Adverse childhood events and self-harming behaviours among individuals in Ontario forensic system: the mediating role of psychopathy

BACKGROUND

Adverse childhood events (ACEs), psychopathy, and self-harming behaviours are prevalent among individuals in the forensic psychiatry system. While existing literature suggests that ACEs, self-harm, and psychopathy are interrelated, little is known about the interplay of psychopathic traits in this relationship. The present study aimed to determine the mediating role of psychopathy in the relationship between ACEs and self-harming behaviours in forensic patients.

METHODS

This was a retrospective study of patients under the Ontario Review Board (ORB) between 2014 and 2015. In the analysis, we included patients with complete data on ACEs, self-harming behaviours, and a Psychopathy Checklist-Revised (PCL-R) score - a measure of psychopathic traits and their severity conducted during the reporting period. Mediation analysis was based on the Baron and Kenny approach, and sensitivity analysis was performed based on the types of ACEs.

RESULTS

​​​The sample population (n = 593) was made up of adults, with a mean age of 41.21 (± 12.35) years and were predominantly males (92.37%). While there was a partial mediating effect of psychopathy on the relationship between ACEs and incidents of self-harming behaviours in the past year, the mediation was complete in the relationship between ACEs and a lifetime history of self-harming behaviours. Following sensitivity analysis based on the types of ACE, the mediating effects were more attributed to specific ACEs, especially having experienced child abuse or having an incarcerated household member before 18 years.

CONCLUSION

Among forensic patients in Ontario, psychopathy mediates​ ​the relationship between experiencing ACEs and engaging in self-harming behaviours. Effective intervention to mitigate self-harming behaviours in this population should consider the potential role of psychopathy, especially among individuals who have experienced ACEs involving a history of child abuse and a family who was incarcerated.

Measuring interpersonal trauma: Development and validation of the German version of the victimization experience schedule (VES)

OBJECTIVE

Interpersonal victimization experiences (VEs) significantly affect mental and physical health, particularly in disorders associated with life-time adversities, like fibromyalgia syndrome (FMS) and major depressive disorder (MDD). However, assessing VEs comprehensively remains challenging due to limited tools that encompass sub-traumatic events, such as bullying or discrimination, and contextual dimensions. We aimed to address this gap by validating the Victimization Experience Schedule (VES) in German, examining its reliability, and assessing VEs in clinical populations with FMS and MDD.

METHODS

We investigated the relationship between VEs and clinical symptoms in individuals with FMS, MDD and healthy controls (N = 105) in a case-control study. We also analyzed correlations between different types of VEs and categories of early childhood abuse and posttraumatic-stress-disorder instruments. Additionally, we validated our findings in an independent sample of individuals with FMS (N = 97) from a clinical study.

RESULTS

We observed excellent inter-rater reliability (Kw = 0.90-0.99), and VEs assessed using the VES were in alignment with subcategories of early childhood abuse. The prevalence of VEs extended beyond the categories covered by traditional survey instruments and was higher in individuals with MDD (4.0 ± 2.6) and FMS (5.9 ± 3.1) compared to controls (1.5 ± 1.7). We consistently identified a significant association between the number of VEs, the associated subjective distress, and clinical scores. Furthermore, distinct correlation patterns between VEs and clinical outcomes emerged across different cohorts.

CONCLUSION

Our study emphasizes the VES's value in understanding VEs within MDD and FMS. These experiences span from traumatic to sub-traumatic and correlate with posttraumatic-stress and clinical symptoms, underscoring the VES's importance as an assessment tool.

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.

Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents

The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.

Emotional neglect and parents' adverse childhood events

INTRODUCTION

Emotional neglect means that the child's emotional and developmental needs are not fulfilled by the parents or other caregivers. Adverse childhood events (ACEs) are a risk factor for mental health problems and impaired parenting skills. The objective here was to examine whether parents' ACEs increase the child's risk of experiencing emotional neglect.

METHODS

The participants in the present study were members of the Northern Finland Birth Cohort 1986 (NFBC1986). Emotional neglect experiences were measured in 190 members of this cohort by means of the Trauma and Distress Scale (TADS), and ACEs in both parents were measured with a specific questionnaire. A linear regression model was used to examine the association between parents' ACEs and the children's emotional neglect scores.

RESULTS

The children's mean emotional neglect score was 8.11 on a scale from 5 to 25. There was no significant difference between males (mean 8.01) and females (mean 8.19). Only father's ACEs were associated with child's emotional neglect score. In the linear regression model, the children's emotional neglect scores increased by 0.3 points for father's ACE.

CONCLUSIONS

Our findings suggest that father's ACEs may increase the child's risk of experiencing emotional neglect. It seems that childhood adversities are transferred from parents to children, but larger samples would be needed to confirm these findings.

Prognostic factors for long-term outcome in children with fetal alcohol spectrum disorders

INTRODUCTION

Known protective factors for long-term outcome in children with fetal alcohol spectrum disorders (FASD) are early diagnosis and a stable, non-violent supportive environment. Which factors contribute to the stability of care is not yet known. Thus, the aim of our study was to evaluate whether the age at diagnosis and the complexity of brain dysfunction play a role for placement changes in children with FASD.

MATERIALS AND METHODS

An online survey was conducted among caregivers and professionals caring for children with FASD and seeking help at the German FASD Competence Centre Bavaria (N = 232). The survey collected information about diagnosis, brain dysfunctions, behavioural factors influencing everyday life and changes of placement. The association of timing of diagnosis, brain dysfunctions and neurobehavioral impairment with changes of placement (<2 vs. 2 or more changes) was evaluated via logistic regression models.

RESULTS

About 50% of the children received their diagnosis of FASD after the age of 5 years. The complexity of brain dysfunctions in children with FASD affecting everyday life was high. 15% of the children experienced four or more changes of placement. Children with more neuropsychological impairments experienced more changes of placement (OR: 2.53, 95% CI: 1.36-4.71).

CONCLUSIONS

Even though our results need to be interpreted with caution due to methodological limitations such as the use of a convenience sample and limited statistical power, they imply that severely affected children with FASD experience a less stable environment. These children may therefore be at high risk for a negative prognosis. To warrant a better prognosis for the affected children, professionals urgently need to pay attention to early recognition and the complexity of neuropsychological impairments in children with FASD as well as to the support that caregivers urgently need.

Triple-jeopardy! COVID-19, high ACE scores, and the US-Mexico border: Mitigating risks with trauma-informed pedagogy

With the urgent need to increase the number of diverse nurses in the healthcare system, it is more necessary than ever to explore and discuss solutions that help students succeed in the extremely stressful nursing school environment. COVID-19 has exacerbated stress for nursing students nationwide. Additionally, high ACE scores and living on the US-Mexico border put certain students in "triple-jeopardy" for failing. Trauma-informed pedagogy mitigates this danger by creating a secure and productive learning environment.

Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events: BRFSS 2019

Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH. Data from the 2019 Behavioral Risk Factor Surveillance System was used to explore ACEs and CVH among 86,584 adults ≥18 years from 20 states. CVH was defined as poor (0-2), intermediate (3-5), and ideal (6-7) from summation of survey indicators (normal weight, healthy diet, adequate physical activity, not smoking, no hypertension, no high cholesterol, and no diabetes). ACEs was summed by number (0,1, 2, 3, and ≥4). A generalized logit model estimated associations between poor and intermediate CVH (ideal as referent) and ACEs accounting for age, race/ethnicity, sex, education, and health care coverage. Overall, 16.7% (95% Confidence Interval[CI]:16.3-17.1) had poor, 72.4% (95%CI:71.9-72.9) had intermediate, and 10.9% (95%CI:10.5-11.3) had ideal CVH. Zero ACEs were reported for 37.0% (95%CI:36.4-37.6), 22.5% (95%CI:22.0-23.0) reported 1, 12.7% (95%CI:12.3-13.1) reported 2, 8.5% (95%CI:8.2-8.9) reported 3, and 19.3% (95%CI:18.8-19.8) reported ≥4 ACEs. Those with 1 (Adjusted Odds Ratio [AOR] = 1.27;95%CI = 1.11-1.46), 2 (AOR = 1.63;95%CI:1.36-1.96), 3 (AOR = 2.01;95%CI:1.66-2.44), and ≥ 4 (AOR = 2.47;95%CI:2.11-2.89) ACEs were more likely to report poor (vs. ideal) CVH compared to those with 0 ACEs. Those who reported 2 (AOR = 1.28;95%CI = 1.08-1.51), 3 (AOR = 1.48;95%CI:1.25-1.75), and ≥ 4 (AOR = 1.59;95%CI:1.38-1.83) ACEs were more likely to report intermediate (vs. ideal) CVH compared to those with 0 ACEs. Preventing and mitigating the harms of ACEs and addressing barriers to ideal CVH, particularly social and structural determinants, may improve health.

The functions of binge eating scale (FBES): Development and preliminary psychometric validation

OBJECTIVE

Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs).

METHOD

The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity.

RESULTS

Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs.

DISCUSSION

Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.

Associations between early childhood adversity and behavioral, substance use, and academic outcomes in childhood through adolescence in a U.S. longitudinal cohort

BACKGROUND

Childhood adversity is strongly associated with adolescent substance use, but few epidemiologic studies have investigated early childhood adversity (ECA) before age 5. This study investigated pathways by which ECA is associated with adolescent alcohol and cannabis use and high school completion through childhood behavioral and academic mediators and their reciprocal effects.

METHODS

Data were from the National Longitudinal Survey of Youth 1979-Child/Young Adult Cohort which surveyed children born 1984-1999 and followed through 2016 (n = 5521). Outcomes included alcohol and cannabis use frequency at ages 15-18, and high school completion by age 19. ECA at ages 0-4 was a cumulative score of maternal heavy drinking/drug use, low emotional support, low cognitive stimulation, and household poverty. Multilevel path models were conducted with ECA, childhood mediators (behavioral (externalizing and internalizing problems) and academics (reading and math scores), accounting for demographics and confounders.

RESULTS

ECA was indirectly associated with adolescent cannabis frequency through mediators of externalizing/internalizing problems, low academics, and early cannabis onset before age 14. ECA was also indirectly associated with alcohol frequency via the same mediators, but not early alcohol onset. Greater behavioral problems elevated substance use risk; whereas, low academics reduced risk. Reciprocal effects were evident between childhood behavioral problems and cannabis frequency to high school completion.

CONCLUSION

Adversity from birth to age 4 is associated with childhood behavioral problems and lower academics, which increased adolescent alcohol and cannabis use and lowered high school completion. Early childhood interventions with parents and preschools/daycare may reduce early onset and adolescent substance use.

The impact of maternal childhood maltreatment on child externalizing behaviour and the mediating factors underlying this association: a three-level meta-analysis and systematic review

Child maltreatment can negatively impact not only survivors but also survivors' children. However, research on the intergenerational effect of maternal childhood maltreatment on child externalizing behaviour has yielded contradictory results and has not yet been systematically synthesised. The current three-level meta-analysis and systematic review aimed to provide a quantitative estimate of the strength of the association between maternal childhood maltreatment and child externalizing behaviour and to summarise research on potential mediating factors of this association. PsycINFO, PubMed, and Embase were searched and 39 studies with 82 effects sizes were included in the meta-analysis. Results revealed a small significant association between maternal childhood maltreatment and child externalizing behaviour (r = 0.16; 95% CI 0.12-0.19; publication bias-adjusted effect size: r = 0.12, 95% CI 0.08-0.16). Maternal mental health, particularly depressive symptoms, maternal parenting and children's maltreatment exposure were the most frequently examined mediators of this association, with relatively robust mediating effects for children's maltreatment exposure and maternal depressive symptoms, but mixed evidence for the mediating role of maternal parenting. This meta-analysis provides evidence for a small but significant association between maternal childhood maltreatment and children's externalizing behaviour, emphasizing the need to develop effective preventive and intervention strategies to minimise the effects of childhood maltreatment on the next generation.

Young children's traumatic stress reactions to the COVID-19 pandemic: The long reach of mothers' adverse childhood experiences

BACKGROUND

The COVID-19 pandemic has negatively impacted parental and child mental health; however, it is critical to examine this impact in the context of parental histories of adversity. We hypothesized that maternal adverse childhood experiences (ACEs) and pandemic-related negative life events would predict child traumatic stress symptoms (TSS) and tested potential mediating pathways through maternal pandemic-related TSS and/or poorer maternal sensitivity during the pandemic.

METHODS

Data were collected from a longitudinal sample of low-income, racially/ethnically diverse mothers and their children. Between May and November 2020, mothers (n = 111) of young children (M age = 7.42 years, SD = 0.45) completed questionnaires to assess their own and their child's pandemic-related TSS, exposure to pandemic-related negative events, and parent-child relationship quality. Maternal ACEs, maternal depression, parent-child relationship quality, and child internalizing symptoms had been assessed approximately 1-3 years prior.

RESULTS

Structural equation analyses revealed that pandemic negative life events were indirectly associated with child TSS via greater maternal TSS. For mothers, recent pandemic-related negative events were associated with their own TSS, whereas maternal ACEs were not. Maternal ACEs directly predicted greater child TSS, with no evidence of mediation by either maternal TSS or maternal sensitivity.

LIMITATIONS

All measures were parent report, and pandemic-related measures were collected at the same time point.

CONCLUSIONS

Findings underscore the long reach of mothers' own adverse childhood experiences, highlighting the negative consequences of these prior traumatic exposures alongside current pandemic-related maternal trauma symptoms for children's adjustment during the pandemic.

Accelerated epigenetic aging mediates link between adverse childhood experiences and depressive symptoms in older adults: Results from the Health and Retirement Study

Adverse childhood experiences (ACEs) increase risk for depression at subsequent ages and have been linked to accelerated biological aging. We hypothesize that accelerated epigenetic aging may partially mediate the link between ACEs and depression. This study examines 3 three second-generation epigenetic aging measures (viz., GrimAge, PhenoAge, and DunedinPoAm38) as mediators of the link between ACEs and depressive symptoms in older adulthood. We utilize structural equation modeling to assess mediation in the Health and Retirement Study (N = 2672). Experiencing ACEs is significantly associated with an older GrimAge and a faster pace of aging via the DunedinPoAm38. Having an older GrimAge and faster DunedinPoAm38 pace of aging were also significantly associated with more depressive symptoms. PhenoAge was not significantly associated with depressive symptoms and was only associated with experiencing three ACEs. These associations were reduced by socioeconomic and lifestyle factors, including obesity and substance use. GrimAge explained between 9 and 14% of the association between ACEs and adult depressive symptoms, and DunedinPoAm38 explained between 2 and 7% of the association between ACEs and adult depressive symptoms. Findings indicate accelerated aging, as measured by GrimAge and DunedinPoAm38, is associated with ACEs and with depressive symptoms in older Americans. Findings also show these epigenetic aging measures mediate a portion of the association between ACEs and adult depressive symptoms. Epigenetic aging may represent a physiological mechanism underlying the link between early life adversity and adult depression. Weight maintenance and substance use are potentially important areas for intervention.

Childhood maltreatment and trauma is common and severe in body dysmorphic disorder

BACKGROUND

Childhood maltreatment and trauma may be risk factors for the development of body dysmorphic disorder (BDD). However, the limited research to date on these topics has been constrained by either the absence of a matched healthy control group or non-comprehensive assessments.

METHODS

This study assessed the prevalence and severity of childhood maltreatment and other traumatic events in 52 BDD participants (56% female) and 57 matched controls (51% female) with no history of mental illness, using the Childhood Trauma Questionnaire and a checklist assessing broader traumatic events.

RESULTS

In comparison with controls, participants with BDD showed a higher prevalence of emotional abuse (61.5% vs. 33.3%) and physical neglect (59.6% vs. 28.1%), as well as more severe overall maltreatment, emotional abuse, and emotional and physical neglect. BDD participants were also more likely to meet cut-offs for multiple types of maltreatment and reported an elevated number and variety of broader traumatic childhood events (e.g., life-threatening illness). In BDD, increasingly severe maltreatment was correlated with greater severity of BDD symptoms, anxiety and suicidal ideation.

CONCLUSIONS

These data suggest that childhood maltreatment and exposure to other traumatic events are common and severe in BDD and are cross-sectionally associated with the severity of clinical symptoms. Adversity linked to maladaptive family functioning during childhood may therefore be especially relevant to people with BDD and could relate to social and emotional processing problems in the disorder.

Child and Adolescent Forensic Psychiatry Examination and Analysis of U.S. Citizen Children with Illegal Immigrant Parents Facing Deportation

Although the citizenship clause of the fourteenth amendment guarantees citizenship to persons born in the United States, the 1996 Immigration Act does not allow illegal immigrant parents to avoid deportation unless such deportation would cause extreme and exceptional hardship to a U.S. citizen relative. This paper reviews the potential adverse effects of such deportation on a child. It presents 12 cases where child and adolescent forensic psychiatric evaluations of U.S. citizen children supported their immigrant parents' petitions for legal resident status. Parent-child attachment, as well as the child's educational status, language proficiencies, acculturation to U.S. culture, and psychiatric distress at the potential deportation, are the factors most helpful in elucidating a child's reaction to this threatened deportation. During the child and adolescent psychiatry evaluations, the parents were interviewed, school records were reviewed and, where appropriate, pediatric records were considered. All the children were examined alone and then as a family unit with their parents using standard DSM-IV-TR diagnostic criteria [1]. Firstly, considering their clinical diagnoses, a clinical prognosis was made for the possibility if the child were to be forced to go to their parents' country of origin with their deported illegal immigrant parent(s). Secondly, each case was examined and analyzed individually to determine the clinical prognosis of the U.S. citizen child if they were to stay in the United States while the illegal immigrant parent(s) was forced to leave. In all of the 12 cases, there was already pre-existing anxiety in the children secondary to the fear of a negative outcome for the parents in the immigration legal cases. In all of the 12 cases it was also determined that the prognosis for the child's adjustment to being without their parent but remaining in the US would have produced a significant exacerbation of the psychopathology already seen. Furthermore, in all of the 12 cases, were the children to be relocated to their parental culture, unfamiliar to the child's American culture, again, the prognosis was made that a significant exacerbation of psychopathology would occur. On the basis of the findings of the child and adolescent psychiatric evaluations and analyses presented to the court, all of the illegal immigrant parents were permitted to receive permanent resident status.

How often were you traumatized? Reconceptualizing adverse childhood experiences for sexual and gender minorities

INTRODUCTION

The manifold consequences of adverse childhood experiences (ACEs) are well-documented. Recent research has demonstrated that sexual and gender minorities (SGMs) typically encounter ACEs more often than cisgender heterosexual individuals. Given the higher exposure rate, the measurement of frequency of exposure to traumatic events may be relevant for SGMs.

METHODS

We changed the response options of the ACEs index from dichotomous to a five-point Likert scale that described frequency of exposure. As part of a larger community-based participatory research study, the Likert ACEs measure was distributed to a large and diverse sample of SGM participants in San Antonio.

RESULTS

A cross-validation design demonstrated that the Likert ACEs scores outperformed the traditional ACEs index in predicting self-reported anxiety and post-traumatic stress disorder. Half of the SGMs in this sample experienced 3 or more ACEs, compared to only 10% of Americans in a nationally representative sample.

LIMITATIONS

These analyses were based on retrospective self-report data instead of structured clinical interviews. Since only the Likert ACEs was administered, we had to assume that any response other than "never" on Likert ACEs corresponded to "yes" on the ACEs Index.

CONCLUSIONS

Future research may assess the utility of the Likert ACEs approach with other minoritized or intersectional populations. For clinical practitioners, these results suggest that a better way to measure ACEs for SGMs is to ask them how often they were exposed, rather than asking whether they were exposed.

Intergenerational Trauma among Families in El Salvador: an Exploratory Study

Adverse childhood events have been shown to impact individuals through adulthood, particularly the impact on relationships. This study aimed to examine intergenerational trauma exposure among a sample of parents living in a semi-urban Salvadoran community and the relationship between child trauma exposure with maternal perceived discrimination, internal strengths and external support. Survey data was collected from 49 mothers residing in El Salvador. Bivariate analyses and multivariate linear regression analyses were used to examine the relationship between children's exposure to adverse childhood events and parents' exposure to adverse childhood events, while controlling for discrimination. The results of the regression analysis indicate that the maternal number of adverse childhood events and experience of discrimination as an adult explained 52.9% of the variance (R ²  = 0.59, F(6, 43) = 10.18, p < .0001). The number of adverse childhood events was significantly predicted by maternal number of adverse events (B = 0.32, 95% CI = 0.17-0.48, p < .0001) and experience of discrimination as adults (B = 5.79, 95% CI = 3.51-8.07, p < .0001). Results suggest that parent exposure to adverse childhood events and parent experience with discrimination are related to the exposure to adverse childhood events of their children. Further research in this area is warranted to better understand the experiences of parents who have been exposed to childhood trauma and the day-to-day parenting challenges. Greater understanding of the impact of childhood trauma also encourages service providers to explore intergenerational interventions.

Combinations of adverse childhood events and risk of postpartum depression among mothers enrolled in a home visiting program

PURPOSE

The purpose of this study was to examine how combinations of adverse childhood events (ACEs) contribute to the risk of postpartum depression and the mediating role of prenatal social support.

METHODS

The Adverse Childhood Experiences Scale Questionnaire and the Edinburgh Postnatal Depression Scale Questionnaire were used to measure the study's exposure and outcome. Among a cohort of 419 mothers enrolled in a home visiting (HV) program, latent class analyses were used to identify classes of ACEs exposure. General linear models assessed the risk of postpartum depression, and prenatal social support was examined as a mediator.

RESULTS

Four distinct classes of ACE exposure were identified. On the Edinburgh Postnatal Depression scale, mothers who were classified in Classes 1-3 scored higher by 2.6-4.4 points compared with women in Class 0. ACE class was found to be indirectly associated with postpartum depression scores through prenatal social support.

CONCLUSIONS

Identifying combinations of ACEs in an HV program has the potential to improve the characterization of ACEs among low-income perinatal women in the United States. Elucidating how these combinations contribute to the risk of postpartum depression has the potential to identify women at increased risk, which can help HV programs prioritize prevention efforts.

The effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role

BACKGROUND

Adverse childhood experiences are a factor that may cause physical illness and deterioration of lifelong well-being in addition to many mental and psychiatric problems in the future. It is important to question and treat them.

OBJECTIVE

This study examined the effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role.

METHODS

This cross-sectional study was conducted on 536 pregnant women. The data were collected using the "Personal Information Form", the "Adverse Childhood Experience Questionnaire (ACEQ)", the "Acceptance of Motherhood Role (AoMR)" subscale of the "Prenatal Self Evaluation Questionnaire (PSEQ)" and the "Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2)".

RESULTS

It was found that those with high levels of negative childhood experience had higher levels of anxiety in pregnancy and lower acceptance of maternal role than the other groups (p<0.05). Additionally, a one-unit change in the AoMR score led to a 0.23-unit decrease in the ACEQ score, whereas a one-unit change in the PRAQ-R2 score led to a 0.57-unit increase in the ACEQ score (p<0.001).

CONCLUSION

Adverse childhood events increase pregnancy-related anxiety and negatively affect acceptance of motherhood role.

Association between adverse childhood experiences, bullying, self-esteem, resilience, social support, caries and oral hygiene in children and adolescents in sub-urban Nigeria

BACKGROUND

Adverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases.

METHODS

This was a secondary analysis of data collected through a cross-sectional school survey of children 6-16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression.

RESULTS

Of the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85-0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97-1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09-1.17; p = 0.03).

CONCLUSION

There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.

Something to despair: Gender differences in adverse childhood experiences among rural patients

Existing research has demonstrated that patients in treatment for an opioid use disorder (OUD) have high rates of adverse childhood experiences (ACE) compared to community-based samples. While research has documented important gender differences in ACEs in patients with OUD receiving treatment in urban areas, research has not shown whether these findings would generalize to rural and Appalachian areas, which are known to have lower ACE scores. We conducted a secondary analysis of existing clinical data, utilizing intake assessment data from a rural Appalachian outpatient buprenorphine program. We restricted the sample to patients with an OUD who presented for treatment between June 2018 and June 2019 (n = 173). The clinical intake assessment included a modified 17-item ACE instrument that patients self-administered. More than half (54.3%) of patients reported having experienced 4+ categories of adverse childhood experiences. On average, females endorsed 4.5 categories of adverse experiences, whereas males endorsed 3.3 (p < 0.00); female patients were significantly more likely to have experienced sexual abuse (42.4% versus 10.6%, p < 0.00). Alarmingly, 25.9% of females and 8.2% of males reported being forced to have sex before age 18. Disproportionately high rates of childhood adversities, particularly among females, may partially explain despair in rural Appalachian areas. OUD treatment programs should conduct clinical assessments of trauma and integrate trauma-informed care into drug treatment, especially for female patients residing in rural Appalachia.

The Impact of Environmental Chronic and Toxic Stress on Asthma

Several factors have been associated with the development of asthma and asthma-related morbidity and mortality. Exposures in the environment such as allergens and air pollutants have traditionally been linked to the risk of asthma and asthma outcomes. More recent literature has identified chronic psychosocial stress as an additional environmental exposure to consider in relation to asthma. Adverse childhood events (ACEs) and chronic and toxic stress have been associated with chronic diseases such as cardiovascular disease, cancer, and chronic obstructive pulmonary disease. Chronic stress has also been shown to result in biological changes such as expression of immunologic genes, changes in expression of the beta-adrenergic (B2AR) and the glucocorticoid receptor (GR-α) genes, cytokine regulation, and alterations in the hypothalamic pituitary axis and cortisol levels which all may affect asthma pathophysiology and therapeutic response among patients exposed to chronic stress. Recent research has revealed associations between ACEs and chronic and toxic stress and asthma risk in pre-conception to early childhood as well as morbidity and response to asthma treatments among pediatric and adult age groups. As some populations are more significantly impacted by asthma such as racial and ethnic minority groups, the influence of psychosocial stress has also been explored as a potential factor responsible for observed disparities in asthma prevalence and outcomes among these groups which also experience higher rates of psychosocial stress. Racial discrimination has specifically been shown to affect asthma-related outcomes among minority groups. Interventions to address the impact of chronic and toxic stress such as yoga and meditation have been shown to improve asthma outcome measures. Chronic and toxic stress is an important environmental exposure to further consider as we continue to explore the differences in underlying asthma pathophysiology leading to various disease phenotypes among patients and clinical/therapeutic response to interventions and treatments.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort

Background

Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset.

Methods

Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes.

Results

T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2–3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (OR_adj = 1.14; 95% CI 1.02–1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI).

Conclusion

ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.

Childhood trauma and clinical high risk for psychosis

As a risk factor for psychosis, childhood trauma rates are elevated in the clinical-high-risk (CHR) syndrome compared to the general population. However, it is unknown whether trauma is typically experienced in childhood or adolescence/young adulthood, whether it occurred prior to CHR syndrome onset, and how severe trauma relates to presenting symptoms. In this study, we examined the relationship of trauma history to symptoms and functioning in individuals diagnosed with the CHR syndrome on the Structured Interview for Psychosis-Risk Syndromes (N = 103). Trauma, defined as meeting the DSM-IV A1 criterion of actual or threatened death or injury, was assessed by semi-structured interview. A large proportion of CHR participants (61%) reported trauma exposure, including interpersonal trauma, trauma prior to CHR onset, and childhood trauma prior to age 12. Those with a trauma history (versus those without trauma) were rated as having more severe perceptual disturbances, general/affective symptoms and more impairment on the Global Assessment of Functioning Scale. The number of traumatic events correlated with more severe ratings in those three domains. Additionally, the number of interpersonal traumas was correlated with ratings of suspiciousness. Trauma was unrelated to specific measures of social and role functioning. A small proportion of CHR participants were diagnosed with formal PTSD (14%), which was unrelated to symptom severity or functioning. Thus, we demonstrate that trauma exposure is often early in life (before age 12), occurs prior to the onset of the CHR syndrome, and is related to both positive and affective symptoms.

The Relationship of Adverse Childhood Events to Smoking, Overweight, Obesity and Binge Drinking Among Women in Hawaii

OBJECTIVES

To evaluate how the associations of adverse childhood events (ACEs) with smoking, overweight, obesity and binge drinking differ by race/ethnicity among women, including a large, understudied cohort of Asians and Native Hawaiians/Pacific Islanders (NHOPIs).

METHODS

The number and type (household dysfunction, and physical, verbal and sexual abuse) of ACEs were examined in relation to adulthood smoking, overweight, obesity and binge drinking among 3354 women in Hawaii using the 2010 Behavioral Risk Factor Surveillance System data using Poisson regression with robust error variance. We additionally investigated for interaction by race/ethnicity. Covariates included age, race/ethnicity, education, emotional support, healthcare coverage, and the other health outcomes.

RESULTS

Overall, 54.9 % reported at least 1 ACE. The prevalence of smoking (PR = 1.40 (1 ACE) to PR = 2.55 [5+ ACEs]), overweight (PR = 1.22 [1 ACE] to PR = 1.31 [5+ ACEs]) and obesity (PR = 1.00 [1 ACE] to PR = 1.85 [5+ ACEs]) increased with increasing ACE count. Smoking was associated with household dysfunction (PR = 1.67, CI = 1.26-2.22), and physical (PR = 2.04, CI = 1.50-2.78) and verbal (PR = 1.62, CI = 1.25-2.10) abuse. Obesity was also significantly related to household dysfunction (PR = 1.22, CI = 1.01-1.48), and physical (PR = 1.36, CI = 1.10-1.70), verbal (PR = 1.35, CI = 1.11-1.64) and sexual (PR = 1.53, CI = 1.25-1.88) abuse. Among Asians, sexual abuse was associated with a lower prevalence of binge drinking (PR = 0.26, CI = 0.07-0.93), which was significantly different from the null association among Whites (interaction p = 0.02).

CONCLUSION

Preventing/addressing ACEs may help optimize childhood health, and reduce the likelihood of smoking/obesity among women including Asians/NHOPIs. Further studies are warranted to evaluate the sexual abuse-binge drinking association among Asians, which may support the need for culturally-tailored programs to address ACEs.

Childhood Stress and Adversity is Associated with Late-Life Dementia in Aboriginal Australians

OBJECTIVES

High rates of dementia have been observed in Aboriginal Australians. This study aimed to describe childhood stress in older Aboriginal Australians and to examine associations with late-life health and dementia.

DESIGN

A cross-sectional study with a representative sample of community-dwelling older Aboriginal Australians.

SETTING

Urban and regional communities in New South Wales, Australia.

PARTICIPANTS

336 Aboriginal and/or Torres Strait Islander Australians aged 60-92 years, of whom 296 were included in the current analyses.

MEASUREMENTS

Participants completed a life course survey of health, well-being, cognition, and social history including the Childhood Trauma Questionnaire (CTQ), with consensus diagnosis of dementia and Alzheimer disease.

RESULTS

CTQ scores ranged from 25-117 (median: 29) and were associated with several adverse childhood indicators including separation from family, poor childhood health, frequent relocation, and growing up in a major city. Controlling for age, higher CTQ scores were associated with depression, anxiety, suicide attempt, dementia diagnosis, and, specifically, Alzheimer disease. The association between CTQ scores and dementia remained significant after controlling for depression and anxiety variables (OR: 1.61, 95% CI: 1.05-2.45). In contrast, there were no significant associations between CTQ scores and smoking, alcohol abuse, diabetes, or cardiovascular risk factors.

CONCLUSIONS

Childhood stress appears to have a significant impact on emotional health and dementia for older Aboriginal Australians. The ongoing effects of childhood stress need to be recognized as people grow older, particularly in terms of dementia prevention and care, as well as in populations with greater exposure to childhood adversity, such as Aboriginal Australians.

Developmental psychoneuroendocrine and psychoneuroimmune pathways from childhood adversity to disease

Childhood adversity has been repeatedly and robustly linked to physical and mental illness across the lifespan. Yet, the biological pathways through which this occurs remain unclear. Functioning of the inflammatory arm of the immune system and the hypothalamic-pituitary-adrenal (HPA)-axis are both hypothesized pathways through which childhood adversity leads to disease. This review provides a novel developmental framework for examining the role of adversity type and timing in inflammatory and HPA-axis functioning. In particular, we identify elements of childhood adversity that are salient to the developing organism: physical threat, disrupted caregiving, and unpredictable environmental conditions. We propose that existing, well-characterized animal models may be useful in differentiating the effects of these adversity elements and review both the animal and human literature that supports these ideas. To support these hypotheses, we also provide a detailed description of the development and structure of both the HPA-axis and the inflammatory arm of the immune system, as well as recent methodological advances in their measurement. Recommendations for future basic, developmental, translational, and clinical research are discussed.

Double whammy: Adverse childhood events and pain reflect symptomology and quality of life in women in substance abuse treatment

BACKGROUND

This study examined the profiles of symptoms and health-related quality of life (QOL) of women in substance abuse treatment, comparing those with higher versus lower histories of adverse childhood events (ACE), and those with versus without current pain.

METHODS

Adult women in outpatient substance abuse treatment (n = 30) completed questionnaires (cross-sectional study) on topics including drug use, adverse childhood events (ACE), QOL, functional ability, current pain, and depression.

RESULTS

Women with pain indicated significant differences in emotional (p < 0.05), and functional ability (p < 0.01); but no significant differences were found between women with high versus low levels of ACE. Yet, radar plots of women with both current pain and high levels of ACE, versus those without, portrayed a distinctive profile indicating high levels of anxiety and depression.

CONCLUSIONS

Rather than a checklist, visual composites of symptoms experienced by women in substance abuse treatment illustrates areas of concern in the overall status of women in substance abuse treatment.

Health effects of adverse childhood events: Identifying promising protective factors at the intersection of mental and physical well-being

Research documents how exposure to adversity in childhood leads to negative health outcomes across the lifespan. Less is known about protective factors - aspects of the individual, family, and community that promote good health despite exposure to adversity. Guided by the Resilience Portfolio Model, this study examined protective factors associated with physical health in a sample of adolescents and adults exposed to high levels of adversity including child abuse. A rural community sample of 2565 individuals with average age of 30 participated in surveys via computer assisted software. Participants completed self-report measures of physical health, adversity, and a range of protective factors drawn from research on resilience. Participants reporting a greater burden of childhood victimization and current financial strain (but not other adverse life events) had poorer physical health, but those with strengths in emotion regulation, meaning making, community support, social support, and practicing forgiveness reported better health. As hypothesized, strengths across resilience portfolio domains (regulatory, meaning making, and interpersonal) had independent, positive associations with health related quality of life after accounting for participants' exposure to adversity. Prevention and intervention efforts for child maltreatment should focus on bolstering a portfolio of strengths. The foundation of the work needs to begin with families early in the lifespan.

Life adversity is associated with smoking relapse after a quit attempt

Multiple cross-sectional studies have linked adverse childhood events and adult adversities to current smoking, lifetime smoking, and former smoking. To date, however, there have been no direct observational studies assessing the influence of adversities on smoking relapse. We prospectively followed 123 participants, 86 of whom were habitual smokers, from pre-quit ad libitum smoking to four weeks post-quit. Thirty-seven non-smokers were also tested in parallel as a comparison group. Subjects provided biological samples for confirmation of abstinence status and self-report history of adversities such as abuse, neglect, family dysfunction, incarceration, and child-parent separation. They also completed mood and smoking withdrawal symptom measures. The results indicated that within non-smokers and smokers who relapsed within the first month of a quit attempt, but not abstainers, females had significantly higher adversity scores than males. Cigarette craving, which was independent from depressive affect, increased for low adversity participants, but not those with no adversity nor high adversity. These results demonstrate that sex and relapse status interact to predict adversity and that craving for nicotine may be an important additional mediator of relapse. These results add further support to the previous cross-sectional evidence of an adversity and smoking relationship. Further studies to clarify how adversity complicates smoking cessation and impacts smoking behaviors are warranted.

Adverse Childhood Events are Related to the Prevalence of Asthma and Chronic Obstructive Pulmonary Disorder Among Adult Women in Hawaii

PURPOSE

In the US, women surpass men in the prevalence of lung diseases. Limited studies exist on the association of adverse childhood events (ACEs) to asthma and chronic obstructive pulmonary disorder (COPD) particularly among women and cohorts of understudied populations (e.g., Pacific Islanders). This study evaluated the ACEs-asthma and ACEs-COPD relationships among women in Hawaii and the contribution of poor health factors (smoking, binge drinking, and obesity) in these associations.

METHODS

Using data from 3363 women in the Behavioral Risk Factor Surveillance System-Hawaii, we assessed how self-reported ACEs [count and type (household dysfunction, and physical, verbal and sexual abuse)] relate to asthma and COPD. Multivariable log-binomial regression, accounting for the sampling design, and model adjustments for socio-demographics, healthcare access, emotional support, current smoking, binge drinking, and BMI status were used to generate prevalence ratios.

RESULTS

For every increase in ACE count, the likelihood for asthma increased by 7 % (CI = 1.02-1.13), and for COPD, by 21 % (CI = 1.12-1.31) accounting for socio-demographics, healthcare access, and emotional support. Verbal abuse was also associated with greater likelihood for asthma independent of these covariates (PR = 1.43, CI = 1.14-1.79). Household dysfunction (PR = 1.82, CI = 1.15-2.82) and physical (PR = 2.01, CI = 1.20-3.37), verbal (PR = 2.24, CI = 1.38-3.65) and sexual (PR = 1.81, CI = 1.10-2.97) abuse were all associated with COPD using similar adjustments. Additional adjustment for smoking, binge drinking, and BMI status did not impact the ACE-asthma associations and only modestly attenuated the ACE-COPD relationships.

CONCLUSIONS

Primary and secondary prevention of ACEs may optimize the health of young girls in Hawaii, and reduce the burden of asthma and COPD among women in the state.

Psychoneuroimmunology and the pediatric surgeon

The mind-body connection is receiving increasing scrutiny in a large number of clinical settings, although research has lagged in the pediatric specialties. Psychoneuroimmunology (PNI) is a novel interdisciplinary scientific field that examines the relationship of the mind to the patient's neurologic, endocrine, and immune systems by examining critical parameters such as the effects of mental stress on wound healing and infection rates. Techniques that modify a patient's emotional and mental responses to illness and surgery have positive effects on their physiology resulting in improved recoveries and higher patient satisfaction rates. In the appropriate clinical settings, an awareness of PNI can enhance outcomes for pediatric surgical patients.