Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis

"Rest of the folks are tired and weary": The impact of historical lynchings on biological and cognitive health for older adults racialized as Black

Childhood structural racism may lead to poorer health and longevity for individuals racialized as Black. Racism-related stress cumulatively taxes the body resulting in worsening biological and cognitive health. This study examines the association between state-level exposure to historical lynchings (adverse childhood racism for modern older adults), with C-reactive protein (CRP, a marker of systemic inflammation), and global cognitive performance (modified TICS). We linked the percentage of lynchings of people racialized as Black at the state-level between 1882 and 1968 from the Archives at Tuskegee Institute with repeated CRP and cognitive test scores at baseline (2006/2008), year 4 (2010/2012), and year 8 (2014/2016) for a national sample of older adults in the Health and Retirement Study (N = 10,500, aged >50). In multivariable generalized estimating equation models, we compared participants (by racialized group) living in states with high lynching proportions (>50th percentile) on changes in CRP and cognitive test scores adjusting for demographics, health conditions, and behaviors. Mean age was 69 (SD = 9.9) and most participants were cisgender women (59%). On average participants racialized as non-LatinX Black living in states with high lynching proportions experienced 18.5% (95% CI 3%, 36%) higher CRP levels and -0.92 (95% CI -1.34, -0.50) lower cognitive test scores than participants racialized as non-LatinX Black that lived in states with lower lynching proportions. As artist Marvin Gaye sang in Flyin' High (in the Friendly Sky), "Rest of the folks are tired and weary," which describes how adverse childhood racism is associated with inflammation and dementia risk for people racialized as Black.

Sex Differences in the Effects of Adverse Childhood Experiences on Institutional Misconduct among Adults in Prison

Research from the past few decades has highlighted the long- and wide-reaching effects of adverse childhood experiences (ACEs). These experiences can negatively affect mental and physical health, as well as behaviors and interpersonal relationships well into adulthood. While it is generally understood that ACEs are prevalent in correctional populations, no prior studies have measured this issue using a large representative and racially and ethnically diverse sample of both male and female adult correctional populations in the United States. The data used for this study were collected via an assessment administered to more than 2,100 adults in Minnesota's prison system. Descriptive findings revealed that multiple and varied forms of ACEs were common in the histories of this state's incarcerated population, particularly among females and incarcerated persons who identified as Black, White/non-Hispanic, and American Indian/Alaskan Native. The multivariate results revealed that past exposure to ACEs increased the likelihood and speed of disciplinary convictions after admission to prison for males, but not for females. Overall, the results underscored the importance of assessing for responsivity factors upon admission to prison, including ACEs.

Adverse childhood experiences in adults with chronic traumatic brain injury: Support for a life course approach to brain injury rehabilitation

BACKGROUND

Adverse childhood experiences (ACEs) confer greater risk for adult traumatic brain injury (TBI), but little is known about their effects on post-injury outcomes.

OBJECTIVE

To determine the prevalence and correlates of conventionally defined ACEs (occurring within household/in private; e.g., physical abuse) and community-level ACEs (e.g., bullying) after TBI.

METHODS

Participants were 85 Philadelphia-area TBI Model System participants with chronic (>1 year post-injury) TBI. We examined cross-sectional associations between total conventional and community ACEs reported (out of 21) before age 18, mental health symptoms, and health-related quality of life (HRQoL), as well as relationships between ACEs and neighborhood deprivation (census-derived neighborhood socioeconomic status).

RESULTS

The median number of total ACEs was 3 (range: 0-17). Emotional abuse, physical abuse, and alcohol abuse in the household were the most common conventional ACEs (each at 36.5 %). Witnessing violence (45 %) was the most common community ACE. Black individuals (n = 32) reported more community ACEs (p < .001) than White individuals (n = 45). Community ACEs were significantly associated with greater neighborhood deprivation, though this relationship was confounded by race. Total ACEs was significantly related to more severe mental health symptoms (p < .001) and poorer HRQoL (p = .005), even after covariate adjustment. A fully-adjusted path model supported mental health as a mediator between total ACEs and HRQoL.

CONCLUSIONS

Results of this preliminary study reveal an appreciable prevalence and potential far-reaching consequences of conventional and community ACEs among those with chronic TBI. The results underscore the value of trauma-informed and life course approaches to research and clinical care in TBI.

Association between adverse childhood experiences and mortality: A systematic review and meta-analysis

Adverse childhood experiences represent a critical public health concern that warrants urgent attention and cannot be overlooked. The evidence regarding the relationship between adverse childhood experiences and mortality has been insufficient and inconsistent. To address this gap, we conducted a systematic review and meta-analysis to explore the association between adverse childhood experiences, including their subtypes, and various mortality outcomes. We systematically searched PubMed, Web of Science, EMBASE, CINAHL, and the Cochrane Library from inception to 9 March 2024. Ultimately, 49 studies were included. Among them, 46 studies involving 24,276,424 participants investigated the association between adverse childhood experiences and mortality. The results showed adverse childhood experiences were significantly associated with overall mortality (OR, 1.64; 95 % CI, 1.51 to 1.78; P < 0.001), external cause mortality (OR, 1.91; 95 % CI, 1.7 to 2.15; P < 0.001), and internal cause mortality (OR, 1.3; 95 % CI, 1.17 to 1.44; P < 0.001). Among women and men, the effect sizes were 1.39 (95 %CI, 1.25 to 1.54; P < 0.001) and 1.4 (95 %CI, 1.22 to 1.6; P < 0.001), respectively. Increased mortality risk was also observed for those exposed to maltreatment (OR, 1.95; 95 %CI, 1.65 to 2.3; P < 0.001), household dysfunction (OR, 1.36; 95 %CI, 1.22 to 1.51; P < 0.001), low socioeconomic status (OR, 1.25; 95 %CI, 1.09 to 1.43; P = 0.002), or out-of-home care (OR, 2.87; 95 %CI, 2.12 to 3.9; P < 0.001). Gender differences were not statistically significant, except for minor variations within the low socioeconomic status. This study underscores the profound impact of adverse childhood experiences on mortality risk, highlighting the need for targeted public health interventions and policies.

Do meaningful dimensions of childhood adversity exist? Data-driven evidence from two prospective cohort studies

BACKGROUND

There is not yet a consensus on the best way to conceptualise adverse childhood experiences (ACEs). We used data-driven methods across two populations to examine (a) if there were meaningful dimensions underlying ACEs and (b) whether dimensions were differentially associated with increased risk of adolescent psychopathology.

METHODS

Participants were 18,539 British children from the UK Millennium Cohort Study (MCS) and 11,876 American children from the US Adolescent Brain Cognitive Development Study (ABCD). A wide range of ACEs (e.g., abuse, neglect, parental psychopathology, peer victimisation) were measured prospectively from infancy to mid-adolescence using interviews and questionnaires. Internalising and externalising symptoms were assessed with child and/or parent reports during adolescence.

RESULTS

Our preregistered exploratory factor analysis revealed four latent dimensions in the MCS (parental threat, deprivation, victimisation, and parental discipline) and ABCD (parental threat, deprivation, victimisation, and traumatic events). All dimensions except deprivation were associated with increased risk for internalising and externalising symptoms. Over and above the other dimensions, victimisation was more strongly associated with internalising (MCS β = .34, 95% CI 0.33-0.36; ABCD β = .11, 95% CI 0.10-0.13) and externalising (MCS β = .31, 95% CI 0.30-0.33; ABCD β = .13, 95% CI 0.11-0.15) symptoms.

CONCLUSIONS

Across two distinct populations, we found that ACEs can be captured by common underlying dimensions of parental threat, deprivation, and victimisation, as well as additional sample-specific dimensions. Our findings expand dimensional theories of childhood adversity by suggesting that in addition to threat and deprivation, victimisation is a distinct dimension of adversity that has the strongest associations with adolescent psychopathology.

Association Between Parental Adverse Childhood Experiences and Offspring's Risk of Suboptimal Health: A Systematic Review and Meta-Analysis

Previous reviews and meta-analysis have not adequately explored the impact of specific parental adverse childhood experiences (ACEs) subtypes on offspring's health. This updated systematic review and meta-analysis aimed to investigate the association between parental ACE subtypes and various offspring health outcomes. A comprehensive search was conducted in electronic databases including PubMed, Web of Science, the Cochrane Library, WANFANG, and China National Knowledge Infrastructure for studies published in English and Chinese from January 1, 1998, until July 18, 2023. Two independent reviewers screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. A random-effects model was applied to generate pooled odds ratios (ORs) and 95% confidence interval (95% CI). A total of 47 eligible studies were included in the final analysis. Overall, parental ACEs were significantly associated with several offspring's health outcomes, including preterm birth (PTB), low birth weight (LBW), total developmental delay, social-emotional problems, and behavioral problems (total, externalizing and internalizing behaviors), with ORs ranging from 1.06 to 3.02. Specific subtypes of parental ACEs, such as household dysfunction, sexual abuse, and physical abuse (but not emotional abuse) were significantly associated with PTB. Household dysfunction was notably linked to delayed cognition ability in offspring. Parental sexual abuse, physical abuse, emotional abuse, and emotional neglect were significantly correlated with social-emotion problems, with the expception of household dysfunction. Regarding total behavioral problems, parental household dysfunction, physical abuse, emotional abuse, physical neglect, and peer bullying were all significantly associated with children's behavioral issues, except for emotional neglect. There is a positive correlation between parental household dysfunction, sexual abuse, physical abuse, emotional abuse, emotional neglect, physical neglect, peer bullying, and neighborhood-related adversity and their children's externalizing behavior problems. These findings underscore the significant impacts of parental ACEs on multiple adverse health outcomes in children, with specific parental ACEs subtypes exerting unique effects. This highlight the significance of comprehending the intergenerational effects of different ACE subtypes, and emphasizes the urgency of interventions to address these issues.

The association between adverse experiences and longitudinal allostatic load changes with the depression symptoms trajectories in middle-aged and older adults in China: A longitudinal study

BACKGROUND

This study investigated the associations between adverse childhood experiences (ACEs), adverse adulthood experiences (AAEs), allostatic load (AL) changes, and later depression symptoms trajectories in middle-aged and older Chinese longitudinally.

METHODS

1921 individuals aged ≥45 years at baseline were included from the China Health and Retirement Longitudinal Study (CHARLS). Measures included ACEs, AAEs, depression symptoms scores, health-related factors, and demographic characteristics. AL changes were assessed by the difference in AL scores between wave 3 (2015) and wave 1(2011).

RESULTS

Compared to consistently low trajectory, 2 or more ACEs (OR 1.78, 95 % CI 1.28-2.46), 2 or more AAEs (OR 1.82, 95 % CI 1.26-2.64), decreasing metabolic AL over time (OR 0.63, 95 % CI 0.46-0.86), increasing inflammatory AL over time (OR 1.60, 95 % CI 1.07-2.37), and decreasing renal AL over time (OR 1.38, 95 % CI 1.01-1.87) were associated with the low-moderate depression symptoms trajectory. Furthermore, 2 or more ACEs (OR 1.48, 95 % CI 1.10-2.00), 2 or more AAEs (OR 1.85, 95 % CI 1.32-2.60), decreasing metabolic AL over time (OR 0.75, 95 % CI 0.57-1.00), increasing inflammatory AL over time (OR 1.69, 95 % CI 1.19-2.42) were associated with the high-moderate depression symptoms trajectory.

CONCLUSION

Experiencing more ACEs and AAEs was associated with higher depression symptoms trajectories. Moreover, participants with decreasing metabolic AL over time showed a low depression symptoms trajectory, while those with increasing inflammatory AL over time and decreasing renal AL over time showed a worse depression symptoms trajectory. These findings highlighted the physiological damage caused by stress on mental health outcomes.

A study of impulsivity and adverse childhood experiences in a population health setting

As complex mental health traits and life histories are often poorly captured in hospital systems, the utility of using the Barratt Impulsivity Scale (BIS) and Adverse Childhood Experiences (ACEs) for assessing adult disease risks is unknown. Here, we use participants from the Healthy Nevada Project (HNP) to determine if two standard self-assessments could predict the incidence and onset of disease. We conducted a retrospective cohort study involving adult participants who completed the Behavioral and Mental Health Self-Assessment (HDSA) between September 2018 and March 2024. Impulsivity levels were measured using the BIS-15, and retrospective self-reports of ACEs were collected through a standardized questionnaire. In total, 17,482 HNP participants completed the HDSA. Our findings indicate that ACEs were significantly associated with impulsivity. Disease associations with impulsivity and ACEs were evaluated using a phenome-wide association study, identifying 230 significant associations with impulsivity. Among these, 44 were related to mental health diagnoses, including major depressive disorder (MDD). Kaplan-Meier survival estimates characterized the differences in the lifetime predicted probability between high and low impulsivity for major depressive disorder and essential hypertension. This analysis showed that having both high ACEs and high impulsivity confer substantial risk of MDD diagnosis (hazard ratios 2.81, 2.17, respectively). Additionally, lifetime predicted probability of MDD was approximately 40% higher for high ACEs and high impulsivity compared to no ACEs and low impulsivity. Essential hypertension demonstrated similar trends, with an approximate 20% increase in predicted lifetime probability of diagnosis. These results demonstrate that high ACES and elevated impulsivity scores are associated with a range of negative health outcomes and a simple self-assessment of complex traits and life history may significantly impact clinical risk assessments.

Childhood Exposure to Interparental Physical Violence and Adult Cardiovascular Disease

Importance

Childhood adverse experiences have been linked with long-term risk of cardiovascular disease (CVD), yet the transgenerational associations between interparental behaviors and CVD remain poorly understood.

Objectives

To explore the association between exposure to childhood interparental physical violence and the subsequent risk of CVD and to examine whether the association is modified by adult depressive symptoms.

Design, Setting, and Participants

This population-based cohort study included data from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing study recruiting individuals aged 45 years or older, dated between June 1, 2011, and December 31, 2020, with a follow-up duration of 9 years. The data were analyzed from October 1, 2023, to May 10, 2024.

Exposures

An early life exposure questionnaire with information on the frequency of witnessing interparental physical violence was administered. Depressive symptoms were assessed via the validated 10-item Center for Epidemiologic Studies Depression Scale.

Main Outcomes and Measures

The outcome measures included self-reported physician-diagnosed heart disease (defined as myocardial infarction, angina, coronary heart disease, heart failure, or other heart problems) and stroke. Multivariate Cox proportional hazards regression models using attained age as the time scale were conducted.

Results

Of 10 424 participants, the mean (SD) age was 58.1 (9.0) years, 5332 (51.2%) were female, and 872 (8.4%) reported exposure to interparental physical violence. Exposure to childhood interparental physical violence was associated with increased risks of adult-onset CVD (hazard ratio [HR], 1.36; 95% CI, 1.20-1.55), heart disease (HR, 1.36; 95% CI, 1.17-1.57), and stroke (HR, 1.28; 95% CI, 1.03-1.61). Participants exposed to childhood interparental physical violence had a greater prevalence of depressive symptoms (2371 of 9335 participants [25.4%]), which mediated 11.0% of the association between childhood interparental physical violence and CVD (HR, 1.26; 95% CI, 1.09-1.45).

Conclusions and Relevance

In this cohort study, childhood exposure to interparental physical violence was associated with a higher risk of adult-onset CVD, which was partially mediated by adult depressive symptoms. The findings emphasize the need for comprehensive strategies and policy efforts that address the social determinants of interparental violence and provide household education opportunities.

Brain connectivity disruptions in PTSD related to early adversity: a multimodal neuroimaging study

Background: Post-traumatic stress disorder (PTSD) is increasingly prevalent in individuals with adverse childhood experiences (ACE). However, the underlying neurobiology of ACE-related PTSD remains unclear.Objective: The present study investigated the brain connectivity in ACE-related PTSD using multimodal neuroimaging data.Methods: Using a total of 119 participants with ACE (70 with ACE-related PTSD and 49 ACE-exposed controls), this study acquired T1-weighted MRI, diffusion-weighted MRI, and resting-state fMRI data to examine structural and functional connectivity between groups. Joint connectivity matrix independent component analysis (Jcm-ICA) was employed to allow shared information from all modalities to be examined and assess structural and functional connectivity differences between groups.Results: Jcm-ICA revealed distinct connectivity alterations in key brain regions involved in cognitive control, self-referential processing, and social behaviour. Compared to controls, the PTSD group exhibited functional hyperconnectivity of the right medial prefrontal cortex (PFC) of the default mode network and right inferior temporal cortex, and functional hypoconnectivity in the lateral-PFC of the central executive network and structural hypoconnectivity in white matter pathways including the right orbitofrontal region (OFC) linked to social behaviour. Post-hoc analyses using the joint brain-based information revealed that the severity of ACE, the number of traumas, and PTSD symptoms later in life significantly predicted the effects of ACE-related PTSD on the brain. Notably, no direct association between brain connectivity alterations and PTSD symptoms or the number of traumas within the PTSD group was observed.Conclusion: This study offers novel insights into the neurobiology of ACE-related PTSD using multimodal data fusion. We identified alterations in key brain networks (DMN, CEN) and OFC, suggesting potential deficits in cognitive control and social behaviour alongside heightened emotional processing in individuals with PTSD. Furthermore, our findings highlight the combined influence of ACE exposure, number of traumas experienced, and PTSD severity on brain connectivity disruptions, potentially informing future interventions.

Adverse Childhood Experiences Module Nonresponse: Behavioral Risk Factor Surveillance System, 2019 and 2021

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.

Supporting student learning and development through trauma-informed campuses

Many students come to higher education with a history of trauma. College life may also expose students to traumatizing events. While the past decade has witnessed greater discussion of trauma-informed frameworks, it has not regularly been applied to the college environment. We advance the concept of a trauma-informed campus, where administrators, faculty, staff, and students from diverse disciplines create an environment that recognizes the widespread nature of trauma, integrates knowledge about trauma into practices and procedures, and minimizes further re-traumatization for all community members. A trauma-informed campus is prepared for students' past or future traumatic experiences, while also recognizing and responding to structural and historical harms. In addition, it recognizes the role of the surrounding community challenges, particularly how violence, substance use, hunger, poverty, and housing insecurity may contribute to further trauma or negatively impact healing. We use an ecological model to frame and shape the construct of trauma-informed campuses.

Association between adverse childhood experiences and obesity, and sex differences: A systematic review and meta-analysis

BACKGROUND

Obesity is one of the most common health problems worldwide. Although studies have reported associations between adverse childhood experiences (ACEs) and obesity, specific subtype associations and sex differences are unclear.

OBJECTIVE

To systematically evaluate the association between ACEs and adult obesity risk and sex differences.

METHODS

Five databases, PubMed, Web of Science, Cochrane Library, Embase, and PsycINFO, were searched with a June 10, 2024 deadline. Included studies investigated the association between at least one ACE and obesity. Two researchers independently assessed the risk of bias using the Newcastle-Ottawa Scale (NOS) and its adaptations and extracted relevant characteristics and outcomes. Statistical analyses were performed using STATA 17.0, including random effects models, heterogeneity tests, sensitivity analyses, publication bias assessments, Meta-regression analyses, and subgroup analyses. Dose-response analyses revealed potential trends between different levels of abuse and risk of obesity.

RESULTS

The meta-analysis included 46 studies and showed a notable increased risk of obesity in adults experiencing ACEs (OR: 1.48, 95% CI: 1.38-1.59). Subgroup analyses showed significantly increased risk in Europe and North America, with significant increases observed in both developed and developing countries. Prospective, retrospective, and cross-sectional studies showed strong associations. Different types of ACEs (physical, sexual, psychological, and non-physical, psychological, or sexual abuse) were linked to a higher obesity risk. Sex difference analyses showed that females faced a greater risk when experiencing physical (OR: 1.606), sexual (OR: 1.581), and non-physical, psychological, or sexual (OR: 1.319) abuse; males exhibited increased risk only with non-physical, psychological, or sexual abuse (OR: 1.240). Dose-response analyses indicated that a higher number of ACEs was associated with an increased risk of obesity in adults.

CONCLUSIONS

ACEs significantly increase the risk of adult obesity, with consistent findings across geographic regions, levels of economic development, and types of study design. Sex difference analysis indicates that females are particularly affected. Future research should prioritize including studies from underrepresented geographic areas to enhance understanding of the global impact of ACEs on obesity risk. Additionally, strengthening child protection and intervention efforts is crucial to mitigate the adverse effects of ACEs on adult health.

Prevalence of Functional Difficulty Among School-Aged Children and Effect on School Enrolment in Rural Southern India: A Cross-Sectional Analysis

Despite the large number of children in India, there is little information on the impact of children's disability on school enrolment, and how this differs by population. We estimated the prevalence of childhood disability in two sites in Tamil Nadu, southern India, and the effect of functional difficulty on school enrolment. We used a parent-reported survey containing the UNICEF-Washington Group questions to identify children aged 5 to 17 years with functional difficulty during a census conducted for an ongoing trial. We estimated pooled- and gender-specific prevalence of functional difficulty among 29,044 children. We fitted regression models to identify subgroups with higher rates of functional difficulty and the effect of functional difficulty on reported school enrolment. We estimated the modification of the effect of functional difficulty by age, gender, socioeconomic status, household education, and sub-site, on additive and multiplicative scales. We found of 29,044 children, 299 (1.0%) had any functional difficulty, equal among boys and girls. Being understood (0.5%) and walking (0.4%) were the most common difficulties. Functional difficulty was strongly associated with non-enrolment in school (Prevalence ratio [PR] 4.59, 95% CI: 3.87, 5.43) after adjusting for age, gender, and site. We show scale-dependent differences between age and socioeconomic groups in the effect of functional difficulty on enrolment. This study shows that at least one in a hundred children in this region have severe functional difficulties and nearly half of these children are not enrolled in school, highlighting the need for further efforts and evidence-based interventions to increase school enrolment among these groups.

Differences in Exposures to Adverse Childhood Experiences by Primary Source of Health Care, Behavioral Risk Factor Surveillance System 2019-2020

OBJECTIVES

To estimate the prevalence of adverse childhood experiences (ACEs) among a population-based sample of adults in the United States by their primary source of health care.

BACKGROUND

Debate continues around the effectiveness and implementation of health care-based screening of ACEs. However, it is unclear how the burden of ACEs would be distributed across different sources of health care (ie, what a health system might expect should it implement ACEs screening).

METHODS

Data are from 8 U.S. states that include optional modules for ACEs and health care utilization in their 2019 or 2020 Behavioral Risk Factor Surveillance System survey. The analytic sample includes respondents with completed interviews (n = 45,820). ACEs were categorized into ordinal categories of 0, 1, 2, 3, or ≥4; and the prevalence of ACEs was summarized across 5 sources of health care: (1) employer-based or purchased plan; (2) Medicare, Medicaid, or other state programs; (3) TRICARE, Veterans Affairs, or military (ie, military-related health care); (4) Indian Health Service; or (5) some other source. All estimates were weighted to account for the complex sampling design.

RESULTS

Across all health insurance types, at least 60% of individuals reported at least one ACE. The greatest prevalence of patients reporting ≥4 ACEs occurred for military-related health care (21.6%, 95% CI = 18.2-25.5) and Indian Health Service (45.4%, 95% CI = 22.6-70.3).

CONCLUSIONS

ACEs are extremely common across sources of health care, but some health systems have greater proportions of patients with high ACE exposures. The unique strengths and challenges of specific health care systems need to be integrated into the debate about clinical ACEs screening.

Patterns of adverse childhood experiences and their associations with depression, life satisfaction and short-form video addiction in Chinese college students

BACKGROUND

Adverse childhood experiences (ACEs) are widespread in East Asia, heightening the susceptibility to psychological and behavioral complications in adulthood.

OBJECTIVE

To identify polyvictimization patterns among Chinese college students and investigate the associations between diverse patterns and symptoms of depression, short-form video addiction (SVA), and life satisfaction.

PARTICIPANTS AND SETTING

This study encompassed 13,307 college students from four urban centers in China (Mage = 20.2; 46.4 % female).

METHODS

Latent class analysis (LCA) was employed to discern patterns of ACEs among college students. The three-step method (R3step) was utilized to explore the influence of demographic characteristics on the distribution of latent classes. Additionally, the automatic Bolck-Croon-Hagenaars (BCH) Method was deployed to investigate the latent classes effect on distal outcomes.

RESULTS

Left-behind experience was the most common ACE among Chinese college students. Four ACEs patterns were identified: 1) No/Very Low ACEs class (N = 8936, 67.2 %); 2) Parental Absence class (N = 430, 3.2 %); 3) Low/Moderate ACEs class (N = 3565, 26.8 %); and 4) High Violence and Left-behind class (N = 376, 2.8 %). The findings revealed a progressive escalation in healthy outcomes associated with the four ACEs patterns. Specifically, from the first class to the fourth, the severity of associated consequences (depression, life satisfaction and SVA) intensified.

CONCLUSIONS

Distinct ACEs patterns correlate with varying degrees of mental health issues. Compared to participants solely separated from parents, those exposed to abuse and neglect demonstrate more pronounced mental health challenges and addiction susceptibilities.

The Association Between a Neighborhood Adverse Childhood Experiences Index and Body Mass Index Among New York City Youth

Background: The role of neighborhood factors in the association between adverse childhood experiences (ACEs) and body mass index (BMI) has not been widely studied. A neighborhood ACEs index (NAI) captures neighborhood environment factors associated with ACE exposure. This study examined associations between BMI and an NAI among New York City (NYC) youth. An exploratory objective examined the NAI geographic distribution across NYC neighborhoods. Methods: Data for students attending NYC public general education schools in kindergarten-12th grade from 2006-2017 (n = 1,753,867) were linked to 25 geospatial datasets capturing neighborhood characteristics for every census tract in NYC. Multivariable hierarchical linear regression tested associations between BMI and the NAI; analyses also were conducted by young (<8 years), school age (8-12 years), and adolescent (>12 years) subgroups. In addition, NAI was mapped by census tract, and local Moran's I identified clusters of high and low NAI neighborhoods. Results: Higher BMI was associated with higher NAI across all sex and age groups, with largest magnitude of associations for girls (medium NAI vs. low NAI: unstandardized β = 0.112 (SE 0.008), standardized β [effect size] = 0.097, p < 0.001; high NAI vs. low NAI: unstandardized β = 0.195 (SE 0.008), standardized β = 0.178, p < 0.001) and adolescents (medium NAI vs. low NAI: unstandardized β = 0.189 (SE 0.014), standardized β = 0.161, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.364 (SE 0.015), standardized β = 0.334, p < 0.001 for adolescent girls; medium NAI vs. low NAI: unstandardized β = 0.122 (SE 0.014), standardized β = 0.095, p < 0.001, high NAI vs. low NAI: unstandardized β = 0.217 (SE 0.015), standardized β = 0.187, p < 0.001 for adolescent boys). Each borough of NYC included clusters of neighborhoods with higher and lower NAI exposure, although clusters varied in size and patterns of geographic dispersion across boroughs. Conclusions: A spatial index capturing neighborhood environment factors associated with ACE exposure is associated with higher BMI among NYC youth. Findings complement prior literature about relationships between neighborhood environment and obesity risk, existing research documenting ACE-obesity associations, and the potential for neighborhood factors to be a source of adversity. Collectively, evidence suggests that trauma-informed place-based obesity reduction efforts merit further exploration as potential means to interrupt ACE-obesity associations.

Childhood Violence, High School Academic Environment, and Adult Alcohol Use Among Latinas and Black Women: A Structural Equation Modeling Study

OBJECTIVE

Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population.

METHODS

Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables.

RESULTS

Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = -0.59, B = -9.38, 95% CI [-14.00, -4.76]), anxiety symptoms (β = -0.61, B = -14.19, 95% CI [-21.76, -6.61]), appetite loss (β = -0.41, B = -10.52, 95% CI [-15.61, -5.42]), and sleeplessness (β = -0.50, B = -9.56, 95% CI [-13.95, -5.17]) in the early 20s.

CONCLUSIONS

Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools.

Sleep, Screen Behaviors, and Adverse Childhood Experiences: A Cross-Sectional Study of U.S. Children and Adolescents

To examine the associations between adverse childhood experiences (ACEs) and children's obesogenic behaviors (meeting recommendations for sleep duration and screen time) in a representative sample of U.S. children and adolescents. This study assessed data from the 2019-2020 National Survey of Children's Health. Separate multinomial logistic regressions examined the likelihood of failing to meet sleep and screen time recommendations given individual and cumulative ACE scores. 15,581 children (48% female, 32% non-White) experienced one ACE, representing 32% of the analyzed sample. Parents reported financial hardship as the most prevalent ACE (48%). After adjusting for child race/ethnicity, sex of the child, highest education in the household, and child age, we found that participants with four or more ACEs were (1) age-specific sleep recommendations compared with participants with zero ACEs (OR 1.96; 95%CI = 1.64-2.35), and (2) more likely to fall short of meeting screen use recommendations compared with participants with zero ACEs (OR 1.61; 95%CI = 1.26-2.07). U.S. children and adolescents who have experienced four or more ACEs are significantly more likely to fall short of sleep and screen time recommendations compared to their counterparts who experienced zero ACEs. Given the strong associations between ACEs and health outcomes in adulthood, screening for ACEs may better inform practitioners when attempting to improve youth health outcomes.

Parental Alcohol Intoxication, Adverse Childhood Experiences, and Negative Psychological Reactions to Childhood Adversities: Cross-Sectional and Prospective Data from the Population‑Based HUNT Study

Children growing up with alcohol-dependent parents have elevated risk for adverse childhood experiences (ACEs), but few studies have assessed the adverse effects of occasional or frequent exposure to parental intoxication episodes. This study examined whether such exposure was associated with increased risk of ACEs and negative psychological reactions (NPRs) in adolescence and young adulthood. The study relied on cross-sectional and longitudinal data from the Trøndelag Health Study in Norway and included 2,230 adolescents (ages 13-19 years) followed up 11 years later. Self-report questionnaires were used to collect information about exposure to parental intoxication, ACEs, and NPRs in adolescence and NPRs in young adulthood. Seeing parents drunk occasionally was associated with increased odds of six ACEs (odds ratios 1.42 [95% confidence interval 1.17-1.73] to 2.08 [1.44-3.01]) and increased odds of one NPR in adolescence (1.46, 1.12-1.91) compared with those who had never seen their parents intoxicated. Compared with those who had never seen parents intoxicated, seeing parents intoxicated frequently was associated with increased odds of all ACEs measured (1.80 [1.00-3.23] to 3.27 [1.92-5.56]), two NPRs in adolescence (1.60 [1.02-2.50] and 2.06 [1.30-3.27]), one NPR in adulthood (3.56, 1.83-6.94), and the perception of childhood as difficult/very difficult (2.99, 1.51-5.93). In conclusion, exposure to intoxicated parents was associated with increased risk of ACEs and NPRs during childhood, even at low frequency. Frequent exposure to parental intoxication was also associated with NPR in young adulthood.

Applying the Principles of Trauma-Informed Care to the Evaluation and Management of Patients Who Undergo Metabolic and Bariatric Surgery

Evaluation of relevant psychosocial variables is an important aspect of comprehensive, high-quality metabolic and bariatric surgery (MBS) care. Given the high rates of adverse childhood experience (ACEs) and other forms of trauma experienced later in life reported by individuals with class III obesity, it is time to apply the principles of trauma-informed care to the multidisciplinary care of MBS patients. This narrative review begins with a summary of the literature on the psychosocial functioning of individuals who present for MBS. Emphasis is placed upon the relationship between ACEs, class III obesity, and MBS. Trauma-informed care is defined, and its principles are applied to the MBS care continuum. The paper ends with a recommendation on how the field of MBS can integrate trauma-informed care into clinical practice and future research.

Genetics, Epigenetics, and the Environment: Are Precision Medicine, Provider Compassion, and Social Justice Effective Public Health Measures to Mitigate Disease Risk and Severity?

Environmental forces impacting public health include exposure to toxic substances, adverse childhood experiences (ACEs), diet, and exercise. Here, we examine the first two of these forces in some detail since they may be amenable to correction through cultural, medical, and practitioner intervention. At the same time, changing people's dietary and exercise routines are likely more resistant to these interventions and are referred to only incidentally in this review. That is, societal efforts could prevent exposure to toxicants and ACEs-not necessarily requiring cooperation by the affected individuals-whereas changing diet and exercise practices requires an individual's discipline. Toxic substances considered in this review include endocrine disruptors, arsenics, 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), the organic solvent, Trichloroethylene (TCE), and the Benzo[a]pyrene (B[a]P) produced from incomplete combustion of tobacco and other organic materials. Exposure to each of these toxic substances may have serious adverse health effects, especially in genetically more susceptible individuals. For example, children of mothers exposed to the endocrine disruptor, Atrazine, have significantly lower birth length, weight, and head circumference. Moreover, male offspring exhibit genital abnormalities, and all of these effects may be transgenerational. However, analyses of interactions among genes, the environment, and epigenetic modifications have already revealed distinctive individual risks of adverse reactions to toxic exposure. So, interventions through precision medicine might improve the health of those exposed individuals. Adults previously exposed to more than one ACE (e.g., child abuse and inter-parental violence) are more likely to develop anxiety, cancer, and diabetes. Detecting ACE exposures in children in the general population is fraught with difficulty. Thus, the risks of ACEs to our health remain even more insidious than exposures to toxicants. Nevertheless, higher provider compassion is associated with significantly better clinical outcomes for patients with these afflictions. For all these reasons, the first major aim of this review is to recount several of the major forces contributing to or impairing public health. Our second major aim is to examine mitigating influences on these forces, including social justice and provider compassion in the setting of precision medicine. Idealistically, these mitigators might eventually lead to the development of more cooperative and compassionate cultures and societies.

Adverse childhood experiences and falls in older adults: The mediating role of depression

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.

Does cancer clinical trial enrollment for sexual and gender minority people differ from heterosexual, cisgender people?

BACKGROUND

Sexual and gender minority (SGM) people experience cancer disparities compared to heterosexual and cisgender (non-SGM) people and likely have barriers to cancer clinical trial enrollment. Data are sparse, however, regarding cancer clinical trial enrollment for SGM versus non-SGM people.

METHODS

Using data from the 2020 Behavioral Risk Factor Surveillance Survey (BRFSS), we applied a logistic regression to assess associations between SGM status and clinical trial enrollment for 346 SGM and 9441 non-SGM people diagnosed with cancer. The model was adjusted for age at diagnosis, race/ethnicity, partnership status, education, employment, and sex assigned at birth.

RESULTS

SGM individuals had 94 % greater odds than non-SGM individuals to report participation in a clinical trial (aOR 1.94; 95 % CI 1.02-3.68) after adjusting for other factors.

CONCLUSIONS

Data from the BRFSS suggest that SGM people with cancer have higher odds of clinical trial enrollment compared to non-SGM people with cancer. Future work is needed to prospectively track oncology treatment, including clinical trial participation, and outcomes of SGM people versus non-SGM people with cancer. Other studies will be needed to develop and implement systematic, consistent, and non-stigmatizing sexual orientation and gender identity data collection methods.

Surviving the Storm: Exploring Lives Through Personal Stories of Childhood Trauma

Background

Traumatic experiences in an early phase of an individual's life stand out as a highly influential risk factor for poor developmental outcomes. Studies examining poor childhood experiences revealed childhood trauma linked to a negative impact on mental health. Therefore, the objective of this study is to comprehend and investigate the subjective childhood experiences of the affected children.

Methods

A qualitative approach was adopted to explore the lived experiences with their consequences. The study employed a purposeful sampling technique to choose adolescents who had encountered abuse and were capable of articulating their experiences with clarity. In-depth interviews were carried out with 18 adolescents aged 13-18 years, all from childcare homes (mean = 16, SD = 1.46). The transcriptions of these interviews were analyzed using a thematic approach.

Results

The analysis indicated that the children experienced physical abuse, sexual abuse, rape, abandonment, and neglected home environment. The children took responsibility for the abuse directed toward them and were also engaged in substance use. They further reported experiencing negative effects on their behavioral functions (anger, isolation), cognitive function (difficulty in concentration, low academic performances), emotional function (fear, helplessness), social function (withdrawal, mutism), and biological function (sleeplessness, lack of appetite) due to the adverse events in their life. Perceived needs, for instance, emotional, social, and educational support and positive relationship, as well as growth from traumatic experiences were stated by the children.

Conclusion

The findings of the study could have practical implications for clinicians, aiding in the understanding of low emotional expression and unexplained behavior among individuals and assisting in addressing the underlying vulnerability to facilitate their overcoming of these challenges. Additionally, it is suggested that a comprehensive strategy be used that addresses stigma, cultural values, and social norms in addition to legal issues to address the problem.

The Frequency and Impact of Adverse Childhood Experiences on Mood, Alcohol Relapse, and Outcomes in Liver Transplantation: A Retrospective Cohort Study

BACKGROUND

Adverse childhood experiences (ACEs) are associated with the development of negative health behaviors and medical illnesses. ACE's association with poor health outcomes has been well documented in the general population; however, this relationship remains less clear in liver transplant (LT) recipients.

OBJECTIVE

The aims of this study were to determine the prevalence of ACE and the influence of ACE on LT outcomes.

METHODS

A retrospective electronic medical record review of all LT recipients over 11 years at an academic LT center. Demographic, diagnostic, and disease characteristics were extracted and compared for a history of ACE. Associations between a history of ACE and extracted variables were statistically tested using Student's t-test, chi-square tests, or Fisher's exact test, where appropriate. Graft and patient survival were tested using log-rank tests.

RESULTS

Of the 1172 LT recipients, 24.1% endorsed a history of ACE. Females (P = 0.017) and recipients with lower levels of education (P < 0.001) had a higher frequency of ACE. Those with a history of ACE had a higher prevalence of hepatitis C virus (P < 0.001) and higher pretransplant body mass index (P < 0.001). Recipients with a history of ACE had higher prevalence of mood (P < 0.001), anxiety (P < 0.001), post traumatic stress disorder (P < 0.001), alcohol use (P < 0.001), and cannabis use (P < 0.001) disorders, as well as higher Patient Health Questionnaire-9 (P < 0.001) and General Anxiety Disorder-7 (P < 0.001) scores pre- and post-transplant. Those with ACE had a higher incidence of recorded relapses to alcohol by 3 years post-transplant (P = 0.027). Mean lab values, graft survival, and patient survival were not significantly different between those with and without a history of ACE except for total bilirubin at 6 months (P = 0.021).

CONCLUSIONS

One-quarter of LT recipients have experienced ACE. ACE was associated with a history of psychiatric diagnoses, substance use disorders, elevated Patient Health Questionnaire-9 and General Anxiety Disorder-7 scores, and a higher prevalence of relapse to alcohol use after transplant. This population may benefit from increased/improved access to appropriate mental health and substance use services and support in the peri- and post-transplant period.

Strong cultural connectedness buffers urban American Indian children from the negative effects of stress on mental health

We explored whether urban American Indian (AI) caregivers who maintained a strong sense of cultural connectedness buffered their children from the negative effects of stress on mental health. A community sample of 161 urban AI children (91 girls) ages 8-15 years (M = 11.20 years) and their primary caregivers participated between 2016 and 2017. Caregiver cultural connectedness moderated associations among child stressful life events and increased anger (R 2 = .13) and post-traumatic stress disorder (PTSD) symptoms (R 2 = .15). For caregivers with greater cultural connectedness, associations were attenuated and not significant. Higher hair cortisol was related to increased depressive (R 2 = .11), anxiety (R 2 = .10), and PTSD (R 2 = .15) symptoms and was not moderated by cultural connectedness.

An Umbrella Review of Systematic Reviews on Trauma Informed Approaches

Trauma and adversity significantly impact on morbidity and mortality. Hence, trauma-informed care is proliferating practice and research contexts. However, the evidence base for organisational wide trauma-informed care is far from conclusive, with the extant literature providing low quality and conflicting evidence. The purpose of this umbrella review of systematic reviews, is to summarise the existing evidence on trauma-informed care implemented at the organisational level. The preferred reporting items for systematic review and meta-analyses (PRISMA) was used to conduct an umbrella review. Six databases were searched; Academic Search Complete, APA Psych Articles, Cochrane Library, Embase, Scopus, and the Web of Science, supplemented with bibliography searches. Articles were included if they were peer reviewed in the English language from inception to 2024 and reported on trauma-informed care with an implementation context. The Joanne Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses was used to assess the quality of the included reviews. Findings are mapped to the 10 trauma-informed care implementation domains described by the Substance Use and Mental Health Service Administration (SAMHSA) and reported using a narrative synthesis. The search strategy yielded 5,297 articles, of which (N = 14) systematic reviews are included. The reviews had a combined study count of (N = 311), with a total sample size of (N = 157,724). Most reviews used a narrative synthesis to report results, with no meta-analyses. Critical appraisal categorised the reviews as 28% high quality, 22% moderate quality, and 50% as low quality. Most reviews (50%), were conducted on youth populations, with school settings being the most studied context. There was a great deal of heterogeneity across the reviews, with 62 different models of trauma informed approaches discussed. The composition of the individual studies included in each systematic review were generally of low quality with mixed findings of effectiveness and implementation. Findings are discussed for moving forward with trauma-informed care implementation. Trauma-informed care is proposed as a system wide intervention to improve outcomes for service users, however the research base is still under scrutiny. Emerging research identifies the benefit of using the 10 trauma-informed implementation domains to shift cultural practices. Further research needs to be undertaken in various contexts with different populations.

Examining adolescents' experiences of distress when participating in research on well-being and early life adversity

RATIONALE

Most child well-being and childhood adversity research is informed by proxy informants such as parents or teachers rather than children and youth. This may be due to concerns about perceived sensitivity, challenges accessing and engaging with children in research, ethical considerations, and apprehensions about causing undue harm and distress. This study aimed to understand adolescents' identification of, and reactions to, questions in the context of participating in a survey of well-being and adversity.

OBJECTIVES

The aim of this study was to enhance our understanding of how adolescents identify and respond to potentially upsetting questions about well-being and life experiences, including childhood adversity.

METHOD

Data were from 1002 adolescent respondents aged 14 to 17 years. The Well-being and Experiences (WE) survey assessed several domains of life, including general health and well-being and early life adversity. Data were analyzed using descriptive statistics, logistic regression models, and thematic analysis approaches.

RESULTS

Few adolescent respondents reported feeling upset when completing the survey (11.2 %). Among those who reported feeling upset, 92.0 % indicated that it was still important to ask those upsetting questions, and only two respondents (1.8 %) thought upsetting questions should be removed. Ten themes emerged from the adolescents' reflections on self-reported upsetting questions, including identity and life satisfaction, motivation, mental health, and school; childhood adversity was not primarily identified.

CONCLUSIONS

Findings indicate that conducting research on well-being and childhood adversity directly with adolescents is feasible and minimally distressing. Future research should consider how to engage youth directly in research to understand better the scope and outcomes associated with childhood adversity.

Pierre J. An Examination of Underlying Domains in Childhood Adversity: A Scoping Review of Studies Conducting Factor Analyses on Adverse Childhood Experiences

There is an abundance of research linking experiences of childhood adversity to negative physical and mental health outcomes. Areas that remain to be explored and expanded upon include the ideal set of events for inclusion in measures of childhood adversity and testing the models of risk (e.g., cumulative, specificity, dimensional). In the current paper, we performed a scoping review to develop a comprehensive list of studies that conducted factor analyses of childhood adversity measures. There were 89 articles that met the inclusion criteria; trends in the underlying factor structures are reported. Highly associated yet distinct constructs of adversity have demonstrated empirical utility in predicting outcomes in dozens of studies, with consensus that physical abuse, emotional abuse, sexual abuse, physical and emotional neglect, and household dysfunction offer important predictive value to understanding developmental mechanisms of change. We endorse revisions to one commonly used scale that could offer researchers a consistent and psychometrically robust measure of adversity.

Correlation of Chronic Cervico-Cranio-Mandibular Pain in Individuals with Adverse Childhood Events: An Observational Study

OBJECTIVES

This cross-sectional observational study examines the relationship between chronic cervico-cranio-mandibular pain, a significant health concern associated with temporomandibular disorders, and adverse childhood experiences (ACEs). Given the high prevalence of cervical pain and the gap in adequate treatment for temporomandibular disorders, this research highlights the interplay between psychological, social factors, and musculoskeletal health.

METHODS

The study, conducted from January to June 2023, included 114 participants (mean age = 31 ± 12 years, 69.3% female) experiencing chronic cervico-cranio-mandibular pain. Pain severity and dysfunction were assessed, and exposure to ACEs was measured using validated questionnaires. Statistical analysis, performed using Jamovi (v 2.23.28) software.

RESULTS

Data revealed a significant correlation between the number of ACEs and both pain intensity (r = 0.254, p = 0.006, η2 = 0.062) and disability (r = 0.262, p = 0.005, η2 = 0.068). However, no significant association was found between ACEs and mandibular functional limitation (p = 0.222). These findings suggest that while early life stressors impact overall health, their specific influence on cervico-cranio-mandibular pain is limited.

CONCLUSION

The study emphasizes the importance of integrated early intervention strategies to mitigate the long-term musculoskeletal repercussions of adverse events, advocating for comprehensive mental health support and preventive measures. This research contributes valuable insights into the necessity of a multifaceted approach to understanding, diagnosing, and treating musculoskeletal disorders, highlighting the complexity of their causes and effects.

Effects of adverse childhood experiences on university students' ability to lead healthy lives: an exploratory qualitative study in Lahore, Pakistan

BACKGROUND

Adverse Childhood Experiences are a significant global public health concern as these experiences have adverse effects on all the health determinants.

METHODS

The interpretive phenomenological research design was used to explore the implications of adverse childhood experiences on the adult life of university students. An interpretive thematic analysis method was employed to analyze this study.

RESULTS

Five major themes emerged after a comprehensive review of the information obtained from the interviews with the ten selected participants. These were (1) Chronic health struggles (2) Mental health disorders (3) Emotional and social difficulties (4) Paranoia and distrust and (5) Academic and professional under-performance.

CONCLUSION

This study concludes that adverse childhood experiences have long-lasting negative effects on university students' health and behaviour, preventing them from leading healthy lives and excelling academically and professionally.

Digital Health Innovations for Screening and Mitigating Mental Health Impacts of Adverse Childhood Experiences: Narrative Review

Background

Exposures to both negative and positive experiences in childhood have proven to influence cardiovascular, immune, metabolic, and neurologic function throughout an individual's life. As such, adverse childhood experiences (ACEs) could have severe consequences on health and well-being into adulthood.

Objective

This study presents a narrative review of the use of digital health technologies (DHTs) and artificial intelligence to screen and mitigate risks and mental health consequences associated with ACEs among children and youth.

Methods

Several databases were searched for studies published from August 2017 to August 2022. Selected studies (1) explored the relationship between digital health interventions and mitigation of negative health outcomes associated with mental health in childhood and adolescence and (2) examined prevention of ACE occurrence associated with mental illness in childhood and adolescence. A total of 18 search papers were selected, according to our inclusion and exclusion criteria, to evaluate and identify means by which existing digital solutions may be useful in mitigating the mental health consequences associated with the occurrence of ACEs in childhood and adolescence and preventing ACE occurrence due to mental health consequences. We also highlighted a few knowledge gaps or barriers to DHT implementation and usability.

Results

Findings from the search suggest that the incorporation of DHTs, if implemented successfully, has the potential to improve the quality of related care provisions for the management of mental health consequences of adverse or traumatic events in childhood, including posttraumatic stress disorder, suicidal behavior or ideation, anxiety or depression, and attention-deficit/hyperactivity disorder.

Conclusions

The use of DHTs, machine learning tools, natural learning processing, and artificial intelligence can positively help in mitigating ACEs and associated risk factors. Under proper legal regulations, security, privacy, and confidentiality assurances, digital technologies could also assist in promoting positive childhood experiences in children and young adults, bolstering resilience, and providing reliable public health resources to serve populations in need.

Childhood maltreatment predicts poor sleep quality in Chinese adults: The influence of coping style tendencies

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.

Maternal separation as early-life stress: Mechanisms of neuropsychiatric disorders and inspiration for neonatal care

The establishment of positive early parent-infant relationships provide essential nourishment and social stimulation for newborns. During the early stages of postnatal brain development, events such as synaptogenesis, neuronal maturation and glial differentiation occur in a highly coordinated manner. Maternal separation, as an early-life stress introducer, can disrupt the formation of parent-child bonds and exert long-term adverse effects throughout life. When offspring are exposed to maternal separation, the body regulates the stress of maternal separation through multiple mechanisms, including neuroinflammatory responses, neuroendocrinology, and neuronal electrical activity. In adulthood, early maternal separation has long-term effects, such as the induction of neuropsychiatric disorders such as anxiety, depression, and cognitive dysfunction. This review summarized the application of maternal separation models and the mechanisms of stress system response in neuropsychiatric disorders, serving as both a reminder and inspiration for approaches to improve neonatal care, "from bench to bedside".

More adverse childhood experiences are associated with increased social thinning and severe psychological distress

Adverse childhood experiences have been linked to psychopathology due to reduced social networks or social thinning. However, evidence of the temporal associations between adverse childhood experiences, social networks, and psychopathology was lacking, as few studies assessed social networks repeatedly. Further, their underlying neurocognitive and biological mechanisms related to hypervigilance and inflammation remain unclear. This study aimed to clarify these associations using a three-wave population-based cohort study during the COVID-19 pandemic (n = 465), where we leveraged repeated social network assessments. Self-reported questionnaires assessed adverse childhood experiences, social network size and diversity, psychological distress, and hypervigilance regarding COVID-19. Blood tests were conducted to measure inflammation markers. Individuals with more adverse childhood experiences demonstrated lesser increases in their social networks than those without adverse childhood experiences. Decreased network sizes were associated with severe psychological distress, but this association did not remain after adjusting for baseline distress. On the other hand, reduced network diversities were associated with increased psychological distress. We did not find any paths through hypervigilance regarding COVID-19 and inflammation that explain associations between adverse childhood experiences, social thinning, and psychological distress. These findings emphasize the significant social network changes in the associations between adverse childhood experiences and psychopathology.

Effects of childhood adversities on alexithymia features vary between sexes. Results of a prospective population study

Introduction: Adverse childhood experiences (ACEs) associate with various mental disorders, including personality features. Our understanding of how ACEs influence alexithymia features in the general population is limited. In a prospective population setting, we studied whether ACEs associate with alexithymia, and the role of sex and emotional symptoms in this association.Methods: In a Finnish population-based prospective study, 3,142 individuals aged between 30 and 64 years completed eleven ACE questions and the Toronto Alexithymia Scale in 2000 and 2011, and the Hopkins Symptoms Checklist in 2011. The effect of ACEs on alexithymia and its subdomains - difficulty identifying feelings (DIF), difficulty describing feelings (DDF), and externally oriented thinking (EOT) in 2000 and 2011 - was analysed using repeated measures ANOVA.Results: The number of ACEs and their main component, childhood social disadvantage, associated positively with total alexithymia scores and its subdomains DIF and DDF, and negatively with EOT. After controlling for the effect of depression and anxiety, the strength of these associations was reduced, but the effect of social disadvantage on DIF and EOT remained significant in females. Childhood family conflicts associated positively with DIF in males and negatively with EOT in females. Additionally, maternal mental problems associated positively with DIF and DDF in females.Discussion: In the general population, ACEs, particularly social disadvantage, are associated with adult alexithymia features. Alexithymia features, detectable from youth, may predispose individuals to emotional disturbances caused by childhood adversities. The effect of family conflicts and maternal mental problems on alexithymia features varies between sexes.

The mediating role of behavioral risk factors in the pathway between childhood disadvantage and adult psychological distress in a Finnish employee cohort

Childhood disadvantage is associated with increased adult psychological distress, but the role of behavioral risk factors in the pathway remains unclear. We examined whether behavioral risk factors mediate the effects of childhood disadvantage on adult psychological distress. We used the Helsinki Health Study data of employees of the City of Helsinki, Finland, aged 19-39 (mean age 32.0) years at baseline (2017). We included women (n = 2397) and men (n = 586) who responded to both baseline and follow-up (2022) surveys. At baseline, eight types of childhood disadvantage were asked retrospectively, and six adult behavioral risk factors were included. Psychological distress was measured by the DASS-21 at follow-up. We conducted mediation analyses using generalized structural equation modeling. Among women, we found indirect path effects of childhood disadvantage on adult psychological distress through behavioral risk factors (symptoms of depression: β = 0.68, 95% CI 0.20-1.17; anxiety: β = 0.54, 95% CI 0.13-0.95; and stress: β = 0.69, 95% CI 0.20-1.09). Among men, childhood disadvantage contributed only directly to adult depressive (β = 0.71, 95% CI 0.16-1.26) and stress (β = 0.61, 95% CI 0.10-1.13) symptoms. Our findings suggest that behavioral risk factors can mediate some of the adverse effects of childhood disadvantage on adult psychological distress among women.

Lagged effects of childhood depressive symptoms on adult epigenetic aging

BACKGROUND

Cross-sectional studies have identified health risks associated with epigenetic aging. However, it is unclear whether these risks make epigenetic clocks 'tick faster' (i.e. accelerate biological aging). The current study examines concurrent and lagged within-person changes of a variety of health risks associated with epigenetic aging.

METHODS

Individuals from the Great Smoky Mountains Study were followed from age 9 to 35 years. DNA methylation profiles were assessed from blood, at multiple timepoints (i.e. waves) for each individual. Health risks were psychiatric, lifestyle, and adversity factors. Concurrent (N = 539 individuals; 1029 assessments) and lagged (N = 380 individuals; 760 assessments) analyses were used to determine the link between health risks and epigenetic aging.

RESULTS

Concurrent models showed that BMI (r = 0.15, PFDR < 0.01) was significantly correlated to epigenetic aging at the subject-level but not wave-level. Lagged models demonstrated that depressive symptoms (b = 1.67 months per symptom, PFDR = 0.02) in adolescence accelerated epigenetic aging in adulthood, also when models were fully adjusted for BMI, smoking, and cannabis and alcohol use.

CONCLUSIONS

Within-persons, changes in health risks were unaccompanied by concurrent changes in epigenetic aging, suggesting that it is unlikely for risks to immediately 'accelerate' epigenetic aging. However, time lagged analyses indicated that depressive symptoms in childhood/adolescence predicted epigenetic aging in adulthood. Together, findings suggest that age-related biological embedding of depressive symptoms is not instant but provides prognostic opportunities. Repeated measurements and longer follow-up times are needed to examine stable and dynamic contributions of childhood experiences to epigenetic aging across the lifespan.

Prevalence, subtypes, and risk factors of adverse childhood experiences among Chinese residents: a multicenter cross-sectional study

Background

Addressing the long-term physical and mental health impacts of adverse childhood experiences (ACEs) remains a significant public health challenge. Additionally, ACEs can contribute to intergenerational transmission, affecting future generations. While previous studies have primarily focused on children and adolescents, there is limited data on ACE subtypes and influencing factors among the general adult population, particularly in China. This study aims to explore the prevalence, subtypes, and factors influencing ACEs among Chinese adults.

Method

A total of 1,932 Chinese residents from southwest China (Sichuan, Yunnan, Guizhou provinces, and Chongqing Municipality) participated in the study, consisting of 867 men (44.9%) and 1,065 women (55.1%). Latent class analysis (LCA) was used to identify ACE clusters, and regression analysis examined associations between ACE clusters and demographic factors, physical illness, and mental health outcomes.

Results

The findings revealed that 28.7% of participants had experienced at least one ACE, while 13.2% had experienced three or more ACEs. Three distinct ACE clusters were identified: a low ACE group, a high emotional and physical abuse/family dysfunction group, and a high ACE/sexual abuse group. Regression analysis showed significant associations between childhood adversity and demographic factors (age, education, birthplace), as well as physical and mental health outcomes (anxiety, depression). ANOVA further confirmed significant differences in depression and anxiety scores across the clusters.

Conclusion

These findings offer critical insights for developing targeted public health interventions. Policymakers should consider strategies to reduce childhood ACEs and mitigate their long-term consequences, with particular attention to high-risk groups.

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

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.

Health and wellbeing of survivors of sexual violence and abuse attending sexual assault referral centres in England: the MESARCH mixed-methods evaluation

Background

One million people in England and Wales experience sexual violence and abuse each year, with nearly half experiencing serious sexual offences; around 30,000 survivors access sexual assault referral centres.

Objectives

This research was commissioned by National Institute for Health and Care Research to evaluate access, interventions and care pathways for survivors, especially those provided through sexual assault referral centres.

Design, setting, participants

The sexual assault referral centres care pathway was investigated through six sub-studies. There were two Cochrane Reviews (4274 participants). Seventy-two providers and 5 survivors were interviewed at eight sites; the children and young people study involved 12 participants from two sexual assault referral centres. A cohort study involving three-wave data collection over 1 year (21 sites; 2602 service users screened, 337 recruited) used a multilevel modelling framework to explore risk factors for burden of post-traumatic stress disorder symptoms at baseline and change at 1 year. We analysed costs and outcomes and conducted a narrative analysis (41 survivors). We worked closely with survivors and prioritised the safety/welfare of participants and researchers.

Results

Cochrane Reviews identified large effects from psychosocial interventions for post-traumatic stress disorder and depression. Sexual assault referral centres delivered a high-quality frontline service for survivors but groups experiencing domestic abuse and some ethnic and cultural minorities were under-represented. The qualitative research emphasised inter-agency collaboration for survivor benefit. The cohort study identified a risk 'triad' of adverse childhood experiences, poor mental health and economic deprivation, which was associated with baseline trauma burden. There were important improvements in trauma symptoms a year later. These improvements were unrelated to different sexual assault referral centre models. Costs and other outcomes were also similar across models. Harmful policing and justice practices/procedures were identified by 25% of participants. In this context, trauma-competent interviewing techniques, regular/timely updates and conveying case decisions with care signalled good practice.

Limitations

The cohort study lacked a comparison group, reducing confidence in the finding that access to sexual assault referral centres explained the reduction observed in post-traumatic stress disorder.

Conclusions and future work

Barriers to access call for concerted efforts to implement trauma-informed universal health services. The risk 'triad' underscores the value of holistic approaches to care at sexual assault referral centres and timely follow-on care. Poor mental health was the main barrier to service access beyond sexual assault referral centres. The persistence of trauma symptoms a year after accessing sexual assault referral centres signals urgent need for tackling counselling wait-lists, expanding support options and commitment to lifelong care. Multidisciplinary evaluation of sexual assault referral centres for better health provides a foundation for advancing trauma-informed practices in the context of sexual violence and abuse.

Study registration

This study is registered as ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/117/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 35. See the NIHR Funding and Awards website for further award information.

The development and evaluation of a virtual, asynchronous, trauma-focused treatment program for adult survivors of childhood interpersonal trauma

BACKGROUND

The long-term mental and physical health implications of childhood interpersonal trauma on adult survivors is immense, however, there is a lack of available trauma-focused treatment services that are widely accessible. This study, utilizing a user-centered design process, sought feedback on the initial design and development of a novel, self-paced psychoeducation and skills-based treatment intervention for this population.

AIMS

To explore the views and perspectives of adult survivors of childhood interpersonal trauma on the first two modules of an asynchronous trauma-focused treatment program.

METHODS

Fourteen participants from our outpatient hospital service who completed the modules consented to provide feedback on their user experience. A thematic analysis of the three focus groups was conducted.

RESULTS

Four major themes emerged from the focus groups: (1) technology utilization, (2) module content, (3) asynchronous delivery, and (4) opportunity for interactivity. Participants noted the convenience of the platform and the use of multimedia content to increase engagement and did not find the modules to be emotionally overwhelming.

CONCLUSIONS

Our research findings suggest that an asynchronous virtual intervention for childhood interpersonal trauma survivors may be a safe and acceptable way to provide a stabilization-focused intervention on a wider scale.

Childhood adversity, accelerated GrimAge, and associated health consequences

Childhood adversity is linked to psychological, behavioral, and physical health problems, including obesity and cardiometabolic disease. Epigenetic alterations are one pathway through which the effects of early life stress and adversity might persist into adulthood. Epigenetic mechanisms have also been proposed to explain why cardiometabolic health can vary greatly between individuals with similar Body Mass Index (BMIs). We evaluated two independent cross-sectional cohorts of adults without known medical illness, one of which explicitly recruited individuals with early life stress (ELS) and control participants (n = 195), and the other a general community sample (n = 477). In these cohorts, we examine associations between childhood adversity, epigenetic aging, and metabolic health. Childhood adversity was associated with increased GrimAge Acceleration (GAA) in both cohorts, both utilizing a dichotomous yes/no classification (both p < 0.01) as well as a continuous measure using the Childhood Trauma Questionnaire (CTQ) (both p < 0.05). Further investigation demonstrated that CTQ subscales for physical and sexual abuse (both p < 0.05) were associated with increased GAA in both cohorts, whereas physical and emotional neglect were not. In both cohorts, higher CTQ was also associated with higher BMI and increased insulin resistance (both p < 0.05). Finally, we demonstrate a moderating effect of BMI on the relationship between GAA and insulin resistance where GAA correlated with insulin resistance specifically at higher BMIs. These results, which were largely replicated between two independent cohorts, suggest that interactions between epigenetics, obesity, and metabolic health may be important mechanisms through which childhood adversity contributes to long-term physical and metabolic health effects.

Association Between Adverse Childhood Experiences and Academic Performance Among Children and Adolescents: A Global Meta-Analysis

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.

Healthy Communities for Youth: A Cost Analysis of a Community-Level Program to Prevent Youth Violence

Youth violence is a national public health concern in USA, especially in resource-constrained urban communities. Between 2018 and 2021, the Healthy Communities for Youth (HCFY) program addressed youth violence prevention in select economically marginalized urban communities, with the HCFY program reducing the likelihood of youth-involved violent crime. Leveraging costs from program expense reports, this study analyzes the costs of the HCFY program in order to inform policymaking and the program's future ongoing implementation. Total HCFY program costs were $821,000 ($290,100 annually including program start-up costs) over the 34-month project period. Operationalization costs contributed the largest share (64.8%), with 45% attributable to intervention coordinators. In the intervention community, the program costs $100 per capita, $1100 per youth-involved crime case, and $8100 per youth-involved violent crime case. Findings were sensitive to the number of youth-involved crime or violent crime cases and costs of high-level program leadership and self-evaluation analysts, with the per youth-involved violent crime case cost ranging between $700 and $1600 over the program period. Analysis of HCFY program costs is an important step in determining the affordability of a community-level program to prevent youth violence in resource-limited urban communities.

Intersection of adverse childhood experiences, suicide and overdose prevention

Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.

Adverse childhood experience, adopting a healthy lifestyle in adulthood, and risk of cardiovascular diseases

BACKGROUND

Both adverse childhood experiences (ACEs) and lifestyle factors have been associated with risk of cardiovascular diseases (CVDs) in later life, but whether and to what extent adherence to a healthy lifestyle in adulthood can offset the increased cardiovascular risk associated with ACEs is unclear. We aimed to determine whether and to what extent adopting to a healthy lifestyle in adulthood can offset the risk of CVDs in individuals according to their ACEs.

METHODS

A prospective cohort study included 143,869 participants aged 38-72 years, free of CVDs at baseline from the UK Biobank. The history of ACEs was assessed using the Childhood Trauma Screener. Participants were divided into three risk groups based on ACEs: low (no ACEs), intermediate (one or two ACEs), and high (three or more ACEs). A healthy lifestyle score in adulthood was constructed as the sum of four modifiable lifestyle factors (no smoking, adequate physical activity, healthy diet, no obesity), and participants were then categorized into three groups based on this score (unfavorable [0-1 point], intermediate [2-3 points], favorable [4 points]). Cox proportional hazard models were conducted to investigate the association between ACEs, healthy lifestyle, and incident CVDs.

RESULTS

During a median follow-up of 12.49 years, 13,373 incident cases of overall CVDs were identified. This included 7521 cases of coronary heart disease (CHD), 6175 cases of atrial fibrillation (AF) and 1813 cases of stroke. Individuals with high ACEs had a greater risk of incident overall CVDs (hazard ratio [HR] = 1.39, [95%CI = 1.29 to 1.50]), CHD (1.50 [1.36 to 1.65]) and AF (1.18 [1.05 to 1.33]) compared to those with low ACEs. The risk of CVDs decreased moving from unfavorable to favorable lifestyle categories (P for trend<0.001), with the lowest risk observed among individuals with a favorable lifestyle (0.70 [0.66 to 0.74] for overall CVDs, 0.69 [0.64 to 0.75] for CHD, and 0.71 [0.65 to 0.78] for AF). Participants with high ACEs and a favorable lifestyle had a 39 %, 40 % and 47 % lower risk of developing overall CVDs (0.61 [0.48 to 0.76]), CHD (0.60 [0.44 to 0.81], and AF (0.53 [0.36 to 0.77]) than those with high ACEs and an unfavorable lifestyle.

CONCLUSIONS

Having a healthy lifestyle in adulthood could substantially attenuate the increased risk of overall CVDs, CHD, and AF conferred by ACEs.

Adverse Childhood Events Significantly Impact Depression and Mental Distress in Adults with a History of Cancer

Objectives: Adverse childhood experiences (ACEs) are linked to a heightened risk of depression. We explored the relationship between ACEs and both depression and mental distress among cancer survivors. Methods: This was a cross-sectional analysis using the 2022 Behavioral Risk Factor Surveillance System database of cancer survivors aged ≥18 (n = 14,132). The primary outcome was self-reported history of depression, and the secondary outcome was mental distress. The exposure variable was the number of ACEs, classified as 0, 1-2, and ≥3. Weighted multivariable logistic regression models assessed the association between the number of ACEs and depression and mental distress while adjusting for covariates. Results: Approximately 22% of respondents reported experiencing ≥3 ACEs. The prevalence of depression was 21.8%, and mental distress was 15.4%. Compared with cancer survivors who had experienced 0 ACEs, those who had experienced ≥3 (aOR = 3.94; 95% CI, 3.04-5.10) or 1-2 (aOR = 1.85; 95% CI, 1.47-2.32) ACEs had a higher likelihood of reporting depression. Compared with cancer survivors who had experienced 0 ACEs, those who had experienced ≥3 (aOR = 0.67; 95% CI, 0.48-0.93) had a lower likelihood of reporting mental distress. Conclusions: This study highlights the impact of ACEs on depression in adulthood among cancer survivors.