Childhood maltreatment and violence: mediation through psychiatric morbidity

Association Between Adverse Childhood Experiences and a Combination of Psychosis and Violence Among Adults: A Systematic Review and Meta-Analysis

Relationships have been well established between adverse childhood experiences (ACEs) and later psychosis (29 systematic reviews) or violence (4 systematic reviews). To date, just one review has explored childhood maltreatment, specifically, and violence risk with psychosis. We conducted a systematic review and meta-analyses of a wider range of ACEs and later psychosis with actual violence compared with psychosis alone, violence alone or neither, completing searches in January 2021. In all, 15 studies met inclusion criteria, but only six included all four groups of interest. Two substantial studies recorded ACEs from sources independent of those affected and probably before emergent psychosis or violence; others relied on retrospective recall. Meta-analyses were possible only for within-psychosis-group comparisons; histories of physical abuse, sexual abuse, and having a criminal/violent parent or living with family alcohol/drug use were each associated with around twice the odds of psychosis with violence as psychosis alone. Although ACE measures in the four-way comparisons were too divergent for firm conclusions, abuse histories, and parental criminality emerged as likely antecedents, one study evidencing psychosis as mediating between ACEs and violence. Without longitudinal prospective study, pathways between ACEs and later problems remain unclear. Our findings add weight to the case for exploring ACEs in addition to abuse as possible indicators of later violence among people with psychosis and for trauma-informed interventions, which is important because some people are reluctant to disclose abuse histories.

Prevalence of co-occurring severe depression and psychotic symptoms in college students and its relationship with childhood maltreatment

BACKGROUND

It has been demonstrated that childhood maltreatment (CM) is associated with an increased risk of depression and psychotic symptoms. However, there is still a lack of studies on the prevalence of co-occurring severe depression and psychotic symptoms (CSDPS) and the association between CM and CSDPS among college students.

OBJECTIVE

We aim to investigate the prevalence and demographic distribution of CSDPS among Chinese college students and to examine its relationship with CM.

PARTICIPANTS AND SETTING

A total of 7351 college students aged 18 and above completed the survey. Finally, 6854 valid questionnaires were included for further analysis.

METHODS

The Childhood Trauma Questionnaire and the item for witnessing domestic violence were used to assess the CM. The Prodromal Questionnaire-16 and the depression subscale of the Depression Anxiety and Stress-21 scale were used to assess psychotic symptoms and depressive symptoms.

RESULTS

The prevalence of CSDPS was 1.47 % among the college students. The multivariate logistic regression analysis showed that emotional abuse and emotional neglect were associated with an increased risk of CSDPS (all p < 0.05). The risk of CSDPS was dramatically increased for individuals who had experienced ≥3 types of CM (OR = 22.929, p < 0.001), as compared to those who had experienced 1-2 types of CM (OR = 4.452, p < 0.001) and those without the experience of CM.

CONCLUSION

CM was found to be associated with an increased risk of CSDPS among the college students. Notably, experiencing more types of CM was also associated with a higher risk of CSDPS.

Child maltreatment and associated sociodemographic factors among children affected by HIV/AIDS in Ghana: a multi-informant perspective

ABSTRACTChild maltreatment is considered a major public health concern among children because they can cause significant physical and psychological problems. Child maltreatment is widespread but often underestimated. Surprisingly, there is hardly any data on child maltreatment and any associated sociodemographic factors children affected by HIV/AIDS in low-income countries. This study employed cross-sectional, quantitative survey that involved 291 children aged 10-17 years and their caregivers in the Lower Manya Krobo District, Ghana and examined their exposure to and experience of child maltreatment. The results show that at least one form of maltreatment was reported by approximately 90% of the children, and it was significantly higher among orphans and vulnerable children (OVC) as compared with comparison children. Older age, frequent changes in residence, non-schooling and living with many siblings are associated with child maltreatment. The results demonstrate that maltreatment among children affected by HIV/AIDS are not rare, and that the dysfunction family conditions that they find themselves bear systemic risks for maltreatment. It is important that culturally appropriate and evidence-based interventions are implemented to address the maltreatment.

Childhood emotional abuse and motor impulsiveness among male violent inmates with antisocial personality disorder

This study aimed to explore the relationship among childhood maltreatment, impulsiveness and antisocial personality through a questionnaire survey of violent male inmates. We found that the scores of inmates with Antisocial Personality Disorder (ASPD) in Childhood Trauma Questionnaire-28 item Short Form (CTQ-SF) and Barratt Impulsive Scale-11 (BIS-11) were higher than those in the Non-Antisocial personality group, and there was a significant correlation between the scores of CTQ-SF and BIS-11. We found that the interaction between impulsivity and childhood abuse predicts ASPD levels. Moreover, motor and non-planning impulsiveness played important roles in the observed differences in antisocial personality scores among the inmates who had experienced childhood maltreatment; motor impulsiveness was mainly related to emotional abuse, physical abuse, and sexual abuse, while non-planning impulsiveness was mainly related to emotional neglect and physical neglect. These findings suggest that identifying and providing timely intervention for inmates with high impulsiveness who experienced maltreatment in childhood may also contribute to the prevention of violent behavior and to better prison management.

Child abuse and aggressiveness in individuals diagnosed with schizophrenia in Lebanon

OBJECTIVES

To identify individual and clinical risk factors of aggressiveness, including exposure to different forms of childhood trauma, in a sample of Lebanese patients with schizophrenia.

METHODS

A total of 131 patients diagnosed with schizophrenia participated in this cross-sectional study.

RESULTS

Higher physical (Beta = 0.24, p < 0.001) and sexual (Beta = 0.29, p = 0.003) abuse, alcohol drinking (Beta = 1.46, p = 0.008), having a history of head trauma (Beta = 1.10, p = 0.041), and male gender (Beta = -1.59, p = 0.009) were significantly associated with higher mean aggression scores.

PRACTICAL IMPLICATIONS

Our investigation of the factors linked to aggressiveness in patients with schizophrenia complement those of earlier findings, showing that the relationship between interacting individual and environmental risk factors and later aggressiveness is quite complex, and needs further longitudinal and prospective studies.

The Maltreatment–Aggression Link among Prosecuted Males: What about Psychopathy?

Criminal offenders constitute a high-risk sample regarding experiences of childhood maltreatment and engagement in severe aggression. Moreover, psychopathic traits are more common in samples of offenders than non-offenders. Although research has underlined the relationship between childhood maltreatment and adult aggression, the influence of psychopathy on this link is still unclear. We examined the dynamics of maltreatment, aggression, and psychopathy in a mixed sample of 239 male violent, sexual, and other offenders using latent factor structural equation modeling. We found a consistent positive association of maltreatment with aggression. Psychopathy did not mediate this relation. Maltreatment was not associated with psychopathy, although psychopathy had a positive effect on aggressive behavior. These dynamics appeared similar for violent, sexual, and other offenders. However, latent variables were constructed somewhat differently depending on the offender status. For instance, sexual abuse appeared to be of specific importance in sexual offenders. Violent offenders showed high rates of psychopathy compared to sexual and other offenders. The current findings may inspire future research to focus more closely on the different subtypes of psychopathy when examining its role in the prediction of aggression based on childhood maltreatment. Moreover, childhood maltreatment must not be neglected in treatment and prevention approaches aimed at reducing the risk of aggressive behavior.

Childhood Adversity Trajectories and Violent Behaviors in Adolescence and Early Adulthood

Violence and other antisocial behaviors, including fighting and weapon carrying, are highly prevalent among adolescents but usually decrease in young adulthood. Childhood adversities, including exposure to abuse, intimate partner violence, and household substance use and mental health problems, have been linked to violent behaviors in adolescence and adulthood. However, few studies of childhood adversity as determinants of persistent violent behavior among community-based samples have been conducted. Furthermore, the effects of adversity timing and duration on subsequent violent behaviors are unclear. We examined the association between five childhood adversity trajectories (representing stable-low, stable-mild, decreasing, increasing, and stable-high adversity from birth through age 11.5 years) and physical fighting and weapon carrying at ages 13-20 years among a sample of young adults followed continuously since birth from the Avon Longitudinal Study of Parents and Children (n = 9,665). The prevalence of violent behaviors declined sharply as participants aged (e.g., whereas 42.8% reported engaging in physical fighting in the past year at ages 13-15 years, this dropped to 10.4% at ages 17-20 years). Childhood adversity trajectories exhibited a strong dose-response relation with physical fighting and weapon carrying, with particularly pronounced relations for violent behaviors persisting across both adolescence and early adulthood (e.g., for physical fighting at both ages 13-15 years and 17-20 years compared to no fighting at either period, adjusted odds ratio [aOR] = 1.62, 95% confidence interval [CI] = 1.31-2.00 for stable-mild; aOR = 2.33, 95% CI = 1.64-3.33 for decreasing; aOR = 3.18, 95% CI = 2.20-4.60 for increasing; and aOR = 3.73, 95% CI = 2.13-6.52 for stable-high adversity, compared to stable-low adversity). This work highlights the substantial implications of exposure to childhood adversity for youth violence prevention.

Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters

Posttraumatic stress symptoms (PTSS) are associated with both childhood physical abuse (CPA) and antisocial (AS) traits, yet their potential as mediators of the CPA-AS traits link is understudied and the specific roles of individual symptom clusters in this relation is unknown. The current study aimed to examine the mediational role of PTSS in the relation between CPA and AS traits in a sample of low-income African American women with histories of intimate partner violence (IPV). It was hypothesized that avoidance would emerge as a significant mediator, whereas reexperiencing, numbing, and hyperarousal would not. Participants (N = 150) were recruited from a level-1 trauma public hospital and evaluated as part of a randomized controlled trial of a group therapy intervention for low-income, African American women suicide attempters with histories of IPV. The Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale (PDS), and International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were used to measure variables of interest. Using bootstrapping analyses, a parallel mediation model compared PTSS clusters as potential mediators of the CPA-AS traits relation, controlling for IPV. When reexperiencing, avoidance, numbing, and hyperarousal were entered simultaneously as potential mediators, only avoidance emerged as a significant mediator of the CPA-AS traits link. Avoidance symptoms may play a unique role in the link between early experiences of CPA and later AS traits among multiply traumatized African American women. Findings have implications for understanding AS traits in the context of early life trauma and suggest that targeting specific PTSS clusters (e.g., avoidance) may improve treatment outcomes for women in this population.

Adverse Childhood Experiences (ACEs), Alcohol Use in Adulthood, and Intimate Partner Violence (IPV) Perpetration by Black Men: A Systematic Review

Intimate partner violence (IPV) is a serious social and public health problem in the United States. Adverse childhood experiences (ACEs) and alcohol use have been found to be associated with IPV perpetration; however, limited studies have examined the interrelationships of these variables among Black men. This is the first known study to systematically review and synthesize studies on the interrelationships of ACEs, alcohol use, and IPV perpetration among Black men. Comprehensive literature searches were conducted in PubMed and six EBSCOhost databases by a research librarian and two researchers. Twenty studies met inclusion criteria: empirical; available in English; included ACEs, alcohol use/substance abuse, and IPV perpetration variables in the analyses; and samples included Black/African American male IPV perpetrators aged ≥ 18 years. ACEs were found to be associated with IPV perpetration among Black men, but findings were mixed regarding the role of alcohol in relation to ACEs and IPV. Numerous ACE factors (1-6) were used across studies. However, findings regarding the co-occurrence of ACE factors are inconclusive because none of the studies examined the cumulative effects of exposure to more than one type of ACE on subsequent IPV perpetration. Implications for policy, practice, and research related to the interrelationships of ACEs, alcohol use, and IPV perpetration are provided. Future work is needed to better explicate the interrelationships among these constructs.

Associations Among Child Maltreatment, Mental Health, and Police Contact in Adulthood: Findings From a National Canadian Sample

The purpose of this study was to examine associations between three subtypes of childhood maltreatment (physical abuse, sexual abuse, and exposure to intimate partner violence) and two forms of adult police contact (criminality, victimization) using nationally representative Canadian data. Presence of a mental health disorder was also explored as a potential mediating variable in these associations. The weighted sample included 23,846 adult participants from the 2012 Canadian Community Health Survey-Mental Health. Logistic and multinomial regression analyses examined associations among individual and multiple exposures to subtypes of childhood maltreatment with police contact. The Sobel test was used to assess the mediating effect of mental health disorders. Adjusting for sociodemographic variables, results indicated that all maltreatment subtypes were significantly associated with increased odds of both forms of police contact (adjusted odds ratios ranged from 2.06 to 2.95). Presence of a mental health disorder was a partial mediator in the associations between child maltreatment and both forms of adult police contact (adjusted odds ratios ranged from 1.52 to 2.32). In addition, a dose-response relationship was observed for victimization; as the number of subtypes of maltreatment increased, there was an incremental increase in risk of victimization. Future efforts are needed to prioritize child maltreatment prevention, trauma-informed approaches, mental health awareness, and training in law enforcement.

Epidemiology of knife carrying among young British men

PURPOSE

Knife carrying has caused considerable public concern in the UK. But little is known of the epidemiology and characteristics of men who carry knives. We investigated associations with socioeconomic deprivation, area-level factors, and psychiatric morbidity.

METHODS

Cross-sectional surveys of 5005 British men, 18-34 years, oversampling Black and Minority Ethnic (BME) men, lower social grades, and in London Borough of Hackney and Glasgow East. Participants completed questionnaires covering violent behaviour and psychiatric morbidity using standardised self-report instruments. Socioeconomic deprivation measured at small area level.

RESULTS

Prevalence of knife carrying was 5.5% (4.8-6.9) and similar among white and BME subgroups. However, prevalence was twice the national rate in Glasgow East, and four times higher among Black men in Hackney, both areas with high levels of background violence and gang activity. Knife carrying was associated with multiple social problems, attitudes encouraging violence, and psychiatric morbidity, including antisocial personality disorder (AOR 9.94 95% CI 7.28-13.56), drug dependence (AOR 2.96 95% CI 1.90-4.66), and paranoid ideation (AOR 6.05 95% CI 4.47-8.19). There was no evidence of a linear relationship with socioeconomic deprivation.

CONCLUSION

Men who carry knives represent an important public health problem with high levels of health service use. It is not solely a criminal justice issue. Rates are increased in areas where street gangs are active. Contact with the criminal justice system provides opportunity for targeted violence prevention interventions involving engagement with integrated psychiatric, substance misuse, and criminal justice agencies.

Childhood Trauma in Persons With Schizophrenia and a History of Interpersonal Violence

BACKGROUND

Childhood trauma is a risk factor for psychosis as well for violent behavior and offending later in life. Childhood trauma comprises subdomains of abuse and neglect that may be differently related to later violence among patients with schizophrenia. The aim of this study was to map the subdomains of childhood trauma associated with violent offending in schizophrenia.

METHODS

Information on childhood trauma from predominantly male patients with a DSM-IV diagnosis of schizophrenia and a history of violent offending (interpersonal violence) (SCZ-V, n = 19), schizophrenia patients without a history of violence (SCZ-NV, n = 34), and healthy controls (HC, n = 66) was obtained with the Childhood Trauma Questionnaire (CTQ). Differences between groups in total maltreatment scores and the five subdomains including physical, emotional, and sexual abuse, as well as physical and emotional neglect were analyzed.

RESULTS

SCZ-V had the highest median CTQ scores for all sub-domains. SCZ-V reported significantly higher total CTQ scores than SCZ-NV and HC. SCZ-V had significantly higher scores than HC on all subdomains, and significantly higher than SCZ-NV on physical and emotional neglect. SCZ-NV had higher scores on all domains except sexual abuse compared to HC.

CONCLUSION

SCZ-V patients had higher exposure to childhood trauma than SCZ-NV, and both schizophrenia groups had higher exposure than HC. The results suggest that childhood physical and emotional neglect may be of specific importance to later violence in schizophrenia.

Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence

Objective:

To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users.

Methods:

A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated.

Results:

The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36).

Conclusion:

Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.

Post-traumatic stress symptom development as a function of changing witnessing in-home violence and changing peer relationship quality: Evaluating protective effects of peer relationship quality

In the present study, witnessing in-home violence and peer relationship quality are evaluated as to their relative impact on Post Traumatic Stress (PTS) symptoms among children aged 8 to 17 investigated by child protective services (CPS) for maltreatment exposure. The sample included 2151 children from the National Survey of Child and Adolescent Well-Being II (NSCAW II). Linear growth models were estimated to assess associations between changes in PTS symptoms, witnessing in-home violence, and peer relationship quality over time. Greater frequency of witnessing in-home violence at baseline (i.e. wave 1) was associated with higher baseline PTS symptoms (β = 0.44). Increases in witnessing in-home violence frequency over time (average annual change across three years) had a strong association with increases in PTS symptoms over time (β = 0.88). Baseline peer relationship quality was associated with fewer PTS symptoms at baseline (β = -0.45). Increases in peer relationship quality over time were strongly associated with declines in PTS symptoms over time (β = -0.68). Peer relationship quality at baseline did not moderate baseline or over time associations between witnessing in-home violence and PTS symptoms. The average decline in PTS symptoms due to decreases in witnessing in-home violence and increases in peer relationship quality was 0.51 and 0.65 standard deviations respectively, over the three-year study period. Reducing chronic witnessing in-home violence and promoting the development of healthy social relationships with peers are critical for PTS symptom recovery.

Childhood trauma and suicide attempt: A meta-analysis of longitudinal studies from the last decade

Childhood trauma (CT) is a modifiable risk factor for lifetime suicide attempts (SA). However, the extent to which each type of CT increases SA risk is unclear. This study aimed to conduct a meta-analysis of longitudinal studies published in the last 10 years about the relationship between CT and lifetime SA risk. The PUBMED, PsycINFO, ISI, and EMBASE databases were searched for cohort studies that reported AS during follow-up and included an assessment of CT. A meta-analysis was conducted to identify potential effects of each type of CT on SA. Seven unique studies were included for review. Sexual (n=6, OR=3.73, 95%CI 2.94-4.75, p<0.001), physical (n=6, OR=4.11, 95%CI 2.30-7.33, p<0.001), and emotional abuse (n=3, OR=3.98, 95%CI 2.89-5.64, p<0.001), as well as physical neglect (n=2, OR=3.42, 95%CI 2.09-5.59, p<0.001), were associated with SA. Emotional neglect and a broken home were not significantly associated with further SA. The modes of CT that most contribute to SA in later life are physical, emotional, and sexual abuse and physical neglect, in descending order.

Childhood maltreatment and Chinese adolescents' bullying and defending: The mediating role of moral disengagement

In the present study, we tested the mediating role of moral disengagement in the effect of childhood maltreatment on bullying and defending. We also examined whether the mediating effect of moral disengagement differed between girls and boys, early and middle adolescents, as well as only and non-only children. Five hundred and fifty-two Chinese adolescents participated in this study. The results indicated that the prevalence rates of physical abuse, physical neglect, emotional abuse, and emotional neglect were 4.0%, 40.0%, 10.5%, and 27.9%, respectively. Path analysis showed that moral disengagement partially mediated the relation between childhood maltreatment and bullying, but did not mediate the relation between childhood maltreatment and defending. Moreover, multi-group analyses indicated that no significant path in the final model differed by gender. However, early adolescents exposed to high levels of childhood maltreatment were more likely to engage in bullying and less likely to engage in defending than middle adolescents, and early adolescents with high levels of moral disengagement were more likely to engage in bullying than middle adolescents. Compared to non-only children, only children exposed to high levels of childhood maltreatment were more likely to score higher on moral disengagement and less likely to engage in defending.

Substantiated Childhood Maltreatment and Intimate Partner Violence Victimization in Young Adulthood: A Birth Cohort Study

Little is known about the associations between various types of childhood maltreatment and multiple forms of intimate partner violence victimization in early adulthood. This study examines the extent to which childhood experiences of maltreatment increase the risk for intimate partner violence victimization in early adulthood. Data for the present study are from 3322 young adults (55 % female) of the Mater Hospital-University of Queensland Study of Pregnancy with the mean age of 20.6 years. The Mater Hospital-University of Queensland Study of Pregnancy is a prospective Australian pre-birth cohort study of mothers consecutively recruited during their first antenatal clinic visit at Brisbane's Mater Hospital from 1981 through to 1983. Participants completed the Composite Abuse Scale at 21-year follow-up and linked this dataset to agency recorded substantiated cases of childhood maltreatment. In adjusted models, the odds of reporting emotional intimate partner violence victimization were 1.84, 2.64 and 3.19 times higher in physically abused, neglected and emotionally abused children, respectively. Similarly, the odds of physical intimate partner violence victimization were 1.76, 2.31, 2.74 and 2.76 times higher in those children who had experienced physical abuse, sexual abuse, neglect and emotional abuse, respectively. Harassment was 1.63 times higher in emotionally abused children. The odds of severe combined abuse were 3.97 and 4.62 times greater for emotionally abused and neglected children, respectively. The strongest associations involved reports of child emotional abuse and neglect and multiple forms of intimate partner violence victimization in young adulthood. Childhood maltreatment is a chronic adversity that is associated with specific and multiple forms of intimate partner violence victimization in adulthood.

Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment

BACKGROUND

Borderline personality disorder (BPD) is characterised by difficulties with impulse control and affective dysregulation. It is unclear whether BPD contributes to the perpetration of violence or whether this is explained by comorbidity. We explored independent associations between categorical and dimensional representations of BPD and violence in the general population, and differential associations from individual BPD criteria.

METHODS

We used a representative combined sample of 14,753 men and women from two British national surveys of adults (≥16 years). BPD was assessed using the Structured Clinical Interview II- Questionnaire. We measured self-reported violent behaviour in the past 5 years, including severity, victims and locations of incidents. Associations for binary, dimensional and trait-level exposures were performed using weighted logistic regression, adjusted for demography and comorbid psychopathology.

RESULTS

Categorical diagnosis of BPD was associated only with intimate partner violence (IPV). Associations with serious violence leading to injuries and repetitive violence were better explained by comorbid substance misuse, anxiety and antisocial personality disorder (ASPD). However, anger and impulsivity BPD items were independently associated with most violent outcomes including severity, repetition and injury; suicidal behaviours and affective instability were not associated with violence. Both trait-level and severity-dimensional analyses showed that BPD symptoms might impact males and females differently in terms of violence.

CONCLUSIONS

For individuals diagnosed BPD, violence is better explained by comorbidity. However, BPD individual traits show different pathways to violence at the population level. Gender differences in BPD traits and their severity indicate distinct, underlying mechanisms towards violence. BPD and traits should be evaluated in perpetrators of IPV.