Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic

Adverse childhood experiences and falls in older adults: The mediating role of depression

OBJECTIVES

To explore the relationship between adverse childhood experiences and falls in older adults, and the mediating effects of depression on such associations.

METHODS

This is a prospective study used survey data from the China Health and Retirement Longitudinal Study. Twelve expanded ACEs obtained from the 2014 Life History Survey. Depression levels were assessed using the Centre for Epidemiologic Studies Depression Scale-10. Self-reported outcomes of falling evaluated based on "Have you fallen down since the last survey?" and "How many times have you fallen down seriously enough to need medical treatment?" Logistic regression models were used to explore the relationship between ACEs with falls and recurrent falls. Poisson regression models were used to explore the relationship between ACEs and number of severe falls. Besides, mediation analysis was used to explore whether depression mediates the relationship between ACEs and falls in older adults.

RESULTS

The more adverse childhood experiences experienced, the higher the risk of fall and recurrent falls, and the more severe the falls. Additionally, depression partially mediated the relationship between adverse childhood experiences and falls. Besides, middle-aged individuals were more susceptible to the impact of adverse childhood experiences on falls than older individuals, especially males.

CONCLUSIONS

Exposure to adverse childhood experiences is associated with falls in older adults, and depression partially mediates this association. Middle-aged adults were more susceptible to the impact of adverse childhood experiences on falls. These offer important information for clinical practice and public health interventions to prevent falls and reduce fall-related injuries among older adults.

Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity

Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced ICD-11 criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using ICD-11 criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (N = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder- and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable ICD-11 diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, rs = .285-.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.

Intimate Partner Violence Risk Factors: A Vulnerability-Adaptation Stress Model Approach

Intimate partner violence (IPV) disproportionally affects women. Using the vulnerability-adaptation stress model, we examined adverse childhood experiences (ACEs), self-esteem, and hope as vulnerability indicators and relationship status and length, positive and negative affect, and socioeconomic status (SES) as stressors to ascertain the risk for IPV. Women (N = 491, M = 37.15, standard deviation = 12.51) completed an online survey comprised of the Positive and Negative Affect Scale, Rosenberg's Self-esteem Scale, Snyder's Hope Scale, ACE questionnaire, Composite Abuse Scale Revised-Short Form, and demographic questions. Factor analysis identified four ACE factors of sexual abuse, physical or psychological abuse, witnessing domestic violence, and household dysfunction. A five-step hierarchical multiple regression identified that greater exposure to physical or psychological child abuse was associated with an increased risk of IPV (Step 2), B = 0.73 [0.16, 1.34]. Lower self-esteem, B = -0.30 [-0.47, -0.14] predicted IPV (Step 3). Age B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length, B = -1.24 [-2.16, 0.41] were associated with a higher risk of IPV (Step 4). In Step 5, previous variables attenuated to non-significance while age, B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length B = -1.25 [-2.16, 0.41] remained significant. While the key findings of this study were inconsistent with some commonly reported findings (e.g., ACEs, self-esteem, hope, relationship status, SES, age), these inconsistencies are important to highlight given the factorial approach to examining ACEs, the comprehensive analyses conducted, and our examination of these variables' direct relationship to IPV. The study was limited by its cross-sectional nature, higher prevalence of IPV victims, and not examining IPV sub-types. Similar studies need to be conducted for other relationship types and victimized individuals (e.g., same-sex relationships and male victims) to provide a complete picture of risk factors for IPV.

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.

Gender differences in the association between adverse childhood experiences and premature mortality: A prospective population study

BACKGROUND

Birth cohort studies have shown that adverse childhood experiences (ACEs) are associated with all-cause mortality. The effect of ACEs on premature mortality among working-age people is less clear and may differ between the genders.

OBJECTIVE

In this prospective population study, we investigated the association of ACEs with all-cause mortality in a working-age population.

PARTICIPANTS AND METHODS

In a representative Finnish population study, Health 2000, individuals aged 30 to 64 years were interviewed in 2000, and their deaths were registered until 2020. At baseline, the participants (n = 4981, 2624 females) completed a questionnaire that included 11 questions on ACEs and questions on tobacco smoking, alcohol abuse, self-reported health and sufficiency of income. All-cause mortality was analysed by Cox regression analysis.

RESULTS

Of the ACEs, financial difficulties, parental unemployment and individual's own chronic illness were associated with mortality. High number (4+) of ACEs was significantly associated with all-cause mortality in females (HR 2.11, p < 0.001), not in males. Poor health behaviour, self-reported health and low income were the major predictors of mortality in both genders. When the effects of these factors were controlled, childhood family conflicts associated with mortality in both genders.

CONCLUSIONS

Among working-age people, females seem to be sensitive to the effects of numerous adverse childhood experiences, exhibiting higher premature all-cause mortality. Of the individual ACEs, family conflicts may increase risk of premature mortality in both genders. The effect of ACEs on premature mortality may partly be mediated via poor adult health behaviour and low socioeconomic status.

WHAT IS ALREADY KNOWN

In birth cohort studies, adverse childhood experiences (ACEs) have been associated with all-cause mortality. In working-age people, the association of ACEs with premature mortality is less clear and may differ between the genders.

WHAT THIS STUDY ADDS

In working-age people, high number of ACEs associate with all-cause premature mortality in females, not in males. The effect of ACEs on premature mortality may partly be mediated via poor adult health behaviour, self-reported health and low socioeconomic status.

A Preliminary Analysis of the Clinical Effectiveness of Audiologist-Delivered Cognitive Behavioral Therapy Delivered via Video Calls for Rehabilitation of Misophonia, Hyperacusis, and Tinnitus

PURPOSE

Cognitive behavioral therapy (CBT) is a key intervention for management of misophonia, hyperacusis, and tinnitus. The aim of this study was to perform a preliminary analysis comparing the scores for self-report questionnaires before and after audiologist-delivered CBT via video calls for adults with misophonia, hyperacusis, or tinnitus or a combination of these.

METHOD

This was a retrospective cross-sectional study. The data for 37 consecutive patients who received CBT for misophonia, hyperacusis, or tinnitus from a private institute in the United Kingdom were analyzed. Self-report questionnaires taken as part of routine care were as follows: 4C Questionnaires for tinnitus, hyperacusis, and misophonia (4C-T, 4C-H, and 4C-M, respectively), Tinnitus Impact Questionnaire (TIQ), Hyperacusis Impact Questionnaire (HIQ), Misophonia Impact Questionnaire (MIQ), Sound Sensitivity Symptoms Questionnaire (SSSQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T). Responses were also obtained to other questionnaires related to tinnitus, hyperacusis, insomnia, and anxiety and mood disorders. A linear mixed-model method was used to assess the changes in response to the questionnaires pretreatment and posttreatment.

RESULTS

Pretreatment-posttreatment comparisons showed that scores for the 4C-T, 4C-H, 4C-M, TIQ, HIQ, MIQ, SSSQ, and SAD-T improved, with effect sizes of 1.4, 1.2, 1.3, 2.6, 0.9, 0.7, 0.9, and 1.4, respectively (all p < .05).

CONCLUSIONS

This preliminary analysis suggests that CBT via video calls may be effective in reducing the impact of misophonia, hyperacusis, and tinnitus. However, this study did not have a control group, so its results need to be interpreted with caution.

ACEs and Mental and Behavioral Health: Examining Maltreatment vs. Household Dysfunction and the Moderating Role of Spirituality

Purpose

Different types of adverse childhood experiences (ACEs) may be differentially linked to mental and behavioral health. Additionally, spirituality is associated with well-being, but little research has examined whether it is protective in the context of ACEs. The present study examines the influence of maltreatment and household dysfunction ACEs on distress, substance use, and sexual risk taking, and tests whether spirituality moderates the associations between childhood maltreatment, household dysfunction and distress, substance use, and sexual risk taking.

Method

314 college students completed the ACE-Q and measures of general mental (distress) and behavioral (substance use, sexual risk taking) health. To examine the distinct effects of maltreatment and household dysfunction on mental and behavior health, linear regression models that included both ACE types as predictors were constructed for each of the health variables. Moderation between spirituality and each type of ACEs was then examined for each outcome.

Results

Childhood maltreatment predicted greater distress and sexual risk-taking even after accounting for household dysfunction, and household dysfunction predicted greater substance use even after accounting for childhood maltreatment. Childhood maltreatment interacted significantly with spirituality to predict distress, but in the opposite direction than was hypothesized. That is, the relationship between cumulative childhood maltreatment ACEs and distress was stronger among those with higher levels of spirituality.

Conclusions

Results suggest that childhood maltreatment and household dysfunction ACEs are linked to distinct mental and behavioral health consequences among young adults. Additionally, while spirituality is associated generally with better mental and behavioral health, our findings suggest that it does not buffer the impacts of childhood maltreatment or household dysfunction.

Adverse Childhood Experience-Related Conditions and Substance Use in Adolescents: A Secondary Analysis of Cross-Sectional Survey Data

BACKGROUND

Adverse childhood experiences (ACEs) cluster within children. In addition to standardized ACE measures, there exist "ACE-related" measures that are either directly or indirectly related to the standardized ACE constructs. This study aimed to identify ACE-related latent classes of adolescents and describe past-month substance use in each class by sex and race/ethnicity.

METHODS

Data from the 2018 Indiana Youth Survey (N = 70,703), which is a repeated self-administered, cross-sectional survey, were used. Latent class analysis was conducted using ACE-related family (parent incarceration, insulting/yelling within family, inability to discuss personal problems) and school (hate being in school, feeling unsafe, inability to talk to teachers one-on-one) items. Dependent variable combined past 30-day use-frequency of 17 substances. Two-way analysis of variances examined ACE by sex and race/ethnicity interaction.

RESULTS

Four ACE-related classes emerged: "Family-Only" (11.2%), "School-Only" (16.5%), "Family-School" (8.0%), and "No-ACE" (64.3%). Substance use was highest in "Family-School" (mean = 0.67); lowest in "No-ACE" (mean = 0.21). Significant race/ethnicity (F = 27.06; p < .0001), ACE * sex interaction (F = 12.13; p < .0001) and ACE * race/ethnicity interaction (F = 4.57; p < .0001) effects emerged. Within each ACE-related class, substance use was lowest for Asians and highest for Hispanics.

CONCLUSIONS

Adverse childhood experience-related items cluster within children across school and family environments and clustering differs by race/ethnicity, but not by sex. Incorporating ACE-related items into school surveys enhances the ability to implement interventions that target relationships between ACEs and substance use.

Do Adverse Childhood Experiences Make Us More Utilitarian in Moral Dilemmas?

Purpose

Adverse childhood experiences (ACEs) have been associated with various aspects of morality, but their precise impact on moral decision-making remains unclear. This study aims to explore how ACEs influence moral decision-making in sacrificial dilemmas.

Methods

Study 1 employed traditional dilemma analysis to quantify utilitarian responses and compare them among groups with no, low, and high ACEs. Study 2 utilized the CNI model to quantify three determinants of moral decision-making: sensitivity to consequences (C parameter), sensitivity to norms (N parameter), and general action tendencies (I parameter). Differences in these parameters among groups with no, low, and high ACEs were investigated.

Results

Both Study 1 and Study 2 revealed that the high-ACE and low-ACE groups showed significantly higher utilitarian responses compared to the no-ACE group. However, no notable differences emerged between the high-ACE and low-ACE groups. Study 2 found that the N parameter was significantly lower in the high-ACE group compared to the low and no-ACE groups. Similarly, the low-ACE group exhibited significantly lower scores in the N parameter compared to the no-ACE group. Additionally, no significant differences were observed in the C and I parameters among groups with no, low, and high ACEs.

Conclusion

These findings suggest that individuals with a high number of ACEs tend to exhibit more utilitarian responses, attributed to decreased affective response to the violation of moral rules, rather than increased deliberative cost-benefit reasoning or a general preference for action. Such insights deepen our understanding of the precise aspects of moral decision-making influenced by ACEs.

Adverse childhood experiences, sarcopenia, and social participation in older adults: a cohort study

OBJECTIVES

To examine the relationships between adverse childhood experiences (ACEs) and developing sarcopenia in older adults and the modifying effects of active social participation.

METHODS

This prospective cohort study used survey data from the China Health and Retirement Longitudinal Study, including baseline surveys from 2011, follow-up data from 2013, follow-up data from 2015, and information on ACEs from the 2014 Life History Survey. Information concerning 10 ACEs, including five threat-related ACEs and five deprivation-related ACEs before 17 years of age was obtained by questionnaires through face-to-face interviews. Sarcopenia status was assessed according to the Asian Working Group for Sarcopenia 2019 algorithm, consisted of low muscle mass, and low muscle strength, or poor physical performance. The relationship between ACEs, social participation, and sarcopenia was evaluated using Cox proportional hazard regression models.

RESULTS

The study population comprised 6859 older adults in main analyses. Having experienced ≥ 3 ACEs led to an increased 31% risk of developing sarcopenia (hazard ratio [HR]:1.31, 95% confidence interval [CI]:1.10-1.56). Participants having experienced ≥ 2 threat-related ACEs (HR:1.22, 95%CI:1.04-1.43) or deprivation-related ACEs (HR:1.22, 95%CI:1.02-1.46) had a 22% higher risk of developing sarcopenia. Active social participation significantly modified the association between ACEs (p < 0.05), especially threat-related ACEs (p < 0.05), and sarcopenia.

CONCLUSIONS

ACEs were associated with the development of sarcopenia; however, social participation had a modifying effect. These findings provide insights for early identification of vulnerable groups, advance intervention timing, and highlight the benefits of promoting active social participation among individuals with sarcopenia who have experienced ACEs.

Social Determinants of Health: Associations Between Dichotomous Versus Dimensional Scores, Neuropsychological Test Performance, and Psychiatric Symptoms

This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation (Mage = 43.91, 53.5% male, 44.2% non-Hispanic White). Both dimensional and dichotomous health literacy scores accounted for substantial variance in all cognitive outcomes assessed, whereas dimensional and dichotomous adverse childhood experience scores were significantly associated with psychiatric symptoms. Tests of differences between correlated correlations indicated that correlations with cognitive and psychiatric outcomes were not significantly different across dimensional versus dichotomous scores, suggesting that these operationalizations of SDOH roughly equivalently characterize risk of poorer cognitive performance and increased psychiatric symptoms. Results highlight the necessity of measuring multiple SDOH, as different SDOH appear to be differentially associated with cognitive performance versus psychiatric symptoms. Furthermore, results suggest that clinicians can use cut-scores when characterizing patients' risk of poor cognitive or psychiatric outcomes based on SDOH.

Time-lagged associations between two adverse childhood experiences and later-life cognitive function through educational attainment and stroke

OBJECTIVE

Adverse childhood experiences (ACEs) have been associated with worse cognitive health in older adulthood. This study aimed to extend findings on the specificity, persistence, and pathways of associations between two ACEs and cognition by using a comprehensive neuropsychological battery and a time-lagged mediation design.

METHOD

Participants were 3304 older adults in the Health and Retirement Study Harmonized Cognitive Assessment Protocol. Participants retrospectively reported whether they were exposed to parental substance abuse or experienced parental physical abuse before age 18. Factor scores derived from a battery of 13 neuropsychological tests indexed cognitive domains of episodic memory, executive functioning, processing speed, language, and visuospatial function. Structural equation models examined self-reported years of education and stroke as mediators, controlling for sociodemographics and childhood socioeconomic status.

RESULTS

Parental substance abuse in childhood was associated with worse later-life cognitive function across all domains, in part via pathways involving educational attainment and stroke. Parental physical abuse was associated with worse cognitive outcomes via stroke independent of education.

CONCLUSIONS

This national longitudinal study in the United States provides evidence for broad and persistent indirect associations between two ACEs and cognitive aging via differential pathways involving educational attainment and stroke. Future research should examine additional ACEs and mechanisms as well as moderators of these associations to better understand points of intervention.

Unveiling hidden dimensions: A novel bifactor approach to unraveling adverse childhood experiences

BACKGROUND

Adverse Childhood Experiences (ACEs) are associated with diverse negative health outcomes and are commonly screened for in primary care, research, and clinical practice. However, more research is needed surrounding the conceptualization, measurement, and application of ACEs measures.

OBJECTIVE

This study examines the bifactor structure and internal reliability of a short, practical, and commonly used ACEs questionnaire and assesses how the factor structure is associated with correlates of ACEs.

PARTICIPANTS AND SETTING

Data from Utah's 2020 Behavioral Risk Factor Surveillance System, a telephone survey assessing the prevalence of health-related behaviors among a sample of adults in Utah (N = 8978, Mage = 51.5, SD = 19.4, Range = 18-99; 50 % female, 87.1 % White) was analyzed.

METHODS

Exploratory and confirmatory factor analyses were conducted to determine the best-fitting factor structure and examined correlations between the identified factors and poor health and substance use with structural equation modeling.

RESULTS

A three-factor bifactor model best fit the data and its components had associations of different direction and magnitude with outcomes (bifactor: health β = 0.83, p < .001, substance use β = 0.14, p = .025; household hardship: health ß = -0.49, p < .001, substance use ß = 0.23, p < .001; general abuse: health ß = -0.63, p < .001, substance use ß = 0.18, p = .036; sexual abuse: health ß = -0.25, p < .001).

CONCLUSIONS

Results highlight the importance of using a bifactor approach to examine and score ACEs measures rather than a traditional total sum score method.

Pivots and Partnerships: Successes, Challenges, and Lessons Learned From Conducting Research During a Global Pandemic

While the importance of including vulnerable populations in research is widely acknowledged, the differential effects of COVID-19 on vulnerable populations necessitated thoughtful participant recruitment. This research note describes one team's attempt at conducting a longitudinal, mixed-methods study during the COVID-19 pandemic with women in the perinatal period who had experienced intimate partner violence. Initial recruitment strategies are provided, as well as the ways in which those initial efforts necessitated revision and redesign. Lessons learned are offered, including ways these strategies may be adapted for other similarly vulnerable populations in the context of a community-level trauma.

Cognitive-Affective-Behavioral Pathways Linking Adversity and Discrimination to Daily Pain in African-American Adults

The tendency to ruminate, magnify, and experience helplessness in the face of pain - known as pain catastrophizing - is a strong predictor of pain outcomes and is associated with adversity. The ability to maintain functioning despite adversity - referred to as resilience - also influences pain outcomes. Understanding the extent to which pain catastrophizing and resilience influence relations between adversity and daily pain in healthy African-American adults could improve pain risk assessment and mitigate racial disparities in the transition from acute to chronic pain. This study included 160 African-American adults (98 women). Outcome measures included daily pain intensity (sensory, affective) and pain impact on daily function (pain interference). Adversity measures included childhood trauma exposure, family adversity, chronic burden from recent stressors, and ongoing perceived stress. A measure of lifetime racial discrimination was also included. Composite scores were created to capture early-life adversity (childhood trauma, family adversity) versus recent-life adversity (perceived stress, chronic burden). Increased pain catastrophizing was correlated with increased adversity (early and recent), racial discrimination, pain intensity, and pain interference. Decreased pain resilience was correlated with increased recent-life adversity (not early-life adversity or racial discrimination) and correlated with increased pain intensity (not pain-related interference). Bootstrapped multiple mediation models revealed that relationships between all adversity/discrimination and pain outcomes were mediated by pain catastrophizing. Pain resilience, however, was not a significant mediator in these models. These findings highlight opportunities for early interventions to reduce cognitive-affective-behavioral risk factors for persisting daily pain among African-American adults with greater adversity exposure by targeting pain catastrophizing.

The Association of Adverse Childhood Experiences with Long-term Mood and Anxiety Disorders After Childhood Traumatic Brain Injury: A Population-based Case-Control Study

OBJECTIVE

To assess the association between ACEs and the development of psychiatric disorders by age 25 among individuals who sustained TBI prior to age 10.

DESIGN

Population-based case-control study.

SETTING

Olmsted County, Minnesota.

PARTICIPANTS

566 individuals (N=566) who sustained a TBI prior to age 10 were identified and classified using a validated TBI classification system. Among these individuals, cases with a subsequent mood or anxiety disorder prior to age 25 were identified through clinical diagnostic codes and manual record review. For each case, a 1:1 matched control was randomly selected from individuals with a pediatric TBI who did not have a mood/anxiety disorder prior to the matched case's mood/anxiety disorder.

INTERVENTIONS

Not applicable MAIN OUTCOME MEASURES: Development of a mood/anxiety disorder.

RESULTS

Among the 114 matched pairs of individuals with a TBI prior to age 10, a subsequent mood/anxiety diagnosis was significantly associated with a history of 10 of 14 ACE categories and with having an ACE score ≥1 (odds ratio 5.17; 95% confidence interval 2.78-9.59).

CONCLUSIONS

This is the first population-based study to the authors' knowledge showing that among children who sustained a TBI prior to age 10, those who experienced ACEs are at increased risk of developing a mood or anxiety disorder.

The Effect of Maternal Adverse Childhood Experiences (ACEs) on Substance Use During Pregnancy

OBJECTIVES

To analyze adverse childhood experiences (ACEs) among mothers of newborns referred to a hospital's child protection team (CPT) for suspected substance exposure. Researchers hypothesized that a higher prevalence of these mothers have ≥ 4 ACEs than female counterparts in the general population. The study team also explored whether associations existed between type of maternal ACEs and substance use in pregnancy.

METHODS

Retrospective review of infant referrals to the CPT in the 3 years after adding an ACEs questionnaire to the consultation process. Bivariate analyses and multivariate logistic regression models examined associations between prenatal substance use and maternal ACEs prevalence, controlling for demographics.

RESULTS

Data from 222 infants (four sets of twins) and 218 mothers were analyzed. Half (50.0%) the infants had withdrawal symptoms. Most (67.0%) women had positive toxicology screens, while 85.0% reported prenatal substance use. Half (50.9%) the mothers reported ≥ 4 ACEs and these individuals had significantly higher odds of cannabinoid use [adjusted odds ratio (aOR), 3.7; 95%CI 2.0, 6.9, p < 0.001) than those with < 4 ACEs. A significant association was found between substance use and ACEs in the household challenges category (p = 0.03), especially parental separation/divorce (p < 0.001).

CONCLUSIONS FOR PRACTICE

As hypothesized, a higher prevalence of mothers referred to the CPT had ≥ 4 ACEs than women in the general population (50.9% vs. 15.2%), and a large proportion had used substances while pregnant. Routine prenatal ACEs screening and universal, nonpunitive toxicology testing of infants and mothers at birth may provide opportunities for intervention while reducing the transgenerational impact of ACEs.

Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland

Emerging data suggest that certain adverse childhood experiences (ACEs) are associated with perinatal depression (PND). However, few studies have comprehensively assessed the cumulative number and types of ACEs and their association to PND. We conducted a cross-sectional analysis among 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, 2018. ACEs were surveyed with the World Health Organization ACE-International questionnaire, while PND symptoms were assessed using the Edinburgh Postnatal Depression Scale (lifetime version). We, while adjusting for confounding factors, estimated the prevalence ratio (PR) of PND in relation to total number of ACEs using the Poisson quasi-likelihood model and further performed analyses for type-specific ACEs. At a mean age of 44 years (SD ± 11.1), 6,201 (36.8%) participants had experienced probable PND. Total number of ACEs was positively associated with PND (PR 1.11 per ACE, 95% CI: 1.10-1.11), also among women without any psychiatric comorbidities (PR 1.13, 95% CI: 1.11-1.14). PRs increased in a dose-response manner with the number of ACEs (P for trend < 0.001); women that endorsed 5 or more ACEs were twice as likely to have experienced PND (PR 2.24, 95% CI: 2.09-2.41). All ACE types (n = 13) were associated with PND, with most pronounced association for emotional neglect by a guardian (PR 1.53, 95% CI: 1.47-1.59). Our findings suggest a positive association between number of ACEs and PND symptoms. If our results are confirmed with prospective data, healthcare providers need to be alert of the risk of PND among expecting mothers with history of ACEs.

The impact of adverse childhood experiences and posttraumatic stress symptoms on chronic pain

Introduction

Chronic pain is a prevalent worldwide health condition. The current study aimed to extend previous research that investigated the dynamics between chronic pain, adverse childhood experiences (ACEs), and post-traumatic stress symptoms (PTSS).

Method

Adult participants worldwide with chronic pain were recruited for this study (N = 199; 89% females). Three hypotheses were proposed: (a) a high ACEs score would result in more severe pain intensity and interference compared to no ACEs; (b) a low ACEs score would result in more severe pain intensity and interference compared to no ACEs; and (c) PTSS would fully mediate the ACEs-pain relationship.

Results

Initially results indicated individuals with high ACEs reported more pain interference than those with no ACEs, although pain intensity did not differ between high and no ACEs. However, after controlling for age, socioeconomic status (SES), and pain duration, low and high ACEs were not significantly associated with pain intensity or interference compared to no ACEs. However, SES status was associated with pain intensity and interference, although not with pain interference after adding low and high ACEs to the model. Because of this the mediation exploration of PTSS was not viable.

Discussion

Implications for practice, limitations and future research outcomes are outlined.

Relationship between caregiver adverse childhood events and age of autism spectrum diagnosis

BACKGROUND

The age at which children are diagnosed with autism spectrum disorder (ASD) has not significantly decreased in the past 20 years. Adverse childhood events (ACEs) experienced by caregivers of autistic children may predict delays in caregivers attending ASD diagnostic evaluations, negatively impacting the age at which the child is diagnosed with ASD. The purpose of this study was to further explore the caregiver delay response by analyzing recurring events common in caregivers of children at risk for ASD.

METHODS

We used a quantitative research design with convenience sampling to categorize caregivers of children referred for an ASD diagnostic evaluation into three groups based on their ACEs score and medical history.

FINDINGS

A higher percentage of caregivers with four or more ACEs compared to the national average was noted. Parental separation or divorce, verbal aggression, emotional abuse, and parental alcohol or substance abuse occurred most frequently, and the latter predicted a prolonged time in attending the diagnostic evaluation.

DISCUSSION

ACEs experienced by caregivers of children with ASD may delay the age of ASD diagnosis. Further investigation into the effect of ACEs on caregivers' mental health status and executive functioning is warranted to develop best practice for assisting caregivers in ASD recognition, diagnosis, and care management.

APPLICATION TO PRACTICE

Clinicians should consider caregiver ACEs score when referring a child for a diagnostic developmental evaluation. Resources to address caregiver mental health needs should be provided at the onset of the referral process to increase the likelihood of caregiver adherence.

Burnout and secondary traumatic stress in staff working with people with intellectual disabilities: The role of adverse childhood experiences, resilience and trauma-informed organisational climate

BACKGROUND

There has been extensive research into adverse childhood experiences (ACEs), however, less consideration has been given to the prevalence and impact of ACEs for staff working with people with intellectual disabilities.

METHOD

Participants were staff employed by agencies that care for people with intellectual disabilities. An online survey collected demographic information and measures of ACEs, resilience, trauma-informed organisational climate, burnout and secondary traumatic stress. Correlation, regression, mediation and moderation analyses were used.

RESULTS

81.7% of 109 participants had experienced at least one ACE. Burnout, secondary traumatic stress and resilience were greater in the present study than in comparable samples. Trauma-informed organisational climate significantly predicted burnout and secondary traumatic stress. Resilience significantly predicted burnout.

CONCLUSIONS

Staff working with people with intellectual disabilities are likely to have experienced ACEs. Working in a trauma-informed organisational climate and resilience may be effective avenues for reducing burnout and secondary traumatic stress.

Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence

BACKGROUND

In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention.

OBJECTIVE

We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA.

PARTICIPANTS AND SETTING

A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified.

RESULTS

Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan.

CONCLUSIONS

Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.

Peripheral and Cerebral Vasodilation in Black and White Women: Examining the Impact of Psychosocial Stress Exposure Versus Internalization and Coping

BACKGROUND

Black women have among the highest rates of cardiovascular and cerebrovascular disease prevalence and mortality in part due to blunted vascular function. Psychosocial stress likely also contributes but its relationship to vascular function remains incompletely understood. Recent studies suggest that stress internalization and coping strategies are more important than stress exposures alone. We hypothesized that Black women would have blunted peripheral and cerebral vasodilation and that, among Black women, this would be inversely related with psychosocial stress internalization/coping but not stress exposures.

METHODS

Healthy Black (n=21; 20±2 years) and White (n=16; 25±7 years) women underwent testing for forearm reactive hyperemia, brachial artery flow-mediated dilation (FMD), and cerebrovascular reactivity. Psychosocial stress exposures (adverse childhood experiences; past week discrimination) and internalization/coping techniques (John Henryism Active Coping Scale; Giscombe Superwoman Schema Questionnaire) were assessed.

RESULTS

Reactive hyperemia and cerebrovascular reactivity were not different between groups (P>0.05), whereas FMD was lower in Black women (P=0.007). Neither adverse childhood experiences nor past week discrimination were associated with FMD in either group (P>0.05 for all). John Henryism Active Coping Scale scores were negatively associated with FMD in Black women (P=0.014) but positively associated with FMD in White women (P=0.042). Superwoman Schema-Succeed was negatively associated (P=0.044) and Superwoman Schema-Vulnerable tended to be negatively associated (P=0.057) with FMD in Black women.

CONCLUSIONS

These findings indicate that blunted FMD in Black women may be due more to stress internalization and maladaptive coping than stress exposures alone.

Prospective longitudinal associations between adverse childhood experiences and adult mental health outcomes: a protocol for a systematic review and meta-analysis

BACKGROUND

Research cites a strong, dose-response relationship between adverse childhood experiences (ACEs) and poor adult mental health outcomes including anxiety, depression, post-traumatic stress disorder (PTSD), self-harm, suicidality, and psychotic-like experiences.

AIM

To systematically investigate the existence and strength of association between ACEs and adult mental health outcomes in prospective longitudinal studies. The review will focus on the outcomes: anxiety, depression, PTSD, self-harm, suicidal ideation, and psychotic-like experiences.

METHODS

Twelve electronic databases will be searched: Embase, PsycINFO, MEDLINE, and Global Health through the OVID interface. ProQuest will be used to search Public Affairs Information Service (PAIS), Dissertations and Theses, Sociology Database (including Sociological Abstracts and Social Services Abstracts), PTSDpubs (formerly The Published International Literature on Traumatic Stress (PILOTS) Database) and Applied Social Sciences Index and Abstracts (ASSIA). CINAHL, World Health Organisation (WHO) Global Index Medicus, and WHO Violence Info will also be searched. Eligible studies will be double screened, assessed, and their data will be extracted. Any disagreement throughout these processes will be settled by a third reviewer. If enough studies meet the criteria and the methodological quality of each study is sufficient, a meta-analysis will be conducted.

ANALYSIS

A narrative synthesis of included studies and the associations between ACEs and adult mental health will be completed. If the number of studies included per mental health outcome is two or more, a multi-level meta-analysis will be completed using odds ratio effect sizes as outcomes.

DISCUSSION

This review will contribute to the existing body of literature supporting the long-term effects of ACEs on adult mental health. This review adds to previous reviews that have either synthesised cross-sectional associations between ACEs and mental health outcomes, synthesised longitudinal studies exploring the effect of ACEs on different physical and mental health outcomes or synthesised longitudinal studies exploring the effect of ACEs on the same mental health outcomes using different methods. This review aims to identify methodological weaknesses and knowledge gaps in current literature that can be addressed in future primary studies.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered in PROSPERO (CRD42021297882).

Adverse Childhood Experiences, Depression, and Intimate Partner Violence Among Chinese Immigrant Women: Mediation by Social and Partner Support

BACKGROUND

Adverse childhood experiences (ACEs) are associated with an increased risk of depression and intimate partner violence (IPV). Social support and partner support may help explain this association. Few researchers have focused on Chinese immigrant women, who are less likely than native-born women to seek help for mental health challenges and IPV.

OBJECTIVE

The purpose of this study was to examine the mediation effects of social and partner support on the relationship between (a) ACEs and (b) depressive symptoms and IPV among Chinese immigrant women living in the United States.

METHODS

This is a secondary analysis of data from 475 Chinese immigrant women recruited online. Depressive symptoms, IPV, ACEs, perceived social support, and perceived partner support were measured cross-sectionally. Mediation analyses were conducted to test the mediating role of social and partner support on the associations between ACEs and depressive symptoms and IPV.

RESULTS

Social support and partner support fully mediated the relationship between ACEs and depressive symptoms. However, partner support only partially mediated the relationship between ACEs and IPV.

DISCUSSION

ACEs indirectly affect depressive symptoms by undermining both general perceptions of support and perceived partner support. The findings of this study underscore the critical influence of a lack of partner support in mediating the effects of ACEs on Chinese immigrant women's risk of IPV. Promoting strong existing support networks, creating new support resources, and improving partner relationships are important targets for interventions to mitigate the effects of ACEs on depression and IPV in Chinese immigrant women.

Perceived control, loneliness, early-life stress, and parents' perceptions of stress

The COVID-19 pandemic has highlighted the importance of understanding what contributes to individual variability in experiences of stress. Increases in stress related to the pandemic have been especially pronounced in parents, indicating a need for research examining what factors contribute to parents' perceptions of stress. Here, we assessed the relationship between parents' perceptions of stress, control, loneliness, and experiences of childhood trauma in two populations of caregivers. In Study 1, we examined the relationship between perceptions of stress, control, loneliness, and history of early stress, along with indices of socioeconomic risk and resting parasympathetic nervous systema activity, which has been linked to variability in perceptions of stress, in caregivers of young children. Perceived control, loneliness, childhood stress, and resting parasympathetic nervous system activity predicted caregivers' stress. In Study 2, we replicated these initial findings in a second sample of caregivers. Additionally, we examined how these processes change over time. Caregivers demonstrated significant changes in perceptions of control, loneliness, and stress, and changes in control and childhood trauma history were associated with changes in perceptions of stress. Together these results indicate the importance of assessing how caregivers perceive their environment when examining what contributes to increased risk for stress. Additionally, they suggest that caregivers' stress-related processes are malleable and provide insight into potential targets for interventions aimed at reducing parents' stress.

Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study

BACKGROUND

The relationship between adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) and their association with incident cardiovascular disease (CVD) have not been extensively studied. Considering social support, we evaluated the complex relations of ACEs and AAEs with incident CVD.

METHODS

This prospective cohort study used data from the 2014 life course survey and the 2015 and 2018 surveys of the China Health and Retirement Longitudinal Study, a national survey of Chinese adults aged ≥ 45 years from 28 provinces across China. The study population included 5836 individuals (mean [SD] age, 59.59 [8.22] years, 49.7% were males). Information on ACEs, AAEs, young adulthood social support, health behavior factors, health status factors, and demographics was measured. Cox regression models, the difference method to estimate the mediation proportion, and the additive and multiplicative interactions were performed. Subgroup and sensitivity analyses were also conducted.

RESULTS

During follow-up, 789 incident cases of CVD occurred. The fully adjusted model, including demographics, health behaviors, health status factors (e.g., depressive symptoms), and social support as control variables, demonstrated that the overall number of ACEs (Hazard ratio [HR]: 1.11, 95% CI: 1.08 to 1.14) and AAEs (HR: 1.19, 95% CI: 1.16 to 1.22) were associated with an increased risk of incident CVD. A dose-response relationship existed between the number of ACEs or AAEs and incident CVD risk. The overall AAEs were found to mediate 17.7% (95% CI: 8.2 to 34.2%) of the association between ACEs and incident CVD. Moreover, a significant additive interaction between ACEs and AAEs was detected (RERI [95% CI]: 0.32 [0.09 to 0.56]). Compared with adults without exposure to both ACE and AAE, those with exposure to both at least one ACE and one AAE indicator had the highest risk of incident CVD (HR: 1.96, 95% CI: 1.72 to 2.23).

CONCLUSIONS

Exposure to ACEs or AAEs was independently associated with an increased risk of incident CVD among Chinese middle-aged and older adults in a dose-response manner, and the overall AAEs partially mediated the association between ACEs and incident CVD. Preventive measures aimed at addressing either ACEs or AAEs alone may not significantly reduce the risk of CVD later in life. The necessity of a comprehensive life-course health strategy targeting the prevention of adversity merits increased attention.

Traumatic events in childhood and adulthood in a diverse-ancestry sample and their role in bipolar disorder

We examined the presence of adverse events in both childhood and adulthood and the prevalence of PTSD in individuals with Bipolar Disorder (BD). There were 191 adults diagnosed with BD Type I and 924 controls, of predominantly African Ancestry (AA). All were administered the GPC-Screening Tool and the BD group the DIPAD. In addition Childhood adversities were measured using the ACE (from 0 to 10), about traumatic events before age 18 and lifetime adversities were measured with 15 questions adapted from the Study of Addiction: Genetics and Environment (A-SAGE (from 0 to 15) for all cases and controls. Probable PTSD (pPTSD) was measured with 4 questions on the GPC screener. Sum scores were calculated for the ACE and A-SAGE by tallying positive responses. Odd Ratios (OR) were used to measure the association between BD and Controls exposure to adversity. BD was associated with a significantly higher mean ACE score and A-SAGE score compared to controls. There was a significantly higher prevalence of pPTSD in the BD (54.5%) versus Controls (6.6%) as well. Greater OR's were seen in the BD compared to Controls for each ACE question (p<0.05). Results were similar for A-SAGE. Limitations include possible recall bias, and missing data.

Childhood Residential Mobility and Mental and Physical Health in Later Life: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = -0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = -0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people (p = 0.06), those with low childhood SES compared to high childhood SES (p = 0.02), and high ACEs compared to low ACEs (p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.

Adverse Childhood Experiences, Social Isolation, Job Strain, and Cardiovascular Disease Mortality in U.S. Older Employees

Stress is a key driver of cardiovascular disease (CVD), yet the contribution of psychosocial stressors to the development of CVD has not been systematically examined in United States (U.S.) populations. The objective of this study was to assess prospective associations of adverse childhood experiences (ACEs), social isolation, and job strain with CVD mortality. Data were from the large, nationally representative, population-based Health and Retirement Study (HRS). ACEs, social isolation and job strain were assessed using validated survey instruments at baseline between 2006-2008, and death information was followed up through 2018. Cox proportional hazards regression models were used to examine prospective associations of ACEs, social isolation, and job strain with CVD mortality among 4046 older employees free from CVD at baseline. During 42,149 person-years of follow-up time, 59 death cases of CVD were reported. After adjustment for covariates, ACEs and job strain were significantly associated with increased risk of CVD mortality (aHR and 95% CI = 3.67 [1.59, 8.48] and 2.24 [1.21, 4.11], respectively), whereas social isolation demonstrated an inflated but nonsignificant association (aHR and 95% CI = 1.62 [0.72, 3.66]). These findings highlight the role of psychosocial exposures as novel and clinically relevant risk factors for CVD.

Distress among undergraduates: Marginality, stressors and resilience resources

Objective: This study addresses mental health concerns among university students, examining cumulative stress exposure as well as resilience resources. Participants: Participants were 253 first- and second-year undergraduate students (age = 18.76; 49.80% male, 69% students of color) enrolled at a large western US university. Methods: Data were obtained from a cross-sectional online survey examining marginalized statuses and multiple stressors alongside coping responses, adaptive self-concept, and social support as predictors of stress, anxiety, and depression. Results: Multivariate regressions demonstrated significant associations between stress exposures and lower levels of resilience resources with each mental health indicator (with substantial R2 of.49-.60). Although stressor exposures accounted for significant increases in mental health concerns, their exploratory power was attenuated by resilience resources (e.g., beta decreases from.25 to.16). Conclusions: Better understanding cumulative adversity/resilience resource profiles, particularly among marginalized students, can help universities in prioritizing institutional support responses toward prevention and mitigating psychological distress.

Applying the interpersonal-psychological theory of suicide to inform the association between bullying victimization and suicidal ideation in college students

Objective: Victims of bullying are at increased risk for suicidal ideation. The purpose of the current study is to examine the impact of bullying victimization in childhood on college student's current report of suicidal ideation through two mechanisms derived from the interpersonal-psychological theory of suicide. Participants: Our sample consists of 304 undergraduate college students from a large, southeastern university. Methods: We employed a cross-sectional design with self-report surveys to examine the indirect effects of childhood bullying victimization frequency on suicidal ideation through thwarted belongingness and perceived burdensomeness. Results: The association between bullying victimization and suicidal ideation was explained by perceived burdensomeness, but not thwarted belongingness. Conclusions: Bullying victimization in childhood may have distal effects on suicidal ideation through influencing perceptions of worthlessness and self-hatred. Interventions in college settings that address the impact of bullying victimization on perceived burdensomeness may reduce potential for suicidal ideation among college students.

Addressing Adverse Childhood Experiences and Psychological Symptoms Among Bariatric Patients

Adverse Childhood Experiences (ACEs) have been shown to be prevalent in bariatric surgery candidates with comorbid psychological symptoms. While bariatric patients who have mental illness or a history of ACEs are less likely to lose weight, presence of a support system has been reported to mitigate ACEs' effects and to maintain long-term weight loss. The current study aims to examine the association between ACEs and psychological symptoms and the effect of potential protective factors on the association among bariatric patients. The study included a total of 199 subjects seeking bariatric surgery who completed a psychological evaluation including ACEs, psychological symptoms, and presence of support system as part of the presurgical multidisciplinary weight management consultations at a large university hospital. Multivariate regression models were used to examine the association between ACEs and psychological symptoms and potential effect of support system on the association. The study found that there is a significant association between ACEs and psychological symptoms. The study also revealed that patients who reported having a childhood supportive person were significantly associated with a lower BMI, while those who reported having adulthood supportive person showed significantly less symptoms of depression, anxiety, and binge eating. The findings have significant implications that addressing ACEs in preoperative surgical process in relation to psychological conditions and therapeutic interventions within their close environmental system will be beneficial for patients to achieve optimal surgical outcomes.

Psychometric properties of the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) among Hungarian adolescents

Introduction

Although a number of studies have been conducted since the 1995 initiation of the ACE study to map the effects of adverse childhood experiences, few studies have examined the psychometric properties of the individual versions of the ACE questionnaire.

Aims

The Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) has only been tested in a single study in an adult population, while its applicability in a particularly vulnerable population, the adolescents, has not been investigated yet. Our present study aims to address this gap in an adolescent sample of 792 subjects from a non-representative general population.

Methods

Besides demographic data, the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Symptom Checklist (HBSC-SCL) were employed.

Results

Our results showed acceptable internal consistency (ɵ = 0.86, α = 0.64) and adequate internal validity (r = 0.28-0.70, p < 0.001). In addition, proper concurrent criterion validity of the questionnaire was found when tested along the SDQ and HBSC-SCL items.

Conclusion

Our results demonstrate that the ACE-10 is suitable for assessing intrafamilial adverse childhood experiences in adolescents.

The Influence of Adverse Childhood Experiences on Suicidal Behaviors in South Korea: The Mediating Effects of Depressive Symptoms and Latent Class Analysis

This study examines the relationship between patterns of adverse childhood experiences (ACEs) and suicidal behaviors. It investigates the role of depressive symptoms as an underlying mechanism between patterns of ACEs and suicidal behaviors in South Korea. Data came from the 2012 Korean General Social Survey (KGSS), a nationally representative sample in South Korea (N = 1,048). The dependent variables included two suicidal behaviors: suicidal thoughts and a suicide plan or attempt. The independent variable was the patterns of ACEs identified using ten binary indicators of childhood adversity. The mediating variable of depressive symptoms was measured using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Covariates were also included to control for socio-demographic characteristics: age, gender, education, and household income. This study conducted a latent class analysis (LCA) to classify different patterns of ACEs and then employed path analysis to examine mediating effects of depressive symptoms in the relationship between ACEs and suicidal behavior. Among the results, three latent classes of ACEs were identified-child maltreatment, child maltreatment and family dysfunction, and low ACEs. The child maltreatment and child maltreatment and family dysfunction classes were more likely to have suicidal thoughts and to plan or attempt suicide compared to the low ACEs class. Path analysis also showed significant indirect pathways from ACEs exposure to suicidal behaviors through depressive symptoms. This evidence corroborates previous research that shows family dysfunction and child maltreatment as detrimental factors leading to depressive symptoms and suicidal behaviors. Practitioners and policy-makers should therefore consider childhood life experiences when assessing suicidal behaviors in health prevention and intervention strategies.

Childhood Adversity Predicts Maternal Pre-Pregnancy BMI but not Gestational Weight Gain

INTRODUCTION

Obesity and excessive weight gain during pregnancy have lasting implications for both women and infant health. Adverse childhood experiences and stressful life events have been associated with pre-pregnancy obesity and excessive gestational weight gain. However, the effect of each has been examined independently and scant work has investigated the effects of both in the same analysis. The current study examined the unique and conjoint effects of adverse childhood experiences and recent stressful life events on women's pre-pregnancy BMI and gestational weight gain.

METHODS

A racially and socioeconomically diverse sample of 176 pregnant women completed questionnaires and anthropometric measurements during the third trimester and two months postpartum.

RESULTS

Maternal adverse childhood experiences were uniquely associated with pre-pregnancy BMI (β = 0.21, p = .02), but not gestational weight gain. Recent stressful life events did not uniquely predict pre-pregnancy BMI or gestational weight gain, nor did it explain the association between adverse childhood experiences and pre-pregnancy BMI. Adverse childhood experiences and recent stressful life events did not interact to predict either of the women's weight outcomes.

DISCUSSION

Adverse childhood experiences have lasting unique effects on women's pre-pregnancy BMI. Obesity is related to several perinatal health issues for the mother and child, thus understanding the effects of childhood adversity on women's weight outcomes is critical. Routine screening for ACEs among women of childbearing age and pregnant women, paired with referrals and educational resources, can mitigate the deleterious effects of childhood adversity on women and infant health.

The association between adverse childhood experiences and oral health: A systematic review

OBJECTIVE

It is well established that adverse childhood experiences (ACEs) negatively affect health and are associated with health-risk behaviors. This study aimed to provide a systematic review of the studies that examine the relationship between ACE exposure and oral health among adults aged 18 years and older.

METHODS

The following electronic databases were searched in January 2022: MEDLINE, Cochrane, Web of Science, CINAHL via EBSCOhost, ProQuest, ScienceDirect, and Google Scholar. Data were extracted independently by two reviewers. The quality of the studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

Among the 292 articles identified, four met the eligibility criteria. All included studies were cross-sectional and of satisfactory quality. The dental outcomes included: last dental visit, last dental cleaning, number of filled teeth, number of extracted teeth, and number of remaining teeth. The studies showed that exposure to ACE was negatively associated with oral health. The relationship between ACE score and oral health outcome measures was found to be directly proportional.

CONCLUSION

There is an association between ACE and poor oral health. Moreover, the association was proven to have a dose-response relationship. Given that the studies in the literature were cross-sectional, causality cannot be determined with certainty, therefore interpretation of the results should be cautious. Longitudinal follow-up studies are needed to understand how ACEs contribute to oral diseases later in life.

The Effects of Severe Childhood Physical and Sexual Abuse on Adult Socioeconomic Prosperity

Our study utilizes Adverse Childhood Experience (ACE) scores to estimate the relationship between forced sexual intercourse and physical abuse on socioeconomic outcomes in adulthood. ACEs have been shown to have long-term negative impacts on health, mental health, and cognition. We expand upon the literature that analyzes the effects of ACEs on human capital investment and adult socioeconomic outcomes by focusing on the ACE scores pertaining to repeated physical and forced sexual abuse in childhood. Specifically, we estimate probit models using data from the Behavioral Risk Factor Surveillance System to measure the marginal effects of childhood sexual abuse (CSA) and physical abuse on the probability of high school completion, unemployment, and the likelihood of living in poverty in adulthood. We find adults who suffered physical abuse in childhood are more likely to live in poverty. Adult survivors of CSA are less likely to finish high school and more likely to live in poverty. The likelihood of high school noncompletion increases when the individual suffered both forms of abuse. We also find that only those who suffered both forms of abuse in childhood had a greater likelihood of being unemployed and high school noncompletion. We find the negative socioeconomic impact in adulthood is larger for women than for men, implying gender heterogeneity in outcomes of CSA and physical abuse. Researchers should control for the correlation between sexual abuse and physical abuse in childhood, particularly in women, when estimating their effects on socioeconomic outcomes.

Examining the Effects of Adverse Childhood Experiences and Gender on Trauma-Informed Intervention Outcomes

Purpose

The prevalence of Adverse Childhood Experiences (ACEs) and their link to negative behavioral and health outcomes is well documented, but very few studies have empirically examined the effect of ACEs on intervention outcomes. There is also emerging evidence of gender differences in vulnerability to developing traumatic symptoms, which relates to intervention outcomes. The current study examined the effects of ACEs and gender on trauma-informed intervention outcomes in a community-based clinical setting.

Methods

The study includes data from children who were treated with trauma-informed intervention services grounded in the Attachment, Self-Regulation, and Competency (ARC) framework from 2017 to 2019. ACE scores are measured as a total across 10 items and different types, maltreatment versus family dysfunction, at intake. Children's trauma-related symptoms are assessed at intake and every 90 days under the ARC framework. In order to examine the changes of traumatic symptoms over time, a total of 362 children with three time points are included for the current analyses using Multilevel modeling with SAS PROC MIXED.

Results

The study found that a trauma-informed intervention based on the ARC framework was effective in reducing children's trauma related symptoms until they experienced 6 or more ACEs. The intervention effect, however, did not hold when children's ACEs were cumulated to 7 or more. The study also revealed gender differences in intervention outcomes.

Conclusions

The finding has significant implications for early detection and preventative intervention efforts with children's ACEs before their ACEs further cumulate to a higher number. Gender difference should be considered in intervention planning and monitored during the intervention process.

Adverse childhood experiences are associated with altered cardiovascular reactivity to head-up tilt in young adults

Adverse childhood experiences (ACEs) are associated with greater prevalence of cardiovascular disease and altered acute stress reactivity. The current study investigated the effect of ACEs on hemodynamic and autonomic responses to orthostatic stress imposed by 60° head-up tilt (HUT) in young adults. Two-hundred twenty-six healthy young adults (age = 22.6 ± 1.5 yr; n = 116 females) without cardiovascular disease participated and had complete data. Participants underwent supine blood pressure (BP), R-R interval (RRI), cardiac output (CO), total peripheral resistance (TPR), and cardiovagal baroreflex sensitivity (cvBRS) testing followed by a transition to 60° HUT where measures were reassessed. Childhood adversity exposures were assessed based on categorical exposure and nonexposure to childhood household dysfunction and maltreatment, and <4 and ≥4 types of ACEs. Significantly greater increases in SBP (P < 0.05), DBP, MAP, and TPR (P < 0.01; all) following 60° HUT were observed in individuals with ≥4 compared with those with <4 types of ACEs. Attenuated decreases in RRI and cvBRS were observed in those with ≥4 types of ACEs (P < 0.05). Experiencing ≥4 types of ACEs was associated with augmented BP and TPR reactivity and a blunted decrease in cvBRS in response to 60° HUT in young adults. Results suggest that a reduced vagal response to orthostatic stress is present in those who have experienced ≥4 types of ACEs that may promote autonomic dysfunction. Future research examining the sympathetic and vagal baroreflex branches is warranted.

Elements of Control Differentiate Associations Between Childhood Emotional Abuse and Anxiety Symptoms

Among adolescents experiencing childhood maltreatment, there exists wide variability regarding the development and maintenance of anxious symptoms. Existing research has identified the protective role of effortful control against childhood anxiety (Raines et al. in Child Psychiatry and Human Development, 2021). The current study aimed to uncover how distinct elements of effortful control differentially diminish or intensify anxiety symptoms arising from a perceived lack of control following childhood emotional abuse (CEA). 467 college student participants provided reports of their experience with childhood emotional abuse, locus of control, anxiety symptoms, and effortful control via in-person surveys. We explored three categories of effortful control: inhibitory control (the capacity to suppress inappropriate behavior), attentional control (the capacity to focus or shift attention), and activational control (the capacity to perform an action despite a strong tendency to avoid). Consistent with our hypotheses, results revealed that CEA predicted increased anxiety symptoms. External LOC significantly mediated the relationship between CEA and anxiety. When effortful control was broken down into its component elements, higher inhibitory control acted as a protective factor for locus of control driven anxiety, whereas higher levels of activational control acted as a risk factor. Attentional control was not a significant moderator. These findings stress the importance of identifying risk and protective factors that contribute to resilience, and may aid in the development of interventions targeted to specific aspects of effortful control.

Maternal adverse childhood experiences impact fetal adrenal volume in a sex-specific manner

BACKGROUND

The mechanisms by which parental early life stress can be transmitted to the next generation, in some cases in a sex-specific manner, are unclear. Maternal preconception stress may increase susceptibility to suboptimal health outcomes via in utero programming of the fetal hypothalamic-pituitary-adrenal (HPA) axis.

METHODS

We recruited healthy pregnant women (N = 147), dichotomized into low (0 or 1) and high (2+) adverse childhood experience (ACE) groups based on the ACE Questionnaire, to test the hypothesis that maternal ACE history influences fetal adrenal development in a sex-specific manner. At a mean (standard deviation) of 21.5 (1.4) and 29.5 (1.4) weeks gestation, participants underwent three-dimensional ultrasounds to measure fetal adrenal volume, adjusting for fetal body weight (_waFAV).

RESULTS

At ultrasound 1, _waFAV was smaller in high versus low ACE males (b = - 0.17; z = - 3.75; p < .001), but females did not differ significantly by maternal ACE group (b = 0.09; z = 1.72; p = .086). Compared to low ACE males, _waFAV was smaller for low (b = - 0.20; z = - 4.10; p < .001) and high ACE females (b = - 0.11; z = 2.16; p = .031); however, high ACE males did not differ from low (b = 0.03; z = .57; p = .570) or high ACE females (b = - 0.06; z = - 1.29; p = .196). At ultrasound 2, _waFAV did not differ significantly between any maternal ACE/offspring sex subgroups (ps ≥ .055). Perceived stress did not differ between maternal ACE groups at baseline, ultrasound 1, or ultrasound 2 (ps ≥ .148).

CONCLUSIONS

We observed a significant impact of high maternal ACE history on _waFAV, a proxy for fetal adrenal development, but only in males. Our observation that the _waFAV in males of mothers with a high ACE history did not differ from the _waFAV of females extends preclinical research demonstrating a dysmasculinizing effect of gestational stress on a range of offspring outcomes. Future studies investigating intergenerational transmission of stress should consider the influence of maternal preconception stress on offspring outcomes.

Developmental predictors of young adult borderline personality disorder: a prospective, longitudinal study of females with and without childhood ADHD

BACKGROUND

Research on the precursors of borderline personality disorder (BPD) reveals numerous child and adolescent risk factors, with impulsivity and trauma among the most salient. Yet few prospective longitudinal studies have examined pathways to BPD, particularly with inclusion of multiple risk domains.

METHODS

We examined theory-informed predictors of young-adult BPD (a) diagnosis and (b) dimensional features from childhood and late adolescence via a diverse (47% non-white) sample of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder (ADHD).

RESULTS

After adjustment for key covariates, low levels of objectively measured executive functioning in childhood predicted young adult BPD diagnostic status, as did a cumulative history of childhood adverse experiences/trauma. Additionally, both childhood hyperactivity/impulsivity and childhood adverse experiences/trauma predicted young adult BPD dimensional features. Regarding late-adolescent predictors, no significant predictors emerged regarding BPD diagnosis, but internalizing and externalizing symptoms were each significant predictors of BPD dimensional features. Exploratory moderator analyses revealed that predictions to BPD dimensional features from low executive functioning were heightened in the presence of low socioeconomic status.

CONCLUSIONS

Given our sample size, caution is needed when drawing implications. Possible future directions include focus on preventive interventions in populations with enhanced risk for BPD, particularly those focused on improving executive functioning skills and reducing risk for trauma (and its manifestations). Replication is required, as are sensitive measures of early emotional invalidation and extensions to male samples.

Maternal adverse childhood experiences and health-related quality of life in preschool children: a cross-sectional study

BACKGROUND

The intergenerational association between maternal adverse childhood experiences (ACEs) and their children's health-related quality of life (HRQOL) is underexplored. This study aimed to examine such association in Chinese preschool children and to test the moderation role of children's sex.

METHODS

A cross-sectional study was conducted among 4243 mother-child dyads who attended randomly selected preschools. Mothers self-reported their experience of 12 forms of ACEs, including emotional abuse, physical abuse, emotional neglect, physical neglect, intimate partner violence, substance abuse in the household, incarcerated household member, mental illness in household, parental death, parental separation or divorce, bullying, and community violence. Children's HRQOL was evaluated through mother report of the Pediatric Quality of Life Inventory version 4.0. Linear regression models were established to estimate the associations between maternal ACEs and their children's HRQOL sub-scores and total scores. Stratified analysis and test for interaction were further conducted to evaluate whether the associations were moderated by children's sex.

RESULTS

Of the included mothers, 85.8% (n = 3641) had reported exposure to at least one ACE, and 22.3% (n = 948) were exposed to three or more ACEs. Compared to children of mothers without any ACE exposure, those of mothers with 1, 2, or ≥ 3 ACEs all had significantly lower scores of physical, social, and school functioning, as well as lower psychosocial health summary score and total scale score in both crude and adjusted models. However, only children of mothers with two or more ACEs had significantly poorer emotional functioning when compared to their counterparts whose mothers had no ACE exposure. A significant dose-response pattern was also observed between the number of maternal ACEs and children's HRQOL sub-scores and total scores. Stratified analysis revealed sex-specific pattern between maternal ACEs and their children's HRQOL. Nonetheless, children's sex was not a significant moderator.

CONCLUSIONS

Our study showed that preschool children of mothers who had any experience of ACEs were at risk of poorer HRQOL. Our findings indicated that screening maternal ACEs in young children and promoting targeted interventions might be a feasible way to mitigate or stop the potential negative intergenerational health and wellbeing implications of ACEs.

Searching for secrets, searching for self: Childhood adversity, self-concept clarity, and the motivation to uncover family secrets through direct-to-consumer genetic testing

Direct-to-consumer (DTC) genetic tests have become an attractive product for those hoping to gain insight into their health, ancestry, and biological relatedness. In some cases, test results are unexpected, and lead to the revelation of previously undisclosed family secrets. A subset of individuals may pursue testing explicitly for this purpose; however, the psychosocial processes underlying this motivation remain unexamined. Grounded in the literature on family secrecy, trauma, and the development of self-concept, we tested a hypothesized mediation model to provide insight into this motivation among a sample of 433 individuals in pursuit of DTC genetic testing. In line with the documented association between maladaptive family communication patterns and trauma exposure in childhood, we found that exposure to adverse childhood experiences was associated with the motivation to pursue DTC genetic testing for the purpose of uncovering family secrets. We also found evidence of an indirect effect through reduced self-concept clarity. These findings suggest that impaired identity formation processes may have played a role in transmitting the effect. Furthermore, the findings highlight a novel way in which family histories may contribute to DTC genetic testing motivations. Future examination of these and other psychosocial phenomena that contribute to DTC genetic testing will be crucial to consider as the tests become increasingly accessible, and as the information they can provide becomes increasingly comprehensive. Findings from this line of research could help to identify for whom and under what conditions DTC genetic testing benefits well-being, and the conditions under which the act of testing and receipt of results could have adverse psychosocial effects. These insights will be of interest to genetic counselors working in the field of DTC genetic testing, and those working with individuals and families affected by unexpected test results.

Racial/Ethnic Differences in Associations Between Traumatic Childhood Experiences and Both Metabolic Syndrome Prevalence and Type 2 Diabetes Risk Among a Cohort of U.S. Women

OBJECTIVE

Childhood adversity has been associated with metabolic syndrome (MetS) and type 2 diabetes risk in adulthood. However, studies have yet to investigate traumatic childhood experiences (TCEs) beyond abuse and neglect (e.g., natural disaster) while considering potential racial/ethnic differences.

RESEARCH DESIGN AND METHODS

To investigate race/ethnicity as a potential modifier of the association between TCEs, MetS, and type 2 diabetes, we used prospectively collected data from 42,173 eligible non-Hispanic White (NHW; 88%), Black/African American (BAA; 7%), and Hispanic/Latina (4%) Sister Study participants (aged 35-74 years) enrolled from 2003 to 2009. A modified Brief Betrayal Trauma Survey captured TCEs. At least three prevalent metabolic abnormalities defined MetS, and self-report of a new diagnosis during the study period defined type 2 diabetes. We used adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs for type 2 diabetes over a mean ± SD follow-up of 11.1 ± 2.7 years, overall and by race/ethnicity. We also tested for modification and mediation by MetS.

RESULTS

Incident cases of type 2 diabetes were reported (n = 2,479 among NHW, 461 among BAA, and 281 among Latina participants). Reporting any TCEs (50% among NHW, 53% among BAA, and 51% among Latina participants) was associated with a 13% higher risk of type 2 diabetes (HR 1.13; 95% CI 1.04-1.22). Associations were strongest among Latina participants (HR 1.64 [95% CI 1.21-2.22] vs. 1.09 for BAA and NHW). MetS was not a modifier but mediated (indirect effect, HR 1.01 [95% CI 1.00-1.01]; P = 0.02) the overall association.

CONCLUSIONS

TCE and type 2 diabetes associations varied by race/ethnicity and were partially explained by MetS.

The Interplay Between Childhood Sexual Abuse, Self-Concept Clarity, and Dissociation: A Resilience-Based Perspective

BACKGROUND

Despite a robust consensus regarding the potentially negative implications of childhood sexual abuse (CSA), research investigating risk and protective factors-particularly among well-functioning young adults-is scant. Dissociation is one of the major maladaptive outcomes of CSA. Nevertheless, CSA explains only about 10% of the variance of dissociation. Possibly, this modest effect size is due to protective factors moderating the relation between CSA and dissociative symptoms. One such factor may be the extent to which one has succeeded in developing a clear and coherent sense of who they are.

OBJECTIVE

We aimed to explore whether self-concept clarity (SCC) moderates the relationship between CSA and dissociation (Model 1), and an alternative hypothesis, whereby CSA may moderate the relationship between SCC and dissociation (Model 2).

PARTICIPANTS AND SETTING

This was tested among 65 well-functioning young women drawn from an earlier study that intentionally oversampled CSA survivors.

METHODS

We included data from survivors of CSA by a known perpetrator (n = 35) and women with no sexual trauma (n = 30).

RESULTS

Findings were consistent with both Model 1 and Model 2, but only when depersonalization-derealization, namely detachment, was considered. Simple effects analyses revealed that CSA was related to depersonalization-derealization only under low SCC levels (Model 1), and SCC was negatively related to depersonalization-derealization only in the CSA group (Model 2).

CONCLUSIONS

Findings suggest that SCC is a protective factor, buffering the association between CSA and detachment (depersonalization-derealization) symptoms. Clinical implications are discussed.

Associations Between Adverse Childhood Experiences and Tobacco, Alcohol, and Drug Use Among Individuals with Serious Mental Illnesses in Public-Sector Treatment Settings

Adverse childhood experiences (ACEs) increase risk of substance use disorders (SUDs). Little research has focused on individuals with serious mental illnesses (SMI), despite their high prevalence of both ACEs and SUDs. We combined two datasets from prior studies (n = 299 and n = 240, total n = 539) that measured ACEs and made research diagnoses for SUDs. When controlling for other variables-age, gender, race, diagnostic category (psychotic disorder versus mood disorder), and study site (Washington, DC-area versus southeast Georgia)- in logistic regression models, ACE score was associated with tobacco use, presence of any SUD, alcohol use disorder, cannabis use disorder, and cocaine use disorder. Each one-unit increase in the ACE score increased the odds of SUD-related outcomes by 9-18%. Clinicians, program planners, and researchers should be aware of the powerful and long-lasting impact of ACEs, and the need for thorough screening and assessment of both SUDs and ACEs among patients with SMI.

Prevalence of Poor Mental Health Days and Adverse Childhood Experience Reporting in U.S. Adults Before and After COVID-19

This is the first study of US adults to examine change in the prevalence of psychological burden (i.e., self-reported poor mental health days in the past 30 days, and ACEs recollections) before compared to after COVID-19 started. We analyzed the prevalence of self-reported poor mental health days, and ACEs recollections from 17 states using the Behavioral Risk Factor Surveillance System. Adjusted models identified an increase in prevalence from before compared to after COVID-19 onset in those married or partnered reporting 48% more poor mental health days in the past 30 days; persons of color reporting living with anyone with mental illness during childhood by 73% and reporting more ACEs by 35%; those employed or self-employed reporting childhood sexual abuse by 45%. This ecological-level analysis revealed population-level changes in psychological well-being reporting of U.S. adults from before compared to after the pandemic onset.