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Hsueh YZ, Huang CY, Kuo PH, Cheng YC, Huang MC, Chiu CC, Kuo CJ, Chen PY, Chen WY. Cluster analysis exploring the impact of childhood neglect on cognitive function in patients with bipolar disorder. Int J Bipolar Disord 2024; 12:13. [PMID: 38676782 PMCID: PMC11055839 DOI: 10.1186/s40345-024-00335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
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.
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Affiliation(s)
- Yuan-Zhi Hsueh
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
| | - Cho-Yin Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ying-Chih Cheng
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chian-Jue Kuo
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Yu Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Songde branch, Taipei, Taiwan.
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Cooper ZW, Wolfer TA. Conceptualizing the Biopsychosocial-Spiritual Health Influences of Adverse Childhood Experiences and the Application of Primary Care Behavioral Health for Their Treatment. JOURNAL OF RELIGION AND HEALTH 2024; 63:619-639. [PMID: 37831309 DOI: 10.1007/s10943-023-01928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/14/2023]
Abstract
Adverse Childhood Experiences (ACEs) are common and affect the overall functioning of adults, but there is a need to understand how to better address the health impact of ACEs on adults in primary healthcare settings. A narrative review was utilized to extract data from seminal articles to (1) operationalize the influence of ACEs on health outcomes, (2) assess the primary care behavioral health (PCBH) model as a mechanism to address the influence of ACEs, and (3) identify mechanisms to expand the PCBH model to explicitly address spiritual determinants of health. The extracted data revealed that ACEs influence the biological, psychological, social, and spiritual health of patients providing a rationale for integrating psychosocial and spiritual treatment within primary healthcare settings. Simultaneously, the PCBH model integrates psychosocial interventions into existing primary care services but does not explicitly address spiritual determinants. Recommendations for expansion include (1) training for clinicians on evidence-based interventions to address spirituality, (2) spiritual screening tools in PCBH settings, and (3) consultation with chaplains as needed.
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Affiliation(s)
- Zachary W Cooper
- School of Social Work, University of Georgia, 279 Williams St, Athens, GA, 30602, USA.
| | - Terry A Wolfer
- College of Social Work, University of South Carolina, Columbia, SC, USA
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Tao H, Zeng X, Hou M, Chen S, Shen J, Liao X, Zou C. Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia. Front Psychol 2023; 14:1134631. [PMID: 37205075 PMCID: PMC10185847 DOI: 10.3389/fpsyg.2023.1134631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Background Few studies have explored the mechanisms linking adverse childhood experiences (ACEs) to depression in medical students. This study aimed to investigate the relationship between ACEs and depression through the serial mediation effect of family functioning and insomnia. Methods A cross-sectional survey was conducted with 368 medical students from university in Chengdu in 2021. The participants were asked to complete four self-report questionnaires, including ACEs scale, the family APGAR index, the ISI and PHQ-9. Singe and serial mediation analyses were conducted using structural equation modeling by Mplus 8.3. Results ACEs had a significant direct effect on depression (β = 0.438, p < 0.001) and through three significantly indirect pathways: (1) through family functioning (β = 0.026, 95% CI: 0.007-0.060), accounting for 5.9% of the total effect; (2) through insomnia (β = 0.103, 95% CI: 0.011-0.187), accounting for 23.5% of the total effect; and (3) through the serial mediators involving in family functioning and insomnia (β = 0.038, 95% CI: 0.015-0.078), accounting for 8.7% of the total effect. The total indirect effect was 38.1%. Limitations This cross-sectional study prevented us from establishing causality. Conclusion This study highlights the role of family functioning and insomnia as serial mediators of the relationship between ACEs and depression. Findings help to elucidate the mechanism that underlines the pathway between ACEs and depression in medical students. These findings may indicate developing measures to strengthen family functioning and improve insomnia aiming to reduce depression in medical students with ACEs.
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Affiliation(s)
- Hongxia Tao
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- The Department of General Practice, Chengdu Fifth People’s Hospital, Chengdu University of TCM, Chengdu, China
| | - Xin Zeng
- The Department of General Practice, Chengdu Fifth People’s Hospital, Chengdu University of TCM, Chengdu, China
| | - Mutian Hou
- Psychological Research and Counseling Center, Southwest Jiaotong University, Chengdu, China
| | - Shanping Chen
- The Department of Geriatric Medicine, Chengdu Fifth People’s Hospital, Chengdu University of TCM, Chengdu, China
| | - Jing Shen
- The Department of General Practice, Chengdu Fifth People’s Hospital, Chengdu University of TCM, Chengdu, China
| | - Xiaoyang Liao
- General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xiaoyang Liao, ; Chuan Zou,
| | - Chuan Zou
- The Department of General Practice, Chengdu Fifth People’s Hospital, Chengdu University of TCM, Chengdu, China
- *Correspondence: Xiaoyang Liao, ; Chuan Zou,
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Talevi D, Imburgia L, Luperini C, Zancla A, Collazzoni A, Rossi R, Pacitti F, Rossi A. Interpersonal violence: identification of associated features in a clinical sample. CHILD ABUSE & NEGLECT 2018; 86:349-357. [PMID: 30220425 DOI: 10.1016/j.chiabu.2018.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Abstract
Violence is a burdensome problem in daily psychiatric practice, even though the diagnosisof a mental disorder is not sufficient to determine a violent behavior; therefore, other factors are involved. We predicted that the participants could be distributed in two groups (e.g. high versus low violence-maltreatment groups) because this grouping would better describe specific patterns of associations in a clinical sample. We aimed to investigate the relation between interpersonal violence and maltreating experiences in childhood. Affective states and personal functioning were also explored as meaningful outcomes. Consecutive patients (N = 101) admitted to a psychiatric unit were evaluated with the Risky Families Questionnaire, the Psychological Maltreatment Review, the Karolinska Interpersonal Violence Scale (KIVS), the Positive and Negative Affect Schedule and the Personal and Social Performance Scale. Single, with average education and unemployed individuals showed significantly higher KIVS scores. High levels of interpersonal violence (IV) in childhood correlated with a harsh family climate in early life. Moreover, IV correlated with perceived parental maltreatment and did not with parental support. The cluster analysis identified two clusters of patients. The first (n = 41) showed negative dysfunctional experiences; the second (n = 60) showed a more positive perception of parental support.The impairment of social functioning and emotions regulation are both involved in this complex relation. The study supports the hypothesis of a clustering of patients that needs tailored management of violence causes and consequences.
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Affiliation(s)
- Dalila Talevi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Giovanni di Vincenzo, 16/B, 67100 L'Aquila, Italy.
| | - Lorenzo Imburgia
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Giovanni di Vincenzo, 16/B, 67100 L'Aquila, Italy.
| | - Chiara Luperini
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Giovanni di Vincenzo, 16/B, 67100 L'Aquila, Italy.
| | - Alessandro Zancla
- School of Public Health and Preventive Medicine, University of L'Aquila, Via Giovanni di Vincenzo, 16/B, 67100 L'Aquila, Italy.
| | - Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Giovanni di Vincenzo, 16/B, 67100 L'Aquila, Italy.
| | - Rodolofo Rossi
- PhD programme Tor Vergata University of Rome, Via Cracovia, 50, 00133 Rome, Italy.
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Giovanni di Vincenzo, 16/B, 67100 L'Aquila, Italy; Department of Mental Health, ASL 1 Abruzzo, L'Aquila San Salvatore Hospital, Via Lorenzo Natali, 1, 67100 Coppito, L'Aquila, Italy.
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, Via Giovanni di Vincenzo, 16/B, 67100 L'Aquila, Italy; Department of Mental Health, ASL 1 Abruzzo, L'Aquila San Salvatore Hospital, Via Lorenzo Natali, 1, 67100 Coppito, L'Aquila, Italy.
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Poletti S, Aggio V, Brioschi S, Dallaspezia S, Colombo C, Benedetti F. Multidimensional cognitive impairment in unipolar and bipolar depression and the moderator effect of adverse childhood experiences. Psychiatry Clin Neurosci 2017; 71:309-317. [PMID: 28004481 DOI: 10.1111/pcn.12497] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/29/2016] [Accepted: 12/15/2016] [Indexed: 12/15/2022]
Abstract
AIM Studies have demonstrated neuropsychological deficits across a variety of cognitive domains in depression. These deficits are observable both in major depressive disorder (MDD) and in bipolar disorder (BD) and are present in each phase of the illness, including euthymia. Adverse childhood experiences (ACE) have been associated with an increased risk of developing psychiatric disorders and cognitive deficits. The aim of this study was to assess neuropsychological performances in a sample of MDD and BD patients during a depressive episode compared to healthy controls (HC) and, to investigate if ACE affect the cognitive profiles in the three groups. METHODS Seventy-six BD patients, 57 MDD patients, and 57 HC underwent neuropsychological assessment for cognitive performances through the Brief Assessment of Cognition in Schizophrenia and Wisconsin Card Sorting Test. RESULTS Both BD and MDD patients obtained significantly lower domain scores across the entire battery compared to HC. Splitting the sample according to exposure to ACE (high and low), the differences observed in the whole sample persisted only in the subsample of those patients exposed to high ACE. CONCLUSION This study confirms that cognitive impairment is present both in MDD and BD, albeit in different degrees of severity, and highlights the importance of early stress as a moderator factor when investigating cognitive functions in mood disorders.
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Affiliation(s)
- Sara Poletti
- Division of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Veronica Aggio
- Division of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Brioschi
- Division of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Sara Dallaspezia
- Division of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Cristina Colombo
- Division of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Division of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
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CLOCK gene variants associated with the discrepancy between subjective and objective severity in bipolar depression. J Affect Disord 2017; 210:14-18. [PMID: 27992853 DOI: 10.1016/j.jad.2016.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/21/2016] [Accepted: 12/13/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The discrepancy between subjective and objective severity of depressive syndromes has been proposed as a predictor of treatment outcome and suicidal risk in depression, and is associated with depressive cognitive distortions. A recent study reported that evening-type depressed patients showed higher depressive cognitions than morning-type patients. Therefore, it can be hypothesized that genetic factors affecting evening preference, such as carrying of the CLOCK rs1801260*C allele, may influence the discrepancy. METHOD We tested this hypothesis in 132 patients affected by a major depressive episode in the course of bipolar disorder. The severity of depression was evaluated using self-rated (Beck Depression Inventory: BDI) and observer-rated (Hamilton Depression Rating Scale: HDRS) measures. The BDI-HDRS discrepancy score was calculated and the effects of the rs1801260 polymorphism on this score and on depressive cognitive distortions, as measured on the Cognitions Questionnaire, were examined. RESULTS The rs1801260*C carriers showed higher BDI-HDRS discrepancy scores than T/T homozygotes. Mediation analysis using bootstrapping procedures revealed that the dimension of depressive cognition "hopelessness" fully mediates the association between the rs1801260 polymorphism and the BDI-HDRS discrepancy. LIMITATIONS Many gene polymorphisms other than CLOCK rs1801260 may also influence the BDI-HDRS discrepancy and depressive cognitive distortions. CONCLUSION Our current results suggest that factors affecting the biological clock can influence the "non-clock" psychopathological features of mood disorders.
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The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma. CHILDREN-BASEL 2017; 4:children4030016. [PMID: 28264496 PMCID: PMC5368427 DOI: 10.3390/children4030016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 01/22/2023]
Abstract
Research suggests that many children are exposed to adverse experiences in childhood. Such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioral, and physical outcomes. Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood.
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Different roles of resilience in a non clinical sample evaluated for family stress and psychiatric symptoms. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2015.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Benedetti F, Riccaboni R, Dallaspezia S, Locatelli C, Smeraldi E, Colombo C. Effects of CLOCK gene variants and early stress on hopelessness and suicide in bipolar depression. Chronobiol Int 2015. [PMID: 26204460 DOI: 10.3109/07420528.2015.1060603] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with mood disorders show a high dependence of behavior on the molecular characteristics of the biological clock. CLOCK rs1801260 gene polymorphism influences circadian behavior in bipolar disorder (BD), with *C carriers showing a delayed sleep onset and worse insomnia. Sleep phase delay and insomnia associate with suicide in the general population. METHODS We investigated the effects of rs1801260, and of exposure to stressful life events, on current suicidal ideation and history of suicide attempts in 87 depressed patients with BD. RESULTS rs1801260*C carriers currently showed worse Hamilton Depression Rating Scale scores for suicide and worse ratings for depressive cognitive distortions. Previous history of attempted suicide associated with exposure to higher stressful events in the early life, with rs1801260*C carriers showing a higher dependency of the modeled probability of attempting suicide on the severity of exposure to early stress. DISCUSSION CLOCK rs1801260 modulated the relationship between early stress, adult history of attempted suicide and current suicide ideation. Factors affecting the biological clock can influence "non-clock" core psychopathological features of mood disorders.
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Affiliation(s)
- Francesco Benedetti
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Roberta Riccaboni
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Sara Dallaspezia
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Clara Locatelli
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Enrico Smeraldi
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
| | - Cristina Colombo
- a Department of Clinical Neurosciences , Scientific Institute Ospedale San Raffaele and University Vita-Salute , Milano, Italy
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