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Cahill A, Martin M, Beachy B, Bauman D, Howard-Young J. The contextual interview: a cross-cutting patient-interviewing approach for social context. MEDICAL EDUCATION ONLINE 2024; 29:2295049. [PMID: 38320114 PMCID: PMC10848999 DOI: 10.1080/10872981.2023.2295049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
Patient interviewing pedagogy in medical education has not evolved to comprehensively capture the biopsychosocial model of healthcare delivery. While gathering a patient's social history targets important aspects of social context it does not adequately capture and account for the real-time reassessment required to understand evolving factors that influence exposure to drivers of health inequities, social determinants of health, and access to supports that promote health. The authors offer a patient interviewing approach called the Contextual Interview (CI) that specifically targets dynamic and ever-changing social context information. To substantiate the use of the CI in medical education, the authors conducted a qualitative review of the Accreditation Council for Graduate Medical Education Milestones for primary care specialties (Family Medicine, Internal Medicine, and Pediatrics). Milestones were coded to the extent to which they reflected the learner's need to acknowledge, assess, synthesize and/or apply patient contextual data in real-time patient encounters. Approximately 1 in 5 milestones met the context-related and patient-facing criteria. This milestone review further highlights the need for more intentional training in eliciting meaningful social context data during patient interviewing. The CI as a cross-cutting, practical, time-conscious, and semi-structured patient interviewing approach that deliberately elicits information to improve the clinician's sense and understanding of a patient's social context. The authors reviewed future directions in researching adapted versions of the CI for undergraduate and graduate medical education.
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Affiliation(s)
- Amber Cahill
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Matthew Martin
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Bridget Beachy
- Central Washington Family Medicine Residency, Community Health of Central Washington, Yakima, WA, USA
| | - David Bauman
- Central Washington Family Medicine Residency, Community Health of Central Washington, Yakima, WA, USA
| | - Jordan Howard-Young
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Huang R, Li S, Hu J, Ren R, Ma C, Peng Y, Wang D. Adverse childhood experiences and falls in older adults: The mediating role of depression. J Affect Disord 2024; 365:87-94. [PMID: 39151763 DOI: 10.1016/j.jad.2024.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES To explore the relationship between adverse childhood experiences and falls in older adults, and the mediating effects of depression on such associations. METHODS This is a prospective study used survey data from the China Health and Retirement Longitudinal Study. Twelve expanded ACEs obtained from the 2014 Life History Survey. Depression levels were assessed using the Centre for Epidemiologic Studies Depression Scale-10. Self-reported outcomes of falling evaluated based on "Have you fallen down since the last survey?" and "How many times have you fallen down seriously enough to need medical treatment?" Logistic regression models were used to explore the relationship between ACEs with falls and recurrent falls. Poisson regression models were used to explore the relationship between ACEs and number of severe falls. Besides, mediation analysis was used to explore whether depression mediates the relationship between ACEs and falls in older adults. RESULTS The more adverse childhood experiences experienced, the higher the risk of fall and recurrent falls, and the more severe the falls. Additionally, depression partially mediated the relationship between adverse childhood experiences and falls. Besides, middle-aged individuals were more susceptible to the impact of adverse childhood experiences on falls than older individuals, especially males. CONCLUSIONS Exposure to adverse childhood experiences is associated with falls in older adults, and depression partially mediates this association. Middle-aged adults were more susceptible to the impact of adverse childhood experiences on falls. These offer important information for clinical practice and public health interventions to prevent falls and reduce fall-related injuries among older adults.
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Affiliation(s)
- Runnian Huang
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China; Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China; Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Siru Li
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Junwei Hu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China
| | - Rui Ren
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China
| | - Chunhua Ma
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China
| | - Yang Peng
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
| | - Difei Wang
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, China.
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Smail MA, Lenz KM. Developmental functions of microglia: Impact of psychosocial and physiological early life stress. Neuropharmacology 2024; 258:110084. [PMID: 39025401 DOI: 10.1016/j.neuropharm.2024.110084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 07/03/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
Microglia play numerous important roles in brain development. From early embryonic stages through adolescence, these immune cells influence neuronal genesis and maturation, guide connectivity, and shape brain circuits. They also interact with other glial cells and structures, influencing the brain's supportive microenvironment. While this central role makes microglia essential, it means that early life perturbations to microglia can have widespread effects on brain development, potentially resulting in long-lasting behavioral impairments. Here, we will focus on the effects of early life psychosocial versus physiological stressors in rodent models. Psychosocial stress refers to perceived threats that lead to stress axes activation, including prenatal stress, or chronic postnatal stress, including maternal separation and resource scarcity. Physiological stress refers to physical threats, including maternal immune activation, postnatal infection, and traumatic brain injury. Differing sources of early life stress have varied impacts on microglia, and these effects are moderated by factors such as developmental age, brain region, and sex. Overall, these stressors appear to either 1) upregulate basal microglia numbers and activity throughout the lifespan, while possibly blunting their responsivity to subsequent stressors, or 2) shift the developmental curve of microglia, resulting in differential timing and function, impacting the critical periods they govern. Either could contribute to behavioral dysfunctions that occur after the resolution of early life stress. Exploring how different stressors impact microglia, as well as how multiple stressors interact to alter microglia's developmental functions, could deepen our understanding of how early life stress changes the brain's developmental trajectory. This article is part of the Special Issue on "Microglia".
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Affiliation(s)
- Marissa A Smail
- Department of Psychology, Ohio State University, Columbus, OH, USA.
| | - Kathryn M Lenz
- Department of Psychology, Ohio State University, Columbus, OH, USA; Department of Neuroscience, Ohio State University, Columbus, OH, USA; Institute for Behavioral Medicine Research, Ohio State University, Columbus, OH, USA; Chronic Brain Injury Program, Ohio State University, Columbus, OH, USA
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Chen J, Cheng X, Wang Q, Wang R, Zhang J, Liu J. Childhood maltreatment predicts poor sleep quality in Chinese adults: The influence of coping style tendencies. J Affect Disord 2024; 363:366-372. [PMID: 39029677 DOI: 10.1016/j.jad.2024.07.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/29/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND This longitudinal study assessed the prospective link between childhood maltreatment and sleep quality in adulthood, with a specific focus on examining whether different coping style tendencies influence these associations. METHODS The baseline sample included 1600 adult participants, with 1140 participants successfully followed up 5 years later. The key variables were measured using the Childhood Trauma Questionnaire (CTQ), Simplified Coping Style Questionnaire (SCSQ), and Pittsburgh Sleep Quality Index (PSQI). Generalized linear mixed models were employed to estimate unstandardized β estimates and 95 % confidence intervals (95%CIs). Structural equation modeling was used to test the mediation model. RESULTS Individuals reported childhood maltreatment at baseline were at an increased risk for sleep disturbances at follow-up. Childhood maltreatment negatively predicted the baseline coping style tendency (β = -0.29, P < 0.001), the baseline coping style tendencies negatively predicted the follow-up sleep quality (β = -0.10, P < 0.001), and childhood maltreatment positively predicted the follow-up sleep quality (β = 0.42, P < 0.01). The mediating effect of baseline coping style tendencies between childhood maltreatment and the follow-up sleep quality was significant, with an effect value of 0.03. LIMITATIONS First, the sample was from a single province (Shandong), which limits the generalizability of the findings. Second, recall bias was unavoidable in this adult sample study. CONCLUSIONS Developing positive coping strategies is an important way to reduce the risk of sleep problems in adults with a history of childhood maltreatment.
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Affiliation(s)
- Jie Chen
- Shandong Mental Health Center, Shandong University, Jinan, China
| | - Xiaojing Cheng
- Institute of Mental Health, Occupational Diseases Hospital of Shandong First Medical University, Jinan, China
| | - Qian Wang
- Institute of Mental Health, Occupational Diseases Hospital of Shandong First Medical University, Jinan, China
| | - Ruzhan Wang
- Shandong Mental Health Center, Shandong University, Jinan, China
| | - Jingxuan Zhang
- Shandong Mental Health Center, Shandong University, Jinan, China.
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Fadeeva A, Hashemi L, Cooper C, Stewart R, McManus S. Violence against older people and associations with mental health: A national probability sample survey of the general population in England. J Affect Disord 2024; 363:1-7. [PMID: 39032711 DOI: 10.1016/j.jad.2024.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Official estimates of violence prevalence in England exclude older people. There are few studies of elder abuse and these excluded violence from acquaintances and strangers and lack comparability with younger adults. OBJECTIVES To estimate prevalence of past-year violence victimisation in older people, identify factors associated with violence in older age, quantify the extent to which experience of violence in older people was associated with common mental disorder (CMD). STUDY DESIGN/METHODS Analysis of a 2014 general population probability sample survey of 2570 adults aged 60+ and 4484 16-59 year olds. Modified version of the Conflict Tactics Scale measured domestic violence and List of Threatening Experiences captured bullying and serious assault. CMD were assessed using the revised Clinical Interview Schedule. Associations were examined using regression models adjusted for childhood victimisation and other adversities. RESULTS 2.0 % (n = 52,CI:1.4-2.6) of older people experienced violence in the past year, with intimate partner violence the most prevalent form. Older people of non-white ethnicity, those who were socially isolated or lonely, and the formerly married were more likely to experience violence. Violence was associated with CMD in older people (adjusted odds ratio 2.2, CI:1.0-4.8), controlling for impairments, adversities and other factors. CONCLUSION Violence, especially from an intimate partner, is evident in later life and strongly associated with poor mental health. Better instruments for the identification of violence and abuse in older people in research and safe enquiry in practice settings are needed, with recognition of and attention to ethnic and other inequalities among older people in exposure.
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Affiliation(s)
- Anastasia Fadeeva
- Violence and Society Centre, City University of London, EC1V OHB, United Kingdom.
| | - Ladan Hashemi
- Violence and Society Centre, City University of London, EC1V OHB, United Kingdom
| | - Claudia Cooper
- Wolfson Institute of Population Health, Queen Mary University of London, E1 4NS, United Kingdom
| | - Rob Stewart
- Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sally McManus
- Violence and Society Centre, City University of London, EC1V OHB, United Kingdom; National Centre for Social Research, London, EC1V OAX, United Kingdom
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Riemann G, Chrispijn M, Kupka RW, Penninx BWJH, Giltay EJ. Borderline personality features in relationship to childhood trauma in unipolar depressive and bipolar disorders. J Affect Disord 2024; 363:358-364. [PMID: 39029699 DOI: 10.1016/j.jad.2024.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/09/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Childhood trauma, including emotional neglect, emotional abuse, physical abuse, and sexual abuse, may contribute to borderline personality features like affective instability, identity problems, negative relationships, and self-harm. This study aims to explore how different types of childhood trauma affect these features in bipolar versus unipolar depressive disorders. METHODS We included 839 participants of the Netherlands Study of Depression and Anxiety (NESDA) with a lifetime diagnosis of major depressive disorder single episode (MDDS; N = 443), recurrent major depressive disorder (MDD-R; N = 331), or bipolar disorder (BD; N = 65). Multivariate regression was used to analyze data from the Childhood Trauma Interview and borderline features (from the self-report Personality Assessment Inventory). RESULTS On average, participants were 48.6 years old (SD: 12.6), with 69.2 % being women, and 50.3 % of participants assessed positive for childhood trauma. Adjusted analyses revealed that participants diagnosed with BD, followed by MDD-R, exhibited the highest number of borderline personality features. Additionally, within the entire group, a strong association was found between childhood trauma, especially emotional neglect, and the presence of borderline personality features. CONCLUSION Given the high prevalence of childhood trauma and borderline personality features, screening for these factors in individuals with mood disorders is crucial. Identifying these elements can inform and enhance the management of the often fluctuating and complex nature of these comorbid conditions, leading to more effective and tailored treatment strategies.
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Affiliation(s)
- Georg Riemann
- Fontys, University of Applied Science, Emmasingel 28, 5611 AZ Eindhoven, the Netherlands.
| | - Melissa Chrispijn
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, the Netherlands
| | - Ralph W Kupka
- Amsterdam UMC, VU University, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, VU University, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Erik J Giltay
- Leiden University Medical Center (LUMC), Department of Psychiatry, Leiden, the Netherlands; Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, the Netherlands
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Gautam N, Rahman MM, Khanam R. Adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in children and adolescents: A longitudinal study. J Affect Disord 2024; 363:124-133. [PMID: 39043305 DOI: 10.1016/j.jad.2024.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/27/2024] [Accepted: 07/14/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have a profound impact on individuals, shaping their long-term health and life opportunities. This study delves into the complex ties between ACEs and the socioemotional development of Australian children and youth by examining the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors. METHODS This study utilized data from the Longitudinal Study of Australian Children and employed the generalized estimating equation method to investigate the relationships between adverse childhood experiences and externalizing, internalizing, and prosocial behaviors in Australian children and adolescents. RESULTS Adverse childhood experiences such as physical punishment, hostile parenting, parental conflicts, separation, financial strain, and parental mental health issues increased the risk of externalizing and internalizing behaviors while reducing prosocial behaviors. The risk increases with the number of ACEs, as evidenced by the incidence ratio (IR); for example, for externalizing behaviors, an ACEs score of one leads to IR = 1.69, while an ACEs score of 4 results in IR = 3.34. Similar trends were observed for internalizing and prosocial behaviors. LIMITATIONS The presence of imbalanced longitudinal data, arising from variations in the number of observations across different time points, challenges robust inferences. Furthermore, this study investigates the relationship between ACEs and behavioral problems, without establishing causality. Consequently, the results should be interpreted with caution. CONCLUSIONS The findings of this study highlight that adverse childhood experiences significantly influence behavioral outcomes in children and adolescents. These findings underscore the critical need for early detection and intervention to mitigate the consequences of traumatic childhood experiences.
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Affiliation(s)
- Nirmal Gautam
- School of Business, University of Southern Queensland, Toowoomba 4350, Queensland, Australia; The Centre for Health Research, University of Southern Queensland, Toowoomba 4350, Queensland, Australia.
| | - Mohammad Mafizur Rahman
- School of Business, University of Southern Queensland, Toowoomba 4350, Queensland, Australia; The Centre for Health Research, University of Southern Queensland, Toowoomba 4350, Queensland, Australia
| | - Rasheda Khanam
- School of Business, University of Southern Queensland, Toowoomba 4350, Queensland, Australia; The Centre for Health Research, University of Southern Queensland, Toowoomba 4350, Queensland, Australia
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Reid BM. Early life stress and iron metabolism in developmental psychoneuroimmunology. Brain Behav Immun Health 2024; 40:100824. [PMID: 39161875 PMCID: PMC11331713 DOI: 10.1016/j.bbih.2024.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/03/2024] [Accepted: 07/15/2024] [Indexed: 08/21/2024] Open
Abstract
An estimated 250 million children face adverse health outcomes from early life exposure to severe or chronic social, economic, and nutritional adversity, highlighting/emphasizing the pressing concern about the link between ELS and long-term implications on mental and physical health. There is significant overlap between populations experiencing high levels of chronic stress and those experiencing iron deficiency, spotlighting the potential role of iron as a key mediator in this association. Iron, an essential micronutrient for brain development and immune function, is often depleted in stress conditions. Iron deficiency among the most common nutrient deficiencies in the world. Fetal and infant iron status may thus serve as a crucial intermediary between early chronic psychological stress and subsequent immune system changes to impact neurodevelopment. The review presents a hypothesized pathway between early life stress (ELS), iron deficiency, and neurodevelopment through the hypothalamic-pituitary-adrenocortical (HPA) axis and the IL-6-hepcidin axis. This hypothesis is derived from (1) evidence that stress impacts iron status (2) long-term neurodevelopmental outcomes that are shared by ELS and iron deficiency exposure, and (3) possible mechanisms for how iron may mediate the relation between ELS and iron deficiency through alterations in the developing immune system. The article concludes by proposing future research directions, emphasizing the need for rigorous studies to elucidate how stress and iron metabolism interact to modify the developing immune system. Understanding these mechanisms could open new avenues for improving human health and neurodevelopment for women and children globally, making it a timely and vital area of study in psychoneuroimmunology research.
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Affiliation(s)
- Brie M. Reid
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, USA
- Department of Psychology, Department of Health Sciences, Northeastern University, USA
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Wang L, Zou HO, Liu J, Hong JF. Prevalence of Adverse Childhood Experiences and Their Associations with Non-Suicidal Self-Injury Among Chinese Adolescents with Depression. Child Psychiatry Hum Dev 2024; 55:1441-1451. [PMID: 36811752 DOI: 10.1007/s10578-023-01508-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
The presence of adverse childhood experiences (ACEs) in adolescents diagnosed with depression has been associated with an extensive range of mental health issues, including non-suicidal self-injury (NSSI). However, there has been a dearth of research into the prevalence of ACEs and their associations with NSSI among depressed adolescent populations in China. This study aimed to investigate the prevalence of different types of ACEs and their associations with NSSI in depressed Chinese adolescents. Utilizing Chi-squared tests, latent class analysis (LCA), and multinomial logistic regression, the prevalence of different types of ACEs and their associations with NSSI were determined in a sample of 562 adolescents with depression. Among depressed adolescents. 92.9% of depressed adolescents reported ACEs, and the prevalence of emotional neglect, physical abuse, caregiver treated violently, and bullying was relatively high. ACEs, including sexual abuse (OR = 5.645), physical abuse (OR = 3.603), emotional neglect (OR = 3.096), emotional abuse (OR = 2.701), caregiver divorce/family separation (OR = 2.5), caregiver treated violently (OR = 2.221), and caregiver substance abuser (OR = 2.117), were associated with increased odds of exposure among depressed adolescents with NSSI. The high ACEs class (19%), the moderate ACEs class (40%), and the low ACEs class (41%) were identified as latent classes. NSSI was more prevalent in the high/moderate ACEs class compared to the low ACEs class, particularly in the high ACEs class. The situation of the prevalence of ACEs among adolescents with depression was unsatisfactory, and certain types of ACEs were associated with NSSI. Eliminating potential risk factors for NSSI requires the early prevention and targeted intervention of ACEs. Moreover, additional large-scale longitudinal studies are necessary to assess the different development trajectories associated with ACEs, such as the relationships between the different development periods of ACEs and NSSI, and to ensure the adoption of evidence-based prevention and intervention strategies.
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Affiliation(s)
- Lu Wang
- School of Nursing, Anhui Medical University, No. 81 Mei Shan Road, Shu Shan District, He Fei, 230032, Anhui Province, China
| | - Hai-Ou Zou
- School of Nursing, Peking Union Medical College, No. 33 Ba Da Chu Road, Shi Jing Shan District, 100144, Beijing, China
| | - Jun Liu
- Department of Nursing, Beijing Anding Hospital, Capital Medical University, No. 5 An Kang Hutong, Xi Cheng District, 100088, Beijing, China
| | - Jing-Fang Hong
- School of Nursing, Anhui Medical University, No. 81 Mei Shan Road, Shu Shan District, He Fei, 230032, Anhui Province, China.
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Shao L, Zhao C, Yu G. The Long-Term Effect of Early-Life Uncertainty on Mental Health in Adolescence and Adulthood: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:3211-3225. [PMID: 38551176 DOI: 10.1177/15248380241241028] [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: 09/03/2024]
Abstract
Turbulent changes in early life are a hidden source of childhood trauma, increasing potential risks for mental illness. Many studies have identified the link between childhood uncertainty and mental health. However, research on the long-term effect of early-life uncertainty (EU) on mental health has not been systematically synthesized. This meta-analysis aims to provide a quantitative estimate of the association between EU and subsequent mental health outcomes. Eight electronic databases and gray literature were searched. Twenty-eight studies met our inclusion criteria: samples of non-clinical adolescents or adults and clear and valid assessments. Random-effect models were used to calculate the pooled effect sizes of EU on internalizing problems, externalizing problems, and well-being. Meta-regression and subgroup analysis were used to explore potential moderators. Results indicated small to moderate associations involving EU and internalizing problem (r = .28; 95% confidence interval [CI] [0.228, 0.326]) and externalizing problem (r = .16; 95% CI [0.102, 0.220]). EU was not significantly associated with well-being (r = -.41; 95% CI [-0.738, 0.071]). Furthermore, moderator analyses found that composite uncertain experiences in childhood had a stronger negative effect than single experiences. EU was a stronger predictor of mental health problems in adults than in adolescents. Cross-sectional studies would amplify the correlation between EU and mental illness compared to longitudinal studies. In the future, childhood uncertain and unpredictable risks should receive more attention. More research needs to focus on positive psychological indicators and samples from non-Western countries.
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Affiliation(s)
- Lei Shao
- School of Education, Renmin University of China, Beijing, China
| | - Chengjia Zhao
- School of Education, Renmin University of China, Beijing, China
| | - Guoliang Yu
- Institute of Psychology, Renmin University of China, Beijing, China
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Scarlett H, Wiernik E, van der Waerden J. Longitudinal trajectories and associated risk factors of paternal mental illness in the nine years surrounding the transition to fatherhood. J Affect Disord 2024; 362:363-374. [PMID: 38986876 DOI: 10.1016/j.jad.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/07/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The arrival of one's first child is a known risk factor for mental illness, yet investigations on fathers' mental health are limited. We conducted a longitudinal investigation on paternal depression and anxiety in the nine years surrounding the transition to fatherhood. METHODS Using a national cohort of French men (CONSTANCES, n = 6299), we investigated the prevalence and associated risk factors of mental illness amongst first-time fathers. Responses to the Center for Epidemiological Studies Depression (CES-D) and 12-item General Health Questionnaire (GHQ-12) scales were used to identify clinically significant symptom scores. Self-declared mental illness was also reported by participants. Group-based modelling was used to identify latent trajectory groups for both measures. RESULTS Levels of self-declared anxiety (averaging 4.9 % pre-fatherhood, 7.8 % post) exceeded that of depression (1.9 % pre- fatherhood, 3.3 % post) or other disorders. However, rates of clinically significant symptom scores (17-27 %) were consistently higher. Participants' mental health appeared to worsen from two-years prior to their child's arrival and improve from two-years after. We identified three trajectory groups for fathers' self-declared mental illness: Low stable (90.3 %); Low risk with high temporary increase (5.6 %); and Consistent high risk (4.1 %). Risk factors associated with worsening mental health trajectories were unemployment, not living with one's partner, having had adverse childhood experiences and foregoing healthcare due to financial reasons. LIMITATIONS All measures of mental illness relied on participant self-reports and are thus subject to bias. CONCLUSIONS This study reveals an important period of heightened psychological vulnerability amongst first-time fathers, emphasising the need for increased and better adapted paternal mental health screening.
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Affiliation(s)
- Honor Scarlett
- UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne University, INSERM, Paris, France.
| | - Emmanuel Wiernik
- UMS 011 Population-based Cohorts Unit, Paris Cité University, Paris Saclay University, Versailles Saint-Quentin-en-Yvelines University, INSERM, Paris, France
| | - Judith van der Waerden
- UMR-S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne University, INSERM, Paris, France
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Qu G, Shu L, Liu H, Ma S, Han T, Zhang H, Huang C, Wang J, Yang L, Sun Y. Association Between Adverse Childhood Experiences and Academic Performance Among Children and Adolescents: A Global Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:3332-3345. [PMID: 38651820 DOI: 10.1177/15248380241246758] [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: 04/25/2024]
Abstract
This study was conducted to quantify the association of adverse childhood experiences (ACEs) and the academic performance of children and adolescents. The literature was systematically searched in six electronic databases, and a meta-analysis was conducted. Twenty studies with a total of 1,196,631 children and adolescents from five countries were included. Meta-analysis showed that ACE score was positively associated with poor academic achievement, grade repetition, and special education support. Compared with children and adolescents without any ACE, those with one or more ACE had a significantly higher risk of poor academic achievement (pooled odds ratio [OR]: 1.45, 95% confidence interval [CI] [1.13, 1.85], I2 = 82.6%) and grade repetition (pooled OR: 1.36, 95% CI [1.29, 1.43], I2 = 71.0%). Moreover, all types of ACEs were positively associated with poor academic achievement and grade repetition. In addition, there was a significant dose-response relationship between the ACE score and the risk of poor academic achievement. This study supported that ACE had a significant impact on the academic performance of children and adolescents. Based on these findings, we recommend that early screening of ACEs for children and adolescent is critical and appropriate support and prevention in education should be developed for those with ACEs. Further studies are needed to further explore the long-term effect of ACEs on education and its gender differences.
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Affiliation(s)
| | - Liqin Shu
- Anhui Province Maternity and Child Health Hospital (Affiliated Maternity and Child Health Hospital of Anhui Medical University), Hefei, China
| | | | - Shaodi Ma
- Anhui Medical University, Hefei, China
| | | | | | - Christy Huang
- Touro University Nevada College of Osteopathic Medicine, Henderson, USA
| | - Jun Wang
- Anhui Medical University, Hefei, China
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13
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Armer JS, Oh W, Davis MT, Issa M, Sexton MB, Muzik M. Post-traumatic change and resilience after childhood maltreatment: Impacts on maternal mental health over the postpartum period. J Affect Disord 2024; 361:1-9. [PMID: 38844162 DOI: 10.1016/j.jad.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Mothers with a history of childhood maltreatment (CM) are particularly vulnerable to postpartum mental health changes. Variability in mental health trajectories is present over the first 18-months postpartum. Little is known about the potentially unique impacts of post-traumatic change or resilience on later postpartum mental health. METHODS Participants (N = 97) completed questionnaires over the first 18-months postpartum measuring demographic risk, mental health symptoms, traumatic experiences, and resilience. Mothers also completed an interview measure coded for post-traumatic changes at 6-months postpartum. Multinomial logistic regression models examined post-traumatic change and resilience factors as predictors of mothers' longitudinal latent mental health trajectory. RESULTS Three classes of latent postpartum mental health emerged: low-symptom, vulnerable, and chronic high-risk. Mothers reporting stronger positive post-traumatic changes were more likely to be in the low-symptom class than the chronic high-risk class (B = -1.082, p = .01). Mothers reporting stronger negative post-traumatic changes were more likely to be in the vulnerable class (B = 0.778, p = .006) or chronic high-risk class (B = 0.906, p = .046) than the low-symptom class. Resilience was not predictive of mental health class. LIMITATIONS Findings are correlational, and causal effects between post-traumatic growth and mental health symptoms cannot be assumed. Mothers who consented to the interview may not be fully representative of all women who have experienced CM, limiting generalizability of findings. CONCLUSIONS Positive post-traumatic change is associated with reduced psychopathology. These findings may assist in identification of mothers at greater risk of adverse postpartum outcomes and futher inform interventions focused on enhancing positive changes in post-traumatic cognitions.
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Affiliation(s)
- Jessica S Armer
- Mental Health Service (116c), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Wonjung Oh
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock, TX, United States of America
| | - Margaret T Davis
- Deparment of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Meriam Issa
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Minden B Sexton
- Mental Health Service (116c), VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America.
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America; Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, United States of America
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14
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Campbell JA, Egede LE. Contextualizing risk, pathways, and solutions for the relationship between adverse childhood experiences (ACEs) and type 2 diabetes among inner-city African Americans: A qualitative analysis and development of a theoretical framework. J Affect Disord 2024; 361:522-527. [PMID: 38917888 PMCID: PMC11328455 DOI: 10.1016/j.jad.2024.06.051] [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: 01/03/2024] [Revised: 05/29/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Adverse childhood experiences (ACEs) confer significant risk for diabetes in adulthood. The purpose of this study was to explore perceptions about risk, potential pathways leading to diabetes, and solutions based on the lived experience. METHODS Three focus groups were conducted. A semi-structured interview guide was used to explore prevalence and causes of ACEs, pathways to diabetes, and possible solutions. Grounded theory was used for analysis. Constant comparisons resulted in emergent themes that were indexed and compared with the rest of the data to establish analytical categories. Analytical categories were further refined as additional data was collected until groups of key themes or categories were identified and used to construct a theoretical framework. RESULTS Participants totaled 23 across 3 groups. All participants were African American. Average age was 49, average number of years living with diabetes was 13 years. Participants included both men and women. Participants experienced one or more occasions of sexual abuse, physical and verbal abuse, and neglect. The major themes can be classified as A. Cause, B. Pathway, and C. Treatment/solution. LIMITATIONS Findings may not generalize to the overall population with ACEs and diabetes. CONCLUSIONS Three major themes were identified: family instability and financial hardship as risks for ACEs, maladaptive coping leading to diabetes, and social structure as a potential solution. Future research is needed to examine quantitatively, pathways to inform prevention at the primary, secondary, and tertiary levels of care for both the prevention of ACEs, mitigating risk for diabetes, and improving overall health.
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Affiliation(s)
- Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
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15
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Guo S, Wijesuriya R, O'Connor M, Moreno-Betancur M, Goldfeld S, Burgner D, Liu R, Priest N. The effects of adverse and positive experiences on cardiovascular health in Australian children. Int J Cardiol 2024; 411:132262. [PMID: 38878872 DOI: 10.1016/j.ijcard.2024.132262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/01/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Limited evidence suggests that positive experiences in childhood may promote cardiovascular health, providing additional opportunities for prevention and early intervention. This study aimed to examine the effects of adverse and positive experiences on cardiovascular health in late childhood. METHODS Data sources: Longitudinal Study of Australian Children (N = 1874). EXPOSURES Adverse and positive experiences assessed repeatedly (age 0-11 years). OUTCOMES Cardiovascular health (high versus low or moderate) quantified by four health behaviors (diet, physical activity, cigarette smoking, and sleep) and four health factors (body mass index, non-high-density lipoprotein, blood pressure, and blood glucose) (age 11-12 years) as per the American Heart Association's Life's Essential 8 metrics. ANALYSES Separate generalized linear models with log-Poisson links were used to estimate the effects of adverse and positive experiences on cardiovascular health, adjusting for confounders. RESULTS Children exposed to multiple adverse experiences (≥ 2) were less likely to have high cardiovascular health (RR = 0.82, 95% CI = 0.67 to 1.02) than those not exposed. Children exposed to multiple positive experiences (≥ 2) were more likely to have high cardiovascular health (RR = 1.14, 95% CI = 0.94 to 1.38) than those not exposed. Stratified analyses suggested that exposure to multiple positive experiences might buffer the detrimental effects of multiple adverse experiences on cardiovascular health. CONCLUSIONS Both adverse and positive experiences were found to be modestly associated with cardiovascular health in Australian children. Future research and practice should not only consider addressing childhood adversity but also use a strengths-based approach to promoting positive experiences to improve cardiovascular health.
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Affiliation(s)
- Shuaijun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia.
| | - Rushani Wijesuriya
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Meredith O'Connor
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Melbourne Children's LifeCourse Initiative, Murdoch Children's Research Institute, Melbourne, Australia; Faculty of Education, University of Melbourne, Melbourne, Australia
| | - Margarita Moreno-Betancur
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - David Burgner
- Department of Pediatrics, University of Melbourne, Melbourne, Australia; Inflammatory Origins Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, Monash University, Melbourne, Australia
| | - Richard Liu
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Naomi Priest
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia; The Centre for Social Policy Research, Australian National University, Canberra, Australia; Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Avery F, Kennedy N, James M, Jones H, Amos R, Bellis M, Hughes K, Brophy S. A systematic review of non-clinician trauma-based interventions for school-age youth. PLoS One 2024; 19:e0293248. [PMID: 39240823 DOI: 10.1371/journal.pone.0293248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/11/2024] [Indexed: 09/08/2024] Open
Abstract
Exposure to adverse childhood experiences (ACEs) is recognised globally as a risk factor for health problems in later life. Awareness of ACEs and associated trauma is increasing within schools and educational settings, as well as the demand for supportive services to address needs. However, there is a lack of clear evidence for effective interventions which can be delivered by non-clinicians (e.g., the school staff themselves). Thus, we undertook a systematic review to answer the question: What evidence exists for the efficacy of non-clinician delivered trauma-based interventions for improving mental health in school-age youth (4-18 years) who have experienced ACEs? The protocol for the review is registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023417286). We conducted a search across five electronic databases for studies published between January 2013 and April 2023 that reported on interventions suitable for non-clinician delivery, were published in English in the last 10 years, and involved participants aged 4-18 years (school-age) that had exposure to ACEs. Of the 4097 studies identified through the search, 326 were retrieved for full text screening, and 25 were included in the final review. Data were extracted from included articles for analysis and selected studies were quality assessed using validated assessment tools. Data were analysed through narrative synthesis. There was considerable heterogeneity in study design, outcome measures, and the interventions being studied. Interventions included CBT, mindfulness and art-based programs. A key finding was that there is a lack of high-quality research evidence to inform non-clinician delivered trauma-informed interventions. Many included studies were weak quality due to convenience sampling of participants and potential bias. Cognitive Behavioural Therapy (CBT)-based approaches are tentatively suggested as a suitable target for future rigorous evaluations of interventions addressing ACE-related trauma recovery and mental health improvement in school-age youth.
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Affiliation(s)
- Flo Avery
- National Centre for Population Health and Wellbeing, School of Medicine, Swansea University, Swansea, United Kingdom
| | - Natasha Kennedy
- National Centre for Population Health and Wellbeing, School of Medicine, Swansea University, Swansea, United Kingdom
| | - Michaela James
- National Centre for Population Health and Wellbeing, School of Medicine, Swansea University, Swansea, United Kingdom
| | - Hope Jones
- National Centre for Population Health and Wellbeing, School of Medicine, Swansea University, Swansea, United Kingdom
| | - Rebekah Amos
- School of Human Sciences, Bangor University, Wrexham, United Kingdom
| | - Mark Bellis
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Karen Hughes
- School of Human Sciences, Bangor University, Wrexham, United Kingdom
- Policy and International Health Directorate, World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham, United Kingdom
| | - Sinead Brophy
- National Centre for Population Health and Wellbeing, School of Medicine, Swansea University, Swansea, United Kingdom
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Eisman AB, Palinkas LA, Koffkey C, Lafta H, Fridline J, Harvey C, Kilbourne AM. Building on Strong Foundations: Deploying Enhanced Replicating Effective Programs for evidence-based prevention curriculum adaptation. Transl Behav Med 2024; 14:537-548. [PMID: 39011615 PMCID: PMC11370631 DOI: 10.1093/tbm/ibae038] [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] [Indexed: 07/17/2024] Open
Abstract
Schools frequently adopt new interventions for each new public health issue, but this is both time- and resource-intensive. Adversity exposure is an example of a pervasive public health issue that emerged during Coronavirus Disease 2019 (COVID-19) with notable consequences, including an elevated risk of developing substance use disorders and mental illnesses. Adapting existing, universal, evidence-based interventions, such as the Michigan Model for HealthTM (MMH), by incorporating trauma-sensitive content is a promising approach to meet this need. We examined critical steps in promoting MMH adaptability as part of the Enhanced REP (Replicating Effective Programs) implementation strategy during the COVID-19 pandemic. We share usability testing from the 2020 to 2021 school year and describe how we apply the results to inform the group randomized trial pilot study. We applied key steps from implementation adaptation frameworks to integrate trauma-sensitive content as COVID-19 unfolded, documenting the process through field notes. We conducted initial usability testing with two teachers via interviews and used a rapid qualitative analysis approach. We conducted member checking by sharing the information with two health coordinators to validate results and inform additional curriculum refinement. We developed an adapted MMH curriculum to include trauma-sensitive content, with adaptations primarily centered on adding content, tailoring content, substituting content, and repeating/reinforcing elements across units. We designed adaptations to retain the core functional elements of MMH. Building foundational relationships and infrastructure supports opportunities to user-test intervention materials for Enhanced REP that enhance utility and relevance for populations that would most benefit. Enhanced REP is a promising strategy to use an existing evidence-based intervention to meet better the needs of youth exposed to adversity. Building on the foundations of existing evidence-based interventions, is vital to implementation success and achieving desired public health outcomes.
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Affiliation(s)
- Andria B Eisman
- Division of Kinesiology, Health, and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
| | - Christine Koffkey
- Division of Kinesiology, Health, and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Hajir Lafta
- Division of Kinesiology, Health, and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202 USA
| | - Judy Fridline
- Genesee Intermediate School District, Flint, MI 48507, USA
| | - Christina Harvey
- Oakland Intermediate School District, Waterford Township, MI 48328, USA
| | - Amy M Kilbourne
- Health Services Research (HSR), U.S. Department of Veterans Affairs, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, 48109USA
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Kasinger C, Schlack R, Brähler E, Fegert JM, Clemens V. Prevalence of child maltreatment in a nationwide sample of 18 to 31 year-olds in Germany. Child Adolesc Psychiatry Ment Health 2024; 18:111. [PMID: 39227864 PMCID: PMC11373430 DOI: 10.1186/s13034-024-00795-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/09/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Child maltreatment (CM) can have devastating and potentially lifelong effects for those affected and is a major contributor to mental health problems. To tackle public health problems it is crucial to have reliable data on CM. The aim of this study is to assess the prevalence and predictors of CM in a nationwide sample of the German population of young adults. METHODS The study population (young adults aged 18 to 31 years) stems from the KiGGS Cohort study, the longitudinal branch of the German Health Interview and Examination Survey for children and adolescents. This sample meets the criteria of the United Nations Sustainable Development Goals (SDG) indicator 16.2.3. The data was collected between 2014 and 2017. CM were assessed with the Childhood Trauma Questionnaire (CTQ) in. In addition, socio-demographic variables and other known risk factors for CM were assessed. A total of 6433 (47.8% female) participants were included in the analyses. Binary logistic regression analyses were used to investigate predictors of maltreatment subtypes. Ordinal regression was used to examine their association with experience of multiple forms of CM. RESULTS Overall, 18.4% (f: 20.9%, m: 16.1%) of the participants reported having experienced at least one type of CM; 6.7% (f: 8.8%, m: 4.8%) reported experiences of emotional abuse, 3.7% (f: 3.9%, m: 3.5%) physical abuse, 3.5% (f: 5.3%, m: 1.7%) sexual abuse, 9.0% (f: 9.9%, m: 8.2%) emotional neglect and 8.6% (f: 8.5%, m: 8.7%) physical neglect. Gender, subjective social status, education and household dysfunction (e.g. living with an individual who is using substances) emerged as significant predictors for different types of CM. Additionally, all these factors were significant risk factors for experiencing cumulative CM. CONCLUSIONS CM is common in the German population, with almost one in five people experiencing at least one type of CM. The results reveal important risk factors for the occurrence of CM. In particular, people with lower social status and those who grew up in dysfunctional households are at higher risk of CM. Greater support for this vulnerable population may reduce the prevalence of CM.
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Affiliation(s)
- Christoph Kasinger
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes Gutenberg University of Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Robert Schlack
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Elmar Brähler
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes Gutenberg University of Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Hospital, Leipzig, Germany
| | - Jörg M Fegert
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
| | - Vera Clemens
- Department for Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
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19
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Goerigk S, Elsaesser M, Reinhard MA, Kriston L, Härter M, Hautzinger M, Klein JP, McCullough JP, Schramm E, Padberg F. Childhood Trauma Questionnaire-based child maltreatment profiles to predict efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus non-specific psychotherapy in adults with early-onset chronic depression: cluster analysis of data from a randomised controlled trial. Lancet Psychiatry 2024; 11:709-719. [PMID: 39147459 DOI: 10.1016/s2215-0366(24)00209-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression. METHODS We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study. FINDINGS 253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in β -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046). INTERPRETATION CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health. FUNDING The German Research Foundation and the German Federal Ministry of Education and Research.
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Affiliation(s)
- Stephan Goerigk
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Psychology, Charlotte Fresenius Hochschule, Munich, Germany; DZPG (German Center for Mental Health), Partner Site Munich-Augsburg, Munich, Germany
| | - Moritz Elsaesser
- Department of Psychiatry and Psychotherapy, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany; DZPG (German Center for Mental Health), Partner Site Munich-Augsburg, Munich, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hautzinger
- Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | | | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany; DZPG (German Center for Mental Health), Partner Site Munich-Augsburg, Munich, Germany.
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Vaccarino V, Bremner JD. Stress and cardiovascular disease: an update. Nat Rev Cardiol 2024; 21:603-616. [PMID: 38698183 DOI: 10.1038/s41569-024-01024-y] [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] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Diagnostic Imaging, Emory University School of Medicine, Atlanta, GA, USA
- Veterans Administration Medical Center, Decatur, GA, USA
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21
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Bertollo AG, Galvan ACL, Dallagnol C, Cortez AD, Ignácio ZM. Early Life Stress and Major Depressive Disorder-An Update on Molecular Mechanisms and Synaptic Impairments. Mol Neurobiol 2024; 61:6469-6483. [PMID: 38307968 DOI: 10.1007/s12035-024-03983-2] [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: 07/05/2023] [Accepted: 01/21/2024] [Indexed: 02/04/2024]
Abstract
Early life stress (ELS), characterized as abuse, neglect, and abandonment, can cause several adverse consequences in the lives of affected individuals. ELS experiences can affect an individual's development in variable ways, persisting in the long term and promoting lasting impacts, considering that early exposure to stressors can be biologically incorporated, as prolonged stimulation of stress response systems affects the development of the brain structure and other body systems, increasing the risk of diseases associated with stress and cognitive impairment. This type of stress increases the risk of developing major depressive disorder (MDD) in a severe form that does not respond adequately to traditional antidepressant treatments. Several alterations are studied as mechanisms that relate ELS with MDD, such as epigenetic alterations, neurotransmitters, and neuronal signaling. This review discusses research that brings evidence about the ELS mechanisms involved in synaptic impairments and MDD. The processes involved in epigenetic changes and the HPA axis are highlighted, as well as changes in neurotransmitters and neuronal signaling mechanisms.
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Affiliation(s)
- Amanda Gollo Bertollo
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó, SC, 89815-899, Brazil
| | - Agatha Carina Leite Galvan
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó, SC, 89815-899, Brazil
| | - Claudia Dallagnol
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó, SC, 89815-899, Brazil
| | - Arthur Dellazeri Cortez
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó, SC, 89815-899, Brazil
| | - Zuleide Maria Ignácio
- Laboratory of Physiology Pharmacology and Psychopathology, Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó, SC, 89815-899, Brazil.
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Tutelman PR, Noel M, Bernier E, Schulte FSM, Kopala-Sibley DC. Adverse Childhood Experiences Moderate the Relationship Between Pain and Later Suicidality Severity Among Youth: A Longitudinal High-Risk Cohort Study. THE JOURNAL OF PAIN 2024; 25:104554. [PMID: 38719156 DOI: 10.1016/j.jpain.2024.104554] [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: 12/15/2023] [Revised: 03/22/2024] [Accepted: 04/27/2024] [Indexed: 06/16/2024]
Abstract
Pain in adolescence can lead to the development of serious mental health issues, including suicidality. This risk may be strengthened among youth exposed to more adverse childhood experiences (ACEs; abuse, neglect, household challenges). This longitudinal study examined the role of ACEs in the relationship between pain and later suicidality onset and severity among a cohort of adolescents at risk for developing mental health problems. Participants were 139 healthy youth (Mage = 13.74 years, standard deviation = 1.56, 64% female) between the ages of 11 to 17 years, recruited based on parental history of depression or anxiety. Youth completed validated measures of internalizing symptoms, ACEs, and pain characteristics at baseline and follow-up diagnostic interviews 9 and/or 18 months later to assess for onset and severity of suicidality. After controlling for demographics, baseline internalizing symptoms, and ACEs, worse pain interference and increased ACEs at baseline predicted increased suicidality severity at follow-up. Moderation analyses revealed that there was a significant interaction between ACEs and pain interference and pain intensity. Increased pain interference (b = 7.65, P < .0001) or intensity (b = 6.96, P = .0003) was only associated with increased suicidality severity at follow-up in youth with high levels of ACEs. This study demonstrates that ACEs strengthen the relationship between pain and later suicidality severity among youth at risk of developing mental health problems. Findings underscore the critical need to adopt a trauma-informed lens to pediatric pain prevention and treatment (eg, screening for ACEs) and for the pain to be on the child's mental health agenda. PERSPECTIVE: This article provides evidence that, while pain is a risk factor for future increased suicidality severity, it is a particularly strong risk factor in youth who experienced increased childhood adversity. These results may help identify youth at greatest risk for suicidality.
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Affiliation(s)
- Perri R Tutelman
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada; Owerko Centre, Calgary, Alberta, Canada
| | - Emily Bernier
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Daniel C Kopala-Sibley
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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23
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Canady MT, Barrington-Trimis JL, Harlow AF. Racial/Ethnic Differences in Adverse Childhood Experiences and Mental Health. Am J Prev Med 2024; 67:397-406. [PMID: 38697322 DOI: 10.1016/j.amepre.2024.04.013] [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: 10/11/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Racial/ethnic differences exist in the prevalence of adverse childhood experiences (ACEs). However, few studies have examined racial/ethnic differences in the association between ACEs and poor mental health outcomes in young adulthood. METHODS Data on 10 self-reported, recalled ACEs (prior to age 18) and current symptoms of depression, anxiety, post-traumatic stress disorder, and sleep problems in early adulthood were collected from 2,020 young adults (age 20-23 years) between January and June 2021 enrolled in a Southern California prospective community-based cohort. Logistic regression models run in 2022-2023 evaluated the association of cumulative (0, 1, 2, 3, 4+ ACEs), grouped (abuse, neglect, household dysfunction), and individual ACE exposure with mental health outcomes; interaction models tested for differences by race/ethnicity. RESULTS All ACE exposures (cumulative, grouped, individual ACEs) were associated with increased odds of most mental health symptoms. Significant differences by race/ethnicity emerged for individual and grouped (but not cumulative) ACEs. For example, associations of any abuse-related ACE and emotional and physical abuse with depressive symptoms were greater for Hispanic participants than for those of another race/ethnicity. Further, associations of emotional abuse with sleep problems were greater for Hispanic participants than for Asian American and Pacific Islander participants (interaction ps<0.05). Though not significant, the association of familial incarceration with depression symptoms was higher for AAPI participants than for other racial/ethnic groups (interaction p-value=0.06). CONCLUSIONS Evaluation of individual and grouped ACEs reveals important racial/ethnic heterogeneity in associations with mental health outcomes. Findings have implications for targeted prevention efforts for racial/ethnic groups at higher risk for poor mental health.
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Affiliation(s)
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California; Institute for Addiction Science, University of Southern California, Los Angeles, California.
| | - Alyssa F Harlow
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California; Institute for Addiction Science, University of Southern California, Los Angeles, California
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24
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Perez N, He N, Wright F, Condon E, Weiser S, Aouizerat B. Social determinants of inflammatory markers linking depression and type 2 diabetes among women: A scoping review. J Psychosom Res 2024; 184:111831. [PMID: 38905780 DOI: 10.1016/j.jpsychores.2024.111831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Inflammation is implicated in the pathophysiology of depression and type 2 diabetes (T2D) and is linked to social determinants of health (SDoH) associated with socioeconomic disadvantage. The objective of this review is to identify and map the range of SDoHs associated with inflammation in depression, T2D, or their co-occurrence among women. METHODS PubMed, CINAHL, PsychINFO, and Web of Science were searched March-July 2023 to identify studies where 1) an SDoH was a predictor or independent variable, 2) depression or T2D was a clinical focus, 3) inflammatory markers were collected, and 4) analysis was specific to women. We used the National Institute on Minority Health and Health Disparities research framework to guide searching SDoHs, organize findings, and identify gaps. RESULTS Of the 1135 studies retrieved, 46 met criteria. Within the reviewed studies, the most used inflammatory measures were C-reactive protein, interleukin-6, and tumor necrosis factor-α, and the most studied SDoHs were early life stress and socioeconomic status. Individual and interpersonal-level variables comprised the bulk of SDoHs in the included studies, while few to no studies examined built environment (n = 6) or health system level (n = 0) factors. Disadvantageous SDoHs were associated with higher levels of inflammation across the included studies. CONCLUSION The scope and intersection of depression and T2D represent a syndemic that contributes to and results from socioeconomic inequities and disproportionately affects women. Simultaneous inclusion of social and inflammatory measures, particularly understudied SDoHs, is needed to clarify potent targets aimed at advancing health and equity.
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Affiliation(s)
- Nicole Perez
- New York University, Rory Meyers College of Nursing, 433 1(st) Ave, New York, NY 10010, USA.
| | - Ning He
- New York University, Silver School of Social Work, 1 Washington Squire North, New York, NY 10003, United States of America.
| | - Fay Wright
- Northwell Health Northern Westchester Hospital, 400 East Main Street, Mt Kisco, NY 10549, United States of America.
| | - Eileen Condon
- University of Connecticut, College of Nursing, 231 Glenbrook Rd, Storrs, CT 06269, United States of America.
| | - Sheri Weiser
- University of San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Brad Aouizerat
- New York University, College of Dentistry, 345 E 24th St, New York, NY 10010, United States of America; University of San Francisco, School of Pharmacy, 513 Parnassus Ave, San Francisco, CA 94143, United States of America.
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25
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Garbutt K, Rennoldson M, Gregson M. Sexual Offending: Adverse Childhood Experiences, Shame, and Self-Compassion Explain the Variance in Self-Harm and Harm Towards Others? SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:662-691. [PMID: 37695944 PMCID: PMC11311929 DOI: 10.1177/10790632231201398] [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: 09/13/2023]
Abstract
Research investigating potential pathways from Adverse Childhood Experiences (ACEs) to later self-harming and offending behaviours has inconsistent findings. Past research, however, has not fully explored the interplay between ACEs and modifiable psychological factors, such as shame and self-compassion. The present study explored the relationship between ACE, shame, and self-compassion to identify their role in explaining the variance in later harm in a sample of individuals who have committed sexual offences. Two hundred and fifty adults incarcerated for sexual offences participated. Multiple Regression and Mediation Analyses were applied to establish if ACE, shame and self-compassion explained the variance in harm and explore potential psychological pathways between ACE and harm, with shame and self-compassion as potential modifiable mediators. ACE, shame and self-compassion explained 55% of self-harm and 52% of psychological and physical harm variance. A more complex relationship was indicated for sexual harm, with only 19% of the variance explained by the model. The study increases our understanding of the relationship between variables and potential modifiable pathways between ACEs and later harming behaviours in a sample of individuals with sexual convictions. These modifiable psychological factors could be targeted to increase resilience, post-traumatic growth and reduce the risk of harm in later life.
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Affiliation(s)
- Kerri Garbutt
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Mike Rennoldson
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Mick Gregson
- Department of Psychology, Nottingham Trent University, Nottingham, UK
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26
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Holuka C, Grova N, Charalambous EG, Le Cléac H J, Turner JD, Mposhi A. Transgenerational impacts of early life adversity: from health determinants, implications to epigenetic consequences. Neurosci Biobehav Rev 2024; 164:105785. [PMID: 38945418 DOI: 10.1016/j.neubiorev.2024.105785] [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: 04/03/2024] [Revised: 06/09/2024] [Accepted: 06/23/2024] [Indexed: 07/02/2024]
Abstract
Exposure to different environmental factors, social and socioeconomic factors promotes development of the early-life adversity (ELA) phenotype. The persistence of this phenotype across generations is an interesting phenomenon that remains unexplored. Of late many studies have focused on disease-associated outcomes of ELA following exposure during childhood but the persistence of epigenetic imprints transmitted by ELA exposed parents to their offspring remains poorly described. It is possible that both parents are able to transmit ELA-associated genetic imprints to their offspring via transgenerational inheritance mechanisms. Here, we highlight the role of the mother and father in the biological process of conception, from epigenetic reprogramming cycles to later environmental exposures. We explain some of the known determinants of ELA (pollution, socioeconomic challenges, infections, etc.) and their disease-associated outcomes. Finally, we highlight the role of epigenetics, mitochondria and ncRNAs as mechanisms mediating transgenerational inheritance. Whether these transgenerational inheritance mechanisms occur in the human context remains unclear but there is a large body of suggestive evidence in non-human models that points out to its existence.
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Affiliation(s)
- Cyrielle Holuka
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg; Faculty of Science, University of Luxembourg, Belval L-4365, Luxembourg
| | - Nathalie Grova
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg; UMR Inserm 1256 nGERE, Nutrition-Génétique et exposition aux risques environnementaux, Institute of Medical Research (Pôle BMS) - University of Lorraine, B.P. 184, Nancy 54511, France
| | - Eleftheria G Charalambous
- Department of Psychiatry and Psychotherapy, University Medecine Greifswald, Ellernholzstr. 1-2, Greifswald 17489, Germany; Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus
| | - Jeanne Le Cléac H
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg; Faculty of Science, University of Luxembourg, Belval L-4365, Luxembourg
| | - Jonathan D Turner
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg.
| | - Archibold Mposhi
- Immune Endocrine Epigenetics Research Group, Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg
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27
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Koball AM, Ames GE, Grothe K. Role of Adverse Childhood Experiences in the Onset of Overweight/Obesity. Curr Obes Rep 2024; 13:574-583. [PMID: 38874702 DOI: 10.1007/s13679-024-00563-2] [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] [Accepted: 03/21/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW The goal of this chapter was to summarize the literature on childhood adversity and obesity, discuss treatment implications with a case example, and provide recommendations for trauma-informed care for clinicians who work with individuals living with obesity. RECENT FINDINGS Adversity in childhood is related directly and indirectly to obesity development. Upstream contributors like adverse childhood experiences (ACEs) and other factors can lead to experiences of toxic stress and increased allostatic load, resulting in downstream effects of obesity and other chronic health conditions. A well-established literature has linked ACEs and obesity suggesting complex interactions between genetic, biological, behavioral, mental health, social, and environmental factors and obesity. Trauma-informed care strategies can be used to optimize care for individuals living with obesity. Care pathways should include individual (clinician) and systemic (organizational) evidence-based interventions.
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Affiliation(s)
| | - Gretchen E Ames
- Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Karen Grothe
- Mayo Clinic, 200 1st SW, Rochester, MN, 55905, USA
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28
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Lee E, Schofield D, Dronavalli M, Lawler K, Uebel H, Burns L, Bajuk B, Page A, Gu Y, Eastwood J, Dickson M, Green C, Dicair L, Oei JL. Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood. JAMA Pediatr 2024; 178:888-898. [PMID: 39037833 PMCID: PMC11264092 DOI: 10.1001/jamapediatrics.2024.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/15/2024] [Indexed: 07/24/2024]
Abstract
Importance Children exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain. Objective To evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years. Design, Setting, and Participants This was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021. Main Outcomes Main outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care. Results Of the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02. Conclusion and Relevance Children who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.
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Affiliation(s)
- Evelyn Lee
- Centre for Social Research in Health, University of New South Wales, Kensington, New South Wales, Australia
- Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Mithilesh Dronavalli
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Kate Lawler
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia
| | - Hannah Uebel
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia
- Department of Paediatrics, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Bajuk
- Critical Care Program, Sydney Children’s Hospitals Network, Sydney, New South Wales, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - John Eastwood
- National Public Health Service, Te Whatu Ora – Health New Zealand, Dunedin, New Zealand
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
- Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Early Years Research Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Michelle Dickson
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | | | - Ju Lee Oei
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
- Drug and Alcohol Services, Murrumbidgee Local Health District, Wagga Wagga, New South Wales, Australia
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29
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Tyrer P, Duggan C, Yang M, Tyrer H. The effect of environmental change, planned and unplanned life events on the long-term outcome of common mental disorders. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1587-1598. [PMID: 37428194 PMCID: PMC11343966 DOI: 10.1007/s00127-023-02520-1] [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: 02/27/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years. METHODS In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion. RESULTS In all analyses positive changes were found to be associated with better outcome at 12 years with respect to accommodation (P = 0.009), relationships (P = 007), and substance misuse (P = 0.003), with fewer psychiatric admissions (P = 0.011) and fewer social work contacts at 30 years (P = 0.043). Using a consolidated outcome measure positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30 years (39% v 3.6% and 30.2% v 9.1%, respectively). Those with personality disorder at baseline had fewer positive changes (P = 0.018) than others at 12 years and fewer positive occupational changes at 30 years (P = 0.041). Service use was greatly reduced in those with positive events with 50-80% more time free of all psychotropic drug treatment (P < 0.001). Instrumental positive change had greater effects than imposed changes. CONCLUSIONS Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends.
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Affiliation(s)
- Peter Tyrer
- Division of Psychiatry, Imperial College, London, UK.
| | - Conor Duggan
- Department of Forensic Psychotherapy, University of Nottingham, Nottingham, UK
| | - Min Yang
- School of Public Health, Sichuan University, Chengdu, China
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
| | - Helen Tyrer
- Division of Psychiatry, Imperial College, London, UK
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30
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Valencia N, Seeger FR, Seitz KI, Carius L, Nkrumah RO, Schmitz M, Bertsch K, Herpertz SC. Childhood maltreatment and transdiagnostic connectivity of the default-mode network: The importance of duration of exposure. J Psychiatr Res 2024; 177:239-248. [PMID: 39033670 DOI: 10.1016/j.jpsychires.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/08/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
Childhood maltreatment (CM) has been demonstrated to be associated with changes in resting-state functional connectivity of the default-mode network (DMN) across various mental disorders. Growing evidence regarding severity of CM is available but transdiagnostic research considering the role of both severity and duration of CM for DMN connectivity at rest is still scarce. We recruited a sample of participants with varying levels of CM suffering from three disorders in which a history of CM is frequently found, namely, post-traumatic stress disorder, major depressive disorder, or somatic symptom disorder, as well as healthy volunteers to examine DMN connectivity in a transdiagnostic sample. We expected to find changes in inter-network connectivity of the DMN related to higher self-reported levels of CM severity and duration. Resting-state functional magnetic resonance imaging scans of 128 participants were analyzed focusing on regions of interest (ROI-to-ROI approach) and whole-brain Seed-to-Voxel analyses with retrospectively assessed CM as predictor in a regression model. Changes in connectivity between nodes of the DMN and the visual network were identified to be associated with CM duration but not severity. CM duration showed associations with increased connectivity of the precuneus and visual regions, as well as sensory-motor regions. The observed changes in connectivity could be interpreted as an impairment of information transfer between the transmodal DMN and unimodal visual and sensory-motor regions with impairment increasing with duration of exposure to CM.
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Affiliation(s)
- Noel Valencia
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany.
| | - Fabian R Seeger
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany
| | - Katja I Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany
| | - Lisa Carius
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany
| | - Richard O Nkrumah
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Marius Schmitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany; German Center for Mental Health (DZPG), Partner Site Mannheim/Heidelberg/Ulm, Germany; Department of Psychology, Julius-Maximilians-University Wuerzburg, Marcusstr. 9-11, 97070, Wuerzburg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Voßstr. 2, 69115, Heidelberg, Germany; German Center for Mental Health (DZPG), Partner Site Mannheim/Heidelberg/Ulm, Germany
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31
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Hiscock H, Kabir A, Honisett S, Morris T, Constable L, Forell S, Woolfenden S, Goldfeld S, Jorm A. Identifying Service, Research and Policy priorities for preventing the impacts of family adversity on children's mental health: An Australian national resource allocation study with professional and lived experience experts. Aust N Z J Public Health 2024; 48:100184. [PMID: 39217838 DOI: 10.1016/j.anzjph.2024.100184] [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: 03/25/2024] [Revised: 07/08/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES The objective of this study was to develop Service, Research and Policy priorities to prevent the impact of family adversity on child mental health and determine comparative priorities of diverse stakeholders to those with lived experience of adversity. METHODS Value-weighting approach conducted in a staged process: (i) professionals and experts with lived experience from health, education, justice and social care sectors attended a national symposium to identify priorities for family adversity and mental health and (ii) a subsequent resource allocation survey gathered views from participants and external experts on symposium priorities. RESULTS Consensus was reached on priorities. Service priorities included establishing intersectoral hubs for children and families and early childhood nurse home-visiting programs. Research priorities included scaling up evidence-based interventions and evaluating cross-sector, flexible funding models for services addressing childhood adversity. Policy priorities included developing evidence-based policies with evaluation and implementation plans and flexible funding models to support integrated care. CONCLUSIONS Our results provide detailed and actionable clarity on next steps to address family adversities. IMPLICATIONS FOR PUBLIC HEALTH The priorities call for a focus on cross-sectoral approaches to preventing or mitigating the effects of family adversity. The current Australian policy environment provides a timely opportunity to action the proposed interventions.
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Affiliation(s)
- Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Ashraful Kabir
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Suzy Honisett
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Tamara Morris
- School of Clinical Medicine, University of New South Wales, Sydney, 2031, Australia
| | - Leanne Constable
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Suzie Forell
- Health Justice Australia, Sydney, NSW, 2000, Australia; School of Law, University of New South Wales, Australia
| | - Sue Woolfenden
- Community Paediatrics, Sydney Local Health District, Australia; Community Paediatrics, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
| | - Sharon Goldfeld
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria, 3052, Australia; Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Anthony Jorm
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010, Australia
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Hamilton J, Welham A, Morgan G, Jones C. Exploring the prevalence of childhood adversity among university students in the United Kingdom: A systematic review and meta-analysis. PLoS One 2024; 19:e0308038. [PMID: 39196983 PMCID: PMC11356454 DOI: 10.1371/journal.pone.0308038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 07/17/2024] [Indexed: 08/30/2024] Open
Abstract
OBJECTIVES The focus of this review was to systematically review and meta-analyse the prevalence of ACEs among university students in the UK. METHOD The systematic searching of six electronic databases (conducted February 2024) identified ten relevant articles (peer-reviewed articles of a quantitative nature that included ACE prevalence). PROSPERO reference: CRD42022364799. RESULTS Pooled prevalence for number of ACEs endured was 55.4% (95% CI: 32.4% - 78.4%; I2 > 99.5%) for one or more, and 31.6% (7.5% - 55.6%; I2 > 99.5%) for three or more. Pooled prevalence was: 15.9% (7.0% - 24.7%; I2 > 94.5%) for physical abuse; 27.0% (18.1% - 35.9%; I2 > 94.5%) for emotional abuse; 12.1% (5.2% - 19.0%; I2 > 94.5%) for sexual abuse; 8.4% (1.7% - 15.1%; I2 > 95.4%) for physical neglect, and 30.0% (21.5% - 38.5%; I2 > 95.4%) for emotional neglect. Pooled prevalence for household dysfunction categories were: 34.4% (22.8% - 46.0%) for parental separation; 18.4% (10.1% - 26.8%) for domestic violence; 35.2% (23.6% - 46.8%) for mental health difficulties; 21.4% (12.9% - 29.9%) for substance use; and 5.7% (2.3% - 9.1%) for incarceration (I2 > 88.8% for all household dysfunction items). Significant heterogeneity was observed between studies for most categories of adversity, and it was not possible to explain/reduce this variance by removing small numbers of influential/discrepant studies. Further analyses suggested potential influences of measurement tool used, country of data collection, and age and sex of participants. CONCLUSION Results demonstrate considerable, largely unaccounted-for, heterogeneity in estimates of the prevalence of ACEs, impeding confidence in any summary statistics. Conclusions must be tentative due to analyses being underpowered given small numbers of papers, as well as potential confounds, meaning results may not be truly representative. However, results do suggest high prevalence rates which warrant further investigation, with appropriate support offered to students.
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Affiliation(s)
- Jackie Hamilton
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Alice Welham
- Depatment of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Gareth Morgan
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Christopher Jones
- Depatment of Psychology, University of Birmingham, Birmingham, United Kingdom
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Santelices MP, Barrera P, Undurraga C, Valenzuela E, Viviani P, Hamilton J, Murillo J. Analyzing the relationship between individual and cumulative score of adverse childhood experiences (ACEs) with self-reported mental health disorders in Chile. CHILD ABUSE & NEGLECT 2024; 155:106997. [PMID: 39208600 DOI: 10.1016/j.chiabu.2024.106997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are widely recognized as significant predictors of poor mental health in adulthood. Latin America presents several unique challenges regarding ACEs, such as higher prevalence of violence and income and political inequality. However, little is known about this issue from nationally representative samples in the region, particularly in Chile. OBJECTIVE This investigation examines the association between individual and cumulative ACE scores and seven self-reported mental health conditions (substance abuse, depression, PTSD, generalized anxiety, suicide ideation, non-suicidal self-harm, and learning disorders) in a representative Chilean urban sample. METHODS A representative urban sample of 2101 adult Chileans completed the International Adverse Childhood Experiences Questionnaire (ACE-IQ) and disclosed any prior mental health diagnoses. RESULTS Around 40 % of the sample had experienced four or more ACEs in their lifetime. For these individuals, the risk of reporting a mental health disorder was significantly higher. Several logistic regression analyses were conducted to address the associations between ACEs and the seven mental health conditions. Notably, sexual abuse, bullying, and exposure to collective violence were the ACEs most strongly associated with self-reported mental health issues. Additionally, a cumulative ACE score was found to be a significant predictor of having a previous mental health diagnosis. CONCLUSIONS We found a significant predictive association between exposure to collective violence and six out of the seven self-reported mental health disorders. Similarly, sexual abuse demonstrated an association with all mental health conditions. Finally, individuals who experienced four or more ACEs had a notably higher chance of reporting a previous mental health diagnosis. We recommend conducting further ACE research in Latin America due to its cultural and contextual singularities.
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Affiliation(s)
| | - Pablo Barrera
- Pontificia Universidad Católica de Chile, Chile; Centro CUIDA, Chile.
| | | | | | - Paola Viviani
- Pontificia Universidad Católica de Chile, Chile; Centro CUIDA, Chile.
| | - James Hamilton
- Pontificia Universidad Católica de Chile, Chile; Centro CUIDA, Chile; Fundación para la Confianza, Chile
| | - José Murillo
- Pontificia Universidad Católica de Chile, Chile; Centro CUIDA, Chile; Fundación para la Confianza, Chile.
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Stein REK. Defining child health in the 21st century. Pediatr Res 2024:10.1038/s41390-024-03423-w. [PMID: 39187632 DOI: 10.1038/s41390-024-03423-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/25/2024] [Indexed: 08/28/2024]
Abstract
The concept of child health has evolved over many decades and has gone from defining health as the absence of disease and disability to a much more sophisticated understanding of the ways in which a confluence of many factors leads to a healthy childhood and to producing the infrastructure for a healthy lifetime. We review the evolution of these ideas and endorse the definition featured in Children's Health, the Nation's Wealth, which states that child health is: "… the extent to which individual children or groups of children are able or enabled to: (a) develop and realize their potential, (b) satisfy their needs, and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments." IMPACT: The definition of child health and the model presented form a framework for conducting and interpreting research in child health and understanding the ways in which influences affect child health. They also demonstrate how child health is the foundation for life-long health. Child health is dynamic and is always changing. There are many influences affecting child health at any given time. Because each child's health is different, they may react in distinctive ways to a new health challenge.
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Affiliation(s)
- Ruth E K Stein
- Professor of Pediatrics Albert Einstein College of Medicine and Children's Hospital at Montefiore, 1300 Morris Park Avenue, VE 6B27, Bronx, NY, 10461, USA.
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Allen K, Melendez-Torres GJ, Ford T, Bonell C, Berry V. Parental domestic violence and abuse, mental ill-health, and substance misuse and the impact on child mental health: a secondary data analysis using the UK Millennium Cohort Study. BMC Public Health 2024; 24:2310. [PMID: 39187800 PMCID: PMC11346203 DOI: 10.1186/s12889-024-19694-1] [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: 11/20/2023] [Accepted: 08/05/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) can have a negative impact on both parents and children. However, it remains unclear if and how parental DVA, MH, and SU cluster and the impacts this clustering might have. We examined how parental DVA, MH, and SU cluster during early childhood, the demographic/contextual profiles of these clusters, and how these clusters relate to child MH trajectories. METHODS We examined data from 15,377 families in the UK Millennium Cohort Study. We used: (1) latent class analysis to create groups differentially exposed to parental DVA, MH, and SU at age three; (2) latent growth curve modelling to create latent trajectories of child MH from ages 3-17; and (3) a case-weight approach to relate latent classes to child MH trajectories. RESULTS We identified three latent classes: high-frequency alcohol use (11.9%), elevated adversity (3.5%), and low-level adversity (84.6%). Children in the elevated adversity class had higher probabilities of being from low-socioeconomic backgrounds and having White, younger parents. Children exposed to elevated adversity displayed worse MH at age three (intercept = 2.274; p < 0.001) compared the low-level adversity (intercept = 2.228; p < 0.001) and high-frequency alcohol use class (intercept = 2.068; p < 0.001). However, latent growth factors (linear and quadratic terms) of child MH did not differ by latent class. CONCLUSIONS Parental DVA, MH, and SU cluster during early childhood and this has a negative impact on children's MH at age three, leading to similar levels of poor MH across time. Intervening early to prevent the initial deterioration, using a syndemic-approach is essential.
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Affiliation(s)
- Kate Allen
- University of Exeter, South Cloisters, St Luke's Campus, College Road, Exeter, EX1 1TE, UK.
| | - G J Melendez-Torres
- University of Exeter, South Cloisters, St Luke's Campus, College Road, Exeter, EX1 1TE, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
| | - Chris Bonell
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Vashti Berry
- University of Exeter, South Cloisters, St Luke's Campus, College Road, Exeter, EX1 1TE, UK
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Osode E, Cook E, Tomlin A. Child Maltreatment and Metabolic Syndrome: A Systematic Review. Diabetes Metab Syndr Obes 2024; 17:3163-3176. [PMID: 39220800 PMCID: PMC11363932 DOI: 10.2147/dmso.s460058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
Background Evidence suggests that child maltreatment (CM) is associated with an elevated risk of adult diseases in later life. Emerging evidence shows that CM in childhood is associated with metabolic syndrome (MetS) in adulthood. However, no study has systematically examined the evidence. Hence, this review aims to synthesise the evidence on the association between forms of CM and MetS in adulthood. Methods Electronic databases of CINAHL, Medline, PsychInfo, SOCINDEX, and Scopus were systematically searched using predefined key terms to identify relevant published studies on the association between CM and MetS from the beginning of indexing to 1st January 2024. Studies were included if they met the selection criteria. The quality of studies was appraised using suitable criteria for cross-sectional and prospective studies. Results The search revealed a total of 2411 studies. Five studies met the inclusion criteria and were included in the review. The findings revealed that there was an association between physical abuse and MetS in women across two studies and one study in men. In addition, one study reported an association between emotional abuse and the risk of MetS in men, while two studies revealed increased odds with CM. However, no significant associations were reported between MetS and childhood sexual abuse and neglect, respectively. Conclusion These findings suggest that some forms of CM may increase a person's risk of having MetS. However, there is a need for methodological improvements due to heterogeneity in studies, mainly on the assessment and definition of CM. Further research is needed on forms of CM and MetS to understand the underlying mechanisms of the associations found and to identify targeted strategies to prevent the impact of CM on MetS and subsequent future health.
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Affiliation(s)
- Eno Osode
- Institute for Health Research, University of Bedfordshire, Luto, UK
| | - Erica Cook
- School of Psychology, University of Bedfordshire, Luton, UK
| | - Ali Tomlin
- School of Psychology, University of Bedfordshire, Luton, UK
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Kious BM. Disability, Offense, and the Expressivist Objection to Medical Aid in Dying. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024:jhae031. [PMID: 39186563 DOI: 10.1093/jmp/jhae031] [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: 08/28/2024] Open
Abstract
One criticism of medical aid in dying (MAID) is the expressivist objection: MAID is morally wrong because it expresses judgments about disabilities or persons with disabilities, that are offensive, disrespectful, or discriminatory. The expressivist objection can be made at the level of individual patients, medical providers, or the state. The expressivist objection originated with selective abortion, and responses to it in that context typically claim either that selective abortion does not express specific judgments about disabilities, or that any judgments expressed are not offensive. This response is inadequate: MAID often does express negative judgments about disabilities, which could reasonably be seen as offensive. But, does this offensiveness make MAID wrong? Drawing on Joel Feinberg's account of offense, I argue that it is unlikely that the offensiveness of the judgments expressed by individuals who seek MAID or through the state's legalization of MAID is enough to make it morally impermissible.
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Houweling TAJ, Grünberger I. Intergenerational transmission of health inequalities: towards a life course approach to socioeconomic inequalities in health - a review. J Epidemiol Community Health 2024; 78:641-649. [PMID: 38955463 DOI: 10.1136/jech-2022-220162] [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: 12/05/2022] [Accepted: 04/19/2024] [Indexed: 07/04/2024]
Abstract
Adult health inequalities are a persistent public health problem. Explanations are usually sought in behaviours and environments in adulthood, despite evidence on the importance of early life conditions for life course outcomes. We review evidence from a broad range of fields to unravel to what extent, and how, socioeconomic health inequalities are intergenerationally transmitted.We find that transmission of socioeconomic and associated health (dis)advantages from parents to offspring, and its underlying structural determinants, contributes substantially to socioeconomic inequalities in adult health. In the first two decades of life-from conception to early adulthood-parental socioeconomic position (SEP) and parental health strongly influence offspring adult SEP and health. Socioeconomic and health (dis)advantages are largely transmitted through the same broad mechanisms. Socioeconomic inequalities in the fetal environment contribute to inequalities in fetal development and birth outcomes, with lifelong socioeconomic and health consequences. Inequalities in the postnatal environment-especially the psychosocial and learning environment, physical exposures and socialisation-result in inequalities in child and adolescent health, development and behavioural habits, with health and socioeconomic consequences tracking into adulthood. Structural factors shape these mechanisms in a socioeconomically patterned and time-specific and place-specific way, leading to distinct birth-cohort patterns in health inequality.Adult health inequalities are for an important part intergenerationally transmitted. Effective health inequality reduction requires addressing intergenerational transmission of (dis)advantage by creating societal circumstances that allow all children to develop to their full potential.
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Affiliation(s)
- Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ilona Grünberger
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Xavier MO, Tovo-Rodrigues L, Santos IS, Murray J, Maruyama JM, Matijasevich A. Harsh parenting trajectories from childhood through adolescence and socioemotional competences at age 18: 2004 Pelotas Birth Cohort Study. J Affect Disord 2024; 366:434-444. [PMID: 39181164 DOI: 10.1016/j.jad.2024.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Limited research has explored the course of harsh parenting practices throughout childhood and adolescence and its impact on socioemotional competences from a longitudinal perspective. This study examined the association between harsh parenting trajectories and socioemotional competences at age 18. METHODS Data from the 2004 Pelotas (Brazil) Birth Cohort study, originally comprising 4231 live births, were used. Harsh parenting was measured using the parent-report version of the Parent-Child Conflict Tactics Scale at ages 6, 11, 15 and 17 years, and trajectories were identified using a group-based modelling approach. Socioemotional competences were emotion regulation, assessed by the Emotional Regulation Index for Children and Adolescents; self-esteem, measured by the self-report Rosenberg Self-esteem Scale; prosocial behaviour and peer relationship problems, both assessed by the Strengths and Difficulties Questionnaire. Multivariate linear and Poisson regression models were applied to examine the effects of harsh parenting trajectories on socioemotional competences, adjusting for confounding variables. RESULTS We identified three trajectories: a "low harsh parenting" trajectory (49.7 %), a "moderate harsh parenting" (44.7 %), and a "high harsh parenting" trajectory (5.6 %). Compared to those belonging to the low harsh parenting trajectory group, adolescents who experienced either a moderate or high harsh parenting trajectory exhibited lower scores in emotion regulation, self-esteem, and prosocial behaviour scales, along with higher scores of peer relationships problems. LIMITATIONS Data on harsh parenting at 15 and 17 years were available only for a sub-sample. CONCLUSIONS Our study extends the evidence of the adverse effects of persistent harsh parenting on socioemotional competences during adolescence.
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Affiliation(s)
- Mariana Otero Xavier
- Universidade de São Paulo, Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP - São Paulo, Brazil.
| | | | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil.
| | - Jessica Mayumi Maruyama
- Postgraduate Program on Human Developmental Sciences, Mackenzie Presbyterian University, São Paulo, Brazil.
| | - Alicia Matijasevich
- Universidade de São Paulo, Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP - São Paulo, Brazil.
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Luan PT, Pham QL, Tan DD, Linh NT, Long NT, Oanh KT, Michel L, Van Tuan N. Suicide risk among young people who use drugs in Hanoi, Vietnam: Prevalence and related factors. J Paediatr Child Health 2024. [PMID: 39158023 DOI: 10.1111/jpc.16648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/30/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
AIM Adolescents and young adults are vulnerable to suicidality, especially those at high risk such as young people who use drugs (YPUD). This study aimed to assess the prevalence and related factors of suicide risk among this population. METHODS We conducted a descriptive, cross-sectional study on YPUD aged 16-24 in the community in Hanoi, Vietnam. Data on socio-demographic characteristics, drug use, and adverse childhood experiences were collected using face-to-face questionnaires by research assistants. YPUD were screened by psychiatrists for depression, psychotic symptoms, and suicide risk, using the MINI questionnaire. RESULTS Three hundred-seven YPUD (250 males, 57 females) participated in the study; of those, 86 (28.0%) were at risk of suicide. Gender (female), adverse childhood experiences, depression, and psychosis were relevant factors. CONCLUSION The prevalence of suicide risk among young people using drugs was high. Therefore, suicide risk should be screened and monitored in the clinical assessment of this population. In addition, the intervention efforts to detect and intervene in adverse events during childhood may be one way to prevent mental health and suicide in later life.
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Affiliation(s)
- Pham T Luan
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Quang L Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Doan D Tan
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen T Linh
- Supporting Community Development Initiative, Hanoi, Vietnam
| | - Nguyen T Long
- Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
| | - Khuat Th Oanh
- Supporting Community Development Initiative, Hanoi, Vietnam
| | - Laurent Michel
- CESP/Inserm 1018, Centre Pierre Nicole, French Red Cross, Paris, France
| | - Nguyen Van Tuan
- Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
- National Institute of Mental Health, Hanoi, Vietnam
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Kruckow S, Tolstrup JS. All cause and cause specific mortality in 15-24-year-olds in Denmark 2010 to 2022: nationwide study of socioeconomic predictors. BMJ MEDICINE 2024; 3:e000685. [PMID: 39175917 PMCID: PMC11340248 DOI: 10.1136/bmjmed-2023-000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/12/2024] [Indexed: 08/24/2024]
Abstract
Objective To assess inequalities in all cause and cause specific mortality in young people and if there are differences across gender and age groups. Design Nationwide cohort study of socioeconomic predictors. Setting Denmark, 1 January 2010 to 31 December 2022. Participants All Danes of ages 15 to 24 years during the study period summing to a total of 9 314 807 person years and 2297 deaths. Participant and parental information were linked to obtain information on socioeconomic background to investigate differences in parents' educational level, employment status, and family's disposable income, using annually updated nationwide registers. Main outcome measures All cause and cause specific mortality including natural deaths (ie, medical conditions and diseases) and unnatural deaths (accidents, suicides, and homicides). Poisson regression was used to calculate incidence rate ratios and 95% confidence intervals (CI). Results Overall mortality rate was 24.7 (95% CI 23.7 to 25.7) and higher for men (33.2 (31.5 to 34.8)) compared with women (15.8 (14.6 to 16.9)). All cause and cause specific mortality were higher in financially disadvantaged groups compared with more affluent groups, and consistently so for all three measures of socioeconomic position. Results generally reflected a dose dependent association showing a higher mortality with lower levels of socioeconomic position. For instance, incidence rate ratios of all cause mortality related to parents' education was 2.3 (95% CI 2.0 to 2.7) for elementary level, 1.5 (1.3 to 1.6) for low, and 1.3 (1.1 to 1.4) for medium level as compared with high level. For deaths, incidence rate ratios of elementary education level compared with the most well educated group were 2.2 (1.5 to 3.2) for natural causes, 3.3 (2.5 to 4.4) for accidents, 1.6 (1.2 to 2.2) for suicides, and 3.1 (0.8 to 12) for homicides. Associations were similar in strata of men and women and by age group (15-17 v 18-24 years). Mortality in young men was considerably higher than in young women for all of the causes. Conclusion Young people from disadvantaged backgrounds have a markedly higher mortality from all causes than those from more affluent families. The socioeconomic position of their parents was associated with premature mortality in a dose dependent manner meaning that this effect is not only a concern for marginalised groups. Public health attention should be directed to respond to these inequities by strengthening advocacy for adolescent health, ensuring focus on adolescents in health policies and strategies, using the response to adolescent health as an indicator of equity, and prioritising research into the underlying mechanisms linking socioeconomic position in adolescence and mortality.
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Affiliation(s)
- Sofie Kruckow
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Zeng Q, Ding J, Tu R, He H, Wang S, Huang Y, Wang Z, Chen Q, Lu G, Li Y. The mediating effect of depressive symptoms on the association between childhood friendship and physical function in middle-aged and older adults: Evidence from the China Health and Retirement Longitudinal Study (CHARLS). J Affect Disord 2024; 359:196-205. [PMID: 38777265 DOI: 10.1016/j.jad.2024.05.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND This study examines the extent to which depressive symptoms mediate the link between childhood friendship (CF) and physical function among middle-aged and older adults in China. METHODS China Health and Retirement Longitudinal Study (CHARLS) data were used; specifically, CHARLS life history survey (conducted from June 1-December 31, 2014) and follow-up health survey (conducted from July 1-September 30, 2015) data were used. The Sobel test, Bootstrap test and multivariable logistic regression were performed to examine the mediating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between CF (measured by a standardized retrospective questionnaire) and physical function, which was measured by basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and grip strength. RESULTS A total of 12,170 participants aged 45 years or older were included in this cross-sectional study. After controlling for covariates, low-quality CF was associated with an increased prevalence of BADL disability (OR = 1.18; 95 % CI = 1.05-1.32), IADL disability (OR = 1.25; 95 % CI = 1.12-1.40), and low grip strength (OR = 1.21; 95 % CI = 1.09-1.34). The proportion of the mediating effect of depressive symptoms was 48 % for CF and BADL, 40 % for CF and IADL, and 11 % for CF and grip strength. Depressive symptoms and worse CF have a joint effect on BADL disability (OR = 3.30; 95 % CI = 2.82-3.85), IADL disability (OR = 3.52; 95 % CI = 3.03-4.09), and low grip strength (OR = 1.65; 95 % CI = 1.43-1.92). LIMITATIONS Not all potential confounding factors (such as childhood behavioural problems, genetic factors, and memory function) were measured in the analysis, and there may have been recall bias in the retrospective collection of CF data. CONCLUSIONS Individuals with high-quality CF were more likely to have a decreased prevalence of impaired physical function in later life. Depressive symptoms acted as a mediator associated with the development of CF.
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Affiliation(s)
- Qingping Zeng
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China; School of Nursing, Medical College of Yangzhou University, Yangzhou University, China
| | - Jiali Ding
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, China
| | - Raoping Tu
- School of Health Management, Fujian Medical University, Fuzhou, Fujian, China
| | - Huihui He
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, China
| | - Suhang Wang
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, China
| | - Yujia Huang
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Zhiyao Wang
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Qi Chen
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, China
| | - Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, China.
| | - Yuping Li
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
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Senaratne DNS, Thakkar B, Smith BH, Hales TG, Marryat L, Colvin LA. The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis. BMC Med 2024; 22:315. [PMID: 39143489 PMCID: PMC11325707 DOI: 10.1186/s12916-024-03505-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/14/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity. METHODS We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose-response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528). RESULTS From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose-response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity (p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies (I2 = 76.9%, Cochran Q = 102, p < 0.001). CONCLUSIONS This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.
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Affiliation(s)
- Dhaneesha N S Senaratne
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Bhushan Thakkar
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Blair H Smith
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Tim G Hales
- Institute of Academic Anaesthesia, Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Lesley A Colvin
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
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Testa A, Jacobs B, Thompson J, Pang N, Jackson DB, Nagata JM, Ganson KT. Adverse Childhood Experiences and Police Contact in Canada. JOURNAL OF INTERPERSONAL VIOLENCE 2024:8862605241270047. [PMID: 39143752 DOI: 10.1177/08862605241270047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
A growing body of research has demonstrated that adverse childhood experiences (ACEs) are a risk factor for criminal justice system contact. However, much of this research is limited by (1) being conducted in the United States and (2) a lack of details on specific types of harmful experiences of criminal justice system contact, such as police contact characterized by intrusion or harassment. Using survey data from 940 individuals aged 16 to 30 in Canada from the Canadian Study of Adolescent Health Behaviors, this study investigates the relationship between ACEs and police contact, focusing on encounters involving intrusion or harassment. Results from logistic and multinomial logistic regression analyses reveal that individuals with high ACE exposure, particularly those with four or more ACEs, are more likely to have police contact, including experiences of intrusion and harassment. The results are significant in understanding the interplay between childhood trauma and later encounters with the criminal justice system, emphasizing the need for trauma-informed approaches in policing and healthcare. The study highlights the importance of early interventions to mitigate the effects of ACEs and prevent adverse outcomes in police interactions.
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Affiliation(s)
| | | | | | | | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Besera G, Annor FB, Swedo EA, Aslam MV, Massetti GM. Adverse Childhood Experiences Module Nonresponse: Behavioral Risk Factor Surveillance System, 2019 and 2021. Am J Prev Med 2024:S0749-3797(24)00267-8. [PMID: 39122158 DOI: 10.1016/j.amepre.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Data on adverse childhood experiences are key to understanding their burden and informing prevention programs and strategies. Population-based surveys that collect adverse childhood experiences data may be affected by item nonresponse. This study examines differences in nonresponse to the optional Behavioral Risk Factor Surveillance System adverse childhood experiences module overall, by sociodemographic characteristics, by year, and by question. METHODS This study used Behavioral Risk Factor Surveillance System adverse childhood experiences module data from 21 states in 2019 and 16 states in 2021. Weighted proportions and 95% CIs of responders and nonresponders to the adverse childhood experiences module by year and sociodemographic characteristics and percentages of nonresponders for each question were calculated. Chi-square tests were used to assess statistically significant (p<0.05) differences. Analyses were conducted in 2023. RESULTS In 2019 and 2021, 1.2% (95% CI=1.1, 1.4) and 2.4% (95% CI=2.2, 2.5) of Behavioral Risk Factor Surveillance System participants were nonresponders to the adverse childhood experiences module, respectively (p<0.01). Nonresponders were more likely to be non-Hispanic Black (p=0.01) or non-Hispanic Asian (p=0.01), to be unemployed (p<0.01), to have income <$15,000 (p<0.01), or to report poor health (p<0.01) than responders. Nonresponse by question increased as the module progressed, and nonresponse was highest for sexual abuse questions. CONCLUSIONS Overall, findings demonstrate that individuals are willing to respond to the adverse childhood experiences module questions. Although low, nonresponse to the module increased from 2019 to 2021. Higher nonresponse for sexual abuse questions may be due to their sensitivity or potential survey fatigue due to placement at the end of the module. Higher nonresponse among racial/ethnic minorities and economically disadvantages groups highlights opportunities to improve existing surveillance systems.
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Affiliation(s)
- Ghenet Besera
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Violence Prevention, Injury Center, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Francis B Annor
- Division of Violence Prevention, Injury Center, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth A Swedo
- Division of Violence Prevention, Injury Center, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria V Aslam
- Division of Injury Prevention, Injury Center, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Greta M Massetti
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Wang Y, Ge F, Aspelund T, Ask H, Hauksdóttir A, Hu K, Jakobsdóttir J, Zoega H, Shen Q, Whalley HC, Pedersen OBV, Lehto K, Andreassen OA, Fang F, Song H, Valdimarsdóttir UA. History of childhood maltreatment associated with hospitalization or death due to COVID-19: a cohort study. BMC Med 2024; 22:319. [PMID: 39113083 PMCID: PMC11304908 DOI: 10.1186/s12916-024-03399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/22/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Childhood maltreatment (CM) has been indicated in adverse health outcomes across the lifespan, including severe infection-related outcomes. Yet, data are scarce on the potential role of CM in severe COVID-19-related outcomes as well as on mechanisms underlying this association. METHODS We included 151,427 individuals in the UK Biobank who responded to questions on the history of CM in 2016 and 2017 and were alive on January 31, 2020. Binomial logistic regression models were performed to estimate the association between a history of CM and severe COVID-19 outcomes (i.e. hospitalization or death due to COVID-19), as well as COVID-19 diagnosis and vaccination as secondary outcomes. We then explored the potential mediating roles of socio-economic status, lifestyle and pre-pandemic comorbidities, and the effect modification by polygenic risk score for severe COVID-19 outcomes. RESULTS The mean age of the study population at the start of the pandemic was 67.7 (SD = 7.72) years, and 56.5% were female. We found the number of CM types was associated with the risk of severe COVID-19 outcomes in a graded manner (pfor trend < 0.01). Compared to individuals with no history of CM, individuals exposed to any CM were more likely to be hospitalized or die due to COVID-19 (odds ratio [OR] = 1.54 [95%CI 1.31-1.81]), particularly after physical neglect (2.04 [1.57-2.62]). Largely comparable risk patterns were observed across groups of high vs. low genetic risks for severe COVID-19 outcomes (pfor difference > 0.05). Mediation analysis revealed that 50.9% of the association between CM and severe COVID-19 outcomes was explained by suboptimal socio-economic status, lifestyle, and pre-pandemic diagnosis of psychiatric disorders or other chronic medical conditions. In contrast, any CM exposure was only weakly associated with COVID-19 diagnosis (1.06 [1.01-1.12]) while significantly associated with not being vaccinated for COVID-19 (1.21 [1.13-1.29]). CONCLUSIONS Our results add to the growing knowledge base indicating the role of childhood maltreatment in negative health outcomes across the lifespan, including severe COVID-19-related outcomes. The identified factors underlying this association represent potential intervention targets for mitigating the harmful effects of childhood maltreatment in COVID-19 and similar future pandemics.
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Affiliation(s)
- Yue Wang
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fenfen Ge
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Helga Ask
- PsychGen Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Kejia Hu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Qing Shen
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Institute for Advanced Study, Tongji University, Shanghai, China
| | - Heather C Whalley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Generation Scotland, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Ole Birger Vesterager Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Roskilde, Denmark
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Ole A Andreassen
- Institute of Clinical Medicine, NORMENT Centre, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, NORMENT Centre, Oslo University Hospital, Oslo, Norway
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Unnur A Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
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Song M, McHill AW, Dieckmann NF, Musil CM, Hayman LL. Association Between Adverse Childhood Experiences and Sleep Duration in US Children: Analysis of 2020-2021 National Survey of Children's Health. J Cardiovasc Nurs 2024:00005082-990000000-00213. [PMID: 39116380 DOI: 10.1097/jcn.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) and suboptimal sleep both negatively associate with cardiovascular health. Although an association between ACEs and suboptimal sleep in youth has been reported, there has been no investigation for differential effects among ACE subdomains. OBJECTIVE We examined associations between total and subdomain ACEs and sleep duration, and age as a moderator. METHODS Using the 2020-2021 National Survey of Children's Health and the American Heart Association Life's Essential 8 scoring algorithm, we created 3 sleep subgroups: (1) optimal, (2) suboptimal (≥1 to <2 hours below or ≥1 hour above optimal), and (3) very suboptimal (≥2 hours below optimal). We assessed association between ACEs (total and subdomains) and sleep duration using multinomial logistic regression, controlling for sex, age, race/ethnicity, caregiver's education, household income, habitual bedtime, and physical activity. We tested the interactions between ACEs and child's age. RESULTS In children aged 6 to 17 years (N = 58 964), mean sleep duration score was 77.2 (95% confidence interval, 76.6-77.9). The mean number of ACEs was 0.89 (95% confidence interval, 0.87-0.91). Adjusting for covariates, each additional ACE increased the likelihood of falling into the suboptimal subgroup by 8% and the very suboptimal subgroup by 26%. There was an association between each subdomain of ACE and suboptimal sleep duration, with no significant interaction with age. CONCLUSIONS Our findings show a dose-response relationship between ACEs and suboptimal sleep duration-a new cardiovascular health indicator in Life's Essential 8. Healthcare providers should screen for ACEs and suboptimal sleep in children to reduce future cardiovascular disease risk.
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Winhusen TJ, Kropp F, Greenfield SF, Krans EE, Lewis D, Martin PR, Gordon AJ, Davies TH, Wachman EM, Douaihy A, Parker K, Xin X, Jalali A, Lofwall MR. Trauma Prevalence and Its Association With Health-Related Quality of Life in Pregnant Persons with Opioid Use Disorder. J Addict Med 2024:01271255-990000000-00354. [PMID: 39105509 DOI: 10.1097/adm.0000000000001366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
OBJECTIVES Trauma screening is recommended for pregnant persons with opioid use disorder (OUD), but there is limited literature on screening results from buprenorphine treatment. This study's objectives were to 1) describe the types, and severity, of traumatic events reported and 2) evaluate the associations between trauma and health-related quality of life (HRQoL). METHODS Baseline data from an ongoing trial were analyzed. Participants were 155 pregnant persons with OUD receiving, or enrolling in, buprenorphine treatment at one of 13 sites. The experience, and relative severity, of 14 high magnitude stressors were assessed with the trauma history screen. The Patient-Reported Outcomes Measurement Information System-29+2 was used to assess 8 HRQoL domains. RESULTS Traumatic stressors were reported by 91% of the sample (n = 155), with 54.8% reporting a lifetime persisting posttraumatic distress (PPD) event and 29.7% reporting a childhood PPD event. The most prevalent lifetime PPD event was sudden death of a close family/friend (25.8%); physical abuse was the most prevalent childhood PPD event (10.3%). Participants with lifetime PPD, relative to no PPD, reported significantly greater pain interference (P = 0.02). Participants with childhood PPD, relative to no PPD, had significantly worse HRQoL overall (P = 0.01), and worse pain intensity (P = 0.002), anxiety (P = 0.003), depression (P = 0.007), fatigue (P = 0.002), and pain interference (P < 0.001). CONCLUSIONS A majority of pregnant persons enrolled/enrolling in buprenorphine treatment reported persisting posttraumatic distress with sudden death of close family/friend being the most prevalent originating event; clinicians should consider the impact that the opioid-overdose epidemic may be having in increasing trauma exposure in patients with OUD.
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Affiliation(s)
- T John Winhusen
- From the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH (TJW, FK, DL); Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH (TJW, FK, DL); Depart of Psychiatry, Harvard Medical School, Boston, MA (SFG); McLean Hospital, Division of Women's Mental Health and Division of Alcohol, Drugs and Addiction, Belmont, MA (SFG); Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA (EEK); Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA (EEK); Department of Psychiatry and Behavioral Sciences and Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN (PRM); Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AJG); Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT (AJG); Department of Family and Community Health, Marshall University Joan C. Edwards School of Medicine, Huntington, WV (THD); Department of Pediatrics, One Boston Medical Center Place, Boston Medical Center, Boston, MA (EMW); University of Pittsburgh School of Medicine, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical, Pittsburgh, PA (AD, XX); Department of Family Medicine Oregon Health Sciences University Portland, OR (KP); Department of Population Health Sciences, Joan & Sanford I. Weill Medical College of Cornell University, New York, NY (AJ); and Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research University of Kentucky College of Medicine, Lexington, KY (MRL)
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Tironi M, Charpentier Mora S, Liotti M, Fiorini Bincoletto A, Tanzilli A, Cavanna D, Lingiardi V, Speranza AM, Giovanardi G, Bizzi F. Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning. J Clin Psychol 2024. [PMID: 39101491 DOI: 10.1002/jclp.23733] [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: 12/06/2023] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents. METHODS A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors. RESULTS ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators. CONCLUSION Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.
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Affiliation(s)
- Marta Tironi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | | | - Marianna Liotti
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Annalisa Tanzilli
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Donatella Cavanna
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
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50
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McGovern R, Balogun-Katung A, Artis B, Bareham B, Spencer L, Alderson H, Brown E, Brown J, Lingam R, McArdle P, Newham JJ, Wojciechowska A, Rankin J, Redgate S, Thomason P, Kaner E. The Effectiveness of Preventative Interventions to Reduce Mental Health Problems in at-risk Children and Young People: A Systematic Review of Reviews. JOURNAL OF PREVENTION (2022) 2024; 45:651-684. [PMID: 38884876 PMCID: PMC11271346 DOI: 10.1007/s10935-024-00785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
Mental health problems are the leading cause of childhood disability worldwide, resulting in poor outcomes for children and young people that persist into adulthood. It is essential that those young people most at risk of developing mental health problems receive effective preventative interventions. Whilst there have been a number of systematic reviews which have examined the effectiveness of secondary prevention interventions for specific groups of children and young people, or to address identified mental health concerns, no review has engaged with the breadth of this literature. We conducted a systematic review of systematic reviews to map this complex field of secondary preventative interventions and identify effective interventions to prevent mental health problems in children and adolescents aged 3-17 years. The review protocol was registered on PROSPERO. We searched five electronic databases from inception to February 2023. The certainty of the evidence was appraised using the AMSTAR 2. We included 49 unique systematic reviews each including between 2 and 249 (mean 34) unique studies; the majority of which were reviews which included only or mostly randomised controlled trials (70%). The reviews examined selective interventions (defined as interventions which are delivered to sub-group populations of young people at increased risk of mental health problems) (n = 22), indicated interventions (defined as interventions which target young people who are found to have pre-clinical symptoms) (n = 15) or a synthesis of both (n = 12). The certainty of the evidence in the reviews was rated as high, (n = 12) moderate (n = 5), low (n = 9) and critically low (n = 23). We found evidence to support both selective and indicated interventions in a range of populations and settings, with most of this evidence available for children and young people in their mid-years (6-10 years) and early adolescence (11-13 years). There was a large body of evidence suggesting that resilience enhancing, cognitive behaviour therapy-based and psychoeducational interventions for children who experience adversity, or those with subclinical externalising problems may offer promise. Early selective interventions for a subpopulation of children and young people who have experienced adversity which combines risk reduction and resilience enhancing approaches directed at children and their families may be effective at reducing mental health problems.
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Affiliation(s)
- R McGovern
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - A Balogun-Katung
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - B Artis
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - B Bareham
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - L Spencer
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - H Alderson
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - E Brown
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - J Brown
- Children's Social Care, Newcastle City Council, Newcastle upon Tyne, UK
| | - R Lingam
- Population Child Health Research Group, School of Women and Children's Health, University New South Wales, Sydney, Australia
| | - P McArdle
- Child and Adolescent Mental Health Services, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J J Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - A Wojciechowska
- Disabilities Integrated Team at the Tees, Esk and Wear Valleys, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Rankin
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - S Redgate
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - P Thomason
- Children's Social Care, Gateshead Council, Tyne and Wear, UK
| | - E Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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