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Giampetruzzi E, Tan AC, LoPilato A, Kitay B, Posse PR, McDonald WM, Hermida AP, Crowell A, Hershenberg R. The impact of adverse childhood experiences on adult depression severity and treatment outcomes. J Affect Disord 2023; 333:233-239. [PMID: 37086798 DOI: 10.1016/j.jad.2023.04.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Past research has established that adverse childhood experiences (ACE) are correlated with depression severity. The purpose of the present study was to examine how the number and nature of ACE exposure is associated with symptomatology and treatment outcomes in adult patients with treatment resistant depression (TRD). METHODS Participants include 454 patients with a diagnosis of major depression or persistent depressive disorder. A one-way analysis of variance (ANOVA) was used to assess whether number of ACEs was associated with certain outcomes. Linear regression analyses were performed to model the associations between the five ACE subtypes (e.g., sexual abuse, physical violence, injury/illness, childhood grief, and parental upheaval) and symptom severity. Logistic regression analyses were then used to model the association between ACE subtypes and history of lifetime suicide attempt(s) and inpatient admission(s). RESULTS Greater ACE exposure was associated with more severe symptomatology and treatment outcomes, but these differences were only seen between patients reporting no ACEs versus 3+ ACEs. Only the subtypes of violence and illness/injury were significant predictors of more severe symptomatology. The ACE subtypes of sexual trauma and violence uniquely predicted a lifetime suicide attempt(s), and only the subtype of sexual trauma predicted lifetime inpatient admission(s). LIMITATIONS Limitations of the present study include retrospective adult assessments of childhood trauma, lack of data on ACE severity and timing, and the cross-sectional reporting of multiple study measures. CONCLUSIONS Exposure to multiple ACE subtypes, particularly sexual and physical trauma, is associated with depression symptom severity, and history of suicidality, and inpatient admission(s).
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Affiliation(s)
- Eugenia Giampetruzzi
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America.
| | - Amanda C Tan
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
| | - Allison LoPilato
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
| | - Brandon Kitay
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
| | - Patricio Riva Posse
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
| | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
| | - Adriana P Hermida
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
| | - Andrea Crowell
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
| | - Rachel Hershenberg
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, United States of America
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Ewing-Cobbs L, Danna CV, Tolar TD, Granger D, Cox CS, Prasad MR. Stress Reactivity after Pediatric Traumatic Brain Injury: Relation with Behavioral Adjustment. J Neurotrauma 2023. [PMID: 36424831 DOI: 10.1089/neu.2022.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Traumatic injury is linked increasingly to alterations in both stress response systems and psychological health. We investigated reactivity of salivary analytes of the hypothalamic-pituitary-adrenal axis (cortisol) and autonomic nervous system (salivary alpha amylase, sAA) during a psychosocial stress procedure in relation to psychological health outcomes. In a prospective cohort design, stress reactivity of children ages 8 to 15 years hospitalized for traumatic brain injury (TBI; n = 74) or extracranial injury (EI; n = 35) was compared with healthy controls (n = 51) 7 months after injury. Area under the curve increase (AUCinc) assessed pre-stressor to post-stressor cortisol and sAA values. Multi-variable general linear models evaluated demographic, family functioning, group, cortisol, and sAA AUCinc, and their interactions in relation to concurrent child and parent ratings of emotion regulation and internalizing and externalizing problems. Although AUCinc values were similar across groups, their relations with outcomes varied by group. Higher stress reactivity is typically associated with fewer adjustment problems. Relative to controls, greater sAA reactivity was associated with greater emotion dysregulation after TBI. In contrast, the relation of sAA reactivity with internalizing and generalized anxiety scores was flatter for both TBI and EI groups. The flattened and/or reversed direction of sAA reactivity with psychological health outcomes after TBI, and to a lesser degree EI, suggests autonomic nervous system dysregulation. Across groups, sAA reactivity interacted with sex on several psychological health outcomes with greater dysregulation in girls than in boys. Our findings highlight altered sAA, but not cortisol reactivity, as a potential mechanism of biological vulnerability associated with poorer adjustment after TBI.
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Affiliation(s)
- Linda Ewing-Cobbs
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Christina V Danna
- Children's Learning Institute and Department of Pediatrics, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | | | - Douglas Granger
- Institute for Interdisciplinary Salivary Bioscience, University of California, Irvine, Irvine, California, and Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Charles S Cox
- Department of Pediatric Surgery, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Mary R Prasad
- McGovern School of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Ewing-Cobbs L, Montroy JJ, Clark AE, Holubkov R, Cox CS, Keenan HT. As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury. Front Neurol 2021; 12:687740. [PMID: 34290664 PMCID: PMC8287068 DOI: 10.3389/fneur.2021.687740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes. Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4-15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire. Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery. Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Janelle J. Montroy
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Amy E. Clark
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Richard Holubkov
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Charles S. Cox
- Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Heather T. Keenan
- Department of Pediatrics, Division of Critical Care, School of Medicine, University of Utah, Salt Lake City, UT, United States
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Anxiety Disorders in Adults With Childhood Traumatic Brain Injury: Evidence of Difficulties More Than 10 Years Postinjury. J Head Trauma Rehabil 2019; 33:191-199. [PMID: 28520662 DOI: 10.1097/htr.0000000000000312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore long-term psychiatric outcomes in individuals with a history of childhood traumatic brain injury (TBI) or orthopedic injury (OI). SETTING Hospital emergency department, medical admission records and outpatient settings. PARTICIPANTS There were 95 males (M = 22.78 years, SD = 3.44 years) and 74 females (M = 22.27 years, SD = 3.09 years), 65 with mild TBI (M = 23.25 years, SD = 3.58 years), 61 with moderate-severe TBI (M = 22.34 years, SD = 2.79 years), and 43 with OI (M = 21.81 years, SD = 3.36 years). DESIGN Longitudinal, between-subjects, cross-sectional design using retrospective and current data. MAIN MEASURES Semistructured interview to obtain psychiatric diagnoses and background information, and medical records for identification of TBI. RESULTS Group with moderate-severe TBI presented with significantly higher rates of any anxiety disorder (χ2 = 6.81, P = .03) and comorbid anxiety disorder (χ2 = 6.12, P < .05). Group with overall TBI presented with significantly higher rates of any anxiety disorder (χ1 = 5.36, P = .02), panic attacks (χ1 = 4.43, P = .04), specific phobias (χ1 = 4.17, P = .04), and depression (χ1 = 3.98, P < .05). Prediction analysis revealed a statistically significant model (χ7 = 41.84, P < .001) explaining 23% to 37% of the variance in having any anxiety disorder, with significant predictors being group (TBI) and gender (female). CONCLUSIONS Children who have sustained a TBI may be vulnerable to persistent anxiety, panic attacks, specific phobias, and depression, even 13 years after the injury event.
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Barker-Collo S, Theadom A, Jones K, Starkey N, Kahan M, Feigin V. Depression and anxiety across the first 4 years after mild traumatic brain injury: findings from a community-based study. Brain Inj 2018; 32:1651-1658. [DOI: 10.1080/02699052.2018.1540797] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Alice Theadom
- National Institute for Stroke and Applied Neuroscience, School of Public health & Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Kelly Jones
- National Institute for Stroke and Applied Neuroscience, School of Public health & Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Starkey
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Michael Kahan
- Waikato Occupational Services, Hamilton, Waikato District Health Board, New Zealand
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, School of Public health & Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
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Woolhouse R, McKinlay A, Grace RC. Women in Prison With Traumatic Brain Injury: Prevalence, Mechanism, and Impact on Mental Health. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:3135-3150. [PMID: 28831827 DOI: 10.1177/0306624x17726519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Relatively little is known about the characteristics of female offenders. Here, we studied the prevalence of traumatic brain injury (TBI) and mental health issues in an exclusively female prison population in New Zealand. Participants ( N = 38) were recruited from all security levels at Christchurch Women's Prison. Measures for depression, anxiety, and stress, sleep, and a history of TBI were administered; 94.7% (36/38) of participants presented with a history of TBI. Younger age at first injury was associated with an increased risk of mental health problems. The study concludes that TBI is highly prevalent among female offenders and may be linked to increased mental health problems. TBI should be considered as an important factor in offender pathways and treatment programs.
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Affiliation(s)
| | - Audrey McKinlay
- 1 University of Canterbury, Christchurch, New Zealand
- 2 The University of Melbourne, Australia
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Starkey NJ, Jones K, Case R, Theadom A, Barker-Collo S, Feigin V. Post-concussive symptoms after a mild traumatic brain injury during childhood and adolescence. Brain Inj 2018; 32:617-626. [PMID: 29446658 DOI: 10.1080/02699052.2018.1439533] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) is common injury during childhood and adolescence but the long-term outcomes are poorly understood. This study examined post-concussive symptoms and behavioural outcomes in children and adolescents up to 24 months post-mTBI. METHOD Parents of children aged 8-15 years with mTBI completed the BASC-2 and Rivermead Post-Concussion Symptoms Questionnaire at baseline, 1-, 6-, 12- and 24 months post-injury. An age-matched traumatic brain injury-free cohort was recruited and assessed at 12- and 24 months. RESULTS PCSs decreased significantly over the first 12 months post-injury. At 12- and 24 months post-injury, the mTBI group reported more PCSs and behavioural symptoms compared to controls. Parents of children with mTBI were more likely to report ≥4 problematic PCS symptoms (28% at both time points) compared to controls (7.7% and 1.7% at 12 and 24 months, respectively). The mTBI group was 4.63 times more likely to have four or more ongoing PCS symptoms at 12 months post-injury compared to controls. Headache was the most common acute post-injury symptom (55%), while the most commonly reported persistent symptoms were irritability, frustration, forgetfulness and fatigue. CONCLUSIONS PCSs are common 2 years post-mTBI in childhood or adolescence. Given this, additional intervention and support is needed for families post-injury.
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Affiliation(s)
- Nicola J Starkey
- a School of Psychology , University of Waikato , Hamilton , New Zealand
| | - Kelly Jones
- b National Institute for Stroke and Applied Neurosciences , AUT University , Auckland , New Zealand
| | - Rosalind Case
- c School of Psychology Counselling and Psychotherapy , Cairn Miller Institute , Melbourne , Australia
| | - Alice Theadom
- b National Institute for Stroke and Applied Neurosciences , AUT University , Auckland , New Zealand
| | | | - Valery Feigin
- b National Institute for Stroke and Applied Neurosciences , AUT University , Auckland , New Zealand
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Abstract
PURPOSE OF REVIEW The purpose of this study was to review the frequency, risk factors, phenomenology, and course of prolonged recovery from concussion and of psychiatric sequelae in pediatric populations. RECENT FINDINGS Youth with prolonged recovery from concussions have higher initial symptoms, a history of multiple and/or recent concussions, and a tendency to somatization. Depression, post-traumatic stress disorder, behavioral disorders, and perhaps, suicidal behavior disorder are more common as both short- and longer-term sequelae of concussions. The weight of evidence supports a graduated return to function as compared to prolonged rest, which may actually impede recovery. For those with prolonged recovery, cognitive behavior therapy aimed at education about concussions, improving coping, problem-solving, sleep hygiene, and dealing with anxiety and depression provided in a collaborative care model is superior to usual care. Concussed youth have an increased risk of psychiatric symptoms and sleep disturbance that can be prevented or treated with proper management.
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Affiliation(s)
- David A Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Room 311 Bellefield Towers, Pittsburgh, PA, 15213, USA. .,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Jeffrey Max
- Department of Psychiatry, University of California, San Diego, CA, USA.,Rady Children's Hospital, San Diego, CA, USA
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Albicini M, Eggleston M, McKinlay A. The prevalence of traumatic brain injury, comorbid anxiety and other psychiatric disorders in an outpatient child and adolescent mental health service. J Ment Health 2017; 29:439-445. [DOI: 10.1080/09638237.2017.1385733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michelle Albicini
- Faculty of Medicine Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Australia,
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia, and
| | - Matthew Eggleston
- Child and Family Specialty Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Audrey McKinlay
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia, and
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10
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Allely CS. Prevalence and assessment of traumatic brain injury in prison inmates: A systematic PRISMA review. Brain Inj 2016; 30:1161-80. [DOI: 10.1080/02699052.2016.1191674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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