The long-term health outcomes of childhood abuse. An overview and a call to action

Childhood Maltreatment and Amygdala-Mediated Anxiety and Posttraumatic Stress Following Adult Trauma

Background

Childhood abuse (physical, emotional, and sexual) is associated with aberrant connectivity of the amygdala, a key threat-processing region. Heightened amygdala activity also predicts adult anxiety and posttraumatic stress disorder (PTSD) symptoms, as do experiences of childhood abuse. The current study explored whether amygdala resting-state functional connectivity may explain the relationship between childhood abuse and anxiety and PTSD symptoms following trauma exposure in adults.

Methods

Two weeks posttrauma, adult trauma survivors (n = 152, mean age [SD] = 32.61 [10.35] years; women = 57.2%) completed the Childhood Trauma Questionnaire and underwent resting-state functional magnetic resonance imaging. PTSD and anxiety symptoms were assessed 6 months posttrauma. Seed-to-voxel analyses evaluated the association between childhood abuse and amygdala resting-state functional connectivity. A mediation model evaluated the potential mediating role of amygdala connectivity in the relationship between childhood abuse and posttrauma anxiety and PTSD.

Results

Childhood abuse was associated with increased amygdala connectivity with the precuneus while covarying for age, gender, childhood neglect, and baseline PTSD symptoms. Amygdala-precuneus resting-state functional connectivity was a significant mediator of the effect of childhood abuse on anxiety symptoms 6 months posttrauma (B = 0.065; 95% CI, 0.013-0.130; SE = 0.030), but not PTSD. A secondary mediation analysis investigating depression as an outcome was not significant.

Conclusions

Amygdala-precuneus connectivity may be an underlying neural mechanism by which childhood abuse increases risk for anxiety following adult trauma. Specifically, this heightened connectivity may reflect attentional vigilance for threat or a tendency toward negative self-referential thoughts. Findings suggest that childhood abuse may contribute to longstanding upregulation of attentional vigilance circuits, which makes one vulnerable to anxiety-related symptoms in adulthood.

The impact of adverse childhood experiences on depression in middle and late life: A national longitudinal study

BACKGROUND

Adverse childhood experiences (ACEs) are one of the causes of depression in middle-aged and older adults, but the combined effects of ACEs, cognitive function and ability to perform activities of daily living (ADL) on depression have not been fully explored.

METHODS

This study was based on data from 4 waves (2013, 2014, 2015 and 2018) of data from the China Health and Retirement Longitudinal Study, including 10,995 middle-aged and older adults. ACEs were derived from the 2014 self-report life history module. A latent variable growth curve model was used to assess the mediating effect of cognitive function and ability to perform ADL in the relationship between ACEs and depression.

RESULTS

ACEs were significantly associated with lower initial cognitive status (β = -0.156, P < .001), worse ability to perform ADL (β = 0.051, P < .001) and higher severity of depression (β = 0.228, P < .001). The results of mediation analysis indicated that the association between ACEs and the intercept of depression was partly mediated by the initial level of cognitive function and ADL, and the association between ACEs and the slope of depression was total mediated by cognitive (intercept and slope) and ADL (intercept and slope).

CONCLUSIONS

ACEs were associated with higher severity of depression in part due to lower cognitive function and worse ability to perform ADL. Interventions that focus on reducing ACEs and improving cognitive level and ability to perform ADL may effectively reduce the incidence of depression among middle-aged and older individuals.

The mediating role of social support in associations between childhood adversity, military sexual trauma, and homelessness in a nationally representative sample of US veterans

Among veterans, availability of social support and histories of military sexual trauma (MST) and/or adverse childhood experiences (ACEs) are particularly salient correlates of homelessness. Using path analyses, we investigated whether social support (i.e., interpersonal social support and community integration) would at least partially account for the relationships of MST and ACEs with any lifetime homelessness in a large, nationally representative sample of veterans (N = 4069, 9.8% female). Interpersonal social support and community integration partially explained the relationship between ACEs and any lifetime homelessness. However, they did not mediate the relationship between MST and any lifetime homelessness. Female veterans also reported higher trauma rates and lower perceived social support than male counterparts during correlational analyses. These results reinforce existing literature on the importance of research and interventions tailored to veterans with low social support and integration. Results have potential to inform interventions and policy for veterans experiencing and/or at risk for homelessness.

Examining biopsychosocial predictors of risk for cognitive impairment among a racially diverse sample of men who have sex with men living with HIV

Background

Cognitive decline among people living with HIV (PLWH) is growing concern as world populations become increasing older including higher proportions of PLWH. It is vitally important to understand psychosocial predictors of age-related cognitive decline men who have sex with men (MSM) living with HIV.

Objectives

The current study seeks to examine psychosocial risk factors the contribute to the risk of age-related cognitive impairment as measured by Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score in a racially diverse sample of MSM living with HIV.

Design

The present analysis utilizes data from the baseline (n = 196) and 6-month follow-up (n = 135) time points of a longitudinal cohort study of PLWH.

Methods

Using a self-report survey, we examine the associations between psychosocial predictors (e.g. trauma, mental health, chronic pain, sleep disturbance, etc.) and risk of dementia using the CAIDE risk score. Analyses include linear and logistic regression.

Results

In adjusted model stress, chronic pain, Black racial identity, and having a sexual identity that is bisexual or another category are all positively associated with CAIDE scores. Childhood sexual abuse history was negatively associated with CAIDE scores indicating a protective effect. Sleep disorder has a positive association with CAIDE scores after adjusting for the baseline CAIDE scores.

Conclusion

These results indicate modifiable correlates of cognitive risk (stress and chronic pain). Interventions should seek to address these comorbid factors including the consideration of minority stress and stigma. Interventions should seek to reach Black and bisexual men living with HIV, including possible cultural tailoring to interventions and messaging. Lastly, future research should examine the impact of variation within childhood sexual abuse histories to better understand their association with cognitive impairment later in life. This may include considering the nature, severity, and potential treatment of trauma symptoms.

Adverse Childhood Experiences and Aging-Associated Functional Impairment in a National Sample of Older Community-Dwelling Adults

BACKGROUND

Prior research on the health implications of adverse childhood experiences (ACEs) has focused on early or midlife adults, not older adults who bear the greatest burden of health-related functional impairment.

OBJECTIVE

To examine associations between ACEs, objectively measured physical mobility and cognitive impairment, and functional disability in older community-dwelling adults.

DESIGN

Cross-sectional analysis.

PARTICIPANTS

Community-dwelling older U.S. adults ages 50 years and older.

MAIN MEASURES

Participants completed structured questionnaires assessing history of ACEs (childhood experience of violence/abuse, witnessing of violence, financial insecurity, parental separation, or serious illness), underwent standardized physical performance testing (tandem balance, 3-m walk, chair stand test) and cognitive testing (survey adaptation of the Montreal Cognitive Assessment), and reported functional disability (difficulty with activities of daily living).

KEY RESULTS

Among the 3387 participants (aged 50 to 97 years; 54% female), 44% reported a history of one or more types of ACEs. Thirty-five percent met criteria for physical mobility impairment, 24% for cognitive impairment, and 24% for functional disability. After adjusting for age, gender, race, and ethnicity, participants reporting any ACE history were more likely to demonstrate physical mobility impairment (OR 1.30, 95% CI 1.11-1.52) and cognitive impairment (OR 1.26, 95% CI 1.03-1.54) and report functional disability (OR 1.69, 95% CI 1.38-2.07), compared to those with no ACE history. Childhood experience of violence was associated with greater physical mobility impairment (OR 1.38, 95% CI 1.11-1.71) and functional disability (OR 1.86, 95% CI 1.49-2.33).

CONCLUSIONS

Older adults with a history of ACEs are more likely to experience physical and cognitive functional impairment, suggesting that efforts to mitigate ACEs may have implications for aging-associated functional decline. Findings support the need for trauma-informed approaches to geriatric care that consider the potential role of early life traumatic experiences in shaping or complicating late-life functional challenges.

Effect of lifestyle interventions to reduce depression, anxiety and stress among married women of reproductive age group: A non-randomised controlled trial in urban slums of Bhubaneswar

BACKGROUND

Women are more prone to develop mental disorders as compared to men and the role of physical activities to reduce its burden by improving self-esteem is appreciable. This study aimed to evaluate the effect of lifestyle interventions to reduce depression, anxiety and stress among women in urban slums.

MATERIALS AND METHODS

This study was a non-randomized controlled trial carried out in two slums of Bhubaneswar in married women of reproductive age group (15 years-49 years) from June 2019 to September 2021 after approval from the institutional ethics committee. A total of 128 married women were recruited, 64 women in each arm. DASS-21 was used for assessing depression, anxiety, and stress of all participants. The lifestyle intervention program was provided to 64 women in the intervention group and educational materials were provided to the control arm. DASS score was assessed again and compared with follow-up scores in both groups. Descriptive statistics were expressed as frequency, mean, median, and standard deviations. Independent t-test and paired t-tests were done where applicable.

RESULTS

There was no significant difference in socio-demographic factors and DASS-21 scores in both groups during baseline. Depression, Anxiety, and stress score were significantly lower in the intervention arm than control arm in the follow-up (P < 0.05). There was a significant difference between the pre-intervention and post-intervention levels of depression, anxiety, and stress among the intervention group (P = 0.05).

CONCLUSIONS

Simple community-based physical activities as in our intervention program focusing on the reduction of depression, anxiety, and stress levels in women may prevent the rising problems of common mental disorders.

Traumatic Stress and Resilience Among Transgender and Gender Diverse Youth

Traumatic stress increases the risk for mental health conditions and adversely impacts health, academic performance, and coping. Transgender and gender diverse (TGD) youth experience higher rates of abuse and maltreatment and interpersonal and community-embedded discrimination than their cisgender peers. Neurobiologic stress responses and social stress theory provide useful frameworks for understanding the effects of discrimination, stigma, and rejection. Despite facing higher rates of interpersonal trauma, TGD youth are quite resilient when able to access supports and affirming trauma-informed services. Clinicians play an important role in identifying and addressing traumatic stress impacting TGD youth and bolstering resilience.

Do adverse experiences predict unemployment and need of psychiatric help after treatment for drug use disorders?

Background: This study prospectively examined the association between adverse experiences (physical abuse, sexual abuse and parental substance use problems [SUPs]), not being employed, in education or training (NEET) and being in need of acute psychiatric help among patients receiving treatment for substance use disorders. Methods: A total of 580 adolescents and early adults aged 15-25 years enrolled in treatment for drug use disorders were included in the analyses. Treatment data were linked to participants' register data on employment, education and acute contact to psychiatric services for the following two years. Multivariable logistic regression models were used to examine associations between the three adverse experiences, NEET and need of acute psychiatric help, adjusting for confounders such as age, gender, ethnicity, treatment response and treatment condition. Results: More than half of the participants were NEET two years after treatment enrolment. After controlling for demographics and treatment conditions, NEET was predicted by parental substance use problems (odds ratio [OR] = 1.89, 95% confidence interval [CI] 1.31- 2.70), exposure to physical abuse (OR = 1.48, 95% CI 1.03-2.13) and non-abstinence (abstinence was negatively associated with NEET, OR = 0.53, 95% CI 0.37-0.76). Being exposed to two (OR = 3.17, 95% CI 1.93-5.21) and three types of adverse experiences (OR = 3.14, 95% CI = 1.47-6.70) predicted NEET more strongly than exposure to one type. One out of 10 participants sought acute care from psychiatric services at least once within two years after treatment. Only sex and ethnic minority status were associated with contacting psychiatric services acutely. Conclusion: The present study suggests that adverse experiences, such as being exposed to parental problematic substance use and physical abuse, may be important predictors for NEET after treatment for SUDs.

Physical, sexual, and psychosocial health impacts of child abuse: Evidence from Ghana

Child abuse is a significant global health problem. While data on child abuse in Ghana are scant, anecdotal evidence suggests the vast majority of Ghanaian children have experienced some form of physical or sexual abuse. This paper explores links between early childhood abuse and health outcomes using a life course perspective. Nationally representative cross-sectional data were collected from a sample of 2289 ever-married Ghanaian women in 2017. Women provided retrospective accounts of different types of violence in early childhood. Random-effects logit models were used to examine the impact of two dimensions of early childhood abuse (physical and sexual) on the physical, sexual, and psychosocial health outcomes of women in later years. Women who experienced childhood physical abuse, but not often, were significantly more likely to report physical disabilities in later years than women who did not experience it. Women reporting childhood sexual abuse were more likely to be depressed in later years than those who never experienced such abuse. They were also significantly more likely to report sexually transmitted diseases. Our findings provide support for the life course theory by showing abuse experienced in childhood could have a long-term impact. We therefore suggest the need for early interventions to address child abuse.

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments

BACKGROUND

Nearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many sexual assault survivors, healthcare professionals are the first point of contact and disclosure. This study aimed to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrical and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals' perspectives with the patients' to determine how sexual violence conversations should occur in these environments.

METHODS

Data were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 (n = 22) living in Indiana who sought community-based or private healthcare for women's reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization.

RESULTS

There were three resulting themes: (1) healthcare professionals' approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize.

CONCLUSIONS

Findings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women's reproductive health settings. The findings offer strategies to address barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professional and patient experiences and preferences for violence-related discussions during obstetrical and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes.

Adverse childhood experiences and health risk behaviours among adolescents and young adults: evidence from India

BACKGROUND

Adverse childhood experiences (ACEs) are traumatic and stressful events that occur in childhood. These experiences at home, school, or in the community may damage the cognitive health and emotional skills of children and adolescents.

OBJECTIVE

The present study examines the association between Adverse childhood experiences and risky health behaviour indicators while controlling other background characteristics among boys and girls. This study also assesses outcomes in the aggregate to estimate the impact of cumulative adversity on various risky health behavioural factors among boys and girls among adolescents and young adults (age group 13-23) in India.

DATA AND METHODS

Data were drawn from the second wave of the "Understanding the lives of adolescents and young adults (2018-2019)" survey. Bivariate and logistic regression analysis were conducted to fulfill the objective.

RESULTS

The findings show that nearly 30% of boys and 10% of girls had violent behaviour. Substance use prevalence was much higher among boys (34.11%) than girls (6.65%). More boys had negative gender attitudes. The majority of the study participants had multiple ACEs. Boys who experienced more than three or more childhood adversity had two times higher odds (OR: 2.04; CI: 1.01-4.16) of the early sexual debut, while the same figure for girls was thirteen times (OR: 13.13; CI: 3.95-43.69) than their male counterparts.

CONCLUSION

The study findings underlined the need for implementing outcome-oriented approaches to adolescents' health care and behavioural risks. Therefore, identifying and intervening with adolescents and young adults who are at the highest risk of engaging in risky behaviors early in life may reduce the risk of these behaviors persisting into adulthood. In order to avoid health risk behavior in later stages among adolescents and young adults, policymakers need to focus on ACEs as risk factors and take action to reduce this burden. A potential model could be to create awareness among family members, caregivers, and communities to be more empathetic toward the children.

Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations

BACKGROUND

Adverse childhood experiences (ACEs) among university students have been linked to a variety of factors and have been shown to have a dose-response relationship with adult health and behavior.

OBJECTIVE

To investigate the effect of exposure to ACEs on academic performance, depression, and suicidal ideations among university students.

METHODS

A cross-sectional survey among university students at a public university in southwestern Uganda was conducted in 2021, integrating the Adverse Childhood Experiences International Questionnaire for assessing ACEs, the Patient Health Questionnaire for assessing depression symptoms and suicidal ideations, and questions assessing the family structure and academic performance as adopted from similar studies. Regression analysis was performed, and 3 models were generated to answer the study hypotheses.

RESULTS

A total of 653 undergraduate university students with a mean age of 22.80 (± 3.16) years were recruited. Almost all students (99.8%) experienced one or more ACEs, with physical abuse being the common ACE reported. The average depression symptom severity was statistically higher among individuals who experienced any form of ACEs. No relationship was observed between the ACEs experienced and self-rated academic performance. Similarly, on regression analysis, the cumulative number of ACEs was not associated with self-rated academic performance (β =  - 0.007; 95% CI - 0.031 to 0.016; p = 0.558). However, the cumulative number of ACEs was positively associated with depression symptom severity (β = 0.684; 95% CI 0.531-0.837; p < 0.001), as well as increased the likelihood of suicidal ideations (aOR = 1.264; 95% CI 01.090-1.465; p < 0.001).

CONCLUSIONS

The burden of ACEs is exceedingly high among Ugandan university students, highlighting the urgency in strengthening effective child protection strategies to protect Uganda's rapidly growing population from mental ill-health and avoid future psychological disability, a burden to the healthcare system. The study's findings will also be useful to practitioners/policymakers working to prevent/limit child maltreatment globally.

The Mental Health of Emerging Adults: Hostile Home Environments and COVID-19

Purpose

Due to shifts in societal and educational expectations alongside the COVID-19 pandemic, many emerging adults live with their family of origin for extended periods of time. Little is known about patterns of parent-perpetrated maltreatment in emerging adulthood. Therefore, this study evaluates the relation between forms of parent-perpetrated maltreatment, including economic abuse, and COVID stress, on symptoms of depression, anxiety, and traumatic stress.

Method

423 emerging adults who were enrolled in college in the United States in March of 2020 were recruited via MTurk to complete an online survey. An age-related COVID questionnaire and six empirically validated measures assess levels of COVID-19 exposure, lifetime maltreatment, economic abuse, and mental health status.

Results

13.0% of participants reported maltreatment that most recently occurred over the age of 18 in their household of origin. Mean COVID stress level was found to be significantly higher in the Maltreated Over 18 group compared to the Never Maltreated group (t(345) = -3.03, p = 0.003), and in the Maltreated Under 18 group compared to the Never Maltreated group (t(346) = -3.20, p = 0.002). In accounting for the contribution of demographic variables, maltreatment chronicity, economic abuse, and COVID stress, our model predicted 38.6% of variance in depression symptoms, 37.2% of variance in anxiety symptoms, and 42.9% of variance in traumatic stress.

Conclusions

Findings indicate need for increased maltreatment screenings within the emerging adult population and calls for age-specific interventions to address the mental health disparities experienced by emerging adults with maltreatment histories.

Impact of childhood maltreatment on psychosomatic outcomes among men and women with disabilities

PURPOSE

This project examined the impact of childhood maltreatment types on psychosomatic outcomes among adults with a range of self-reported disabilities.

MATERIALS AND METHODS

Participants (n = 643) were recruited using Amazon Mechanical Turk and Cloud Research. Single-item questions assessed sociodemographic information. The Childhood Trauma Questionnaire measured childhood maltreatment types (emotional, physical, and sexual abuse, and emotional and physical neglect) and the RAND-36 Item Health Survey evaluated physical functioning, pain, and energy/fatigue. Logistic regressions determined associations between childhood trauma and psychosomatic outcomes; stratified models compared men and women.

RESULTS

Multivariate-adjusted models indicated physical abuse was positively associated with poor physical functioning (OR: 2.03; 95%CI: 1.35-3.06) with this relationship being stronger for men (OR: 3.25; 95%CI: 1.42-7.43) than women (OR: 1.91; 95%CI: 1.17-3.13). Adjusted models showed that physical neglect was protective against fatigue (OR: 0.58; 95% CI: 0.36-0.94), while emotional neglect increased the risk of fatigue (OR: 1.74; 95%CI: 1.02-2.95). Lastly, physical abuse was positively associated with pain (OR: 1.53; 95%CI: 1.01-2.33). This relationship was stronger in men (OR: 4.99; 95%CI: 1.91-12.99).

CONCLUSIONS

Results improve our understanding of risk factors for poor physical health outcomes and can guide the development of trauma-sensitive rehabilitation services.Implications for RehabilitationIndividuals with disabilities who report childhood maltreatment may experience poor psychosomatic outcomes in adulthood.Consequences of experiencing childhood maltreatment may manifest differently between men and women over the course of the lifespan.It is essential to integrate trauma-informed principles into treatment plans for individuals with poor psychosomatic health.Rehabilitation professionals should screen for abuse and refer individuals to the appropriate mental and physical health services.

Concerns about Household Violence during the COVID-19 Pandemic

Evidence about how the pandemic affected household violence in Canada is mixed, but inarguably, the risk factors increased. This study used data from the 2020 Canadian Perspective Survey Series and the 2020 and 2021 Surveys of COVID-19 and Mental Health to examine the following: changes in the prevalence of concern about violence in individuals' own homes during the pandemic; the characteristics of those who expressed concern; and the prevalence of concerns for specific household members. Among Canadians, the prevalence of concern about violence in individuals' own homes decreased significantly between July and Fall 2020 (5.8% to 4.2%). Among women, the characteristics that were significantly associated with higher adjusted odds of concern about household violence included larger household size and lower household income. Lower education among women was associated with lower adjusted odds of concern. The associations with higher adjusted odds of concern among men included: being an immigrant, larger household size, and lower household income. From Fall 2020 to Spring 2021, the prevalence of concerns for oneself and for a child/children increased (1.7% to 2.5% and 1.0% to 2.5%, respectively), but concern for other adults in the household decreased (1.9% to 1.2%). Ongoing surveillance is needed to understand vulnerable populations' exposure to household violence and to inform policies and programs.

Poverty, Cortical Structure, and Psychopathologic Characteristics in Adolescence

IMPORTANCE

Childhood poverty has been associated with increased internalizing and externalizing problems in adolescence, a period of peak onset for psychiatric problems. The underlying neural mechanisms remain unclear because longitudinal studies of poverty, brain structure, and changes in psychiatric symptoms are lacking.

OBJECTIVE

To examine whether structural differences in cortical regions mediate the association between household poverty and change in psychiatric symptoms in early adolescence.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal cohort study used baseline and 1-year follow-up data from the Adolescent Brain Cognitive Development Study. Children aged 9 to 10 years in the US were enrolled between September 1, 2016, and October 15, 2018. Data analysis was performed from August 13, 2021, to September 30, 2022.

EXPOSURES

Household poverty as measured by income-to-needs ratio, which incorporates family income and adjusts for family size as a percentage of the federal poverty level.

MAIN OUTCOMES AND MEASURES

Mediators were children's cortical surface area, thickness, and volume, obtained using magnetic resonance imaging. Internalizing and externalizing problems at 1-year follow-up were outcomes measured by maternal report using the Child Behavior Checklist. Analyses were adjusted for baseline psychiatric problems and sociodemographic variables, including sex, race and ethnicity, parental educational level, and study site.

RESULTS

Of the 7569 children (mean [SD] age, 9.91 [0.62] years; 3970 boys [52.5%]) included in the analysis, 1042 children (13.8%) lived below the poverty threshold between 2016 and 2018. Poverty was associated with increased externalizing symptoms score at 1-year follow-up (b = 1.57; 95% CI, 1.14-1.99), even after adjustment for baseline externalizing symptoms (b = 0.35; 95% CI, 0.06-0.64). The longitudinal associations of poverty with increases in externalizing problems over time were mediated by reductions in surface area in multiple cortical regions that support executive functioning (middle frontal gyrus), decision-making (lateral orbitofrontal cortex), visual processing (fusiform gyrus), auditory processing (transverse temporal gyrus), and emotion and language processing (superior temporal gyrus).

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that childhood poverty is associated with increases in externalizing problems, but not internalizing problems, over time in early adolescence. This association is mediated by reductions in cortical surface area across numerous brain regions. These findings highlight potential neurobiological mechanisms underlying the link between poverty and the emergence of externalizing problems during early adolescence.

Adverse childhood experiences, adult trauma, and depressive symptom trajectories

OBJECTIVES

Associations among adverse childhood experiences prior to age 18 (ACEs), subjective reports of trauma during Hurricane Sandy, and trajectories of depressive symptoms reported by community-dwelling older people were examined.

METHODS

We analyzed 6 waves of data from 5,688 people aged 50-74 recruited in 2006 and followed for 12-years using multilevel mixed effects models.

RESULTS

We found that: (1) people who experienced ACEs had trajectories of depressive symptoms in late life that were higher than people not having these experiences, (2) people experiencing two or more ACEs were more likely to report fear and distress when Hurricane Sandy hit than people experiencing either one or no adverse childhood experiences, and (3) while both ACE exposure and peri-traumatic stress were associated with trajectories having higher levels of depressive symptoms, the risk associated with ACEs (especially multiple ACEs) was greater.

CONCLUSION

Findings support life course stress theories including the cumulative inequality theory and stress proliferation theory, suggesting that inequalities are manifested over the life course and that people experiencing adversity during childhood are at increased risk of experiencing adversity in late life. By studying the relationship between adverse childhood experiences and response to Hurricane Sandy our findings demonstrate that adverse childhood experiences can alter the way traumatic events in adulthood are experienced. This finding in turn, has important implications for clinical practice, as it identifies a group of people likely to be at risk for adult trauma.

My Sister's Keeper: Survivors Disclosing Sexual Violence to a Sibling

Siblings are often cited as a source of support throughout life, but they have not been included in studies of sexual violence disclosure. Survivors of sexual violence often delay or do not disclose their sexual violence. The current study investigated if and why survivors of sexual violence decided to disclose to their sibling. This qualitative investigation included 10 female participants, of which six had disclosed their abuse to their sibling. The participants ranged in age from 20 to 58, five identified as Hispanic, one as Hispanic and White three identified as White, and one identified as Middle Eastern. Thematic analysis was used to examine the data. Three major themes were identified that affected sibling disclosure decisions: sibling dynamics, perceived and real reactions to disclosure, and words of advice. The findings from this study demonstrate the continued need to investigate siblings and their role in disclosure of sexual violence. Practitioners may also want to examine the sibling relationship as a source of support for survivors of sexual violence. Finally, as policies continue to develop around support of survivors of sexual violence, inclusion of siblings in family policies, outreach centers, and counseling services may be beneficial.

The association between childhood sexual abuse and historical intimate partner violence with body mass index and diabetes: Evidence from the Australian Longitudinal Study on Women's Health

The purpose of this study was to investigate the associations of childhood sexual abuse and historical intimate partner violence with body mass index and diabetes among mid-age women. Data from 5782 participants in the 1946-51 cohort of the Australian Longitudinal Study on Women's Health were used. The association of abuse reported to have occurred before 1996 with body mass index and incident diabetes during 20 years of follow-up were examined using longitudinal logistic regression. Women who experienced childhood sexual abuse only, historical intimate partner violence only, or both forms of abuse had higher risk of obesity compared to women who did not experience either form of abuse. The associations between experiencing childhood sexual abuse only, historical intimate partner violence only, or both forms of abuse and incident diabetes (adjusted odds ratios, AOR = 1.28, 95%CI = 1.00, 1.65, AOR = 1.27 (1.02, 1.58) and AOR = 1.74 (1.27, 2.38) respectively) were attenuated by adding body mass index and other variables in the model (AOR = 1.16, 95%CI = 0.90, AOR = 1.49, 1.17 (0.94, 1.46) and AOR = 1.41 (1.03, 1.95) respectively) compared with women who did not experience abuse. The clinical implication is that awareness of a woman's early life experience of abuse may provide insight into managing her weight and risk of diabetes.

Adverse childhood experiences and maternal self-efficacy: Examining the mediating role of intimate partner violence and the moderating role of caste membership in rural India

Maternal self-efficacy (MSE) is associated with healthy functioning in mothers and children globally. Maternal exposure to adverse childhood experiences (ACEs) and intimate partner violence (IPV) is known to negatively impact MSE in high-income countries; however, the association has not been examined in low-and-middle-income countries, such as India, which face socioeconomic risks including poverty, illiteracy, and discrimination based on caste membership. The present study examines the mediating role of IPV in the association between ACEs (specifically-emotional, physical, and sexual abuse, neglect, household dysfunction, and discrimination) and MSE and tests caste membership as a moderator. A community-based, cross-sectional survey was performed with 316 mothers with at least one child between 0 and 24 months in a rural area in the North Indian state of Uttar Pradesh. A structural equation framework was used to test the moderated-mediation model. Results from the moderated-mediation model indicate that greater ACEs exposure was associated with lower MSE and this association was mediated by IPV exposure for low-caste but not high-caste mothers, even after controlling for wealth and literacy. These findings add to existing evidence on ACEs exposure as a significant burden for rural Indian mothers, negatively impacting parenting outcomes such as MSE. The critical role of caste membership is also highlighted, providing implications for future research.

Examining differences in diet quality between Canadian Indigenous and non-Indigenous adults: results from the 2004 and 2015 Canadian Community Health Survey Nutrition Surveys

OBJECTIVES

The Truth and Reconciliation Commission includes a call to action to close gaps in health outcomes, including type 2 diabetes, of which diet quality must be considered an important mediator. The objectives of this study were to compare diet quality between off-reserve Indigenous and non-Indigenous adults in 2004 and 2015, and examine food security as a predictor of diet quality.

METHODS

We employed a repeated cross-sectional design using the 2004 and 2015 Canadian Community Health Surveys-Nutrition. Both surveys include a representative sample of the Canadian population in the 10 provinces, excluding the northern territories and people living on-reserve. Healthy Eating Index (HEI) values were estimated, using 24-hour dietary recalls, for the Indigenous and non-Indigenous population in each time period. After matching, a generalized linear model was applied to test for differences in HEI between groups across time period, adjusting for household food security.

RESULTS

Overall, HEI scores were not significantly different for Indigenous men and women in 2015 as compared with 2004, but continued to be lower compared with those of the non-Indigenous population. Indigenous adults reported significantly lower diet quality independent of food security status and other factors. Scores pertaining to percent energy from 'other' foods improved in 2015 compared with 2004.

CONCLUSION

Dietary disparities persist between Indigenous and non-Indigenous populations. While addressing household food insecurity among Indigenous populations is necessary to improve diet quality, it is not sufficient. Results suggest that factors other than food insecurity and socio-economic status are impacting disparities in diet quality among Indigenous adults.

The Relationship between Adverse Family Experiences during Childhood and Self-rated Health Outcome in Adulthood

Although there is increasing evidence of a link between adverse family experiences (AFEs) and long-term health outcomes, few studies have investigated the role of educational attainment in the relationship between AFEs and adult health. The data of this study comes from the China Health and Retirement Longitudinal Study (CHARLS). Here, 15,359 samples were analyzed. Ordered logistic regression with interaction terms was used to explore the moderating effect of education on the relationship between AFEs in childhood and adult self-rated health. The self-rated health scores of people with childhood AFEs were significantly lower than of those without them, particularly in the categories of "parents divorced," "parent died," "physical abuse," "domestic conflict," "parental bias," "physical and emotional neglect," "parental physical illness," 'parental mental illness," "family economic hardship," "experience of starvation," "lived in an insecure neighborhood," and "lived in an unhygienic community." Increases in education level reduced the adverse effects of parental bias and neglect in childhood, but this did not eliminate the negative effect of community's environment on adult health. This study highlighted the role of the level of education in eliminating health disparities, which can reduce the adverse effects of AFEs on health in adulthood.

Going beyond risk factor: Childhood maltreatment and associated modifiable targets to improve life-long outcomes in mood disorders

Childhood maltreatment increases risk for mood disorders and is associated with earlier onset-and more pernicious disease course following onset-of mood disorders. While the majority of studies to date have been cross-sectional, longitudinal studies are emerging and support the devastating role(s) childhood maltreatment has on development of, and illness course in, mood disorders. This manuscript extends prior reviews to emphasize more recent work, highlighting longitudinal data, and discusses treatment studies that provide clues to mechanisms that mediate disease risk, course, relapse, and treatment response. Evidence suggesting systemic inflammation, alterations in hypothalamic-pituitary-adrenal (HPA) axis function and corticotropin-releasing factor (CRF) neural systems, genetic and other familial factors as mechanisms that mediate risk and onset of, and illness course in, mood disorders following childhood maltreatment is discussed. Risky behaviors following maltreatment, e.g., substance use and unhealthy lifestyles, may further exacerbate alterations in the HPA axis, CRF neural systems, and systematic inflammation to contribute to a more pernicious disease course. More research on sex differences and the impact of maltreatment in vulnerable populations is needed. Future research needs to be aimed at leveraging knowledge on modifiable targets, going beyond childhood maltreatment as a risk factor, to inform prevention and treatment strategies and foster trauma-informed care.

Patterns of polyvictimization predict stimulant use, alcohol and marijuana problems in a large cohort of sexual minority and gender minority youth assigned male at birth

OBJECTIVE

Men who have sex with men (MSM) and gender minorities (GM) are more likely to have substance problems and experience various forms of victimization compared to their heterosexual and cisgender counterparts. Polyvictimization allows for the assessment of the combined impact of multiple forms of victimization on health. This study examines the effects of polyvictimization patterns on stimulant use, alcohol and marijuana problems among a large cohort study.

METHOD

The sample was collected between 2015 and 2019 (n = 1,202). Mean age was 22. The sample was racially diverse (34.4% Black, 29.0% Hispanic/Latinx, 25.8% white, 5.9% other racial identity), 92.4% of the sample were MSM and 7.6% of the sample were GM. Using latent class analysis five qualitatively different polyvictimization classes were identified. Associations between these classes and stimulant use, alcohol and marijuana problems were examined using negative binomial and logistic regressions.

RESULTS

Polyvictimization class significantly predicted alcohol problems and cannabis problems, at baseline as well as methamphetamine, and cocaine use at both time points. The polyvictimization profiles that were characterized by intimate partner violence (IPV), childhood sexual abuse (CSA), and high victimization across types were associated with substance outcomes at baseline. The polyvictimization class that was characterized by report of IPV was associated with cocaine use at 6 month follow-up. The polyvictimization class that was characterized by CSA was associated with methamphetamine use at 6 month follow-up.

CONCLUSIONS

Researchers should examine the effects of victimization experiences more holistically and develop substance interventions that take multiple forms of victimization experiences into account. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD)

Early life trauma is a risk factor for many mental disorders; however, there is a lack of research exploring early life trauma in Premenstrual Dysphoric Disorder (PMDD), a debilitating form of Premenstrual Syndrome (PMS). This descriptive study aimed to determine the prevalence of early life trauma in women with PMDD and characterise type and age of trauma experience. Data for 100 women diagnosed with PMDD was extracted from the Monash Alfred Women's Mental Health Clinic Database. Experience of early life trauma was subclassified into four types (Physical abuse, sexual abuse, emotional abuse and/or neglect) and four age groups (0-5, 6-10, 11-14 and/or 15-18 years old). Prevalence of early life trauma was calculated and compared with Australian population estimates. Eighty-three percent of women with PMDD had experienced early life trauma, with emotional abuse being the most common (71%). All types of trauma were more common amongst PMDD women than the general Australian population. Trauma prevalence was similar across the four age groups, ranging from 59 to 66%. Of note, 51.8% women experienced trauma across all age groups. Our results suggest a strong association between early life trauma and PMDD. Emotional abuse and/or chronic trauma across childhood may be most strongly associated with PMDD.

COVID-19 epidemic-induced changes in mood and anxiety mediate the relationship between resilience and symptoms of depression and generalized anxiety in sexual assault survivors

Background

Sexual assault survivors are a vulnerable sub-population that might be severely affected by the COVID-19 pandemic, yet received little research attention during this global crisis. Higher levels of resilience are generally associated with lower symptoms of depression and anxiety and are thus considered as promoting adjustment to stress. Here, we tested the associations between resilience, depression, and anxiety symptoms among sexual assault survivors during the COVID-19 epidemic. Pandemic-induced changes in mood and anxiety were also examined as potential mediators of the relations between resilience and clinical symptoms of depression and anxiety.

Methods

At the pandemic onset, 83 sexual assault survivors (66 females, average age=37.68±10.90 years) undergoing treatment at a specialized psychiatric outpatient clinic completed a survey aimed at identifying patients in distress during the lockdown. The survey included a battery of questionnaires assessing resilience, pandemic-induced changes in mood and anxiety, and clinical symptoms of depression and generalized anxiety.

Results

Resilience scores were significantly negatively correlated with both depression and generalized anxiety symptoms. Furthermore, pandemic-induced changes in mood and anxiety significantly mediated these effects.

Limitations

Due to the cross-sectional study design, a temporal relationship between pandemic induced changes (mood and anxiety) and clinical symptoms (depression and generalized anxiety) could not be determined.

Conclusions

Our findings highlight the need to develop interventions for reducing situational changes in mood and anxiety during periods of acute stress, while increasing resilience factors, in order to decrease the burden of stress on sexual assault survivors’ mental health during the pandemic and beyond.

The COVID-19 pandemic: Adverse effects on the social determinants of health in children and families

OBJECTIVE

To describe the impact of social determinants on the experience of the coronavirus disease 2019 (COVID-19) pandemic within the pediatric population, how this impact may influence the long-term health and security of children, and what measures can be taken to ameliorate this impact moving forward.

DATA SOURCES

Nonsystematic review of relevant literature and news sources.

STUDY SELECTIONS

Relevant literature and news sources.

RESULTS

There have been increases in housing insecurity and food insecurity during the pandemic, including global increases in poverty. Public policies such as school closures have had a disproportionate impact on those facing adverse social determinants. There has been a dramatic increase in reports of abuse-related injuries and other injuries indicative of child abuse during the pandemic. In addition, there are disproportionate impacts of COVID-19 based on race and ethnicity within the United States. It is clear that children are facing more adverse determinants as a result of this pandemic and that there are both short-term and long-term implications associated. For those living in poverty or with other adverse social determinants of health, the pandemic has made a bad situation worse. Ongoing studies are required to measure the impact of COVID-19 on those with adverse social determinants, in particular among children.

CONCLUSION

Social determinants of health must be part of pandemic research priorities, public health and vaccination goals, and economic policy implementation. The impact of the COVID-19 pandemic has further served to shed a light on the broad disparities that exist within our society and their direct and indirect impacts on health outcomes.

Post-traumatic stress disorder, depression and the associated factors among children and adolescents with a history of maltreatment in Uganda

Worldwide, children who grow up under adverse conditions risk the development of mental health problems. However, reliable data on the estimated magnitude of mental disorders of PTSD, depression and their associated factors among maltreated children and adolescents in low- and middle-income-countries (LMICs) is still lacking. This study estimated the magnitude of PTSD, depression and the associated factors among the children and adolescents with ahistory of maltreatment in Southwestern Uganda.

METHODS

In this cross-sectional study, we assessed 232 children and adolescents on the prevalence of PTSD using Child PTSD Symptoms Scale for DSM-5 - Self-Report (CPSS-VSR) and Depression using the Center for Epidemiological Studies Depression Scale for Children (CES-DC). Predictor variables were taken from the Maltreatment and Abuse Chronology of Exposure- Paediatric Version (Pedi MACE). Logistic regressions analyses were selected for statistical modelling while odds-ratios were calculated to assess the strength of associations between the predictor and outcome variables.

RESULTS

In total, 140 (60%) participants fulfiled diagnostic criteria for PTSD and 91 (39%) for depression respectively. Predictor variables of PTSD were witnessing intimate partner violence (OR = 1.48, 95% CI: 1.19-1.83, p = <0.001), having lived in more than two homes (OR = 2.69, 95%CI: 1.34-5.41, p = .005), and being cared for by non-relatives (OR = 2.25; 95%CI: 2.26-223.9, p = .008). Variables predicting depression were witnessing intimate partner violence (OR = 1.30; 95%CI: 108-1.57, p = .006); being cared for by non-relatives (OR = 5.62, 95%CI: 1.36-23.1, p = .001) and being female (OR = .054, 95% CI: 0.30-1.00, p = .005).

CONCLUSION

Children living under adverse conditions are at a higher risk of developing PTSD and depression. We recommend interventions that aim at reducing adverse psychosocial stressors so as to improve or restore the children's mental health.Abbreviations: PTSD: Post traumatic stress disorder; LMICs: Low- and middle-income countries; IPV: Intimate partner violence; OVC: Orphans and vulnerable children.

Childhood Victimization and Neuroticism Mediate the Effects of Childhood Abuse on Adulthood Depressive Symptoms in Volunteers

BACKGROUND

When assessing patients with depressive and anxiety disorders in psychiatric clinical practice, it is common to encounter children and adolescents who have experienced abuse and victimization. To date, it has been clarified that experiences of "childhood abuse" and "childhood victimization" lead to "neuroticism", and that neuroticism leads to "adult depressive symptoms". In this study, we analyzed how these four factors are interrelated.

SUBJECTS AND METHODS

The following self-administered questionnaire surveys were conducted in 576 adult volunteers: Patient Health Questionnaire-9, Eysenck Personality Questionnaire-revised shortened version, Child Abuse and Trauma Scale, and Childhood Victimization Rating Scale. For statistical analysis, Pearson correlation coefficient analysis, t-test, multiple regression analysis, and covariance structure analysis (path analysis) were performed.

RESULTS

Path analysis showed that the indirect effects of childhood abuse and childhood victimization on depressive symptoms through neuroticism were statistically significant. In addition, the indirect effects of childhood abuse on neuroticism through childhood victimization were statistically significant. Finally, the indirect effects of childhood abuse on depressive symptoms through the combined paths of childhood victimization and neuroticism were statistically significant.

CONCLUSION

Our results suggest that "childhood abuse (A)" induces changes in the personality trait of "neuroticism (C)" with "childhood victimization (B)" as a mediator, and that these adversities affect the expression of "depressive symptoms in adulthood (D)" through "neuroticism (C)" as a mediator. In other words, to our knowledge, this is the first study to clarify that these four factors are not only individually associated with each other but also cause a chain reaction of A to B to C to D.

Design Strategies, Chemistry and Therapeutic Insights of Multi-target Directed Ligands as Antidepressant Agents

Depression is one of the major disorders of the central nervous system worldwide and causes disability and functional impairment. According to the World Health Organization, around 265 million people worldwide are affected by depression. Currently marketed antidepressant drugs take weeks or even months to show anticipated clinical efficacy but remain ineffective in treating suicidal thoughts and cognitive impairment. Due to the multifactorial complexity of the disease, single-target drugs do not always produce satisfactory results and lack the desired level of therapeutic efficacy. Recent literature reports have revealed improved therapeutic potential of multi-target directed ligands due to their synergistic potency and better safety. Medicinal chemists have gone to great extents to design multitarget ligands by generating structural hybrids of different key pharmacophores with improved binding affinities and potency towards different receptors or enzymes. This article has compiled the design strategies of recently published multi-target directed ligands as antidepressant agents. Their biological evaluation, structural-activity relationships, mechanistic and in silico studies have also been described. This article will prove to be highly useful for the researchers to design and develop multi-target ligands as antidepressants with high potency and therapeutic efficacy.

Physical Intimate Partner Violence, Childhood Physical Abuse and Mental Health of U.S. Caribbean Women: The Interrelationship of Social, Contextual, and Migratory Influences

The literature has shown an increased risk for mental health conditions among victims of domestic violence. Few studies have examined the relationship between mental health disorders and domestic violence among Caribbean women, and how the association might be influenced by migratory and contextual factors. This study addresses the mental well-being of U.S. Caribbean Black women victims of domestic violence, and the relationships between acculturation, discrimination, and demographic influences. An analysis of data from the 2001-2003 National Survey of American Life (NSAL) re-interview, the first and most complete study on U.S. Caribbean Blacks, was conducted. Bivariate analysis revealed an association between acts of physical domestic violence and mental health conditions, with generally higher risk among women who reported both severe physical intimate partner violence and childhood physical abuse. Multivariate logistic regression indicates an association between specific mental disorders and acts of domestic violence. Acculturation, length of residence in the United States, age, education, poverty, and country of origin were also associated with mental health. The study highlights future directions for exploration including additional investigation of the influence of acculturation on the physical health of victims of domestic violence.

Multimorbidity and polyvictimization in children - An analysis on the association of children's disabilities and long-term illnesses with mental violence and physical violence

BACKGROUND

Children's disabilities and long-term illnesses (DLTIs) are a significant risk factor in the development of maltreatment.

OBJECTIVE

The study is focused on the association of children's DLTIs with child maltreatment and poly-victimization perpetrated by parents.

PARTICIPANTS AND SETTING

The study is based on a 2013 Child Victim Survey (N = 11,364), which is a cross-sectional survey. This nationally representative survey focused on the life situation of Finnish children aged 12-17 years, as well as on experiences of violence, crime, and bullying.

METHODS

Multinomial logistic regression analysis was used to examine the association of children's DLTIs and child maltreatment.

RESULTS

Poly-victimization played a significant role in child maltreatment. Children's hearing impairment (OR 5.68, 95% Cl 2.25-14.35), physical disability (OR 3.32, 95% Cl 1.61-6.88), and mental health problems (OR 4.37, 95% Cl 1.63-11.72) increased the odds of poly-victimization more than other forms of abuse. The situation was similar with both somatic diseases (OR 1.59, 95% Cl 1.14-2.21) and psychiatric illnesses (OR 2.12, 95% Cl 1.36-2.47) in children. Further, somatic and psychiatric multimorbidity in children increased the odds of poly-victimization (OR 4.17, 95% Cl 2.25-7.75) slightly more than risk of physical abuse (OR 3.57, 95% 1.11-11.49). As control variables, child's gender and age, the family financial situation, and the parent's intimate partner violence were adjusted in all of the analyses.

CONCLUSION

Clinical professionals should consider children's multimorbidity as a potential risk factor of maltreatment. The results of the study can be used to support families and children with DLTIs.

Are Children With a Number of Disabilities and Long-Term Illnesses at Increased Risk of Mental Violence, Disciplinary Violence, and Serious Violence?

The focus of this study was on the question of whether or not children with a number of disabilities and long-term illnesses are at increased risk of child maltreatment (mental violence, disciplinary violence, and serious violence). This study was based on the Child Victim Survey of 2013 (FSD2943). The data consist of a nationally representative sample of pupils in Finland in sixth grade (12-13 years of age) and ninth grade (15-16 years of age). The sampling was undertaken as a stratified cluster by province, municipality type, and school size. The total number of respondents was 11,364. According to the logistic regression analyses, the children with at least three disabilities or long-term illnesses had an increased risk of violence compared with children with no disability: The risk of mental violence increased by 2.96 times, the risk of disciplinary violence by 4.30 times, and the risk of serious violence by 3.53 times. The effect of the category of at least three disabilities and illnesses remained statistically significant, although the analysis also accounted for several confounding factors. Thus, a child's multiple morbidity (in the case of three or more disabilities and illnesses) can be categorized as one of the major risk factors for child maltreatment. The study complements the results of previous studies concerning the effect of children's disabilities and long-term illnesses and their impact on child maltreatment. The results underline the importance of employees of health and social care having knowledge of multiple morbidity and its importance as a key factor regarding child maltreatment.

Adverse childhood experiences in relation to comorbid cardiovascular diseases and diabetes among middle-aged and old adults in China

AIM

To examine whether various aspects of adverse childhood experiences (ACEs) are associated with comorbid cardiovascular diseases (CVDs) and diabetes among middle-aged and old adults in China.

METHODS

Using the 2018 China Health and Retirement Longitudinal Study survey and the 2014 Life History survey, in total, 17 115 respondents aged ≥45 years were included. Logistic regressions were applied to estimate the relationship between aspects of ACEs and diagnosis of both CVDs and diabetes while adjusting for adulthood demographics, health and health behaviors.

RESULTS

Childhood hunger (OR = 1.75, P < 0.01), childhood socioeconomic status (OR = 1.45, P < 0.05) and abuse from father (OR = 1.50, P < 0.05) were significantly associated with greater odds of comorbid CVDs and diabetes above and beyond adulthood characteristics. In addition, the effects of these ACEs on comorbidity were stronger than their effects on the single chronic condition.

CONCLUSIONS

Our findings suggest that, for middle-aged and old Chinese adults, ACEs could have long-lasting impacts on multiple chronic conditions in later life. Public health interventions should focus on the early life stage as the protective childhood conditions might help in warning of later clustering chronic diseases. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; ••: ••-••.

Resilience of Adolescents Survivors of Domestic Violence: A Qualitative Study

BACKGROUND: The ability of adolescents to overcome the impact of domestic violence and reflect on the achievements is a form of resilience. AIM: The study explored an in-depth description of the discovery process of the resilience ability in adolescent survivors of domestic violence. METHODS: This qualitative research with a descriptive phenomenology approach interviewed seven adolescent survivors between the ages of 15 and 21. In-depth interviews were conducted, and demographic data were collected. Interviews were transcribed and coded thematically. Data was analyzed with the method of Colaizzi. RESULTS: Four themes were derived from the interviews, including painful words from the close family member as a form of intimidation; the emotional response as imprinted feeling caused by the domestic violence; self-struggle starts from their own; and the happiness of the close family member as the purpose of life. CONCLUSION: Adolescents responses to domestic violence cause mental health problems, however, they also manage to overcome problems, fulfill goals, and review their past and current life events to achieve life's purpose.

Risk-Taking Propensity and Sensation Seeking in Survivors of Adverse Childhood Experiences

Risk-taking propensity and sensation seeking are developmentally meaningful traits for emerging adults, individuals ages 18 to 25 years. Adverse childhood experiences (ACEs) of childhood abuse and neglect, exposure to domestic violence, residing with a substance abusing or mentally ill caregiver, and growing up with an incarcerated family member negatively impact the well-being of emerging adults. However, the specific association between ACEs and risk-taking propensity and sensation seeking has not been previously examined in this age group. This study aims to determine whether ACEs are individually or cumulatively related to risk-taking propensity (assessed by the Domain-Specific Risk-Taking Scale) and sensation seeking (assessed by the Behavior Inhibition System/Behavior Approach System Scales) in a diverse sample of undergraduates, n = 436; M_age = 19.73 years (SD = 1.83 years); 67% female; 22% Hispanic. Multivariate ordinary least squares regressions were run to examine the association between ACEs and risk-taking propensity and sensation seeking. Individually, emotional abuse predicted greater inhibition (B = .28, p < .001), growing up with a mentally ill family member (B = -.12, p < .05) and emotional neglect (B = -.13, p < .05) predicted reduced motivation to pursue rewarding cues, and emotional neglect (B = -.12, p < .05) and witnessing domestic violence (B = -.10, p < .05) predicted less reward responsiveness. No cumulative effects were found. ACEs related to environmental instability may have a unique impact on sensation seeking domains in emerging adults. Clarifying the role of sensation seeking in emerging adults can contribute to better understanding of risk and resilience factors in this vulnerable population.

History of abuse and psychogenic nonepileptic seizures: A systematic review

Psychogenic nonepileptic seizures resemble epileptic seizures but lack the physiological basis of epileptic seizures. We conducted a systematic review to explore whether childhood abuse is a risk factor for subsequent development of PNES. We reviewed only papers with an epilepsy control group, which employed strict criteria for diagnosis of epilepsy and well-validated tools for assessing abuse history. Odds ratios (ORs) for the different categories of childhood abuse and for childhood abuse as a whole were calculated where not previously available, and pooled ORs were calculated where suitable. In papers where OR could not be calculated data are presented as p values. Most Odds Ratios fell between 1.8 and 5.2 with relatively narrow confidence intervals. In 14 out of 18 calculations, 95% confidence intervals did not cross 1. This suggests that the chance of reporting abuse is higher in people with PNES than those with epilepsy and may be a causative factor in developing PNES. Several limitations of the data and directions for future study are discussed.

Experience of neighbourhood violence and mental distress in Brazilian favelas: a cross-sectional household survey

Background

Living in informal settlements with extensive neighbourhood violence has been shown to be linked with poorer mental health. However, there is little evidence as to whether different levels of personal experiences and fears of neighbourhood violence within such settlements affect mental health. This study assessed such personal experiences and fears of residents in favelas in Brazil. We tested whether variations predict mental health symptoms and quality of life, and whether this is independent of the influence of sociodemographic characteristics and poverty.

Methods

In a population-based survey of adults living in a group of favelas in Rio de Janeiro, Brazil, we assessed: sociodemographic characteristics; extent of personal experiences and fear of neighbourhood violence; mental health symptoms on the Brief Symptom Inventory; and quality of life on the Manchester Short Assessment of Quality of Life. Univariate and multivariate regressions were fit to predict mental health symptoms and quality of life.

Findings

We interviewed 1,211 residents. Both more experiences of neighbourhood violence and more fear of violence predicted higher levels of mental health symptoms and poorer quality of life. In multivariate regression analyses, the associations remained significant after adjusting for the influence of other factors, in particular female gender, younger age, and marked poverty.

Interpretation

Even within a context in which the whole population can be exposed to violence and economic disadvantage, individual variations in the experiences of violence still make a significant difference for mental distress and quality of life. Policies to improve mental health and quality of life of residents in informal settlements need to address risk factors separately, most importantly the personal experiences of violence and poverty.

Funding

Economic and Social Research Council and Arts and Humanities Research Council in the United Kingdom.

Antecedentes

Viver em assentamentos informais, com ampla violência na vizinhança, parece estar associado a piores condições de saúde mental. No entanto, há poucas evidências de que, nestes locais, os diferentes níveis de experiências pessoais e o medo da violência na vizinhança afetem a saúde mental. Este estudo avaliou experiências pessoais e medos de moradores de favelas no Brasil. Testamos se tais variações predizem sintomas de saúde mental e qualidade de vida, e se isso é independente da influência das características sociodemográficas e da pobreza.

Métodos

Com base em um inquérito domiciliar de base populacional, realizado com adultos residentes em um grupo de favelas do Complexo da Maré, Rio de Janeiro, Brasil, foram observadas: características sociodemográficas; a extensão das experiências pessoais de exposição à violência e o medo da violência na vizinhança; sintomas de saúde mental, a partir do Inventário de Sintomas Psicopatológicos (BSI); e qualidade de vida, a partir da escala Manchester Short Assessment of Quality of Life (MANSA). Regressões univariadas e multivariadas foram ajustadas para explicar variações nos sintomas de saúde mental e qualidade de vida.

Resultados

Entrevistamos 1.211 pessoa adultas residentes na Maré. Tanto maiores níveis de exposição a experiências de violência na vizinhança quanto mais medo dessa violência estiveram relacionados a piores níveis de saúde mental (maior número e intensidade de sintomas no BSI) e pior qualidade de vida. Nas análises de regressão multivariada, tais associações permaneceram significativas mesmo após controlarmos pela influência de outros fatores, em particular sexo (feminino), idade (mais jovem) e pobreza acentuada.

Interpretação

Mesmo em um contexto no qual toda a população pode estar exposta à violência e a desvantagens materiais e econômicas, as variações individuais nas experiências de violência ainda assim fazem diferença significativa nas condições de sofrimento mental e qualidade de vida. Políticas para melhorar a saúde mental e a qualidade de vida dos residentes de assentamentos informais, como as favelas, precisam abordar fatores de risco separadamente focando, principalmente, na redução da exposição a experiências pessoais de violência e da pobreza.

Financiamento

Economic and Social Research Council (ESRC) e Arts and Humanities Research Council (AHRC), ambos do Reino Unido.

'Distant socializing,' not 'social distancing' as a public health strategy for COVID-19

Social distancing, also referred to as physical distancing, means creating a safe distance of at least two meters (six feet) between yourself and others. This is a term popularized during the COVID-19 pandemic, as it is one of the most important measures to prevent the spread of this virus. However, the term 'social distancing' can be misleading, as it may imply that individuals should stop socializing. However, socializing in a safe context (i.e. over the phone, video-chat, etc.) is especially important during this time of crisis. Therefore, in this narrative review, we suggest the term 'distant socializing' as more apt expression, to promote physical distancing measures while also highlighting the importance of maintaining social bonds. Further, articles discussing the practice, implementation, measurement, and mental health effects of physical distancing are reviewed. Physical distancing is associated with psychiatric symptoms (such as anxiety and depression), suicidal ideation, and domestic violence. Further, unemployment and job insecurity have significantly increased during COVID-19, which may exacerbate these negative mental health effects. Governments, medical institutions, and public health bodies should therefore consider increasing mental health resources both during and after the pandemic, with a specific focus on frontline workers, COVID-19 survivors, and marginalized communities.

Evaluating the Cumulative Impact of Childhood Misfortune: A Structural Equation Modeling Approach

Most studies of the early origins of adult health rely on summing dichotomously measured negative exposures to measure childhood misfortune (CM), neglect, adversity, or trauma. There are several limitations to this approach, including that it assumes each exposure carries the same level of risk for a particular outcome. Further, it often leads researchers to dichotomize continuous measures for the sake of creating an additive variable from similar indicators. We propose an alternative approach within the structural equation modeling (SEM) framework that allows differential weighting of the negative exposures and can incorporate dichotomous and continuous observed variables as well as latent variables. Using the Health and Retirement Study data, our analyses compare the traditional approach (i.e., adding indicators) with alternative models and assess their prognostic validity on adult depressive symptoms. Results reveal that parameter estimates using the conventional model likely underestimate the effects of CM on adult health outcomes. Additionally, while the conventional approach inhibits testing for mediation, our model enables testing mediation of both individual CM variables and the cumulative variable. Further, we test whether cumulative CM is moderated by the accumulation of protective factors, which facilitates theoretical advances in life course and social inequality research. The approach presented here is one way to examine the cumulative effects of early exposures while attending to diversity in the types of exposures experienced. Using the SEM framework, this versatile approach could be used to model the accumulation of risk or reward in many other areas of sociology and the social sciences beyond health.

Correlates of Lifetime Physical Abuse Among Schoolchildren Aged 15 Years in Post-communist Albania

Aim: Our aim was to assess the prevalence and correlates of lifetime physical abuse among schoolchildren in Albania, a post-communist country in South Eastern Europe which is currently undergoing a rapid socioeconomic transition.

Methods: The third wave of Health Behavior in School-Aged Children (HBSC) in Albania was conducted in 2017–18 including a nationwide representative sample of 1,708 schoolchildren aged 15 years (54% girls; response rate: 95%). Children were asked to report on lifetime physical abuse and a wide range of socio-demographic factors, lifestyle factors and health status characteristics. Binary logistic regression was used to assess the independent association of lifetime physical abuse with covariates.

Results: Overall, the prevalence of lifetime physical abuse was about 32% (30% in boys vs. 32% in girls). In multivariable-adjusted logistic regression models, independent positive correlates of lifetime physical abuse among Albanian schoolchildren included lifetime smoking (OR = 1.5, 95% CI = 1.1–2.2), lifetime alcohol consumption (OR = 1.6, 95%CI = 1.2–2.1), irritability (OR_{[dailyvs.rarely/never]} = 2.0, 95%CI = 1.3–3.0), and especially lifetime witnessed domestic violence (OR = 4.2, 95%CI = 2.2–7.9). Conversely, a higher score on life satisfaction was inversely related to lifetime physical abuse (P < 0.01).

Conclusion: Our study provides novel evidence about the magnitude and selected independent correlates of lifetime physical abuse among schoolchildren in Albania, a country still embedded in an everlasting transition which is associated with tremendous changes in family structure, community links and societal norms and values. Irrespective of a wide range of sociodemographic factors and health characteristics, lifetime smoking, alcohol consumption, irritability, a lower score on life satisfaction and, particularly, witnessed domestic violence were strong and significant correlates of lifetime physical abuse among Albanian schoolchildren aged 15 years.

Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women With Early Life Abuse: A Randomized Controlled Trial

OBJECTIVE

Early life abuse (ELAb) initiates pathophysiological cascades resulting in long-term maladaptive stress responsivity, hyperalgesia, and an increased risk of psychopathology. Mindfulness-based stress reduction (MBSR) is effective in modifying psychological and somatic symptoms; thus, we predicted that MBSR would be particularly efficacious for women with ELAb.

METHOD

Medically healthy women (mean age = 31 years) with or without a history of early (≤13 years) physical or sexual abuse provided self-report measures and were tested in the laboratory before and after randomization to standard MBSR (n = 52) or social support (SSG) (n = 60) for 8 weeks. The laboratory procedure involved pain testing using the cold pressor and temporal summation of heat pain (indexing central sensitization) procedures, and exposure to the Trier Social Stress Test. Plasma cortisol in response to the experimental protocol was assessed as area under the curve (AUC).

RESULTS

The interventions differentially impacted pain sensitivity and cortisol AUC for women with ELAb, as MBSR increased the temporal summation of heat pain intensity ratings (p = .024) and reduced cortisol AUC (p = .004). For women without ELAb, MBSR decreased cold pressor tolerance (p = .045) and decreased the temporal summation of heat pain intensity ratings relative to SSG (p = .024). Both MBSR and SSG improved depression symptoms and emotion regulation abilities (p values < .001); however, MBSR was associated with greater benefits in describing emotions (p = .008) and impulse control (p = .017) for women with ELAb.

CONCLUSIONS

Women with ELAb benefited from MBSR-specific improvements in central sensitization, mindfulness skills, and emotion regulation abilities. This is the first study to examine the efficacy of MBSR in modifying affective and somatic symptoms based on ELAb status and provides evidence for considering ELAb in tailoring treatment approaches.Trial Registration: ClinicalTrials.gov Identifier: NCT01995916; https://clinicaltrials.gov/ct2/show/NCT01995916.

The prevalence and impact of maltreatment of child laborers in the context of four South Asian countries: A scoping review

BACKGROUND

Child maltreatment is a global health concern, which adversely affects millions of children. Among them, child laborers are highly susceptible to maltreatment due to their economic vulnerability and workplace practices.

OBJECTIVES

This review seeks to identify the extent, risk factors and psychological impairments associated with the maltreatment of child laborers in four South East Asian countries.

METHODS

A scoping review was adopted, in accordance with the PRISMA framework. Scopus, Medline, PsycINFO, ProQuest, Web of Sciences, and grey literature from relevant institutional websites were searched. Search date parameters were 1960-2020. A thematic synthesis and a proportion test were adopted to analyse data.

RESULTS

A total of 9 studies were retrieved. The physical maltreatment against child laborers (15.14 %) was found across all studies with high heterogeneity (from 2.3%-73.27%). The prevalence of emotional maltreatment was more than three times that of physical abuse. Sexual abuse rate was measured (16.82 %) followed by neglect against child laborers (12.9 %). Witness victimization, financial exploitation, forced work, and work intensification were also observed as notable forms of maltreatment. A thematic analysis suggests that the victims and caregivers' characteristics and socio-cultural practices are strong predictors of maltreatment. Parental dysfunctions were also associated with rates of child labor victimization followed by poverty. The review found maltreated children were often traumatized and manifest specific phobias (38.79 %), social phobias (30.2 %), conduct disorders (20.6 %), and obsessions (18.21 %), which are significantly associated (p < 0.05) across studies.

CONCLUSIONS

While the methodical study base is limited, the results of this review can inform further research on violence against child laborers.

Pocket ACE: Child sexual abuse survivors missed by the ACEs Study Questionnaire

BACKGROUND

A 1998 seminal study catapulted adverse childhood experiences (ACEs) into the zeitgeist and shaped assessment of these experiences and long-term health consequences via The ACEs Study Questionnaire (ACE-SQ). However, the ACE-SQ's childhood sexual abuse (CSA) item requires the perpetrator have been 5-years or older than the survivor for endorsement. This may not adequately capture CSA and limit the questionnaire's ability to detect survivors.

OBJECTIVE

This study assessed whether CSA survivors were missed by this 5-year modifier, whether service access was restricted, and whether those missed were at elevated risk for adverse outcomes.

PARTICIPANTS AND SETTING

A sample of 974 women (M_age = 30.46) completed an online survey.

METHODS

Histories of CSA were assessed using the original ACE-SQ and an alternative version without the 5-year modifier. Participants were grouped by endorsement (Modifier, No Modifier, No CSA) and compared across numerous physical and mental health outcomes using MANOVA, ANOVA, and logistic regression.

RESULTS

Numerous CSA survivors are presently missed by the 5-year modifier (n = 118 of N = 249). This group demonstrated the same elevated depression (t = 3.44, p = .002, d = 0.34), heightened somatic symptom burden (t = 3.34, p = .003, d = 0.35), and poorer subjective health (t = -2.86, p = .012, d = 0.27) as those captured by the modifier.

CONCLUSIONS

Recommendations for research, practice, and policy include removing the 5-year modifier from CSA assessment, creating an empirically informed CSA definition, and eliminating or adjusting requisite cut-scores for accessing services.

Anxiety among Lebanese adolescents: scale validation and correlates

BACKGROUND

The Lebanese population has undergone several conflicts and were the most afflicted by shelling and chaos during the civil war from 1975 to 1990, or even by displacement, bereavement, emigration, family separations, not to mention the economic crises that have hit the country since 2019 under which young adults are still succumbing. Our study aims to validate the Lebanese Anxiety Scale and assess correlates of anxiety among Lebanese adolescents.

METHODS

A cross-sectional study was carried between January and May 2019, using a proportionate random sampling of schools from all five Lebanese governorates, among which 1810 adolescents aged 14 to 17 years.

RESULTS

All LAS items remained in the model and formed one factor solution that explained 61.38% of the total variance (KMO = 0.873; p_{Bartlett test} < 0.001), with an excellent Cronbach's alpha of 0.93. Higher neglect (B = 0.38), insomnia (B = 0.21) and child psychological abuse (B = 0.08) were significantly associated with more anxiety. Those results were considered adjusted overall sociodemographic variables since the latter had no statistically significant association with anxiety.

CONCLUSION

The study confirmed the association between anxiety and some variables such as psychological child abuse, neglect, and insomnia and emphasized the correlation between anxiety and these factors. Further, the LAS appears to be a short, valid and efficient tool for assessing anxiety among Lebanese adolescents. Further studies need to be carried to evaluate whether the LAS-10 gives a similar diagnosis to psychiatrists.

Impact of childhood trauma on multidimensional frailty in older patients with a unipolar depressive-, anxiety- or somatic symptom disorder

OBJECTIVES

Frailty marks an increased risk for adverse health outcomes. Since childhood trauma is associated with the onset of physical and mental health diseases during the lifespan, we examined the link between childhood trauma and multidimensional frailty.

METHOD

A cross-sectional study embedded in a clinical cohort study (ROM-GPS) of older (≥60 years) patients (n=182) with a unipolar depressive-, anxiety- and/or somatic symptom disorder according to DSM-criteria referred to specialized geriatric mental health care. Frailty was assessed with the Tilburg Frailty Indicator (TFI), comprising a physical, psychological, and social dimension. Physical, sexual and psychological abuse and emotional neglect before the age of 16 years was measured with a structured interview.

RESULTS

Of 182 patients, 103 (56.6%) had experienced any childhood trauma and 154 (84.6%) were frail (TFI sum score ≥5). Linear regression analyses, adjusted for lifestyle, psychological and physical-health factors, showed that the presence of any type of childhood trauma was not associated with the TFI sum score, however when considered separately, physical abuse was (ß=0.16, p=.037). Regarding the specific frailty dimensions, any childhood trauma was associated with social frailty (ß=0.18, p=.019), with emotional neglect as main contributor.

CONCLUSION

These findings demonstrate a complex link between different types of childhood trauma and multidimensional frailty among older psychiatric patients. Regarding the three dimensions of frailty, social frailty seems most affected by childhood trauma. This may have been underestimated until now and should receive more attention in clinical care and future research.