%CI = 0.03-0.09, P < 0.001; suicidal ideation: OR = 0.15, 95%CI = 0.09-0.26, P < 0.001) protected the mental health of adolescents (reference: low BCEs).

CONCLUSIONS

High ACEs and emotional abuse classes were significantly associated with poorer mental health symptoms, including suicidal ideation and depression. In contrast, high BCEs and high quality of life classes were associated with better mental health. These findings point out that it is more necessary to identify and support victims of ACEs, and it is urgent to increase BCEs in early childhood.

Childhood adversities and mental health outcomes: Does the perception or age of the event matter?

The current study extends knowledge regarding the individual contribution of different adverse experiences to mental health symptoms in late adolescence by including the perception of how upsetting each experience was to the adolescent and the age at the first occurrence. We also sought to move beyond sum scores of adverse experiences by using a person-centered approach to classifying individuals with similar co-occurrence of adversities. The data came from a longitudinal study of maltreatment on adolescent development (N = 454). Self-reported childhood adversities were assessed at Wave 4 (average of 7 years postbaseline) and examined with respect to current mental health symptoms (depression, PTSD, anxiety, and externalizing). Although the adversity sum score was a potent predictor of all mental health outcomes, the results indicated that the use of a sum score obscures information about the importance of individual adversities. Additionally, the influence of age of occurrence varied based on the adversity and outcome, while the perception of the event did not add much unique variance. Finally, the latent class analyses provided unique information about the patterns of co-occurring adversity in this sample, and that membership in either of the multiple-adversity classes was associated with more mental health symptoms.

Dual trajectories of parenting self-efficacy and depressive symptoms in new, postpartum mothers and socioemotional adjustment in early childhood: A growth mixture model

Postpartum depression and low parental self-efficacy (PSE) are risk factors for poor child behavior. Little is known, however, about the course of dual trajectories of cooccurring depressive symptoms and PSE or its impact on children's socioemotional development. This study sought to identify trajectories of postpartum PSE and depressive symptoms in new, first-time mothers using growth mixture modeling. Results demonstrated a class of women with "low risk" (88.8%) who manifested low levels of depression and high levels of PSE during the postpartum period; a second group of women, labeled "early risk" (6.3%) with high levels of depression that decreased over time but lower levels of PSE that remained fairly stable; and a final trajectory group deemed the "late-risk" class (4.9%) with initially low levels of depression and high levels of PSE that significantly increased and decreased, respectively, over the period. Early childhood trauma, parenting stress, and poor parenting practices were associated membership in a high-risk class. Mothers in the high-risk groups reported children with more aggressive and defiant behavior at age 3. We conclude by discussing the implications of our findings for developing effective and sensitive interventions.

Classes of lifetime adversity in emerging adult women and men and their associations with weight status

The aim of this paper was to better understand how child and adult adversities cluster together into classes, and how these classes relate to body weight and obesity. Analyses included 2015 and 2018 data from emerging adults (18-25 years old) who participated in a state surveillance system of 2- and 4-year college students in Minnesota (N = 7475 in 2015 and N = 6683 in 2018). Latent Class Analyses (LCA) of 12 child and adult adversities were run stratified by gender and replicated between 2015 and 2018. The distal outcome procedure and three-step Bolck-Croon-Hagenaars approach were used to estimate predicted BMI means and predicted probabilities of obesity for each class, adjusted for covariates. The LCA identified seven classes in women and 5 in men. In women, BMI ranged from 23.9 kg/m2 in the lowest-BMI class ("Adult Adversities and Childhood Household Dysfunction"; 95% CI: 22.6-25.1) to 27.3 kg/m2 in the highest-BMI class ("High Lifetime Adversities"; 95% CI: 25.9-28.7), a statistically significant difference of 3.4 kg/m2. In men, the adjusted BMIs ranged from 24.6 kg/m2 ("Low Adversities"; 95% CI: 24.3-25.0) to 26.0 kg/m2 ("Childhood Household Mental Illness"; 95% CI: 25.1-26.9), a statistically significant difference of 1.4 kg/m2. The pattern was similar for obesity. These results indicate that specific classes of child and adult adversities are strongly associated with BMI and obesity, particularly in women. A key contribution of LCA appeared to be identification of small classes at high risk for excess weight.

People with dyssomnia showed increased vulnerability to CoVID-19 pandemic: a questionnaire-based study exploring the patterns and predictors of sleep quality using the latent class analysis technique in Indian population

INTRODUCTION

CoVID-19 pandemic and the subsequent lockdown have impacted the sleep quality and the overall wellbeing of mankind. The present epidemiological study measured various aspects of sleep disturbance such as sleep quality, daytime impairments, negative emotionality, sleep hygiene, and well-being associated with CoVID-19 pandemic among the Indian population.

METHODS

This cross-sectional voluntary online survey (using Google form) was communicated across the country from 4th June to 3rd July 2020 through mail and social media applications. The responses received (N = 450) were categorized and validated using the latent class analysis and logistic regression tests respectively, and the classes and subclasses derived were profiled. These techniques are used for the first time in a CoVID-19 sleep study.

RESULTS

Out of the three classes derived from the LCA, people with severe dyssomnia belonging to class 1 (33.3%) showed high daytime impairments, negative emotionality and high vulnerability towards CoVID-19 pandemic measures. In addition, the two subclasses derived from the severe dyssomnia group; one with negative emotionality predominance and the other with excessive daytime sleepiness, were similarly affected by CoVID-19 measures. People with moderate dyssomnia (class 2, 28.5%) showed frequent arousals with daytime impairments and the majority (38.2%) which fell in to class 3, the 'no dyssomnia' category, were not impacted by CoVID-19 pandemic.

CONCLUSION

People with existing sleep problems or those who were vulnerable to the same were the ones affected by CoVID-19 pandemic. Those with inadequate emotional coping styles have showed heightened vulnerability. Proper medical and cognitive interventions are highly recommended for this population. No or moderate dyssomnia categories (class 3 and 2 respectively) were less impacted by CoVID-19.

Expanding our Understanding of Intergenerational Exposure to Adversity

The present study examined the intergenerational continuity of adverse childhood experiences (ACEs) for parents and their adolescent offspring. Data were from a longitudinal study of the effects of maltreatment on adolescent development. Only biological parents (n=185) and one adolescent per parent (n=164) were included in the analytic sample. Self-reported retrospective data on childhood adversities was obtained at the 3^rd wave for parents and the 4^th wave for adolescents (M _age=18.16). For siblings in the study, one was randomly chosen to be included. Latent class analysis was used to examine 1-4 class solutions for parents and adolescents separately and crosstabs were used to show the concordance between assignment to similar classes for the parent and child. Results indicated 2 class solutions for both the parent and child: a high ACEs class characterized by witnessing intimate partner violence and all maltreatment types and a low ACES class characterized by no adversities. Concordance was highest for both parent and child being assigned to the low ACEs class (52% of the dyads). There were 9% of the dyads who were concordant for being assigned to the high ACEs class, indicating less continuity of adversity than expected. Overall the findings show some intergenerational continuity of adversity, but further work should be done to characterize the different patterns of concordance/discordance between parent and child ACEs.

Adverse childhood experiences (ACEs) on mental disorders in young adulthood: Latent classes and community violence exposure

Adverse childhood experiences (ACEs) have significant impacts on mental health outcomes. There is a growing interest in expanding the scope of ACEs beyond household environments. To date, few studies examine multidimensional ACEs with community violence. This study aims to (1) identify underlying ACE classes including exposure to community violence, and (2) investigate the associations of ACE classes with mental disorders in adulthood: depression, anxiety, and Post-Traumatic Stress Disorder (PTSD). We employed Latent Class Analysis (LCA) and logistic regression analyses using the data from the National Longitudinal Study of Adolescent and Adult Health (Add Health). The LCA identified four heterogeneous ACE classes: (1) child maltreatment (17.47%), (2) household dysfunction (14.39%), (3) community violence (5.36%), and (4) low adversity (62.79%). Three logistic analyses showed that the "child maltreatment" class was more likely to report a depression (OR = 1.56, CI = 1.26-1.92), anxiety (OR = 1.31, CI = 1.06-1.62), and PTSD (OR = 1.97, CI = 1.35-2.87) in adulthood compared to the "low adversity" class. Also, the "community violence" class was more likely to have PTSD (OR = 2.15, CI = 1.14-4.06) in adulthood, compared to the "low adversity" class. However, the "household dysfunction" class was not significantly different in all three mental disorders from the "low adversity" class. Findings supported the differences in mental disorders in young adulthood by types of exposures to ACEs. The study highlights the importance of considering types of ACEs exposure for promoting mental health of young adults.

Diversity of adverse childhood experiences among adolescent mothers and the intergenerational transmission of risk to children's behavior problems

RATIONALE

It is important to investigate the diversity and variability among adverse childhood experiences (ACEs) in young mothers because they are likely to experience considerable adverse exposures during childhood as well as challenging environments following childbirth.

OBJECTIVE

The current study used latent class analysis with a diverse sample of young mothers to identify subgroups of mothers based on their adverse childhood experiences (ACEs). Subsequent analyses were conducted to examine class specific differences in maternal mental health postpartum and their children's socio-emotional functioning at eight years of age.

RESULTS

Four classes of participants were identified based on mothers' ACEs, including a high, multiple-risk class, a low-risk class, a high-risk for abuse class, and a high-risk for household dysfunction class. These classes were associated with differences in maternal and child functioning. The low-risk class showed significantly better maternal and child health and well-being than the high-risk class. However, nuanced differences were seen for mothers and their children across all classes; for example, children of mothers in the high-risk for abuse class scored significantly better on internalizing behaviors than children from the high, multiple-risk class, but not better on externalizing behaviors. Further, children of mothers in the high-risk for household dysfunction class scored better than the high, multiple-risk class on externalizing behaviors but not better on scores of internalizing behaviors.

CONCLUSION

Understanding the differences in how certain types of childhood adversity are associated with mothers' and their children's later health and well-being will bolster the use of only a sum score of ACEs for both how we research risk and in supporting clinicians to provide targeted care.

Unique roles of childhood poverty and adversity in the development of lifetime co-occurring disorder

Gender differences in stressors that affect the development of co-occurring psychiatric and substance use disorders (COD) have been given inadequate attention, despite evidence that women and men commonly develop different types of both psychiatric disorder and substance use disorders and have different experiences of illness and treatment. This paper assesses early life antecedents of COD, specifically childhood poverty and childhood adversity, and how they vary by gender. Weighted multinomial logistic regressions were conducted with the National Epidemiologic Survey of Alcohol and Related Conditions-III (NESARC-III) (n = 33,676) nationally representative data from 2014-2015 to assess whether antecedents of COD are conditional on gender. Results demonstrate that overall nearly one in five people (17.5%) have lifetime COD, and disorder prevalence differs for males and females (COD: 18.0% vs 16.4%; psychiatric disorder: 8.5% vs. 20.9%; substance use disorder: 5.6% vs. 13.0%, respectively). Males with childhood poverty are more likely than males without to have COD but poverty does not affect COD risk for females. For both males and females, increases in number of adversities are associated with increased probability of COD, however, the magnitude of this association is stronger for males. To understand COD risk, conditional relationships between early poverty, early adversity and gender must be considered. With this knowledge, prevention and treatment efforts have the potential to be targeted more effectively.

Heterogeneity in Risk and Protection Among Alaska Native/American Indian and Non-Native Children

Currently, little is known about patterns of co-occurring risk and protective factors among young children. Understanding variations in co-occurring risk and protective factors among children in Alaska is important as experiences of collective trauma may contribute to differences in the intersection of risk and protective factors between Alaska Native/American Indian (AN/AI) and non-Native children. Using data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of the 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System survey and administrative data sources, and the 2012-2014 Childhood Understanding Behaviors Survey, we conducted latent class analysis to identify classes of AN/AI (N = 593) and non-Native (N = 1018) children in terms of seven risk factors (poverty, maternal depression, maternal binge drinking, parental incarceration, intimate partner violence exposure, other violence exposure, child maltreatment) and four protective factors (father figure involvement, reading by adults, family meals, peer interactions) experienced prior to age 3 years. We identified two classes among AN/AI children: (1) high risk-moderate protection (29.1%) and (2) low socioeconomic status-high protection (70.9%). We identified two classes among non-Native children: (1) moderate risk-high protection (32.9%) and (2) low risk-high protection (67.1%). A test of invariance revealed that risk and protective factor probabilities differed significantly for corresponding classes of AN/AI and non-Native children. Overall, results demonstrate heterogeneity within and between AN/AI and non-Native children in early experiences of risk and protection and suggest that interventions will be more effective if tailored to the experiences and developmental needs of specific groups of Alaska children.

Identifying Distinct Latent Classes of Adverse Childhood Experiences Among US Children and Their Relationship with Childhood Internalizing Disorders

This study aimed to determine the relationship between latent classes of adverse childhood experience (ACEs) and internalizing disorders (anxiety and depression) among US children. The 2016 National Survey of Children's Health data for children aged 6-17 was used. Latent class analysis was performed to identify distinct sub-types of ACE exposures and survey-weighted logistic regression models were employed to determine whether these classes were associated with any or comorbid childhood internalizing disorders, after controlling for meaningful covariates. Four latent classes were identified: income hardship, divorce, mental health or substance abuse exposure, and high ACEs overall. Children in three of the four classes were significantly more likely to have any childhood internalizing disorder when compared to children reporting no ACEs, while children in all classes were significantly more likely to have a comorbid history of anxiety and depression. Thus, children exposed to ACEs should receive necessary mental health screenings and treatments.

Where are all the males? Gender-specific typologies of childhood adversity based on a large community sample

BACKGROUND

Methodological issues have been identified when quantifying exposure to adversity and abuse. To address a single type may obscure covarying effects. To sum multiple exposures gives equal weight to each. Latent class analysis (LCA) addresses this by identifying homogenous subpopulations. Most studies using LCA have pooled gender data in spite of evidence that the nature and frequency of exposure differs by gender. Males report more interpersonal abuse, females report more of other exposures, particularly sexual.

OBJECTIVE

This study aimed to identify if stratifying data by gender resulted in different profiles of adversity/abuse Participants and setting: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave II, a large community-based survey, nationally representative of the US population.

METHOD

This study used 14 indicators of childhood adversity as the basis for LCA.

RESULTS

The number and nature of classes differed by gender. The best solution for females was 4-class: a low risk class; a class at higher risk of sexual abuse; a class at higher risk of physical abuse; a class at higher risk of combined physical and sexual abuse. The best solution for males had only 3-classes; a low risk class, a class at higher risk of sexual abuse; a class at higher risk of physical abuse. The combined dataset resulted in a solution similar to the female solution.

CONCLUSION

The importance of developing models for males and females separately was evidenced by the male and female classes being differentially associated with mental health variables.

Outcomes related to adverse childhood experiences in college students: Comparing latent class analysis and cumulative risk

The aims of this study were to identify latent classes of adverse childhood experiences (ACEs) in a large sample of college students (N = 8997), investigate the relations between ACEs classes and life functioning, and compare results using latent class analysis to analyses using cumulative risk scores. Nine types of ACEs were assessed (three types of child abuse and six types of household dysfunction). Outcomes were self-report measures of mental health, physical health, alcohol consequences, and academic performance. Latent class analysis (LCA) results indicated that four classes fit the data best across random halves of the sample and were labeled High ACEs, Moderate Risk of Non-Violent Household Dysfunction, Emotional and Physical Child Abuse, and Low ACEs. Comparing across latent classes, the largest differences in outcomes were between the High ACEs and Low ACEs classes. There were no differences in outcomes between the Moderate Risk of Non-Violent Household Dysfunction and Emotional and Physical Child Abuse classes. The largest between-class differences were found for mental health and the smallest differences were found for academic performance. Comparing results using LCA latent classes and cumulative ACEs scores, the differences between the High and Low ACEs latent classes were similar to the differences between those with zero ACEs and those with 5 or more ACEs. Both approaches also accounted for roughly equivalent amounts of variance in all outcomes. Thus, latent class and cumulative risk analyses provided similar results with regard to predicting outcomes of interest among college students.

Accumulation, Timing, and Duration of Early Childhood Adversity and Behavior Problems at Age 9

We utilized a life course framework to examine associations between the accumulation, timing, and duration of adverse childhood experiences (ACEs) across early childhood (ages 1-5 years) and internalizing and externalizing behavior problems at age 9. The sample included 1,789 children from the Fragile Families and Child Wellbeing Study, a birth cohort study of children born between 1998 and 2000. Primary caregivers reported on seven ACEs at child ages 1, 3, 5, and 9. We created 2 summary measures of early childhood ACEs to capture (a) accumulation and (b) timing and duration. We derived indicators of caregiver-reported internalizing and externalizing problems at ages 5 and 9. Logistic regression was used to estimate associations between early childhood ACEs and behavior problems at age 9, sequentially adjusting for sociodemographic covariates, age 9 ACEs, and age 5 behavior problems. In fully adjusted models, children exposed to 6 or more ACEs in early childhood faced 3 times the odds of age 9 behavior problems, compared to children exposed to 0-1 ACE. Intermittent adversity was associated with the greatest increase in odds of age 9 behavior problems, relative to other early childhood timing/duration categories. Categories of high early and high late adversity were also associated with age 9 behavior problems. Chronic adversity was not associated with age 9 behaviors in final models that adjusted for age 5 problems. These results demonstrate the importance of a developmental perspective for understanding the role of childhood adversity in the etiology of child psychopathology.

Latent Classes and Cumulative Impacts of Adverse Childhood Experiences

Studies of adverse childhood experiences (ACEs) have gauged severity using a cumulative risk (CR) index. Few studies have focused on the nature of the context of adversity and their association with psychosocial outcomes. The objective of this study was to examine the patterning of ACEs and to explore the resultant patterns' association with HIV risk-taking, problem drinking, and depressive symptoms in adulthood. Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 11 of the most commonly used ACEs. The LCA resulted in four high-risk profiles and one low-risk profile, which were labeled: (1) highly abusive and dysfunctional (3.3%; n = 1,983), (2) emotionally abusive alcoholic with parental conflict (6%, n = 3,303), (3) sexual abuse only (4.3%, n = 2,260), (4) emotionally abusive and alcoholic (30.3%, n = 17,460), and (5) normative, low risk (56.3%, n = 32,950). Compared to the low-risk class, each high-risk profile was differentially associated with adult psychosocial outcomes even when the conditional CR within that class was similar. The results further our understanding about the pattern of ACEs and the unique pathways to poor health. Implications for child welfare systems when dealing with individuals who have experienced multiple forms of early childhood maltreatment and/or household dysfunction are discussed.

Resilience following emotional abuse by teachers: Insights from a cross-sectional study with Greek students

An integrative socio-ecological model was developed to investigate the impact of emotional abuse by teachers on children's psychological functioning and test the role of social support and self-confidence as protective factors associated with resilience. Emotional abuse by teachers, social support from family, peers, school and a significant adult from the community, self-confidence and psychological functioning were assessed in a sample of young Greek school students aged 9-12 years (n=223, mean age=10.8, SD=0.885). Results revealed that exposure to emotional abuse by teachers predicted behavioural problems in school students suggesting a negative effect of these experiences on psychological functioning. The bootstrapped mediation model showed that the impact of emotional abuse by teachers on psychological functioning was significantly diminished through the influence of social support and self-confidence. Also, social support exerted a strong positive impact on self-confidence. This is the first study to show that individual and environmental factors using a socio-ecological model of resilience influence the adverse outcomes of this form of abuse in school aged children. These findings suggest that emotional abuse by teachers should be considered as a potential source of behavioural problems and adjustment in elementary students. Social support through its strong effect on self-confidence is an important protective factor of resilience against emotional abuse by teachers.

Profiles of Contextual Risk at Birth and Adolescent Substance Use

This study examined whether there are subgroups of families with distinct profiles of prenatal/birth contextual risk, and whether subgroup membership was differentially related to adolescent substance use. Data from the Northern Finland Birth Cohort 1986 were used. A five-class model provided the most meaningful solution. Large Family Size (7.72%) and Low Risk (69.69%) groups had the lowest levels of alcohol, cigarette, and illegal drug use. Similar high levels for each of the three substance-related outcomes were found for Parent Substance Misuse (11.20%), Maternal School Dropout (4.66%), and Socioeconomic Disadvantage (6.72%) groups. Maternal smoking and drinking while pregnant and paternal heavy alcohol use were found to be key prenatal risk factors that tended to cluster together and co-occur with other prenatal risk factors differently for different subgroups of youth.

Mauvais traitements subis dans l’enfance et problèmes de santé mentale à l’âge adulte : une étude nationale conduite auprès des Québécoises

L’étude vise à déterminer la contribution spécifique de différentes formes de mauvais traitements à la santé mentale de femmes québécoises. Une enquête téléphonique a été réalisée auprès d’un échantillon représentatif de 1 001 femmes québécoises. Diverses variables sociodémographiques et quatre formes de mauvais traitements durant l’enfance ont été mesurées afin d’explorer leur association avec l’état de stress post-traumatique et la dépression des répondantes au moment de l’enquête. La violence conjugale au cours des 12 derniers mois ainsi que la négligence et la violence physique subies durant l’enfance sont associées à la présence de symptômes de stress post-traumatique d’intensité clinique. Le plus jeune âge des répondantes, la violence sexuelle et psychologique durant l’enfance sont associés à la présence de dépression. Les résultats soulignent l’importance de considérer les mauvais traitements durant l’enfance et leur cooccurrence dans l’évaluation et l’intervention en santé mentale auprès des femmes adultes.

Associations between emotional abuse and neglect and dimensions of alexithymia: The moderating role of sex

OBJECTIVE

Child maltreatment, specifically emotional maltreatment (i.e., an act, such as belittling, blaming, or rejection, that is potentially harmful to a child's emotional development), has emerged as an important correlate of alexithymia. However, the evidence is mixed with regard to how emotional abuse and neglect might relate to dimensions of alexithymia (i.e., externally oriented thinking, difficulty describing feelings, and difficulty identifying feelings). Furthermore, research is needed to identify individual factors that might influence these associations. The current study examined the links between emotional abuse and neglect and externally oriented thinking, difficulty describing feelings, and difficulty identifying feelings and evaluated whether sex moderated these associations.

METHOD

Participants included 500 emerging adults (49.6% male) who completed an online battery of questionnaires assessing history of child maltreatment and dimensions of alexithymia.

RESULTS

Regression analyses revealed that emotional abuse was associated with difficulty describing feelings and externally oriented thinking, but not difficulty identifying feelings. Emotional neglect was associated with difficulty identifying feelings, but not difficulty describing feelings or externally oriented thinking. There were no sex differences associated with difficulty describing feelings or externally oriented thinking. However, sex moderated the associations between emotional abuse and neglect and difficulty identifying feelings such that emotional abuse and neglect were both more strongly associated with difficulty identifying feelings for females.

CONCLUSION

These results suggest that, in the aftermath of emotional maltreatment, sex may play an important role in the development of difficulty identifying feelings. (PsycINFO Database Record

Traumatic Life Events and Psychopathology in a High Risk, Ethnically Diverse Sample of Young Children: A Person-Centered Approach

Studies of the association between traumatic experiences and psychopathology in early childhood have primarily focused on specific types of events (e.g., sexual abuse) or aggregated different types of events without differentiating among them. We extend this body of work by investigating patterns of traumatic event exposure in a high-risk, ethnically diverse sample of children ages 3-6 (N = 211; 51 % female) and relating these different patterns to parents' reports of child externalizing, internalizing, and post-traumatic stress symptomatology. Using latent class analysis, which divides a heterogeneous population into homogenous subpopulations, we identified three patterns of traumatic events based on parents' responses to an interview-based assessment of trauma exposure in young children: (1) severe exposure, characterized by a combination of family violence and victimization; (2) witnessing family violence without victimization; and (3) moderate exposure, characterized by an absence of family violence but a moderate probability of other events. The severe exposure class exhibited elevated internalizing and post-traumatic stress symptoms relative to the witness to violence and moderate exposure classes, controlling for average number of traumatic events. Results highlight the need for differentiation between profiles of traumatic life event exposure and the potential for person-centered methods to complement the cumulative risk perspective.

Patterns of Childhood Abuse and Neglect in a Representative German Population Sample

BACKGROUND

Different types of childhood maltreatment, like emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse are interrelated because of their co-occurrence. Different patterns of childhood abuse and neglect are associated with the degree of severity of mental disorders in adulthood. The purpose of this study was (a) to identify different patterns of childhood maltreatment in a representative German community sample, (b) to replicate the patterns of childhood neglect and abuse recently found in a clinical German sample, (c) to examine whether participants reporting exposure to specific patterns of child maltreatment would report different levels of psychological distress, and (d) to compare the results of the typological approach and the results of a cumulative risk model based on our data set.

METHODS

In a cross-sectional survey conducted in 2010, a representative random sample of 2504 German participants aged between 14 and 92 years completed the Childhood Trauma Questionnaire (CTQ). General anxiety and depression were assessed by standardized questionnaires (GAD-2, PHQ-2). Cluster analysis was conducted with the CTQ-subscales to identify different patterns of childhood maltreatment.

RESULTS

Three different patterns of childhood abuse and neglect could be identified by cluster analysis. Cluster one showed low values on all CTQ-scales. Cluster two showed high values in emotional and physical neglect. Only cluster three showed high values in physical and sexual abuse. The three patterns of childhood maltreatment showed different degrees of depression (PHQ-2) and anxiety (GAD-2). Cluster one showed lowest levels of psychological distress, cluster three showed highest levels of mental distress.

CONCLUSION

The results show that different types of childhood maltreatment are interrelated and can be grouped into specific patterns of childhood abuse and neglect, which are associated with differing severity of psychological distress in adulthood. The results correspond to those recently found in a German clinical sample and support a typological approach in the research of maltreatment. While cumulative risk models focus on the number of maltreatment types, the typological approach takes the number as well as the severity of the maltreatment types into account. Thus, specific patterns of maltreatment can be examined with regard to specific long-term psychological consequences.

Severity of mental illness as a result of multiple childhood adversities: US National Epidemiologic Survey

PURPOSE

To examine patterns of childhood adversity, their long-term consequences and the combined effect of different childhood adversity patterns as predictors of subsequent psychopathology.

METHODS

Secondary analysis of data from the US National Epidemiologic Survey on alcohol and related conditions. Using latent class analysis to identify childhood adversity profiles; and using multinomial logistic regression to validate and further explore these profiles with a range of associated demographic and household characteristics. Finally, confirmatory factor analysis substantiated initial latent class analysis findings by investigating a range of mental health diagnoses.

RESULTS

Latent class analysis generated a three-class model of childhood adversity in which 60 % of participants were allocated to a low adversity class; 14 % to a global adversities class (reporting exposures for all the derived latent classes); and 26 % to a domestic emotional and physical abuse class (exposed to a range of childhood adversities). Confirmatory Factor analysis defined an internalising-externalising spectrum to represent lifetime reporting patterns of mental health disorders. Using logistic regression, both adversity groups showed specific gender and race/ethnicity differences, related family discord and increased psychopathology.

CONCLUSIONS

We identified underlying patterns in the exposure to childhood adversity and associated mental health. These findings are informative in their description of the configuration of adversities, rather than focusing solely on the cumulative aspect of experience. Amelioration of longer-term negative consequences requires early identification of psychopathology risk factors that can inform protective and preventive interventions. This study highlights the utility of screening for childhood adversities when individuals present with symptoms of psychiatric disorders.

Childhood adversity subtypes and depressive symptoms in early and late adolescence

Within a longitudinal study of 1,005 adolescents, we investigated how exposure to childhood psychosocial adversities was associated with the emergence of depressive symptoms between 14 and 17 years of age. The cohort was classified into four empirically determined adversity subtypes for two age periods in childhood (0-5 and 6-11 years). One subtype reflects normative/optimal family environments (n = 692, 69%), while the other three subtypes reflect differential suboptimal family environments (aberrant parenting: n = 71, 7%; discordant: n = 185, 18%; and hazardous: n = 57, 6%). Parent-rated child temperament at 14 years and adolescent self-reported recent negative life events in early and late adolescence were included in models implementing path analysis. There were gender-differentiated associations between childhood adversity subtypes and adolescent depressive symptoms. The discordant and hazardous subtypes were associated with elevated depressive symptoms in both genders but the aberrant parenting subtype only so in girls. Across adolescence the associations between early childhood adversity and depressive symptoms diminished for boys but remained for girls. Emotional temperament was also associated with depressive symptoms in both genders, while proximal negative life events related to depressive symptoms in girls only. There may be neurodevelopmental factors that emerge in adolescence that reduce depressogenic symptoms in boys but increase such formation in girls.

Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States

PURPOSE

This study examined profiles of adverse childhood experiences (ACEs) and mental and substance use disorders (MSUDs), and associations between distinct profiles of ACEs and MSUDs.

METHODS

Participants were adults (N = 34, 652) involved in the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analysis was used to examine both profiles of ten ACEs and ten past year MSUDs. Dual latent class analysis regression was used to examine associations between profiles of ACEs and MSUDs. Given gender differences in ACEs and MSUDs, analyses were conducted separately for females and males.

RESULTS

Four profiles of ACEs and three profiles of MSUDs were selected for both genders. The four profiles of ACEs were characterized by the following probabilities: high multiple ACEs, high parental substance abuse, high childhood physical abuse, and low ACEs. The three profiles of MSUDs were characterized by the following probabilities: high multiple MSUDs for females and low MSUDs except alcohol use disorders for males, moderate-to-high major depressive episode, and low MSUDs. When compared to the low ACEs and MSUDs profiles, members in the higher ACEs profiles had 3.71-89.75 times greater odds of also being members in the higher MSUDs profiles. However, more than one-third of members in the high multiple ACEs profiles were also in the low MSUDs profiles.

CONCLUSIONS

Study findings suggest four profiles of the ACEs widely studied as part of the Adverse Childhood Experiences study and risk and resilience for recent MSUDs among men and women nationally affected by ACEs.

Description of relational processes: recent changes in DSM-5 and proposals for ICD-11

Epidemiologic, prospective, and retrospective research confirms that family relational variables are significant risk factors for the development of mental and physical health problems in children as well as adults. In addition, relationships also play a moderating role in the maintenance, exacerbation, or amelioration of chronic health problems. Although acknowledgment of the importance of these variables in the pathophysiology of a number of health conditions is reaching more prominence, the integration of assessments of family factors as part of standard health care has made little progress. With the arrival of the Affordable Care Act in the United States, there is a desire for earlier identification of these risk factors, and the ability to implement prevention programs that reduce risk, and enhance protective factors. On a global level, there is increased awareness of the health impact of relational problems, for example, many countries have attempted to implement programs to decrease domestic violence. More reliable and standardized assessments of key relational processes will enhance both of these missions, and allow comparison of a variety of prevention and intervention programs. This article discusses progress over the last decade in constructing more reliable definitions of relationship processes, how these have been integrated into the Diagnostic and Statistical Manual 5th edition (DSM-5), and progress toward implementation into the World Health Organization's International Classification of Diseases (ICD-11).

Sociodemographic characteristics of domestic violence in China: a population case-control study

A population case-control study of domestic violence in China was conducted to examine the relationship between individual- and household-level characteristics and violence perpetration and victimization. Demographic comparisons were conducted between perpetrators and victims (n = 624), perpetrators and matched controls (n = 628), and perpetrator households and control households (n = 620). A multivariate model of demographic risk was tested, integrating individual- and household-level correlates of violence perpetration. Compared with victims, perpetrators were more likely to be older, male, and have lower levels of education. In the final model, violence perpetration was more likely among individuals who earned more income, contributed a lower proportion of the household income, had a family member who was unemployed or lived in households with an authoritarian or independent power structure.

Mexican American adolescents' profiles of risk and mental health: a person-centered longitudinal approach

Although Mexican American adolescents experience multiple risk factors in their daily lives, most research examines the influences of risk factors on adjustment independently, ignoring the additive and interactive effects of multiple risk factors. Guided by a person-centered perspective and utilizing latent profile analysis, this study identified Mexican American fifth graders' (N = 749) risk profiles based on family, peer, and socio-cultural risk factors and examined the relations of these risk profiles to mental health symptomatology in seventh grade. Results revealed three distinct profiles that differed quantitatively and qualitatively. Profiles were then linked to levels of mental health symptomatology, with youth in the highest risk profile displaying the most symptoms. Youth in two other risk profiles displayed lower levels. The findings suggest that Mexican American youth develop within distinct risk contexts that differ in their relations to adjustment. Such findings inform prevention/intervention efforts aimed at reducing mental health problems in adolescence.

The sustained impact of adolescent violence histories on early adulthood outcomes

A history of victimization and violence perpetration are well-established risk factors that hamper positive development in early adulthood, yet their separate and overlapping effects are rarely examined simultaneously, confounding understanding of their relative impacts. This study follows a diverse sample of at-risk adolescents (N=570) into early adulthood, comparing roles and resources, stress and distress, and maladaptive behaviors for those with a history of no violence, victimization only, perpetration only, and both perpetration and victimization. Results demonstrate four distinctive profiles, although all violence-exposed youth report more problems in the three assessed domains relative to those with no violence histories. Implications for intervention are discussed.

Early-life stress and recurrent psychological distress over the lifecourse predict divergent cortisol reactivity patterns in adulthood

Early-life stress (ELS) is associated with substantially increased lifetime risk for recurrent psychological problems, with evidence indicating that dysregulation of the physiological stress reactivity system may be partly responsible. However, some ELS-exposed people remain psychologically resilient. Although two distinct patterns of hypothalamic-pituitary-adrenal axis (HPA) stress reactivity have been observed in ELS-exposed samples (hyper- and hypo-reactive), the hypothesis that these patterns may be associated with long-term history of psychological problems has not been explored. We used healthy Whitehall II study subjects (n=543) who participated in the 2008 Heart Scan Study (HSS) to assess salivary cortisol responses to a cognitive stressor, ELS exposure, and other psychosocial factors. Mean age of the sample at the HSS was 63 years. HSS data were linked to nearly 20 years of participants' Whitehall data, including repeated measures of psychological distress (GHQ-28). Piecewise growth curve analyses revealed that ELS-exposed persons with a history of recurrent psychological distress in adulthood had significantly blunted cortisol reactivity compared to non-ELS-exposed participants, while ELS-exposed persons with little or no history of distress had significantly elevated baseline cortisol, prolonged responses, and greater total cortisol production. Our findings indicate that for ELS-exposed individuals, different trajectories in psychological health over their adult lifetimes predict different cortisol reactivity patterns. These findings have important implications for our understanding of ELS-related mental health risk and treatment of these disorders.

Common patterns of violence experiences and depression and anxiety among adolescents

PURPOSE

A considerable amount of research has examined violence experiences and psychopathology; however, few studies have examined how multiple settings and experiences of violence are associated with major depressive disorder (MDD) and generalized anxiety disorder (GAD).

METHODS

The sample included 2,345 adolescents from a community-based sample in the US. The mean age was 14 years at the time that violence experiences in the home, school, and neighborhood were reported; psychiatric outcomes were assessed 2 years later using the Diagnostic Interview Schedule for Children. We applied latent class analysis to identify adolescents with common patterns of violence exposure and obtained adjusted prevalence ratios for the associations between violence classes and psychopathology.

RESULTS

A four-class model was selected based on fit statistics and meaningfulness, and adolescents were categorized into four classes: low violence, home violence, neighborhood violence/traumatic news, and multiple settings of violence. Relative to adolescents in the low violence class, risk of MDD for adolescents in the home violence, neighborhood violence/traumatic news, and multiple settings classes was 1.62, 1.47, and 2.44 times higher, respectively (p values <0.05); risk for GAD was 1.61 and 2.87 times higher for adolescents in the neighborhood violence/traumatic news and multiple settings classes, respectively (p values <0.05).

CONCLUSION

Exposure to a high level of violence-within a single domain or multiple domains-poses significant risk for MDD and GAD, and risk increases with high exposure in multiple domains. Thus, pervasive exposure to violence is associated with the highest risk for the development of psychopathology. Based on these results, prevention and treatment efforts should target adolescents exposed to violence in multiple settings.

Classes and consequences of multiple maltreatment: a person-centered analysis

While the overwhelming majority of research on the consequences of childhood maltreatment reports differential outcomes of specific maltreatment subtypes (e.g., physical abuse vs. emotional abuse) as though they are independent, maltreatment experiences often occur in combination. The present study evaluated multiple maltreatment experiences in a sample of 2,637 undergraduate students who reported on childhood maltreatment and current adjustment. The authors used latent class analysis to examine predominant patterns of multiple maltreatment experiences and investigated indices of psychosocial adjustment associated with those patterns. Results suggested that specific constellations of multiple maltreatment have qualitatively different associations with adjustment. Emotional abuse, alone or in combination with other maltreatment types, was especially salient for psychopathology (e.g., anxiety, depression), while a combination of physical and emotional abuse was most strongly associated with conduct-related problems (e.g., substance use, risky sexual behavior). These findings have both practical and empirical significance for understanding and classifying experiences of maltreatment.

Parsing the effects violence exposure in early childhood: modeling developmental pathways

OBJECTIVE

To prospectively examine pathways from early childhood violence exposure and trauma-related symptoms to school-age emotional health.

METHODS

A longitudinal, birth cohort (N = 437) was assessed with parent reports of lifetime violence exposure and trauma-related symptoms at 3 years of age and later, internalizing and externalizing symptoms, and social competence at school age.

RESULTS

Early family and neighborhood violence correlated significantly with early trauma-related symptoms and also significantly predicted school-age internalizing and externalizing symptoms and poorer competence, independent of sociodemographic risk and past-year violence exposure. Longitudinal pathways were significantly mediated by arousal and avoidance symptoms at 3 years of age, which increased risk for clinically significant emotional problems and lower competence at school age (adjusted odds ratios = 3.1-6.1, p < 0.01).

CONCLUSIONS

Trauma-related symptoms may mediate developmental pathways from early violence exposure to later emotional health. Interventions that prevent or reduce early trauma-related symptoms may ameliorate the long-term deleterious impact of violence exposure.

Profiles of family-focused adverse experiences through childhood and early adolescence: the ROOTS project a community investigation of adolescent mental health

BACKGROUND

Adverse family experiences in early life are associated with subsequent psychopathology. This study adds to the growing body of work exploring the nature and associations between adverse experiences over the childhood years.

METHODS

Primary carers of 1143 randomly recruited 14-year olds in Cambridgeshire and Suffolk, UK were interviewed using the Cambridge Early Experiences Interview (CAMEEI) to assess family-focused adversities. Adversities were recorded retrospectively in three time periods (early and later childhood and early adolescence). Latent Class Analysis (LCA) grouped individuals into adversity classes for each time period and longitudinally. Adolescents were interviewed to generate lifetime DSM-IV diagnoses using the K-SADS-PL. The associations between adversity class and diagnoses were explored.

RESULTS

LCA generated a 4-class model for each time period and longitudinally. In early childhood 69% were allocated to a low adversity class; a moderate adversity class (19%) showed elevated rates of family loss, mild or moderate family discord, financial difficulties, maternal psychiatric illness and higher risk for paternal atypical parenting; a severe class (6%) experienced higher rates on all indicators and almost exclusively accounted for incidents of child abuse; a fourth class, characterised by atypical parenting from both parents, accounted for the remaining 7%. Class membership was fairly stable (~ 55%) over time with escape from any adversity by 14 years being uncommon. Compared to those in the low class, the odds ratio for reported psychopathology in adolescents in the severe class ranged from 8 for disruptive behaviour disorders through to 4.8 for depressions and 2.0 for anxiety disorders. Only in the low adversity class did significantly more females than males report psychopathology.

CONCLUSIONS

Family adversities in the early years occur as multiple rather than single experiences. Although some children escape adversity, for many this negative family environment persists over the first 15 years of life. Different profiles of family risk may be associated with specific mental disorders in young people. Sex differences in psychopathologies may be most pronounced in those exposed to low levels of family adversities.

A global perspective on child sexual abuse: meta-analysis of prevalence around the world

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

Father's and mother's psychological violence and adolescent behavioral adjustment

Maternal and paternal psychological violence were examined as potential risk factors for internalized and externalized behavior problems displayed by adolescents. Childhood family violence (physical and psychological parental violence), current extrafamily violence (bullying and dating violence), and family structure were taken into account. A sample of 278 adolescents (mean age: 14.2) were recruited in three public schools located in low to high socioeconomic areas. Participants were in the 7th, 8th, and 9th grades, and each completed a self-administered questionnaire. Frequency of current psychological violence is about the same for each parental figure. The three most frequent and least frequent psychologically violent parental practices were also the same for both parental figures. Psychological violence of both parents was related to internalized and externalized behavior problems over and above family structure, childhood family violence, and current extrafamily violence.

A person-centred approach to modelling population experiences of trauma and mental illness

BACKGROUND

Exposure to traumatic events has been implicated in the onset and development of a range of psychiatric disorders. People can be exposed to multiple traumatic events and previous research suggests that traumatic experiences may cluster at the individual level.

METHODS

This study aimed to examine the distribution of traumatic experiences in a large nationally representative sample using latent class analysis, and estimate the relationship between these classes and a number of demographic and clinical variables. Data from the National Comorbidity Survey was used.

RESULTS

Four latent classes, each representative of a range of traumatic experiences were identified. The classes were labelled 'high risk' (class 1), 'exposure to non-sexual adult interpersonal/non-interpersonal trauma' (class 2), 'intermediate risk/sexual abuse' (class 3), and 'low risk' (class 4). Each of the latent classes was predicted by several of the demographic variables. In addition, membership of classes 1, 2, and 3 increased the risk of each of the clinical variables.

CONCLUSIONS

The findings have clinical implications for the assessment of trauma histories across a range of psychiatric diagnoses.

Clustering of trauma and associations with single and co-occurring depression and panic attack over twenty years

Individuals who experience one type of trauma often experience other types, yet few studies have examined the clustering of trauma. This study examines the clustering of traumatic events and associations of trauma with risk for single and co-occurring major depressive disorder (MDD) and panic attack for 20 years after first trauma. Lifetime histories of MDD, panic attack, and traumatic events were obtained from participants in an Australian twin sample. Latent class analysis was used to derive trauma classes based on each respondent's trauma history. Associations of the resulting classes and of parental alcohol problems and familial effects with risk for a first onset of single and co-occurring MDD and panic attack were examined from the year of first trauma to 20 years later. Traumatic events clustered into three distinct classes characterized by endorsement of little or no trauma, primarily nonassaultive, and primarily assaultive events. Individuals in the assaultive class were characterized by a younger age at first trauma, a greater number of traumatic events, and high rates of parental alcohol problems. Members of the assaultive trauma class had the strongest and most enduring risk for single and co-occurring lifetime MDD and panic attack. Assaultive trauma outweighed associations of familial effects and nonassaultive trauma with risk for 10 years following first trauma.

Epidemiology of child traumatic stress

In this article, we present an update on epidemiologic research that addresses the scope and impact of children's exposure to traumatic events in daily living, as well as under special circumstances, such as natural disasters. Toward this end, we provide an overview of the findings of key selected studies that estimate the prevalence of children's exposure to trauma and associated developmental, functional, mental, and physical health problems. Over the past few years, epidemiologic research on child traumatic stress has demonstrated that children's exposure to traumatic events is more common than once thought and that children exposed to multiple traumatic events are at a substantially greater risk for a wide range of adverse mental and physical health problems than children who have not suffered cumulative traumatic experiences. These findings have important implications for the provision of mental health and medical services to children and adolescents who have experienced child traumatic stress.

Configurations of common childhood psychosocial risk factors

BACKGROUND

Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors.

METHODS

Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class structure was retested in a representative population sample of 1420 children aged 9 to 13. In each sample, the child and one parent were interviewed with the Child and Adolescent Psychiatric Assessment. Concurrent psychiatric status was used to validate class membership.

RESULTS

LCA identified five latent classes in both samples: two low risk classes; two moderate risk classes both involving family poverty configured with various other risk factors; and a high risk class characterized by family relational dysfunction and parental risk characteristics. Of the primary sample, 48.6% were categorized as low risk, 42.8% as moderate risk, and 8.6% as high risk. Moderate risk classes differed in their prediction of disruptive and emotional disorders depending on their specific risk factor configurations. High risk youth had the highest levels of both emotional and disruptive disorders. Combining our latent classes with a cumulative risk approach best accounted for the effects of risk factors on psychopathology in our primary sample.

CONCLUSIONS

Particular risk configurations have specific associations with psychiatric disorders. Configurational approaches are an important asset for large-scale epidemiological studies that integrate information about patterns of risk and disorders.

A call for mental health needs assessments in HIV positive children in Africa

There is a worldwide pandemic of HIV infection. The WHO has compiled estimates of cases of HIV/AIDS for each country. In sub-Saharan Africa, HIV infection is causing decreased life expectancy. There is an overall increase in the number of orphans as a result of AIDS. Poverty, the lack of technologies and adequate resources are widening the gap between Africa and industrialized countries. In the instance of HIV positive children in Africa, we should aim to look into ways to identify and treat those with mental health issues or at risk for future mental health problems. This will help those affected to cope with the chronic illness associated with HIV infection, and to better comply with treatment that may lead to improved outcomes in terms of their quality of life.

Nurturing natural resources: the ecology of interpersonal relationships in women who have thrived despite childhood maltreatment

Childhood maltreatment and its consequences are a public health issue. There continues to be a need for improving the lives and life prospects for survivors of child abuse. The important role that positive interactions can play was evident in a large study of women who considered themselves successful despite maltreatment. Interactions of import ranged from brief encounters with strangers to enduring relationships. Two distinct motifs emerged: The "Saw something in me" and "No matter what" relationships. Findings will be discussed within the context of extant theories with possible implications for researchers, practitioners, and careful, caring adults in any setting.