Typologies of adverse childhood experiences and their relationship to incarceration in U.S. military veterans

Scoping review of military veterans involved in the criminal legal system and their health and healthcare: 5-year update and map to the Veterans-Sequential Intercept Model

BACKGROUND

A previous scoping review of legal-involved veterans' health and healthcare (1947-2017) identified studies and their limitations. Given the influx of literature published recently, this study aimed to update the previous review and map articles to the Veterans-Sequential Intercept Model (V-SIM) - a conceptual model used by key partners, including Veterans Health Administration, veteran advocates, criminal justice practitioners, and local governments to identify intercept points in the criminal legal system where resources and programming can be provided. Developing an updated resource of literature is essential to inform current research, discover gaps, and highlight areas for future research.

METHODS

A systematic search of 5 databases identified articles related to legal-involved veterans' health and healthcare published between December 2017 through December 2022. The first and senior authors conducted abstract reviews, full-text reviews, and data extraction of study characteristics. Finally, each article was sorted by the various intercept points from the V-SIM.

RESULTS

Of 903 potentially relevant articles, 107 peer-reviewed publications were included in this review, most related to mental health (66/107, 62%) and used an observational quantitative study design (95/107, 89%). Although most articles did not explicitly use the V-SIM to guide data collection, analyses, or interpretation, all could be mapped to this conceptual model. Half of the articles (54/107, 50%) collected data from intercept 5 (Community Corrections and Support Intercept) of the V-SIM. No articles gathered data from intercepts 0 (Community and Emergency Services Intercept), 1 (Law Enforcement Intercept), or 2 (Initial Detention and Court Hearings Intercept).

CONCLUSIONS

There were 107 articles published in the last five years compared to 190 articles published in 70 years covered in the last review, illustrating the growing interest in legal-involved veterans. The V-SIM is widely used by front-line providers and clinical leadership, but not by researchers to guide their work. By clearly tying their research to the V-SIM, researchers could generate results to help guide policy and practice at specific intercept points. Despite the large number of publications, research on prevention and early intervention for legal-involved veterans is lacking, indicating areas of great need for future studies.

Adverse Childhood Experiences and Pathways to Violent Behavior for Women and Men

Childhood maltreatment is associated with risk for committing future violence, but the relationship between subgroups and biological sex is unknown. The relationship between adverse childhood experiences (ACEs), violence, and sex was examined using a nationally representative sample. Results from a latent class analysis suggested a four-class model (low adversity; moderate maltreatment with high household dysfunction; severe maltreatment with moderate household dysfunction; severe multi-type adversities). When compared to low adversity, all typology groups were at significantly higher risk to engage in violence (odds ratio > 2.10, ps < .013). The data supported a linear trajectory, meaning increased childhood trauma was associated with increased risk for violence. Although men endorsed more violent behavior, the relationship between ACEs and violence was significantly stronger among women. Prior findings identify that women are more negatively impacted by ACEs and the current findings newly identify that this extends to violent crime.

Childhood adversities and post-military-service incarceration in a male UK Armed Forces Veteran sample from Northern Ireland

LAY SUMMARY

Experiencing stressful or traumatic events in childhood has been linked with negative outcomes later in adulthood, one of which is involvement with the criminal justice system. This study explored whether there was a relationship between experiencing stressful life events in childhood and incarceration in adulthood (post-military service) among UK Armed Forces Veterans based in Northern Ireland (NI). Some individuals may experience only one type of adversity, some may experience many types of adversities, and others may experience no adversity. This study used a statistical technique (latent class analysis) that allowed the authors to explore how adverse childhood experiences (ACEs) varied among a sample of UK Armed Forces Veterans residing in NI. It revealed four groups of Veterans, each characterized by different types of experiences in childhood. The authors explored whether belonging to these groups increased the likelihood of incarceration, finding that those who experienced multiple adversities were at greater risk of incarceration after military service. Personnel involved in the care and support of military personnel should consider military personnel’s history of multiple ACEs.

Patterns of Childhood Adversities and Their Associations With Adult Victimization Among Incarcerated Men and Women in Spanish Prisons

Adverse childhood experiences (ACEs) are prevalent and have long lasting effects. There is evidence of gender differences in exposure to different types of ACEs, with women experiencing higher levels of sexual abuse and cumulative adversity than men. Despite this, most research examining patterns of adversities have used joint samples, assuming that men and women have comparable profiles. The current study examines if distinct profiles of childhood adversities exist for men and women and analyzes their associations with multiple forms of interpersonal victimization during adulthood. Participants were 2,709 residents (91.6% men and 8.4% women) from eight prisons in Spain, who completed a self-administered survey. Latent Class Analysis revealed different patterns of childhood adversities for men and women. For both groups, higher adversity was associated with interpersonal harm during adulthood.

The Role of Childhood Abuse and Psychological Symptoms in Discriminating Frequency of Drug Use and Self-Harm in Incarcerated Men Convicted of Robbery

The aim of the present study was to investigate the role of prior childhood abuse and current psychological symptoms on the frequency of drug use and self-harming behavior among a group of male prisoners convicted of robbery. The sample consists of 127 men convicted of armed, aggravated, unarmed/forced robbery, who were held in Metris T-type closed penitentiary state correctional institution. History of childhood abuse was assessed with The Childhood Trauma Questionnaire (CTQ) and psychological symptoms were assessed with The Brief Symptom Inventory (BSI). Frequency of drug use was assessed with three questions and self-harm was assessed through four questions both on the self-completed demographic information form. Among 127 men recruited, history of childhood abuse and psychological symptoms provided discrimination concerning frequency of drug use and self-harm. The rate of self-harming individuals in the present study was relatively high compared to the literature. There was a significant correlation between CTQ total and subscale scores and BSI total and subscale scores, except for the emotional neglect subscale.

Typologies of Stressful Life Events and Their Association With Sexual Risk Behaviors and Communication Among Justice-Involved Males and Their Female Sex Partners

Stressful life events are prevalent among justice-involved populations and are associated with sexual risk behaviors and partner communication regarding safe-sex practices. We describe patterns of stress exposure for heterosexual couples (where males are under community supervision) and how stress patterns are associated with sexual risk behaviors and communication (460 individuals; 230 couples). Latent class analysis identified patterns of stress. Multinominal logistic regression models identified associations between sex, race, ethnicity, and stress classes. Multilevel Poisson regression models described relationships between sexual risk behaviors and frequency of communication about condoms/HIV, and stress classes. We found four classes that differed by sex, race, and ethnicity and were associated with the number of sexual partners, condom use self-efficacy, discussing condoms with partner, and discussing HIV prevention with partner. Partner class was associated with the number of sexual partners. Findings inform future assessment/interventions for sexual health that consider patterns of stress and demographics.

"I've just never done that:" The influence of transitional anxiety on post-incarceration reentry and reintegration experiences among veterans

Military veterans involved in the criminal justice system are a vulnerable subpopulation that has extensive physical and behavioural health treatment needs. Like non-veteran populations, safe and stable housing, employment and social support are critical for veterans returning to society after incarceration. The challenges of social reintegration are immense, and the risk of recidivism is high. The U.S. Department of Veteran Affairs (VA) has developed specific programmes to assist veterans plan for and assist with reentry. While there have been successes, recidivism and early mortality are persistent concerns. This study examined reentry experiences of veterans living in one northeastern state to gain a better understanding of factors that influence social reintegration. The study was conducted in 2017 to inform an enhancement of VA reentry services through the addition of peer support. Qualitative interviews were conducted with 16 veterans with recent incarceration experiences and 27 reentry specialists working in five correctional facilities, two VA hospitals, five community agencies and two state departments. Interview transcripts were reviewed and coded using a Framework Analysis approach. Narratives highlight high levels of anxiety and uncertainty experienced as participants went through physical and emotional transitions associated with reentry and reintegration. This 'transitional anxiety' was often rooted in the absence of prior positive experiences engaging in socially normative activities, like obtaining housing and employment. Embarrassment and shame regarding a lack of experience with expected responsibilities were commonly reported. Although salient in veterans' narratives, reentry specialists rarely talked about problems post-incarceration in terms of limited life experience and skills, focusing instead on substance use and mental health issues. Few resources were available to support the development of critical life skills. Findings call attention to the need for understanding pre-incarceration experiences that may influence social reintegration and the development of tailored interventions to build skills and experience when needed.

Childhood Abuse Classes for Incarcerated Men and Women: Are There Unique Gender Patterns in Abuse Classes?

Childhood adversity is predictive of poorer health and behavioral health outcomes in adulthood. Males and females are known to experience different types of childhood adversity, with females experiencing more sexual and emotional harm in childhood. Latent class analysis (LCA) has been used to identify patterns among types of childhood adversity. These studies have constructed class structures using single gender or blended gender samples. Class structures based on blended gender samples, however, may misrepresent the nuances of gender-specific adversity histories through averaging, potentially distorting the relative need for gender-specific types of intervention. This study investigated whether latent class structures of childhood abuse are equivalent for incarcerated males and females. Our sample included 4,204 residents (3,986 males, 218 females) drawn from a single prison system. Residents completed an hour-long audio computer-assisted self-interview that included questions on 10 types of childhood abuse, depression, and anxiety symptoms, the Beck Hopelessness Scale (BHS), Buss-Perry Aggression Questionnaire, and Criminal Sentiments Scale-Modified (CSS-M). Overall, female residents were both more likely to experience childhood abuse and have more extensive victimization experiences. Small subgroups of males, however, had even more extensive victimization experiences. Abuse patterns for males and females, while optimally clustering in four classes, are rather unique, especially for higher abuse classes, in terms of distribution of membership and types of abuse. These differences may matter in terms of identifying the relative need for therapeutic intervention among incarcerated males and females and targeting those interventions in ways that reflect the gradient and density of therapeutic need. The next step is to test whether using blended or gendered latent class structures matters in terms of predicting outcomes, such as prison-based behavioral health problems, suicidality, and victimization.

Profiles of adverse childhood experiences and protective resources on high-risk behaviors and physical and mental disorders: Findings from a national survey

BACKGROUND

Adverse childhood experiences (ACE) vary across culture and their heterogenous impact on health outcomes is understudied. The present population-based study determined latent classes of adverse childhood experiences, examined socio-demographic variations between identified classes, and elucidated the interactions between class membership and protective resources (i.e., positive mental health and perceived social support) on high-risk behaviors (i.e., smoking, binge drinking, and suicidality), chronic physical disorders, and mental disorders.

METHODS

A total of 4441 adult Singapore residents were recruited from the community. Lifetime mental disorders and suicidality were assessed on structured clinical interviews by trained interviewers, while chronic physical disorders, smoking, binge drinking, ACE, perceived social support, and positive mental health were self-reported.

RESULTS

Latent class analysis identified three distinct profiles; a multiple adversities class endorsing elevated levels of abuse and violence (6.1%), an emotionally neglected and bullied class (7.6%), and a low adversities class (86.2%). The multiple adversities class was associated with younger age, female gender, lower education status, more high-risk behaviors (e.g. binge drinking and suicidality), and physical/mental disorders. A three-way interaction was observed between ACE profiles, social support, and positive mental health on suicidality; high social support and positive mental health reduced the risk of suicidality in the multiple adversities class.

LIMITATIONS

Results may not be generalizable beyond the Singapore population due to cultural factors.

CONCLUSIONS

Clinical assessment should adopt a person-centered approach to identify profiles of ACE and determine their interactions with protective resources on high-risk behaviors and physical/mental disorders; patient-tailored treatment may subsequently build upon these profiles.

The Clustering of Adverse Childhood Experiences in the Avon Longitudinal Study of Parents and Children: Are Gender and Poverty Important?

Previous research has demonstrated a graded relationship between the number of Adverse Childhood Experiences reported (an ACE score) and child outcomes. However, ACE scores lack specificity and ignore the patterning of adversities, which are informative for interventions. The aim of the present study was to explore the clustering of ACEs and whether this clustering differs by gender or is predicted by poverty. Data on 8,572 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) were used. ALSPAC is a regionally representative prenatal cohort of children born between 1991 and 1992 in the Avon region of South-West England. ACEs included parental divorce, death of a close family member, interparental violence, parental mental health problems, parental alcohol misuse, parental drug use, parental convictions, and sexual, emotional, and physical abuse, between birth and 19 years. Latent class analysis was used to derive ACE clusters and associations between poverty, gender, and the derived classes tested using multinomial logistic regression. Five latent classes were identified: "Low ACEs" (55%), "Parental separation and mother's mental health problems" (18%), "Parental mental health problems, convictions and separation" (15%), "Abuse and mental health problems" (6%), and "Poly adversity" (6%). Death of a close family member and sexual abuse did not cluster with other adversities. The clustering did not differ by gender. Poverty was strongly related to both individual ACEs and clusters. These findings demonstrate that ACEs cluster in specific patterns and that poverty is strongly related to this. Therefore, reducing child poverty might be one strategy for reducing ACEs.

Latent Class Patterns of Adverse Childhood Experiences and Their Relationship to Veteran Status and Sex in the National Epidemiologic Survey of Alcohol and Related Conditions Wave III

INTRODUCTION

Adverse childhood experiences (ACEs) are associated with poor psychosocial and health outcomes in adulthood. Veterans and females experience ACEs disproportionately. A greater understanding of this disparity may be achieved by examining the relationship between distinct ACE patterns and these demographic characteristics. Therefore, this study examined distinct ACE patterns and their association with Veteran status, sex, and other demographics in a nationally representative sample of U.S. adults to inform interventions tailored to ACE patterns experienced by specific groups.

MATERIALS AND METHODS

Latent class analysis (LCA) was conducted with data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative structured diagnostic interview conducted from 2012-2013. The target population was the noninstitutionalized adult population living in the USA. The analytic sample was 36,190 (mean age 46.5 years; 48.1% male). Of these participants, 3,111 were Veterans. Data were analyzed between September 2020 and January 2021.

RESULTS

Latent class analysis revealed a four-class solution: (1) "Low adversity" (75.3%); (2) "Primarily household dysfunction" (9.0%); (3) "Primarily maltreatment" (10.7%); and (4) "Multiple adversity types" (5.1%). Compared to "Low adversity," members in the other classes were more likely to be Veterans (odds ratio (OR)C2vC1 = 1.33, ORC3vC1 = 1.55, ORC4vC1 = 1.98) and female (ORC2vC1 = 1.58, ORC3vC1 = 1.22, ORC4vC1 = 1.65). While lower education and income were also related to higher adversity class membership, Veteran status and sex were the strongest predictors, even when controlling for education and income.

CONCLUSIONS

Distinct and meaningful patterns of ACEs identified in this study highlight the need for routine ACE screenings in Veterans and females. As in the current study, operationalizing and clustering ACEs can inform screening measures and trauma-informed interventions in line with personalized medicine. Future work can test if classes are differentially associated with health outcomes.

The interaction of exposure to adverse childhood and combat experiences on the current mental health of new post-9/11 veterans

Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000 new post-9/11 veterans. Results revealed that male veterans exposed to one or two ACEs, but no warfare, were more likely to experience anxiety, depression, suicidal thinking, and angry outbursts than the reference group (i.e., no ACEs and no warfare exposure). Female veterans exposed to one or two ACEs, but no warfare, were only more likely to experience suicidal thinking. Male and female veterans exposed to three or more ACEs and no warfare were more likely to experience probable posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and angry outbursts. Among those veterans who experienced corollaries of combat only (e.g., seeing someone killed or seriously wounded), male, but not female veterans were more likely to have probable PTSD, anxiety, and depression. Veterans exposed to warfare (i.e., combat and the corollaries of combat), irrespective of ACEs exposure, were the most likely to report mental health symptoms. Implications for community-based mental health services are discussed.

Measurement of Adverse Childhood Experiences: It Matters

INTRODUCTION

Alternative measurement approaches for adverse childhood experiences (i.e., count score versus individual adverse childhood experiences measured dichotomously versus individual adverse childhood experiences measured ordinally) can alter the association between adverse childhood experiences and adverse outcomes. This could significantly impact the interpretation of adverse childhood experiences research.

METHODS

Data were collected in 2018 (analyzed in 2020) via Amazon's Mechanical Turk and from people incarcerated in 4 correctional facilities (N=1,451). Included adverse childhood experience questions measured the following: physical, emotional, and sexual abuse; physical and emotional neglect; household mental illness, substance use, domestic violence, and incarceration; and exposure to community violence before age 18 years. A total of 19 measured outcomes spanned 4 domains of functioning: general functioning, substance use, psychopathology, and criminal behavior.

RESULTS

Regression models using the count score explained the least amount of variance in outcomes, whereas multivariable regression models assessing adverse childhood experiences on a continuum explained the most variance. In many instances, the explained variance increased by 2-5 times across the predictive models. When comparing regression coefficients for multivariable regression models that measured adverse childhood experiences as binary versus ordinal, there were notable differences in the effect sizes and in which adverse childhood experiences predicted outcomes. Disparities in results were most pronounced among high-risk populations that experience a disproportionate amount of adverse childhood experiences.

CONCLUSIONS

Alternative methods of measuring adverse childhood experiences can influence understanding of their true impact. These findings suggest that the deleterious effects of imprecise measurement methods may be most pronounced in the populations most at risk of adverse childhood experiences. For the sake of prevention, the measurement of adverse childhood experiences must evolve.

Differences in functional and structural social support among female and male veterans and civilians

PURPOSE

Social support is an important correlate of health behaviors and outcomes. Studies suggest that veterans have lower social support than civilians, but interpretation is hindered by methodological limitations. Furthermore, little is known about how sex influences veteran-civilian differences. Therefore, we examined veteran-civilian differences in several dimensions of social support and whether differences varied by sex.

METHODS

We performed a cross-sectional analysis of the 2012-2013 National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative sample of 34,331 respondents (male veterans = 2569; female veterans = 356). We examined veteran-civilian differences in functional and structural social support using linear regression and variation by sex with interactions. We adjusted for socio-demographics, childhood experiences, and physical and mental health.

RESULTS

Compared to civilians, veterans had lower social network diversity scores (difference [diff] = - 0.13, 95% confidence interval [CI] - 0.23, - 0.03). Among women but not men, veterans had smaller social network size (diff = - 2.27, 95% CI - 3.81, - 0.73) than civilians, attributable to differences in religious groups, volunteers, and coworkers. Among men, veterans had lower social network diversity scores than civilians (diff = - 0.13, 95% CI - 0.23, - 0.03); while among women, the difference was similar but did not reach statistical significance (diff = - 0.13, 95% CI - 0.23, 0.09). There was limited evidence of functional social support differences.

CONCLUSION

After accounting for factors that influence military entry and social support, veterans reported significantly lower structural social support, which may be attributable to reintegration challenges and geographic mobility. Findings suggest that veterans could benefit from programs to enhance structural social support and improve health outcomes, with female veterans potentially in greatest need.

The mediating role of resilience on psychopathology following childhood adversities among UK armed forces veterans residing in Northern Ireland

BACKGROUND

Childhood adversities can have a deleterious impact on mental health. Elevated levels of such adversities have been reported in veteran populations. Levels of resilience may be protective but early adverse experiences may impact on the development of resilience in the first instance.

OBJECTIVE

This study aims to identify classes of childhood adversities among UK military veterans residing in Northern Ireland (NI) and explore levels of resilience and the mediating role resilience may play following such experiences in relation to mental health.

METHOD

The study utilizes data from the Northern Ireland Veterans' Health and Wellbeing Study (n = 656). All participants were UK Armed Forces veterans who were residents of NI with an average age of 56 (586 males, 70 females).

RESULTS

Four childhood adversity classes were revealed, with almost a half of the sample experiencing early adverse experiences. Individuals who experienced a range of adversities, particularly those related to maltreatment were more likely to have PSTD, depression and anxiety disorders and lower levels of resilience. However, those who experienced adversity related to family dysfunction had similar levels of resilience as the low risk class, suggesting tentatively that some adversity may be protective. Mediation analyses revealed that veterans with elevated levels of resilience were less likely to have psychological problems following negative childhood experiences.

CONCLUSIONS

The study highlights the importance of promoting resilience building programmes among military veterans, especially among those who experienced maltreatment as a child.

ADVERSITY, MENTAL HEALTH, AND SUBSTANCE USE DISORDERS AS PREDICTORS AND MEDIATORS OF RULE VIOLATIONS IN U.S. PRISONS

This study explores how typologies of adversity and mental health/substance use disorders impact rule violations during incarceration. Data come from the 2004 cross-sectional Survey of Inmates in State and Federal Correctional Facilities (SI-SFCF). Logistic regression and structural equation modeling were used for analysis. Results link history of adverse experiences to rule violations during incarceration and demonstrate how mental health and substance use disorders mediate this relationship. Incarcerated people with severe histories of adverse experiences had the highest odds of rule violations, relative to people with low adversity, for all typologies. More severe adversity typologies predicted mental health and substance use disorders. Alcohol and substance use disorders predicted drug violations, whereas substance use and mental health disorders predicted major violations. Serious mental illness did not predict rule violations when accounting for adversity. Findings suggest that addressing adverse experiences, mental health, and substance use disorders may prevent rule violations.

Typologies of adversity in childhood & adulthood as determinants of mental health & substance use disorders of adults incarcerated in US prisons

BACKGROUND

Incarcerated people have disproportionately high rates of adverse experiences, mental health and substance use disorders.

OBJECTIVE

This study identifies typologies of adversity among adults incarcerated in US prisons. Typologies are used to predict mental health and substance use disorders. Disparities by gender, race and ethnicity are also examined.

PARTICIPANTS AND SETTING

Data come from the 2004 Survey of Inmates in State and Federal Correctional Facilities (SI-SFCF), a cross sectional survey of incarcerated adults (n = 18,185).

METHODS

Bivariate statistics compared rates of adverse experiences, mental health and substance use disorders by gender, race and ethnicity. Latent class analysis was conducted using adverse experiences as indicators of latent classes of adversity. Using multinomial regression, latent class membership was predicted by gender, race and ethnicity. Finally, logistic regression predicted mental health and substance use disorders by latent classes.

RESULTS

Incarcerated people identifying as either women or white experienced higher rates of nearly all types of adverse experiences, as compared to either men or non-white people. Women also had higher rates of mental health and substance use disorders, except for alcohol use disorder. Four typologies of adverse experiences were found: Class-1) low exposure, Class-2) moderate deprivation, high violence exposure, Class-3) high deprivation, low violence exposure, and Class-4) high exposure. As compared to the low exposure group, all other typologies predicted mental health and substance use disorders.

CONCLUSIONS

Given that incarcerated people experience high rates of adverse experiences, mental health and substance use disorders, findings can inform how to tailor services to typologies of adversity.

Co-occurrence of adverse childhood experiences and its association with family characteristics. A latent class analysis with Dutch population data

BACKGROUND

Although adverse childhood experiences (ACEs) are relatively common among children, there is limited knowledge on the co-occurrence of such experiences.

OBJECTIVE

The current study therefore investigates co-occurrence of childhood adversity in the Netherlands and whether specific clusters are more common among certain types of families.

PARTICIPANTS AND SETTING

Representative data from the Family Survey Dutch population 2018 (N = 3,128) are employed.

METHOD

We estimate Latent Class Analysis (LCA) models to investigate co-occurrence of ACEs. As ACEs we examine maltreatment, household dysfunction, demographic family events, as well as financial and chronic health problems. Gradual measures for maltreatment and financial problems are studied to make it possible to differentiate with regard to the severity of experiences.

RESULTS

Our results show that four ACE clusters may be identified: 'Low ACE', 'Moderate ACE: Household dysfunction', 'Moderate ACE: Maltreatment' and 'High ACE'. Regression analyses indicated that mother's age at first childbirth and the number of siblings were related to experiencing childhood adversity. We found limited evidence for ACEs to be related to a family's socioeconomic position.

CONCLUSION

The found clusters of ACEs reflect severity of childhood adversity, but also the types of adversity a child experienced. For screening and prevention of childhood adversity as well as research on its consequences, it is relevant to acknowledge this co-occurrence of types and severity of adversity.

Childhood adversities and psychopathology among military veterans in the US: The mediating role of social networks

Childhood adversities can impact negatively on psychological health across the lifespan. Many military veterans have a history of adverse childhood experiences, which when combined with deployment related traumas, can lead to high levels of psychopathology. Social networks can however be protective. The current study aimed to identify typologies of childhood adversity in U.S. military veterans (n = 3092) and explore relationships between the adversity typologies and PTSD, mood and anxiety disorders, utilising data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III). The mediating role of quality and quantity of social networks were examined. Latent class analysis identified four adversity classes; 1) baseline, 2) household dysfunction, 3) maltreatment, and 4) multi-adversity. Individuals in the adversity classes (2-4), especially those who experienced multi-adversity had higher rates of psychopathology. The quality of social networks played an important mediating role, while quantity of networks did not. Those who experienced adversity were less likely to have supportive social networks, therefore adversity had both a direct and indirect impact on psychopathology. The findings highlight the importance of developing and maintaining social networks following military life. Recommendations include interpersonal skills training and programmes which may help them engage back into the community and enhance relationships.

Child maltreatment is mediating long-term consequences of household dysfunction in a population representative sample

Background:

Adverse childhood experiences (ACE) exhibit long-lasting consequences on later life and are considered as a major public health problem. ACEs can be divided into household dysfunctions, which affect the child indirectly, and direct maltreatment. As a high correlation between ACEs in general is known, we assessed the risk for child maltreatment associated with the occurrence of household dysfunctions. To provide a better understanding for the mechanisms leading to the deleterious sequelae of ACEs, we furthermore assessed whether the long-term consequences of household dysfunction are mediated by child maltreatment and thereby might be targeted by effective child protection programs.

Methods:

A representative sample of the German population above the age of 14 (N = 2531) was assessed in a cross-sectional observational population-based survey.

Results:

The data reveal that mental illness of a household member was associated with significantly increased risks for all child maltreatment subtypes (ORs 4.95–5.55), just as household substance abuse (ORs 5.32–6.98), violence against the mother (ORs 4.43–10.26), incarceration of a household member (ORs 6.11–14.93) and parental separation (OR 3.37–4.87). Child maltreatment partially mediated the association of household mental illness, substance abuse and parental separation with later depression, anxiety, life satisfaction and subjective general health status and completely mediated the associations of intimate partner violence (IPV) and incarceration of a household member with anxiety, depression and subjective health status in adulthood.

Conclusions:

ACEs linked to household dysfunction are associated with an increased risk for all subtypes of child maltreatment. The assessed widespread consequences of household dysfunction are mediated by child maltreatment. This underlines the role of prevention of child maltreatment in families with household dysfunction and implies child protection as a priority in any interventions.

Examining patterns of adversity in Chinese young adults using the Adverse Childhood Experiences-International Questionnaire (ACE-IQ)

Ample evidence supports significant and enduring associations between adverse childhood experiences (ACEs) and negative outcomes later in life. Subsets of ACEs (e.g. childhood maltreatment and household dysfunction) have been examined in Chinese populations, but no known study has comprehensively examined the full constellation of different types of ACEs or patterns of ACE exposure in Chinese samples. As a direct response to the call to establish a global ACEs surveillance framework, this study provides the first translation and validation of the World Health Organization ACE - International Questionnaire (ACE-IQ). Further, patterns of ACE exposure were identified through latent class analysis. The 29-item ACE-IQ was translated and back-translated from English to traditional Chinese to measure exposure to 13 categories of ACEs. The Chinese ACE-IQ demonstrated good content validity; the ACE-IQ domain subscales also showed satisfactory test-retest reliability and semantic equivalence. In a sample of 433 Chinese young adults, three patterns of ACE exposure were uncovered: Low ACEs (65.82%), Household Violence (24.94%), and Multiple ACEs (9.24%). Concurrent exposure to physical abuse, domestic violence, and emotional abuse (i.e. Household Violence) was a novel pattern found in this study sample, and suggests there may be traditional Chinese norms that potentiate risks for violent household environments in the absence of other household risk factors. Findings underscore the importance of examining ACE exposure within local contexts, as children's adverse experiences may be idiosyncratic to geographic, social, and cultural norms.