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Chen EYJ, Tung EYL. Similarities and Differences in the Longitudinal Trajectories of Depressive Symptoms from Mid-Adolescence to Young Adulthood: the Intersectionality of Gender, Race/Ethnicity, and Levels of Depressive Symptoms. J Racial Ethn Health Disparities 2024; 11:1541-1556. [PMID: 37162740 DOI: 10.1007/s40615-023-01630-5] [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: 03/22/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Understanding similarities and differences between groups with intersecting social identities provides key information in research and practice to promote well-being. Building on the intersectionality literature indicating significant gender and racial/ethnic differences in depressive symptoms, the present study used quantile regression to systematically present the diversity in the development of depressive symptoms for individuals with intersecting gender, race/ethnicity, and levels of symptoms. METHODS Information from the National Longitudinal Survey of Youth 79: Child and Young Adult study was employed. A detailed picture of depressive symptom trajectories from low to high quantiles was illustrated by depicting 13 quantile-specific trajectories using follow-up data from ages 15 to 40 in six gender-race/ethnicity groups: both genders of Black, Hispanic, and non-Black, non-Hispanic individuals. RESULTS From low to high quantiles, Black and non-Black, non-Hispanic individuals showed mostly curved, and Hispanic individuals showed mostly flat trajectories. Across the six gender-race/ethnicity groups, the trajectories below 0.50 quantiles were similar in levels and shapes from mid-adolescence to young adulthood. The differences between the six gender-race/ethnicity groups widened, indicated by outspreading trajectories, especially at quantiles above 0.50. Furthermore, non-Black, non-Hispanic males and females showed especially fast-increasing patterns at quantiles above 0.75. Among those without or with only a high school degree, Black females and non-Black, non-Hispanic females tended to report similar levels of depressive symptoms higher than other groups at high quantiles. These unique longitudinal trajectory profiles cannot be captured by the mean trajectories. CONCLUSIONS The intersectionality of gender, race/ethnicity, and quantile of symptoms on the development of depressive symptoms was identified. Further studying the mechanism explaining this diversity can help reduce mental health disparities.
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Affiliation(s)
- Eva Yi-Ju Chen
- Department of Educational Psychology, Foundations, and Leadership Studies, University of Northern Iowa, Cedar Falls, IA, 50614, USA.
| | - Eli Yi-Liang Tung
- Department of Analytics and Operations, National University of Singapore, Singapore, 119077, Singapore
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Hughes K, Bellis MA, Cresswell K, Hill R, Ford K, Hopkins JC. Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK. BMJ Open 2024; 14:e081924. [PMID: 38692715 PMCID: PMC11086514 DOI: 10.1136/bmjopen-2023-081924] [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: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) can affect individuals' resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being. DESIGN National cross-sectional face-to-face survey. Recruitment used a random quota sample of households stratified by health region and deprivation quintile. SETTING Households in Wales, UK. PARTICIPANTS 1880 Welsh residents aged ≥18 years. MEASURES Outcome variables were perceived inability to cope financially during the cost-of-living crisis; rising costs of living causing substantial distress and anxiety; and self-reported negative impact of rising costs of living on mental health, physical health, family relationships, local levels of antisocial behaviour and violence, and community support. Nine ACEs were measured retrospectively. Socioeconomic and demographic variables included low household income, economic inactivity, residential deprivation and activity limitation. RESULTS The prevalence of all outcomes increased strongly with ACE count. Perceived inability to cope financially during the cost-of-living crisis increased from 14.0% with 0 ACEs to 51.5% with 4+ ACEs. Relationships with ACEs remained after controlling for socioeconomic and demographic factors. Those with 4+ ACEs (vs 0 ACEs) were over three times more likely to perceive they would be unable to cope financially and, correspondingly, almost three times more likely to report substantial distress and anxiety and over three times more likely to report negative impacts on mental health, physical health and family relationships. CONCLUSIONS Socioeconomically deprived populations are recognised to be disproportionately impacted by rising costs of living. Our study identifies a history of ACEs as an additional vulnerability that can affect all socioeconomic groups. Definitions of vulnerability during crises and communications with services on who is most likely to be impacted should consider childhood adversity and history of trauma.
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Affiliation(s)
- Karen Hughes
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Katie Cresswell
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Rebecca Hill
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
| | - Kat Ford
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Joanne C Hopkins
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
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Pisavadia K, Spencer LH, Tuersley L, Coates R, Ayers S, Edwards RT. Health economic evaluations of preventative care for perinatal anxiety and associated disorders: a rapid review. BMJ Open 2024; 14:e068941. [PMID: 38417959 PMCID: PMC10900391 DOI: 10.1136/bmjopen-2022-068941] [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: 03/01/2024] Open
Abstract
OBJECTIVES Perinatal mental health problems affect one in five women and cost the UK £8.1 billion for every year of births, with 72% of this cost due to the long-term impact on the child. We conducted a rapid review of health economic evaluations of preventative care for perinatal anxiety and associated disorders. DESIGN This study adopted a rapid review approach, using principles of the standard systematic review process to generate quality evidence. This methodology features a systematic database search, Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram, screening of evidence, data extraction, critical appraisal and narrative synthesis. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Applied Social Sciences Index and Abstracts, PsycINFO and MEDLINE. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that evaluated the costs and cost-effectiveness of preventative care for perinatal anxiety and associated disorders carried out within the National Health Service and similar healthcare systems. DATA EXTRACTION AND SYNTHESIS A minimum of two independent reviewers used standardised methods to search, screen, critically appraise and synthesise included studies. RESULTS The results indicate a lack of economic evaluation specifically for perinatal anxiety, with most studies focusing on postnatal depression (PND). Interventions to prevent postnatal mental health problems are cost-effective. Modelling studies have also been conducted, which suggest that treating PND with counselling would be cost-effective. CONCLUSION The costs of not intervening in maternal mental health outweigh the costs of preventative interventions. Preventative measures such as screening and counselling for maternal mental health are shown to be cost-effective interventions to improve outcomes for women and children. PROSPERO REGISTRATION NUMBER CRD42022347859.
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Affiliation(s)
- Kalpa Pisavadia
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Llinos Haf Spencer
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Lorna Tuersley
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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Victor TS, Jacquet B, El Massioui F. Exploring stress response's role in executive function impairments among adults with early adverse childhood experiences. Sci Rep 2024; 14:4081. [PMID: 38374227 PMCID: PMC10876952 DOI: 10.1038/s41598-024-53819-1] [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: 08/31/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Adverse childhood experiences (ACEs) are recognised as precursors to numerous physical and mental health challenges. However, research on their impact on inhibitory control and working memory, particularly among healthy young adults, remains limited. The role played by the stress response as a moderator in these effects is likewise underexplored. Our study addresses this gap by examining cognitive impairments in non-clinical adults with early childhood trauma, specifically trauma before the age of 13 years, and by assessing the influence of the stress response on these effects. A total of 15 participants with early ACEs were compared with a control group (n = 18) using the Corsi Block Tapping Test (CBTT) and Stroop Word Colour Test (SCWT). Results showed that participants with early ACEs exhibited lower scores on the SCWT but not the CBTT. The stress response emerged as a potential factor in the relationship between early ACEs and cognitive performance. The implications of these findings are then discussed in relation to the existing literature.
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Affiliation(s)
- Taïna Steevine Victor
- Université Paris 8, UFR Psychologie, 93200, Saint-Denis, France.
- Laboratoire Cognition Humaine et Artificielle (CHArt, RNSR 200515259U), 93322, Aubervilliers, France.
| | - Baptiste Jacquet
- Université Paris 8, UFR Psychologie, 93200, Saint-Denis, France
- Laboratoire Cognition Humaine et Artificielle (CHArt, RNSR 200515259U), 93322, Aubervilliers, France
| | - Farid El Massioui
- Université Paris 8, UFR Psychologie, 93200, Saint-Denis, France
- Laboratoire Cognition Humaine et Artificielle (CHArt, RNSR 200515259U), 93322, Aubervilliers, France
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Protić S, Wittmann L, Taubner S, Conejo-Cerón S, Ioannou Y, Heinonen E, Saliba A, Moreno-Peral P, Volkert J, Barkauskiene R, Julia Schmidt S, Rangel Santos Henriques MI, Pinheiro Mota C, Sales CMD, Røssberg JI, Adler A, Giacomo DD, Mucha Vieira F, Drndarević N, Ulberg R, Stepisnik Perdih T, Mestre JM. Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380231223264. [PMID: 38281152 DOI: 10.1177/15248380231223264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
This article aimed to provide a systematic narrative synthesis of existing studies on the mediators of change in psychotherapy with adolescents (10-19 years) and transition age youth (TAY) (20-29 years) who have experienced trauma-related symptoms or posttraumatic disorder. Additionally, we were interested in identifying psychotherapy-, trauma type-, and clients' age- and gender-specific mediators of treatment outcome. Following the preferred reporting items for systematic reviews and meta-analyses, a total of 3,723 studies published in PubMed and PsycINFO databases were screened against inclusion criteria, revealing 15 eligible studies. No studies with only TAY were found; therefore, all results were limited to therapy with adolescents. Cognitive mediators were tested in 66% of selected studies, followed by parents/family-related, mental-health-related, therapy-related, and behavioral mediators. Moderate evidence was found for posttraumatic cognitions, whereas therapeutic alliance seemed to be a promising candidate for future research. Striking absence of non-cognitive-behavioral therapy interventions, emotional and adolescent-specific mediators, as well as studies with males and in non-Western societies was evident. Future original studies would benefit from applying methodological rigor in respect to mediation testing.
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Affiliation(s)
- Sonja Protić
- Institute of Criminological and Sociological Research, Belgrade, Serbia
- Evangelische Hochschule Darmstadt/University of Applied Science Darmstadt, Darmstadt, Germany
| | - Lutz Wittmann
- International Psychoanalytic University Berlin, Germany
| | | | - Sonia Conejo-Cerón
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAN, Malaga, Andalucía, Spain
| | | | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
- University of Oslo, Norway
| | - Andrea Saliba
- University of Malta and Mental Health Services Malta, Malta
| | - Patricia Moreno-Peral
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAN, Malaga, Andalucía, Spain
| | - Jana Volkert
- Clinic for Psychosomatic Medicine and Psychotherapy University of Ulm, Ulm, Germany
| | | | | | | | | | | | | | | | | | | | - Nikola Drndarević
- Institute of Criminological and Sociological Research, Belgrade, Serbia
| | - Randi Ulberg
- University of Oslo, Norway
- Diakonhjemmet Hospital, Oslo, Norway
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Judd N, Hughes K, Bellis MA, Hardcastle K, Amos R. Is parental unemployment associated with increased risk of adverse childhood experiences? A systematic review and meta-analysis. J Public Health (Oxf) 2023; 45:829-839. [PMID: 37253685 PMCID: PMC10687894 DOI: 10.1093/pubmed/fdad069] [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: 05/09/2022] [Revised: 12/21/2022] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Unemployment has adverse consequences for families and can put children at risk of harm. This study presents a systematic review and meta-analysis of global evidence on associations between parental unemployment and adverse childhood experiences (ACEs). METHODS Systematic literature searches across four databases identified cross-sectional, cohort or case-control studies measuring associations between parental employment and individual or cumulative ACEs in children. Available risk estimates were extracted and pooled odds ratios calculated using random-effects models. RESULTS Of 60 included studies, 37 provided risk estimates suitable for pooling across seven ACE types. Paternal/any parental unemployment was associated with a 29% increased risk of sexual abuse, 54% increased risk of neglect, 60% increased risk of physical abuse and around 90% increased risk of child maltreatment and parental mental illness. No associations were found between maternal unemployment and ACEs. Pooling estimates from representative general population studies also identified increased risk of child maltreatment with paternal/any parental unemployment (82%) but not maternal unemployment. CONCLUSIONS Children who grow up with parental unemployment can be at increased risk of ACEs. A combination of socioeconomic measures to increase employment opportunities and parental support targeting fathers and mothers may help break multigenerational cycles of abuse and deprivation.
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Affiliation(s)
- Natasha Judd
- Public Health Collaborating Unit, BIHMR, School of Medical and Health Sciences, Wrexham Technology Park, Bangor University, Wrexham LL13 7YP, UK
- Policy and International Health, WHO Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham Technology Park, Wrexham LL13 7YP, UK
| | - Karen Hughes
- Public Health Collaborating Unit, BIHMR, School of Medical and Health Sciences, Wrexham Technology Park, Bangor University, Wrexham LL13 7YP, UK
- Policy and International Health, WHO Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham Technology Park, Wrexham LL13 7YP, UK
| | - Mark A Bellis
- Policy and International Health, WHO Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham Technology Park, Wrexham LL13 7YP, UK
- Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK
| | - Katie Hardcastle
- Policy and International Health, WHO Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham Technology Park, Wrexham LL13 7YP, UK
| | - Rebekah Amos
- Public Health Collaborating Unit, BIHMR, School of Medical and Health Sciences, Wrexham Technology Park, Bangor University, Wrexham LL13 7YP, UK
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Wakuta M, Nishimura T, Osuka Y, Tsukui N, Takahashi M, Adachi M, Suwa T, Katayama T. Adverse childhood experiences: impacts on adult mental health and social withdrawal. Front Public Health 2023; 11:1277766. [PMID: 37954050 PMCID: PMC10639139 DOI: 10.3389/fpubh.2023.1277766] [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: 08/15/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Background Adverse childhood experiences (ACEs) have been found to negatively impact adult mental health outcomes. Numerous studies have highlighted on ACEs in family and community settings. However, few have examined the impact of ACEs in school settings, despite the potential influence on social participation. Hikikomori, characterized by severe social withdrawal, was first studied in Japan and has gained recognition in recent years. The present study aims to present the concept of ACEs specific to schools and investigate the impact of both school ACEs and traditional ACEs on adult mental health and Hikikomori. Methods A total of 4,000 Japanese adults, aged 20-34, were recruited through an Internet survey form. All data were obtained in October 2021. Participants answered questions regarding their ACEs in the family (10 items), school ACEs (five teacher-related items and two bullying-related items), depressive/anxiety symptoms, and Hikikomori (remaining at home for more than 6 months). Results A significant association with depressive/anxiety symptoms was shown in both ACEs and school ACEs. An increase of one point in the ACE scores was associated with a 24% increase in the risk of depressive/anxiety symptoms. School ACE scores also demonstrated a significant association with depressive/anxiety symptoms, with an increase of one point associated with a 44% increase in the risk of these symptoms. As for Hikikomori, a significant association was shown in the school ACEs only: a 29% increased risk of Hikikomori for every one-point increase in school ACE scores. Both school ACE scores for teacher-related and bullying-related factors revealed a significant association with Hikikomori; the rates of increased risk were 23 and 37%, respectively. Conclusion These results suggest that school ACEs, rather than ACEs in the family, are associated with the risk of Hikikomori. School ACEs are important for social adaptation, and reducing traumatic experiences in school settings may have the potential to prevent problems in later life, specifically in terms of social participation.
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Affiliation(s)
- Manabu Wakuta
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoko Nishimura
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuko Osuka
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Nobuaki Tsukui
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Michio Takahashi
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Smart-Aging Research Center, Tohoku University, Sendai, Japan
| | - Masaki Adachi
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
- Department of Psychology, Meiji Gakuin University, Yokohama, Japan
| | - Toshiaki Suwa
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- Department of Health and Welfare, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Taiichi Katayama
- Research Department, Institute of Child Developmental Science Research, Hamamatsu, Japan
- United Graduate School of Child Development, Osaka University, Suita, Japan
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Patel P, Oremus M. The Association Between Adverse Childhood Experiences and Late-Life Cognition: A Systematic Review of Cross-Sectional and Case-Control Studies. THE GERONTOLOGIST 2023; 63:1087-1103. [PMID: 35323913 DOI: 10.1093/geront/gnac041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adverse childhood experiences (ACEs) are a recognized risk factor for unfavorable health outcomes. No prior systematic review has explored the association between ACEs and cognition in late life, a critical period for cognitive fluctuation. The objective of this review is to address the following research question: What is the association between ACEs and late-life cognition? RESEARCH DESIGN AND METHODS Articles were obtained from PubMed, PsycINFO, and Scopus. The last search was performed in May 2021. Eligible articles examined the association between exposure to at least 1 ACE and the outcome of late-life cognition, measured either by cognitive testing or the presence/absence of a neurocognitive disorder. Data were synthesized narratively using the synthesis without meta-analysis guidelines, and the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Adapted NOS. RESULTS Twenty articles representing 18 unique studies were included in the narrative synthesis. Associations with lower late-life cognition were reported for: childhood maternal death, parental divorce, physical neglect, emotional neglect, physical abuse, and combinations of ACEs. However, most results were statistically nonsignificant, and many were unlikely to be clinically important. DISCUSSION AND IMPLICATIONS We found an association between ACEs and late-life cognition. However, the direction and magnitude of association varied between and within types of ACEs and measures of cognitive function. Most included articles had a moderate risk of bias. This review is the first attempt to synthesize the literature on this topic and it outlines the next steps to improve the evidence base in the area.
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Affiliation(s)
- Priya Patel
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Oremus
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
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Giovanelli A, Mondi CF, Reynolds AJ, Ou SR. Evaluation of Midlife Educational Attainment Among Attendees of a Comprehensive Early Childhood Education Program in the Context of Early Adverse Childhood Experiences. JAMA Netw Open 2023; 6:e2319372. [PMID: 37347483 PMCID: PMC10288333 DOI: 10.1001/jamanetworkopen.2023.19372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/05/2023] [Indexed: 06/23/2023] Open
Abstract
Importance Educational attainment is a key social determinant of health and can be particularly consequential for racial and ethnic minority populations. Although the consequences of adverse childhood experiences (ACEs) are well established, there is little research on protective factors and policy-relevant strategies to mitigate ACE-related inequities. Objective To examine associations between early ACEs, comprehensive early intervention, and midlife educational attainment in a cohort of predominantly Black participants. Design, Setting, and Participants The Chicago Longitudinal Study is a prospective cohort study of Black and Latinx children from Chicago, Illinois. The intervention group included 989 children entering the Child-Parent Center (CPC) preschool Early Childhood Education (ECE) program in the 1980s. The comparison group comprised 550 children participating in usual early childhood services. All participants were followed up for 30 years after the end of the intervention. Analyses were conducted from July 1 to September 1, 2022. Intervention Attendance at the CPC preschool ECE program. Main Outcomes and Measures A standard battery of early childhood ACEs (conventional ACEs), a set of early childhood ACEs more commonly associated with high-poverty contexts (expanded ACEs), and educational attainment at 35 years of age were measured from self-report and administrative records. Results The original Chicago Longitudinal Study sample comprised 1539 participants (1430 Black participants [92.9%]; 774 female participants [50.3%]). Data on educational attainment and ACEs were available for 1083 of 1467 living participants (73.8%). Participants in the present study (1013 Black participants [93.5%]; 594 female participants [54.9%]) were a mean (SD) age of 35.1 (0.3) years at completion of the midlife survey. For the comparison group but not the CPC intervention group, having 1 or more conventional or expanded ACEs in early childhood was associated with fewer years of education (β = -0.64; 95% CI, -1.02 to -0.26), reduced likelihood of attaining a bachelor's degree or higher (odds ratio, 0.26; 95% CI, 0.09-0.70), and reduced likelihood of attaining an associate's degree or higher (odds ratio, 0.26; 95% CI, 0.11-0.62) after adjusting for covariates. Moderation analyses indicated that CPC participants with either conventional or expanded ACEs in early childhood attained a bachelor's degree or higher and an associate's degree or higher at rates similar to CPC participants without early ACEs (15.4% vs 13.6% for bachelor's degree or higher; 22.4% vs 19.9% for associate's degree or higher). Conversely, comparison group participants with early ACEs had significantly lower rates of educational attainment than their counterparts without ACEs (3.7% vs 12.1% for bachelor's degree or higher; 5.6% vs 17.1% for associate's degree or higher). Conclusions This cohort study suggests that early ACEs were associated with reduced educational attainment for the comparison group but not for the group participating in the CPC comprehensive early intervention. These results build on research suggesting that youths at higher risk can benefit most from intervention and support ECE as a tool for reducing ACE-related disparities.
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Affiliation(s)
- Alison Giovanelli
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco
| | - Christina F. Mondi
- Brazelton Touchpoints Center, Division of Developmental Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arthur J. Reynolds
- Human Capital Research Collaborative, Institute of Child Development, University of Minnesota, Minneapolis
| | - Suh-Ruu Ou
- Human Capital Research Collaborative, Institute of Child Development, University of Minnesota, Minneapolis
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Kim K, Yaffe K, Rehkopf DH, Zheng Y, Nannini DR, Perak AM, Nagata JM, Miller GE, Zhang K, Lloyd-Jones DM, Joyce BT, Hou L. Association of Adverse Childhood Experiences With Accelerated Epigenetic Aging in Midlife. JAMA Netw Open 2023; 6:e2317987. [PMID: 37306997 PMCID: PMC10261996 DOI: 10.1001/jamanetworkopen.2023.17987] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/05/2023] [Indexed: 06/13/2023] Open
Abstract
Importance Adverse childhood experiences (ACEs) are associated with the risk of poorer health, and identifying molecular mechanisms may lay the foundation for health promotion in people with ACEs. Objective To investigate the associations of ACEs with changes in epigenetic age acceleration (EAA), a biomarker associated with various health outcomes in middle-aged adults, in a population with balanced race and sex demographics. Design, Setting, and Participants Data for this cohort study were from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants in CARDIA underwent 8 follow-up exams from baseline (year 0 [Y0]; 1985-1986) to Y30 (2015-2016), and participant blood DNA methylation information was obtained at Y15 (2000-2001) and Y20 (2005-2006). Individuals from Y15 and Y20 with available DNA methylation data and complete variables for ACEs and covariates were included. Data were analyzed from September 2021 to August 2022. Exposures Participant ACEs (general negligence, emotional negligence, physical violence, physical negligence, household substance abuse, verbal and emotional abuse, and household dysfunction) were obtained at Y15. Main Outcomes and Measures The primary outcome consisted of results from 5 DNA methylation-based EAA measurements known to be associated with biological aging and long-term health: intrinsic EAA (IEAA), extrinsic EAA (EEAA), PhenoAge acceleration (PhenoAA), GrimAge acceleration (GrimAA), and Dunedin Pace of Aging Calculated From the Epigenome (DunedinPACE), measured at Y15 and Y20. Linear regression and generalized estimating equations were used to assess associations of the burden of ACEs (≥4 vs <4 ACEs) with EAA adjusting for demographics, health-related behaviors, and early life and adult socioeconomic status. Results A total of 895 participants for Y15 (mean [SD] age, 40.4 [3.5] years; 450 males [50.3%] and 445 females [49.7%]; 319 Black [35.6%] and 576 White [64.4%]) and 867 participants for Y20 (mean [SD] age, 45.4 [3.5] years; 432 males [49.8%] and 435 females [50.2%]; 306 Black [35.3%] and 561 White [64.7%]) were included after excluding participants with missing data. There were 185 participants with (20.7%) vs 710 participants without (79.3%) 4 or more ACEs at Y15 and 179 participants with (20.6%) vs 688 participants without (79.4%) 4 or more ACEs at Y20. Having 4 or more ACEs was positively associated with EAA in years at Y15 (EEAA: β = 0.60 years; 95% CI, 0.18-1.02 years; PhenoAA: β = 0.62 years; 95% CI = 0.13-1.11 years; GrimAA: β = 0.71 years; 95% CI, 0.42-1.00 years; DunedinPACE: β = 0.01; 95% CI, 0.01-0.02) and Y20 (IEAA: β = 0.41 years; 95% CI, 0.05-0.77 years; EEAA: β = 1.05 years; 95% CI, 0.66-1.44 years; PhenoAA: β = 0.57 years; 95% CI, 0.08-1.05 years; GrimAA: β = 0.57 years; 95% CI, 0.28-0.87 years; DunedinPACE: β = 0.01; 95% CI, 0.01-0.02) after adjusting for demographics, health-related behaviors, and socioeconomic status. Conclusions and Relevance In this cohort study, ACEs were associated with EAA among middle-aged adults after controlling for demographics, behavior, and socioeconomic status. These findings of the associations between early life experience and the biological aging process in midlife may contribute to health promotion in a life course perspective.
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Affiliation(s)
- Kyeezu Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - David H. Rehkopf
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Yinan Zheng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Drew R. Nannini
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M. Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco
| | - Greg E. Miller
- Department of Psychology, Northwestern University, Evanston, Illinois
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer
| | - Donald M. Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Potocsnak Longevity Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brian T. Joyce
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Potocsnak Longevity Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [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: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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12
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Barboza-Salerno GE, Kosloski A, Weir H, Thompson D, Bukreyev A. A Network Analysis of the Relationship Between Mental and Physical Health in Unsheltered Homeless Persons in Los Angeles County. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:5902-5936. [PMID: 36300615 DOI: 10.1177/08862605221127222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Homelessness is a public health crisis both nationally, in the United States, and internationally. Nevertheless, due to the hidden vulnerabilities of persons who are without shelter, little is known about their experiences during periods of homelessness. The present research adopts a network approach that conceptualizes how the major risk factors of homelessness interact, namely substance abuse problems, poor mental health, disability, and exposure to physical or sexual violence by an intimate partner. Our analysis draws on a large demographic survey of over 5,000 unsheltered homeless persons conducted in 2017 by the Los Angeles Homeless Services Authority. We estimated a network structure for 12 survey items tapping individual risk using the graphical least absolute shrinkage and selection operator algorithm. We then examined network centrality metrics and implemented a community detection algorithm to detect communities in the network. Our results indicated that mental illness and intimate partner violence (IPV) are central measures that connect all other mental and physical health variables together and that post-traumatic stress disorder and IPV are both highly affected by changes in any part of the network and, in turn, affect changes in other parts of the network. A community detection analysis derived four communities characterized by disability, sexual victimization and health, substance use, and mental health issues. Finally, a directed acyclic graph revealed that drug abuse and physical disability were key drivers of the overall system. We conclude with a discussion of the major implications of our findings and suggest how our results might inform programs aimed at homelessness prevention and intervention.
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Affiliation(s)
| | - Anna Kosloski
- School of Public Affairs, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Henriikka Weir
- School of Public Affairs, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | | | - Alexey Bukreyev
- College of Arts, Letters and Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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13
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de Vries TR, Arends I, Oldehinkel AJ, Bültmann U. Associations between type of childhood adversities and labour market participation and employment conditions in young adults. J Epidemiol Community Health 2023; 77:230-236. [PMID: 36805940 PMCID: PMC10086506 DOI: 10.1136/jech-2022-219574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Cumulative exposure to childhood adversity is associated with a variety of labour market outcomes in young adulthood. It remains largely unclear whether the type of adversity matters in this association. This prospective study examined the differences in exposure to 14 adverse experiences among groups of young adults aged 22 characterised by distinct labour market participation states and employment conditions. METHODS We used data from the TRacking Adolescents' Individual Lives Survey, a Dutch prospective cohort study with 15 years of follow-up (N=1524). We included 14 adverse experiences (ages 0-16) across five domains: peer influences, loss or threat of loss, material deprivation, family dynamics and maltreatment. Labour market participation states and employment conditions were assessed at age 22. We used latent class analysis to derive labour market outcome groups, which we subsequently compared on exposure to adverse experiences using pairwise comparisons. RESULTS Inactive individuals (n=85, 5.6%), often neither in education (77.4%) nor employment (98.6%) and on benefits (94.4%), were more likely to be exposed to many distinct types of adverse experiences (eg, parental addiction, bullying victimisation) as compared with all other groups. Early workers (n=413, 27.1%), often on temporary contracts and low monthly incomes, were more likely to be exposed to parental divorce (22.7%) compared with students with side jobs (12.9%). CONCLUSIONS Different adverse experiences are not equally associated with labour market outcomes. Researchers and stakeholders in policy and practice should be aware of the differences between adverse experiences in their importance for labour market outcomes in young adults.
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Affiliation(s)
- Tjeerd Rudmer de Vries
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris Arends
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Arbo Unie BV, Utrecht, The Netherlands
| | - Albertine J Oldehinkel
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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14
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Xie D, Wang J, Huang F. The Role of Adverse Childhood Experiences in Multidimensional Nature of Subjective Age. J Gerontol B Psychol Sci Soc Sci 2023; 78:230-241. [PMID: 36208468 DOI: 10.1093/geronb/gbac160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Age stereotypes and expectations about one's own aging commence in childhood, while most research focuses on predictive associations with midlife cognition and health outcomes in later life. This study instead aims to examine adverse childhood experiences (ACEs) contributing to multiple measures of subjective age (SA) among Chinese older adults and test whether these relationships differ by household registration (hukou). METHODS In a representative sample of Chinese older adults aged 60 and older from the 2018 China Longitudinal Aging and Social Survey (n = 7,815), ordinary least squares is used to examine the associations between ACEs and 3 facets of SA: felt age, look age, and self-defined aging standard. RESULTS Childhood starvation experience and limited health care access predict older felt age and look age, while parental death is associated with lower self-defined aging standard. Zooming in on hukou-specific associations shows that the dose-response relationship on older adults with rural hukou is particularly pronounced. DISCUSSION Findings provide empirical support for views of aging from a life-course perspective and highlight the enduring impact of ACEs for late-adulthood SA, as well as their differential influence on multiple indicators of SA. Interventions that focus on promoting health and development in childhood could potentially have effects beyond the childhood phase, and benefit for their positive aging attitude in later life.
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Affiliation(s)
- Donghong Xie
- Institute of Governance, Shandong University, Qingdao, China
| | - Jiwen Wang
- Research Center for Rural Economy, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Fan Huang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
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15
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Tognin S, Catalan A, Kempton MJ, Nelson B, McGorry P, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Ruhrmann S, Sachs G, Rutten BPF, van Os J, de Haan L, van der Gaag M, McGuire P, Valmaggia LR. Impact of adverse childhood experiences on educational achievements in young people at clinical high risk of developing psychosis. Eur Psychiatry 2023; 66:e16. [PMID: 36649929 PMCID: PMC9970149 DOI: 10.1192/j.eurpsy.2022.2351] [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] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACE) can affect educational attainments, but little is known about their impact on educational achievements in people at clinical high risk of psychosis (CHR). METHODS In total, 344 CHR individuals and 67 healthy controls (HC) were recruited as part of the European Community's Seventh Framework Programme-funded multicenter study the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI). The brief version of the Child Trauma Questionnaire was used to measure ACE, while educational attainments were assessed using a semi-structured interview. RESULTS At baseline, compared with HC, the CHR group spent less time in education and had higher rates of ACE, lower rates of employment, and lower estimated intelligence quotient (IQ). Across both groups, the total number of ACE was associated with fewer days in education and lower level of education. Emotional abuse was associated with fewer days in education in HC. Emotional neglect was associated with a lower level of education in CHR, while sexual abuse was associated with a lower level of education in HC. In the CHR group, the total number of ACE, physical abuse, and neglect was significantly associated with unemployment, while emotional neglect was associated with employment. CONCLUSIONS ACE are strongly associated with developmental outcomes such as educational achievement. Early intervention for psychosis programs should aim at integrating specific interventions to support young CHR people in their educational and vocational recovery. More generally, public health and social interventions focused on the prevention of ACE (or reduce their impact if ACE occur) are recommended.
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Affiliation(s)
- Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ana Catalan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Biobizkaia Health Research Institute, Basurto University Hospital, OSI Bilbao-Basurto, University of the Basque Country UPV/EHU, Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto deSalud Carlos III, Barakaldo, Spain
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR), Biomedical Research Centre (BRC), London, United Kingdom
| | - Barnaby Nelson
- The National Centre of Excellence in Youth Mental Health, Orygen, Parkville, Victoria3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Parkville, Victoria3052, Australia
| | - Patrick McGorry
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), University of Copenhagen, Mental Health Centre Glostrup, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Rodrigo Bressan
- LiNC - Lab Integrative Neuroscience, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver (Spain), Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université Paris Descartes, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie, Paris, France.,Faculté de Médecine Paris Descartes, GHU Paris - Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), University of Copenhagen, Mental Health Centre Glostrup, Copenhagen, Denmark.,Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, Early Psychosis Department, Amsterdam, The Netherlands
| | - Mark van der Gaag
- VU University, Faculty of Behavioural and Movement Sciences, Department of Clinical Psychology and Amsterdam Public Mental Health Research Institute, Amsterdam, The Netherlands.,Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research (NIHR), Biomedical Research Centre (BRC), London, United Kingdom
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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16
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Buckles K, Evans WN, Lieber EMJ. The drug crisis and the living arrangements of children. JOURNAL OF HEALTH ECONOMICS 2023; 87:102723. [PMID: 36638640 DOI: 10.1016/j.jhealeco.2022.102723] [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: 05/16/2022] [Revised: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
We examine the impact of the US drug crisis on children's living arrangements. Because factors that lead to drug use could also alter family structure, we instrument for the intensity of the drug crisis with cross-state exposure to marketing of the prescription opioid at the epicenter of the crisis. We find that the crisis increased the likelihood that a child lives away from a parent or in a household headed by a grandparent. Our results suggest that if drug use had remained at 1996 levels, 1.5 million fewer children aged 0-16 would have lived away from a parent in 2015.
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Affiliation(s)
- Kasey Buckles
- University of Notre Dame, NBER, and IZA, United States
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17
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Jacobsen SA, Bibby BM, Frostholm L, Petersen MW, Ørnbøl E, Schovsbo SU, Dantoft TM, Carstensen TBW. Development and Validation of the Weighted Index for Childhood Adverse Conditions (WICAC). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013251. [PMID: 36293829 PMCID: PMC9602749 DOI: 10.3390/ijerph192013251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Adverse experiences in childhood are a major public health concern, promoting social inequality in health through biopsychosocial mechanisms. So far, no known measures comprehend the complexity and variations of severity of adverse events. This study aims to develop and validate a new index: the Weighted Index for Childhood Adverse Conditions (WICAC). METHODS The population consists of 7493 randomly invited men and women aged 18-72 years. Data were collected in 2012-2015 as part of the Danish Study of Functional Disorders (DanFunD). Content and construct validation of the WICAC was performed with the hypothesis testing of multiple biopsychosocial outcomes: cardiovascular disease, cancer, poor health, back pain, BMI, obesity, anxiety, depression, low vitality, subjective social status, lower education, smoking, and alcohol consumption. Data were analysed with binominal and linear regression models with risk ratios (RR) and mean differences (MD). RESULTS Content validation is fitting for WICAC. The strongest associations observed were for most severe adversity: Poor Health RR = 2.16 (1.19-2.91), Anxiety RR = 3.32 (2.32-4.74), Heavy Drinking RR = 4.09 (1.85-9.04), and Subjective Social Status MD = -0.481 (-0.721-(-0.241)). Similar results were found for the remaining outcomes. Discriminative validation was undecided. CONCLUSIONS WICAC is an adequate instrument for measuring cumulative adverse life events in childhood and adolescence for research purposes.
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Affiliation(s)
- Sofie A. Jacobsen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Correspondence:
| | - Bo M. Bibby
- Department of Public Health, Biostatistics, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
| | - Marie W. Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
| | - Signe U. Schovsbo
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2400 Copenhagen, Denmark
| | - Thomas M. Dantoft
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2400 Copenhagen, Denmark
| | - Tina B. W. Carstensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensen Boulevard 11, 8200 Aarhus, Denmark
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18
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Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry 2022; 13:800687. [PMID: 35935425 PMCID: PMC9352895 DOI: 10.3389/fpsyt.2022.800687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.
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Affiliation(s)
- Daniel Cruz
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | | | - Kevin Berg
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | - Preethi George
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
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19
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Haugland SH, Stea TH. Risky Lives? Self-Directed Violence and Violence From Others Among Young People Not in Education, Employment, or Training (NEET). Front Public Health 2022; 10:904458. [PMID: 35875022 PMCID: PMC9301122 DOI: 10.3389/fpubh.2022.904458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Self-directed violence and violence from others comprise a major public health concern in youth. However, we lack knowledge about the prevalence of violent experiences among young people that are not in education, employment, or training (NEET), whether violent occurrences are similar among girls and boys, and whether violence differs between NEET youths and young students. This cross-sectional study compared the occurrences of self-directed violence (suicide attempts and self-harm) and exposure to violence from others (violent threats, beaten without visible marks, or injured due to violent events) between 96 NEET youth and 384 age- and sex-matched upper secondary school students (16–21 years). Suicide attempts were reported by 45.2% of NEET girls and 18.8% of schoolgirls (p < 0.001), but no significant difference was found between NEET boys (17.6%) and schoolboys (13.1%). Self-harm was reported by 78.9% of NEET girls and 33.9% of schoolgirls (p < 0.001). Self-harm was less prevalent among boys; it was reported by 34.6% of NEET boys and 21.8% of schoolboys (p = 0.056). A multivariable logistic regression analysis, adjusted for parental education, showed that, compared to schoolgirls, NEET girls had much higher odds ratios (ORs) for both self-directed violence and violence from others with OR ranging from 4.39; CI 1.96–9.85 to 7.68; CI 3.20–18.41. The risk of injury due to violent events was higher among NEET boys (OR: 3.23, 95%CI: 1.21–8.62) compared to schoolboys. Our findings highlighted the importance of including NEET individuals in studies on violence and emphasized the importance of psychosocial health services for young people marginalized from education and the labor market.
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Affiliation(s)
- Siri Havas Haugland
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway
- *Correspondence: Siri Havas Haugland
| | - Tonje Holte Stea
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway
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20
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Haugland SH, Stea TH. Commentary on Welford, Danielsson & Manhica: The complexity of life conditions among offspring exposed to parental SUD. Addiction 2022; 117:2057-2058. [PMID: 35307883 PMCID: PMC9310837 DOI: 10.1111/add.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Siri H. Haugland
- Department of Psychosocial HealthUniversity of AgderGrimstadNorway
| | - Tonje H. Stea
- Department of Health and Nursing ScienceUniversity of AgderKristiansandNorway,Department of Child and Adolescence Mental HealthSørlandet HospitalKristiansandNorway
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21
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Loeb DF, Durfee J, Monson S, Bayliss EA, Garcia C, Kline D, Barrett K, Rinehart D. Prevalence of adverse childhood experiences and post traumatic stress disorder symptoms in a primary care safety-net population: Implications for healthcare service needs. Gen Hosp Psychiatry 2022; 77:102-108. [PMID: 35596962 DOI: 10.1016/j.genhosppsych.2022.04.001] [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: 08/27/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We characterized the prevalence and associated characteristics of Adverse Childhood Experiences (ACEs) and Post-traumatic stress disorder (PTSD) in a safety net system and assessed patient preferences for trauma informed care. METHODS We performed a cross-sectional survey among adult patients attending primary care at three urban federally qualified healthcare centers. We used a method of recruitment that included both convenience and systemic sampling. The survey included the ACEs Questionnaire, the PTSD for DSM 5 (PC-PTSD5), and trauma-informed care preferences. We accessed Electronic Health Records for demographic and clinical data. We used descriptive and multivariable statistical analyses. RESULTS 303 of 481 (63%) patients that were approached participated. Most participants (81%) had one or more ACEs and 38% had four or more. 88 (29%) patients screened positive for current PTSD. ACEs was associated with a diagnosis of mental illness (p = 0.0125) and substance use disorders (p = 0.01). Patients with ACEs >/=4 or positive PC-PTSD reported stress in attending medical visits and that trauma-informed provider behaviors would make their visits less stressful. CONCLUSIONS Rates of ACES and current PTSD symptoms were high in this population and support the need for research to evaluate universal trauma-informed care strategies for safety-net healthcare systems.
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Affiliation(s)
- Danielle F Loeb
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America.
| | - Joshua Durfee
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, United States of America
| | - Samantha Monson
- Ambulatory Care Services, Denver Health and Hospital Authority, 777 Bannock St., M.C. 1916, Denver, CO 80204, United States of America
| | - Elizabeth A Bayliss
- Kaiser Permanente Colorado Institute for Health Research, 2550 South Parker Road, Aurora, CO 80014, United States of America; Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America
| | - Christine Garcia
- Ambulatory Care Services, Denver Health and Hospital Authority, 777 Bannock St., M.C. 1916, Denver, CO 80204, United States of America
| | - Danielle Kline
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America
| | - Kaeli Barrett
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, United States of America
| | - Deborah Rinehart
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave., Aurora, CO 80045, United States of America; Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, 777 Bannock St., M.C. 6551, Denver, CO 80204, United States of America
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22
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Schlauch KA, Read RW, Neveux I, Lipp B, Slonim A, Grzymski JJ. The Impact of ACEs on BMI: An Investigation of the Genotype-Environment Effects of BMI. Front Genet 2022; 13:816660. [PMID: 35342390 PMCID: PMC8942770 DOI: 10.3389/fgene.2022.816660] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/04/2022] [Indexed: 12/31/2022] Open
Abstract
Adverse Childhood Experiences are stressful and traumatic events occurring before the age of eighteen shown to cause mental and physical health problems, including increased risk of obesity. Obesity remains an ongoing national challenge with no predicted solution. We examine a subset of the Healthy Nevada Project, focusing on a multi-ethnic cohort of 15,886 sequenced participants with recalled adverse childhood events, to study how ACEs and their genotype-environment interactions affect BMI. Specifically, the Healthy Nevada Project participants sequenced by the Helix Exome+ platform were cross-referenced to their electronic medical records and social health determinants questionnaire to identify: 1) the effect of ACEs on BMI in the absence of genetics; 2) the effect of genotype-environment interactions on BMI; 3) how these gene-environment interactions differ from standard genetic associations of BMI. The study found very strong significant associations between the number of adverse childhood experiences and adult obesity. Additionally, we identified fifty-five common and rare variants that exhibited gene-interaction effects including three variants in the CAMK1D gene and four variants in LHPP; both genes are linked to schizophrenia. Surprisingly, none of the variants identified with interactive effects were in canonical obesity-related genes. Here we show the delicate balance between genes and environment, and how the two strongly influence each other.
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Affiliation(s)
- Karen A Schlauch
- Center for Genomic Medicine, Desert Research Institute, Reno, NV, United States
| | - Robert W Read
- Center for Genomic Medicine, Desert Research Institute, Reno, NV, United States
| | - Iva Neveux
- Center for Genomic Medicine, Desert Research Institute, Reno, NV, United States
| | - Bruce Lipp
- Center for Genomic Medicine, Desert Research Institute, Reno, NV, United States
| | | | - Joseph J Grzymski
- Center for Genomic Medicine, Desert Research Institute, Reno, NV, United States.,Renown Health, Reno, NV, United States
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23
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Du B, Mu Y, Wang X. Diet structure and academic achievement of children from difficult families: a cross-sectional study of Chinese children. BMJ Open 2022; 12:e055839. [PMID: 35301209 PMCID: PMC8932259 DOI: 10.1136/bmjopen-2021-055839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Welfare policy focuses on vulnerable populations, such as children with difficult family backgrounds. Education is a crucial way to reduce poverty. This study explored the relationship between children's diet structure and academic achievement and compared these across different family backgrounds. DESIGN A cross-sectional study was conducted to survey the health status of children from difficult families based on a random sampling method in 2018. Survey data were collected from children and their guardians with a questionnaire. A multi-sample latent class model and an ordinal logistic model were applied for data analysis. SETTING This study was conducted in 31 provinces nationwide. Two provinces in the Central (Shandong and Jiangxi), Eastern (Hebei and Henan) and Western (Chongqing and Shanxi) regions and one province in the Northeast (Liaoning) were selected considering different stratum of economic development. PARTICIPANTS A total of 2099 children with difficult family backgrounds and 666 children from ordinary families were surveyed. RESULTS The dietary structure of children from ordinary families was significantly better than that of children with difficult or unstable family backgrounds ([Formula: see text] =9.178, p<0.01). Children from difficult families had an intake of dairy products and fruits below dietary standards. The difference in academic achievement between children in the balanced and deprived groups was statistically significant (OR=0.640, 95% CI 0.429 to 0.955). Other determinants of the academic achievement of children in difficult families were parents' education level (OR=1.331, 95% CI 1.162 to 1.525), family economic status (OR=0.835, 95% CI 0.748 to 0.932) and parents' academic concern (OR=0.373, 95% CI 0.252 to 0.553). CONCLUSIONS To address the differences between children from difficult families and ordinary families, policymakers should develop support policies for difficult children, guide the formation of a reasonable dietary structure. Besides, enhancing family closeness and fostering family nurturing behaviours are the keys to promote the good academic development of children from difficult families.
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Affiliation(s)
- Benfeng Du
- Public Health and Disease Control Interdisciplinary Major Innovation Platform, Center for Population and Development Studies, Renmin University of China, Beijing, China
| | - Yuexuan Mu
- School of Sociology and Population studies, Renmin University of China, Beijing, China
| | - Xuan Wang
- School of Sociology and Population studies, Renmin University of China, Beijing, China
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24
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Association between Self-Reported Childhood Difficulties and Obesity and Health-Related Behaviors in Adulthood-A Cross-Sectional Study among 28,047 Adults from the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031395. [PMID: 35162418 PMCID: PMC8835689 DOI: 10.3390/ijerph19031395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
The aim of the present study was to examine the associations between self-reported childhood difficulties, weight status, and lifestyle behaviors among a representative sample of Norwegian adults. This cross-sectional study included 28,047 adults (>18 years old) living in southern Norway. A self-report questionnaire was used to assess information about the overall quality of the respondents’ childhood retrospectively in addition to current weight status and current lifestyle behaviors. Multivariable logistic regression models adjusted for gender, age, and educational level showed that evaluating childhood as difficult was associated with increased odds of obesity (OR: 1.29; 95% CI; 1.16–1.44) in adulthood. Moreover, a difficult childhood was associated with increased odds of unhealthy lifestyle behaviors in adulthood, including low consumption of fruit and berries (1.21; 1.09–1.34) and fish (1.43; 1.30–1.57), high consumption of sugar-sweetened beverages (1.30; 1.14–1.48), low level of physical activity (1.10; 1.01–1.21), smoking cigarettes (1.78; 1.61–1.97), and using smokeless tobacco (1.20; 1.07–1.36). Overall, results from the present study suggest that experiencing childhood as difficult is associated with an increased risk of obesity and a range of unhealthy lifestyle behaviors in adulthood. Thus, our findings highlight the importance of identifying and providing support to children in difficult life circumstances in addition to customized and targeted public health efforts in adulthood.
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25
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OUP accepted manuscript. Nutr Rev 2022; 80:2089-2099. [DOI: 10.1093/nutrit/nuac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Brown MJ, Kaur A, James T, Avalos C, Addo PNO, Crouch E, Hill NL. Adverse Childhood Experiences and Subjective Cognitive Decline in the US. J Appl Gerontol 2021; 41:1090-1100. [PMID: 34898321 DOI: 10.1177/07334648211058718] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the association between adverse childhood experiences (ACEs) and subjective cognitive decline (SCD) among a representative sample of the adult US population. METHODS Data were obtained from the 2019 Behavioral Risk Factor Surveillance System (N = 82,688, ≥45 years). Adverse childhood experiences included sexual, physical/psychological and environmental ACEs, and a score. Multivariable logistic regression was used to determine the association between ACEs and SCD, and SCD-related outcomes. RESULTS Sexual (adjusted OR (aOR: 2.83; 95% CI: 2.42-3.31)), physical/psychological (aOR: 2.05; 95% CI: 1.83-2.29), and environmental (aOR: 1.94; 95% CI: 1.74-2.16) ACEs were associated with SCD in the past year. There was also a dose-response relationship between ACE score and SCD. CONCLUSION ACEs were associated with SCD. Interventions to maximize cognitive health in aging and prevent future cognitive impairment should consider the potential role of ACEs among affected populations.
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Affiliation(s)
- Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Office of the Study on Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Amandeep Kaur
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Titilayo James
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Carlos Avalos
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Prince N O Addo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Health Services Policy and Management, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Nikki L Hill
- College of Nursing, Pennsylvania State University, University Park, PA, USA
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27
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Kalia V, Knauft K, Hayatbini N. Adverse childhood experiences (ACEs) associated with reduced cognitive flexibility in both college and community samples. PLoS One 2021; 16:e0260822. [PMID: 34855895 PMCID: PMC8638954 DOI: 10.1371/journal.pone.0260822] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
The prefrontal cortex is sensitive to stress experiences and significantly impacted by early life adversity. Cognitive flexibility is an executive function that is associated with positive outcomes in adulthood and implicated in activity in the prefrontal cortex. The relationship between early life adversity and cognitive flexibility is underreported. Using the cumulative risk model, we conducted two studies to examine the association between early life adversity and cognitive flexibility in college students and adults (cumulative N = 510). Exposure to early life adversity was assessed using the adverse childhood experiences scale (ACEs). Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST). Additionally, as perceived chronic stress is associated with impaired prefrontal cortex function, we measured that as well. Higher number of ACEs was correlated with lower number of completed categories on the WCST in both college students and adults. Perceived chronic stress was not associated with cognitive flexibility, but did correlate positively with ACEs. Individuals with a higher number of ACEs were also more likely to report higher levels of perceived chronic stress. Hierarchical regression analyses indicated that exposure to adverse childhood experiences predicted lower scores on completed categories. Our findings provide further evidence that individuals with early life adversity exhibit reduced cognitive flexibility in adulthood.
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Affiliation(s)
- Vrinda Kalia
- Psychology Department, Miami University, Oxford, Ohio, United States of America
| | - Katherine Knauft
- Psychology Department, Miami University, Oxford, Ohio, United States of America
| | - Niki Hayatbini
- Psychology Department, Miami University, Oxford, Ohio, United States of America
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Grummitt LR, Kreski NT, Kim SG, Platt J, Keyes KM, McLaughlin KA. Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review. JAMA Pediatr 2021; 175:1269-1278. [PMID: 34605870 PMCID: PMC9059254 DOI: 10.1001/jamapediatrics.2021.2320] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Childhood adversity (CA) is a powerful determinant of long-term physical and mental health that is associated with elevated risk for chronic disease and psychopathology. However, the degree to which CA contributes to mortality as a preventable driver of ill-health and death is unknown. OBJECTIVE To estimate the contribution of CA to health behaviors, including smoking and sedentary behavior, as well as the annual mortality attributable to CA in the US through influences on leading causes of death (eg, cardiovascular disease). EVIDENCE REVIEW For this systematic review, the PsycINFO and MEDLINE databases were searched on November 15, 2019. The databases were searched for publications from inception (1806 for PsycINFO, 1946 for MEDLINE) to November 15, 2019. Meta-analyses of the associations between CA and morbidity outcomes were included. The population attributable fraction (PAF) was calculated from these associations along with the estimated US prevalence of CA. The PAF was then applied to the number of annual deaths associated with each cause of death to estimate the number of deaths that are attributable to CA. Additionally, the PAF was applied to the incidence of health behaviors to derive the number of cases attributable to CA. Exposure to 1 or more experiences of adversity before the age of 18 years was analyzed, including abuse, neglect, family violence, and economic adversity. FINDINGS A total of 19 meta-analyses with 20 654 832 participants were reviewed. Childhood adversity accounted for approximately 439 072 deaths annually in the US, or 15% of the total US mortality in 2019 (2 854 838 deaths), through associations with leading causes of death (including heart disease, cancer, and suicide). In addition, CA was associated with millions of cases of unhealthy behaviors and disease markers, including more than 22 million cases of sexually transmitted infections, 21 million cases of illicit drug use, 19 million cases of elevated inflammation, and more than 10 million cases each of smoking and physical inactivity. The greatest proportion of outcomes attributable to CA were for suicide attempts and sexually transmitted infections, for which adversity accounted for up to 38% and 33%, respectively. CONCLUSIONS AND RELEVANCE The results of this systematic review suggest that CA is a leading contributor to morbidity and mortality in the US and may be considered a preventable determinant of mortality. The prevention of CA and the intervention on pathways that link these experiences to elevated disease risk should be considered a critical public health priority.
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Affiliation(s)
- Lucinda Rachel Grummitt
- National Health and Medical Research Council Centre of Research Excellence in PREMISE, The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, New South Wales, Australia; Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
| | - Noah T. Kreski
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
| | | | - Jonathan Platt
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
| | - Katherine M. Keyes
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York
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Hansen CD, Kirkeby MJ, Kjelmann KG, Andersen JH, Møberg RJ. The importance of adverse childhood experiences for labour market trajectories over the life course: a longitudinal study. BMC Public Health 2021; 21:2044. [PMID: 34749681 PMCID: PMC8577013 DOI: 10.1186/s12889-021-12060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transitioning from school to work is important in influencing people's trajectories throughout their life course. This study investigated the extent to which adverse childhood experiences (ACEs) were associated with differences in labour market trajectories for young adults in the context of a Nordic child care regime with low levels of child poverty. METHODS Information on labour market participation, educational events, and public transfer records was recoded into seven state spaces for each month between ages 16 and 32 for a cohort of Danish adolescents born in a rural county in 1983 (N = 3373). Cluster analysis of the sequences using the optimal matching algorithm was used to identify groups with similar trajectories. Multinomial regression was used to assess the association between self-reported ACEs and cluster membership, taking gender and family of origin into account. RESULTS 'In employment' was the state space in which the young adults spent the most time over their early life courses (mean: 85 out of 204 months; 42%). Cluster analysis identified three clusters. Cluster 3 was most distinct, where the mean time 'outside the labour market' was 149 months (73%), and only 17 months (8%) were spent 'in employment'. Cumulative ACEs increased the probability of being included in Cluster 3 (OR: 1.51). Experiencing parental divorce (OR: 3.05), witnessing a violent event (OR: 3.70), and being abused (OR: 5.64) were most strongly associated with Cluster 3 membership. CONCLUSIONS Labour market trajectories among adolescents with a higher number of ACEs consisted of more time outside the labour market, compared to adolescents who had experienced fewer adversities. The lasting consequences of childhood adversity should be taken more into account in welfare policies, even in countries such as Denmark, with high social security levels and high-quality universal childcare.
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Affiliation(s)
- Claus D Hansen
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 63, DK-9220, Aalborg, Denmark.
| | - Mette J Kirkeby
- Department of Clinical Medicine, Danish Center for Clinical Health Service Research (DACS), Aalborg University, Aalborg, Denmark
| | - Kristian G Kjelmann
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 63, DK-9220, Aalborg, Denmark
| | - Johan H Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, University Clinic, Herning, Denmark
| | - Rasmus J Møberg
- Department of Sociology and Social Work, Aalborg University, Fibigerstræde 13, 63, DK-9220, Aalborg, Denmark
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30
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Ding R, He P. Associations between childhood adversities and late-life cognitive function: Potential mechanisms. Soc Sci Med 2021; 291:114478. [PMID: 34649168 DOI: 10.1016/j.socscimed.2021.114478] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 12/27/2022]
Abstract
RATIONALE Childhood adversity, which is related to negative cognitive consequences, is highly prevalent across the world. Nonetheless, there is still a scarcity of research on late-life cognitive function that accounted for multiple aspects of adverse events as well as the potential mediating mechanism of social context and individual's wellbeing in adulthood. OBJECTIVE This study aimed to investigate the relationship between childhood adversities and late-life cognitive function among the middle-aged and older Chinese population and to determine the mediating role of education attainment, marital status, financial status, and self-rated health in adulthood. METHODS We used three waves of data from China Health and Retirement Longitudinal Study from 2011 to 2015, which consisted of 23 807 participants aged 45 years and older. Generalized Estimating Equation and Structural Equation Model were applied to examine the association between childhood adversities and cognitive function (mental intactness and episodic memory) and the corresponding potential mechanisms. RESULTS Overall, 77.25%, 64.55%, 38.38%, and 15.03% of respondents experienced socioeconomic disadvantage, parental involved trauma, maladaptive parental trauma, and other trauma in childhood, respectively. Multivariate analyses suggest that all four types of childhood adversities were associated with a lower score of mental intactness and the first three were associated with episodic memory. A large proportion of the associations between childhood adversity and cognitive function was mainly mediated by education attainment, self-rated health and marital status in adulthood. CONCLUSION There are negative linkages between childhood adversities and cognitive function in the middle-aged and older Chinese population. Such associations were primarily functioning indirectly through adult social context and health conditions.
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Affiliation(s)
- Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
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Ford K, Bellis MA, Isherwood KR, Hughes KE. Perceptions of a short animated film on adverse childhood experiences: a mixed methods evaluation. BMJ Open 2021; 11:e050398. [PMID: 34404714 PMCID: PMC8372873 DOI: 10.1136/bmjopen-2021-050398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES An evaluation of a short animated film on adverse childhood experiences (ACEs) to explore attitudes and sentiment towards the film including, for a subsample of professionals, associations between attitudes and personal experience of ACEs. DESIGN Mixed-method exploratory design. SETTING Professionals and the general public. PARTICIPANTS A short online survey with 239 professionals. Interaction and user sentiment towards with the film on social media (Twitter, YouTube). PRIMARY AND SECONDARY OUTCOME MEASURES Survey: participants' attitudes towards the film including feelings invoked, learning gained and ACE count prevalence. Twitter user and YouTube viewer sentiment (positive, negative or neutral) and interaction (likes, retweets or comments) with the film. RESULTS Attitudes to the film were positive: 94.1% and 93.7%, respectively, agreed that it provided a helpful explanation of ACEs and trusted that the film was credible. Of those who reported ACE exposure, 88.9% agreed that those with ACEs would benefit from watching the film. Despite 50.6% reporting that the film had made them feel sad or upset, the majority (66.4%) reported they found the film hopeful or encouraging. Across 358 publicly available tweets from 313 users, 39.1% of tweets expressed positive sentiment, with only 1.4% negative (59.5% neutral). However, there was no association between tweet sentiment and interaction. Thirteen YouTube versions of the film received 171 812 views, 97.3% (n=889/914) ratings were positive (ie, 'thumbs up'). CONCLUSIONS Despite being emotionally arousing, many professionals reflected positive impacts of the film including a perceived increased ability to discuss ACEs. Public sentiment demonstrated a positive reaction to and acceptability of the film. Understanding the professional and public response to materials developed to increase ACE awareness, such as the film explored here, is important given the growing number of international movements which seek to increase ACE awareness, prevent ACEs and mitigate their lifelong negative effects.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales NHS Trust, Wrexham, UK
| | - Kate R Isherwood
- Research and Evaluation Division, Public Health Wales NHS Trust, Cardiff, UK
| | - Karen E Hughes
- Public Health Collaborating Unit, School of Health Sciences, College of Human Sciences, Bangor University, Wrexham, UK
- World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales NHS Trust, Wrexham, UK
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Yoeli H, Macnaughton J, McLusky S. Menopausal symptoms and work: a narrative review of women's experiences in casual, informal, or precarious jobs. Maturitas 2021; 150:14-21. [PMID: 34219903 PMCID: PMC7611109 DOI: 10.1016/j.maturitas.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Governments, employers, and trade unions are increasingly developing "menopause at work" policies for female staff. Many of the world's most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.
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Affiliation(s)
- Heather Yoeli
- Institute for Medical Humanities & Department of Anthropology, Durham University, UK
| | - Jane Macnaughton
- Institute for Medical Humanities & Department of Anthropology, Durham University, UK
| | - Sarah McLusky
- Institute for Medical Humanities & Department of Anthropology, Durham University, UK
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Haugland SH, Dovran A, Albaek AU, Sivertsen B. Adverse Childhood Experiences Among 28,047 Norwegian Adults From a General Population. Front Public Health 2021; 9:711344. [PMID: 34381754 PMCID: PMC8350119 DOI: 10.3389/fpubh.2021.711344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among Norwegian adults from a general population and to identify potential associations with demographic and socioeconomic characteristics. Methods: A randomly drawn sample (N = 61,611) from the public registry of inhabitants was invited to participate in the Norwegian Counties Public Health Survey. The present study was based on online responses from 28,047 adults ≥18 years (mean age: 46.9 years, SD = 16.03). Log-link binomial regression analyses were performed to examine associations between four measures of ACEs (family conflict, lack of adult support, bad memories, and difficult childhood) and demographic (age, gender, civil status, parental divorce) and socioeconomic characteristics (education level, perceived financial situation, and welfare benefits). Results: Single individuals and those with parents that divorced during childhood were at elevated risk of all four ACEs. The risk varied to some degree between the sexes. The prevalence of ACEs declined with increasing age. We found a consistent social gradient that corresponded to the frequency of ACEs for all three socioeconomic characteristics investigated. The risks were highest for those in the lowest socioeconomic levels (RR: 1.53, 95% CI: 1.32-1.78 to RR: 4.95, CI: 4.27-5.74). Conclusions: Public health strategies should direct more attention to the interplay between ACEs and socioeconomic factors. Welfare services should be sensitive to ACEs among their service recipients.
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Affiliation(s)
- Siri H. Haugland
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
| | - Anders Dovran
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
- Stine Sofies Foundation and Stine Sofie Centre, Grimstad, Norway
| | - Ane U. Albaek
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Reid C, McKenzie JE, Brennan SE, Bennetts SK, Clark Y, Mensah F, Hokke S, Ralph N, Brown SJ, Gee G, Nicholson JM, Chamberlain C. Interventions during pregnancy or up to two years after birth for parents who are experiencing complex trauma or have experienced maltreatment in their childhood (or both) to improve parenting capacity or socio-emotional well-being. Hippokratia 2021. [DOI: 10.1002/14651858.cd014874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Reid
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Shannon K Bennetts
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Murdoch Children's Research Institute; Parkville Australia
| | - Yvonne Clark
- South Australian Health and Medical Research Institute; Adelaide Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
| | - Stacey Hokke
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Naomi Ralph
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Central Queensland University; Townsville Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
- South Australian Health and Medical Research Council; Adelaide Australia
| | - Graham Gee
- Murdoch Children's Research Institute; Parkville Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Jan M Nicholson
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Catherine Chamberlain
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity; Murdoch University; Perth Australia
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Haydon KC, Salvatore JE. A Prospective Study of Mental Health, Well-Being, and Substance Use During the Initial COVID-19 Pandemic Surge. Clin Psychol Sci 2021; 10:58-73. [PMID: 35174007 PMCID: PMC8845503 DOI: 10.1177/21677026211013499] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
The COVID-19 pandemic has dramatically altered everyday life worldwide, and some individuals may be at increased risk for pandemic-related distress. In a U.S. community sample (N = 236, 64% female; 78% White; M age = 30.3) assessed prior to COVID-19 and during the initial surge, we examined, prospectively, whether pandemic disruptions and a history of adverse childhood experiences (ACEs) were associated with changes in depressive symptoms, stress, sleep, relationship satisfaction, and substance use over time, and with concurrent anxiety and peritraumatic distress. Negative pandemic-related events were associated with significantly higher depressive symptoms and stress and lower satisfaction over time, as well as higher concurrent anxiety and peritraumatic distress. ACEs were associated with more negative pandemic-related events, which in turn associated with higher peri-pandemic depressive symptoms, stress, anxiety, and peritraumatic distress. Findings underscore that COVID-19 disruptions are associated with greater distress, and that childhood trauma is a key axis of differential risk.
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Affiliation(s)
| | - Jessica E Salvatore
- Virginia Commonwealth University, Department of Psychology, Virginia Institute for Psychiatric and Behavioral Genetics
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36
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van der Velden PG, van Bakel HJA, de Cock ESA, Contino C, Das M. Chronic mental health problems and use of mental health services among adults with and without adverse childhood experiences: a 6-year longitudinal population-based study. J Ment Health 2021; 31:683-691. [PMID: 34027772 DOI: 10.1080/09638237.2021.1922633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The negative effects of single and multiple adverse childhood experiences (ACE) on adult mental health are well-documented. However, little is known about the prevalence of chronic mental health problems (MHPs) and use of mental health services (MHSs) compared to adults without an ACE history. AIMS Examine differences in the prevalence of chronic MHP and MHS use between adults without and with a single and multiple ACE history, and MHS use among ACE and no-ACE adults with chronic MHP. METHOD A 6-year longitudinal study was conducted based on a random sample of the Dutch adult population (n = 2427). RESULTS Multivariate logistic regression analyses showed that adults with a single (n = 280) and multiple ACE (n = 92) history suffered more often from chronic MHP such as chronic depressive and anxiety symptoms. Both ACE subgroups also made greater use of MHS than no-ACE adults (n = 2055). Multiple ACE compared to single ACE, increased the risk of MHP. However, among those with chronic MHP respondents with and without an ACE history did not differ in MHS use. CONCLUSIONS ACE history is strongly related to chronic MHP and persistent use of MHS. However, MHS use among those with chronic MHP is not related to an ACE history.
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Affiliation(s)
- Peter G van der Velden
- CentERdata, Tilburg, The Netherlands.,Tilburg University's Network on Health and Labour (NETHLAB), Tilburg, The Netherlands
| | - Hedwig J A van Bakel
- TRANZO, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Evi S A de Cock
- CentERdata, Tilburg, The Netherlands.,Tilburg University's Network on Health and Labour (NETHLAB), Tilburg, The Netherlands
| | - Carlo Contino
- Victim Support Foundation (FSH), Den Haag, The Netherlands
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Racine N, McDonald S, Chaput K, Tough S, Madigan S. Pathways from Maternal Adverse Childhood Experiences to Substance Use in Pregnancy: Findings from the All Our Families Cohort. J Womens Health (Larchmt) 2021; 30:1795-1803. [PMID: 33524303 DOI: 10.1089/jwh.2020.8632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Exposure to adverse childhood experiences (ACEs) is a risk factor for maternal substance use in pregnancy, however, mechanisms by which maternal ACEs may influence substance use in pregnancy have not been fully explored. The current study examines the association between maternal ACEs and substance use in pregnancy (i.e., alcohol, smoking, and drug use) and explores mediating pathways. Methods: A community sample of 1,994 women as part of the All Our Families Cohort were recruited in pregnancy in Calgary, Canada, between 2008 and 2011. Women provided retrospective reports of ACE exposure before age 18 as well as reports of demographic information, substance use (i.e., moderate-to-high alcohol use, any smoking, or any drug use), a previous history of substance use difficulties, and depressive symptoms during pregnancy. Path analyses were used to examine maternal income, education, depression, and previous substance use as mediating variables. Results: There were significant indirect associations between maternal ACEs and maternal substance use in pregnancy via maternal education (β = 0.05, p < 0.001), previous substance use (β = 0.01, p = 0.001), and depression (β = 0.02, p = 0.02). The direct effect of maternal ACEs on maternal substance in pregnancy remained significant after accounting for the indirect effects (β = 0.22, 95% CI = 0.15-0.29, p < 0.001). Conclusions: Exposure to adversity in childhood can lead to socioeconomic and mental health difficulties that increase risk for substance use in pregnancy. Addressing these difficulties before pregnancy may help to reduce the potential for substance use in pregnancy.
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Affiliation(s)
- Nicole Racine
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Canada
| | - Sheila McDonald
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Kathleen Chaput
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Sheri Madigan
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
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Björkenstam E, Helgesson M, Mittendorfer-Rutz E. Childhood adversity and common mental disorders in young employees in Sweden: is the association affected by early adulthood occupational class? Soc Psychiatry Psychiatr Epidemiol 2021; 56:237-246. [PMID: 32405790 PMCID: PMC7870617 DOI: 10.1007/s00127-020-01874-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/02/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Childhood adversities are associated with an elevated risk for common mental disorders (CMDs). Whether the strength of the association also holds for young employees is unclear. Given the increase in CMD rates in young adults over the past decade, identification of risk factors has important implications for future public health interventions. The current study aimed to investigate the effects of childhood adversities on CMDs. Additionally, the role of occupational class (non-manual/manual workers) in the relationship was examined. METHODS This population-based longitudinal cohort study included 544,003 employees, 19-29 years, residing in Sweden in 2009. Adversities included parental death, parental mental and somatic disorders, parental separation or single-parent household, household public assistance and residential instability. Estimates of risk of CMDs, measured as prescription of antidepressants and/or psychiatric care with a clinical diagnosis of CMDs, between 2010 and 2016 were calculated as relative risks (RR) with 95% confidence intervals (CI), using a modified Poisson regression analysis. Occupational class (non-manual/manual workers) was explored as a potential moderator. RESULTS In both manual and non-manual workers, childhood adversities were associated with an elevated risk of subsequent CMDs. The risk was moderated by occupational class, i.e., especially pronounced risk was found in manual workers who had experienced cumulative adversity (adjusted RR 1.76, 95% CI 1.70-1.83) when compared to non-manual workers with no adversity. Among the adversities examined, having had a parent treated for a mental disorder, having grown up in a household living on public assistance or having experienced residential instability were the strongest predictors of CMDs. CONCLUSION Our findings suggest that, among young employees, manual workers with a history of multiple childhood adversities are especially vulnerable to subsequent CMDs.
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Affiliation(s)
- Emma Björkenstam
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
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Adverse Childhood Experiences in Women With Overactive Bladder or Interstitial Cystitis/Bladder Pain Syndrome. Female Pelvic Med Reconstr Surg 2021; 27:e208-e214. [PMID: 33369968 DOI: 10.1097/spv.0000000000000894] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of the study was to compare the prevalence of adverse childhood experiences (ACEs) in women with overactive bladder (OAB) or interstitial cystitis/bladder pain syndrome (IC/BPS) to age-matched controls. METHODS This case-control study compared numbers and types of ACEs in women with OAB or IC/BPS compared with controls based on the Center for Disease Control's Behavioral Risk Factor Surveillance System ACE Module. Participants completed demographic forms, condition-specific symptom questionnaires, and the ACE Module (11 questions summarizing traumatic exposures occurring before the age of 18 years). Cases and controls were compared using χ2 and t tests, significance level P < 0.05. RESULTS Three hundred twenty-two women were enrolled from April 2018 to March 2019; OAB = 91 cases and 91 controls, IC/BPS = 70 cases and 70 controls. Overactive bladder group's mean age was 56 ± 13 years, and IC/BPS was 46 ± 13 years. Compared with controls, OAB and IC/BPS cases differed in race/ethnicity and education (P < 0.02), history of substance abuse (P ≤ 0.03), and median numbers of ACEs (OAB 3, controls 1; IC/BPS 4, controls 2, P < 0.01). Cases had increased odds of having 4 or more ACEs, a parameter known to be associated with poor health and longevity, and increased greater than 2-fold in OAB and greater than 7-fold in IC/BPS. Interstitial cystitis/bladder pain syndrome cases had notably increased odds of exposure to abuse (physical/emotional/sexual) and witnessed domestic violence (all P < 0.01). CONCLUSIONS Overactive bladder and IC/BPS cases reported increased ACE exposures; more than one-third of OAB and more than IC/BPS cases reported 4 or more ACES, a threshold associated with poor health outcomes. Recognition of increased childhood adversity in OAB and IC/BPS has important treatment and health implications.
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Evans A, Hardcastle K, Bandyopadhyay A, Farewell D, John A, Lyons RA, Long S, Bellis MA, Paranjothy S. Adverse childhood experiences during childhood and academic attainment at age 7 and 11 years: an electronic birth cohort study. Public Health 2020; 189:37-47. [PMID: 33147524 DOI: 10.1016/j.puhe.2020.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/07/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) have a negative impact on childhood health, but their impact on education outcomes is less well known. We investigated whether or not ACEs were associated with reduced educational attainment at age 7 and 11 years. STUDY DESIGN The study design used in the study is a population-based electronic cohort study. METHODS We analysed data from a total population electronic child cohort in Wales, UK. ACEs (exposures) were living with an adult household member with any of (i) serious mental illness, (ii) common mental disorder (CMD), (iii) an alcohol problem; (iv) child victimisation, (v) death of a household member and (vi) low family income. We used multilevel logistic regression to model exposure to these ACEs and not attaining the expected level at statutory education assessments, Key Stage (KS) 1 and KS2 separately, adjusted for known confounders including perinatal, socio-economic and school factors. RESULTS There were 107,479 and 43,648 children included in the analysis, with follow-up to 6-7 years (KS1) and 10-11 years (KS2), respectively. An increased risk of not attaining the expected level at KS1 was associated with living with adult household members with CMD (adjusted odds ratio [aOR]: 1.13 [95% confidence interval [CI]: 1.09-1.17]) or an alcohol problem (adjusted odds ratio [aOR]: 1.16 [95% confidence interval [CI]: 1.10-1.22]), childhood victimisation (adjusted odds ratio [aOR]: 1.58 [95% confidence interval [CI]: 1.37-1.82]), death of a household member (adjusted odds ratio [aOR]: 1.14 [95% confidence interval [CI]: 1.04-1.25]) and low family income (adjusted odds ratio [aOR]: 1.92 [95% confidence interval [CI]: 1.84-2.01]). Similar results were observed for KS2. Children with multiple adversities had substantially increased odds of not attaining the expected level at each educational assessment. CONCLUSION The educational potential of many children may not be achieved due to exposure to adversity in childhood. Affected children who come in to contact with services should have relevant information shared between health and care services, and schools to initiate and facilitate a coordinated approach towards providing additional support and help for them to fulfil their educational potential, and subsequent economic and social participation.
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Affiliation(s)
- A Evans
- School of Medicine, Cardiff University, UK.
| | - K Hardcastle
- Public Health Wales NHS Trust, Bangor University, UK.
| | | | - D Farewell
- School of Medicine, Cardiff University, UK.
| | - A John
- Health Data Research UK, Swansea University, UK.
| | - R A Lyons
- Health Data Research UK, Swansea University, UK.
| | - S Long
- School of Social Sciences, Cardiff University, UK.
| | - M A Bellis
- Public Health Wales NHS Trust, Bangor University, UK.
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Duke NN. Adolescent Adversity, School Attendance and Academic Achievement: School Connection and the Potential for Mitigating Risk. THE JOURNAL OF SCHOOL HEALTH 2020; 90:618-629. [PMID: 32557700 DOI: 10.1111/josh.12910] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/18/2020] [Accepted: 01/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) may be particularly impactful for the learning environment. The purpose of this study was to examine relationships between ACEs and 3 education-related outcomes, no plan to graduate, past month unexcused absences, and low academic achievement, outcomes linked to poor prospects for future social status attainment and by extension, health. METHODS Data are from 9th and 11th grade participants in the 2016 Minnesota Student Survey (N = 81,885). Logistic regression was used to determine if individual and cumulative measures for 10 types of ACEs were significantly associated with education-related outcomes in analytic models adjusting for demographic and individual factors. Final analytic models tested for moderation of relationships between ACEs and adverse education outcomes by student school connection. Analyses were stratified by sex. RESULTS Multiple types of ACEs were significantly associated with each adverse education outcome. Relationships between some types of ACEs and education outcomes were marginally attenuated by school connection. CONCLUSIONS Among high school students, experiences of adversity were significantly associated with scholastic outcomes that portend limited prospects for health and status attainment in adulthood. Strategies for strengthening student school connection may be relevant for supporting youth resilience, and the potential for better stability in adulthood.
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Affiliation(s)
- Naomi N Duke
- Division of Primary Care, Department of Pediatrics, Duke University Medical Center, Civitan Building #num; 138, 2213 Elba Street, Durham, NC, 27705, USA
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42
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Hughes K, Ford K, Kadel R, Sharp CA, Bellis MA. Health and financial burden of adverse childhood experiences in England and Wales: a combined primary data study of five surveys. BMJ Open 2020; 10:e036374. [PMID: 32513892 PMCID: PMC7282338 DOI: 10.1136/bmjopen-2019-036374] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To estimate the health and financial burden of adverse childhood experiences (ACEs) in England and Wales. DESIGN The study combined data from five randomly stratified cross-sectional ACE studies. Population attributable fractions (PAFs) were calculated for major health risks and causes of ill health and applied to disability adjusted life years (DALYs), with financial costs estimated using a modified human capital method. SETTING Households in England and Wales. PARTICIPANTS 15 285 residents aged 18-69. OUTCOME MEASURES The outcome measures were PAFs for single (1 ACE) and multiple (2-3 and ≥4 ACEs) ACE exposure categories for four health risks (smoking, alcohol use, drug use, high body mass index) and nine causes of ill health (cancer, type 2 diabetes, heart disease, respiratory disease, stroke, violence, anxiety, depression, other mental illness); and annual estimated DALYs and financial costs attributable to ACEs. RESULTS Cumulative relationships were found between ACEs and risks of all outcomes. For health risks, PAFs for ACEs were highest for drug use (Wales 58.8%, England 52.6%), although ACE-attributable smoking had the highest estimated costs (England and Wales, £7.8 billion). For causes of ill health, PAFs for ACEs were highest for violence (Wales 48.9%, England 43.4%) and mental illness (ranging from 29.1% for anxiety in England to 49.7% for other mental illness in Wales). The greatest ACE-attributable costs were for mental illness (anxiety, depression and other mental illness; England and Wales, £11.2 billion) and cancer (£7.9 billion). Across all outcomes, the total annual ACE-attributable cost was estimated at £42.8 billion. The majority of costs related to exposures to multiple rather than a single ACE (ranging from 71.9% for high body mass index to 98.3% for cancer). CONCLUSIONS ACEs impose a substantial societal burden in England and Wales. Policies and practices that prevent ACEs, build resilience and develop trauma-informed services are needed to reduce burden of disease and avoidable service use and financial costs across health and other sectors.
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Affiliation(s)
- Karen Hughes
- 1World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, UK
- School of Human Sciences, Bangor University, Wrexham, UK
| | - Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, UK
| | - Rajendra Kadel
- 1World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, UK
| | - Catherine A Sharp
- Public Health Collaborating Unit, College of Human Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- 1World Health Organization Collaborating Centre on Investment for Health and Well-being, Policy and International Health, Public Health Wales, Wrexham, UK
- School of Human Sciences, Bangor University, Wrexham, UK
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Dorji N, Dunne M, Deb S. Adverse childhood experiences: association with physical and mental health conditions among older adults in Bhutan. Public Health 2020; 182:173-178. [PMID: 32334184 DOI: 10.1016/j.puhe.2020.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are events stressful, traumatic, and related to the development of a wide range of health conditions throughout the person's lifespan. This study explored the relationship between ACEs and health conditions among older adults in Bhutan. STUDY DESIGN Cross-sectional survey. METHODS Older adults aged 60-101 years (n = 337) completed a face-to-face interview in a convenient community setting in the four major towns of Bhutan. Measurements included the modified World Health Organization Adverse Childhood Experiences International Questionnaire and the checklist of chronic health conditions. RESULTS Commonest ACEs reported by the sample were related to the contribution of physical labour in childhood (n = 284 [84.3%]) and witnessing of community violence (n = 185 [54.9%]). Assuming an adult role while still a child highly co-occur with other forms of ACEs. Compared to 0-2 ACEs, participants with ≥7 ACEs had the higher odds of reporting lung disease (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.03-4.49), visual impairment (OR = 2.38, 95%CI: 1.16-4.85), insomnia (OR = 2.35, 95%CI: 1.11-4.98), and memory decline (OR = 2.30, 95%CI: 1.10-4.78) by twofold and high blood pressure by threefold (OR = 3.21, 95%CI: 1.39-7.38). Overall, the odds of self-rated poor health conditions among those ≥7 ACEs compared to 0-2 ACEs was high by almost twofold (OR = 1.97; 95%CI: 1.04-3.73). CONCLUSIONS The influence of ACEs on health conditions persisted into late adulthood, and older people in Bhutan have had a complex variety of chronic health conditions implicating greater demand on the free healthcare system in Bhutan. ACEs prevention is critical to promote better health for a country like Bhutan, where the healthcare services are provided free of cost to its citizens.
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Affiliation(s)
- N Dorji
- Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Bhutan.
| | - M Dunne
- School of Public Health and Social Work, Queensland University of Technology, Australia
| | - S Deb
- Department of Applied Psychology, Pondicherry University, India
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Ortiz R. Building Resilience Against the Sequelae of Adverse Childhood Experiences: Rise Up, Change Your Life, and Reform Health Care. Am J Lifestyle Med 2019; 13:470-479. [PMID: 31523212 DOI: 10.1177/1559827619839997] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A reformed approach to health care tackles health at its roots. Adverse childhood experiences (ACEs) in those exposed to them may contribute significantly to the root causes of many diseases of lifestyle. ACEs are traumatic experiences, such as physical and emotional abuse and exposure to risky family environments. In 1998, a ground-breaking study found that nearly 70% of Americans experience at least 1 ACE in their lifetime, and graded exposure is associated with the presence of mental health disorders, heart disease, cancer, and other chronic diseases. Over the past 20 years, evidence has demonstrated further disease risk, outcomes, and epigenetic underpinnings in children and adults with ACEs. Building resilience-the capacity to adapt in healthy ways to traumatic experiences-through lifestyle modification offers potential to combat the negative health effects associated with ACEs. Emerging research demonstrates resilience is cultivated through individual skills (emotional intelligence, coping, and fostering healthy lifestyle choices), and nurturing supportive relationships. Being mindful of the impact and prevalence of ACEs and diversity of individuals' experiences in society will help build resilience and combat the root cause of chronic disease. This review aims to cultivate that awareness and will discuss 3 objectives: to discuss the effects and hypothesized pathophysiological underpinnings of traumatic experiences in childhood on health and wellbeing throughout life, to present ways we can promote resilience in our daily lives and patient encounters, and to demonstrate how advocacy for the reduction of ACEs and promotion of resilient, trauma-informed environments are fundamental to health care reform.
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Affiliation(s)
- Robin Ortiz
- Departments of Internal Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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