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Yu Z, Cole S, Ross K, Hart M, Anis L, Letourneau N. Childhood Adversities and the ATTACH TM Program's Influence on Immune Cell Gene Expression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:776. [PMID: 38929022 PMCID: PMC11204101 DOI: 10.3390/ijerph21060776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To determine whether maternal Adverse Childhood Experiences (ACEs) are (a) associated with increased inflammatory gene expression in mother-child dyads and (b) whether a parenting intervention (ATTACH™) moderates the association between maternal ACEs and mother and/or child inflammatory gene expression. METHODS Twenty mother-child dyads, recruited from a domestic violence shelter in Calgary, AB, Canada, were randomized into an ATTACH™ parenting intervention group (n = 9) or a wait-list control group (n = 11). Maternal ACEs were assessed. The mothers and children each provided one non-fasting blood sample after the intervention group completed the ATTACH™ program, which was assayed to quantify the Conserved Transcriptional Response to Adversity (CTRA) score, indicating inflammatory gene expression profile. Mixed-effect linear models were used, separately in mothers and children, to examine the associations between CTRA score, maternal ACEs, and the ACEs-by-intervention group interaction term. The covariates were age, sex, ethnicity, and maternal medication use. RESULTS Higher maternal ACEs were associated with higher child CTRA scores (b = 0.123 ± SE 0.044, p = 0.005), indicating an increased pro-inflammatory gene expression profile. The ATTACH™ parenting intervention moderated this association between maternal ACEs and child CTRA scores (b = 0.328 ± SE 0.133, p = 0.014). In mothers, the ACEs-by-intervention interaction terms were insignificant (p = 0.305). CONCLUSIONS Maternal ACEs could exert an intergenerational impact on child inflammatory activity, and this association could be moderated by participating in the ATTACH™ parenting intervention.
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Affiliation(s)
- Zhiyuan Yu
- School of Nursing, Johns Hopkins University, 525 N Wolfe St., Baltimore, MD 21205, USA;
| | - Steve Cole
- School of Medicine, University of California-Los Angeles, Le Conte Ave, Los Angeles, CA 10833, USA;
| | - Kharah Ross
- Department of Psychology, Athabasca University, 1 University Dr., Athabasca, AB T9S 3A3, Canada;
| | - Martha Hart
- Alberta Children’s Hospital Research Institute, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (M.H.); (L.A.)
| | - Lubna Anis
- Alberta Children’s Hospital Research Institute, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (M.H.); (L.A.)
| | - Nicole Letourneau
- Faculty of Nursing & Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
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Wu S, Wang C, Jiang J, Kelifa MO, Wang X, Zheng C, Wang P. Adverse Childhood Experiences, Family Support, and Depression: Evidence from Internal Migrants in China. J Psychosoc Nurs Ment Health Serv 2023; 61:19-25. [PMID: 36099484 DOI: 10.3928/02793695-20220906-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies have linked poor family support and adverse childhood experiences (ACEs) to increased risk of depression; however, little is known about the interplay between the two when it comes to their effects on depression. Therefore, the current study examined if family support moderated the cumulative effect of ACEs on depression. Based on data from a migrant survey in Shiyan, Hubei Province, in 2019 (N = 1,326), this study used the ordinary least squares method to analyze the effect of ACEs on depression and evaluate whether family support moderated this effect. Higher exposure to ACEs and lower scores of family support were associated with higher depression levels in adulthood. The moderation model indicated that family support significantly moderated the relationship between ACEs and depression. Appropriate interventions to reduce depression should target internal migrants with history of ACEs. Community nurses should consider ACEs as an integral part of psychosocial assessment. Negative effects of ACEs can be reduced through teaching skills that increase effective family interaction and maintain supportive family networks. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 19-25.].
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DeCandia CJ, Volk KT, Unick GJ. Evolving Our Understanding: Housing Instability as an ACE for Young Children. ADVERSITY AND RESILIENCE SCIENCE 2022; 3:365-380. [PMID: 36320362 PMCID: PMC9607722 DOI: 10.1007/s42844-022-00080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
Abstract
We investigated the conceptualization and impact of adverse childhood experiences (ACEs) in a sample of 231 children ages 3-5 living in poverty and experiencing homelessness, focusing specifically on caregiver well-being and housing instability. Data was collected using the Neurodevelopmental Ecological Screening Tool (NEST), which screens for developmental risk and resilience across three domains (neurodevelopmental, caregiver, and environment). We used structural equation modelling (SEM) to test the association between domains and ACE scores and assessed the impact on neurodevelopmental constructs. Fifty-five percent of the sample had high ACE scores (> 3), which were associated with lower attention, social skills, and emotional regulation. ACEs were strongly associated with 0.17 standard deviation units of higher levels of caregiver distress (p < .001), which was also associated with 0.26 standard deviation units of lower levels of child neurodevelopmental functioning (p = .001). For each unit increase in housing instability, there was a three-fourths increase in ACE (0.78 ACE at p = .004); four or more moves were associated with the worst neurodevelopmental outcomes (53% of the sample). We must use an ecological, developmental lens to understand how early adversity impacts children, at what age, and in what context. Housing stability plays a critical role in developmental well-being and should be accounted for in conceptualizations of child ACE scales. Caregiver and child relationships are reciprocal, and so the impacts of ACEs are also bidirectional. Our policies and practices at individual, community, and systemic levels should account for these dynamics to improve child well-being.
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Affiliation(s)
| | | | - George J. Unick
- grid.411024.20000 0001 2175 4264School of Social Work, University of Maryland, Baltimore, MD USA
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Kang NR, Kwack YS, Song JK, Kim MD, Park JH, Kim BN, Moon DS. The intergenerational transmission of maternal adverse childhood experiences on offspring's psychiatric disorder and the mediating role of maternal depression: Results from a cross sectional study. Clin Child Psychol Psychiatry 2022; 27:613-629. [PMID: 34978939 DOI: 10.1177/13591045211056919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Maternal adverse childhood experiences (ACEs) may negatively affect the mental health and development of their offspring. The purpose of this study was to investigate the association of maternal ACE and offspring's psychiatric disorder and the mediating effect of maternal depression. The subjects included 463 mothers (42.78 ± 5.68 years) and their offspring aged 6-18 years (13.26 ± 3.90 years). Mothers reported their ACE before age 18 and completed the Beck Depression Inventory-II and Diagnostic Predictive Scales (DPS), a screening tool for offspring's psychiatric disorder. 35.42% of subjects had at least one ACE, and 11.0% reported three or more ACEs. Higher maternal ACE scores were associated with a significantly higher prevalence of offspring's psychiatric disorders (p < 0.001). Household dysfunction of maternal ACE (OR = 2.263, p < 0.001) is significantly associated with offspring's psychiatric disorder. In the mediation model in which the household dysfunction affects the number of offspring's psychiatric disorders, the partial mediation model through maternal depression was significant. The mother's experience of household dysfunction before the age of 18 has a significant impact on her offspring's psychiatric disorder and supported significant mediation through maternal depression. Further research is needed to determine the mechanisms of intergenerational transmission of ACE and offspring's psychopathology.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Young Sook Kwack
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Jung-Kook Song
- Department of Preventive Medicine, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Moon-Doo Kim
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Joon Hyuk Park
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry, 37900Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Duk-Soo Moon
- Department of Psychiatry, 37984Jeju National University School of Medicine, Jeju, Republic of Korea
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Johnson MT, Fratantoni JM, Tate K, Moran AS. Parenting With a Kind Mind: Exploring Kindness as a Potentiator for Enhanced Brain Health. Front Psychol 2022; 13:805748. [PMID: 35401369 PMCID: PMC8989141 DOI: 10.3389/fpsyg.2022.805748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
A growing body of research has suggested that high levels of family functioning—often measured as positive parent–child communication and low levels of parental stress—are associated with stronger cognitive development, higher levels of school engagement, and more successful peer relations as youth age. The COVID-19 pandemic has brought tremendous disruption to various aspects of daily life, especially for parents of young children, ages 3–5, who face isolation, disconnection, and unprecedented changes to how they engage and socialize. Fortunately, both youth and parent brains are plastic and receptive to change. Resilience research shows that factors such as engaging in acts of kindness, developing trusting relationships, and responding compassionately to the feelings of others can help lay new neural pathways and improve quality of life. Yet, little research has investigated the effects of brain healthy parental practices of kindness with pre-school aged children. The current study examines whether an interactive, parent–child kindness curriculum can serve as a potentiator for brain health as measured by resilience and child empathy levels. During a peak of the pandemic, mother participants between the ages of 26–46 (n = 38, completion rate 75%) completed questionnaires on parental resilience levels and parent-reported child empathic pro-social behaviors before and after engaging in a 4 weeks online, self-paced, kindness curriculum. Half of the group received additional brain health education explaining the principles of neuroplasticity, empathy, perspective taking, and resiliency. Mothers in both groups showed increased resilience ( p < 0.001) and reported higher levels of empathic behavior in their child ( p < 0.001) after completing the curriculum. There was no significant difference between groups. Comparison of mean resilience levels during COVID-19 to pre-pandemic general means indicated that mothers are reporting significantly lower levels of resilience as well as decreased empathetic behaviors in their children. These results support the notion that kindness is a powerful brain health booster that can increase resilience and empathy. This research study was timely and relevant for parents in light of the myriad of stresses brought about by the ongoing COVID-19 pandemic. There are broader public health implications for equipping individuals with tools to take a proactive and preventative approach to their brain health.
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Crosby RG, Smith EI, Gage J, Blanchette L. Trauma-Informed Children's Ministry: a Qualitative Descriptive Study. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:493-505. [PMID: 34824665 PMCID: PMC8586392 DOI: 10.1007/s40653-020-00334-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 06/13/2023]
Abstract
Over half of American children will experience at least one traumatic event, and nearly one in six will experience four or more events. These traumatic events affect children's physical and mental health throughout their lives. Consequently, organizations which serve children, including local religious congregations, are urged to adopt the principles of trauma-informed care. The purpose of this study was to describe specific ways in which trauma-informed principles are applied by church children's ministries. We gathered interview, focus group, and observational data from nine different children's ministries that were previously identified as being exceptionally inclusive and supportive. Interview participants included nine children's pastors, 17 children's ministry volunteers, and 38 individuals across 14 families. Focus group participants included 20 children ages 7 to 13. Data were analyzed using qualitative descriptive methodology using both a deductive and inductive approach. Drawing from prior literature, we deductively categorized the values (preparation, awareness, collaboration, and transparency) and goals (that children feel safe, regulated, connected, and valued) of trauma-informed children's ministries. Results. Results inductively identify and describe specific ways in which each of these values and goals were applied in the children's ministry context. Our results reveal that churches have the potential to be places of healing for children who have experienced trauma. Moreover, although many of these trauma-informed practices in a children's ministry context are similar to a school context, there are important differences that make children's church a unique context for care. We highlight the implications for children's ministries.
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Affiliation(s)
| | | | - Jeffrey Gage
- California Baptist University, Riverside, CA USA
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Danielson RA, Ray-Degges S. Aging in place among older adults with histories of traumatic experiences: A scoping review. THE GERONTOLOGIST 2021; 62:e1-e16. [PMID: 34436570 DOI: 10.1093/geront/gnab127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adverse childhood and adult experiences can have far-reaching impacts, and when coupled with typical aging-related changes, may impede achievement of a suitable person-environment fit for aging adults. The objective of our study was to determine if extant literature connects older adults with trauma history to successfully aging in place. RESEARCH DESIGN AND METHODS We proposed a conceptual model regarding trauma history, adaptive capacity of aging adults, and trauma-informed supports for aging in place. We conducted a scoping review using six databases [key words older adult(s), aging in place, housing, trauma], with a full review of 32 articles. RESULTS Insights included: 1) Aging in place does not have to mean living in the same house over time. 2) The uncertainty of the aging process can be traumatic and can be exacerbated by previous traumatic experiences. 3) Environmental sensitivities can result from previous traumatic experiences and cause further trauma. 4) Housing precarity is a traumatic experience. 5) Permanent supportive housing is an important resource for people in crisis. 6) Community supports are critical to aging in place. DISCUSSION AND IMPLICATIONS Our review revealed insights about aging in place and trauma, but did not connect the vulnerabilities specific to aging adults with personal trauma histories to aging in place. Research is needed that confirms the relationship between history of traumatic experiences and difficulties with aging in place as well as trauma-informed approaches that can mitigate housing-related stressors and foster community living environments that provide equitable access to aging in place.
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Affiliation(s)
- Ramona A Danielson
- Department of Public Health, North Dakota State University, Fargo, North Carolina, USA
| | - Susan Ray-Degges
- Department of Apparel, Merchandising, Interior Design & Hospitality Management, North Dakota State University, Fargo, North Carolina, USA
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Salarzadeh Jenatabadi H, Shamsi NA, Ng BK, Abdullah NA, Mentri KAC. Adolescent Obesity Modeling: A Framework of Socio-Economic Analysis on Public Health. Healthcare (Basel) 2021; 9:healthcare9080925. [PMID: 34442062 PMCID: PMC8392515 DOI: 10.3390/healthcare9080925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 02/07/2023] Open
Abstract
Bayesian Structural Equation Modeling (SEM-Bayesian) was applied across different research areas to model the correlation between manifest and latent variables. The primary purpose of this study is to introduce a new framework of complexity to adolescent obesity modeling based on adolescent lifestyle through the application of SEM-Bayesian. The introduced model was designed based on the relationships among several factors: household socioeconomic status, healthy food intake, unhealthy food intake, lifestyle, body mass index (BMI) and body fat. One of the main contributions of this study is from considering both BMI and body fat as dependent variables. To demonstrate the reliability of the model, especially in terms of its fitting and accuracy, real-time data were extracted and analyzed across 881 adolescents from secondary schools in Tehran, Iran. The output of this study may be helpful for researchers who are interested in adolescent obesity modeling based on the lifestyle and household socioeconomic status of adolescents.
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Steine IM, LeWinn KZ, Lisha N, Tylavsky F, Smith R, Bowman M, Sathyanarayana S, Karr CJ, Smith AK, Kobor M, Bush NR. Maternal exposure to childhood traumatic events, but not multi-domain psychosocial stressors, predict placental corticotrophin releasing hormone across pregnancy. Soc Sci Med 2020; 266:113461. [PMID: 33126094 PMCID: PMC9380779 DOI: 10.1016/j.socscimed.2020.113461] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/19/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
Maternal psychosocial stress increases the risk of adverse birth and postnatal outcomes for the mother and child, but the role of maternal exposure to childhood traumatic events (CTE) and multi-domain psychosocial stressors for the level and rise of placental Corticotrophin-Releasing Hormone (pCRH) across pregnancy has been understudied. In a sociodemographically and racially diverse sample of 1303 women (64% Black, 36% White/others) with low-medical risk pregnancies at enrollment from Shelby County, Tennessee, USA, blood samples were drawn twice, corresponding roughly to second and third trimester, and extracted prior to conducting radioimmune assays for pCRH. Mothers reported CTE (physical abuse, sexual abuse, or family violence, in childhood), adulthood traumatic events, and interpersonal violence during pregnancy. Neighborhood crime/deprivation was derived using geospatially-linked objective databases. General linear and mixed models tested associations between stress exposure variables and pCRH levels and rate of rise, adjusting for obstetric/clinical/health related factors. Maternal CTE did not predict pCRH levels at time 1, but positively predicted levels at time 2, and the rate of rise in pCRH across pregnancy. Race did not moderate this association. No additional maternal stress exposures across adulthood or during pregnancy predicted pCRH outcomes. Findings indicate that childhood violence or abuse exposure can become biologically embedded in a manner predicting later prenatal physiology relevant for maternal and offspring health, and that such embedding may be specific to childhood, but not adulthood, stress. Findings also highlight the placental-fetal unit as a mechanistic pathway through which intergenerational transmission of the adverse effects of childhood adversities may occur.
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Affiliation(s)
- Iris M Steine
- Visiting Scholar, UC Berkeley, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94704, USA; Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015 Bergen, Norway.
| | - Kaja Z LeWinn
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, USA
| | - Nadra Lisha
- Department of General Internal Medicine, University of California San Francisco, USA
| | - Frances Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Roger Smith
- Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Maria Bowman
- Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Sheela Sathyanarayana
- University of Washington Department of Pediatrics, Seattle, USA; Seattle Children's Research Institute, Seattle, USA; University of Washington Department of Environmental and Occupational Health Sciences, Seattle, USA
| | - Catherine J Karr
- University of Washington Department of Environmental and Occupational Health Sciences, Seattle, USA; University of Washington Departments of Pediatrics, Seattle, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA
| | - Michael Kobor
- Department of Medical Genetics, University of British Columbia, Canada
| | - Nicole R Bush
- Departments of Psychiatry and Pediatrics, University of California San Francisco, USA
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Hubel GS, Davies F, Goodrum NM, Schmarder KM, Schnake K, Moreland AD. Adverse childhood experiences among early care and education teachers: Prevalence and associations with observed quality of classroom social and emotional climate. CHILDREN AND YOUTH SERVICES REVIEW 2020; 111:104877. [PMID: 32921858 PMCID: PMC7480931 DOI: 10.1016/j.childyouth.2020.104877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This study examines the prevalence of self-reported adverse childhood experiences (ACEs) among a sample of 349 early care and education teachers. Seventy-three percent of the sample reported experiencing at least one ACE and 22% reported experiencing 4 or more ACEs. Live observational assessments of the quality of the social and emotional climate in teacher's classrooms were conducted for a subsample of 58 teachers. Within this subsample, reporting a higher number of ACEs was associated with facilitating a lower quality social and emotional classroom climate. Individual ACEs were also examined. Teachers who reported experiencing incarceration of a family member, physical abuse, or emotional abuse were observed to facilitate a lower quality social and emotional classroom climate. This study provides preliminary insight into the prevalence of ACEs among members of the early care and education workforce. Further, it extends previous work examining the multi-generational impacts of ACEs within families by showing that ACEs may influence the care that is provided to children in childcare settings.
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Affiliation(s)
- G S Hubel
- Department of Psychology, The College of Charleston, Charleston, SC 29424, United States
| | - F Davies
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street - 2 South, Charleston, SC 29425, United States
| | - N M Goodrum
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street - 2 South, Charleston, SC 29425, United States
| | - K M Schmarder
- Department of Psychology, The College of Charleston, Charleston, SC 29424, United States
| | - K Schnake
- SC Program for Infant/Toddler Care, Medical University of South Carolina, 1 Carriage Lane, Unit J, Charleston, SC 29407, United States
| | - A D Moreland
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street - 2 South, Charleston, SC 29425, United States
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Nurius P, LaValley K, Kim MH. Victimization, Poverty, and Resilience Resources: Stress Process Considerations for Adolescent Mental Health. SCHOOL MENTAL HEALTH 2020; 12:124-135. [PMID: 32431758 PMCID: PMC7236761 DOI: 10.1007/s12310-019-09335-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Growing evidence suggests that exposure to early life adversity poses risk to youth development, with impaired mental health a central concern. This population-representative study of adolescent students (n=11,222) investigates the effects of two key forms of early adversity- victimization and poverty-on adolescent mental health in a step-wise fashion, also accounting for mutable and accessible resilience resources. Victimization and poverty prevalence reflected social patterning wherein being female, racial and ethnic minority youth, and those with lower resilience resources all reported significantly higher levels of victimization and family poverty. Greater levels of these adversities were significantly associated with lower levels of resilience resources. Poverty and particularly victimization demonstrated significant cumulative and distinct contributions across three indicators of compromised mental health-depression, suicidality, and broader psychological well-being. Resilience resources of family bondedness, school engagement, and sleep sufficiency all carried significant effects and accompanied lesser explanatory strength of victimization and family poverty. In separate analyses, each of four forms of victimization-adult maltreatment, bullying, dating violence, and feeling unsafe at school-were significant contributors to mental health, with cumulative exposure conveying the strongest unique effects. Implications and opportunities for prevention and remedial strategies are discussed, with particular attention to school-based responding.
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