An investigation of child maltreatment and epigenetic mechanisms of mental and physical health risk

Longitudinal DNA methylation in parent-infant pairs impacted by intergenerational social adversity: An RCT of the Michigan Model of Infant Mental Health Home Visiting

INTRODUCTION

Early childhood development is a strong predictor of long-term health outcomes, potentially mediated via epigenetics (DNA methylation). The aim of the current study was to examine how childhood experiences, punitive parenting, and an intergenerational psychotherapeutic intervention may impact DNA methylation in young children and their mothers.

METHODS

Mothers and their infants/toddlers between 0 and 24 months were recruited at baseline (n = 146, 73 pairs) to participate in a randomized control trial evaluating the effectiveness of The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) parent-infant psychotherapy compared to treatment as usual. Baseline and 12-month post-enrollment data were collected in the family's home and included self-report questionnaires, biological saliva samples, home environment observation, video-taped parent-child interaction, and audio-recorded interviews. Saliva DNA methylation was measured at the genes, nuclear receptor subfamily 3 group C member 1 (NR3C1), solute carrier family 6 member 4 (SLC6A4), brain-derived neurotrophic factor (BDNF), and the genetic element, long interspersed nuclear element-1 (LINE1).

RESULTS

For mothers, baseline methylation of BDNF, SLC6A4, NR3C1, or LINE1 was largely not associated with baseline measures of their childhood adversity, adverse life experiences, demographic characteristics related to structurally driven inequities, or to IMH-HV treatment effect. In infants, there were suggestions that methylation in SLC6A4 and LINE1 was associated with parenting attitudes. Infant BDNF methylation suggested an overall decrease in response to IMH-HV psychotherapy over 12 months.

CONCLUSIONS

Overall, our findings suggest that the epigenome in infants and young children may be sensitive to both early life experiences and parent-infant psychotherapy.

Longitudinal Impacts of Housing Cost Burden on Physical and Psychological Aggression of Children From Age 3 to 15

Housing cost burden is stressful for families, interfering with healthy, positive parenting. The present study uses data from the Future of Families and Child Wellbeing Study to examine the relationship between housing cost burden and aggressive parenting with children age 3 to age 15. Latent growth curve modeling finds that both types of aggressive parenting behaviors decline on average, but that housing cost burden contributes to significant ongoing risk. Results indicate within-time associations between housing cost burden and psychological aggression and associations both within- and across-time between housing cost burden and physical aggression. Housing cost burden poses a significant risk factor for families, and child maltreatment prevention approaches must incorporate strategies for addressing housing cost burden.

Investigating the impact of Out-of-Home Care on early childhood development

BACKGROUND

Early childhood development is influential for life course capability. Children exposed to child maltreatment and at high risk of harm may be removed for their safety, but the effect on child development is uncertain.

OBJECTIVES

To assess developmental vulnerability at school commencement across five developmental domains to ascertain whether removal of children with substantiated maltreatment to foster/kinship care is likely protective, or not, of developmental vulnerabilities.

METHODS

The study drew on linked-data for a South Australian population birth cohort (2003 to 2014) N = 74,751. For children exposed to substantiated child maltreatment meeting study criteria (N = 2011, mean age = 5.7 years, 50.7 % boys), the effect of placement in foster/kinship care (N = 666) on developmental vulnerability was explored using generalized linear models, adjusted for child and family covariates, maltreatment severity and propensity score.

RESULTS

Children placed in care had a reduced risk of developmental vulnerability on the Physical Health and Wellbeing (aRR = 0.73 [0.64, 0.84]), Language and Cognitive Skills (school based) (aRR = 0.79 [0.68, 0.92]), and Communication Skills and General Knowledge (aRR = 0.81 [0.70, 0.94]) domains, compared to children who were not removed. However, these children had increased risk of vulnerability on Social Competence (aRR = 1.14 [1.01, 1.29]) and Emotional Maturity (aRR = 1.20 [1.05, 1.37]) domains.

CONCLUSIONS

These findings suggest placement in out-of-home care supported physical health and wellbeing, communication and cognitive but not social and emotional early childhood development. These results highlighting the need for professional therapeutic support for children in care and better attending to the physical development, communication and cognitive skills in maltreated children remaining at home.

Hospital admissions and community health service contacts for mental illness following self-reported child maltreatment: Results from the Childhood Adversity and Lifetime Morbidity (CALM) study

BACKGROUND

Child maltreatment (CM) includes neglect, and several types of abuse, including physical, emotional, and sexual. CM has been associated with a wide range of mental illnesses. Literature examining these illnesses in mid-life is scarce, and the impact of these illnesses on mental health service use is currently unknown.

OBJECTIVE

To examine associations between self-reported CM and subsequent hospital admissions for mental illnesses, and/or community mental health service contacts.

SETTING

Birth cohort study data linked to administrative health data, including hospital admissions and community mental health service contacts, up to the age of 40.

METHODS

Associations between hospital admissions for mental health and community mental health contacts and CM subtypes (neglect, physical abuse, emotional abuse and sexual abuse) were examined using multivariate logistic regression.

RESULTS

Adjusted analyses showed that all subtypes of CM were significantly (p < 0.05) associated with admissions to hospital for any type of mental illness (aOR range 1.87-3.61), non-psychotic mental disorders (aOR range 1.98-3.61), alcohol and/or substance use (aOR range 2.83-5.43), and community mental health service contacts (aOR range 2.44-3.13). Hospital admissions for psychotic mental disorders were significantly associated with physical abuse, emotional abuse, and sexual abuse (aOR range 2.14-3.93).

CONCLUSIONS

The results of this study confirm the current knowledge around CM and subsequent mental health illnesses up to the age of 40, and extend this knowledge to hospital and mental health service use.

Childhood Maltreatment and Longitudinal Epigenetic Aging: NIMHD Social Epigenomics Program

Importance

Child physical and emotional abuse and neglect may affect epigenetic signatures of accelerated aging several years after the exposure.

Objective

To examine the longitudinal outcomes of early-childhood and midchildhood exposures to maltreatment on later childhood and adolescent profiles of epigenetic accelerated aging.

Design, Setting, and Participants

This cohort study used data from the Future of Families and Child Wellbeing Study (enrolled 1998-2000), a US birth cohort study with available DNA methylation (DNAm) data at ages 9 and 15 years (assayed between 2017 and 2020) and phenotypic data at birth (wave 1), and ages 3 (wave 3), 5 (wave 4), 9 (wave 5), and 15 (wave 6) years. Data were analyzed between June 18 and December 10, 2023.

Exposures

Emotional aggression, physical assault, emotional neglect, and physical neglect via the Parent-Child Conflict Tactics Scale at ages 3 and 5 years.

Main Outcomes and Measures

Epigenetic accelerated aging (DNAmAA) was measured using 3 machine learning-derived surrogates of aging (GrimAge, PhenoAge, and DunedinPACE) and 2 machine learning-derived surrogates of age (Horvath and PedBE), residualized for age in months.

Results

A total of 1971 children (992 [50.3%] male) representative of births in large US cities between 1998 and 2000 were included. Physical assault at age 3 years was positively associated with DNAmAA for PhenoAge (β = 0.073; 95% CI, 0.019-0.127), and emotional aggression at age 3 years was negatively associated with PhenoAge DNAmAA (β = -0.107; 95% CI, -0.162 to -0.052). Emotional neglect at age 5 years was positively associated with PhenoAge DNAmAA (β = 0.051; 95% CI, 0.006-0.097). Cumulative exposure to physical assault between ages 3 and 5 years was positively associated with PhenoAge DNAmAA (β = 0.063; 95% CI, 0.003-0.123); emotional aggression was negatively associated with PhenoAge DNAmAA (β = -0.104; 95% CI, -0.165 to -0.043). The association of these measures with age 15 years PhenoAge DNAmAA was almost fully mediated by age 9 years PhenoAge DNAm age acceleration. Similar patterns were found for GrimAge, DunedinPACE, and PhenoAge, but only those for PhenoAge remained after adjustments for multiple comparisons.

Conclusions and Relevance

In this cohort study, altered patterns of DNAmAA were sensitive to the type and timing of child maltreatment exposure and appeared to be associated with more proximate biological embedding of stress.

Subclinical structural atypicality of retinal thickness and its association with gray matter volume in the visual cortex of maltreated children

Childhood maltreatment is reportedly associated with atypical gray matter structures in the primary visual cortex (V1). This study explores the hypothesis that retinal structures, the sensory organs of vision, are associated with brain atypicality and child maltreatment and examines their interrelation. General ophthalmologic examinations, visual cognitive tasks, retinal imaging, and structural magnetic resonance imaging (MRI) were conducted in children and adolescents aged 9-18 years with maltreatment experiences (CM) and typically developing (TD) children. The retinal nerve fiber layer (RNFL), the most superficial of the ten distinct retinal layers, was found to be significantly thinner in both eyes in CM. While whole-brain analysis using Voxel-based morphometry revealed a significantly larger gray matter volume (GMV) in the thalamus in CM, no significant correlation with RNFL thickness was observed. However, based on region-of-interest analysis, a thinner RNFL was associated with a larger GMV in the right V1. Although it cannot be ruled out that this outcome resulted from maltreatment alone, CM demonstrated subclinical structural atypicality in the retina, which may also correlate with the immaturity of V1 development. Examination of retinal thickness offers a novel clinical approach to capturing characteristics associated with childhood maltreatment.

The mediation effect of glucocorticoid receptor gene (NR3C1) methylation between childhood maltreatment and depressive symptoms in Chinese adolescents: A 2-year longitudinal study

This three-wave longitudinal study examined whether methylation alterations in promoter exon 1F of a stress-related gene-NR3C1 (NR3C1-1F)-explained the longitudinal associations between childhood maltreatment and adolescent depressive symptoms. A total of 370 Han Chinese adolescents (Mage  = 16.31 ± 1.28 years; 51.4% girls) recruited from Shandong, China were tracked from 2018 to 2020. The results showed that the severity of childhood maltreatment, especially that of emotional abuse and physical neglect, conferred risk for adolescent depressive symptoms via reducing NR3C1-1F methylation levels. These mediation effects of NR3C1-1F methylation did not vary between adolescent sex or NR3C1 BclI and Tth111I polymorphisms. The findings highlight how childhood maltreatment contributes to psychopathology development at a biological level.

Prevalence of violence against children in the United Kingdom: A systematic review and meta-analysis

BACKGROUND

Violence against children can have extensive, long-term, and far-reaching adverse impacts on survivors and society. There is currently little consensus in the United Kingdom around the prevalence of violence against children: maltreatment, intimate partner violence, sexual violence, bullying, and community violence, and most existing studies focus on only a single or a few forms of violence. This study aims to produce data to highlight the current magnitude of the problem in the UK, to inform policy, drive action and allow for monitoring of progress over time.

OBJECTIVE

To produce weighted prevalence estimates by violence type, as well as gender and age sub-categories, to give as full a picture as possible of the current prevalence of violence against children in the UK.

PARTICIPANTS AND SETTING

The prevalence of violence against children from 23 self-report studies conducted in the United Kingdom was gathered through a systematic review.

METHODS

Databases were searched from inception to 24th June 2022. Studies were reviewed systematically for appropriate data and meta-analyses were conducted to give pooled prevalence data based on a quality effects model.

RESULTS

The most prevalent self-reported experience of childhood violence was community violence at 27.33 % (95 % CI [9.84, 48.97]). Prevalence of bullying was also high at 22.75 % (95 % CI [13.25, 33.86]). The most prevalent forms of child maltreatment were domestic violence exposure at 11.9 % (95 % CI [6.34, 18.84]) and emotional maltreatment at 11.84 % (95 % CI [5.58, 19.89]).

CONCLUSION

National child maltreatment surveys are needed in the UK, using a comprehensive and conceptually robust approach, and valid and reliable instruments, to provide data for researchers and policymakers on the prevalence of all types of violence against children including exposure to multiple types. This allows monitoring of trends over time, can inform strategies for prevention, and can enable monitoring of future progress in reducing violence against children and its associated health and economic burden.

Systemic lupus erythematosus in American Indian/Alaska natives: Incorporating our new understanding of the biology of trauma

OBJECTIVE

To review the literature regarding systemic lupus erythematosus (SLE) in American Indian/Alaska Native (AI/AN) people and relate prevalence and/or disease severity to our emerging understanding of the biology of trauma and toxic stress.

METHODS

We conducted a search and review of the literature using search terms "lupus and American Indians" "ACEs and disease outcome" "Biology of Adversity" "lupus and ACE scores," " lupus and childhood abuse." These search criteria were entered into Google Scholar and articles retrieved from PubMed, NBCI. This approach yielded a small numbers of papers used throughout this review. We excluded articles that were not published in a peer reviewed journals, as well as editorial commentaries.

RESULTS

In the AI/AN population, SLE shows high prevalence rates and severe disease manifestations, comparable to the African American population. AI/AN populations also have high rates of childhood trauma. Toxic stress and trauma such as those catalogued in the Adverse Childhood Experiences (ACE) study have broad-reaching immunologic and epigenetic effects that are likely to be relevant to our understanding of SLE in AI/AN people.

CONCLUSIONS

AI/AN people have high rates of SLE. These high rates are likely to be driven by many complex factors, not all of which are genetic. Future research is needed to establish (or refute) a causal connection between the biology of adversity and SLE in socially marginalized and historically traumatized populations.

Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention

Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.

Profiles of diurnal cortisol and DHEA regulation among children: Associations with maltreatment experiences, symptomatology, and positive adaptation

Person-centered methods represent an important advance in the simultaneous examination of multiple indicators of neuroendocrine functioning and may facilitate a more nuanced understanding of the impact of child maltreatment on hypothalamic-pituitary-adrenal axis dysregulation. The aims of the present study were threefold: (a) identify naturally occurring patterns of diurnal cortisol and dehydroepiandrosterone (DHEA) regulation among a sample of N = 1,258 children with and without histories of maltreatment, (b) investigate which neuroendocrine profiles characterize children with exposure to maltreatment, and (c) examine which profiles are related to adaptive outcomes and symptomatology among children. Cortisol and DHEA were sampled three times per day (9 a.m., 12 p.m., and 4 p.m.) across 5 and 2 days, respectively. Four profiles of cortisol and DHEA regulation were identified. Among females, a pattern marked by high cortisol and low DHEA was associated with more pervasive maltreatment experiences. Furthermore, we found evidence of adaptive interpersonal resilience such that children with maltreatment exposure who evidenced this pattern of high cortisol and low DHEA were viewed as more likeable than maltreated children with other neuroendocrine patterns. Finally, results pointed to higher levels of internalizing symptoms among children who displayed a profile marked by average cortisol and high DHEA.

Neighborhoods and child abuse: Multiple informant perspectives

INTRODUCTION

Using data from the nationally representative longitudinal Future of Families and Child Wellbeing Study, the current study sought to examine associations between neighborhood disorder and physical characteristics of the neighborhood at child age three with the likelihood of experiencing physical and psychological abuse and neglect at age five.

METHODS

Negative binomial regression and zero inflated negative binomial regression models were used to estimate the associations.

RESULTS

Resident perceptions of neighborhood disorder and outside observation of neighborhood physical characteristics were both found to be independently related to the likelihood of physical assault. Resident perceptions were related to psychological aggression. A more positive perception of the neighborhood environment for children (lack of neighborhood disorder) and physical characteristics of the neighborhood were protective against maltreatment. These relationships were not significant for neglect.

DISCUSSION

Neighborhood environment is a crucial contributor to maltreatment risk. Findings from the present study showed that multiple perceptions of neighborhood quality were associated with lower risk for child physical assault and psychological aggression. Mothers' perceptions of a more positive neighborhood environment were associated with significantly lower physical assault and psychological aggression scores.

Stage 2 Registered Report: Epigenetic Intergenerational Transmission: Mothers' Adverse Childhood Experiences and DNA Methylation

OBJECTIVE

Individual differences in risk for mental disorders over the lifespan are shaped by forces acting before the individual is born-in utero, but likely even earlier, during the mother's own childhood. The environmental epigenetics hypothesis proposes that sustained effects of environmental conditions on gene expression are mediated by epigenetic mechanisms. Recent human studies have shown that adversities in childhood are correlated with DNA methylation (DNAm) in adulthood. In the current study, we tested the following pre-registered hypotheses: Mothers' adverse childhood experiences (ACEs) are correlated with DNAm in peripheral blood during pregnancy (hypothesis 1) and in cord blood samples from newborn infants (hypothesis 2), and women's depression and anxiety symptoms during pregnancy mediate the association between mothers' ACE exposure and prenatal/neonatal DNA methylation (hypothesis 3).

METHOD

Data were from the Avon Longitudinal Study of Parents and Children Accessible Resource for Integrated Epigenomic Studies substudy. Women provided retrospective self-reports during pregnancy of ACE exposure. We conducted an epigenome-wide association study testing whether mothers' ACE exposure, cumulative score (0-10), was associated with DNAm in maternal antenatal blood and infant cord blood in more than 450,000 CpG (point on DNA sequence where cytosine and guanine base pairs are linked by a phosphate, where methylation usually occurs) sites on the Illumina 450K BeadChip. Analyses for cord blood were separated by infant sex, a pre-registered analysis.

RESULTS

Hypothesis 1: In 896 mother-infant pairs with available methylation and ACE exposure data, there were no significant associations between mothers' ACE score and DNAm from antenatal peripheral blood, after controlling for covariates. Hypothesis 2: In infant cord blood, there were 5 CpG sites significantly differentially methylated in relation to mothers' ACEs (false discovery rate [FDR] < .05), but only in male offspring. Effect sizes were medium, with partial eta squared values ranging from 0.060 to 0.078. CpG sites were in genes related to mitochondrial function and neuronal development in the cerebellum. Hypothesis 3: There was no mediation by maternal anxiety/depression symptoms found between mothers' ACEs score and DNAm in the significant CpG sites in male cord blood. Mediation was not tested in antenatal peripheral blood, because no direct association between mothers' ACE score and antenatal peripheral blood was found.

CONCLUSION

Our results show that mothers' ACE exposure is associated with DNAm in male offspring, supporting the notion that DNAm could be a marker of intergenerational biological embedding of mothers' childhood adversity.

STUDY REGISTRATION INFORMATION

Epigenetic Intergenerational Transmission: Mothers' Adverse Childhood Experiences and DNA Methylation; https://doi.org/10.1016/j.jaac.2020.03.008.

The association of epigenetic age acceleration and depressive and anxiety symptom severity among children recently exposed to substantiated maltreatment

Child maltreatment is a major risk factor for both depressive and anxiety disorders. However, many children exposed to maltreatment never meet diagnostic threshold for either disorder while experiencing only transitory symptoms post-exposure. Recent research suggests DNA methylation adds predictive value in explaining variation in the onset and course of multiple psychiatric disorders following exposure to child maltreatment. Epigenetic age acceleration (EAA), the biological aging of cells not attributable to chronological aging, is a stress-sensitive biomarker capturing genome-wide variation in DNA methylation with the potential to identify children who have been maltreated at greatest risk for depressive and anxiety disorders. The current study examined two EAA clocks appropriate for the pediatric population, the Horvath and Pediatric Buccal Epigenetic (PedBE) clocks, and their associations with depressive and anxiety symptom severity following child maltreatment. Children (N = 71) 8-15 years of age, all of whom were exposed to substantiated child maltreatment in the 12 months prior to study entry, were enrolled. Risk modeling adjusting for several confounders revealed that EAA estimated via the Horvath clock was significantly associated with more severe depressive and anxiety symptoms. The PedBE clock was not associated with either depressive or anxiety symptom severity. Sensitivity analyses demonstrated that EAA via the Horvath clock robustly predicted depressive and anxiety symptom severity across multiple modeling scenarios. Our findings advance existing research suggesting EAA, as estimated with the Horvath clock, may be a promising biomarker for identifying children at greatest risk for more severe depressive and anxiety symptoms following maltreatment.

Childhood maltreatment and DNA methylation: A systematic review

Child maltreatment (CM) encompasses sexual abuse, physical abuse, emotional abuse, neglect, and exposure to domestic and family violence. Epigenetic research investigating CM has focused on differential DNA methylation (DNAm) in genes associated with the stress response, but there has been limited evaluation of the specific effects of subtypes of CM. This systematic review of literature investigating DNAm associated with CM in non-clinical populations aimed to summarise the approaches currently used in research, how the type of maltreatment and age of exposure were encoded via methylation, and which genes have consistently been associated with CM. A total of fifty-four papers were eligible for review, including forty-one candidate gene studies, eight epigenome-wide association studies, and five studies with a mixed design. The ways in which the various forms of CM were conceptualised and measured varied between papers. Future studies would benefit from assessments that employ conceptually robust definitions of CM, and that capture important contextual information such as age of exposure and subtype of CM.

Examining the biological mechanisms of human mental disorders resulting from gene-environment interdependence using novel functional genomic approaches

We explore how functional genomics approaches that integrate datasets from human and non-human model systems can improve our understanding of the effect of gene-environment interplay on the risk for mental disorders. We start by briefly defining the G-E paradigm and its challenges and then discuss the different levels of regulation of gene expression and the corresponding data existing in humans (genome wide genotyping, transcriptomics, DNA methylation, chromatin modifications, chromosome conformational changes, non-coding RNAs, proteomics and metabolomics), discussing novel approaches to the application of these data in the study of the origins of mental health. Finally, we discuss the multilevel integration of diverse types of data. Advance in the use of functional genomics in the context of a G-E perspective improves the detection of vulnerabilities, informing the development of preventive and therapeutic interventions.

Salivary Diagnostics in Pediatrics and the Status of Saliva-Based Biosensors

Salivary biomarkers are increasingly being used as an alternative to diagnose and monitor the progression of various diseases due to their ease of use, on site application, non-invasiveness, and most likely improved patient compliance. Here, we highlight the role of salivary biosensors in the general population, followed by the application of saliva as a diagnostic tool in the pediatric population. We searched the literature for pediatric applications of salivary biomarkers, more specifically, in children from 0 to 18 years old. The use of those biomarkers spans autoimmune, developmental disorders, oncology, neuropsychiatry, respiratory illnesses, gastrointestinal disorders, and oral diseases. Four major applications of salivary proteins as biomarkers are: (1) dental health (caries, stress from orthodontic appliances, and gingivitis); (2) gastrointestinal conditions (eosinophilic esophagitis, acid reflux, appendicitis); (3) metabolic conditions (obesity, diabetes); and (4) respiratory conditions (asthma, allergic rhinitis, small airway inflammation, pneumonia). Genomics, metabolomics, microbiomics, proteomics, and transcriptomics, are various other classifications for biosensing based on the type of biomarkers used and reviewed here. Lastly, we describe the recent advances in pediatric biosensing applications using saliva. This work guides scientists in fabricating saliva-based biosensors by comprehensively overviewing the potential markers and techniques that can be employed.

Hyperarousal Symptom Severity in Women with Posttraumatic Stress Disorder Might Be Associated with LINE-1 Hypomethylation in Childhood Sexual Abuse Victims

Introduction

Sexual assault and a history of childhood sexual abuse (CSA) are related to posttraumatic stress disorder (PTSD) development. Long interspersed nuclear elements (LINE-1) are transposable elements, and their methylation is used to infer DNA global methylation. DNA methylation can be affected by trauma exposition which in turn would be associated with PTSD. Thus, we investigated if the LINE-1 methylation pattern is related to PTSD symptoms in females with a history of CSA.

Methods

This is a case-control study that examined, at baseline (W1), 64 women victims of sexual assault diagnosed with PTSD and 31 patients with PTSD who completed the 1-year follow-up (W2). Participants were categorized into two groups according to the presence of CSA (PTSDCSA+: NW1 = 19, NW2 = 10; PTSDCSA-: NW1 = 45, NW2 = 21). PTSD symptoms (re-experiencing, avoidance, hyperarousal, alterations in cognition/mood) were assessed using the Clinician-Administered PTSD Scale, and the history of CSA was assessed by the Childhood Trauma Questionnaire. LINE-1 methylation was measured in three sites (CpG1, CpG2, CpG3) located in the 5'UTR region using bisulfite conversion followed by pyrosequencing. Linear regression models were performed to test the relation between LINE-1 CpG sites methylation and PTSD symptoms.

Results

We found a negative association between CpG2 methylation and hyperarousal symptoms among those in the PTSDCSA+ group in W1 (adjusted p = 0.003) compared to the PTSDCSA- group (p > 0.05). Still, no association was observed between other PTSD symptoms and other CpG sites. Further, in the longitudinal analysis, LINE-1 hypomethylation was no longer observed in PTSD participants exposed to CSA.

Conclusion

Our findings suggest that LINE-1 methylation may help understand the relationship between trauma and PTSD. However, more studies are needed to investigate LINE-1 as an epigenetic marker of psychiatric disorders.

Association between child maltreatment and depressive symptoms in emerging adulthood: The mediating and moderating roles of DNA methylation

Prospective studies suggest that child maltreatment substantially increases the risk for depression in adulthood. However, the mechanisms underlying this association require further elucidation. In recent years, DNA methylation has emerged as a potential mechanism by which maltreatment experiences (a) could partly explain the emergence or aggravation of depressive symptoms (i.e., mediation) and/or (b) could increase (or decrease) the risk for depressive symptoms (i.e., moderation). The present study tested whether the methylation levels of nine candidate genes mediated and/or moderated the association between maltreatment experiences in childhood and depressive symptoms in emerging adulthood. The sample comprised 156 men aged between 18 and 35 years. Maltreatment experiences and depressive symptoms were assessed retrospectively using self-reported questionnaires. Methylation levels of nine candidate genes (COMT, FKBP5, IL6, IL10, MAOA, NR3C1, OXTR, SLC6A3 and SLC6A4), previously reported to be sensitive to early-life stress, were quantified from saliva samples. Maltreatment experiences in childhood were significantly associated with depressive symptoms in emerging adulthood. Both maltreatment experiences and depressive symptoms were associated with the methylation levels of two genomic sites, which cumulatively, but not individually, explained 16% of the association between maltreatment experiences in childhood and depressive symptoms in emerging adulthood. Moreover, maltreatment experiences in childhood interacted with the methylation levels of fourteen genomic sites, which cumulatively, but not individually, modulated the level of depressive symptoms in young male adults who were maltreated as children. However, none of these effects survived multiple testing correction. These findings bring attention to the cumulative effects of DNA methylation measured in several candidate genes on the risk of reporting depressive symptoms following maltreatment experiences in childhood. Nonetheless, future studies need to clarify the robustness of these putative cumulative effects in larger samples and longitudinal cohorts.

Foster children avoidance-related interactive behaviors with caregivers

BACKGROUND

A lot of the research concerning foster children - often children who have suffered maltreatment in the family home - has focused on internalized and externalized symptoms. Few studies, however, have looked at the interactions between such children and caregivers.

PURPOSE

The purpose of this study is to explore the Emotion Regulation Strategies (ERS) of children in foster care and to highlight those most commonly employed in family or placement contexts. The parents' and foster carers' ERS are also analyzed in order to understand the co-regulatory processes at work.

METHOD

An in-depth analysis of observation sequences was performed. Three data collection times, spaced across a period of 6 months (t1, t2 and t3), were included in the observation protocol. Each observation, recorded using a video camera, comprised 45 min of free time and 15 min of structured tasks. Transcription and coding of ERS were performed for each sequence using a microanalytical method. Both children's and adults' ERS were coded.

RESULTS

Children tended to be readily distracted when interacting with adults, and more particularly so with their parents. While they tended to display relatively normative processes with a foster carer, they turned to pathological avoidance mechanisms with their parents such as physical venting or self-stimulation. Interactions during structured tasks showed a significant reduction in distraction processes.

CONCLUSION

This study highlights the prevalence of distraction behavior in foster children during their interactions with caregivers, and offers an insight into how structured interactions provide a framework that mitigates children's avoidance behaviors and so enhances adult-child collaboration.

Once upon a Pandemic: 'Online' Therapeutic Groupwork for Infants and Mothers Impacted by Family Violence

This case study describes the transition to an 'online' delivery of an evaluated infant mental health group work intervention for infants/mothers impacted by family violence during the COVID 19 pandemic. The imperative to provide early intervention to infants and their mother is outlined. The model and practice principles integral to this intervention are provided and described are four separate groups run online within two different Australian cities. Facilitators of the groups found that they were able to hold the infants and mothers safely in the online space despite the unexpected presence of others in the families' homes. The home-based nature of the work caused by lockdown restrictions revealed a transparency not found in office-based work, whilst simultaneously, evoking some discomfort. The ease with which infants and young children embraced technology worked in favor of using the online space. Playful, restorative, and creative ways of engaging with a highly vulnerable cohort of families were achieved; enhancing relational repair following both family violence and the isolation created by restrictions imposed by lockdowns. Despite an initial hesitancy to move online, the authors discovered meaningful ways through which to engage, treat and provide safe relational repair work with infants and their mothers impacted by family violence.

Interaction microanalysis of foster care research using THEME

Environmental stress is a key element to the understanding of the psychopathology of children in foster care. Such children often present a wide range of symptoms from anxiety to depression, including abnormal behaviors in their interactions with adults that can be related to experience suffered in their family of origin (e.g., abandonment, abuse, etc.). Foster care should provide a safe environment, both to protect children from abuse and to help them build a well-adjusted developmental trajectory. The relationships with the family of origin may also be maintained. How do children in foster care behave in relation to caregivers given the differences between the families they grow up in? This study focuses on three adult-child relationships: those with a foster carer, a mother and a father. Each adult-child interaction was recorded several times in a day-to-day environment. On each occasion the instruction was given to behave naturally while interacting with a child. No additional material was supplied. Our observations concern the verbal and non-verbal comportment of a 4-year-old foster child named Julia when entering the study, with her caregivers. Once the principal elements had been coded (behaviors, verbalizations), a sequential behavioral patterns analysis was performed using the THEME© program. For this purpose, a 2-min interaction was chosen from the third video of an event which appeared particularly representative of the relationship between Julia and her different caregivers. According to whom Julia was with, the results reveal very different interactive processes. We observe, for example, that with the foster carer the interaction patterns were primarily focused on play objects, whereas they involved more collaborative activity with the father and distraction/avoidance behaviors with the mother. The study identifies the use of disengaging and self-exciting behaviors in all types of interaction. Those emotion regulation strategies are particularly developed during parent–child sessions, showing pathological processes of relationship.

Epigenetics of early-life adversity in youth: cross-sectional and longitudinal associations

BACKGROUND

Altered DNA methylation (DNAm) may be one pathway through which early-life adversity (ELA) contributes to adverse mental and physical health outcomes. This study investigated whether the presence versus absence of ELA experiences reflecting the dimensions of threat and deprivation were associated with epigenome-wide DNAm cross-sectionally and longitudinally in a community-based sample of children and adolescents.

METHODS

In 113 youths aged 8-16 years with wide variability in ELA, we examined associations of abuse (physical, sexual, emotional; indicating threat-related experiences) and neglect (emotional, physical; indicating deprivation-related experiences) with DNAm assessed with the Illumina EPIC BeadChip array, with DNA derived from saliva. In cross-sectional epigenome-wide analyses, we investigated associations of lifetime abuse and neglect with DNAm at baseline. In longitudinal epigenome-wide analyses, we examined whether experiencing abuse and neglect over an approximately 2-year follow-up were each associated with change in DNAm from baseline to follow-up.

RESULTS

In cross-sectional analyses adjusting for lifetime experience of neglect, lifetime experience of abuse was associated with DNAm for four cytosine-phosphodiester-guanine (CpG) sites (cg20241299: coefficient = 0.023, SE = 0.004; cg08671764: coefficient = 0.018, SE = 0.003; cg27152686: coefficient = - 0.069, SE = 0.012; cg24241897: coefficient = - 0.003, SE = 0.001; FDR < .05). In longitudinal analyses, experiencing neglect over follow-up was associated with an increase in DNAm for one CpG site, adjusting for abuse over follow-up (cg03135983: coefficient = 0.036, SE = 0.006; FDR < .05).

CONCLUSIONS

In this study, we identified examples of epigenetic patterns associated with ELA experiences of threat and deprivation that were already observable in youth. We provide novel evidence for change in DNAm over time in relation to ongoing adversity and that experiences reflecting distinct ELA dimensions may be characterized by unique epigenetic patterns.

Examining the effectiveness of trauma-focused cognitive behavioral therapy on children and adolescents' executive function

BACKGROUND

Children and adolescents impacted by childhood trauma often demonstrate executive function difficulties, which negatively affect self-regulation and potentiate the risk for trauma-related psychopathology and functional impairment. Evidence-based treatments for traumatized youth such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) aim to equip youth directly with skills for effective self-regulation and may thus also improve executive function. Moreover, adolescence is a sensitive period for executive function development, and interventions aimed at improving executive function may confer greater benefits for adolescents relative to school-aged children. No study has examined executive function improvements during TF-CBT or the potential differences in these outcomes between children and adolescents.

OBJECTIVE

In the current study, we examined changes in caregiver-reported executive function difficulties during TF-CBT among children ages 6 to 11 and adolescents ages 12 to 17.

PARTICIPANTS AND SETTING

Participants were 278 racially and ethnically diverse youth with interpersonal trauma histories and their caregivers enrolled in a community-based effectiveness trial of TF-CBT in an urban setting. Caregivers reported on youth executive function at pre, mid, and posttreatment assessments.

RESULTS

Both children and adolescents demonstrated reductions in global executive function difficulties during TF-CBT. Improvements were seen across domains of emotional, behavioral, and attentional control and problem solving, with larger effect sizes for adolescents. Follow-up analyses indicated that executive function improvements were positively associated with PTSD symptom reduction in adolescents, but not in children.

CONCLUSIONS

Findings add to the growing evidence of the effectiveness of TF-CBT among youth and highlight caregiver-reported executive function as a potential treatment target during TF-CBT.

Evaluating the challenges and reproducibility of studies investigating DNA methylation signatures of psychological stress

Psychological stress can increase the risk of a wide range of negative health outcomes. Studies have been completed to determine if DNA methylation changes occur in the human brain because of stress and are associated with long-term effects and disease, but results have been inconsistent. Human candidate gene studies (150) and epigenome-wide association studies (67) were systematically evaluated to assess how DNA methylation is impacted by stress during the prenatal period, early childhood and adulthood. The association between DNA methylation of NR3C1 exon 1F and child maltreatment and early life adversity was well demonstrated, but other genes did not exhibit a clear association. The reproducibility of individual CpG sites in epigenome-wide association studies was also poor. However, biological pathways, including stress response, brain development and immunity, have been consistently identified across different stressors throughout the life span. Future studies would benefit from the increased sample size, longitudinal design, standardized methodology, optimal quality control, and improved statistical procedures.

Adulthood asthma as a consequence of childhood adversity: a systematic review of epigenetically affected genes

There is an accumulating data that shows relation between childhood adversity and vulnerability to chronic diseases as well as epigenetic influences that in turn give rise to these diseases. Asthma is one of the chronic diseases that is influenced from genetic regulation of the inflammatory biomolecules and therefore the hypothesis in this research was childhood adversity might have caused epigenetic differentiation in the asthma-related genes in the population who had childhood trauma. To test this hypothesis, the literature was systematically reviewed to extract epigenetically modified gene data of the adults who had childhood adversity, and affected genes were further evaluated for their association with asthma. PRISMA guidelines were adopted and PubMed and Google Scholar were included in the searched databases, to evaluate epigenetic modifications in asthma-related genes of physically, emotionally or sexually abused children. After retrieving a total of 5245 articles, 36 of them were included in the study. Several genes and pathways that may contribute to pathogenesis of asthma development, increased inflammation, or response to asthma treatment were found epigenetically affected by childhood traumas. Childhood adversity, causing epigenetic changes in DNA, may lead to asthma development or influence the course of the disease and therefore should be taken into account for the prolonged health consequences.

Childhood Maltreatment, Mental Well-Being, and Healthy Lifestyle in Patients With Chronic Thromboembolic Pulmonary Hypertension

Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially life-threatening condition associated with high morbidity and mortality. However, advances in medical, surgical and interventional treatment have markedly improved the outcome of patients with CTEPH. Additional factors potentially influencing quality of life (QoL) and outcome in CTEPH are yet to be defined. Child maltreatment is a major risk factor for unfavorable behavioral, mental as well as physical health outcomes and has been associated with decreased QoL. To date, no study assessed the impact of childhood trauma in patients with CTEPH.

Methods

Patients with CTEPH were invited to complete the Childhood Trauma Questionnaire (CTQ). Data were compared to prevalence data from the German population. Mental well-being was assessed using the Hospital Anxiety and Depression Scale (HADS) and quality of life was measured using the WHO Quality of Life Questionnaire (WHOQOL). Furthermore, lifestyle factors and physical health parameters were studied.Logistic regression analysis was used to investigate a possible impact of child maltreatment on markers of disease severity.

Results

One-hundred and seven patients with CTEPH completed the CTQ. These patients reported higher rates of emotional abuse and physical abuse and emotional neglect compared to the German population while rates of physical neglect and sexual abuse did not differ between patients and German population with prevalence of 20.6% for emotional abuse, 20% for physical abuse, 22% for emotional neglect, 46% for physical neglect, and 6% for sexual abuse in patients with CTEPH. Higher CTQ scores were associated with anxiety symptoms as well as negatively associated with QoL. No direct impact of childhood trauma on CTEPH severity was found.

Conclusion

We found a higher rate of child maltreatment in patients with CTEPH in comparison to the German population. Correlations suggest moderate associations between CTQ scores and mental health and QoL. Child maltreatment had no significant impact on disease severity. Further investigation on proper interventions to support affected patients is needed.

Early Life Adversity and Males: Biology, Behavior, and Implications for Fathers' Parenting

Fathers have an important and unique influence on child development, but influences on fathers' parenting have been vastly understudied in the scientific literature. In particular, very little empirical research exists on the effects of early life adversity (ELA; e.g. childhood maltreatment, parental separation) on later parenting among fathers. In this review, we draw from both the human and non-human animal literature to examine the effects of ELA, specifically among males, in the following areas: 1) neurobiology and neurocognitive functioning, 2) hormones and hormone receptors, 3) gene-environment interactions and epigenetics, and 4) behavior and development. Based on these findings, we present a conceptual model to describe the biological and behavioral pathways through which exposure to ELA may influence parenting among males, with a goal of guiding future research and intervention development in this area. Empirical studies are needed to improve understanding of the relationship between ELA and father's parenting, inform the development of paternal and biparental interventions, and prevent intergenerational transmission of ELA.

Stress and spirituality in relation to HPA axis gene methylation among US Black women: results from the Black Women's Health Study and the Study on Stress, Spirituality and Health

Background: Few epigenetics studies have been conducted within the Black community to examine the impact of diverse psychosocial stressors and resources for resiliency on the stress pathway (hypothalamus-pituitary-adrenal axis). Methods: Among 1000 participants from the Black Women's Health Study, associations between ten psychosocial stressors and DNA methylation (DNAm) of four stress-related genes (NR3C1, HSDB1, HSD11B2 and FKBP5) were tested. Whether religiosity or spirituality (R/S) significantly modified these stress-DNAm associations was also assessed. Results: Associations were found for several stressors with DNAm of individual CpG loci and average DNAm levels across each gene, but no associations remained significant after false discovery rate (FDR) correction. Several R/S variables appeared to modify the relationship between two stressors and DNAm, but no identified interaction remained significant after FDR correction. Conclusion: There is limited evidence for a strong signal between stress and DNAm of hypothalamus-pituitary-adrenal axis genes in this general population cohort of US Black women.

Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review

The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years - the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.

Adverse Childhood Events and Health Biomarkers: A Systematic Review

Background: This systematic review aimed to summarize evidence reporting epigenetic and/or neuro-immuno-endocrine embedding of adverse childhood events (ACEs) in children, with a particular focus on the short-term biological effect of those experiences.

Methods: A search was conducted in PsycINFO®, PubMed®, Isi Web of Knowledge and Scopus, until July 2019, to identify papers reporting the short-term biological effects of exposure to ACEs.

Results: The search identified 58 studies, that were included in the review. Regarding exposure, the type of ACE more frequently reported was sexual abuse (n = 26), followed by life stressors (n = 20) and physical abuse (n = 19). The majority (n = 17) of studies showed a positive association between ACEs and biomarkers of the immune system. Regarding DNA methylation 18 studies showed more methylation in participants exposed to ACEs. Two studies presented the effect of ACEs on telomere length and showed that exposure was associated with shorter telomere length.

Conclusion: Overall the associations observed across studies followed the hypothesis that ACEs are associated with biological risk already at early ages. This is supporting evidence that ACEs appear to get “under the skin” and induce physiological changes and these alterations might be strongly associated with later development of disease.

Childhood trauma, the stress response and metabolic syndrome: A focus on DNA methylation

Childhood trauma (CT) is well established as a potent risk factor for the development of mental disorders. However, the potential of adverse early experiences to exert chronic and profound effects on physical health, including aberrant metabolic phenotypes, has only been more recently explored. Among these consequences is metabolic syndrome (MetS), which is characterised by at least three of five related cardiometabolic traits: hypertension, insulin resistance/hyperglycaemia, raised triglycerides, low high-density lipoprotein and central obesity. The deleterious effects of CT on health outcomes may be partially attributable to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which coordinates the response to stress, and the consequent fostering of a pro-inflammatory environment. Epigenetic tags, such as DNA methylation, which are sensitive to environmental influences provide a means whereby the effects of CT can be biologically embedded and persist into adulthood to affect health and well-being. The methylome regulates the transcription of genes involved in the stress response, metabolism and inflammation. This narrative review examines the evidence for DNA methylation in CT and MetS in order to identify shared neuroendocrine and immune correlates that may mediate the increased risk of MetS following CT exposure. Our review specifically highlights differential methylation of FKBP5, the gene that encodes FK506-binding protein 51 and has pleiotropic effects on stress responding, inflammation and energy metabolism, as a central candidate to understand the molecular aetiology underlying CT-associated MetS risk.

A systematic review of childhood maltreatment and DNA methylation: candidate gene and epigenome-wide approaches

Childhood maltreatment is a major risk factor for chronic and severe mental and physical health problems across the lifespan. Increasing evidence supports the hypothesis that maltreatment is associated with epigenetic changes that may subsequently serve as mechanisms of disease. The current review uses a systematic approach to identify and summarize the literature related to childhood maltreatment and alterations in DNA methylation in humans. A total of 100 empirical articles were identified in our systematic review of research published prior to or during March 2020, including studies that focused on candidate genes and studies that leveraged epigenome-wide data in both children and adults. Themes arising from the literature, including consistent and inconsistent patterns of results, are presented. Several directions for future research, including important methodological considerations for future study design, are discussed. Taken together, the literature on childhood maltreatment and DNA methylation underscores the complexity of transactions between the environment and biology across development.

Transforming the paradigm of child welfare

As a founder of the field of applied developmental psychology, Dr Edward Zigler promoted public policy that translated scientific knowledge into real-world programs to improve the outcomes of high-risk children and families. Many researchers, practitioners, and public policy proponents have sought to carry on his legacy through integration of empirical research, evidence-based prevention and intervention, and advocacy to address a range of challenges facing families with young children. To advance the field of child maltreatment, a multidisciplinary team of investigators from the Universities of Rochester and Minnesota partnered with the Eunice Kennedy Shriver National Institute of Child Health and Human Development to create the Translational Research that Adapts New Science FOR Maltreatment Prevention Center (Transform). Building on state-of-the-art research methodologies and clinical practices, Transform leverages theoretically grounded research and evidence-based interventions to optimize outcomes for individuals across the life span who have experienced, or may be at risk for, maltreatment. Inspired by the work of Dr Zigler, Transform is committed to bridging science and real-world practice. Therefore, in addition to creating new science, Transform's Community Engagement Core provides translational science to a broad audience of investigators, child-serving professionals, and parental and governmental stakeholders. This article describes Transform's purpose, theoretical framework, current activities, and future directions.

Preliminary indications that the Attachment and Biobehavioral Catch-up Intervention alters DNA methylation in maltreated children

Maltreatment during development is associated with epigenetic changes to the genome. Enhancing caregiving may mitigate these effects. Attachment and Biobehavioral Catch-Up (ABC) is an intervention that has been shown to improve parent-child relationships and a variety of biological and behavioral outcomes among children that are involved in Child Protective Services. This preliminary study, using a small sample size, explored whether children who received ABC exhibit different methylation patterns than those who received a control intervention. The participants included 23 children aged 6-21 months who were randomized to receive ABC (n = 12) or a control intervention (n = 11). While the children displayed similar methylation patterns preintervention, DNA methylation varied between the ABC and control groups at 14,828 sites postintervention. Functional pathway analyses indicated that these differences were associated with gene pathways that are involved in cell signaling, metabolism, and neuronal development. This study is one of the first to explore parenting intervention effects on children's DNA methylation at the whole genome level in infancy. These preliminary findings provide a basis for hypothesis generation in further research with larger-scale studies regarding the malleability of epigenetic states that are associated with maltreatment.

Adverse childhood experiences: Mechanisms of risk and resilience in a longitudinal urban cohort

There is an extensive literature describing the detrimental effects of adverse childhood experiences (ACE; e.g., abuse, neglect, and household dysfunction) on physical and mental health. However, few large-scale studies have explored these associations longitudinally in urban minority cohorts or assessed links to broader measures of well-being such as educational attainment, occupation, and crime. Although adversity and resilience have long been of interest in developmental psychology, protective and promotive factors have been understudied in the ACE literature. This paper investigates the psychosocial processes through which ACEs contribute to outcomes, in addition to exploring ways to promote resilience to ACEs in vulnerable populations. Follow-up data were analyzed for 87% of the original 1,539 participants in the Chicago Longitudinal Study (N = 1,341), a prospective investigation of the impact of an Early Childhood Education program and early experiences on life-course well-being. Findings suggest that ACEs impact well-being in low-socioeconomic status participants above and beyond the effects of demographic risk and poverty, and point to possible mechanisms of transmission of ACE effects. Results also identify key areas across the ecological system that may promote resilience to ACEs, and speak to the need to continue to support underserved communities in active ways.

Benefit-cost analysis of Promoting First Relationships®: Implications of victim benefits assumptions for return on investment

BACKGROUND

Child abuse and neglect (CAN) cost United States society $136 billion to $428 billion annually. Preventive interventions that reduce CAN may improve people's lives and generate economic benefits to society, but their magnitude is likely to vary greatly with assumptions about victim costs avoided through intervention.

OBJECTIVE

We examined the implications of different assumptions about avoided victim costs in a benefit-cost analysis of Promoting First Relationships® (PFR), a 10-session attachment and strengths-based home visiting intervention.

PARTICIPANTS AND SETTING

Participants were 247 child protection-involved but intact families in Washington State randomized to receive PFR (n = 124) or resource and referral (n = 123).

METHODS

We monetized intervention effects on out-of-home placements and implicit effects on CAN and calculated net present values under three scenarios: (1) benefits from avoided system costs, (2) additional benefits from avoided tangible victim costs, and (3) additional benefits from avoided tangible and intangible quality-of-life victim costs. For scenarios 2 and 3, we varied the CAN effect size and estimated the effect size at which PFR was reliably cost beneficial.

RESULTS

PFR's societal net benefit ranged from $1 (scenario 1) to $5514 - $25,562 (scenario 2) and $7004 - $32,072 (scenario 3) (2014 USD). In scenarios 2 and 3, PFR was reliably cost beneficial at a CAN effect size of approximately -0.25.

CONCLUSIONS

PFR is cost beneficial assuming tangible victim costs are avoided by PFR. Research into the long-term health and economic consequences of reducing CAN in at-risk populations would contribute to comprehensive, accurate benefits models.

When a Head Is about to Burst: Attachment Mediates the Relationship Between Childhood Trauma and Migraine

Background: People exposed to childhood trauma show insecure attachment patterns and are more prone to chronic and pain-related conditions, including migraine. The aim of this study was to explore the mediating role of attachment in the association between childhood trauma and adulthood chronic health conditions, with a focus on migraine. Methods: Respondents from a representative sample of citizens of the Czech Republic (n = 1800, mean age: 46.6 years, 48.7% male) were asked to report various chronic and pain-related conditions, childhood trauma (The Childhood Trauma Questionnaire, CTQ), and attachment anxiety and avoidance (The Experience in Close Relationships Revised, ECR-R) in a cross-sectional, questionnaire-based survey conducted in 2016. Structural equation models (SEM) adjusted for sociodemographic variables were used to assess the relationship between childhood trauma, adulthood attachment, and adulthood chronic health conditions (migraine, other pain-related conditions, chronic health conditions other than pain, no chronic health complaints). Results: After adjusting for sociodemographic variables, SEM confirmed a significant mediation of the relationship between childhood trauma and migraine through adulthood attachment. There was no mediation effect of adulthood attachment found in other health complaints. Conclusion: This study highlights the mediation effect of attachment in the link between childhood trauma and migraine. Attachment-based therapeutic interventions can be useful in the treatment of patients with migraine.

Epigenetic Effects on Pediatric Traumatic Brain Injury Recovery (EETR): An Observational, Prospective, Longitudinal Concurrent Cohort Study Protocol

Introduction: Unexplained heterogeneity in outcomes following pediatric traumatic brain injury (TBI) is one of the most critical barriers to the development of effective prognostic tools and therapeutics. The addition of personal biological factors to our prediction models may account for a significant portion of unexplained variance and advance the field toward precision rehabilitation medicine. The overarching goal of the Epigenetic Effects on Pediatric Traumatic Brain Injury Recovery (EETR) study is to investigate an epigenetic biomarker involved in both childhood adversity and postinjury neuroplasticity to better understand heterogeneity in neurobehavioral outcomes following pediatric TBI. Our primary hypothesis is that childhood adversity will be associated with worse neurobehavioral recovery in part through an epigenetically mediated reduction in brain-derived neurotrophic factor (BDNF) expression in response to TBI. Methods and analysis: EETR is an observational, prospective, longitudinal concurrent cohort study of children aged 3-18 years with either TBI (n = 200) or orthopedic injury (n = 100), recruited from the UPMC Children's Hospital of Pittsburgh. Participants complete study visits acutely and at 6 and 12 months postinjury. Blood and saliva biosamples are collected at all time points-and cerebrospinal fluid (CSF) when available acutely-for epigenetic and proteomic analysis of BDNF. Additional measures assess injury characteristics, pre- and postinjury child neurobehavioral functioning, childhood adversity, and potential covariates/confounders. Recruitment began in July 2017 and will occur for ~6 years, with data collection complete by mid-2023. Analyses will characterize BDNF DNA methylation and protein levels over the recovery period and investigate this novel biomarker as a potential biological mechanism underlying the known association between childhood adversity and worse neurobehavioral outcomes following pediatric TBI. Ethics and dissemination: The study received ethics approval from the University of Pittsburgh Institutional Review Board. Participants and their parents provide informed consent/assent. Research findings will be disseminated via local and international conference presentations and manuscripts submitted to peer-reviewed journals. Trial Registration: The study is registered with clinicaltrials.org (ClinicalTrials.gov Identifier: NCT04186429).

Prevalence, socio-demographic correlates and associations of adverse childhood experiences with mental illnesses: Results from the Singapore Mental Health Study

BACKGROUND

Adverse childhood experiences (ACEs) are associated with deleterious consequences throughout the lifespan of the individual, including an increased risk of mental disorders. However, an in-depth understanding of ACEs in diverse populations is still lacking especially in Asian populations, with few studies done at a population level.

OBJECTIVE

The current study aimed to establish the (i) prevalence of ACEs and its socio-demographic correlates, and, (ii) association of ACEs with mental disorders and suicidality in a multiethnic Asian country.

PARTICIPANTS AND SETTING

Singapore residents aged 18 years and older were recruited from the community as part of a nation-wide cross-sectional epidemiological study.

METHODS

Trained interviewers conducted face-to-face interviews with participants, and administered the Adverse Childhood Experiences - International Questionnaire and the Composite International Diagnostic Interview.

RESULTS

A total of 6126 participants completed the survey. The lifetime prevalence of ACEs in the sample was 63.9 %. Multiple logistic regression analyses revealed that odds of any ACE were higher among those above 65 years (OR = 1.7) and those without university education (OR = 2.2, 1.9, and 1.5 among those with primary and below, secondary and vocational education respectively). The presence of any ACE was significantly associated with increased odds of mood (OR = 3.7, 95 % CI: 2.3-6.0), anxiety (OR = 3.9, 95 % CI: 2.3-6.8) and alcohol use (OR = 1.7, 95 % CI: 1.1-3.0) disorders.

CONCLUSIONS

ACEs are not uncommon in Asian populations. There is a need to build trauma-informed communities that can incorporate the knowledge of the impact of early trauma into policies and programs.

Childhood maltreatment and DNA methylation: A systematic review

DNA methylation (DNAm) - an epigenetic process that regulates gene expression - may represent a mechanism for the biological embedding of early traumatic experiences, including childhood maltreatment. Here, we conducted the first systematic review of human studies linking childhood maltreatment to DNAm. In total, 72 studies were included in the review (2008-2018). The majority of extant studies (i) were based on retrospective data in adults, (ii) employed a candidate gene approach (iii) focused on global maltreatment, (iv) were based on easily accessible peripheral tissues, typically blood; and (v) were cross-sectional. Two-thirds of studies (n = 48) also examined maltreatment-related outcomes, such as stress reactivity and psychiatric symptoms. While findings generally support an association between childhood maltreatment and altered patterns of DNAm, factors such as the lack of longitudinal data, low comparability across studies as well as potential genetic and 'pre-exposure' environmental confounding currently limit the conclusions that can be drawn. Key challenges are discussed and concrete recommendations for future research are provided to move the field forward.

The effects of childhood maltreatment on epigenetic regulation of stress-response associated genes: an intergenerational approach

While biological alterations associated with childhood maltreatment (CM) have been found in affected individuals, it remains unknown to what degree these alterations are biologically transmitted to the next generation. We investigated intergenerational effects of maternal CM on DNA methylation and gene expression in N = 113 mother-infant dyads shortly after parturition, additionally accounting for the role of the FKBP5 rs1360780 genotype. Using mass array spectrometry, we assessed the DNA methylation of selected stress-response-associated genes (FK506 binding protein 51 [FKBP5], glucocorticoid receptor [NR3C1], corticotropin-releasing hormone receptor 1 [CRHR1]) in isolated immune cells from maternal blood and neonatal umbilical cord blood. In mothers, CM was associated with decreased levels of DNA methylation of FKBP5 and CRHR1 and increased NR3C1 methylation, but not with changes in gene expression profiles. Rs1360780 moderated the FKBP5 epigenetic CM-associated regulation profiles in a gene × environment interaction. In newborns, we found no evidence for any intergenerational transmission of CM-related methylation profiles for any of the investigated epigenetic sites. These findings support the hypothesis of a long-lasting impact of CM on the biological epigenetic regulation of stress-response mediators and suggest for the first time that these specific epigenetic patterns might not be directly transmitted to the next generation.

Child maltreatment and the development of substance use and disorder

Children who experience maltreatment are at well-documented risk for the development of problematic substance use and disorder in adolescence and beyond. This review applies a developmental psychopathology framework to discuss the complex multilevel probabilistic pathways from child maltreatment to substance use and substance use disorder (SUD). We begin with an overview of the myriad vulnerabilities associated with child maltreatment, including the development of substance use and SUD. Prominent pathways that may potentiate liability for SUD are discussed. Specifically, we highlight the robust empirical support for the prominent externalizing pathway of risk, and also discuss the state of the research regarding the internalizing pathway. Consistent with the developmental psychopathology perspective, we then review biological processes such as neuroendrocrine mechanisms, allostatic load, and neurobiological pathways that may underlie child maltreatment risk, as well as discuss broader contextual issues. Elucidating the processes underlying the development of substance use and disorder among children exposed to this form of early adversity is paramount for not only informing developmental theories, but also designing effective prevention and intervention programs. Thus, implications for preventive interventions are provided. Finally, critical next steps for research within the area of child maltreatment and the developmental psychopathology of substance use and SUD are proffered.

Animal Models and Their Contribution to Our Understanding of the Relationship Between Environments, Epigenetic Modifications, and Behavior

The use of non-human animals in research is a longstanding practice to help us understand and improve human biology and health. Animal models allow researchers, for example, to carefully manipulate environmental factors in order to understand how they contribute to development, behavior, and health. In the field of behavioral epigenetics such approaches have contributed novel findings of how the environment physically interacts with our genes, leading to changes in behavior and health. This review highlights some of this research, focused on prenatal immune challenges, environmental toxicants, diet, and early-life stress. In conjunction, we also discuss why animal models were integral to these discoveries and the translational relevance of these discoveries.

Epigenetic Changes Associated with Early Life Experiences: Saliva, A Biospecimen for DNA Methylation Signatures

BACKGROUND

Adverse Childhood Experiences (ACEs), which include traumatic injury, are associated with poor health outcomes in later life, yet the biological mechanisms mediating this association are unknown. Neurocircuitry, immune system and hormone regulation differ from normal in adults reporting ACEs. These systems could be affected by epigenetic changes, including methylation of cytosine (5mC) in genomic DNA, activated by ACEs. Since 5mC levels influence gene expression and can be long-lasting, altered 5mC status at specific sites or throughout the genome is hypothesized to influence mental and physical outcomes after ACE(s). Human and animal studies support this, with animal models allowing experiments for attributing causality. Here we provide a lengthy introduction and background on 5mC and the impact of early life adversity.

OBJECTIVE

Next we address the issue of a mixture of cell types in saliva, the most accessible biospecimen for 5mC analysis. Typical human bio-specimens for 5mC analysis include saliva or buccal swabs, whole blood or types of blood cells, tumors and post-mortem brain. In children saliva is the most accessible biospecimen, but contains a mixture of keratinocytes and white blood cells, as do buccal swabs. Even in saliva from the same individual at different time points, cell composition may differ widely. Similar issues affect analysis in blood, where nucleated cells represent a wide array of white blood cell types. Unless variations in ratios of these cells between each sample are included in the analysis, results can be unreliable.

METHODS

Several different biochemical assays are available to test for site-specific methylation levels genome-wide, each producing different information, with high-density arrays being the easiest to use, and bisulfite whole genome sequencing the most comprehensive. We compare results from different assays and use high-throughput computational processing to deconvolve cell composition in saliva samples.

RESULTS

Here we present examples demonstrating the critical importance of determining the relative contribution of blood cells versus keratinocytes to the 5mC profile found in saliva. We further describe a strategy to perform a reference-based computational correction for cell composition, and therefore to identify differential methylation patterns due to experience, or for the diagnosis of phenotypes that correlate between traits, such as hormone levels, trauma status and various mental health outcomes.

CONCLUSION

Specific sites that respond to adversity with altered methylation levels in either blood cells, keratinocytes or both can be identified by this rigorous approach, which will then be useful as diagnostic biomarkers and therapeutic targets.

EARLY MALTREATMENT AND CURRENT QUALITY OF RELATIONAL CARE PREDICT SOCIOEMOTIONAL PROBLEMS AMONG INSTITUTIONALIZED INFANTS AND TODDLERS

The present study is focused on child socioemotional problems 6 months after institutionalization, by considering the putative predictive role of child maltreatment, of developmental functioning at admission and the following months, and of the quality of institutional relational care. Fifty institutionalized infants and toddlers participated in this study. Child developmental functioning (i.e., cognitive, language, and motor development) was assessed at admission to the institution (Wave 0), and 3 (Wave 1) and 6 months (Wave 2) thereafter. The quality of institutional relational care-operationalized in terms of caregivers' sensitivity and cooperation-was measured at Wave 2. Caregivers reported on the presence of disturbed socioemotional behaviors at Wave 2. Child gestational age, birth weight, age, and stunted growth at admission to the institution served as covariates. Results revealed significant associations between socioemotional difficulties and lower levels of motor development at Waves 0 and 1, child maltreatment, and less sensitive caregiving. A logistic regression showed that child maltreatment and caregiver insensitivity were the only significant predictors of disturbed socioemotional functioning by the end of 6 months of institutionalization.

Glucocorticoid receptor gene (NR3C1) DNA methylation in association with trauma, psychopathology, transcript expression, or genotypic variation: A systematic review

The glucocorticoid receptor gene (NR3C1) is a critical component of the stress response system. Cytosine methylation of NR3C1 has been repeatedly associated with trauma and mental disorders, including major depression, post-traumatic stress disorder, anxiety, and personality disorders, suggesting that NR3C1 methylation may play a role in stress-related psychopathology. We systematically reviewed 55 studies examining NR3C1 DNA methylation in association with trauma exposure, psychopathology, gene expression, and/or common genetic variants. Overall, a number of NR3C1 CpG sites were significantly associated with trauma or psychopathology, but significant findings were often inconsistent across studies. This lack of consistency is likely influenced by significant methodological variability - experimentally and analytically - across studies. Selected common genetic variants show no significant effect on NR3C1 CpG methylation. In contrast, there was ample evidence linking increased methylation of NR3C1 to reduced expression of this gene. The inverse association between methylation and gene expression shown across eight out of ten studies supports the notion that methylation in the promoter region of NR3C1 is associated with transcriptional silencing.

Psychosocial adversity and socioeconomic position during childhood and epigenetic age: analysis of two prospective cohort studies

Psychosocial adversity in childhood (e.g. abuse) and low socioeconomic position (SEP) can have significant lasting effects on social and health outcomes. DNA methylation-based biomarkers are highly correlated with chronological age; departures of methylation-predicted age from chronological age can be used to define a measure of age acceleration, which may represent a potential biological mechanism linking environmental exposures to later health outcomes. Using data from two cohorts of women Avon Longitudinal Study of Parents and Children, (ALSPAC), N = 989 and MRC National Survey of Health and Development, NSHD, N = 773), we assessed associations of SEP, psychosocial adversity in childhood (parental physical or mental illness or death, parental separation, parental absence, sub-optimal maternal bonding, sexual, emotional and physical abuse and neglect) and a cumulative score of these psychosocial adversity measures, with DNA methylation age acceleration in adulthood (measured in peripheral blood at mean chronological ages 29 and 47 in ALSPAC and buccal cells at age 53 in NSHD). Sexual abuse was strongly associated with age acceleration in ALSPAC (sexual abuse data were not available in NSHD), e.g. at the 47-year time point sexual abuse associated with a 3.41 years higher DNA methylation age (95% CI 1.53 to 5.29) after adjusting for childhood and adulthood SEP. No associations were observed between low SEP, any other psychosocial adversity measure or the cumulative psychosocial adversity score and age acceleration. DNA methylation age acceleration is associated with sexual abuse, suggesting a potential mechanism linking sexual abuse with adverse outcomes. Replication studies with larger sample sizes are warranted.