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Ndjatou T, Qiu Y, Gerber LM, Chang J. How do Differences in Adolescent and Caregiver Reports of Adolescent Adverse Childhood Experiences Relate to Adolescent Depression? JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 13:200113. [PMID: 38948383 PMCID: PMC11208938 DOI: 10.1016/j.jpedcp.2024.200113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024]
Abstract
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.
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Affiliation(s)
- Tatiana Ndjatou
- Department of Pediatrics, Division of Adolescent Medicine, Children’s Hospital at Montefiore, Bronx, NY
| | - Yuqing Qiu
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, New York, NY
| | - Linda M. Gerber
- Department of Population Health Sciences, Division of Biostatistics, Weill Cornell Medicine, New York, NY
| | - Jane Chang
- Department of Pediatrics, Section of Adolescent Medicine, Weill Cornell Medicine, New York, NY
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Foster AA, Hoffmann JA, Douglas MD, Monuteaux MC, Douglas KE, Benevides TW, Hudgins JD, Stewart AM. Comprehensiveness of State Insurance Laws and Perceived Access to Pediatric Mental Health Care. JAMA Netw Open 2024; 7:e2426402. [PMID: 39133489 PMCID: PMC11320173 DOI: 10.1001/jamanetworkopen.2024.26402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/10/2024] [Indexed: 08/13/2024] Open
Abstract
Importance Many US children and adolescents with mental and behavioral health (MBH) conditions do not access MBH services. One contributing factor is limited insurance coverage, which is influenced by state MBH insurance parity legislation. Objective To investigate the association of patient-level factors and the comprehensiveness of state MBH insurance legislation with perceived poor access to MBH care and perceived inadequate MBH insurance coverage for US children and adolescents. Design, Setting, and Participants This retrospective cross-sectional study was conducted using responses by caregivers of children and adolescents aged 6 to 17 years with MBH conditions in the National Survey of Children's Health and State Mental Health Insurance Laws Dataset from 2016 to 2019. Data analyses were conducted from May 2022 to January 2024. Exposure MBH insurance legislation comprehensiveness defined by State Mental Health Insurance Laws Dataset (SMHILD) scores (range, 0-7). Main Outcomes and Measures Perceived poor access to MBH care and perceived inadequacy of MBH insurance were assessed. Multivariable regression models adjusted for individual-level characteristics. Results There were 29 876 caregivers of children and adolescents with MBH conditions during the study period representing 14 292 300 youths nationally (7 816 727 aged 12-17 years [54.7%]; 8 455 171 male [59.2%]; 292 543 Asian [2.0%], 2 076 442 Black [14.5%], and 9 942 088 White [69.6%%]; 3 202 525 Hispanic [22.4%]). A total of 3193 caregivers representing 1 770 492 children and adolescents (12.4%) perceived poor access to MBH care, and 3517 caregivers representing 1 643 260 of 13 175 295 children and adolescents (12.5%) perceived inadequate MBH insurance coverage. In multivariable models, there were higher odds of perceived poor access to MBH care among caregivers of Black (adjusted odds ratio [aOR], 1.35; 95% CI, 1.04-1.75) and Asian (aOR, 1.69; 95% CI, 1.01-2.84) compared with White children and adolescents. As exposures to adverse childhood experiences (ACEs) increased, the odds of perceived poor access to MBH care increased (aORs ranged from 1.68; 95%, CI 1.32-2.13 for 1 ACE to 4.28; 95% CI, 3.17-5.77 for ≥4 ACEs compared with no ACEs). Compared with living in states with the least comprehensive MBH insurance legislation (SMHILD score, 0-2), living in states with the most comprehensive legislation (SMHILD score, 5-7) was associated with lower odds of perceived poor access to MBH care (aOR, 0.79; 95% CI, 0.63-0.99), while living in states with moderately comprehensive legislation (score, 4) was associated with higher odds of perceived inadequate MBH insurance coverage (aOR, 1.23; 95% CI, 1.01-1.49). Conclusions and Relevance In this study, living in states with the most comprehensive MBH insurance legislation was associated with lower odds of perceived poor access to MBH care among caregivers for children and adolescents with MBH conditions. This finding suggests that advocacy for comprehensive mental health parity legislation may promote improved child and adolescent access to MBH services.
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Affiliation(s)
- Ashley A. Foster
- Department of Emergency Medicine, University of California, San Francisco
| | - Jennifer A. Hoffmann
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Megan D. Douglas
- Department of Community Health and Preventive Medicine, National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Katherine E. Douglas
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Teal W. Benevides
- Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Joel D. Hudgins
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Amanda M. Stewart
- Division of Emergency Medicine, Children’s National Hospital, Washington, District of Columbia
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Jones MS, Everett HD, Hoffmann JP. The combined effects of adverse childhood experiences and neighborhood quality on child health and well-being. CHILD ABUSE & NEGLECT 2024; 154:106913. [PMID: 38936144 DOI: 10.1016/j.chiabu.2024.106913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 06/03/2024] [Accepted: 06/16/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Many studies have investigated the effects of adverse childhood experiences (ACEs) on the health, development, and well-being of children and adolescents. However, most studies have failed to examine whether childhood adversity and ecological factors interact to influence relevant health outcomes. OBJECTIVE We used pooled data from the 2018-19 National Survey of Children's Health (n = 24,817) to assess the relationship between ACEs, neighborhood quality, and three domains of adolescent health and well-being: mental health (i.e., symptoms of anxiety problems and depression), neurodevelopmental health, and behavioral problems. METHODS Nine types of ACEs were captured in the NSCH data. Logistic regression models were employed to explore the relationship between ACEs, neighborhood quality, and adolescent health and well-being. RESULTS Our results indicate that ACEs are associated with each of these domains, with higher ACE scores associated with a higher risk of detrimental outcomes. Neighborhood disorder is also associated with several outcomes. Consistent with our expectations, in the presence of neighborhood disorder the association between higher ACEs exposure and behavior/conduct problems or neurodevelopmental disorders is larger. CONCLUSIONS Our results have important implications for understanding how individual and contextual factors may combine to influence child health and behaviors, as well as offering policy recommendations that might help children who experience traumatic events.
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Affiliation(s)
- Melissa S Jones
- Department of Sociology, Brigham Young University, United States of America.
| | | | - John P Hoffmann
- Department of Sociology, Brigham Young University, United States of America
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Luo J, Ma Y, Zhan HW, Jia WH, Zhang JR, Xie SY, Yu SY, Hou SL, Bi X, Wang XQ. Associations between adverse childhood experiences and pain in middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study. BMC Public Health 2024; 24:1760. [PMID: 38956571 PMCID: PMC11218369 DOI: 10.1186/s12889-024-19239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) have been associated with a range of adverse health outcomes, with pain being potentially one of them. This population-based cross-sectional study aimed to investigate the associations between Adverse Childhood Experiences (ACEs) and pain in Chinese adults and evaluate whether physical activity and demographic and socioeconomic characteristics modify this associations. METHODS Cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS), were utilized in this study. A total of 9923 respondents with information on 12 ACE indicators and 15 self-reported body pains were included. Logistic regression models were used to assess associations of the ACEs and pain. Modification of the associations by physical activity, demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction. RESULTS Among the 9923 individuals included in the primary analyses, 5098 (51.4%) males and the mean (SD) age was 61.18 (10·.44) years. Compared with individuals with 0 ACEs, those who with ≥ 5 ACEs had increased risk of single pains and multiple pain. A dose-response association was found between the number of ACEs and the risk of pain (e.g. neck pain for ≥ 5 ACEs vs. none: OR, 1.107; 95% CI, 0.903-1.356; p < 0.001 for trend). In the associations of each body pain with each ACE indicator, most ACE indicators were associated with an increased risk of pain. In addition, physical activity, sociodemographic and socioeconomic characteristics, such as age, sex, educational level, area of residence, childhood economic hardship, did not demonstrate a significant modify on the associations between ACEs and pain. CONCLUSIONS These findings indicate that cumulative ACE exposure is associated with increased odds of self-reported pain in Chinese adults, regardless of adult physical activity, sociodemographic and socioeconomic characteristics.
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Affiliation(s)
- Jing Luo
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China
- Department of Sport Rehabilitation, Xi'an Physical Education University, Xi'an, 710068, China
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yue Ma
- Department of Sport Rehabilitation, Xi'an Physical Education University, Xi'an, 710068, China
| | - Hao-Wei Zhan
- Department of Sport Rehabilitation, Xi'an Physical Education University, Xi'an, 710068, China
| | - Wang-Hu Jia
- Department of Sport Rehabilitation, Xi'an Physical Education University, Xi'an, 710068, China
| | - Jia-Rui Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China
| | - Shi-Yu Xie
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China
| | - Si-Yin Yu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China
| | - Shuang-Long Hou
- Department of Sport Rehabilitation, Xi'an Physical Education University, Xi'an, 710068, China
| | - Xia Bi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China.
| | - Xue-Qiang Wang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China.
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China.
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Jones MS, Kevorkian SS, Lehmann PS, Chouhy C, Meldrum RC. Adverse childhood experiences, gender, and suicidality among Florida high school students: Examining intervening mechanisms. CHILD ABUSE & NEGLECT 2024; 153:106834. [PMID: 38704885 DOI: 10.1016/j.chiabu.2024.106834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) represent a key risk factor for suicidal thoughts and behaviors among adolescents. However, the intervening mechanisms linking ACEs and suicidality, and whether such processes vary by gender, remain underexplored. OBJECTIVE The present study examines whether the relationships between ACEs and the likelihood of experiencing suicidal thoughts and attempting suicide are indirect through depressive symptoms and low self-control. This study also investigates whether these direct and indirect paths might be moderated by gender. PARTICIPANTS AND SETTING The analyses make use of data on a statewide representative sample of students enrolled in public high schools in Florida (N = 23,078) from the 2022 Florida Youth Substance Abuse Survey (FYSAS). METHODS Generalized structural equation modeling (GSEM) was used to estimate the direct and indirect effects of ACEs on the likelihood of suicidal thoughts and attempting suicide. The indirect effects were assessed using bootstrapping, and between-gender differences in the coefficients were tested. RESULTS ACEs has direct associations with depressive symptoms, low self-control, and both suicidality outcomes. The effects of ACEs on suicidal thoughts are indirect through both depressive symptoms and low self-control, and the effects of ACEs on suicide attempts are indirect through depressive symptoms. Limited gender differences in these pathways emerge. CONCLUSIONS For male and female youth, ACEs are associated with heightened depression symptoms and reduced self-control, and both of these factors partially explain the previously established relationship between ACEs and suicidality.
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Affiliation(s)
- Melissa S Jones
- Department of Sociology, Brigham Young University, United States of America
| | - Salpi S Kevorkian
- Department of Criminology and Criminal Justice, Florida International University, United States of America
| | - Peter S Lehmann
- Department of Criminal Justice and Criminology, Sam Houston State University, United States of America
| | - Cecilia Chouhy
- College of Criminology and Criminal Justice, Florida State Univeristy, United States of America
| | - Ryan C Meldrum
- Department of Criminology and Criminal Justice, Florida Atlantic University, United States of America
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Barreca JA. Exploring the Relationship between Adverse Childhood Experiences (ACEs) and Mental Health in Low Birthweight Children. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:585-596. [PMID: 38938970 PMCID: PMC11199437 DOI: 10.1007/s40653-023-00577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 06/29/2024]
Abstract
Low birthweight is associated with poor health, developmental, and social outcomes throughout the lifespan. Exposure to adverse childhood experiences (ACEs) is also associated with negative mental and physical health outcomes in adulthood. The aims of this study were to explore the relationship between low birthweight (LBW), exposure to ACES, and subsequent utilization of mental health service. Data analysis was conducted using a subset of data from children ages 6-17 years from the National Survey of Children's Health (NSCH) for 2018-2019 (n = 40,656). Welch ANOVA, Pearson's chi-square, and logistic regression investigated the relationship between LBW, ACEs, and mental health. LBW children in this sample had higher exposure to ACEs when compared to not low birthweight (NBW) children. LBW children also had a higher reported incidence of identified mental health (MH) issues. There was no significant association between birthweight and unmet MH service needs. LBW children with an ACE score or two or more were more likely to have an unidentified MH issue and/or an unmet MH service need. The results demonstrate LBW children experience higher levels of adversity. Children with ACE scores of two or more and those with unidentified MH issues have a higher likelihood of unmet MH needs. Professionals working in the health, education, and social service sectors can use this information to raise awareness of the increased vulnerability and more effectively meet the mental health needs of LBW children.
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Affiliation(s)
- Jessica A. Barreca
- Center for Interprofessional Education and Research, Saint Louis University, 1312 Carr Lane, Suite 110, St. Louis, MO 63104 USA
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Sheng B, Zhang S, Gao Y, Xia S, Zhu Y, Yan J. Elucidating the influence of familial interactions on geriatric depression: A comprehensive nationwide multi-center investigation leveraging machine learning. Acta Psychol (Amst) 2024; 246:104274. [PMID: 38631151 DOI: 10.1016/j.actpsy.2024.104274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE A plethora of studies have unequivocally established the profound significance of harmonious familial relationships on the psychological well-being of the elderly. In this study, we elucidate the intergenerational relationships, probing the association between frequent interactions or encounters with their children and the incidence of depression in old age. METHODOLOGY We employed a retrospective cross-sectional study design, sourcing our data from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). To identify cases of depression, we utilized the 10-item Center for Epidemiologic Studies Depression Scale (CESD). Employing a five-fold cross-validation methodology, we endeavored to fashion five distinct machine learning models. Subsequently, we crafted learning curves to facilitate the refinement of hyperparameters, assessing model classification performance through metrics such as accuracy and the Area Under the Receiver Operating Characteristic (AUROC) curve. To further elucidate the relationship between variables and geriatric depression, logistic regression was subsequently applied. RESULTS Our findings accentuated that sleep patterns emerged as the paramount determinants influencing the onset of depression in the elderly. Relationships with offspring ranked as the second most significant determinant, only surpassed by sleep habits. A negative correlation was observed between sleep patterns (Odds Ratio [OR]: 0.78, 95 % Confidence Interval [CI]: 0.75-0.81, P < 0.01), communication with offspring (OR: 0.86, 95 % CI: 0.82-0.90, P < 0.01), and the prevalence of depressive symptoms. Among the evaluated models, the k-Near Neighbor algorithm demonstrated commendable discriminative power. However, it was the Random Forest algorithm that manifested unparalleled discriminative prowess and precision, establishing itself as the most efficacious classifier. CONCLUSION Prolonging the duration of nocturnal sleep, and elevating the frequency of communication with offspring have been identified as measures conducive to mitigating the onset of geriatric depression.
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Affiliation(s)
- Boyang Sheng
- Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Shina Zhang
- Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Yuan Gao
- Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Shuaishuai Xia
- Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Yong Zhu
- Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Junfeng Yan
- Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China.
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Kavanaugh BC, Vigne MM, Tirrell E, Luke Acuff W, Fukuda AM, Thorpe R, Sherman A, Jones SR, Carpenter LL, Tyrka AR. Frontoparietal beta event characteristics are associated with early life stress and psychiatric symptoms in adults. Brain Cogn 2024; 177:106164. [PMID: 38670050 PMCID: PMC11193540 DOI: 10.1016/j.bandc.2024.106164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Recent work has found that the presence of transient, oscillatory burst-like events, particularly within the beta band (15-29 Hz), is more closely tied to disease state and behavior across species than traditional electroencephalography (EEG) power metrics. This study sought to examine whether features of beta events over frontoparietal electrodes were associated with early life stress (ELS) and the related clinical presentation. Eighteen adults with documented ELS (n = 18; ELS + ) and eighteen adults without documented ELS (n = 18; ELS-) completed eyes-closed resting state EEG as part of their participation in a larger childhood stress study. The rate, power, duration, and frequency span of transient oscillatory events were calculated within the beta band at five frontoparietal electrodes. ELS variables were positively associated with beta event rate at Fp2 and beta event duration at Pz, in that greater ELS was associated with higher resting rates and longer durations. These beta event characteristics were used to successfully distinguish between ELS + and ELS- groups. In an independent clinical dataset (n = 25), beta event power at Pz was positively correlated with ELS. Beta events deserve ongoing investigation as a potential disease marker of ELS and subsequent psychiatric treatment outcomes.
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Affiliation(s)
- Brian C Kavanaugh
- E.P. Bradley Hospital, Riverside RI, USA, Brown University; Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA.
| | - Megan M Vigne
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA; Butler Hospital COBRE Center for Neuromodulation, Providence RI, USA
| | - Eric Tirrell
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA; Butler Hospital COBRE Center for Neuromodulation, Providence RI, USA
| | - W Luke Acuff
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA; Butler Hospital COBRE Center for Neuromodulation, Providence RI, USA
| | - Andrew M Fukuda
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA; Butler Hospital COBRE Center for Neuromodulation, Providence RI, USA
| | - Ryan Thorpe
- Brown University, Department of Neuroscience, Providence RI, USA , Providence Veteran's Association Medical Center
| | - Anna Sherman
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA; Butler Hospital COBRE Center for Neuromodulation, Providence RI, USA
| | - Stephanie R Jones
- Brown University, Department of Neuroscience, Providence RI, USA , Providence Veteran's Association Medical Center; Center for Neurorestoration and Neurotechnology, Providence RI, USA
| | - Linda L Carpenter
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA; Butler Hospital COBRE Center for Neuromodulation, Providence RI, USA
| | - Audrey R Tyrka
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Providence RI, USA; Butler Hospital COBRE Center for Neuromodulation, Providence RI, USA
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Song W, McLean KJ, Gifford J, Kissner H, Sipe R. Adverse Childhood Experiences and Health Outcomes Among Transition-Age Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06401-7. [PMID: 38771506 DOI: 10.1007/s10803-024-06401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been associated with poor health outcomes in the general population. However, their impact on autistic youth remains unclear. OBJECTIVE The primary objective was to understand how childhood adversity is related to the general health, mental health, and physical health of transition-age autistic youth. PARTICIPANTS AND SETTING Using data from the 2018-2021 National Survey of Children's Health, this cross-sectional study involved 2056 autistic youth aged 12-17. METHODS Logistic regression was employed to test the association between three measures of ACEs - individual ACEs, cumulative ACEs, and grouped ACEs based on contexts, and health outcomes of autistic youth. RESULTS Our study observed a high prevalence of ACEs among autistic youth, with a substantially higher proportion experiencing multiple ACEs than their neurotypical peers. Individual ACEs were significantly associated with specific health issues. Cumulative ACEs demonstrated a clear dose-response relationship with health outcomes, with higher ACE counts increasing the likelihood of experiencing poor general health, mental health conditions, and physical health issues. Moreover, grouped ACEs associated with health differently, with community-based ACEs being particularly linked to general health status, mental health conditions, and physical health conditions, while family-based ACEs correlated more with more severe mental health conditions and being overweight. CONCLUSION These findings collectively emphasize the importance of addressing ACEs as a public health concern among transition-age autistic youth, highlighting the need for targeted interventions, prevention strategies, and support services to mitigate the negative impact of ACEs on the overall well-being of this growing community.
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Affiliation(s)
- Wei Song
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Kiley J McLean
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Jordan Gifford
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Hailey Kissner
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Rosalind Sipe
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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10
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Zhang Z, Wang W, Yuan X, Wang X, Luo Y, Dou L, Zhang L, Wu M. Adverse childhood experiences and subsequent physical and mental health among young adults: Results from six universities in China. Psychiatry Res 2024; 335:115832. [PMID: 38471243 DOI: 10.1016/j.psychres.2024.115832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
Research has shown that individuals with adverse childhood experiences (ACEs) are more likely to encounter heightened risks of physical and psychological challenges later in life. However, limited research has explored the comprehensive impact on the physical and mental health of young adults. Thus, we conducted a study to investigate the associations of ACEs with the physical and mental health of 18,723 college students in China. Their physical and mental health status was assessed using self-perceived health assessments, self-reported disease diagnoses, and the Generalized Anxiety Disorder-7-item scale. Results showed that 82.6 % of participants had experienced at least one ACE, with 10.7 % reporting exposure to four or more ACEs. Compared to participants with low ACEs exposure (≤ 1), participants with high ACEs exposure (≥ 4) had a nearly twofold increase in the odds of cardiometabolic diseases (OR [95 % CI] = 2.06 [1.55-2.74]) and fractures (2.32 [1.88-2.87]). Additionally, individuals with high ACE exposure exhibited a threefold increased odds of severe anxiety symptoms (3.78 [2.59-5.51]) and bipolar disorder/schizophrenia (3.38 [2.18-5.23]). These findings highlight ACEs as a significant risk factor for poor physical and mental health among young adults. Targeted support and interventions for individuals with multiple ACEs may help mitigate their long-term disease burden.
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Affiliation(s)
- Zheng Zhang
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, PR China; Xiangya School of Medicine, Central South University, Changsha, Hunan, PR China
| | - Wenhua Wang
- Shaanxi Medical Association, Xi'an, PR China; Shaanxi Provincial Health Industry Association Service Center, Xi'an, PR China.
| | - Xiaoxiao Yuan
- Shaanxi Medical Association, Xi'an, PR China; Shaanxi Provincial Health Industry Association Service Center, Xi'an, PR China
| | - Xue Wang
- Shaanxi Medical Association, Xi'an, PR China; Shaanxi Provincial Health Industry Association Service Center, Xi'an, PR China
| | - Yi Luo
- Shaanxi Medical Association, Xi'an, PR China; Shaanxi Provincial Health Industry Association Service Center, Xi'an, PR China
| | - Linfei Dou
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, PR China
| | - Lei Zhang
- Shaanxi Medical Association, Xi'an, PR China; Shaanxi Provincial Health Industry Association Service Center, Xi'an, PR China.
| | - Mingyang Wu
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, PR China.
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Chaudhary V, Walia GK, Devi NK, Shekhawat LS, Saraswathy KN. Adverse childhood experiences in mental health of young adults: An exploratory study from Delhi-NCR, India. Int J Soc Psychiatry 2024; 70:445-456. [PMID: 38063051 DOI: 10.1177/00207640231214986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Despite the growing realization regarding the importance of adverse childhood experiences (ACEs) in adult health outcomes, this area of research has received little scientific attention in low- and middle-income countries, including India. AIMS To understand the overall and domain-specific association of exposure to ACEs with current depression, anxiety, stress, and well-being among young adults of Delhi-NCR. METHODS This cross-sectional study was carried out among 1,812 young adults (aged 18-25 years) of both sexes (68.7% females). Fieldwork was conducted on the campuses of the University of Delhi, Delhi, and Amity University, Noida, India. ACEs, depression, anxiety, stress, and well-being were screened using the Adverse Childhood Experiences International Questionnaire, Beck Depression Inventory-II, Beck Anxiety Inventory, Perceived Stress Scale, and WHO-5 Well-Being Index, respectively. RESULTS Exposure to ACEs was found to increase the odds of moderate/severe depression, moderate/severe anxiety, and high stress and decreased the odds of good well-being in a dose-response manner. Being bullied, followed by emotional abuse, was associated with the highest odds of current moderate/severe depression, moderate/severe anxiety, and high stress and the lowest odds of good well-being. Further, while several domains of household dysfunction showed poor association with studied mental health outcomes, domains of abuse and violence were more consistently associated. CONCLUSIONS The present study revealed the detrimental impact of ACEs on mental health outcomes among young adults of Delhi-NCR, India, and underscored the relevance of ACEs in the Indian context. Considering the lack of trauma awareness in Indian societies, there is an urgent need to create widespread awareness regarding ACEs and associated health implications.
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Affiliation(s)
| | | | | | - Lokesh Singh Shekhawat
- Department of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi, India
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Choi K, Ayala L, Lierly R, Bustamante D, Cioppa-Fong B, Mead M, Mkroyan HJ, Morris E, Babajanyan I, Maryanov D. Implementing the NCTSN Trauma-Informed Organizational Assessment (TIOA) for Improving Trauma-Informed Care in Inpatient Child Psychiatry. J Am Psychiatr Nurses Assoc 2024; 30:722-732. [PMID: 37853611 PMCID: PMC11141099 DOI: 10.1177/10783903231171590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Children and adolescents receiving inpatient psychiatric services have disproportionately high levels of exposure to trauma and adversity. The National Child Traumatic Stress Network Trauma-Informed Organizational Assessment (TIOA) is a comprehensive tool intended to guide implementation of trauma-informed care, but it has not yet been applied in inpatient settings. AIMS The purpose of this quality improvement project was to describe trauma-informed care in inpatient child/adolescent psychiatry with the TIOA, examine relatedness among trauma-informed care domains, and explore barriers or facilitators to applying trauma-informed care. METHODS This quality improvement project used mixed methods. We conducted a web-based survey in Summer 2022 with staff members (clinical and administrative) at two inpatient child/adolescent psychiatric units in California to assess trauma-informed care practices with the TIOA (87 items). Qualitative follow-up interviews were offered to interested participants. A correlation matrix and cluster analyses were used to examine relationships among TIOA domains; qualitative data were analyzed thematically. RESULTS There were 69 survey respondents and seven qualitative interviews. TIOA domain scores ranged from a low of 2.3 to a high of 3.2, indicating that practices were occurring only "rarely" to "sometimes." There were two major themes identified from qualitive interviews: (a) barriers to trauma-informed care in an inpatient context that can be resource-constrained or coercive; and (b) discovering strategies to provide trauma-informed care despite structural barriers. CONCLUSION Organizational interventions targeting any domains of trauma-informed care are needed in inpatient settings given limited uptake of trauma-informed care.
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Affiliation(s)
- Kristen Choi
- Kristen Choi, PhD, RN, FAAN, University of California, Los Angeles, Los Angeles, CA, USA; Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Leilanie Ayala
- Leilanie Ayala, PMHNP-BC, Sutter Center for Psychiatry, Sacramento, CA, USA; University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca Lierly
- Rebecca Lierly, PhD, Sutter Center for Psychiatry, Sacramento, CA, USA
| | - Daniela Bustamante
- Daniela Bustamante, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Benjamin Cioppa-Fong
- Benjamin Cioppa-Fong, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Meredith Mead
- Meredith Mead, MSN, PMHNP-BC, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Hagop J. Mkroyan
- Hagop J. Mkroyan, MSN, PMHNP-BC, Nutrix Care Partners, Los Angeles, CA, USA
| | - Elizabeth Morris
- Elizabeth Morris, PsyD, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Irina Babajanyan
- Irina Babajanyan, AMFT, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
| | - Daniel Maryanov
- Daniel Maryanov, MSN, RN, Gateways Hospital and Mental Health Center, Los Angeles, CA, USA
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13
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Farooq B, Russell AE, Howe LD, Herbert A, Smith ADAC, Fisher HL, Baldwin JR, Arseneault L, Danese A, Mars B. The relationship between type, timing and duration of exposure to adverse childhood experiences and adolescent self-harm and depression: findings from three UK prospective population-based cohorts. J Child Psychol Psychiatry 2024. [PMID: 38613494 DOI: 10.1111/jcpp.13986] [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] [Accepted: 02/14/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are well-established risk factors for self-harm and depression. However, despite their high comorbidity, there has been little focus on the impact of developmental timing and the duration of exposure to ACEs on co-occurring self-harm and depression. METHODS Data were utilised from over 22,000 children and adolescents participating in three UK cohorts, followed up longitudinally for 14-18 years: the Avon Longitudinal Study of Parents and Children (ALSPAC), the Millennium Cohort Study (MCS) and the Environmental Risk (E-Risk) Longitudinal Twin Study. Multinomial logistic regression models estimated associations between each ACE type and a four-category outcome: no self-harm or depression, self-harm alone, depression alone and self-harm with co-occurring depression. A structured life course modelling approach was used to examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of ACEs) had the strongest effects on self-harm and depression in adolescence. RESULTS The majority of ACEs were associated with co-occurring self-harm and depression, with consistent findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and across cohorts. For parental mental health problems, longer duration of exposure was strongly associated with co-occurring self-harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI: 1.10-1.25) and MCS (1.18, 1.11-1.26) cohorts. For other ACEs in ALSPAC, exposure in middle childhood was most strongly associated with co-occurring self-harm and depression, and ACE occurrence in early childhood and adolescence was more important in the MCS. CONCLUSIONS Efforts to mitigate the impact of ACEs should start in early life with continued support throughout childhood, to prevent long-term exposure to ACEs contributing to risk of self-harm and depression in adolescence.
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Affiliation(s)
- Bushra Farooq
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Abigail E Russell
- Children and Young People's Mental Health Research Collaboration, University of Exeter Medical School, Exeter, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Annie Herbert
- MRC Integrative Epidemiology Unit, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Andrew D A C Smith
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Jessie R Baldwin
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Division of Psychology and Language Sciences, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Louise Arseneault
- Mathematics and Statistics Research Group, University of the West of England, Bristol, UK
| | - Andrea Danese
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National and Specialist CAMHS Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK
- National Institute for Health and Care Research, Biomedical Research Centre, Bristol, UK
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14
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Almaradheef R, Alhalal E. Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples. Res Nurs Health 2024; 47:182-194. [PMID: 38217469 DOI: 10.1002/nur.22368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/31/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.
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Affiliation(s)
| | - Eman Alhalal
- Community and Mental Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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15
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Zheng X, Jiang W, Peng S, Liu Q, He Y, Huang C, Hua Y, Lu C, Guo L. Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression. JAMA Netw Open 2024; 7:e246448. [PMID: 38607622 PMCID: PMC11015349 DOI: 10.1001/jamanetworkopen.2024.6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/15/2024] [Indexed: 04/13/2024] Open
Abstract
Importance Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter. Objectives To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups. Design, setting, and participants Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024. Exposures Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected. Main outcomes and measures PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used. Results Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups. Conclusions and relevance In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.
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Affiliation(s)
- Xinyu Zheng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Weiqing Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Shuyi Peng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Qianyu Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yitong He
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Cuihong Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yilin Hua
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People’s Republic of China
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16
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Donovan A, Assari S, Grella C, Shaheen M, Richter L, Friedman TC. Neuroendocrine mechanisms in the links between early life stress, affect, and youth substance use: A conceptual model for the study of sex and gender differences. Front Neuroendocrinol 2024; 73:101121. [PMID: 38253240 PMCID: PMC11088508 DOI: 10.1016/j.yfrne.2024.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 12/14/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
Early life stress (ELS) is defined as an acute or chronic stressor that negatively impacts a child's development. ELS is associated with substance use and mental health problems. This narrative literature review focuses on sex and gender differences in the effects of ELS on 1) adolescent neuroendocrine development; 2) pubertal brain maturation; and 3) development of internalizing symptoms and subsequent substance use. We posit that ELS may generate larger hormonal dysregulation in females than males during puberty, increasing internalizing symptoms and substance use. Future research should consider sex and gender differences in neuroendocrine developmental processes when studying the link between ELS and negative health outcomes.
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Affiliation(s)
- Alexandra Donovan
- Department of Internal Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA 90059, USA.
| | - Shervin Assari
- Department of Internal Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA 90059, USA; Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA 90059, USA.
| | - Christine Grella
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10911 Weyburn Ave, Suite 200, Los Angeles, CA 90024-2886, USA.
| | - Magda Shaheen
- Department of Internal Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA 90059, USA.
| | - Linda Richter
- Department of Internal Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA 90059, USA; Partnership to End Addiction, 711 Third Ave, 5(th) Floor, Suite 500, New York City, NY 10017, USA.
| | - Theodore C Friedman
- Department of Internal Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Los Angeles, CA 90059, USA.
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Knipschild R, Hein I, Pieters S, Lindauer R, Bicanic IAE, Staal W, de Jongh A, Klip H. Childhood adversity in a youth psychiatric population: prevalence and associated mental health problems. Eur J Psychotraumatol 2024; 15:2330880. [PMID: 38530708 DOI: 10.1080/20008066.2024.2330880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/06/2024] [Indexed: 03/28/2024] Open
Abstract
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.
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Affiliation(s)
- Rik Knipschild
- Karakter, Child and Adolescent Psychiatry, Almelo, the Netherlands
| | - Irma Hein
- Levvel Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sara Pieters
- Karakter, Child and Adolescent Psychiatry, Almelo, the Netherlands
- Department of Psychology, Radboud University, Nijmegen, the Netherlands
| | - Ramon Lindauer
- Levvel Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Iva A E Bicanic
- National Psychotrauma Centre for Children and Youth, University Medical Centre Utrecht, Utrecht, Leiden, the Netherlands
| | - Wouter Staal
- Karakter, Child and Adolescent Psychiatry, Almelo, the Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands
- Leiden Institution for Brain and Cognition, the Netherlands
| | - Ad de Jongh
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, the Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, and VU University Amsterdam, Amsterdam, the Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen's University, Belfast, Northern Ireland
| | - Helen Klip
- Karakter, Child and Adolescent Psychiatry, Almelo, the Netherlands
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Wang W, Cui Y, Hu Q, Wei Y, Xu L, Tang X, Hu Y, Liu H, Wang Z, Chen T, Wang R, An C, Wang J, Zhang T. Childhood maltreatment and personality disorders in adolescents and adults with psychotic or non-psychotic disorders. Front Psychiatry 2024; 15:1336118. [PMID: 38577403 PMCID: PMC10991748 DOI: 10.3389/fpsyt.2024.1336118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction While the attention to personality disorders (PD) and childhood maltreatment (CM) has grown in recent years, there remains limited understanding of the prevalence and distinctions of PD and CM in clinical populations of Chinese adolescents in comparison to adults. Methods A total of 1,417 participants were consecutively sampled from patients diagnosed with either psychotic or non-psychotic disorders in the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. The participants were categorized into two groups based on their age: adolescents (aged 15-21 years) and adults (aged 22-35 years). PDs were evaluated using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were assessed using the Chinese version of the Child Trauma Questionnaire Short Form. Results When comparing self-reported PD traits and CM between adolescents and adults, differences emerge. Adolescents, particularly in the psychotic disorder group, exhibit more pronounced schizotypal PD traits (p=0.029), and this pattern extends to non-psychotic disorders (p<0.001). Adolescents in the non-psychotic disorder group also report higher levels of emotional abuse (p=0.014), with a notable trend in physical abuse experiences compared to adults (p=0.057). Furthermore, the most prevalent PDs in the clinical sample are avoidant, borderline, and obsessive-compulsive PDs. Among patients with psychotic disorders, adolescents exhibit higher rates of schizoid, schizotypal, and obsessive-compulsive PDs compared to adults. Logistic regression analyses highlight distinct predictors for psychotic and non-psychotic disorders in adolescents and adults. Discussion The findings emphasize distinct differences in PDs and CMs between adolescent and adult groups, shedding light on their potential roles in psychotic and non-psychotic disorders.
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Affiliation(s)
- WenZheng Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yin Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Qiang Hu
- Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - YeGang Hu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, Shanghai, China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, United States
| | - Ran Wang
- Department of Psychiatry, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - CuiXia An
- Hebei Technical Innovation Center, Mental Health Assessment and Intervention, Shijiazhuang, Hebei, China
- Hebei Clinical Research Center of Mental Disorders, Institute of Mental Health, Shijiazhuang, Hebei, China
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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19
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Raney JH, Weinstein S, Ganson KT, Testa A, Jackson DB, Pantell M, Glidden DV, Brindis CD, Nagata JM. Mental Well-Being Among Adversity-Exposed Adolescents During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e242076. [PMID: 38477919 PMCID: PMC10938185 DOI: 10.1001/jamanetworkopen.2024.2076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
Importance Further research is needed to understand factors associated with well-being during the COVID-19 pandemic among adolescents who have experienced adverse childhood experiences (ACEs). Objective To explore factors associated with improved mental health during the COVID-19 pandemic among adolescents who have experienced ACEs. Design, Setting, and Participants This cross-sectional study used data from the baseline (2016-2018) and sixth (March 2021) COVID Rapid Response Research (RRR) surveys of the Adolescent Brain Cognitive Development study, which includes 21 sites across the US. Adolescents aged 11 to 15 years who completed the COVID RRR mental health measures were included. Data analyses were conducted from June to August 2023. Exposures School-based factors (eg, in-person school) and 8 coping behaviors (eg, exercise). Main Outcomes and Measures The primary outcomes were adolescent-reported positive affect (PA) and perceived stress (PS). Adolescents were stratified by no ACEs, low-to-intermediate ACEs (1-3), and high ACEs (≥4). Linear regressions estimated associations between factors and mental health, adjusting for potential confounders. Unstandardized beta coefficients (B) were compared with equality of coefficients tests. Results The 4515 adolescents in this study (mean [SD] age, 13.3 [0.88] years; 51% [95% CI, 50% to 53%] female) were racially and ethnically diverse (American Indian/Alaska Native, 2% [95% CI, 2% to 3%]; Asian, 8% [95% CI, 7% to 9%]; Black, 11% [95% CI, 10% to 12%]; Latino or Hispanic, 17% [95% CI, 15% to 18%]; White, 61% [95% CI, 60% to 63%]; other, 1% [95% CI, 0% to 2%]). For youths with high ACEs, caring for one's body (PA B = 4.02 [95% CI, 1.39 to 6.66]; PS B = -0.92 [95% CI, -1.84 to 0.00]), exercising (PA B = 3.19 [95% CI, 0.46 to 5.92]; PS B = -1.41 [95% CI, -2.40 to -0.43]), and engaging in healthy behaviors (PA B = 4.07 [95% CI, 1.28 to 6.84]; PS B = -1.01 [95% CI, -1.98 to -0.05]) were associated with higher PA and lower PS scores. In-person schooling had a greater impact on PA scores for youths with high ACEs (B = 5.55 [95% CI, 2.08 to 9.01]) than youths with low-to-intermediate ACEs (B = 1.27 [95% CI, 0.27 to 2.27]). Conclusions and Relevance These findings suggest that in-person schooling and several coping behaviors (caring for one's body, exercising, and engaging in healthy behaviors) were associated with significantly higher PA and lower PS during the COVID-19 pandemic among adolescents with high ACEs. Adolescents with high ACEs demonstrated especially greater mental health scores when they reported in-person schooling. Future studies should build on these findings to identify clinical and school-based mental health protective factors for adolescents with high ACE risk.
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Affiliation(s)
- Julia H. Raney
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | | | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston
| | - Dylan B. Jackson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew Pantell
- Division of Hospital Medicine, Department of Pediatrics, University of California, San Francisco
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Claire D. Brindis
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
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Shi X, Meng Y, Cheng B, Long L, Yin L, Ye A, Yi X, Ran M. Association between traumatic events with suicidality among adolescents: A large-scale cross-sectional study of 260,423 participants. Psychiatry Res 2024; 333:115762. [PMID: 38310687 DOI: 10.1016/j.psychres.2024.115762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
Traumatic events have significant negative impacts throughout one's life. We aimed to comprehensively examine the early associations between traumatic events and suicidality among adolescents. In a cross-sectional sample of 260,423 adolescents in Deyang, China in September 2021, we assessed individual traumatic events, cumulative types, and patterns, alongside suicide risk scores and ideation, attempts, or plans. Linear and Poisson regression models adjusted for demographic confounders evaluated the association. Robust associations existed between interpersonal violence-related traumatic events and higher suicidality, with physical abuse demonstrating the strongest correlation. Moreover, suicide risk scores displayed a clear trend, indicating a progressively stronger association with suicidality as cumulative traumatic event types increased. Four distinct traumatic patterns emerged, including low traumas, high physical abuse, high death/serious injuries of a loved one, and multiple traumas, with the latter showing the strongest association with suicidality. Notably, the stratified analysis showed these associations were more pronounced in females, urban residents, only children, left-behind children, and those aged 13-15, while weaker in participants from families with intact parental relationships and middle socioeconomic status. Understanding the role of demographic factors and traumatic patterns in identifying at-risk youth can enable early detection and targeted interventions for suicide-related concerns.
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Affiliation(s)
- Xinyi Shi
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Yajing Meng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China.
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Lu Long
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Li Yin
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Anhong Ye
- Mental Health Center, Zigong Hospital Affiliated to Southwest Medical University, Zigong, Sichuan, PR China
| | - Xingjian Yi
- Department of Psychosomatic Medicine, Dazhou Yuanda United Hospital, Dazhou, Sichuan, PR China
| | - Maosheng Ran
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
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Wang JX, Liu XQ. Climate change, ambient air pollution, and students' mental health. World J Psychiatry 2024; 14:204-209. [PMID: 38464763 PMCID: PMC10921291 DOI: 10.5498/wjp.v14.i2.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/29/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024] Open
Abstract
The impact of global climate change and air pollution on mental health has become a crucial public health issue. Increased public awareness of health, advancements in medical diagnosis and treatment, the way media outlets report environmental changes and the variation in social resources affect psychological responses and adaptation methods to climate change and air pollution. In the context of climate change, extreme weather events seriously disrupt people's living environments, and unstable educational environments lead to an increase in mental health issues for students. Air pollution affects students' mental health by increasing the incidence of diseases while decreasing contact with nature, leading to problems such as anxiety, depression, and decreased cognitive function. We call for joint efforts to reduce pollutant emissions at the source, improve energy structures, strengthen environmental monitoring and gover-nance, increase attention to the mental health issues of students, and help student groups build resilience; by establishing public policies, enhancing social support and adjusting lifestyles and habits, we can help students cope with the constantly changing environment and maintain a good level of mental health. Through these comprehensive measures, we can more effectively address the challenges of global climate change and air pollution and promote the achievement of the United Nations Sustainable Development Goals.
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Affiliation(s)
- Jing-Xuan Wang
- School of Education, Tianjin University, Tianjin 300350, China
| | - Xin-Qiao Liu
- School of Education, Tianjin University, Tianjin 300350, China
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Mohd Azlan S, Mohamad F, Dahlan R, Ismail IZ, Kadir Shahar H, Kamaruddin KN, Shibraumalisi NA, Syed Mohamad SN, Shamsuddin NH. Self-system and mental health status among Malaysian youth attending higher educational institutions: A nationwide cross-sectional study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2024; 19:12. [PMID: 38496770 PMCID: PMC10944643 DOI: 10.51866/oa.34l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Mental health disorders (MHDs) are a global health burden with an increasing prevalence. During the COVID-19 pandemic, depression was the commonest MHD, followed by anxiety and stress. This nationwide study aimed to determine the prevalence and associated factors of depression, anxiety and stress among Malaysian students attending higher educational institutions. Methods A cross-sectional study was conducted from June to December 2021. Institutions were selected via stratified random sampling and students via convenience sampling. A self-administered questionnaire comprising questions on socio-demographic characteristics, academic background, substance abuse, childhood abuse, religiosity and the Depression Anxiety Stress Scale-21 was used. Data were analysed using SPSS version 27; descriptive, point-biserial correlation, chi-square and multiple binary logistic regression analyses were conducted. Results Sex and adverse childhood experiences significantly predicted all three MHDs (P<0.05). The students from public institutions (odds ratio [OR]=0.71, 95% confidence interval [CI]=0.56-0.90, P=0.004) had a lower risk of depression than those from private institutions. The smokers/vapers (OR=1.43, 95% CI=1.02-2.02, P=0.041) a higher risk of depression than the non-smokers/non-vapers. The social science students (OR=1.29, 95% CI= 1.01-1.65, P=0.039) had a higher risk of anxiety than the science students. The students who highly engaged in organisational religious activity (OR=0.91, 95% CI=0.84-0.98, P=0.015) had a lower risk of anxiety than their counterparts. Conclusion Anxiety is the commonest MHD among Malaysian youth, followed by depression and stress. Childhood abuse is a crucial related factor requiring further attention. Screening, surveillance, preventive measures and comprehensive interventions for MHDs should be initiated among youth.
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Affiliation(s)
- Syifa' Mohd Azlan
- BSc Psychology, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - Fadzilah Mohamad
- MBBS, MMed (Psychiatry), Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - Rahima Dahlan
- MBBS, MMed, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - Irmi Zarina Ismail
- MBBCh BAO, MComm Health (Epidemiology & Biostatistic), Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - Hayati Kadir Shahar
- MBBCh BAO, MMed Fam Med, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Khairatul Nainey Kamaruddin
- MBBCh BAO, MMed Fam Med, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Nur Amirah Shibraumalisi
- MBBS, MMed Fam Med, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Sharifah Najwa Syed Mohamad
- MBBCh BAO, MMed Fam Med, Department of Primary Health Care, Universiti Sains Islam Malaysia, Persiaran Ilmu, Putra Nilai, Nilai, Negeri Sembilan, Malaysia
| | - Nurainul Hana Shamsuddin
- MBBS, MMed, Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
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23
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Iverson IA, Cook NE, Iverson GL. Adverse childhood experiences are associated with perceived cognitive difficulties among high school students in the United States. Front Psychol 2024; 15:1293013. [PMID: 38375116 PMCID: PMC10875032 DOI: 10.3389/fpsyg.2024.1293013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/04/2024] [Indexed: 02/21/2024] Open
Abstract
Objective Adverse childhood experiences (ACEs) are associated with mental health and cognitive problems, and mental health problems are associated with perceived cognitive difficulties among adolescents. The unique contribution of ACEs to cognitive difficulties after adjusting for poor mental health is not well understood and represents the purpose of this study. Methods The Adolescent Behaviors and Experiences Survey was conducted in 2021 with high school students in the United States. Cognitive difficulty was assessed with: 'Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?' Four ACEs were examined: sexual violence (lifetime and past 12 months), parental emotional abuse, and parental physical abuse. Students were asked about feeling sad or hopeless (past year), considering suicide (past year), and having poor mental health (past month). Binary logistic regressions examined the association between ACEs and cognitive problems, adjusting for mental health. Results Participants were 6,945 students. Students reporting poor mental health were very likely to endorse difficulty concentrating, remembering, or making decisions (girls = 81% and boys = 67%). Cognitive difficulty was uncommon among students who denied poor mental health (girls = 17% and boys = 12%). For boys [p < 0.001; R2 = 0.22] and girls [p < 0.001; R2 = 0.31], after adjusting for mental health problems, independent predictors of cognitive difficulties included parental verbal abuse and physical abuse. For girls, lifetime forced sexual intercourse and sexual violence during the past year were also independently associated. Conclusion ACEs are associated with perceived cognitive difficulty in both adolescent girls and boys, even after adjusting for poor mental health.
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Affiliation(s)
- Ila A. Iverson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nathan E. Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Mass General for Children Sports Concussion Program, Boston, MA, United States
| | - Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Mass General for Children Sports Concussion Program, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, United States
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24
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Kim K, Au-Yeung A, Dagher D, Jacobs N, Martin-Hill D, Wekerle C. Exploring the relevance of a psychology-based resilience app (JoyPop™) for Indigenous youth. CHILD ABUSE & NEGLECT 2024; 148:106343. [PMID: 37451896 DOI: 10.1016/j.chiabu.2023.106343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/15/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Despite facing challenges to mental wellness from ongoing multifold trauma, Indigenous youth continue to galvanize their resilience. One pathway undertaken is embracing technology. The JoyPop™ youth resilience mobile application (app) was invited by Six Nations of the Grand River (SN) leadership to consider its use with their reserve youth. OBJECTIVE This study explored the feasibility of JoyPop™ research from the SN community adult perspective for appropriateness and relevance to SN youth, as a precursor to a user-experience study with community youth. METHODS Semi-structured, online interviews with 19 adult community members (26 % male) about JoyPop™ were conducted with nominated stakeholders from SN. Based on a standard presentation of the app, comments were solicited about app features, design, and relevance to Haudenosaunee culture. Interviews were transcribed, coded in a double-blind fashion, and analyzed for themes. RESULTS Most offered positive feedback, with some level of support for each feature of JoyPop™. Themes were identified (Need for Indigenous Design, Incorporation of Indigenous Culture, Appreciation of Ease, Flexibility and Personalization), stemming from comments of appraisal and suggestions for adaptations (e.g., incorporating more cultural elements, localized resources, simplification of app). CONCLUSIONS The JoyPop™ app was viewed as positive and relevant, based on feedback from adults within SN. Adaptations were identified by adults to better fit SN youth needs, and research with SN youth is pending before implementation of adaptations. Research with other communities is encouraged to expand the reach of technology interventions, to holistically support Indigenous youth mental health in a culturally relevant way.
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Affiliation(s)
- Katherine Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Allison Au-Yeung
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Danielle Dagher
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Norma Jacobs
- Department of Social Work, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Dawn Martin-Hill
- Department of Anthropology, Indigenous Studies Program, McMaster University, Hamilton, Ontario, Canada
| | - Christine Wekerle
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Optentia Research Unit, North-West University, South Africa; Department of Psychiatry and Behavioral Neuroscience, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
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25
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Nicolaides NC, Kanaka-Gantenbein C, Pervanidou P. Developmental Neuroendocrinology of Early-Life Stress: Impact on Child Development and Behavior. Curr Neuropharmacol 2024; 22:461-474. [PMID: 37563814 PMCID: PMC10845081 DOI: 10.2174/1570159x21666230810162344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 08/12/2023] Open
Abstract
Our internal balance, or homeostasis, is threatened or perceived as threatened by stressful stimuli, the stressors. The stress system is a highly conserved system that adjusts homeostasis to the resting state. Through the concurrent activation of the hypothalamic-pituitary-adrenal axis and the locus coeruleus/norepinephrine-autonomic nervous systems, the stress system provides the appropriate physical and behavioral responses, collectively termed as "stress response", to restore homeostasis. If the stress response is prolonged, excessive or even inadequate, several acute or chronic stress-related pathologic conditions may develop in childhood, adolescence and adult life. On the other hand, earlylife exposure to stressors has been recognized as a major contributing factor underlying the pathogenesis of non-communicable disorders, including neurodevelopmental disorders. Accumulating evidence suggests that early-life stress has been associated with an increased risk for attention deficit hyperactivity disorder and autism spectrum disorder in the offspring, although findings are still controversial. Nevertheless, at the molecular level, early-life stressors alter the chemical structure of cytosines located in the regulatory regions of genes, mostly through the addition of methyl groups. These epigenetic modifications result in the suppression of gene expression without changing the DNA sequence. In addition to DNA methylation, several lines of evidence support the role of non-coding RNAs in the evolving field of epigenetics. In this review article, we present the anatomical and functional components of the stress system, discuss the proper, in terms of quality and quantity, stress response, and provide an update on the impact of early-life stress on child development and behavior.
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Affiliation(s)
- Nicolas C. Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, ‘Aghia Sophia’ Children's Hospital, Athens, 11527, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, 11527, Greece
- School of Medicine, University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, ‘Aghia Sophia’ Children's Hospital, Athens, 11527, Greece
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
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26
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Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics 2024; 153:e2023064800. [PMID: 38073403 DOI: 10.1542/peds.2023-064800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/02/2024] Open
Abstract
Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.
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Affiliation(s)
- Liwei L Hua
- Division of Integrated Behavioral Health, South Bend Clinic, South Bend, Indiana
| | - Janet Lee
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Maria H Rahmandar
- Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric J Sigel
- Department of Pediatrics, University of Colorado School of Medicine, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado
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27
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Kavanaugh BC, Parade S, Seifer R, McLaughlin NCR, Tirrell E, Festa EK, Oberman LM, Novick AM, Carpenter LL, Tyrka AR. Childhood stress, gender, and cognitive control: Midline theta power. J Psychiatr Res 2024; 169:298-306. [PMID: 38070470 PMCID: PMC10997405 DOI: 10.1016/j.jpsychires.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/24/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
The emergence of psychiatric symptoms is a common consequence of childhood stress exposure. However, there are a dearth of reliable clinical hallmarks or physiological biomarkers to predict post-trauma symptom emergence. The objective of this study was to examine if childhood stressors and stress-related symptoms are associated with altered midline theta power (MTP) during cognitive control demands, and how these associations interact with gender and early adversity. N = 53 children (ages 9-13 years old) from a longitudinal study of children maltreated during early childhood and non-maltreated children participated in this study. EEG recorded neural activity during a Zoo-Themed Go/No-Go task. Stress-related symptoms, recent stressful events, and other adversity experiences were identified. MTP was analyzed with clinical variables in a series of follow-up analyses. The number of stressors in the past six months was negatively correlated with MTP in those with low preschool adversity, but not in those with high preschool adversity. MTP was higher in girls than in boys, and the associations of MTP with stressors and symptoms were moderated by gender. MTP was negatively associated with stressors in the past six months in girls, while in boys, MTP was associated with stress-related symptoms. Childhood stressful events were associated with reduced MTP during cognitive control demands, and this was finding was moderated by gender and early life adversity. These preliminary findings suggest that boys and girls may process stressful experiences in distinct ways, and preschool adversity may potentially blunt the interaction between current stress and neural dynamics. However, ongoing investigation is needed.
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Affiliation(s)
- Brian C Kavanaugh
- E. P. Bradley Hospital, United States; Department of Psychiatry & Human Behavior, Brown University, United States.
| | - Stephanie Parade
- E. P. Bradley Hospital, United States; Department of Psychiatry & Human Behavior, Brown University, United States
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute University of North Carolina at Chapel Hill, United States
| | - Nicole C R McLaughlin
- Department of Psychiatry & Human Behavior, Brown University, United States; Butler Hospital, United States
| | - Eric Tirrell
- Department of Psychiatry & Human Behavior, Brown University, United States; Butler Hospital, United States
| | - Elena K Festa
- Department of Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, United States
| | | | - Andrew M Novick
- Department of Psychiatry, University of Colorado - Anschutz Medical Campus, United States
| | - Linda L Carpenter
- Department of Psychiatry & Human Behavior, Brown University, United States; Butler Hospital, United States
| | - Audrey R Tyrka
- Department of Psychiatry & Human Behavior, Brown University, United States; Butler Hospital, United States
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28
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Karhina K, Bøe T, Hysing M, Nilsen SA. Parental separation, negative life events and mental health problems in adolescence. BMC Public Health 2023; 23:2364. [PMID: 38031009 PMCID: PMC10685480 DOI: 10.1186/s12889-023-17307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Parental separation is associated with mental health problems in adolescence. One suggested pathway for this association is through the accumulated exposure to stress and other negative life events. This study aimed to document the distribution of negative life events among adolescents with separated compared to non-separated parents, and to assess the direct and interactive associations between parental separation, negative life events, and mental health problems in adolescence. METHODS Data stem from the cross-sectional population-based youth@hordaland study of adolescents (aged 16-19) conducted in Norway in 2012, providing self-reported information about parental separation, negative life events, and depression-, anxiety-, conduct-, and ADHD symptoms. Regression analyses were used to assess the direct and interactive associations between parental separation, negative life events, and mental health problems. RESULTS Adolescents with separated parents had more mental health problems across all symptom scales compared to peers with non-separated parents, with standardized mean differences [SMDs] ranging from 0.15 to 0.20. Negative life events moderately attenuated these differences (reduced the SMDs with about 0.04-0.08, depending on the outcome). However, none of the interactions between parental separation and negative life events on mental health problems were statistically significant. CONCLUSIONS Higher exposure to negative life events explains parts of the association between parental separation and mental health problems in adolescence. However, a parental separation does not seem to increase the vulnerability of the effects of negative life events on adolescents' mental health. Assessing exposure to negative life events is important when providing mental health services to adolescents, particularly to those who have parents separated.
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Affiliation(s)
- Kateryna Karhina
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sondre Aasen Nilsen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
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Grabbe L, Duva I, Jackson D, Johnson R, Schwartz D. The impact of the Community Resiliency Model (CRM) on the mental well-being of youth at risk for violence: A study protocol. Arch Psychiatr Nurs 2023; 46:121-126. [PMID: 37813494 DOI: 10.1016/j.apnu.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/16/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Assess the effect of a brief, somatic awareness resiliency training, the Community Resiliency Model (CRM)®, on the mental well-being of incarcerated youth. SPECIFIC AIM 1: Explore the relationship between youth demographics and justice history to baseline well-being scores and response to treatment. Q1: How do personal variables, including length of time in juvenile justice, relate to baseline mental health scores and response to the wellness skills intervention? SPECIFIC AIM 2: Examine the mental health scores over time to determine effectiveness of participating in CRM training while incarcerated. Hypothesis 1: Well-being scores will increase after CRM training. Hypothesis 2: Emotional distress will decrease after participating in a CRM training. Hypothesis 3: Pro-social feelings and behaviors will increase after participating in a CRM training.
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Affiliation(s)
- Linda Grabbe
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America.
| | - Ingrid Duva
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States of America
| | - Douglas Jackson
- Georgia Department of Juvenile Justice, United States of America
| | - Rufus Johnson
- Georgia Department of Juvenile Justice, United States of America
| | - David Schwartz
- Georgia Department of Juvenile Justice, United States of America
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Akintunde TY, Isangha SO, Iwuagwu AO, Adedeji A. Adverse Childhood Experiences and Subjective Well-Being of Migrants: Exploring the Role of Resilience and Gender Differences. GLOBAL SOCIAL WELFARE 2023. [DOI: 10.1007/s40609-023-00310-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 08/01/2024]
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Trombley J. Fine particulate matter exposure and pediatric mental health outcomes: An integrative review. J Nurs Scholarsh 2023; 55:977-1007. [PMID: 36941765 DOI: 10.1111/jnu.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Climate change is expected to worsen air pollution globally, which contributes to a multitude of negative health outcomes in humans. AIM The purpose of this integrative review is to examine the relationship between exposure to fine particulate matter (PM2.5 ) and mental health outcomes in children and adolescents. METHODS This review utilized Whittemore and Knafl's methodology for conducting an integrative review. After a thorough search of the literature, 17 articles were selected for this review and evaluated utilizing the Johns Hopkins Evidence Based Practice Appraisal Tool. RESULTS Of the 17 articles, all were quantitative observational study designs. The studies were then synthesized into four outcome themes. These themes included emergent and general psychiatric outcomes, neurodevelopmental disorders, stress and anxiety, and depression. DISCUSSION The strongest evidence supports a possible correlation between PM2.5 exposure and adolescent mental health outcomes, although there were some studies that contradicted these associations. While research on this topic is in its early stages, more needs to be conducted to determine causality with any of the associations presented to improve generalizability of the findings. IMPLICATIONS FOR PRACTICE Nurses must be aware of and part of the solution to address climate change and resulting air pollution, as it is a potentially significant threat to children's mental health in the 21st century.
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Affiliation(s)
- Janna Trombley
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Wang Y, Sun M, Yao N, Guo R, Liu Y, Wang X, Li J, Xie Z, Yang Y, Li X, Wang S, Li B. Effects of adverse childhood experiences on the Charlson comorbidity index in US adults. Public Health 2023; 222:134-139. [PMID: 37544123 DOI: 10.1016/j.puhe.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES The aim of this article was to explore the association between adverse childhood experiences (ACEs) and the Charlson comorbidity index (CCI) and to provide valuable information for public health professionals and policymakers to improve quality of life and reduce mortality. STUDY DESIGN A cross-sectional analysis was conducted using data pooled from the 2020 Behavioral Risk Factor Surveillance System (BRFSS). METHODS This study involved 102,393 US adult participants from the 2020 BRFSS. The zero-inflated negative binomial (ZINB) and mixed graphical model (MGM) models were used to explore the effect of ACEs on CCI and the interaction between ACEs. RESULTS In the count part of the model (CCI ≥0), sexual abuse had the strongest association with CCI (relative risk [RR] = 1.111, P < 0.001). In the logit part of the model (CCI = 0), the likelihood of having CCI equal to 0 decreased by 23.0% for household substance abuse, which was the highest percentage decrease for all ACEs. Compared to those with ACE scores equal to 0, individuals with ACE scores ≥4 have an expected CCI RR of 1.222, and the likelihood of having CCI equal to 0 decreased by 50.2%. Household substance abuse and incarceration history in the home had the strongest association among interactions of ACEs (0.85). CONCLUSIONS Associations between ACEs and CCI were observed in this study, and these associations differed between genders. The findings of this study provide data to design strategies for disease prevention and improvement of quality of life.
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Affiliation(s)
- Y Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - M Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - N Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - R Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - Y Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - X Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - J Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - Z Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - Y Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - X Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - S Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China
| | - B Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, PR China.
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Guo W, Zhao Y, Chen H, Liu J, Chen X, Tang H, Zhou J, Wang X. The bridge symptoms of childhood trauma, sleep disorder and depressive symptoms: a network analysis. Child Adolesc Psychiatry Ment Health 2023; 17:88. [PMID: 37403102 DOI: 10.1186/s13034-023-00635-6] [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: 02/18/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND This study aimed to elucidate the characteristics of symptom network of childhood trauma (CT) and sleep disorder (SD) in Chinese adolescents, with the influence of depressive symptoms taken into account. METHOD A total of 1301 adolescent students were included, and their CT, SD and depressive symptoms were measured using the Pittsburgh sleep quality index (PSQI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and The Patient Health Questionnaire-9 (PHQ-9), respectively. Central symptoms and bridge symptoms were identified based on centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. RESULTS In CT and SD symptom network, emotional abuse and sleep quality symptoms had the highest centrality values, and two bridge symptoms, i.e., emotional abuse and sleep disturbance symptoms, were also identified. In symptom network for CT, SD, and depressive symptoms, sleeping difficulty symptoms, daily dysfunction symptoms, and emotional abuse appeared to be potential bridge symptoms. In symptom network of CT, SD, and depressive symptoms (excluding the symptom of sleeping difficulty), daily dysfunction symptoms, emotional abuse, and sleep disturbance symptoms appeared to be bridge symptoms. CONCLUSIONS In this study, emotional abuse and poor sleep quality were found to be central symptoms in the CT-SD network structure among Chinese adolescent students, with daytime dysfunction as the bridge symptom in the CT-SD-depression network structure. Systemic multi-level interventions targeting the central symptoms and bridge symptoms may be effective in alleviating the co-occurrence of CT, SD and depression in this population.
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Affiliation(s)
- Weilong Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yixin Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hui Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jiali Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xianliang Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Huajia Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Xiaoping Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Zhang Y, Li Y, Jiang T, Zhang Q. Role of body mass index in the relationship between adverse childhood experiences, resilience, and mental health: a multivariate analysis. BMC Psychiatry 2023; 23:460. [PMID: 37353758 PMCID: PMC10290297 DOI: 10.1186/s12888-023-04869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/13/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVES Depression among adolescents is a global concern. Adverse childhood experiences (ACEs) have been correlated with negative physical and mental health such as obesity and depression; however, increasing evidence has suggested that their correlation might be moderated by BMI and resilience. In this study, we aim to explore (1) whether resilience moderate the risk of mental health by ACEs; (2) whether BMI is a moderator of this relationship. STUDY DESIGN Adolescents were obtained from 4 grade college students by a multi-stage convenience sampling method in the period of May to Jun, 2022. METHODS We use the Connor-Davidson Resilience scale, Depression, Anxiety and Stress Scale-21 Item (DASS-21) questionnaires to measure the ACEs, BMI, resilience and mental health. The primary exposure was ACEs and the primary outcome was mental health; while resilience and BMI were moderators. Multivariable linear regression model was used to establish the relationship of ACEs, resilience and BMI against mental health status. Moderate analysis was employed by PROCESS method to explore the relationship between these variables. RESULTS A total of 3600 individuals were initially enrolled, after excluding 22 with invalid questionnaires, 3578 adolescents were finally included. The mean age was (20.53 ± 1.65) years old. After adjusted for covariates, multivariable linear regression suggest that the high level ACEs (, β =0.58, , 95%CI:0.54,0.62, P < 0.01), resilience (, β=-0.27, 95%CI: , 95%CI: -0.28,-0.26, P < 0.01) were associated with higher depression symptoms, and BMI (, β =0.073, 95%CI: 0.002-0.15, P < 0.05) was associated with higher depression symptoms. There is also the interaction between resilience, ACEs and mental health (depression, anxiety and stress symptoms). In the relationship between ACEs and mental health, resilience and BMI played a moderator role. CONCLUSIONS The moderate analysis also provided further evidence of a link between resilience, ACEs, BMI and mental health. The findings shed new light on potential mechanisms between ACEs and mental health, including the effects of the co-interaction of resilience and BMI, adding to previous literature. ACEs may be a profound variable to measure adolescents' psychosocial environment to influence mental health, and resilience moderate this effect and is also moderated by BMI.
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Affiliation(s)
- Yi Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yonghan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tian Jiang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
| | - Qiu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Valladares-Garrido MJ, León-Figueroa DA, Dawson FM, Burga-Cachay SC, Fernandez-Canani MA, Failoc-Rojas VE, Pereira-Victorio CJ, Valladares-Garrido D, Inga-Berrospi F. Association between childhood trauma and mental health disorders in adolescents during the second pandemic wave of COVID-19, Chiclayo-Peru. Front Psychiatry 2023; 14:1169247. [PMID: 37426089 PMCID: PMC10323439 DOI: 10.3389/fpsyt.2023.1169247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction The COVID-19 pandemic has significantly affected mental health, with children and adolescents being particularly vulnerable. Evidence on the association between childhood trauma and mental health outcomes in schoolchildren during the pandemic is limited. This study aimed to evaluate this relationship in Chiclayo city, northern Peru, during the second wave of COVID-19. Methods A cross-sectional secondary data study was conducted, measuring childhood trauma using the Marshall's Trauma Scale, depressive symptomatology (PHQ-9), and anxiety symptomatology (GAD-7). Additional variables assessed were alcohol use (AUDIT), resilience (abbreviated CD-RISC), and socio-educational data. Prevalence ratios were estimated using generalized linear models. Results Among 456 participants, 88.2% were female, with a mean age of 14.5 years (SD: 1.33). Depressive symptomatology prevalence was 76.3% (95%CI: 72.14-80.15) and increased by 23% in schoolchildren with childhood trauma (PR: 1.23; 95%CI: 1.10-1.37). Factors positively associated with depressive symptomatology included increasing age, seeking mental health help during the pandemic, and severe family dysfunction. Anxiety symptomatology prevalence was 62.3% (95%CI: 57.65-66.75) and increased by 55% in schoolchildren with childhood trauma (PR: 1.55; 95%CI: 1.31-1.85). Anxiety symptomatology was positively associated with mild, moderate, and severe family dysfunction. Conclusion Schoolchildren exposed to childhood trauma are at increased risk for depressive and anxiety symptoms. Monitoring the impact of the COVID-19 pandemic on adolescent mental health is vital. These findings can assist schools in establishing effective measures to prevent mental health outcomes.
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Affiliation(s)
| | - Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru
- Centro de Investigación en Atención Primaria de Salud, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Danai Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Piura, Peru
- Unidad de Epidemiología y Salud Ambiental, Hospital de Apoyo II Santa Rosa, Piura, Peru
| | - Fiorella Inga-Berrospi
- Grupo de Investigación en Gestión y Salud Pública, Universidad Norbert Wiener, Lima, Peru
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Jones MS, Hoffmann JP. Measuring adverse childhood experiences with latent class trajectories. CHILD ABUSE & NEGLECT 2023; 140:106142. [PMID: 36933525 DOI: 10.1016/j.chiabu.2023.106142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with several negative health and behavioral outcomes during adolescence, but most of the extant research has employed ACEs scores at one or two time points. Studies have not assessed whether latent class ACEs trajectories affect adolescent problem behaviors and conditions. OBJECTIVES We used longitudinal data from the Fragile Families and Child Wellbeing Study (FFCWS, n = 3444) to assess ACEs at several time points and empirically developed latent class trajectories. We then examined the sociodemographic characteristics of youth who belonged to each trajectory group. We next evaluated whether the ACEs trajectories during childhood were associated with delinquent behavior, substance use, and symptoms of anxiety or depression. Finally, we explored whether closeness to mother buffered the impact of ACEs on these outcomes. METHODS Eight types of ACEs were captured in the FFCWS data. ACE scores were assessed at year one, three, five, and nine, along with the outcomes during year 15. Trajectories were estimated with a semiparametric latent class models. RESULTS The analysis revealed three latent trajectories during childhood: a low/none ACEs group, a medium exposure group, and a high exposure group. Adolescents in the high exposure group manifested a heightened risk of involvement in delinquent behaviors and substance use. They also reported more symptoms of anxiety and depression than their peers in the low/none and medium exposure groups. CONCLUSIONS Repeated exposure to ACEs during childhood can have serious negative repercussions in the lives of adolescents, but maternal closeness may buffer their effects. Scholars should continue to examine the dynamics of ACEs exposure during childhood by using empirical approaches appropriate for identifying age-graded trajectories.
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Affiliation(s)
- Melissa S Jones
- Department of Sociology, Brigham Young University, United States of America.
| | - John P Hoffmann
- Department of Sociology, Brigham Young University, United States of America
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Hertz M, Heim Viox M, Massetti GM, Anderson KN, Bacon S, Fordyce E, Mercado MC, Verlenden JV. Adverse Childhood Experiences Among US Adolescents Over the Course of the COVID-19 Pandemic. Pediatrics 2023; 151:e2022060799. [PMID: 37158017 PMCID: PMC10233730 DOI: 10.1542/peds.2022-060799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE A national, longitudinal survey of US adolescents assessed adverse childhood experiences (ACEs) twice during the COVID-19 pandemic. Adolescents with more Wave 1 ACEs were expected to be more likely to experience additional ACEs at Wave 2. METHODS Adolescents aged 13 to 18 (n = 727, Fall 2020; n = 569, Spring 2021) recruited via a national, probability-based panel (survey completion rate Wave 1, 62.1%; Wave 2, 78.3%) responded to questions about household challenges, violence or neglect, and community ACE exposure at Wave 1 and Wave 2 (since Wave 1). Unweighted frequencies and 95% confidence intervals of demographic characteristics and individual ACEs were calculated by using weighted data. Odds ratios examined associations between ACEs by Wave 1 and Wave 2. RESULTS Among respondents of both survey waves (n = 506), 27.2% experienced violence or abuse, 50.9% experienced a household challenge, and 34.9% experienced a community ACE by Wave 1. By Wave 2, 17.6% experienced 1 new ACE, 6.1% experienced 2 new ACEs and 2.7% experienced 4 or more new ACEs. Those with ≥4 ACEs by Wave 1 were 2.71 times as likely as those with none to report a new ACE at Wave 2 (confidence interval: 1.18-6.24). CONCLUSIONS This nationwide, longitudinal study of US adolescents measured exposure to ACEs early in and during the COVID-19 pandemic. Nearly one-third of adolescents experienced a new ACE between survey waves. Prevention and trauma-informed approaches in clinical, school, and community settings may be helpful.
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Affiliation(s)
- Marci Hertz
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention
| | | | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - Kayla N. Anderson
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - Sarah Bacon
- Office of the Director, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Fordyce
- NORC at the University of Chicago, Chicago, Illinois
| | - Melissa C. Mercado
- Division of Violence Prevention, National Center for Injury Prevention and Control
| | - Jorge V. Verlenden
- Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention
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Cherewick M, Dahl RE, Bertomen S, Hipp E, Shreedar P, Njau PF, Leiferman JA. Risk and protective factors for mental health and wellbeing among adolescent orphans. Health Psychol Behav Med 2023; 11:2219299. [PMID: 37274749 PMCID: PMC10234133 DOI: 10.1080/21642850.2023.2219299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Background Research has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing. Study objective The purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health. Methods The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures. Results Results of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (β = -0.53, p = 0.015) and mental wellbeing (β = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (β = -0.34, p = 0.108) and mental wellbeing (β = -0.24, p = 0.405) were not significant. Conclusion In a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.
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Affiliation(s)
- Megan Cherewick
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, USA
| | - Samantha Bertomen
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Emily Hipp
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | - Priyanka Shreedar
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
| | | | - Jenn A. Leiferman
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz, Aurora, CO, USA
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Kovács-Tóth B, Oláh B, Kuritárné Szabó I, Fekete Z. Psychometric properties of the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) among Hungarian adolescents. Front Psychol 2023; 14:1161620. [PMID: 37275710 PMCID: PMC10235773 DOI: 10.3389/fpsyg.2023.1161620] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Although a number of studies have been conducted since the 1995 initiation of the ACE study to map the effects of adverse childhood experiences, few studies have examined the psychometric properties of the individual versions of the ACE questionnaire. Aims The Adverse Childhood Experiences Questionnaire 10 item version (ACE-10) has only been tested in a single study in an adult population, while its applicability in a particularly vulnerable population, the adolescents, has not been investigated yet. Our present study aims to address this gap in an adolescent sample of 792 subjects from a non-representative general population. Methods Besides demographic data, the Adverse Childhood Experiences Questionnaire 10 item version (ACE-10), the Strengths and Difficulties Questionnaire (SDQ), and the HBSC Symptom Checklist (HBSC-SCL) were employed. Results Our results showed acceptable internal consistency (ɵ = 0.86, α = 0.64) and adequate internal validity (r = 0.28-0.70, p < 0.001). In addition, proper concurrent criterion validity of the questionnaire was found when tested along the SDQ and HBSC-SCL items. Conclusion Our results demonstrate that the ACE-10 is suitable for assessing intrafamilial adverse childhood experiences in adolescents.
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Affiliation(s)
- Beáta Kovács-Tóth
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Barnabás Oláh
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Ildikó Kuritárné Szabó
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Zita Fekete
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Xiao W, Li S, Xu H, Zhang Y, Wei R, Tao F, Wan Y. Population attributable fractions of adverse childhood experiences for emotional problems and self-harming behaviors among middle school students in China. Asian J Psychiatr 2023; 85:103621. [PMID: 37201384 DOI: 10.1016/j.ajp.2023.103621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
The population attributable fractions of health outcomes attributed to adverse childhood experiences (ACEs) among Chinese middle school students is unknown. Of all the 22,868 middle school students, 29.8 % had exposure to four or more ACEs. Findings showed a graded relationship between ACE scores and those adverse outcomes. The PAFs of six outcomes attributed to experiencing ≥ 4 ACEs ranged from 23.1 % to 44.2 %. The results emphasized the significance of preventive interventions to alleviate the negative legacies of ACEs.
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Affiliation(s)
- Wan Xiao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China
| | - Huiqiong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China
| | - Yi Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Ruihong Wei
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China.
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China; Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Anhui, China.
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Tzouvara V, Kupdere P, Wilson K, Matthews L, Simpson A, Foye U. Adverse childhood experiences, mental health, and social functioning: A scoping review of the literature. CHILD ABUSE & NEGLECT 2023; 139:106092. [PMID: 36907117 DOI: 10.1016/j.chiabu.2023.106092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) negatively impact people's physical and mental health and social functioning. Research literature focuses on the impact of ACEs on physical and mental health, yet to our knowledge, no study has examined the literature on ACEs, mental health, and social functioning outcomes. OBJECTIVE To map how ACEs, mental health, and social functioning outcomes have been defined, assessed, and studied in the empirical literature and identify gaps in the current research which need further investigation. METHODS A scoping review methodology following a five-step framework was implemented. Four databases were searched CINAHL, Ovid (Medline, Embase) and PsycInfo. The analysis involved both numerical and a narrative synthesis in line with the framework. RESULTS Fifty-eight studies were included in the analysis, and three key issues were identified a) the limitations of research samples to date, b) the choice of outcome measures for ACEs, social and mental health outcomes, and c) the limitations of current study designs. CONCLUSION The review demonstrates variability in the documentation of participant characteristics and inconsistencies in the definitions and applications of ACEs, social and mental health and related measurements. There is also a lack of longitudinal and experimental study designs, studies on severe mental illness, and studies including minority groups, adolescents, and older adults with mental health problems. Existing research is highly variable methodologically and limits our broader understanding of the relationships between ACEs, mental health, and social functioning outcomes. Future research should implement robust methodologies to provide evidence that could be used for developing evidence-based interventions.
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Affiliation(s)
- Vasiliki Tzouvara
- Care for Long Term Conditions Research Division, Faculty of Nursing, Midwifery & Palliative Care, King's College London, Waterloo Road, London SE1 8WA, United Kingdom of Great Britain and Northern Ireland.
| | - Pinar Kupdere
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom of Great Britain and Northern Ireland
| | - Keiran Wilson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom of Great Britain and Northern Ireland
| | - Leah Matthews
- Faculty of Nursing, Midwifery & Palliative Care, King's College London, Waterloo Road, London SE1 8WA, United Kingdom of Great Britain and Northern Ireland
| | - Alan Simpson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom of Great Britain and Northern Ireland; Care for Long Term Conditions Research Division, Faculty of Nursing, Midwifery & Palliative Care & Health Service and Population Research Department, King's College London, Waterloo Road, London SE1 8WA, United Kingdom of Great Britain and Northern Ireland
| | - Una Foye
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom of Great Britain and Northern Ireland
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Holcombe EA, Jones MS, Lehmann PS, Meldrum RC. Differential Exposure to Adverse Childhood Experiences Among Florida High School Students: The Intersection of Race, Ethnicity, and Gender. J Adolesc Health 2023; 72:553-559. [PMID: 36528515 DOI: 10.1016/j.jadohealth.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The prevalence of exposure to adverse childhood experiences (ACEs) across distinct intersections of race/ethnicity and gender among adolescents remains relatively unknown. The current study seeks to address this important gap in the literature using a statewide representative sample of Florida high school students. METHODS Data drawn from the 2020 Florida Youth Substance Abuse Survey (FYSAS) (N = 20,438) were analyzed to examine differences in ACE exposure among 26 racial/ethnic and gender subgroups of high-school aged youth. Lifetime exposure to ACEs was constructed using 10 different ACE categories to measure ACEs prevalence as reported exposure to 1+ ACEs and 4+ ACEs. RESULTS Exposure to ACEs was highly gendered and varied according to racial/ethnic subgroup. While notable differences across gender and racial/ethnic groups emerged when measuring prevalence as exposure to 1+ ACEs, several of these disparities were further amplified when prevalence was measured as exposure to 4+ ACEs. Native American female adolescents represented the group at greatest risk of high exposure to ACEs, with more than 50% of such youth reporting exposure to 4+ ACEs. DISCUSSION The prevalence of ACE exposure varies significantly across race/ethnic and gender subgroups of youth. These intersections should be considered for prevention efforts and clinical treatments of trauma exposure as ACEs may be linked to certain outcomes or behaviors based on high exposure in certain subpopulations of youth.
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Affiliation(s)
| | - Melissa S Jones
- Department of Sociology, Brigham Young University, Provo, Utah
| | - Peter S Lehmann
- Department of Criminal Justice and Criminology, Sam Houston State University, Houston, Texas
| | - Ryan C Meldrum
- Department of Criminology and Criminal Justice, Florida International University, Miami, Florida
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Tindberg Y, Janson S, Jernbro C. Unintentional Injuries Are Associated with Self-Reported Child Maltreatment among Swedish Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5263. [PMID: 37047879 PMCID: PMC10093922 DOI: 10.3390/ijerph20075263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Injuries constitute a large share of childhood morbidity and mortality. This study examines whether adolescents with self-reported experiences of different types of child maltreatment more frequently reported unintentional injury events requiring health- or dental care during the last year and/or hospitalization at any time during childhood. Cross-sectional data from a Swedish national representative school survey (2016) including 4741 adolescents were used (78.5% response rate). Data were analyzed with univariate tests and multiple logistic regression. Statistically significant associations between reported experiences of physical, psychological and sexual abuse, neglect, and witnessing partner violence during childhood and reported unintentional injuries requiring health- or dental care during the last year were found (aOR:s between 1.39-1.77). The corresponding association for poly-victimization was aOR 1.91 (95% CI 1.39-2.62). Furthermore, a linear-by-linear association was seen for degree of victimization and number of episodes of unintentional injuries that required care in the last year (p = 0.000), as well as lifetime hospitalizations (p = 0.000). This study shows significant associations between child maltreatment and unintentional injuries requiring health- and/or dental care and hospitalization. To improve both injury and child maltreatment prevention, healthcare professionals need to pay particular attention to children and adolescents who repeatedly seek healthcare services due to injurious events.
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Affiliation(s)
- Ylva Tindberg
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, 631 88 Eskilstuna, Sweden
| | - Staffan Janson
- Division of Public Health Sciences, Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
| | - Carolina Jernbro
- Division of Public Health Sciences, Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
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Makris G, Eleftheriades A, Pervanidou P. Early Life Stress, Hormones, and Neurodevelopmental Disorders. Horm Res Paediatr 2023; 96:17-24. [PMID: 35259742 DOI: 10.1159/000523942] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early life stress (ELS) describes a broad spectrum of adverse and stressful prenatal events, namely, prenatal maternal stress (PMS), or early postnatal events, which can have detrimental long-term influences on the physiology, cognition, and behavior of an individual. There is abundant evidence indicating that ELS exerts its lasting effects on the physical and mental health of the individual, likely acting through a number of mediating mechanisms, including the disruption of developmental programming of the fetus. Neurodevelopmental disorders (NDDs), for example, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are a group of conditions that typically manifest during infancy, childhood, or adolescence and are characterized by developmental deficits in various domains. SUMMARY The scope of the current mini-review is to provide an up-to-date summary of the findings regarding the association of ELS and NDDs and the possible hormonal mechanisms through which PMS exerts its impact on neurodevelopment. We focus on the available evidence regarding children and adolescents diagnosed with ADHD or ASD. ELS exposure during developmental vulnerability windows may increase the risk for either subclinical neuropsychological alterations or clinical conditions, such as NDDs. In fact, a large body of evidence underlies the association of ELS exposure and increased risk for NDDs in the offspring. KEY MESSAGES The majority of data suggest that ELS, including PMS, may be associated with ADHD and ASD in the offspring, although there is no consensus regarding the critical developmental periods. Carefully controlled prospective studies are needed to determine the possible causal processes and mechanisms underlying the association of ELS and NDDs.
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Affiliation(s)
- Gerasimos Makris
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Anna Eleftheriades
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece,
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Keane K, Evans RR. Exploring the Relationship Between Modifiable Protective Factors and Mental Health Issues Among Children Experiencing Adverse Childhood Experiences Using a Resilience Framework. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:987-998. [PMID: 36439658 PMCID: PMC9684361 DOI: 10.1007/s40653-022-00471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to examine whether the National Scientific Council on the Developing Child (NSCDC) resilience framework statistically predicted whether a child with 4 or more adverse childhood experiences (ACEs) ever had a mental health issue. The study also explored which NSCDC modifiable resilience factors had the strongest relationship with mental health issues among children with 4 or more ACEs. Utilizing the 2019 National Survey of Children's Health, secondary data analysis was conducted using a sample of 1,225 children between 6 and 17 years old that had experienced 4 or more ACEs. Logistic regression examined whether the NSCDC framework was associated with a lower likelihood of mental health issues in school-aged children. Analysis found that the NSCDC framework predicted whether children with 4 or more ACEs ever had a mental health issue. Self-regulation had the strongest relationship with whether a child with 4 or more ACEs ever had a mental health issue. A supportive parent/caregiver relationship was also associated with a lower likelihood of ever having a mental health issue. The results demonstrate the promise of the NSCDC framework and modifiable protective factors to mitigate the impact of ACEs on mental health outcomes. Interventions that teach children skill-based self-regulation and parent/caregiver co-regulation while providing safe and supportive environments can build self-regulation to overcome ACEs. Promoting resilience-building parent-child relationships also have the potential to build resilience to mitigate ACEs.
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Affiliation(s)
- Kevin Keane
- University of Alabama at Birmingham, 1720 2nd Avenue South, NB 202, Birmingham, AL 35294-1210 USA
| | - Retta R. Evans
- University of Alabama at Birmingham, 1150 10th Avenue South, EEC 301C, Birmingham, AL 35294-1250 USA
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Family, Neighborhood and Parent Resilience Are Inversely Associated With Reported Depression in Adolescents Exposed to ACEs. Acad Pediatr 2022; 23:773-781. [PMID: 36272724 DOI: 10.1016/j.acap.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the association of 1) extrinsic resilience factors and 2) adverse childhood experiences (ACEs) with a caregiver reported diagnosis of depression in a nationally representative sample of adolescents. METHODS A cross sectional analysis of the 2016-2017 National Survey of Children's Health, restricted to adolescents 12 to 17 years old was conducted. The dependent variable was caregiver reported depression: no current diagnosis vs. current diagnosis of depression. Independent variables were reported ACEs dichotomized as lower (0-3) or higher (4 or more), and specific resilience factors: family resilience, neighborhood cohesion and caregiver emotional support. Resilience factors were analyzed as a composite score dichotomized as lower (0-3) or higher (4 or more) and individually. Purposeful selection multivariable logistic regression model building was used to estimate the associations between reported diagnosis of depression, ACEs and resilience factors adjusting for demographic covariates. RESULTS Study sample consisted of 29,617 (weighted N = 24,834,232) adolescents, 6% with current reported diagnosis of depression, 8% with higher ACEs and 91% with higher resilience. Family resilience, neighborhood cohesion and caregiver emotional supports were each independently associated with lower odds of reported diagnosis of depression. However, with all resilience factors in the model, only family resilience and neighborhood cohesion (specifically school safety) remained significantly associated with lower odds of reported diagnosis of depression. CONCLUSION(S) In this nationally representative sample, family resilience and neighborhood cohesion were associated with lower odds of a reported diagnosis of depression even with confounding ACEs exposure. These factors may be important targets for future intervention.
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Vayngortin T, Clark K, Hollenbach K. Sexual History Documentation and Screening in Adolescent Females with Suicidal Ideation in the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13018. [PMID: 36293599 PMCID: PMC9603263 DOI: 10.3390/ijerph192013018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Adolescents with mental illness often seek care in the emergency department (ED) and are more likely to engage in risky behaviors such as substance abuse and unprotected sex, increasing their risk of sexually transmitted infections (STI), unintended pregnancy, and non-consensual sex. This was a retrospective study of 312 females, aged 13-17 years, presenting to the pediatric ED with the chief complaint of suicidal ideation from February to May 2018. Electronic medical records were reviewed for demographics, psychiatric history, sexual history, and testing for pregnancy or STI. The primary outcome was the documentation of the presence or absence of prior sexual activity. Secondary outcomes included documented aspects of sexual history and pregnancy or STI testing performed in the ED. Of the 312 eligible patients, 144 (46.2%) had a documented sexual history, and of those 50 (34.7%) reported being sexually active. Sexual history documentation was not associated with patient age, race, ethnicity, insurance, or the gender of the ED provider. A history of anxiety and a recent suicide attempt were associated with a lack of sexual history documentation (p = 0.03). Of the sexually active patients, 28 (56%) had documentation of contraception use. Pregnancy testing was performed in 67.3% of all patients and 80% of sexually active patients. Only 10 patients had STI testing in the ED, with most testing occurring in those with sexual history documentation (p = 0.007). In conclusion, more than half of females with suicidal ideation in our ED had no documentation of sexual history, and when documentation was completed, it was often missing important elements, including screening for pregnancy, STI, non-consensual sex, and contraception use. Since the ED visit provides an important opportunity to address the reproductive health needs of this high-risk population, further work is needed to determine ways to improve provider documentation and sexual health screening.
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Affiliation(s)
- Tatyana Vayngortin
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, CA 92123, USA
- Department of Pediatrics, San Diego School of Medicine, University of California, La Jolla, CA 92093, USA
| | - Katie Clark
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, CA 92123, USA
| | - Kathryn Hollenbach
- Division of Emergency Medicine, Rady Children’s Hospital San Diego, San Diego, CA 92123, USA
- Department of Pediatrics, San Diego School of Medicine, University of California, La Jolla, CA 92093, USA
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Hamstra C, Fitzgerald M. Longitudinal Effects from Childhood Abuse to Bullying Perpetration in Adolescence: The Role of Mental Health and Social Problems. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:869-881. [PMID: 35958700 PMCID: PMC9360357 DOI: 10.1007/s40653-021-00409-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 05/13/2023]
Abstract
Bullying has attracted increased attention due to the serious implications for perpetrators, victims, and schools. Recent studies have sought to identify factors that may contribute to bullying perpetration, and child abuse has been identified as one such factor. The mediating processes linking child abuse to bullying perpetration, however, are not well understood. The current study explored adolescent mental health problems, including symptoms of depression, anxiety, dissociation, and posttraumatic stress disorder, and poor social skills as pathways between childhood abuse and adolescent bullying perpetration. Data for the current study are from the Longitudinal Studies of Child Abuse and Neglect. The current study utilized a longitudinal and multi-informant design in which adolescents reported their history of childhood abuse, mental health problems, and social skills when they were 12 years old; bullying perpetration was reported by adolescent's teachers when adolescents were 12 and 14. Results indicated childhood abuse was associated with higher levels of depression, anxiety, anger, dissociation, posttraumatic stress, and poor social skills. Only anxiety and poor social skills at age 12 were significantly associated with bullying perpetration when adolescents when were 14. Bootstrapped indirect effects from childhood abuse to bullying perpetration were significant for both anxiety and poor social skills, indicating full mediation. Addressing anxiety and poor social skills in early adolescence among children who have been abused may prevent bullying perpetration in mid-adolescence. Clinicians, teachers, and school administrators may desire to focus efforts on reducing anxiety and increasing social skills to mitigate bullying perpetration.
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Affiliation(s)
- Cailyn Hamstra
- School of Teacher Education, Florida State University, Tallahassee, FL USA
| | - Michael Fitzgerald
- School of Child and Family Sciences, University of Southern Mississippi, Hattiesburg, MS USA
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Adolescent Mental Health and Family Economic Hardships: The Roles of Adverse Childhood Experiences and Family Conflict. J Youth Adolesc 2022; 51:2294-2311. [PMID: 35997913 DOI: 10.1007/s10964-022-01671-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
Rising and economically disproportionate rates of adverse mental health outcomes among children and youth warrant research investigating the complex pathways stemming from socioeconomic status. While adverse childhood experiences (ACEs) have been considered a possible mechanism linking socioeconomic status (SES) and child and youth psychopathology in previous studies, less is understood about how family environments might condition these pathways. Using data from a longitudinal, multiple-wave study, the present study addresses this gap by examining the direct relationships between family economic status and youth internalizing and externalizing symptoms, if ACEs mediate these relationships, and if conflictual family environments moderate these direct and indirect relationships. The data were obtained from 5510 youth participants [mean age at baseline = 9.52 (SD = 0.50), 47.7% female, 2.1% Asian, 10.3% Black, 17.6% Hispanic, 9.8% Multiracial/Multiethnic, 60.2% White] and their caretakers from the baseline, 1-year, and 2-year follow up waves. Conditional process analysis assessed the direct, indirect, and moderated relationships in separate, equivalent models based on youth- versus caregiver-raters of ACEs and youth psychopathology to capture potential differences based on the rater. The results of both the youth- and caregiver-rated models indicated that lower family economic status directly predicted higher levels of externalizing symptoms, and ACEs indirectly accounted for higher levels of internalizing and externalizing symptoms. Additionally, family conflict moderated some, but not all, of these relationships. The study's findings highlight that lower family economic status and ACEs, directly and indirectly, contribute to early adolescent psychopathology, and conflictual family environments can further intensify these relationships. Implementing empirically supported policies and interventions that target ACEs and family environments may disrupt deleterious pathways between SES and youth psychopathology.
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Cohen JR, Choi JW. Is ACEs Screening for Adolescent Mental Health Accurate and Fair? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1216-1229. [PMID: 35778650 DOI: 10.1007/s11121-022-01391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
Increasingly, adversity-focused assessment tools are being introduced into preventive mental health screening protocols. However, few studies have explicitly examined whether use of these instruments serves as equitable, clinically useful measures of mental health risk in adolescents. In response, the present study examined whether an adverse childhood experiences (ACEs) measure was accurate and fair as an index of environmental risk for adolescent mental health diagnoses. Secondary data analyses were conducted on the National Comorbidity Survey-Adolescent Supplement. Adolescents (N = 10,148; AgeMean = 15.20; 51.3% male; 65.6% White, 15.1% Black, and 14.4% Hispanic) answered ten questions concerning childhood adversities and completed diagnostic interviews for PTSD, depression, and externalizing disorders. In the overall sample, ACEs showed some clinical utility (e.g., area under the curve (AUCs) ≥ 0.64), diagnostic likelihood ratios (DLRs) > 4.0) and acceptable calibration (i.e., expected/observed indices' confidence intervals included 1) across diagnoses. Within subpopulations, however, predictive validity varied. The AUCs were lower for multiple diagnoses in Black male and Hispanic female adolescents and DLRs suggested greater clinical utility for indexing mental health in White, female adolescents. Finally, models were not well-calibrated between adolescent subpopulations, suggesting recommended ACEs screening can potentially produce biased results when used to inform mental health policy and prevention. Reasons for why results from ACEs screening may vary across adolescent subpopulations and the importance of testing statistical fairness for preventive mental health screening are discussed.
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Affiliation(s)
- Joseph R Cohen
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel St., IL, 61820, Champaign, USA.
| | - Jae Wan Choi
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel St., IL, 61820, Champaign, USA
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