Classes and consequences of multiple maltreatment: a person-centered analysis

Associations Between PTSD and Depressive Symptoms and Victimization Among Female College Students: A Latent Class Analysis

Research on subgroups of female college students who share similar experiences of childhood maltreatment (CM) and intimate partner violence (IPV) victimization is sparse. The primary aims of the current study are: (a) to identify subgroups of victims related to experience of psychological, physical, and sexual CM and IPV and (b) to test the association between subgroups and depressive and post-traumatic stress disorder (PTSD) symptom severity. Survey data was collected from 327 female students at a public university in the Northeast. Three distinct subgroups, that is, victimization classes, were found using Latent Class Analysis: A lifetime victimization class, comprised of females reporting high rates of CM and IPV across types (19.0% of the sample), a childhood victimization class (26.9%); and a low victimization class (54.1%). Depressive symptom severity was positively associated with lifetime and childhood, relative to low, victimization class membership. PTSD symptom severity was associated with the childhood victimization class relative to both lifetime and low victimization class. Subgroups of institutions of higher education (IHE) females who share CM and IPV victimization experiences are discernable. The co-occurrence of IPV and CM in female college students is not uncommon. PTSD symptom severity may be more related to CM than IPV in IHE female students.

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis

INTRODUCTION

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied.

METHODS

Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education).

RESULTS

Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes.

CONCLUSIONS

Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

Childhood maltreatment and psychopathy in Chinese juvenile offenders: person-centered perspective

BACKGROUND

Childhood maltreatment stands as a salient risk factor in the etiology of juvenile delinquency, with a profound impact on the behavioral trajectories of young offenders. However, there is limited research on latent profile analysis to explore distinctive patterns of childhood maltreatment in Chinese juvenile offenders. Consequently, there is a lack of understanding regarding the associations between maltreatment profiles and relevant variables in this context. The present study aimed to explore meaningful subgroups of childhood maltreatment in juvenile offenders, and we further examined the associations between subgroups and multiple outcomes especially psychopathy.

METHODS

The data was obtained from a sample of Chinese juvenile offenders (N = 625, M age = 17.22, SD = 1.23). This study employed a latent profile analysis (LPA) based on factor scores of the Childhood Trauma Questionnaire-Short Form to identify the subgroups and examined the differences across subgroups using outcomes variables including psychopathy, callous-unemotional traits, aggression and anxiety. This study includes three self-report measures to evaluate psychopathy, with due regard for the nuanced considerations on the factor structure inherent in the conceptualization of psychopathy.

RESULTS

Two subgroups were identified, including the non-maltreatment subgroup (80.2%) and the maltreatment subgroup (19.8%). Maltreatment subgroup was characterized by a greater level of all types of maltreatment with particularly higher of emotion neglect. Besides, we found that maltreatment subgroup showed a significantly higher level of psychopathy across multiple self-report measures, and greater callous-unemotional traits, lack of empathy, aggression and anxiety. We found two subgroups of child maltreatment in Chinese juvenile offenders.

CONCLUSIONS

These findings may provide a further understanding of childhood maltreatment and the clinical intervention on psychopathy in the early period.

Intergenerational (Dis)continuity of Child Maltreatment: Variation by Parents' Childhood Victimization Experiences and Sex

This longitudinal population-based study examines the association between maltreatment victimization experiences and the likelihood of intergenerational (dis)continuity of maltreatment. Our data include all individuals born in 1983/1984 in Queensland (QLD), Australia who are registered as parents via birth records and who experienced system contacts for maltreatment victimization in childhood (n = 2906). Child safety data on system contacts as a child victim and person responsible for harm to a child were obtained from the Department of Children, Youth Justice and Multicultural Affairs. Out-of-home care experiences and maltreatment frequency, timing, and type were examined. Results indicated that childhood maltreatment experiences significantly differed between parents who were not subsequently responsible for harm to a child (cycle breakers) and parents who were subsequently responsible for harm to a child (cycle maintainers). Different patterns of association were observed across sex. These findings highlight the importance of recognizing the heterogeneity of victim maltreatment experiences and associated risk of maltreatment for their children, and can inform effective and targeted interventions by tailoring these by sex and developmental period.

From Maltreatment to Psychiatric Disorders in Childhood and Adolescence: The Relevance of Emotional Maltreatment

Different forms of maltreatment are thought to incur a cumulative and non-specific toll on mental health. However, few large-scale studies draw on psychiatric diagnoses manifesting in early childhood and adolescence to identify sequelae of differential maltreatment exposures, and emotional maltreatment, in particular. Fine-grained multi-source dimensional maltreatment assessments and validated age-appropriate clinical interviews were conducted in a sample of N = 778 3 to 16-year-olds. We aimed to (a) substantiate known patterns of clinical outcomes following maltreatment and (b) analyse relative effects of emotional maltreatment, abuse (physical and sexual), and neglect (physical, supervisory, and moral-legal/educational) using structural equation modeling. Besides confirming known relationships between maltreatment exposures and psychiatric disorders, emotional maltreatment exerted particularly strong effects on internalizing disorders in older youth and externalizing disorders in younger children, accounting for variance over and above abuse and neglect exposures. Our data highlight the toxicity of pathogenic relational experiences from early childhood onwards, urging researchers and practitioners alike to prioritize future work on emotional maltreatment.

Childhood maltreatment and suicide risk: The mediating role of self-compassion, mentalization, depression

BACKGROUND

Childhood maltreatment (CM) is a well-established risk factor for depression and increased suicide risk. This study aimed to investigate the distinctive mechanisms of individual types of CM on young adult suicide risk, by exploring the potential mediating role of mentalization, self-compassion, and depression.

METHODS

A total of 4873 adults completed a survey screening for experiences of CM, self-compassion, mentalization, depression, and suicide risk.

RESULTS

The path analysis revealed significant direct effects of mentalization, self-compassion, and depression on suicide risk. Moreover, mentalization, self-compassion, and depression mediated the relationship between emotional abuse/neglect and suicide risk, whereas physical neglect contributed to suicide risk only through mentalization and depression. Furthermore, sexual abuse had a significant direct effect on suicide risk, whereas physical abuse did not show any direct or indirect effects.

LIMITATIONS

The cross-sectional design of the study limits its ability to establish causality, and the risk of recall bias in reporting physical or sexual abuse cannot be ignored.

CONCLUSIONS

This study represents the first identification of disturbances in self-compassion, mentalization, and depression that mediate the relationship between various types of CM and suicide risk in young adults. Our findings suggest substantive differences in the impact of emotional CM compared to other forms of CM. Enhancing self-compassion and mentalization abilities could be valuable intervention strategies for individuals with a history of emotional CM. Addressing factors that hinder the recall of relevant subjective experiences of physical and sexual abuse is also critical.

Childhood Polyvictimization and Associated Health Outcomes: A Systematic Scoping Review

Background: Polyvictimization, the experience of multiple types of victimization, is associated with detrimental health outcomes. Despite extensive research on the health consequences of polyvictimization, one challenge in understanding this literature lies in the varied operationalized definitions of polyvictimization and health outcomes. This scoping review provides the volume of the current literature on this topic, documents the varied constructs of polyvictimization and associated health outcomes, identifies knowledge gaps, and guides future research directions. Method: A systematic search of English-language original articles that presented quantitative associations of childhood polyvictimization and health outcomes was performed through six-database searches, a gray literature search, and citation mining from June 2020 to January 2021. The varied constructs of polyvictimization, health outcomes, and other study characteristics were extracted. Results: A total of 96 studies were included. Two ways of creating continuous variables (30.21%) and four ways of constructing categorical variables (72.92%) were identified for operationalizing polyvictimization. The majority of health outcomes were mental, behavioral, or social (96.88%), while slightly more than 10% of studies examined physical health (11.46%) or general health conditions (10.42%), respectively. More than half of studies used U.S. samples (56.25%). Conclusions: The varied constructs of polyvictimization suggests that there is a need to establish a valid polyvictimization construct that is consistently agreed upon in the research community. Findings summarize the specific health outcomes that can be targeted for further investigation and prevention efforts. Findings also suggest that the study of resilience and coping education for childhood polyvictims is sorely needed.

How adverse and benevolent childhood experiences influence depression and suicidal ideation in Chinese undergraduates: a latent class analysis

BACKGROUND

There has been minimal research on the role of benevolent childhood experiences (BCEs) and how such events may offer protection from the insidious effects of adverse childhood experiences (ACEs) or later in life.

OBJECTIVES

This research aims to learn how BCEs and ACEs interact to affect adolescents' psychological distress.

METHODS

Cross-sectional survey was conducted in three cities (Xuzhou, Nanjing, and Wuhan) in China from March 2021 to May 2021. Latent class analysis (LCA) was used to classify the patterns of ACEs and BCEs. We adopted hierarchical multivariable regression to examine the influences of ACEs and BCEs on depression and suicidal ideation.

RESULTS

To explore the relationship between childhood experience and suicidal ideation and depression, LCA revealed three patterns of ACEs: (1) emotional abuse (10.57%); (2) high ACEs (0.55%); and (3) low ACEs classes (88.88%). Adolescents with emotional abuse (depression: OR = 3.82, 95%CI = 2.80-5.22, P < 0.001; suicidal ideation: OR = 5.766, 95%CI = 3.97-8.38, P < 0.001) and high ACEs class (suicidal ideation: OR = 5.93, 95%CI = 1.19-29.66, P < 0.05) had an increased risk of psychological distress (reference: low ACEs). LCA revealed four patterns of BCEs: (1) relationship support (14.54%); (2) low BCEs (4.85%); (3) high BCEs (55.34%); and (4) high quality of life classes (25.28%). Adolescents with a high quality of life (depression: OR = 0.09, 95%CI = 0.05-0.16, P < 0.001; suicidal ideation: OR = 0.22, 95%CI = 0.12-0.40, P < 0.001) and high BCEs (depression: OR = 0.05, 95%CI = 0.03-0.09, P < 0.001; suicidal ideation: OR = 0.15, 95%CI = 0.09-0.26, P < 0.001) protected the mental health of adolescents (reference: low BCEs).

CONCLUSIONS

High ACEs and emotional abuse classes were significantly associated with poorer mental health symptoms, including suicidal ideation and depression. In contrast, high BCEs and high quality of life classes were associated with better mental health. These findings point out that it is more necessary to identify and support victims of ACEs, and it is urgent to increase BCEs in early childhood.

Clustering of adverse and positive childhood experiences: The nature and correlates of risk and protective factors

BACKGROUND

Despite the increased attention paid to the separate effects of cumulative stress and protection on offending, the extent to which distinct clusters of risk and protective factors exist and have unique effects on justice-related outcomes is under-studied.

OBJECTIVE

The current study examines for unique clustering of Adverse Childhood Experiences (ACE) and Positive Childhood Experiences (PCE) and the extent to which they predict juvenile recidivism.

PARTICIPANTS AND SETTING

The sample consists of a cohort of youth adjudicated delinquent in Florida who received a community-based sanction.

METHODS

The study first utilized latent-class analysis to identify distinct classes based upon the youths' ACE and PCE exposures. Next, two sets of regression models were estimated; the first investigated correlates of class membership and the second assessed whether class membership predicted recidivism.

RESULTS

Seven distinct classes of ACE/PCE clusters were found, composing 9.9 % to 20.5 % of the sample each. Relative to the class with low ACE and low PCE, those with low ACEs and high PCE evidenced 27.5 % lower rearrest rates, as did the Moderate Risk/Moderate Protection group.

CONCLUSIONS

Not only do distinct groupings of ACE and PCE exposures exist, but these groups have different likelihoods of future offending, where a youth's cumulative protection appears to be more important than their risk level. This has important policy implications as it offers further support for the use of strength-based treatment approaches.

Adverse Childhood Experiences and Associated Mental Distress and Suicide Risk: Results From the Zambia Violence Against Children Survey

Purpose: Adverse childhood experiences (ACEs) are a global public health concern. Little research exists on the prevalence and health consequences of ACEs in Zambia. The current study examined associations between individual and cumulative ACEs, mental distress, and suicide risk among Zambian youth. Methods: Data from Zambia Violence Against Children and Youth Survey were used (18-24 years old, n=1034). Bivariate and adjusted logistic models were performed with independent variables (i.e., experienced physical violence (PV), sexual violence (SV), and emotional violence (EV); witnessed intimate partner violence (IPV) and community violence (CV); orphan status; cumulative ACE exposure) and dependent variables (i.e., mental distress and suicide risk). Adjusted models controlled for demographic and social characteristics. Results: 76.8% of Zambian youth experienced one or more ACEs, and more than 30% witnessed CV (38.4%) or IPV (30.2%), or experienced PV (35.1%), prior to age 18. 27.5% were orphans, and less than 20% experienced EV (17.3%) or SV (15.4%) in childhood. 42.4% experienced mental distress in the past 30 days, and 12.5% reported lifetime suicidal thoughts or suicide attempts. PV, EV, cumulative ACE exposure, older age, being single, and stronger friendships were significantly related to experiencing mental distress. Cumulative ACEs exposure was associated with significantly higher suicide risk. Conclusions: Preventing ACEs can reduce mental distress and suicide risk among Zambian youth. Youth with cumulative ACE exposure can be prioritized for mental health intervention. More research is warranted to investigate the broad-based prevention of ACEs, especially PV and EV, and protective factors that can promote resilience among youth who have experienced ACEs.

The mediating role of impulsivity in the associations between child maltreatment types and past month substance use

BACKGROUND

Child maltreatment has emerged as an important risk factor for substance use. However, despite evidence consistently demonstrating that substance use peaks during emerging adulthood, less is known about the specificity of maltreatment effects on substance use during this critical developmental period. Further, the factors that might play a role in these associations are not well understood.

OBJECTIVE

The current study examined the associations between child maltreatment types (i.e., physical abuse, physical neglect, sexual abuse, emotional abuse, and emotional neglect) and past month marijuana, alcohol, and tobacco use among emerging adults, and tested whether impulsivity accounted for these associations.

METHODS

Participants were 500 emerging adults ranging in age between 18 and 25 years old (M = 18.96, SD = 1.22, 49.6% male) recruited from a large, public university in the Midwest United States.

RESULTS

Tests of indirect effects suggested that impulsivity accounted for associations between emotional abuse and past month marijuana, alcohol, and tobacco use.

CONCLUSIONS

Current findings provide support for impulsivity as a mechanism linking childhood emotional abuse to substance use among emerging adults, highlighting the need for targeted screening and intervention.

Anxiety and depression related to childhood maltreatment in teenagers: Comparing multiple individual risk model, cumulative risk model and latent profile analysis

BACKGROUND

Few studies have employed person-centered approaches (i.e. latent profile analysis in this study) to investigate the specific patterns of childhood maltreatment in a large sample of Chinese adolescents, and little is known about the predictive validity of latent profile analysis on internalizing problems, compared with multiple individual risk model and cumulative risk model.

OBJECTIVE

The purpose of this study was to investigate whether differential patterns of maltreatment existed by employing latent profile analysis with a sample of 9071 Chinese adolescents, and further examined the predictive validity of latent profile analysis on internalizing problems, relative to the cumulative risk and multiple individual risk model.

PARTICIPANTS

Using a stratified sampling approach, 10,515 participants (Mean age = 14.24; SD = 1.73) were chosen from three different types of middle schools in Chongqing city, China. 9071 valid responses (males = 4775; females = 4296) were obtained for final analysis.

METHODS

Participants reported their childhood maltreatment experience, anxiety and depression symptoms. Latent profile analysis was used to obtain possible patterns of maltreatment with Mplus version 7. 4. Bolck-Croon-Hagenaars (BCH) method was used to test the association between maltreatment patterns and anxiety and depression symptoms. Relative weight analysis and analysis of variance (ANOVA) were used to test the predictive validity of latent profile analysis, multiple individual risk and cumulative risk model.

RESULTS

Using latent profile analysis, two patterns of childhood maltreatment were uncovered ("No Maltreatment" and "Multiple Maltreatment"). Further analysis showed that multiple individual risk model accounted for the largest variance in anxiety (R² = 26.7%) and depression (R² = 33%), followed by the latent profile analysis (R² = 14.7% for anxiety and 18.6% for depression) and the cumulative risk model (R² = 12.9% for anxiety and 15.2% for depression).

CONCLUSIONS

Our findings suggested that the multiple individual risk model is the optimal model for identifying adolescents at the risk of developing anxiety and depression symptoms, and the results suggested emotional abuse and emotional neglect are risk factors for higher levels of anxiety and depression among adolescents.

Heterogeneity in caregiving-related early adversity: Creating stable dimensions and subtypes

Early psychosocial adversities exist at many levels, including caregiving-related, extrafamilial, and sociodemographic, which despite their high interrelatedness may have unique impacts on development. In this paper, we focus on caregiving-related early adversities (crEAs) and parse the heterogeneity of crEAs via data reduction techniques that identify experiential cooccurrences. Using network science, we characterized crEA cooccurrences to represent the comorbidity of crEA experiences across a sample of school-age children (n = 258; 6-12 years old) with a history of crEAs. crEA dimensions (variable level) and crEA subtypes (subject level) were identified using parallel factor analysis/principal component analysis and graph-based Louvain community detection. Bagging enhancement with cross-validation provided estimates of robustness. These data-driven dimensions/subtypes showed evidence of stability, transcended traditional sociolegally defined groups, were more homogenous than sociolegally defined groups, and reduced statistical correlations with sociodemographic factors. Finally, random forests showed both unique and common predictive importance of the crEA dimensions/subtypes for childhood mental health symptoms and academic skills. These data-driven outcomes provide additional tools and recommendations for crEA data reduction to inform precision medicine efforts in this area.

Role of thwarted belongingness, perceived burdensomeness and psychological distress in the association between adverse childhood experiences and suicidal ideation in college students

BACKGROUND

Adverse childhood experiences (ACEs) have a detrimental impact on short- and long-term mental and physical health. A growing body of research has indicated that the prevalence of suicidal phenomena is significantly higher among individuals with a history of ACEs. However, there is a lack of understanding about processes that result in ACEs leading to suicidal ideation when testing within a theoretical framework.

AIMS

To develop and test a multidimensional model that would explain the association between ACEs and suicidal ideation in college students.

METHOD

Data were obtained from a cross-sectional survey completed by 321 college students primarily recruited from universities in Ireland. Participants were aged 18-21 (n = 176) and 22-25 years (n = 145). An ACEs questionnaire, the Interpersonal Needs Questionnaire, which assessed thwarted belongingness and perceived burdensomeness, the CORE-10, which assessed psychological distress, and the Suicide Ideation Scale (SIS) were administered.

RESULTS

After controlling for gender and sexual orientation, results revealed a significant direct effect of ACEs on suicidal ideation such that more accumulated ACEs were associated with higher suicidal ideation (effect size 0.30; 95% CI 0.047-0.538). A significant indirect effect of ACEs on suicidal ideation through perceived burdensomeness and psychological distress, and thwarted belongingness and psychological distress, was observed (effect size 0.90; 95% CI 0.558-1.270).

CONCLUSIONS

Findings suggest that ACEs have a detrimental impact on college students' mental health. Results highlight the potential benefits of ACE-informed interventions that target thwarted belongingness and perceived burdensomeness to countervail suicidal ideation in college students.

Risky Sexual Behavior Profiles in Youth: Associations With Borderline Personality Features

Adolescence and young adulthood are peak periods for risky sexual behaviors (RSB) and borderline personality disorder (BPD) features. RSB is a major public health concern and adolescents with BPD may be particularly vulnerable to RSB, but this is understudied. The aim of this study was to identify distinct RSB profiles in youth and determine whether a specific profile was associated with BPD features. Participants were 220 adolescents and young adults (age 14-21) recruited from the community. To identify groups of adolescents and young adults who engage in similar RSB, a latent profile analysis (LPA) was conducted on sexually active youth (57%). Next ANOVA was used to identify how profiles differed in terms RSB dimensions and BPD features. We identified three distinct RSB profiles: (1) a Low RSB profile that was manifested by the majority (77.7%) of youth; (2) an Unprotected Sex in Relationships profile (13.3%) and; (3) an Impulsive Sex Outside Relationships profile (12%) which was manifested by youth with significantly higher BPD features. The findings shed light on the difficulties youth with BPD manifest around integrating sexuality, intimacy, fidelity, and love. This contrasts with the majority of youth who are sexually active in the context of relationships and engage in little or no RSB. The findings have important clinical implications. Adolescent sexuality is frequently in the blind spot of clinicians. To address the elevated risk of RSB in adolescents with BPD, interventions are needed to help adolescents navigate this period and improve their understanding of the reasons for RSB while addressing difficulties in establishing sexual and attachment relationships.

Racial/ethnic differences in clusters of adverse childhood experiences and associations with adolescent mental health

Childhood adversity is a well-established risk factor for mental health problems during adolescence. Using data from the Fragile Families and Child Wellbeing Study and latent class analysis (LCA), we examined patterns of exposure to ten adverse childhood experiences (ACEs), including socioeconomic adversity, among non-Hispanic (NH) White, NH Black, and Hispanic 9 year olds and determined associations between membership in ACE exposure “classes” and depression and anxiety scores at age 15 (N = 2849). Parental separation/divorce, economic hardship, and paternal incarceration were the most common ACEs. ACE prevalence was significantly higher among Blacks and Hispanics. ACEs clustered into four classes for Whites and Hispanics and three classes for Blacks. Over half of Whites were classified in the ‘Low Adversity’ class. Conversely, most Black and Hispanic adolescents were classified in the ‘High Socioeconomic Adversity and Paternal Incarceration’ class, characterized by above average probabilities of experiencing family economic hardship, parental separation/divorce, low maternal education, and paternal incarceration. A small share of adolescents in all three racial/ethnic groups were in the ‘High Global Adversity’ class, characterized by high probability of exposure to most ACEs, including physical and psychological abuse. Finally, ACE class membership was differentially associated with anxiety and depression across the three racial/ethnic groups, with generally larger differences in mental health scores across ACE groups for Whites than for Blacks and Hispanics. Our findings suggest that studies on the associations between ACEs and health outcomes that do not include childhood economic adversity risk underestimating the role of ACEs on mental health among racial/ethnic minorities. Moreover, different patterns of ACE exposure are differentially linked to anxiety and depression, and ACE group membership differences in anxiety and depression vary by racial/ethnic group. Findings suggest the need for racially tailored prevention and intervention strategies.

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In a U.S. sample of low-income children, 93% experienced at least one ACE in past year.

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ACEs cluster differently for White, Black, and Hispanic adolescents.

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Most White adolescents are in a low adversity class.

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Most Black and Hispanic adolescents are in a high SES adversity and parental incarceration class.

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There are race differences in relationships between ACE classes and mental health.

The impact of adverse childhood experiences and recent life events on anxiety and quality of life in university students

Adverse childhood experiences (ACEs) have been repeatedly associated with a wide range of physical and mental health issues. Research has indicated high levels of anxiety and depression among university students, and a few studies have documented the relationship between ACEs and anxiety in the university student population. This study surveyed first year students at a university located in the most ethnically diverse district in England, with the second highest poverty rate. Eight hundred and fifty-eight responded; a response rate of 12%. The survey included questions about adverse childhood events, recent life stressors, current deprivation, quality of life, positive physical health and positive mental health, and used the Generalized Anxiety Disorder Scale, a standardised measure. Thirty-seven percent of the responding students met the diagnosis for generalised anxiety disorder. In a multivariate multiple regression model, life stressors and childhood adversities were significantly associated with higher levels of anxiety and lower levels of physical and mental health. Only childhood adversities significantly predicted lower levels of quality of life. The findings highlight the importance of considering adverse childhood experiences in enhancing the wellbeing of the student population. Given the demographics of the student population at the University of East London, the high rates of ACEs and anxiety are likely to partially reflect poverty and racism. The implications of the findings for trauma-informed policies and practices in universities are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10734-021-00774-9.

Childhood adversities among students at an English University: A latent class analysis

University students routinely participate in research, including research on trauma and adversity, but the unique implications of trauma and adversity for educational and developmental outcomes for this group have received less attention. This study surveyed first year undergraduate students at an urban university located in the most ethnically diverse district in England, with the second highest poverty rate. Of 7,110 students, 858 responded; a response rate of 12%. The survey included thirteen questions about adverse events and circumstances before age 18. Four in five students (79%) reported at least one adversity, 51% reported three or more, and 20% reported at least six. Female students reported a higher mean number of adversities than men, but men were significantly more likely to report having been "attacked, stabbed, shot or robbed by threat." Where comparisons were possible, rates were higher than for the general population or for the only other UK university survey. A Latent Class Analysis produced four groupings. Besides the 'No adversity' (36%) and "Intermediate" (46%) classes, there were two "High adversity" groups, differentiated by high (12%) or moderate (6%) adversities related to cohabitation (parental separation, lived with depressed person, lived with alcohol/drug user, and lived with incarcerated person). Higher rates of adversities, and latent class membership, were related to predictions that one would not complete one's degree. Implications and next steps are discussed.

A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients

OBJECTIVE

Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual).

METHODS

Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis.

RESULTS

Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average).

CONCLUSION

Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.

The longitudinal effects of maltreatment class membership on post-traumatic stress & depression

BACKGROUND

While the link between maltreatment and mental illness has been largely established, there is a need to better understand how certain types or profiles of maltreatment place youth at heightened risk for depression and traumatic stress, and when the risk of developing symptoms may be greatest.

OBJECTIVE

We examined the extent to which youth experiences of maltreatment co-occur and how certain combinations of maltreatment work to influence the subsequent development of depression and post-traumatic stress over time.

PARTICIPANTS & SETTING

Data were drawn from NSCAW-II, a nationally representative longitudinal sample of 5872 child welfare involved youth, aged 0-18.

METHODS

Latent Class Analysis was used to investigate profiles of child maltreatment. We then used a longitudinal three-wave panel design to examine whether membership in various maltreatment classes predicted development of depression and post-traumatic stress measured at two future time points.

RESULTS

Three classes emerged: Class 1 (68 %) the "Neglect and Adverse Parental Behaviors Class", Class 2 (20 %) the "Physical Abuse Class", and Class 3 (12 %) the "Sexual Abuse Class". Membership in Class 2 increased depression and trauma symptoms at Wave 2, compared to Class 1 (b = 1.8 and 1.4, respectively; p < 0.05). Membership in Class 3 increased trauma symptoms at Wave 3, compared to Class 1 and Class 2 (b = 2.3 and 2.7, respectively; p < 0.01).

IMPLICATIONS

Child welfare involved youth need to be appropriately screened for psychiatric health annually and provided with services that correspond with their level of need.

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

Background

Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates.

Methods

Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being.

Results

86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = −0.096, 95% CI −0.176, −0.033), multiple ACEs (β = −0.338, 95% CI −0.498, −0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being.

Conclusions

Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-021-00993-7.

Classes of lifetime adversity in emerging adult women and men and their associations with weight status

The aim of this paper was to better understand how child and adult adversities cluster together into classes, and how these classes relate to body weight and obesity. Analyses included 2015 and 2018 data from emerging adults (18-25 years old) who participated in a state surveillance system of 2- and 4-year college students in Minnesota (N = 7475 in 2015 and N = 6683 in 2018). Latent Class Analyses (LCA) of 12 child and adult adversities were run stratified by gender and replicated between 2015 and 2018. The distal outcome procedure and three-step Bolck-Croon-Hagenaars approach were used to estimate predicted BMI means and predicted probabilities of obesity for each class, adjusted for covariates. The LCA identified seven classes in women and 5 in men. In women, BMI ranged from 23.9 kg/m2 in the lowest-BMI class ("Adult Adversities and Childhood Household Dysfunction"; 95% CI: 22.6-25.1) to 27.3 kg/m2 in the highest-BMI class ("High Lifetime Adversities"; 95% CI: 25.9-28.7), a statistically significant difference of 3.4 kg/m2. In men, the adjusted BMIs ranged from 24.6 kg/m2 ("Low Adversities"; 95% CI: 24.3-25.0) to 26.0 kg/m2 ("Childhood Household Mental Illness"; 95% CI: 25.1-26.9), a statistically significant difference of 1.4 kg/m2. The pattern was similar for obesity. These results indicate that specific classes of child and adult adversities are strongly associated with BMI and obesity, particularly in women. A key contribution of LCA appeared to be identification of small classes at high risk for excess weight.

Maltreatment during childhood and risk for common mental disorders among first year university students in South Africa

PURPOSE

Childhood maltreatment elevates risk for common mental disorders (CMDs) during late adolescence and adulthood. Although CMDs are highly prevalent among university students, few studies have examined the relationship between childhood maltreatment and 12 month CMDs in a low- to middle-income countries. This paper describes the prevalence of maltreatment and the relationship between type, number and patterns of maltreatment exposure and 12 month CMDs among first-year university students in South Africa.

METHODS

Maltreatment and CMD data were collected via well-validated self-report scales (corresponding with DSM-IV diagnoses) in a web-based survey of first-year students from two large urban universities (n = 1290) in South Africa. Various multivariate modelling approaches (additive, restrictive interactive and latent class) were used to examine the relationship between maltreatment and CMDs.

RESULTS

Overall, 48.4% of participants reported childhood maltreatment, the most common type being emotional abuse (26.7%). Regardless of the modelling approach used, emotional abuse was the only type of maltreatment independently associated with 12-month diagnoses of major depressive disorder (MDD), generalised anxiety disorder (GAD) or drug use disorder (DUD) even after adjusting for types and number of types of maltreatment. Similarly, students in the latent class reflecting histories of emotional abuse (either alone or combined with physical abuse) were more likely to meet criteria for 12-month MDD, GAD or DUD.

CONCLUSION

Findings confirm the high prevalence of childhood maltreatment among South African students. As this exposure elevates risk for MDD, GAD and DUD, interventions aimed at preventing and treating CMDs among first-year students should address experiences of childhood maltreatment.

Rethinking Concepts and Categories for Understanding the Neurodevelopmental Effects of Childhood Adversity

Discovering the processes through which early adverse experiences affect children's nervous-system development, health, and behavior is critically important for developing effective interventions. However, advances in our understanding of these processes have been constrained by conceptualizations that rely on categories of adversity that are overlapping, have vague boundaries, and lack consistent biological evidence. Here, we discuss central problems in understanding the link between early-life adversity and children's brain development. We conclude by suggesting alternative formulations that hold promise for advancing knowledge about the neurobiological mechanisms through which adversity affects human development.

Joining the pieces in childhood irritability: Distinct typologies predict conduct, depressive, and anxiety symptoms

This study utilised a person-centered approach to understand childhood irritability as a transdiagnostic feature of psychopathology. Latent profile analysis was employed within a community sample (n = 93) of 9-11 year olds to identify typologies of self-regulation capabilities, positive wellbeing characteristics of hope and flourishing, and social functioning that cluster with children's irritability to mitigate risk for psychopathology symptoms. Three distinct profiles of youth were derived, High Irritability/Low Self-Regulation of Negative Emotion (9%), Moderate Irritability/Low Behavioural Control (34%) and Low Irritability/High Positive Wellbeing Characteristics (57%). Profiles were empirically validated and differentially related to symptoms of anxiety, depression and conduct problems. Notably, High Irritability/Low Self-Regulation of Negative Emotion children were characterised by the highest levels of irritability and peer problems and the lowest self-regulation of negative emotion, prosocial behaviours, hope and flourishing relative to children within the other profiles, pointing to the potential utility of future targeted, transdiagnostic interventions. Within our community-based sample, a protective profile of Low Irritability/High Positive Wellbeing Characteristics children were also described by the lowest levels of irritability and peer problems and the highest positive and negative emotion self-regulation, behavioural control, prosocial behaviours, hope and flourishing. Findings demonstrate that different levels of irritability severity cluster with different self-regulation capabilities and wellbeing characteristics and predict risk for different types of psychopathology. Targeted interventions should seek to address children's irritability alongside self-regulation and positive wellbeing characteristics to further mitigate risks of psychopathology and associated problems.

Psychological maltreatment: An international challenge to children's safety and well being

BACKGROUND

Child psychological maltreatment (PM), also known as emotional abuse and neglect, mental violence, and emotional maltreatment, is the least recognized and addressed of the four major forms of child maltreatment.

OBJECTIVES

This article provides an 1) the history of PM and its relationship to children's rights, 2) an overview of the current state of knowledge, 3) implications of diversity for the topic of PM, 4) an example of a topic-relevant intervention, and 5) a vision for further progress in addressing this form of child maltreatment.

PARTICIPANTS AND SETTINGS

NA.

METHOD

Literature review, intervention description of fabricated or induced illness, and expert opinion.

RESULTS

PM is directly implicated in seven of the articles of the Convention. PM is common, reliable definitions of PM exist and need to be applied to practice and public health surveillance, harmfulness has been empirically established but is not fully appreciated, and countries vary dramatically in terms of incidence.

CONCLUSIONS

PM is a human rights issue that must be addressed through child protection and promotion of child wellbeing. Adoption of reliable definitions of the different aspects of PM for Child Protective Service practice is a top policy goal. The development of empirically supported curricula on PM for training professionals and parents and culturally sensitive interventions to change social norms on the use of psychologically aggressive disciplinary practices and other forms of PM are critical research needs. Well-validated interventions to support quality parent-child relationships and support families exist and need to be widely adopted. Individual child protective measures should be confined to cases of ongoing serious PM when interventions have failed to reduce harm to the child.

Patterns of childhood trauma and psychopathology among Chinese rural-to-urban migrant children

BACKGROUND

Exposure to childhood trauma can cause psychopathology and negative psychosocial outcomes across the lifespan. Rural-to-urban migrant children are commonly exposed to traumatic experiences (TEs). However, no study has comprehensively examined patterns of childhood trauma in Chinese culture. The current study aimed to examine patterns of childhood trauma exposure among Chinese rural-to-urban migrant children.

METHODS

A large-scale (N = 15,890) cross-sectional survey of rural-to-urban migrant workers' children in grades 4 to 9 was conducted in Beijing. Childhood TEs, including accidents and injuries, interpersonal violence, and vicarious trauma, as well as demographics and internalizing and externalizing behaviors, were measured.

RESULTS

Four patterns of childhood trauma were found: low trauma exposure (60.4%), vicarious trauma exposure (23.9%), domestic violence exposure (10.5%), and multiple trauma exposure (5.3%). Age, gender, parents' marital status, father's education level, family support and peer support differentiated the four TE patterns. Both internalizing and externalizing behaviors were more severe in patterns with more types of TEs.

CONCLUSIONS

Our findings provide a better understanding of childhood trauma in Chinese culture and the relationship between TEs and mental health. Clinicians and policy makers should tailor prevention and treatment programs according to different patterns of victimization.

Emotional violence in childhood and health conditions, risk-taking behaviors, and violence perpetration among young adults in Nigeria

BACKGROUND

Globally, over 1 billion children are victims of violence against children annually. Studies examining the health consequences of childhood violence have mostly focused on childhood physical violence (PV) and sexual violence (SV). Recent evidence suggests that childhood emotional violence (EV) may also be deleterious to the health and wellbeing of victims.

OBJECTIVE

This study examines the independent association between EV and some health conditions, risk taking behaviors, and violence perpetration among Nigerian young adults ages 18-24 years.

PARTICIPANTS AND SETTING

Data from 2014 Nigeria Violence Against Children Survey (n = 4,203), a nationally representative cross-sectional survey of individuals ages 13-24 were used.

METHODS

Childhood EV was defined as EV victimization before age 18 perpetrated by a parent, adult caregiver or other adult relative. Logistic regression analyses assessed the association between EV in childhood and mental distress in the past 30 days, ever self-harm behaviors and history of sexually transmitted infections; risk behaviors such as having multiple sex partners in the past 12 months; and ever violence perpetration.

RESULTS

After controlling for study covariates, EV in childhood was associated with mental distress in both males and females, and self-harm behaviors in females; excessive alcohol use and infrequent condom use in males, and multiple sexual partners in females; and PV perpetration in males and SV perpetration in females.

CONCLUSION

EV in childhood is associated with some health conditions, risk taking behaviors, and violence perpetration. Implementing programs that address all forms of violence in childhood, including EV may benefit children.

Longitudinal Impact of Life Events on Adolescent Binge Drinking in the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA)

Background: Life events experienced during adolescence are associated with risk and resilience to heavy episodic drinking (HED; i.e. binge drinking). The current study builds on prior research using latent class analysis (LCA) to examine heterogeneity in patterns of adolescent life events at baseline to HED over the course of three years (4 timepoints) as part of the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA). Methods: Life event classes were modeled using LCA that characterized NCANDA participants based upon their responses to the Life Events Questionnaire (N = 467, age: M = 14.98, SD = 1.69, 49.7% female). These baseline latent life event classes were then compared to HED at baseline and years 1, 2 and 3 using multinomial logistic regression. Results: At baseline, the LCA characterized four classes of adolescents based on endorsement of life events: negative-relational conflict (n = 65, 13.9%), negative-financial problems (n = 49, 10.5%), low life events (n = 130, 27.8%), and positive life events (n = 223, 47.8%). Life event trajectories differed for the negative life event classes compared to the other two classes, with greater odds of HED in the negative-financial problems class at year 1. Conclusion: The four latent classes derived from the life events of NCANDA youth yielded a characterization of adolescents that could aid in understanding HED over the subsequent three years, suggesting that everyday life events may inform adolescent binge drinking.

Patterns of exposure to adverse childhood experiences and their associations with mental health: a survey of 1346 university students in East Asia

INTRODUCTION

Adverse childhood experiences (ACEs) constitute a significant global mental health burden. Prior studies typically investigated the impact of ACEs on mental health using a cumulative risk approach; most ACEs studies were also conducted in Western settings.

PURPOSE

This study aimed to examine ACEs using a pattern-based approach and assess their associations with mental health outcomes by early adulthood in East Asia.

METHODS

The present study included measures of exposure to 13 categories of ACEs, depression, anxiety, maladjustment, and posttraumatic stress in a sample of 1346 university students from Hong Kong, China, Taiwan, and Japan.

RESULTS

Latent class analysis indicated three distinct patterns of ACE exposure: Class 1: Low ACEs (76.0%); Class 2: Household Violence (20.6%); and Class 3: Household Dysfunction (3.4%). Those representing Class 3 had significantly more ACEs compared with those in Classes 1 or 2. Controlling for age and sex, those in Class 2 reported significantly higher depression and maladjustment symptoms compared with those in Class 1; both Classes 2 and 3 had significantly higher anxiety symptoms and odds for meeting diagnostic criteria for posttraumatic stress disorders compared with those in Class 1.

CONCLUSIONS

Study findings suggest that young adults' mental health, at least under certain contexts, is more closely linked with the nature and pattern of ACE co-occurrence, rather than the number of ACEs.

The patterns of adverse childhood experiences among Chinese children: Four-year longitudinal associations with psychopathological symptoms

The objective of this longitudinal study was to identify the contribution of individual, cumulative and patterns of adverse childhood experiences (ACEs) exposure in the prediction of psychopathological outcomes during adolescence in the context of Chinese culture. Children from 3 large elementary schools of Bengbu, Anhui Province, China were enrolled in the 3 waves survey from 2013 (mean age = 8.15 years, SD = 0.88) to 2017 (mean age = 11.92 years, SD = 0.88). Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 10 most common ACEs. Logistic regression was used to examine the association between individual, cumulative and patterns of ACEs and depressive and externalizing symptoms at Wave 3. Of the 1766 respondents included in the sample, 75% had at least 1 and 21.5% reported 4 or more ACEs. We found the dose-response relationship between cumulative ACEs and psychopathological outcomes. Results from LCA revealed three high-risk profiles and one low-risk profile, which were labeled: high ACEs (5.7%), highly abusive and adverse events (20.1%), highly abusive and neglected (21.3%), and low ACEs (52.9%). Compared to low ACEs class, each high-risk profile was differentially associated with psychopathological outcomes over 4-year period. Children exposed to high ACEs were at higher risk for future depressive and externalizing symptoms than other classes. This study provides evidence for the predictive impact of ACEs on adolescent psychopathological symptoms in Chinese culture. Clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE patterns and provide preventive intervention immediately, rather than provide treatment later in life.

Effects of Adverse Childhood Experiences, Stress, and Social Support on the Health of College Students

The goal of the study was to describe the nature of adverse childhood experiences (ACEs) reported by undergraduates and to examine the effect of ACEs, perceived stress, and perceived social support on their health. Although respondents (N = 321) had parents with relatively high levels of education and indicated generally high levels of social support, results nevertheless showed a relatively high level of mental health problems and rates of ACEs that were similar to those in the general population in the state. Those with higher levels of ACEs had greater levels of stress and lower levels of social support. ACEs, social support, and stress explained more than half the variance in mental health scores, with stress making the greatest contribution. Despite the fact that we used different measures and an independent sample, findings generally replicated a previous study. Results point to a need to increase awareness of the association between ACEs and health on college campuses, to examine the effects of ACEs in more detail, and to design ACE-informed programs for this population.

Associations between childhood maltreatment latent classes and eating disorder symptoms in a nationally representative sample of young adults in the United States

BACKGROUND

Childhood maltreatment is associated with eating disorders, but types of childhood maltreatment often co-occur.

OBJECTIVE

To examine associations between childhood maltreatment patterns and eating disorder symptoms in young adulthood.

PARTICIPANTS AND SETTING

Data came from the National Longitudinal Study of Adolescent to Adult Health (N = 14,322).

METHODS

Latent class analysis was conducted, using childhood physical neglect, physical abuse, and sexual abuse as model indicators. Logistic regression models adjusted for demographic covariates were conducted to examine associations between childhood maltreatment latent classes and eating disorder symptoms.

RESULTS

In this nationally representative sample of U.S. young adults (mean age = 21.82 years), 7.3% of participants reported binge eating-related concerns, 3.8% reported compensatory behaviors, and 8.6% reported fasting/skipping meals. Five childhood maltreatment latent classes emerged: "no/low maltreatment" (78.5% of the sample), "physical abuse only" (11.0% of the sample), "multi-type maltreatment" (7.8% of the sample), "physical neglect only" (2.1% of the sample), and "sexual abuse only" (0.6% of the sample). Compared to participants assigned to the "no/low maltreatment" class, participants assigned to the "multi-type maltreatment" class were more likely to report binge eating-related concerns (odds ratio = 1.97; 95% confidence interval [CI]: 1.52, 2.56) and fasting/skipping meals (OR = 1.85; 95% CI: 1.46, 2.34), and participants assigned to the "physical abuse only" class were more likely to report fasting/skipping meals (OR = 1.35; 95% CI: 1.04, 1.76).

CONCLUSIONS

This study provides evidence that distinct childhood maltreatment profiles are differentially associated with eating disorder symptoms. Individuals exposed to multi-type childhood maltreatment may be at particularly high risk for eating disorders.

Neurocognitive Adaptation and Mental Health Vulnerability Following Maltreatment: The Role of Social Functioning

Childhood maltreatment is associated with a lifetime increase in risk of mental health disorder. We propose that such vulnerability may stem in large part from altered patterns of social functioning. Here, we highlight key findings from the psychological and epidemiological literature indicating that early maltreatment experience compromises social functioning and attenuates social support in ways that increase mental health vulnerability. We then review the extant neuroimaging studies of children and adolescents, focusing on three domains implicated in social functioning: threat processing, reward processing, and emotion regulation. We discuss how adaptations in these domains may increase latent vulnerability to mental health problems by impacting on social functioning via increased stress susceptibility as well as increased stress generation. Finally, we explore how computational psychiatry approaches, alongside systematically reported measures of social functioning, can complement studies of neural function in the creation of a mechanistic framework aimed at informing approaches to prevention and intervention.

Predictors of variation in sate reported rates of psychological maltreatment: A survey of statutes and a call for change

BACKGROUND

Psychological maltreatment (PM) is equivalent in harm to other forms of child maltreatment and yet it is not included in all US State child abuse statutes and past research using the National Child Abuse and Neglect Data System (NCANDS, 1998, 2007, 2008) identified 300-480-fold differences in substantiated cases across US States. This variation is inconsistent with the significance of the problem and the availability of reliable operational definitions.

PARTICIPANTS AND SETTING

US State statutes were coded and compared with reported rates of four different forms of child maltreatment in the 2014 and 1998 NCANDS data sets.

METHODS

Data were extracted from NCCANDS and State statutes were coded independently by the authors (kappa = .96).

RESULTS

For 2014, the difference in reported rates of PM between the State with the lowest rate and the State with the highest rate was 523-fold which was much higher than for physical (30-fold) and sexual abuse (20-fold) but not neglect (524-fold). Statutes still use the term "mental injury" from the original Child Abuse Prevention and Treatment Act (Child Abuse Prevention & Treatment Act, 1974) and two thirds did not define it. Reported rates of PM in NCANDS were not correlated with whether PM was defined in the statute but when a harm standard was present, reported rates were statistically lower. Almost 70% of statutes mentioned a current trend (e.g., sexual/human trafficking) demonstrating a willingness by States to amend statutes.

CONCLUSIONS

A common, reliable definition of PM (and other forms of maltreatment) in CAPTA, NCANDS, and US State statutes is necessary for the US to have a surveillance system that allows for the assessment of the effects of policies on reported rates of all forms of maltreatment.

The association between five forms of child maltreatment and depressive and anxiety disorders: A systematic review and meta-analysis

BACKGROUND

Child maltreatment is a global public health issue that encompasses physical abuse, sexual abuse, emotional abuse, neglect, and exposure to intimate partner violence (IPV). This systematic review and meta-analysis summarises the association between these five forms of child maltreatment and depressive and anxiety disorders.

METHODS

Published cohort and case-control studies were included if they reported associations between any form of child maltreatment (and/or a combination of), and depressive and anxiety disorders. A total of 604 studies were assessed for eligibility, 106 met inclusion criteria, and 96 were included in meta-analyses. The data were pooled in random effects meta-analyses, giving odds ratios (ORs) with corresponding 95% confidence intervals (CIs) for each form of child maltreatment.

RESULTS

All forms of child maltreatment were associated with depressive disorders (any child maltreatment [OR = 2.48, 2.14-2.87]; sexual abuse [OR = 2.11, 1.83-2.44]; physical abuse [OR = 1.78, 1.57-2.01]; emotional abuse [OR = 2.35, 1.74-3.18]; neglect [OR = 1.65, 1.35-2.02]; and exposure to IPV [OR = 1.68, 1.34-2.10]). Several forms of child maltreatment were significantly associated with anxiety disorders ('any child maltreatment' [OR = 1.68, 1.33-2.4]; sexual abuse [OR = 1.90, 1.6-2.25]; physical abuse [OR = 1.56, 1.39-1.76]; and neglect [OR = 1.34, 1.09-1.65]). Significant associations were also found between several forms of child maltreatment and post-traumatic stress disorder (PTSD).

CONCLUSIONS

There is a robust association between five forms of child maltreatment and the development of mental disorders. The Global Burden of Disease Study (GBD) includes only sexual abuse as a risk factor for depressive and anxiety disorders. These findings support the inclusion of additional forms of child maltreatment as risk factors in GBD.

Child Maltreatment in Western China: Demographic Differences and Associations with Mental Health

Background: Child maltreatment has become a serious public health and social problem worldwide. However, knowledge regarding the status of child maltreatment in western China is limited. Objective: The objective of this study was to investigate the status of child maltreatment in western China and its relationship with mental health. Participants and setting: The present study evaluated child maltreatment in a sample of 1511 children (M_age = 11.48 years) from western China. Methods: The participants completed questionnaires designed to collect demographic information and assess their experiences with maltreatment and symptoms of depression and anxiety. Results: In total, 12.3%, 14.0%, 1.3% and 28.1% of the children experienced physical abuse, emotional abuse, sexual abuse and neglect, respectively, while 186 children (12.3%) experienced multiple types of maltreatment. Boys were more likely to experience maltreatment than girls in most cases. Physical abuse, emotional abuse, sexual abuse and neglect had unique effects on depression symptoms. Physical abuse, emotional abuse and neglect, but not sexual abuse, had unique effects on anxiety symptoms. Conclusions: The children who experienced maltreatment had higher levels of depressive and anxiety symptoms. Population-based prevention and educational programs should highlight the serious negative effects of maltreatment, especially emotional abuse and neglect, which have long been ignored in China.

From childhood emotional maltreatment to depressive symptoms in adulthood: The roles of self-compassion and shame

BACKGROUND

Emotional abuse is a form of maltreatment that most strongly predicts adult depressive symptoms in community samples. Introject theories suggest that some depressive symptoms stem from survivors having learned to treat themselves the way they were treated by their perpetrators.

OBJECTIVE

Malevolent introjects may undermine self-compassion, which may subsequently maintain feelings of shame. Thus, we hypothesized that self-compassion and shame would mediate the path from retrospective reports of maltreatment to concurrent depressive symptoms in adulthood.

PARTICIPANTS AND SETTING

Participants were 244 adult community members and college students living in a Southwestern American metroplex.

METHOD

We ran a multiple mediator path model with emotional abuse as the independent variable. We specified four covariates: physical abuse, sexual abuse, physical neglect, and emotional neglect, and held constant the variance they explained in self-compassion, shame, and depression.

RESULTS

Our final model accounted for 53.1% of the variance in adult depressive symptoms. A significant indirect effect from emotional abuse passed through both mediators and ended in adult depressive symptoms. We also found an indirect path from emotional neglect to depression passing through both mediators.

CONCLUSIONS

It appears emotional abuse and emotional neglect can undermine the formation of self-compassion. Low self-compassion predicts greater shame and depressive symptoms. Our model suggests self-compassion may be a particularly effective intervention point for survivors of emotional maltreatment.

Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: Findings from a 25-year longitudinal study

BACKGROUND

We aimed to investigate associations between childhood sexual abuse and maltreatment and internalizing disorders (anxiety, depression, PTSD) across adulthood.

METHODS

Following a postal survey of 2220 women, a subsample was selected to participate in an interview. The subsample included 276 women reporting childhood sexual abuse and 221 women with no reported history of childhood sexual abuse. Interviews were repeated six and 25 years following the first interview. Internalizing disorders were assessed using ICD-8 and DSM-III criteria.

RESULTS

There was a lower probability of having an internalizing disorder at older ages than younger ages for all women, regardless of maltreatment history. Latent class analysis was used to define three classes (no/low maltreatment, sexual abuse, poly-victimisation). Compared with no/low maltreatment, a history of childhood sexual abuse was associated with almost double the risk of an internalizing disorder and a history of poly-victimisation was associated with over four times the risk of an internalizing disorder. Childhood sexual abuse and poly-victimisation remained associated with an elevated risk of a disorder in older age.

LIMITATIONS

Findings are limited by attrition (39% participated at Time 3), low prevalence of severe physical abuse, and changes in assessment practice of childhood maltreatment and mental disorder in the past 30 years.

CONCLUSIONS

Screening and treatment for internalizing disorders in women with histories of childhood maltreatment remains important in older aged populations.

Identifying maltreatment subgroups with patterns of maltreatment subtype and chronicity: A latent class analysis approach

Maltreatment experiences are complex, and it is difficult to characterize the heterogeneity in types of maltreatment. Subtypes, such as emotional maltreatment, sexual abuse, physical abuse, and neglect commonly co-occur and may persist across development. Therefore, treating individual maltreatment subtypes as independently occurring is not representative of the nature of maltreatment as it occurs in children's lives. Latent class analysis (LCA) is employed herein to identify subgroups of maltreated children based on commonalities in maltreatment subtype and chronicity. In a sample of 674 low-income urban children, 51.6% of whom experienced officially documented maltreatment, our analyses identified four classes of children, with three distinct classes based on maltreatment subtypes and chronicity, and one group of children who did not experience maltreatment. The largest class of maltreated children identified was the chronic, multi-subtype maltreatment class (57% of maltreated children); a second class was characterized by only neglect in a single developmental period (31% of maltreated children), and the smallest class was characterized by a single subtype of maltreatment (emotional maltreatment, physical, or sexual abuse) occurring in a single developmental period (12% of maltreated children). Characterization of these groups confirms the overlapping nature of maltreatment subtypes. There were notable differences between latent classes on child behavioral and socio-emotional outcomes measured by child self-report and camp counselors report during a one-week summer camp. The largest differences were between the non-maltreated class and the chronic maltreatment class. Children who experienced chronic, multi-subtype maltreatment showed higher levels of externalizing behavior, emotion dysregulation, depression, and anxiety.

The Role of Emotional Abuse in Youth Smoking

INTRODUCTION

The purpose of this prospective study is to examine the role of emotional abuse in predicting youth smoking.

METHODS

Data were drawn from the Longitudinal Studies of Child Abuse and Neglect. The sample was restricted to those who had an interview at age 12 years and at least one interview at ages 14, 16, or 18 years (n=775). Self-reported smoking at ages 14, 16, and 18 years was the time-varying dependent variable. Peer and household smoking were modeled as time-varying predictors. Type of abuse, youth sex, race/ethnicity, history of child neglect, and study site were modeled as time-invariant predictors. Dates of data collection from age 4 years to age 18 years range from July 1991 to January 2012. Analyses were conducted in 2017.

RESULTS

After controlling for a history of neglect, sex, race/ethnicity, study site, household and peer smoking, those with physical and/or sexual abuse only, or emotional abuse only, were at no greater risk of smoking compared with the no abuse group. However, those classified as having a combination of physical and/or sexual abuse and emotional abuse were at significantly greater risk for youth smoking compared with those with no reported physical/sexual or emotional abuse (β=0.51, z=2.43, p=0.015).

CONCLUSIONS

Emotional abuse, in combination with physical and/or sexual abuse, predicted youth smoking, whereas the other types of abuse (physical and/or sexual abuse), or emotional abuse alone, did not. Considering the important health implications of early smoking initiation, it is important to document critical influential factors to better inform intervention efforts.

Outcomes related to adverse childhood experiences in college students: Comparing latent class analysis and cumulative risk

The aims of this study were to identify latent classes of adverse childhood experiences (ACEs) in a large sample of college students (N = 8997), investigate the relations between ACEs classes and life functioning, and compare results using latent class analysis to analyses using cumulative risk scores. Nine types of ACEs were assessed (three types of child abuse and six types of household dysfunction). Outcomes were self-report measures of mental health, physical health, alcohol consequences, and academic performance. Latent class analysis (LCA) results indicated that four classes fit the data best across random halves of the sample and were labeled High ACEs, Moderate Risk of Non-Violent Household Dysfunction, Emotional and Physical Child Abuse, and Low ACEs. Comparing across latent classes, the largest differences in outcomes were between the High ACEs and Low ACEs classes. There were no differences in outcomes between the Moderate Risk of Non-Violent Household Dysfunction and Emotional and Physical Child Abuse classes. The largest between-class differences were found for mental health and the smallest differences were found for academic performance. Comparing results using LCA latent classes and cumulative ACEs scores, the differences between the High and Low ACEs latent classes were similar to the differences between those with zero ACEs and those with 5 or more ACEs. Both approaches also accounted for roughly equivalent amounts of variance in all outcomes. Thus, latent class and cumulative risk analyses provided similar results with regard to predicting outcomes of interest among college students.

Relationship Between Depression and Subtypes of Early Life Stress in Adult Psychiatric Patients

Numerous studies have researched the aggravating and maintainer effect of Early Life Stress in patients adults with psychiatric disorders. This study examined the relationship between depression and subtypes of early life stress among 81 psychiatric patients treated at the inpatient Day Hospital Unit of a University General Hospital. Psychiatric diagnosis was confirmed according to the MINI International Neuropsychiatric Interview (MINI). The Childhood Trauma Questionnaire (CTQ) was used for evaluating as retrospective assessment of the presence of ELS on these patients, and we also evaluated the severity of hopelessness with the Beck Hopelessness Scale (BHS). Our results suggested that the occurrence of depression in adulthood is related to situations of emotional abuse, sexual, and physical neglect during childhood. The analysis between depression and childhood emotional abuse was significant after a multiple logistic regression analysis OR (IC 95%): 4.4 (1.7-11.2), even accounting for gender adjusted OR [AOR] 4.0; (IC 1.5-10.5); psychiatry family history AOR 3.8 (1.4-10.5); previous suicide attempted AOR 3.7; (1.4-10.5) and Hopelessness AOR 3.2 (1.11-9.4). Thus, these findings demonstrate emotional abuse as a significant risk factor to be part of the mechanism involved in the pathogenesis of depression related to early life stress.

Associations of specific and multiple types of childhood abuse and neglect with personality pathology among adolescents referred for mental health services

The present study investigated the unique association between five types of childhood abuse and neglect and 18 lower-order dimensions of personality pathology, and using latent classes analysis (LCA) explored patterns of childhood abuse or neglect experiences. Further differences across latent classes on personality pathology traits, personality disorder symptom count and a diagnosis of personality disorder were examined. Participants were 178 adolescents and young adults (12-22 years; M = 16.02, 65.7% girls; 83% Axis I/II disorder) from the Netherlands referred for mental health services. Emotional abuse was uniquely associated with 11 personality pathology traits; sexual and physical were associated with three and four traits, respectively. LCA yielded three classes, namely, severe maltreatment (class 1), low-moderate emotional maltreatment and sexual abuse (class 2), and least maltreatment (class 3). After controlling for age, gender, presence of any Axis I disorder, multivariate analysis of covariance indicated that classes with more types of maltreatment experiences and higher severity (classes 1 and 2) endorsed more personality pathology traits, personality disorder symptom counts and a diagnosis of a personality disorder than the least maltreatment class. Findings have theoretical and clinical implications entailing the identification of patterns of maltreatment types and related personality pathology traits among youth.

Patterns of adversity and pathways to health among White, Black, and Latinx youth

Research has demonstrated the negative impact of Adverse Childhood Experiences (ACEs) on long-term trajectories of mental and physical health. Yet existing literature on this topic is limited in its understanding of outcomes among youth samples, optimal measurement items and methods, and differences in adverse experiences across race/ethnicity. The current study used a person-centered approach to measure ACEs and their impact on youth health outcomes across three different racial/ethnic groups from a large national database. Patterns of exposure to adverse experiences among Black, Latinx, and White youth (N = 30,668, ages 12-17) were determined empirically using latent class analysis (LCA). Significant differences in class membership by demographic indicators (age, household income, sex) and concurrent health outcomes were identified. Different models emerged for Black (2 classes), Latinx (3 classes), and White youth (3 classes). Older and lower-income youth were more likely to have experienced adversities, but there were no differences in adversity likelihood by sex. Additionally, racial/ethnic minority youth were at greater risk of experiencing higher levels of adversity, poverty, and poor health when compared to their White counterparts. Rather than occuring in meaningful clusters, adverse experiences among youth reflected a cumulative risk model such that classes were defined by the overall intensity of adverse experiences (i.e., low, moderate, high). Findings provide greater knowledge regarding the relationship between ACEs and health and future research directions to inform more targeted and culturally-appropriate screening, prevention, and intervention programs.

Patterns of Adverse Childhood Experiences in Juveniles Who Sexually Offended

Juveniles who sexually offended (JSOs) are differentially burdened with adverse childhood experiences (ACEs). The present study used Latent Class Analysis (LCA) to derive subtypes of JSOs according to their patterns of 10 different ACEs. An extensive file analysis of 322 male JSOs ( M = 14.14, SD = 1.94) revealed five subtypes with (a) multiple (9.0%), (b) mainly family related (17.1%), (c) mainly peer related (21.7%), (d) mainly neglectful (18.6%), and (e) little/no (33.5%) ACEs. Differences among ACE subtypes with regard to several offense and victim characteristics (e.g., the use of penetration or violence, the choice of a child, a male, a stranger, or multiple victims) were examined. Whereas no differences were found for the use of physical violence or the choice of male, stranger, or multiple victims, binary logistic regressions revealed associations of the multiple-ACE subtype with the choice of a child victim, the family-ACE subtype with the use of penetration as well as further nonsexual delinquency, the peer-ACE subtype with the use of penetration and the choice of a child victim, and the neglect-subtype with the choice of a child victim. Additional analyses including single ACE categories instead of LCA-derived subtypes supported these results. Findings highlight the need for a comprehensive consideration of ACEs in research and clinical work to understand developmental pathways to juvenile sexual offending.

Childhood maltreatment profiles among incarcerated Chinese males and their associations with personality disorder symptoms and criminal behaviors

Few studies have investigated how multiple childhood maltreatment experiences co-occur and influence personality disorder symptoms and criminal behaviors in Chinese population. Using a large sample of 1001 incarcerated Chinese males (M_age = 30.86 years), the current study identified profiles of self-reported childhood maltreatment experiences and examined their associations with Axis II personality disorder symptoms and criminal behaviors. Latent profile model was built on five types of maltreatment (emotional, physical, and sexual abuse; emotional and physical neglect). Results showed high prevalence and co-occurrence of maltreatment, and revealed four profiles: Minimal Maltreatment (61.5%), Low Abuse and High Neglect (26.6%), High Sexual Abuse with Multiple Maltreatment (4%), and High Physical and Emotional Maltreatment (7.8%). Profiles with high neglect level showed higher Cluster A personality disorder symptoms as well as borderline, avoidant, and dependent symptoms than those with minimal maltreatment. The two profiles with moderate to high abuse level showed elevated symptoms in all clusters of personality disorder and higher prevalence of juvenile offense than the other two profiles. High Physical and Emotional Maltreatment profile also had higher prevalence of violent offending and recidivism. These findings revealed the importance and utility of identifying profiles of co-occurring maltreatment to tailor treatment based on specific maltreatment experiences and their co-occurrence to address negative outcomes associated with each maltreatment profile.