Adverse childhood experiences and suicide attempts among those with mental and substance use disorders

Repetitive transcranial magnetic stimulation (rTMS) for depressive-like symptoms in rodent animal models

Repetitive transcranial magnetic stimulation (rTMS) emerged as a non-invasive brain stimulation technique in the treatment of psychiatric disorders. Both preclinical and clinical studies as well as systematic reviews provide a heterogeneous picture, particularly concerning the stimulation protocols used in rTMS. Here, we present a review of rTMS effects in rodent models of depressive-like symptoms with the aim to identify the most relevant factors that lead to an increased therapeutic success. The influence of different factors, such as the stimulation parameters (stimulus frequency and intensity, duration of stimulation, shape and positioning of the coil), symptom severity and individual characteristics (age, species and genetic background of the rodents), on the therapeutic success are discussed. Accumulating evidence indicates that rTMS ameliorates a multitude of depressive-like symptoms in rodent models, most effectively at high stimulation frequencies (≥5 Hz) especially in adult rodents with a pronounced pathological phenotype. The therapeutic success of rTMS might be increased in the future by considering these factors and using more standardized stimulation protocols.

Parental Legal System Involvement, Positive Childhood Experiences, and Suicide Risk

OBJECTIVES

To examine whether adverse parental legal system involvement (incarceration, arrest) was associated with suicide risk, accounting for other adverse childhood experiences, and whether there was a moderating relationship between positive childhood experiences (PCEs) and parental legal system involvement in suicide risk.

METHODS

This cross-sectional study used 2-year follow-up data from the Adolescent Brain Cognitive Development Study when children were age 11 to 12 years. Outcomes were lifetime suicidal ideation, attempts, and nonsuicidal self-injury (NSSI). Exposures were parent incarceration or arrest. We used generalized linear models to estimate the relative risk of suicide outcomes from adverse parent legal involvement and whether there was an interaction between parent legal system involvement and PCE count, controlling for adverse childhood experiences and demographic factors.

RESULTS

Among our sample (n = 10 532;), 687 children (6.5%) reported parent incarceration and 1265 (12.0%) reported parent arrest. Suicidal ideation was the most frequent risk outcome (n = 490; 4.7%). Children whose parents had been incarcerated had a relative risk of suicidal ideation of 1.74 (95% CI: 1.32-2.31). Children whose parents had been arrested had a relative risk of suicidal ideation of 1.89 (95% CI: 1.53-2.37) and a relative risk of suicide attempt of 2.69 (95% CI: 1.7-4.25). Parental incarceration/arrest were not associated with NSSI. PCEs were associated with reduced relative risk of suicidal ideation and NSSI, though there was no significant interaction between PCEs and adverse parent legal system involvement exposures.

CONCLUSIONS

Parental legal system involvement may negatively affect child mental health. Strengthening PCEs in childhood may mitigate suicide-related risks.

Longitudinal Association between Stressful Life Events and Suicidal Ideation in Adults with Major Depression Disorder: The Mediating Effects of Insomnia Symptoms

Stressful life events (SLEs) and suicidal ideation (SI) are prevalent in persons with major depression disorder (MDD). Less is known about the underlying role of insomnia symptoms in the association between SLEs and SI. This three-wave prospective cohort study sought to investigate the longitudinal association among SLEs, insomnia symptoms, and SI in persons with MDD. The study population included 511 persons with MDD (mean [SD] age, 28.7 [6.7] years; 67.1% were females). Generalized estimated equations (GEEs) were utilized to explore prospective association among exposure of SLEs, insomnia symptoms, and SI. Additionally, a structural equation model (SEM) was employed to estimate the longitudinal mediating effect of insomnia symptoms in the relationship between SLEs and SI. Our study demonstrated that cumulative SLEs were determined to be longitudinally associated with SI in persons with MDD. We further observed that the association between SLEs and SI was significantly mediated by insomnia symptoms. Clinicians assessing persons with MDD, especially those with the history of SLE, could carefully evaluate and promptly treat insomnia symptoms as part of personalized assessment of their depressive illness, thereby achieving early prevention and intervention for suicidal behaviors in persons with MDD.

The association between youth violence and mental health outcomes in Colombia: A cross sectional analysis

BACKGROUND

Violence against children and youth poses public health risks regarding mental health symptoms and substance use. Less studied is the relationship between violence and mental health/substance abuse in the Latin American context. This study explored sex-stratified relationships between violence and mental health/substance use among Colombian youth.

METHODS

We analyzed the 2018 Colombian Violence Against Children and Youth Survey, which collected cross-sectional data from Colombian youth (13-24 years) (n = 2705). Exposure variables were (i) binary sexual, emotional, and physical victimization and (ii) poly-victimization. The outcomes were binary suicidal thoughts, self-harm, past-month psychological distress, binge drinking, smoking, and drug use. Sex-stratified, logistic regressions were adjusted for age, primary school, parental presence, relationship status, and witnessing community violence.

RESULTS

For females, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts, self-harm, and psychological distress and (ii) sexual violence was associated with suicidal thoughts and self-harm. For males, (i) emotional violence (compared to being unexposed) was associated with greater odds of suicidal thoughts and psychological distress, but not self-harm and (ii) sexual violence exposure was associated with suicidal thoughts and self-harm. Physical violence was generally not associated with internalized mental health outcomes for females/males, when emotional and sexual violence were held constant. Poly-victimization was consistently and positively associated with internalized mental health symptoms among females, and to a lesser degree for males. Substance use outcomes for males or females were not associated with violence.

CONCLUSIONS

Findings highlight the internalized mental health burden of emotional and sexual violence.

Childhood psychological maltreatment and adolescent depressive symptoms: Exploring the role of social anxiety and maladaptive emotion regulation strategies

BACKGROUND

Despite emerging evidence for the effect of childhood psychological maltreatment on adolescent depressive symptoms, the underlying processes for this effect are largely under-investigated. This study examined a conceptual framework for the effect of childhood psychological maltreatment on adolescent depressive symptoms through social anxiety disorder (SAD) and maladaptive emotion regulation strategies.

METHODS

The participants were 1649 Chinese middle school students (751 girls and 898 boys) with a mean age of 16.29 ± 1.04 years old. A moderation-mediation model hypothesized that childhood psychological maltreatment predicts adolescent depressive symptoms, with SAD as a mediator and maladaptive emotion regulation strategies as a moderator.

RESULTS

Childhood psychological maltreatment significantly positively predicted adolescent depressive symptoms, while SAD mediated the relation. Maladaptive emotion regulation strategies moderated the pathways from psychological maltreatment to depressive symptoms (but not from psychological maltreatment to SAD) and from SAD to adolescent depressive symptoms.

LIMITATIONS

Subjective measures, and the cross-sectional design are the main limitations.

CONCLUSIONS

SAD plays a mediating role in the relation between childhood psychological maltreatment and depressive symptoms. Maladaptive emotion regulation strategies exacerbate the relation between childhood psychological maltreatment and depressive symptoms, as well as the relation between SAD and depressive symptoms. These results highlight the importance of addressing social anxiety in reducing adolescent depressive symptoms by improving their cognitive emotion regulation strategies.

Brief Report: The Association of Adverse Childhood Experiences and Suicide-Related Behaviors Among 10th-Grade Secondary School Students

The association between adverse childhood experiences and suicide-related behaviors (SRB) of adolescents has been widely studied in Western high-income countries, but not yet in Latin America. The aim of this study was to determine this association and to explore a dose-response relationship between adverse childhood experiences and SRB in Chile. We conducted a cross-sectional survey to assess adverse childhood experiences up to 1 year prior to the survey and SRB (suicide ideation and attempts) in a sample of secondary school students. Multilevel and multivariable logistic regressions were run with SRB as dependent and adverse childhood experiences as independent variables, adjusted by self-esteem, general mental health, friend and parental support, and the age at onset of cannabis and alcohol use. We included 7,458 adolescents (48.7% girls), mean age = 16.0 (SD = 0.7), and found a prevalence of 78.1% for at least one adverse childhood experience. The 6-month prevalence of suicidal ideation was 18.1% (95% confidence interval [CI]: 17.2%-19.0%), and the prevalence of suicide attempts was 5.0% (95% CI: 4.6-5.6). Among all adverse childhood experiences, only sexual abuse was a risk factor for both SRB. We also found an independent effect of the total number of adverse childhood experiences on suicidal ideation (p < .001) and on suicide attempts (p < .001). Additionally, ages at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively. This is the first study exploring the influence of adverse childhood experiences on suicide-related behaviors in adolescents from Latin America.HIGHLIGHTSSexual abuse is associated with suicidal ideation and suicide attempts in 10th-grade secondary school studentsThere is a dose-response effect between adverse childhood experiences and suicide-related behaviorAges at onset of alcohol and cannabis use were associated with suicidal ideation and suicidal attempts, respectively.

The negative association of the SARS-CoV-2 pandemic with the health of mother and child considering maternal childhood maltreatment

BACKGROUND

Social distancing strategies during the SARS-CoV-2 pandemic have left families facing a variety of different constraints. Especially in this stressful time, children need a stable parental home to prevent developmental consequences. Additional risk factors such as maternal childhood maltreatment (CM) may affect mother's psychosomatic health and children's physical well-being in this period.

OBJECTIVE

It was aimed to analyze the associations between maternal CM, mother's mental health, and children's physical complaints during the SARS-CoV-2-pandemic.

METHOD

Mothers of a well-documented birth cohort from a longitudinal study were included in this study. Psychosomatic health was assessed with the PHQ-D and children's physical health with the GBB-KJ during the pandemic. N = 159 mothers completed the online survey. To describe the maternal CM, data from a longitudinal survey were used.

RESULTS

The calculation of three mediation analyses demonstrate that maternal depression symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.07, p = .13), somatic symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.07, p = .13) and psychosomatic symptoms (c-path: β = 0.10, p = .02; c'-path: β = 0.06, p = .19) fully mediate the relationship between CM and children's physical health complaints.

CONCLUSIONS

Maternal CM experiences seem to be one relevant risk factor during the pandemic and seem to influence the way in which parents deal with stressful situations and increase the risk for depressive symptoms. The present results highlight the importance to provide individually adjusted assistance to help the families to get through the pandemic.

Associations of adverse and protective childhood experiences with thwarted belongingness, perceived burdensomeness, and suicide risk among sexual minority men

BACKGROUND

Sexual minority men (SMM) experience higher suicidal ideation and suicide attempts than the general population. We examined the associations of adverse childhood experiences (ACES) and protective and compensatory childhood experiences (PACES) with suicidal ideation and suicide attempts in adulthood via thwarted belongingness and perceived burdensomeness among SMM.

METHODS

Data are from the UNITE study, a national longitudinal cohort study of HIV-negative SMM from the 50 U.S. states and Puerto Rico. Between 2017 and 2019, participants (N = 6303) completed web-based assessments at baseline and 12-month follow-up. ACES and PACES occurring before the age of 18, and current symptoms of thwarted belongingness and perceived burdensomeness were assessed at baseline. Past-week suicidal ideation and past-year suicide attempt were assessed at follow-up.

RESULTS

424 (6.7%) participants reported past-week suicidal ideation and 123 (2.0%) reported a past-year suicide attempt. The results of our multivariate model suggest that each additional adverse childhood experience was prospectively associated with 14% higher odds of past-week suicidal ideation (AOR = 1.14, 95% CI 1.09-1.19) and 19% higher odds of past-year suicide attempt (AOR = 1.19, 95% CI 1.11-1.29). Each additional protective childhood experience was prospectively associated with 15% lower odds of past-week suicidal ideation (AOR = 0.85, 95% CI 0.81-0.90) and 11% lower odds of past-year suicide attempt (AOR = 0.89, 95% CI 0.82-0.98). Perceived burdensomeness partially mediated these prospective associations.

CONCLUSION

To reduce suicide, screening and treating perceived burdensomeness among SMM with high ACES may be warranted. PACES may decrease perceived burdensomeness and associated suicide risk.

Simulation Models for Suicide Prevention: A Survey of the State-of-the-Art

Suicide is a leading cause of death and a global public health problem, representing more than one in every 100 deaths in 2019. Modeling and Simulation (M&S) is widely used to address public health problems, and numerous simulation models have investigated the complex, dependent, and dynamic risk factors contributing to suicide. However, no review has been dedicated to these models, which prevents modelers from effectively learning from each other and raises the risk of redundant efforts. To guide the development of future models, in this paper we perform the first scoping review of simulation models for suicide prevention. Examining ten articles, we focus on three practical questions. First, which interventions are supported by previous models? We found that four groups of models collectively support 53 interventions. We examined these interventions through the lens of global recommendations for suicide prevention, highlighting future areas for model development. Second, what are the obstacles preventing model application? We noted the absence of cost effectiveness in all models reviewed, meaning that certain simulated interventions may be infeasible. Moreover, we found that most models do not account for different effects of suicide prevention interventions across demographic groups. Third, how much confidence can we place in the models? We evaluated models according to four best practices for simulation, leading to nuanced findings that, despite their current limitations, the current simulation models are powerful tools for understanding the complexity of suicide and evaluating suicide prevention interventions.

Circumstances Contributing to Suicide Among U.S. Adolescents Aged 10-19 Years With and Without a Known Mental Health Condition: National Violent Death Reporting System, 2013-2018

PURPOSE

Suicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to suicide risk. This study examines characteristics of adolescents who died by suicide and differences in circumstances between those with and without known mental health conditions at the time of death.

METHODS

Logistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals of circumstances contributing to suicide between decedents with and without known mental health conditions using data from the 2013 to 2018 National Violent Death Reporting System (analyzed in 2021).

RESULTS

Decedents with a known mental health condition were 1.2-1.8 times more likely to experience problematic alcohol misuse, substance misuse, family and other nonintimate relationship problems, and school problems; however, there were no significant differences between those with and without a known mental health condition for the preceding circumstances of arguments or conflicts, criminal or legal problems, or any crisis occurring within the two weeks prior to death.

DISCUSSION

A comprehensive suicide prevention approach can address not only mental health conditions as a risk factor but also life stressors and other crises experienced among adolescents without known mental health conditions.

A systems science approach to identifying data gaps in national data sources on adolescent suicidal ideation and suicide attempt in the United States

BACKGROUND

Suicide is currently the second leading cause of death among adolescents ages 10-14, and third leading cause of death among adolescents ages 15-19 in the United States (U.S). Although we have numerous U.S. based surveillance systems and survey data sources, the coverage offered by these data with regard to the complexity of youth suicide had yet to be examined. The recent release of a comprehensive systems map for adolescent suicide provides an opportunity to contrast the content of surveillance systems and surveys with the mechanisms listed in the map.

OBJECTIVE

To inform existing data collection efforts and advance future research on the risk and protective factors relevant to adolescent suicide.

METHODS

We examined data from U.S. based surveillance systems and nationally-representative surveys that included (1) observations for an adolescent population and (2) questions or indicators in the data that identified suicidal ideation or suicide attempt. Using thematic analysis, we evaluated the codebooks and data dictionaries for each source to match questions or indicators to suicide-related risk and protective factors identified through a recently published suicide systems map. We used descriptive analysis to summarize where data were available or missing and categorized data gaps by social-ecological level.

RESULTS

Approximately 1-of-5 of the suicide-related risk and protective factors identified in the systems map had no supporting data, in any of the considered data sources. All sources cover less than half the factors, except the Adolescent Brain Cognitive Development Study (ABCD), which covers nearly 70% of factors.

CONCLUSIONS

Examining gaps in suicide research can help focus future data collection efforts in suicide prevention. Our analysis precisely identified where data is missing and also revealed that missing data affects some aspects of suicide research (e.g., distal factors at the community and societal level) more than others (e.g., proximal factors about individual characteristics). In sum, our analysis highlights limitations in current suicide-related data availability and provides new opportunities to identify and expand current data collection efforts.

Timing of childhood adversities and self-injurious thoughts and behaviors in adolescence

Greater childhood adversity predicts a higher likelihood of later self-injurious thoughts and behaviors (SITB). There is little research focused on whether the timing of childhood adversity predicts SITB. The current research examined whether the timing of childhood adversity predicted parent- and youth-reported SITB at age 12 and 16 years in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) cohort (n = 970). We found that greater adversity at age 11-12 years consistently predicted SITB at age 12 years, while greater adversity at age 13-14 years consistently predicted SITB at age 16 years. These findings suggest there may be sensitive periods during which adversity may be more likely to lead to adolescent SITB, which can inform prevention and treatment.

The prevalence of childhood sexual experiences and intimate partner violence among transgender women in China: Risk factors for lifetime suicidal ideation

Objective

Several studies highlighted childhood sexual experiences (CSEs) and intimate partner violence (IPV) as risk factors that affected lifetime suicidal ideation. TW had higher rates of CSEs and IPV than cisgender people. The aim of this study was to comprehensively assess the prevalence of CSEs and IPV among TW and their association with lifetime suicidal ideation.

Methods

A cross-sectional survey was conducted among 247 TW in Shenyang and Kunming, China, from April to September 2018. CSEs, IPV, and lifetime suicidal ideation were assessed. Logistic regression models were used to examine the association between self-reported CSEs under 18 years of age, IPV in adulthood, and lifetime suicidal ideation.

Results

In the study, 14.2% (35/247) of the sample participants reported CSEs under 18 years of age; 44.9% (111/247) reported experiencing IPV in adulthood, including 18.6% (44/247) of physical IPV, 27.1% (67/247) of trans-specific identity IPV, 31.6% (78/247) of verbal IPV, and 19.4% (48/247) of sexual IPV; and 26.3% (65/247) had thought about attempting suicide at least one time. CSEs and any form of IPV were significantly associated with suicidal ideation in this sample population. A final stepwise multivariate logistic regression model found that both physical and verbal IPVs were significantly associated with suicidal ideation when controlling for other factors (ORm₁ = 2.58, 95% confidence interval (CI) = 1.163-5.724; ORm₂ = 2.72, 95% CI = 1.334-5.547).

Conclusions

The findings highlight the effects of CSEs and IPV among TW and suggest the need for research on suicide in the future. Suicide prevention efforts for this invisible and vulnerable population should focus on those with physical and verbal IPV.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A rapid review to determine the suicide risk and risk factors of men who are survivors of sexual assault

This rapid review assessed the suicide risk and risk factors of men who are survivors of sexual assault. We searched three academic databases (Cochrane, Medline and PsycINFO) for peer-reviewed articles in English published between 2010 and 2022. We rated the quality of the evidence based on the National Health and Medical Research Council Levels of Evidence. One systematic review and 16 papers featuring primary studies were included relating to suicide rates and risk. Findings suggest men who have been sexually assaulted (as a child or adult) are at increased risk of suicidal thoughts, attempts and behaviours compared with men who have not been sexually assaulted. Factors such as frequency of abuse and other concurrent forms of childhood abuse may further increase the risk of suicidal thoughts and behaviours. This evidence base was rated as good. The strength of this evidence supports a need for targeted suicide prevention in this high risk group.

Exploring the Relationship Between Domestic Violence Perpetration and Suicidal Behavior in Male Prisoners

This study is the first to explore the relationship between domestic violence perpetration and suicidal behavior in prisoners in England and Wales. The nature of this relationship is unclear, however, understanding and reducing suicide in prisons is a critical issue for frontline staff and policy makers. Eight participants with a history of suicide attempts and domestic violence perpetration were interviewed. Five key themes were identified through thematic analysis; "Trauma, victimization and life struggles," "Relationship ideals versus relationship reality", "Explaining domestic violence", "The impact of prison" and "Suicide as a coping strategy". This study shows that the relationship between domestic violence and suicide risk in prisoners may be better understood through a pathway of experiences rather than individual risk factors. Further research is needed to test the replicability of this pathway in other samples.

Prevalence of adverse childhood experiences and their association with suicidal ideation and non-suicidal self-injury among incarcerated methamphetamine users in Japan

BACKGROUND

Adverse childhood experiences (ACEs) are distressing and/or traumatic events that occur during childhood that increase the risk of negative health outcomes in adulthood.

OBJECTIVE

This study estimated the prevalence of ACEs in a nationwide sample of Japanese methamphetamine users in prison and examined associations among ACEs, suicidal ideation, and non-suicidal self-injury.

PARTICIPANTS AND SETTING

Participants were 636 inmates (418 male and 218 female) who were newly incarcerated in Japan for Stimulants Control Act violations.

METHODS

First, 699 participants completed an anonymous self-report questionnaire. Of these, 636 participants who did not have any missing responses were included in the analysis. After calculating descriptive statistics, the associations between ACEs and suicidal behaviors were assessed using binary logistic regression analyses.

RESULTS

Results showed that 76.1 % of the participants reported at least one ACE before the age of 18, and female participants reported a significantly higher number of adversities than their male counterparts. The most common ACEs were parental death or divorce, followed by psychological abuse. Logistic regression analyses revealed that ACE scores significantly increased the risk of suicidal ideation (SI; adjusted odd ratio [AOR] = 1.18, p < .001) and non-suicidal self-injury (NSSI; AOR = 1.18, p < .001) after controlling for possible confounding variables.

CONCLUSIONS

Findings suggest the importance of early prevention and intervention for traumatic experiences, and have implications for the recommendation of gender-responsive, trauma-focused interventions, especially for female inmates in the criminal justice system, to break the intergenerational chain of abuse. Future research directions and treatment are discussed.

Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment

Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.

Insights from Expanded Adverse Childhood Experiences Screening in a Hospital-Based Outpatient Psychiatry Service

Adverse childhood experiences (ACEs) are associated with poor mental health in adulthood. Comprehensive prevalence data encompassing all 10 ACE questionnaire items has not previously been described in a hospital-based outpatient psychiatric clinic. This study assessed the prevalence of 10 ACEs in such a clinic and correlated ACEs with indicators of case severity. For 252 patients newly evaluated in an urban clinic, a retrospective chart review was completed and data was collected on ACE questionnaire responses, psychiatric, substance-related, and medical diagnoses, psychiatric hospitalizations, suicide attempts, and suicide and violence risk. Patients in the clinic had an average of 3.4 ACEs, higher than national community sample averages of 1.6. The percentages of patients with at least one, two, and four ACEs were 82% (n = 207), 68% (n = 172), and 42% (n = 106) respectively (compared with 61%, 38%, and 15% nationally). ACEs had statistically significant correlations with an increased number of psychiatric diagnoses, substance use disorders, medical illnesses, suicide attempts, and suicide risk level. This study demonstrated that patients seeking psychiatric care from a hospital-based outpatient clinic are likely to be traumatized to a degree far exceeding what is typical in the general population. While a high prevalence of ACEs in a psychiatric population is an expected finding given the literature to date, this is the first study presenting data on the prevalence of ACEs in such a hospital-based community clinic. Additionally this study reinforces prior research correlating childhood adversity and case severity.

Suicide: Allostatic regulation and resilience

Suicide is a complex public health problem that is the result of a number of intertwined biopsychosocial factors. The diathesis-stress model suggests that suicide is the result of an interaction between genetic vulnerability and environmental stressors. Chronic stress and trauma contribute to biologic adaptations, including hypothalamus-pituitary-adrenal axis dysregulation, that contribute to the degradation of regulatory mechanisms and promote wear and tear the body, represented by allostatic load (AL). AL has been associated with a number of negative outcomes, including mental health problems and suicide. Fortunately, there are pharmacological and non-pharmacological interventions that are effective at reducing AL and reversing its effects. Thus, AL may provide a construct for supporting early risk identification, prevention, and treatment of suicide. AL biomarkers that are amenable to measurable change, effective treatments to reduce AL and perhaps help prevent suicide, and how to best tailor them to the individual and societal levels are important avenues of therapeutic inquiry.

Suicidality Among Transgender Youth: Elucidating the Role of Interpersonal Risk Factors

Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth. Using minority stress theory and the interpersonal theory of suicide, this study aims to better understand suicide risk among transgender youth. The present study examines the influence of intervenable risk factors: interpersonal and environmental microaggressions, internalized self-stigma, and adverse childhood experiences (ACEs), and protective factors: school belonging, family support, and peer support on both lifetime suicide attempts and past 6-month suicidality in a sample of transgender youth (n = 372). SPSS 22 was utilized to examine the impact of the independent variables on both suicidality and lifetime suicide attempt through two separate logistic regressions. Fifty six percent of youth reported a previous suicide attempt and 86% reported suicidality. Logistic regressions indicated that models for both lifetime suicide attempts and suicidality were significant. Interpersonal microaggressions, made a unique, statistically significant contribution to lifetime suicide attempts and emotional neglect by family approached significance. School belonging, emotional neglect by family, and internalized self-stigma made a unique, statistically significant contribution to past 6-month suicidality. Results have significant practice and policy implications. Findings offer guidance for practitioners working with parents and caregivers of trans youth, as well as, for the creation of practices which foster interpersonal belonging for transgender youth.

Age at first exposure to violence and later mental health outcomes: A sex-disaggregated, multi-country analysis in sub-Saharan Africa

BACKGROUND

A growing body of research has begun examining the relationship between a child's age at first exposure to violence and outcomes of mental wellbeing, though no studies have assessed these relationships in the sub-Saharan African (SSA) region.

OBJECTIVE

Given known gender and sex differences in violence exposure and mental health symptomology, this study conducts a multi-country, gender-stratified analysis of the relationship between age at first incident of physical violence and outcomes of wellbeing in SSA.

PARTICIPANTS AND SETTING

This study uses data from the Violence Against Children Surveys on 13-24-year-old males and females in five SSA countries (Kenya (2010), Malawi (2013), Nigeria (2014), Tanzania (2009), and Uganda (2015)).

METHODS

The predictor of interest is a categorical variable indicating whether a respondent's first exposure to physical violence took place from 0 to 5, 6-11, 12 and older, or never. Outcomes of interest include: sadness, anxiety, suicide ideation, smoking, drug use, and alcohol use. Employing both country-specific and pooled data, gender-stratified, multiple logistic regressions are used to estimate the effect of age at first exposure to physical violence on the six outcomes of interest.

RESULTS

Findings show significant variation across countries in age at first exposure to physical violence. For females, findings reveal no association between age at first exposure and outcomes of wellbeing; all periods were equally associated with poor outcomes. For males, results show increased likelihood of anxiety, suicide ideation, and alcohol use when the first violence exposure occurred from 0 to 5 years.

CONCLUSIONS

This study advances the literature on gender and sex differences in mental health symptomology, suggesting that boys and girls may exhibit different symptomology in response to comparable exposures to violence.

Predictors of suicidal ideation in social anxiety disorder - evidence for the validity of the Interpersonal Theory of Suicide

BACKGROUND

This study aims to identify covariates of suicidal ideation (SI) in a large sample of individuals diagnosed with social anxiety disorder (SAD).

METHODS

In a cross-sectional design, 305 individuals (38.4 ± 14.1 years, 59% female) with SAD were assessed by the Social Phobia Inventory, Beck Depression Inventory, Adverse Childhood Experience Questionnaire, State Trait Anger Expression Inventory, Beck Scale for Suicidal Ideation and the Interpersonal Needs Questionnaire.

RESULTS

SAD individuals with SI (n = 142, 46.6%) reported higher SAD and depression symptoms, more adverse childhood experiences (ACE), higher state anger (SA), perceived burdensomeness (PB) and higher thwarted belongingness (TB) compared to SAD individuals without SI (n = 163, 53.4%). In binary logistic regression, PB (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.06-1.15), TB (OR = 1.05, 95% CI = 1.02-1.07), SA (OR = 1.07, 95% CI = 1.01-1.13) and ACE (OR = 1.18, 95% CI = 1.03-1.35) emerged as significant covariates of acute SI (Nagelkerke's R² = 0.39). Receiver operating characteristic (ROC) curves showcased the following areas under the curve (AUC): PB (AUC = 0.78), TB (AUC = 0.76), SA (AUC = 0.62) and ACE (AUC = 0.62). Multinomial logistic regression (no SI = ref.) showcased similar results for passive and active SI (n = 42), with SA reaching significance only for active SI. The Youden index identified appropriate cut-off values for PB, TB, SA and ACEQ by maximizing sensitivity and specificity.

LIMITATIONS

Cross-sectional design and self-reporting measures limit generalization.

CONCLUSION

Our findings confirm the validity of the Interpersonal Theory of Suicide concerning SI in SAD. PB and TB with SA and ACE may support the valid assessment of SI in therapeutic settings.

Preliminary findings for adverse childhood experiences and associations with negative physical and mental health and victimization in transmasculine adults

INTRODUCTION

Studies highlight the impact of adverse childhood experiences (ACEs) on risk for negative health outcomes in adulthood, including cancer, cardiovascular disease, substance use, and mental health. Lesbian, gay, bisexual, and transgender (LGBT) people report higher rates of ACEs than non-LGBT people, with transgender people at greatest risk.

OBJECTIVE

This study aims to comprehensively assess the prevalence of ACEs and association with health outcomes among transmasculine individuals.

PARTICIPANTS AND SETTING

A sample of 131 transmasculine individuals enrolled in a clinical trial on preventive cervical cancer screening between March 2015 and September 2016 in the United States were surveyed about ACEs and health outcomes.

METHODS

Pearson's chi-squared tests and logistic regression models were used to examine associations between self-reported ACEs prior to age 18 and the risk of various negative health outcomes in adulthood. ACEs were categorized as 0-1 ACEs, 2-3 ACEs, and 4+ ACEs.

RESULTS

Over 90% of the sample (120/131) reported at least 1 ACE; 45% (59/131) reported 4+ ACEs. Report of 4 or more ACEs increased risk for negative health outcomes and risk factors compared to 0-1 ACEs, including: depression (AOR = 5.3, 95%CI = 1.7, 16.2), suicidality (AOR = 5.2, 95%CI = 1.4, 18.8), post-traumatic stress disorder (AOR = 6.0, 95%CI (1.6, 22.8)), intimate partner violence (AOR = 5.3, 95%CI = 1.4, 18.8), and obesity (AOR = 8.2, 95%CI = 1.8, 37.2). Report of 2-3 ACEs was also significantly associated with obesity (AOR = 5.9, 95%CI = 1.3, 26.2).

CONCLUSIONS

ACEs are highly prevalent in this sample, and more attention is needed for research and intervention. This exploratory study is the first to comprehensively highlight patterns of physical and mental health risk and victimization associated with report of ACEs among transmasculine individuals. Trauma-informed screening and intervention efforts tailored to the unique needs of this population are needed to provide appropriate and effective care. Clinicians should consider routinely screening for ACEs among transmasculine youth and engage in prevention strategies to reduce health disparities. Further research is warranted to validate these findings among larger, more representative samples to better reflect the diversity of experiences and identities of transmasculine individuals and produce more reliable findings.

Evaluating the association of adverse childhood experiences, mood and anxiety disorders, and suicidal ideation among behavioral health patients at a large federally qualified health center

Although numerous studies have examined the relationship between adverse childhood experiences (ACEs) and suicide, research is needed that studies the effects of specific ACEs, including subclasses of ACEs, independent of the effect of other ACEs. We explored the relationship between ACEs and suicidal ideation (SI) with special attention to patterns according to generation cohort (millennials: 22-37 years old, generation X: 38-53 years old, and baby boomers: 54-72 years old), and assessed the extent to which mood and anxiety disorders account for the relationship between ACEs and suicidal ideation. Patients in behavioral healthcare services of a large federally qualified health center (n = 4,392) were assessed at baseline on ACEs, SI, and mood and anxiety disorders. Logistic regression modeling was used to examine the data. Emotional neglect was the strongest predictor of SI among Millennials (OR = 1.59), Generation X (OR = 1.81), and Baby Boomers (OR = 1.88) after controlling for mood and anxiety disorders, race/ethnicity, and gender. Findings suggest ACEs predict an increased likelihood of having SI over and above the influence of mood and anxiety disorders, in models adjusted for gender and race/ethnicity. Across generations, the association with suicidal ideation was strongest for any child abuse and neglect, but not for household dysfunction. The observed association of ACEs with suicidal ideation suggests that ACEs should be considered as a risk factor and incorporated into screening assessments for suicidal ideation. Lastly, additional research on the association of ACEs and suicidality in individuals not actively being managed in behavioral healthcare settings is also warranted.

Childhood adversity, suicidality, and non-suicidal self-injury among children and adolescents admitted to emergency departments

PURPOSE

This population-based study explored the associations between childhood adversity and admission to emergency departments (EDs) with non-suicidal self-injury (NSSI) and with a suicide attempt.

METHODS

A nationally representative cross-sectional sample of 5-17-year-olds admitted to EDs (N = 143,113,677) from 2006 to 2015 was utilized to assess the associations between childhood adversities, NSSIs, and suicide attempts.

RESULTS

ED admissions with NSSI and admissions with a suicide attempt were associated with greater odds of exposure to individual childhood adversities (aORs: 1.34 to 5.86; aORs: 2.37 to 15.69, respectively). ED admissions with a suicide attempt were associated with greater odds of exposure to childhood adversities that might be perceived as less extreme or harmful (separation or divorce aOR: 15.69) than other adversities (death of a family member aOR: 13.38; history of physical abuse aOR: 9.56) as well as greater odds of exposure to three or more childhood adversities (aOR: 20.98).

CONCLUSION

Early detection of childhood adversities is important for identifying potential risk factors for self-harm. ED admission data can provide population-level surveillance to aid in these efforts and lead to more targeted and effective interventions aimed at reducing the negative effects of toxic stress that can result from exposure to childhood adversities.

Adverse and Benevolent Childhood Experiences Predict Mental Health During the COVID-19 Pandemic

Adverse childhood experiences (ACEs) are associated with poorer adult mental health, and benevolent childhood experiences (BCEs) are associated with better adult mental health. This study aims to test whether ACEs and BCEs predict adult mental health above and beyond current stress and social support during the COVID-19 pandemic. We analyzed data from undergraduate and graduate students (N = 502) at an urban private university in the Western United States. An online survey was conducted to assess ACEs and BCEs, current stress and social support, depressive and anxiety symptoms, perceived stress, and loneliness in May 2020. Higher levels of ACEs were associated with higher levels of depressive symptoms, β = 0.45, p = 0.002. Higher levels of BCEs were associated with lower depressive symptoms, β = −0.39, p = 0.03; lower perceived stress, β = −0.26, p = 0.002; and less loneliness, β = −0.12, p = 0.04. These associations held while controlling for current stress, social support, and socioeconomic status. Childhood experiences are associated with mental health during the COVID-19 pandemic. BCEs should be considered an important promotive factor, independent of ACEs, for psychological well-being during a global public health crisis. BCEs should be included along with ACEs in future research, assessment, and screening with distressed and vulnerable populations.

Population-attributable risk of adverse childhood experiences for high suicide risk, psychiatric admissions, and recurrent depression, in depressed outpatients

Background: Population-attributable risk (PAR) may help estimate the potential contribution of adverse childhood experiences (ACEs) to serious clinical presentations of depression, characterized by suicidality, previous psychiatric admissions, and episode recurrence. Objective: To determine the PAR of ACEs for serious clinical presentations of depression (high suicide risk, previous psychiatric admissions, and recurrent depression) in outpatients with ICD-10 clinical depression. Method: Systematic chart review of 1,013 adults who were assessed and/or treated in a mental health clinic in Santiago, Chile for a major depressive episode. Data were collected on demographics and clinical characteristics of depression. Exposure to ACEs was determined with the Brief Physical and Sexual Abuse Questionnaire, assessing seven types of ACEs. Multivariable logistic regression analysis was used to assess the association between exposure to ACEs and suicidality, previous psychiatric admissions, and recurrence. Predicted probabilities were used for calculations of PAR. Results: Of the 1,001 study participants with complete data, 53.3% had recurrent depression, 13.5% had high suicide risk, and 5.0% had previous psychiatric admissions. Exposure to at least one ACE was recorded for 69.0% of the sample. Exposure to at least one ACE and specific types of ACEs (i.e. childhood sexual abuse and traumatic separation from caregiver) were associated with serious clinical presentations of depression. A dose-response relationship was observed between cumulative exposure to ACEs and the most serious clinical presentations of depression. ACEs were attributed to a significant proportion of disease: 61.6% of previous psychiatric admissions, 45.0% of high suicide risk, and 14.5% of recurrent depression. Conclusions: A substantial proportion of serious clinical presentations of depression among outpatients are associated with ACEs. Early detection of depressive episodes associated with ACEs, and tailored treatment for these patients, may potentially reduce the incidence of serious complications in this population.

Clustering suicidal phenotypes and genetic associations with brain-derived neurotrophic factor in patients with substance use disorders

Suicide attempts (SA), especially recurrent SA or serious SA, are common in substance use disorders (SUD). However, the genetic component of SA in SUD samples remains unclear. Brain-derived neurotrophic factor (BDNF) alleles and levels have been repeatedly involved in stress-related psychopathology. This investigation uses a within-cases study of BDNF and associated factors in three suicidal phenotypes ('any', 'recurrent', and 'serious') of outpatients seeking treatment for opiate and/or cocaine use disorder. Phenotypic characterization was ascertained using a semi-structured interview. After thorough quality control, 98 SNPs of BDNF and associated factors (the BDNF pathway) were extracted from whole-genome data, leaving 411 patients of Caucasian ancestry, who had reliable data regarding their SA history. Binary and multinomial regression with the three suicidal phenotypes were further performed to adjust for possible confounders, along with hierarchical clustering and compared to controls (N = 2504). Bayesian analyses were conducted to detect pleiotropy across the suicidal phenotypes. Among 154 (37%) ever suicide attempters, 104 (68%) reported at least one serious SA and 96 (57%) two SA or more. The median number of non-tobacco SUDs was three. The BDNF gene remained associated with lifetime SA in SNP-based (rs7934165, rs10835210) and gene-based tests within the clinical sample. rs10835210 clustered with serious SA. Bayesian analysis identified genetic correlation between 'any' and 'serious' SA regarding rs7934165. Despite limitations, 'serious' SA was shown to share both clinical and genetic risk factors of SA-not otherwise specified, suggesting a shared BDNF-related pathophysiology of SA in this population with multiple SUDs.

Adverse and Benevolent Childhood Experiences Predict Mental Health During the COVID-19 Pandemic

Adverse childhood experiences (ACEs) are associated with poorer adult mental health, and benevolent childhood experiences (BCEs) are associated with better adult mental health. This study aims to test whether ACEs and BCEs predict adult mental health above and beyond current stress and social support during the COVID-19 pandemic. We analyzed data from undergraduate and graduate students (N = 502) at an urban private university in the Western United States. An online survey was conducted to assess ACEs and BCEs, current stress and social support, depressive and anxiety symptoms, perceived stress, and loneliness in May 2020. Higher levels of ACEs were associated with higher levels of depressive symptoms, β = 0.45, p = 0.002. Higher levels of BCEs were associated with lower depressive symptoms, β = -0.39, p = 0.03; lower perceived stress, β = -0.26, p = 0.002; and less loneliness, β = -0.12, p = 0.04. These associations held while controlling for current stress, social support, and socioeconomic status. Childhood experiences are associated with mental health during the COVID-19 pandemic. BCEs should be considered an important promotive factor, independent of ACEs, for psychological well-being during a global public health crisis. BCEs should be included along with ACEs in future research, assessment, and screening with distressed and vulnerable populations.

Association of Child Placement in Out-of-Home Care With Trajectories of Hospitalization Because of Suicide Attempts From Early to Late Adulthood

Importance

Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited.

Objective

To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood.

Design, Setting, and Participants

This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14 559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016.

Exposures

Childhood experiences of OHC based on information from the Social Register (age 0-19 years).

Main Outcomes and Measures

Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years).

Results

In this cohort of 14 559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions.

Conclusions and Relevance

The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span.

Childhood neglect and suicidal behavior: Findings from the National Comorbidity Survey Replication

BACKGROUND

Although child neglect is common, there has been comparatively little research on it or its specific forms and their effects on mental health in adulthood.

OBJECTIVE

This study aimed to examine the association between exposure to different forms of childhood neglect and lifetime suicidal behavior among a nationally representative sample of adults in the U.S. general population.

METHODS

Data were analyzed from 5665 adults that were drawn from the National Comorbidity Survey Replication (NCS-R). Information was obtained on 'care', 'supervisory' and 'medical' neglect in childhood and lifetime suicidal behavior (ideation, plan, attempt). Lifetime psychiatric disorders were based on the World Mental Health - Composite International Diagnostic Interview. Logistic regression analysis was used to examine the associations.

RESULTS

In fully adjusted models, any neglect was associated with significantly increased odds for all forms of suicidal behavior (suicidal ideation, odds ratio [OR]: 1.80, 95 % confidence interval [CI]: 1.42-2.29; plan, OR: 2.27, 95 % CI: 1.78-2.91; attempt, OR: 2.05, 95 % CI: 1.63-2.59, all p < 0.001). In unadjusted analyses all individual forms of neglect were significantly associated with all forms of suicidal behavior. However, when all forms of neglect were included together in the fully adjusted models, care neglect was no longer significantly associated with any form of suicidal behavior.

CONCLUSION

Different forms of childhood neglect are associated with suicidal behavior in adults independent of common mental disorders. Future studies should focus on childhood neglect subtypes in order to better understand the effects of neglect on adult mental health.

South Korean mothers' childhood abuse experience and their abuse of their children with intellectual and developmental disabilities: Moderating effect of parenting self-efficacy

BACKGROUND

A history of childhood abuse has been found to adversely affect the transition to motherhood. Compared to other children, children with intellectual and developmental disabilities are at higher risk of being maltreated at home. However, maternal parenting self-efficacy has been found to improve mothers' positive interactions with their children.

OBJECTIVE

Given that, this study examined the moderating effect of maternal parenting self-efficacy on the relationship between mothers' childhood abuse experience and their abuse of their children with IDDs.

PARTICIPANTS AND SETTING

Participants include 134 South Korean mothers with children between 2 and 8 years of age with intellectual and developmental disabilities.

METHOD

Mothers' childhood abuse experience was assessed using the Childhood Trauma Questionnaire, which measures the extent of mothers' exposure to parental abuse in their childhood. Parenting self-efficacy was measured using the Echelle Globle du Sentiment de Competence Parentale (EGSCP). The Abusive Parenting scale was used to assess mothers' abusive parenting; it measured the degree to which mothers had ever either physically or emotionally abused their children.

RESULTS

The moderating effects of parenting self-efficacy on the relationships between childhood emotional abuse and abusive parenting (B = -.06, t(126) = -2.33, p = .022, 95 % CI[-.1142, -.0092]) and between childhood physical abuse and abusive parenting (B = -.07, t(126) = -2.64, p = .009, 95 % CI[-.1283, -.0184]) were significant.

CONCLUSIONS

These findings emphasize the importance of helping mothers with a history of abuse alleviate parental stress arising from raising children with IDDs by enhancing their parenting self-efficacy.

Social context and change in suicide ideation in a community sample of youths

PURPOSE

Adolescent suicide ideation (SI) often portends more grievous suicidal behavior; yet, long-term studies of what risk factors predict SI are limited. We employ a multi-wave longitudinal design to investigate the impact of earlier social contexts on change in SI.

METHOD

A community sample of 748 youths drawn from the Children in the Community (CIC) study was first assessed with the CIC Youth SI Scale at mean age 13.7 (range 9-18) (baseline) and in two follow-ups over 10 years. GEE Poisson Regression was used to estimate SI between ages 10 and 25 (intercept set at age midpoint of 17), and to examine associations between baseline measures of parent, peer, and school social contexts and subsequent change in SI. Analyses were controlled for demographic characteristics and known risks for SI: sexual or physical abuse before age 18 (obtained by official reports) and major depressive disorder (MDD, diagnosed by psychiatric interview at baseline and follow-ups).

RESULTS

SI declined significantly by age 17 with greater mother affection (β = - 0.091, SE = 0.037), peer friendship quality (β = - 0.115, SE = 0.034), peer social support (β = - 0.116, SE = 0.042), and school engagement (β = - 0.083, SE = 0.045, trend), but increased significantly with more parent punishment (β = 0.143, SE = 0.045) and school conflict (β = 0.168, SE = 0.042). SI associations with sexual or physical abuse (β = 0.299, SE = 0.137) and MDD (β = 0.777, SE = 0.130) were independent of other effects.

CONCLUSIONS

Earlier social contexts influence change in SI independent of each other and of known risks for SI in community youths, and may be a resource for intervention efforts to deter future SI.

Specific traumatic events elevate the risk of a suicide attempt in a 10-year longitudinal community study on adolescents and young adults

Traumatic events (TEs) have been associated with suicide attempts (SAs). However, the empirical status of some TEs is inconclusive. This also concerns community adolescents and young adults, known to be a high-risk group for SAs. We examined associations between (a) a range of prior TEs (physical attack, rape/sexual abuse, serious accident, and witnessing somebody else experiencing a TE) and a subsequent SA, and (b) the number of prior TEs and an SA, and (c) we estimated attributable proportions of SAs, in relation to each TE. Over a 10-year period, the Early Developmental Stages of Psychopathology (EDSP) study prospectively assessed community members, aged 14-24 years at baseline. Starting with 3021 subjects, each individual was assessed up to four times. Assessment was based on the Munich-Composite International Diagnostic Interview. Temporal associations were estimated using the Cox model with time-dependent covariates. Attributable proportions were based on the results of the Cox models. All four TEs elevated the risk for a subsequent SA, adjusting for confounders. Highest risk was found for the combined TE rape/sexual abuse. Results showed that 56-90% of SAs could be attributed to TEs in the exposed group; on the population level, attributable proportions ranged between 6.9% and 23.5%. Different TEs have been shown to elevate the risk of an SA in a young community sample. Our results suggest that both health professionals and health policy decision-makers consider specific TEs and the number of prior TEs as risk factors for SAs.

Suicidality among young adults: Unique and cumulative roles of 14 different adverse childhood experiences

BACKGROUND

College students with suicidal ideation (SI) are at high risk of suicide. Adverse childhood experiences (ACEs) are important risk factors for suicidal behavior. Most research in this area has been restricted to 10 conventional ACEs and suggests negative long-term developmental effects from other common childhood adversities such as peer victimization, peer isolation/rejection, exposure to community violence, and low socioeconomic status.

OBJECTIVE

To test the unique and cumulative associations of 14 different ACEs with SI among young adults.

PARTICIPANTS AND SETTING

Participants were 989 college students from two universities in China's provincial-leveled Hui Autonomous Region.

METHODS

Associations between ACEs and SI were analyzed by logistic regression. A Chi-square trend test was used to examine the association between cumulative ACEs and SI.

RESULTS

The rates of suicidal ideation, plans, and attempts among the cohort were 11.9%, 3.7%, and 1.6%, respectively; 43.9% had experienced at least one ACE. The strongest predictor of SI in adulthood was peer isolation/rejection, followed by emotional neglect, then low socioeconomic status. There was a cumulative effect of ACEs and SI, whereby the greater the number of ACEs, the greater the likelihood of SI.

CONCLUSION

Peer isolation/rejection, emotional neglect, and low socioeconomic status were associated with increased risk of SI in adulthood. Two (peer isolation/rejection and low socioeconomic status) of the three factors that emerged from the analysis are not typically included in ACEs research. There was a cumulative effect of 14 kinds of ACEs on SI among young adults. Early recognition of risk factors is therefore important.

Effectiveness of Peer-Delivered Trauma Treatment in a Rural Community: A Randomized Non-inferiority Trial

This randomized controlled non-inferiority trial explored the effectiveness of Seeking Safety (SS) delivered by peer providers compared to its delivery by licensed behavioral health clinicians. The study enrolled 291 adults with PTSD and/or substance use disorders. Data were collected at 3 and 6-months post start of treatment. With respect to long-term outcomes, at 6 months PTSD symptoms decreased by 5.1 points [95% CI (- 9.0, - 1.1)] and by 4.9 points [95% CI (- 8.6, - 1.1)] and coping skills increased by 5.5 points [95% CI (0.4, 10.6)] and by 5.6 points [95% CI (0.8, 10.4)], in the peer- and clinician-led groups, respectively. This study demonstrated non-inferiority of peer-delivered SS compared to clinician-delivered SS for reducing PTSD symptoms and similar outcomes for both groups with respect to coping skills. A confirmatory study on the effectiveness of peer-delivered trauma-specific services is warranted, especially given the potential for increasing access to such treatment in underserved rural communities.

Longitudinal changes in brain function associated with symptom improvement in youth with PTSD

BACKGROUND

Previous studies indicate that youth with posttraumatic stress disorder (PTSD) have abnormal activation in brain regions important for emotion processing. It is unknown whether symptom improvement is accompanied by normative changes in these regions. This study identified neural changes associated with symptom improvement with the long-term goal of identifying malleable targets for interventions.

METHODS

A total of 80 functional magnetic resonance imaging (fMRI) scans were collected, including 20 adolescents with PTSD (ages 9-17) and 20 age- and sex-matched healthy control subjects, each scanned before and after a 5-month period. Trauma-focused cognitive behavioral therapy was provided to the PTSD group to ensure improvement in symptoms. Whole brain voxel-wise activation and region of interest analyses of facial expression task data were conducted to identify abnormalities in the PTSD group versus HC at baseline (BL), and neural changes correlated with symptom improvement from BL to EOS of study (EOS).

RESULTS

At BL, the PTSD group had abnormally elevated activation in the cingulate cortex, hippocampus, amygdala, and medial frontal cortex compared to HC. From BL to EOS, PTSD symptoms improved an average of 39%. Longitudinal improvement in symptoms of PTSD was associated with decreasing activation in posterior cingulate, mid-cingulate, and hippocampus, while improvement in dissociative symptoms was correlated with decreasing activation in the amygdala.

CONCLUSIONS

Abnormalities in emotion-processing brain networks in youth with PTSD normalize when symptoms improve, demonstrating neural plasticity of these regions in young patients and the importance of early intervention.

'The self-destruction force is so strong': male survivors' experience of suicidal thoughts following sexual violence

Suicidal thoughts are common among male sexual violence survivors. However, very few studies have focused specifically on this aspect. The purpose of this study was to explore the experience of male survivors themselves of suicidal thoughts following sexual violence within the framework of men and masculinity. The research methodology was The Vancouver School of Doing Phenomenology, and a total of 17 interviews were conducted with seven male survivors. The main findings of the study are that the source of the suicidal thoughts after sexual violence is based on an experienced strong self-destruction force that involves almost unbearable and unexpressed suffering. The strong self-destruction force appeared among other things in risk behaviour and negligence towards own life and health. Participants all agreed that the thought of suicide was a certain escape route, that is to be constantly trying to escape from oneself and inner suffering. Negative thoughts that were difficult to suppress developed into suicidal thoughts that developed into thinking about the best possible way to commit suicide. Shattered self-esteem, shame and loneliness characterised the lives of participants, and they felt disgusting and worthless as human beings. Much self-degradation was characteristic. Perceived common societal norms about male masculinity had major negative impact on participants, for example that they should not show emotions because they were men and therefore should not express emotional pain or disclose their traumas. This resulted in emotional silencing. Disclosing the violence proved extremely difficult for all participants, but they experienced a high level of positive energy following disclosure. Participants experienced lack of knowledge, understanding and appropriate support from healthcare professionals and felt that sexual violence survivors' trauma history needed to be better explored within health care. It is important that professionals acquire knowledge and understanding of male sexual violence survivors, and their suicidal thoughts, and become able to provide trauma-specific support.

Associations of adverse childhood experiences and suicidal behaviors in adulthood in a U.S. nationally representative sample

BACKGROUND

Suicide is a leading cause of death among adolescents and young adults. The current study extends the research linking adverse childhood experiences (ACEs) to suicidal behaviors by testing these associations using a nationally representative sample, assessing for suicide ideation and attempts in adulthood, controlling for established risk factors for suicidality, and measuring a broad array of ACEs.

METHODS

The sample included 9,421 participants from the National Longitudinal Study of Adolescent Health who participated in four waves of assessments spanning 13 years. We examined longitudinal associations between eight different ACEs (physical, sexual, and emotional abuse, neglect, parental death, incarceration, alcoholism, and family suicidality) with suicidal ideation and suicide attempts in adulthood, while controlling for depression, problem alcohol use, drug use, delinquency, impulsivity, gender, race, age, and urbanicity. We also tested for cumulative associations of ACEs with suicide ideation and attempts.

RESULTS

Logistic regression analyses indicated that physical, sexual, and emotional abuse, parental incarceration, and family history of suicidality each increased the risk by 1.4 to 2.7 times for suicidal ideation and suicide attempts in adulthood. The accumulation of ACEs increased the odds of suicide ideation and attempts. Compared with those with no ACEs, the odds of seriously considering suicide or attempting suicide in adulthood increased more than threefold among those with three or more ACEs.

CONCLUSIONS

Intervention strategies need to prevent ACEs from occurring and, if they do occur, should take into account the impact of cumulative ACEs on suicide risk. Future research should focus on identifying mediating mechanisms for the ACEs-suicidality association using longitudinal research designs and determine which ACEs are most important to include in a cumulative ACE measure.

A Trauma-Informed Approach to Building College Students' Resilience

PURPOSE

This paper describes the development of a new psychoeducational universal prevention resilience program ( https://strong.fsu.edu ) designed to complement existing mental health services at a large public university. The first set of descriptive data (n = 229) from the project's student surveys is discussed.

METHODS

A voluntary and anonymous online questionnaire was used to determine student attitudes toward the new program.

RESULTS

A large majority of participants (more than 80%) perceived the website to be credible, rating it as believable, trustworthy, and accurate. 90% believe the university resources included in the project would help themselves and others overcome struggles and challenges. Other results are also discussed.

DISCUSSION

This data from a unique project shows the promise of using an online, integrative tool for a campus resilience initiative. The project is dynamic; analysis of student responses will inform ongoing revisions and refinements.

Longitudinal association of child maltreatment and cognitive functioning: Implications for child development

Although research investigating associations among child maltreatment, cognitive functioning, and academic achievement has grown in recent years, important questions remain. In particular, assessing the influence of maltreatment apart from that of other co-occurring and confounding factors remains difficult. This study was developed to further the field's understanding by investigating cognitive functioning in association with time-variant maltreatment patterns. Using multiple time-variant linear mixed models, we investigated the relationships between maltreatment timing and three domains of cognitive functioning (i.e., knowledge, comprehension, and analysis). In general, the cognitive functioning of students who experienced maltreatment was lower than that of their peers who had yet to experience maltreatment at the time of testing. Results of LMM indicated that the cognitive functioning of students who experienced maltreatment concurrent with the testing year fluctuated over time whereas the cognitive functioning of students who experienced maltreatment prior to or after the testing year remained stable. Students who experienced concurrent maltreatment showed the lowest functioning of any group. While maltreatment timing was a significant predictor of cognitive functioning over time, the addition of poverty into the model resulted in a non-significant effect of maltreatment timing. Additional research is needed to disentangle the longitudinal effect of maltreatment on cognitive functioning and address the interacting role of poverty and chronic maltreatment.