Multi-exposure and clustering of adverse childhood experiences, socioeconomic differences and psychotropic medication in young adults

Early adversity and prosocial behavior in adolescents from Bogotá: a cross-sectional study

BACKGROUND

The association between Adverse Childhood Experiences (ACEs), prosocial behavior, and depression (like other negative mental health outcomes) has not been thoroughly understood. This study aimed at evaluating their simultaneous association while controlling for key confounding variables.

METHODS

A cross-sectional study was carried-out with 2918 secondary school students from seven charter schools located in low-resourced neighborhoods in Bogota (Colombia), 54.12% were female, and mean age was 13.81 years. The self-report instrument included demographic variables, well-being, mental health, risk behaviors and symptoms of psychopathology. Assessment of ACEs was done by a series of yes/no questions, prosocial behavior was evaluated with the corresponding subscale in the Strengths and Difficulties Questionnaire, and depression was assessed with the Self-Reporting Questionnaire. Associations were tested using the Spearman correlation coefficient, Z tests and Chi-square tests, and all primary outcome analyses were adjusted for potential confounding variables through multivariate logistic regression using depression as outcome.

RESULTS

Mean exposure to ACEs was 3.15 events; those exposed to four or more obtained lower scores in well-being, satisfaction with life and family functioning, and higher scores in symptoms of psychopathology. For the prosocial behavior scores, 64.35% were classified as close to the average, 17.51% as slightly lowered, 11.91% as low, and 6.23% as very low; participants with higher levels of prosocial behavior showed lower scores in symptoms of psychopathology. While ACEs had a positive association with depressive symptoms (Odds Ratio [OR] 2.21, 95% confidence interval [CI] 1.67-2.94), prosocial behavior did not have a significant association with either ACEs or depressive symptoms in multivariate regression models.

CONCLUSIONS

Novel studies should further elucidate the developmental pathways involving positive and negative mental health constructs to better understand the actual effectiveness of interventions that use these constructs in their design.

Drivers of Inequalities among Families Involved with Child Welfare Services: A General Overview

When parents are unable to raise their children or to meet the minimum acceptable standards for their care, this can lead to involvement with child welfare services [...].

Joint association of socioeconomic circumstances and minor mental health problems with antidepressant medication

Background

Disadvantageous socioeconomic circumstances and minor mental health problems have both been associated with mental disorders, such as depression, but their joint contribution remains unknown.

Methods

The Helsinki Health Study baseline survey (2000–02) of 40- to 60-year-old employees was linked with antidepressant medication data from registers of the Social Insurance Institution of Finland. The analyses were made using logistic regression with first prescribed antidepressant medication purchase during a 10-year follow-up as the outcome. Minor mental health problems were measured by the emotional well-being scale of the RAND-36. Odds ratios were calculated for joint association of the lowest quartile of the emotional well-being scale of the RAND-36 and socioeconomic circumstances. Childhood (parental education and childhood economic difficulties), conventional (education, occupational class and income) and material (housing tenure and current economic difficulties) socioeconomic circumstances were examined. This study included 5450 participants.

Results

Minor mental health problems dominated the joint associations. Minor mental health problems were associated with antidepressant medication irrespective of socioeconomic circumstances whereas only low income, current economic difficulties and living in rented housing showed an association without minor mental health problems at baseline. Marital status, working conditions and BMI and health behaviours had only minimal contributions to the associations.

Conclusions

Minor mental health problems were consistently and strongly associated with antidepressant medication and dominated the joint associations with socioeconomic circumstances. Paying attention to minor mental health problems might help prevent mental disorders such as depression.

Child socioeconomic status, childhood adversity and adult socioeconomic status in a nationally representative sample of young adults

Introduction

Numerous studies have examined the consequences of childhood adversity (CA) and socioeconomic status (SES) for health over the life course. However, few studies have examined the relation between childhood SES and CA as well as the influence of CA on adult SES. The objective of this study was to examine direct and indirect associations between childhood SES, CA and adult SES.

Methods

Participants in the National Longitudinal Study of Adolescent to Adult Health, (N = 6844) reported on nine CA experiences. Childhood SES was characterized as a composite measure of parental highest education level, median household income, and parental occupational status. Adult SES was characterized as composite measure of highest education level attained at age 37, median household income and occupation.

Results

In mediation analyses, adjusted for age, race and sex pathways were noted in that lower child SES was associated with CAs and CAs were associated with lower adult SES. Furthermore, CAs partially mediated the relation between childhood SES and adult SES. The proportion mediated by CA was small and only noted among African-American (4%) and White participants (5%).

Conclusions

Childhood SES is associated with CAs. In turn, CAs are associated with lower adult SES, independent of childhood SES supporting the notion that intervening on CAs early on in the lifecourse could influence health and wellbeing throughout the life course.

Adverse childhood experiences and handgrip strength among middle-aged and older adults: a cross-sectional study in China

BACKGROUND

Evidence on the association between adverse childhood experiences (ACEs) and handgrip strength (HGS) in later life was limited and inconclusive. We aimed to explore the impact of ACEs on HGS among middle-aged and older Chinese adults.

METHODS

We conducted a cross-sectional study with data extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey with respondents recruited from 450 villages/urban communities of 28 provinces. Participants aged 45 years or older were drawn from the CHARLS 2014 life history survey and the 2015 health survey. Twelve ACE indicators before the age of 17 years were collected. HGS was measured with a dynamometer and the maximum value of HGS obtained from both hands was used in the analyses. Low muscle strength (LMS) was defined according to the recommendation of European Working Group on Sarcopenia in Older People (EWGSOP). Multivariate linear and logistic regression models were constructed to evaluate the association of ACEs with continuous HGS and LMS, with adjustment for age, sex, marital status, ethnicity, area of residence, smoking and drinking status, body mass index, hypertension, dyslipidaemia, diabetes mellitus, cardiovascular disease, arthritis, hip fracture, and memory-related disease.

RESULTS

Of the 7209 eligible participants, 2258 (31.3%) had experienced three or more ACEs. Compared to individuals without ACEs, exposure to ≥ 3 ACEs was negatively associated with continuous HGS in kilogram (β = -0.93, 95% CI: -1.37, -0.49) and positively associated with the risk of LMS (OR = 1.34, 95% CI: 1.12, 1.61). Such associations were consistently found both in men and women who had experienced three or more ACEs. Significant dose-response relationship between the number of ACEs and outcomes was also observed in the overall population and different sex groups.

CONCLUSION

Exposure to ACEs was associated with lower HGS and increased risk of LMS among middle-aged and older Chinese adults, indicating the importance of intervention in individuals with experience of ACEs in order to mitigate its detrimental impact on HGS and promote healthy ageing.

Adverse childhood experiences and behavioral problems in early adolescence: An empirical study of chinese children

The aim of the present study was to examine the relationships between ACEs and behavioral problems of children in their early adolescence in Chinese society. Results from bivariate analyses of 2,910 Chinese children in early adolescence indicated that children begin to exhibit behavioral problems being related to the exposure of adverse childhood experiences (ACEs). Compared to those with 0 ACEs, children with 4 or more ACEs were 4.45 times (p < 0.001), 4.44 times (p < 0.001), 7.80 times (p < 0.001), 4.49 times (p < 0.001), and 6.63 times (p < 0.001) more likely to demonstrate hyperactivity, peer communication problems, pro-social problems, emotional problems and conduct problems, respectively. Rural children, children of mothers with low education, and boys were particularly likely to have been exposed to multiple categories of ACE. This study evidenced that there was a strong association between exposure to ACEs and behavioral problems in early adolescence in China.

Community Adversity and Utilization of Psychotropic Medications Among Children in Foster Care

The objective of this study was to examine the association between community adversity and psychotropic use among children in foster care in one US state. This study uses a cross-sectional design integrated foster care and Medicaid administrative data with data from Kids Count, the US Census, and the Area Health Resource File. There were 4,334 children ages 5-18 in foster care in 2014. We used K-means cluster analysis grouped state counties using indicators of school performance, juvenile justice involvement, and food insecurity. Chi-square tests assessed significance between psychotropic medication and community adversity cluster. A generalized linear mixed model assessed the relationship between psychotropic use and community adversity cluster, accounting for individual-level and cluster-level factors. Children in foster care living in high adversity communities were significantly less likely to use psychotropic medication (p < .0001). Future research can investigate the specific community factor influencing judicious use of psychotropic medication and the impact on children outcomes.

Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics

IMPORTANCE

Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored.

OBJECTIVES

To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020.

EXPOSURES

Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more.

MAIN OUTCOMES AND MEASURES

Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction.

RESULTS

Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity.

CONCLUSIONS AND RELEVANCE

In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.

A Systematic Review of the Prospective Relationship between Child Maltreatment and Chronic Pain

Objective: The present systematic review aimed to evaluate the association between childhood maltreatment and chronic pain, with specific attention to the temporal nature of the relationship and putative moderators, including, the nature (type), timing of occurrence, and magnitude of maltreatment; whether physical harm or injury occurred; and whether post-traumatic stress disorder (PTSD) subsequently developed. Method: We included studies that measured the prospective relationship between child maltreatment and pain. Medline, EMBASE, PsycINFO, and CINAHL were searched electronically up to 28 July 2019. We used accepted methodological procedures common to prognosis studies and preregistered our review (PROSPERO record ID 142169) as per Cochrane review recommendations. Results: Nine studies (17,340 participants) were included in the present review. Baseline participant age ranged from 2 years to more than 65 years. Follow-up intervals ranged from one year to 16 years. Of the nine studies included, three were deemed to have a high risk of bias. With the exception of one meta-analysis of three studies, results were combined using narrative synthesis. Results showed low to very low quality and conflicting evidence across the various types of maltreatment, with the higher quality studies pointing to the absence of direct (non-moderated and non-mediated) associations between maltreatment and pain. PTSD was revealed to be a potential mediator and/or moderator. Evidence was not found for other proposed moderators. Conclusions: Overall, there is an absence of evidence from high quality studies of an association between maltreatment and pain. Our results are limited by the small number of studies reporting the relationship between child maltreatment and pain using a prospective design. High quality studies, including prospective cohort studies and those that assess and report on the moderators described above, are needed to advance the literature.

Associations between adverse childhood experiences and migraine among teenage mothers in Peru

OBJECTIVE

The objective of this study was to evaluate the association between (1) different types of ACEs and migraine, and (2) the number of ACEs and migraine among adolescent mothers in Lima, Peru.

METHODS

Our cross-sectional study included 787 adolescent mothers (14- to 18-years of age) in Peru. In-person interviews were conducted postpartum, in hospital, within 2-days of delivery. Nine types of ACEs were assessed, including exposure to three categories of abuse, two categories of neglect, and four categories of household dysfunction. Multivariable logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between ACEs and migraine while adjusting for putative confounders.

RESULTS

Approximately 75% of adolescent mothers reported having experienced at least one type of ACE. Adolescent mothers who reported any childhood abuse had 1.49-fold increased odds of migraine (aOR = 1.49; 95% CI 1.03-2.18) compared to those with no history of childhood abuse. Adolescent mothers who reported experiencing household dysfunction had 1.56-fold increase odds of migraine (aOR = 1.56; 95% CI 1.09-2.24). Compared to participants who reported no ACE, those who experienced four or more ACEs had 3.09-fold (aOR = 3.09; 95% CI 1.80-5.40) increased odds of migraine (ptrend < 0.001).

CONCLUSION

Exposure to ACEs is highly prevalent in adolescent-aged mothers postpartum and is associated with increased odds of migraine. These findings support the importance of screening for ACEs and migraine among adolescent mothers; and the need for providing culturally appropriate, trauma-informed headache care.

The Impact of Parental Injury on Children's Mental Health Diagnoses and Classes of Psychotropic Medication by Child Age

BACKGROUND

Civilian and military research has linked parental illness and injury with increased overall mental health care and psychiatric medication use in children. Care for specific mental health conditions and medications by child age have not been reported.

OBJECTIVE

We sought to quantify the effect of parental illness and injury on child mental health care and psychiatric medication use in children overall and stratified by age.

METHODS

A self-controlled case series analyzed the impact of parental illness/injury on mental health and psychiatric medication use of military dependent children. Children were aged 2-16 years (51% male) when their parents were injured and received care in the Military Health System for 2 years before and 2 years after their parent's illness/injury. We used International Classification of Diseases 9th edition codes to identify outpatient mental healthcare visits. Outpatient care for 14 specific mental health diagnoses was classified using the Agency for Healthcare Research and Quality clinical classification system. Outpatient pharmacy records identified psychiatric medication prescriptions by therapeutic class. Parental illness/injury was identified by inclusion in the Military Health System Ill, Injured, and Wounded Warrior database. Adjusted negative binomial regression analysis compared rates of outpatient visits and medication days in the 2 years following parental illness/injury to the 2 years before the parent's illness/injury overall. Secondary analyses were stratified by age groups of 2-5 years (n = 158,620), 6-12 years (n = 239,614), and 13-16 years n = 86,768) and adjusted for parental pre-injury/illness deployment and child sex. Additional secondary analysis compared post-parental injury/illness care of children whose parents had post-traumatic stress disorder or traumatic brain injury to children of parents with physical/mental health injury/illness.

RESULTS

There were 485,002 children of 272,211 parents injured during the study period. After adjustment for child sex, years of pre-injury/illness parental deployment, and child age, parental illness/injury was associated with increased mental visits across all categories of care except developmental diagnoses. Post-parental injury visits for suicidal ideation, alcohol abuse, mood, and anxiety disorders were all doubled. For children aged 2-5 years at parental illness/injury, the largest increases in care were in psychotic, anxiety, attention deficit, and mood disorders. In children aged 6-12 years, the largest increases were in psychotic conditions, suicidal ideation, and personality disorders. In adolescents aged 13-16 years, the largest increases were for alcohol and substance abuse disorders, with visits increasing by 4-5 times. For children of all ages, parental injury was associated with increased use of all therapeutic classes of psychiatric medications; use of stimulant medications was increased in younger children and decreased in older children following parental injury (P < .001).

CONCLUSION

Parental illness/injury is associated with increased mental health care and days of psychiatric medication use in dependent children. Practitioners who care for families impacted by parental illness/injury should be cognizant of children's mental health risk. Early identification and treatment of child-related mental health issues can improve family functioning and increase military family readiness.

Social consequences and contexts of adverse childhood experiences

Adverse childhood experiences' (ACEs) negative consequences on health, education, and life opportunities are often explained through the neurodevelopmental changes in a person's stress reactivity and coping, which contribute to the adoption of health-damaging and antisocial behaviors. However, such focus on the biological dimension eclipses the equally important social dimension of adversity, in particular, how adversities at home can influence association with peers who exhibit and can exacerbate negative behaviors like early and binge drinking, illegal drug use, and gang involvement. More than the consequences for peer formation, this study also investigates the contexts in which ACEs are most predictive. Using a longitudinal study of US youths who were adolescents in 2007 and young adults in 2017, I find that experiencing adversity predicted involvement in peers exhibiting negative behaviors. However, the consequences of ACEs are not similar for everyone and for every outcome: (1) In disadvantaged families where ACEs were most likely, experiencing adversity influenced having peers in gangs but not the other outcomes. (2) In the most advantaged families where ACEs were least likely, having an ACE only predicted adult peers' regular drug use. (3) In families who were in the middle, experiencing adversity predicted early and binge drinking among peers. Taken together, they suggest that complex social processes and environments operate in the negative effects of ACEs, and the present research suggests a method to investigate how ACEs' impact may differ according to one's social context.

Adverse Childhood Experiences are associated with choice of partner, both partners' relationship and psychosocial health as reported one year after birth of a common child. A cross-sectional study

Adverse Childhood Experiences (ACEs) are common and known to have consequences for individuals' adult health, leading to a higher risk of illness. The aims of the study were to investigate the ACEs in couples, to examine the extent of assortative mating and to investigate the association between the relationship of the load of ACEs within couples and health outcomes, one year after the birth of a common child. At antenatal clinics in Sweden 818 couples were recruited and investigated one year after the birth of a common child answering a questionnaire including the exposure to ten ACE categories and several outcome variables. In total, 59% of both mothers and partners reported exposure to at least one of the ten ACE categories. Among the mothers 11% and among the partners 9% reported exposure to ≥4 ACE categories (p = 0.12). There was a correlation between the numbers of ACE categories reported by the mothers and their partners (Spearman's ρ = 0.18, p<0.001). This association pertained to six of the ten ACE categories. In multiple logistic regression analyses, there were associations between the ACE exposure load and unfavourable outcomes among the mothers, the partners and within the couples. Unfavourable outcomes concerning health were most prominent in couples where both members reported exposures to ≥4 ACE categories (self-rated bad health (OR 13.82; CI 2.75-69.49), anxiety (OR 91.97; CI 13.38-632.07), depression (OR 17.42; CI 2.14-141.78) and perceived stress (OR 11.04; CI 2.79-43.73)). Mothers exposed to ACEs tend to have partners also exposed to ACEs. Exposure to ACEs was associated with bad health and unfavourable life conditions within the couples, especially among couples where both members reported exposure to multiple ACEs. These results should stimulate incentives to find, to support and to treat individuals and couples where both members report multiple ACEs. The consequences for the children should be further studied as well as how these families should be treated in health care and society.

The impact of adverse childhood experiences on healthcare utilization in children

BACKGROUND

Adverse childhood experiences (ACEs) are related to long-term negative outcomes. The impact of these experiences on healthcare utilization in children has been understudied.

OBJECTIVE

To examine the impact of ACEs on children's healthcare utilization, medical diagnoses, and pharmacological treatment.

PARTICIPANTS AND SETTING

Children aged 6 months to 17 years who were screened for ACEs in the Behavioral Health Department or in primary care locations as part of an initial consultation visit and who had at least one subsequent healthcare visit during the study period were included in the study.

METHODS

Adverse childhood experiences were measured using the ACE screening questionnaire designed by Felitti et al. (1998). Data from the year following administration of the ACE screening tool were retrospectively extracted from the electronic health record.

RESULTS

Overall, 1,183 children met study inclusion criteria. Children with any reported ACEs were more likely to no show appointments (1-3 ACEs incidence rate ratio (IRR) [95 % confidence interval (CI)]: 1.40 [1.11-1.77]; 4+ ACEs IRR [95 % CI]: 1.41 [1.08-1.84]) and to use emergency services (1-3 ACEs IRR [95 % CI]: 1.24 [1.00-1.53]; 4+ ACEs: IRR [95 % CI]: 1.42 [1.11-1.81) than children with no ACEs. Those with 4+ ACEs used the telephone nurse advisor less frequently (1-3 ACEs IRR [95 % CI]: 0.67 [0.53-0.84]; 4+ ACEs IRR [95 % CI]: 0.69 [0.53-0.90]). Although ACE scores were associated with healthcare utilization, insurance status was more robustly associated with healthcare utilization than ACE score.

CONCLUSIONS

Healthcare systems may employ results from this study to adopt trauma-informed care initiatives. Ensuring that all patients have insurance may be a first step toward improving healthcare utilization.

The influence of adverse and advantageous childhood experiences during adolescence on young adult health

BACKGROUND

Research indicates that adverse childhood experiences (ACEs) can lead to poorer adult health, but less is known how advantageous childhood experiences (counter-ACEs) may neutralize the negative effects of ACEs, particularly in young adulthood.

PURPOSE

We examined the independent contributions of Adverse Childhood Experiences (ACEs) and Advantageous Childhood Experiences (counter-ACEs) that occur during adolescence on five young adult health indicators: depression, anxiety, risky sexual behaviors, substance abuse, and positive body image.

PARTICIPANTS AND SETTING

The sample included 489 adolescents from a large northwestern city in the United States who were 10-13 years at baseline (51 % female).

METHODS

Flourishing Families Project survey data were used for this secondary analysis using structural equation modeling. Adolescents and their parents completed an annual survey. ACEs and counter-ACEs were measured over the first five years of the study. The five health indicators were measured in wave 10 when participants were 20-23 years old.

RESULTS

Participants had on average 2.7 ACEs and 8.2 counter-ACEs. When both ACEs and counter-ACEs were included in the model, ACEs were not predictive of any of the health indicators and counter-ACEs were predictive of less risky sex (-.12, p < .05), substance abuse (-.12, p < .05), depression (-.11, p < .05), and a more positive body image (.15, p < .01). Higher ratios of counter-ACEs to ACEs had a particularly strong effect on improved young adult health.

CONCLUSIONS

Counter-ACEs that occur in adolescence may diminish the negative effects of ACEs on young adult health and independently contribute to better health.

Specific adverse childhood experiences and their association with other adverse childhood experiences, asthma and emotional, developmental and behavioral problems in childhood

BACKGROUND

Adverse childhood experiences (ACEs) have lifelong health consequences, yet screening remains challenging. Particularly in clinical settings, brief screeners that could lead to comprehensive assessments may be more feasible. We explore how two ACEs (economic hardship, parental/caregiver divorce/separation) are associated with other ACEs, asthma, and emotional, developmental, or behavioral (EDB) problems.

METHODS

Using the 2016 National Survey of Children's Health, we assessed the associations between ACEs and asthma and EDB problems and calculated sensitivities, specificities and predictive values.

RESULTS

Parents frequently reported 1+ ACEs for their child (50.3%). Individual ACE frequency ranged from 4.2 to 29.6%; all were significantly associated with EDB problems (adjusted odds ratios (aORs): 2.2-5.1) and more ACEs confirmed higher odds. Two ACES (economic hardship, parental/caregiver divorce/separation) co-occurred frequently with other ACEs, having either predicted EDB problems similarly to other ACEs (aORs 1.8; 95% CI 1.4, 2.3) and having both greatly increased odds (aOR 3.8; 95% CI 2.8, 5.2). The negative predictive value of EDB problems associated with citing neither ACE was high (95.7%). Similar trends with asthma were observed.

CONCLUSIONS

Economic hardship and caregiver separation are strongly associated with other ACEs, EDB problems and asthma. A brief screener including these ACEs may reduce clinical barriers to broader ACEs screening.

Family Adverse Experiences and Psychotropic Polypharmacy Among US Youth: 2009-2015

OBJECTIVE

To determine if adverse family factors are associated with a higher likelihood of psychotropic polypharmacy among US youth with a mental health condition.

METHODS

The 2009-2015 Medical Expenditure Panel Survey data were used to identify family characteristics of 5136 youth aged ≤18 years with an emotional or behavioral health condition. Family adversity was based on family size, number of parents in the household, parental education and income, and parent-reported physical and/or cognitive or mental health disability. Cluster analysis identified family adversity subgroups. Polypharmacy was defined as 3 or more psychotropic classes (eg, stimulants, antipsychotics, antidepressants, mood stabilizers, and sedatives) in at least 1 interview round in a calendar year. Weighted logistic regression evaluated associations between family adversity and psychotropic polypharmacy among youth.

RESULTS

Nearly half (47.8%) of youth lived with parents who had a disability. Parents in the least socioeconomically disadvantaged cluster mainly had a mental illness, and 94% of parents in the most socioeconomically disadvantaged cluster had a parent-reported physical and/or cognitive disability and mental illness. Among youth, mood disorder (24.2%; 95% confidence interval [CI]: 12.6%-16.0%), antidepressant use (16.0%; 95% CI: 10.6%-21.5%), and antipsychotic use (7.5%; 95% CI: 5.4%-9.6%) were higher in the most socioeconomically disadvantaged cluster relative to the other clusters. Approximately 3% of youth received psychotropic polypharmacy. The odds of psychotropic polypharmacy were 2.7 (95% CI: 1.1-6.4) times greater among youth in the most relative to the least socioeconomically disadvantaged cluster.

CONCLUSIONS

Higher use of psychotropic polypharmacy among youth with parents who have multiple disabilities raises concerns about oversight and monitoring of complex psychotropic treatment.

Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: A prospective cohort study in the UK

BACKGROUND

Experiencing multiple adverse childhood experiences (ACEs) is a risk factor for many adverse outcomes. We explore associations of ACEs with educational attainment and adolescent health and the role of family and socioeconomic factors in these associations.

METHODS AND FINDINGS

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort of children born in southwest England in 1991-1992, we assess associations of ACEs between birth and 16 years (sexual, physical, or emotional abuse; emotional neglect; parental substance abuse; parental mental illness or suicide attempt; violence between parents; parental separation; bullying; and parental criminal conviction, with data collected on multiple occasions between birth and age 16) with educational attainment at 16 years (n = 9,959) and health at age 17 years (depression, obesity, harmful alcohol use, smoking, and illicit drug use; n = 4,917). We explore the extent to which associations are robust to adjustment for family and socioeconomic factors (home ownership, mother and partner's highest educational qualification, household social class, parity, child's ethnicity, mother's age, mother's marital status, mother's depression score at 18 and 32 weeks gestation, and mother's partner's depression score at 18 weeks gestation) and whether associations differ according to socioeconomic factors, and we estimate the proportion of adverse educational and health outcomes attributable to ACEs or family or socioeconomic measures. Among the 9,959 participants (49.5% female) included in analysis of educational outcomes, 84% reported at least one ACE, 24% reported 4 or more ACEs, and 54.5% received 5 or more General Certificates of Secondary Education (GCSEs) at grade C or above, including English and Maths. Among the 4,917 participants (50.1% female) included in analysis of health outcomes, 7.3% were obese, 8.7% had depression, 19.5% reported smoking, 16.1% reported drug use, and 10.9% reported harmful alcohol use. There were associations of ACEs with lower educational attainment and higher risk of depression, drug use, and smoking. For example, odds ratios (ORs) for 4+ ACEs compared with no ACEs after adjustment for confounders were depression, 2.4 (1.6-3.8, p < 0.001); drug use, 3.1 (2.1-4.4, p < 0.001); and smoking, 2.3 (1.7-3.1, p < 0.001). Associations with educational attainment attenuated after adjustment but remained strong; for example, the OR after adjustment for confounders for low educational attainment comparing 4+ ACEs with no ACEs was 2.0 (1.7-2.4, p < 0.001). Associations with depression, drug use, and smoking were not altered by adjustment. Associations of ACEs with harmful alcohol use and obesity were weak. For example, ORs for 4+ ACEs compared with no ACEs after adjustment for confounders were harmful alcohol use, 1.4 (0.9-2.0, p = 0.10) and obesity, 1.4 (0.9-2.2, p = 0.13) We found no evidence that socioeconomic factors modified the associations of ACEs with educational or health outcomes. Population attributable fractions (PAFs) for the adverse educational and health outcomes range from 5%-15% for 4+ ACEs and 1%-19% for low maternal education. Using data from multiple questionnaires across a long period of time enabled us to capture a detailed picture of the cohort members' experience of ACEs; however, a limitation of our study is that this resulted in a high proportion of missing data, and our analyses assume data are missing at random.

CONCLUSIONS

This study demonstrates associations between ACEs and lower educational attainment and higher risks of depression, drug use, and smoking that remain after adjustment for family and socioeconomic factors. The low PAFs for both ACEs and socioeconomic factors imply that interventions that focus solely on ACEs or solely on socioeconomic deprivation, whilst beneficial, would miss most cases of adverse educational and health outcomes. This interpretation suggests that intervention strategies should target a wide range of relevant factors, including ACEs, socioeconomic deprivation, parental substance use, and mental health.

The burden of mental ill health associated with childhood maltreatment in the UK, using The Health Improvement Network database: a population-based retrospective cohort study

BACKGROUND

Childhood maltreatment is a global public health, human rights, and moral issue that is associated with a substantial mental health burden. We aimed to assess the association between childhood maltreatment and the development of mental ill health and the initiation of new prescriptions for mental ill health.

METHODS

In this population-based, retrospective, open cohort study, we used a dataset from individuals in The Health Improvement Network (THIN) database. THIN database comprises UK electronic medical records taken from 787 general practices throughout the UK. We used read codes in these records to identify exposed patients (those with a read code identifying officially confirmed childhood maltreatment or a maltreatment-related concern) and up to two unexposed patients (those without such read codes) from the same general practice, who were matched by age and sex. We evaluated the risk of developing depression, anxiety, or serious mental illness (a composite mental ill health outcome) or initiation of a prescription drug used to treat mental ill health, and the odds ratio of these events at baseline, in the exposed versus unexposed patients.

FINDINGS

The first possible date for cohort entry (the study start date) was Jan 1, 1995, and patients could enter the cohort until the study end date, Dec 31, 2018. During the study period, 11 831 850 patients were eligible to participate. Of these patients, we identified 217 758 (1·8%) patients with any recorded childhood maltreatment. These patients were matched to 423 410 unexposed control patients with no recorded exposure to childhood maltreatment. The exposed group were followed up for a median of 1·8 years (IQR 0·6-4·3) versus 3·2 years (1·3-6·1) in the unexposed group. During the study period, 11 665 (5·9%) new diagnoses of mental ill health were made in the exposed group, giving an incidence rate of 16·8 events per 1000 person-years versus 15 301 (3·7%) new recorded diagnoses at an incidence rate of 8·3 events per 1000 person-years in the unexposed cohort, giving an adjusted IRR of 2·14 (95% CI 2·08-2·19). 30 911 (14·8%) patients in the exposed group received a new prescription for any type of mental ill health (incidence rate 46·5 events per 1000 person-years) versus 36 390 (8·9%) patients in the unexposed group (20·5 per 1000 person-years) resulting in an adjusted IRR of 2·44 (95% CI 2·40-2·48).

INTERPRETATION

Childhood maltreatment is thought to affect one in three children globally; therefore, a doubled risk of developing mental ill health among these individuals represents a substantial contribution to the mental ill health burden in the UK. It is imperative that public health approaches, including those aimed at preventing and detecting childhood maltreatment and its associated negative consequences, are implemented to prevent mental ill health.

FUNDING

None.

Adverse Childhood Experiences and Criminal Propensity Among Intimate Partner Violence Offenders

Adverse childhood experiences (ACEs), defined as exposure to abuse and adverse household events, are prevalent among certain offenders including those who commit intimate partner violence (IPV). However, it is not clear how ACEs relate to criminal propensity among IPV offenders, who have been shown to exhibit less antisociality and institutional violence than other offenders. We compared 99 male offenders with a current or previous offense of IPV with 233 non-IPV violent offenders and 103 nonviolent offenders undergoing institutional forensic assessment. This convenience sample allowed for use of extensive psychosocial records as well as study of institutional violence. IPV offenders had the highest mean ACE score and more extensive criminal propensity on some measures (violent and nonviolent criminal history and psychopathy) than both other groups. ACEs were associated with most measures of criminal propensity in the whole sample but with only one (actuarial risk of violent recidivism) in the subsample of IPV offenders. Finding that ACEs are prevalent among IPV offenders even in this sample with extensive mental illness demonstrates the robustness of this phenomenon. IPV offenders, though, are similar to other violent offenders in this respect, and there is insufficient evidence that ACEs represent a criminogenic need among IPV offenders specifically. Further research could draw from the batterer typology literature and attend to IPV offenders' broader criminal careers.

Expanding the Original Definition of Adverse Childhood Experiences (ACEs)

We report two studies examining psychometric properties of an expanded measure of adverse childhood experiences (ACEs) that combined the original ACEs items with items from the Juvenile Victimization Questionnaire. In Study 1, we examined its factorial structure, internal consistency, and concurrent validity in undergraduates (N = 1479). In Study 2, we also examined replicability of frequencies of ACEs, test-retest reliability, and convergent and predictive validity. Results suggested a model with four inter-related factors: maltreatment, household dysfunction, community dysfunction, and peer dysfunction/property victimization. Internal consistency, test-retest reliability, concurrent and convergent validity were acceptable, and findings were replicated across samples. We suggest that this expanded measure is assessing early experiences of victimization and helplessness in the face of perceived intentional emotional and physical threats or actual harm by others, and that although they may not all be "traumatic," their cumulative impact is associated with poor mental health in young adults.

The Number of Adverse Childhood Experiences Is Associated with Emotional and Behavioral Problems among Adolescents

This study aims to examine the association of adverse childhood experiences (ACE) with emotional and behavioral problems (EBP) among adolescents and the degree to which this association is stronger for more ACE. In addition, we assessed whether socioeconomic position (SEP) modifies the association of ACE with EBP. We obtained data from 341 adolescents aged 10–16 (mean age = 13.14 years; 44.0% boys), the baseline of a cohort study. We measured EBP with the strengths and difficulties questionnaire and socioeconomic position (SEP) with self-reported financial status. We used generalized linear models to analyze the association between ACE (0 vs. 1–2 vs. 3 and more) and EBP, and the modifying effect of SEP. Adolescents with 1–2 ACE (regression coefficient: 0.19; 95%-confidence interval (CI): 0.06–0.32) and with 3 ACE and over (0.35; 0.17–0.54) reported more overall problems compared with adolescents without ACE. Moreover, adolescents with 1–2 ACE (0.16; −0.01–0.32, and 0.16; 0.03–0.29) and with 3 and over ACE (0.33; 0.10–0.56, and 0.28; 0.09–0.47) reported more emotional problems and behavioral problems, respectively. The interactions of SEP with ACE were not significant. ACE are related to EBP among adolescents, with a clear dose-response association, and this association similarly holds for all SEP categories.

Association of Constellations of Parental Risk With Children's Subsequent Anxiety and Depression: Findings From a HUNT Survey and Health Registry Study

IMPORTANCE

The research focus on children of parents with alcohol use disorder has eclipsed the potentially wider-reaching detrimental effects of subclinical parental drinking, both alone and in combination with other parental risk factors.

OBJECTIVE

To identify constellations of early parental risk characterized by variations in drinking, mental health, and education in both parents and examine their prospective associations with children's contact with the health care system for anxiety and/or depression (ie, diagnoses or treatment).

DESIGN, SETTING, AND PARTICIPANTS

This prospective study was based on linked survey and health registries data. The sample included 8773 children from 6696 two-parent families in Norway who participated in the Nord-Trøndelag Health Study (HUNT) survey in 1995 to 1997 or 2006 to 2008, when the children were aged 13 to 19 years. Data were analyzed from January to September 2018.

EXPOSURES

Five constellations of early parental risks, characterized by variations in drinking frequencies and amounts, mental health, and education for both parents, as identified through latent profile analysis.

MAIN OUTCOMES AND MEASURES

Children's diagnoses or treatment of anxiety and/or depression from 2008 to 2016 were recorded in 3 health registries. The primary outcome was the total number of registries where participants presented (ranging from 0 to 3).

RESULTS

Of the 8773 included children, 4404 (50.2%) were boys, and the mean (SD) age at the time of participation in the Nord-Trøndelag Health Study was 16.1 (1.8) years. Prevalence of anxiety and/or depression, as evidenced in at least 1 registry record, was 24.3% (2132 of 8773). Early parental risk profiles risks marked by (1) the lowest parental education (adjusted relative risk, 1.13; 95% CI, 1.01-1.25) and (2) elevated drinking in both parents and elevated mental health symptoms in fathers (adjusted relative risk, 1.52; 95% CI, 1.03-2.22) were associated with a significant increase in risk of anxiety and/or depression in children from those families compared with children from no-risk families.

CONCLUSIONS AND RELEVANCE

Studies seeking to understand prospective associations of parental drinking with children's mental health need to consider additional risk factors in combination with one another as well as parental behaviors and characteristics below clinically defined levels. When accumulated at a family level, even seemingly innocuous characteristics contributed to meaningful increases in risk of anxiety and/or depression among children, potentially translating into poorer mental health outcomes for many young people.

Associations between adverse childhood experiences and health outcomes in adults aged 18-59 years

Background

Adverse childhood experiences (ACEs) have been associated with poor health status later in life. The objective of the present study was to examine the relationship between ACEs and health-related behaviors, chronic diseases, and mental health in adults.

Methods

A cross-sectional study was performed with 1501 residents of Macheng, China. The ACE International Questionnaire (ACE-IQ) was used to assess ACEs, including psychological, physical, and sexual forms of abuse, as well as household dysfunction. The main outcome variables were lifetime drinking status, lifetime smoking status, chronic diseases, depression, and posttraumatic stress disorder. Multiple logistic regression models were used to examine the associations between overall ACE score and individual ACE component scores and risk behaviors/comorbidities in adulthood after controlling for potential confounders.

Results

A total of 66.2% of participants reported at least one ACE, and 5.93% reported four or more ACEs. Increased ACE scores were associated with increased risks of drinking (adjusted odds ratio [AOR] = 1.09, 95% confidence intervals [CI]: 1.00–1.09), chronic disease (AOR = 1.17, 95% CI: 1.06–1.28), depression (AOR = 1.37, 95% CI: 1.27–1.48), and posttraumatic stress disorder (AOR = 1.32, 95% CI: 1.23–1.42) in adulthood. After adjusting for confounding factors, the individual ACE components had different impacts on risk behavior and health, particularly on poor mental health outcomes in adulthood.

Conclusions

ACEs during childhood were significantly associated with risk behaviors and poor health outcomes in adulthood, and different ACE components had different long-term effects on health outcomes in adulthood.

Linkage between teen mother's childhood adversity and externalizing behaviors in their children at age 11: Three aspects of parenting

BACKGROUND

Experiences of childhood adversity are consistently associated with compromised behavioral health later in life. Less clear is the intergenerational influence of maternal childhood adversity on developmental outcome in children. Completely unknown are the mechanisms linking teen mother's childhood adversity to child developmental outcomes.

OBJECTIVE

The present study tested whether aspects of parenting (parenting stress, physical discipline, and disagreement with grandparents) served as the pathways between teen mother's childhood adversity and the externalizing behaviors of their offspring at age 11, by gender.

PARTICIPANTS AND SETTING

Data were from a longitudinal panel study of teen mothers and their children, the Young Women and Child Development Study (N = 495; 57% male).

METHODS

The pathways from teen mother's childhood adversity to their offspring's externalizing behavior were tested by two subscales: rule-breaking behavior and aggressive behavior. In addition, multiple-group analysis was examined for potential gender differences.

RESULTS

Teen mother's childhood adversity was positively associated with greater use of parenting stress (β = 0.16, p < .01) and physical discipline (β=0.11, p < .05). In addition, parenting stress, physical discipline, and disagreement with grandparent were all associated with increased rule-breaking and aggressive behaviors in children. Multiple group analysis revealed that the path between physical discipline and externalizing behavior differed by gender, with the path only significant for girls.

CONCLUSIONS

These findings have implications for early intervention efforts that emphasize the need to intervene with children and parents, particularly helping teen mothers gain knowledge and skills to offset the impact of their experiences of childhood adversity on their parenting behaviors.

Parental education and adolescent health problems due to violence, self-harm and substance use: what is the role of parental health problems?

BACKGROUND

Adolescent health problems are more prevalent in families with low socioeconomic position, but few studies have assessed the role of parental health in this association. This study examines the extent to which parental health problems, particularly those related to high-risk health behaviour, might explain the association between parental education and adolescent health problems due to violence, self-harm and substance use.

METHODS

We used longitudinal register data on a 20% representative sample of all families with children aged 0-14 years in 2000 in Finland with information on parental social background and parental and offspring health problems based on hospital discharge data. We estimated discrete-time survival models with the Karlson-Holm-Breen method on hospital admissions due to violence, self-harm and substance use among adolescents aged 13-19 years in 2001-2011 (n=145 404).

RESULTS

Hospital admissions were 2-3 times more common among offspring of basic educated parents than tertiary educated parents. Similar excess risks were observed among those with parental mental health problems and parental health problems due to violence, self-harm and substance use. The OR for offspring of basic educated parents was attenuated from OR 2.73 (95% CI 2.34 to 3.18) to OR 2.38 (2.04 to2.77) with adjustment for parental health problems, particularly those due to violence, self-harm and substance use. Having both low parental education and parental health problems showed simple cumulative effects.

CONCLUSIONS

The excess risks of hospital admissions due to violence, self-harm and substance use among adolescents with lower educated parents are largely independent of severe parental health problems.

Adverse Childhood Experiences in Children with Intellectual Disabilities: An Exploratory Case-File Study in Dutch Residential Care

Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child’s family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to the improvement of their health and well-being. Deficiencies in intellectual and adaptive functioning and living circumstances can increase their vulnerability to adversities. In the present exploratory study 69 case-files of children referred to a Dutch national center for residential youth care for children with ID were analyzed to assess the prevalence and associations of ACEs. It was found that almost half (49.3%) of the children experienced 2 ACEs from the original ACEs framework or more (M (mean) = 2.1; SD (standard deviation) = 1.8) and that the number of ACEs in children was related to the presence of ACEs in parents. Both child and parental ACEs were also related to attachment- and trauma- and stressor-related disorders. Finally, living circumstances and multiple ACEs from the expanded ACEs framework, especially related to parental characteristics, were found to be related to ACEs in children with ID. This implicates the importance of a transgenerational approach when further investigating the impact of ACEs on mental and physical health in children with ID (intellectual disabilities).

Tailoring health-related messages for young adults with adverse childhood experiences (ACEs)

The goal was to identify factors that might affect likelihood of seeking health-related interventions for young adults with adverse childhood experiences (ACEs). We tested whether ACEs were associated with (1) regulatory focus (tendency toward promoting good outcomes versus preventing bad outcomes), and (2) patient activation (the intention to take active charge of one's health). We further tested whether promotion and prevention and patient activation were associated with each other and with health. Students at a public university (N = 321) completed online questionnaires assessing ACEs, regulatory focus, patient activation, and health. Greater childhood adversity showed small but significant associations with being a less activated patient and being less focused on promoting good outcomes. In contrast, greater childhood adversity had a much stronger association with focusing on preventing negative outcomes. Students with a more significant mental health history were more likely to have been exposed to childhood adversity, to be less activated patients, and to focus more on prevention. Results suggest that using a prevention focus may be effective in health messages aimed to reach individuals with high levels of ACEs. Furthermore, individuals with high levels of ACEs may benefit from interventions aimed at increasing patient activation.

Early life predictors of adolescent suicidal thoughts and adverse outcomes in two population-based cohort studies

Background

Understanding suicidality has proven challenging given the complex aetiology in early childhood. Being able to accurately predict groups at increased risk of developing suicidal thoughts may aid in the development of targeted prevention programs that mitigate increased vulnerability. Further, the predictors of suicidal thoughts may be shared with other outcomes in adolescence. Previous research has linked many factors to suicidality, so the objective of this study was to consider how these factors may act together to increase risk of suicidal thoughts and other non-mental health outcomes.

Methods

Two longitudinal datasets were used in this analysis: the National Longitudinal Survey of Children and Youth (NLSCY) and the Avon Longitudinal Survey of Parents and Children (ALSPAC). A Classification and Regression Tree model comprised of 75 factors describing early childhood was constructed to identify subgroups of adolescents at high risk of suicidal thoughts in the NLSCY and was validated in ALSPAC. These subgroups were investigated to see if they also had elevated rates of antisocial behaviour, substance misuse, poor physical health, poor mental health, risky health behaviours, and/or poor academic performance.

Results

The sensitivity was calculated to be 22·7%, specificity was 89·2%, positive predictive value 17·8%, and negative predictive value 91·8% and had similar accuracy in the validation dataset. The models were better at predicting other adverse outcomes compared to suicidal thoughts.

Conclusion

There are groups of risk factors present in early life that can predict higher risk of suicidality in adolescence. Notably, these factors were also predictive of a range of adverse outcomes in adolescence.

Association between childhood adversity and a diagnosis of personality disorder in young adulthood: a cohort study of 107,287 individuals in Stockholm County

Childhood adversity (CA) may increase the risk for later developing of personality disorder (PD). However, less is known about the association between cumulative CA and PD, and the role of childhood psychopathology and school performance. The current study examined the relationship between a range of CAs and a diagnosis of PD in young adulthood, and the roles of childhood psychopathology and school performance in this relationship. All individuals born in Stockholm County 1987–1991 (n = 107,287) constituted our cohort. Seven CAs were measured between birth and age 14: familial death, parental criminality, parental substance abuse and psychiatric morbidity, parental separation and/or single-parent household, household public assistance and residential instability. Individuals were followed from their 18th birthday until they were diagnosed with PD or until end of follow-up (December 31st 2011). Adjusted estimates of risk of PD were calculated as hazard ratios (HR) with 95% confidence intervals (CI). Associations were observed between cumulative CA and PD. During the follow-up 770 individuals (0.7%) were diagnosed with PD. Individuals exposed to 3+ CAs had the highest risks of being diagnosed with PD (HR 3.0, 95% CI 2.4–3.7). Childhood psychopathology and low school grades further increased the risk of PD among individuals exposed to CA. Cumulative CA is strongly associated with a diagnosis of PD in young adulthood. Our findings indicate that special attention should be given in schools and health services to children exposed to adversities to prevent decline in school performance, and to detect vulnerable individuals that may be on negative life-course trajectories.

When Emotional Pain Becomes Physical: Adverse Childhood Experiences, Pain, and the Role of Mood and Anxiety Disorders

OBJECTIVE

We examined the association between retrospective reports of adverse childhood experiences (ACEs) and painful medical conditions. We also examined the mediating and moderating roles of mood and anxiety disorders in the ACEs-painful medical conditions relationship.

METHOD

Ten-year longitudinal data were obtained from the National Comorbidity Surveys (NCS-1, NCS-2; N = 5001). The NCS-1 obtained reports of ACEs, current health conditions, current pain severity, and mood and anxiety disorders. The NCS-2 assessed for painful medical conditions (e.g., arthritis/rheumatism, chronic back/neck problems, severe headaches, other chronic pain).

RESULTS

Specific ACEs (e.g., verbal and sexual abuse, parental psychopathology, and early parental loss) were associated with the painful medical conditions. Baseline measures of depression, bipolar disorder, and posttraumatic stress disorder were also associated with the number of painful medical conditions. Anxiety and mood disorders were found to partially mediate the ACEs-painful medical conditions relationship. We determined through mediation analyses that ACEs were linked to an increase in anxiety and mood disorders, which, in turn, were associated with an increase in the number of painful medical conditions. We determined through moderation analyses that ACEs had an effect on increasing the painful medical conditions at both high and low levels of anxiety and mood disorders; though, surprisingly, the effect was greater among participants at lower levels of mood and anxiety disorders.

CONCLUSION

There are pernicious effects of ACEs across mental and physical domains. Dysregulation of the hypothalamic-pituitary-adrenal stress response and the theory of reserve capacity are reviewed to integrate our findings of the complex relationships.

Adverse Childhood Experiences and Health in Adulthood in a Rural Population-Based Sample

BACKGROUND

Adverse childhood experiences (ACEs), including emotional abuse, substance abuse in the household, separation or divorce, physical abuse, violence between adults, mental illness in the household, sexual abuse, or incarceration of a household member, have the potential to profoundly impact health and well-being in adulthood. To assess whether previously reported relationships between ACEs and health outcomes withstand validation, we conducted a community-based ACE study with the unique capacity to link self-reported ACEs and other survey results to validated health data in an electronic medical record (EMR).

METHODS

Information regarding ACEs and health outcomes was captured from 2013-2014 via a telephone survey of residents of the predominantly rural northern and central regions of Wisconsin and electronic abstraction of EMR data. ACE score was calculated by counting each exposure as one point. We examined the relationship between ACE score, type, and self-reported and validated health outcomes.

RESULTS

A total of 800 participants completed the telephone survey. Overall, 62% reported at least one ACE and 15% reported experiencing four or more. All self-reported measures of poor health were associated with increased ACE score. EMR data were positively correlated with ACE score for increased body mass index and diagnoses of depression, anxiety, and asthma. In contrast, diagnoses of hypertension, hypercholesterolemia, myocardial infarction, and skin and other cancers were inversely related to ACE score. Emotional abuse was the most common ACE reported followed by substance abuse in the household. ACEs tended to cluster so that people who reported at least one ACE were likely to have experienced multiple ACEs. There was no clear correlation between abuse type (e.g., direct abuse vs. household dysfunction) and health outcomes.

CONCLUSIONS

In the first community-based study to link self-reported ACEs to comprehensive health measures documented in the medical record, we observed previously reported associations between childhood adversity and poor outcomes in adulthood, but also noted an inverse relationship between ACE score and certain medical diagnoses. Potential explanations for this finding warrant further investigation.

Childhood adversity and depressive symptoms following retirement in the Gazel cohort

BACKGROUND

Only a few studies have examined whether specific moderators may impact the magnitude of the relationship between retirement and depression. The aim of this study was to examine the potential moderating role of adverse childhood life events (ACLE) on changes in depressive symptoms following retirement in the GAZEL cohort.

METHODS

9242 participants, followed up since 1989, completed the Center of Epidemiologic Studies Depression scale (CESD) every three years and were asked in 2004 to answer an ACLE questionnaire. Subjects were classed according to 6 clusters by Two-Step Cluster Analysis (no ACLE: cluster 1; increasing material deprivation: clusters 2 to 4; history of early separation: cluster 5 and history of conflicts or violence: cluster 6), and then stratified for sex. Analyses were based on general linear models with the CESD variation between, before and after retirement as dependent variable. All results were adjusted according to age, marital status, occupational status, alcohol consumption, self-rated health and CESD score before retirement.

RESULTS

The association between exposure to ACLE and changes in depressive symptoms following retirement was significant in both men (F = 6.929; p < 0.001; eta(2) = 0.005) and women (F = 6.890; p < 0.001; eta(2) = 0.016). Exposure to early separation or history of conflicts or violence during childhood was associated with less improvement in both men and women, whereas early exposure to material deprivation only affected results in men.

CONCLUSIONS

Programs aimed at facilitating retirement transition may focus on subjects at risk of not experiencing the expected benefits of retirement, which is the case for those with a history of ACLE.

Parental alcohol-related disorders and school performance in 16-year-olds-a Swedish national cohort study

AIMS

To study the links between parental alcohol-related disorders and offspring school performance and, specifically, whether associations vary by gender of parent or child and whether associations are mediated by other adverse psychosocial circumstances commonly appearing together with parental alcohol problems, such as parental mental health problems or criminal behaviour.

DESIGN

Register study in a national cohort.

SETTING

Sweden.

PARTICIPANTS

A total of 740 618 individuals born in Sweden in 1990-96.

MEASUREMENTS

Parental hospital admissions for alcohol-related disorders and school performance in their offspring, in the final year of compulsory school at age 15-16 years was analysed in relation to socio-demographic confounders and psychosocial covariates, using linear and logistic regressions.

FINDINGS

Both mothers' and fathers' alcohol-related hospital admissions were associated with lower Z-scores of grades and national mathematics tests scores. After adjustment for parental education and socio-demographic confounders, beta-coefficients of Z-scores of grades were -0.42 [95% confidence interval (CI) = -0.45, -0.39] and -0.42 (95% CI =  -0.43, -0.40), and beta-coefficients of mathematics tests scores were -0.36 (95% CI = -0.39, -0.33) and -0.31 (95% CI = -0.33, -0.29), for mothers' and fathers' alcohol-related disorders, respectively. Adjusted odds ratios (ORs) for not being eligible for secondary school were 1.99 (95% CI = 1.84-2.15) and 2.04 (95% CI = 1.95-2.15) for mothers' and fathers' alcohol-related disorders, respectively. Adjusting the analyses for psychosocial factors in the family almost eradicated the statistical effects of parental alcohol-related disorders on offspring school performance to beta-coefficients of 0.03 to -0.10 and ORs of 0.89-1.15. The effect of a mother's alcohol-related hospital admission on school performance was stronger in girls than in boys, whereas no gender differences were seen for a father's alcohol-related hospital admission.

CONCLUSIONS

In Sweden, alcohol-related disorders in both mothers and fathers are associated with lower school performance in their children at age 15-16 years, with most of the statistical effects being attributed to psychosocial circumstances of the family, such as parental psychiatric disorders, drug use and criminality and receipt of social or child welfare interventions.

Childhood adversity and psychiatric disorder in young adulthood: An analysis of 107,704 Swedes

Childhood adversity (CA) is associated with increased risks of psychiatric disorder in young adulthood, but details in this association are less known. We aimed to explore the association of a range of CA indicators with psychiatric disorder in young adulthood, and the impact of age at exposure, disorder type and accumulation of indicators. We capitalized on Sweden's extensive and high-quality registers and analyzed a cohort of all Swedes (N = 107,704) born in Stockholm County 1987-1991. Adversities included familial death, parental substance misuse and psychiatric disorder, parental criminality, parental separation, public assistance recipiency and residential instability. Age at exposure was categorized as: 0-6.9 years (infancy and early childhood), 7-11.9 years (middle childhood), and 12-14 years (early adolescence). Psychiatric disorders after age 15 were defined from ICD codes through registers. Risks were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI). Results showed that exposure to at least one CA was associated with an increased risk of psychiatric disorder (HR 1.4, 95% CI: 1.3-1.4). Risks were increased for mood, anxiety, and psychotic disorders and ADHD but not for eating disorders. The risk varied with type of disorder but was similar for all exposure periods. Individuals with multiple (3+) CAs had a two-fold risk of psychiatric disorder (HR 2.0, 95% CI: 1.9-2.1). In conclusion, our findings support the long-term negative impact of CA on mental health, regardless of developmental period of exposure. Given that experience of CA is common, efforts should be put to alleviate the burden of childhood adversities for children, particularly among the most disadvantaged.

Mental disorders and harmful substance use in children of substance abusing parents: A longitudinal register-based study on a complete birth cohort born in 1991

INTRODUCTION AND AIMS

Adverse childhood experiences and their accumulation over childhood have negative outcomes to children, yet earlier findings on the independent effect of parental substance abuse seem inconsistent. Our aims were to examine: (i) whether parental substance abuse is associated with children's mental disorders in mid-childhood (7-12 years) and mental disorders and own substance use in adolescence (13-17 years); and (ii) whether children are affected differently by a mother or father's substance abuse.

DESIGN AND METHODS

A register-based longitudinal data on a complete birth cohort of children born in Finland in 1991 (n = 65 117) and their biological parents. The children were followed until their 18^th birthday. Data were derived from the Finnish administrative registries. Bivariate and multivariate logistic regression models were used in the analysis.

RESULTS

Maternal, paternal and both parents' substance abuse were significant predictors of mental disorders and harmful substance use in children aged 13-17 years, even after controlling for other adverse childhood experiences, parental education and child's gender. Parental substance abuse predicted mental disorders in children aged 7-12 years in bivariate model but in multivariate model the association disappeared. Maternal substance abuse had stronger effect on harmful substance use in adolescent children than paternal. There were no significant interactions between substance abusing parents' gender and the child's gender.

DISCUSSION AND CONCLUSIONS

Early identification, prevention and treatment of substance abuse in families with children in primary health care, child welfare and other services are crucial in preventing intergenerational transmission of the problems associated with parental substance abuse. [Jääskeläinen M, Holmila M, Notkola I-L, Raitasalo K. Mental disorders and harmful substance use in children of substance abusing parents: A longitudinal register-based study on a complete birth cohort born in 1991. Drug Alcohol Rev 2016;35:728-740].

Child welfare clients have higher risks for teenage childbirths: which are the major confounders?

BACKGROUND

Aiming to support effective social intervention strategies targeting high-risk groups for teenage motherhood, this study examined to what extent the elevated crude risks of teenage childbirth among child welfare groups were attributable to the uneven distribution of adverse individual and family background factors.

METHODS

Comprehensive longitudinal register data for more than 700 000 Swedish females born 1973-1989 (including around 29 000 child welfare clients) were analysed by means of binary logistic regression. The Karlson/Holm/Breen-method was used to decompose each confounding factor's relative contribution to the difference between crude and adjusted odds ratios (ORs).

RESULTS

Elevated crude risks for teenage childbirth are to a large extent attributable to selection on observables. Girls' school failure was the most potent confounder, accounting for 28-35% of the difference between crude and adjusted ORs.

CONCLUSION

As in majority populations, girls' school failure was a strong risk factor for teenage childbirth among former child welfare children. At least among pre-adolescents, promoting school performance among children in the child welfare system seems to be a viable intervention path.

Childhood Household Dysfunction, Social Inequality and Alcohol Related Illness in Young Adulthood. A Swedish National Cohort Study

The aim of this paper is to estimate the cumulative effect of childhood household dysfunction (CHD) on alcohol related illness and death later in life and to test the interaction between CHD and socioeconomic background. The study utilised Swedish national registers including data of a Swedish national cohort born 1973–82 (n = 872 912), which was followed from age 18 to 29–40 years. Cox regression analyses were used to calculate hazard ratios (HR) for alcohol related illness or death in young adulthood. The CHD measure consisted of seven indicators: parental alcohol/drug misuse, mental health problems, criminality, death, divorce, social assistance, and child welfare interventions. Childhood socioeconomic position (SEP) was indicated by parental occupational status. Outcomes were alcohol related inpatient hospital care, specialised outpatient care or deaths. Using the highest socioeconomic group without CHD experience as a reference, those in the same socioeconomic group with one indicator of CHD had HRs of 2.1 [95% CI: 1.7–2.5], two CHD indicators 5.6 [4.4–7.1], three or more indicators 9.4 [7.1–12.4] for retrieving inpatient care. Socioeconomic disadvantage further increased the risks–those with low socioeconomic background and three CHD indicators or more had a HR of 12.5 [10.9–14.3]. Testing for interaction suggests that the combined HRs deviates from additivity [Synergy index: 1.6, 95% CI: 1.4–1.9]. The results for outpatient care were similar, but not as pronounced. In conclusion, this Swedish national cohort study shows that childhood household dysfunction is strongly and cumulatively associated to alcohol related illness later in life and that it interacts with socioeconomic disadvantage.

Racial Disparities in Child Adversity in the U.S.: Interactions With Family Immigration History and Income

INTRODUCTION

Childhood adversity is an under-addressed dimension of primary prevention of disease in children and adults. Evidence shows racial/ethnic and socioeconomic patterning of childhood adversity in the U.S., yet data on the interaction of race/ethnicity and SES for exposure risk is limited, particularly with consideration of immigration history. This study examined racial/ethnic differences in nine adversities among children (from birth to age 17 years) in the National Survey of Child Health (2011-2012) and determined how differences vary by immigration history and income (N=84,837).

METHODS

We estimated cumulative adversity and individual adversity prevalences among white, black, and Hispanic children of U.S.-born and immigrant parents. We examined whether family income mediated the relationship between race/ethnicity and exposure to adversities, and tested interactions (analyses conducted in 2014-2015).

RESULTS

Across all groups, black and Hispanic children were exposed to more adversities compared with white children, and income disparities in exposure were larger than racial/ethnic disparities. For children of U.S.-born parents, these patterns of racial/ethnic and income differences were present for most individual adversities. Among children of immigrant parents, there were few racial/ethnic differences for individual adversities and income gradients were inconsistent. Among children of U.S.-born parents, the Hispanic-white disparity in exposure to adversities persisted after adjustment for income, and racial/ethnic disparities in adversity were largest among children from high-income families.

CONCLUSIONS

Simultaneous consideration of multiple social statuses offers promising frameworks for fresh thinking about the distribution of disease and the design of targeted interventions to reduce preventable health disparities.

Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County

BACKGROUND

Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.

METHODS

We used a Swedish cohort of 96 399 individuals born during 1987-1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.

RESULTS

Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.

CONCLUSIONS

Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.

Cumulative exposure to childhood stressors and subsequent psychological distress. An analysis of US panel data

Research has shown that childhood stress increases the risk of poor mental health later in life. We examined the effect of childhood stressors on psychological distress and self-reported depression in young adulthood. Data were obtained from the Child Development Supplement (CDS) to the national Panel Study of Income Dynamics (PSID), a survey of US families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood (TA) data drawn from a national sample of young adults, 18-23 years old. This study included data from participants in the CDS and the TA (n = 2128), children aged 4-13 at baseline. Data on current psychological distress was used as an outcome variable in logistic regressions, calculated as odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses were used to identify clusters based on the different childhood stressors. Associations were observed between cumulative exposure to childhood stressors and both psychological distress and self-reported depression. Individuals being exposed to three or more stressors had the highest risk (crude OR for psychological distress: 2.49 (95% CI: 1.16-5.33), crude OR for self-reported depression: 2.07 (95% CI: 1.15-3.71). However, a large part was explained by adolescent depressive symptoms. Findings support the long-term negative impact of cumulative exposure to childhood stress on psychological distress. The important role of adolescent depression in this association also needs to be taken into consideration in future studies.

Childhood adversities predict strongly the use of psychotropic drugs in adulthood: a population-based cohort study of 24,284 Finns

BACKGROUND

Exposure to adverse childhood experiences has been shown to be associated with negative health outcomes including mental health problems, but only a few studies with register-based data have used psychotropic drugs as an outcome variable. The purpose of this study is to examine whether adverse emotional childhood experiences, such as serious conflicts in the family and frequent fear of a family member, predict the use of psychotropic drugs in adulthood. In addition, the association of a child-parent relationship during childhood with the use of psychotropic drugs is studied.

METHODS

The participants of the population-based Health and Social Support Study (24,284 working aged Finns) were followed up for 9 years. The information on childhood experiences and child-parent relationships was obtained from the questionnaires in 1998 and 2003. The number of psychotropic purchases (antipsychotics, drugs for bipolar disorder, antidepressants, anxiolytics, hypnotics and sedatives) was obtained from the National-Drug-Prescription-Register. Logistic and multinomial regression models were used.

RESULTS

A graded association between childhood adversities and the use of psychotropic drugs was found, even after adjustments for occupational training, work status, recent life events and health behaviour. Frequent fear of a family member showed the strongest association: the OR for multiple use of antidepressants was 3.08 (95% CI 2.72 to 3.49) and 2.69 (2.27 to 3.20) for multiple use of anxiolytics. Use of psychotropic drugs was clearly increased among those with poor child-parent relationship and multiple childhood adversities.

CONCLUSIONS

The results highlight the effect of environmental factors during childhood on mental health and the need for early recognition of families at risk.

Bullying, adverse childhood experiences and use of texting to promote behavior change

PURPOSE OF REVIEW

This article addresses three areas in which new research demonstrates the potential to impact the health of children and adolescents: bullying, adverse childhood experiences (ACEs) and texting to promote behavior change.

RECENT FINDINGS

Recent research on bullying emphasizes its impact on children with chronic medical conditions, and highlights cyber bullying as a rising issue. ACEs are now recognized as risk factors for many health issues, particularly mental health problems. Text messaging is a promising new method to communicate with parents and adolescent patients.

SUMMARY

Pediatric healthcare providers can help patients with chronic medical problems by addressing bullying at well child visits. Screening for ACEs may identify children at risk for mental health issues. Incorporating text messaging into clinical practice can improve disease management and patient education.