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

Influence of social determinants of health and adversity on computerized neurocognitive assessment

Introduction: Social determinants of health and adversity, including poverty, maltreatment, and neighborhood deprivation, are individual-level factors that may significantly affect baseline neurocognitive testing and management that have yet to be thoroughly explored within the computerized neurocognitive assessment.Objectives: Examine individual-level experiences of poverty, abuse, neighborhood deprivation, and social mobility on computerized cognitive testing.Methods: The sample included 3,845 student-athletes who completed a baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and were enrolled in the Child-Household Integrated Longitudinal Data database. Multivariable linear regressions were used to assess independent variables of Supplemental Nutrition Assistance Program enrollment, abuse or neglect cases, Area Deprivation Index scores, and other demographic factors on four baseline ImPACT composite scores: verbal and visual memory, visuomotor, and reaction time.Results: Individual-level factors of persistent poverty and neighborhood deprivation were associated with lower composite scores; however, upward social mobility was not significantly associated with cognitive performance. The effects of mother's race on computerized cognitive testing performance were attenuated when accounting for measures of adversity.Conclusion: Findings highlight the importance of social determinants of health in computerized neurocognitive testing to ensure more culturally sensitive and precise understanding of athletic baselines.

Treatment of type 2 diabetes and stress using neuro-emotional technique: case report

This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.

The effects of a defendant's childhood physical abuse on lay support for sentencing: The moderating role of essentialism

Research suggests that a defendant's history of experiencing childhood abuse, and its effects on their life and later decision-making, may impact public support for a defendant's sentencing, particularly mitigation. However, no existing research has examined how and why sentencing support may vary based on the time period when the abuse occurs during a defendant's childhood. This experiment, using a sample of the U.S. public (N = 400), examines how the age at which a defendant's childhood physical abuse occurs affects lay support for the goals of their sentencing. We hypothesized that participants with higher levels of social and biological trait essentialism would moderate their increased support for more punitive sentencing goals-particularly when a defendant was abused earlier, rather than later, in childhood. Results suggest that social essentialism is associated with increased support for restoration and rehabilitation toward defendants with histories of childhood physical abuse, potentially indicating that the public views the effects of child abuse as more of a social, versus biological, process which may affect support for utilitarian punishment goals.

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.

Associations between adverse childhood experiences and pain in middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study

OBJECTIVE

Adverse childhood experiences (ACEs) have been associated with a range of adverse health outcomes, with pain being potentially one of them. This population-based cross-sectional study aimed to investigate the associations between Adverse Childhood Experiences (ACEs) and pain in Chinese adults and evaluate whether physical activity and demographic and socioeconomic characteristics modify this associations.

METHODS

Cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS), were utilized in this study. A total of 9923 respondents with information on 12 ACE indicators and 15 self-reported body pains were included. Logistic regression models were used to assess associations of the ACEs and pain. Modification of the associations by physical activity, demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction.

RESULTS

Among the 9923 individuals included in the primary analyses, 5098 (51.4%) males and the mean (SD) age was 61.18 (10·.44) years. Compared with individuals with 0 ACEs, those who with ≥ 5 ACEs had increased risk of single pains and multiple pain. A dose-response association was found between the number of ACEs and the risk of pain (e.g. neck pain for ≥ 5 ACEs vs. none: OR, 1.107; 95% CI, 0.903-1.356; p < 0.001 for trend). In the associations of each body pain with each ACE indicator, most ACE indicators were associated with an increased risk of pain. In addition, physical activity, sociodemographic and socioeconomic characteristics, such as age, sex, educational level, area of residence, childhood economic hardship, did not demonstrate a significant modify on the associations between ACEs and pain.

CONCLUSIONS

These findings indicate that cumulative ACE exposure is associated with increased odds of self-reported pain in Chinese adults, regardless of adult physical activity, sociodemographic and socioeconomic characteristics.

Role of the Sibling Relationship to Reduce the Negative Impact of Adverse Childhood Experiences (ACEs) on Wellbeing in Adulthood

Over the past two decades, public health research has demonstrated that Adverse Childhood Experiences (ACEs) are associated with significant and prolonged physical and mental health problems, demanding investigation into the factors that may mitigate the poor outcomes. One potential factor that may attenuate the negative impact of ACEs on individuals' health is social support. An important source of social support, both during and after adverse childhood experiences, is sibling relationships. Consequently, the purpose of the current study was to examine if two components of sibling relationships-perceived warmth and conflict-affect the relationship between ACEs and wellbeing in adulthood. A total of 439 participants (Mage = 35.06, SD = 11.19) completed self-report measures of their ACEs, their perceived warmth and conflict with a living sibling, and their wellbeing. Results revealed that sibling relationships characterized by higher perceived warmth-and, interestingly, higher perceived conflict-attenuated the negative impact of ACEs on wellbeing in adulthood. Findings from the current study provide valuable information about how psychologist, social workers, and other health professionals may use siblings as a source of social support to mitigate the negative effects of ACEs on wellbeing in adulthood.

Coping motives as a mediator of the relationship between child maltreatment and substance use problems in south African adolescents

BACKGROUND

Evidence suggests that adults with a history of child maltreatment (CM) engage in substance misuse driven by 'coping motives': maladaptive beliefs that substances help them cope with negative emotions. However, the specificity of this risk pathway is under-researched in younger and non-Western cohorts.

OBJECTIVE

The present study aimed to determine whether coping motives play a distinct role compared to other motives for substance use in mediating the relationship between CM and problematic alcohol and marijuana use in a sample of South African adolescents.

PARTICIPANTS AND SETTING

A sample of 688 high school students (M age = 15.03 years; 62.5 % female) in Cape Town, South Africa, completed a cross sectional survey.

METHODS

Participants completed self-report measures of CM exposure, motives for using alcohol and marijuana (coping, enhancement, social and conformity), and alcohol and marijuana related problems. Participants who endorsed using alcohol (N = 180) or marijuana (N = 136) were included in analysis. A parallel mediation model was conducted for each substance (alcohol and marijuana, respectively) to assess which motives mediated the relationship between CM exposure and substance-related problems.

RESULTS

CM exposure predicted both alcohol-and marijuana related problems. The relationship between CM exposure and alcohol-related problems was partially mediated by coping motives (p < .001, 95%CI 0.028, 0.115) and, to a lesser extent, conformity motives (p < .01, 95%CI 0.001, 0.041), but not by social motives or enhancement motives. The relationship between CM exposure and marijuana-related problems was partially mediated by coping motives (p < .001, 95%CI 0.004, 0.037), but not by conformity, social or enhancement motives.

CONCLUSIONS

The findings support the importance of coping motives as a mediator between CM and problematic substance use across different substances of abuse in South African adolescents, and the role of conformity motives in problematic alcohol use. Future research should explore whether these findings hold across other sociocultural contexts, and the utility of interventions to address coping motives for substance use in adolescence.

Bullying Victimization and Adverse Childhood Experiences: Retrospective Reports of Relative Impact on Emotional Distress

The literature suggests that there is a significant overlap in definition, measurement, and outcomes between trauma and bullying victimization, but the relative impact on current emotional distress of these events has not been explored. The goal of the current study was to explore whether traditional and cyber bullying victimization has a similar negative impact on current emotional disrtresss as other adverse childhood experiences which may also lead to a traumatic response. In addition, this study examined whether the association between bullying victimization and emotional distress is exacerbated when individuals also experience additional ACEs. Retrospective reports from a diverse sample of 576 adults were collected via an online survey. When ranked against other ACEs such as viewing family mental health problems or substance abuse, or verbal, physical, emotional, and sexual victimization not from peers, nearly 30% of participants ranked bullying victimization as having the most negative impact on their levels of emotional distress. Multi-group path analyses indicated that experiencing additional ACEs seems to exacerbate distress caused by bullying and cyber bullying victimization. The current study suggests that bullying victimization may be just as detrimental as other types of ACEs that occur in childhood.

Adverse childhood experiences among people with schizophrenia at comprehensive specialized hospitals in Bahir Dar, Ethiopia: a comparative study

Background

People who have encountered adverse childhood experiences (ACEs) are predisposed to developing schizophrenia, experiencing exacerbated symptoms, and facing an elevated risk of disease relapse. It is imperative to evaluate the prevalence of ACEs to comprehend the specific attributes of this condition and enable the implementation of suitable interventions.

Aims

The aim of this study was to assess the prevalence of ACEs and its determinants among people with schizophrenia and the patient attendants in Bahir Dar, Ethiopia.

Method

A comparative cross-sectional study was carried out at the Comprehensive Specialized Hospitals in Bahir Dar, Ethiopia, from April 26 to June 10, 2023. A total of 291 individuals with schizophrenia and 293 individuals from the patient attendants were selected using a systematic random sampling method. A proportional odds model ordinal logistic regression analysis was used to identify the factors associated with ACEs.

Results

The occurrence of at least one ACE among individuals diagnosed with schizophrenia was 69.4%, while patient attendants had a 46.8%, as indicated by the Chi-square test, which showed a significant difference at p <0.05. The study findings indicated that individuals with schizophrenia who have encountered four or more ACEs are more inclined to have lower educational attainment (AOR: 4.69 [1.94 - 11.61]), low resilient coping mechanisms (AOR: 2.07 [1.11 - 3.90]), and poor social support (AOR: 3.93 [2.13 - 7.32]). Conversely, factors such as rural residency, illiteracy, and heightened attachment-related anxiety were found to be notably associated with the patient attendants.

Conclusion

In this study, the substantial prevalence of ACEs emphasized the necessity for ACE screening and the implementation of evidence-based interventions to address and alleviate the overall burden of ACEs.

Tobacco use, trauma exposure and PTSD: a systematic review

Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.

Prevalence of adverse childhood experiences and their cumulative impact associated lifetime health outcomes in the Emirate of Abu-Dhabi, United Arab Emirates

BACKGROUND

Adverse Childhood Experiences have been associated with poor health outcomes later in life.

OBJECTIVE

The objective of the study was to determine the relationship between cumulative ACEs, risky health behaviors, chronic diseases, and mental health among a large-scale sample from the Emirate of Abu Dhabi.

PARTICIPANTS AND SETTING

A retrospective cross-sectional study was performed with 922 participants over the age of 18, living in Abu Dhabi.

METHODS

The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess ACEs, alongside a survey of adult health outcomes, mental health outcomes, and risk-taking behaviors.

RESULTS

Logistic regression models examined the association between retrospective ACEs and these outcomes. The respondents reported an average of 1.74 ACEs. The most prevalent ACEs were household violence, parental death or divorce, and community violence. The accumulation of ACEs significantly predicts increases in the risk of a variety of adult-onset health morbidities, all measured mental health morbidities, and all measured risk-taking behaviors, with evidence of thresholds of ACE accumulation dictating risk.

CONCLUSIONS

The baseline presence of ACEs among this Abu Dhabi sample, along with the associated risks of physical and mental health morbidities, and risk-taking behaviors play a significant role in understanding the extent, nature, and associated sequalae of ACEs in this population; providing nuanced context for early intervention. Our findings will inform the planning and implementation of specific prevention and awareness raising programs while promoting safe environments where children are healthy and can thrive.

Examining adverse childhood experiences and Black youth's engagement in a hospital-based violence intervention program using administrative data

BACKGROUND

Stemming from poverty and systemic racism, Black youth are disproportionately represented in hospital-based violence intervention programs (HVIPs) due to greater violence exposure. HVIPs are a critical intervention that have been shown to reduce rates of reinjury in urban hospitals and trauma centers across the United States; however, they are plagued by low enrollment and engagement rates. Few studies have examined factors related to engagement, particularly among Black youth.

METHODS

Guided by Trauma Theory and Critical Race Theory, this study uses a retrospective cohort design. Between-group differences of adverse childhood experiences (ACEs) among engaged youth compared to nonengaged youth who were violently injured and recruited for a HVIP were examined using chi-square and logistic regression. ACEs were approximated using a novel approach with administrative data.

RESULTS

Results indicated that the total ACE score was not significantly associated with engagement status. Individual ACEs were tested across age groups.

CONCLUSIONS

This study highlights a novel approach to understanding ACEs among a hard-to-reach population and illuminates the significant level of ACEs faced by violence-exposed Black youth at young ages. Considering theory, Black families may be more reluctant to engage due to fear and past harms in social service systems stemming from systemic racism. Though ACEs did not predict engagement in this study, considering the high rates of ACEs experienced by Black youth and their families in the context of systemic racism suggests that HVIPs should acknowledge historical harms and foster trauma-informed and healing-centered interactions during recruitment and later stages of engagement.

Outcomes of adverse childhood experience during late adolescence: Evidence from college and community samples

Scant studies have investigated adverse childhood experience (ACE) outcomes and mastery during adolescence in different cultural contexts. This cross-sectional study examines the impact of ACEs on subjective well-being, health complaints, and healthcare utilization during late adolescence, including the mediating role of the sense of mastery in the Saudi context. Adolescents (N = 396) aged 17-21 years were recruited via convenience sampling from colleges and local communities from two regions in Saudi Arabia. Data were collected using a paper-pencil anonymous survey and analyzed using path analysis. Of the sample, 85.5% experienced at least one ACE. ACEs had a direct effect on subjective well-being (p = 0.034), health complaints (p < 0.001), healthcare utilization (p < 0.001), and sense of mastery (p < 0.001). Sense of mastery had an effect on subjective well-being (p < 0.001) and health complaints (p < 0.001), but not on healthcare utilization (p = 0.436). Sense of mastery partially mediated the relationship between ACEs and subjective well-being (p = 0.034) and health complaints (p < 0.001), but not healthcare utilization (p = 0.438). ACEs have detrimental effects on adolescent health. Attention should be paid to primary prevention and early detection to avoid further harm, and interventions that address the role of the sense of mastery should be developed for adolescents.

Adverse Childhood Experiences and Associations with Mental Health, Substance Use, and Violence Perpetration among Young Adults in sub-Saharan Africa

Background

Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA).

Objective

To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA.

Participants and setting

Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18-24 years.

Methods

Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated.

Result

ACEs prevalence ranged from 7.8% (emotional violence) to 55.0% (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes.

Conclusion

ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population.

Partitioning the Composition of Adverse Childhood Experiences From Accumulated Adversity: Cross-Sectional Evidence From 2 U.S. Samples

Introduction

Adverse childhood experiences are linked to adult morbidity and mortality. However, it is unknown whether the patterning of adverse childhood experiences, individually and in combination, confer health risk distinct from that of a cumulative adversity score. This study evaluates whether individual and comorbid adverse childhood experience exposures within a cumulative risk score are equally associated with current smoking and lifetime history of depression.

Methods

Cross-sectional analysis of adverse childhood experience assessments in the Behavioral Risk Factor Surveillance System from 21 states in 2019 (n=115,183) and 23 states in 2020 (n=120,416) was performed. We modeled cumulative adverse childhood experience scores and the 5 most common distinct adverse childhood experience components that compose a given adverse childhood experience score, up to a cumulative score of 4. We compared adverse childhood experience components, adjusting for covariates.

Results

Across both samples, 23% and 57%-58% of persons reported 1 adverse childhood experience and 2 or more adverse childhood experiences, respectively. In 2019 smoking prevalence was 10.4% for persons reporting zero adverse childhood experiences and 14.2% for persons reporting 1 adverse childhood experience. When the single adverse childhood experience was experiencing parental divorce, smoking was higher (16.6%) than when the single adverse childhood experience was verbal abuse (11.8%) or living with a mentally ill household member (9.5%). Lifetime depression prevalence was 9.6% and 14.1% across zero and 1 adverse childhood experience, respectively, whereas it was 26.6% if the single adverse childhood experience was living with a mentally ill household member and 11.0% when the adverse childhood experience was experiencing parental divorce. This heterogeneity was replicated in 2020 data. Additional heterogeneity was observed for higher cumulative adverse childhood experience scores.

Conclusions

Cumulative adverse childhood experience scores mask substantial health risk heterogeneity, which can be delineated by examining distinct components of cumulative adverse childhood experience scores.

Prevalence and associated factors of adverse childhood experiences (ACE) in a sample of Brazilian university students

BACKGROUND

Adverse childhood experiences (ACEs) have long been associated with health risk behaviors, but they are poorly studied in Brazilian university students.

OBJECTIVE

To estimate the prevalence of ACEs and investigate their association with sociodemographic data, health risk factors and self-related health in a sample of university students.

PARTICIPANTS AND SETTING

A cross-sectional study conducted with 546 students from a Brazilian public university.

METHOD

The self-reported 10-ACE Study questionnaire (ACE-Q) and sociodemographic information (age, sex, family income), health risk factors (body mass index, physical exercise, alcohol and tobacco use) and self-related health were assessed. Chi-square Test and multivariate logistic regression were used to evaluate the association between the cumulative occurrence of ACE (ACE ≥4) and the studied factors.

RESULTS

Of the 546 participants, 464 responded to all ACE-Q questions; 74.4% reported at least one ACE, and 13.1 % reported four or more. Lower family income (OR = 2.02; 95%CI = 1.13-3.61; p = 0.01) and self-related poor health (OR = 2.29; 95%CI = 1.28-4.08; p = 0.00) were associated with the occurrence of ACE ≥4.

CONCLUSION

Most students reported at least one ACE, while a minority reported ≥4 ACEs associated with lower family income and poor self-health. The data suggest that preventive actions should be considered to mitigate the problem, with lower-income students being treated as a priority.

Medical Students' Knowledge, Attitudes Toward, and Identification of Adverse Childhood Experiences and Trauma-Informed Care

INTRODUCTION

Adverse childhood experiences (ACEs) are traumatic experiences that occur prior to age 18 years and can have a long-term impact on adult physical and mental health. Knowledge of ACEs, including the link between ACEs and health, and trauma-informed care (TIC), is essential for medical professionals to ensure respectful and compassionate care for those with a history of childhood adversity. This study examined medical students' knowledge, attitudes toward, and identification of ACEs and TIC to inform curricular efforts.

METHODS

Using a cross-sectional design, students were recruited from 2 medical schools, one allopathic (medical degree) and one osteopathic (doctor of osteopathic medicine degree) to complete an electronic needs assessment survey. The survey included a patient vignette to assess students' ability to identify ACEs as contributing factors to patient health. The students were blind to the full purpose of the study to obtain an objective measurement of their ability to identify ACEs as contributors to patient health. Additional questions targeting knowledge and attitudes of ACEs and TIC were devised from previously published surveys with supplemental study-designed questions.

RESULTS

Two hundred forty students completed the survey. Results demonstrated variable ability to identify ACEs; strong general knowledge of ACEs, with less developed practical knowledge; and overall positive attitudes toward ACEs and TIC. No differences were found between the medical degree and doctor of osteopathic medicine degree, or year in program.

CONCLUSIONS

Medical students would benefit from curricular efforts that help to increase knowledge of the link between ACEs and health, increase practical application of ACEs and TIC, and improve their ability to identify ACEs in clinical scenarios.

Adverse Childhood Experiences and Mental Distress Among Adolescents and Youth in Zimbabwe

Adverse childhood experiences (ACEs) are a global public health crisis associated with physical and poor mental health outcomes. The current study examined the prevalence and association between individual and cumulative ACEs with mental distress among adolescents and youth in Zimbabwe. Data from the 2017 Violence Against Children and Youth Survey were utilized (13-25 years old, n = 8,715). Bivariate analysis was conducted using chi-square tests to obtain the prevalence estimates. Two sets of logistic regression models were conducted to determine significant associations between independent variables (i.e., experiencing childhood physical, emotional, and sexual violence; witnessing intimate partner violence (IPV) and community violence; orphan status; and cumulative ACE exposure) and the dependent variable (i.e., mental distress in the past 30 days as measured by Kelser 6). 28.4% of the adolescents and youth reported experiencing mental distress in the past 30 days. Regarding ACEs, cumulative ACE exposure (34.7%; adjusted odds ratio [AOR] = 2.13) and individual ACEs (i.e., experiencing childhood physical violence [39.3%; AOR = 1.41], emotional violence [55.8%; AOR = 2.67], sexual violence [50.8%; AOR = 2.00], witnessing community violence [47.3%; AOR = 1.52], witnessing IPV [43.1%; AOR = 1.47], and being orphaned during childhood [33.6%; AOR = 1.24]) were significantly associated with higher prevalence rates and odds of experiencing mental distress in the past 30 days among adolescents and youth in Zimbabwe. These findings show that ACEs are highly prevalent and increases the risk of mental distress for vulnerable adolescents and youth in Zimbabwe. Effective interventions to reduce violence exposure in families, schools, and communities are essential to mitigate the negative consequences of ACEs and mental distress of adolescents and youth in Zimbabwe. Strengthening child protection policies and involving social workers, psychologists, and mental health workers are also crucial for safeguarding vulnerable children who might be impacted by ACEs in Zimbabwe. Implications for future research are further discussed.

The role of adverse childhood experiences in predicting child abuse perpetration among married mothers in Alexandria, Egypt: a cross-sectional study

BACKGROUND

Adverse childhood experiences (ACEs) are receiving increased amounts of attention as a critical public health issue. ACEs have a massive impact on future violence victimization and perpetration. They are also associated with lifelong mental and physical health consequences as well as premature mortality. The present study aimed to investigate the role of different ACEs among married mothers in predicting the risk of child abuse perpetration in offspring.

METHODS

A cross-sectional study was conducted on 350 mothers of children aged 2-12 years attending family health centres in Alexandria. The mothers completed a predesigned interview questionnaire on sociodemographic data and data related to ACEs, spousal violence, and child abuse perpetration. Suitable bivariate and multivariate statistical tests were used to analyse the collected data using version 20.0 of the Statistical Package for Social Sciences (SPSS).

RESULTS

Two-thirds of mothers (66.3%) reported ever having been exposed to any ACE, and 18.6% of them had experienced 3 or more ACEs. Psychological abuse (46%) and witnessing domestic violence (17%) were the most common. Psychological aggression (95.4%), minor physical assault (79%), and neglect (52%) were the most common forms of child abuse perpetrated by the mothers. The number of ACEs experienced by mothers showed a moderate positive significant correlation with the 5 forms of child abuse examined. Different ACEs, mother's age, socioeconomic status, and current exposure to spousal violence were found to be independent predictors of different forms of child abuse (psychological aggression, neglect, minor physical assault, and severe physical assault).

CONCLUSION

Different practices of family violence are strongly connected throughout different stages of an individual's life and across generations. Further understanding of the interconnections among forms of violence and addressing them should be prioritized. Additionally, concerted national strategies across all levels and sectors are needed to address this complex problem.

Adverse childhood events and mental health problems in cancer survivors: a systematic review

PURPOSE

The purpose of this study was to systematically review the literature on the association between adverse childhood events (ACEs) and mental health problems in cancer survivors.

METHODS

This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Four databases (PubMed, PsychINFO, Web of Science, and Cochrane) were searched on 27-08-2023.

RESULTS

Of the 1413 references yielded by the literature search, 25 papers met inclusion criteria and were reviewed. Most studies were performed in the USA, most included breast cancer survivors, and the number of included participants ranged between 20 and 1343. ACEs were relatively prevalent, with self-report rates ranging between 40 and 95%. Having been exposed to ACEs was a risk factor for heightened levels of emotional distress, anxiety, depressive symptoms, and fatigue during cancer treatment. Results varied depending on the variables included, and per subscale, but were consistent across different cultures and heterogenous patient groups.

CONCLUSION

The association between ACE and mental health outcomes was significant in most studies. In order to improve treatment for this vulnerable population, it may be necessary to screen for ACEs before cancer treatment and adjust treatment, for example, by means of trauma-informed care (TIC), which recognizes and responds to the impact of trauma on individuals seeking healthcare.

Protocol for a hybrid type 3 effectiveness-implementation trial of a pragmatic individual-level implementation strategy for supporting school-based prevention programming

BACKGROUND

For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement.

METHODS

This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective.

DISCUSSION

This study will provide a rigorous test of BASIS-T-a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms-to increase the yield of standard EBPP training and support strategies.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023.

Variety ACEs and risk of developing anxiety, depression, or anxiety-depression co-morbidity: the 2006-2022 UK Biobank data

Objectives

Adverse childhood experiences (ACEs) and anxiety-depression co-morbidity are attracting widespread attention. Previous studies have shown the relationship between individual psychiatric disorders and ACEs. This study will analyze the correlation between anxiety-depression co-morbidity and different levels of ACEs.

Methods

Seven categories of ACE and four classifications of psychiatric disorders were defined in a sample of 126,064 participants identified by the UK Biobank from 2006-2022, and correlations were investigated using logistic regression models. Then, to explore nonlinear relationships, restricted spline models were developed to examine differences in sex and age across cohorts (n = 126,064 for the full cohort and n = 121,934 for the European cohort). Finally, the impact of the category of ACEs on psychiatric disorders was examined.

Results

After controlling for confounders, ACEs scores showed dose-dependent relationships with depression, anxiety, anxiety-depression co-morbidity, and at least one (any of the first three outcomes) in all models. ACEs with different scores were significantly positively correlated with the four psychiatric disorders classifications, with the highest odds of anxiety-depression co-morbidity (odds ratio [OR] = 4.87, 95% confidence intervals [CI]: 4.37 ~ 5.43), p = 6.08 × 10-178. In the restricted cubic spline models, the risk was relatively flat for females at ACEs = 0-1 and males at ACEs = 0-2/3 (except in males, where ACEs were associated with a lower risk of anxiety, all other psychiatric disorders had an increased risk of morbidity after risk smoothing). In addition, the risk of having anxiety, depression, anxiety-depression co-morbidity, and at least one of these disorders varies with each category of ACEs.

Conclusion

The prevalence of anxiety-depression comorbidity was highest across ACE scores after controlling for confounding factors and had a significant effect on each category of ACEs.

Association of childhood adversities with psychosocial difficulties among Chinese children and adolescents

BACKGROUND

Adverse childhood experiences (ACEs) have been well recognized as risk factors for various adverse outcomes. However, the impacts of ACEs on psychological wellbeing among Chinese children and adolescents are unknown.

METHODS

In total, 27 414 participants (6592 Grade 4-6 and 20 822 Grade 7-12 students) were included and information on ACEs and various psychosocial outcomes was collected. We identified subgroups with distinct psychosocial statuses using cluster analysis and logistic regression was applied to measure the associations of ACEs [individual, cumulative numbers by categories or co-occurring patterns identified by using multiple correspondence analysis (MCA)] with item- and cluster-specific psychosocial difficulties.

RESULTS

Three and four cluster-based psychosocial statuses were identified for Grade 4-6 and Grade 7-12 students, respectively, indicating that psychosocial difficulties among younger students were mainly presented as changes in relationships/behaviours, whereas older students were more likely featured by deviations in multiple domains including psychiatric symptoms and suicidality. Strongest associations were found for threat-related ACEs (e.g. bullying experiences) with item- or cluster-based psychosocial difficulties (e.g. for cluster-based difficulties, the highest odds ratios = 1.72-2.08 for verbal bullying in Grade 4-6 students and 6.30-12.81 for cyberbullying in Grade 7-12 students). Analyses on cumulative numbers of ACEs and MCA-based ACE patterns revealed similar risk patterns. Additionally, exposure patterns predominated by poor external environment showed significant associations with psychosocial difficulties among Grade 7-12 students but not Grade 4-6 students.

CONCLUSIONS

Chinese adolescents faced different psychosocial difficulties that varied by age, all of which were associated with ACEs, particularly threat-related ACEs. Such findings prompt the development of early interventions for those key ACEs to prevent psychosocial adversities among children and adolescents.

The Impact of Adverse Childhood Experiences on Mental Health and Suicidal Behaviors: A Study from Portuguese Language Countries

Background: Research on adverse childhood experiences (ACEs) demonstrates that they can be associated with physical and mental health problems throughout the lifecourse. However, few studies have examined this topic in the Community of Portuguese Language Countries (CPLC). Objective: This study aims to assess the impact of ACEs on mental health and suicidal behaviors in a sample of participants from the CPLC. Participants and Setting: The sample consists of 1006 participants aged between 18 and 80 years (mean = 41.76; SD = 14.19). Methods: This study used an online survey that included a sociodemographic questionnaire, the Brief Symptom Inventory-18 (BSI-18) to assess somatization, depression, and anxiety symptoms, and overall mental functioning, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) to assess suicidal behaviors, and the Family Adverse Childhood Experiences Questionnaire to assess ACEs. Results: Emotional abuse was the most reported ACE (32.7%). Participants from Brazil had higher levels of somatization, depression, anxiety, and suicide ideation and attempt, while participants from Portugal had a higher probability of suicide in the future. ACEs were strong and significant predictors of psychological symptoms and the likelihood of suicide in the future, with emotional abuse and emotional neglect being the domains with the greatest contribution, respectively. Conclusions: ACEs are a prevalent and general phenomenon across several countries. It is urgent to alert policymakers and mental health professionals of the need to intervene with children and families to ensure their harmonious and adjusted development, thus promoting quality of life and well-being of populations.

Adolescent mental health in post-conflict communities: results from a cross-sectional survey in Northern Uganda

PURPOSE

This study evaluated adolescents' mental health their knowledge, attitudes, and beliefs about mental health conditions, and their access to critical mental health services in Lira District, northern Uganda. The political history of the region, the epicenter of the decades-long conflict between the Lord's Resistance Army and the Ugandan government, makes for an interesting case study of the political and social determinants of mental health of those directly impacted by conflict, and on subsequent generations growing up in post-conflict communities.

METHODS

This paper presents the results of a community-based participatory research study carried out by youth public health ambassadors in Lira District, Uganda. The study consisted of a mixed methods cross-sectional survey of households, schools, and healthcare facilities.

RESULTS

The study found 66% of adolescents indicated poor well-being and possible symptoms of depression and 41% of adolescents reported at least 4 childhood trauma events. Over 35% reported feeling extremely sad and 60% reported feeling socially isolated during the COVID lockdowns that lasted from 2020 to 2021. Nearly half of the adolescents aged 14-17 surveyed (N = 306) believed that witchcraft caused mental health problems, while less than 20% believed that traumatic experiences could be a cause. Forty percent of respondents had no idea of where to seek mental health care, and few facilities had mental health services available.

DISCUSSION

These findings illustrate the need to study the political and social determinants of mental health, especially on those directly impacted by armed conflict and for the generations growing up in post-conflict communities as they seek to rebuild.

Internalizing disorders as a mediator of the association between adverse childhood experiences and perceived medication intolerance or poly-allergy

OBJECTIVES

There is a well-established link between adverse childhood events, mental health, and physical health conditions. There is also a large literature showing the relationship between medication intolerance or allergies, and poor health outcomes. However, less is understood about the role of medication intolerance and adverse childhood events. Thus, the present study examines the relationship between adverse childhood events, internalizing disorders (depression, anxiety) and medication intolerance.

METHOD

Three hundred forty-nine participants were recruited from 11 primary care practices and health networks located in a large, Midwestern metropolitan area. Unrelated linear and Poisson regression was used to determine whether internalizing disorders, such as depression and anxiety, mediated the relationship between adverse childhood experiences (ACEs) and allergies to medications, accounting for error terms in regression equations that were correlated.

RESULTS

Results indicated an association between ACEs and number of allergies to medication, whereby ACEs was associated with depression, anxiety and number of allergies. Sensitivity analysis confirmed these findings. There was a small but significant indirect effect of anxiety on allergies to medication after bootstrapping.

CONCLUSION

This study found that inflammatory responses occurring because of trauma and depression may be increasing medication allergies. However, given the size of the sample, more research is needed to confirm these results. Implications for healthcare providers are discussed.

Depression in the next generation is related with maternal behaviors: A cross-comparison by alternating rat's mother care

This study investigated the potential impacts of depressive rats' maternal behavior as an early life stress on the outcome of offspring as an adulthood. Offspring from the same mother were divided into two groups, half of them were fostered or remained by a depressive mother, and the other half remained or fostered by a control mother, respectively. The results showed that offspring fostered by depressive mothers presented significant depressive behaviors. Meanwhile, depressive mothers engaged in more grooming during the light cycle, but less off-the-pup behavior during the dark phase. In conclusion, offspring exposed to a postnatal depressive maternal environment developed a depressive-like behavior. Contrarily, postpartum maternal behaviors play an essential role, which might determine the outcome of the next generation. Furthermore, the appropriate timing of postpartum maternal caring sequences, which might eliminate prenatal stressful influences, was recognized and might be a promising approach for reducing children's predisposition to mental disorders in their life time.

Physical, sexual, and psychosocial health impacts of child abuse: Evidence from Ghana

Child abuse is a significant global health problem. While data on child abuse in Ghana are scant, anecdotal evidence suggests the vast majority of Ghanaian children have experienced some form of physical or sexual abuse. This paper explores links between early childhood abuse and health outcomes using a life course perspective. Nationally representative cross-sectional data were collected from a sample of 2289 ever-married Ghanaian women in 2017. Women provided retrospective accounts of different types of violence in early childhood. Random-effects logit models were used to examine the impact of two dimensions of early childhood abuse (physical and sexual) on the physical, sexual, and psychosocial health outcomes of women in later years. Women who experienced childhood physical abuse, but not often, were significantly more likely to report physical disabilities in later years than women who did not experience it. Women reporting childhood sexual abuse were more likely to be depressed in later years than those who never experienced such abuse. They were also significantly more likely to report sexually transmitted diseases. Our findings provide support for the life course theory by showing abuse experienced in childhood could have a long-term impact. We therefore suggest the need for early interventions to address child abuse.

An E-Learning Program for Continuing Midwifery Education on Handling High-Risk Abuse Cases: A Pretest-Posttest Design

It is essential to equip midwives and nurses working in the perinatal period with comprehensive knowledge and awareness regarding child abuse prevention. However, most midwives and nurses in Japan do not have the opportunity to learn about abuse prevention during their basic education. We aimed to develop an e-learning program to assist obstetric midwives and nurses in acquiring the knowledge needed to provide support and handle cases with a high risk of abuse, as well as to assess the program's usefulness. This study employed a single-group pre-post design; e-learning served as the intervention. Seventy-one obstetric midwives and nurses were recruited. The program's usefulness was the difference between the participants' pretest and post-test knowledge and efficacy scores. The score data were analyzed using the t-test. A paired t-test revealed that the post-test scores of knowledge and efficacy were significantly higher than those of the pretest, with a large effect size (d = 1.71). Platforms where basic knowledge on how to respond to high-risk abuse cases are lacking in nursing education; thus, this e-learning program is recommended for nurses working in the perinatal field throughout Japan. This educational opportunity for perinatal midwives and nurses will increase awareness and contribute to abuse prevention.

How Do Survivor and Mandatory Reporter Status Correlate with Program Outcomes for an Adult-Focused Child Sexual Abuse Prevention Program?

This exploratory study investigated group differences and pre-post changes in knowledge, beliefs, and behavior by mandatory reporters and Child Sexual Abuse (CSA) survivor status for a CSA prevention training designed for the general public. Of the 8,114 study participants, 32% identified as having experienced CSA, and 77% indicated they were mandatory reporters for child abuse and neglect. Mandatory reporters had higher baseline knowledge about CSA than those who were not mandatory reporters and reported more CSA preventative behaviors. Mandatory reporters continued to have higher levels of knowledge following the training. Survivors of CSA also had higher baseline knowledge about CSA and preventative behavior scores than individuals who are not survivors of CSA. Unlike mandatory reporters, they experienced fewer increases in knowledge. At posttest, there was no evidence of a difference in knowledge between CSA survivors and non-CSA survivors. For items related to beliefs, mandatory reporters had higher baseline scores than other participants. However, they had smaller gains, so mandatory reporters and non-mandatory reporters had more similar beliefs related to CSA after the training. There were few differences between CSA survivors and non-survivors on baseline beliefs related to CSA, though CSA survivors reported greater increases in beliefs that CSA prevention is their responsibility and in the idea that they know what to do to prevent CSA. These results have significant results for the development and evaluation of trauma-informed prevention programming.

Adverse Childhood Experiences in Mexico: Prevalence and Association with Sociodemographic Variables and Health Status

Background

Adverse Childhood Experiences (ACEs) refer to a semantic field of negative childhood events that, in conjunction with insufficient personal, family, or contextual coping resources, have the potential of becoming traumatic.

Objective

To assess the prevalence of Adverse Childhood Experiences (ACEs) and their association with sociodemographic variables and physical and mental illnesses in a Mexican sample.

Design

A cross-sectional design was used. The sample included 917 Mexican adults who responded to the Adverse Childhood Experiences International Questionnaire (ACE-IQ). Most of the participants were female (79.3%) with an average age of 37 years, a monthly income between 500 and 2,500 USD (59.2%), had completed university education (45.6%) and were married or in a common-law marriage (53.1%). Data was collected through Google Forms, and the link to the form was shared through electronic social networks.

Results

A total of 48.3% of the participants presented seven to nine types of ACEs. Among their responses, the most prevalent categories were emotional neglect (95.1%), family violence (83.3%), and emotional abuse (78.6%). A significant association was found between the number of ACEs and the mental illness diagnosis (x2(20) = 15.16; p<001). Women were found to report more experiences of sexual abuse (z = -6.62, p<. 001), whereas men reported more experiences of community violence (z= -4.27, p < .001) and collective violence (z = -3.94, p<.001).

Conclusions

The prevalence of ACEs in the Mexican population is high. However, men and women reported differences in certain types of ACEs. It was found that people with a diagnosis and family history of mental illnesses presented a higher number of ACE categories.

Childhood abuse and association with adult depressive symptoms among people with cardiovascular disease

Background

To study the association between the total/different types of childhood abuse and adult depressive symptoms in people with cardiovascular disease (CVD).

Methods

The subjects were people with CVD who continuously participated in the China Health and Retirement Longitudinal Study (CHARLS) life history survey and the 2018 wave of the CHARLS national baseline Survey. Multi-level logistic regression models were used to analyze the relationship between emotional neglect, physical neglect, physical abuse and adult depressive symptoms.

Results

A total of 4,823 respondents were included in this study. The incidence of childhood abuse (existed emotional neglect, physical neglect or physical abuse) was 43.58% among people over 45 years old with CVD, which was higher than that of the general population (36.62%, p < 0.05). Adjusted model showed that overall childhood abuse was associated with adult depressive symptoms (OR = 1.230, 95%CI:1.094-1.383). Among different types of childhood abuse, only physical abuse was associated with depressive symptoms in adulthood (OR = 1.345, 95%CI:1.184-1.528).

Conclusion

Compared with that of the general population, the incidence of childhood abuse in CVD population is higher. Physical abuse in childhood increased the risk of depressive symptoms in adulthood. It suggested that the occurrence of depressive symptoms was the result of related factors in the whole life course. In order to prevent the depressive symptoms, childhood abuse also needs to be considered. It is very important to identify and prevent the continuation of childhood abuse in time.

Association of adverse childhood experiences with lipid profiles and atherogenic risk indices in a middle-to-older aged population

Background

Adverse childhood experiences (ACE) have been associated with poor later life health outcomes, including cardiovascular disease (CVD). Limited research investigating potential underlying biological mechanisms linking ACE to CVD exists, particularly regarding lipid biomarkers.

Objectives

The aim of this study was to examine the associations between childhood adversity and unfavourable lipid profiles and derived atherogenic risk indices in a middle-to-older aged population.

Methods

This cross-sectional study includes 1820 participants from the Mitchelstown cohort (49% male) in Ireland. Participants' self-reported history of childhood adversity (overall and by subtypes household dysfunction, abuse and neglect) were assessed through a validated 10-item ACE questionnaire. Lipid profiles were determined and atherogenic risk indices including Castelli's Risk Index 1 and 2 (CRI-I and CRI-II), Atherogenic Coefficient (AC) and Atherogenic Index Plasma (AIP) were generated. Logistic regression analysed ACE associations with unfavourable lipid outcomes, controlling for potential confounders.

Results

ACE history (reported by 23% of sample), in particular childhood exposure to household dysfunction, was associated with later-life non-optimal TG and HDL-C concentrations and atherogenic risk indices CRI-II and AC in age and sex-adjusted models (all p < 0.05). In fully adjusted models, adults reporting ACE or exposure to household dysfunction were approximately twice as likely to have pro-atherogenic CRI-II relative to adults with no ACE (OR = 1.86, 95% CI: 1.19-2.92, p = 0.006 and OR = 2.19, 95% CI: 1.33-3.61, p = 0.002, respectively). Sex-stratified analysis demonstrated sex-specific associations.

Conclusions

This study provides evidence that ACEs are common among older adults in Ireland and are associated with unfavourable lipid profiles and derived atherogenic risk indices.

Social Determinants of Health: Implications for Voice Disorders and Their Treatment

PURPOSE

Adverse childhood experiences (ACEs) and related conditions, such as discrimination, are social determinants of health (SDOHs). Critical race theory (CRT) is a lens through which to understand SDOHs in a way that may impact our clinical care. When prolonged or chronic, SDOHs might cause toxic stress and trauma, which, in turn, adversely affect health and are shown to be relevant for some voice disorders. The goals of this tutorial are to (a) review the literature on SDOHs that potentially contribute to disparities; (b) discuss explanatory models and theories that describe how psychosocial factors influence health; (c) relate the foregoing information to voice disorders, highlighting functional voice disorders (FVDs) as a particular case in point; and (d) describe how trauma-informed care can improve patient outcomes and advance health equity for vulnerable populations.

CONCLUSIONS

This tutorial concludes with a call for heightened awareness of the role that SDOHs such as structural and individual discrimination may play in voice disorders, and a call for research into SDOHs, traumatic stress, and health disparities in this patient population. A call is also made for more universal practice of trauma-informed care in the clinical voice domain.

Anorexia Nervosa in Juvenile Systemic Lupus Erythematosus (SLE): A Causality Dilemma

Juvenile-onset systemic lupus erythematosus (jSLE) is an autoimmune disorder with multifaceted clinical findings in different organ systems. Neuropsychiatric manifestations affect more than half of SLE patients, and there is increasing evidence that anorexia nervosa (AN), a feeding and eating disorder (FED) characterized by significantly reduced energy intake, is among them. Herein, a review of the literature on the potential association between jSLE and AN was performed. Reported clinical cases were identified, and putative pathophysiological mechanisms were sought that could potentially explain the observed relationship between these two pathological entities. Four reports of isolated cases and a case series including seven patients were identified. In this limited patient pool, the diagnosis of AN preceded that of SLE in the majority of cases, whereas in all cases both entities were diagnosed within a time span of two years. Many explanations for the observed relationships have been proposed. AN has been associated with the stress of chronic disease diagnosis; on the other hand, the chronic inflammation associated with AN may contribute to the development/appearance of SLE. Adverse childhood experiences, concentrations of leptin, shared autoantibodies, and genetic traits appear to be important factors in this well-established interplay. In essence, it seems important to increase clinician awareness of the concomitant development of AN and SLE and invite further research on the subject.

Age, β-endorphin, and sex dependent effects of maternal separation on locomotor activity, anxiety-like behavior, and alcohol reward

Introduction

Childhood adversity is pervasive and linked to numerous disadvantages in adulthood, including physical health problems, mental illness, and substance use disorders. Initial sensitivity to the rewarding effects of alcohol predicts the risk of developing an alcohol use disorder, and may be linked to developmental stress. The opioid peptide β-endorphin (β-E) regulates the stress response and is also implicated in the risk for excessive alcohol consumption.

Methods

We explored the influence of β-E in an animal model of early life adversity using controlled maternal separation by evaluating changes in locomotor activity, anxiety-like behavior, and the initial rewarding effects of alcohol in a single exposure conditioned place preference paradigm in control C57BL/6J and β-E deficient β-E +/+ 0.129S2-Pomc tm1Low/J; β-E −/− mice. Maternal separation (MS) occurred for 3 h each day from post-natal days (PND) 5–18 in approximately half the subjects.

Results

Maternal interactions increased following the separation protocol equally in both genotypes. MS and control subjects were tested as adolescents (PND 26–32) or adults (PND 58–72); the effects of MS were generally more pronounced in older subjects. Adults were more active than adolescents in the open field, and MS decreased activity in adolescent mice but increased it in adults. The increase in adult activity as a result of early life stress depended on both β-E and sex. β-E also influenced the effect of maternal separation on anxiety-like behavior in the Elevated Plus Maze. MS promoted rewarding effects of alcohol in male β-E deficient mice of either age, but had no effect in other groups.

Discussion

Taken together, these results suggest that the effects of MS develop over time and are β-E and sex dependent and may aid understanding of how individual differences influence the impact of adverse childhood experiences.

Impacts on children's health of adverse childhood experiences of their mothers: A gender-specific mediation analysis using data from the China Health and Retirement Longitudinal Study

BACKGROUND

Numerous people have suffered adverse childhood experiences (ACEs) that can have lasting negative consequences. However, few studies have focused on maternal ACEs' effect on their children's health. This study aimed to evaluate the impact on children's health of ACEs that their mothers experienced.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 combined with the CHARLS 2014 Life History Survey were analyzed. The logistic regression was used to investigate maternal ACEs' impact on their children's health. Based on the stepwise regression model and bias-corrected bootstrap, we estimated the mediating effects.

RESULTS

Maternal ACEs could result in harm to the health of children (P < 0.05). If the types of maternal ACEs increased by one unit, the odds ratio of their children's poor health would rise by 9.6 %. Moreover, if the types of maternal ACEs increased by one unit, the odds ratio of daughters' and sons' poor health would increase by 8.3 % and 10.2 %, respectively. Three mediating mechanisms of mothers' education, physical health, and mental health were confirmed by empirical tests.

LIMITATIONS

We could not employ objective indicators to measure children's health. Meanwhile, maternal ACEs were all self-reported from the mothers' recollection, which might descend the accuracy due to memory bias.

CONCLUSION

Maternal ACEs harmed the health of both their sons and daughters. The children's health would deteriorate as the maternal ACEs increased. Mother's education, physical health, and mental health mediated the relationships between maternal ACEs and children's health.

Association of childhood adversity with frailty and the mediating role of unhealthy lifestyle: Findings from the UK biobank

Background

Childhood adversity and lifestyle have been associated with frailty in later life, but not much is known about factors that may explain these associations. An unhealthy lifestyle may play an important role in the pathway from childhood adversity to frailty. Therefore, this study aims to investigate the association of childhood adversity with frailty, and the mediating role of unhealthy lifestyle in the association.

Methods

This lifespan analysis included 152914 adults aged 40-69 years old from the UK Biobank. We measured childhood adversity with five items: physical neglect, emotional neglect, sexual abuse, physical abuse, and emotional abuse through online mental health survey. Frailty was measured by the frailty index; an unhealthy lifestyle score (range: 0-5) was calculated based on unhealthy body mass index, smoking, drinking, physical inactivity, and unhealthy diet at the baseline survey. Multiple logistic regression and mediation analysis were performed.

Results

A total of 10078 participants (6.6%) were defined as having frailty. Participants with any childhood adversity had higher odds of frailty. For example, in the fully adjusted model, with a one-point increase in cumulative score of childhood adversity, the odds of frailty increased by 41% (Odds Ratio: 1.41; 95% Confidence Interval: 1.39, 1.44). Unhealthy lifestyle partially mediated the associations of childhood adversity with frailty (mediation proportion: 4.4%-7.0%). The mediation proportions were largest for physical (8.2%) and sexual (8.1%) abuse.

Conclusions

Among this large sample, childhood adversity was positively associated with frailty, and unhealthy lifestyle partially mediated the association. This newly identified pathway highlights the potential of lifestyle intervention strategies among those who experienced childhood adversity (in particular, physical and sexual abuse) to promote healthy aging.

Adverse Childhood Experiences and Chronic Diseases: Identifying a Cut-Point for ACE Scores

Adverse Childhood Experiences (ACEs) contribute to many negative physiological, psychological, and behavioral health consequences. However, a cut-point for adverse childhood experience (ACE) scores, as it pertains to health outcomes, has not been clearly identified. This ambiguity has led to the use of different cut-points to define high scores. The aim of this study is to clarify a cut-point at which ACEs are significantly associated with negative chronic health outcomes. To accomplish this aim, a secondary analysis using data from a cross-sectional study was conducted. The Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used for data collection. Descriptive statistics, nonparametric regression, and logistic regression analyses were performed on a sample of 10,047 adults. Data from demographic and self-report health measures were included. The results showed that a cut-point of four or more ACEs was significantly associated with increased rates of chronic disease. Participants with at least one chronic disease were almost 3 times more likely (OR = 2.8) to be in the high ACE group. A standardized cut-point for ACE scores will assist in future research examining the impact of high ACEs across cultures to study the effect of childhood experiences on health.

Associated factors to depression diagnosed during incarceration in Peruvian male prisoners: a sub-analysis of the national census of prison population

PURPOSE

Depression has become a major health concern, particularly in developing countries. This disorder is highly prevalent among certain vulnerable populations, such as prisoners. In Peru, prisons are overcrowded, and the health of prisoners is neglected. Thus, this study aims to estimate the prevalence of depression diagnosed during incarceration in male inmates from all Peruvian prisons and assess its associated factors.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study was conducted based on the secondary data analysis of the National Census of Prison Population 2016 in Peru. This study included records of prisoners who reported whether they were diagnosed with depression by a health-care professional after admission into the prisons. Descriptive, bivariate and multivariable analyses were performed.

FINDINGS

Of the 63,312 prisoners included in this study, 1,007 reported an in-prison diagnosis of depression by a health-care professional, which represents a prevalence of 1.59%. Substance use disorder (adjusted prevalence ratio [aPR] 3.10; 95% confidence interval [CI]: 1.91-5.03), hypertension (aPR 7.20; 95% CI: 6.28-8.24) and previous discrimination (aPR 1.97; 95% CI: 1.62-2.40) were strongly associated with depression, even when adjusting for multiple confounders. Other directly associated variables were, for example, violence during childhood, infrequent visits in prison and diabetes.

ORIGINALITY/VALUE

The right of prisoners to adequate health care is being neglected in Peru. Mental health is a cornerstone of health quality. Acknowledging which factors are associated with depression in prison is important to implement strategies to improve the mental health of prisoners.

The Relationship Between Adverse Childhood Experiences, Symptom Severity, Negative Thinking, Comorbidity, and Treatment Response in Youth with Obsessive-Compulsive Disorder

Although youth and adults with obsessive-compulsive disorder (OCD) endorse elevated incidence of exposure to traumatic life events during childhood, the existing literature on adverse childhood experiences (ACEs) and OCD is mixed and studies focusing on pediatric OCD are limited. The present study examines the relationship between ACEs and OCD onset, symptom severity, negative cognitive patterns, comorbidity, and cognitive-behavioral therapy (CBT) response in 142 children and adolescents with OCD. ACEs were ascertained from parent reports. Most parents reported child exposure to ACEs. Out of the parents who reported ACEs, 50% reported ACE exposure prior to OCD diagnosis and 50% reported ACE exposure after OCD diagnosis. No significant associations between ACEs and comorbidity or CBT response were found, suggesting that CBT for pediatric OCD is effective regardless of ACE exposure. Family financial problems were associated with increased obsessive-compulsive symptom severity and negative thinking. Implications for research and practice are discussed.

Adverse childhood experiences and deviant behaviors among Chinese rural emerging adults: the role of social support

BACKGROUND

ACEs hurt subsequent physical and mental health outcomes. However, still little has been known about the rate of ACEs among rural Chinese emerging adults and the different buffering effects of the three types of social support on different kinds of ACEs. This study described the rate of ACEs among Chinese rural emerging adults, examined the relationship between ACEs and deviant behaviors, and tested the moderating effect of three different sources of perceived social support on this relationship. We hope these results will be helpful in further interventions.

METHODS

We used the second wave of a longitudinal survey that included ACEs variables in 2018. A total of 1031 emerging adults aged 18 to 25 participated in the current study.

RESULTS

we found that (1) the rate of abuse, neglect, and household dysfunction was 10.0, 30.0, and 24.9%, respectively among Chinese rural emerging adults; (2) abuse and household dysfunction experience were significantly and positively associated with deviant behaviors; (3) friend support moderated the relationship between three types of ACEs and deviant behaviors. Other support moderated the relationship between abuse/household dysfunction and deviant behaviors.

CONCLUSIONS

ACEs could increase the risk of deviant behaviors. Perceived friend support could reduce the negative effect of three types of ACEs. Other support could reduce the negative impact of abuse and household dysfunction. These results suggest that reducing ACEs to make children's family environments safer and enhancing social support for emerging adults from rural areas are beneficial, which could prevent or reduce their deviant behaviors.

Neurocognition and its association with adverse childhood experiences and familial risk of mental illness

Environmental factors such as adverse childhood experiences (ACEs) may affect neurocognition, an endophenotype for several mental illnesses. This study examines the effect of ACEs on neurocognitive performance in first-degree relatives (FDRs) of patients with severe mental illness to determine whether familial risk has a moderating effect on the relationship between ACEs and neurocognition. Unaffected FDRs from multiplex families with severe mental illnesses (schizophrenia, bipolar disorder, obsessive-compulsive disorder, or alcohol use disorder) (n = 324) and healthy controls (with no familial risk) (n = 188) underwent neurocognitive tests for processing speed, new learning, working memory and Theory of Mind. ACEs were measured using the WHO ACE-International Questionnaire (ACE-IQ). Regression models were done to predict each neurocognitive domain by the effect of familial risk, ACE-IQ Score and their interaction (familial risk*ACE-IQ score). The main effect of familial risk predicted poor performance in all domains of neurocognition (p < 0.01), and the interaction had a negative association with global neurocognition (β = -0.093, p = 0.009), processing speed (β = -0.109, p = 0.003) and working memory (β = -0.092, p = 0.01). Among the ACEs sub-domains, only maltreatment (specifically the main effect of physical neglect and the interaction effect of sexual abuse with familial risk) predicted poorer neurocognition. In FDRs of schizophrenia and bipolar disorder, only the main effects of familial risk were significantly associated with poorer neurocognition. We conclude that there is a relationship between ACEs (especially maltreatment) and neurocognitive functioning, which is moderated by the familial risk of mental illnesses. Genetic/familial vulnerability may have a stronger association with neurocognition in schizophrenia and bipolar disorder.

The Associations Between Adverse Childhood Experiences, Physical and Mental Health, and Physical Activity: A Scoping Review

BACKGROUND

Adverse childhood experiences (ACEs) may be associated with worse physical and mental health in adulthood, and low physical activity engagement, but the relationships are not fully understood.

OBJECTIVES

To establish the scope of the literature exploring associations between ACEs, physical activity, and physical and mental health.

METHODS

We conducted this scoping review according to PRISMA-ScR guidelines. We searched MEDLINE, Scopus, SPORTDiscus, and PsycInfo for relevant articles.

RESULTS

Eighteen studies were included, 17 observational and 1 randomized controlled trial. The majority of studies were cross-sectional and employed self-reported physical activity and ACE measures. Six studies explored physical health, 9 explored mental health, and 3 explored both. Associations between ACEs and poor physical health outcomes (poor self-reported physical health, inflammation, high resting heart rate, and obesity) were consistently weaker or attenuated among those who were physically active. Physical activity may also moderate the associations between ACEs and depressive symptoms, psychological functioning, and health-related quality of life.

CONCLUSION

Associations between ACEs and poor physical and mental health were observed in those with less frequent physical activity engagement, though the majority of evidence relies on cross-sectional observational designs with self-report instruments. Further research is required to determine whether physical activity can prevent or treat poor physical and mental health in the presence of ACEs.

The Latent Class Analysis of Adverse Childhood Experiences among Chinese Children and Early Adolescents in Rural Areas and Their Association with Depression and Suicidal Ideation

Exposure to adverse childhood experiences (ACEs) is a global public health concern that is detrimental to the psychological outcomes of Chinese children in rural areas due to the lack of public awareness of ACEs and mental health resources. The objective of this study was to identify the patterns of ACEs and the impact of ACE patterns on depression and suicidal ideation among 4683 students (mean age = 10.08 years, SD = 0.99; 48.17% female students) from 63 elementary schools in rural areas in Guizhou Province, China. Latent class analysis was conducted to identify the best class pattern. A three-step approach was undertaken to explore the association between the class patterns and demographic covariates and depression and suicidal thoughts. An overall three-class pattern of ACEs was identified, which was: (1) high ACEs, (2) high verbal abuse and emotional neglect and low household dysfunction, and (3) low ACEs. The results also showed that children in the high ACEs class tended to show higher depression rates and more frequent suicidal ideation across the three groups. Being female and younger and having a lower socioeconomic status were risk factors. Our study identified a class pattern that was not found in previous research, which is high verbal abuse and emotional neglect and low household dysfunction.

The relationship between adverse childhood experiences and impulsive and risky behaviors: the mediating role of positive and negative emotional motivations

BACKGROUND

Although the impact of adverse childhood experiences (ACEs) on healthy behaviors of adulthood is largely investigated, the role of these adversities in a wide variety of impulsive and risky behaviors (RBs) as well as the role of mediating variables has been rarely studied. Therefore, the present study aimed to investigate the mediating role of positive-negative emotional motivations in the relationship between ACEs and RBs.

METHODS

In a cross-sectional study, 401 adults of the general population of Kermanshah (201 individuals) and Kurdistan (200 individuals) were selected and they were assessed using the Risky, Impulsive, & Self-destructive behavior Questionnaire (RISQ) and the Childhood Trauma questionnaire (CTQ). Data were analyzed using latent profile analysis (LPA), the correlation tests and structural equation modeling.

RESULTS

The prevalence of ACEs using LPA was estimated 37.7%. There was a significant correlation between all types of child abuse (not child neglect) and RBs. Emotional motivations played a mediating role in the relationship between ACEs and RBs (RMSEA=0.07, SRMR=0.05, CFI=0.92, TFI=0.90). The proposed model could explain about 11% of the variance of emotional motivations and around 70% of the variance of RBs.

CONCLUSIONS

Considering the impact of ACEs on emotional motivations and the impact of emotional motivations on RBs, intervention on emotional motivations may help to reduce RBs in people who suffer from ACEs.

Omar ZT, Segun E, Evbayekha EO, Abolurin A, Egberuare EO, Ezegbe HC, Adegbosin A, Adedeji AG, Angaye EG, Izundu IC, Oyelade BO. Impact of Adverse Childhood Experiences on Resilience and School Success in Individuals With Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

Adolescents with emotional and behavioral disorders face known academic challenges and poor life outcomes. It was imperative to explore and find if the new diagnostic criterion for diagnosing autism profoundly affects educational outcomes and resilience in individuals diagnosed with co-occurring autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). The literature is robust on the impact of adverse childhood experiences (ACEs) on educational outcomes and resilience in adolescents with no history of disability. Still, there remains a dearth of literature explaining, with no ambiguity, the complex relationships between ACEs and resilience, school engagement, and success in individuals with co-occurring ASD and ADHD. This study reviews the existing scholarships on the topic. The significance of this review is that it informs healthcare providers, rehabilitation counselors, and educators about the need for early identification of individuals with ASD and ADHD with a background in ACEs. This will enable interventions early enough to ensure they are more resilient and can obtain improved success in school-related and outside-school activities and eventually improved quality of life.

Child's perceived stress: A concept analysis

PROBLEM

Child's perceived stress is a term used widely in literature, yet it is poorly defined. Perceived stress in childhood has been linked to negative health outcomes throughout the lifespan. Therefore, the ability of researchers and healthcare providers to conceptualize child's perceived stress and form accurate measures of the concept is of utmost importance.

ELIGIBILITY CRITERIA

Following the eight steps identified by Walker and Avant, a literature review was conducted to identify studies that measured perceived stress in school-age children over the last 10 years.

SAMPLE

Of 914 records identified, 136 were screened, and 16 met inclusion criteria.

RESULTS

Child's perceived stress is best defined as any actual or imagined threat, personal and specific to childhood, which overwhelms the child and leads to changes in emotional, psychological, developmental, and/or physiological domains.

CONCLUSIONS

While the concept of child's perceived stress is understood similarly throughout studies, there is notable variation in the way child's perceived stress is measured. Because of the specificity of perceived stress to childhood, and the wide range of what may be perceived as stressful by the child, the child is the best reporter of child's perceived stress.

IMPLICATIONS

Researchers and clinicians must use child self-report tools to measure the concept of child's perceived stress. Opportunities exist for healthcare workers to intervene, educate, and help children and families recognize and manage child's perceived stress. This concept analysis includes many resources that practitioners may use to help alleviate stress in children.

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

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