Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale

Pilot study of parental alienation items in the adverse childhood experiences scale

BACKGROUND

Adverse Childhood Experiences (ACEs) and Parental Alienation (PA)are forms of adverse events negatively affecting children globally. The current study was to identify a revised ACEs measure that includes a screening item for PA.

METHODS

A total of 231 undergraduate students, ages 18 to 37, were surveyed for this analysis. A factor analyses was performed to identify what PA item, out of four, would correlate most strongly with existing ACEs scale items. Convergent and divergent validity was assessed. An exploratory factory analyses was conducted to identify factor structure of scale items and a confirmatory factory analysis of extracted factors was used to assess model fit.

RESULTS

Over half (60 %) of the sampled population reported at least one ACEs item. All four PA items were significantly correlated with converging constructs (r = 0.68, p < .01). Out of four PA items, one PA item significantly outperformed the other three items in relation to convergent validity and was used to create a new ACEs-PA scale item (r = 0.33, p < .01). A two factor solution was identified with the new PA item loading, accounting for 35 % of the variance, explaining more variance in both outcomes (R2 = 0.43 and R2 = 0.16) than the original ACEs scale when comparing the adjusted R2 values (R2 = 0.35 and R2 = 0.13). Limitations This study used participant self-reporting methods subjecting it to retrospective bias.

CONCLUSION

Within the population, the new PA item factored significantly with existing ACEs, suggesting the capture of an additional adverse childhood experience.

Examining the relative impact of adverse and positive childhood experiences on adolescent mental health: A strengths-based perspective

BACKGROUND

It is well-documented that Adverse Childhood Experiences (ACEs) have a negative impact on mental health outcomes across the lifespan, while Positive Childhood Experiences (PCEs) act as a protective factor. Less is known about the relative impact of ACEs and PCEs on mental health outcome for adolescents.

OBJECTIVE

The present study sought to identify the relative impact of ACEs and PCEs on mental health outcomes for youth.

PARTICIPANTS AND SETTING

Data were drawn from a state-wide, cross-sectional health survey of 12-17 year-olds (n = 1169) conducted on a continuous basis throughout 2021, following the height of the COVID-19 pandemic.

METHODS

Adolescents completed ACEs and PCEs screeners and the Kessler 6-item Psychological Distress Scale to assess current mental health symptoms. A multiple regression analysis controlling for age, gender, and poverty level, was conducted to examine the relative impacts of ACEs and PCEs on mental health outcomes.

RESULTS

Male gender, younger age, lower family poverty level (e.g., more financial hardship), absence of ACEs, and experiencing more PCEs were significantly associated with better mental health outcomes for adolescents [F(5, 1163) = 104.48, p < .001]. Notably, ACEs were found to account for only 9 % of variance in mental health outcomes (ΔR2 = 0.09), while PCEs accounted for 18 % of variance (ΔR2 = 0.18).

CONCLUSIONS

PCEs explained approximately double the variance in mental health outcomes for adolescents compared to ACEs. Results indicate promoting youths' exposure to PCEs in childhood and adolescence may offer a meaningful pathway for supporting adaptive mental health outcomes.

The impact of positive and adverse childhood experiences on social connectedness in young adults

Establishing and maintaining social relationships is a critical developmental milestone for adolescents and young adults and can be disrupted by childhood adversities. Adverse and positive childhood experiences (ACEs and PCEs, respectively) represent independent, yet critical, domains that support the exploration of positive and adverse childhood experiences (PACEs) as pathways to social connection. Recent research has examined the impact of COVID-19 on child development. The current study expands on existing research by examining the effects that PACEs clusters and high school enrollment during COVID-19 had on social connectedness. Young adults (N = 211; Mage = 20.97 years, SD = 2.14) completed an online survey examining social functioning and childhood experiences. Two measures comprised PACEs: Benevolent Childhood Experiences (BCEs) scale and Adverse Childhood Experiences questionnaire. An adapted Berkman-Syme Social Network Index measured social connection. High school enrollment during COVID-19 was determined by graduation year. Cluster analyses identified three PACEs profiles: (1) high BCEs/low ACEs (74.9%), (2) moderate BCEs/high ACEs (14.7%), and (3) low BCEs/moderate ACEs (10.4%). Regression analyses showed that High Risk/High Protection (β = -3.326, p = .001) and Moderate Risk/Moderate Protection (β = -4.845, p < .001) profiles had significantly fewer social connections than the Low Risk/High Protection profile. High school enrollment at the COVID-19 onset did not predict social connection (β = 0.067, p = .305). Implications include clinicians considering PACEs when forming a holistic view of clients and integrating positive contexts into adversity research.

Associations between Positive Childhood Experiences (PCEs), Discrimination, and Internalizing/Externalizing in Pre-Adolescents

OBJECTIVE

This study aimed to investigate the relationships between four types of perceived discrimination (based on race and ethnicity, nationality/country of origin, gender identity, weight/body size), individually and cumulatively; positive childhood experiences (PCEs); and behavioral symptoms among pre-adolescent youth.

METHODS

This study was a secondary analysis of data from the Adolescent Brain Cognitive Development (ABCD) Study, a US-based cohort study of pre-adolescent youth in the United States (N = 10,915). Our outcome was emotional/behavioral symptoms measured by the Child Behavior Checklist. Primary exposures were four types of discrimination, a count of 0-5 PCEs, and other adverse childhood experiences (ACEs). Multiple logistic regression models were used to estimate the relationship between perceived discrimination and clinical-range behavioral symptoms, including the role of PCEs and ACEs.

RESULTS

Weight discrimination was the most frequent exposure (n = 643, 5.9%). Race and weight perceived discrimination were associated with clinical-range externalizing and internalizing symptoms, respectively, but these associations were non significant once other ACEs were added to models. Cumulative discrimination was associated with clinical-range Child Behavior Checklist (CBCL) scores, even when accounting for other ACEs (aOR=1.47, 95% CI=1.2-1.8). PCEs slightly reduced the strength of this relationship and were independently associated with reduced symptoms (aOR=0.82, 95% CI=0.72-0.93).

CONCLUSIONS

Results of this national study suggest cumulative discrimination can exert emotional/behavioral health harm among youth. PCEs were independently associated with reduced behavioral symptoms. There is a need for further research on how to prevent discrimination and bolster PCEs by targeting upstream social inequities in communities.

Intergenerational transmission of adverse and positive childhood experiences and associations with child well-being

BACKGROUND

Parental adverse childhood experiences (ACEs) contribute to offspring adversity and poor health outcomes, but little is known about whether and to what extent parental positive childhood experiences (PCEs) influence offspring positive experiences and well-being.

OBJECTIVE

To investigate the association between parent and child ACEs and PCEs and their impact on child well-being and psychopathology.

PARTICIPANTS AND SETTING

A national sample of n = 1016 US parents of 1-5-year-olds completed online surveys in September 2019.

METHODS

Mediation analysis in a path modeling framework was used with stratified probability weights for generalizability to the US population.

RESULTS

Each additional parent PCE equated to 0.32 (95 % CI: 0.20, 0.45) increase in child PCEs and each additional parent ACE equated to 0.18 (95 % CI: 0.06, 0.31) increase in child PCEs and 0.13 (95 % CI: 0.08, 0.18) increase in child ACEs. In turn, an increase in 1 child PCE was associated with 0.10-0.16 SD increase in well-being and 0.06-0.10 decrease in psychopathology, and each additional child ACE equated to 0.10-0.18 SD increase in psychopathology.

CONCLUSIONS

Results support the intergenerational transmission of PCEs and ACEs, advancing understanding of the role that parent PCEs play in promoting child PCEs and fostering child well-being. Findings underscore the importance of extending clinical surveillance of ACEs to include PCEs in pediatric and adult healthcare settings. Dual-generation programs that address the negative consequences of parental ACEs may be able to increase their impact by adding a parallel emphasis on PCEs and providing parents with tools to foster PCEs in their children.

Early Childhood Routines and Adolescent Health & Well-Being: Associations From a US Urban Cohort of Children With Socioeconomic Disadvantage

PURPOSE

To investigate longitudinal associations between the presence of early childhood routines- predictable and repeatable functional practices that promote healthy growth, development, and relationships - and adolescent health outcomes.

DESIGN

Secondary data analysis.

SETTING

20 large U.S. cities.

SUBJECTS

2943 children with socioeconomic disadvantage from the Future of Families cohort.

MEASURES

Routines at age 3 (shared family meals, bedtime routine, daily reading); outcomes later in the same children at age 15 (healthy routines, overall health, psychological well-being).

ANALYSIS

Descriptive statistics, regression analyses.

RESULTS

We detected longitudinal associations between early childhood routines and later adolescent routines (increased count of shared family meals by parent report [IRR 1.13, 95% CI: 1.03, 1.24, P = 0.007], bedtime routine and daily reading by adolescent report [aOR 1.34, 95% CI: 1.08, 1.67, P = 0.008; aOR 1.18, 95% CI: 1.01, 1.38, P = 0.04; respectively]). A bedtime routine in early childhood was associated with excellent health in adolescence (aOR 1.42, 95% CI: 1.12, 1.79, P = 0.004]. Adolescent routines were concurrently associated with overall health and psychological well-being. We also detected two longitudinal patterns of associations suggesting multiple mechanisms for how early childhood routines influence later health and well-being.

CONCLUSION

Early childhood routines predict adolescent routines, and may contribute to long term adolescent health outcomes. Future studies may promote childhood routines during critical developmental stages as a strength-based strategy to promote long-term health and well-being.

The moderating role of early-life parental adverse and positive factors in the genetic and environmental contributions to objectively assessed sleep duration in middle childhood

Early-life positive and adverse parental factors, such as positive parent personality and parental stress, affect the environmental context in which children develop and may influence individual differences in children's sleep health. This study examined the moderating role of early-life parental factors in the heritability (i.e., the extent to which individual differences are due to genetic influences) of objectively assessed childhood sleep duration. A total of 351 families from the Arizona Twin Project were studied. Primary caregivers (95% mothers) reported on multiple dimensions of stress and facets of their own personality when the twins were 12 months old. Seven years later (Mage = 8.43 years, SD = 0.68), families completed a home visit, and twins (51% female; 57% White, 29% Hispanic; 30% monozygotic, 39% same-sex dizygotic, 31% other-sex dizygotic) wore actigraph watches to assess their sleep, with caregivers completing similar assessments on their personality attributes and stress. Early-life positive parent personality moderated the heritability of sleep duration (Δ-2LL [-2 log likelihood] = 2.54, Δdf = 2, p = .28), such that as positive parent personality increased, the heritability of duration decreased. Early-life parental stress also moderated the genetic contribution to sleep duration (Δ-2LL = 2.02, Δdf = 2, p = .36), such that as stress increased, the heritability of duration increased. Concurrent positive parent personality and parental stress composites showed similar patterns of findings. Results highlight the likely contribution of parent positive traits and adverse experiences to the etiology of children's sleep health, with genetic influences on children's sleep more prominent in "riskier" environments. Understanding how genetics and environments work together to influence the etiology of sleep may inform prevention programs.

Positive Childhood Experiences are Associated With Alcohol Use in Adolescent and Emerging Adult Females by Adverse Childhood Experiences Dimension

PURPOSE

Experiencing multiple adverse childhood experiences (ACEs) is associated with alcohol use in female adolescents and emerging adults. Protective and compensatory experiences (PACEs) have been theorized to off-set the health and behavioral consequences from the accumulation of ACEs throughout childhood. This study examines the association between protective experiences and subsequent alcohol and binge alcohol use frequency over one month among female adolescent and emerging adults reporting high and low levels of two ACE dimensions (household dysfunction and emotional abuse/neglect).

METHODS

One hundred 43 females between the ages of 15-24 who indicated at least one binge episode in the past two weeks completed the six-item ACEs scale, the PACEs scale, and demographics at baseline. Alcohol consumption was measured prospectively over the next month during weekly appointments using the timeline follow back approach.

RESULTS

Two PACEs factors had significant direct associations, a source of unconditional love was associated with less frequent alcohol use (β = -0.437, 95% confidence interval [CI] -0.744, -0.131, exp(β) = 0.65, p = .005) in the context of high household dysfunction; and having a trusted adult to count on for help and advice (β = -1.373, 95% CI -2.283, -0.464, exp(β) = 0.25, p = .003) predicted fewer binge occasions in the context of high emotional abuse/neglect. Regardless of ACE dimension exposure, nonsport social group membership was associated more frequent alcohol use over the month across all ACE dimensions (β = 0.11-0.74, 95% CI -0.11, 0.74, exp(β) = 1.37 - 1.62, p ≤ .002); and having a trusted adult to count on for help and advice was associated with a 5.7 times more frequent of alcohol use among those with low household dysfunction (β = 1.74, 95% CI 0.83, 2.65, exp(β) = 5.70, p < .001).

DISCUSSION

Few PACE items are associated with direct reductions in alcohol outcomes. Indeed, there is consistently heightened risk associated with nonsport group membership for alcohol use frequency, regardless of experiences of childhood adversity. Future research should identify which protective factors have the most potential to off-set alcohol use by ACE dimension.

"I Just Wouldn't Like Him to go Through What I Went Through as a Kid": A Qualitative Study on the Mitigating Effects of Positive Childhood Experiences in Mothers with a History of Adverse Childhood Experiences in an Irish Population

Adverse Childhood Experiences (ACEs) are increasingly being acknowledged as a major risk factor for instigating and sustaining cycles of trauma between mother and child. Recently, the concept of Benevolent Childhood Experiences (BCEs) has been introduced to ACEs research as a buffer against the transmission of ACEs between generations. Positive childhood experiences such as attachment to caregivers, positive peer relations and positive sense of self have been found to counteract the effects of adverse childhood experiences. The emergence of positive childhood experiences as an adaptive capacity against ACEs should be explored as a tool for psychological change, to help break the cycle of inherited trauma between generations. The present study aims to examine the lived experiences of mothers with a history of ACEs, if they consider their positive childhood experiences when parenting, and how they use these positive experiences to break the cycle of intergenerational trauma. Three women residing in a low-support service for parenting were recruited for this study. Participants were all low-income, first-time single mothers in their early thirties. A qualitative approach was designed for the study. ACEs and BCEs questionnaires were administered to participants and scores were taken into account to contextualise participant interviews. A semi-structured interview was designed in accordance with IPA guidelines. Questions were directed towards phenomenological material, focusing on participants' understanding of their experiences as mothers. Analysis of the interview data revealed three superordinate themes (replicating positive experiences, creating new positive experiences and protecting children from intergenerational trauma) related to participants' BCEs, their children's BCEs and their desire to break the cycle of intergenerational trauma. The findings of this study, namely that participants intentionally tried to create positive experiences with their own children through drawing on their own positive experiences in childhood, supports the idea that BCEs are a legitimate source of adaptive capacity for mothers with ACEs. Parenting interventions for parents with ACEs should be developed taking into account ACE and BCE scores.

A protocol for enhancing the diagnostic accuracy and predictive validity of neonatal opioid withdrawal syndrome: The utility of non-invasive clinical markers

Every 15 minutes in the US, an infant exposed to opioids is born. Approximately 50% of these newborns will develop Neonatal Opioid Withdrawal Syndrome (NOWS) within 5 days of birth. It is not known which infants will develop NOWS, therefore, the current hospital standard-of-care dictates a 96-hour observational hold. Understanding which infants will develop NOWS soon after birth could reduce hospital stays for infants who do not develop NOWS and decrease burdens on hospitals and clinicians. We propose noninvasive clinical indicators of NOWS, including newborn neurobehavior, autonomic biomarkers, prenatal substance exposures, and socioeconomic environments. The goals of this protocol are to use these indicators shortly after birth to differentiate newborns who will be diagnosed with NOWS from those who will have mild/no withdrawal, to determine if the indicators predict development at 6 and 18 months of age, and to increase NOWS diagnostic sensitivity for earlier, more accurate diagnoses.

Cross-sectional study on university students' mental health during the COVID-19 pandemic: Exploring the influence of adverse and positive childhood experiences

Aim

This study examined the psychological impact of the COVID-19 pandemic on university students, focusing on how adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) influence mental health.

Methods

A web-based survey was administered to 3000 university students from October 26 to 31, 2022, following the peak of the COVID-19 pandemic. Mental health assessments included the Japanese version of the Kessler Psychological Distress 6-Item Scale (K6) for depressive/anxiety symptoms, the Impact of Event Scale-Revised (IES-R-J) for distress, fear of COVID-19, and a three-item loneliness scale.

Results

Of the respondents, 46.9% reported depressive/anxiety symptoms, 55.4% reported distress, and 37.3% reported fear of COVID-19. Factors such as current psychiatric treatment history and reduced income (either parental or personal) were predictive of worsening depressive/anxiety symptoms, distress, and loneliness. ACEs were found to exacerbate depressive/anxiety symptoms and distress, while PCEs mitigated these symptoms, and vice versa.

Conclusion

This study underscores the importance of considering both ACEs and PCEs in supporting the mental health of university students. PCEs were found to independently prevent mental health deterioration, including depressive/anxiety symptoms and distress, which may include post-traumatic stress disorder symptoms, even in the presence of ACEs. Recognizing and fostering PCEs emerged as an effective strategy for mitigating mental health issues.

The influence of Adverse and Positive Childhood Experiences on facets of empathy

BACKGROUND

Although Adverse Childhood Experiences (ACEs) have been associated with empathy, research findings have been incongruous. In contrast, positive parenting practices have been consistently, and positively, associated with empathy.

OBJECTIVE

The current study investigated whether the relationship between ACEs and facets of empathy (i.e., perspective taking, empathic concern, personal distress, fantasy) were moderated by Positive Childhood Experiences (PCEs).

PARTICIPANTS AND SETTING

A sample of 923 participants completed an online survey.

METHOD

Participants completed online versions of the Childhood Experiences Scale-17, the Benevolent Childhood Experiences Scale, and the Interpersonal Reactivity Index.

RESULTS

We found that ACEs were not significantly associated with any facet of empathy. PCEs, on the other hand, were positively associated with fantasy, empathic concern, and perspective taking, and moderated the relationships between (a) ACEs and empathic concern, and (b) ACEs and perspective taking.

CONCLUSIONS

These results provide a more nuanced understanding of the role ACEs and PCEs play in empathy. Specifically, PCEs appear to be a protective factor when ACEs are low, but when people experience above average levels of childhood adversity, PCEs have little influence on empathic concern or perspective taking.

Facilitating Greater Understanding of Trauma-Informed Care in Applied Behavior Analysis: An Introduction to the Special Issue

Trauma-informed care (TIC) refers to the guiding principles that inform how organizations or individuals arrange services with respect to acknowledging both the prevalence and impact of trauma. Given the elevated risks of trauma in the populations with which many behavior analysts work, clarifying why, how, and if TIC should be incorporated into behavior analytic work seems prudent. Although the core commitments of TIC are inherently aligned with ethical and effective applied behavior analytic practice, there are few exemplars of how TIC can be intentionally incorporated into behavioral assessment and treatment. This special issue is intended to begin to fill that gap, as well as to promote further discussion of the benefits and limitations of TIC in ABA. In this introduction, we review both the prevalence and potential outcomes of trauma, as well as attempting to dispel misconceptions about TIC that appear common among the behavior analytic community. We highlight how the articles in the special issue are important in developing an evidence base for TIC in ABA, as well as suggesting areas for future research.

Pathways of Intergenerational Risk: Examining the Association Between Maternal Adverse Childhood Experiences and Child Socio-Emotional and Behavioral Concerns at 8 Years of Age

Support has been found for the intergenerational transmission of risk from maternal adverse childhood experiences (ACEs) to child outcomes. Less research has focused on longitudinal psychosocial pathways that account for this transmission. In the current study, path analysis examined mediating pathways (i.e., maternal adult attachment insecurity, romantic relationship functioning, and maternal anxiety and depression symptoms) in the association between maternal ACEs and internalizing and externalizing concerns among their child at eight years of age. Participants included 1,994 mother-child dyads from a prospective longitudinal cohort sample. Maternal ACEs were significantly associated directly with child internalizing concerns (β = .06, p = .025) and indirectly via both maternal attachment anxiety and avoidance, lower romantic relationship functioning, and depression, (β = .002, p = .006; β = .003, p = .005, respectively). Maternal ACEs were directly associated with child externalizing concerns (β = .06, p = .018) and indirectly via both maternal attachment anxiety and avoidance, lower romantic relationship functioning, and depression, (β = .001, p = .008; β = .002, p = .010, respectively). This study identified several maternal risk factors that have implications for downstream internalizing and externalizing concerns among their children.

A replication and extension of adverse and benevolent childhood experiences along with contemporaneous social support and sociodemographic stress for perinatal mental health problems

This study replicated and extended Narayan and colleagues' (2018) original benevolent childhood experiences (BCEs) study. We examined associations between adverse and positive childhood experiences and mental health problems in a second sample of low-income, ethnically diverse pregnant individuals (replication). We also examined effects of childhood experiences on perinatal mental health problems while accounting for contemporaneous support and stress (extension). Participants were 175 pregnant individuals (M = 28.07 years, SD = 5.68, range = 18-40; 38.9% White, 25.7% Latina, 16.6% Black, 12.0% biracial/multiracial, 6.8% other) who completed standardized instruments on BCEs, childhood maltreatment and exposure to family dysfunction, sociodemographic stress, and perinatal depression and post-traumatic stress disorder (PTSD) symptoms. They completed the Five-Minute Speech Sample at pregnancy and postpartum to assess social support from the other biological parent. Higher family dysfunction predicted higher prenatal depression symptoms, while higher BCEs and prenatal social support predicted lower prenatal PTSD symptoms. Prenatal depression and prenatal PTSD symptoms were the most robust predictors of postnatal depression and PTSD symptoms, respectively, although higher postnatal social support also predicted lower postnatal PTSD symptoms. Findings replicated many patterns found in the original BCEs study and indicated that contemporaneous experiences are also associated with perinatal mental health problems.

Association between disturbance of self-organization and irritable bowel syndrome in Japanese population using the international trauma questionnaire

Disturbance of self-organization (DSO) is defined by affective dysregulation, negative self-concept, and disturbances in relationships. Along with post-traumatic stress disorder (PTSD), DSO is a part of complex post-traumatic stress disorder (CPTSD), which often results from childhood trauma and has life-long consequences. We investigated the association between CPTSD, PTSD, DSO, childhood adversity, and irritable bowel syndrome (IBS). Individuals with IBS exhibited markedly higher prevalences of DSO, CPTSD, and PTSD symptoms and higher trauma scores compared with healthy individuals. The odds of having IBS were 3.718 and 1.924 times greater for those with DSO symptoms (p < .001) and CPTSD symptoms (p = .005), respectively. IBS severity was highest in the DSO group, followed by the CPTSD, PTSD, and non-DSO/CPTSD/PTSD groups. DSO symptoms mediate the impact of childhood adversity on IBS symptoms, explaining half of this effect, whereas PTSD symptoms do not. These findings suggest a significant role of DSO in the development of IBS.

Considering the associations of adverse and positive childhood experiences with health behaviors and outcomes among emerging adults

Childhood is a sensitive period of development during which early life experiences can facilitate either positive or negative health trajectories across subsequent developmental periods. Previous research has established strong links between adverse childhood experiences (ACEs) and adverse health outcomes (e.g., sleep-related problems, pain, substance use). Despite this, less is known about positive childhood experiences (PCEs) and how they may buffer the effects of ACEs on health outcomes. The current study investigated whether PCEs moderate the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference) in a sample of at-risk emerging adults. Participants (N = 165) were undergraduate college students (18-25 years of age) who reported frequent alcohol and/or cannabis use (≥3 times in the past week). A significant positive association was found between ACEs and cannabis use. There were also significant negative associations found between PCEs and pain interference and intensity. PCEs did not moderate any of the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference). Findings suggest that PCEs may be unlikely to serve as a strong enough protective factor during early life to decrease risk for suboptimal health and health behaviors during emerging adulthood among individuals who report a greater accumulation of ACEs. Longitudinal research is needed to identify additional related risk and protective factors during early life to further support health and health behavior during this transitional period of development and beyond.

Multisystemic factors predicting street migration of children in Kenya: A multilevel longitudinal study of families and villages

BACKGROUND

Street-migration of children is a global problem with sparse multi-level or longitudinal data. Such data are required to inform robust street-migration prevention efforts.

OBJECTIVE

This study analyzes longitudinal cohort data to identify factors predicting street-migration of children - at caregiver- and village-levels.

PARTICIPANTS AND SETTING

Kenyan adult respondents (n = 575; 20 villages) actively participated in a community-based intervention, seeking to improve factors previously identified as contributing to street-migration by children.

METHODS

At two time points, respondents reported street-migration of children, and variables across economic, social, psychological, mental, parenting, and childhood experience domains. Primary study outcome was newly reported street-migration of children at T2 "incident street-migration", compared to households that reported no street-migration at T1 or T2. For caregiver-level analyses, we assessed bivariate significance between variables (T1) and incident street-migration. Variables with significant bivariate associations were included in a hierarchical logistical regression model. For community-level analyses, we calculated the average values of variables at the village-level, after excluding values from respondents who indicated an incident street-migration case to reduce potential outlier influence. We then compared variables between the 5 villages with the highest incidence to the 15 villages with fewer incident cases.

RESULTS

In regression analyses, caregiver childhood experiences, psychological factors and parenting behaviors predicted future street-migration. Lower village-aggregated depression and higher village-aggregated collective efficacy and social curiosity appeared significantly protective.

CONCLUSIONS

While parenting and economic strengthening approaches may be helpful, efforts to prevent street migration by children should also strengthen community-level mental health, collective efficacy, and communal harmony.

The CARING study: Examining biological, behavioral, and genetic mechanisms in the intergenerational transmission of toxic stress

When children experience extreme or persistent stressors (e.g., maltreatment, housing insecurity, intimate partner violence), prolonged elevation of the stress-response system can lead to disrupted development of multiple physiological systems. This response, known as toxic stress, is associated with poor physical and mental health across the life course. Emerging evidence suggests that the effects of toxic stress may be transmitted through generations, but the biological and behavioral mechanisms that link caregivers' childhood history with the health of the children they care for remain poorly understood. The purpose of this report is to describe the research protocol for The CARING (Childhood Adversity and Resilience In the Next Generation) Study, a cross-sectional study of caregivers with children aged 3-5 years designed to (1) examine the intergenerational transmission of toxic stress and protective factors; (2) explore three hypothesized pathways of transmission: parenting, daily routines, stressors, and supports; and (3) explore the extent to which genotypic variation in candidate genes related to caregiving and stress contribute to caregivers' and children's susceptibility to the effects of early childhood experiences (i.e., gene × environment interactions). We expect that findings from this study will provide critical data needed to identify targets for precision health interventions, reduce health disparities related to toxic stress, and prevent cycles of adversity among families at risk.

Adverse childhood experiences and aggression in adulthood: The moderating role of positive childhood experiences

BACKGROUND

Adverse childhood experiences (ACEs) have a significant impact on a person's psychological development and predispose them to various harmful consequences in adulthood, such as different forms of aggression. Contrarily, positive childhood experiences (PCEs) operate as protective factors, buffering against the adverse effects of ACEs and promoting adaptive behaviors and psychological well-being. However, the role of PCEs in the relationship between ACEs and aggression remains relatively unexplored.

OBJECTIVE

To explore the moderation role of PCEs in the relationship between ACEs and aggression and its different components across sexes in a community sample.

METHODS

A sample of 1541 Portuguese adults answered an online protocol with a sociodemographic questionnaire, the Benevolent Childhood Experiences Scale, the Childhood History Questionnaire, and the Buss-Perry Aggression Questionnaire.

RESULTS

ACEs were positively correlated with aggression, including physical and verbal aggression, anger, and hostility, with women reporting a higher prevalence of ACEs and higher levels of anger. Men revealed higher scores in physical and verbal aggression. Furthermore, moderation analyses clarified the moderating effect of PCEs on the relationship between ACEs and aggression in women and between ACEs and anger in both sexes. PCEs attenuate the adverse impact of ACEs, reducing aggression and anger levels.

CONCLUSIONS

This study stresses the complex interplay between childhood experiences and adult aggression, highlighting the differential effects of ACEs and PCEs across men and women. By clarifying these dynamics, interventions can be tailored to bolster protective factors like PCEs. This will ultimately foster healthier developmental trajectories and reduce the prevalence of aggression in adulthood.

Adverse and benevolent childhood experiences among adults in the United Kingdom: a latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) are important factors for population mental and physical health. While considerable public health literature demonstrates the global relevance of ACEs, more recent research shows that benevolent childhood experiences (BCEs) might be important to consider in their direct and mitigating roles for psychological distress and other mental health outcomes. There is little evidence of latent class examinations involving both ACEs and BCEs among adults in western nations. The present study sought to replicate and extend prior literature by: (1) assessing the extent to which past latent class groupings reproduce in present samples, and (2) analyzing the association of latent classes of childhood experiences with psychological distress and suicidal thoughts and behaviours (STBs). We examined psychological distress (i.e., depression, anxiety, post-traumatic stress, general wellbeing) and STBs (i.e., suicidal ideation, self-harm ideation and behaviour, entrapment, and defeat).

METHOD

Data were drawn from two nationwide cross-sectional online survey studies in the United Kingdom. The first sample (N = 488) was drawn from a study on suicidal behaviour, and the second sample (N = 447) was from a study concerning risk for interpersonal violence.

RESULTS

Results largely replicated an existing four class solution of childhood experiences: Class 1 (Moderate ACEs/High BCEs; 17.6%), Class 2 (High ACEs/Moderate BCEs; 15.3%), Class 3 (Low ACEs/High BCEs; 48.3%), and Class 4 (Low ACEs/Moderate BCEs; 18.8%). Class 2 (High ACEs/Moderate BCEs) was associated with consistently worse psychological distress and STBs. Classes containing high BCEs (1 and 3) were characterized by generally lower levels of psychological distress and STBs.

CONCLUSIONS

Results affirm the potential value for jointly considering ACEs and BCEs to understand psychological distress and STBs. ACEs and BCEs may serve foundational roles in theories of suicide. The protective role of BCEs hypothesized in resiliency theory may be supported. Prevention practice and research implications are discussed.

Cultural continuity, identity, and resilience among indigenous youth: Honoring the legacies of Michael Chandler and Christopher Lalonde

This essay is an introduction to the thematic issue of Transcultural Psychiatry in honor of the work of Michael Chandler and Christopher Lalonde, developmental psychologists who made essential contributions to the study of identity and wellness among Indigenous youth in Canada and internationally. We outline their major contributions and illustrate the ways their innovative theory and methods have inspired decades of research, including the recent work presented in this issue, which addresses four broad themes: (1) the importance of a developmental perspective in mental health research; (2) the role of individual and collective continuity of identity in suicide prevention and mental health promotion; (3) Indigenous perspectives on trauma and resilience; and (4) Indigenous knowledge and values as a basis for culturally adapted and culturally grounded mental health services and interventions.

Leveraging biosocial methods to examine and address structural determinants of health and promote health equity

BACKGROUND

Biosocial approaches in nursing research have largely focused on the ways that social determinants of health influence individual-level outcomes, including symptom management, family and social support, and educational interventions.

PURPOSE

Theoretical, methodological, and practical strategies are needed to expand current biosocial methods for nursing science and focus on upstream, structural determinants of health and the policies that underlie health inequities.

METHODS

This paper summarizes presentations given at the 2023 Council for the Advancement of Nursing Science Advanced Methods Conference, Biosocial Methods to Advance Health Equity, in a panel titled "Individual, community, systems and policy related to biosocial methods."

DISCUSSION

Nurses are uniquely positioned to examine upstream, structural determinants of health by leveraging expertise in biosocial methods, collaborating with interdisciplinary researchers and community members, and advocating for policy change. By conducting theory-grounded biosocial research, nurse researchers can significantly advance scientific knowledge and promote health equity for individuals and communities.

CONCLUSION

Nurse scientists are conducting research using biosocial methods and provide recommendations for expansion of this approach in the field.

The trajectory of anxiety in therapy: The role of ACEs

The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.

Leveraging Public Health and Public School Partnerships for Local Surveillance of Positive Childhood Experiences

Childhood psychosocial experiences can have a lifelong effect on health. These experiences can be measured together as positive and adverse childhood experiences or individually as positive childhood experiences (PCEs) or adverse childhood experiences. Most research on PCEs has focused on how PCEs promote health outcomes. However, limited research has been conducted on the prevalence of PCEs among adolescents in local areas served by public health departments. The St. Joseph County Department of Health developed a study to test the feasibility of surveillance of PCEs through local public health departments and to establish a prevalence for PCE exposure among a population of urban public-school students in Indiana. We conducted a survey in spring 2022 that collected demographic information on students at 2 high schools and 1 middle school and assessed exposure to PCEs. We assessed prevalence of PCEs on a 5-point Likert scale (0 = never, 1 = rarely, 2 = sometimes, 3 = usually, 4 = always). PCE scores were grouped into low (0-2), medium (3-5), and high (6 or 7). The prevalence of individual PCE items ranged from 35.6% to 86.8%. Among 798 respondents, 189 (23.7%) reported low PCE scores, 396 (49.6%) reported medium scores, and 213 (26.7%) reported high scores. This research demonstrates the feasibility of school-based PCE surveillance and establishes a baseline prevalence of PCE exposure among a population of middle and high school students. These methods are applicable to different contexts and can provide both local health departments and school systems with a new tool to address adverse childhood experiences.

Patient-Provider Trust as a Key Component of Prenatal Screening for Adverse Childhood Experiences (ACES): A Concept Analysis

INTRODUCTION

The concept of patient-provider trust in prenatal adverse childhood experiences (ACEs) screening remains unexplored. This concept analysis illuminates the role of trust in prenatal ACE screening to improve patient-provider relationships, increase patient uptake of ACE screening, and ensure that ACE screening is implemented in a strengths-based, trauma-informed way.

METHODS

A concept analysis was conducted using the Rodgers' evolutionary method to define the antecedents, attributes, and consequences of this construct. The databases searched were PubMed, PsychInfo, and Scopus between 2010 and 2021. A total of 389 articles were retrieved using the search terms prenatal, adverse childhood experiences screening, adverse childhood experiences, and adverse childhood experiences questionnaire. Included articles for detailed review contained prenatal screening, trauma screening (ACE or other), trust or building trust between patient and health care provider, patient engagement, and shared decision making. Excluded articles were those not in the context of prenatal care and that were exclusively about screening with no discussion about the patient-provider relationship or patient perspectives. A total of 32 articles were reviewed for this concept analysis.

RESULTS

We define trust in prenatal ACE screening as a network of evidence-based attributes that include the timing of the screening, patient familiarity with the health care provider, cultural competence, demystifying trauma, open dialogue between the patient and health care provider, and patient comfort and respect.

DISCUSSION

This concept analysis elucidates the importance of ACE screening and provides suggestions for establishing trust in the context of prenatal ACE screening. Results give insight and general guidance for health care providers looking to implement ACE screening in a trauma-informed way. Further research is needed to evaluate pregnant patients' attitudes toward ACE screening and how a health care provider's trauma history might influence their care. More inquiry is needed to understand the racial, ethnic, and cultural barriers to ACE screening.

Promotive and protective effects of community-related positive childhood experiences on adult health outcomes in the context of adverse childhood experiences: a nationwide cross-sectional survey in Japan

OBJECTIVE

Although adverse childhood experiences (ACEs) are associated with poor health in adulthood, positive childhood experiences (PCEs) can reduce the risk of negative health outcomes. This study aimed to investigate whether PCEs in the community (CPCEs, ie, trusted adults other than parents, supportive friends, belongingness to school, or community traditions) would have an independent effect on better health outcomes and moderate the association between ACEs and adult illnesses.

DESIGN

Cross-sectional survey.

SETTING

Data were gathered from a nationwide, cross-sectional internet survey conducted in Japan in 2022.

PARTICIPANTS

This study included 28 617 Japanese adults aged 18-82 years (51.1% female; mean age=48.1 years).

PRIMARY AND SECONDARY OUTCOME MEASURES

The associations among self-reported ACEs, CPCEs before the age of 18 years and current chronic diseases (eg, cancer and depression) were investigated using multivariable logistic regression models.

RESULTS

CPCEs were associated with lower odds of adult diseases (such as stroke, chronic obstructive pulmonary disease (COPD), chronic pain, depression, suicidal ideation and severe psychological distress) after adjusting for ACEs. More CPCEs weakened the association between ACEs and adult diseases. Specifically, among those with ACEs, ≥3 CPCEs (vs 0-2 CPCEs) lowered the adjusted prevalence by ≥50% for stroke (2.4% to 1.2%), COPD (2.2% to 0.7%) and severe psychological distress (16.4% to 7.4%).

CONCLUSION

CPCEs could reduce ACE-related risk of poor physical and mental health in later life. Early-life interventions that enhance PCEs in schools and/or neighbourhoods are recommended.

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.

Two Sides of the Coin: The Roles of Adverse Childhood Experiences and Positive Childhood Experiences in College Students' Mental Health

Several studies have established a link between adverse childhood experiences (ACEs) and mental health issues in college students. However, less is known about how positive childhood experiences (PCEs) may promote mental health and well-being, and potentially act as a buffer in the relationship between risk exposure and poor outcomes. This study investigates how ACEs and PCEs relate to college students' mental health (N = 321), within the framework of Resiliency Theory with specific attention focus on the compensatory and the protective factors models. Three key hypotheses were examined using quantitative data collected by way of an online anonymous survey: (1) ACEs will predict poorer mental health outcomes; (2) PCEs will predict better mental health outcomes and will lessen the negative effects of ACEs on mental health outcomes (compensatory factor model), and (3) PCEs will moderate the association between ACEs and mental health outcomes so that the relationship will be weaker among participants with higher PCEs (protective factor model). Findings supported each of these hypotheses and are important for our understanding of the long-term mental health correlates of ACEs and PCEs among college students. Our study underscores the importance of promoting PCEs while also underscoring the necessity of proactively preventing ACEs. Practical implications are discussed in relation to improving assessments of student needs and providing targeted interventions for those at risk.

Bodily experiences of trauma and psychosis risk

Bodily self-disturbances including anomalous embodiment of emotions are observed in psychosis-spectrum conditions. Psychosis is also associated with trauma exposure but the relationship between altered bodily experiences and trauma has not been extensively investigated in individuals at risk for psychosis (HR). We implemented a mapping task to localize felt sensations associated with trauma. Results show that trauma experiences were always localized in the body. HR reported increased rates of traumatic experiences than low-risk group (LR). HR reported sensations associated with trauma across widespread body areas. Further research is needed to elucidate how trauma might lead to psychotic-like experiences via bodily self-disturbances.

Risk and resilience factors for psychopathology during pregnancy: An application of the Hierarchical Taxonomy of Psychopathology (HiTOP)

Pregnancy is a time of increased vulnerability to psychopathology, yet limited work has investigated the extent to which variation in psychopathology during pregnancy is shared and unshared across syndromes and symptoms. Understanding the structure of psychopathology during pregnancy, including associations with childhood experiences, may elucidate risk and resilience factors that are transdiagnostic and/or specific to particular psychopathology phenotypes. Participants were 292 pregnant individuals assessed using multiple measures of psychopathology. Confirmatory factor analyses found evidence for a structure of psychopathology consistent with the Hierarchical Taxonomy of Psychopathology (HiTOP). A common transdiagnostic factor accounted for most variation in psychopathology, and both adverse and benevolent childhood experiences (ACEs and BCEs) were associated with this transdiagnostic factor. Furthermore, pregnancy-specific anxiety symptoms most closely reflected the dimension of Fear, which may suggest shared variation with manifestations of fear that are not pregnancy-specific. ACEs and BCEs also linked to specific prenatal psychopathology involving thought problems, detachment, and internalizing, externalizing, antagonistic, and antisocial behavior. These findings extend the dimensional and hierarchical HiTOP model to pregnant individuals and show how maternal childhood risk and resilience factors relate to common and specific forms of psychopathology during pregnancy as a period of enhanced vulnerability.

Do childhood experiences influence associations between posttraumatic stress disorder symptoms and positive autobiographical memories among military veteran students? An exploratory study

BACKGROUND

Evidence links posttraumatic stress disorder (PTSD) symptoms and features of positive autobiographical memories (accessibility, vividness, coherence, sharing, emotional intensity, distancing). There is a knowledge gap on how adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) may influence these relationships.

OBJECTIVES

The current study explored whether the number ACEs or BCEs moderated associations between PTSD symptom severity and features of positive autobiographical memories.

DESIGN AND METHODS

The sample included 124 student military veterans who had experienced a trauma (Mage = 33.90; 77.4% male; 75.0% White).

RESULTS

Path analyses showed more PTSD symptom severity was significantly associated with less positive autobiographical memory vividness (β = -0.26, p = .019, R2 = 0.06). Further, the number of ACEs moderated the relationship between PTSD symptom severity and positive autobiographical memory accessibility (β = -0.25, p = .023, R2 = 0.10) and vividness (β = -0.20, p = .024, R2 = 0.10). Among individuals with more ACEs (1 SD above the mean) compared to those with fewer ACEs (1 SD below the mean), less accessibility and vividness of positive autobiographical memories was associated with greater PTSD symptom severity. The number of BCEs was not a significant moderator.

CONCLUSIONS

Positive memory-based interventions may be particularly useful to address PTSD symptoms among military veterans with a history of childhood adversity.

The impact of adverse childhood experiences on mental health, sexual risk behaviors, and alcohol consumption in adulthood

The purpose of the study was to determine how Adverse Childhood Experiences (ACE) relate to adulthood flourishing, symptoms of depression, anxiety, somatization, self-reported health, sexual risk behaviors, and alcohol consumption. A quantitative cross-sectional methodology was used. A total of 452 adults completed the survey. The most prevalent ACE include physical abuse (44.69%), separation/divorce of parents (41.81%), living with someone with alcohol problems (39.38%), and being sworn, insulted, or humiliated by adults at home (35.62%). Almost one out of every four respondents (24.34%) reported being touched by an adult, 17.92% reported that an adult tried to manipulate the respondent into touching them, and 8.19% were forced to have sexual intercourse. Results indicate that women reported a higher number of ACE than men. The number of ACE is inversely related to flourishing and self-reported health; while being positively associated with participant's scores in depression, anxiety, somatization, sexual risk behaviors, and alcohol use. The regression model, including the eleven ACE and respondents' sex and age, achieved medium effect sizes for somatization, depression, and anxiety symptoms and small effect sizes for flourishing, self-reported health, sexual risk behaviors, and alcohol consumption. Specific ACE have a particularly significant negative impact on mental health outcomes: forced intercourse, witnessing familial violence, verbal humiliation, and living with individuals struggling with mental health issues and drug consumption or who were incarcerated. In conclusion, the study highlights the alarming prevalence of ACE among the Honduran population and their significant negative impact on mental health outcomes during adulthood.

Service-seeking behaviors among male victims of violence in five African countries: The effects of positive and adverse childhood experiences

BACKGROUND

Violence against boys and men is widely under-reported. Boys and men face unique and gendered barriers to accessing services following experiences of violence.

PARTICIPANTS AND SETTING

The study is a secondary data analysis of five nationally representative population-based Violence Against Children and Youth Surveys (VACS) conducted in Kenya (2019), Côte d'Ivoire (2018), Lesotho (2018), Mozambique (2019), and Namibia (2019). Analysis was limited to males between 18 and 24 years who experienced lifetime physical or sexual violence.

OBJECTIVE AND METHODS

We analyzed the association between positive and adverse childhood experiences (PCEs and ACEs), and seeking post-violence services among males using bivariate chi-squared tests and multivariable logistic regression.

RESULTS

8.02 % (5.55-10.50 %) of male victims between the ages of 18 and 24 sought services for any lifetime physical or sexual violence. Witnessing interparental violence and experiencing death of one or both parents were each associated with increased odds of having sought post-violence services (aOR 2.43; 95 % CI: 1.25-4.79; aOR 2.27; 95 % CI: 1.14-4.50), controlling for education, violence frequency, and violence type. High parental monitoring was associated with increased odds of service seeking (aOR 1.79; 95 % CI: 1.02-3.16), while strong father-child relationship was associated with lower odds (aOR 0.45; 95 % CI: 0.23-0.89).

CONCLUSION

These findings contribute to limited research on service-seeking behaviors among men and boys. While some parent-youth relationship factors were associated with higher odds of service-seeking, the outcome remained rare. Age and gender-related barriers should be addressed where post-violence care services are offered.

Life experience pathways to college student emotional and mental health: A structural equation model

Objective: Previous research suggests that both adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and current life experiences are associated with emotional wellbeing and mental health. The purpose of this study was to explore the influence of these life experience and coping processes on college student emotional and mental health. Participants: College students (N = 555) were recruited from a large western university. Methods: Participants completed an online cross-sectional survey measuring early and current life experiences, cognitive and emotional coping efforts, and emotional and mental health outcomes. Data were analyzed using structural equation modeling. Results: There was an indirect effect of PCEs on emotional and mental health through cognitive and emotional coping efforts. No association was observed between ACEs and mental health. Conclusions: Increases in PCEs are protective, enhance coping efforts, and strengthen emotional and mental health outcomes among college students.

Stressful life events and prenatal representations of the child

Caregivers' mental representations of their children can be assessed prenatally and are prospectively associated with later caregiving quality and caregiver-child attachment. Compared to balanced, distorted or disengaged representations are linked to insecure caregiver-child attachments. The present study explored factors (i.e. stressful life experiences and positive experiences) that may be linked to risk for distorted and disengaged representations. We used a brief version of the Prenatal Working Model of the Child Interview in a sample of 298 pregnant people (ages 19 to 45 years; M = 30.83, SD = 5.00) between gestational age 11-38 weeks (M = 23.49, SD = 5.70). A greater number of stressful events across three developmental periods (i.e., lifespan, childhood, and pregnancy) were related to increased odds of distorted, compared to balanced classification. Pregnancy stress had the largest association. Positive experiences from childhood did not buffer the association between stress and representations. Findings highlight the importance of stress on prenatal representations of one's child.

Early-life participation in cognitively stimulating activities and risk of depression and anxiety in late life

BACKGROUND

Early-life stressful experiences are associated with increased risk of adverse psychological outcomes in later life. However, much less is known about associations between early-life positive experiences, such as participation in cognitively stimulating activities, and late-life mental health. We investigated whether greater engagement in cognitively stimulating activities in early life is associated with lower risk of depression and anxiety in late life.

METHODS

We surveyed former participants of the St. Louis Baby Tooth study, between 22 June 2021 and 25 March 2022 to collect information on participants' current depression/anxiety symptoms and their early-life activities (N = 2187 responded). A composite activity score was created to represent the early-life activity level by averaging the frequency of self-reported participation in common cognitively stimulating activities in participants' early life (age 6, 12, 18), each rated on a 1 (least frequent) to 5 (most frequent) point scale. Depression/anxiety symptoms were measured by Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Screener (GAD-7). We used logistic regressions to estimate odds ratios (OR) and 95% confidence intervals (CI) of outcome risk associated with frequency of early-life activity.

RESULTS

Each one-point increase in the early-life composite cognitive activity score was associated with an OR of 0.54 (95% CI 0.38-0.77) for late-life depression and an OR of 0.94 (95% CI 0.61-1.43) for late-life anxiety, adjusting for age, sex, race, parental education, childhood family structure, and socioeconomic status.

CONCLUSIONS

More frequent participation in cognitively stimulating activities during early life was associated with reduced risk of late-life depression.

Parenting-related positive childhood experiences, adverse childhood experiences, and mental health-Four sub-Saharan African countries

BACKGROUND

Adverse Childhood Experiences (ACEs) are associated with poor mental health outcomes and risk-taking behaviors. Positive childhood experiences (PCEs) may mitigate these negative impacts.

OBJECTIVE

This study 1) assessed the associations between ACEs and negative health outcomes and risk-taking behaviors among young adults, and 2) evaluated whether - and which - PCEs moderate the association between ACEs and these outcomes in sub-Saharan Africa.

METHODS

This multi-country analysis combined cross-sectional representative survey data from young adults, ages 18-24 years, from the 2019 Kenya, 2018 Lesotho, 2019 Mozambique, and 2019 Namibia Violence Against Children and Youth Surveys. The association between experiencing any ACEs and each health outcome was assessed using Wald's chi-square tests. Multivariable logistic regression analyses assessed the association between each PCE and each outcome of interest.

RESULTS

Females who experienced any ACEs had higher odds of experiencing moderate to severe mental distress (aOR = 2.7, 95%CI: 1.9, 3.9). Males who experienced any ACEs had higher odds of experiencing suicidal/self-harm behaviors (aOR = 6.7, 95%CI: 2.8, 16.0) and substance use (aOR = 2.5, 95%CI: 1.4, 4.2). In females, strong mother-child relationship was protective against moderate to severe mental distress (aOR = 0.7, 95%CI: 0.6, 0.9), suicidal/self-harm behaviors (aOR = 0.6, 95%CI: 0.4, 0.9), and substance use (aOR = 0.6, 95%CI: 0.4, 0.9). For males, a strong mother-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.5, 95%CI: 0.2, 0.9), and a strong father-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.4, 95%CI: 0.2, 0.7) and substance use (aOR = 0.6, 95%CI: 0.4, 0.8).

CONCLUSIONS

Strong parenting programs may likely play an important role in improving the psychosocial health of young adults.

Mental health in Ukraine in 2023

BACKGROUND

Very little is known about the mental health of the adult population of Ukraine following Russia's full-scale invasion in February 2022. In this study, we estimated the prevalence of seven mental health disorders, the proportion of adults screening positive for any disorder, and the sociodemographic factors associated with meeting requirements for each and any disorder.

METHODS

A non-probability quota sample (N = 2,050) of adults living in Ukraine in September 2023 was collected online. Participants completed self-report questionnaires of the seven mental health disorders. Logistic regression was used to determine the predictors of the different disorders.

RESULTS

Prevalence estimates ranged from 1.5% (cannabis use disorder) to 15.2% (generalized anxiety disorder), and 36.3% screened positive for any of the seven disorders. Females were significantly more likely than males (39.0% vs. 33.8%) to screen positive for any disorder. Disruption to life due to Russia's 2014 invasion of Ukraine, greater financial worries, and having fewer positive childhood experiences were consistent risk factors for different mental health disorders and for any or multiple disorders.

CONCLUSION

Our findings show that approximately one in three adults living in Ukraine report problems consistent with meeting diagnostic requirements for a mental health disorder 18 months after Russia's full-scale invasion. Ukraine's mental healthcare system has been severely compromised by the loss of infrastructure and human capital due to the war. These findings may help to identify those most vulnerable so that limited resources can be used most effectively.

Childhood experiences and sleep problems: A cross-sectional study on the indirect relationship mediated by stress, resilience and anxiety

BACKGROUND

Childhood experiences either adverse (ACE) or benevolent (BCE) can indirectly impact sleep quality in adult life, which in turn are modulated by the interplay of a variety of factors such as depression, anxiety, resilience and mental health problems.

METHODS

A cross-sectional observational study was conducted across the UK and the Middle Eastern countries during the COVID-pandemic on 405 participants. An online survey used a combination of questionnaires to assess ACE and BCEs. The following tools were then used to assess the contribution of resilience, stress, depression and anxiety respectively: Brief Resilience Scale (BRS), Perceived Stress Scale (PSS-10), Patient Health Questionnaire-2 (PHQ-2) and General Anxiety Disorder-2 (GAD-2) scale on childhood experiences. The extent of sleep disturbances experienced over a period of seven days was assessed using the PROMIS Sleep Disturbance Short-Form Tool. A serial-parallel mediation model was used to evaluate the impact of the mediators on childhood experiences and sleep quality.

RESULTS

Over 50% of the cohort were from Middle Eastern countries. Four or more BCEs were experienced by 94.3% of the cohort. In contrast, 67.9% of participants experienced at least one ACE before the age of 18 years, with moderate levels of stress, mild depression and anxiety were reported in 3.7%, 13% and 20% of participants respectively. Whilst 25.4% of participants reported having had four or more ACEs, with higher reports in the middle easter countries (32%). ACEs were found to correlate with sleep disturbance whilst BCEs showed an inverse correlation. The relationship between ACE and sleep disturbances was shown to be mediated by stress, and anxiety, but not by resilience or depression. Resilience and stress, and resilience and anxiety serially mediated the interaction between ACE and sleep disturbance. With regards to BCE, an inverse association with sleep disturbance was recorded with similar mediators of stress and anxiety observed.

CONCLUSION

This study confirms the negative effects of ACEs, and the positive effects of BCEs on sleep in adulthood which are both mediated predominantly by psychological resilience, anxiety and stress. Strategies aimed at improving psychological resilience as well as addressing stress and anxiety may help improve sleep quality.

Workplace trauma and professional quality of Life in clinical and forensic psychiatry: the CRITIC study

Background

Frontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL).

Method

The Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling.

Discussion

The CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals.

Trial registration

The CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20.

Parenting the parent without losing sight of the child. A qualitative study of therapists' experiences with intergenerational adversities in perinatal psychotherapy

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow-up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry.

Association of adverse and positive childhood experiences with health-related quality of life in adolescents

OBJECTIVES

To investigate the independent impacts of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) on the health-related quality of life (HRQOL) of Chinese adolescents, and to explore the potential moderating role of PCEs in the association between ACEs and HRQOL.

STUDY DESIGN

This was a cross-sectional study.

METHODS

We surveyed 6982 students aged 11-20 in Guangzhou, China, from November to December 2021. Adolescents self-reported their ACEs, PCEs, and HRQOL by the Childhood Trauma Questionnaire Short Form, the Adverse Childhood Experiences-International Questionnaire, the Benevolent Childhood Experiences Scale, and the Paediatric Quality of Life Inventory Version 4.0, respectively. Multivariable linear regressions were performed to examine the associations between ACEs, PCEs, and HRQOL controlled for adolescents' age, gender, single-child status, boarding school attendance, primary caregivers, as well as parental age and occupational status. Likelihood-ratio tests were further applied to explore the moderating role of PCEs.

RESULTS

In the models that considered both ACEs and PCEs, ACEs were significantly associated with lower HRQOL scores in all dimensions, summary scales, and total scale (β = -13.88, 95% confidence interval [CI]: -14.82, -12.94 for total scale). Conversely, exposure to an above-average number of PCEs was associated with higher HRQOL scores in all measured aspects (β = 7.20, 95%CI: 6.57, 7.84 for total scale). PCEs significantly moderated the association between ACEs and all HRQOL dimensions, summary scales, and total scale, except school functioning.

CONCLUSION

ACEs and PCEs exert independent and opposite impacts on adolescents' HRQOL. PCEs could mitigate the negative impacts of ACEs. Enhancing resilience, like PCEs, may contribute to improving the HRQOL among adolescents who have exposed to ACEs.

The resounding influence of benevolent childhood experiences

Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.

Beyond developmental psychopathology: Positive child development

The field of developmental psychopathology has made significant contributions to our understanding of both typical and atypical development. However, while there are established theories for developmental psychopathology with detailed criteria for pathological outcomes, there is less agreement regarding development under optimal conditions and the definition of positive outcomes. In this conceptual paper, I make the case that a better understanding of positive child development is crucial because it will not only advance our general knowledge on human development but also complement current work on developmental psychopathology. After defining positive development as the development of positive functioning in children, such as skills, strengths, competencies, and wellbeing, rather than the absence of problems, current concepts with relevance for positive development are reviewed, before highlighting gaps in our knowledge on positive development and suggestions for future research. Although several of the reviewed frameworks provide important contributions to the conceptualization of positive development, most of them focus on positive functioning in adults with limited consideration of development in the early years. More research is needed that specifically targets the development of positive outcomes from early childhood onward in order to develop a more comprehensive and holistic theory of positive child development.

How positive childhood experiences foster college students' adjustment: the role of sibling number and self-esteem

Introduction

In recent years, growing concern has emerged regarding the mental health and well-being of college students who confront numerous challenges and transitions during their higher education journey. This research aims to investigate the influence of positive childhood experiences on the adaptability of college students and the underlying mechanisms.

Methods

A cross-sectional survey was conducted with 5,787 college students from Chinese universities. Participants completed an online questionnaire assessing positive childhood experiences, self-esteem, the number of siblings, and China college students' adjustment.

Results

The results revealed that positive childhood experiences positively predicted the adjustment of China college students, with self-esteem playing a mediating role in this positive effect. Moreover, siblings played an antagonistic moderating role in the positive effect of positive childhood experiences on China college students' adjustment.

Discussion

It is recommended to enhance positive childhood experiences, improve self-esteem, and provide additional care and support to students from multi-sibling families to enhance China college students' adjustment.

Psychosocial Factors Associated With Perinatal Anxiety and Perinatal Depression Among Adolescents: A Rapid Review

The current review examined the influence of psychosocial factors on adolescents' perinatal anxiety (PA) and perinatal depression (PND) across geographical regions. Three databases were searched for articles published between 2017 and 2022 and 15 articles were reviewed. We categorized factors into social, cultural, and environmental domains. Social factors included adolescent caregiver trust/attachment, social support, perceived social support, trauma/poly-traumatization, and peer solidarity. Cultural factors included feelings of shame, marital satisfaction, partner's rejection of pregnancy, lack of parental involvement in care, parenting stress, childhood household dysfunction, and adverse childhood events. Environmental factors included neighborhood support, food insecurity, domestic violence, going to church, going out with friends, and sources for obtaining information. Routine assessment of psychosocial factors among perinatal teens is crucial to identify those at higher risk for PA and PND. Further research is necessary to examine the influence of cultural and environmental factors on PA, PND, and perinatal outcomes among adolescents. [Journal of Psychosocial Nursing and Mental Health Services, 62(2), 13-22.].

Tribal Reservation Adolescent Connections Study: A study protocol using mixed methods for examining social networks and associated outcomes among American Indian youth on a Northern Plains reservation

BACKGROUND

Rich cultural and traditional practices make interpersonal relationships vital for American Indian (AI) youth. Social relations and multigenerational networks (i.e., peer, family, kinship, and community) remain a salient fixture of AI culture, survival and thriving in reservation communities. Research in other populations has demonstrated how social networks impact youth risk and resilience, but data are lacking on AI adolescent networks. Intergenerational trauma from settler colonialism leads some AI youth to early initiation of substance use and subsequent substance misuse, along with disproportionately high risk for suicide and vulnerability to witnessing and experiencing violence. Using network data to develop prevention strategies among this population is a promising new avenue of research. In this study protocol paper, we describe the rationale and methodology of an exploratory study to be conducted with American Indian 9th and 10th graders at three schools on a Northern Plains reservation.

METHODS

This mixed methods study will collect quantitative social network surveys (N = 300) and qualitative interviews (n = 30). The study will examine the extent to which existing social network theories and data metrics adequately characterize AI youth networks or how they may need to be expanded for this population. Associations of network characteristics with risk and protective factors for substance use, exposure to violence, and suicide will also be examined.

DISCUSSION

This innovative methodological approach holds promise for informing the development of effective preventive approaches to address co-occurring risks for substance use, violence and suicide among AI adolescents. Understanding processes that impact social networks among AI adolescents can promote culturally resonant social relationships that may support better outcomes for youth.

A mixed-methods study protocol on factors contributing to suicide clusters among Native American youth in a northern plains reservation

Introduction

Suicide and suicide clusters within Native American Reservation communities are devastating to the entire community and increase individuals' risk for suicide over the lifespan. The objective of this paper is to describe the Indigenous community-based participatory research protocol implemented in partnership with the Fort Belknap Indian Community in Montana, United States. The study protocol was developed to understand suicide risk and protective factors, and community-derived solutions, in a reservation community with history of a suicide cluster and high rates of youth suicide.

Methods

In this mixed-methods study, qualitative data from youth, adults, and service providers and quantitative data from 200 adolescents and young adults (aged 14-24 years) were collected in Fort Belknap, Montana from May - December of 2022. Qualitative data were collected first via in-depth interviews and focus groups. Survey questions included validated and pre-tested measures of factors youth experience across socio-ecological levels. Thematic analysis was applied to the qualitative data; and logistic regression models were used to examine relationships within the quantitative data.

Discussion

This study will add a multi-dimensional perspective to our current understanding of (1) risk and protective factors for suicide, community-derived postvention solutions, and insights on community assets, and (2) the current health and psychosocial status of youth in the Fort Belknap community. This study may serve as an exemplar of co-created, culturally safe solutions designed to address mental health resource gaps. Next steps include development of a suicide crisis response tool kit and a culturally aligned postvention intervention that will enhance individual, family, and community survivance.