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Zhu J, Exner-Cortens D, Dobson K, Wells L, Noel M, Madigan S. Adverse childhood experiences and intimate partner violence: A meta-analysis. Dev Psychopathol 2024; 36:929-943. [PMID: 37009672 DOI: 10.1017/s0954579423000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Intimate partner violence (IPV) represents a significant public health concern. Adverse childhood experiences (ACEs) represent one risk factor for IPV, however, the results of existing research on the association between ACEs and IPV demonstrate mixed findings. The present research sought to meta-analytically examine the association between ACEs and (a) IPV perpetration and (b) IPV victimization. Moderator analyses were conducted to determine factors that may impact the association between ACEs and IPV involvement. Electronic searches were conducted in MEDLINE, Embase, and PsycINFO in August of 2021. One-hundred and twenty-three records were screened for inclusion. All studies included a measure of ACEs and IPV victimization or perpetration. Among the 27 studies and 41 samples included in the meta-analysis, 65,330 participants were included. The results of the meta-analyses demonstrated that ACEs were positively associated with IPV perpetration and victimization. Significant methodological and measurement moderators further inform our understanding of ACEs and IPV involvement. The present meta-analyses demonstrates that trauma-informed approaches to IPV screening, prevention, and intervention may be useful, given that individuals who are involved with IPV may be more likely to possess a history of ACEs exposure.
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Affiliation(s)
- Jenney Zhu
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Deinera Exner-Cortens
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Keith Dobson
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Lana Wells
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Sheri Madigan
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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2
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Long T, Aggar C, Grace S. Trauma-informed care education for midwives: Does education improve attitudes towards trauma-informed care? Midwifery 2024; 131:103950. [PMID: 38359645 DOI: 10.1016/j.midw.2024.103950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/13/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Continuing education is important to improve midwives' attitudes to trauma-informed care in addressing the needs of women during the perinatal period. This study aimed to evaluate if there was a significant difference in attitudes towards trauma-informed care between midwives who participated in a 2-day trauma-informed care education program and those who did not. METHOD A static group comparison design was adopted with a convenience sample of midwives to analyse differences in attitudes towards trauma-informed care between midwives who received a 2-day TIC education (n = 19, intervention group) and their peers who did not receive the education (n = 18, comparison group). RESULTS The results suggest that midwives who participated in a 2-day trauma-informed care education program had significantly higher scores for positive attitudes towards trauma-informed care compared to those who did not take part in the program and that this effect was sustained at 6 months. CONCLUSION To minimise perinatal trauma for mothers and babies, midwives require specific trauma-informed care education. This study proposes that trauma-informed care education is a foundational pathway for implementing a trauma-informed care framework across a maternity service.
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Affiliation(s)
- Trish Long
- Northern NSW Local Health District, Australia.
| | - Christina Aggar
- Northern NSW Local Health District, Australia; Southern Cross University, Faculty of Health, Australia
| | - Sandra Grace
- Southern Cross University, Faculty of Health, Australia
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3
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Sosnowski DW, Rojo-Wissar DM, Peng G, Parade SH, Sharkey K, Hoyo C, Murphy SK, Hernandez RG, Johnson SB. Maternal Childhood Adversity and Infant Epigenetic Aging: Moderation by Restless Sleep During Pregnancy. Dev Psychobiol 2024; 66:e22464. [PMID: 38601952 PMCID: PMC11003750 DOI: 10.1002/dev.22464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 01/11/2024] [Indexed: 04/12/2024]
Abstract
Maternal exposure to childhood adversity is associated with detrimental health outcomes throughout the lifespan and may have implications for offspring. Evidence links maternal adverse childhood experiences (ACEs) to detrimental birth outcomes, yet the impact on the infant's epigenome is unclear. Moreover, maternal sleep habits during pregnancy may influence this association. Here, we explore whether restless sleep during pregnancy moderates the association between exposure to maternal childhood adversity and infant epigenetic age acceleration in 332 mother-infant dyads (56% female; 39% Black; 25% Hispanic). During the 2nd trimester, mothers self-reported childhood adversity and past-week restless sleep; DNA methylation from umbilical vein endothelial cells was used to estimate five epigenetic clocks. Multivariable linear regression was used to test study hypotheses. Despite no evidence of main effects, there was evidence of an interaction between maternal ACEs and restless sleep in predicting infant epigenetic age acceleration using the EPIC Gestational Age clock. Only infants whose mothers reported exposure to both ACEs and restless sleep demonstrated accelerated epigenetic aging. Results provide preliminary evidence that maternal childhood adversity and sleep may influence the infant epigenome.
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Affiliation(s)
- David W. Sosnowski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Darlynn M. Rojo-Wissar
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
- Bradley/Hasbro Children’s Research Center, E.P. Bradley Hospital
| | - Gang Peng
- Department of Medical & Molecular Genetics, Indiana University School of Medicine
| | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
- Bradley/Hasbro Children’s Research Center, E.P. Bradley Hospital
| | - Katherine Sharkey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
- Department of Medicine, The Warren Alpert Medical School of Brown University
| | - Cathrine Hoyo
- Department of Biological Sciences, Center for Human Health and the Environment North Carolina State University
| | - Susan K. Murphy
- Department of Obstetrics and Gynecology, Duke University School of Medicine
| | | | - Sara B. Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
- Department of Pediatrics, Johns Hopkins School of Medicine
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Ceballos NA, Watt TT. The Influence of Adverse Childhood Experiences on Malevolent Creativity in Young Adulthood. Behav Sci (Basel) 2023; 13:961. [PMID: 38131817 PMCID: PMC10740602 DOI: 10.3390/bs13120961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Childhood trauma may increase the risk of antisocial behavior in young adulthood. Our study examined the relationship between Adverse Childhood Experiences (ACEs) and the specific antisocial behavior of malevolent creativity (MC), the application of original ideas to purposely harm others, often to gain an unfair advantage through manipulation, threat, or harm. METHODS We surveyed college students (N = 524; 78% women) on demographics, ACEs, empathy, social support, coping, general creativity, and malevolent creativity. The data were analyzed via sequential linear regression models. RESULTS Reporting ≥ 4 ACEs was associated with increased MC, which remained significant when general creativity and demographics were controlled. The association between higher ACEs and MC was no longer significant when psychosocial control variables (social support, empathy, and coping) were included in the statistical model. Social support and empathy were negatively associated with MC, while coping and MC were positively associated. CONCLUSIONS ACEs may increase the likelihood of malevolent creativity in young adulthood, but empathy and social support may disrupt this trajectory. Care should be taken that coping skills, while typically viewed as a positive addition to one's behavioral repertoire, do not push individuals toward over-reliance on themselves, which may reduce prosocial behaviors and increase MC.
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Affiliation(s)
| | - Toni Terling Watt
- Department of Sociology, Texas State University, San Marcos, TX 78666, USA;
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Johnsen H, Juhl M, Rydahl E, Karentius SM, Rath SM, Friis-Alstrup M, Backhausen MG, Røhder K, Schiøtz ML, Broberg L, de Lichtenberg V. The Feasibility of the Adverse Childhood Experiences Questionnaire among Women in Danish Antenatal Care: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6601. [PMID: 37623184 PMCID: PMC10454047 DOI: 10.3390/ijerph20166601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
A traumatic upbringing increases the risks of antenatal health problems, unfavourable pregnancy outcomes, and mental disorders. Such childhood experiences may affect women's pa-renting skills and the social-emotional functioning of their children. Research on screening for adverse childhood experiences in antenatal care is limited. The objective of this study was to explore pregnant women's attitudes towards and experiences of an adverse childhood experiences questionnaire, and to assess the relevance of the questionnaire among a population of pregnant women referred to antenatal care levels one and two, targeting women who are generally not perceived to be vulnerable. Data were collected at three maternity wards and consisted of quantitative data on 1352 women's adverse childhood experience scores, structured observations of 18 midwifery visits, and in-depth interviews with 15 pregnant women. Quantitative data were analysed by descriptive statistics, and qualitative data were analysed using systematic text condensation. The qualitative analysis revealed two main categories: "Being screened for childhood adversities" and "Having adverse childhood experiences". In the study population, the prevalence of adverse childhood experiences was high. The women assessed the adverse childhood experiences questionnaire to be a relevant and acceptable screening method. Furthermore, women's perceptions of their relationship with their midwife greatly impacted their attitudes towards and experiences of the questionnaire.
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Affiliation(s)
- Helle Johnsen
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Mette Juhl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Eva Rydahl
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Sara Mbaye Karentius
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Sabine Marie Rath
- Department of Gynaecology and Obstetrics, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark;
| | | | - Mette Grønbæk Backhausen
- Department of Gynaecology and Obstetrics, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark;
| | - Katrine Røhder
- Department of Psychology, Copenhagen University, Øster Farimagsgade 2A, 1350 Copenhagen, Denmark;
- The Family Clinic, Department of Obstetrics and Gynaecology, Amager and Hvidovre Hospital, Pavillon 4, Østre Hospitalsvej 5A, 2650 Hvidovre, Denmark
| | - Michaela Louise Schiøtz
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark (L.B.)
| | - Lotte Broberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, The Capital Region of Denmark, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark (L.B.)
| | - Vibeke de Lichtenberg
- Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen, Denmark
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Amirazizi S, Dowdy E, Sharkey J, Barnett M. Considerations for conducting legal and ethical ACEs screening in schools. PSYCHOLOGY IN THE SCHOOLS 2023. [DOI: 10.1002/pits.22822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Samira Amirazizi
- Department of Counseling, Clinical, and School Psychology University of California Santa Barbara Santa Barbara California USA
| | - Erin Dowdy
- Department of Counseling, Clinical, and School Psychology University of California Santa Barbara Santa Barbara California USA
| | - Jill Sharkey
- Department of Counseling, Clinical, and School Psychology University of California Santa Barbara Santa Barbara California USA
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology University of California Santa Barbara Santa Barbara California USA
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7
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Gentry SV, Paterson BA. Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? A rapid evidence summary. J Public Health (Oxf) 2022; 44:810-822. [PMID: 34231848 DOI: 10.1093/pubmed/fdab238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are traumatic events in childhood that can have impacts throughout life. It has been suggested that ACEs should be 'screened' for, or routinely enquired about, in childhood or adulthood. The aim of this work is to review evidence for this against the United Kingdom National Screening Committee (UKNSC) programme criteria. METHODS A rapid review of evidence on ACEs screening was conducted using the approach of the UKNSC. RESULTS Good quality evidence was identified from meta-analyses for associations between ACEs and a wide range of adverse outcomes. There was no consistent evidence on the most suitable screening tool, setting of administration, and time or frequency of use. Routine enquiry among adults was feasible and acceptable to service users and professionals in various settings. A wide range of potentially effective interventions was identified. Limited evidence was available on the potential for screening or routine enquiry to reduce morbidity and mortality or possible harms of screening. CONCLUSIONS Based on the application of available evidence to UKNSC screening criteria, there is currently insufficient evidence to recommend the implementation of a screening programme for ACEs. Further research is needed to determine whether routine enquiry can improve morbidity, mortality, health and wellbeing.
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Affiliation(s)
- S V Gentry
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK.,Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - B A Paterson
- Public Health England East of England Centre, Fulbourn, Cambridge CB21 5XA, UK
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8
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Kemp L, Bruce T, Elcombe EL, Byrne F, Scharkie SA, Perlen SM, Goldfeld SR. Identification of families in need of support: Correlates of adverse childhood experiences in the right@home sustained nurse home visiting program. PLoS One 2022; 17:e0275423. [PMID: 36190969 PMCID: PMC9529103 DOI: 10.1371/journal.pone.0275423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/31/2022] [Indexed: 11/07/2022] Open
Abstract
Background Little is known about the efficacy of pregnancy screening tools using non-sensitive sociodemographic questions to identify the possible presence of as yet undiagnosed disease in individuals and later adverse childhood events disclosure. Objectives The study aims were to: 1) record the prevalence of risk disclosed by families during receipt of a sustained nurse home visiting program; and 2) explore patterns of relationships between the disclosed risks for their child having adverse experiences and the antenatal screening tool, which used non-sensitive demographic questions. Design Retrospective, observational study. Participants and methods Data about the participants in the intervention arm of the Australian right@home trial, which is scaffolded on the Maternal Early Childhood Sustained Home-visiting model, collected between 2013 and 2017 were used. Screening data from the 10-item antenatal survey of non-sensitive demographic risk factors and disclosed risks recorded by the nurse in audited case files during the subsequent 2 year intervention were examined (n = 348). Prevalence of disclosed risks for their child having adverse experiences were analysed in 2019 using multiple response frequencies. Phi correlations were conducted to test associations between screening factors and disclosed risks. Results Among the 348 intervention participants whose files were audited, 300 were noted by nurses to have disclosed risks during the intervention, with an average of four disclosures. The most prevalent maternal disclosures were depression or anxiety (57.8%). Mental health issues were the most prevalent partner and family disclosures. Screening tool questions on maternal smoking in pregnancy, not living with another adult, poverty and self-reporting anxious mood were significantly associated with a number of disclosed risks for their child having adverse experiences. Conclusions These findings suggest that a non-sensitive sociodemographic screening tool may help to identify families at higher risk for adverse childhood experiences for whom support from a sustained nurse home visiting program may be beneficial.
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Affiliation(s)
- Lynn Kemp
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- * E-mail:
| | - Tracey Bruce
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Emma L. Elcombe
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Fiona Byrne
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sheryl A. Scharkie
- School of Nursing and Midwifery, Western Sydney University, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Susan M. Perlen
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Sharon R. Goldfeld
- Population Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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9
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Ballard J, Turner L, Cuca YP, Lobo B, Dawson-Rose CS. Trauma-Informed Home Visiting Models in Public Health Nursing: An Evidence-Based Approach. Am J Public Health 2022; 112:S298-S305. [PMID: 35679545 PMCID: PMC9184900 DOI: 10.2105/ajph.2022.306737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/04/2022]
Abstract
Traumatic experiences can have significant health effects, particularly when they are experienced during childhood. Structural determinants of health including environmental disasters and limited access to mental health services and affordable housing can contribute additional stress for parents with a personal history of childhood adversity. These factors can directly affect their children, contributing to intergenerational trauma. Pregnant people and families with young children are often referred to public health nursing maternal and child home visiting (HV) programs when there are concerns about historical or evolving childhood trauma. The strict eligibility and participation requirements of existing evidence-based maternal and child HV programs can exclude families that have experienced or are experiencing childhood trauma and its effects and can limit innovation by public health nurses, a hallmark of the field. Therefore, we advocate and describe the implementation of the Trauma Informed Approach in Public Health Nursing (TIA PHN) model, which incorporates a trauma-informed approach into a traditional maternal and child HV program in 3 California counties. TIA PHN, which began enrollment in March 2021, involves public health nurses and community health workers and integrates program evaluations in pursuit of evidence-based status. (Am J Public Health. 2022;112(S3):S298-S305. https://doi.org/10.2105/AJPH.2022.306737).
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Affiliation(s)
- Julianne Ballard
- Julianne Ballard, Laura Turner, and Brittany Lobo are with the Sonoma County Department of Health Services, Santa Rosa, CA. Yvette P. Cuca and Carol S. Dawson-Rose are with the School of Nursing, University of California, San Francisco
| | - Laura Turner
- Julianne Ballard, Laura Turner, and Brittany Lobo are with the Sonoma County Department of Health Services, Santa Rosa, CA. Yvette P. Cuca and Carol S. Dawson-Rose are with the School of Nursing, University of California, San Francisco
| | - Yvette P Cuca
- Julianne Ballard, Laura Turner, and Brittany Lobo are with the Sonoma County Department of Health Services, Santa Rosa, CA. Yvette P. Cuca and Carol S. Dawson-Rose are with the School of Nursing, University of California, San Francisco
| | - Brittany Lobo
- Julianne Ballard, Laura Turner, and Brittany Lobo are with the Sonoma County Department of Health Services, Santa Rosa, CA. Yvette P. Cuca and Carol S. Dawson-Rose are with the School of Nursing, University of California, San Francisco
| | - Carol S Dawson-Rose
- Julianne Ballard, Laura Turner, and Brittany Lobo are with the Sonoma County Department of Health Services, Santa Rosa, CA. Yvette P. Cuca and Carol S. Dawson-Rose are with the School of Nursing, University of California, San Francisco
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10
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Kang NR, Kwack YS, Song JK, Kim MD, Park JH, Kim BN, Moon DS. The Impact of Maternal Adverse Childhood Experiences on Offspring's Internalizing and Externalizing Problems. Psychiatry Investig 2021; 18:1050-1057. [PMID: 34710961 PMCID: PMC8600217 DOI: 10.30773/pi.2021.0343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/27/2020] [Accepted: 08/02/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) are associated with negative physical and mental health outcomes across the lifespan, but research on intergenerational transmission of maternal ACEs and its impact on the offspring's mental health problems are limited. The study examines the effects of maternal ACEs on the risk of internalizing or externalizing problems among offspring. METHODS There were 450 mother-child dyads. Mothers completed the Adverse Childhood Experiences Questionnaire. The child outcomes included internalizing and externalizing problems assessed by the Korean Child Behavior Checklist (K-CBCL) and Korean Youth Self-Report (K-YSR), depression assessed by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) and anxiety assessed by the Screen for Child Anxiety Related Emotional Disorders (SCARED). RESULTS 36.1% of mothers experienced at least one ACE, and 11.1% experienced three or more ACEs. Cumulative maternal ACEs were associated with internalizing problems, externalizing problems, depression and anxiety in the offspring. Household dysfunction from maternal ACEs was significantly associated with delinquent behavior, anxiety/depression, and somatic complaints in the offspring. CONCLUSION The findings support the hypothesis that maternal ACEs are related to mental health problems in the offspring. Further research is needed to determine the factors mediating intergenerational transmission as well as intervention strategies to prevent ACEs and mental health problems in the offspring.
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Affiliation(s)
- Na Ri Kang
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Young Sook Kwack
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Republic of Korea
| | - Jeong-Kook Song
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Moon-Doo Kim
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Joon Hyuk Park
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Bung-Nyun Kim
- Department of Psychiatry, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Duk-Soo Moon
- Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
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11
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Long T, Aggar C, Grace S, Thomas T. Trauma informed care education for midwives: An integrative review. Midwifery 2021; 104:103197. [PMID: 34788724 DOI: 10.1016/j.midw.2021.103197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nearly half of new mothers describe their childbirth as traumatic. Perinatal trauma impacts both short and long-term biopsychosocial outcomes for mother and child. Midwife trauma-informed care education and practice is essential to mitigate this risk. OBJECTIVE This review aimed to identify and describe the nature and extent of trauma informed care education provided for midwives and midwifery students. DESIGN An integrative review. METHODS Five databases (Medline, Embase, CINAHL, Psycinfo, and Emcare) were searched to identify primary research regarding trauma informed care education for midwives and midwifery students. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. RESULTS Three papers were identified. None of the papers were midwifery focused, with midwives representing a small proportion of the participants. Most midwives reported receiving no previous trauma informed care education and lacked confidence to provide quality care to women with lived trauma. Midwives reported trauma informed care education as essential and relevant for providing quality practice. Improvements in knowledge, skills and attitudes was demonstrated following trauma informed care education. More in-depth content and content delivered in multiple ways were recommended. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Midwives are well placed to deliver trauma informed care. Trauma informed care education for midwives is limited. Given the impact of perinatal trauma, further trauma informed care education and research is paramount.
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Affiliation(s)
- Trish Long
- Northern New South Wales Local Health District, 89 Tamar St, Ballina NSW 2478 Australia.
| | - Christina Aggar
- Northern New South Wales Local Health District, 89 Tamar St, Ballina NSW 2478 Australia; Southern Cross University, School of Health & Human Sciences, School of Health & Human Sciences, Southern Cross Drive, Bilinga QLD 4225 Australia
| | - Sandra Grace
- Southern Cross University, School of Health & Human Sciences, School of Health & Human Sciences, Southern Cross Drive, Bilinga QLD 4225 Australia
| | - Tamsin Thomas
- Southern Cross University, School of Health & Human Sciences, School of Health & Human Sciences, Southern Cross Drive, Bilinga QLD 4225 Australia
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12
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Mishra K, Atkins DE, Gutierrez B, Wu J, Cousineau MR, Hempel S. Screening for adverse childhood experiences in preventive medicine settings: a scoping review. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01548-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Abstract
Aim
Adverse childhood experiences (ACEs) are associated with numerous adverse mental and physical health outcomes. While interest in routine screening for ACEs is growing, there is still significant opposition to universal screening. This review explores the feasibility of implementing routine screening for ACEs in primary care settings.
Subject and methods
We searched PubMed, CINAHL, and PsycINFO, reference-mined relevant reviews, and consulted with key experts (June 2020). Studies from 1970 to date evaluating screening for childhood trauma, adversity, and ACEs in a routine healthcare setting, reporting quantitative or qualitative data were eligible. The project is registered in Open Science Framework (osf.io/5wef8) and reporting follows PRISMA-ScR guidelines.
Results
Searches retrieved 1402 citations. Of 246 publications screened as full text, 43 studies met inclusion criteria. Studies evaluated provider burden, familiarity with ACEs, practice characteristics, barriers to screening, frequency of ACE inquiry, reported or desired training, patient comfort, and referrals to support services.
Conclusions
This review found that the following factors increase the likelihood that ACE screenings can be successfully integrated into healthcare settings: staff trainings that increase provider confidence and competence in administering screenings, accessible and robust mental health resources, and organizational support. Further research should examine the scalability and sustainability of universal screening.
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13
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Plamondon A, Racine N, McDonald S, Tough S, Madigan S. Disentangling adversity timing and type: Contrasting theories in the context of maternal prenatal physical and mental health using latent formative models. Dev Psychopathol 2021; 34:1-13. [PMID: 34016211 DOI: 10.1017/s0954579421000353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Research on the effects of adversity has led to mounting interest in examining the differential impact of adversity as a function of its timing and type. The current study examines whether the effects of different types (i.e., physical, sexual, and emotional abuse) and timing (i.e., early, middle childhood, adolescence, or adulthood) of adversity on maternal mental and physical health outcomes in pregnancy, are best accounted for by a cumulative model or independent effects model. Women from a prospective pregnancy cohort (N =3,362) reported retrospectively on their experiences of adversity (i.e., physical, sexual, and emotional abuse) in early childhood (0-5 years], middle childhood (6-12 years], adolescence (13-18 years], and adulthood (19+ years]. Measures of overall health, stress, anxiety, and depression were gathered in pregnancy. Results showed that a cumulative formative latent model was selected as more parsimonious than a direct effects model. Results also supported a model where the strength of the effect of adversity did not vary across abuse timing or type. Thus, cumulative adversity resulted in greater physical and mental health difficulties. In conclusion, cumulative adversity is a more parsimonious predictor of maternal physical and mental health outcomes than adversity at any one specific adversity timing or subtype.
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Affiliation(s)
- André Plamondon
- Department of Educational Fundamentals and Practices, Université Laval, Québec, Canada
| | - Nicole Racine
- Department of Psychology, Faculty of Arts, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Sheila McDonald
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Suzanne Tough
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sheri Madigan
- Department of Psychology, Faculty of Arts, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Canada
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Thomas-Giyer J, Keesler JM. Exploring maternal adversity and childhood outcomes among low-income rural families. CHILD ABUSE & NEGLECT 2021; 111:104817. [PMID: 33250276 DOI: 10.1016/j.chiabu.2020.104817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research has linked adversity among mothers to poorer outcomes among their offspring. However, additional inquiry is warranted particularly in rural communities where risk factors for adversity are prevalent. OBJECTIVE This study had two objectives: (1) to describe and compare relationships between individual and cumulative maternal adversity with childhood outcomes; and, (2) to determine if mother-child attachment mediated the relationship between maternal adversity and childhood outcomes. PARTICIPANTS AND SETTING A convenient sample of 140 women with low socio-economic status (SES) were recruited through Head Start programs in the rural Midwest. METHODS Data was gathered using a survey comprised of multiple measures to assess maternal adversity and childhood outcomes (i.e. behavior and attachment). Data were analyzed in SPSS using bivariate and multivariate analyses, including stepwise regression. RESULTS Nearly 80 % of respondents experienced at least one adverse childhood experience (ACE) and 48 % reported having one or more traumatic experiences. Higher levels of adversity were associated with increased attention problems, increased emotional reactivity, and decreased harmonious attachment (p < .05, d = 0.37-0.38). Maternal experiences of childhood physical abuse and sexual abuse, as well as witnessing trauma, significantly predicted childhood outcomes, however, the variance accounted for by each type of adversity was small (4%-6%). Maternal adversity was unrelated to mother-child attachment. CONCLUSIONS Low-SES mothers in rural communities have significant histories of adversity. It is important to consider individual and cumulative adverse experiences, as well as the mother's perception of events as traumatic. Factors associated with rural communities and Head Start programming, as well as implications for research and practice surrounding maternal adversity and childhood outcomes, are discussed.
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Affiliation(s)
- Jennifer Thomas-Giyer
- Indiana University Bloomington, School of Social Work, 1105 E. Atwater, Bloomington, IN, 47421, United States
| | - John M Keesler
- Indiana University Bloomington, School of Social Work, 1105 E. Atwater, Bloomington, IN, 47421, United States.
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Nidey N, Bowers K, Ammerman RT, Shah AN, Phelan KJ, Clark MJ, Van Ginkel JB, Folger AT. Combinations of adverse childhood events and risk of postpartum depression among mothers enrolled in a home visiting program. Ann Epidemiol 2020; 52:26-34. [PMID: 33010417 DOI: 10.1016/j.annepidem.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/30/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to examine how combinations of adverse childhood events (ACEs) contribute to the risk of postpartum depression and the mediating role of prenatal social support. METHODS The Adverse Childhood Experiences Scale Questionnaire and the Edinburgh Postnatal Depression Scale Questionnaire were used to measure the study's exposure and outcome. Among a cohort of 419 mothers enrolled in a home visiting (HV) program, latent class analyses were used to identify classes of ACEs exposure. General linear models assessed the risk of postpartum depression, and prenatal social support was examined as a mediator. RESULTS Four distinct classes of ACE exposure were identified. On the Edinburgh Postnatal Depression scale, mothers who were classified in Classes 1-3 scored higher by 2.6-4.4 points compared with women in Class 0. ACE class was found to be indirectly associated with postpartum depression scores through prenatal social support. CONCLUSIONS Identifying combinations of ACEs in an HV program has the potential to improve the characterization of ACEs among low-income perinatal women in the United States. Elucidating how these combinations contribute to the risk of postpartum depression has the potential to identify women at increased risk, which can help HV programs prioritize prevention efforts.
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Affiliation(s)
- Nichole Nidey
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katherine Bowers
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Robert T Ammerman
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH
| | - Anita N Shah
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kieran J Phelan
- The Permanente Medical Group, Kaiser Permanente Pediatrics, San Rafael, CA
| | - Margaret J Clark
- Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH
| | - Judith B Van Ginkel
- Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH
| | - Alonzo T Folger
- Cincinnati Children's Hospital Medical Center, Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Cincinnati Children's Hospital Medical Center, Every Child Succeeds Program, Cincinnati, OH.
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Rariden C, SmithBattle L, Yoo JH, Cibulka N, Loman D. Screening for Adverse Childhood Experiences: Literature Review and Practice Implications. J Nurse Pract 2020; 17:98-104. [PMID: 32963502 PMCID: PMC7498469 DOI: 10.1016/j.nurpra.2020.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Adverse childhood experiences (ACEs) are linked with negatively impacting child and adult health outcomes. Clinicians are integral in identifying childhood adversities and offering supportive measures to minimize negative effects. This systematic literature review included 13 ACE studies that examined the acceptability, feasibility, and implementation of ACE screenings from the perspectives of clinicians and patients. The findings of this review can assist clinicians in considering the appropriateness of ACE screenings for their patients and the ethical and practical issues that must be addressed for effective screening implementation.
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Merrick JS, Narayan AJ. Assessment and screening of positive childhood experiences along with childhood adversity in research, practice, and policy. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/10796126.2020.1799338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Merrick JS, Labella MH, Narayan AJ, Desjardins CD, Barnes AJ, Masten AS. The Child Life Challenges Scale (CLCS): Associations of a Single-Item Rating of Global Child Adversity with Children's Total Life Stressors and Parent's Childhood Adversity. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E33. [PMID: 32290263 PMCID: PMC7230288 DOI: 10.3390/children7040033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/18/2020] [Accepted: 04/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although many existing measures tabulate specific risk factors to yield cumulative risk indices, there is a need for low-burden strategies to estimate general adversity exposure. AIMS AND METHODS This study introduces a brief, new measure of lifetime adversity, the Child Life Challenges Scale (CLCS), and examines its validity in a sample of parents and children residing in emergency housing. The CLCS comprises a single global item for rating cumulative life challenges utilizing either a paper-pencil scale or a sliding scale on a tablet. Parents are provided with anchor examples of mild and extreme challenges and asked to mark a location along the scale reflecting number and severity of challenges in their children's lives to date. Study participants included 99 parents and their 3- to 6-year-old children. RESULTS CLCS scores were moderately associated with children's parent-reported total life stressors, and these associations were robust to controls for parental history of adversity, parental distress, and family demographics. Control variables also did not moderate associations between CLCS scores and total life stressors, suggesting that the CLCS functions similarly across a range of sociodemographic risk. Paper-pencil and tablet versions showed similar convergent validity. CONCLUSION The CLCS shows promise as an efficient measure for estimating children's lifetime adversity with minimal parent or administrator burden.
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Affiliation(s)
| | - Madelyn H. Labella
- Department of Psychology, University of Delaware, Newark, DE 19716, USA;
| | - Angela J. Narayan
- Department of Psychology, University of Denver, Denver, CO 80210, USA;
| | | | - Andrew J. Barnes
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Ann S. Masten
- Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, USA;
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Youth exposure to violence involving a gun: evidence for adverse childhood experience classification. J Behav Med 2019; 42:646-657. [PMID: 31367930 DOI: 10.1007/s10865-019-00053-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/30/2019] [Indexed: 01/13/2023]
Abstract
Adverse childhood experiences (ACEs) have historically included child maltreatment, household dysfunction, and other critical issues known to impact children negatively. Although youth experiences with violence are broadly captured in some ACE measures, youth exposure to violence involving a gun has not been included specifically in the operationalizing, and therefore scientific study, of ACEs. There are numerous implications of this omission, including limiting access to ACE interventions that are currently available and resources for individuals who have been exposed to gun violence. Thus, and given the persistent prevalence of gun violence in the US, we conducted a systematic review of the literature over the past two decades on the assessment of and response to ACEs and gun violence. Eighty-one journal articles across four search engines met our inclusion criteria. Our findings provide evidence that youth gun violence exposure should be classified as an ACE. In addition to increasing access to resources for youth affected by gun violence, these findings may improve the likelihood of funding and research into gun violence, with direct implications for prevention and intervention efforts.
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Ballard J, George L, Zazueta‐Lara E, Turner L, Aguado J, Law J, Alger R. Trauma informed public health nursing visits to parents and children. Public Health Nurs 2019; 36:694-701. [DOI: 10.1111/phn.12634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/22/2019] [Accepted: 06/10/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Julianne Ballard
- Department of Health Services Sonoma County Santa Rosa California
| | - Liz George
- Department of Health Services Sonoma County Santa Rosa California
| | - Eva Zazueta‐Lara
- Department of Health Services Sonoma County Santa Rosa California
| | - Laura Turner
- Department of Health Services Sonoma County Santa Rosa California
| | - Jesús Aguado
- Department of Health Services Sonoma County Santa Rosa California
| | - Jennifer Law
- Department of Health Services Sonoma County Santa Rosa California
| | - Renée Alger
- Department of Health Services Sonoma County Santa Rosa California
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Ford K, Hughes K, Hardcastle K, Di Lemma LCG, Davies AR, Edwards S, Bellis MA. The evidence base for routine enquiry into adverse childhood experiences: A scoping review. CHILD ABUSE & NEGLECT 2019; 91:131-146. [PMID: 30884399 DOI: 10.1016/j.chiabu.2019.03.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Exposure to adverse childhood experiences (ACEs; e.g., maltreatment, household dysfunction) is associated with a multiplicity of negative outcomes throughout the life course. Consequently, increasing interest is being paid to the application of routine enquiry for ACEs to enable identification and direct interventions to mitigate their harms. OBJECTIVE To explore the evidence base for retrospective routine enquiry in adults for ACEs, including feasibility and acceptability amongst practitioners, service user acceptability and outcomes from implementation. METHODS A scoping review of the literature was conducted, drawing upon three databases (CINAHL, MEDLINE, PsycINFO) and manual searching and citation tracking. Searches included studies published from 1997 until end of April 2018 examining enquiry into ACEs, or the feasibility/acceptability of such enquiry across any setting. All included studies presented empirical findings, with studies focusing on screening for current adversities excluded. RESULTS Searches retrieved 380 articles, of which 15 met the eligibility criteria. A narrative approach to synthesize the data was utilized. Four studies examined practitioner feasibility and/or acceptability of enquiry, three reported service user acceptability and six studies implemented routine ACE enquiry (not mutually exclusive categories). Further, eight studies explored current practice and practitioner attitudes towards ACE enquiry. CONCLUSIONS Limited literature was found providing evidence for outcomes from enquiry. No studies examined impacts on service user health or service utilization. Few studies explored feasibility or acceptability to inform the application of routine ACE enquiry. The implementation of routine ACE enquiry therefore needs careful consideration. Focus should remain on evaluating developing models of ACE enquiry to advance understanding of its impact.
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Affiliation(s)
- Kat Ford
- Public Health Collaborating Unit, College of Human Sciences, BIHMR, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Karen Hughes
- Public Health Collaborating Unit, College of Human Sciences, BIHMR, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK; Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
| | - Katie Hardcastle
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
| | - Lisa C G Di Lemma
- Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
| | - Alisha R Davies
- Research, Evaluation and Development Directorate, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
| | - Sara Edwards
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mark A Bellis
- Public Health Collaborating Unit, College of Human Sciences, BIHMR, Bangor University, Wrexham Technology Park, Wrexham, LL13 7YP, UK; Policy and International Development Directorate, a World Health Organization Collaboration Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, LL13 7YP, UK
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22
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Olsen JM. Integrative Review of Pregnancy Health Risks and Outcomes Associated With Adverse Childhood Experiences. J Obstet Gynecol Neonatal Nurs 2018; 47:783-794. [PMID: 30308147 DOI: 10.1016/j.jogn.2018.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To identify pregnancy risk factors and outcomes associated with a woman's history of adverse childhood experiences (ACEs) and summarize what is known about routine screening for ACEs as part of prenatal care. DATA SOURCES The Academic Search Premier, Academic Search Complete, CINAHL, Health Source: Nursing Academic Edition, MEDLINE, PsychINFO, and PubMed databases were searched. The terms adverse childhood experiences or ACEs, trauma informed care, and childhood trauma were each paired individually with the terms pregnancy or pregnant or prenatal or antenatal or perinatal or maternal; obstetrics; and maternal-child health. STUDY SELECTION Database and reference list searches resulted in 1,626 articles with 230 retained for full review and 17 included in the final sample. Studies were included if results were reported specific to pregnancy and ACEs as operationally defined in the ACE Study. DATA EXTRACTION Studies were evaluated for methodologic quality using Joanna Briggs Institute appraisal tools. Data were extracted with the matrix method. Tabular synthesis was used to cluster and compare findings and identify themes. DATA SYNTHESIS Five categories of pregnancy health risks and outcomes related to ACEs were identified: physiologic risk, psychologic risk, social risk, behavioral risk, and negative pregnancy outcomes. Limited research was found on routine screening for ACEs as part of prenatal care, but findings indicated women's support for ACE screening during prenatal appointments. CONCLUSION Routine prenatal ACE screening may be accepted by women and may help identify significant pregnancy health risks. This could provide opportunities for interventions that improve pregnancy outcomes. More research is needed to determine the most effective and efficient methods to screen pregnant women for ACEs and intervene for those with high screening scores. To optimally advance science in this area, conceptual and operational clarity in ACE research is important. Nurses should be at the forefront of these research and practice translation efforts.
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Wiehn J, Hornberg C, Fischer F. How adverse childhood experiences relate to single and multiple health risk behaviours in German public university students: a cross-sectional analysis. BMC Public Health 2018; 18:1005. [PMID: 30103728 PMCID: PMC6090638 DOI: 10.1186/s12889-018-5926-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/01/2018] [Indexed: 12/31/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) have been shown to be linked to health risk behaviours (HRBs). This study aims to identify risk factors for ACEs and to examine the associations between ACEs and single and multiple HRBs in a sample of university students in Germany. Methods An online-based cross-sectional study was conducted among public university students (N = 1466). The widely applied ACE questionnaire was used and extended to operationalise 13 categories of childhood adversity. First, variables for each type of ACE and HRB were dichotomised (single ACEs and single HRBs), and then used for cumulative scores (multiple ACEs and multiple HRBs). Frequencies were assessed, and (multinomial) logistic regression analyses were performed. Results Prevalence rates of ACEs ranged from 3.9 to 34.0%, depending on the type of childhood adversity. Sociodemographic risk and protective factors for single/multiple ACEs varied strongly depending on the outcome. In particular, a high family socioeconomic status seemed to be a consistent protective factor for most ACEs. After adjusting for sociodemographic characteristics, both single and multiple HRBs were associated with single events of ACEs. Moreover, dose-response relationships between multiple ACEs and various single and multiple HRBs were found. Conclusions The study provides strong evidence that ACEs are associated with HRBs. The number of ACEs may play a role in single or multiple HRBs. Reducing the number of ACEs could thus decrease HRBs, which account for many of the leading causes of morbidity and death. The findings highlight the importance of trauma-informed health interventions designed to prevent the occurrence of ACEs, and build capacity among children and adults. Electronic supplementary material The online version of this article (10.1186/s12889-018-5926-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jascha Wiehn
- Department of Public Health Medicine, School of Public Health, Bielefeld University, P.O. Box 100 131, 33501, Bielefeld, Germany
| | - Claudia Hornberg
- Department of Environment and Health, School of Public Health, Bielefeld University, P.O. Box 100 131, 33501, Bielefeld, Germany
| | - Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, P.O. Box 100 131, 33501, Bielefeld, Germany.
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