Adverse Childhood Experiences (ACE) in outpatients with anxiety and depressive disorders and their association with psychiatric and somatic comorbidity and revictimization. Cross-sectional observational study

Research priorities for medically not yet explained symptoms expressed by patients, carers, and healthcare professionals in the Netherlands following the James Lind Alliance priority setting partnership approach

OBJECTIVE

Experiencing physical symptoms that are medically not yet explained (MNYES) is associated with considerable burden in daily life. Research priorities in this area have been primarily investigator-driven. The present study identifies the top 10 research priorities, incorporating the views of patients, carers and healthcare professionals.

METHODS

This study used the Priority Setting Partnership approach in collaboration with the James Lind Alliance (JLA). The priority setting approach combines survey-based data from patients with a specific disorder/condition and relevant stakeholders (i.e., caregivers and healthcare professionals) with input from group meetings and a final priority setting consensus meeting. There were three consecutive phases: (1) online survey with an open-ended question to collect topics for future scientific research (N = 345 participants); (2) an online survey among stakeholders to prioritise the research questions generated in Phase 1 (N = 400); and (3) a final multi-stakeholder consensus meeting, held over two half-days to determine the final top 10 research priorities for the Netherlands (day 1 N = 25, day 2 N = 24).

RESULTS

Phase 1 resulted in 572 topics, which were reduced to 37 summary research questions. Phase 2 resulted in 18 research priorities, that were ranked and the top 10 priorities were established during the final consensus meeting. The top 10 research priorities included three main themes: optimising efficient diagnosis and treatment, aetiology and prevention, and coping with MNYES.

CONCLUSION

The top 10 priorities provide insight into what is most important for future research into MNYES from the perspective of patients, carers and healthcare professionals.

How do Differences in Adolescent and Caregiver Reports of Adolescent Adverse Childhood Experiences Relate to Adolescent Depression?

Objective

To compare adolescent and caregiver reports of adolescent adverse childhood experiences (ACEs) and their relationship with current adolescent depression and to analyze the relationship between ACEs and depression.

Methods

We recruited 46 adolescent-caregiver dyads from a large, inner-city medical center's adolescent medicine clinic. Adolescents and caregivers completed the Center for Youth Wellness ACE questionnaire, encompassing traditional ACEs (eg, abuse, neglect, household dysfunction) and nontraditional ACEs (eg, foster care, parental death, exposure to community violence). Adolescents also completed the Patient Health Questionnaire-9A (PHQ-9A) depression screening tool.

Results

Among adolescents, 14 (30%) reported no traditional ACEs, 11 (24%) reported 1, and 21 (46%) reported more than 1. Regarding nontraditional ACEs, 16 (35%) reported none, 11 (24%) reported 1, and 19 (41%) reported more than 1. Caregiver reports consistently indicated lower ACEs compared with adolescent self-reports (P < .005). For the PHQ-9A scores, 26 (57%) of adolescents showed no or minimal depression, 14 (30%) mild, and 6 (13%) moderate depression. A moderate positive correlation emerged between PHQ-9A scores and self-reported traditional ACEs (rs = 0.5, P < .001) and nontraditional ACEs (rs = 0.49, P < .001). In addition, a positive correlation was observed between the absolute differences in adolescent and caregiver reports of traditional ACEs and PHQ-9A scores (n = 46, ρ = 0.51, P < .001).

Conclusions

As the differences in ACE reports between adolescents and caregivers increased, there was a corresponding increase in adolescent depression scores. It is essential to incorporate comprehensive ACE screening and encourage open communication between adolescents and caregivers, which may improve mental health outcomes.

Adverse childhood experiences and risky behaviors in Oman: A cross-sectional study

Objective

Adverse childhood experiences (ACEs), which refer to potentially traumatic events occurring during childhood, have been consistently linked to detrimental effects on high-risk behaviors through various studies. Nonetheless, such an association has rarely been examined in the context of Arab culture. This study aimed to investigate the association between ACE levels and high-risk behaviors (e.g., smoking, alcohol consumption, drug use, high-risk sexual behavior, and physical inactivity) among Omani adults.

Methods

This was a cross-sectional study with convenience sampling. The participants were recruited from a university-affiliated medical facility in Oman. Data were collected in 2022. They were asked to complete the Adverse Childhood Experience International Questionnaire (ACE-IQ).

Results

The study included 1648 Omani adults. Analyses revealed that the adjusted odds ratios (ORs) for engaging in some of the identified high-risk behaviors increased as the level of ACEs increased. Specifically, individuals with an ACE level of 4 exhibited higher odds of smoking (OR: 2.6), alcohol consumption (OR: 2.9), and risky sexual behavior (OR: 32) than those without ACEs.

Conclusion

The findings of this study underscore a notable association between ACEs and high-risk behaviors among Omani adults. Consequently, there is a pressing need for intensified efforts to prevent ACEs when possible and to alleviate their adverse effects, emphasizing the importance of public health initiatives and interventions in Oman.

Role of the Sibling Relationship to Reduce the Negative Impact of Adverse Childhood Experiences (ACEs) on Wellbeing in Adulthood

Over the past two decades, public health research has demonstrated that Adverse Childhood Experiences (ACEs) are associated with significant and prolonged physical and mental health problems, demanding investigation into the factors that may mitigate the poor outcomes. One potential factor that may attenuate the negative impact of ACEs on individuals' health is social support. An important source of social support, both during and after adverse childhood experiences, is sibling relationships. Consequently, the purpose of the current study was to examine if two components of sibling relationships-perceived warmth and conflict-affect the relationship between ACEs and wellbeing in adulthood. A total of 439 participants (Mage = 35.06, SD = 11.19) completed self-report measures of their ACEs, their perceived warmth and conflict with a living sibling, and their wellbeing. Results revealed that sibling relationships characterized by higher perceived warmth-and, interestingly, higher perceived conflict-attenuated the negative impact of ACEs on wellbeing in adulthood. Findings from the current study provide valuable information about how psychologist, social workers, and other health professionals may use siblings as a source of social support to mitigate the negative effects of ACEs on wellbeing in adulthood.

The trajectory of anxiety in therapy: The role of ACEs

The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.

Retrospective ACEs predict complex PTSD symptoms in a large sample of Chinese young adults longitudinally: the moderating role of self-compassion

This longitudinal study in Mainland China (2021-2022) explored the impact of adverse childhood experiences (ACEs) on complex posttraumatic stress disorder (CPTSD) symptoms, with a focus on the role of self-compassion. Among 18,933 surveyed university students, 21.2% reported experiencing at least one ACE. Results revealed a clear relationship between ACEs and CPTSD symptoms. Furthermore, self-compassion, particularly the dimensions of self-judgment and isolation, moderated the association between retrospective ACEs and posttraumatic stress disorder (PTSD) and disturbance in self-organization (DSO) symptoms. These findings highlight the enduring impact of ACEs on CPTSD symptoms and emphasize the importance of early identification and targeted interventions, especially addressing self-judgment and isolation, to mitigate CPTSD risk among young Chinese adults.

War and women: An analysis of Ukrainian refugee women staying in the Czech Republic

In addition to the loss of life, Russian aggression against Ukraine, which began in February 2022, also brings interpersonal losses resulting from the need to emigrate. Parallel to the fighting men, women bear most of the burden of caring for the family. Using in-depth interviews supplemented by questions about adverse childhood experiences and administration of The Centrality of Events Scale and the PTSD Checklist - PCL-5 with 43 Ukrainian women (18-60 years old), we analyzed adaptation to the situation of emigration and the association of their war and earlier experiences with the level of traumatization. Women were interviewed shortly after emigration to the Czech Republic (3-42 week afterward). High levels of adverse childhood experiences and post-traumatic stress symptoms were found. The war was perceived as a currently negative central event associated with traumatic stress symptoms, and 79% of the sample expressed the opinion that the war had changed them. The results of this study suggest an intertwining of previous life experiences with the current need and ability to adapt.

Childhood adversity in a youth psychiatric population: prevalence and associated mental health problems

Background: Childhood adversity can have lasting negative effects on physical and mental health. This study contributes to the existing literature by describing the prevalence rates and mental health outcomes related to adverse childhood experiences (ACEs) among adolescents registered for mental health care.Methods: Participants in this cross-sectional study were youths (aged 12-18 years) who were referred to outpatient psychiatric departments in the Netherlands. Demographic information was collected from the medical records. The Child Trauma Screening Questionnaire (CTSQ) was used to examine the presence of ACEs and posttraumatic stress symptoms (PTSS). To assess mental health problems, we used the Dutch translation of the Youth Self Report. Descriptive statistics and frequencies were used to calculate prevalence rates across the various ACEs domains. ANOVA and chi-square tests were used to explore the relationship between ACEs and mental health.Results: Of the 1373 participants, 69.1% reported having experienced at least one ACE and 17.1% indicated exposure to four or more ACEs in their lives. Although there was substantial overlap among all ACE categories, the most frequently reported were bullying (49.2%), emotional abuse (17.8%), physical abuse (12.2%), and sexual abuse (10.1%). Female adolescents (72.7%) reported significantly more ACEs than their male counterparts (27.0%). Furthermore, a higher number of ACEs was associated with significantly more self-reported general mental health problems, an elevated prevalence of both mood and post-traumatic stress disorders, and a greater presence of two or more co-existing psychiatric diagnoses (comorbid psychiatric classification).Conclusions: This cross-sectional study on childhood adversity and its association with mental health showed that ACEs are highly prevalent in youth registered for mental health care. This study provides support for a graded and cumulative relationship between childhood adversity and mental health problems.

Workplace trauma and professional quality of Life in clinical and forensic psychiatry: the CRITIC study

Background

Frontline staff in psychiatry need to perform at a very high professional level in order to ensure patient and community safety. At the same time they are exposed to high levels of stress and workplace trauma. This may have severe consequences for their professional quality of life. In addition, health care workers in general have higher incidence levels of childhood adversity than the general population. The CRITIC (CRITical Incidents and aggression in Caregivers) Study aims to improve increased understanding of the interaction between personal life history (childhood adversity and benevolence), individual capabilities, exposure to trauma and violence at work and Professional Quality of Life (ProQOL).

Method

The Critic Study is a cross-sectional survey of these aspects in frontline, treatment and administrative staff in clinical and forensic psychiatry. We aim to include 360 participants. Participants will be asked to complete questionnaires on childhood adversity and childhood benevolence (assessing personal life history), professional quality of life, current trauma and violence exposure, current mental health (depression, anxiety and stress), coping, social support, work engagement and resilience. In this study we will examine the moderating role of adverse and benevolent childhood experiences in the association between workplace trauma exposure and professional quality of life. Finally, a theoretical model on the relationships between trauma, stress and coping in the context of professional functioning will be tested using structural equation modelling.

Discussion

The CRITIC study examines which factors influence the complex relationship between childhood adversity and benevolence, and ProQOL in healthcare workers. It also aims to provide insight into the complex relationship between personal life history, individual characteristics, exposure to trauma and violence at work and ProQOL. The results can be used for designing interventions to increase resilience to trauma and to improve professional quality of life among health care professionals.

Trial registration

The CRITIC study has been approved by the Medical Ethical Committee of the Erasmus Medical Centre, under trial registration number NL73417.078.20.

Routine screening for adverse childhood experiences (ACEs) still doesn't make sense

When a serious health or social problem is identified as both prevalent and in need of attention, a common response is to propose that various systems implement routine identification, such as universal screening. However, these well-intentioned responses often fail to consider the key requirements necessary to determine whether benefits outweigh harms. Unfortunately, this continues to be the case for calls to implement routine screening for Adverse Childhood Experiences (ACEs). Persistent evidence gaps for this type of screening include the lack of any randomized controlled trials demonstrating that ACEs screening programs lead to any benefits. Rather than being informed by established screening principles, the calls to proceed with ACEs screening appear to rely on the assumption that simply identifying risk factors can lead to beneficial outcomes that outweigh any risk of harms. This may reflect a gap in understanding that patterns identified at the population level (e.g., that more ACEs are associated with more health and social problems) cannot be directly translated to practices at the level of the individual. This commentary does not question the importance of ACEs; rather it identifies that directing limited resources to screening approaches for which there is no evidence that benefits outweigh harms is problematic. Instead, we advocate for the investment in high-quality trials of prevention interventions to determine where best to direct limited resources to reduce the occurrence of ACEs, and for the prioritization of evidence-based treatment services for those with existing health and social conditions, whether or not they are attributed to ACEs.

Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents

OBJECTIVES

Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children.

DESIGN

Single-center prospective observational study.

SETTING

Urban academic children's hospital from January to December 2021.

PATIENTS

One hundred forty-five children (2-18 yr old, admitted ≥ 2 d) and their parents.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03-100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients' risk for PTSD (aOR = 3.5 [95% CI, 0.56-21.31]; p = 0.18).

CONCLUSIONS

ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child's PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.

Virtual reality aggression prevention treatment in a Dutch prison-based population: a pilot study

Background

Treating violent behavior in prisons comes with challenges, such as the inability to practice safely with triggering situations and motivational issues. A solution may be the use of Virtual Reality (VR). With VR, specific conditions or needs can be tailored for individual practice, it can enhance motivation and VR has proven to be a safe and effective tool in mental health treatment.

Objective

A pilot study was conducted to test the acceptability, feasibility, and preliminary effects of VR Aggression Prevention Treatment (VRAPT) in a prison-based population.

Methods

In total 17 detainees with aggressive behavior were included in this single-group pilot study. Acceptability and feasibility were assessed using qualitative measures for participants and therapists. Preliminary treatment effects were measured with self-report and observational measures on aggression, anger, emotion regulation, and impulsiveness.

Results

Participants and therapists were predominantly positive about VRAPT. Participants rated the sessions with an average satisfaction score of 9.2 out of 10 (SD = 0.3). Qualitative data showed that participants reported having learned to respond more adequately to aggressive behavior and gained insights into their own and others' triggers and tension. The combination of VR and theory was experienced as a strength of the treatment, as well as the ability to trigger aggression in VR which provided insights into aggression. However, the theoretical framework was found to be too complex, and more aggressive and personal scenarios should be incorporated into the sessions. Self-reported aggression, anger, provocation, emotion regulation, and observed verbal aggression decreased and seemed to stabilize after the treatment ended, with small to medium effect sizes.

Conclusion

VRAPT proved feasible and acceptable for most participants and therapists. An adapted treatment protocol called Virtual Reality Treatment for Aggression Control (VR-TrAC), will be used in a future RCT to investigate the effects of the treatment in a prison-based population.

Protocol for evaluation of effects of a psychoeducational trauma-informed intervention directed at schools

Background: Adverse childhood experiences (ACE) can have negative effects on cognitive, social and emotion regulation abilities, which can threaten the child's school integration and capacity to learn. While steady relations to sensitive, understanding adults may moderate these negative outcomes, the difficulties of children with ACEs pose a major challenge for teachers, whose insufficient preparation may lead to career attrition.Objective: Psychoeducational trauma-informed care (TIC) interventions targeting teachers may strengthen teacher preparation and buffer the deleterious outcomes of ACEs, yet the evidence-base for these interventions is limited. Importantly, while minority groups are overrepresented among those with ACEs and additionally risk exposure to ethno-racial trauma, TIC interventions lack a social disadvantage/discrimination perspective. The Present trial addresses these issues.Method: The study protocol employs a quasi-experimental design for assessing effects of a psychoeducational TIC intervention carried out in Swedish schools by Save the Children, Sweden (SCS). We compare, for the first time, an intervention group (N = 160) and a control group (N = 160) over time (pre-intervention, immediately after, 6 and 12 months post-intervention), assessing teacher stress, compassion fatigue, self-efficacy and trauma-informed knowledge. We monitor teacher attitudes and attributions of students' academic weaknesses and behavioural and mental difficulties. The trial is preregistered (DOI:10.17605/OSF.IO/V7SH8).Results: We hope that the mitigating effects of the SCS-TIC school intervention may be independent of social category, and that the trial will additionally generate knowledge of how providers and recipients of TIC may respond to it differently depending on their social and cultural identities. As school-based TIC practices and interventions are expansively relied on as means of preventing teacher burnout and career attrition, and buffering negative consequences of ACEs for children, establishing their effects with methodological robustness is important and timely.Conclusion: Such knowledge may be used to tailor and target interventions to specific populations, while ensuring maximum effectiveness.

Prevalence of Childhood Trauma in a Community-Based Mental Health Clinic

A large number of individuals in the US have experienced childhood trauma. However, little is known about the prevalence of trauma in a diverse patient population entering treatment in a community mental health center. To assess early trauma in this population, the Adverse Childhood Experience (ACEs) questionnaire was administered to 856 participants over a nine-month period. 40% reported four or more ACEs. Among high scorers, emotional abuse, physical abuse and emotional neglect were the most prevalent ACE experiences. High mean ACE sum scores were observed among patients with PTSD, depression, impulse disorder and substance use disorder. Having a higher ACE sum score was associated with a greater number of co-occurring psychiatric disorders. Characterizing ACEs by patient sociodemographic attributes and psychiatric diagnoses extracted from the electronic medical records (EMR) can benefit therapeutic interventions. These findings indicate a need for creating more trauma-informed settings with knowledgeable, trained staff.

The associations among childhood trauma, loneliness, mental health symptoms, and indicators of social exclusion in adulthood: A UK Biobank study

AIMS

Childhood trauma has been associated with adult psychosocial outcomes linked to social exclusion. However, the strength of these associations in the general population is unknown. The emergence of the UK Biobank, with rich phenotypic characterization of the adult population, affords the exploration of the childhood determinants of adult psychopathology with greater statistical power. The current study aims to explore (1) the associations between childhood trauma and social exclusion in adulthood and (2) the role that self-reported loneliness and symptoms of distress play in the associations.

METHODS

This study was an analysis of 87,545 participants (mean [± SD] age = 55.68 [7.78], 55.0% female, 97.4% White) enrolled in the UK Biobank. Childhood trauma was determined by the five-item Childhood Trauma Screener. Current loneliness and symptoms of anxiety (Generalized Anxiety Disorder Scale-7) and depression (Patient Health Questionnaire-9) were also entered in analyses. Outcomes were "limited social participation," "area deprivation," "individual deprivation," and "social exclusion" from a previously determined dimensional measure of social exclusion in the UK Biobank.

RESULTS

Hierarchical multiple regression models indicated small associations between childhood trauma and social exclusion outcomes, explaining between 1.5% and 5.0% of the variance. Associations weakened but remained significant when loneliness, anxiety, and depression were entered in the models; however, anxiety symptoms demonstrated a negative association with "individual deprivation" and "social exclusion" in the final models. Depression was most strongly associated with "individual deprivation," "area deprivation," and "social exclusion" followed by childhood trauma. Loneliness was most strongly associated with "limited social participation."

CONCLUSIONS

Experiences of childhood trauma can increase the propensity for adulthood social exclusion. Loneliness and symptoms of depression attenuate but do not eliminate these associations. Anxiety symptoms have a potentially protective effect on the development of "individual deprivation." Findings add to the growing body of literature advocating for trauma-informed approaches in a variety of settings to help ameliorate the effects of childhood trauma on adult psychosocial outcomes. Further research, however, is required.

The association between childhood trauma and pain symptoms in depressed adults: The moderating role of anxious attachment

Studies have previously demonstrated that anxious attachment shapes the association between childhood traumatic experiences and somatic pain; however, it remains unclear how this relationship is influenced by anxious attachment in patients with depression. This study investigated how anxious attachment influences the relationship between childhood traumatic experiences and pain symptoms in depressed patients from a social psychological perspective. A total of 139 adult patients with depression participated in this study; the level of depression was assessed by a psychiatric professional. Childhood trauma, pain symptoms, and attachment dimensions were tested by various questionnaires. The moderating role of anxious attachment in the trauma-pain association was examined using the PROCESS Model 1. Our findings showed that in depressed patients, childhood maltreatment had a significant positive impact on the severity of pain ratings. Moreover, anxious attachment influenced the relationship between childhood trauma and pain symptoms. Our study indicated that anxious attachment is not necessarily a negative outcome for depressed patients; moderate levels of anxious attachment alleviate childhood trauma-related pain symptoms in individuals with highly traumatic experiences. Understanding the traumatic experiences and attachment styles of depressed patients with pain complaints can help to develop intervention strategies.

Conduct Problems As a Pathway From Childhood Adversity to Community Violence Exposure: The Protective Roles of Caregiver Knowledge and Involvement

Exposure to community violence (ECV) poses a prevalent threat to the health and development of adolescents. Research indicates those who have more Adverse Childhood Experiences (ACEs) are at higher risk for ECV, which further exacerbates risk of negative mental and physical health impacts. Additionally, those with more ACEs are more likely to exhibit conduct problems, which has also been linked to risk for ECV. Despite the prevalence and impact of ECV, there is limited longitudinal research on the risk factors that precede this exposure as well as family-level factors that may prevent it. The current study examined conduct problems as a potential mediator between ACEs and future indirect (i.e. witnessing) ECV in adolescents. Additionally, this study included caregiver factors, such as caregiver knowledge about their adolescent, caregiver involvement, and caregiver-adolescent relationship quality as potential protective moderators. Participants included (N = 1137) caregiver-adolescent dyads identified as at-risk for child maltreatment prior to child's age four for inclusion in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Conduct problems at age 14 mediated the relationship between ACEs from ages 0-12 and indirect ECV at age 16 (standardized indirect effect = .03, p = .005). Caregiver knowledge moderated the indirect relationship (b = -.40, p = .030), and caregiver involvement moderated the direct relationship between ACEs and indirect ECV (b = -.03, p = .033). Findings expand our knowledge about the longitudinal pathways that increase risk of violence exposure over the course of adolescent development, as well as the protective benefits caregivers can offer to disrupt these pathways and reduce risk of future traumatization. Implications are discussed for interventions that aim to address and prevent trauma and adverse outcomes among youth exposed to child maltreatment, household dysfunction, and community violence.

Links between mothers' ACEs, their psychopathology and parenting, and their children's behavior problems-A mediation model

Introduction

Children of mothers with a history of adverse childhoods are at greater risk of behavior problems. However, the mechanisms through which a mother's early adverse experiences (ACEs) are transmitted to her children need further study. Our goal was to examine a conceptual mediational model linking mothers' ACEs, maternal psychopathology symptoms, and parenting behaviors with children's internalizing and externalizing behaviors sequentially.

Methods

A sample of 153 Israeli mothers of children ages 3-12 (52% girls) participated in the study, and most of the mothers (94.7%) were cohabiting with a spouse. Mothers completed online questionnaires about their early adverse experiences, psychopathology symptoms, parenting behavior, and their children's internalizing and externalizing behavior.

Results

Results showed that mothers with higher ACE scores reported more maternal psychopathology symptoms and more internalizing behavior in their children. The mother's psychopathology in and of itself mediated the link between her ACEs and her child's internalizing and externalizing behavior. Moreover, an indirect sequential path emerged linking ACEs with the mother's psychopathology symptoms, which, in return, were linked with hostile parenting. Hostile parenting, in turn, was linked with children's internalizing and externalizing behavior.

Discussion

These findings highlight the complicated and intertwined ways in which adverse experiences early in the mother's life might put her child's wellbeing at risk. The findings suggest that ACEs are linked to maternal affect dysregulation, which interferes with parenting, increasing the risk of behavior problems in children. The findings underscore the need to assess mothers' adverse history, psychological distress, and parenting behavior, and provide treatments that can reduce the intergenerational transmission of early adverse experiences.

Modeling the Adverse Childhood Experiences Questionnaire-International Version

Adverse childhood experiences (ACEs) are related to a host of deleterious physical and mental health outcomes. The ACE-International Questionnaire (ACE-IQ) was developed to assess categories of ACEs (e.g., sexual, emotional, and physical abuse) in internationally representative samples. Though the ACE-IQ has been used world-wide, little work has examined the structure of this measure. Further, much of the modeling techniques implemented lacked theoretical rationale. The present work used two principal components analyses (PCA) to evaluate the ACE-IQ structure using both the identified ACE categories as defined by the World Health Organization (WHO) and using the ACE-IQ items as individual indicators. Using the WHO method, a two-component structure was indicated. Alternatively, a PCA of the individual items yielded a six-component structure. Results highlight the importance of theoretically grounded measure evaluation and the potential distinctions amongst types of ACEs. Implications and future directions for research and practice are discussed.

Insights from Expanded Adverse Childhood Experiences Screening in a Hospital-Based Outpatient Psychiatry Service

Adverse childhood experiences (ACEs) are associated with poor mental health in adulthood. Comprehensive prevalence data encompassing all 10 ACE questionnaire items has not previously been described in a hospital-based outpatient psychiatric clinic. This study assessed the prevalence of 10 ACEs in such a clinic and correlated ACEs with indicators of case severity. For 252 patients newly evaluated in an urban clinic, a retrospective chart review was completed and data was collected on ACE questionnaire responses, psychiatric, substance-related, and medical diagnoses, psychiatric hospitalizations, suicide attempts, and suicide and violence risk. Patients in the clinic had an average of 3.4 ACEs, higher than national community sample averages of 1.6. The percentages of patients with at least one, two, and four ACEs were 82% (n = 207), 68% (n = 172), and 42% (n = 106) respectively (compared with 61%, 38%, and 15% nationally). ACEs had statistically significant correlations with an increased number of psychiatric diagnoses, substance use disorders, medical illnesses, suicide attempts, and suicide risk level. This study demonstrated that patients seeking psychiatric care from a hospital-based outpatient clinic are likely to be traumatized to a degree far exceeding what is typical in the general population. While a high prevalence of ACEs in a psychiatric population is an expected finding given the literature to date, this is the first study presenting data on the prevalence of ACEs in such a hospital-based community clinic. Additionally this study reinforces prior research correlating childhood adversity and case severity.

Expanding the Traumatic Stress Framework to Incorporate a Socioecological Family Systems Perspective

Over the past few decades, there has been a growing interest among systemic researchers and clinicians to address issues related to psychological traumatic stress. Yet, research in this area has largely focused on intrapersonal and physiological processes in conceptualizing traumatic stress and its various outcomes. Despite the usefulness of intrapersonally focused models of traumatic stress, this approach has its limitations. Emerging evidence indicates that both proximal contexts, such as family, and distal socioecological contexts, such as political and environmental systems, can have a profound effect on traumatic stress risk, presentation, and recovery. In the present article, we review and synthesize emerging research on traumatic stress and integrate findings from intrapersonally and systemically focused models of traumatic stress. We propose and present evidence for what we term the dynamic socioecological framework of traumatic stress, a heuristic framework for conceptualizing the interactions between different forms of traumatic stress. This framework puts forward the dimensions of traumatic stress typology, severity, and timing, underscoring how traumatic stress risk, presentation, and recovery are highly dependent upon the systems in which people are embedded. We conclude with a discussion of the research and clinical implications of this conceptual framework.

Adverse childhood experiences among adults with eating disorders: comparison to a nationally representative sample and identification of trauma

BACKGROUND

Adverse childhood experiences (ACEs) are prevalent, impact long-term physical and mental health, and are associated with eating disorders (EDs) in adulthood. The primary objectives of the current study were: (1) to examine and compare ACEs between two samples: treatment-seeking adults, and a nationally representative sample of adults, (2) to characterize ACEs items and total scores across demographic and diagnostic information in adults seeking treatment for an ED, (3) to statistically classify ACEs profiles using latent class analysis, and (4) to examine associations between ACEs profiles and diagnosis.

METHODS

This cross-sectional study assessed patients with a DSM-5 ED receiving treatment between October 2018 and April 2020 at the inpatient, residential, or partial hospitalization levels of care at one of two private ED treatment facilities. ACEs were assessed with the Adverse Childhood Experiences Survey at admission. Generalized linear models and Welch's t-tests were used to compare ACEs in the current sample with national estimates. A latent class analysis was conducted to examine subgroups of ACEs responses, and differences in these classes by ED diagnoses were examined with multinomial logistic regression.

RESULTS

Patients with EDs had significantly higher ACEs scores (M = 1.95, SD = 1.90) than the nationally representative sample (M = 1.57, SD = 4.72; t = 6.42, p < .001). Within patients with EDs, four latent classes of ACEs item endorsement were identified. Patients with other specified feeding or eating disorder (OSFED) and binge eating disorder (BED) were more likely to fall into the "Household ACEs" and "Abuse ACEs" groups, respectively, compared to anorexia nervosa-restricting subtype (AN-R).

CONCLUSIONS

Patients with EDs reported more ACEs than the nationally representative sample, and differences in total ACEs and latent class membership were found across ED diagnoses. The current study can inform the development of trauma-informed care for patients with EDs.

Four clinical profiles of adult outpatients with somatic Symptom Disorders and Related Disorders (SSRD). A latent class analysis

OBJECTIVE

To obtain more insight into the patterns of co-occurring symptoms, biomarkers and predictors in Somatic Symptom Disorders and Related Disorders (SSRD) and to identify subgroups with profiles that might allow for personalised treatment.

METHODS

Cross-sectional study design with Latent class analysis (LCA) to determine different subgroups in a cohort of 239 outpatients with SSRD in 3 steps: 1) building a latent class model; 2) assigning subjects to the latent classes that suited them best based on their posterior probability; 3) investigating the associations between these classes and personal characteristics such as age, gender, somatic comorbidity and general health perception.

RESULTS

Four classes with clinically relevant profiles were found. One with trauma plus elevated inflammation biomarkers, high somatic symptom levels, pain and comorbid depression and anxiety. One with pain plus elevated biomarkers, depression and anxiety. One with low IL-6 and hsCRP, mostly linked to Illness Anxiety. And one with high pain and high elevated biomarkers, but less probability of other factors, that occurred mostly in men. General health perception was lower in classes with elevated inflammation biomarkers.

CONCLUSIONS

The findings of this first study exploring latent classes in an SSRD sample corroborate the current DSM-5 SSD subclassification for pain and Illness Anxiety Disorder. There is scope to extend the current DSM-5 classification with a subclassification of SSD with trauma, and a subclassification with elevated IL6 or hsCRP, as relevant for developing new personalised treatments addressing trauma or SLI in SSRD. Further research is needed to explore this.

Limitations of the protective measure theory in explaining the role of childhood sexual abuse in eating disorders, addictions, and obesity: an updated model with emphasis on biological embedding

In addition to its immediate negative consequences, childhood sexual abuse is associated with lifelong deleterious mental and physical health outcomes. This review employs a biopsychosocial perspective to better understand pathways from childhood sexual abuse to eating disorders, food and drug addictions, and obesity across the life course. Guided by an updated conceptual model, this review delineates how the biological embedding of childhood sexual abuse triggers a cascade of interrelated conditions that often result in failed attempts at weight suppression and eventually obesity. Such biological embedding involves pathways such as inflammation, allostatic load, reward sensitivity, activation of the hypothalamic-pituitary-adrenal axis, epigenetics, and structural and functional changes in the brain. These pathways are in turn theorized to lead to food addiction, substance use disorder, and eating disorders-each with potential pathways toward obesity over time. Predisposing factors to childhood sexual abuse including gender, culture, and age are discussed. This model calls into question the longstanding "protective measure" theory that purports individuals exposed to sexual abuse will deliberately or subconsciously gain weight in attempt to prevent future victimization. A more comprehensive understanding of the mechanisms by which childhood sexual abuse becomes biologically embedded may help clinicians and survivors normalize and/or address disordered eating and weight-related outcomes, as well as identify intervention strategies.Level of evidence: Level V: opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Sexual Victimization in Adulthood and Associated Factors Among Men and Women: Cross-Sectional Evidence from Mainland China

Limited empirical research addresses sexual victimization and related factors among the general adult population in China. To address this gap, we explored the association between sexual victimization in adulthood and associated factors (unwanted sexual experiences [USE] before age 18, binge drinking prior to sex, hooking up, violent pornography use, awareness and perceived behavioral control of consent, and sexual refusal assertiveness) among a convenience Chinese sample. A cross-sectional study was performed in September 2020 among 898 screened men and women from 29 provinces in mainland China. Overall, 52.5% of men and 57.9% of women experienced sexual victimization at least once in adulthood. Men and women differed in the severity of sexual victimization in adulthood, with the mean severity scores of women being significantly higher than those of men. Hierarchical ordinal logistic regression revealed that, after considering control variables, correlates of severity of sexual victimization in adulthood included gender (OR 3.17, 95% CI 2.30-4.40), severity of USE before age 18 (OR 2.28, 95% CI 1.92-2.73), binge drinking prior to sex (OR 2.52, 95% CI 1.83-3.49), hook-up history (OR 2.24, 95% CI 1.49-3.39), violent pornography use (OR 1.07, 95% CI 1.04-1.09), lack of perceived behavioral control of communicating consent (OR 1.04, 95% CI 1.01-1.07), and sexual refusal assertiveness (OR 0.92, 95% CI 0.89-0.95). These findings indicate that early adverse sexual experiences, potential risky sexual behaviors, violent pornography use, and beliefs about consent and refusal may play an important role in predicting sexual victimization among Chinese adults.

Adverse childhood experiences among a treatment-seeking sample of adults with eating disorders

OBJECTIVE

The purpose of the current study was to examine the prevalence of adverse childhood experiences (ACEs) among adults with eating disorders (EDs), to assess whether experiencing a greater number of ACEs is associated with more severe ED psychopathology, and to determine whether ACEs predict treatment outcome.

METHOD

Participants were 1819 patients (88.5% female, ages 18-72) admitted to one of two treatment facilities at inpatient, residential, or partial hospitalisation levels of care. The Adverse Childhood Experiences Survey and the Eating Pathology Symptom Inventory (EPSI) were completed at admission and the EPSI at discharge.

RESULTS

Female patients reported higher ACEs than males (p = 0.03), and all diagnoses except avoidant/restrictive food intake disorder had significantly higher ACEs than patients with anorexia nervosa-restricting type (AN-R) (p's < 0.01). Across diagnoses, higher ACEs were associated with decreases in binge eating scores during treatment, but were not associated with changes in purging or restricting. Within diagnoses, higher ACEs scores were associated with decreases in purging for patients with AN-R and increases in purging for patients with binge eating disorder.

CONCLUSIONS

Results partially supported the hypothesis that higher ACEs would be associated with more severe ED psychopathology.

Internalizing Symptoms Among Youth in Foster Care: Prevalence and Associations with Exposure to Maltreatment

Among youth in foster care (N = 303, aged 11-17 years), we investigated prevalence of internalizing symptoms; associations between symptom level and maltreatment types and numbers; and the interaction between gender and maltreatment, on internalizing symptoms. Youth completed Spence Children Anxiety Scale, Short Mood Feelings Questionnaire, and Child and Adolescent Trauma Screen. Compared to community samples, symptom levels above clinical cut-off was more frequent, with social- and generalized anxiety (ES = 0.78-0.88) being most prevalent among youth in foster care. Girls reported more internalizing symptoms (ES = 0.59-0.93). Sexual abuse and neglect were associated with a broader range of internalizing symptoms (ES = 0.35-0.64). Increased incidence of maltreatment was associated with increased levels of symptoms (ES = 0.21-0.22). Associations between maltreatment and symptom level were stronger for girls. This study stresses the importance of broad screening of maltreatment and internalizing symptoms to meet the needs of youth in foster care.

Deconstructing pathways to resilience: A systematic review of associations between psychosocial mechanisms and transdiagnostic adult mental health outcomes in the context of adverse childhood experiences

Adverse childhood experiences (ACEs) are identified with increased risk of adult mental health difficulties and negative impacts on well-being. However, there is a need to go beyond simple associations and identify candidate mechanisms underpinning the ACEs-mental health relationship. Further methodological heterogeneity points to issues around the operationalization of ACEs and the importance of modelling data using robust research designs. The aim of the current review was to synthesize studies that utilized formal mediation and/or moderation analyses to explore psychological and social variables on the pathway between clearly defined ACEs (as measured by the ACE questionnaire and Childhood Trauma Questionnaire [CTQ]) and common mental health outcomes (depressive, anxiety and post-traumatic stress disorder [PTSD] symptoms) across community samples aged over 18. A total of 31 papers were retrieved for critical appraisal. The majority of the studies explored factors mediating/moderating the link between child adversity and depression and less on anxiety and trauma. Most mechanisms were tested in only single studies, limiting the consistency of evidence. Evidence indicated that the mechanisms underlying associations between ACEs and adult mental health are likely to reflect multiple intervening variables. Further, there are substantial methodological limitations in the extant literature including the proliferation of causal inferences from cross-sectional designs and both measurement and conceptual issues in operationalizing adversity. Consistent transdiagnostic mechanisms relevant to common mental health problems were identified, including perceived social support, emotion regulation and negative cognitive appraisals/beliefs. Further research using longitudinal design is required to delineate the potential contribution of the identified mechanisms.

Adverse childhood experiences as risk factors for recurrent admissions in young psychiatric inpatients

BACKGROUND

Patients who require psychiatric inpatient treatment early in life are a particularly at-risk population. Factors such as adverse childhood experiences (ACEs) are, however, not well studied in those requiring psychiatric inpatient treatment during both childhood or adolescence and adulthood. Thus, the aim of the current study was to investigate, in young adult inpatients, the risk factors for prior admissions in Child and Adolescent Psychiatry, with a focus on ACEs.

MATERIALS AND METHODS

An explorative population-based systematic chart investigation of psychiatric inpatients aged 18-25 was conducted at the University Hospital Tulln, Austria. Data analysis was done with descriptive methods and Pearson's chi- squared-, Fisher's exact-, Mann-Whitney-U-tests and predictive logistic regression models.

RESULTS

The sample comprised 390 inpatients (51.8% female), with an average age of 20 years at first psychiatric hospital admission. Those with a former child and adolescent psychiatry inpatient treatment (10.3%) were predominantly female (77.5%). Their number of documented ACEs was increased compared to those without former child and adolescent psychiatry admissions (2 vs 1.1), with up to twice as many experiences of family dysfunction, neglect or abuse. Sexual abuse (OR: 3.0), having been an adopted or fostered child (OR: 4.5), and female sex (OR: 3.0) were identified as main risk factors. Furthermore, former child and adolescent psychiatry inpatients suffered from higher rates of psychosomatic or personality disorders, comorbidities and functional impairment, and were readmitted twice as often in young adulthood.

CONCLUSION

Young adult inpatients with reoccurring psychiatric inpatient treatments have increased rates of severe ACEs. Thus, special attention should be given to identifying ACEs, evaluating needs for psychosocial support and therapy, and meeting these needs after discharge.

Multiomic biological approaches to the study of child abuse and neglect

Childhood maltreatment, occurring in up to 20-30% of the population, remains far too common, and incorporates a range of active and passive factors, from abuse, to neglect, to the impacts of broader structural and systemic adversity. Despite the effects of childhood maltreatment and adversity on a wide range of adult physical and psychological negative outcomes, not all individuals respond similarly. Understanding the differential biological mechanisms contributing to risk vs. resilience in the face of developmental adversity is critical to improving preventions, treatments, and policy recommendations. This review begins by providing an overview of childhood abuse, neglect, maltreatment, threat, and toxic stress, and the effects of these forms of adversity on the developing body, brain, and behavior. It then examines examples from the current literature of genomic, epigenomic, transcriptomic, and proteomic discoveries and biomarkers that may help to understand risk and resilience in the aftermath of trauma, predictors of traumatic exposure risk, and potential targets for intervention and prevention. While the majority of genetic, epigenetic, and gene expression analyses to date have focused on targeted genes and hypotheses, large-scale consortia are now well-positioned to better understand interactions of environment and biology with much more statistical power. Ongoing and future work aimed at understanding the biology of childhood adversity and its effects will help to provide targets for intervention and prevention, as well as identify paths for how science, health care, and policy can combine efforts to protect and promote the psychological and physiological wellbeing of future generations.

IL-6 and hsCRP in Somatic Symptom Disorders and related disorders

Interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) are biomarkers of systemic low-grade inflammation (SLI) in depression and anxiety. The question if SLI in those conditions is related to comorbid chronic medical conditions has not been resolved. DSM-5 Somatic symptom disorders and related disorders (SSRD) are conditions with serious distress related to physical symptoms as main criterion. They can occur in patients with medically unexplained symptoms (MUS) and in patients with known comorbid chronic medical conditions. Often, comorbid depression and anxiety are present. SSRDs offer the opportunity to explore the role of SLI in relation to mental distress, including trauma, MUS, chronic medical conditions and comorbid mental disorder.

AIM

We hypothesized that increased IL-6 and hsCRP may be directly linked to SLI in SSRD, and that comorbid chronic medical conditions, childhood trauma, current stress and comorbid depression and anxiety may be risk factors that account for some of the variance of SLI in SSRD.

METHODS

We explored these relationships in a large sample of 241 consecutive outpatients with SSRD.

RESULTS

Mean hsCRP level was 3.66 ​mg/l, and mean IL-6 level was 3.58 ​pg/ml. IL-6 and hsCRP levels were associated with each other: τ ​= ​0.249, p ​< ​.001; a medium size correlation. Comorbid chronic medical conditions, adverse childhood events other than sexual trauma, and current stress levels were not associated with IL-6 or hsCRP levels.

CONCLUSION

IL-6 and hsCRP are elevated in SSRD, indicating SLI in SSRD independently of comorbid chronic medical conditions. In clinical research, elevated IL-6 and hsCRP can be used as biomarkers of SLI and can indicate risk for childhood sexual abuse in SSRD. Elevated hsCRP may be a biomarker indicating risk for comorbid depression or high pain levels in SSRD as well.

Childhood adversity links to self-reported mood, anxiety, and stress-related disorders

BACKGROUND

Child abuse has been identified within the DSM-5 as a putative etiologic risk for over two dozen psychiatric disorders.

METHODS

This study examined associations between self-reported diagnostic histories of six Mood, Anxiety and Stress-Related Disorders and childhood adversities measured using dichotomous ACE (Adverse Childhood Experiences) counts and dimensional indices of child abuse.

RESULTS

Adversity odds ratio were all significant (p < .001) and averaged as follows: sexual abuse, OR_M = 3.16; emotional abuse, OR_M = 2.62; physical abuse, OR_M = 2.41; maternal battering, OR_M = 2.15. An effort was made to differentiate between additive and interactive adversity risks. While significant adversity interactions were found, they tended to be modest in effect sizes and scope. The combination of sexual, physical and emotional abuse was associated with a maximal odds ratio and prevalence for Major Depression (OR = 5.13, 70.8%). The large impacts of unitary adversities limited the potential for large interactive effects.

LIMITATIONS

The cross-sectional analysis relied on retrospective self-reports that may not generalize fully to respondents differing in ethnicity, religion, sexual orientation, or other factors.

CONCLUSIONS

Childhood adversity in four different forms was associated with higher prevalence rates for six different mood and anxiety disorders. Childhood sexual and emotional abuse appeared to account for unshared variance in all of these lifetime diagnoses. Significant high risk adversity combinations were found for Major Depression (sexual/physical/ emotional), Post-Traumatic Stress Disorder (sexual/physical & physical/maternal battering), and Generalized Anxiety Disorder (physical/emotion/maternal battering).

Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

BACKGROUND

Conversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown.

AIM

1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND.

METHOD

Feasibility study.

RESULTS

The study showed active involvement of patients despite high clinical illness burden and disability, neurocognitive symptoms, childhood adverse experiences (ACE) and current life events. The study provided valuable knowledge regarding the feasibility of conducting a study in these patients that will inform future study phases. In the sample there were elevated levels of IL6, IL12, IL17A, IFNg, TNFa and VEGF-a, suggesting systemic low-grade inflammation. Also, microRNAs involved in inflammation and vascular inflammation were correlated with TNFa and VEGFa respectively, suggesting proof of concept for an epigenetic mechanism. Owing to the COVID-19 outbreak, the patient sample was limited to 15 patients.

CONCLUSION

It is a novelty that this study is conducted in the clinical setting. This innovative, translational study explores stress-related SLI in CD/FND patients and the feasibility of a larger project aiming to develop new treatments for this vulnerable population. Given the positive findings, there is scope to conduct further research into the mechanism of disease in CD/FND.

Cognitive flexibility and perceived threat from COVID-19 mediate the relationship between childhood maltreatment and state anxiety

Converging empirical evidence indicates that exposure to adversity in childhood is associated with increased vulnerability to mental health problems in adulthood. As early life adversity has the potential to alter an individual’s appraisal of threat, we hypothesized that individuals exposed to adversity in childhood may also exhibit increased threat from environmental stressors, which in turn may impact their state anxiety levels. We examined the relations between adverse childhood experiences, assessed using the Adverse Childhood Experiences Scale (ACEs), perceived threat from COVID-19, and state anxiety in a sample of adults. Additionally, flexibility is implicated in adaptive coping with life’s stressors so we also assessed participants’ cognitive flexibility. Parallel mediation regression analyses revealed that both perceived threat from COVID-19 and flexibility in the appraisal of challenges mediated the influence of maltreatment, but not household dysfunction, on state anxiety. Our data indicate that experience with early life adversity in the form of maltreatment is associated with increased perceived threat from COVID-19, which results in higher anxiety levels for the individual. In contrast, childhood maltreatment is associated with reduced flexibility in appraising challenges, which in turn mediates the relationship between maltreatment and anxiety. The findings of this study adds to the limited literature on the impact of early life adversity on cognitive flexibility and highlights the psychological toll of COVID-19 on individuals who have been exposed to adverse childhood experiences.

Effects of psychosocial and socio-environmental factors on anxiety disorder among adolescents in Bangladesh

BACKGROUND

Anxiety is a common psychiatric disorder among adolescents in developing countries. This study aimed to examine the risk factors of anxiety disorder and the adverse consequences of anxiety disorder among adolescents in Bangladesh.

METHODS

A total of 2,989 adolescent data of the 2014 Global School-based Student Health Survey (GSHS), Bangladesh, was analyzed WHO. The prevalence of anxiety disorder across psychosocial and socio-environmental factors was calculated as descriptive statistics, whereas their effects on occurring anxiety disorder were determined using the unadjusted and adjusted multivariable binary logistic regression model. The consequences of anxiety disorder were also determined using the multivariable binary logistic regression model.

RESULTS

The prevalence of anxiety disorder was 4.7%, which was found higher among female than their male counterparts. The psychosocial factors were found associated with the anxiety disorder are loneliness (AOR: 2.26, 95% CI: 1.08-4.72), being bullied (AOR: 6.00, 95% CI: 3.14-11.47), and physical abuse (AOR: 2.12, 95% CI: 1.07-4.21). Moreover, poor understandings with parents (AOR: 1.75, 95% CI: 1.02-3.01) and lack of peer support (AOR: 2.23, 95% CI: 1.18-4.23) were the socio-environmental factors that found associated with the anxiety disorder. Subgroup analysis across gender found these associations were consistent for adolescent male and female. Moreover, the likelihood increased with the increasing number of the adverse psychosocial, or socio-environmental factors.

CONCLUSIONS

Around 5% of school-going adolescents in Bangladesh reported anxiety associated with the exposure of single or multiple adverse psychosocial and socio-environmental factors including bullying and physical abuse. Early screening and interventions are essential, targeted to adolescent at risk, which could reduce the rate of anxiety disorder among adolescent in Bangladesh.

Is the psychological impact of exposure to COVID-19 stronger in adolescents with pre-pandemic maltreatment experiences? A survey of rural Chinese adolescents

BACKGROUND

Since the COVID-19 outbreak at the end of 2019, it has evolved into a global pandemic with tremendous mental health impact besides the threats to people's physical health.

OBJECTIVE

The aims were to examine whether exposure to COVID-19 predicts elevated levels of anxiety and post-traumatic stress symptoms and whether pre-pandemic maltreatment experiences exacerbate this impact on mental health in adolescents.

PARTICIPANTS AND SETTING

The survey was conducted online from February 8 st to February 27th, 2020, and the questionnaires were distributed and retrieved through a web-based platform. This study includes a total of 6196 subjects, aged range from 11 to 18 years old.

METHODS

Several multivariable linear regressions were used to analyse the data.

RESULTS

The largest variance in PTSS and anxiety problems was explained by ACEs, with more pre-pandemic maltreatment experiences predicting more PTSS (effect size beta = 0.16∼0.27), and more anxiety (effect size beta = 0.32∼0.47). Experienced or subjective fear of exposure to COVID-19 predicted statistically significant variance in PTSS and anxiety, and standardized betas ranged from 0.04 to 0.09. Participants who had adverse childhood experiences and had experienced exposure to COVID-19 showed elevated PTSS.

CONCLUSIONS

After pre-pandemic maltreatment experiences the impact of exposure to COVID-19 on mental health may be stronger. Scars from the past seem to be vulnerabilities during societal upheaval. We therefore suggest that when exposed to COVID-19 rural adolescents should get prioritized professional family support and mental health counseling in particular when they have experienced family abuse and neglect in childhood, even though such support is more difficult to organize in rural areas.

PID-5 Trait Indicators of Emotional Instability and Childhood Adversity Antecedents

Personality traits provide natural mechanisms through which childhood maltreatment may translate into psychiatric symptomatology. The PID-5 has provided a DSM-supported exemplar for canvassing traits that may contribute to the developmental trajectories of many personality and mood disorders. This general population survey (N = 2,430) examined associations between adverse childhood experiences (ACE questionnaire) and selected PID-5 trait indicators of emotional well-being (Depressivity, Anxiousness, and Emotional Lability). These associations were contrasted with others derived from traditional dimensional measures of childhood maltreatment. ACE counts and all six of the dimensional maltreatment indicators were linked to the three trait scores. Family emotional abuse and ACE counts provided equally strong correlates of Depressivity and Anxiousness. ACE counts and childhood sexual abuse were especially strong in their associations with all three traits. Graded relationships were found in these trait-adversity relationships with polyvictimized respondents generating the highest personality maladjustment. The odds of a trait score elevation (>1 SD) were raised substantially (two to five fold) by singular adversity exposures, and the co-occurrence of only two different forms of adversity maximized odds of extreme trait expression. These results contribute to an evidentiary base suggesting steeper developmental trajectories for personality maladjustment among maltreated youth.

Association of Acyl-Ghrelin With Posttraumatic Stress Disorder in Adolescents Who Experienced Severe Trauma

This cross-sectional study examines acyl-ghrelin levels in Pakistani adolescents who experienced severe trauma and have posttraumatic stress disorder (PTSD) compared with adolescents who have not experienced severe trauma.

Opening the door: inviting youth and parent perspectives on youth mental health emergency department use

BACKGROUND

Canadian Emergency Departments (EDs) have seen increasing use by children and youth for mental health concerns in recent years. This trend is likely a result of several complex factors, and researcher-posed potential explanations include gaps or access problems in primary care or mental health services, increasing prevalence or awareness of mental disorders and fear of potentially harmful outcomes, or expectations of need for urgent specialist care. Youth, parent, or caregiver perceptions and reasons for increasing mental health ED use may differ, and to date have been underrepresented in informing research directions. We sought to engage with youth and parents or caregivers served by a Canadian tertiary paediatric health centre to: 1) inform research directions for an emerging program of research in child and youth ED use for mental health care; and 2) develop strategies to support ongoing patient engagement in our research.

METHODS

Youth and parents were consulted to inform the development of a research engagement strategy. Partnerships with local community agencies facilitated supported engagement with both youth and parents. Group and individual in-person engagement opportunities were offered, as well as opportunities for written submissions and information sharing.

RESULTS

Youth and parents identified specific mechanisms to support engagement and for sharing ongoing opportunities and progress, including providing multiple platforms for engagement, offering separate opportunities for youth and parents or caregivers, and minimizing the potential for distress by ensuring appropriate supports and providing alternative opportunities for feedback, including written submissions. They identified lack of timely access to mental health care in primary care and community mental health settings, and accessibility, dependability, and familiarity of the ED as areas for further research.

CONCLUSIONS

Strategies to mitigate potential concerns regarding distress, readiness for participation, literacy, and protection of privacy were highlighted as important considerations. Youth and parents were interested in ongoing research engagement through consultation and information sharing. Youth and parents identified areas of interest for research and refined the research team's proposed research directions by adding contextualizing information.

TRIAL REGISTRATION

Not applicable.

Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

OBJECTIVE

Explore trauma, stress, and other predictive factors for treatment outcome in conversion disorder/functional neurological disorder (CD/FND).

METHODS

Prospective observational design. Clinical cohort study among consecutive outpatients with DSM-IV CD/FND in a specialized mental health institution for somatic symptom disorders and related disorders (SSRD), presented between 1 February 2010 and 31 December 2017. Patient files were assessed for early childhood trauma, childhood sexual abuse, current stress, and other predictive factors. Patient-related routine outcome monitoring (PROM) data were evaluated for treatment outcome at physical (Patient Health Questionnaire [PHQ15], Physical Symptoms Questionnaire [PSQ]) level as primary outcome, and depression (Patient Health Questionnaire [PHQ9]), anxiety (General Anxiety Disorder [GAD7]), general functioning (Short Form 36 Health Survey [SF36]), and pain (Brief Pain Inventory [BPI]) as secondary outcome.

RESULTS

A total of 64 outpatients were included in the study. 70.3% of the sample reported childhood trauma and 64.1% a recent life event. Mean scores of patients proceeding to treatment improved. Sexual abuse in childhood (F(1, 28) = 30.068, β = 0.608 p < .001) was significantly associated with worse physical (PHQ15, PSQ) treatment outcome. 42.2% reported comorbid depression, and this was significantly associated with worse concomitant depressive (PHQ9) (F[1, 39] = 11.526, β = 0.478, p = .002) and anxiety (GAD7) (F[1,34] = 7.950, β = 0.435, p = .008) outcome.

CONCLUSION

Childhood sexual abuse is significantly associated with poor treatment outcome in CD/FND. Randomized clinical trials evaluating treatment models addressing childhood sexual abuse in CD are needed.

The Role of Adverse Childhood Experience on Depression Symptom, Prevalence, and Severity among School Going Adolescents

METHODS

A cross-sectional school-based study was employed. Five hundred forty-six secondary school students were selected using multistage sampling technique from 5 selected secondary schools. We obtained retrospective information on adverse childhood experiences of adolescents by ACEs, self-reported 10-item questionnaire, and current depression prevalence and severity by PHQ-9. Multivariate linear regression models were used to estimate child depression severity by retrospective ACE count.

RESULTS

Among the 546 adolescents who participated in this study, 285 (50.7%) of the participants answered yes to at least one or more questions among the total 10 questions of ACEs. Experiences of ACEs increased the risk for depressive symptoms, with unstandardized β = 1.123 (β = 1.123, 95% CI (0.872, 1.373). We found a strong, dose-response relationship between the ACE score and the probability of lifetime and recent depressive disorders (p < 0.0001).

CONCLUSIONS

The number of ACEs has a graded relationship to both the prevalence and severity of depressive symptoms. These results suggest that exposure to ACEs is associated with an increased risk of depressive symptoms up to decades after their occurrence. Early recognition of childhood abuse and appropriate intervention may thus play an important role in the prevention of depressive disorders throughout the life span.

Revisiting the link between childhood sexual abuse and adult sexual aggression

BACKGROUND

Childhood maltreatment poses a risk factor for adult sexual aggression among men.

OBJECTIVE

Efforts were made to examine links between childhood sexual abuse (CSA) and sexual aggression after controlling variance associated with other forms of abuse.

PARTICIPANTS AND SETTING

This sample was comprised of men (n = 489) who completed a national survey regarding their history of possible abuse and/or sexual aggression.

METHODS

Maltreatment indices included CSA, parental and sibling physical abuse, exposure to domestic violence, peer bullying, and family emotional abuse. Self-report indicators of sexual frotteurism, coercion and rape were provided by the Sexual Experiences Survey-Short Form Perpetration.

RESULTS

CSA links with the criterion indicators were relatively stronger (r = 0.36, d = 0.65, p <  .001) than those found for non-sexual forms of abuse. CSA accounted for unshared variance in sexual aggression with these effects magnified by the addition of parental physical abuse (d = 2.1) or exposure to domestic violence (d = 2.2). The relative risks of prior acts of rape were elevated by CSA (RR = 4.39, p <  .001), parental physical abuse (RR = 3.85, p < 0.001), exposure to domestic violence (RR = 3.81, p <  .001), or sibling physical abuse (RR = 2.56, p = 0.007). These risks of completed rape were higher as well among respondents polyvictimized by two (RR = 4.92, p <  .001) or more (RR = 8.94, p < 0.001) forms of abuse.

CONCLUSIONS

Multiple forms of child maltreatment, particularly CSA, were strongly associated with adult sexual aggression in this sample of men from the general population.

Psychometric evaluation of the Adverse Childhood Experience International Questionnaire (ACE-IQ) in Malawian adolescents

BACKGROUND

Adverse childhood experiences (ACEs) can have lifelong adverse impacts on health and behavior. While this relationship has been extensively documented in high-income countries, evidence from lower-income contexts is largely missing. In order to stimulate greater research on the prevalence and consequences of ACEs in low-income countries, the World Health Organization (WHO) developed the ACE-International Questionnaire (ACE-IQ).

OBJECTIVE

In this paper, we explore the factor structure, validity and reliability of the original ACE-IQ, and evaluate whether potential adaptations improve its predictive validity.

PARTICIPANTS AND SETTING

Four hundred and ten adolescents (age 10-16 years old) from Malawi.

METHODS

The adolescents answered an adapted version of ACE-IQ and Beck Depression Inventory (BDI).

RESULTS

Taken together, our results suggest that (a) the ACE-IQ is structured in three dimensions: household disruption, abuse, and neglect; (b) there is support for the validity of the scale evidenced by the correlation between subdimensions (average across 13 correlations, phi = .20, p < 0,01; across subdomains (phi = .10, p < 0,01); partial agreement among children with the same caregiver (ICC = .43, p < .001) and correlation between ACE and depression (predictive validity; r = .35, p < .001); (c) information on the timing of the adversities ("last year" in addition to "ever") modestly improved the predictive value of the ACE-IQ in models of depression (from R2 = .12 to .15, p < .001); and (d) additional HIV-related questions showed low endorsement and a modest correlation with BDI (r = .25, p < 0,01).

CONCLUSION

Our findings suggest that the ACE-IQ is appropriate for use among adolescents from a low-income context.