Cumulative childhood risk and adult functioning in abused and neglected children grown up

Mapping resilience: a scoping review on mediators and moderators of childhood adversity with a focus on gender patterns

BACKGROUND

Childhood adversity is associated with a host of negative health and socioeconomic outcomes far into adulthood. The process of avoiding such outcomes is often referred to as resilience. Mapping resilience comprehensively and across contexts is highly relevant to public health, as it is a step towards understanding environments and interventions that contribute to preventing or reversing negative outcomes after early adverse experiences.

OBJECTIVES

This review scoped out the literature on resilience factors in relation to adulthood outcomes as diverse as mental health and educational attainment. Our aim was to understand where there is untapped research potential, by examining the current evidence base on resilience factors in terms of (a) resources that can buffer the impact of childhood adversity and (b) the pathways linking adversity to long-term outcomes. Furthermore, we aimed to identify gender patterns in these resources and pathways, which has not been a primary interest of reviews on resilience to date, and which can add to our understanding of the different ways in which resilience may unfold.

ELIGIBILITY CRITERIA

Studies had to include an adversity experienced in childhood, an outcome considered indicative of resilience in adulthood, and at least one putative resilience factor, which had to be approached via mediation or moderation analysis. We considered cohort, case-control and cross-sectional studies.

SOURCES OF EVIDENCE

We searched PubMed, Scopus and PsycINFO and included original, peer-reviewed articles published before 20 July 2023 in English, German, French, Spanish, Dutch and Swedish.

CHARTING METHODS

All three authors collaborated on the extraction of information relevant to answering the research questions. The results were visually and narratively summarised.

RESULTS

We included 102 studies. Traditionally anchored in the field of psychology, the resilience literature focuses heavily on individual-level resilience factors. Gender was considered in approximately 22% of included studies and was always limited to comparisons between men and women. There is no evidence that childhood adversity impacts men and women differently in the long term, but there is some evidence for gender differences in resilience factors.

CONCLUSIONS

There is untapped potential in resilience research. By considering structural-level factors simultaneously with individual-level factors, and including gender as one of the elements that shape resilience, we can map resilience as a heterogeneous, multilevel process from a public health perspective. This would complement the extensive existing literature on individual-level factors and help reframe resilience as a concept that can be intervened on at a structural level, and that is subject to societal norms and forces, such as gender. There is a lack of quantitative studies including transgender and gender-non-conforming persons.

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety

Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear.Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety.Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment.Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse - but not physical or emotional abuse - a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types.Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

Toward understanding the neural mechanisms involved in early life stress-induced aggression: A Highlight for "Maternal separation early in life induces excessive activity of the central amygdala related to abnormal aggression"

Early life stress, such as childhood abuse and neglect, is one of the major risk factors for the development of antisocial behavior. In rat models, repeated maternal separation (MS) stress, in which the pups are separated from the dams for a few hours each day during the first 2-3 weeks of life, increases aggressive behavior in adult males. This Editorial highlights an article in the current issue of the Journal of Neurochemistry that demonstrates the involvement of the central nucleus of the amygdala (CeA) in the escalation of aggressive behavior in the MS model. The authors show that MS rats exhibit higher c-Fos expression in the CeA during an aggressive encounter compared to non-isolated control rats. Unexpectedly, other amygdala subnuclei did not show differential activation between MS and control groups. Using optogenetics, they provide direct evidence that activation of CeA neurons increases intermale aggressive behavior and that bilateral CeA activation shifts behavioral patterns toward more qualitatively intense aggressive behavior than unilateral CeA activation. These findings highlight the important role of the CeA in the development of abnormal aggression and indicate that this region may be an important therapeutic target for human aggression induced by early life stress.

Central amygdala is related to the reduction of aggressive behavior by monosodium glutamate ingestion during the period of development in an ADHD model rat

Introduction

Monosodium glutamate (MSG), an umami substance, stimulates the gut-brain axis communication via gut umami receptors and the subsequent vagus nerves. However, the brain mechanism underlying the effect of MSG ingestion during the developmental period on aggression has not yet been clarified. We first tried to establish new experimental conditions to be more appropriate for detailed analysis of the brain, and then investigated the effects of MSG ingestion on aggressive behavior during the developmental stage of an ADHD rat model.

Methods

Long-Evans, WKY/Izm, SHR/Izm, and SHR-SP/Ezo were individually housed from postnatal day 25 for 5 weeks. Post-weaning social isolation (PWSI) was given to escalate aggressive behavior. The resident-intruder test, that is conducted during the subjective night, was used for a detailed analysis of aggression, including the frequency, duration, and latency of anogenital sniffing, aggressive grooming, and attack behavior. Immunohistochemistry of c-Fos expression was conducted in all strains to predict potential aggression-related brain areas. Finally, the most aggressive strain, SHR/Izm, a known model of attention-deficit hyperactivity disorder (ADHD), was used to investigate the effect of MSG ingestion (60 mM solution) on aggression, followed by c-Fos immunostaining in aggression-related areas. Bilateral subdiaphragmatic vagotomy was performed to verify the importance of gut-brain interactions in the effect of MSG.

Results

The resident intruder test revealed that SHR/Izm rats were the most aggressive among the four strains for all aggression parameters tested. SHR/Izm rats also showed the highest number of c-Fos + cells in aggression-related brain areas, including the central amygdala (CeA). MSG ingestion significantly decreased the frequency and duration of aggressive grooming and attack behavior and increased the latency of attack behavior. Furthermore, MSG administration successfully increased c-Fos positive cell number in the intermediate nucleus of the solitary tract (iNTS), a terminal of the gastrointestinal sensory afferent fiber of the vagus nerve, and modulated c-Fos positive cells in the CeA. Interestingly, vagotomy diminished the MSG effects on aggression and c-Fos expression in the iNTS and CeA.

Conclusion

MSG ingestion decreased PWSI-induced aggression in SHR/Izm, which was mediated by the vagus nerve related to the stimulation of iNTS and modulation of CeA activity.

Association Between Child Maltreatment and Substance Use Disorder Across Emerging Adulthood

Child maltreatment is associated with substance use beginning in adolescence and throughout early adulthood. Substance use disorders (SUD) are most likely to develop during emerging adulthood (18-25 years old). Thus, to develop effective substance use prevention strategies, it is useful to know the ages at which associations between maltreatment exposure (prior to age 18) and SUD are most strongly tied. This study examined the age-varying association between child maltreatment and past-year SUD in emerging adulthood by sex and by maltreatment type using time-varying effect models (TVEM). Data were from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). The analytic sample consisted of 5194 emerging adults. The association was strongest at younger ages, with individuals who experienced child maltreatment having three times greater odds of reporting SUD in the past-year. Differential associations were found by sex, racial-ethnic group, and maltreatment type across age. Prevention efforts may be more effective if their development is informed by these important differences and targeted at emerging adults rather than adolescents.

Does it add up? Educational achievement mediates child maltreatment subtypes to allostatic load

BACKGROUND

Childhood maltreatment (CM) has been linked to higher levels of allostatic load (AL) and educational achievement is a possible pathway and may differ across gender. It is also critical to determine if CM severity or specific subtypes of CM are more or less influential.

OBJECTIVE

This study examined educational achievement as a mediator linking cumulative and individual types of CM to AL and examined gender as a moderator.

PARTICIPANTS AND SETTING

Using two waves of data, 897 adults from the study Midlife in the United States were analyzed.

METHODS

Multiple group structural equation models stratified across gender to test were used cumulative maltreatment and maltreatment subtypes to AL and test gender as a moderator.

RESULTS

Overall CM was associated with educational achievement (β = -0.12, p < .01) and AL (β = 0.11, p < .05) and education was inversely associated with AL (β = -0.17, p < .001) in men but not women. The subtypes model revealed that physical abuse predicted lower level of education achievement (β = -0.20, p < .001) and among men. Educational achievement, in turn, was associated with lower levels of AL (β = -0.02, p = .002). Educational achievement was a possible pathway linking physical abuse to AL (β = 0.02, 95 % CI [0.001, 0.040]) among men but was non-significant in women. Gender did not moderate any of the pathways.

CONCLUSIONS

Educational achievement is a potentially modifiable social determinant of health that can be a focus of prevention and intervention efforts among men who were maltreated, particularly for those who experienced physical abuse.

"Many bad things had been happening to me": Children's perceptions and experiences of polyvictimization in the context of child physical abuse

BACKGROUND

The association between child maltreatment and polyvictimization has received growing attention since being identified by Finkelhor and colleagues in 2005.

OBJECTIVE

The current study was designed to explore the experiences and perceptions of children who reported polyvictimization during forensic interviews.

METHODS

This mixed-methods study sample comprised 117 children aged 5-14, referred for the first time to forensic interviews following suspected physical abuse by a parent. More than one-third of the children reported polyvictimization. A thematic analysis was carried out to spotlight these children's experiences.

RESULTS

The analysis identified three main themes: the way children comprehend the polyvictimization, the consequences of the polyvictimization regarding the children's negative self-attribution, and the way the polyvictimization was constructed through the dynamic with the forensic interviewers.

CONCLUSIONS

The findings pointed to the importance of the forensic interview platform in assessing children's maltreatment burden. The current study also provided a glance into the possible involvement of the mechanics of self-blame among maltreated children. These findings have the potential to enhance our understanding of the excessive psychological toll taken on polyvictimized children.

Exposure to violence in childhood and risk of violence in adult schizophrenia: Results from a multinational study

This study investigated the connection between childhood violence exposure and violent behavior in adults with schizophrenia spectrum disorders (SSDs). The case-control study included 398 SSD patients: 221 cases with a history of severe interpersonal violence in the past and 177 controls with no history of violence. The findings indicated that cases were significantly more likely to report childhood exposure to all forms of witnessed or personally sustained violence both within and outside the family, with those who had witnessed intra-familial violence being more likely to assault a family member in adulthood. Cases reported exposure to violence before the age of 12 years significantly more frequently than controls, and those with early-life violence exposure were significantly more likely to report that they were in a state of intense anger when they behaved violently. A dose-response relationship was observed, with evidence of an increased risk of later violence when the exposure occurred before the age of 12 and an increased likelihood of intrafamilial violence. The evidence suggests that childhood violence exposure was associated with an increased risk of violent behavior in adult SSD patients, and early exposure was linked to an increased likelihood of physical violence occurring in states of intense anger.

Cumulative Family Risk and Depressive Symptoms Among Chinese Adolescents: The Moderating Role of Friendship Quality

Family risk is inimical to adolescent development. The relationship between cumulative family risk and adolescent depressive symptoms was explored in the current study, with friendship quality examined as a moderator of the relationship. A sample of 595 seventh-grade students was tracked at 10-month intervals. Results suggested that exposure to cumulative family risk predicted adolescents' current and subsequent depressive symptoms, and that there was a linear, additive relationship between cumulative family risk and depressive symptoms. Friendship quality moderated the linear relationship between cumulative family risk and adolescents' current depressive symptoms. It is worth noting that the protective role of friendship quality is limited. The results highlight that the detrimental impact of family risk needs to be recognized and addressed.

Identifying differential trajectories and predictors for depressive symptoms in adolescents using latent class growth analysis: A population-based cohort study

INTRODUCTION

This study investigated the differential trajectories and relevant determinants of depressive symptoms in adolescents by following cohorts that included junior, senior, and vocational high school adolescents, over a 3-year period in Taiwan.

METHODS

Longitudinal data were obtained from 575 adolescents who participated in the Taiwan Adolescent to Adult Longitudinal Study. Data analysis included latent class growth with time-varying covariate, univariate, and multivariate analysis.

RESULTS

A three-class ("low but increasing trajectory," "moderate and stable trajectory," and "high but decreasing trajectory") model fit the data of the cohort. Our findings indicated that 29%, 38%, and 33% of the adolescents were in the low but increasing, moderate and stable, and high but decreasing trajectories, respectively. After confounders were controlled for, bullying experiences were identified as a risk factor for depressive symptoms. The protective factors against depressive symptoms included resilience and peer and social support.

CONCLUSIONS

The transitions between different educational stages critically influence the depressive symptoms of adolescents, and the adolescents follow different depressive trajectories, that have different etiology. Therefore, identifying adolescents at high risk for depression and designing student-centered intervention programs through individualized and multidimensional assessment of depressive symptoms are crucial for adolescents.

Context-relevant risk and protective factors for children in rural communities: Long-term implications for adulthood educational and mental health outcomes

Globally, rural children are more likely than others to experience barriers to opportunity. We propose context-relevant family risk and protective factors for children in rural villages in one of China's poorest provinces and analyze long-term implications for educational and mental health outcomes in early adulthood. Four proposed risk factors-low parental education, insufficient income, parental migration, and parental ill-health-show statistically significant detrimental implications for educational attainment. Low parental education stands out, with negative estimated effects on all outcomes. Insufficient income predicts higher scores for depression but not self-esteem. Parental migration and parental ill health have no significant relationships with mental health outcomes. Proposed protective factors- parental warmth, doing things together, and household credit limit-have positive estimated effects on educational attainment, but not on most mental health outcomes. Few interactions between protective and risk factors exist, and patterns are generally similar for girls and boys.

Adverse Childhood Experiences and Pathways to Violent Behavior for Women and Men

Childhood maltreatment is associated with risk for committing future violence, but the relationship between subgroups and biological sex is unknown. The relationship between adverse childhood experiences (ACEs), violence, and sex was examined using a nationally representative sample. Results from a latent class analysis suggested a four-class model (low adversity; moderate maltreatment with high household dysfunction; severe maltreatment with moderate household dysfunction; severe multi-type adversities). When compared to low adversity, all typology groups were at significantly higher risk to engage in violence (odds ratio > 2.10, ps < .013). The data supported a linear trajectory, meaning increased childhood trauma was associated with increased risk for violence. Although men endorsed more violent behavior, the relationship between ACEs and violence was significantly stronger among women. Prior findings identify that women are more negatively impacted by ACEs and the current findings newly identify that this extends to violent crime.

The Effects of Adverse Childhood Experiences and Warfare Exposure on Military Sexual Trauma Among Veterans

Military sexual trauma (MST) is a pervasive problem; this study examined the relationship of the precursory traumas of adverse childhood experiences (ACEs) and warfare exposure with MST. Post-9/11 veterans were surveyed at 3 months and at 24 to 30 months post-military separation. Female veterans who experienced at least 1 ACE but no warfare exposure were significantly more likely to receive unwanted sexual attention. Veterans (males and females) experiencing three or more ACEs but no warfare exposure were significantly more likely to receive unwanted sexual attention and contact. Experiencing only warfare exposure was not related to unwanted sexual attention or contact for females; however, a significant interaction was found between combined warfare exposure, ACEs, and MST for males and females. Veterans who reported warfare exposure and one to two or three or more ACEs were more likely to report unwanted sexual attention and/or contact. Exploration of individual ACEs revealed a significant relationship between childhood sexual abuse and unwanted sexual contact. For females, witnessing domestic violence predicted unwanted sexual contact. There was also a significant interaction between childhood sexual abuse and warfare exposure. Females who experienced both childhood sexual abuse and warfare exposure were significantly more likely to receive unwanted sexual attention and unwanted sexual contact. Albeit a small sample, males who experienced both were also significantly more likely to receive unwanted sexual attention. The findings reveal that precursory traumatic experiences in childhood and the interaction of ACEs and warfare exposure during military service can increase the likelihood of unwanted sexual attention and contact. This research further substantiates the need for screening efforts. It also demonstrates the importance of practitioners engaging in trauma-informed care principles and practices to address the residual effects of previous experiences during sexual trauma or mental health treatment efforts.

Cumulative Ecological Risk and Academic Burnout in Chinese College Students: A Moderated Mediation Model

This study explored the relationship between cumulative ecological risk exposure and academic burnout among Chinese college students and the mediating and moderating effects of neuroticism and gender, respectively. A total of 580 college students were selected as participants. They completed a battery of questionnaires that measured cumulative ecological risk, neuroticism, and academic burnout. The results showed that: (1) cumulative ecological risk was positively related to neuroticism and academic burnout; (2) cumulative ecological risk positively predicted academic burnout; (3) neuroticism partly mediated the relationship between cumulative ecological risk and academic burnout; and (4) gender moderated the effect of cumulative ecological risk and academic burnout. A high level of cumulative ecological risk had a greater impact on neuroticism among women, compared to men. These findings advance our current knowledge of the specific effects of cumulative ecological risk on academic burnout and the underlying internal mechanisms of this relationship. Furthermore, this study provides a constructive perspective on preventing and reducing academic burnout among college students.

The role of social isolation stress in escalated aggression in rodent models

Anti-social behavior and violence are major public health concerns. Globally, violence contributes to more than 1.6 million deaths each year. Previous studies have reported that social rejection or neglect exacerbates aggression. In rodent models, social isolation stress is used to demonstrate the adverse effects of social deprivation on physiological, endocrinological, immunological, and behavioral parameters, including aggressive behavior. This review summarizes recent rodent studies on the effect of social isolation stress during different developmental periods on aggressive behavior and the underlying neural mechanisms. Social isolation during adulthood affects the levels of neurosteroids and neuropeptides and increases aggressive behavior. These changes are ethologically relevant for the adaptation to changes in local environmental conditions in the natural habitats. Chronic deprivation of social interaction after weaning, especially during the juvenile to adolescent periods, leads to the disruption of the development of appropriate social behavior and the maladaptive escalation of aggressive behavior. The understanding of neurobiological mechanisms underlying social isolation-induced escalated aggression will aid in the development of therapeutic interventions for escalated aggression.

"Mental Health Problems in Abused Institutionalised Serbian Adolescents and Their Use of Social and Mental Health Services"

"The aim of the study was to determine the frequency of various forms of maltreatment in adolescents without parental care, their mental health problems and treatment needs. Sixty examinees of both genders, aged 12-18, were divided in two groups: abused group (adolescent without parental care in an institutional setting) and control group (general population). The presence/absence of registered abuse/neglect by official social services were the criterion for classifying respondents into groups. The general questionnaire, Childhood Trauma Questionnaire and Youth Self Report were used. 46.67% of adolescents were neglected, 40% of them suffered several types of abuse, 10% were physically abused, 3.33% were emotionally abused, and no adolescent was sexually abused. 16.6% of cases of sexual abuse in the abused group as well as milder forms of maltreatment in the control group were registered by self-reported retrospective measures, which are not part of official registers. Delinquency, aggressive behavior and somatic complaints are significantly more prominent in the abused group compared to the control group. 86% of adolescents used some form of support and counseling from professionals, 56.6% were included in psychiatric treatment, and only 36.6% in psychotherapy. Mental health problems in abused adolescents without parental care indicates the specific needs for psychotherapy and psychiatric treatment."

Childhood trauma and current depression among Chinese university students: a moderated mediation model of cognitive emotion regulation strategies and neuroticism

BACKGROUND

Childhood trauma (CT) is considered as a highly risk factor for depression. Although the pathway of CT to depression, especially the mediating or moderating effects of cognitive emotion regulation strategies (CERS) or neuroticism, have investigated by several studies, the results were inconsistent and there is a paucity of full models among these interactive factors. This study aims to examine the relationships among CT, adaptive / maladaptive CERS, neuroticism, and current depression symptoms in university students.

METHODS

We recruited 3009 freshman of 2019, aged averagely 18.00 (SD = 0.772) years, from universities in Hunan province in 2019. A moderated mediation model was built to examine the relationships among CT, CERS, neuroticism, and current depression using the SPSS PROCESS 3.5 macro. We conducted bootstrapping of regression estimates with 5000 samples and 95% confidence interval.

RESULTS

Results revealed that the significant mediating effects of adaptive CERS (β = 0.012; 95% CI: 0.006 to 0.018) and maladaptive CERS (β = 0.028; 95% CI: 0.016 to 0.040) between CT and depression were observed, accounting for 5.69% and 13.52% of the total effect respectively. Then, moderated mediation analyses results showed that neuroticism simultaneously moderated the direct effect of CT on current depression (β = 0.035; 95% CI: 0.001 to 0.009), and the indirect effects of CT on current depression through adaptive CERS (adaptive CERS - current depression: β = - 0.034; 95% CI: - 0.007 to - 0.001) and maladaptive CERS (maladaptive CERS - current depression: β = 0.157; 95% CI: 0.017 to 0.025). However, the moderating effects of neuroticism in the indirect paths from CT to adaptive CERS (β = 0.037; 95% CI: 0.000 to 0.014) and maladaptive CERS (β = - 0.001; 95% CI: - 0.006 to 0.005) were not significant.

CONCLUSIONS

This study provides powerful evidences through a large university students sample for the mediating role of adaptive / maladaptive CERS and the moderating role of neuroticism between CT and current depression. This manifests that cognitive emotion regulation may be a vital factor for people who suffered from CT and current depression. Furthermore, the influence of neuroticism in this process cannot be ignored.

The relationship between childhood trauma and depressive symptom among Zhuang adolescents: Mediating and moderating effects of cognitive emotion regulation strategies

BACKGROUND

Not all adolescents who have endured childhood trauma will develop depressive symptom, nor will they all experience the same level of depressive symptom. According to previous research, cognitive emotion regulation strategies may explain a portion of the variance. Observe the connection between childhood trauma and depressive symptom and investigate whether cognitive emotion regulation strategies mediate or moderate this association.

METHODS

In October 2019, a cross-sectional study measuring childhood trauma, cognitive emotion regulation strategies, and depressive symptom among Zhuang adolescents was done in one senior high school and two junior highs in Chongzuo, Guangxi, China, using a self-report questionnaire. To examine the hypothesis of mediating and moderating effects, SPSS PROCESS was utilized.

RESULTS

In this study, there was a positive relationship between childhood trauma and depressive symptom, whereas there were positive correlations between expressive suppression and childhood trauma and depressive symptom (r = 0.380, 0.246, and 0.089, respectively, p < 0.01). The 5,000-sample bootstrap procedure revealed that the indirect relationship between the independent variable (childhood trauma or emotional abuse) and the dependent variable (depressive symptom) was statistically significant (β = 0.0154 95% CI: 0.0019, 0.0165, β = 0.0442 95% CI: 0.0008, 0.0117). The statistical significance of the interaction effect enhanced the R-square value of the moderating effect when the independent variable was the total childhood trauma score (ΔR2 = 0.0044, 0.0089).

CONCLUSIONS

Our findings corroborated the conclusion of prior research that cognitive emotion regulation strategies mediate and moderate the development of depressive symptom. Although we demonstrate that cognitive emotion regulation strategies play a mediating and moderating role in the relationships between childhood trauma and depressive symptom, the mediating effects on the relationships between the other types of childhood traumas, including physical abuse and neglect, sexual abuse, emotional neglect, and depressive symptom, did not emerge.

Cumulative risk exposure and emotional symptoms among early adolescent girls

Background

From early adolescence, girls and women report the highest rates of emotional symptoms, and there is evidence of increased prevalence in recent years. We investigate risk factors and cumulative risk exposure (CRE) in relation to emotional symptoms among early adolescent girls.

Methods

We used secondary data analysis, drawing on data capturing demographic information and self-reported emotional symptoms from 8327 girls aged 11–12 years from the 2017 baseline data collection phase of the HeadStart evaluation. We used structural equation modelling to identify risk factors in relation to self-reported emotional symptoms, and collated this into a CRE index to investigate associations between CRE and emotional symptoms.

Results

Four risk factors were found to have a statistically significant relationship with emotional symptoms among early adolescent girls: low academic attainment, special educational needs, low family income, and caregiving responsibilities. CRE was positively associated with emotional symptoms, with a small effect size.

Conclusions

Results identify risk factors (outlined above) that are associated with emotional symptoms among early adolescent girls, and highlight that early adolescent girls experiencing a greater number of risk factors in their lives are likely to also experience greater emotional distress. Findings highlight the need for identification and targeted mental health intervention (e.g., individual or group counselling, approaches targeting specific symptoms), for those facing greater risk and/or with emergent symptoms.

The Co-Occurrence of Child Maltreatment and Intimate Partner Violence in Families: Effects on Children's Externalizing Behavior Problems

Children exposed to maltreatment are at risk of experiencing intimate partner violence (IPV) and behavioral problems. This study examined different forms of family violence that co-occur and their relationship to children's externalizing behaviors across developmental stages (early childhood, middle childhood, adolescence). Longitudinal data (N = 1,987) at baseline and 18 months and 36 months post-baseline from the NSCAW II were used. Mixture modeling was employed in which latent class models estimated subgroups of children who experienced co-occurring forms of family violence; regression models estimated which subgroups of children were at risk of externalizing behaviors. Three latent classes were identified across developmental stages: high family violence, low family violence, and child physical abuse and psychological aggression. For children in early childhood, a fourth class was identified: partner and child physical abuse and child psychological aggression. Results from regression models revealed differences in externalizing scores by class membership across developmental age groups and over time. That distinct classes of child maltreatment and IPV co-occur and differentially impact children's behavior suggests a need for strong prevention and intervention responses to address children's dual maltreatment and IPV exposure.

Reduction in Epigenetic Age Acceleration Is Related to Empathy in Mothers with Neglectful Caregiving

DNA methylation clocks are used as molecular estimators of epigenetic age, but with little evidence in mothers and none in neglectful mothering. We investigated differences in epigenetic age acceleration (EAA) and the role of empathy using the PhenoAge clock. We collected saliva samples from mothers with extreme disregard for their child's needs (50 in the neglect group, NG) and mothers with non-neglectful caregiving (87 in the control group, CG). Mothers completed an empathy scale, along with questionnaires of their own childhood maltreatment, adverse life events and psychiatric disorders. Sociodemographic variables potentially affecting EAA were also measured. The ANCOVA solution showed a significant increase in EAA in the NG compared to the CG, after adjustment for maternal age, number of pregnancies, financial assistance, adverse events, childhood maltreatment and psychiatric disorder. The group interaction effects showed a reduction in EAA for greater empathic concern and for a higher education level both as positive factors, and an increment in EAA for mothers living in a two-parent family as a risk factor, all in the NG. Our findings open the search for protective factors of EAA associated with caregiver behavior to reduce health vulnerabilities and poor social functioning, especially for mothers at risk of maladaptive caregiving.

Validation and further development of a risk assessment instrument for child welfare

BACKGROUND

Although many child maltreatment risk assessment instruments have been implemented in child welfare organizations, thorough studies on their predictive validity are scarce.

OBJECTIVE

To examine (1) the predictive validity of a risk assessment instrument that has been widely implemented in the Netherlands, and to examine (2) whether the actuarial risk estimation could be improved and simplified to widen the instrument's applicability to different organizations serving different populations.

PARTICIPANTS AND SETTING

The sample comprised risk assessments (N = 3,681) performed for families enrolled at one of five child welfare agencies in the Netherlands between January 2015 and December 2017.

METHODS

In a follow-up period of at least one year, child maltreatment was operationalized as whether or not child protection orders, residential care, or hotline reports occurred. Area Under the Curve values were calculated to determine the predictive accuracy of the risk classifications. Chi-square Automatic Interaction Detection was used to develop a new risk classification based on a new cumulative risk variable.

RESULTS

The original risk classification and the newly developed and simplified risk classification showed a similar discriminative accuracy for the different outcome measures: Area Under the Curve values were .68 and .69 for child protection orders, .62 and .63 for residential care, and .58 and .60 for hotline reports, respectively.

CONCLUSIONS

The original and new risk classification of the instrument had a medium predictive validity with the latter being simpler, more widely applicable, and based on more valid risk factors.

How Early Stressful Life Experiences Combine With Adolescents' Conjoint Health Risk Trajectories to Influence Cardiometabolic Disease Risk in Young Adulthood

Research has primarily focused on additive (unique) associations between early stressful life experiences (specifically, socioeconomic adversity and maltreatment) and young adults' cardiometabolic disease risk without considering multiplicative (synergistic) influences. Furthermore, research has not fully considered the varying patterns of health risk trajectories (e.g., substance use, obesogenic-related behaviors, depressive symptoms) across adolescence and the transition to young adulthood that may link earlier stressful experiences and later cardiometabolic disease risk. This study examined heterogeneity in conjoint health risk trajectories from adolescence to the transition to young adulthood and their additive and multiplicative (synergistic) influences with early stressful life experiences on cardiometabolic disease risk in young adulthood using data from the National Longitudinal Study of Adolescent to Adult Health (n = 9,421; 55.6% female) over a period of 13 years. Four distinct conjoint health risk trajectories were identified considering trajectories of substance use behaviors, obesogenic-related behaviors, and depressive symptoms: (a) overall high-risk, (b) behavioral risks, (c) psycho-obesogenic risks, and (d) overall low-risk. Socioeconomic adversity and maltreatment were additively and multiplicatively associated with cardiometabolic disease risk in young adulthood. Individuals with overall high-risk conjoint trajectories averaged higher cardiometabolic disease risk in young adulthood when they were exposed to early socioeconomic adversity. Implications for personalized interventions for individuals who have experienced multiple forms of health risks are discussed.

Child maltreatment and cognitive and academic functioning in two generations

BACKGROUND

Childhood maltreatment has been associated with deficits in cognitive functioning and poor academic performance. Not known is whether these characteristics are the direct consequence of the childhood maltreatment (that is, maltreatment plays a causal role) or whether other factors explain the relationship.

OBJECTIVES

To examine whether childhood maltreatment predicts cognitive and academic functioning and whether these relationships are explained by other factors (parent cognitive and academic functioning, family social class, or parent maltreatment).

PARTICIPANTS

Data are from a longitudinal study of previously maltreated children, matched controls, and a subset of their offspring (697 parent-offspring dyads) interviewed in 2009-2010.

METHOD

Cognitive and academic functioning were assessed in both parents and offspring with the same measures. Maltreatment was determined through official records. Hierarchical linear regressions were conducted to examine predictors of offspring cognitive and academic functioning.

RESULTS

Childhood maltreatment was associated with poorer cognitive functioning and worse academic performance in both generations. Controlling for age, sex, race, and whether the parent had more than one child in the study, offspring maltreatment predicted offspring cognitive functioning when it was the only predictor in the model. In a final model with all variables, only parent cognitive functioning predicted offspring cognitive functioning and parent academic functioning and parent history of maltreatment predicted offspring academic functioning.

CONCLUSION

These results challenge assumptions that childhood maltreatment directly causes deficits in cognitive and academic functioning. Policy makers and practitioners may need to rethink the design of interventions to improve the cognitive and academic functioning of maltreated children.

The contribution of early adverse stress to complex and severe depression in depressed outpatients

BACKGROUND

To assess whether linear effects or threshold effects best describe the association between early adverse stress (EAS) and complex and severe depression (i.e., depression with treatment resistance, psychotic symptoms, and/or suicidal ideation), and to examine the attributable risk of complex and severe depression associated with EAS.

METHODS

A cross-sectional study was conducted using deidentified clinical data (on demographics, presence of complex and severe depression, and exposure to seven types of EAS) from 1,013 adults who were seen in an outpatient mental health clinic in Santiago, Chile, for a major depressive episode. Multivariate logistic regressions were fitted to estimate odds ratios (ORs), using a bootstrap approach to compute 95% bias-corrected confidence intervals (95% BC CIs). A detailed examination of the cumulative risk score and calculations of the attributable risk was conducted.

RESULTS

Exposure to at least five EASs was reported by 3.6% of the sample. In the multivariate logistic regression models, there was a marked increase in the odds of having complex and severe depression associated with exposure to at least five EASs (OR = 4.24; 95% BC CI: 1.25 to 9.09), according to a threshold effect. The attributable risk of complex and severe depression associated with exposure to at least one EAS was 36.8% (95% BC CI: 17.7 to 55.9).

CONCLUSIONS

High levels of EAS distinctively contribute to complex clinical presentations of depression in adulthood. Patients with complex clinical presentations of depression and history of EAS should need a differentiated treatment approach, particularly those having high levels of EAS.

Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators

OBJECTIVE

This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood.

METHODS

Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators).

RESULTS

Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE-asthma association were 'severe financial difficulties' (24%), 'emotional, physical or sexual violence' (15%), 'major increase in marital problems' (8%), 'severe conflicts with supervisor' (7%), and 'divorce or separation' (5%).

CONCLUSIONS

Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset.

[Trauma, Psychological Stress and Family Situation of Fathers who Experienced Child and Youth Welfare Services: Implications for Youth Welfare Interventions and Therapy]

Trauma, Psychological Stress and Family Situation of Fathers who Experienced Child and Youth Welfare Services: Implications for Youth Welfare Interventions and Therapy This paper explores the current family situation and psychological stress of fathers who experienced trauma and different kinds of youth welfare services including out-of-home placement during their childhood. The main group consisted of n = 119 fathers and was compared to a group of n = 36 fathers whose families never received services from the child and youth welfare authority. In the main group, a high correlation was found between trauma and current psychological stress, albeit the out-of-home care intervention or intensive home-support by child and youth welfare services during childhood. The higher stress level in the main group of fathers in contrast to the comparison group effects their current family situation, especially concerning the contact between fathers and their children. Fathers with higher stress levels were less likely to be in contact with their children. Acting on the assumption that fathers are important for their children, the results implicate a heightened focus on earlier trauma-informed interventions in families with difficulties and out-of-home care settings, to reduce stress levels and prevent intergenerational transmission of problematic family experiences. Current child and youth welfare services, in particular out-of-home placements, should take these trauma-informed approaches and therapy into account.

Early childhood psychosocial family risks and cumulative dopaminergic sensitizing score: Links to behavior problems in U.S. 9-year-olds

BACKGROUND

We examined, (a) whether in early childhood exposure to risky family environment in different domains (socioeconomic, mental, parenting practices, health behavior, and child-related risks) and accumulatively across various domains (cumulative risk) is associated with child's problem behavior at age 9, and (b) whether the association is more pronounced in children carrying cumulative dopaminergic sensitizing genotype or living in low-income families.

METHODS

Participants were 2,860 9-year old children (48% females; 48% Black) and their mothers from the 'Fragile Families and Child Wellbeing Study', a probability birth cohort from large U.S. cities. Mothers responded to questions on child's problem behavior (CBCL). Children responded to questions about their vandalism and substance use.

RESULTS

Cumulative family risk was associated with higher internalizing and externalizing behavior and higher vandalism and substance use. All domain-specific risk clusters were associated with higher internalizing behavior and, with the exception of child-related risk, with higher externalizing behavior. Mental health risks, risky parenting practices, and risky health behavior were associated with higher vandalism. Risky parenting practices were associated with higher substance use. The associations were robust to adjustment for cumulative dopaminergic sensitizing genotype. No G x E interactions with dopaminergic genotype and family SES were observed.

LIMITATIONS

Sample size was relatively small for genetic analysis and polygenic risk scores were not available.

CONCLUSIONS

Exposure to cumulative psychosocial family risks from early childhood is associated with early indicators of problem behavior in adolescence.

Adverse Childhood Experiences (ACEs) and Timely Bachelor’s Degree Attainment

It is well established that adverse childhood experiences (ACEs) are linked to health and emotional outcomes. However, less is known about the relationship between ACEs and educational attainment—a potentially important feature of educational stratification in America. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative study following 7–12th grade students in the 1994–95 school year, I investigate the link between ACEs and these students’ timely post-secondary attainment. I also explore the role of health and socio-emotional factors as mediators. Results confirm that there is a graded relationship between ACEs and timely bachelor’s degree attainment—an additional ACE decreases the odds of timely bachelor’s degree attainment by about 17%, even after accounting for other related factors. In addition, the findings suggest that general health partially mediates this link.

Children of Parents With Opioid Use Disorder

Substance use disorders (SUDs) have been a priority public health concern for decades, with most recent conversations focusing on the opioid use disorder (OUD) epidemic. Children of parents with OUD have been impacted through poverty, violence, neglect, and emotional and physical abuse. Although treatment programs may address the family and parental role, few focus on the children. Without building resiliency in a child's mental and physical health, the far-reaching impact of the opioid epidemic will continue. The goal of the current literature review was to critique available intervention programs that focus on children of parents with SUD/OUD and provide recommendations for best practice. A literature search found six child-focused intervention programs dated in the 1990s and early 2000s and generalized to parents with SUDs. No intervention was found specific to children of parents with OUD. Nurses and other health professionals can use these findings to determine which evidence-based intervention is most appropriate for the needs of this specific population. [Journal of Psychosocial Nursing and Mental Health Services, 59(3), 28-34.].

Intervention Response to the Trauma-Exposed, Justice-Involved Female Youth: A Narrative Review of Effectiveness in Reducing Recidivism

This study aims to examine current research about trauma-exposed, justice-involved (TEJI) female youth, and evaluate the current literature regarding the effectiveness of gender-specific interventions aimed at reducing their recidivism. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was utilized to examine quantitative and qualitative literature, published from 2000 through March 2020, about interventions for female justice-involved youth with trauma exposure. Analysis of selected studies utilized an integrated framework based on Andrew’s Risk-Need-Responsivity (RNR) model and Lipsey’s factors of effectiveness, which reviewed studies showing the relationship between female justice-involved youth with mental health symptomologies and trauma. The findings show that effective intervention for this population targets the youth’s negative internal mechanisms related to trauma-subsequent psychosocial problems. These studies suggest that trauma-sensitive modalities have the potential to mitigate the further risk of problematic external behaviors. All studies had limited sample sizes, low follow-up rates, and unknown long-term outcomes. Future research should explore dimensions of sustainability and achieving stability in relation to intervention setting. Selecting the proper venue and facilitator for quality implementation and stability of setting is critical in delivering effective therapies. Modifications in public expectations of juvenile justice policy and practice, from disciplinary to therapeutic approaches, is needed.

Exploring the interrelatedness of risk factors for child maltreatment: A network approach

BACKGROUND

Theories on the etiology of child maltreatment generally focus on the interaction between multiple risk and protective factors. Moreover, the quadratic model of cumulative risk describes a threshold at which the risk of child maltreatment increases exponentially, suggesting a synergistic effect between risk factors.

OBJECTIVE

This study explored the interrelatedness of risk factors for child maltreatment.

PARTICIPANTS AND SETTING

The sample consisted of risk assessments performed for both high-risk families (n = 2,399; child protection services) and lower risk families (n = 1,904; community outreach services).

METHODS

Network analyses were performed on parental risk factors. Three networks were constructed: a cross-sample network, a high-risk network, and a lower risk network. The relations between risk factors were examined, as well as the centrality of each risk factor in these networks. Additionally, the networks of the two samples were compared.

RESULTS

The networks revealed that risk factors for child maltreatment were highly interrelated, which is consistent with Belsky's multi-dimensional perspective on child maltreatment. As expected, risk factors were generally stronger related to each other in the high-risk sample than in the lower risk sample. Centrality analyses showed that the following risk factors play an important role in the development of child maltreatment: "Caregiver was maltreated as a child", "History of domestic violence", and "Caregiver is emotionally absent".

CONCLUSIONS

We conclude that studying the interrelatedness of risk factors contributes to knowledge on the etiology of child maltreatment and the improvement of both risk assessment procedures and interventions for child maltreatment.

Risk models for predicting the health-related quality of life of caregivers of youth with gastrointestinal concerns

PURPOSE

To determine the usefulness of cumulative and additive risk models in predicting the healthy-related quality of life (HRQOL) of caregivers of youth with chronic gastrointestinal conditions.

METHODS

203 caregivers (82.8% mothers; 77.3% white) of youth (M = 11.27 years; 44.3% female; 78.8% White) completed self-report questionnaires focused on potential environmental, child health, and family risk factors that could impact caregiver HRQOL. Cumulative risk models, evaluating overall combined risk level, as well as an additive risk model, exploring individual risk variables, were evaluated.

RESULTS

Higher levels of cumulative risk were associated with poorer caregiver HRQOL after controlling for child and caregiver sex. A linear cumulative risk model was a better fit than a quadratic cumulative risk model for predicting caregiver HRQOL, while an additive model identified child HRQOL, child pain interference and family functioning as the most individually impactful risk variables.

CONCLUSION

This study illustrates the usefulness of both additive and cumulative risk approaches in identifying caregivers at risk for poor HRQOL. Provision of appropriate referrals and interventions based on the caregiver's risk factors can help protect caregiver quality of life and, in turn, benefit the care children with chronic conditions receive at home.

The Role of Trauma Type and Age in the Relation Between Trauma Exposure and Intelligence

Experiencing potentially traumatic events (PTEs) is associated with deficits in cognitive functioning for youth. Previous research has demonstrated that PTE type may influence the association between PTE experiences and intelligence, such that IQ scores may differ by the type of PTE experienced. Additionally, mixed findings in the literature suggest that these associations might differ by age. The current study examined the association between PTE type and IQ and how age may moderate this association. In a sample of youth in foster care (N = 328, M_age = 13.25), physical, psychological, and sexual abuse and family PTEs were directly associated with verbal and nonverbal IQ. Age significantly moderated the association between IQ and neglect and academic PTEs. Results suggest that broad PTE grouping methods or failing to account for both maltreatment and general PTEs in samples of youth in foster care may conceal differences in how PTEs relate to intellectual functioning.

Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

BACKGROUND

Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women's birth outcomes.

METHODS

We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant's reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education.

RESULTS

Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08-1.17), preterm birth (OR = 1.07; 95% CI = 1.01-1.12), and low birthweight (OR = 1.08; 95% CI = 1.03-1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern.

CONCLUSIONS

Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

The Complexity of Adaptation to Childhood Polyvictimization in Youth and Young Adults: Recommendations for Multidisciplinary Responders

Exposure to violence is pervasive in our society. An abundance of research has demonstrated that individuals who experience polyvictimization (PV)-prolonged or multiple forms of traumatic victimizations-are at heightened risk for continuing to experience repeated victimizations throughout their lifetimes. The current article reviews several overlapping constructs of traumatic victimizations with the ultimate goal of providing a unifying framework for conceptualizing prolonged and multiple victimization (defined in this article as PV) as a precursor to complex post-traumatic biopsychosocial adaptations, revictimization, and in some instances reenactment as a perpetrator (defined as complex trauma [CT]). This model is then applied to three socially disadvantaged victim populations-lesbian, gay, bisexual, transgender, queer, or questioning; commercially sexually exploited individuals; and urban communities of color-who are at heightened risk for PV and for exhibiting complex clinical presentations to demonstrate how the PV-CT framework can destigmatize, reframe, and ultimately reduce health disparities experienced by these populations. Trauma-informed recommendations are provided to aid researchers and multidisciplinary providers working to reduce harm and improve the quality of life for polyvictims.

Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial

Background: Developmental trauma disorder (DTD) has been proposed to describe the biopsychosocial sequelae of exposure to interpersonal victimization in childhood that extend beyond the symptoms of post-traumatic stress disorder (PTSD). Objective: To characterize the psychopathology comorbid with DTD and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric disorders were identified with screening modules on the Kiddie Schedule for Affective Disorders and Schizophrenia, Present/Lifetime version (K-SADS-PL), in a multi-site sample of 236 children (7-18 years old; 50% female) referred by paediatric or mental health providers. Results: DTD (N = 80, 34%) and PTSD (N = 69, 29%) were highly comorbid and shared several DSM-IV internalizing disorder and DSM, 5th Edition (DSM-5) dysregulation disorder comorbidities. However, DTD, but not PTSD, was associated with comorbid panic disorder and disruptive behaviour disorders. On a multivariate basis including all probable DSM-IV disorders and DSM-5 dysregulation disorders, DTD was associated with separation anxiety disorder and attention deficit hyperactivity disorder after controlling for PTSD, while PTSD was associated with major depression and generalized anxiety disorder after controlling for DTD. Conclusions: DTD's comorbidities overlap with but extend beyond those of PTSD to include panic, separation anxiety, and disruptive behaviour disorders. DTD warrants further investigation as a potential diagnosis or a complex variant of PTSD in children, similar to the adult symptoms of disturbances of self-organization in the proposed International Classification of Diseases, 11th revision (ICD-11) complex post-traumatic stress disorder subtype.

Does the type of maltreatment matter? Assessing the individual and combined effects of multiple forms of childhood maltreatment on exclusive breastfeeding behavior

BACKGROUND

Childhood maltreatment (CM) has been associated with a range of adult health outcomes; however, extant research has focused more on exposure to a single form of abuse rather than multiple forms. Moreover, very few studies have specifically investigated the impact of CM on exclusive breastfeeding (EBF) outcomes.

OBJECTIVES

This study aims to examine: (1) the individual and combined effects of multiple forms of CM on EBF outcomes; and (2) whether postpartum depression and maternal stress act to mediate or moderate the association between CM and EBF.

METHOD

Cross-sectional survey data were collected between October 2015 and January 2016 from 426 women of Bangladesh who were six months postpartum.

RESULTS

Based on the adjusted multivariate logistic regression model, women who experienced childhood sexual abuse (CSA) were significantly less likely to exclusively breastfeed babies than their non-abused counterparts (AOR: 0.38, 95% CI [0.15, 0.92]). When a composite measure was created to examine the additive effects of adverse childhood experiences, a dose-response association was observed between the reported number of different types of CM and early termination of EBF. Though experiencing postpartum depression and maternal stress do not mediate the effect of CSA on EBF, they do moderate them such that the odds of early termination of EBF are notably higher among women who experienced CSA in combination with postpartum depression or high levels of stress.

CONCLUSIONS

Findings from this study offer some insight into the intergenerational effects associated with CM experiences, and underpin the need for effective policies and programs to prevent or reduce its occurrence and improve the EBF outcomes.

When Nowhere Is Safe: Interpersonal Trauma and Attachment Adversity as Antecedents of Posttraumatic Stress Disorder and Developmental Trauma Disorder

Developmental trauma disorder (DTD) has been proposed as clinical framework for the sequelae of complex trauma exposure in children. In this study, we investigated whether DTD is associated with different traumatic antecedents than posttraumatic stress disorder (PTSD). In a multisite sample of 236 children referred from pediatric or mental health treatment, DTD was assessed using the DTD Structured Interview. Trauma history was assessed using the Traumatic Events Screening Instrument (TESI). On an unadjusted basis, both DTD, odds ratios (ORs) = 2.0-3.8, 95% CI [1.17, 7.19]; and PTSD, ORs = 1.8-3.0, 95% CI [1.04, 6.27], were associated with past physical assault and/or abuse, family violence, emotional abuse, neglect, and impaired caregivers; and DTD was associated community violence, OR = 2.7, 95% CI [1.35, 5.43]. On a multivariate basis after controlling for the effects of PTSD, DTD was associated with family and community violence and impaired caregivers, ORs = 2.0-2.5, 95% CI [1.09, 5.97], whereas PTSD was only associated with physical assault and/or abuse after controlling for the effects of DTD, OR = 2.4, 95% CI [1.07, 4.99]. Exposure to both interpersonal trauma and attachment adversity was associated with the highest DTD symptom count, controlling for the PTSD symptom count. Although childhood PTSD and DTD share several traumatic antecedents, DTD may be uniquely associated with pervasive exposure to violent environments and impaired caregiving. Therefore, DTD warrants further investigation as a framework for the assessment and treatment of children with histories of interpersonal victimization and attachment adversity.

Early socioeconomic adversity and cardiometabolic risk in young adults: mediating roles of risky health lifestyle and depressive symptoms

The study examined the mediating roles of risky health lifestyle and depressive symptoms in relation to childhood/adolescence adversity and young adult cardiometabolic risk with data from the National Longitudinal Study of Adolescent to Adult Health (n = 9421). Four classes of youth emerged from a latent class analysis with varying early adversity patterns: (a) both low disadvantaged SES and stressful experience (54.8%), (b) high disadvantaged SES and low stressful experience (31.0%), (c) low disadvantaged SES and high stressful experience (10.9%), and (d) both high disadvantaged SES and stressful experience (3.3%). Early adversity had multiple direct and indirect effects on CM risk for those experiencing SES-related adversities. Instead, early adversity generated mediational processes between adversity and CM risks through risky health lifestyle and depressive symptoms for those experiencing stressful experience. Implications for intervention when dealing with youths who have experienced multiple forms of early adversity are discussed.

A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students

OBJECTIVE

This study investigated associations between adverse childhood experiences (ACE) prior to age 18 years and multiple health behaviors (eg, cigarette and other substance use) and outcomes (eg, obesity, depression) for a large college sample.

PARTICIPANTS

2,969 college students from seven universities in the state of Georgia were included in the analysis.

METHODS

Web-based surveys were completed by students (45-60 minutes) during the spring semester, 2015.

RESULTS

Findings indicate that more ACEs are associated with higher levels of depressive symptoms, ADHD symptoms, cigarette use, alcohol use, marijuana use, and BMI, in addition to lower levels of fruit and vegetable intake, and sleep.

CONCLUSION

ACEs may carry forward in the lifespan to influence a range of unhealthy outcomes among college students. College intervention programs may benefit by recognizing the pervasiveness of ACEs and their associations with health behaviors and outcomes, and include interventions across more than one health behavior.

Disparities for LGBTQ and Gender Nonconforming Adolescents

OBJECTIVES

To identify patterns of childhood adversity in a sample of adolescents and assess disparities in these experiences for lesbian, gay, bisexual, transgender, and questioning adolescents and by level of gender nonconformity.

METHOD

By using the cross-sectional, statewide, anonymous 2016 Minnesota Student Survey, 81 885 students were included in the current study (50.59% male; mean age = 15.51). Participants were enrolled in grades 9 and 11 in a total of 348 schools.

RESULTS

Four patterns of childhood adversity were identified with sex-stratified latent class analyses (entropy = 0.833 males; 0.833 females), ranging from relatively low levels of abuse (85.3% males; 80.1% females) to polyvictimization (0.84% males; 1.98% females). A regression analysis showed that compared with heterosexual adolescents, gay, lesbian, bisexual, and questioning adolescents were more likely to be classified into profiles characterized by polyvictimization (odds ratio [OR] 1.81-7.53) and psychological and/or physical abuse (OR 1.29-3.12), than no or low adversity. Similarly, compared with nontransgender adolescents, transgender adolescents were more likely to be classified into profiles characterized by patterns of polyvictimization (OR 1.49-2.91) and psychological and/or physical abuse (OR 1.23-1.96). A higher level of gender nonconformity predicted a higher likelihood of being classified into each adversity profile compared with the no or low adversity profile (OR 1.14-1.45).

CONCLUSIONS

Sexual minority adolescents and adolescents with high levels of gender nonconformity are vulnerable to experience adversity. The disparities for lesbian, gay, bisexual, transgender, and questioning adolescents and adolescents with high gender nonconformity highlight the variation in patterns of childhood adversity that these youth are at risk of experiencing. The findings reveal the need for further research on the benefits and harm of screening for childhood adversity by physicians and pediatricians.

Polyvictimization in childhood and its adverse impacts across the lifespan: Introduction to the special issue

Although much empirical work has focused on the adverse impact of specific types of childhood victimization (e.g., sexual, physical, or emotional abuse), researchers and clinicians increasingly are recognizing the prevalence of polyvictimization, or exposure to multiple types of victimization. Polyvictimization during formative developmental periods may have detrimental and potentially lifelong biopsychosocial impacts over and above the effects of exposure to specific types of adversity. In this guest editorial, we summarize the key questions and findings for six empirical studies on polyvictimization included in this Special Issue of the Journal of Trauma & Dissociation. These empirical studies further our understanding of the nature, consequences, and assessment of polyvictimization. We conclude with recommendations for continued scientific research and clinical inquiry on polyvictimization.

A Cumulative Risk Model of Child Physical Maltreatment Potential: Findings From a Community-Based Study

Previous studies have identified the predictive risk factors of child physical maltreatment (CPM). However, a significant number of these studies assessed risk factors in isolation. The cumulative risk hypothesis postulates that health problems are caused by the accumulation of risk factors, independently of the presence or absence of specific risk indicators. Few studies examined the effect of cumulative risk on CPM potential. This study aimed to test two concurrent models of cumulative risk of CPM potential by investigating whether CPM potential was better predicted by a threshold cumulative risk model or a linear cumulative risk model. Data from the National Representative Study of Psychosocial Context of Child Abuse and Neglect in Portugal were used. Parents of school-age children ( N = 796) answered to self-report measures regarding sociodemographic variables, history of child maltreatment, psychological distress, and CPM potential. A cumulative risk index was computed, comprising 10 dichotomized risk factors. Evidence for a threshold cumulative effect was found. Additional bivariate logistic regressions revealed that the odds for high-potential CPM were dramatically higher for those parents with six or more risk factors when compared with parents with any one risk factor. By testing and confirming a threshold cumulative effect on CPM potential, it was possible to find a "trigger point" from which a dramatic increase in child physical maltreatment potential occurs.

Polyvictimization and Girls' Involvement in the Juvenile Justice System: Investigating Gender-Differentiated Patterns of Risk, Recidivism, and Resilience

A recent dramatic rise in girls' arrests has increased our need to examine whether our models of youth justice system involvement need to be differentiated by gender. Polyvictimization, in particular, has been implicated as a powerful predictor of youth problem behavior. However, recent research suggests that polyvictimization is associated with youth involvement in the justice system in ways that differ for girls at the levels of the independent variables (i.e., the sources of risk), the dependent variables (i.e., youth outcomes), and the mediators of these associations (i.e., the purported mechanisms that account for these relations). The present critique describes growth points in the current research with the goal of suggesting promising directions for future investigations. In particular, gaps are noted regarding our understanding of the specific forms of polyvictimization that affect traumatized girls' development, especially given the highly disproportionate prevalence of sexual abuse among justice-involved girls. In addition, increased attention is needed to gender differences in the timing of victimization and the onset of risky behavior, as well as the nature of trauma-linked youth offenses and recidivism, which research also suggests may differ for boys and girls. Furthermore, a new body of research on psychophysiological reactivity promises to shed light on gender differences in trauma response, resilience, and risk. Finally, the importance acknowledging the intersection of polyvictimization, gender, and race is noted. The article ends with a discussion of the ways in which understanding gender differences and similarities can inform gender-responsive approaches to prevention and intervention efforts.

Does adult attachment style mediate the relationship between childhood maltreatment and mental and physical health outcomes?

Attachment theory has been proposed as one explanation for the relationship between childhood maltreatment and problematic mental and physical health outcomes in adulthood. This study seeks to determine whether: (1) childhood physical abuse and neglect lead to different attachment styles in adulthood, (2) adult attachment styles predict subsequent mental and physical health outcomes, and (3) adult attachment styles mediate the relationship between childhood physical abuse and neglect and mental and physical health outcomes. Children with documented cases of physical abuse and neglect (ages 0-11) were matched with children without these histories and followed up in adulthood. Adult attachment style was assessed at mean age 39.5 and outcomes at 41.1. Separate path models examined mental and physical health outcomes. Individuals with histories of childhood neglect and physical abuse had higher levels of anxious attachment style in adulthood, whereas neglect predicted avoidant attachment as well. Both adult attachment styles (anxious and avoidant) predicted mental health outcomes (higher levels of anxiety and depression and lower levels of self-esteem), whereas only anxious adult attachment style predicted higher levels of allostatic load. Path analyses revealed that anxious attachment style in adulthood in part explained the relationship between childhood neglect and physical abuse to depression, anxiety, and self-esteem, but not the relationship to allostatic load. Childhood neglect and physical abuse have lasting effects on adult attachment styles and anxious and avoidant adult attachment styles contribute to understanding the negative mental health consequences of childhood neglect and physical abuse 30 years later in adulthood.

Identifying diverse life transition patterns from adolescence to young adulthood: The influence of early socioeconomic context

The purposes of the present study are to investigate: (1) the heterogeneity in life transition patterns of youth from adolescence to young adulthood (ages 18-30) involving the timing and sequence of four transition events (college graduation, full-time employment, marriage, and parenthood), (2) the influence of early socioeconomic adversity on life transition patterns from adolescence to young adulthood, and (3) the influence of gender and race/ethnicity on these transition patterns. Using a multivariate discrete-time mixture survival model with a sample of 14,503 adolescents from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study identified four life transition patterns and found that early socioeconomic adversity shapes disrupted life transition patterns from adolescence to young adulthood. Gender and race/ethnicity differences are discussed. These results highlight the need for prevention and intervention programs that selectively target at-risk youth beginning in adolescence and continuing through subsequent transition periods.

Cumulative childhood trauma, emotion regulation, dissociation, and behavior problems in school-aged sexual abuse victims

BACKGROUND

Child sexual abuse is associated with a plethora of devastating repercussions. A significant number of sexually abused children are likely to experience other forms of maltreatment that can seriously affect their emotion regulation abilities and impede on their development. The aim of the study was to test emotion regulation and dissociation as mediators in the association between cumulative childhood trauma and internalized and externalized behavior problems in child victims of sexual abuse.

METHODS

Participants were 309 sexually abused children (203 girls and 106 boys; Mean age = 9.07) and their non-offending parent. Medical and clinical files were coded for cumulative childhood trauma. At initial evaluation (T1), parents completed measures assessing children's emotion regulation abilities and dissociation. At Time 2 (T2), parents completed a measure assessing children's behavior problems. Mediation analyses were conducted with emotion regulation and dissociation as sequential mediators using Mplus software.

RESULTS

Findings revealed that cumulative childhood trauma affects both internalized and externalized behavior problems through three mediation paths: emotion regulation alone, dissociation alone, and through a path combining emotion regulation and dissociation.

LIMITATIONS

Both emotion regulation and dissociation were assessed at T1 and thus the temporal sequencing of mediators remains to be ascertained through a longitudinal design. All measures were completed by the parents.

CONCLUSIONS

Clinicians should routinely screen for other childhood trauma in vulnerable clienteles. In order to tackle behavior problems, clinical interventions for sexually abused youth need to address emotion regulation competencies and dissociation.