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Remmers MCC, Reijs RP, Hoebe CJPA. Defining and distinguishing early life stress, trauma, adversity, toxic and chronic stress and allostatic load: a descriptive review. Scand J Public Health 2024:14034948241260105. [PMID: 39087715 DOI: 10.1177/14034948241260105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
AIMS Various concepts are used to study the impact of stress on childhood development. These concepts are often used inconsistently or interchangeably. Our main objectives were to determine how selected stress concepts (chronic stress, toxic stress, allostatic load, early life stress, childhood adversity, childhood trauma and adverse childhood experiences; ACEs) are defined, operationalized and described, and to provide a theoretical context to aid the choice for a preferred concept in public health research. METHODS For this descriptive review, we systematically searched for literature published before 4 August 2021, on PubMed, Embase and PsycInfo. Two independent reviewers included studies. Exclusion criteria were: no systematic review, not peer reviewed, not published in English, selected stress concepts were no predetermined variable or a substantial topic in the discussion, full text was unobtainable or study described non-human or non-childhood populations. Data extraction forms were used. Descriptives were gathered, publication fields were identified through Journal Citation Reports categories, and verbatim descriptions were ordered in text and Venn diagrams. RESULTS Of 264 screened studies, 124 were included. ACEs, childhood adversity and childhood trauma were used most. ACEs were the main concept used most frequently (47.6%). A total of 11 of 14 public and environmental health journals used ACEs. All concepts refer to prolonged, repeated, interpersonal stress from 0 to 18 years, that can alter physiological systems. Four concepts were stressor oriented, two concepts focused on stress response and effect and one on the state of challenged homeostasis. CONCLUSIONS ACEs seem most fitting for public health setting, due to their operationalizability, large set of core experiences and widespread use.
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Affiliation(s)
- Maarten C C Remmers
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Public Health Service Limburg-North, Venlo, Netherlands
| | - Rianne P Reijs
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, Netherlands
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Draxler JM, Ruppar TM, Carbray JA, Delaney KR. Screening for Adverse Childhood Experiences in Adolescents Using the Bright Futures Previsit Questionnaire. J Pediatr Health Care 2024:S0891-5245(24)00173-1. [PMID: 39023459 DOI: 10.1016/j.pedhc.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/29/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
In pediatric primary care, incorporation of existing practice tools into screening for adverse childhood experiences (ACEs) may reduce screening barriers, promoting timely intervention on negative health impacts from childhood trauma. One such screening tool is the Bright Futures Previsit Questionnaire (PVQ). To evaluate the extent to which the PVQ may be used to screen for ACEs, this research aimed to map items related to ACEs from adolescent PVQs against adverse events historically identified as conventional and expanded ACEs. The adolescent PVQs mapped effectively to nine ACEs: adverse neighborhood experiences, bullying, emotional neglect, friend or family substance misuse, household safety, intimate partner violence, interpersonal violence, physical neglect, and sexual abuse. Universal ACE screening can be conducted using adolescent PVQs; however, issues remain regarding the reliability and validity of using the PVQs to identify ACEs, and some ACEs are not effectively assessed using adolescent PVQs.
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Strenth CR, Smith M, Gonzalez L, Grant A, Thakur B, Levy Kamugisha EI. Mediational pathways exploring the link between adverse childhood experiences and physical health in a transgender population. CHILD ABUSE & NEGLECT 2024; 149:106678. [PMID: 38309101 DOI: 10.1016/j.chiabu.2024.106678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) consist of instances of abuse, neglect, or household dysfunction occurring before adulthood. Prevalence rates of ACEs are higher among specific populations, including gender minorities. In addition to ACEs, transgender individuals (TG) face many personal, social, and structural factors that have the potential to negatively impact their physical health. OBJECTIVE This study examines exploratory mediational pathways between ACEs and two health outcomes (i.e., general health and days physically ill) in TG. Mediators include everyday discrimination, social support, gender non-affirmation, and mental distress. METHODS Cross-sectional data from the U.S. Transgender Population Health Survey (TransPop) was used to conduct a serial/parallel mediation analysis. The TransPop survey included a total of 274 TG. RESULTS For both outcome variables, the same three indirect pathways were significant. First, ACEs were associated with increased mental distress, which was associated with a decrease in general health and an increase in days physically ill. Second, ACEs were associated with increased discrimination, which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill. Finally, ACEs were associated with discrimination, which was associated with increased gender non-affirmation which was associated with increased mental distress, and this was associated with a decrease in general health and an increase in days physically ill. CONCLUSION Interventions focused on reducing discrimination, gender non-affirmation, and poor mental health may be vital to improving the health of TG and to mitigating the indirect role of ACEs on TG health.
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Affiliation(s)
- Chance R Strenth
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Margaret Smith
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Leo Gonzalez
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Abigail Grant
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Bhaskar Thakur
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
| | - Emily I Levy Kamugisha
- University of Texas Southwestern Medical Center, Department of Family and Community Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America.
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Negriff S, Sidell MA, DiGangi MJ. Adverse childhood experiences screening in healthcare settings: A focus on pediatric primary care. CHILD ABUSE & NEGLECT 2024:106709. [PMID: 38418328 DOI: 10.1016/j.chiabu.2024.106709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) screening in healthcare settings is emerging as one of the tangible responses to address the consistent evidence linking ACEs with health. Kaiser Permanente Southern California (KPSC) began ACEs screening in pediatric primary care in 2018 and has developed screening and referral processes based on continued feedback from stakeholders as well as data driven assessment. OBJECTIVE We give an overview of the state of ACEs screening in pediatric healthcare settings, challenges facing pediatric providers, and suggestions to address them. We then describe the development of our ACEs screening and referral process within KPSC as an example of how a large healthcare system has implemented and adapted ACEs screening from pilot testing, to phased expansion, to complete implementation. PARTICIPANTS AND SETTING Children aged 2-18 years old who were members of KPSC 2018-2023. RESULTS We present data on the tailored screening and referral workflows we have developed, rates of positive screens and referrals, and how the initiation of ACEs screening may affect the rates of visit to behavioral health as a treatment option. We also integrate qualitative data to demonstrate the perspective of parents, with the goal of understanding what might help or hinder receipt of behavioral health treatment after ACEs screening. CONCLUSIONS We close with future directions for ACEs screening in healthcare settings and considerations for pediatric healthcare providers who may want to begin ACEs screening or adapt their screening and referral processes.
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Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States of America.
| | - Margo A Sidell
- Kaiser Permanente Southern California, Department of Research & Evaluation, United States of America
| | - Mercie J DiGangi
- Kaiser Permanente Southern California, Department of Pediatrics, United States of America
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Chaplo SD, Shepard Abdulahad LD, Keeshin BR. Utilizing screening as a trauma-responsive approach in pediatric health care settings. Curr Probl Pediatr Adolesc Health Care 2024; 54:101548. [PMID: 38336539 DOI: 10.1016/j.cppeds.2023.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Given the widespread impact of child trauma, it is important that child- and family-serving systems adopt trauma-informed care. Because of their integral relationships with families, pediatricians and family medicine physicians play critical roles in disrupting negative societal and developmental cascades for trauma-exposed youth through their potential for early identification and intervention. When implemented alongside organization-wide trauma-informed care practices, trauma screening is one concrete trauma-informed care practice that has shown both feasibility and positive impacts on pediatric healthcare. In support of this practice, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS) helps pediatric care providers to identify and respond to children and adolescents who may need trauma-focused supports. In this paper we discuss the importance of pediatric physicians adopting trauma-informed care and how evidence-based screening practices in pediatric settings is a trauma-responsive approach with great potential for meeting unmet needs among trauma-exposed children and families.
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Estrada-Darley I, Chen P, McBain R, Alvarado G, Engel C, Malika N, Kim D, Machtinger E, McCaw B, Thyne S, Thompson N, Shekarchi A, Lightfoot M, Kuo A, Benedict D, Gantz L, Perry R, Yap N, Eberhart N. Patient and Caregiver Perspectives on Implementation of ACE Screening in Pediatric Care Settings: A Qualitative Evaluation. J Pediatr Health Care 2023; 37:616-625. [PMID: 37589629 DOI: 10.1016/j.pedhc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/08/2023] [Accepted: 06/22/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION This qualitative research study explored the perspectives of adolescents, 12 to 19-years-old, and caregivers of children under 12-years-old on the acceptibility of adverse childhood experiences (ACEs) screenings in five pediatric clinics. METHOD A constructivist grounded theory approach was utilized. One-on-one semistructured phone interviews were conducted with 44 adolescents and 95 caregivers of children less than 12 years old. Interviews were analyzed using thematic analysis. RESULTS Most participants reported feeling comfortable discussing ACEs with their providers. Some reported that screening helped build trust. Others expressed privacy concerns and did not receive information about the reason for screening. Adolescent patients shared conflicting feelings-of both comfort and discomfort. Caregivers attending to multiple children, foster parents, and monolingual Spanish speakers disclosed unique challenges to ACEs screening. We found no evidence of lasting adverse effects. DISCUSSION Participants generally found ACEs screenings acceptable. Some adolescents identified benefits from the experience. However, clinics planning to adopt routine ACEs screening should ensure clear messaging on why screening is occurring, anticipate and address privacy concerns, and adopt workflows to discuss screening results.
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Selvaraj K, Korpics J, Osta AD, Hirshfield LE, Crowley-Matoka M, Bayldon BW. Parent Perspectives on Adverse Childhood Experiences & Unmet Social Needs Screening in the Medical Home: A Qualitative Study. Acad Pediatr 2022; 22:1309-1317. [PMID: 36007805 DOI: 10.1016/j.acap.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To explore parental perspectives regarding disclosure of child and parental adverse childhood experiences (ACE) and family unmet social needs (USN) and to elicit parental recommendations for screening in the pediatric medical home. METHODS We conducted a qualitative study using a purposive sample of English- and Spanish-speaking parents in our urban academic community clinic. Between January 2018 and March 2019, each parent underwent one semistructured interview that was audiotaped, transcribed, and independently coded in Atlas.ti by 2 study team members. Data analysis was based in constructivist grounded theory methodology to identify common themes and subthemes. RESULTS We interviewed 25 English-speaking and 15 Spanish-speaking parents who were mostly female, racial/ethnic minorities with ≥1 ACE. English-speaking subjects were more likely to have a high school degree and be single parents. Four themes were identified: 1) Pediatricians should ask about ACE and USN. 2) Disclosure is a longitudinal process, not a discrete event. 3) Barriers to disclosure are significant, involving concrete and emotional risks for the family. 4) Trauma-informed providers and practices support disclosure. CONCLUSIONS Families support pediatricians addressing ACE and USN in the medical home despite significant barriers. Even if providers screen using trauma-informed principles, parents may prefer not to disclose ACE initially because they regard disclosure as a stepwise process. These findings contribute to a new conceptual framework for thinking of ACE screening not merely as a way to generate information, but as an interactive, therapeutic relationship-building activity irrespective of whether or when it produces disclosure.
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Affiliation(s)
- Kavitha Selvaraj
- Pediatrics (K Selvaraj and BW Bayldon), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Pediatrics, Feinberg School of Medicine (K Selvaraj and BW Bayldon), Northwestern University, Chicago, Ill.
| | - Jacqueline Korpics
- Pediatrics and Public Health (J Korpics), Cook County Health, Chicago, Ill
| | - Amanda D Osta
- Pediatrics (AD Osta), University of Illinois at Chicago, Chicago, Ill; Medicine (AD Osta), University of Illinois at Chicago, Chicago, Ill
| | - Laura E Hirshfield
- Medical Education (LE Hirshfield), University of Illinois at Chicago, Chicago, Ill; Sociology (LE Hirshfield), University of Illinois at Chicago, Chicago, Ill
| | - Megan Crowley-Matoka
- Anthropology (M Crowley-Matoka), Northwestern University, Evanston, Ill; Medical Education, Feinberg School of Medicine (M Crowley-Matoka), Northwestern University, Chicago, Ill
| | - Barbara W Bayldon
- Pediatrics (K Selvaraj and BW Bayldon), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Pediatrics, Feinberg School of Medicine (K Selvaraj and BW Bayldon), Northwestern University, Chicago, Ill
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Tidmarsh LV, Harrison R, Ravindran D, Matthews SL, Finlay KA. The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care. FRONTIERS IN PAIN RESEARCH 2022; 3:923866. [PMID: 35756908 PMCID: PMC9226323 DOI: 10.3389/fpain.2022.923866] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022] Open
Abstract
Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.
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Affiliation(s)
- Lydia V. Tidmarsh
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- *Correspondence: Lydia V. Tidmarsh
| | - Richard Harrison
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | | | - Samantha L. Matthews
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Katherine A. Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
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