Article

Developmental timing of child maltreatment and symptoms of depression and suicidal ideation in young adulthood: Results from the National Longitudinal Study of Adolescent Health

Authors:
  • Harvard T. H. Chan School of Public Health
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Abstract

Background: Child maltreatment is a potent risk factor for psychopathology. Although the developmental timing of first exposure to maltreatment is considered important in shaping risk of future psychopathology, no consensus exists on whether earlier or later exposures are more deleterious. This study examines whether age at first exposure to abuse is associated with subsequent depression and suicidal ideation. Methods: Data were drawn from the National Longitudinal Study of Adolescent Health (n = 15,701). Timing of first maltreatment exposure was classified using: (1) a crude measure capturing early childhood (ages 0-5), middle childhood (ages 6-10), or adolescence (ages 11-17); and (2) a refined measure capturing infancy (ages 0-2), preschool (ages 3-5), latency (ages 6-8), prepubertal (ages 9-10), pubertal (ages 11-13), or adolescence (ages 14-17). We examined whether timing of first exposure was associated with depression and suicidal ideation in early adulthood in the entire sample and among those exposed to maltreatment. Results: Respondents exposed to abuse, particularly physical abuse, at any age had a higher odds of depression and suicidal ideation in young adulthood than non-maltreated respondents. Among maltreated respondents, exposure during early childhood (ages 0-5), particularly preschool (ages 3-5), was most strongly associated with depression. Respondents first exposed to physical abuse during preschool had a 77% increase in the odds of depression and those first exposed to sexual abuse during early childhood had a 146% increase in the odds of suicidal ideation compared to respondents maltreated as adolescents. Conclusions: Developmental timing of first exposure to maltreatment influences risk for depression and suicidal ideation. Whether these findings are evidence for biologically based sensitive periods requires further study.

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... Accordingly, the experience of abuse, regardless of the types of sexual assault (being touched or raped), is associated with stress among survivors (Pérez-Fuentes et al., 2013). The association of CSA with lifetime psychiatric diagnoses and suicide attempts (Dunn et al., 2013), fears of revictimization, intimate relationship dissatisfaction (Jaffe et al., 2012;Pérez-Fuentes et al., 2013;Schuetze & Eiden, 2005), and alcohol and substance use problems (Jong et al., 2015) is well-documented, across both male and female genders. ...
... Furthermore, emotional regulation and cognitive development likely mediate this relationship. While there is no study to examine the specific association between age of parents at the time of CSA and parenting outcomes, research findings on the impact of childhood maltreatment experiences and adult mental health suggest that developmental timing of trauma exposure is related to the trajectory of emotion dysregulation in adult survivors (Dunn et al., 2013;Dunn et al., 2018;Ehring & Quack, 2010). Proposition 3: The relationship between parents with a history of CSA and parenting outcomes may be moderated by the parent's gender. ...
... In particular, survivors of early-onset chronic interpersonal trauma reported significantly higher emotion regulation difficulties than survivors who experienced noninterpersonal traumas and early single interpersonal trauma (Ehring & Quack, 2010). Compared to adolescence, first exposure to CSA during early childhood (aged 0-5 years) is associated with higher suicidal ideation in early adulthood (Dunn et al., 2013). Developmental theories in psychology agree that the experience of crisis in different developmental phases of childhood yields different outcomes during adulthood. ...
Article
Transitioning to a parenting role is a complex psychological process that can be stressful for a parent with a history of childhood sexual abuse (CSA). Over the past decade, important advances have been made in identifying the effects of childhood trauma on parents' relationships with their children. This article presents a new theoretical framework that emerged from a scoping study of parenting experiences among adults who experienced CSA. The methods of Arksey and O'Malley were used to conduct the scoping study, and the guidelines for theory construction and model building developed by Jaccard and Jacoby were adopted. Only peer-reviewed published journal articles in English that studied exclusively CSA and its effects on parenting among individuals aged 18 years or older were included. Three resources for collecting data were used: (1) internet databases including PsycINFO and PubMed, (2) reference lists of review articles, and (3) the citation index functionality of Google Scholar for review articles. Forty-six articles were included in the scoping study. These studies mainly focused on mothers and their relationships with their children. No articles considered the age(s) at which parents experienced CSA and potential effects on parenting outcomes. In addition, there is limited knowledge about fathers with a history of CSA and their relationship with their children. The development of a theoretical framework designed through a methodologically driven identification of gaps in the body of knowledge provides a foundation for future research in this area.
... Several studies from high-income countries find evidence suggesting that early childhood (ages 0-5) may represent such a "sensitive period." For example, in separate studies from 2013 and 2017, Dunn and colleagues determined that young adults who had been abused in childhood were more likely to experience depression, suicidal ideation, and PTSD if the onset of abuse had occurred before the age of 5, rather than in adolescence (Dunn et al., 2013. Similarly, Keiley et al. (Keiley et al., 2001) found that earlier incidence of physical maltreatment of children was associated with higher levels of internalizing and externalizing problems as the children entered early adolescence (Keiley et al., 2001). ...
... Similarly, Keiley et al. (Keiley et al., 2001) found that earlier incidence of physical maltreatment of children was associated with higher levels of internalizing and externalizing problems as the children entered early adolescence (Keiley et al., 2001). Dunn and colleagues hypothesized that, as childhood violence victimization is known to impact the developmental processes that in turn affect emotional regulation, and given that these processes are developed most substantially in early childhood, experiencing violence during this period could have an especially negative impact on mental health later in life (Dunn et al., 2013;Shonkoff & Phillips, 2000). Two other studies similarly found that earlier exposure to trauma is associated with either a greater prevalence of major depressive disorder or PTSD; however, both studies treat pre-adolescence as a monolith, comparing only exposure during childhood to exposure during adolescence (Maercker et al., 2004;V. ...
... Furthermore, the present research advances the well-established literature on gender differences in mental health symptomology (Mościcki, 1994;Piccinelli & Wilkinson, 2000). The results noted for males may be indicative of broader gender norms related to mental health, coping mechanisms, and physical trauma and are in line with a body of literature that emphasizes the damaging effects of first exposure to physical violence in early childhood and internalizing mental health symptoms, namely anxiety and suicidal thoughts (Dunn et al., 2013Keiley et al., 2001;Maercker et al., 2004;V. McCutcheon et al., 2010), and externalizing symptoms (Dunn et al., 2019). ...
Article
Background A growing body of research has begun examining the relationship between a child's age at first exposure to violence and outcomes of mental wellbeing, though no studies have assessed these relationships in the sub-Saharan African (SSA) region. Objective Given known gender and sex differences in violence exposure and mental health symptomology, this study conducts a multi-country, gender-stratified analysis of the relationship between age at first incident of physical violence and outcomes of wellbeing in SSA. Participants and setting This study uses data from the Violence Against Children Surveys on 13–24-year-old males and females in five SSA countries (Kenya (2010), Malawi (2013), Nigeria (2014), Tanzania (2009), and Uganda (2015)). Methods The predictor of interest is a categorical variable indicating whether a respondent's first exposure to physical violence took place from 0 to 5, 6–11, 12 and older, or never. Outcomes of interest include: sadness, anxiety, suicide ideation, smoking, drug use, and alcohol use. Employing both country-specific and pooled data, gender-stratified, multiple logistic regressions are used to estimate the effect of age at first exposure to physical violence on the six outcomes of interest. Results Findings show significant variation across countries in age at first exposure to physical violence. For females, findings reveal no association between age at first exposure and outcomes of wellbeing; all periods were equally associated with poor outcomes. For males, results show increased likelihood of anxiety, suicide ideation, and alcohol use when the first violence exposure occurred from 0 to 5 years. Conclusions This study advances the literature on gender and sex differences in mental health symptomology, suggesting that boys and girls may exhibit different symptomology in response to comparable exposures to violence.
... In other words, it remains unknown whether sensitive periods exist for the effects of trauma on theory of mind development. Sensitive periods are specific windows of time during which human brain development is particularly plastic and, therefore, more responsive to life experiences [27,28]. Several cognitive domains, such as face processing and language acquisition, have timedependent growth and plasticity [29][30][31]. ...
... For each traumatic event endorsed, participants reported their age (in years) of their first exposure. Using this data, we created three categories for age at first exposure, which were aligned with previous research [27,59,60]: early childhood (age 0-5 years), middle childhood (ages 6-10 years), and adolescence (ages [11][12][13][14][15][16][17]. A main objective of this study was to test the existence of a sensitive period of childhood trauma on adult theory of mind ability. ...
Article
Full-text available
Theory of mind (ToM) is an essential social cognitive process encompassing abilities to represent and understand others’ mental states. Although previous reports linked childhood trauma to social cognitive deficits, how characteristics of trauma exposure, such as subtype or timing, affect ToM remains unaddressed. Using data from a diverse adult sample (n = 2200), we tested whether exposure type and first exposure timing of common childhood trauma associated with ToM. Neither interpersonal loss (β = − 0.25, p = 0.170, [− 0.61, 0.10]) nor child maltreatment (β = − 0.21, p = 0.369, [− 0.66, 0.25]) was associated with lower ToM. There was no effect of timing of age at which trauma was experienced (F = 2.19, p = 0.087). While we did not identify age-dependent effects, future studies should examine links between timing or chronicity of prospectively reported childhood trauma and social cognition. Understanding of how childhood experiences shape ToM could reveal mechanisms underlying social cognition development and inform prevention efforts.
... Investigators have found significant associations between childhood maltreatment and adolescent suicidal ideation (Fergusson et al., 2000) and attempts (Fergusson et al., 2000;Rhodes et al., 2012) using both cross-sectional (Hoertel et al., 2015) and prospective designs (Fergusson et al., 2000). These results extend to studies with young adults (Dunn et al., 2013;Johnson et al., 2002;Puzia et al., 2014) and adult samples (Dube et al., 2001). In a nationally representative sample of maltreated youth, researchers found that 23% of adolescents reported suicidal ideation (Coohey et al., 2014). ...
... Several studies have indeed investigated maltreatment timing and chronicity in relation to subsequent suicidal thoughts and behaviors during adolescence. In the National Longitudinal Study of Adolescent Health, adolescents who were first exposed to physical abuse in preschool (i.e., ages 3-5) or in adolescence (i.e., ages 11-17), and adolescents who were first exposed to sexual abuse in preschool, had a heightened risk for suicidal ideation (Dunn et al., 2013). Further, emerging adults who first experienced maltreatment during infancy were more likely to exhibit suicidal ideation compared to those who first experienced maltreatment in later childhood . ...
Article
Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.
... Personality traits such as trait anger, neuroticism, obsessive-compulsive traits, impulsivity, and impulsive-aggressive personality are associated with PMDD (Critchlow et al., 2001;Dawson et al., 2018;Ducasse et al., 2016;Gingnell et al., 2010;Hartlage and Arduino, 2002;Petersen et al., 2016;Sassoon et al., 2011;Soyda Akyol et al., 2013). There are many overlaps in the etiology of suicide and PMDD, i.e., environmental risk factors and correlates such as sexual, physical, and emotional abuse (Dunn et al., 2013;Fergusson et al., 2008;Gomez et al., 2017;Miller et al., 2017); psychological risk factors and correlates such as neuroticism, trait impulsivity, impulsive aggression, and anger (Daniel et al., 2009;Enns et al., 2003;Fergusson et al., 2000;Kasen et al., 2011;McGirr and Turecki, 2007;McKeown et al., 1998); biological risk factors and correlates such as abnormal brain structure and activity in the dorsolateral prefrontal cortex and default mode network (Gosnell et al., 2016;Ho et al., 2015;Zhang et al., 2016), alterations in serotonin function, and gene polymorphism like serotonin transporter gene (5-HTTLPR) polymorphism (Gingnell et al., 2010;Zalsman et al., 2001). Given these overlaps in the etiology of PMDD and suicide, patients with PMDD are speculated to have a higher risk of suicidality than healthy controls. ...
... Abnormal emotional regulation related to abnormal brain structure and function, and personality traits such as trait anger, neuroticism, impulsivity, especially impulsive-aggressive personality may explain a part of the increased suicide risk of women with PMDD Gingnell et al., 2012;Hartlage and Arduino, 2002;Petersen et al., 2018;Rapkin et al., 2011). A high proportion of women with PMDD have prior sexual, physical, and emotional abuse experiences compared to healthy controls, which may increase suicide risk in these patients (Dunn et al., 2013;Fergusson et al., 2008;Girdler et al., 2007;Girdler et al., 2003;Gomez et al., 2017;Miller et al., 2017;Soydas et al., 2014). Overall, the pathophysiology of the increased risk of suicidality in women with PMDD remains unclear. ...
Article
Background Whether premenstrual dysphoric disorder (PMDD) is correlated with the risk of suicidality and the extent of its effect on suicidality are unclear. The present study was conducted to elucidate the association between PMDD and suicidality from relevant studies. Methods Four electronic databases, namely, Scopus, Embase, PubMed, and Web of Science, were searched from inception to November 15, 2020. Quality assessment, data synthesis, and sensitivity analysis were performed on the included studies. Results Six studies with 8 532 participants were included in this meta-analysis. PMDD was associated with an increased risk of suicidal ideation (odds ratio [OR]=2.34, 95% confidence interval [CI]=1.50–3.18, I²=0.0%, p=0.99, k=4). Patients with PMDD had a greater risk of experiencing suicide attempt (OR=2.13, 95% CI=1.05–3.21, I²=0.0%, p=0.81, k=5). PMDD was associated with an increased risk of suicidal plan (OR=2.24, 95% CI=1.03–3.45, I²=0.0%, p=0.96, k=2). Limitations The diagnosis of PMDD should be considered “provisional” in all the included studies. Conclusions Among PMDD sufferers there would be a group of particularly suicidal women. Clinicians who treat patients with PMDD should be vigilant for signs of suicidal ideation and behavior to implement better treatment and preventive measures.
... For example, relations between childhood sexual abuse and suicidal thoughts and behaviors have been shown to be mediated via depressed mood for late adolescents of both genders (Sigfusdottir, Asgeirsdottir, Gudjonsson & Sigurdsson, 2013). This mediational path also appears to operate for childhood experiences of physical and emotional abuse (Dunn et al., 2013). In contrast, anxiety has been described as a protective factor for risk behaviors (Ham & Hope, 2006) and could operate similarly as a mediator of risk for suicidal thoughts. ...
... Although adolescent psychopathology mediated relations between childhood maltreatment and suicidal thoughts during adolescence, the only significant mediational path was that from neglect/negative home environment via affective disorder symptoms to suicidal thoughts. This finding replicated previous studies identifying a mediational role for depressive symptoms (e.g., Dunn et al., 2013;Miller et al., 2016). No mediational role was identified for either anxiety or conduct disorder symptoms in relations between childhood maltreatment and suicidal thoughts, although externalizing problems and anger have been found to predict suicidal thoughts and behaviors in some studies (Ammerman, Kleinman, Uyeji, Knorr, & McCloskey, 2015;Kerr, Reinke, & Eddy, 2013). ...
Article
Introduction Childhood maltreatment experiences are associated with future suicidal thoughts and suicide attempts, yet the roles of specific psychiatric symptoms mediating this relation remain to be clarified. To clarify these relations, we tested a model incorporating multiple forms of childhood maltreatment (sexual abuse, physical punishment, emotional neglect), past year psychiatric disorder symptoms during adolescence (anxiety, mood, and conduct disorders) and recent suicidal thoughts. Methods We administered structured interviews to 394 adolescents receiving outpatient substance use treatment services in the Southeastern United States (280 males; Mage = 16.33; SDage = 1.15). Structural equation models (SEMs) were used to evaluate the degree to which relations between childhood maltreatment and suicidal thoughts were mediated by specific past-year psychiatric symptoms. Results Mood disorder symptoms significantly mediated the relation between neglect/negative home environment and suicidal thoughts. This path of influence did not vary by gender. Conclusions Childhood maltreatment and subsequent psychopathology influence suicidal thoughts among adolescents receiving substance use treatment services. The findings of the present study have implications for the adaptation and delivery of substance use treatment services to adolescents to enhance treatment engagement and outcomes.
... 11 Erişkin yaşamdaki olumsuz etkileri açısından EDS'nin nitelik ve şiddetinin yanı sıra strese maruz kalınan gelişim dönemleri de önem taşımaktadır. 9,12 Erken çocukluk (0-5 yaş), özellikle okul öncesi dönemde (3-5 yaş) fi-ziksel istismara maruz kalmanın genç erişkinlik döneminde depresyon gelişimi ile güçlü bir ilişki gösterdiği, bu bireylerde ergenlik döneminde fiziksel istismar yaşayanlara göre depresyon gelişme riskinin %77 arttığı, yine erken çocukluk döneminde cinsel istismara maruz kalanlarda intihar düşüncesi olasılığının %146 arttığı bildirilmektedir. 12 Mevcut literatürde EDS maruziyeti erişkin yaşamda major depresyondan, travma sonrası stres bozukluğu, panik bozukluk, bipolar bozukluk, şizofreni, sınır kişilik bozukluğu ve yeme bozukluklarına kadar birçok psikiyatrik bozuklukla ilişkilendirilmektedir. ...
... 9,12 Erken çocukluk (0-5 yaş), özellikle okul öncesi dönemde (3-5 yaş) fi-ziksel istismara maruz kalmanın genç erişkinlik döneminde depresyon gelişimi ile güçlü bir ilişki gösterdiği, bu bireylerde ergenlik döneminde fiziksel istismar yaşayanlara göre depresyon gelişme riskinin %77 arttığı, yine erken çocukluk döneminde cinsel istismara maruz kalanlarda intihar düşüncesi olasılığının %146 arttığı bildirilmektedir. 12 Mevcut literatürde EDS maruziyeti erişkin yaşamda major depresyondan, travma sonrası stres bozukluğu, panik bozukluk, bipolar bozukluk, şizofreni, sınır kişilik bozukluğu ve yeme bozukluklarına kadar birçok psikiyatrik bozuklukla ilişkilendirilmektedir. Depresyon ve anksiyete bozuklukları açısından bakıldığında, sistematik bir derlemede fiziksel istismarın depresyon, cinsel istismarın travma sonrası stres bozukluğu, panik bozukluk ve agorafobi ile ilişkili olduğu bildirilmektedir. ...
Chapter
Early life stress (ELS) is usually a wide concept that contains different traumatic experiences that may have effects on growth and development in childhood and adolescence period. There are many preclinical and clinical studies assessing the effects of ELS on adulthood mental health. These studies indicate that severe and chronic ELS leads to long-term negative results on cognitive, emotional, and behavioral functioning in children and adolescents, and the negative course of anxiety and depressive disorders, reduced response to the treatment and relapse of these disorders in adulthood. This predisposition is mainly based on three main mechanisms: Cognitive and emotional information processing against threatening stimuli because of neuroanatomical and functional disorders associated with changes in the HPA axis, changes in autonomous nervous system reactivity, and finally genetic and epigenetic changes. It is believed that understanding these mechanisms and determining neurobiological mechanisms specific to stress will aid in determining what will provide resilience against negative mental and physical outcomes in children who have experienced early life stress.
... A recent umbrella review of nineteen meta-analyses including 559 studies (N = 4,089,547) found childhood sexual abuse is strongly associated with elevated rates of clinical depression and anxiety (14). Evidence suggests a 77% increased likelihood of depression in young adulthood in individuals with ACEs (27). Such meta-analytic evidence shows depression and anxiety are significantly associated with chronic pain (28,29), with higher levels of psychological distress predicting more severe and disabling pain (30). ...
... Indeed, comorbid chronic pain and anxiety is related to an increase in suicide attempts (31) and also mediates the relationship between ACEs and greater suicide risk (32). ACEs exposure increases risk of suicidal behavior (33) with 146% greater odds of suicidal ideation in adulthood compared to individuals with no ACEs (27). A recent systematic review, including 28 studies, found ACEs significantly predict suicide attempts and suicidal ideation, with increased likelihood of both ideation and suicide attempts occurring in those with more numerous ACEs (34). ...
Article
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Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: ( 1 ) providing an overview of the relationship between ACEs and chronic pain; ( 2 ) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; ( 3 ) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and ( 4 ) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.
... Child maltreatment has been found to increase the risk for depressive symptoms and heavy episodic drinking in both adolescence (Miller et al., 2013;Tonmyr et al., 2010) and young adulthood (Cicchetti & Handley, 2019;Dunn et al., 2013) through both neurological and social mechanisms (see Tricket et al., 2011). For example, child maltreatment has been shown to impact the quality of adolescents' relationships which can lead to associations with deviant peers and poor social bonds, both of which can then culminate in depressive symptoms, substance use, and heavy episodic drinking (Tricket et al., 2011). ...
... Depressive symptoms during the past seven days were assessed at each wave (I-IV) using a subset of nine items from the 20 items Center for Epidemiologic Studies Depression Scale (CES-D). The subset of CES-D has commonly been used to measure adolescents and young adults' depressive symptoms (Dunn et al., 2013;Schuler et al., 2015), and has good internal consistency (α = 0.81). Participants were asked how frequently in the past two weeks they "were bothered by things that usually don't bother you", "could not shake off the blues, even with help from your family and your friends", "felt that you were just as good as other people" (reverse coded), "had trouble keeping your mind on what you were doing", "trouble concentrating", "felt depressed", "were too tired to do things", "enjoyed life" (reverse coded), and "felt that people disliked you". ...
Article
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Child maltreatment represents a prevalent public health issue that has been shown to predict both adolescent and young adult depressive symptoms and heavy episodic drinking; however, little is known regarding how associations between specific types of maltreatment (e.g., physical abuse, sexual abuse, care neglect, supervisory neglect) and depressive symptoms and heavy episodic drinking change across adolescence and into young adulthood. Similarly, there is lack of research that has examined how an accumulation of child maltreatment types relates to depressive symptoms and heavy episodic drinking across ages. Time-varying effect models—a statistical approach that allows researchers to pinpoint specific ages where the association between two variables is strongest—were used in the current study to address these gaps. Nationally representative data came from the first four waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 16,053; 49.4% female; 51.0% European American/White, 21.0% African American, 10.2% Biracial, 9.1% Hispanic; MAGE W1 = 17.00). Results suggested that certain types of maltreatment are more predictive of negative outcomes than others and that different types of maltreatment confer greater risk in different developmental periods. In addition, while victims of between one and three types of maltreatment had comparable prevalence of depressive symptoms and heavy episodic drinking across adolescence and young adulthood, victims of four types of maltreatment had a much higher prevalence of these outcomes indicating the extreme risk that accompanies an accumulation of maltreatment.
... Metaanalyses of self-reported cases indicate that approximately 23% of the world's children experienced lifetime physical abuse, 36.3% experienced emotional abuse, and 13% experienced sexual abuse (Stoltenborgh et al., 2012;Stoltenborgh et al., 2013;Stoltenborgh et al., 2011). An increasing number of studies over the past two decades illustrate that violence in childhood has a relationship with health risk behavior, disease, epigenetic alterations and aging, intergenerational transmission of violence, and an array of other social and health factors (Anda et al., 2006;Dunn et al., 2013;Fulu et al., 2017;Hughes et al., 2017;Jovanovic et al., 2017). Global agreements to protect children from violence have existed since the ratification of the Convention on the Rights of the Child (CRC) and increased in their visibility with publication of the 2002 World Report on Violence and Health (Krug et al., 2002;United Nations General Assembly, 1989). ...
Article
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Background: This systematic review and meta-regression sought to identify the relative importance of factors associated with physical, emotional, and sexual violence against children in low- and middle-income countries. Understanding of factors associated with violence is important for targeted programming and prevention on the population level. Methods: We searched 17 electronic databases from 1989 to 2018 and reports from child violence surveys. Nationally representative studies that described evidence on potential factors associated with violence against children under 18 years old were included. The search was restricted to the English language. Factors were synthesized quantitatively using robust variance estimation, with 95% confidence intervals, for each violence type. Results: We identified 8,346 unduplicated studies, and 103 publications met our eligibility criteria. The data distribution was uneven across region, country income status, factors, and violence types. Of the 94 eligible studies quantitatively synthesized, no specific factors were significant for physical violence. Lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence, and being a girl was associated with sexual violence. Conclusion: A broad spectrum of factors merit consideration for physical violence policy and prevention among the general population of children in low- and middle-income countries. Conversely, a tailored approach may be warranted for preventing emotional and sexual violence. Information is unequally distributed across countries, factors, and violence types. Greater emphasis should be placed on collecting representative data on the general population and vulnerable subgroups to achieve national reductions in violence against children.
... Forms of adversity related to maladaptive functioning within the family have a particularly strong association with the onset of psychopathology McLaughlin et al., 2012). Of these types of maladaptive family functioning, exposure to childhood abuse is strongly related to risk for psychopathology, including depression and suicidal ideation and behaviors (Dunn, McLaughlin, Slopen, Rosand, & Smoller, 2013;Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013;Norman et al., 2012). Childhood abuse is associated not only with higher risk for developing depression, but it also predicts the persistence of depression and greater resistance to treatment (Nanni, Uher, & Danese, 2012). ...
Article
Identifying the potential pathways linking childhood abuse to depression and suicidal ideation is critical for developing effective interventions. This study investigated implicit self-esteem—unconscious valenced self-evaluation—as a potential pathway linking childhood abuse with depression and suicidal ideation. A sample of youth aged 8–16 years ( N = 240) completed a self-esteem Implicit Association Test (IAT) and assessments of abuse exposure, and psychopathology symptoms, including depression, suicidal ideation, anxiety, and externalizing symptoms. Psychopathology symptoms were re-assessed 1–3 years later. Childhood abuse was positively associated with baseline and follow-up depression symptoms and suicidal ideation severity, and negatively associated with implicit self-esteem. Lower implicit self-esteem was associated with both depression and suicidal ideation assessed concurrently and predicted significant increases in depression and suicidal ideation over the longitudinal follow-up period. Lower implicit self-esteem was also associated with baseline anxiety, externalizing symptoms, and a general psychopathology factor (i.e. p-factor). We found an indirect effect of childhood abuse on baseline and follow-up depression symptoms and baseline suicidal ideation through implicit self-esteem. These findings point to implicit self-esteem as a potential mechanism linking childhood abuse to depression and suicidal ideation.
... In addition, child abuse was a stronger predictor in those with moderate NSSI; this result is consistent with the findings of previous studies (1,13,16,19,30,(43)(44)(45). Child abuse occurs during childhood when the child's mind is at maximum growth, and other primary components, such as attachment, type of reaction to stress, emotional regulation, and executive functioning, are developing (46)(47)(48). Confrontation with abuse during childhood disrupts the at-Iran J Psychiatry Behav Sci. In Press(In Press):e101562. ...
Article
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Background: Non-suicidal self-injury (NSSI) is defined as inflicting damage to one’s own body. It begins in adolescence and tends to become chronic. Objectives: Considering the high prevalence and chronicity of NSSI among girls, the present study aimed to investigate the factors affecting the prevalence of NSSI in female adolescents from their perspective. Methods: The participants consisted of 604 female high-school students in Saveh, aged 14 - 17 years (14.29 ± 1.11), who were selected via random cluster sampling from November 2018 to January 2019. They answered six questionnaires, including the Inventory of Statements About Self-injury (ISAS), Ways of Coping questionnaire (WCQ), Child Abuse Self-report scale (CASRS), Family Emotional Involvement and Criticism scale (FEICS), Emotion Reactivity scale (ERS), and Aggression questionnaire (AQ). Data were analyzed using logistic regression analysis. Results: The predictor variables of child abuse, emotion reactivity, perceived parental criticism, family emotional involvement, and problem- and emotion-focused coping styles could successfully distinguish NSSI individuals from those without NSSI (P < 0.05). There were no significant differences between minor and moderate groups. Conclusions: Family emotional support is a protective factor, while criticism, child abuse, and emotion-focused coping style are risk factors for NSSI.
... Anxiety and severe depressive symptoms also share a broad range of psychosocial risk factors, although they depend upon the age of the samples studied. For example, the most risk of having both anxiety and depression during adolescence and early adulthood is most strongly predicted by exposure to trauma in early life (e.g. a history of childhood maltreatment) (Dunn et al., 2013) and either parent suffering from a mood disorder (Levis et al., 2011). Financial hardship and family break-up, through bereavement, divorce, or separation, also increase the likelihood of comorbidity (Hyland et al., 2016). ...
Article
Background Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. Methods In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. Results The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22–7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83–16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31–5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07–0.65; OR=0.26, 95% CI: 0.09–0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13–0.80; OR=0.22, 95% CI: 0.09–0.53) were associated with lower odds of developing CAD. Limitations The cross-sectional design; the use of self-report questionnaires. Conclusion CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.
... Types of maltreatment have been the primary focus of most studies, with physical abuse and sexual abuse typically conferring the greatest risk for subsequent suicide-related behaviours (Miller et al., 2013;Zatti et al., 2017). Whilst studies have established an increased risk of self-harm associated with higher lifetime frequency of maltreatment (Dube et al., 2001), more recent research has investigated the importance of the developmental timing of maltreatment but there is no consensus on specific critical periods of risk (Dunn, McLaughlin, Slopen, Rosand, & Smoller, 2013;Gomez et al., 2017;Hu, Taylor, Li, & Glauert, 2017). Further implications for prevention are emerging from studies identifying modifiable risk and protective factors that mediate and moderate, respectively, the relationship between maltreatment experiences and subsequent suicide-related behaviours (Abdelraheem, McAloon, & Shand, 2019;Paul & Ortin, 2019). ...
Article
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Background A history of child maltreatment is known to elevate the risk of self-harm in adolescence. However, this link has not been investigated for Aboriginal children who experience a greater burden of both. Objective Identify patterns of involvement with child protection services by Aboriginal children associated with a higher risk of self-harm in adolescence. Participants and setting A cohort study was established using linked administrative records of Aboriginal children born in the Northern Territory (NT) of Australia. Methods Survival analysis techniques were used to determine the risk of self-harm in adolescence associated with different levels and timing of child protection involvement throughout childhood. Result The relative risk of self-harm was greatest for children with substantiated maltreatment in both early and middle childhood had nine times higher risk for self-harm (aHR: 9.11, 95% CI: 3.39-24.46,p < 0.001) and six times higher for children who experienced notifications in early childhood and substantiated maltreatment in middle childhood (aHR: 6.72, 95% CI:2.16-20.90, p < 0.001). Other patterns of child protection involvement observed in middle childhood alone also conferred a higher relative risk of self-harm in adolescence. Conclusion This study confirms a higher risk of self-harm in adolescence is associated with child maltreatment, especially in middle childhood. Addressing the intergenerational trauma in Aboriginal families is crucial to preventing child maltreatment and informing reforms to child protection responses that can better identify and address the culturally-specific unmet needs of Aboriginal families. This would go some way to fostering the healthy growth and development of Aboriginal children and reduce self-harm risk.
... However, other studies have found that early childhood exposure to child maltreatment does have detrimental consequences during adolescence or early adulthood. For example, Dunn, McLaughlin, Slopen, Rosand, and Smoller (2013) found that experiencing sexual abuse between ages 3-5 years doubles risk of suicidal ideation, and Khan et al. (2015) found that verbal abuse in early childhood was the strongest predictor of suicidal ideation among young men. Interestingly however, Khan et al. also reported that sexual abuse during late adolescence was the strongest predictor of suicidal ideation among young women. ...
Article
Background Research has indicated an association between child abuse and adolescent suicide. Little population-based information exists, however, about the nature of maltreatment experiences or interactions with the child protection system (CPS). Objective To examine child maltreatment characteristics and system-level responses associated with risk of adolescent suicide. Participants and setting Linked vital death records and CPS records were used to identify the population of adolescents who died by suicide in California between 2010 and 2017 and who had a history of at least one report to CPS prior to death. Method A case control design was used, with cases defined as a suicide of an adolescent with a history of CPS involvement. Using CPS records, living controls were then matched to cases based on year of birth, sex, race and ethnicity, and age of first child maltreatment allegation. A conditional logistic regression model was used to estimate the adjusted odds of adolescent suicide across various CPS and maltreatment characteristics. Results Recent CPS involvement, allegations of physical abuse, and allegations of sexual abuse emerged as significant risk factors for death by suicide. No differences in suicide risk were observed between youth with unsubstantiated or substantiated allegations. Conclusions Suicide risk appears to be more closely tied to specific maltreatment experiences than to substantiation or placement into foster care. As adolescent suicide rates rise, better a understanding of risk factors among already vulnerable populations of youth is critical.
... Otro metaanálisis de 124 estudios con diseños que buscan identificar efectos causales también sugiere que la exposición a diferentes formas de violencia y maltrato en la infancia predice una mayor probabilidad de sufrir de diferentes desórdenes y problemas de salud mental, tales como depresión, ansiedad y pensamientos suicidas (Norman et al., 2012). Consistente con lo que se explicó anteriormente en relación a las etapas sensibles de desarrollo, la evidencia también sugiere que los efectos en la salud mental y la ideación suicida son aún más fuertes si la exposición a la violencia ocurre en los primeros años de vida (Dunn, McLaughlin, Slopen, Rosand, y Smoller, 2013). ...
Article
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Millones de niños, niñas y adolescentes alrededor del mundo sufren de la exposición a diferentes formas de violencia, incluido el maltrato físico, abuso emocional, el castigo físico, el observar violencia intrafamiliar o de pareja y la negligencia. En este documento presento teorías y evidencia empírica sobre la causas, consecuencias y posibles soluciones a la violencia contra niños, niñas y adolescentes. En particular, discuto modelos teóricos y evidencia empírica para entender factores de riesgo contextuales que pueden incrementar el riesgo de exposición a la violencia. Adicionalmente, presento teorías y evidencias sobre algunas consecuencias neuronales, físicas, cognitivas, socioemocionales y económicas de la violencia en la infancia y adolescencia. Finalmente, propongo algunas intervenciones y estrategias prometedoras y recomendaciones de política para reducir la violencia contra niños, niñas y adolescentes
... For example, early maltreatment (e.g., emotional or physical neglect and emotional, physical, or sexual abuse) is a wellestablished risk factor for suicidal behavior in adolescents (for systematic reviews and meta-analyses, see [1,27,35]. The timing of maltreatment seems to matter, with earlier exposure having an even more devastating impact on the young person compared to later exposure [1,9]. This finding may be partly explained by the fact that the risk for suicidal behavior is higher when the abuser is a member of the immediate or extended family compared to a non-related person [3]. ...
... In contrast to prior maltreatment research (e.g., Dunn et al., 2013;Duprey et al., 2020;Thompson et al., 2005), our results did not reveal that aspects of the maltreatment or foster care experience were related to suicidal ideation in either preadolescents or adolescents. We also did not find that maltreatment, namely abuse versus neglect, interacted with subjective social status or developmental status, at least in our sample, to predict suicidal ideation. ...
Article
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Recent decades have seen an alarming increase in rates of suicide among young people, including children and adolescents (“youth”). Although child maltreatment constitutes a well-established risk factor for suicidal ideation in youth, few efforts have focused on identifying factors associated with maltreated youths’ increased risk for suicidal ideation, especially across development. The present study examined the relations between maltreated youths' ( N = 279, M = 12.06 years, 52% female, 53% Latinx) perceptions of their social status and suicidal ideation and compared those relations between pre-adolescents and adolescents. Findings revealed unique developmental patterns: Perceived social status was associated with suicidal ideation, but only in adolescents, who showed greater risk for suicidal ideation if they viewed themselves as lower ranked in society and lower risk for suicidal ideation if they viewed themselves as higher ranked in society. Findings have implications for scientific and practical efforts aimed at better understanding and preventing suicide in a high-risk developmental population.
... The majority of articles (61%; n = 37) assessed the effects of ACEs on a psychological outcome, such as symptoms of depression (B. E. Carlson et al., 2003;Dunn et al., 2013;Wise et al., 2001) or post-traumatic stress (Ogle et al., 2013;Ogle et al., 2014) (DeTore et al., 2019. One-fifth (n = 13) assessed physical health outcomes, such as preterm birth (Selk et al., 2016), or urologic symptoms (Link et al., 2007;Schrepf et al., 2018). ...
Article
Objective: Despite extensive research, the concept of adverse childhood experiences (ACEs) is not fully developed and there is low agreement on how the concept should be defined and measured. The purpose of this study was to 1) identify different conceptual dimensions associated with ACEs, such as timing or frequency; and 2) determine how these dimensions have been operationalized and analyzed to this point, in order to advance the conceptual understanding of ACEs. Methods: We conducted a scoping review of empirical journal articles on ACEs published after the original ACE-Study in 1998 to summarize the use of dimensions for the 10 conventional ACE domains. We used a PRISMA methodology to identify articles that assessed at least two of the 10 conventional ACE domains and at least two ACE dimensions. A standardized data extraction spreadsheet was used to record basic article information and specifics on ACE domains and dimensions. Results: Of 15,417 initial search results, 61 articles met all selection criteria. We identified four primary dimensions used for most ACE domains: frequency, timing, perception, and the role of the perpetrator. Additionally, we found several secondary and domain-specific dimensions, which relate to the intensity of the adverse event. Discussion: We identified the most commonly used ACE dimensions, but these lack standardized phrasing of items and response options. The inclusion of ACE dimensions may increase the accuracy of the association between ACEs and health outcomes and provide for more tailored treatment plans for people who have experienced ACEs. Future research should include a more comprehensive list of ACE domains and aim to develop a clearly articulated, standardized approach to assessing and analyzing ACE dimensions.
... Metaanalyses of self-reported cases indicate that approximately 23% of the world's children experienced lifetime physical abuse, 36.3% experienced emotional abuse, and 13% experienced sexual abuse (Stoltenborgh et al., 2012;Stoltenborgh et al., 2013;Stoltenborgh et al., 2011). An increasing number of studies over the past two decades illustrate that violence in childhood has a relationship with health risk behavior, disease, epigenetic alterations and aging, intergenerational transmission of violence, and an array of other social and health factors (Anda et al., 2006;Dunn et al., 2013;Fulu et al., 2017;Hughes et al., 2017;Jovanovic et al., 2017). Global agreements to protect children from violence have existed since the ratification of the Convention on the Rights of the Child (CRC) and increased in their visibility with publication of the 2002 World Report on Violence and Health (Krug et al., 2002;United Nations General Assembly, 1989). ...
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Abstract This systematic review and meta-regression sought to identify the relative importance of factors associated with physical, emotional, and sexual violence against children in low- and middle- income countries. Understanding of factors associated with violence is important for targeted programming and prevention on the population level. Methods We searched 17 electronic databases from 1989 to 2018 and reports from child violence surveys. Nationally representative studies that described evidence on potential factors associated with violence against children under 18 years old were included. The search was restricted to the English language. Factors were synthesized quantitatively using robust variance estimation, with 95% confidence intervals, for each violence type. Results We identified 8346 unduplicated studies, and 103 publications met our eligibility criteria. The data distribution was uneven across region, country income status, factors, and violence types. Of the 94 eligible studies quantitatively synthesized, no specific factors were significant for physical violence. Lower household socioeconomic status, being a girl, and primary education of mothers and adults in the household were associated with emotional violence, and being a girl was associated with sexual violence. 2 Conclusion A broad spectrum of factors merit consideration for physical violence policy and prevention among the general population of children in low- and middle-income countries. Conversely, a tailored approach may be warranted for preventing emotional and sexual violence. Information is unequally distributed across countries, factors, and violence types. Greater emphasis should be placed on collecting representative data on the general population and vulnerable subgroups to achieve national reductions in violence against children.
... These age groups follow standard categories used in the literature and reflect knowledge of sensitive periods in brain formation. 8,[20][21][22][23][24] Third, to assess whether a dose-response association existed between HDI exposure and later outcomes within the 4 age groups, I constructed 4 count variables that measured duration of HDI exposure in years in the following age groups: birth to 2 years, 3 to 5 years, 6 to 12 years, and 13 to 17 years. ...
Article
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Importance The current focus on the association of negative experiences in early childhood with adverse outcomes later in life is based on limited empirical evidence. Objective To evaluate whether age at exposure to negative experiences in childhood and adolescence is associated with outcomes in early adulthood. Design, Setting, and Participants This cohort study used population data from administrative sources for all Danish individuals born between 1987 and 1995 who were living in Denmark at 19 years of age. Data were analyzed in July 2020. Exposures Exposure to 6 household dysfunction items (HDIs) from birth to 17 years of age by age group. Age groups were as follows: 0 to 2 years (early childhood), 3 to 5 years (preschool), 6 to 12 years (mid-childhood), and 13 to 17 years (early adolescence). The 6 items were parents’ unemployment, incarceration, mental disorders, death, and divorce and the child’s foster care experiences. Main Outcomes and Measures Mental disorders, low educational attainment, disconnection from education and the labor market, and criminal charges. A fixed-effects model was used to estimate the dose-response and age-specific associations between HDI exposure and the collated outcome measure. Results The study sample included 605 344 individuals observed from birth to 19 years of age (mean [SD] birth year, 1991 [2.56] years; range, 1987-1995; 335 725 [55%] male). Overall, 278 115 individuals (45.94%) were exposed to 1 or more of the 6 HDIs from birth to 17 years of age. Exposure was most prevalent at 1 year of age (exposure rate, 11.3%), and parental unemployment was the most common HDI (15.5% observed in mid-childhood). The risk of experiencing the 4 outcomes was monotonically associated with the number of HDIs. For example, experiencing 1 HDI between birth and 17 years of age was associated with an increased risk of experiencing an adverse outcome by approximately 1.0 percentage point (β = 0.011; 95% CI, 0.010-0.012; P < .001). Similarly, the risk of experiencing adverse outcomes varied significantly in association with age at exposure. Exposure during early adolescence was more strongly associated with adverse outcomes than was exposure during early childhood (increased risk of 5.8 percentage points [β = 0.058; 95% CI, 0.052-0.063; P < .001] vs 1.0 [β = 0.010; 95% CI, 0.004-0.015; P = .001]). Conclusions and Relevance In this cohort study, exposure to negative experiences in early adolescence was more strongly associated with later adverse outcomes than was exposure at other points in childhood. Knowledge of age-specific associations is important information for policy makers who need to prioritize resources targeting disadvantaged children and youths.
... Moore et al. (2015) reported that chronic childhood maltreatment was a significant contributor to a range of mental health issues, such as depression and anxiety, and self-harm in Australia. Moreover, complex trauma exposure is associated with a range of other mental illnesses including Borderline Personality Disorder (van Dijke et al., 2012), mood disorders (Dunn et al., 2013), eating disorders (Mitchell et al., 2012), substance abuse (Mandavia et al., 2016) and psychotic disorders (Isvoranu et al., 2016). ...
Article
Phase-based approaches are a recommended treatment option for individuals with complex trauma histories; however, this is based on a limited body of empirical evidence. Phase-based approaches often involve two stages of treatment, with one focusing on safety and stabilisation and phase two on trauma memory processing. Historically, the Australian Better Access Scheme offered a government rebate for up to 10 group and 10 individual psychological sessions annually. In response to the coronavirus pandemic, the number of rebated individual sessions has been increased to 20 through June 2022. Combining individual and group session rebates, phase-based approaches that include both treatment modalities represent a feasible and accessible treatment option for complex trauma. Delivering phase one in a group milieu and providing individual treatment during phase two may be cost effective and optimise outcomes by leveraging the benefits of group and individual treatment for complex trauma. This article aims to provide an overview of the psychological impact of complex trauma, to highlight barriers to seeking mental healthcare, and to critically evaluate phase-based approaches for treating complex trauma. We highlight gaps in the research, followed by a discussion regarding the benefits and limitations of using this approach in the Australian mental health care system. Key points What is already known about this topic: • (1) Individuals with complex trauma face barriers when seeking psychological treatment in Australia, including the affordability of specialised mental health care. • (2) The number of Medicare-rebated sessions provided by the Better Access Scheme to treat mental health problems is at times inadequate, and clients bear the burden of cost for extra treatment. • (3) Despite garnering support from trauma experts, phase-based treatments for trauma related disorders have promising but limited empirical support. What this topic adds: • (1) Updating prior reviews, a rapid review of the literature identified 15 peer-reviewed papers that examined the delivery of a phase-based treatment for individuals with histories of complex trauma, demonstrating the ongoing implementation of this treatment approach. • (2) A phase-based treatment approach for complex trauma is a feasible, accessible and cost-effective option under the current Better Access Scheme, which offers rebates for up to 10 individual sessions (increased to 20 in response to the COVID-19 pandemic through June 2022) and 10 group sessions annually. • (3) A phase-based approach that combines group and individual therapy may enable clients to benefit from both group and individual interventions and facilitate continuity of care.
... During childhood and adolescence, maltreated children are at heightened risk for internalizing and externalizing behavior problems, mental health problems (e.g., posttraumatic stress symptoms), poor school performance, and health-risk behaviors, such as risky sexual behavior, adolescent substance use, delinquency, and suicidal behavior (Jones et al., 2013;Kolko et al., 2010;Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013;Romano, Babchishin, Marquis, & Frechette, 2015; Authors redacted for blind review, 2017). Child maltreatment also has long-term consequences; adults with a history of childhood maltreatment experience a host of negative outcomes, including depressive symptoms, posttraumatic stress symptoms, criminal arrest, suicidal ideation, and reduced health-related quality of life (Dunn, McLaughlin, Slopen, Rosand, & Smoller, 2013;Nikulina, Widom, & Czaja, 2011;Weber, Jud, & Landolt, 2016). ...
Article
The negative impacts of childhood maltreatment are vast and span multiple domains. Recently, studies have examined the characteristics of maltreated children who exhibit a lack of negative outcomes; in other words, children who displayed resilience. Though resilience has become a more prevalent topic, the perspectives of practitioners working with children following maltreatment have been inadequately represented. The purpose of the current study was to explore the perspectives of practitioners working with maltreated children to better understand the factors that promote and inhibit resilience. Semi-structured qualitative interviews were completed with practitioners who provide services to maltreated children (N=27). After audio-recording and professional transcription, the research team engaged in a process of thematic coding and analysis, with collaborative theme development. Study codes yielded two primary themes relating to factors that inhibit or promote resilience among maltreated children. Internal factors referred to characteristics of the individual child that could influence their likelihood of displaying resilience. External factors referred to context and circumstances outside of the child that can impact the development and display of resilience. Practitioners understood resilience as the interaction of internal and external factors which influence the degree to which children display resilience following maltreatment. The findings help to incorporate practitioner perspectives into current conceptualizations of resilience. This study carries implications for increased reliance on translational research in the resilience field, reflecting the perspectives and needs of direct service providers. Further, the results help us to better understand how practitioner perspectives shape the interventions they deliver to build resilience capacity.
... For example, Kaplow and Widom [43] showed that early onset childhood maltreatment (i.e., early (0-5 years of age) versus later (6-11 years of age)) predicted more severe symptoms of depression and symptoms of anxiety when the participants were adults. Similarly, research evidence indicates that risk for depression and thoughts of suicide are influenced by the developmental age when first exposed to child maltreatment: exposure during early childhood (0-5 years) is more detrimental than exposure during adolescence [23]. First exposure to child maltreatment between 0-5 years of age (early childhood) has also been linked to elevated risk for PTSD relative to first exposure during middle childhood or adolescence [24], a finding which may have implications for chronic pain [17,25]. ...
Article
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Objective: The present systematic review aimed to evaluate the association between childhood maltreatment and chronic pain, with specific attention to the temporal nature of the relationship and putative moderators, including, the nature (type), timing of occurrence, and magnitude of maltreatment; whether physical harm or injury occurred; and whether post-traumatic stress disorder (PTSD) subsequently developed. Method: We included studies that measured the prospective relationship between child maltreatment and pain. Medline, EMBASE, PsycINFO, and CINAHL were searched electronically up to 28 July 2019. We used accepted methodological procedures common to prognosis studies and preregistered our review (PROSPERO record ID 142169) as per Cochrane review recommendations. Results: Nine studies (17,340 participants) were included in the present review. Baseline participant age ranged from 2 years to more than 65 years. Follow-up intervals ranged from one year to 16 years. Of the nine studies included, three were deemed to have a high risk of bias. With the exception of one meta-analysis of three studies, results were combined using narrative synthesis. Results showed low to very low quality and conflicting evidence across the various types of maltreatment, with the higher quality studies pointing to the absence of direct (non-moderated and non-mediated) associations between maltreatment and pain. PTSD was revealed to be a potential mediator and/or moderator. Evidence was not found for other proposed moderators. Conclusions: Overall, there is an absence of evidence from high quality studies of an association between maltreatment and pain. Our results are limited by the small number of studies reporting the relationship between child maltreatment and pain using a prospective design. High quality studies, including prospective cohort studies and those that assess and report on the moderators described above, are needed to advance the literature.
... As maltreated youth become parents, there is a heightened risk for the continuation of the cycle of maltreatment due to the normalization of maltreatment within the family system (Assink et al., 2018;Berlin et al., 2011;Bosquet-Enlow Englund, & Egeland, 2018;Dunn et al., 2013;Egeland et al., 1988;Finzi-Dottan & Harel, 2014;Thornberry & Henry, 2013). Specifically, caregivers with a history of childhood maltreatment may be more likely to engage in aggressive and/or harsh parenting compared to caregivers without a history of childhood maltreatment (Assink et al., 2018;Bandura, 1977), and parents who were maltreated as children and/or adolescents may even be more likely than parents who were not maltreated to expose their own children to maltreatment (Babcock-Fenerci & Allen, 2018;Berlin et al., 2011;Dixon et al., 2005;Milaniak & Widom, 2015;Thornberry & Henry, 2013). ...
Article
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Background When caregivers experience childhood maltreatment, their children may bear increased risk for maltreatment as well. Teachers have frequent opportunities to observe child behavior in the classroom and are likely to notice symptoms of maltreatment and have opportunities to intervene. Thus, teacher identification of PTSD may serve an important preventive purpose and may mitigate risk for children who experience any form of maltreatment early in life. Objective The present study utilized secondary data from the LONGSCAN consortium to examine caregiver history of childhood maltreatment as a moderator of the association among teacher identification of student PTSD symptomology and child-reported PTSD symptomology for children at risk for maltreatment (n = 872). Method Children and adolescents completed the Trauma Symptom Checklist for Children to assess the severity of PTSD. The Caregiver’s History of Loss and Victimization measure identified retrospective reports of caregiver history of childhood maltreatment. The Teacher Report Form was used to assess teachers’ observations of children’s behaviors in the classroom. Results Caregiver history of childhood maltreatment moderated the association between teacher identification of child internalizing behaviors and PTSD symptomology severity at age 12. Simple slope analyses indicated that the association among teacher and child report of symptomology was stronger if the child’s caregiver experienced childhood maltreatment than if caregivers were not maltreated as children. Conclusions Results illustrate the importance of teacher training in basic mental health symptomology identification in the classroom, as well as mental health services for caregivers with a history of maltreatment, to break the cycle of childhood maltreatment.
... The extent to which ACEs influence these developmental processes and thereby the risk of suicidal behavior appear to be shaped by various characteristics of ACE exposure. For example, the type, frequency, chronicity, and severity of ACE exposure have all been associated with suicidal behaviors (e.g., Cicchetti & Toth, 2016;Dunn et al., 2013), and exposure to multiple types of ACEs has been identified as one of the most common predictors of suicidal behavior (Felitti et al., 1998;Serafini et al., 2015). ...
Article
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Suicide in youth exacts significant personal and community costs. Thus, it is important to understand predisposing risk factors. Experiencing adverse childhood experiences (ACEs), such as child maltreatment (CM-ACE), and the presence of post-traumatic stress disorder has been identified as a risk factor of suicidal behaviors among adults. Theoretical models of suicide suggest that the presence of painful experiences such as CM-ACEs increase the risk of suicidal behaviors. The relation between child maltreatment, post-traumatic stress symptom clusters (PTSS) and suicidal behaviors has not been explicitly examined among youth. The present study examined the relations between CM-ACEs, PTSS clusters, and suicidal behaviors in a clinical population of children. Children, male, ages 6 to 14, enrolled in a residential treatment program completed self-report measures to evaluate variables of interest. Path analyses revealed statistically significant direct effects of CM-ACEs and PTSS clusters on suicidal behaviors. Significant total indirect effects and marginally significant individual indirect effects of intrusion and avoidance symptoms were observed for the relation between CM-ACEs and suicidal behavior. Findings suggest that symptoms associated with specific PTSS clusters might help explain the relation between CM-ACEs and suicidal behavior, and therefore, present important implications for clinical practice and future research.
... The impact of child maltreatment is diverse, such as death (annual worldwide estimate of 155,000 deaths of children under 15 years as a consequence of abuse or neglect; Pinheiro, 2006); to economic deprivation (Fang et al., 2015;Pinheiro, 2006); academic failure (i.e., school maladjustment and failure, dropouts; Corrás et al., 2017;Seijo et al., 2015); adult physical disorders (e.g., ischemic heart disease, cancer, chronic lung disease, skeletal fractures, autoimmune disorders, liver disease; Nemeroff, 2016); behavioural problems (e.g., delinquency, violence, suicidal; Dunn et al., 2013;Del Hoyo-Bilbao et al., 2020;Stewart et al., 2008); internalising (e.g., mood and anxiety disorders), and externalising (e.g., anger, aggressive behaviour, substance, and alcohol abuse) mental health problems [MHPs] (Li et al., 2016;Marcos et al., 2020;Oksanen et al., 2021); which were of a magnitude that accounted for a significant proportion of the Global Burden of Disease (Gilbert et al., 2009). These MHPs become chronic as confirmed by the systematic finding of long-term disorders in adulthood (Amado et al., 2015;Kisely et al., 2018;Lindert et al., 2014;Springer et al., 2007). ...
Article
The literature on the prevalence of child maltreatment is extensive, but studies are required to assess the impact on mental health to enhance the effectiveness of intervention programs. Thus, a field study was undertaken to evaluate depression, anxiety, and anger in 65 child victims of multiple types of maltreatment. The results showed that child maltreatment victim (CM‐V) reported more depressive (36%), anxiety (45%), and anger (69%) symptoms than the normative sample. However, subjects were asymptomatic in approximately 25% of depression, 20% anxiety, and 5% of anger. Epidemiologically, the results revealed that the probability of caseness among the CM‐Vs sample increased to around 85% for depression and anxiety and 90% for anger. The clinical, social, and legal implications of the results are discussed.
... I utilize restricted-use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which recruited a random sample of children in grades 7-12, first by sampling schools from the national database (Harris, 2013). Add Health has been previously used to study relationships between childhood maltreatment and adult physical health (Shin & Miller, 2012;Suglia et al., 2014), mental health (Dunn et al., 2013;Fletcher, 2009;Foster et al., 2008), and crime (Currie & Tekin, 2012). I construct a sample of participants who responded to the Wave I and Wave IV home interviews. ...
Article
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Childhood sexual abuse is a prevalent problem, yet understanding of later‐in‐life outcomes is limited due to unobservable determinants. I examine impacts on human capital and economic well‐being by estimating likely ranges around causal effects, using a nationally representative U.S. sample. Findings suggest that childhood sexual abuse leads to lower educational attainment and worse labor market outcomes. Results are robust to partial identification methods applying varying assumptions about unobservable confounding, using information on confounding from observables including other types of child abuse. I show that associations between childhood sexual abuse and education outcomes and earnings are at least as large for males as for females. Childhood sexual abuse by someone other than a caregiver is as influential or more so than caregiver sexual abuse in predicting worse outcomes. Considering the societal burden of childhood sexual abuse, findings could inform policy and resource allocation decisions for development and implementation of best practices for prevention and support.
... Although the contribution of child maltreatment is well established for psychopathology (Arseneault, 2017), the evidence is less consistent on whether there are sensitive periods of developmental stages and when the exposure to maltreatment has the most impact on the risk of psychopathology (Dunn et al., 2018;Dunn & Nishimi et al., 2017;Gomez et al., 2017). For MD, several prospective (Keiley et al., 2001;Thornberry et al., 2010) and retrospective studies (Dunn & Nishimi et al., 2017;Dunn et al., 2013;Schalinski et al., 2016) have suggested that the sensitive periods of exposure might exist, and earlier exposure to maltreatment before age of five is associated with greater risk of depression. However, other studies have expanded the sensitive period to the age of 12 (Maercker et al., 2004;Schoedl et al., 2010). ...
Article
Although empirical evidence has confirmed the causal relationship between childhood maltreatment and depression, findings are inconsistent on the magnitude of the effect of age of exposure to childhood maltreatment on psychological development. This systematic review with meta-analysis aims to comprehensively synthesize the literature on the relationship between exposure age of maltreatment and depression and to quantitatively compare the magnitude of effect sizes across exposure age groups. Electronic databases and grey literature up to April 6th, 2022, were searched for English-language studies. Studies were included if they: 1) provided the information on exposure age; and 2) provided statistical indicators to examine the relationship between childhood maltreatment and depression. Fifty-eight articles met eligibility criteria and were included in meta-analyses. Subgroup analyses were conducted based on subtypes of maltreatment and measurements of depression. Any kind of maltreatment (correlation coefficient [r] = 0.17, 95% CI = 0.15–0.18), physical abuse (r =0.13, 95% CI = 0.10–0.15), sexual abuse (r = 0.18, 95% CI = 0.15–0.21), emotional abuse (r = 0.17, 95% CI=0.11–0.23), and neglect (r = 0.08, 95% CI=0.06–0.11) were associated with an increased risk of depression. Significant differential effects of maltreatment in depression were found across age groups of exposure to maltreatment (Q = 34.81, p < 0.001). Age of exposure in middle childhood (6–13 years) had the highest risk of depression, followed by late childhood (12–19 years) and early childhood (0–6 years). Implications of the findings provide robust evidence to support targeting victimized children of all ages and paying closer attention to those in middle childhood to effectively reduce the risk of depression.
... Importantly, although ACEs have been conceptualized as a risk factor for psychopathology, there is no one to one mapping of ACEs to psychiatric disorder, ergo not everyone who has experienced childhood adversity will experience mental health problems (Belsky & Pluess, 2009). Evidence suggests the impact of ACEs may depend on various factors, such as the type of event and severity of exposure (Schalinski et al., 2016), the doseage or cumulative effects of adverse events (Edwards et al., 2003), age of exposure (Dunn et al., 2013;Riem et al., 2015, and the socio-economic context (Nurius et al., 2012). This suggests a need to understand the multi-factorial nature of ACEs and unpack mechanisms by which ACEs are implicated in potential trajectories of risk (psychopathology) and resilience. ...
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Adverse childhood experiences (ACEs) are identified with increased risk of adult mental health difficulties and negative impacts on wellbeing. However, there is a need to go beyond simple associations and identify candidate mechanisms underpinning the ACEs‐mental health relationship. Further methodological heterogeneity points to issues around the operationalisation of ACEs and the importance of modelling data using robust research designs. The aim of the current review was to synthesize studies that utilised formal mediation and/or moderation analyses to explore psychological and social variables on the pathway between clearly defined ACEs (as measured by the ACE questionnaire and CTQ) and common mental health outcomes (depressive, anxiety, PTSD symptoms) across community samples aged over 18. A total of 31 papers were retrieved for critical appraisal. The majority of the studies explored factors mediating/moderating the link between child adversity and depression, and less on anxiety and trauma. Most mechanisms were tested in only single studies, limiting the consistency of evidence. Evidence indicated that the mechanisms underlying associations between ACEs and adult mental health are likely to reflect multiple intervening variables. Further, there are substantial methodological limitations in the extant literature including the proliferation of causal inferences from cross‐sectional designs, and both measurement and conceptual issues in operationalizing adversity. Consistent transdiagnostic mechanisms relevant to common mental health problems were identified, including perceived social support, emotion regulation, and negative cognitive appraisals/beliefs. Further research using longitudinal design is required to delineate the potential contribution of the identified mechanisms.
... Contrario a este trabajo, los estudios de Dunn, McLaughlin, Slopen, Rosand y Smoller (2013), Khan et al. (2015) y Thompson et al. (2012) encontraron una variabilidad significativa en la magnitud del riesgo conferido por conductas suicidas en función de la etapa de desarrollo en que ocurrió el evento de maltrato, lo que evidenció que la exposición al abuso físico y sexual en etapas más tempranas de desarrollo (3 a 5 años) aumentó la probabilidad de manera significativa para desarrollar trastornos anímicos e ideación suicida. Dunn et al. (2013), con una muestra de 15 701 adolescentes, encontraron que las personas expuestas por primera vez al abuso físico durante la etapa preescolar tuvieron un aumento del 77 % en las probabilidades de desarrollar depresión, y los que fueron expuestos al abuso sexual durante la primera infancia tuvieron un aumento del 146 % en las probabilidades de ideación suicida en comparación con los adolescentes maltratados en la adolescencia. ...
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Chapter
A third of the general population worldwide has a history of childhood trauma, and it remains a major public health and social welfare problem. Exposure to childhood trauma during development has long-lasting effects on physical and mental health, drug and alcohol use and crime, with high costs for both the individual and the society. Worldwide, up to 20% of children and adolescents experience mental disorders, but early intervention in this age group is largely absent. Psychological and biological mechanisms interact in the association between childhood trauma and poor health outcomes from birth to adult life. In recent years, research and practice on traumatic childhood experiences have shifted from delineating effects of trauma on adulthood health problems to preventing potentially traumatic events in children. This paper aims to summarise the literature on the impact of childhood trauma on mental health and to describe the current evidence base for early interventions focused on preventing and reducing the psychobiological sequelae of childhood trauma. Public health strategies for prevention of childhood trauma include both universal and targeted interventions, ranging from home visiting programmes to parent training programmes, routine screening for adversity in children and caregivers and specialised therapeutic approaches. Childhood is a time of vulnerability but also of opportunity; intervention offered at critically sensitive periods of development may improve the well-being of children throughout their life.
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Childhood adversity is associated with the development or expression of many neuropsychiatric disorders, including those with strong genetic underpinnings. Despite reported associations between perceived stress and tic severity, the relationship between potentially traumatic events in childhood and Tourette Syndrome (TS), a highly heritable neuropsychiatric disorder, is unknown. This study aimed to assess whether exposure to eight categories of adverse childhood experiences (ACEs) is associated with TS severity and impairment, and whether TS genetic risk modifies this association. Online survey data were collected from 351 adult males with TS who previously participated in genetic studies. Participants completed the ACE questionnaire and a lifetime version of the Yale Global Tic Severity Scale (YGTSS). Demographic and relevant health data were assessed; polygenic risk scores (PRS) measuring aggregated TS genetic risk were derived using genome-wide association data. Univariable and multivariable linear regressions examined the relationships between childhood adversity and retrospectively recalled worst-ever tic severity and impairment, adjusting for covariates. Potential gene-by-environment (GxE) interactions between ACE and PRS were estimated. After covariate adjustment, there was a significant graded dose-response relationship between ACE Scores and increases in lifetime worst-ever tic severity and impairment. There was some evidence that TS genetic risk moderated the relationship between ACE Score and tic impairment, but not tic severity, particularly for individuals with higher TS polygenic risk. We provide evidence that childhood adversity is associated with higher lifetime TS severity and impairment, although future longitudinal studies with genetically-sensitive designs are needed to determine whether these relationships are causal and/or directional.
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Child physical abuse (CPA) is a pervasive societal problem with serious outcomes. Understanding CPA risk factors is necessary to identify those at risk for CPA perpetration and to inform efforts to prevent the occurrence of CPA. The present study provides an updated review of conceptual models of CPA, a review of model-related CPA risk factors, and a meta-analytic review of CPA risk factors found in cross-sectional, case-controlled studies. The review of conceptual models yielded >70 explanatory models of CPA from which >140 putative CPA risk factors were extracted. A three-level random-effects meta-analysis of CPA risk factors was conducted. Database and literature searches yielded 58 studies that met the inclusion criteria from which 300 effect size (ES) estimates were identified. In the meta-analysis, 292 ESs were placed into 38 CPA risk factor domains. Twenty significant individual CPA risk factor domain ES estimates and five significant relationship CPA risk factor domain ESs were found. Future studies that simultaneously consider CPA risk and protective factors from within and between ecological levels and that establish causal CPA factors are needed to better inform CPA prevention and treatment efforts.
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Introduction: Among adolescents, an increasing rate of interpersonal interactions occurs online. Previous research has shown that interpersonal context exerts a robust impact on suicidal thoughts or behaviors, yet little attention has focused on examining the content of online interactions surrounding self-injurious thoughts or behaviors. As such, the present study sought to compare online social networking behaviors among adolescents on days with and without experiencing self-injurious thoughts or behaviors, as influenced by childhood maltreatment history. Method: Adolescents aged 13-18 hospitalized for self-injurious thoughts or behaviors were recruited as part of an ongoing longitudinal study. A subsample (N = 22) of adolescents provided data from their online social networking platforms (i.e., text messages, Facebook, Instagram, and Twitter). Using a mixed-methods approach, online social networking data on days of experiencing self-injurious thoughts or behaviors and days of not experiencing self-injurious thoughts or behaviors were compared. Results: Results indicate the frequency and content of online social networking messaging do not change by day of self-injurious thoughts or behaviors or history of childhood maltreatment. However, childhood maltreatment predicts received conflictual messages as well as sent symptomatic messages on days of experiencing self-injurious thoughts or behaviors. Conclusions: Childhood maltreatment may play a role in the content of adolescent online behaviors, particularly on days when they experience self-injurious thoughts or behaviors. Implications for intervention are discussed.
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This study aimed to explore the association between the experience of polyvictimization in childhood and physical/mental health during early adulthood (between the ages of 18–39). Retrospective cross‐sectional data from 406 respondents aged 18–39 were selected from the 2012 Korean General Social Survey. Following standards set in previous studies, polyvictimization is defined in this study as experiencing five or more types of violence. The outcomes of this study included self‐rated health, depression, and suicidal ideation. The results indicated that 8.37% (n = 34) of the total respondents were polyvictimized. This study found that all health‐related outcomes in adulthood were significantly associated with polyvictimization in childhood, and women who experienced polyvictimization in childhood faced greater the risk of suicidal ideation and depression than men. In conclusion, this study suggests the importance of taking into account the lasting association of childhood polyvictimization with health into adulthood. Practical implications for social work and suggestions for future studies are described.
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Although drawing an equivalence between sexual and non-sexual violence has been critical to the feminist analysis of rape, the distinction between the two has not been the subject of much empirical research. Using the longitudinal component of the National Comorbidity Survey this study compares the long-term associations of sexual and non-sexual physical violence with psychological distress. In addition, it explores associations of sexual and physical violence with perceptions of self and others. The results reveal similarities and differences between the two types of violence. For psychological distress, the associations are statistically equivalent—both are positively associated with distress. But only sexual violence is associated with self-esteem, self-criticism, and attachment style. Survivors of sexual violence report much lower self-esteem and much more self-criticism. They are also much less likely to report a secure attachment style and, instead, report more interpersonal avoidance and anxiety. The association between sexual violence and perceptions of self and others explains much of the association between sexual violence and psychological distress, and differences in the associations are not driven by other measured characteristics of violence.
Article
Aims To identify young people with different levels of family-related problems, including parental substance use disorder (PSUD), and investigate differences in grades at graduation from compulsory school and further enrollment in education. Methods Participants included 6,784 emerging adults (aged 15–25 years) from samples drawn for two national surveys in Denmark 2014-2015. Latent classes were constructed using the following parental variables: PSUD, offspring not living with both parents, and parental criminality, mental disorders, chronic diseases and long-term unemployment. The characteristics were analyzed using an independent one-way ANOVA. Differences in grade point average and further enrollment were analyzed using linear regression and logistic regression, respectively. Results Four classes of families were identified: 1. “Low adverse childhood experiences (ACE) families”, 2. “Families with PSUD”, 3. “Families with unemployment” and 4. “High ACE families”. There were significant differences in grades, with the highest average among youth from “Low ACE families” (7.11, 95% CI: 7.04-7.18) and lower averages among youth from the other types of families (“Families with PSUD” = 6.20, 95% CI: 6.00-6.41; “Families with unemployment” = 6.39, 95% CI: 6.27-6.52; “High ACE families” = 5.66, 95% CI: 5.42-5.90). Youth from “Families with PSUD” (OR = 1.65; 95% CI: 1.19-2.29) and “High ACE families” (OR = 2.25; 95% CI: 1.58-3.20) were significantly more likely not to be enrolled in further education compared with “Low ACE families”. Conclusions Young people who experience PSUD, both as the primary family-related problem as well as among multiple family-related problems, are at increased risk for negative school-related outcomes.
Article
This study examined therapists’ perceived competence in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and its association with youth treatment outcomes (posttraumatic stress and depression). Participants included 99 community therapists enrolled in a TF-CBT-focused Learning Collaborative (LC), along with one of their randomly selected TF-CBT training cases. Analyzed data included: 1) caregiver/youth-reported posttraumatic stress and depressive symptoms, pre- and post-treatment, and 2) therapist-perceived competence with TF-CBT components across treatment delivery. Youth- and caregiver-reports indicated large, significant pre- to post-treatment decreases in youth posttraumatic stress ( ds = 1.10–1.30, ps < .001) and depressive symptoms ( d = 1.01, p < .001). Higher therapist-perceived competence with TF-CBT predicted positive treatment responses for posttraumatic stress ( ds = 0.38–0.39, ps = .03) and depression ( d = 0.25), though only the former association was significant ( ps = .03 vs. p = .15). Findings highlight the need to monitor and improve therapists’ competencies to enhance clinical outcomes for trauma-exposed youth and suggest that LCs may be an effective training/implementation model to help achieve those critical goals.
Article
Childhood adversity (CA) as a significant stressor has consistently been associated with the development of mental disorders. The interaction between CA and genetic variants has been proposed to play a substantial role in disease etiology. In this review, we focus on the gene by environment (GxE) paradigm, its background and interpretation and stress the necessity of its implementation in psychiatric research. Further, we discuss the findings supporting GxCA interactions, ranging from candidate gene studies to polygenic and genome-wide approaches, their strengths and limitations. To illustrate potential underlying epigenetic mechanisms by which GxE effects are translated, we focus on results from FKBP5 × CA studies and discuss how molecular evidence can supplement previous GxE findings. In conclusion, while GxE studies constitute a valuable line of investigation, more harmonized GxE studies in large, deep-phenotyped, longitudinal cohorts, and across different developmental stages are necessary to further substantiate and understand reported GxE findings.
Thesis
Dimensions of early adversity, such as violence exposure and social deprivation, may have different effects associated with socioemotional functioning in the developing brain and different factors may be protective. This dissertation examined the downstream effects of childhood violence exposure and social deprivation in data from the Fragile Families and Child Wellbeing Study at birth, and ages 1, 3, 5, 9, and 15 years. Study one examined the association between violence exposure, social deprivation, and amygdala-prefrontal cortex white matter connectivity, a crucial circuit for emotion regulation. High violence exposure coupled with high social deprivation related to less amygdala–OFC white matter connectivity. Violence exposure was not associated with white matter connectivity when social deprivation was at mean or low levels (i.e., relatively socially supportive contexts). Therefore, social deprivation may exacerbate the effects of childhood violence exposure on the development of white matter connections involved in emotion processing and regulation. Conversely, social support may buffer against them. Study two investigated the association between violence exposure, social deprivation, and adolescent resting-state functional connectivity in two resting-state networks involved in socioemotional functioning (salience network, default mode network) using a person-specific modeling approach. Childhood violence exposure, but not social deprivation, was associated with reduced adolescent resting-state density of the salience and default mode networks. A data-driven algorithm, blinded to childhood adversity, identified youth with heightened violence exposure based on resting-state connectivity patterns. Childhood violence exposure was associated with adolescent functional connectivity heterogeneity, which may reflect person-specific neural plasticity and should be considered when attempting to understand the impacts of early adversity on the brain. Study three examined whether school connectedness was protective against violence exposure and social deprivation when predicting symptoms of internalizing and externalizing psychopathology and positive function and if school connectedness was uniformly protective against both dimensions of adversity. Results suggest that school connectedness is broadly related to better outcomes and may confer additional protection against social deprivation. These findings highlight the important role that the school environment can play for youth who have been exposed to adversity in other areas of their lives. Additionally, the interactive effect of school connectedness with social deprivation, but not violence exposure, supports modeling risk and resilience processes using dimensional frameworks to better identify specific groups of youth that may benefit from interventions that boost social connectedness at school in future research. Overall, this dissertation provides evidence for the complex and person-specific ways through which risk and resilience relate to development and points to considerations for future research. This research has implications for understanding how dimensions of adversity affect the brain and behavior during development and what factors can be protective, which can inform future neuroscience-informed policy interventions.
Article
Childhood maltreatment increases risk for mood disorders and is associated with earlier onset—and more pernicious disease course following onset—of mood disorders. While the majority of studies to date have been cross-sectional, longitudinal studies are emerging and support the devastating role(s) childhood maltreatment has on development of, and illness course in, mood disorders. This manuscript extends prior reviews to emphasize more recent work, highlighting longitudinal data, and discusses treatment studies that provide clues to mechanisms that mediate disease risk, course, relapse, and treatment response. Evidence suggesting systemic inflammation, alterations in hypothalamic–pituitary–adrenal (HPA) axis function and corticotropin-releasing factor (CRF) neural systems, genetic and other familial factors as mechanisms that mediate risk and onset of, and illness course in, mood disorders following childhood maltreatment is discussed. Risky behaviors following maltreatment, e.g., substance use and unhealthy lifestyles, may further exacerbate alterations in the HPA axis, CRF neural systems, and systematic inflammation to contribute to a more pernicious disease course. More research on sex differences and the impact of maltreatment in vulnerable populations is needed. Future research needs to be aimed at leveraging knowledge on modifiable targets, going beyond childhood maltreatment as a risk factor, to inform prevention and treatment strategies and foster trauma-informed care.
Article
Background The effects of child maltreatment (CM) on psychopathology are well-established, yet the complex effects of timing and chronicity of maltreatment exposure on the development of psychopathology are still unclear. Objective To elucidate developmental pathways from distinct dimensions of CM (chronicity and timing) to psychopathology during emerging adulthood using data from a longitudinal, multi-method study. Participants and setting Children with and without maltreatment exposure were recruited at wave 1 (ages 10–12) to participate in a research summer camp. At wave 2, participants were recontacted during emerging adulthood (ages 18–22). The current study includes 391 participants (51.3% female; 77.5% Black, 11.3% white, 7.4% Hispanic, 3.8% other race). Methods Timing and chronicity of maltreatment exposures were coded from child protective services records using the Maltreatment Classification System. Childhood internalizing and externalizing symptoms were assessed using child- and camp counselor-report. Emerging adults completed self-report questionnaires and were interviewed about their current and past symptoms of psychopathology. Structural equation modeling was used to estimate direct and indirect links between childhood maltreatment dimensions (chronicity and timing) to adult psychopathology via childhood internalizing and externalizing. Results Child maltreatment experiences that spanned several developmental periods, including both early and later childhood stages, predicted a cascade of both internalizing and externalizing symptoms in childhood that eventuated in greater symptoms of anxiety, depression, substance use disorder, and antisocial personality disorder in emerging adulthood. Conclusions Results suggest that chronic childhood maltreatment exposure is associated with multifinality in psychopathology presentations that can be detected in childhood and extend into emerging adulthood. Early prevention and intervention efforts to promote positive and safe parenting are essential to decrease the burden of mental health symptoms conferred by chronic maltreatment exposures on individuals, families, and public health systems.
Article
This study examined injuries that may precede a child maltreatment (CM) diagnosis, by age, race/ethnicity, gender, and Medicaid status using a retrospective case–control design among child members of a large integrated healthcare system ( N = 9152 participants, n = 4576 case). Injury categories based on diagnosis codes from medical visits were bruising, fractures, lacerations, head injury, burns, falls, and unspecified injury. Results showed that all injury categories were significant predictors of a subsequent CM diagnosis, but only for children < 3 years old. Specifically, fracture and head injury were the highest risk for a subsequent CM diagnosis. All injury types were significant predictors of maltreatment diagnosis for Hispanic children < 3 years, which was not the case for the other race/ethnicities. Overall, these findings suggest that all types of injury within these specific categories should have a more thorough assessment for possible abuse for children under 3 years. This work can inform the development of clinical decision support tools to aid healthcare providers in detecting abusive injuries.
Chapter
In the US, suicide is the second leading cause of death among youth between the ages of 10 and 24. Suicide and suicidal behavior are rare in childhood, and their prevalence increases sharply in early adolescence. While suicide ideation and attempts peak in middle-to-late adolescence, suicide rates continue to increase until late adulthood. Exposure to childhood adversities is an important suicide risk factor. Experiences of maltreatment, including sexual, physical, and emotional abuse, and neglect, are among the most frequently studied adversities in the suicide field. However, the mechanisms through which maltreatment increases suicide risk remain poorly understood. In this chapter, we first provide the prevalence rates of suicide and suicidal behavior for children, adolescents, and young adults and their distribution by suicide methods, sex, race/ethnicity, and sexual orientation. Then, we propose three frameworks that can be used to study the experiences of maltreatment and suicide risk, including the Adverse Childhood Experiences Model, the Dimensional Model of Adversity and Psychopathology, and the Interpersonal Theory of Suicide. Then, we describe several cognitive and biological factors that may serve as mechanisms that explain the association between maltreatment experiences and suicidal behavior, including epigenetics, executive functioning, stress reactivity, and emotion regulation. Finally, we focus on how timing of pubertal changes may be related to suicide risk and maltreatment, and we provide a summary of the limited literature on the menstrual cycle and its implications for suicide risk.
Article
Background and objective This study explored the associations between child maltreatment and functional resilience at school commencement, and investigated factors related to resilience separately for boys and girls. Participants and setting Children were part of a birth cohort of all children born in South Australia between 1986 and 2017 who had completed the Early Australian Development Census (AEDC) at about age 5–6 years when starting primary school (N = 65,083). Methods Multivariable logistic regression analysis was conducted with a subsample of 3414 high-risk children who had a maltreatment substantiation or investigation, with resilience defined as having well or highly developed strengths on the Multiple Strength Indicator of the AEDC. Results CPS involvement was strongly associated with poorer functioning at school commencement. Among high-risk children, 51.2% demonstrated resilience. Predictors of resilience in the multivariable model were being older, not having an emotional condition, and being read to at home. Risk factors were being male, living in rural or remote areas, having a physical or sensory disability, or having a learning disability. Boys who had been maltreated demonstrated few strengths and had less resilience than girls. Boys and girls who were read to regularly at home had more than three times the odds of showing resilience than children who were not read to at home. Conclusions The early learning environment provides an ideal opportunity to identify and intervene to help those children who are struggling with school adjustment following familial maltreatment. Boys are likely to need additional help.
Article
Background A certain link between sexual abuse (SA) victimization and suicidal behaviors has been confirmed, but it remains unclear whether this association varies with regard to SA characteristics and gender. Methods Participants were 4034 college students drawn from a cross-sectional study conducted in Hefei, China. Gender-stratified latent class analysis (LCA) and logistic regression models were used to examine the relationships between timing, duration, types and patterns of SA victimization and suicidal behaviors. Results For the males, SA in the elementary school or earlier period was associated with suicidal ideation (OR: 3.29, 95%CI: 2.20-5.38), plans (OR: 3.44, 95% CI: 1.54-7.77) and preparations (OR:3.05, 95% CI: 1.19-7.74). All types of SA were significantly associated with the four types of suicidal behaviors. Dose-response relationship and cumulative effect were found between duration, types of SA victimization and suicidal behaviors. Three latent classes of SA victimization were identified for males and females, respectively. For males, the “moderate SA” class and “persistent SA” class were associated with the four types of suicidal behaviors. For the females, SA during the university period was associated with suicidal ideation (OR: 2.47, 95% CI: 1.24-4.93). Only suicidal ideation was associated with the “moderate SA” class. Limitations The cross-sectional survey design did not allow to conclude any causality. Conclusions The relationship between SA victimization and suicidal behaviors varies in terms of SA victimization characteristics and the relationships were stronger in males than in females.
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This chapter describes the prevalence of early childhood trauma in the general population of the USA using data from the National Comorbidity Study-Replication (NCS-R). It discusses some of the methodological issues around assessing the prevalence of childhood trauma, focusing on estimates of child maltreatment as a specific example. The chapter explains the risk factors for childhood trauma. The prevalence of exposure to any traumatic event, to any other injury or shocking experience and for most specific event types did not significantly differ by race. Factors associated with greater risk of childhood trauma occur at the individual, family, neighborhood, local, regional and national level; the bulk of research focuses on individual and family factors. Individual factors associated with risk of childhood trauma include demographic descriptors such as sex, age and race/ethnicity, as well as health and behavioral characteristics, including mental health, substance use, sexuality and prior traumatization.
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The authors investigated the emergence of gender differences in clinical depression and the overall development of depression from preadolescence to young adulthood among members of a complete birth cohort using a prospective longitudinal approach with structured diagnostic interviews administered 5 times over the course of 10 years. Small gender differences in depression (females greater than males) first began to emerge between the ages of 13 and 15. However, the greatest increase in this gender difference occurred between ages 15 and 18. Depression rates and accompanying gender differences for a university student subsample were no different than for a nonuniversity subsample. There was no gender difference for depression recurrence or for depression symptom severity. The peak increase in both overall rates of depression and new cases of depression occurred between the ages of 15 and 18. Results suggest that middle-to-late adolescence (ages 15–18) may be a critical time for studying vulnerability to depression because of the higher depression rates and the greater risk for depression onset and dramatic increase in gender differences in depression during this period.
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Little is known about normative variation in stress response over the adolescent transition. This study examined neuroendocrine and cardiovascular responses to performance and peer rejection stressors over the adolescent transition in a normative sample. Participants were 82 healthy children (ages 7–12 years, n = 39, 22 females) and adolescents (ages 13–17, n = 43, 20 females) recruited through community postings. Following a habituation session, participants completed a performance (public speaking, mental arithmetic, mirror tracing) or peer rejection (exclusion challenges) stress session. Salivary cortisol, salivary alpha amylase (sAA), systolic and diastolic blood pressure (SBP, DBP), and heart rate were measured throughout. Adolescents showed significantly greater cortisol, sAA, SBP, and DBP stress response relative to children. Developmental differences were most pronounced in the performance stress session for cortisol and DBP and in the peer rejection session for sAA and SBP. Heightened physiological stress responses in typical adolescents may facilitate adaptation to new challenges of adolescence and adulthood. In high-risk adolescents, this normative shift may tip the balance toward stress response dysregulation associated with depression and other psychopathology. Specificity of physiological response by stressor type highlights the importance of a multisystem approach to the psychobiology of stress and may also have implications for understanding trajectories to psychopathology.
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We used structural MRI and EEG to examine brain structure and function in typically developing children in Romania (n = 20), children exposed to institutional rearing (n = 29), and children previously exposed to institutional rearing but then randomized to a high-quality foster care intervention (n = 25). In so doing, we provide a unique evaluation of whether placement in an improved environment mitigates the effects of institutional rearing on neural structure, using data from the only existing randomized controlled trial of foster care for institutionalized children. Children enrolled in the Bucharest Early Intervention Project underwent a T1-weighted MRI protocol. Children with histories of institutional rearing had significantly smaller cortical gray matter volume than never-institutionalized children. Cortical white matter was no different for children placed in foster care than never-institutionalized children but was significantly smaller for children not randomized to foster care. We were also able to explain previously reported reductions in EEG α-power among institutionally reared children compared with children raised in families using these MRI data. As hypothesized, the association between institutionalization and EEG α-power was partially mediated by cortical white matter volume for children not randomized to foster care. The increase in white matter among children randomized to an improved rearing environment relative to children who remained in institutional care suggests the potential for developmental "catch up" in white matter growth, even following extreme environmental deprivation.
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abuse and neglect are embedded in a wide range of adolescent problems—delinquency, parricide, running away, and prostitution / these links provide an important aspect of the context within which we must understand and intervene in adolescent maltreatment / a second aspect of that context is public and professional stereotypes about adolescents the challenge of being parent to an adolescent / the adolescent's power is much greater than the child's / the adolescent has a broader field of other significant individuals with whom the parents must come to terms / the adolescent's cognitive abilities are likely to be more advanced than are the child's / adolescents are likely to be a financial drain / families at high risk for maltreatment in adolescence are more likely to contain stepparents / adolescents at high risk for maltreatment are less socially competant and exhibit more developmental problems than their peers / adolescent maltreatment includes all forms of abuse and neglect, but psychological and sexual abuse appear to be particularly prevalent (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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provides a review of social-emotional responsiveness in middle childhood and beyond in which she presents a set of developmental principles linking increasing age, transitional stressor events, children's vulnerabilities, and emerging coping patterns in the move from childhood to adolescence (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Prior research reports stronger associations between childhood maltreatment and adult psychopathology when maltreatment is assessed retrospectively compared with prospectively, casting doubt on the mental health risk conferred by maltreatment and on the validity of retrospective reports. To investigate associations of psychopathology with prospective v. retrospective maltreatment ascertainment. A nationally representative sample of respondents aged 16-27 years (n = 1413) in New Zealand completed a retrospective assessment of maltreatment and DSM-IV mental disorders. Survey data were linked with a national child protection database to identify respondents with maltreatment records (prospective ascertainment). Childhood maltreatment was associated with elevated odds of mood, anxiety and drug disorders (odds ratios = 2.1-4.1), with no difference in association strength between prospective and retrospective groups. Prospectively ascertained maltreatment predicted unfavourable depression course involving early onset, chronicity and impairment. Prospectively and retrospectively assessed maltreatment elevated the risk of psychopathology to a similar degree. Prospectively ascertained maltreatment predicted a more unfavourable depression course.
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Beginning in adolescence, females are at significantly higher risk for depression than males. Despite substantial efforts, gaps remain in our understanding of this disparity. This study tested whether gender differences in adolescent-onset depression arise because of female's greater exposure or sensitivity to violence. Data came from 5,692 participants in the National Comorbidity Survey Replication. Trained interviewers collected data about major depression and participants' exposure to four types of interpersonal violence (physical abuse, sexual assault, rape, and witnessing violence) using a modified version of the Composite International Diagnostic Interview. We used discrete time survival analysis to investigate gender differences in the risk of adolescent onset depression. Of the entire sample, 5.7% met DSM-IV criteria for depression by age 18; 5.8% of the sample reported being physically abused, 11.7% sexually assaulted, 8.5% raped, and 13.2% witnessed violence by age 18. Females had 1.51 times higher odds of depression by age 18 than males. Exposure to all types of violence was associated with an increased odds of depression in both the past year and the years following exposure. Adjusting for exposure to violence partially attenuated the association between gender and depression, especially for sexual assault (odds ratio [OR] attenuated = 1.28; 15.23%) and rape (OR attenuated = 1.32; 12.59%). There was no evidence that females were more vulnerable to the effects of violence than males. Gender differences in depression are partly explained by females' higher likelihood of experiencing interpersonal violence. Reducing exposure to sexual assault and rape could therefore mitigate gender differences in depression.