Evaluating the Feasibility of a Novel Firearm Injury Prevention Program for Pre-adolescent Children Through Health Care and Community-Based Partnerships: The Future Healers Program Pilot Study

BACKGROUND

Firearm violence is an American public health crisis that negatively impacts children and disproportionately affects Black youth. Few firearm injury prevention programs have been described in pre-adolescent children. The Future Healers Program is a novel collaboration constructed via partnership between the medical school, trauma center, academic surgery department, and local non-profit community organization. Our study sought to evaluate if (1) partnering with community organizations facilitated recruitment of children with prior exposure to firearm violence and (2) the health care community was a potential trusted partner appropriate for program delivery.

METHODS

Children aged 4-13 were recruited to join the program via news outlets and social media and in partnership with a local non-profit organization. Of the children and parents participating in the program, 48% (44/92) and 59% (38/64), respectively, completed an IRB-approved survey study. Pearson's chi-square, percentages, and 95% confidence intervals evaluated differences between children and caregivers on sociodemographic characteristics, firearm exposure (FE), firearm violence exposure (FVE), and perception of health care. Participant's residence was geocoded in relationship to incidents of firearm injury (2008-2021) in the same region.

RESULTS

Caregivers (95%) and children (84%) reported substantial exposure to firearm violence and resided in areas with frequent firearm injury incidents. Notably, 82% of caregivers and 66% of children reported having a family member injured by gunfire. A high percentage of caregivers (79%) and children (91%) self-reported trust in the health care system.

CONCLUSION

Partnerships between community organizations and health care systems can develop prevention programs that effectively recruit and engage pre-adolescent children impacted by firearm violence.

Adverse Childhood Experience-Related Conditions and Substance Use in Adolescents: A Secondary Analysis of Cross-Sectional Survey Data

BACKGROUND

Adverse childhood experiences (ACEs) cluster within children. In addition to standardized ACE measures, there exist "ACE-related" measures that are either directly or indirectly related to the standardized ACE constructs. This study aimed to identify ACE-related latent classes of adolescents and describe past-month substance use in each class by sex and race/ethnicity.

METHODS

Data from the 2018 Indiana Youth Survey (N = 70,703), which is a repeated self-administered, cross-sectional survey, were used. Latent class analysis was conducted using ACE-related family (parent incarceration, insulting/yelling within family, inability to discuss personal problems) and school (hate being in school, feeling unsafe, inability to talk to teachers one-on-one) items. Dependent variable combined past 30-day use-frequency of 17 substances. Two-way analysis of variances examined ACE by sex and race/ethnicity interaction.

RESULTS

Four ACE-related classes emerged: "Family-Only" (11.2%), "School-Only" (16.5%), "Family-School" (8.0%), and "No-ACE" (64.3%). Substance use was highest in "Family-School" (mean = 0.67); lowest in "No-ACE" (mean = 0.21). Significant race/ethnicity (F = 27.06; p < .0001), ACE * sex interaction (F = 12.13; p < .0001) and ACE * race/ethnicity interaction (F = 4.57; p < .0001) effects emerged. Within each ACE-related class, substance use was lowest for Asians and highest for Hispanics.

CONCLUSIONS

Adverse childhood experience-related items cluster within children across school and family environments and clustering differs by race/ethnicity, but not by sex. Incorporating ACE-related items into school surveys enhances the ability to implement interventions that target relationships between ACEs and substance use.

Single mothers' perceptions of neighborhood social cohesion, parenting stress, adverse childhood experiences in early childhood and Black children's behavior problems in middle childhood and adolescence

This study examined the roles of neighborhood social cohesion, adverse childhood experiences (ACEs), and parenting stress in early childhood on child behavioral outcomes in middle childhood and adolescence among socioeconomically disadvantaged Black families. To test a model linking perceptions of neighborhood social cohesion, single mothers' parenting stress, ACEs, and behavior problems in middle childhood and adolescence. We used four waves of longitudinal data from a subsample of 800 unmarried Black mothers and their children (at child birth and ages 3, 5, 9, and 15) from the Future of Families and Child Wellbeing Study, a nationally representative data set. Structural equation modeling with latent variables was used to measure direct and indirect effects. Mothers' perceptions of neighborhood social cohesion were significantly and negatively associated parenting stress (β = -0.34, p < 0.05); parenting stress was significantly and positively related to adverse childhood experiences (β = 0.40, p < 0.05) and behavior problems (β = 0.32, p < 0.05); Adverse childhood experiences were significantly and positively related to behavior problems (β = 0.26, p < 0.05); and behavior problems were indirectly influenced by neighborhood social cohesion through adverse childhood experiences (β = -0.14, p < 0.05) and parenting stress (β = 0.10, p < 0.05). Neighborhood factors may play a significant role in parenting stress, adverse childhood experiences in early childhood, and children's behavior problems in middle childhood and adolescence among some single mothers and children in economically and socially disadvantaged Black families. Interventions that enhance neighborhood social cohesion and foster supportive interactions among community members and organizations are recommended.

Metabolic syndrome after childhood trauma: a 9-year longitudinal analysis

BACKGROUND

Childhood trauma (CT) has been cross-sectionally associated with metabolic syndrome (MetS), a group of biological risk factors for cardiometabolic disease. Longitudinal studies, while rare, would clarify the development of cardiometabolic dysregulations over time. Therefore, we longitudinally investigated the association of CT with the 9-year course of MetS components.

METHODS

Participants (N = 2958) from the Netherlands Study of Depression and Anxiety were assessed four times across 9 years. The CT interview retrospectively assessed childhood emotional neglect and physical, emotional, and sexual abuse. Metabolic outcomes encompassed continuous MetS components (waist circumference, triglycerides, high-density lipoprotein [HDL] cholesterol, blood pressure [BP], and glucose) and count of clinically elevated MetS components. Mixed-effects models estimated sociodemographic- and lifestyle-adjusted longitudinal associations of CT with metabolic outcomes over time. Time interactions evaluated change in these associations.

RESULTS

CT was reported by 49% of participants. CT was consistently associated with increased waist (b = 0.32, s.e. = 0.10, p = 0.001), glucose (b = 0.02, s.e. = 0.01, p < 0.001), and count of MetS components (b = 0.04, s.e. = 0.01, p < 0.001); and decreased HDL cholesterol (b = -0.01, s.e.<0.01, p = .020) and systolic BP (b = -0.33, s.e. = 0.13, p = 0.010). These associations were mainly driven by severe CT and unaffected by lifestyle. Only systolic BP showed a CT-by-time interaction, where CT was associated with lower systolic BP initially and with higher systolic BP at the last follow-up.

CONCLUSIONS

Over time, adults with CT have overall persistent poorer metabolic outcomes than their non-maltreated peers. Individuals with CT have an increased risk for cardiometabolic disease and may benefit from monitoring and early interventions targeting metabolism.

Predicting Black Parents' Attitudes Toward Corporal Punishment: A Moderated-Mediation Model of Frequency and Valence of Childhood Experiences

Child corporal punishment (CP) may lead to child physical abuse, which is a public health concern in the United States. The present study examined major risk factors predicting attitudes toward CP among a sample of Black parents (N = 394), including frequency and valence of experiences of CP during childhood, outcome expectancies of CP, and perceptions of self-efficacy and response efficacy of non-physical discipline strategies. Structural equation modeling results revealed that the indirect associations between CP frequency and attitudes through self-efficacy and response efficacy were moderated by CP valence. Results extend the literature and point to the need for incorporating information about efficacy of evidence-based non-physical discipline strategies into intervention messages targeting prevention of child physical abuse.

Adverse childhood experiences and dental cleaning during pregnancy: Findings from the North and South Dakota PRAMS, 2017-2021

OBJECTIVE

Research demonstrates that adverse childhood experiences (ACEs)-that is, experiences of abuse, neglect, and household dysfunction-are related to lower preventive dental care utilization in childhood and adolescence. However, limited research has explored the connection between ACEs and preventive dental care utilization in adulthood, and no research has examined this relationship during pregnancy. The current study extends existing research by investigating the relationship between ACEs and dental cleaning and dental care utilization during pregnancy among a sample of women who delivered live births in North Dakota and South Dakota.

METHODS

Data are from the 2017 to 2021 Pregnancy Risk Assessment Monitoring System (PRAMS) in North Dakota and South Dakota (n = 7391). Multiple logistic regression is used to examine the relationship between the number of ACEs (0, 1, 2, 3 or 4 or more) and dental cleaning during pregnancy.

RESULTS

Relative to respondents with 0 ACEs, those with 4 or more ACEs were significantly less likely to report having dental care during pregnancy (OR = 0.757, 95% CI = 0.638, 0.898). By racial and ethnic background, the results showed that the significant associations are concentrated among White and Native American respondents.

CONCLUSIONS

The results suggest that exposure to 4 or more ACEs is associated with a significantly lower likelihood of dental cleaning during pregnancy among women who delivered a live birth in North Dakota and South Dakota. Further investigations are necessary to understand the mechanisms underlying the relationship between ACEs and dental cleaning during pregnancy and replicate the findings in other geographic contexts.

Structural adverse childhood experiences associated with suicidal ideation, suicide attempts, and repetitive nonsuicidal self-injury among racially and ethnically minoritized youth

INTRODUCTION

High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self-injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots.

METHODS

Using the 2013-2019 Minnesota Student Surveys, we assessed associations of student-reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety.

RESULTS

Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures.

CONCLUSION

Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.

Association Between Adverse Childhood Experiences and Academic Performance Among Children and Adolescents: A Global Meta-Analysis

This study was conducted to quantify the association of adverse childhood experiences (ACEs) and the academic performance of children and adolescents. The literature was systematically searched in six electronic databases, and a meta-analysis was conducted. Twenty studies with a total of 1,196,631 children and adolescents from five countries were included. Meta-analysis showed that ACE score was positively associated with poor academic achievement, grade repetition, and special education support. Compared with children and adolescents without any ACE, those with one or more ACE had a significantly higher risk of poor academic achievement (pooled odds ratio [OR]: 1.45, 95% confidence interval [CI] [1.13, 1.85], I2 = 82.6%) and grade repetition (pooled OR: 1.36, 95% CI [1.29, 1.43], I2 = 71.0%). Moreover, all types of ACEs were positively associated with poor academic achievement and grade repetition. In addition, there was a significant dose-response relationship between the ACE score and the risk of poor academic achievement. This study supported that ACE had a significant impact on the academic performance of children and adolescents. Based on these findings, we recommend that early screening of ACEs for children and adolescent is critical and appropriate support and prevention in education should be developed for those with ACEs. Further studies are needed to further explore the long-term effect of ACEs on education and its gender differences.

The Relationship Between Self-Reported Childhood Maltreatment and Mental Health in Substance Use Disorders: A 6-Year Retrospective Analysis

OBJECTIVE

This longitudinal cohort study aims to investigate the relationship between self-reported childhood maltreatment (CM) and the retrospective trajectory of substance use, mental health, and satisfaction with life in individuals with substance use disorders.

METHODS

One hundred eleven treatment-seeking individuals with substance use disorder were recruited from clinical settings and monitored prospectively for 6 years. The participants' substance use, mental health, and satisfaction with life were assessed using standardized measures. Cluster analysis divided the cohort into two groups-low CM and high CM-based on their scores on the Childhood Trauma Questionnaire Short Form at year 6. Mixed-effects linear models were fitted to assess the association between longitudinal scores on drug use, mental health, and satisfaction with life and CM group.

RESULTS

Most participants (92%) reported at least 1 CM. Out of all participants, 36% were categorized into the high-CM group, while 59% were categorized into the low-CM group. CM group was not associated with the amount of substance or alcohol use. CM group was significantly associated with the longitudinal course of mental health and life satisfaction.

CONCLUSIONS

This study underscores the association between self-reported CM and mental health and life satisfaction in patients with substance use disorder. Our results may imply an increased risk of adverse outcomes in patients with high levels of CM, while bearing in mind that both current and retrospective mental health and substance use problems can influence the accuracy of recalling CM.

Evaluating the Psychometric Properties of the Sexual and Gender Minority Adverse Childhood Experiences Scale Among Sexual Minority Men and Women

BACKGROUND

Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual and gender minority (SGM) individuals have higher ACE scores than non-SGM individuals. The SGM-ACE scale was developed to better assess this population but is not yet validated in SGM subgroups.

AIMS

This study aims to validate the sexual and gender minority adverse childhood experiences (SGM-ACE) scale among sexual minority men (SMM) and sexual minority women (SMW), while testing measurement invariance across both groups.

METHODS

A cross-sectional survey included 530 sexual minority adults (265 men, 265 women) in the United States. Cronbach's alpha established internal consistency reliability. Validity was assessed via confirmatory factor analysis (CFA) for the SGM-ACE's theoretical structure and Pearson's correlations for concurrent validity with substance use outcomes (alcohol, cannabis, and drugs). Multigroup structural equation modeling (SEM) determined measurement invariance between SMM and SMW.

RESULTS

The CFA of the original model exhibited good fit. Fit was improved after removing the institutionalization item, chi-square (χ2) = 14.26, degrees of freedom (df) = 9, p = 0.113, minimum discrepancy (CMIN/df) = 1.59, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.03, 90% confidence interval (CI): (0.00-0.06), and standardized root mean square residual (SRMR) = 0.02. Internal consistency reliability was established (α = 0.78). SGM-ACE exhibited weak, yet significant relationships with each substance use outcome. Multigroup SEM indicated measurement invariance between SMM and SMW.

CONCLUSION

This study provides psychometric validation of the SGM-ACE, establishing measurement invariance between SMM and SMW. Future research should explore its utility in diverse SGM minority subgroups.

Gender differences in the pathway of childhood trauma, impulsivity and adult eating behaviour: a cross-sectional study

Objective: The current cross-sectional study aimed to examine the association between childhood trauma, impulsivity, binge eating symptoms, and body mass index (BMI) in a sample of males and females. We also aimed to investigate the indirect association of childhood trauma with binge eating through impulsivity while controlling for BMI.Method: Participants were 410 young adults (mean age = 20.9 years, range 18-24; female = 73.9%) who completed online measures of childhood trauma, impulsivity, binge eating symptoms, and self-reported height and weight. Mediation models were tested using multi-group structural equation modelling.Results: Childhood trauma and impulsivity were associated with an increased risk of binge eating symptoms in females but not males, corroborating previous studies. There was a significant difference in the binge eating symptoms index between sexes, but not regarding the index of childhood trauma and impulsivity. Additionally, adverse childhood experiences were associated with impulsivity and the association of childhood trauma with binge eating was mediated by impulsivity in the female sample.Conclusions: Our results suggest sex-dependent patterns and risk factors that may impact binge eating symptoms. The implications of our results suggest that impulsivity might be a vulnerability factor for binge eating, especially for females.

Recent Stressful Life Events and Perceived Stress as Serial Mediators of the Association between Adverse Childhood Events and Insomnia

Insomnia is common in college students and linked to poorer mental and physical health. There is growing evidence that adverse childhood experiences (ACEs) may contribute to insomnia in adulthood. However, beyond the need for additional replication of these findings, there is a need to identify underlying mechanisms that plausibly connect the two experiences. Based on a serial mediation model, the current study examined the role of two theoretically informed mediators: recent stressful life events and perceived stress. A cross-sectional survey of 2,218 college students at a large university in the southwestern United States was conducted between August 2020 and December 2021. The sample was predominantly Hispanic (96%) and female (73%), with a mean age of 20.7 years. Standardized measures of adverse childhood experiences, recent stressful life events, perceived stress, and insomnia were administered to participants online. Almost 20% of participants reported having experienced four or more adverse childhood experiences and 63% met the threshold for insomnia. Reporting four or more ACEs was associated with significantly greater insomnia severity, and this relationship was serially mediated by both recent stressful life events and perceived stress. However, recent stressful life events appeared to be the most powerful mediator. The results of the current study indicate that recent exposure to stressful life events serves as a plausible mechanism linking early adversity during childhood to adult insomnia and could therefore serve as a potential target for intervention. The findings suggest that students would benefit from university-wide efforts to reduce the number and/or intensity of common stressors.

The impact of adverse childhood experiences on mental health, sexual risk behaviors, and alcohol consumption in adulthood

The purpose of the study was to determine how Adverse Childhood Experiences (ACE) relate to adulthood flourishing, symptoms of depression, anxiety, somatization, self-reported health, sexual risk behaviors, and alcohol consumption. A quantitative cross-sectional methodology was used. A total of 452 adults completed the survey. The most prevalent ACE include physical abuse (44.69%), separation/divorce of parents (41.81%), living with someone with alcohol problems (39.38%), and being sworn, insulted, or humiliated by adults at home (35.62%). Almost one out of every four respondents (24.34%) reported being touched by an adult, 17.92% reported that an adult tried to manipulate the respondent into touching them, and 8.19% were forced to have sexual intercourse. Results indicate that women reported a higher number of ACE than men. The number of ACE is inversely related to flourishing and self-reported health; while being positively associated with participant's scores in depression, anxiety, somatization, sexual risk behaviors, and alcohol use. The regression model, including the eleven ACE and respondents' sex and age, achieved medium effect sizes for somatization, depression, and anxiety symptoms and small effect sizes for flourishing, self-reported health, sexual risk behaviors, and alcohol consumption. Specific ACE have a particularly significant negative impact on mental health outcomes: forced intercourse, witnessing familial violence, verbal humiliation, and living with individuals struggling with mental health issues and drug consumption or who were incarcerated. In conclusion, the study highlights the alarming prevalence of ACE among the Honduran population and their significant negative impact on mental health outcomes during adulthood.

Childhood maltreatment and the risk of impaired glucose metabolism or type 2 diabetes in young adults: Findings from the Lifelines Cohort Study

We examined the associations between childhood maltreatment and the risk of impaired glucose metabolism (IGM) or type 2 diabetes (T2D) in young adults aged 18-35. Participants (N = 8506) from the Lifelines Cohort Study without IGM or diabetes at baseline (2007-2013) were included. Childhood maltreatment was assessed by the Childhood Trauma Questionnaire (CTQ) and incident IGM/T2D was assessed by haemoglobin A1c levels (≥5.7%) in 2014-2017. There were 223 (2.6%) cases of IGM/T2D during the follow-up period. After adjusting for sociodemographic and health/lifestyle covariates and follow-up time, only the CTQ Sexual Abuse subscale was significantly associated with IGM/T2D (RR = 1.05 [95% CI = 1.01, 1.10]). The association remained when additionally accounting for depressive and anxiety symptoms (RR = 1.05 [95% CI = 1.00, 1.09]). Childhood sexual abuse was associated with an increased risk of IGM/T2D in young adults, highlighting the long-term metabolic consequences of childhood maltreatment.

Adverse childhood experience and depression: the role of gut microbiota

Depression is the most common psychiatric disorder that burdens modern society heavily. Numerous studies have shown that adverse childhood experiences can increase susceptibility to depression, and depression with adverse childhood experiences has specific clinical-biological features. However, the specific neurobiological mechanisms are not yet precise. Recent studies suggest that the gut microbiota can influence brain function and behavior associated with depression through the "microbe-gut-brain axis" and that the composition and function of the gut microbiota are influenced by early stress. These studies offer a possibility that gut microbiota mediates the relationship between adverse childhood experiences and depression. However, few studies directly link adverse childhood experiences, gut microbiota, and depression. This article reviews recent studies on the relationship among adverse childhood experiences, gut microbiota, and depression, intending to provide insights for new research.

Association between Adverse Childhood Experiences and Unmet Health Care Needs among Children in the United States

Although studies have investigated and found an association between adverse childhood experiences and poor health and mental health outcomes, there is a dearth of studies investigating the association between adverse childhood experiences and unmet health care needs among children. The objective of this study is to examine the association between adverse childhood experiences and unmet health care needs after adjusting for predisposing, enabling, and need factors of health care service utilization. Data for this study came from the 2016-2017 National Survey of Children's Health. An analytic sample of 46,081 children (51.3% males; average age 11.5 years) was analyzed using negative binomial regression. Based on parent reports, about 3.5% of children had unmet health care needs, and half (50%) of the sample had experienced at least one childhood adversity. Controlling for other factors, children who experienced three or more childhood adversities had 4.51 times higher odds of having unmet health care needs (AOR = 4.51, p < .001, 95% CI = 3.15-6.45) when compared to their counterparts with no childhood adversity. Children with parents who have someone to turn to for everyday emotional support were 31% less likely to have unmet health care needs (AOR = .69, p < .01, 95% CI = .54-.89). Adverse childhood experiences have a detrimental effect on unmet health care needs. The findings of this study offer an important opportunity for further research on how best to prevent adverse childhood experiences and mitigate their impact on families.

The impact of adverse childhood events on service support and educational outcomes of children who are autistic: A theory-guided analysis using structural equation modeling

Autistic children who have experienced adverse childhood experiences (ACEs) may have barriers to receiving special education or other developmental services-thus, impacting educational outcomes. Our objective was to model such a pathway using the 2016-2021 National Survey of Children's Health datasets. We extracted data for school outcomes, use of special education and autism-related specialty services and sociodemographic characteristics among autistic children within the data. Associations between sociodemographics and ACEs (categorized as 0, 1-3, and 4+) were tested using design-based X2 tests. We then used structural equation modeling to map the quasi-causal pathways. The sample for our analysis included 4717 autistic children-38.94% were aged 6-10 years, 35.73% of children aged 11-14 years, and 25.32% were between 15 and 17 years-with 88.70% living in metropolitan areas. The X2 showed significant relationships between ACEs and age, ethnoracial groups, and urbanicity among others. The SEM showed ACEs were directly associated with poorer school outcomes (β = -0.14 (0.04), p = 0.002) and through their inverse relationship with support services (β = -0.08 (0.04), p = 0.023)- when support services were increased, school outcomes improved (β = 0.62, p < 0.001). Findings suggested ACEs have a significant direct and indirect impact on school outcomes of autistic children, and 10.76% of children who are autistic have experienced four or more ACEs-which were more likely to occur with severe autism symptomatology and in rural areas. Results highlight the need for communities to recognize the potential long-term impact of ACEs on the academic outcomes of autistic children.

The intersection of adverse childhood experiences and neighborhood determinants of health: An exploratory spatial analysis

OBJECTIVE

Adverse childhood experiences (ACEs) are associated with elevated risk for poor physical and psychological health outcomes. Nearly all of the literature on the association between ACEs and poor health focuses on the individual and family level; the potential role of neighborhood environment is overlooked. Understanding the relationship between ACEs and characteristics of the neighborhood environment is a necessary first step in determining if and how place-based, trauma-informed interventions might mitigate the negative effects of ACEs. The purpose of this exploratory study was to describe the neighborhood environment of adults who have experienced ≥ 4 versus ≤ 3 ACEs.

METHOD

An exploratory secondary analysis of cross-sectional and geospatial data was conducted during 2021. Data sources included 2011/2012 Philadelphia ACE Survey data, a telephone survey of 1,784 randomly sampled Philadelphia adults, linked with geospatial data on 21 neighborhood-level determinants of health. Neighborhood was defined as participant's home census tract at the time of survey. The sample for this secondary analysis included the 1,679 Philadelphia ACE Survey participants for whom home census tract was available. Bivariate logistic regression examined differences between groups (≤ 3 ACEs vs. ≥ 4 ACEs).

RESULTS

Individuals with ≥ 4 ACEs lived in neighborhoods with higher neighborhood poverty rates, less socioeconomic resources, worse food access, poorer perceived physical and mental health, more substance overdose deaths, higher crime, and less green space.

CONCLUSIONS

Findings suggest future work may benefit from considering neighborhood environments when examining and intervening upon the association between ACEs and poor physical and psychological health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Depressed, stressed, and inflamed: C-reactive protein linked with depression symptoms in midlife women with both childhood and current life stress

To determine whether the relationship between inflammatory factors and clinically significant depression symptoms is moderated by high exposure to adverse childhood experiences and current life stressors in a longitudinal community cohort of midlife women. Methods: Participants from the Penn Ovarian Ageing Study community cohort (age at baseline: M = 45.3 [SD = 3.8]) were included in analyses if they had a blood sample measuring basal inflammatory markers during at least one visit where depression symptom severity and current stressful life events were also assessed (N = 142, average number of visits per participant = 1.75 [SD = 0.92]). Approximately annually over the course of 16 years, participants self-reported depression symptom severity using the Centre for Epidemiologic Studies Depression (CESD) Scale, provided menstrual diaries to determine menopause stage, and contributed blood samples. Residual blood samples were assayed for interleukin (IL)-6, IL 1-beta (IL-1β), tumour necrosis factor alpha (TNF-α), and high sensitivity C-reactive protein (hsCRP). Early life stress was quantified using the Adverse Childhood Experiences questionnaire (low [0-1 experience(s)] versus high [≥ 2 experiences]). Current stressful life events were assessed using a structured interview (low [0-1 events] vs. high [≥ 2 events]). Generalised estimating equation models were used to model associations with the outcome of interest-clinically significant depression symptoms (CESD ≥16)-and risk factors: inflammatory marker levels (log transformed), adverse childhood experiences group, and current life stressors group. Covariates included menopause stage, age at study baseline, body mass index, race, and smoking status. We found a significant three-way interaction between log hsCRP levels, adverse childhood experiences group, and current life stressors group on likelihood of experiencing clinically significant depression symptoms (OR: 4.33; 95% CI: 1.22, 15.46; p = 0.024) after adjusting for covariates. Solely for women with high adverse childhood experiences and with high current life stressors, higher hsCRP was associated with higher odds of having clinically significant depression symptoms (OR: 1.46; 95% CI 1.07, 1.98; p = 0.016). This three-way interaction was not significant for IL-6, IL-1β, or TNF-α. For women in midlife with exposure to high adverse childhood experiences and multiple current life stressors, elevated levels of CRP were uniquely associated with clinically significant depression symptoms. Early life adversity and current life stressors represent identifiable individual risk factors whose negative impact may be curtailed with inventions to target inflammation in midlife women.

The Association Between Adverse Childhood Experiences and Preterm Delivery: A Latent Class Approach

Background: Racial and socioeconomic status (SES) disparities in preterm delivery (PTD) have existed in the United States for decades. Disproportionate maternal exposures to adverse childhood experiences (ACEs) may increase the risk for adverse birth outcomes. Moreover, racial and SES disparities exist in the prevalence of ACEs, underscoring the need for research that examines whether ACEs contribute to racial and SES disparities in PTD. Methods: We examined the relationship between ACEs and PTD in a longitudinal sample of N = 3,884 women from the National Longitudinal Study of Adolescent to Adult Health (1994-2018). We applied latent class analysis to (1) identify subgroups of women characterized by patterns of ACE occurrence; (2) estimate the association between latent class membership (LCM) and PTD, and (3) examine whether race and SES influence LCM or the association between LCM and PTD. Results: Two latent classes were identified, with women in the high ACEs class characterized by a higher probability of emotional abuse, physical abuse, sexual abuse, and foster care placement compared with the low ACEs class, but neither class was associated with PTD. Race and SES did not predict LCM. Conclusions: Our findings suggest that ACEs may not impact PTD risk in previously hypothesized ways. Future research should assess the impact of ACEs on the probability of having live birth pregnancies as well as the role of potential protective factors in mitigating the impact of ACEs on PTD.

Patterns of Adverse Childhood Experiences and Problematic Health Outcomes Among US Young Adults: A Latent Class Analysis

INTRODUCTION

Adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied.

METHODS

Latent class analysis (LCA) identified classes of ACEs among 2209 US young adults (Mage = 24.69, range: 18-34; 57.4% female; 30.9% sexual minority; 35.8% racial/ethnic minority) in a 2-year study (2018-2020). Multivariable logistic regressions examined ACEs (reported in 2019) in relation to 2020 reports of current (past 30-day) substance use (ie, tobacco use; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, ≥moderate depression and anxiety symptoms), controlling for sociodemographics (ie, age, gender, race, ethnicity, sexual orientation, education).

RESULTS

Overall, 65.4% reported ≥1 ACE (M = 2.09, SD = 2.30); 34.8%, 39.1%, and 71.1% current tobacco, cannabis, and alcohol use; 39.1% and 15.3% hazardous cannabis use and binge drinking; and 24.2% and 34.5% ≥moderate depression and anxiety symptoms, respectively. LCA yielded 4 classes: Low ACEs (referent; 55.6%), Poor family health and divorce (16.3%), Parental abuse (16.0%), and High ACEs (12.1%). High ACEs (vs Low ACEs) was associated with each adverse substance use and mental health outcome except alcohol use. Poor family health and divorce was associated with tobacco use, cannabis use, and both mental health outcomes. Parental abuse was associated with tobacco use, cannabis use, hazardous cannabis use, and both mental health outcomes.

CONCLUSIONS

Health promotion interventions for young adults must assess ACEs, given that certain types of ACEs may be associated with distinct substance use and mental health outcomes.

Does Where You Work and What You Do Matter? Testing the Role of Organizational Context and Job Type for Future Study of Occupation-Based Secondary Trauma Intervention Development

Organizational context (e.g., criminal justice, community-based, and healthcare) and job type (e.g., police, social workers, and healthcare providers) may impact the extent of occupation-based secondary trauma (OBST). Survey data collected from a multiphase community-based participatory research project were analyzed from a variety of professionals, who were likely to "encounter the consequences of traumatic events as part of their professional responsibilities" (n = 391, women = 55%, White = 92%). Results document high trauma exposure (adverse childhood experiences [ACEs] and workplace) and OBST-related outcomes (Maslach Burnout Inventory, Secondary Traumatic Stress Scale, post-traumatic stress disorder symptom checklist for DSM-5) for the entire sample with important differences across organizational context and job type. Using multivariate regression, the strongest determinants of suffering, however, were not related to a provider's specific profession but to their number of years on the job and their ACEs (e.g., adjusted R2 = 0.23, b = 2.01, p < .001). Likewise, the most protective factors were not profession specific but rather the provider's age and perceived effectiveness of OBST-related training (e.g., b = 2.26, p < .001). These findings inform intervention development and have implications for rural and other often under-resourced areas, where the same OBST-related intervention could potentially serve many different types of providers and organizations.

A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges

Adverse childhood experiences (ACEs) studies reveal the profound impacts of experiencing trauma and hardships in childhood. However, the cumulative risk approach of treating ACEs obscures the heterogeneity of ACEs and their consequences, making actionable interventions impossible. latent class analysis (LCA) has increasingly been used to address these concerns by identifying underlying subgroups of people who experience distinctive patterns of co-occurring ACEs. Though LCA has its strengths, the existing research produces few comparable findings because LCA results are dependent on ACEs measures and indicators, which vary widely by study. Therefore, a scoping review of ACEs studies using LCA that focuses on ACEs measures, indicators, and findings is needed to inform the field. Following Arksey and O'Malley's five-stage scoping review methodological framework, we first identified 211 articles from databases of EBSCOhost, PubMed, and Scopus using "adverse childhood experiences" for title search and "latent class analysis" for abstract search. Based on the inclusion criteria of peer-reviewed articles written in English published from 2012 to 2022 and the exclusion criteria of nonempirical studies and the LCA not analyzing ACEs, we finally selected 58 articles in this scoping review. Results showed LCA has been increasingly endorsed in the ACEs research community to examine the associations between ACEs and human health and well-being across culturally diverse populations. LCA overcame the limitations of the traditional methods by revealing specific ACEs clusters that exert potent effects on certain outcomes. However, the arbitrary nature of selecting ACEs indicators, measures, and the limited use of theory impedes the field from moving forward.

Pathways between adverse childhood experiences and viral suppression among male HIV-infected adolescents in South Africa

Fewer adolescents achieve viral suppression compared to adults. One impediment may be a history of adverse childhood experiences (ACEs). To better develop targets and timeframes for intervention, this study created more robust estimates of the impact of cumulative adversity on viral suppression, tested whether the association is sensitive to the timing of adversity, and simultaneously tested several potential mechanisms. We focus on males, who have lower viral suppression than females and who may contribute to disproportionate incidence among young women. We recruited 251 male perinatally HIV-infected adolescents aged 15-19 from HIV clinics in Soweto, South Africa. Adversity was captured using the Adverse Childhood Experience - International Questionnaire (ACE-IQ). Viral load was measured using blood samples; viral suppression was defined as <20 copies/mL. Indicators of medication adherence, depression, post-traumatic stress disorder (, and substance misuse were captured. A series of pathway analysis were performed. Our sample experienced a median of 7 lifetime and 4 past-year adversities. Less than half (44%) exhibited viral suppression. Adversity demonstrated a significant association with suppression; depression mediated the association. Primary prevention of adversity among children living with HIV is paramount, as is addressing the subsequent mental and behavioral health challenges that impede viral suppression among adolescents.

Placental Cortisol Dysregulation in Mothers with Experiences of Childhood Adversity: Potential Mechanisms and Clinical Implications

Adverse childhood experiences (ACEs) are extremely prevalent in the United States population. Although ACEs occurs in childhood, exposure to them has been associated with adverse future pregnancy outcomes and an increased risk of poorer social determinants of health, which further drive the risk of negative pregnancy outcomes. In addition, maternal ACE exposure has been linked to poor infant and child outcomes, highlighting the intergenerational transmission of risk from mother to child. While alterations along the Maternal-Placental-Fetal Hypothalamic-pituitary-adrenal (HPA) axis is hypothesized to be involved, the exact biological pathway underlying this intergenerational passage of risk is mostly unknown. This present work will highlight what is known about pregnancy-related stress hormone physiology, discuss the potential mechanisms of action of ACEs on cortisol regulation, and suggest opportunities for further clinical and translational studies.

Increases in stress and adverse childhood experiences are associated with the co-occurrence of anxiety and depression in oncology patients

PURPOSE

Identify subgroups of patients with distinct joint anxiety AND depression profiles and evaluate for differences in demographic and clinical characteristics, as well as stress, resilience, and coping.

DESIGN

Longitudinal study.

PARTICIPANTS

Patients (n = 1328) receiving chemotherapy.

METHODS

Measures of state anxiety and depression were done six times over two cycles of chemotherapy. All of the other measures were completed prior to second or third cycle of chemotherapy. Latent profile analysis was used to identify the distinct joint anxiety and depression profiles.

FINDINGS

Three classes were identified (i.e. Low Anxiety and Low Depression (57.5%); Moderate Anxiety and Moderate Depression (33.7%), High Anxiety and High Depression (8.8%)). For all of the stress measures, a dose response effect was seen among the profiles. Two worst profiles reported higher occurrence rates for a number of adverse childhood experiences.

IMPLICATIONS FOR PROVIDERS

Patients need referrals for stress reduction techniques and mental health and social services.

Adverse childhood experiences, dental insurance, and developmental disability: Association with unmet dental needs in Ohio

OBJECTIVE

This study investigated whether insurance status and/or developmental disability moderated the association between adverse childhood experiences (ACE) and unmet dental needs among children aged 0 to 17 in Ohio.

METHODS

We utilized cross-sectional data from the 2021 Ohio Medicaid Assessment Survey to assess the dental needs of children. ACE scores, dental insurance status, and developmental disability status were analyzed using multivariable logistic regression to identify their potential association with parental-reported unmet dental needs.

RESULTS

The weighted sample represented 2,752,222 children in Ohio. Over half reported zero ACEs (55.8%) and no dental needs (56.1%). Approximately 1 in 9 lacked dental insurance (11.1%), and 1 in 10 had a developmental disability (9.9%). Children with one to three ACEs had three times the odds of unmet dental needs compared to children with zero ACEs (OR = 3.20; 95%CI [2.10, 4.89]), and children with four or more ACEs had eight times the odds of unmet dental needs (OR = 8.78; 95%CI [5.26, 14.67]). Children lacking dental insurance had over six times higher odds of unmet dental needs compared to children with dental insurance (OR = 6.10; 95%CI [3.92, 9.49]). The presence of developmental disability status did not moderate the presence of unmet dental needs; however, the lack of dental insurance status significantly moderated the association between ACEs and unmet dental needs.

CONCLUSION

Insurance status, not developmental disability, moderated the association between ACEs and unmet dental needs among children in Ohio. Efforts to ensure continuous access to dental insurance are warranted.

Childhood adversities characterize the heterogeneity in the brain pattern of individuals during neurodevelopment

BACKGROUND

Several factors shape the neurodevelopmental trajectory. A key area of focus in neurodevelopmental research is to estimate the factors that have maximal influence on the brain and can tip the balance from typical to atypical development.

METHODS

Utilizing a dissimilarity maximization algorithm on the dynamic mode decomposition (DMD) of the resting state functional MRI data, we classified subjects from the cVEDA neurodevelopmental cohort (n = 987, aged 6-23 years) into homogeneously patterned DMD (representing typical development in 809 subjects) and heterogeneously patterned DMD (indicative of atypical development in 178 subjects).

RESULTS

Significant DMD differences were primarily identified in the default mode network (DMN) regions across these groups (p < 0.05, Bonferroni corrected). While the groups were comparable in cognitive performance, the atypical group had more frequent exposure to adversities and faced higher abuses (p < 0.05, Bonferroni corrected). Upon evaluating brain-behavior correlations, we found that correlation patterns between adversity and DMN dynamic modes exhibited age-dependent variations for atypical subjects, hinting at differential utilization of the DMN due to chronic adversities.

CONCLUSION

Adversities (particularly abuse) maximally influence the DMN during neurodevelopment and lead to the failure in the development of a coherent DMN system. While DMN's integrity is preserved in typical development, the age-dependent variability in atypically developing individuals is contrasting. The flexibility of DMN might be a compensatory mechanism to protect an individual in an abusive environment. However, such adaptability might deprive the neural system of the faculties of normal functioning and may incur long-term effects on the psyche.

Adverse Childhood Experiences and Prescription Stimulant Use in Adults: A Systematic Review

Nonmedical prescription stimulant use (NPSU) is an ongoing public health crisis in the United States. There exists, however, a dearth of research investigating specific childhood risk factors that may contribute to this illicit use. Adverse childhood experiences (ACEs) may be a significant risk factor to address in the prevention and treatment of NPSU, as research has provided evidence for increased substance use, potentially including prescription stimulant misuse, among individuals who have experienced trauma. A systematic review of the literature was conducted to gather and synthesize research articles specifically examining the relationship between nonmedical prescription stimulant use in adults and the experience of adverse childhood experiences (ACEs). Four studies met all inclusion criteria and were included in the review. The results demonstrated that the nonmedical use of prescription stimulants in adults is significantly associated with ACEs, with a higher numerical count of ACEs associated with a greater likelihood of nonmedical prescription stimulant use. Gaps in the literature were identified, specifically noting a lack of information available regarding the relationship between ACEs and NPSU within gender- and racially diverse populations. The findings have implications for informing interventions related to ACEs and the misuse of prescription stimulant medication in adults.

Personalized Mobile Health-Enhanced Cognitive Behavioral Intervention for Maternal Distress: Examining the Moderating Role of Adverse Childhood Experiences

BACKGROUND

Maternal history of trauma is a risk factor for distress during pregnancy. The purpose of this paper was to examine the theorized differential impact of a cognitive behavioral intervention (Mothers and Babies Personalized; MB-P) on maternal distress and emotional regulation for those with ≥ 1 adverse childhood experiences (ACEs; vs no ACEs) from pregnancy to 3 months postpartum.

METHODS

Between August 2019 and August 2021, eligible pregnant individuals aged ≥ 18 years, < 22 weeks' gestation, and English-speaking were recruited from 6 university-affiliated prenatal clinics. Participants (N = 100) were randomized to MB-P (n = 49) or control (n = 51). Analyzable data were collected for 95 participants. Analyses tested progression of change (slope) and at individual timepoints (panel analysis) for perinatal mental health outcomes.

RESULTS

The majority of participants (n = 68, 71%) reported experiencing > 1 ACE (median = 1, range: 0-11). Participants demonstrated significant differential effects for depressive symptoms in absence of ACEs (standardized mean differences [SMD] = 0.82; 95% confidence interval [CI] = [0.13-1.51]) vs in presence of ACEs (SMD = 0.39; 95% CI = [-0.20 to 0.97]) and perceived stress in absence of ACEs (SMD = 0.92; 95% CI = [0.23-1.62]) vs in presence of ACEs (SMD = -0.05; 95% CI = [-0.63 to 0.53]). A panel analysis showed significantly reduced depressive symptoms postintervention and increased negative mood regulation at 3 months postpartum for individuals with ACEs.

CONCLUSIONS

Findings support effectiveness of the MB-P intervention to reduce prenatal distress for all pregnant individuals. Preliminary exploration suggests the possibility that individuals with ACEs may benefit from enhanced trauma-informed content to optimize the effects of a perinatal intervention.

Transformational narrative changes as a community-level approach to the prevention of adverse childhood experiences and substance use

There is increasing scientific evidence linking substance use, childhood adversity, and social determinants of health. However, little research has considered the evaluation of community-level strategies to reduce substance use by increasing awareness and implementation of evidence-based strategies for preventing adverse childhood experiences (ACEs). This article lays out the conceptual framework for a $2.9 million demonstration project designed to raise awareness of the impact of ACEs on substance use, including primary prevention strategies. Communities used transformational narrative change-with an emphasis on the voices of those most impacted by ACEs and substance use-to highlight the importance of addressing social determinants of health along with primary prevention strategies. The conceptual background highlighted in this article informed media, public health, and local efforts in the three accompanying articles and invited commentary. These findings may help inform future efforts to promote community-level strategies and strengthen the evidence-base for transformational narrative change efforts.

Reduced reactivity to fear conditioning and pain tests in persons involved in violent video gaming is influenced by adverse childhood experiences

Video gaming, including violent video gaming, has become very common and lockdown measures of the COVID-19 pandemic even increased the prevalence rates. In this study, we examined if violent video gaming is associated with more adverse childhood experiences (ACE) and if it impairs pain processing and fear conditioning. We tested three groups of participants (violent video gamers, nonviolent video gamers, and non-gamers) and examined fear conditioning as well as pain perception during functional magnetic resonance imaging (fMRI). Violent video gamers displayed significantly higher pain thresholds as well as pain tolerance for electric stimulation, pressure pain stimulation, and cold pressor pain measurements than nonviolent video gamers and non-gamers. This relationship was moderated by adverse childhood experiences, especially physical neglect. Brain images acquired during the fear conditioning fMRI task showed that violent video gamers display significantly less differential brain activation to stimuli signaling pain versus no pain in the anterior cingulate cortex, the juxtapositional lobule cortex, and the paracingulate gyrus compared to non-gamers. There was also a significant negative correlation between adverse childhood experiences and activation in the precuneus and the intracalcarine cortex for signals of pain versus safety. The results of this study imply that violent video gaming is related to reduced processing of pain and signals of pain in a fear learning task, dependent of adverse childhood experiences. These mechanisms need to be examined in more detail and these data could be helpful in preventing the onset and adverse consequences of violent video gaming.

Sleep Quality as a Critical Pathway Between Adverse Childhood Experiences and Multimorbidity and the Impact of Lifestyle

OBJECTIVES

This study aims to establish the effects of ACEs on multimorbidity through sleep quality and investigate whether lifestyle factors (e.g., eating habits and exercise) may influence this relationship among middle-aged and older adults.

METHODS

Participants were drawn from a cross-sectional sample of community dwelling older adults (N = 276, 55+) and three waves of data from the Midlife in the United States study (MIDUS, N = 843). We examined the direct and indirect effects of ACEs, sleep quality, and health conditions, as well as the conditional effects of physical activity and eating habits.

RESULTS

Across both samples, sleep quality mediated the relationship between ACEs and chronic health conditions. Moderating effects of unhealthy eating and physical activity differed between samples.

DISCUSSION

Sleep quality is an important pathway connecting ACEs and adult multimorbidity, and health behaviors may provide targets for intervention particularly in older adults.

Maternal childhood adversity and pregnancy intentions as predictors of pregnancy happiness

OBJECTIVES

Nearly half of all pregnancies in the U.S. are classified as unintended (e.g. unplanned, mistimed, or unwanted), which have been linked to numerous adverse consequences for maternal and child outcomes. Recent evidence suggests that happiness about a pregnancy is often a better predictor of maternal and infant health outcomes than pregnancy intentions, but few studies have examined maternal predictors of pregnancy happiness.

METHODS

Using a clinic-based sample of pregnant women (n = 177), we apply multiple regression analysis to examine the association between maternal adverse childhood experiences and pregnancy happiness, as well as the moderating role of pregnancy intentions.

RESULTS

Women with more childhood adversity and pregnancies that were unplanned and mistimed or unwanted reported lower levels of pregnancy happiness, compared with women with less childhood adversity and intended pregnancies. However, pregnancy intentions did not moderate the relationship between maternal adverse childhood experiences and pregnancy happiness.

CONCLUSION

Our results suggest that pregnancy happiness is lower among mothers with a history of childhood adversity and pregnancies classified as unplanned and mistimed or unwanted. Understanding the factors that impact pregnancy happiness is critical to inform prenatal clinical practice and health policy, particularly when caring for those with a history of adversity.

Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis

OBJECTIVE

Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events.

DATA SOURCES

PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022.

STUDY ELIGIBILITY CRITERIA

Observational cohort, cross-sectional, and case-control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English.

METHODS

Two reviewers independently screened studies, obtained data, and assessed study quality, and conflicts were resolved by a third reviewer. Dichotomous outcomes were evaluated using meta-analysis, and pooled odds ratios and 95% confidence intervals were generated using random-effects models. Moderation analysis and meta-regression were used to investigate heterogeneity.

RESULTS

In total, 21 cohort studies, 9 cross-sectional studies, and 3 case-control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33-2.76; I2=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23-2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14-3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88-8.30; I2=99.9%; P<.001). Considerable heterogeneity (I2>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance.

CONCLUSION

The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.

The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study

BACKGROUND

A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency.

METHODS

An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors.

RESULTS

A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress.

CONCLUSIONS

The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.

Association of adverse childhood experiences with irritable bowel syndrome in Mexican adults: A cross-sectional study

BACKGROUND

Adverse childhood experiences (ACEs) are linked to the development of gastrointestinal disorders during adulthood, but there is limited research on the prevalence of ACEs in Latin American populations. This study aimed to assess the prevalence and impact of ACEs on Mexican adults with irritable bowel syndrome (IBS).

METHODS

In this cross-sectional study, we recruited 290 Mexican adults (aged 18-65), including 90 individuals with IBS and 200 healthy controls. All participants completed four self-reported questionnaires: The Adverse Childhood Experiences Questionnaire (ACEs), Visceral Sensitivity Index, Irritable Bowel Syndrome Symptom Severity Scale, and Hospital Anxiety and Depression Scale. Statistical analyses included mean differences using either the Student's t-test or the Wilcoxon test, correlations assessed with Spearman's correlation coefficient, and logistic regression models. Statistical significance was defined as a p-value less than 0.05.

KEY RESULTS

Among IBS subjects, the prevalence of ACEs was 80%, significantly higher than the 59% prevalence observed in controls (p < 0.0001). Individuals with ACEs exhibited elevated levels of anxiety and depression. Seventy-five percent of IBS subjects with severe symptoms reported four or more ACEs. The presence of four or more ACEs was found to be associated with an increased risk of IBS.

CONCLUSIONS AND INFERENCES

ACEs are notably prevalent among Mexican individuals with IBS and are positively correlated with the severity of gastrointestinal pain. These findings underscore the critical significance of evaluating and addressing ACEs in the comprehensive management of IBS within Latin American populations.

Childhood and Adulthood Trauma Associate With Cognitive Aging Among Black and White Older Adults

Sociocontextual factors powerfully shape risk for age-related cognitive impairment, including excess risk burdening medically underserved populations. Lifecourse adversity associates with cognitive aging, but harms are likely mitigable. Understanding population-salient relationships and sensitive periods for exposure is crucial for targeting clinical interventions.

OBJECTIVE

The authors examined childhood and adulthood traumatic events in relation to cognition among Black and White older adults in the Health and Retirement Study (HRS).

PARTICIPANTS

Participants (N = 13,952) aged 55+ had complete lifetime trauma and cognitive testing data at the 2006/08, 2010/12, and/or 2014/16 waves.

MEASURES

Trauma indices comprised childhood and adulthood event counts. Outcomes included baseline performance and trajectories on the Telephone Interview for Cognitive Status.

DESIGN

Main and nonlinear trauma effects were modeled via linear regression, and overall contributions assessed with omnibus likelihood ratio tests.

RESULTS

Black participants (N = 2,345) reported marginally lower adulthood trauma exposure than White participants (N = 11,607) with no other exposure differentials observed. In White participants only, greater childhood trauma exposure predicted worse baseline cognition but slower change over time. Across race, adulthood trauma robustly associated with baseline cognition. Relationships were frequently nonlinear: low but nonzero trauma predicted highest cognitive scores, with much poorer cognition observed as trauma exposure increased. Relationships between adulthood trauma and trajectory were limited to the White sample.

CONCLUSION

Traumatic experiences, particularly in adulthood, may impact late-life cognitive health if not addressed. Findings highlight foci for clinical researchers and providers: adverse life events as a source of cognitive risk, and identification of community-specific resources that buffer behavioral, physical, and mental health sequelae of previous and incident trauma.

Parental attachment and childhood trauma in adolescents engaged in non-suicidal self-injury

AIM

In this study, it was aimed to compare parental attachment and childhood traumas in adolescents with NSSI with healthy peers.

METHODS

Fifty adolescents aged 14-18 years with lifetime NSSI and 56 healthy peers were included in the study. Inventory of Statements About Self-injury (ISAS), The Parental Bonding Instrument (PBI) and Child Trauma Questionnaire (CTQ-28) scales were used.

RESULTS

Eighty-two percentage of the NSSI group and 70% of the control group were girls. The mean age was 15.6 ± 1.1 years in the NSSI group and 15.3 ± 0.9 years in the control group. There was no significant difference between the groups in terms of age and gender. The NSSI group had more negative scores than the control group in terms of childhood traumas and attachment characteristics to both mother and father. The analyses showed that mother PBI care/control and sexual abuse score had a relationship with both ISAS Autonomic Functions and ISAS Social Functions scores.

CONCLUSIONS

These results suggest that secure attachment with the mother may be protective for both the autonomic and social functions of the NSSI. Therefore, interventions for dysfunctional parental attachment may prevent the development of NSSI.

An Integrative Review of Adverse Childhood Experiences and Reproductive Traumas of Infertility and Pregnancy Loss

INTRODUCTION

Adverse childhood experiences (ACEs) can lead to chronic diseases and mental health conditions; however, less is known about the associations of ACEs to the reproductive traumas of infertility and pregnancy loss. The purpose of this integrative review was to explore relationships between ACEs and the reproductive traumas of infertility and pregnancy loss.

METHODS

We searched PubMed, SocINDEX, PsycINFO, and CINAHL databases in December 2021 and 2022. Inclusion criteria were qualitative or quantitative research, systematic or integrative reviews, or meta-analysis articles in English that were peer-reviewed and full-text, addressing any ACE from the ACE Checklist and infertility or pregnancy loss. A total of 20 articles were included in the review. We used Whittemore and Knafl's integrative review framework, Preferred Reporting Items for Systematic Reviews and Meta-analyses for reporting, and Covidence software for data management. A quality appraisal using Joanna Briggs Institute critical appraisal tools was performed. Relevant data were extracted into a matrix for iterative comparison.

RESULTS

Twenty studies were included in the review. Results support there may be an association between pregnancy loss and infertility in women with a history of ACE, although results are mixed between infertility and ACEs. We also identified other concepts related to ACEs and the reproductive traumas of infertility and pregnancy loss and include racial and ethnically diverse populations, social determinants of health, modifiable risk factors, and stress appraisals.

DISCUSSION

Midwives and other women's health care providers should be aware that ACEs may be associated with pregnancy loss and infertility, although additional research is needed to further explore the relationships with infertility, mental health, and hypothalamic-pituitary-adrenal axis dysregulation from allostatic load. Trauma-informed care and the development of effective interventions are warranted for women who experience ACEs. Providers should consider earlier interventions, including emotional services, for women with a history of ACE or reproductive trauma.

Social Determinants of Health: Associations Between Dichotomous Versus Dimensional Scores, Neuropsychological Test Performance, and Psychiatric Symptoms

This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation (Mage = 43.91, 53.5% male, 44.2% non-Hispanic White). Both dimensional and dichotomous health literacy scores accounted for substantial variance in all cognitive outcomes assessed, whereas dimensional and dichotomous adverse childhood experience scores were significantly associated with psychiatric symptoms. Tests of differences between correlated correlations indicated that correlations with cognitive and psychiatric outcomes were not significantly different across dimensional versus dichotomous scores, suggesting that these operationalizations of SDOH roughly equivalently characterize risk of poorer cognitive performance and increased psychiatric symptoms. Results highlight the necessity of measuring multiple SDOH, as different SDOH appear to be differentially associated with cognitive performance versus psychiatric symptoms. Furthermore, results suggest that clinicians can use cut-scores when characterizing patients' risk of poor cognitive or psychiatric outcomes based on SDOH.

Adverse childhood experiences and early initiation of substance use: A survival analysis

OBJECTIVE

Early adversity, such as adverse childhood experiences (ACEs), is a risk factor for the development of substance use disorder (SUD). ACEs are associated with earlier initiation of substance use. This study examined the relationship between ACEs and age of initiation of substance use using survival analysis. It is hypothesized that individuals with higher ACEs will have an earlier age of initiation.

METHOD

Participants were recruited from the University of Kentucky's Laboratory for Human Behavioral Pharmacology. Participants were 18 years or older, English speaking, and actively engaged in substance use. Participants were not in substance abuse treatment nor were they seeking treatment. ACE scores were calculated, and age of substance use initiation was recorded. A Cox proportional hazard model was used to examine the effect of ACE score on age of substance use initiation.

RESULTS

A total of 107 participants completed the study. An average number of 2.3 ACEs (SD = 2.2) were endorsed with 24% of participants reporting 4 or more ACEs. Higher ACE scores were associated with cigarette smoking and non-medical prescription opioid use onset ( hazard ratio (HR) = 1.14, 95% CI=1.02-1.28, p = 0.02, and HR=1.19, 95% CI = 1.04-1.37, p = 0.01, respectively.

CONCLUSIONS

A significant association was found between higher ACE scores and earlier initiation of cigarette and non-medical prescription opioid use, consistent with prior research. Primary prevention of ACEs, screening for ACEs during childhood, and interventions for ACEs if detected, may help to reduce the risk of substance use/SUD in adulthood.

Substance use among rural adolescents with incarcerated parents: Evidence from a state-wide sample

PURPOSE

Incarceration rates are highest in rural communities, disproportionately exposing rural children to parental incarceration (PI). Substance use is a pressing public health issue-and a key driver of incarceration-in rural areas, yet limited research has examined PI as a social determinant of health for adolescent alcohol and drug use. This study links exposure to PI with rural adolescent substance use and examines the role of coresidence with parents in these associations.

METHODS

Data come from the 2019 Minnesota Student Survey, including 18,820 rural adolescents. Respondents self-reported experiences of PI (current, former, never), whether they lived with the parent at the time of incarceration, and past-year alcohol, marijuana, cocaine, heroin, and methamphetamine use.

FINDINGS

Over 22% of rural adolescents experienced PI. In adjusted logistic regression models, current PI was associated with greater past-year alcohol (aOR = 2.20), marijuana (aOR = 4.08), cocaine (aOR = 3.61), heroin (aOR = 4.96), and methamphetamine (aOR = 5.43) use compared to peers who never experienced PI. Current PI was also associated with greater counts of use. Associations between coresidence and substance use were largely nonsignificant.

CONCLUSIONS

The elevated risk for substance use in the context of rural PI and its adverse sequelae call for expanded prevention and intervention strategies that support adolescent health alongside targeted decarceration efforts in rural communities that reduce the number of families put in the potentially compromising situation of PI.

Parenting the parent without losing sight of the child. A qualitative study of therapists' experiences with intergenerational adversities in perinatal psychotherapy

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow-up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry.

Pathway to terrorist behaviors: The role of childhood experiences, personality traits, and ideological motivations in a sample of Iraqi prisoners

Radicalization to terrorism is a multifaceted process with no single theory or approach to explain it. Although research has focused on understanding the process, there is still a dearth of studies that examine an empirically driven pathway to terrorism behavior. This study examines a cross-sectional sample of incarcerated men convicted of terrorism in Iraq (N = 160). A questionnaire-guided interview included adverse childhood experiences (ACEs), conduct disorder (CD), antisocial personality disorder (ASPD), religious and political ideology, views about causes of terrorism, and the severity of terrorist acts. Path analysis was employed to examine the relationships between these factors and to identify the model with the best fit. After adjusting for age, employment, and location, results indicated that ACEs positively impacted CD, ASPD, religious guidance, and terrorism attitudes. ASPD positively affected political commitment and terrorism attitudes, but inversely affected current religious commitment. Political commitment inversely influenced terrorism attitudes. Religious commitment positively influenced the prioritization of religion in life, which subsequently impacted terrorism attitudes and behavior severity. Additionally, attitudes toward terrorism directly affected the severity of terrorism behavior. All paths in the final model were statistically significant at p < 0.05. Although these findings may be limited in generalizability due to the unique sample, results support the complex and interdependent nature of childhood and adult experiences on the development of both terrorism attitudes and the severity of terrorism behavior.

Older mothers and their difficult adult children: a life course exploration

Adult child to parent violence is a growing international social problem that needs to be better understood to develop clinical interventions. An exploratory study on the antecedents of early life adversity on adult child to parent violence/elder mistreatment was carried out using secondary analysis. Directed content analysis was used based on life course theory with a data set of older mothers all > 57 years old (J. R. Smith 2021, 2022). Measurement of instances of child abuse, domestic violence, and birth trauma among abused older mothers was conducted. All the older women had reported being negatively affected by their adult children's problems and 56% reported being physically attacked. A case example is presented to illustrate how repeated incidents of abuse or neglect in early life might explain an older woman's inability to take actions for her own safety.

What are the Experiences of and Interventions for Adult Survivors of Childhood Sexual Abuse in South Asia? A Systematic Review and Narrative Synthesis

Adult survivors of childhood sexual abuse (CSA) may experience emotional, social, and psychological difficulties, heightened due to the interpersonal nature of harm. Despite the demonstrated effectiveness of trauma-focused treatments in the West, a culturally specific understanding of the needs of and treatments for survivors in South Asia is still in its infancy. The study aimed to systematically review research findings on the mental health impacts of CSA on adult survivors and current treatment approaches and their efficacy and acceptability in South Asia. Seven databases (Scopus, Ovid, CINAHL, ProQuest, EThOS, Google Scholar, and Dogpile) and five peer-reviewed South Asian journals were searched from inception until March 30, 2023. Searches included participants who were adult survivors of CSA of South Asian origin residing in South Asia. Studies on their mental health, different treatments, and the efficacy and acceptability of these treatments were included. Quality assessment tools were used to appraise the quality of included studies. The results were synthesized narratively. A total of 3,362 records were retrieved, and 24 articles were included in the final review. Twenty studies reported mental health impacts of CSA on adult survivors, four studies reported current treatments offered, and two studies were on recovery. However, no study focused on the efficacy or acceptability of the treatments being delivered. Even though the needs of adult CSA survivors in South Asia have been partly identified, there is very little research into the treatments for them.