The Direct and Indirect Influences of Adverse Childhood Experiences on Physical Health: A Cross-Sectional Study

Gender differences in adverse childhood experiences, resilience and internet addiction among Tunisian students: Exploring the mediation effect

Adverse Childhood Experiences (ACEs) are a common public health issue with a variety of consequences, including behavioral addiction such as Internet Addiction (IA). Despite widespread recognition of this issue, the underlying mechanisms are not well studied in recent literature. Additionally, studies have indicated gender disparities in the prevalence and manifestation of ACEs and IA. The objective of this study was to investigate the mediating effect of resilience on the link between ACEs and IA among high-school students according to gender in Mahdia city (Tunisia). We conducted a cross-sectional survey for two months (January- February 2020), among 2520 schooled youth in Mahdia city (Tunisia). The Arabic-language edition of the World Health Organisation ACE questionnaire was used. The validated Arabic versions of the Adolescent Psychological Resilience Scale and the Internet Addiction Test were the screening tools for resilience and IA. Data were analyzed according to gender. The majority of youth (97.5%) were exposed to at least one ACE with the most prevalent being emotional neglect (83.2%). Exposure to extra-familial ACEs was also high reaching 86.9% with higher rates among boys for all types of social violence. Internet addiction was common among students (50%) with higher prevalence for boys (54.4% vs 47.7%for girls, p = 0.006). Resilience scores were86.43 ± 9.7 for girls vs 85.54 ± 9.79 for boys. The current study showed that resilience mediated the link between ACEs, especially intrafamilial violence, and internet addiction (%mediated = 15.1). According to gender, resilience had a significant mediating role on internet addiction for girls (%mediated = 17) and no significant role for boys. The mediating effect of resilience in the relationship between ACEs and cyberaddiction among schooled adolescents in the region of Mahdia (Tunisia) has been identified.

How are adverse childhood experiences and women's mental health associated? A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) have a cumulative effect on adult mental health; however, the effect of such combinations is less well known. The purpose of this study is to assess the association between specific combinations of early adversities and women's mental health.

METHODS

A total of 378 women (Myears = 41.4; SDyears = 13) receiving support from mental health and social services participated in this cross-sectional study. Latent class analysis was performed to classify participants based on the number of ACEs types.

RESULTS

Our results provided support for four latent classes which differed in ACEs types reported: class 1 range of maltreatment but no family disruption (16.40 %; n = 62), class 2 range of maltreatment with family disruption (24.87 %; n = 94), class 3 few ACEs (44.71 %; n = 169), class 4 high maltreatment/high family disruption (14.02 %; n = 53). Differences in psychological functioning (presence of psychopathology, attachment, emotion dysregulation, and coping strategies) were found between the classes, especially between few ACEs and high maltreatment/high family disruption classes. In addition, women who lived in a low-adversity home and those who lived in a home with maltreatment, but no family disruption, differed in their desire for closeness, problem-solving and emotional expression strategies.

CONCLUSION

This study highlights that the probability of exposure to different combinations of ACEs is associated with differences in adult psychological functioning. Deeper insight into this association may contribute to a better understanding of mental health problems and to improved prevention and intervention strategies in public support systems.

Adverse childhood experiences and trauma informed care for chiropractors: a call to awareness and action

BACKGROUND

Trauma is an emotional response to distressing events where coping and subsequent recovery are absent. Adverse Childhood Experiences (ACEs) are traumas, occurring before the age of 18 years, such as child abuse or neglect, caregiver instability, and household dysfunction. Sixty-four percent of the U.S. population report experiencing at least one ACE, with over 1 billion children experiencing abuse and neglect annually worldwide. Chronic exposure to stressful circumstances or multiple traumatic events has negative physiologic impacts. Persons who experience 3 or more ACEs in childhood are at greater risk of poor mental health outcomes and may be more likely to engage in high-risk behaviors, predisposing them to long-term health impacts, such as metabolic diseases, anxiety, depression, substance use, and chronic pain. Trauma informed care (TIC) is a recommended approach to healthcare delivery across professions, especially when a trauma history is suspected. This commentary aims to increase awareness of the impact of ACEs on health outcomes and introduce TIC concepts as they may apply to chiropractic care for adults with a history of ACEs.

DISCUSSION

This commentary reviews an introductory model (4R's: realize, recognize, respond, resist re-traumatization) as one TIC framework used by healthcare practitioners. Prior trauma can lessen trust, alter perceptions of physical touch, and hands-on examinations and chiropractic treatments may trigger stress responses. Using TIC after appropriate training, includes referrals to multidisciplinary providers to address trauma-related concerns outside the scope of chiropractic, and screening for ACEs if deemed appropriate. Creating safe spaces, communicating clearly, avoiding victimizing language, explaining procedures, asking for consent before physical contact, and giving patients choice and control in their own care may avoid triggering prior traumas.

CONCLUSION

Given the high worldwide prevalence of persons experiencing 3 or more ACEs, TIC principles are practical adaptations to chiropractic care for use with many patient populations. As TIC and ACEs are emerging concepts within chiropractic, students and practitioners are encouraged to undertake additional training to better understand these complex and sensitive topics. Exploratory research on the incidence, presentation, and impacts of various trauma types, including ACEs, to support adoption of TIC in chiropractic settings is essential.

Influence of childhood trauma, HIV infection, alcohol use disorder, and resilience on health-related quality of life in adulthood

Experience of childhood trauma, especially physical, emotional, and sexual abuse, carries a risk for developing alcohol use disorder (AUD) and engaging in risky behaviors that can result in HIV infection. AUD and HIV are associated with compromised self-reported health-related quality of life (HRQoL) possibly intersecting with childhood trauma. To determine whether poor HRQoL is heightened by AUD, HIV, their comorbidity (AUD + HIV), number of trauma events, or poor resilience, 108 AUD, 45 HIV, 52 AUD + HIV, and 67 controls completed the SF-21 HRQoL, Brief Resilience Scale (BRS), Ego Resiliency Scale (ER-89), and an interview about childhood trauma. Of the 272 participants, 116 reported a trauma history before age 18. Participants had a blood draw, AUDIT questionnaire, and interview about lifetime alcohol consumption. AUD, HIV, and AUD + HIV had lower scores on HRQoL and resilience composite comprising the BRS and ER-89 than controls. Greater resilience was a significant predictor of better quality of life in all groups. HRQoL was differentially moderated in AUD and HIV: more childhood traumas predicted poorer quality of life in AUD and controls, whereas higher T-lymphocyte count contributed to better quality of life in HIV. This study is novel in revealing a detrimental impact on HRQoL from AUD, HIV, and their comorbidity, with differential negative contribution from trauma and beneficial effect of resilience to quality of life. Channeling positive effects of resilience and reducing the incidence and negative impact of childhood trauma may have beneficial effects on health-related quality of life in adulthood independent of diagnosis.

Development and Validation of the Weighted Index for Childhood Adverse Conditions (WICAC)

BACKGROUND

Adverse experiences in childhood are a major public health concern, promoting social inequality in health through biopsychosocial mechanisms. So far, no known measures comprehend the complexity and variations of severity of adverse events. This study aims to develop and validate a new index: the Weighted Index for Childhood Adverse Conditions (WICAC).

METHODS

The population consists of 7493 randomly invited men and women aged 18-72 years. Data were collected in 2012-2015 as part of the Danish Study of Functional Disorders (DanFunD). Content and construct validation of the WICAC was performed with the hypothesis testing of multiple biopsychosocial outcomes: cardiovascular disease, cancer, poor health, back pain, BMI, obesity, anxiety, depression, low vitality, subjective social status, lower education, smoking, and alcohol consumption. Data were analysed with binominal and linear regression models with risk ratios (RR) and mean differences (MD).

RESULTS

Content validation is fitting for WICAC. The strongest associations observed were for most severe adversity: Poor Health RR = 2.16 (1.19-2.91), Anxiety RR = 3.32 (2.32-4.74), Heavy Drinking RR = 4.09 (1.85-9.04), and Subjective Social Status MD = -0.481 (-0.721-(-0.241)). Similar results were found for the remaining outcomes. Discriminative validation was undecided.

CONCLUSIONS

WICAC is an adequate instrument for measuring cumulative adverse life events in childhood and adolescence for research purposes.

Configurations of Adult Attachment, Indicators of Mental Health and Adverse Childhood Experiences in Women: A Cross-Sectional Study

The relationship between adverse childhood experiences, attachment and adult mental health has been pointed out in a large amount of studies. In a sample of 339 women receiving support from mental health and social services, this research analyzed the association between three adult attachment variables (fear of rejection or abandonment—FRA; desire for closeness—DC; preference for independence—PI) and four mental health indicators. After dichotomizing these variables, we constructed eight configurations of attachment and examined their association with mental health indicators. BAB people (those below the median in FRA, above in DC and below in PI) obtained the most favorable scores in mental health, whereas the ABA configuration (above the median in FRA, below in DC and above in PI) was the least favorable. The association between attachment configurations and mental health indicators was different to what might be expected, aggregating the effects of individual attachment variables. When analyzing the relationship between configurations and adverse childhood experiences (ACEs), women with an ABA configuration reported the highest number of ACEs and eight ACE types had a higher-than-expected contingency coefficient. In conclusion, these findings suggest that certain adult attachment configurations are associated with a greater number of ACEs and poorer mental health indicators in adult women.

Adverse childhood experiences and adult diet quality

Childhood trauma is strongly associated with poor health outcomes. Although many studies have found associations between adverse childhood experiences (ACEs), a well-established indicator of childhood trauma and diet-related health outcomes, few have explored the relationship between ACEs and diet quality, despite growing literature in epidemiology and neurobiology suggesting that childhood trauma has an important but poorly understood relationship with diet. Thus, we performed a cross-sectional study of the association of ACEs and adult diet quality in the Southern Community Cohort Study, a largely low-income and racially diverse population in the southeastern United States. We used ordinal logistic regression to estimate the association of ACEs with the Healthy Eating Index-2010 (HEI-10) score among 30 854 adults aged 40-79 enrolled from 2002 to 2009. Having experienced any ACE was associated with higher odds of worse HEI-10 among all (odds ratio (OR) 1⋅22; 95 % confidence interval (CI) 1⋅17, 1⋅27), and for all race-sex groups, and remained significant after adjustment for adult income. The increasing number of ACEs was also associated with increasing odds of a worse HEI-10 (OR for 4+ ACEs: 1⋅34; 95 % CI 1⋅27, 1⋅42). The association with worse HEI-10 score was especially strong for ACEs in the household dysfunction category, including having a family member in prison (OR 1⋅34; 95 % CI 1⋅25, 1⋅42) and parents divorced (OR 1⋅25; 95 % CI 1⋅20, 1⋅31). In summary, ACEs are associated with poor adult diet quality, independent of race, sex and adult income. Research is needed to explore whether trauma intervention strategies can impact adult diet quality.