Patterns of adverse childhood experiences and subsequent risk of interpersonal violence perpetration among men in Dar es Salaam, Tanzania

Cluster analysis exploring the impact of childhood neglect on cognitive function in patients with bipolar disorder

BACKGROUND

Bipolar disorder (BD) is a severe mental disorder related to neurocognitive deficits. Exposure to childhood trauma is associated with worse cognitive performance. Different compositions of childhood trauma in BD and their impacts on cognition are rarely reported.

METHODS

We used the Brief Assessment of Cognition in Affective Disorders (BAC-A) to assess cognitive performance and the Chinese version of the Short Form of the Childhood Trauma Questionnaire (C-CTQ-SF) to assess childhood trauma experience among 55 euthymic BD patients. Cluster analysis was applied to dissect their childhood trauma experiences, which revealed three distinct clusters: a low trauma group, neglect-focus group, and multiple-trauma-experience group. We compared the cognitive function between the three clusters and used a generalized linear model to evaluate the impact of childhood neglect on cognitive domains.

RESULTS

The neglect-focus cluster showed prominent exposures to physical and emotional neglect (41.8%). BD patients in this cluster performed worse in BAC-A compared with patients in the multiple trauma cluster, especially in working memory and processing speed. The neglect-focus group revealed a significant negative effect on the composite score (ß = -0.904, p = 0.025) and working memory (ß = -1.150, p = 0.002) after adjusting sex, age, education year, BMI and total psychotropic defined daily dose.

CONCLUSIONS

Distinct patterns of childhood trauma experience are seen in BD patients and are related with different cognitive profiles. Early exposure of neglect-focus trauma was associated with the worst cognitive performance in current study. Further studies investigating the intensity of the neglect, as well as individual resilience and coping mechanisms in BD, are warranted.

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.

Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa

BACKGROUND

Multiple adverse childhood experiences (ACEs) are associated with poor sexual and mental health outcomes in low- and middle-income countries (LMICs). Less well understood is how discrete and gendered clustering of ACEs may influence health.

OBJECTIVE

To assess how multiple ACEs co-occur and how dominant patterns of co-occurrence are associated with mental distress, substance use, and sexual risk behaviors among young women and men in Sub-Saharan Africa.

PARTICIPANTS AND SETTING

We used pooled data of young men and women aged 19-24 from comparable, nationally representative Violence Against Children and Youth Surveys (VACS) conducted in Cote d'Ivoire, Kenya, Lesotho, Mozambique, and Namibia (nf = 7183; nm = 2207).

METHODS

We estimated sex-disaggregated latent classes of six ACEs among young women and men. We ran Bolck-Croon-Hagenaars (BCH) distal outcome analysis to test the sex-stratified relationships between ACEs latent classes and health outcomes.

RESULTS

A six class solution best fit the female data. Classes included witnessing violence and experiencing physical violence (PV); experiencing PV; high ACEs; witnessing community violence; orphanhood; and low ACEs exposure. Among males, the best-fitting three-class solution included experiencing PV and witnessing community violence; high ACEs; and low ACEs exposure. Membership in the high ACEs class was associated with mental distress among females and males, and substance use among males. No differences in sexual risk behavior were identified by class membership among either females or males.

CONCLUSIONS

Discrete clusters of co-occurring ACEs are associated with elevated odds of mental distress among females, and mental distress and substance use among males. Preventing ACEs may improve mental health among young women and men in LMICs in Sub-Saharan Africa.

A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges

Adverse childhood experiences (ACEs) studies reveal the profound impacts of experiencing trauma and hardships in childhood. However, the cumulative risk approach of treating ACEs obscures the heterogeneity of ACEs and their consequences, making actionable interventions impossible. latent class analysis (LCA) has increasingly been used to address these concerns by identifying underlying subgroups of people who experience distinctive patterns of co-occurring ACEs. Though LCA has its strengths, the existing research produces few comparable findings because LCA results are dependent on ACEs measures and indicators, which vary widely by study. Therefore, a scoping review of ACEs studies using LCA that focuses on ACEs measures, indicators, and findings is needed to inform the field. Following Arksey and O'Malley's five-stage scoping review methodological framework, we first identified 211 articles from databases of EBSCOhost, PubMed, and Scopus using "adverse childhood experiences" for title search and "latent class analysis" for abstract search. Based on the inclusion criteria of peer-reviewed articles written in English published from 2012 to 2022 and the exclusion criteria of nonempirical studies and the LCA not analyzing ACEs, we finally selected 58 articles in this scoping review. Results showed LCA has been increasingly endorsed in the ACEs research community to examine the associations between ACEs and human health and well-being across culturally diverse populations. LCA overcame the limitations of the traditional methods by revealing specific ACEs clusters that exert potent effects on certain outcomes. However, the arbitrary nature of selecting ACEs indicators, measures, and the limited use of theory impedes the field from moving forward.

Adverse childhood experience trajectories and individual high risk-behaviors of sexual offenders: A developmental victimology perspective

BACKGROUND

Developmental victimology theory suggests that developmental features of risk and impact stemming from various types of victimization depend on the age of the child or adolescent.

OBJECTIVE

A next step is studying the developmental victimization trajectories of individuals involved in sexual crimes by focusing on traumatic events occurring during childhood and adolescence respectively. Building on the developmental victimology perspective, the study's specific aims encompass two key objectives: 1) exploring the diverse trajectories of Adverse Childhood Experiences (ACEs) within a sample of individuals involved in sexual crimes, and 2) assessing whether these ACEs trajectories influence the emergence of distinct high-risk behaviors.

PARTICIPANTS AND SETTING

252 individuals convicted of sexual crimes were selected from a federal penitentiary in Quebec, Canada.

METHODS

Semi-structured interviews with a computerized questionnaire produced data on numerous aspects of the participant's life history, criminal career, and victimization experiences that were analyzed via latent class modeling.

RESULTS

Four classes (no ACEs trajectory, poly exposure and victimization trajectory, childhood exposure trajectory, and poly victimization trajectory) were identified.

CONCLUSIONS

Consistent with hypotheses, developmental ACEs trajectories are heterogeneous and associated with the criminal careers, adolescent problematic behaviors, substance use disorders, and violence history among individuals involved in sexual offending.

Adverse Childhood Experiences and Intimate Partner Violence Among Youth in Cambodia: A Latent Class Analysis

Adverse childhood experiences (ACEs) are a global public health problem, including in low- and middle-income country settings, and are associated with increased risk of intimate partner violence (IPV) during young adulthood. However, current measurement of ACEs may underestimate sequelae of different combinations, or classes, of ACEs and mask class-specific associations with adult exposure to IPV. We used data among ever-partnered young women and men aged 18-24 years from the Cambodia Violence Against Children Survey (N_w = 369; N_m = 298). Participants retrospectively reported on seven ACEs and lifetime physical and/or sexual IPV victimization and perpetration. Latent classes comprised of ACEs were used as predictors of physical and/or sexual IPV perpetration and victimization, controlling for household wealth. Identified latent classes for women were "Low ACEs" (60%), "Community Violence and Physical Abuse" (23%), and "Physical, Sexual and Emotional Abuse" (17%). Latent classes for men were "Low ACEs" (48%) and "Household and Community Violence" (52%). Among women, those in the Physical, Sexual and Emotional Abuse class were more likely to experience and perpetrate physical and/or sexual IPV in their romantic relationships compared to the reference group (Low ACEs). Women in the Community Violence and Physical Abuse class were more likely to perpetrate physical and/or sexual IPV, but not experience IPV, compared to women in the Low ACEs class. Among men, those in the Household and Community Violence class were more likely to perpetrate physical and/or sexual IPV against a partner, compared to men in the Low ACEs class. Overall, patterns of ACEs were differently associated with IPV outcomes among young women and men in Cambodia. National violence prevention efforts might consider how different combinations of childhood experiences shape risk of young adulthood IPV and tailor interventions accordingly to work with youth disproportionately affected by varied combinations of ACEs.

The prevalence, incidence, and recurrence of intimate partner violence and its association with adverse childhood experiences among pregnant and breastfeeding women living with HIV in Malawi

Background

Intimate partner violence (IPV) is associated with suboptimal HIV treatment outcomes, but its distribution and risk factors among certain subpopulations of people living with HIV in resource-limited settings are not well known. We examined the prevalence, incidence, and recurrence of IPV and its association with adverse childhood experiences (ACEs) among pregnant/breastfeeding women living with HIV in Malawi.

Methods

This study used longitudinal data for 455 pregnant women living with HIV continuously enrolled in the VITAL Start trial. IPV was assessed at baseline and months 1, 6, and 12 using the widely validated WHO IPV survey. Forms of IPV assessed were physical IPV, emotional IPV, and sexual IPV measured as prevalence, incidence, and recurrence. ACE histories were assessed using WHO's ACE International Questionnaire (ACE-IQ) tool. Logistic and log-binomial regressions were used in multivariable analyses that controlled for factors such as depression and alcohol use.

Results

Participants' mean age was 27.6 ± 5.7 years. Forty-three percent (43%) reported IPV prevalence, 13% reported IPV incidence, and another 13% reported IPV recurrence, with emotional IPV being the most commonly reported IPV type. Over 96% reported experiencing ⩾1 ACE. In regression analysis, cumulative ACE scores were significantly associated with IPV prevalence and IPV recurrence and in both cases, the magnitude of association was greatest for sexual IPV compared with physical IPV and emotional IPV. ACE scores were not significantly associated with IPV incidence.

Conclusions

IPV is highly prevalent among pregnant women living with HIV and continues to occur throughout the pregnancy and postpartum period; its graded relationship with ACEs is a concern in resource-limited settings where HIV/AIDS remains a public health concern. Strategies aimed to address the needs of pregnant/breastfeeding women living with HIV may benefit from the regular screening of this population for IPV and ACE, including in antenatal care clinics.

The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi

INTRODUCTION

Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi-an HIV endemic resource-limited setting.

METHODS

This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association.

RESULTS

The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms-even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse.

LIMITATIONS

Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias.

CONCLUSIONS

ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.

"Mtoto Wa Nyoka Ni Nyoka," The Child of a Snake is a Snake: A Narrative Analysis of Adverse Childhood Experiences and Perpetration of Interpersonal Violence Among Men in Dar es Salaam, Tanzania

Childhood exposure to adversity, including abuse and neglect, is consistently found to be a predictor of intimate partner violence (IPV) and peer violence (PV) perpetration in adulthood. The purpose of this study is to qualitatively examine factors that may facilitate or impede the use of violence among those who have been exposed to adversity early in life. We are particularly interested in protective experiences or environments for these participants. The qualitative data were analyzed through thematic coding and narrative analysis of participant life histories.We found three salient themes: (a) parental acceptance and early attachment is protective for coping with stress with intimate partners in adulthood; (b) certain key life turning points can provide a protective context against violent behavior in adulthood; and (c) poverty in adulthood compromises one's ability to cope with stress and anger in adulthood.Our findings contextualize the different factors that may affect the behavior of perpetration of interpersonal violence among high-risk men in Dar es Salaam who have been exposed to adversity in childhood. These findings provide important information on the risk and protective factors for interpersonal violence spanning from childhood to adulthood. This study highlights the importance of child development interventions in this situation, both for the primary prevention of child adversity and for promoting resilience and mitigating the effects of childhood adversity that put men at risk for perpetration of interpersonal violence in adulthood.

The Adverse Childhood Experiences - International Questionnaire (ACE-IQ) in community samples around the world: A systematic review (part I)

BACKGROUND

The Adverse Childhood Experiences International Questionnaire (ACE-IQ) collects additional data (e.g., witness community violence/terrorism) than the previous version. Despite ACE-IQ is widely used and validated in several languages, no reviews focus on this measure.

OBJECTIVE

The main goals are to: 1) synthesize the ACE-IQ prevalence rates and average means among community samples, both for total ACE and single dimensions (e.g., intrafamily abuse, bullying); 2) discuss these data in light of the characteristics of studies and samples; 3) identify main research lines of the field.

PARTICIPANTS AND SETTING

The search for studies using the ACE-IQ with community participants was conducted on seven academic databases, including retrieval of grey literature. The screening process led to include 63 documents.

METHODS

A systematic review following the PRISMA guidelines was performed.

RESULTS

1) On average, 75% of community respondents experienced ACEs, with a mean of three, primarily emotional abuse and bullying. 2) Males experienced more ACEs, but they were underrepresented, as well as children and adolescents. Most studies were conducted in Asia or Africa, and different geographical areas showed different pathways of prevalence in subdimensions. 3) Most research focused on prevalence and relationships between ACE-IQ scores and respondents' mental and physical health, suicide and parenting, focusing on intrafamily ACEs more than on those outside the household.

CONCLUSIONS

Several issues emerged in terms of lack of reporting prevalence or means, lack of studies in Europe, America and Oceania, and no attention to collective/community/peer violence, plus a lack of consensus toward the dimensions of the ACE-IQ.

From fathers to peers: Association between paternal violence victimization and peer violence perpetration among youth in Malawi, Nigeria, and Zambia

Interpersonal violence against children and youth, including parental violence and peer violence, are major global health concerns. However, the majority of the parental violence and peer violence literature examines each separately from one another. In this study, we specifically investigate the role of fathers and whether paternal violence victimization is associated with peer violence perpetration, above and beyond maternal violence victimization. We used nationally-representative data from three sub-Saharan African country surveys of the Violence Against Children Surveys, which comprised a pooled sample of 8184 youth aged 13-24 years in Malawi (conducted in 2013), Nigeria (2014), and Zambia (2014). We used multivariable logistic regression models to estimate the association between paternal violence victimization and peer violence perpetration, controlling for maternal violence victimization, witnessing violence, and other covariates. We also tested a structural equation model to determine whether the direct association between paternal violence victimization and peer violence perpetration was mediated through youth mental distress or alcohol use, controlling for other violence exposures and covariates. In the pooled sample, 22.8% of youth reported paternal violence victimization, and 18.8% of youth reported peer violence perpetration in their lifetime. Youth who experienced paternal violence had a greater odds of perpetrating peer violence (OR = 1.74, 95% CI: 1.50-2.02), compared with youth who did not experience paternal violence and after controlling for maternal violence victimization and other covariates. Structural equation model results revealed that approximately a quarter of the total association between paternal violence victimization and peer violence perpetration was mediated by youth mental distress and alcohol use. Our study underscores the role of fathers in the context of parental violence against youth and highlights the need for multicomponent and two-generation violence prevention interventions that address paternal violence and support youth psychosocial wellbeing to prevent cycles of violence perpetration against youth in sub-Saharan Africa.