Mental health benefits of a 1-week intensive multimodal group program for adolescents with multiple adverse childhood experiences

Prevalence of Adverse Childhood Experiences in Child Population Samples: A Systematic Review and Meta-Analysis

Importance

Exposure to adverse childhood experiences (ACEs) before the age of 18 years is a major contributor to the global burden of disease and disability.

Objective

To meta-analyze data from samples with children 18 years or younger to estimate the average prevalence of ACEs, identify characteristics and contexts associated with higher or lower ACE exposure, and explore methodological factors that might influence these prevalence estimates.

Design, Setting, and Participants

Studies that were published between January 1, 1998 and February 19, 2024, were sourced from MEDLINE, PsycINFO, CINHAL, and Embase. Inclusion criteria required studies to report the prevalence of 0, 1, 2, 3, or 4 or more ACEs using an 8- or 10-item ACEs questionnaire (plus or minus 2 items), include population samples of children 18 years or younger, and be published in English. Data from 65 studies, representing 490 423 children from 18 countries, were extracted and synthesized using a multicategory prevalence meta-analysis. These data were analyzed from February 20, 2024, through May 17, 2024.

Main Outcomes and Measures

ACEs.

Results

The mean age of children across studies was 11.9 (SD, 4.3) years, the age range across samples was 0 to 18 years, and 50.5% were female. The estimated mean prevalences were 42.3% for 0 ACEs (95% CI, 25.3%-52.7%), 22.0% for 1 ACE (95% CI, 9.9%-32.7%), 12.7% for 2 ACEs (95% CI, 3.8%-22.3%), 8.1% for 3 ACEs (95% CI, 1.4%-16.8%), and 14.8% for 4 or more ACEs (95% CI, 5.1%-24.8%). The prevalence of 4 or more ACEs was higher among adolescents vs children (prevalence ratio, 1.16; 95% CI, 1.04-1.30), children in residential care (1.26; 95% CI, 1.10-1.43), with a history of juvenile offending (95% CI, 1.29; 1.24-1.34), and in Indigenous peoples (1.63; 95% CI, 1.28-2.08), as well as in studies where file review was the primary assessment method (1.29; 95% CI, 1.23-1.34). The prevalence of 0 ACEs was lower in questionnaire-based studies where children vs parents were informants (0.85; 95% CI, 0.80-0.90).

Conclusions

In this study, ACEs were prevalent among children with notable disparities across participant demographic characteristics and contexts. As principal antecedent threats to child and adolescent well-being that can affect later life prospects, ACEs represent a pressing global social issue. Effective early identification and prevention strategies, including targeted codesigned community interventions, can reduce the prevalence of ACEs and mitigate their severe effects, thereby minimizing the harmful health consequences of childhood adversity in future generations.

Remodeling the Epigenome Through Meditation: Effects on Brain, Body, and Well-being

Epigenetic mechanisms are key processes that constantly reshape genome activity carrying out physiological responses to environmental stimuli. Such mechanisms regulate gene activity without modifying the DNA sequence, providing real-time adaptation to changing environmental conditions. Both favorable and unfavorable lifestyles have been shown to influence body and brain by means of epigenetics, leaving marks on the genome that can either be rapidly reversed or persist in time and even be transmitted trans-generationally. Among virtuous habits, meditation seemingly represents a valuable way of activating inner resources to cope with adverse experiences. While unhealthy habits, stress, and traumatic early-life events may favor the onset of diseases linked to inflammation, neuroinflammation, and neuroendocrine dysregulation, the practice of mindfulness-based techniques was associated with the alleviation of many of the above symptoms, underlying the importance of lifestyles for health and well-being. Meditation influences brain and body systemwide, eliciting structural/morphological changes as well as modulating the levels of circulating factors and the expression of genes linked to the HPA axis and the immune and neuroimmune systems. The current chapter intends to give an overview of pioneering research showing how meditation can promote health through epigenetics, by reshaping the profiles of the three main epigenetic markers, namely DNA methylation, histone modifications, and non-coding RNAs.

Psychological Interventions for Pediatric Posttraumatic Stress Disorder: A Systematic Review and Network Meta-Analysis

Importance

Pediatric posttraumatic stress disorder (PTSD) is a common and debilitating mental disorder, yet a comprehensive network meta-analysis examining psychological interventions is lacking.

Objective

To synthesize all available evidence on psychological interventions for pediatric PTSD in a comprehensive systematic review and network meta-analysis.

Data Sources

PsycINFO, MEDLINE, Web of Science, and PTSDpubs were searched from inception to January 2, 2024, and 74 related systematic reviews were screened.

Study Selection

Two independent raters screened publications for eligibility. Inclusion criteria were randomized clinical trial (RCT) with at least 10 patients per arm examining a psychological intervention for pediatric PTSD compared to a control group in children and adolescents (19 years and younger) with full or subthreshold PTSD.

Data Extraction and Synthesis

PRISMA guidelines were followed to synthesize and present evidence. Two independent raters extracted data and assessed risk of bias with Cochrane criteria. Random-effects network meta-analyses were run.

Main Outcome and Measures

Standardized mean differences (Hedges g) in PTSD severity.

Results

In total, 70 RCTs (N = 5528 patients) were included. Most RCTs (n = 52 [74%]) examined trauma-focused cognitive behavior therapies (TF-CBTs). At treatment end point, TF-CBTs (g, 1.06; 95% CI, 0.86-1.26; P < .001), eye movement desensitization and reprocessing (EMDR; g, 0.86; 95% CI, 0.54-1.18; P < .001), multidisciplinary treatments (MDTs) (g, 0.88; 95% CI, 0.53-1.23; P < .001), and non-trauma-focused interventions (g, 0.95; 95% CI, 0.62-1.28; P < .001) were all associated with significantly larger reductions in pediatric PTSD than passive control conditions. TF-CBTs were associated with the largest short-term reductions in pediatric PTSD relative to both passive and active control conditions and across all sensitivity analyses. In a sensitivity analysis including only trials with parent involvement, TF-CBTs were associated with significantly larger reductions in pediatric PTSD than non-trauma-focused interventions (g, 0.35; 95% CI, 0.04-0.66; P = .03). Results for midterm (up to 5 months posttreatment) and long-term data (6-24 months posttreatment) were similar.

Conclusions and Relevance

Results from this systematic review and network meta-analysis indicate that TF-CBTs were associated with significant reductions in pediatric PTSD in the short, mid, and long term. More long-term data are needed for EMDR, MDTs, and non-trauma-focused interventions. Results of TF-CBTs are encouraging, and disseminating these results may help reduce common treatment barriers by counteracting common misconceptions, such as the notion that TF-CBTs are harmful rather than helpful.

Psychological Interventions for Post-traumatic Stress Disorder as a Primary Diagnosis Among Adolescents: A Meta-analysis

Purpose

The objective of this study was to do a meta-analysis focusing on the efficacy of psychological intervention for the adolescent population and PTSD as a primary outcome variable.

Collection and Analysis of Data

An electronic search was conducted on PubMed, Science Direct, PsycINFO, and Cochrane Library databases from January 1, 1990, to March 31, 2023. Original studies and systematic reviews/meta-analyses were segregated. In the first study, 129 meta-analyses (MAs) were screened and 8 MAs were analyzed. In the second study, six RCTs and five non-RCTs exclusively including adolescents with a primary diagnosis of PTSD were analyzed. The MA revealed the average sample size to be 243.33 (SD = 372.94) with 63.98% female participants in RCTs and 153 (SD = 237.17) with 56.99% female participants in non-RCTs. A total of 13 different interventions were analyzed. Cognitive-behavioral intervention had a large effect size of 1.63 for PTSD. Cochrane's Q test and I2 index revealed considerable heterogeneity among groups. There was no significant difference between RCTs and non-RCTs in the total number and duration of intervention sessions and the duration of each session. However, the average follow-up time points varied significantly between RCTs and non-RCTs. RCTs followed random sequence generation and, hence, had a low risk of selection bias.

Conclusion

Although the CBT framework with a focus on trauma and traumatic emotions was at the core of treatment efficacy, the type of trauma was the key consideration. Further studies of treatment efficacy moderated by specific trauma characteristics are required to advance the knowledge base in the treatment of PTSD in adolescents.

Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis

Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.

Do dimensions of childhood adversity differ in their direct associations with youth psychopathology? A meta-analysis

Growing evidence supports the unique pathways by which threat and deprivation, two core dimensions of adversity, confer risk for youth psychopathology. However, the extent to which these dimensions differ in their direct associations with youth psychopathology remains unclear. The primary aim of this preregistered meta-analysis was to synthesize the associations between threat, deprivation, internalizing, externalizing, and trauma-specific psychopathology. Because threat is proposed to be directly linked with socioemotional development, we hypothesized that the magnitude of associations between threat and psychopathology would be larger than those with deprivation. We conducted a search for peer-reviewed articles in English using PubMed and PsycINFO databases through August 2022. Studies that assessed both threat and deprivation and used previously validated measures of youth psychopathology were included. One hundred and twenty-seven articles were included in the synthesis (N = 163,767). Results of our three-level meta-analyses indicated that adversity dimension significantly moderated the associations between adversity and psychopathology, such that the magnitude of effects for threat (r's = .21-26) were consistently larger than those for deprivation (r's = .16-.19). These differences were more pronounced when accounting for the threat-deprivation correlation. Additional significant moderators included emotional abuse and youth self-report of adversity. Findings are consistent with the Dimensional Model of Adversity and Psychopathology, with clinical, research, and policy implications.

Allostatic Load in Children and Adolescents: A Systematic Review

INTRODUCTION

The concept of allostatic load encompasses the cumulative effects of both ordinary daily life events as well as major challenges, and also includes related health-damaging behavior. Allostatic overload ensues when environmental challenges exceed the individual's ability to cope. Identification of allostatic load is carried out through the use of biomarkers and clinimetric criteria. Studies are increasingly reported on allostatic load in younger populations, yet a systematic review is missing.

OBJECTIVE

The aim of the present systematic review was to summarize the current knowledge on allostatic load/overload among children and adolescents.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to April 2023. A manual search of the literature was also performed. We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical populations younger than 18 years.

RESULTS

A total of 38 original investigations were included in this systematic review. Studies reported an association between allostatic load and sociodemographic characteristics (e.g., poverty, ethnicity, perceived discrimination, adverse childhood experiences) and environmental factors, as well as consequences of allostatic load on both physical and mental health among children and adolescents.

CONCLUSIONS

The findings indicate that greater allostatic load is associated with poorer health outcomes in both clinical and non-clinical pediatric populations, with possible enduring effects. The results support the clinical utility of the transdiagnostic identification of allostatic load and overload in children and adolescents across a variety of settings, with a number of potential clinical implications.