Adverse childhood experiences are associated with a higher risk for increased depressive symptoms during Covid-19 pandemic - a cross-sectional study in Germany

Longitudinal relationship between adverse childhood experiences and depressive symptoms: the mediating role of physical pain

BACKGROUND

This study explored the relationship between Adverse Childhood Experiences (ACE), physical pain, and depressive symptoms, and examined the mediating role of pain in the correlation between ACE and depressive symptoms among middle-aged and elderly Chinese (over the age of 45).

METHODS

Cox proportional hazards regression models were used to analysis the association between ACE, physical pain, and depressive symptoms. To assess the mediating role of physical pain in the relationship between ACE and depressive symptoms, mediation analysis was conducted. Indirect, direct, and total effects were estimated by combining mediation and outcome models, adjusting for relevant covariates. Bayesian network models were used to visually demonstrate the interrelations between factors influencing depressive symptoms, further verifying the association between ACE, physical pain, and depressive symptoms.

RESULTS

In the fully adjusted model, middle-aged and elderly individuals reporting ACE had a higher risk of developing depressive symptoms (hazard ratios [HR] and 95% confidence intervals [95% CI], 1.379 [1.266-1.503]). Compared to those without physical pain, individuals reporting severe physical pain were at an increased risk of depressive symptoms (HR [95% CI], 1.438 [1.235-1.673]). The risk was even higher for those with both ACE and severe physical pain compared to those with neither (HR [95% CI], 2.020 [1.630-2.505]). The intensity of pain explained 7.48% of the association between ACE and depressive symptoms, while the number of pain sites accounted for 7.86%.

CONCLUSIONS

Physical pain partially mediated the association between ACE and depressive symptoms. The study findings highlighted the importance of early screening and intervention for physical pain in middle-aged and older adults with ACE.

CLINICAL TRIAL NUMBER

Not applicable.

Associations Between Psychopathological Symptom Severity Amid the Pandemic and the Childhood Sociodemographic Environment

It is well-documented that childhood socioeconomic status (SES) is associated with various health conditions in adulthood. Here, we examine the extent to which childhood SES is associated with COVID-19 pandemic anxiety and depression. Participants (n = 212), recruited from Amazon Mechanical Turk, were assessed for depression and anxiety in February 2022 for both the current context and retrospective self-perceived early pandemic depression and anxiety (April 2020). Participants also reported childhood SES and current demographics. Consistent with predated findings, we show a strong, positive correlation between depression and anxiety under both conditions. Paternal unemployment in childhood was associated with increased anxiety, while maternal occupation was not. High household education in childhood was generally associated with greater anxiety and depression, similar to past studies examining education levels and depression. However, the shift from high school to post-secondary degrees (trade school and associate's) was associated with decreased anxiety and depression, which may reflect "essential work" careers, therefore indicating a dualism. Growing up in crowded, de-individualized spaces was associated with lower anxiety and depression, suggesting better conditioning for the imposition of COVID-19 quarantines. Pandemic-related unemployment was associated with an increase in anxiety and depression. Strong political views, regardless of ideology, were associated with increased anxiety. Finally, participants in our cohort perceived their mental health to be worse in the early pandemic for anxiety and depression, up 6.6% and 7.9%, respectively. Our work suggests a complex relationship between SES, demographics, and anxiety and depression during the pandemic. These findings emphasize the importance of exploring the dynamics between early SES and mental health in adulthood, particularly during extended societal stressors.

Adverse childhood experiences are associated with perceived cognitive difficulties among high school students in the United States

Objective

Adverse childhood experiences (ACEs) are associated with mental health and cognitive problems, and mental health problems are associated with perceived cognitive difficulties among adolescents. The unique contribution of ACEs to cognitive difficulties after adjusting for poor mental health is not well understood and represents the purpose of this study.

Methods

The Adolescent Behaviors and Experiences Survey was conducted in 2021 with high school students in the United States. Cognitive difficulty was assessed with: 'Because of a physical, mental, or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions?' Four ACEs were examined: sexual violence (lifetime and past 12 months), parental emotional abuse, and parental physical abuse. Students were asked about feeling sad or hopeless (past year), considering suicide (past year), and having poor mental health (past month). Binary logistic regressions examined the association between ACEs and cognitive problems, adjusting for mental health.

Results

Participants were 6,945 students. Students reporting poor mental health were very likely to endorse difficulty concentrating, remembering, or making decisions (girls = 81% and boys = 67%). Cognitive difficulty was uncommon among students who denied poor mental health (girls = 17% and boys = 12%). For boys [p < 0.001; R2 = 0.22] and girls [p < 0.001; R2 = 0.31], after adjusting for mental health problems, independent predictors of cognitive difficulties included parental verbal abuse and physical abuse. For girls, lifetime forced sexual intercourse and sexual violence during the past year were also independently associated.

Conclusion

ACEs are associated with perceived cognitive difficulty in both adolescent girls and boys, even after adjusting for poor mental health.

Effects of COVID-19 stress, proximity, and adverse childhood experiences on healthcare workers' mental health

Past research has shown that healthcare workers (HCWs) experience high levels of psychological distress during epidemics and pandemics, resulting in cascading effects that have led to chronically understaffed hospitals and healthcare centers. Due to the nature of their responsibilities and workplace stress, HCWs are among vulnerable groups especially during global health crises. During COVID-19 many healthcare workers reported greater symptoms of anxiety, depression, and COVID-19 related worries. Furthermore, adverse childhood experiences increase vulnerability for psychological conditions, especially during pandemics. This study sets out to (1) investigate the moderating effects of adverse childhood experiences on healthcare workers' COVID-19 related stressors and depression/anxiety symptoms, and (2) investigate the moderating effects of adverse childhood experiences on proximity to the COVID-19 virus and depression/anxiety symptoms. Participants included 438 employed HCWs recruited from academic medical centers and smaller healthcare agencies in northcentral Florida between October to December 2020. Mean age of participants was 38.23 (SD = 11.5) with most of the HCWs being white (72.1%), non-Hispanic (86.8%) and female (82%). Healthcare workers completed several online questionnaires, including the Adverse Childhood Experiences scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, a COVID-19 specific worries scale, and a Social Proximity to COVID-19 scale. Healthcare workers experiencing specific COVID-19 worries reported experiencing anxiety and depressive symptoms. A significant positive interaction was seen between childhood adverse experiences globally and COVID-19 worries on anxiety symptoms. A significant positive interaction was observed between childhood maltreatment specifically and COVID-19 worries on depressive symptoms. Additionally, a positive interaction effect was seen between childhood adverse experiences and COVID-19 social proximity for both depression symptoms and anxiety symptoms. Findings from the present study indicate that adverse childhood experiences strengthen the relationship between COVID-19 worry/proximity and negative psychological symptoms. Vulnerable populations such as individuals who have experienced ACEs could benefit from targeted and specific interventions to cope with the collective trauma experienced globally due to COVID-19. As COVID-19 becomes endemic, hospital leadership and authorities should continue addressing COVID-19 worries and HCWs' psychological symptoms through mental health support and organizational interventions.

Mother-Child and Father-Child Emotional Availability during the COVID-19 Pandemic

While the body of literature on COVID-19's impacts on family life is rapidly expanding, most studies are based entirely on self-report data, leaving a critical gap in observational studies of parent-child interactions. The goal of this study was to evaluate parent-child relationships during the COVID-19 pandemic using the observational emotional availability (EA) construct. Parents (n = 43) were assessed using the Epidemic-Pandemic Impacts Inventory (EPII), the Flourishing Scale (FLS), and the adverse childhood experiences (ACEs) questionnaires. The subcategories of the EPII were used to develop an EPII negative and an EPII positive for each parent. EA (sensitivity, structuring, nonhostility, nonintrusiveness, child responsiveness, and child involvement) was coded from filmed parent-child interactions. Separate hierarchical multiple regressions (HMRs) were run to evaluate each of the variables of interest (EPII and FLS) as predictive of EA. Child age (M = 6, SD = 4.68) and ACEs were added in subsequent steps for EPII negative and positive if the initial step was significant. For mothers (n = 25), results demonstrated EPII negative as a significant predictor of EA with child age and ACEs adding only small amount of variance to the prediction. The same HMR process was repeated for flourishing, with the covariate child age alone. For fathers (n = 18), flourishing was a significant predictor of EA and child age added only a small amount of variance to the prediction. Results indicate that experiencing high COVID-19-related stressors is associated with lower EA for mothers, but not fathers. Having high levels of flourishing during the pandemic was predictive of higher EA for fathers, but not mothers.

Adverse Childhood Experiences and COVID-19 Stress on Changes in Mental Health among Young Adults

The COVID-19 pandemic has been linked to poor mental health outcomes and may be particularly damaging for young adults who may be more affected by governmental pandemic responses such as mandatory school and work closures, online schooling, and social isolation. Exposure to Adverse Childhood Experiences (ACEs) has also been shown to have a significant impact on mental health among young adults. This prospective study examined whether young adults with higher ACE profiles were more vulnerable to COVID-19 stressors. Using pre-COVID-19 data from the Niagara Longitudinal Heart Study and a follow-up online survey during COVID-19, we examined 171 young adults and found that high COVID-19-related stress, especially emotional and relationship stress, led to a greater reduction in mental health among young adults with higher levels of ACEs. Findings indicate that young adults with high ACE profiles may benefit from resources and intervention programs directed at mental health in times of crisis, such as the COVID-19 pandemic.