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Lu X, Li Z, Zhu X, Li D, Wei J. The Role of Alexithymia and Moral Disengagement in Childhood Physical Abuse and Depressive Symptoms: A Comparative Study Among Rural and Urban Chinese College Students. Psychol Res Behav Manag 2024; 17:3197-3210. [PMID: 39296528 PMCID: PMC11409930 DOI: 10.2147/prbm.s466379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 09/09/2024] [Indexed: 09/21/2024] Open
Abstract
Purpose There is robust evidence indicating the adverse association between childhood abuse and depressive symptoms. However, the ways in which childhood physical abuse is indirectly associated with adulthood depressive symptoms by alexithymia and moral disengagement remain poorly understood, particularly in the context of China. The present study aims to investigate how childhood physical abuse may be associated with depressive symptoms via the serial mediation effects of alexithymia and moral disengagement among college students in China. Methods A total of 686 college students (female: 53.2%) aged from 17 to 28 years old (M = 21.33; SD = 2.53) were recruited from mainland China to participate in an online survey assessing the variables of interest. Structural equation modeling and multiple group analysis were performed using Mplus 7.0 to investigate the hypothesized model. Results College students' experiences with childhood physical abuse was significantly associated with their depressive symptoms. This relationship was partially mediated by alexithymia and then by moral disengagement. Meanwhile, alexithymia and moral disengagement had a chain mediating effect on childhood physical abuse and depressive symptoms. Furthermore, multigroup analysis revealed that the association between alexithymia and depressive symptoms was stronger among rural students compared to urban students. Furthermore, the mediation model involving moral disengagement applies exclusively to rural students. Conclusion Alexithymia and moral disengagement exerted serial mediating effect on the association between childhood physical abuse and depressive symptoms. This pattern was particularly pronounced among rural students. These findings underscore the importance of addressing both childhood adversity and maladaptive cognitive processes in the prevention and treatment of depression.
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Affiliation(s)
- Xinyong Lu
- College of Economy and Trade, Zhongkai University of Agriculture and Engineering, Guangzhou, Guangdong, People's Republic of China
| | - Zixuan Li
- Peking University, School of Psychological and Cognitive Sciences, Beijing, People's Republic of China
| | - XianFeng Zhu
- University of Macau, Faculty of Education, Macau, People's Republic of China
| | - Dong Li
- Department of International Culture Education, Chodang University, Muan, Republic of Korea
| | - Jiahui Wei
- College of Economy and Trade, Zhongkai University of Agriculture and Engineering, Guangzhou, Guangdong, People's Republic of China
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Idini E, Paredes-Carreño P, Navarro-Gil M, Barceló-Soler A, Valera-Ceamanos D, Garcia-Campayo J. "Age of traumatic experience as a predictor of distorted body image in patients with eating disorders". Clin Child Psychol Psychiatry 2024; 29:1043-1057. [PMID: 38696812 DOI: 10.1177/13591045241251902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The timing of trauma exposure is a risk factor for the development of psychopathology in adulthood. We aim to assess the presence of adverse life events (ALEs) before age 13 in patients with eating disorders (ED). Specifically, we examined the relationship between exposure to interpersonal trauma before the age of 13 and body image distortion (BID), impulsivity, and perfectionism. We conducted a cross-sectional, retrospective study in which 79 outpatients with ED were consecutively enrolled. Assessment was performed using the Traumatic Life Event Questionnaire, Contour Drawing Rating Scale, and Eating Disorder Inventory. Linear regression models were used to analyze the predictive role of interpersonal trauma before age 13 on BID perfectionism and impulsivity. Seventy-two patients (91.1%) reported ALEs throughout their lives. Patients with trauma before age 13 (55.6%) overestimated their shape. Patients with ED and bulimic symptoms had significantly higher BID levels. Interpersonal trauma predicted higher levels of impulsivity and perfectionism. Experiencing interpersonal ALEs before age 13 may be a risk factor for the development of BID, impulsivity, and perfectionism in adulthood. Body image can be modified during childhood through interventions focused on identifying stressful relationships.
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Affiliation(s)
- Ester Idini
- Psychiatric Department, Miguel Servet Hospital, Spain
| | | | - Mayte Navarro-Gil
- Department of Psychology and Sociology, University of Zaragoza, Spain
| | - Alberto Barceló-Soler
- Department of Psychology and Sociology, University of Zaragoza, Spain
- Aragón Institute for Health Research (IIS Aragón), Spain
| | | | - Javier Garcia-Campayo
- Psychiatric Department, Miguel Servet Hospital, Spain
- Mindfulness Master Coordinator, University of Zaragoza, Spain
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3
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Chen S, Fu T, Wang Y, Sun G. Childhood trauma, psychache, and depression among university students: a moderated mediation model. Front Psychiatry 2024; 15:1414105. [PMID: 38979495 PMCID: PMC11228253 DOI: 10.3389/fpsyt.2024.1414105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Background Childhood trauma is a potential threat to depression and can have a lifelong impact on the mental health of university students. Our study aimed to construct a moderated mediation model to explore the relationship between childhood trauma, psychache, ambivalence over emotional expression, physical activity, and depression in university students. Methods A cross-sectional study was conducted in three universities in China, recruiting 476 university students using self-report questionnaires. The moderated mediation model was examined using the SPSS PROCESS model 21. Results Ambivalence over emotional expression (F=12.843), childhood trauma (F=117.639), and psychache (F=581.594) all had a significant positive effect on depression (p<0.001), explaining 2.9%, 21.7%, and 56.8% of the variance, respectively. On the chain of influence between childhood trauma and depression, the mediating effect of psychache, the moderating effect of ambivalence over emotional expression, and the moderating effect of physical activity are all significant the overall indirect effect value of the three is 0.287, accounting for 61.59% of the total effect. Conclusion This study investigated the relationship between childhood trauma, ambivalence over emotional expression, psychache, physical activity, and depression in university students. Future interventions should focus on developing good emotional expression among university students, increasing opportunities for physical activity, and reducing psychache to reduce depression.
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Affiliation(s)
- Shufeng Chen
- School of Physical Education, Shandong University, Jinan, China
| | - Tiantian Fu
- School of Physical Education, Shandong University, Jinan, China
| | - Yiwen Wang
- School of Physical Education, Shandong University, Jinan, China
| | - Guoxiao Sun
- School of Physical Education, Shandong University, Jinan, China
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Rowland GE, Purcell JB, Lebois LM, Kaufman ML, Harnett NG. Child sexual abuse versus adult sexual assault: A review of psychological and neurobiological sequelae. MENTAL HEALTH SCIENCE 2024; 2:e51. [PMID: 39006552 PMCID: PMC11244653 DOI: 10.1002/mhs2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 07/16/2024]
Abstract
Sexual trauma (ST) occurs with alarming frequency in the United States (U.S.) in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well-established that the effects of ST are pervasive, and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.
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Affiliation(s)
- Grace E Rowland
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
| | - Juliann B Purcell
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Lauren M Lebois
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Milissa L Kaufman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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Lawrence-Sidebottom D, Huffman LG, Beam AB, Guerra R, Parikh A, Roots M, Huberty J. Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time. JMIR Pediatr Parent 2024; 7:e55560. [PMID: 38412001 PMCID: PMC10933721 DOI: 10.2196/55560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. OBJECTIVE This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non-posttraumatic DMHI is linked to reductions in PTS symptoms. METHODS This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children's trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. RESULTS Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. CONCLUSIONS This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment.
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Affiliation(s)
| | | | | | | | | | | | - Jennifer Huberty
- Bend Health Inc, Madison, WI, United States
- FitMinded Inc LLC, Phoenix, AZ, United States
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Roché S, Kearns H, Brindle RC. Testing adverse childhood experiences (ACEs) as a potential moderator of the association between current chronic stress and cardiovascular reactivity. Int J Psychophysiol 2023; 193:112245. [PMID: 37730123 DOI: 10.1016/j.ijpsycho.2023.112245] [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: 05/23/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
Motivated by mixed findings regarding the relationship between chronic stress and cardiovascular reactivity, the current study aimed to investigate whether adverse childhood experiences (ACEs) serve as a potential moderator of the association between current chronic stress and cardiovascular reactivity. Incidence of ACEs, levels of current chronic stress, and heart rate (HR) reactivity to a mental arithmetic stress task were measured in 111 participants (age = 20.83, 76 % female, 66 % White). ACEs were measured using the Childhood Trauma Questionnaire and current chronic stress was measured using the Perceived Stress Scale. Moderation analyses were conducted with HR reactivity as the outcome and ACEs as the moderator. Results indicated that a greater amount of current chronic stress was significantly associated with relatively blunted HR reactivity (β = -0.25, p = 0.03) even after controlling for sociodemographic variables. Exposure to ACEs was not significantly related to HR reactivity, (all p ≥ 0.66), and there was no significant interaction between current chronic stress and ACE exposure in predicting HR reactivity, (all p ≥ 0.44). These results show that current chronic stress is associated with relatively blunted HR reactivity and that exposure to ACEs does not moderate the relationship between chronic stress and cardiac stress reactivity.
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Affiliation(s)
- Sophia Roché
- Department of Biology, Washington and Lee University, USA
| | - Hannah Kearns
- Department of Cognitive and Behavioral Science, Washington and Lee University, USA
| | - Ryan C Brindle
- Department of Cognitive and Behavioral Science, Neuroscience Program, Washington and Lee University, USA.
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Luk JW, Leiter N, Axelowitz JC, Stangl BL, Melendez CR, Schwandt ML, Gunawan T, Goldman D, Diazgranados N, Ramchandani VA. Effects of clustering and timing of early life stress exposure on mood problems, ADHD symptoms, and problematic drinking. J Psychiatr Res 2023; 166:130-138. [PMID: 37769594 PMCID: PMC10686194 DOI: 10.1016/j.jpsychires.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/14/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Exposure to early life stress (ELS) may lead to long-term health consequences. The Early Life Stress Questionnaire (ELSQ) is a retrospective measure of multiple ELS and their timing. Latent class analysis (LCA) has not been applied to the ELSQ and questions regarding timing are rarely explored. This study examined the effects of clustering and timing of ELS exposure on internalizing and externalizing symptoms. METHOD Data from 1095 participants in the NIAAA Natural History Protocol were analyzed. LCA was conducted on 18 ELS items. Regression and correlational analyses examined associations of latent classes with sociodemographic variables and clinical outcomes. RESULTS LCA revealed three classes: Class 1: Minimal ELS (54.2%), Class 2: Moderate ELS (33.2%), and Class 3: Multiple and High ELS (12.6%). Black/African American participants were more likely to be in Class 2, and participants with low household income were more likely to be in Classes 2 and 3. Family history of problematic alcohol use and individual alcohol use disorder diagnosis were linked to Classes with higher ELS exposure. Compared with Class 1, Class 2 reported higher anxiety symptoms, depressive symptoms, ADHD symptoms, and problematic drinking, and Class 3 reported the highest levels across all these outcomes. Regarding timing, earlier exposure to ELS (e.g., sustained family conflict and witnessed domestic violence) was associated with higher psychopathological symptoms. CONCLUSIONS The ELSQ can effectively capture clustering and timing of exposure to multiple ELS. Greater and earlier exposure to ELS were positively associated with internalizing and externalizing symptoms, underscoring the need for early and well-timed intervention.
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Affiliation(s)
- Jeremy W Luk
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
| | - Noa Leiter
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Jared C Axelowitz
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Bethany L Stangl
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Carlos R Melendez
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Tommy Gunawan
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA; Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA; Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA
| | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Vijay A Ramchandani
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
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Associação entre a violência intrafamiliar experienciada e transtorno mental comum em adolescentes. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao02391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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9
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Dark HE, Harnett NG, Hurst DR, Wheelock MD, Wood KH, Goodman AM, Mrug S, Elliott MN, Emery ST, Schuster MA, Knight DC. Sex-related differences in violence exposure, neural reactivity to threat, and mental health. Neuropsychopharmacology 2022; 47:2221-2229. [PMID: 36030316 PMCID: PMC9630543 DOI: 10.1038/s41386-022-01430-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 02/06/2023]
Abstract
The prefrontal cortex (PFC), hippocampus, and amygdala play an important role in emotional health. However, adverse life events (e.g., violence exposure) affect the function of these brain regions, which may lead to disorders such as depression and anxiety. Depression and anxiety disproportionately affect women compared to men, and this disparity may reflect sex differences in the neural processes that underlie emotion expression and regulation. The present study investigated sex differences in the relationship between violence exposure and the neural processes that underlie emotion regulation. In the present study, 200 participants completed a Pavlovian fear conditioning procedure in which cued and non-cued threats (i.e., unconditioned stimuli) were presented during functional magnetic resonance imaging. Violence exposure was previously assessed at four separate time points when participants were 11-19 years of age. Significant threat type (cued versus non-cued) × sex and sex × violence exposure interactions were observed. Specifically, women and men differed in amygdala and parahippocampal gyrus reactivity to cued versus non-cued threat. Further, dorsolateral PFC (dlPFC) and inferior parietal lobule (IPL) reactivity to threat varied positively with violence exposure among women, but not men. Similarly, threat-elicited skin conductance responses varied positively with violence exposure among women. Finally, women reported greater depression and anxiety symptoms than men. These findings suggest that sex differences in threat-related brain and psychophysiological activity may have implications for mental health.
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Affiliation(s)
- Heather E Dark
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Nathaniel G Harnett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Danielle R Hurst
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muriah D Wheelock
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Radiology, Washington University in St. Louis, St Louis, MO, USA
| | - Kimberly H Wood
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, Samford University, Homewood, AL, USA
| | - Adam M Goodman
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Sylvie Mrug
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Susan Tortolero Emery
- Texas Prevention Research Center, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Mark A Schuster
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - David C Knight
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Schaefer JD, Cheng TW, Dunn EC. Sensitive periods in development and risk for psychiatric disorders and related endpoints: a systematic review of child maltreatment findings. Lancet Psychiatry 2022; 9:978-991. [PMID: 36403600 PMCID: PMC10443538 DOI: 10.1016/s2215-0366(22)00362-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/19/2022]
Abstract
Variation in the mental health of people who have experienced childhood maltreatment is substantial. One hypothesis is that this variation is attributable, in part, to the timing of maltreatment-specifically, whether maltreatment occurs during sensitive periods in development when the brain is maximally sensitive to particular types of environmental input. To determine whether there is scientific consensus around when periods of peak sensitivity occur, we did a systematic review of human observational studies. Although 89 (75%) of the 118 unique cross-sectional or longitudinal cohort studies we identified reported timing effects, no consistent sensitive periods were identified for any of the most studied outcomes. Thus, observational research on childhood maltreatment has yet to converge on a single period (or set of periods) of increased vulnerability. We identified study characteristics that might contribute to these between-study differences and used observations from our Review to suggest a comprehensive set of recommendations for future research.
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Affiliation(s)
| | - Theresa W. Cheng
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Center on the Developing Child, Harvard University, Cambridge, MA, USA
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Seitz KI, Gerhardt S, von Schroeder C, Panizza A, Thekkumthala D, Bertsch K, Herpertz SC, Schmahl C, Schalinski I. Measuring types and timing of childhood maltreatment: The psychometric properties of the KERF-40+. PLoS One 2022; 17:e0273931. [PMID: 36074774 PMCID: PMC9455860 DOI: 10.1371/journal.pone.0273931] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022] Open
Abstract
Childhood maltreatment, specifically during sensitive developmental periods, is a major risk factor for poor physical and mental health. Despite its enormous clinical relevance, there is still a lack of scales measuring different types, timing, and duration of childhood maltreatment. The current study sought to validate and determine the psychometric properties of the brief German version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale, the KERF-40. The KERF-40 was administered as an interview (i.e., KERF-40-I) to 287 adult participants with and without mental disorders. Based on item response theory, items of the KERF-40-I were assigned to different types of maltreatment, resulting in a scaled version, the KERF-40+. Test-retest reliability was assessed in a small subsample (n = 14). Convergent and relative predictive validity were measured with correlations of the KERF-40+ and the Childhood Trauma Questionnaire (CTQ) as well as self-report measures of general and trauma-related psychopathology. Rasch analysis and fit statistics yielded a 49-item version, encompassing ten different types of maltreatment. The test-retest reliability of the KERF-40+ was shown to be acceptable to excellent for almost all global and subscale scores (.74 ≤ ρ ≤ 1.00), with the exception of the subscale emotional neglect (ρ = .55). Convergent validity with the CTQ was confirmed for both KERF-40+ global scores (.72 ≤ r ≤ .87) and corresponding subscale scores (.56 ≤ r ≤ .78). Relative predictive validity was reflected by significant small-to-moderate correlations between KERF-40+ global scores and indices of general and trauma-related psychopathology (.24 ≤ r ≤ .45). Taken together, the KERF-40+ appears to be suited for clinicians and researchers interested in retrospectively assessing different types, timing, and duration of childhood maltreatment experiences during sensitive periods in adults.
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Affiliation(s)
- Katja I. Seitz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Claudius von Schroeder
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Angelika Panizza
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | | | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Inga Schalinski
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Psychologische Hochschule Berlin, Berlin, Germany
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12
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Martins J, Yusupov N, Binder EB, Brückl TM, Czamara D. Early adversity as the prototype gene × environment interaction in mental disorders? Pharmacol Biochem Behav 2022; 215:173371. [PMID: 35271857 DOI: 10.1016/j.pbb.2022.173371] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
Childhood adversity (CA) as a significant stressor has consistently been associated with the development of mental disorders. The interaction between CA and genetic variants has been proposed to play a substantial role in disease etiology. In this review, we focus on the gene by environment (GxE) paradigm, its background and interpretation and stress the necessity of its implementation in psychiatric research. Further, we discuss the findings supporting GxCA interactions, ranging from candidate gene studies to polygenic and genome-wide approaches, their strengths and limitations. To illustrate potential underlying epigenetic mechanisms by which GxE effects are translated, we focus on results from FKBP5 × CA studies and discuss how molecular evidence can supplement previous GxE findings. In conclusion, while GxE studies constitute a valuable line of investigation, more harmonized GxE studies in large, deep-phenotyped, longitudinal cohorts, and across different developmental stages are necessary to further substantiate and understand reported GxE findings.
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Affiliation(s)
- Jade Martins
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich 80804, Germany.
| | - Natan Yusupov
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich 80804, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich 80804, Germany; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Tanja M Brückl
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich 80804, Germany
| | - Darina Czamara
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich 80804, Germany
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Keenan K, Fu H, Tung I, Berona J, Krafty RT, Hipwell AE, Stepp SD, Carpio K. Capturing the dynamic nature of stress exposure in the Pittsburgh Girls Study. SSM Popul Health 2021; 16:100983. [PMID: 34950762 PMCID: PMC8671117 DOI: 10.1016/j.ssmph.2021.100983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background The science of stress exposure and health in humans has been hampered by differences in operational definitions of exposures and approaches to defining timing, leading to results that lack consistency and specificity. In the present study we aim to empirically derive variability in type, timing and chronicity of stress exposure for Black and White females using prospectively collected data in the Pittsburgh Girls Study (PGS). Methods The PGS is an ongoing 20-year longitudinal, community-based study. In this paper we focused on annual caregiver reports of three domains of stress: subsistence (e.g., resource strain, overcrowding); safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression) from early childhood through adolescence. Z-scores were used to conduct a finite mixture model-based latent class trajectory analysis. Model fit was compared using the Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). We examined differences in timing and chronicity of stress exposure between Black and White girls. Results Distinct trajectory groups characterized by differential timing and chronicity of stress exposure were observed across all stress domains. Six trajectories characterized subsistence and safety stress, and five characterized caregiving stress. Variability in initial level, chronicity, and magnitude and timing of change was observed within and across domains of stressors. Race differences also varied across the domains: race differences in timing and chronicity were most pronounced for the subsistence and safety domains, whereas Black and White girls had similar levels of exposure to caregiving stress. Conclusions Substantial variability in timing and chronicity was observed within and across stress domains. Modeling specific domains and dimensions of stress exposure is likely important in testing associations between exposure and health; such specificity may lead to more effective deployment of preventive interventions based on stress exposure. Distinct trajectories in exposure were observed for subsistence, safety, and caregiving stress domains. Race differences in timing and chronicity of exposure were pronounced for subsistence and safety domains. Patterns of exposure (e.g., level, timing) are likely critical for understanding the impact on stress exposure on health.
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Affiliation(s)
- Kate Keenan
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA
| | - Haoyi Fu
- University of Pittsburgh, Department of Biostatistics, Pittsburgh, PA, USA
| | - Irene Tung
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - Johnny Berona
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, USA
| | - Robert T Krafty
- Emory University, Department of Biostatistics & Bioinformatics, Atlanta, GA, USA
| | - Alison E Hipwell
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - Stephanie D Stepp
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
| | - Kristen Carpio
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA
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Aye WT, Lien L, Stigum H, Bjertness E. Childhood abuse and its association with adults' mental health problems: a cross-sectional study among men and women in the Yangon Region of Myanmar. BMJ Open 2021; 11:e045870. [PMID: 34824104 PMCID: PMC8627399 DOI: 10.1136/bmjopen-2020-045870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms. DESIGN A community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale-Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively. SETTING Urban and rural areas of the Yangon Region, Myanmar. PARTICIPANTS A total of 2377 men and women aged 18-49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. RESULTS Overall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men. CONCLUSIONS Childhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.
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Affiliation(s)
- Win Thuzar Aye
- Community Medicine and Global Health, University of Oslo Faculty of Medicine, Oslo, Norway
- Preventive and Social Medicine Department, University of Medicine 2, Yangon, Myanmar
| | - Lars Lien
- National Norwegian Advisory Board for Concurrent Addiction and Mental Health Problems, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Hein Stigum
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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15
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Russotti J, Warmingham JM, Duprey EB, Handley ED, Manly JT, Rogosch FA, Cicchetti D. Child maltreatment and the development of psychopathology: The role of developmental timing and chronicity. CHILD ABUSE & NEGLECT 2021; 120:105215. [PMID: 34293550 PMCID: PMC8384692 DOI: 10.1016/j.chiabu.2021.105215] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND The effects of child maltreatment (CM) on psychopathology are well-established, yet the complex effects of timing and chronicity of maltreatment exposure on the development of psychopathology are still unclear. OBJECTIVE To elucidate developmental pathways from distinct dimensions of CM (chronicity and timing) to psychopathology during emerging adulthood using data from a longitudinal, multi-method study. PARTICIPANTS AND SETTING Children with and without maltreatment exposure were recruited at wave 1 (ages 10-12) to participate in a research summer camp. At wave 2, participants were recontacted during emerging adulthood (ages 18-22). The current study includes 391 participants (51.3% female; 77.5% Black, 11.3% white, 7.4% Hispanic, 3.8% other race). METHODS Timing and chronicity of maltreatment exposures were coded from child protective services records using the Maltreatment Classification System. Childhood internalizing and externalizing symptoms were assessed using child- and camp counselor-report. Emerging adults completed self-report questionnaires and were interviewed about their current and past symptoms of psychopathology. Structural equation modeling was used to estimate direct and indirect links between childhood maltreatment dimensions (chronicity and timing) to adult psychopathology via childhood internalizing and externalizing. RESULTS Child maltreatment experiences that spanned several developmental periods, including both early and later childhood stages, predicted a cascade of both internalizing and externalizing symptoms in childhood that eventuated in greater symptoms of anxiety, depression, substance use disorder, and antisocial personality disorder in emerging adulthood. CONCLUSIONS Results suggest that chronic childhood maltreatment exposure is associated with multifinality in psychopathology presentations that can be detected in childhood and extend into emerging adulthood. Early prevention and intervention efforts to promote positive and safe parenting are essential to decrease the burden of mental health symptoms conferred by chronic maltreatment exposures on individuals, families, and public health systems.
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Affiliation(s)
- Justin Russotti
- Mt. Hope Family Center, University of Rochester, United States of America.
| | | | - Erinn B Duprey
- Mt. Hope Family Center, University of Rochester, United States of America; Institute of Child Development, University of Minnesota, United States of America
| | | | - Jody T Manly
- Mt. Hope Family Center, University of Rochester, United States of America
| | - Fred A Rogosch
- Mt. Hope Family Center, University of Rochester, United States of America
| | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester, United States of America; Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, United States of America
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Abstract
In this chapter, we will focus on childhood maltreatment and its role in the vulnerability to BD.We will review how childhood maltreatment and trauma not only predispose to the development of BD but also to a more unstable, pernicious, and severe clinical expression of the disorder. This environmental risk factor is suggested to be part of a multiple hit model of vulnerability, involving not only early stressors (prenatal and postnatal ones) but also interactions with the genetic background of individuals and with other stressors occurring later in life. We will also review how childhood maltreatment and trauma may modify the brain functioning and circuits and alter some biological pathways in BD, hence leading to psychopathology. Finally, we will briefly discuss the implications for clinical practice and treatment.
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Affiliation(s)
- Bruno Etain
- Université de Paris, Paris, France.
- INSERM U1144, Faculté de Pharmacie de Paris, Université de Paris, Paris, France.
- Assistance Publique des Hôpitaux de Paris P-HP, GHU Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.
| | - Monica Aas
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Cuevas AG, Greatorex-Voith S, Abuelezam N, Eckert N, Assari S. Educational mobility and telomere length in middle-aged and older adults: testing three alternative hypotheses. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2020; 66:220-235. [PMID: 34583600 DOI: 10.1080/19485565.2021.1983760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Critical period, social mobility, and social accumulation are three hypotheses that may explain how educational mobility impacts health. Thus far, there is little evidence on how these processes are associated with biological aging as measured by telomere length. Using cross-sectional data from the 2008 Health and Retirement Study, we examined the association between educational mobility (parental education and contemporaneous education) and telomere length. The final model is adjusted for sociodemographic factors and socioeconomic status, childhood adversity, and health behaviors/risk factors, as well as depressive symptoms. A total of 1,894 participants were included in the main analyses. High parental education was associated with longer telomere length in a fully adjusted model (B = 0.03, CI [0.002,0.07]). Downwardly mobile individuals (high parental education and low contemporaneous education) had longer telomere length compared to stably low individuals in a fully adjusted model (B = 0.05, CI [0.004,0.09]). There was support for the critical period hypothesis and partial support for the change hypothesis. There was no evidence to support the social accumulation hypothesis. Prospective studies are needed to understand the mechanism that can help further explain the association between educational mobility and telomere length.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Community Health, Tufts University, Medford, MA
| | | | - Nadia Abuelezam
- Boston College William F. Connell School of Nursing, Chestnut Hill, Ma, USA
| | - Natalie Eckert
- Department of Community Health, Tufts University, Medford, MA
| | - Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
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Lippard ET, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders. Am J Psychiatry 2020; 177:20-36. [PMID: 31537091 PMCID: PMC6939135 DOI: 10.1176/appi.ajp.2019.19010020] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.
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Affiliation(s)
- Elizabeth T.C. Lippard
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, USA,Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX USA,Department of Psychology, University of Texas, Austin, TX, USA,Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX
| | - Charles B. Nemeroff
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, USA,Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX USA,Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX
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