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Childhood maltreatment and mental health problems in a 10-year follow-up study of adolescents in youth residential care: A latent transition analysis

Childhood maltreatment and mental health problems are common among young people placed out-of-home. However, evidence on the impact of maltreatment on the course of mental health problems in at-risk populations is sparse. The aim of this longitudinal study is twofold: (a) describe the course of mental health problems and the shift in symptom patterns among adolescents in youth residential care into young adulthood and (b) assess how childhood maltreatment is related to the course of mental health problems. One hundred and sixty-six adolescents in Swiss youth residential care were followed up into young adulthood (36.1% women; MAge-Baseline = 16.1 years; MAge-Follow-Up = 26.4 years). Latent transition analysis was employed to analyze transitions of symptom patterns and their association with maltreatment exposure. We found three latent classes of mental health problems: a "multiproblem"-class (51.8% baseline; 33.7% follow-up), a "low symptom"-class (39.2% baseline; 60.2% follow-up), and an "externalizing"-class (9.0% baseline; 6.0% follow-up). Individuals in the "multiproblem"-class were likely to transition towards less-complex symptom patterns. Higher severity of self-reported childhood maltreatment was associated with more complex and persistent mental health problems. Our study underlines the need for collaboration between residential and psychiatric care systems within and after care placements, with a specialized focus on trauma-informed interventions and care.

Adverse childhood experiences increase the risk for low perceived social participation and health-related quality of life in a large-scale population-based study in Germany

BACKGROUND

Adverse childhood experiences (ACEs) are highly prevalent and increase the risk for long-term adverse health outcomes. Next to well-known ACE-associated risks for morbidity, recent research is increasingly invested in exploring pathways towards health, overall functioning, and partaking in society following early adversity.

OBJECTIVES

Thus, this study aims to assess the association between latent classes of ACEs with perceived social participation and health-related Quality of Life (QoL) in a large population-based sample and to explore potential moderators of these associations.

METHOD

A representative sample of the German population (N = 2531; Mage = 48.7; 51 % women) was cross-sectionally investigated for ACEs, social participation (KsT-5), and health-related QoL (EuroQol-5D-5L). Latent Class Analysis (LCA) was performed to derive groups with similar ACE patterns. Multiple regression analyses were used to investigate the association of latent classes of ACEs with social participation and health-related QoL and to explore potential moderators.

RESULTS

Four distinct latent classes of ACEs were identified; "no/low ACEs" (N = 1968, 77.8 %); "household-dysfunction" (N = 259, 10.2 %), "child abuse and neglect" (N = 188, 7.4 %), and "polyadversity" (N = 116, 4.6 %). Compared to participants in the no/low ACE class, those in the ACE-exposed classes showed overall lower levels of perceived social participation and health-related QoL. The polyadversity class showed lower levels of social participation compared to the two other ACE-exposed classes. Chronic stress, living with a partner, education, current job/educational involvement, and gender were found to moderate these associations in exploratory analyses.

CONCLUSIONS

This study shows people exposed to ACEs to have a higher risk for lower perceived social participation and lower health-related QoL - an increased risk, however, is not a deterministic uninventable fortune. Reduction of chronic stress, fostering of social support, and educational and vocational paths as interventional targets are discussed to enable those with precarious starting conditions to partake in society.

Adverse and traumatic exposures, posttraumatic stress disorder, telomere length, and hair cortisol – Exploring associations in a high-risk sample of young adult residential care leavers

Background

Childhood adversities (CAs), potentially traumatic exposures (PTEs), and posttraumatic stress disorder (PTSD) are known to increase the risk for poor health outcomes, including diseases of aging and early mortality. Telomere length (TL) and hair cortisol concentrations (HCC) are biomarkers known to be associated with CA and PTEs, and PTSD, but there is considerable heterogeneity in findings.

Objectives

This study aims to investigate the association of CAs, PTEs, and PTSD with TL and HCC in a high-risk sample of young adults who were previously placed in youth residential care institutions throughout Switzerland.

Method

Our sample includes 130 participants (30.8% women, M _Age = 26.5 ± 3.7 years) with previous youth residential care placements (M_Placements= 3.9). CAs and PTEs, as well as PTSD, were assessed with self-reported questionnaires and semi-structured clinical interviews. Immune cell TL was measured with quantitative polymerase chain reaction (qPCR) in whole blood. Hair samples were collected for HCC measurement and assayed with high-sensitivity ELISA. Multivariate regression models were fitted to describe the associations between CAs, PTEs, and PTSD with TL and HCC, adjusting for covariates.

Results

In our high-risk sample, a higher burden of CAs, PTEs, Criterion A trauma, and PTSD was associated with longer TL. PTEs, Criterion A trauma, and PTSD were associated with lower HCC, however no significant associations between CAs and HCC were found. The magnitude of these effects varied depending on the dimensional or categorical nature of the stress-phenotype and the specific measure used.

Conclusions

Our findings are in contrast with many, but not all, previous studies of associations between adversity and both TL and HCC. For instance, our findings are in line with other studies that find a state of hypocortisolism in PTSD. Better measurement of adversities and trauma, multisystem biomarker approaches, and more research in larger high-risk samples at the upper end of the adversity-continuum is warranted.

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In this high-risk sample,childhood adversities, potential traumatic exposures, criterion A trauma, or posttraumatic stress disorder (PTSD) was associated with longer telomere length (TL).

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Potentially traumatic exposures, criterion A trauma, and PTSD were associated with lower hair cortisol concentrations.

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The magnitude of these effects varied depending on the dimensional or categorical nature of the stress-phenotype and the specific measure used.

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Hypocortisolism might explain findings of longer TL in participants with cumulated adverse and traumatic exposures.

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Research in high-risk populations is strongly needed as results across the entire spectrum of adversity exposures may not generalize to the top end of the spectrum.

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Zusammenfassung. Theoretischer Hintergrund: Verschiedene Studien zeigen auf, dass ehemals ausserfamiliär platzierte Jugendliche, die viele biologische und psychosoziale Risikofaktoren akkumulieren, im weiteren Lebenslauf häufig eine geringere soziale Teilhabe aufweisen. Fragestellung: Dieser Themenschwerpunkt berichtet von einer Längsschnittstudie (JAEL – Jugendhilfe aus Erfahrung lernen) mit ehemals fremdplatzierten jungen Erwachsenen, die einer Hochrisikostichprobe zugeordnet werden können. Methode: Die Studie kombiniert für ihre Forschungsfragen prospektive und retrospektive Aspekte sowie qualitativ und quantitativ erhobene Daten. Ergebnisse: Der Themenschwerpunkt gibt sowohl eine kurze Einführung in die Methoden und die Rekrutierung der Stichprobe als auch einen Einblick in drei ausgewählte Themen, die in den drei Beiträgen dieses Themenschwerpunktes behandelt werden. Der erste Beitrag berichtet über die Ergebnisse zum Verlauf der psychischen Probleme vom Jugend- bis ins junge Erwachsenenalter. Der zweite Beitrag befasst sich mit Misshandlung und Vernachlässigung in der Kindheit als Risikofaktor für die soziale Teilhabe im jungen Erwachsenenalter, wie z. B. Arbeitslosigkeit, Legalbewährung, sozioökonomische Lage, psychische Gesundheit oder auch Beziehungsfähigkeit. Diese negativen Auswirkungen können durch Selbstwirksamkeitserfahrungen abgemildert werden. Der dritte Beitrag beinhaltet einen der bisher weniger beachteter Längsschnittstudienaspekte, nämlich die Risikofaktoren für eine Persönlichkeitsstörung in einer Hochrisikostichprobe sowie deren Stabilität. Diskussion und Schlussfolgerung: Auf die Bedeutung und Implikationen für Interventionen und Jugendhilfepolitik einerseits und die Forschung in diesem Feld andererseits wird eingegangen.