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Childhood abuse and trajectories of externalizing behaviors among individuals presenting at a psychiatric emergency service: exploring the biopsychosocial signature

Authors:

Abstract

Background. Childhood abuse (CA) and trajectories of externalizing behaviors (EB) have both been associated with different psychiatric symptoms as well as dysregulated secretion of stress hormones in adulthood. To date, no studies have assessed the influence of CA and EB trajectories on signs and symptoms of mental illness at the time of admission to a psychiatric emergency service (PES). Objective. This study aims to explore the influence of CA and EB trajectories on the biopsychosocial signature of adults presenting at a PES. Method. We used data obtained from the Signature biobank (http://www.banquesignature.ca/en/). Self-reported questionnaires assessing CA and history of EB were administered to the participants upon their admission to PES as well as self-reported questionnaires assessing current levels of depression, anxiety, impulsivity, alcohol and drug use. Salivary cortisol and hair cortisol were collected to provide a proxy measure of acute (saliva) and chronic (hair) stress hormone levels. Taken together, these measures constitute a biopsychosocial signature. Latent class growth analyses were performed to identify trajectories of EB. Membership to each trajectory was predicted by CA. Latent class analyses were performed to identify biopsychosocial signature of individuals presenting at PES. Structural equation modeling was finally used to assess the influence of the EB trajectories on the biopsychosocial signature of individuals presenting at PES. Preliminary analyses. Patients who suffered severe childhood trauma, either physical or sexual, were most likely to belong to a high trajectory of EB across childhood, adolescence and adult life. The risk of being in the high trajectory vs. a low trajectory was 2.97 times higher (p = .008) in individuals who had experience childhood abuse relative to those who experienced either less severe abuse or no abuse at all. Individuals who were in the high trajectory of externalizing behaviors were 9.29 times more likely to exhibit a signature characterized by high depression, impulsivity, and anxiety levels, as well as substance use, relative to individuals who belonged to other trajectories who had high levels on only one or two dimensions. Further analyses including biological signature, assessed via salivary and hair cortisol, will be presented and discussed at the meeting. Given that the manifestations of mental illnesses are characterized by robust differences between men and women, sex will also be used as a moderator in all analyses. Implications. Better characterizing the profile of individuals presenting at PES will allow improving detection methods and developing better treatments that are tailored to individuals’ needs and profiles, which could ultimately reduce the risk of relapse.
Child abuse and trajectories of externalizing behaviors among
psychiatric emergency patients: Exploring their biopsychosocial signature
Steve Georiona,b, Marie-France Marina,b & The Signature consortium
aTrauma studies center, Institut universitaire en santé mentale de Montréal, bUniversité de Montréal
corresponding author: s.georion@umontreal.ca
Introduction
Objectives
Methods Results Conclusion
References
Measures
Objecve 1
    

Objecve 2
  
 !  "
  # $
"  " % 
#
Objecve 3

&   
 '$
 

 
' (" "  #" &"  )" & **' +# ,
-    # - Canadian Medical
Association Journal"164'"./..
01"2"1")+"3 -")***45/ 6
# ,  # # # International
Journal of Law and Psychiatry"23'"./7'
. " +"  4" & 0 '887  -#
- Journal of
the American Academy of Child & Adolescent Psychiatry" 347"
7'/797
# ""4":"+ #"4";" <""4 0" " :
+"  )1;" <  *'7 +#    , +&3/7
 #  ##! &  ,   
$1-#Journal of Psychiatric Research"
61"'*9/''.
7-) ""0=">"+< ""?? "*'7
###!+,
## #;     - 
#@Child Abuse & Neglect"46"'/'7'
9")"%":"&#"**' 
  -# , #    
 Development and Psychopathology"13*"8A'/888
B + ?" 3" +#" C"   " < *' 4
 % -  $  #
 # -% Tijdschrift voor
psychiatrie"55"78/9AAD"&"0=">"3"
" " <"  D " & *'7 ) , -1 ,
%; - #  %;  % ,
Journal of Threat Assessment and Management"2./"'87/'.
8+"3+"E;" *'4,
 #Child and Adolescent Psychiatric Clinics of North America,
23(2), 'A7/
'* >;" 3 C" C1"  " " "  C" <  **B
0,# -" "   , 
F !   ,#  > # & -
<Journal of Child Psychology and Psychiatry"48B"B*./
B'.
GG &" C 0" " C" ;" & <"+ " 0 <" C" +
*'9 $#     
%    #    # 
Psychoneuroendocrinology"71"'BH'7
' < " " C" D" <" 3"  ? I #" & *' 
   #; ,  !   "
,     % J 
Psychoneuroendocrinology, 377"7A8/99*
Predictors
Childhood abuse: Childhood
Experiences of Violence Questionnaire
(CEVQ)
EB trajectories: Brown-Goodwin History
of Aggression (BGHA)
Biopscyhosocial signature
Alcohol use: Alcohol Use Disorders
Identification Test (AUDIT)
Drug use: Drug Abuse Screening Test
(DAST)
Impulsivity: UPPS Impulsive Behavior
Scale
Anxiety: State-Trait Anxiety Inventory
(STAl)
Depressive symptoms: Patient Health
Questionnaire (PHQ)
Stress hormones: Hair cortisol12
Potential cofounders : Hair cortisol
Implications
K "     #" 
      
)& #    
 ## , # 
#)& 
L  %;  
-# ,G   #,
 - ,    %; %
 - , # 
# 
M N     %  
 %   
-   
1
Acknowledgements
+ -  
# - )&  ,
#$# 
  $' O 
  %;  ,
)&
P,   , )&
    ,
 #  ,   # ,
-""#
 ,
$1 -  - 
  % 
 ##  % 
   , 
# 
 O    
, ,   #
 ,  - " 
G -#"   
.
 O   -
-" ; -" 
,/ - -   
 
7"9
   ; , - #
/## B
     - 
 A
      
 ; , - # /
## '*
  -   -
''
? %, 
  ## , #  
#,)&#@
? 2 "
 F  #   Q 
,    
",)&@
Participants: <#  A* R
 A* S -   & 
;   #  , 
# -
Data :
http://www.iusmm.ca/research/signature-bank.html
2T  ; , "
"    
-    ,# #
#
N  # , #  ! 4' O
#  )&" 4 O "
4. O F $ #
#" 4O ' # ,
4.
N O4'
Data collection : >- *'  (
*'B
Analysis:
('!00
( ! 0    NT
$
4$
Q ,

4$

 
)&
4$
Q ,


 
Signatur
e
+  



0

 


+
$


P# -


N  '! 3    
 U
4'0(DP4V
4NT$V
 p < .**)
*
'
.
7
9
' .
CA
EB Trajectories
Figure 3. Level of CA x EB Trajectories
*
'
.
7
9
B
W' '/'7 '9/'B ³'A
Figure 2. Externalized Behavior Trajectories
D<(I)'>O8B D<(I)>O'' D<(I).>O.7 D<(I)>O'7
*
9
A
'*
'
'
'9
>VP4X +)<&&P(> 0((0I& &I&4>
I&
P3)I0&P?P4X P<
(<4P&(0
Scores on dimension
Figure 4. Biopscyhosocial signatures
D '>O D >O'7 D >O'' D >O'*A
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