The effect of adverse childhood experiences on chronic pain and major depression in adulthood: a systematic review and meta-analysis

The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis

BACKGROUND

Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity.

METHODS

We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose-response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528).

RESULTS

From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose-response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity (p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies (I2 = 76.9%, Cochran Q = 102, p < 0.001).

CONCLUSIONS

This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.

Associations and Mediating Pathways Between Childhood Adversity and Risk of Dementia: A Cohort Study in the UK Biobank

BACKGROUND

While childhood adversity (CA) is known to be associated with multiple adverse outcomes, its link with dementia is an area with limited exploration and inconsistent agreement. The study aimed to examine the longitudinal associations of CA with incident all-cause dementia and to quantify the potential mediating pathways.

METHODS

Data from the UK Biobank. CA, encompassing neglect and abuse, was evaluated retrospectively by an online mental health questionnaire. Physical performance, psychological factors, lifestyles, and biological indicators assessed at baseline were considered potential mediators. Incident all-cause dementia was defined by International Classification of Diseases, Tenth Revision codes obtained through self-reported medical conditions, primary care, hospital admission, and death registrations. Cox proportional hazard models were applied to estimate the longitudinal associations. Mediation analyses were conducted on potential mediators to examine their contribution.

RESULTS

This cohort study comprised 150 152 nondemented individuals (mean [SD] age, 55.9 [7.7] years) at baseline (2006-2010). Compared to individuals who did not experience CA, those exposed to any CA exhibited a 30.0% higher risk of dementia (hazard ratio = 1.300, 95% confidence interval [CI]: 1.129-1.496). Each additional CA was associated with a 15.5% (95% CI: 8.8%-22.5%, pfor trend < .001) increased dementia risks. Depression, smoking, and low grip strength explained 8.7%, 2.4%, and 0.9% of the associations, respectively. Biomarkers involving inflammation, erythrocytes, liver, and kidney function mediated the associations by 0.6%-1.4%.

CONCLUSIONS

The study revealed the detrimental effects of CA on dementia and identified some potential mediators, namely depression, smoking, low grip strength, and several targeted biomarkers. In addition to calling more attention to CA, the findings underscore the importance of interventions targeting modifiable mediators in preventing dementia.

Relational vulnerability in motherhood-an existential perspective on pain and exhaustion among women

Introduction

Stress-related ill-health like pain and exhaustion are demanding public health problems in Europe. In Sweden, women are particularly at risk to develop stress-related ill-health during a period in life that coincides with child-rearing years. When entering motherhood, Swedish women's sick leave substantially increases. Yet, motherhood is rarely acknowledged in clinical encounters concerning pain and exhaustion although women suffer from these ailments more often than men. To incorporate motherhood as an existential dimension of health in the care of women living with pain and exhaustion might alleviate women's suffering. But knowledge on women's experiences of motherhood and health is scarce. Therefore, the aim of the study is to reach a deeper understanding of how women suffering from long-lasting pain and exhaustion experience their health in relation to motherhood.

Methods

Ricoeur's interpretation theory has been applied to analyze 27 phenomenological interviews with 14 mothers suffering from long-lasting pain and exhaustion.

Results

These women's experiences shed light on how closely motherhood is interwoven with the experience of their health and suffering: The women's suffering seems to be rooted in a relational vulnerability that has been uncovered during motherhood. Further, the women suffer from a burden of difficult life experiences and inner conflicts. Reconciliation with life is possible when women find an existential shelter, which offers ways to relate to their suffering making the own suffering more bearable.

Associations between adverse childhood experiences and pain in middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study

OBJECTIVE

Adverse childhood experiences (ACEs) have been associated with a range of adverse health outcomes, with pain being potentially one of them. This population-based cross-sectional study aimed to investigate the associations between Adverse Childhood Experiences (ACEs) and pain in Chinese adults and evaluate whether physical activity and demographic and socioeconomic characteristics modify this associations.

METHODS

Cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS), were utilized in this study. A total of 9923 respondents with information on 12 ACE indicators and 15 self-reported body pains were included. Logistic regression models were used to assess associations of the ACEs and pain. Modification of the associations by physical activity, demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction.

RESULTS

Among the 9923 individuals included in the primary analyses, 5098 (51.4%) males and the mean (SD) age was 61.18 (10·.44) years. Compared with individuals with 0 ACEs, those who with ≥ 5 ACEs had increased risk of single pains and multiple pain. A dose-response association was found between the number of ACEs and the risk of pain (e.g. neck pain for ≥ 5 ACEs vs. none: OR, 1.107; 95% CI, 0.903-1.356; p < 0.001 for trend). In the associations of each body pain with each ACE indicator, most ACE indicators were associated with an increased risk of pain. In addition, physical activity, sociodemographic and socioeconomic characteristics, such as age, sex, educational level, area of residence, childhood economic hardship, did not demonstrate a significant modify on the associations between ACEs and pain.

CONCLUSIONS

These findings indicate that cumulative ACE exposure is associated with increased odds of self-reported pain in Chinese adults, regardless of adult physical activity, sociodemographic and socioeconomic characteristics.

PV and SST neurons in the anterior cingulate cortex regulate social disorders in adulthood induced by sensory abnormalities in childhood

OBJECTIVE

Childhood sensory abnormalities experience has a crucial influence on the structure and function of the adult brain. The underlying mechanism of neurological function induced by childhood sensory abnormalities experience is still unclear. Our study was to investigate whether the GABAergic neurons in the anterior cingulate cortex (ACC) regulate social disorders caused by childhood sensory abnormalities experience.

METHODS

We used two mouse models, complete Freund's adjuvant (CFA) injection mice and bilateral whisker trimming (BWT) mice in childhood. We applied immunofluorescence, chemogenetic and optogenetic to study the mechanism of parvalbumin (PV) neurons and somatostatin (SST) neurons in ACC in regulating social disorders induced by sensory abnormalities in childhood.

RESULTS

Inflammatory pain in childhood leads to social preference disorders, while BWT in childhood leads to social novelty disorders in adult mice. Inflammatory pain and BWT in childhood caused an increase in the number of PV and SST neurons, respectively, in adult mice ACC. Inhibiting PV neurons in ACC improved social preference disorders in adult mice that experienced inflammatory pain during childhood. Inhibiting SST neurons in ACC improved social novelty disorders in adult mice that experienced BWT in childhood.

CONCLUSIONS

Our study reveals that PV and SST neurons of the ACC may play a critical role in regulating social disorders induced by sensory abnormalities in childhood.

Aberrant functional connectivity of the globus pallidus in the modulation of the relationship between childhood trauma and major depressive disorder

BACKGROUND

Childhood trauma plays a crucial role in the dysfunctional reward circuitry in major depressive disorder (MDD). We sought to explore the effect of abnormalities in the globus pallidus (GP)-centric reward circuitry on the relationship between childhood trauma and MDD.

METHODS

We conducted seed-based dynamic functional connectivity (dFC) analysis among people with or without MDD and with or without childhood trauma. We explored the relationship between abnormal reward circuitry, childhood trauma, and MDD.

RESULTS

We included 48 people with MDD and childhood trauma, 30 people with MDD without childhood trauma, 57 controls with childhood trauma, and 46 controls without childhood trauma. We found that GP subregions exhibited abnormal dFC with several regions, including the inferior parietal lobe, thalamus, superior frontal gyrus (SFG), and precuneus. Abnormal dFC in these GP subregions showed a significant correlation with childhood trauma. Moderation analysis revealed that the dFC between the anterior GP and SFG, as well as between the anterior GP and the precentral gyrus, modulated the relationship between childhood abuse and MDD severity. We observed a negative correlation between childhood trauma and MDD severity among patients with lower dFC between the anterior GP and SFG, as well as higher dFC between the anterior GP and precentral gyrus. This suggests that reduced dFC between the anterior GP and SFG, along with increased dFC between the anterior GP and precentral gyrus, may attenuate the effect of childhood trauma on MDD severity.

LIMITATIONS

Cross-sectional designs cannot be used to infer causality.

CONCLUSION

Our findings underscore the pivotal role of reward circuitry abnormalities in MDD with childhood trauma. These abnormalities involve various brain regions, including the postcentral gyrus, precentral gyrus, inferior parietal lobe, precuneus, superior frontal gyrus, thalamus, and middle frontal gyrus.

CLINICAL TRIAL REGISTRATION

ChiCTR2300078193.

Patterns of adverse childhood experiences and associations with lower mental well-being among university students

BACKGROUND

University students report high levels of adverse childhood experiences (ACEs), which can lead to severe mental health problems. Understanding how ACEs impact well-being in this population is essential, yet research to date is limited.

OBJECTIVE

To explore ACE patterns and their association with lower well-being in university students.

PARTICIPANTS AND SETTING

1023 Spanish students (71.6 % female) aged between 18 and 64 years old (M = 20.10, SD = 3.93) completed a self-report questionnaire.

METHODS

This study used a cross-sectional design. The ACE International Questionnaire (ACE-IQ) and the Short Warwick-Edinburgh Mental Well-being Scale were used to assess, respectively, childhood adversities and mental well-being. Latent Class Analysis and regression modeling were conducted to analyze the link between ACEs and lower mental well-being, considering the covariates of age, country of origin, sexual orientation, and mental illness.

RESULTS

Four ACE classes were identified: Low ACEs (49.5 %), Dysfunctional Household (12.3 %), Household and Peer Abuse (31.0 %), and High ACEs (7.2 %). The regression analysis (F(3, 1007) = 19.2, p < .001, R2adj = 0.054) successfully predicted well-being scores based on ACE classes. When compared with the Low ACE class, all other classes exhibited lower levels of well-being. Age, sexual orientation, and mental illness were also related to lower well-being, with mental illness having the strongest negative effect (β = -0.635, t(1015) = -6.49, p < .001).

CONCLUSIONS

These findings underscore the relationship between childhood adversity and mental health, offering insights for future prevention efforts and enriching our understanding of ACEs and their impact on well-being.

Measuring interpersonal trauma: Development and validation of the German version of the victimization experience schedule (VES)

OBJECTIVE

Interpersonal victimization experiences (VEs) significantly affect mental and physical health, particularly in disorders associated with life-time adversities, like fibromyalgia syndrome (FMS) and major depressive disorder (MDD). However, assessing VEs comprehensively remains challenging due to limited tools that encompass sub-traumatic events, such as bullying or discrimination, and contextual dimensions. We aimed to address this gap by validating the Victimization Experience Schedule (VES) in German, examining its reliability, and assessing VEs in clinical populations with FMS and MDD.

METHODS

We investigated the relationship between VEs and clinical symptoms in individuals with FMS, MDD and healthy controls (N = 105) in a case-control study. We also analyzed correlations between different types of VEs and categories of early childhood abuse and posttraumatic-stress-disorder instruments. Additionally, we validated our findings in an independent sample of individuals with FMS (N = 97) from a clinical study.

RESULTS

We observed excellent inter-rater reliability (Kw = 0.90-0.99), and VEs assessed using the VES were in alignment with subcategories of early childhood abuse. The prevalence of VEs extended beyond the categories covered by traditional survey instruments and was higher in individuals with MDD (4.0 ± 2.6) and FMS (5.9 ± 3.1) compared to controls (1.5 ± 1.7). We consistently identified a significant association between the number of VEs, the associated subjective distress, and clinical scores. Furthermore, distinct correlation patterns between VEs and clinical outcomes emerged across different cohorts.

CONCLUSION

Our study emphasizes the VES's value in understanding VEs within MDD and FMS. These experiences span from traumatic to sub-traumatic and correlate with posttraumatic-stress and clinical symptoms, underscoring the VES's importance as an assessment tool.

Linking inter-subject variability of cerebellar functional connectome to clinical symptoms in major depressive disorder

Major depressive disorder (MDD) is a highly prevalent psychiatric disorder with remarkable inter-subject variability in clinical manifestations. Neuroimaging changes of the cerebellum have been recently proposed as a way to characterize MDD-related brain disruptions and might further explain various clinical symptoms. However, the cerebellar contributions to MDD clinical heterogeneity remain largely unknown. The analyzed data consisted of 251 MDD patients and 235 matching healthy controls (HC). The inter-subject variability of functional connectomes (IVFC) was estimated via Pearson's correlation analysis between each pair of the cerebellar and cerebral regions based on resting-state functional magnetic resonance imaging (rs-fMRI). A partial least squares (PLS) regression analysis was performed to determine the potential dimension linking the IVFC to clinical symptom measures. The results indicated that similar spatial distribution patterns of the cerebellar IVFC were observed between MDD and HC, but the MDD group exhibited abnormal IVFC alterations in the bilateral Cerebelum_4_5, bilateral Cerebelum_6, Vermis_1_2 and Vermis_8. The PLS model revealed that the IVFC pattern in the left Cerebelum_6 was significantly associated with three HAMD-17 items including the work and activities, psychomotor retardation, and depressed mood. These findings provided new evidence for the cerebellar changes in MDD. Specifically, we found that the altered inter-subject variability measurements correlated with clinical manifestations of this illness. Elucidating this variability could prove helpful for the evaluation of MDD heterogeneity as well as for understanding its pathophysiological mechanism.

Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis

BACKGROUND/AIMS

Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV.

METHODS

The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses.

RESULTS

Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2  = 99%) and 4% (95% CI: 1%-10%, I2  = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2  = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%).

CONCLUSION

The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).

Impact of painful physical symptoms on first-episode major depressive disorder in adults with subthreshold depressive symptoms: A prospective cohort study

OBJECTIVE

To investigate the impact of baseline painful physical symptoms (PPS) on subsequent first-episode major depressive disorder (MDD) in adults with subthreshold depressive symptoms, including subgroup analyses to assess whether the associations differ in individuals with and without physical diseases.

METHODS

A total of 2343 adults with subthreshold depressive symptoms were recruited at 34 primary health care centers. PPS were measured at baseline. First-episode MDD during follow-up was diagnosed by professional psychiatrists using the Mini-International Neuropsychiatric Interview.

RESULTS

Baseline PPS showed independent impacts on first-episode MDD in adults with subthreshold depressive symptoms without physical diseases, but not in those with physical diseases. A non-linear association (P < 0.001) was observed between PPS burden and the risk of first-episode MDD. The HRs for first-episode MDD exhibited a rapidly increasing trend between PPS burden scores of 10-16, and maintained consistently high when scores exceeded 16. The analyses for specific PPS revealed that headache, neck pain, and heart or chest pain were independently associated with first-episode MDD in participants without physical diseases, the HRs were 1.57 (1.15-2.36), 1.53 (1.02-2.30), and 1.69 (1.14-2.50), respectively. Further network analysis demonstrated that heart or chest pain serves as a bridge symptom among the seven specific PPS and first-episode MDD in those without physical diseases.

CONCLUSION

PPS burden and heart or chest pain may be significant indicators for first-episode MDD in adults with subthreshold depressive symptoms without physical diseases. Future studies should investigate whether interventions targeting PPS can prevent episode MDD in this subthreshold population.

Hidden family rules: perspective on a dysfunctional paternalistic system and the persistence of pain

This article explores how paternalistic control and power reside within the family system and how this may influence pain and its persistence. Drawing upon clinical case studies and existing literature, this exploration emphasises the role of paternal dysfunction in creating emotional memory images and delves into how this may influence the chronification and treatment resistance of pain (i.e., making pain "sticky"). We argue that a dysfunctional paternalistic family system, often characterised by authoritarian dynamics, emotional neglect, and abuse, results in adverse experiences and emotional memory images that create a fertile ground for the entrenchment and propagation of psychosomatic symptoms, including pain. Further, the paper emphasizes the potential intergenerational effects of such a scenario, where inherited "Family Rules" drive maladaptive coping mechanisms, which contribute to the persistence of psychological and physiological distress across generations. Understanding these complexities offers new perspectives on treating psychological disorders and their physiological ramifications. It also highlights the urgency of addressing dysfunctional familial dynamics in psychotherapeutic interventions for both immediate and long-term psychophysiological health outcomes.

Adverse childhood experiences and psychopathology in adolescents from northern Chile: the moderating role of the attachment style

BACKGROUND

Identifying the underlying mechanisms through which adverse childhood experiences affect (ACEs) the mental health of adolescents is of paramount importance for disease prevention in later stages of life.

OBJECTIVE

The present study examines the relationship between ACEs and psychopathology in adolescents from northern Chile and how attachment style (abandonment anxiety and intimacy avoidance) may moderate this relationship. A total of 154 schooled adolescents aged 12 to 17 (M = 15.08, SD = 1.64) completed a series of self-report questionnaires including the Adverse Childhood Experience Questionnaire (ACEs), Experiences in Close Relationships- Relationship Structures (ECR-RS), and Youth Self Report (YSR-18).

RESULTS

The data analysis was carried out using SPSS version 25, which included descriptive analysis, one-way ANOVA, and Spearman correlation analysis. To address moderation analysis, the PROCESS macro extension version 4.1 was employed. In this process, the bootstrap method was applied to construct confidence intervals, and the pick-a-point approach was used to define the levels of the moderating variable. According to the results, 80.3% of the sample experienced one or more ACEs, and 16.4% reported experiencing at least three. Furthermore, the variables under study exhibited significant correlations with each other, except for intimacy avoidance, which showed no correlation with ACEs (rho = -0.10; p = 0.273). When considering abandonment anxiety as a moderating variable, the direct effect of ACEs on externalizing symptoms showed statistically significant changes (β = 0.60, p = 0.03). No other moderating effects were found according to the proposed models.

CONCLUSION

In childhood, the accumulation of ACEs is associated with the development of psychopathology in adolescents from northern Chile, specifically with the presence of internalizing and externalizing symptoms. These findings suggest that lower levels of abandonment anxiety could mitigate the effects of ACEs on adolescent psychopathology, while higher levels of abandonment anxiety could exacerbate these effects on psychopathology.

Individual and Combined Effect of MAO-A/MAO-B Gene Variants and Adverse Childhood Experiences on the Severity of Major Depressive Disorder

BACKGROUND

Major depressive disorder (MDD) is a mood disorder with a high prevalence worldwide that causes disability and, in some cases, suicide. Although environmental factors play a crucial role in this disease, other biological factors may predispose individuals to MDD. Genetic and environmental factors influence mental disorders; therefore, a potential combined effect of MAO-A/MAO-B gene variants may be a target for the study of susceptibility to MDD. This study aimed to evaluate the effects of MAO-A and -B gene variants when combined with adverse childhood experiences (ACEs) on the susceptibility and severity of symptoms in MDD.

METHODS

A case-control study was performed, including 345 individuals, 175 MDD cases and 170 controls. Genotyping was performed using real-time PCR with hydrolysis probes. The analysis of the rs1465107 and rs1799836 gene variants of MAO-A and -B, respectively, was performed either alone or in combination with ACEs on the severity of depression, as determined through specific questionnaires, including DSM-IV diagnostic criteria for MDD.

RESULTS

According to individual effects, the presence of ACEs, as well as the allele G of the rs1465107 of MAO-A, is associated with a higher severity of depression, more significantly in females. Furthermore, the allele rs1799836 G of MAO-B was associated with the severity of depression, even after being adjusted by gene variants and ACEs (IRR = 1.67, p = 0.01). In males, the allele rs1799836 G of MAO-B was shown to interact with SNP with ACEs (IRR = 1.70, p < 0.001). According to combined effect analyses, the severity of depression was associated with ACEs when combined with either allele rs1465107 of MAO-A or allele rs17993836 of MAO-B, whereas SNP risk association was influenced by gender.

CONCLUSIONS

The severity of depression is related to either individual or combined effects of temperamental traits and genetic susceptibility of specific genes such as MAO-A and MAO-B.

Perspectives on emotional memory images and the persistence of pain

Multiple influences prevent recovery from pain. Our viewpoint is that non-conscious emotional memory images (EMIs) triggers outdated stress responses contributing to the intractability of pain. In this perspectives article we explore the concept that EMIs contribute to the persistence of pain. We contend that psychophysiological "stress" responses, resulting from first-time, novel and unprecedented pernicious or adverse events form EMIs within very short time frames (split-second learning). Subsequently, these EMIs are re-triggered in daily living, "re-playing" stress responses. We postulate that EMIs continually "raise the alarm" to socio-ecological stimuli by re-triggering the HPA-axis and amplifying neural input associated with threat, fear, anxiety, and pain, creating a debilitating state of psychophysiological dis-ease. We position the EMI within a philosophical debate on the nature and locus of memory and explain how the EMI, irrespective of whether it is a "thing" or a metaphor, can create a basis of understanding for the client to grasp. We describe a therapeutic approach (Split-Second Unlearning) to "clear" EMIs and the "stickiness" of pain and help people embark on a healing journey. This involves surveillance of clients for micro-expression(s) signifying an in-the-moment stress response, representative of the presence of an EMI, and encouraging the client to become a curious observer within/of their own experience. This helps the client detach their EMI from its stress response. We contend that this occurs rapidly without the need to get bogged down in a whole-life narrative. We advocate further exploration of our EMI model of dis-ease in the context of intractable pain.