The associations of cumulative adverse childhood experiences and irritability with mental disorders in detained male adolescent offenders

Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation

Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.

Unveiling the Shadows: Childhood Traumas and the Dynamics of Seeking Psychological Help and Self-Stigmatization Among Prisoners

BACKGROUND

Compared with the general population, prison inmates show a higher prevalence of mental disorders, particularly among those with childhood traumas. Despite childhood traumas being robust indicators of poor mental health, there is limited research on their relationship with prisoners' attitudes toward seeking psychological help. This study investigates the impact of childhood traumas on prisoners' attitudes toward help-seeking and self-stigmatization.

METHODS

This cross-sectional, explanatory study was conducted with 250 persons in prison. Data were collected using a sociodemographic information form, the Childhood Trauma Questionnaire, the Attitudes Toward Seeking Psychological Help Scale, and the Self-Stigma of Seeking Help Scale. Statistical analysis was performed using Spearman correlation test and multiple linear regression analysis with SPSS Version 28.

RESULTS

A significant link was found between childhood traumas and self-stigmatization in seeking psychological help. Positive attitudes toward help-seeking were significantly associated with increased self-stigmatization. Childhood traumas were significantly related to single-parent families, conflicted intrafamilial relationships, entering prison at the age of 19 years or older, mental health issues, and behavioral disorders. Moreover, a meaningful association was observed between self-stigmatization in help-seeking and being from a single-parent family with a low socioeconomic status.

CONCLUSION

In conclusion, imprisoned persons with childhood traumas exhibit higher levels of self-stigmatization in seeking psychological help, contributing to negative attitudes. Recommendations for adequate access to mental health services in prisons include fostering a culture of psychological help, enhancing mental health literacy, providing trauma-informed care, and developing comprehensive strategies. In addition, the suggestion is made for the development of societal reintegration programs.

Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth

BACKGROUND

Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods.

METHODS

The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care.

RESULTS

Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity.

CONCLUSIONS

Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.

Irritability in Youths: A Critical Integrative Review

Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinicians and researchers should assess irritability routinely, and specific assessment tools are now available. Informant effects are prominent, are stable, and vary by age and gender. The prevalence of irritability is particularly high among individuals with attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Developmental trajectories of irritability (which may begin early in life) have been identified and are differentially associated with clinical outcomes. Youth irritability is associated with increased risk of anxiety, depression, behavioral problems, and suicidality later in life. Irritability is moderately heritable, and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for treating psychological problems related to irritability, but its efficacy in treating irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeting exposure to frustration). Associations between irritability and suicidality and the impact of cultural context are important, underresearched topics. Analyses of large, diverse longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, revealing important translational opportunities.

Irritability, Negative Life Events and the Course of Anxiety and Depressive Symptoms in a Clinical Sample of Youth: A Longitudinal Study

Objective

Irritability, the tendency to react with anger, and the experience of negative life events (NLE) have independently been associated with the emergence of anxiety and depression. Here, we investigate how irritability and cumulative effects of NLE interactively predict the course of anxiety and depression in the context of common psychiatric disorders.

Method

432 youth with no psychiatric diagnosis, or a diagnosis of an anxiety disorder, Attention-Deficit/ Hyperactivity Disorder (ADHD), or Disruptive Mood Dysregulation Disorder (DMDD), participated in this study. At baseline, we assessed NLE, parent and youth reports of irritability and anxiety, and youth reports of depression. Symptoms were annually reassessed for up to four years.

Results

In youth without psychiatric diagnoses but with elevated baseline irritability, the presence of NLE predicted decreasing anxiety, while the absence of NLE predicted increasing anxiety. In youth with an anxiety disorder, elevated baseline irritability predicted decreasing anxiety independent of NLE, while a large cumulative effect of NLE predicted increasing depression. NLE predicted persisting mild anxiety in ADHD and persisting mild depressive symptoms in DMDD.

Conclusion

Our findings suggest that, particularly in non-referred samples, NLE might moderate the relationship between irritability and future anxiety such that irritability/ anger in the context of NLE can positively affect the course of anxiety. Future work replicating this finding while repeatedly measuring NLE and rigorously controlling for potentially confounding effects of treatment, is warranted.

Association Between Child Maltreatment and Aggression in Chinese Early Adolescents: The Mediating Role of Irritability

Child maltreatment (CM) is a major global public health issue, and a strong association exists between CM and aggression. However, the underlying mechanism of this association has not been understood to date. The objective of this study was to explore the mediating role of irritability in the association between CM and aggression in Chinese early adolescents. A cross-sectional study was conducted using a self-report questionnaire to evaluate the levels of CM, aggression, and irritability in 5,724 middle school students from the Anhui Province, China. Structural equation modeling was used to test the hypothesis of the mediating effect of irritability on the relationship between CM and aggression. We further investigated gender differences in this association using multiple group analyses. CM was positively related to both irritability and aggression, and irritability was positively associated with aggression (p < .01). The mediating effects of irritability between CM and aggression were significant (β = .107, 95% confidence intervals [CI]: 0.077-0.133, p < .05). Males had a higher indirect effect size of the pathway from CM to aggression via irritability compared with females. Overall, irritability was a crucial mediator in the relationship between CM and aggression in Chinese adolescents, and males were more prone to engage in aggression compared with females through the pathway of irritability. Therefore, early irritability characteristics should be carefully monitored in adolescents, and they should be provided adequate support to acquire critical emotion regulation skills.

The impact of adverse childhood experiences on depression: the role of insecure attachment styles and emotion dysregulation strategies

Objectives: The previous studies have reported that adverse childhood experiences (ACEs) can have detrimental effects on victims' attachment styles, emotion regulation strategies and depression. How the insecure attachment styles and emotion dysregulation strategies play a role in the relationship between ACEs and depression among Chinese university students remains unclear. Methods: The research was made known to students studying at universities in China. Five hundred and eighty-nine college students completed questionnaires measuring ACEs, insecure attachment styles, emotion dysregulation strategies and depression. Sequential chain mediation model was built by Mplus. Results: The model showed that insecure attachment styles and emotion dysregulation strategies mediated the relationship between ACEs and depression respectively. Moreover, the sequential chain mediation showed an indirect path (ACEs - insecure attachment styles - emotion dysregulation strategies - depression). Conclusion: Following childhood adversities, students can experience elevated depression which is influenced by attachment styles and emotion regulation strategies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04613-1.

The Suitability of the Childhood Trauma Questionnaire in Criminal Offender Samples

Adverse childhood experiences (ACEs) are common in community samples and are associated with various dysfunctional physical, psychological, and behavioral consequences. In this regard, criminal offenders are at specific risk, considering their elevated ACE rates compared with community samples and the associations of ACEs with criminal behaviors. However, assessing ACEs in offender samples by self-reports has been criticized with regard to their validity and reliability. We examined the suitability of ACE-self-reports using the Childhood Trauma Questionnaire (CTQ) in a sample of 231 male offenders involved in the German criminal justice system by comparing self-reported to externally rated ACEs to externally rated ACEs based on the information from the offenders' criminal and health-related files and on interviews conducted by forensically trained psychological/psychiatric experts. The accordance between self-ratings and expert ratings was examined considering mean differences, correlations, inter-rater agreement measures, and regression analyses. Offenders themselves reported a higher ACE burden than the one that was rated externally, but there was a strong relationship between CTQ self-assessments and external assessments. However, associations were stronger in offenders seen for risk assessment than in those evaluated for criminal responsibility. Overall, the CTQ seems suitable for use in forensic samples. However, reporting bias in self-reports of ACEs should be expected. Therefore, the combination of self-assessments and external assessments seems appropriate.

Frequency of anger and its potential relationship with Selfesteem and Adverse Childhood Experiences among Medical and Sociology undergraduate students in Pakistan

Objectives

To determine the frequency of clinical anger, adverse childhood experiences, self-esteem, and their mutual relationship among undergraduate medical and sociology students.

Methods

In this descriptive cross-sectional study, data from 400 undergraduate medical and sociology students was collected from the Northwest School of Medicine, Peshawar, and the sociology department of the International Islamic University, Islamabad, from July to September 2021. A self-administered questionnaire incorporating a Clinical Anger Scale (CAS), Adverse childhood experience (ACE) scale and Rosenberg self-esteem (RSE) scale was utilized for data collection. Descriptive statistics, ANOVA and logistic regression model were executed to perform data analysis using SPSS.

Result

The mean CAS score was 19.65 ± 13.23 suggesting that 60.2% of the participants experienced mild to severe degrees of clinical anger. Females were experiencing more anger issues than males (64% vs 54%, p = .040) RSE scale showed that 72.8% of the participants had low self-esteem with a mean score of 12.70 ± 5.43. Besides, 51.5% of the participants had at least one type of adverse childhood experience while 15.8% of the sample population reported being sexually abused in childhood. Significant correlation was found between CAS and age, ACEs and RSE score (p = <0.01). The logistic regression model also suggested that the prevalence of anger was higher in individuals with ACEs (OR = 1.29, 95% CI: 1.12, 1.14, p = <.001) and low self-esteem (OR = 1.15, 95% CI: 1.09, 1.22, p = <.001).

Conclusion

The high frequency of clinical anger necessitates the implementation of periodic screening across all universities. Keeping in mind the problem of low self-esteem and the history of ACEs, there is an urgent need for the development of strategies to preserve and improve the mental well-being of the young generation.

Trauma exposure, social functioning, and common mental health disorders in Somali refugee male and female youth: An SEM analysis

Background:

Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy.

Aims:

This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains.

Method:

We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15–35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample ( N = 305) and then assessed gender differences by running one model for male participants ( n = 124) and another for female participants ( n = 181).

Results:

In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample.

Conclusions:

This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population.

Associations Between Adverse Childhood Experiences and Trauma Among Young People Who Offend: A Systematic Literature Review

This systematic review synthesized current knowledge about the prevalence of adverse childhood experiences (ACEs) among young people known to have offended and examined evidence of associations between ACEs, trauma symptoms, and offending behavior. A systematic search of English-language, peer-reviewed studies published from the year 2000 onwards was conducted. A final pool of 124 studies that reported quantitative data were included in the review. The Cambridge Quality Checklist for the assessment of studies on offending was used to assess methodological quality of included studies. Pooled data indicated that almost 87% of justice-involved young people across 13 countries experienced at least one traumatic event. The odds of experiencing at least one ACE were over 12 times greater for justice-involved young people compared with nonjustice-involved young people. Prevalence of individual ACEs ranged from 12.2% for childhood sexual abuse to 80.4% for parental separation among justice-involved young people. Those who reported both a higher number and multiple types of ACEs were more likely to be diagnosed with post-traumatic stress symptoms. However, when considering only high-quality studies, there was minimal evidence to suggest that a higher incidence of ACEs predicted trauma symptoms or that trauma symptoms mediated the association between ACEs and offending behavior. Further research is needed to elucidate factors that differentiate young people exposed to ACEs who go on to offend from those who do not. This research is essential to understanding whether ACEs and trauma are drivers of offending behavior and for informing prevention and intervention strategies.

Childhood adversity increases risk of psychotic experiences in patients with substance use disorder

INTRODUCTION

Adverse childhood experiences (ACEs) increase the risk of psychotic experiences (PE), but little is known about heterogeneities of this association in different developmental stages, dimensions, or whether they are affected by substance use disorder (SUD). This study examines the association between different types of ACEs at various developmental stages and lifetime PE in patients with SUD in Chile.

METHODS

We included 399 consenting adults in outpatient or residential SUD treatment programs. Sociodemographic data and information about PE and ACEs were obtained by trained clinical psychologists.

RESULTS

Patients reporting PE experienced more ACEs compared to patients without PE (4.2 versus 3.4). They also experienced more complex adversities (41.8% versus 25.1%), had more psychiatric comorbidities (85% versus 70.4%), and reported using more substances (mean 4.5 versus 3.9). Adjusted association between ACEs and PE showed the highest OR for arrests (1.88), sexual abuse (1.81), alcohol abuse by parents (1.48), school exclusion (1.39), foster or residential care (18.3).

CONCLUSION

Early exposure to ACEs is a risk factor for later PE among patients with SUD. Type of ACE and the period when they occurred is important, suggesting the existence of critical periods where the individual is more susceptible to adverse environmental stimuli.

Adverse Childhood Experiences, Personality, and Crime: Distinct Associations among a High-Risk Sample of Institutionalized Youth

Despite high rates of adverse childhood experiences (ACEs) and personality-related disturbances among delinquent juveniles, associations among ACEs, youth personality, and juvenile crime involvement are still unclear. High-risk samples of institutionalized youth are in specific need of a comprehensive assessment of ACEs and personality features in order to broaden the current knowledge on the occurrence and persistence of juvenile crime and to derive implications for prevention and intervention. We examined a heterogeneous high-risk sample of 342 adolescents (35.1% females, 64.9% males) aged between 12 and 18 years (M = 15.74, SD = 1.61 years) living in child-welfare or juvenile justice institutions regarding cumulative ACEs, psychopathic traits, temperament, and clinical personality disorder ratings, and criminal involvement before and up to 10 years after assessment. We found considerable rates of ACEs, although cumulative ACEs did not predict future crime. Latent Profile Analysis based on dimensional measures of psychopathy, temperament, and personality disorders derived six distinct personality profiles, which were differently related to ACEs, personality disturbances, clinical psychopathology, and future delinquency. A socially difficult personality profile was associated with increased risk of future crime, whereas avoidant personality traits appeared protective. Findings indicate that the role of ACEs in the prediction of juvenile delinquency is still not sufficiently clear and that relying on single personality traits alone is insufficient in the explanation of juvenile crime.

Irritable Mood and Subthreshold Hypomanic Episodes Correlate with More Severe Major Depression

INTRODUCTION

Irritable mood (IM) and subthreshold hypomanic symptoms are reported in half and two-fifths of major depressed subjects respectively, but their clinical and prognostic meanings remain unclear. The aim of this study was to test the clinical usefulness of 2 specifiers in DSM-IV major depressive disorder (MDD): IM occurring during an index episode (IM+) and lifetime episodes of elated mood or IM with at least 2 concurrent hypomanic symptoms (subthreshold hypomanic episodes [SHEs]).

METHOD

We included 482 outpatients with MDD participating in the Combining Medications to Enhance Depression Outcome study (mean age 43.14 ± 12.46 years, 144 males - 30%). The main aim of the original study was to test whether 2 different medications when given in combination as the first treatment step, compared to 1 medication, would improve antidepressant response.

RESULTS

IM + subjects (N = 349; 70%) were younger and more often females, with a more severe depression, a more marked social impairment, and more psychiatric comorbidities. The IM + group was also characterized by higher levels of suicidal ideation and more cases of emotional abuse. The combination of IM+ and SHEs was associated with an even more severe clinical picture. Limitations include the post hoc method, incomplete assessment of bipolar validators (e.g., family history of bipolar illness), personality disorders and suicide attempts.

CONCLUSIONS

The presence of IM and SHEs in MDD correlate with an overall more severe clinical condition.

Mental Health in Young Detainees Predicts Perpetration of and Desistance From Serious, Violent and Chronic Offending

Mental health problems are common among young offenders but their role in predicting criminal recidivism is still not clear. Early identification and treatment of young offenders at risk of serious, violent, and chronic (SVC) offending is of major importance to increase their chances to develop into a healthy and non-criminal future and protect society from further crime. In the present study, we assessed mental health among 106 young offenders while incarcerated and analyzed their criminal careers up to 15 years after release. We found high rates of mental health issues, especially externalizing problems, but also concerning illegal substance and alcohol use patterns as well as personality disorders. Rule-breaking behavior and internalizing problems were negatively related to incarceration time until study assessment, but withdrawal and internalizing problems were positively associated with remaining time to release. Whereas, SVC status before assessment and after release were not statistically dependent, mental health issues predicted perpetration of and desistance from SVC offending after release. Alarming alcohol use appeared to be of specific importance in this regard. Findings indicate that young offenders at risk of future SVC offending may benefit from mental health treatment with specific focus on problematic alcohol consumption to prevent ongoing crime perpetration.

ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders

Attention-deficit/hyperactivity disorder (ADHD) and co-existing psychiatric/psychological impairments as well as adverse childhood experiences (ACEs) are common among young offenders. Research on their associations is of major importance for early intervention and crime prevention. Intermittent explosive disorder (IED) warrants specific consideration in this regard. To gain sophisticated insights into the occurrence and associations of ADHD, IED, ACEs, and further psychiatric/psychological impairments in young (male and female) offenders, we used latent profile analysis (LPA) to empirically derive subtypes among 156 young offenders who were at an early stage of crime development based on their self-reported ADHD symptoms, and combined those with the presence of IED. We found four distinct ADHD subtypes that differed rather quantitatively than qualitatively (very low, low, moderate, and severe symptomatology). Additional IED, ACEs, and further internalizing and externalizing problems were found most frequently in the severe ADHD subtype. Furthermore, females were over-represented in the severe ADHD subtype. Finally, ACEs predicted high ADHD symptomatology with co-existing IED, but not without IED. Because ACEs were positively associated with the occurrence of ADHD/IED and ADHD is one important risk factor for on-going criminal behaviors, our findings highlight the need for early identification of ACEs and ADHD/IED in young offenders to identify those adolescents who are at increased risk for long-lasting criminal careers. Furthermore, they contribute to the debate about how to best conceptualize ADHD regarding further emotional and behavioral disturbances.

Adverse Childhood Experiences Predict Common Neurodevelopmental and Behavioral Health Conditions among U.S. Children

OBJECTIVE

Adverse childhood experiences (ACEs) can have a significant but variable effect on childhood neurodevelopment. The purpose of this study was to quantify and compare the associations between "household challenge" ACEs and common childhood neurodevelopmental and behavioral health conditions, using nationally representative U.S.

DATA

METHOD

This study used data from the 2016-2019 National Survey of Children's Health, a nationwide, population-based, cross-sectional survey. Seven household challenge ACEs (not including child maltreatment) were reported by parents/guardians: parental death, incarceration, divorce/separation, family violence, mental illness, substance abuse, and poverty. Logistic regression with sample weights was used to estimate the odds ratio (OR) for 15 parent-reported neurodevelopmental and behavioral health conditions, by the number of reported ACEs. A dose-response relationship was examined by applying tests of orthogonal polynomial contrasts to fitted logistic regression models.

RESULTS

Down syndrome, Tourette syndrome and cerebral palsy were not associated with household challenge ACEs, whereas behavior/conduct problems, depression, and substance abuse were strongly associated, with adjusted ORs ranging from 6.36 (95% confidence interval (CI) 5.53, 7.32) to 9.19 (95% CI 7.79, 10.84). Other neurodevelopmental conditions not traditionally associated with childhood adversity showed moderate yet robust associations with ACEs, including autism (adjusted OR 2.15, 95% CI 1.64, 2.81), learning disability (adjusted OR 3.26, 95% CI 2.80, 3.80), and attention deficit hyperactivity disorder (adjusted OR 3.95, 95% CI 3.44, 4.53). The ORs increased with the number of ACEs, showing significant positive linear trends.

CONCLUSION

We found significant dose-dependent or cumulative associations between ACEs and multiple neurodevelopmental and behavioral conditions.

OXTR moderates adverse childhood experiences on depressive symptoms among incarcerated males

OBJECTIVES

This study examined the moderation of an oxytocin receptor (OXTR) gene in the link between childhood adversity and depressive symptoms among incarcerated males.

METHODS

Questionnaires about adverse childhood experiences and depressive symptoms, as well as genomic DNA from blood were collected among 608 incarcerated males (M_age = 32.4 years, SD = 9.41, 18-74 years). Moderation analysis was applied to examine the interaction between adverse childhood experiences (including abuse, neglect, and household dysfunction) and the OXTR polymorphisms (rs2254298, rs53576) in predicting depressive symptoms.

RESULTS

Incarcerated males had relatively higher prevalence of childhood adversity (70.2%) and depressive symptoms (49.8%). Higher childhood adversity was associated with increased depressive symptoms, and the effect was more pronounced in the GG homozygotes of OXTR rs2254298 (b = 0.406, p < .001), as compared with the AA/AG carriers (b = 0.236, p < .001). By contrast, the OXTR rs53576 did not interact with childhood adversity in predicting depressive symptoms.

CONCLUSIONS

Chinese incarcerated males with the GG genotype of OXTR rs2254298 have higher vulnerability in the effect of childhood adversity on depressive symptoms.

The association between adverse childhood experiences and mental health problems in young offenders

High rates of adverse childhood experiences (ACEs, e.g., abuse and neglect) have been found in young offenders. Furthermore, ACEs seem to increase the risk of developing relevant mental health problems, in non-offending juveniles and adults. However, this association has only seldomly been addressed in offending juveniles and young adults. The present study aimed at evaluating the prevalence of ACEs and mental health problems as well as their association within a sample of male and female young offenders. Altogether, 161 adolescent and young adult offenders (16.8% females) from the youth detention center Worms (Germany) filled out questionnaires concerning ACEs and mental health problems with a focus on attention-deficit/hyperactivity disorder and intermittent explosive disorder. Considerable rates of mental health problems were found, e.g., a prevalence of 35.9% was found for intermittent explosive disorder. Furthermore, a greater proportion of the female offenders fell into the clinically significant category for somatic complaints, anxiety/depression, and attention problems than the male offenders. Female young offenders also reported more frequently about all forms of ACEs compared to the male offenders. Latent class analysis defined three subtypes of young offenders depending on their individual ACE patterns: (1) low ACEs, (2) mainly neglectful ACEs, and (3) multiple ACEs. ACEs were significantly associated with the occurrence of both internalizing and externalizing mental health disturbances, with the multiple-ACE subtype being most likely to report about significant mental health problems. The results of the present study point towards the relevance to routinely assess ACEs in young offenders to identify possible precursors of mental health problems and of future criminal behaviors.

The Relationship Between ACEs, Trauma-Related Psychopathology and Resilience in Vulnerable Youth: Implications for Screening and Treatment

This study examined the impact of ACEs in vulnerable adolescents and assessed whether resilience would have a moderating impact on psychological functioning. Participants included 40 youth, aged 12-17 identified as having experienced family violence and who were referred for treatment at the San Diego Center for Counseling (SD-CC). The relationship between ACEs, trauma-related symptomology, and psychological functioning was examined using results from the Child Posttraumatic Stress Scale (CPSS) and the Personality Assessment Inventory for Adolescents (PAI-A). The Child Youth Resiliency Measure was utilized to assess whether resilience buffered against the impact of ACEs. A positive relationship between the number of reported ACEs and trauma-related symptomology was found. There was a dose dependent response: youth endorsing 4 or more ACEs had significantly more psychopathology and showed less resilience as compared to those scoring below 4. The more resilient the sample, the less symptomatology was found. Regression analysis showed that resilience had a protective influence: as ACE distress increased, those high in resilience reported less somatization or depression. These findings support the use of the ACE measure as a screening tool and underscore the importance of assessing resilience in conjunction.

Cumulative early childhood adversity and later antisocial behavior: The mediating role of passive avoidance

Twenty-six percent of children experience a traumatic event by the age of 4. Negative events during childhood have deleterious correlates later in life, including antisocial behavior. However, the mechanisms that play into this relation are unclear. We explored deficits in neurocognitive functioning, specifically problems in passive avoidance, a construct with elements of inhibitory control and learning as a potential acquired mediator for the pathway between cumulative early childhood adversity from birth to age 7 and later antisocial behavior through age 18, using prospective longitudinal data from 585 participants. Path analyses showed that cumulative early childhood adversity predicted impaired passive avoidance during adolescence and increased antisocial behavior during late adolescence. Furthermore, poor neurocognition, namely, passive avoidance, predicted later antisocial behavior and significantly mediated the relation between cumulative early childhood adversity and later antisocial behavior. This research has implications for understanding the development of later antisocial behavior and points to a potential target for neurocognitive intervention within the pathway from cumulative early childhood adversity to later antisocial behavior.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Effects of psychosocial and socio-environmental factors on anxiety disorder among adolescents in Bangladesh

BACKGROUND

Anxiety is a common psychiatric disorder among adolescents in developing countries. This study aimed to examine the risk factors of anxiety disorder and the adverse consequences of anxiety disorder among adolescents in Bangladesh.

METHODS

A total of 2,989 adolescent data of the 2014 Global School-based Student Health Survey (GSHS), Bangladesh, was analyzed WHO. The prevalence of anxiety disorder across psychosocial and socio-environmental factors was calculated as descriptive statistics, whereas their effects on occurring anxiety disorder were determined using the unadjusted and adjusted multivariable binary logistic regression model. The consequences of anxiety disorder were also determined using the multivariable binary logistic regression model.

RESULTS

The prevalence of anxiety disorder was 4.7%, which was found higher among female than their male counterparts. The psychosocial factors were found associated with the anxiety disorder are loneliness (AOR: 2.26, 95% CI: 1.08-4.72), being bullied (AOR: 6.00, 95% CI: 3.14-11.47), and physical abuse (AOR: 2.12, 95% CI: 1.07-4.21). Moreover, poor understandings with parents (AOR: 1.75, 95% CI: 1.02-3.01) and lack of peer support (AOR: 2.23, 95% CI: 1.18-4.23) were the socio-environmental factors that found associated with the anxiety disorder. Subgroup analysis across gender found these associations were consistent for adolescent male and female. Moreover, the likelihood increased with the increasing number of the adverse psychosocial, or socio-environmental factors.

CONCLUSIONS

Around 5% of school-going adolescents in Bangladesh reported anxiety associated with the exposure of single or multiple adverse psychosocial and socio-environmental factors including bullying and physical abuse. Early screening and interventions are essential, targeted to adolescent at risk, which could reduce the rate of anxiety disorder among adolescent in Bangladesh.

Is the psychological impact of exposure to COVID-19 stronger in adolescents with pre-pandemic maltreatment experiences? A survey of rural Chinese adolescents

BACKGROUND

Since the COVID-19 outbreak at the end of 2019, it has evolved into a global pandemic with tremendous mental health impact besides the threats to people's physical health.

OBJECTIVE

The aims were to examine whether exposure to COVID-19 predicts elevated levels of anxiety and post-traumatic stress symptoms and whether pre-pandemic maltreatment experiences exacerbate this impact on mental health in adolescents.

PARTICIPANTS AND SETTING

The survey was conducted online from February 8 st to February 27th, 2020, and the questionnaires were distributed and retrieved through a web-based platform. This study includes a total of 6196 subjects, aged range from 11 to 18 years old.

METHODS

Several multivariable linear regressions were used to analyse the data.

RESULTS

The largest variance in PTSS and anxiety problems was explained by ACEs, with more pre-pandemic maltreatment experiences predicting more PTSS (effect size beta = 0.16∼0.27), and more anxiety (effect size beta = 0.32∼0.47). Experienced or subjective fear of exposure to COVID-19 predicted statistically significant variance in PTSS and anxiety, and standardized betas ranged from 0.04 to 0.09. Participants who had adverse childhood experiences and had experienced exposure to COVID-19 showed elevated PTSS.

CONCLUSIONS

After pre-pandemic maltreatment experiences the impact of exposure to COVID-19 on mental health may be stronger. Scars from the past seem to be vulnerabilities during societal upheaval. We therefore suggest that when exposed to COVID-19 rural adolescents should get prioritized professional family support and mental health counseling in particular when they have experienced family abuse and neglect in childhood, even though such support is more difficult to organize in rural areas.

Effects of Irritability of the Youth on Subjective Well-Being: Mediating Effect of Coping Styles

BACKGROUND

The global COVID-19 pandemic caused great impacts and influences to human psychology. As a result, youths who are kept at home for a long time easily develop irritability and problematic behaviors. However, relatively little attention has been paid to the relations among irritability, coping style, and subjective well-being of the youth.

METHODS

Overall, 1,033 youth respondents (aged 18-30 yr) from seven provinces in China were investigated in 2020 using the irritability, depression, and anxiety scale, coping style scale, and well-being index scale.

RESULTS

Among the dimensions of irritability of the youth, anxiety received the highest score, followed by introversion irritability, extroversion irritability, and depression. Irritability had significant regional differences. The total score of irritability among rural youth was significantly higher than that of urban youth (P<0.05). The irritability level of youths with parents' emotional status was harmonious and good relations with family members and peers was far lower than those of youths who have poor relations between parents, family members, and peers (P<0.05). The irritability level of youths with a lower monthly household income was higher (P<0.05). Irritability of the youth had significantly negative correlations with positive response and SWB, and it had a significantly positive correlative with negative response. Coping style can mediate the relationship between irritability and SWB of the youth to some extent.

CONCLUSION

Significant correlations exist among irritability, coping style, and SWB of the youth. Irritability can be used to predict SWB indirectly through positive response.

From trauma-blind to trauma-informed: re-thinking criminalization and the role of trauma in persons with serious mental illness

Trauma-informed approaches offer a new perspective for understanding how and why individuals with serious mental illness (SMI) become entangled in the criminal justice system. There is growing awareness that many individuals with SMI have experienced significant life trauma, and factors beyond SMI that contribute to criminalization are being identified; however, the role of trauma continues to be overlooked in many formulations. In trauma-blind systems, trauma-related behaviors are often misunderstood and met with responses that exacerbate psychiatric and behavioral problems. Trauma-informed approaches provide a richer understanding of underlying drivers of behavior, and view trauma as an integral component of risk management, case formulation, relationship-based care, and referral. Embedding trauma-informed principles across organizations promotes continuity of care, safety, and more compassionate cultures that help reduce the flow of individuals with SMI into the criminal justice system. An expanded view of the criminalization hypothesis is offered, which incorporates all factors addressed in current research.

Meta-analysis: Exposure to Early Life Stress and Risk for Depression in Childhood and Adolescence

OBJECTIVE

Early life stress (ELS) is associated with increased risk for the development of major depressive disorder (MDD) in adulthood; however, the degree to which ELS is associated with an early onset of MDD (ie, during childhood or adolescence) is not known. In this meta-analysis, we estimated the associations between ELS and the risk for onset of MDD before age 18 years. In addition, we examined the associations between eight specific forms of ELS (ie, sexual abuse, physical abuse, poverty, physical illness/injury, death of a family member, domestic violence, natural disaster, and emotional abuse) and risk for youth-onset MDD.

METHOD

We conducted a systematic search in scientific databases for studies that assessed both ELS and the presence or absence of MDD before age 18 years. We identified 62 journal articles with a total of 44,066 unique participants. We assessed study quality using the Newcastle-Ottawa Scale. When heterogeneous effect sizes were detected, we tested whether demographic and/or methodological factors moderated the association between ELS and MDD.

RESULTS

Using a random-effects meta-analysis, we found that individuals who experienced ELS were more likely to develop MDD before the age of 18 years than were individuals without a history of ELS (odds ratio = 2.50; 95% confidence interval 2.08, 3.00). Separate meta-analyses revealed a range of associations with MDD: whereas some types of ELS (eg, poverty) were not associated with MDD, other types (eg, emotional abuse) were associated more strongly with MDD than was ELS considered more broadly.

CONCLUSION

These findings provide important evidence that the adverse effect of ELS on MDD risk manifests early in development, prior to adulthood, and varies by type of ELS.

[Patterns of psychopathology and psychosocial background of patients at first presentation at the child and adolescent psychiatric outpatient department of the University Clinic Salzburg]

BACKGROUND

This study examines the prevalence of psychiatric disorders and psychosocial background of outpatients at an Austrian child and adolescent psychiatry department.

METHODS

One hundred eighty-three patients were examined using the Mini International Neuropsychiatric Interview for Children and Adolescents and the Multidimensional Clinical Screening Inventory. Pearson's chi-square tests were used to explore the prevalence of psychiatric disorders between gender and age-groups and their relationship with the psychosocial background of patients.

RESULTS

Most patients (86.9%) had at least one psychiatric disorder. Almost three quarters (72.4%) of these patients made use of extramural facilities. Boys and girls did not differ in age or presence of a disorder. Internalising disorders were more common among older patients. Externalising disorders were more common among boys and younger patients. 65.2% of patients suffered from at least one co-morbid disorder. Boys and those with at least one externalising disorder showed more problems at school. Girls were victims of sexual assault more often, but boys experienced more extra-familial physical abuse. Girls and those with internalising disorders showed more self-harming and suicidal behaviour. A combination of internalising and externalising disorders correlated with increased drug consumption. Boys spent more time using a computer.

CONCLUSIONS

The results show that particular psychopathologies often appear in connection with certain psychosocial burdens. Especially boys show increased vulnerability in relation to school problems. The willingness of patients to make use of extramural points of contact should guide future policies to consider therapeutic options encompassing parents, schools and welfare institutions for children prone to the development of psychiatric symptoms due to psychosocial risk.

Associations between Child Maltreatment, Harsh Parenting, and Sleep with Adolescent Mental Health

Youth who suffer from psychiatric disorders are at high risk for negative outcomes, including aggression and substance abuse. Although many youth with psychiatric disorders have endured harsh parenting and/or child maltreatment (CM), differential associations between these experiential factors have yet to be fully explored. Sleep problems have also been implicated in psychiatric disorders and are consistently associated with CM. The overlap and unique contributions of CM and sleep problems to the mental health of youth remains unclear; longitudinal studies from late childhood into adolescence, when psychiatric illnesses frequently onset, are rare. The current longitudinal study examined associations of CM, harsh parenting, and sleep problems with symptoms of four psychiatric disorders: Conduct Disorder, Attention Deficit Hyperactivity Disorder, Anxiety, and Depression. Early adolescent youth with no history of substance use (N = 529) were sampled from a working class, medium-sized city in northern Kentucky, and an extensive battery of tests were administered to youth and a parent. CM was more strongly and consistently related to psychiatric disorder symptoms at baseline than was harsh parenting. Reports of harsh parenting were more strongly associated with externalizing symptoms than internalizing symptoms. Sleep problems were also positively associated with psychiatric disorder symptoms at baseline, but did not exacerbate the effects of CM or harsh parenting on symptom counts. Longitudinally, harsh parenting was more predictive of change in psychiatric symptoms two to three years later than was CM. The potential significance of childhood adversity and sleep problems for prevention of later mental health problems are discussed.

Adverse Childhood Experiences and Psychological Distress in Juvenile Offenders: The Protective Influence of Resilience and Youth Assets

PURPOSE

To examine whether internal resiliency and external assets directly protect juvenile offenders exposed to adverse childhood experiences (ACEs) from psychological distress and moderate the relationship between ACE exposure and psychological distress.

METHODS

A total of 429 male and female adolescents involved with juvenile justice systems in a Western state completed an audio computer-assisted self-interview. Validated measures assessed ACEs, psychological distress, internal resiliency, and external youth assets. Hierarchical linear regression was used to assess the direct and moderating protective effects of internal resilience, family communication, school connectedness, peer role models, and nonparental role models on psychological distress. All models controlled for age, sex, race/ethnicity, free/reduced lunch qualification, current custody, supervision status, detention, and site.

RESULTS

The mean ACE score among participants was 3.7 (standard deviation = 2.2) and 52.8% reported four or more ACEs. Participants with 4-5 ACEs (β = .37, p < .001) and 6-8 ACEs (β = .49, p < .001) were at increased risk for psychological distress. High internal resilience (β = -.20, p < .001), family communication (β = -.19, p < .001), school connectedness (β = -.14, p < .01), and peer role models (β = -.09, p < .05) were associated with a reduction in psychological distress in the presence of high ACE exposure. In the interaction models, having a high number of ACEs remained strongly associated with increased psychological distress. However, internal resilience (β = -.24, p < .01) and school connectedness (β = -.18, p < .05) significantly moderated (reduced) the relationship between high ACE exposure and psychological distress.

CONCLUSIONS

Our findings suggest that programs and policies that promote internal resilience and protective factors across multiple levels of influence may protect juvenile offenders exposed to childhood trauma from psychological distress.

Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies

BACKGROUND

Irritability is gaining considerable attention as a risk factor for suicide-related outcomes (suicide mortality, attempt, and ideation). However, the evidence of this association is scant. We conducted a systematic review of the evidence regarding the associations between irritability and suicide-related outcomes across the life-course.

METHODS

We conducted a systematic search on Medline and PsycINFO (up to January 2018) for original articles published in English investigating the association between irritability and suicide-related outcomes. Two researchers independently screened the articles, assessed the quality of the evidence (New-Castle-Ottawa Scale) and extracted study characteristics.

RESULTS

Thirty-nine studies were retrieved, most were of low/medium quality. Twelve assessed irritability in childhood/adolescence (6 in community samples, 6 in clinical samples) and 27 in adulthood (7 in community samples, 20 in clinical samples). In both childhood/adolescence and adult samples, most community-based studies reported a positive association between irritability and suicidal ideation and/or attempt, while clinical studies reported mixed findings. More specifically, in clinical studies, the association of irritability with suicide-related outcomes (i) was not supported among adult depressed patients, (ii) findings were inconsistent in adult bipolar patients, (iii) for inpatients/outpatients with various psychiatric disorders/conditions, association was observed in adulthood but not in childhood/adolescence.

LIMITATIONS

Differences in methodology and definition/measurement of irritability limited the comparability of included studies.

CONCLUSIONS

Although irritability has been proposed as a promising transdiagnostic factor associated with suicide-related outcomes, the absence of consensus in the definition of irritability (vs anger or reactive/impulsive aggression), the poor methodological quality, and the lack of developmental considerations mitigate the conclusions.

Evaluation of childhood trauma with respect to criminal behavior, dissociative experiences, adverse family experiences and psychiatric backgrounds among prison inmates

OBJECTIVE

To evaluate childhood trauma in relation to criminal behavior, dissociative experiences, adverse family experiences during childhood and psychiatric backgrounds among prison inmates.

METHODS

In total, 200 prison inmates were included in this questionnaire-based study. Data on demographic characteristics, adverse family experiences during childhood and psychiatric backgrounds were collected via face-to-face interviews, and a psychometric evaluation was conducted using the Childhood Trauma Questionnaire (CTQ-28) and Dissociative Experiences Scale (DES).

RESULTS

Several historical items were more common in females than in males including family history of psychiatric disease (23.0% vs. 13.0%, p = 0.048), a personal history of psychiatric disease (51.0% vs. 29.0%, p < 0.001), and previous suicide attempts (49.0% vs. 25.0%, p < 0.001). In male inmates, in contrast, there were higher rates of substance abuse (48.0% vs. 29.0%, p < 0.001) and previous convictions (50.0% vs. 25.0%, p < 0.001). Males had a younger age at first crime (24.9 ± 8.9 years vs. 30.3 ± 9.2 years, p < 0.001), whereas females had higher rates of violent crimes (69.2% vs. 30.8% p < 0.001) and higher CTQ total scores (51.9 ± 20.9 vs. 46.2 ± 18.9, p = 0.04). A significant relationship of CTQ total score was noted with age at first offense (β = 0.772, p < 0.001) but not with sentence length (β = 0.075, p = 0.292). There were also possible mediating roles of psychiatric problems, adverse family experiences and DES in the relationship between CTQ and age at first offense.

CONCLUSION

In conclusion, our findings revealed a high prevalence of and significant associations among childhood trauma, dissociative experiences, adverse family experiences and psychiatric problems in a cohort of incarcerated females and males. A psychiatric background, childhood trauma characterized by sexual abuse and violent crimes were found to be predominant in female prison inmates, whereas a criminal background with a younger age at first offense and frequent previous convictions, substance use and sexual crimes were more prevalent among male prison inmates. Our findings indicate a potential link between childhood traumatization and criminal behavior in terms of subsequent offending but not in terms of severity of the subsequent offense.

The Stress Acceleration Hypothesis of Nightmares

Adverse childhood experiences can deleteriously affect future physical and mental health, increasing risk for many illnesses, including psychiatric problems, sleep disorders, and, according to the present hypothesis, idiopathic nightmares. Much like post-traumatic nightmares, which are triggered by trauma and lead to recurrent emotional dreaming about the trauma, idiopathic nightmares are hypothesized to originate in early adverse experiences that lead in later life to the expression of early memories and emotions in dream content. Accordingly, the objectives of this paper are to (1) review existing literature on sleep, dreaming and nightmares in relation to early adverse experiences, drawing upon both empirical studies of dreaming and nightmares and books and chapters by recognized nightmare experts and (2) propose a new approach to explaining nightmares that is based upon the Stress Acceleration Hypothesis of mental illness. The latter stipulates that susceptibility to mental illness is increased by adversity occurring during a developmentally sensitive window for emotional maturation—the infantile amnesia period—that ends around age 3½. Early adversity accelerates the neural and behavioral maturation of emotional systems governing the expression, learning, and extinction of fear memories and may afford short-term adaptive value. But it also engenders long-term dysfunctional consequences including an increased risk for nightmares. Two mechanisms are proposed: (1) disruption of infantile amnesia allows normally forgotten early childhood memories to influence later emotions, cognitions and behavior, including the common expression of threats in nightmares; (2) alterations of normal emotion regulation processes of both waking and sleep lead to increased fear sensitivity and less effective fear extinction. These changes influence an affect network previously hypothesized to regulate fear extinction during REM sleep, disruption of which leads to nightmares. This network consists of a fear circuit that includes amygdala, hippocampus, and medial prefrontal cortex and whose substantial overlap with the stress acceleration findings allows the latter to be incorporated into a wider, more developmentally coherent framework.